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MRT Year 2 > Fluoro Comp > Flashcards

Fluoro Comp Flashcards

1
Q

What does the liver do?

A

Manufacture bile

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2
Q

2 major lobes of the liver? What separates them?

A

-Right (larger)
-Left
Falciform ligament

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3
Q

2 minor lobes of the liver?

A

Located in the posterior right lobe

  • Quadrate: between gallbladder and falciform ligament (inferior)
  • Caudate: posterior to quadrate and IVC (superior)
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4
Q

Parts of the gallbladder?

A

Fundus, body, neck

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5
Q

What prevents the cystic duct from collapsing?

A

Membranous folds “spiral valve”

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6
Q

How does the gallbladder concentrate the bile?

A

Hydrolysis

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7
Q

How does the gallbladder sit in relation to the MCP?

A

Anterior

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8
Q

Choledocholithiasis?

A

Stones in the biliary duct

Enlargement/narrowing of biliary ducts

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9
Q

Cholelithiasis?

A

Stones in the gallbladder

Radiolucent/radiopaque/move around

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10
Q

Acute cholecystitits?

A

Inflammation

Thickened wall of gallbladder

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11
Q

Chronic cholecystitis?

A
  • chronic inflammation

- calcification of the wall of the gallbladder

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12
Q

Neoplasms

A

Mass seen within gallbladder, liver, biliary ducts

-extensive calcification of gallbladder wall

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13
Q

Biliary stenosis?

A

-elongation/tapering/narrowing of CBD

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14
Q

Alimentary canal?

A
  • oral cavity
  • pharynx
  • esophagus
  • stomach
  • small intestine
  • large intestine
  • anus
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15
Q

Accessory organs?

A
  • salivary glands
  • pancreas
  • liver
  • gallbladder
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16
Q

Functions of the alimentary canal?

A
  • intake/digestion of food, water, vitamins, minerals
  • absorb digested food particles
  • eliminate unused materials
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17
Q

Deglutition?

A

Swallowing

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18
Q

Mastication?

A

Chewing

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19
Q

Defecation?

A

Excretion

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20
Q

Salivary glands and their locations

A
  • Parotid: anterior to ear, largest
  • Submandibular: below mandible/maxilla
  • Sublingual: below tongue, most anterior
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21
Q

Mumps

A

Inflammation of the parotid glands

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22
Q

Is the nasopharynx part of the digestive system?

A

No

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23
Q

Borders of oropharynx?

A

-soft palate to epiglottis

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24
Q

Borders of laryngopharynx (hypopharynx)?

A

-epiglottis to lower border of the larynx (C6)

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25
Q

Esophagus

A
  • laryngopharynx to stomach
  • begins posterior to C5/C6
  • ends at T11
  • posterior to trachea, anterior to aorta and spine
  • passes through the diaphragm at T10
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26
Q

2 indents in the esophagus?

A
  • aortic arch

- left primary bronchus

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27
Q

After the esophagus passes through the diaphragm, the distal portion right before the LES is the?

A

Cardiac antrum

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28
Q

Muscle of the esophagus?

A

Upper 1/3rd: well developed skeletal muscle
Middle 1/3rd: skeletal and smooth muscle
Lower 1/3rd: smooth muscle

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29
Q

What is peristalsis?

A

Involuntary muscular contractions that propel materials through the alimentary canal

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30
Q

What position best demonstrates the esophagus?

A

RAO

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31
Q

Parts of the stomach?

A

Fundus: posterior, “gastric bubble” when upright
Body: curves inferior and anterior
Pylorus: directed posteriorly

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32
Q

What separates the fundus and pylorus?

A

Angular notch

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33
Q

Parts of the pylorus?

A
  • pyloric antrum: immediately distal to angular notch

- pyloric canal: narrow, ends at sphincter

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34
Q

Where are the rugae of the stomach most evident?

A

Along the greater curvature

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35
Q

What are rugae for?

A

Assist with mechanical digestion

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36
Q

What funnels fluids directly through the stomach?

A

Gastric canal along lesser curvature

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37
Q

Air/Barium distribution in different positions?

A

Supine: barium in fundus
RAO recumbent: gas in fundus, barium in body and pylorus
Prone: air in fundus

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38
Q

How long does it take to empty the stomach?

A

2-6hrs

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39
Q

How long does it take for things to pass through the small intestine?

A

3-5 hrs

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40
Q

What is the shortest and widest part of the small intestine?

A

Duodenum

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41
Q

the duodenal bulb in intraperitoneal, but the rest of the duodenum is retroperitoneal

A

.

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42
Q

What is the duodenaljejunal flexure held in place by?

A

Ligament of Treitz

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43
Q

Body habitus and organ position?

A

Sthenic: J shaped stomach T11-L2, duodenal bulb L1/L1 right of MSP, gallbladder midway between lateral abdomen and midline, high spenlic flexure
Hypersthenic: high transverse colon, gallbladder is high and transverse, stomach high and tranverse T9-T12, duodenal bulb T11/T12 right of MSP
Asthenic: low transverse colon, J shaped stomach T11-L5 or lower, duodenal bulb L3-L4, gallbladder at crests near midline

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44
Q

Other factors that affect position of the stomach?

A
  • contents
  • respiration (fundus attached to diaphragm)
  • body position (upright vs supine)
  • previous abdominal surgeries
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45
Q

How much do organs drop when upright?

A

2.5-5cm

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46
Q

What parts of the alimentary canal can be seen without contrast?

A
  • fundus (gastric bubble)

- parts of the large intestine (pockets of gas/feces)

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47
Q

Fluoro allows the radiologist to?

A
  • observe the GI tract in motion
  • produce radiographic images during the exam
  • determine most appropriate course of action for a complete radiographic exam
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48
Q

Radiopaque contrast?

A

Barium sulfate

Water soluble

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49
Q

Radiolucent contrast?

A

-Co2, swallowed air (barium coats better with air)

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50
Q

Transit time of contrast depends on?

A

-consistency
-temperature
-suspending medium and additives
-motile function of the alimentary canal
(Water soluble has a shorter transit time)

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51
Q

Ratio of thin and thick barium

A

1:1 = thin

3 or 4: 1 = thick

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52
Q

Contraindications for barium sulfate?

A

-any chance it would get into the peritoneal cavity (peritonitis)

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53
Q

Polyps, diverticula, ulcers are better seen with?

A

Double contrast

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54
Q

Radiation protection?

A
  • lead drape shield for tower
  • bucky slot shield
  • lead aprons 0.5mm equivalency
  • use compression paddles instead of hands
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55
Q

3 rules of radiation protection?

A
  • time
  • distance
  • shielding
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56
Q

Why do we do lay people down during an esophogram?

A
  • demonstrates a hiatal hernia, if present
  • takes away gravity: must rely on peristalsis
  • demonstrates a barium filled esophagus better
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57
Q

How to demonstrate esophageal reflux?

A
  • Breathing exercises (increase abdominal pressure): valsalva maneuver, mueller maneuver
  • Water test: LPO supine, swallow water, positive test = reflux
  • Compression technique: provide pressure to the stomach
  • Toe touch: reflux and hernias demonstrated
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58
Q

What is done to visualize esophageal varicies?

A

Valsalva maneuver

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59
Q

What best demonstrates the esophagus between the shadows of the heart and vertebra?

A

40 deg RAO

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60
Q

What is used to demonstrate air filled fundus on and asthenic patient?

A

AP partial trendelenberg

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61
Q

What is used to demonstrate a hiatal hernia?

A

Full trendelenberg

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62
Q

Why is an MBS performed?

A

To assess the patients ability to swallow

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63
Q

What make up the mucosal folds of the jejunum? What are they for?

A

Plicae circularis

Help increase surface area to air in absorption of materials

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64
Q

Difference between the colon and large intestine?

A

Colon DOES NOT include the cecum and rectum, only 4 sections and 2 flexures

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65
Q

What does the ileocecal valve do??

A
  • acts as a sphincter
  • prevents too fast forward flow
  • prevents reflux
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66
Q

What is classed as the rectum?

A

The sigmoid colon to the anus, begins at S3

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67
Q

What is the rectal ampulla?

A

Dilated rectum anterior to the coccyx

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68
Q

Whats important to know about the rectum for enema tip insertion?

A

-2 anteroposterior curves

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69
Q

Barium in the large intestine for different positions?

A

Supine: air in the transverse colon and loops of sigmoid
Prone: barium in the transverse colon

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70
Q

Functions of the intestines?

A
  • Digestion (small)
  • Absorption (small)
  • Reabsorption (small/large)
  • Elimination (large)
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71
Q

What is rhythmic segmentation?

A

-localized contractions in areas with food

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72
Q

How does the small intestine move food?

A
  • peristalsis

- rhythmic contractions

73
Q

How does the large intestine move food?

A
  • peristalsis
  • haustral churning
  • mass peristalsis
  • defecation
74
Q

Most movement of organs from recumbent to upright occurs in what body habitus?

A

Hyposthenic/asthenic

75
Q

Common water soluble contrast brand names

A
  • gastrografin
  • hypaque
  • telebrix
  • conray
76
Q

Which adheres better? Barium or water soluble?

A

Barium

77
Q

What is a colostomy?

A

Surgically putting 2 parts of the intestines together after removing part

78
Q

What is a stoma?

A

An artificial opening in the intestines (bag on the outside)

79
Q

Parts of the urinary system?

A
  • 2 kidneys (retroperitoneal)
  • 2 ureters (retroperitoneal)
  • 1 bladder
  • 1 urethra
80
Q

How do the kidneys sit in the body?

A
  • posterior to lower liver and spleen
  • 30 degrees anterior (lower pole more anterior)
  • upper pole closer to midline (i think 20 deg angle from MSP)
  • T12-L3
  • move 1-4cm from inspiration to expiration
  • drop 5cm from recumbent to upright
81
Q

Where do the ureters enter the bladder?

A

Posterolateral aspect

82
Q

Functions of the urinary system?

A
  • removed nitrogenous waste from the blood
  • regulate water levels in the body
  • regulate acid-base balance and electrolyte levels in the blood
83
Q

Urinary system examinations?

A
  • KUB
  • Intravenous Urography
  • Retrograde Urography
  • Cystography
  • Voiding Cystourethrogram
  • Percutaneous Catheter Nephrostomy
84
Q

Indications for urinary system exams?

A
  • renal calculi
  • chronic UTIs
  • urethral strictures
  • anatomic evaluation
85
Q

Constriction points of the ureters?

A
  • Ureteropelvic junction
  • Brim of pelvis (iliac blood vessel cross over ureter)
  • Ureterovesical junction (most common)
86
Q

Methods of stone removal?

A
  • Extracorporeal Shock Wave Lithotripsy
  • Laser Stone Fragmentation
  • Percutaneous Nepholithotomy (basket extraction or ultrasonic lithotripter)
87
Q

Routes of contrast media administration?

A
  • intravenously
  • direct injection
  • indwelling
88
Q

Exams for the biliary system?

A
  • Endoscopic Retrograde Cholangiopancreatography
  • Percutaneous Transhepatic Cholangiography
  • Intraoperative Cholangiogram
89
Q

Purpose of an esophagram? Contraindications? Indications?

A

To demonstrate the form and function of the esophagus
Contraindications: sensitivity to contrast media
Indications: achalasia, anatomic anomalies, barretts esophagus, carcinoma, dysphagia, esophageal varicies, foreign bodies, GERD, Zenkers diverticulum

90
Q

Prep and projections for an esophagram?

A

No prep

  • thin and thick barium used
  • AP/PA
  • Lateral
  • RAO/LPO
  • Optional swimmers
91
Q

AP/PA esophagus

A
  • CR 1” below sternal angle (T5/T6), top of IR 2” above shoulders
  • recumbent allows for more filling of the esophagus
  • strictures, foreign bodies, anatomic anomalies, neoplasms
  • *not as diagnostic as RAO**
  • expiration
92
Q

Lateral Esophagus

A
  • CR at T5/T6 along MCP
  • expose on expiration
  • barium filled esophagus seen between heart and vertebrae
93
Q

RAO/LPO esophagus centering/rotation?

A
  • CR at T5/T6 1” lateral to MSP on elevated side
  • 35-40 degrees rotation
  • 40 degrees best demonstrates*
  • esophagus between the heart and vertebrae
94
Q

Other names for an upper GI?

A
  • UGI
  • OS+D
  • Barium swallow
  • Barium Meal
95
Q

Purpose of an upper GI? Contraindications? Indications?

A

To evaluate the form and function of the distal esophagus, stomach, and duodenum
Contraindications: sensitivity to contrast, history of perforated bowel, laceration, or ruptured viscus
Indications: Bezoar, diverticula, emesis, carcinoma, gastritis, hiatal hernia, hypertropic pyloric stenosis, ulcers

96
Q

Upper GI prep and positions

A
  • NPO from midnight to time of exam (at least 8hrs)
  • no smoking/chewing gum (increases gastric secretions)
  • RAO
  • PA
  • RT lateral
  • LPO
  • AP
97
Q

RAO stomach and duodenum

A

Sthenic: CR @ L1, 45-55 degrees rotation
Asthenic: CR 2” below L1, 40 degrees rotation
Hypersthenic: CR 2” above L1, 70 degrees rotation

-expiration

98
Q

What is the best image of the pyloric canal and duodenal bulb in profile?

A

RAO stomach and duodenum

99
Q

What will demonstrate a hiatal hernia, if present?

A

AP stomach

100
Q

PA/AP stomach

A

Sthenic: CR @ L1 left of MSP
Asthenic: CR 2” below L1
Hypersthenic: CR 2” above L1 nearer midline
-barium filled stomach spreads more horizontal in PA

101
Q

What is the alternate to an AP/PA stomach for hypersthenic people?

A

35-45 degrees cephalad angle

102
Q

RT lateral stomach and duodenum

A

Sthenic: CR @ L1, 1-1.5” anterior to MCP
Asthenic: CR 2” below L1
Hypersthenic: CR 2” above L1
-stomach, duodenum, retrogastric space, lateral vertebrae
**stomach located 1 vertebrae higher than PA and oblique positions*

103
Q

LPO stomach and duodenum

A

Sthenic: CR @ L1, 45 degrees
Asthenic: CR 2” below L1, 30 degrees
Hypersthenic: CR 2” below L1, 60 degrees
-air filled pylorus and duodenal bulb- better demonstrate gastritis and ulcers

104
Q

Small Bowel Follow Through

A
  • NPO from midnight
  • pictures taken at specific time intervals
  • exam done after contrast reaches cecum
105
Q

What is the “money shot” of the SBFT?

A

Terminal ileum

106
Q

Centering for initial image of SBFT?

A

CR 4” above iliac crests to include entire stomach on image

107
Q

Centering for all other images of SBFT?

A

CR @ crests and MSP

108
Q

Why is PA better than AP on SBFT?

A
  • less gonadal dose
  • less OID
  • compression on front separates bowel loops
109
Q

What might the radiologist recommend if the contrast hasn’t reached the cecum after 4 hours?

A
  • something to eat: peristalsis
  • cold water: flushes through
  • lay on right side: gravity
110
Q

Enteroclysis?

A
  • injection of a nutrient or medical liquid into the bowel by a special catheter passing through the nose to the duodenojejunal junction
  • pts with clinical histories of small bowel obstructions, Crohn’s disease, or celiac disease
  • evaluation of small bowel tumours
  • barium and methylcellulose or air
111
Q

Why is methylcellulose preferred?

A

It adheres to and distends the bowel and enhances the visibility of the mucosa

112
Q

Disadvantages of enteroclysis?

A
  • increases patient discomfort
  • possibility of perforation with the NJ tube
  • potential of high radiation dose
113
Q

Is enteroclysis or a regular SBFT better to see inflammatory bowel or Crohn’s?

A

Regular SBFT

114
Q

What position helps advance the NG tube?

A

RAO

115
Q

Another name for gastrointestinal intubation?

A

Small bowel enema

116
Q

What is a gastrointestinal intubation?

A

-NG tube to jejunum
Diagnostic: single lumen tube, barium or water soluble contrast, radiographs at times intervals
Therapeutic: double lumen (miller abbott) to stomach to jejunum, relieve post op distention or decompress

117
Q

Another name for barium enema?

A

BE

Lower GI

118
Q

Why should we check if a patient has had a biopsy of the colon before a barium enema?

A

Weakened wall of intestine could cause perforation

119
Q

Why do we administer glucagon/buscopan during a barium enema? How do we administer it? Who administers it?

A
  • decrease spasms and peristalsis
  • IV/IM
  • Rad or nurse
120
Q

Prep for barium enema? Indications?

A
  • 2 day diet of clear liquids, laxatives or cleansing enema, NPO fro midnight the night before
  • scout to confirm prep
  • colitis, ulcerative colitis, diverticulum, intussusception, neoplasms, annular carcinoma, volvulus, cecal volvulus
121
Q

Types of enema tips?

A
  1. Plastic disposable (no balloon)
  2. Plastic Disposable with retention (balloon)
  3. Plastic disposable air contrast retention (balloon)
122
Q

Projections for single contrast enema?

A
  • AP/PA
  • LPO
  • RPO
  • Sigmoid/axial
  • Lateral rectum
  • Post evac
123
Q

Projections for double contrast enema?

A
  • AP/PA
  • Rt and Lt lateral decubitus
  • Obliques
  • Sigmoid/axial
  • lateral rectum
  • post evac
124
Q

When are balloons inflated?

A

ONLY under fluoro as they could cause rupture

125
Q

Why are there more projections for a double contrast enema than a single?

A

The barium moves faster through

126
Q

AP/PA barium enema

A
  • CR @ iliac crests
  • expiration
  • include to rectal ampulla
127
Q

PA vs AP barium enema: where is the barium?

A

PA: barium in transverse colon
AP: barium in ascending and descending colon

128
Q

RAO barium enema

A
  • 35-45 degrees rotation
  • CR @ crests, 1” LEFT of MSP
  • right hepatic (colic) flexure visualized
  • ascending colon and sigmoid colon
129
Q

LAO barium enema

A

35-45 degrees rotation

  • CR @ iliac crests
  • left splenic (colic) flexure demonstrated
  • descending colon
  • may have to center higher to include high left flexure
130
Q

RPO barium enema

A

35-35 degrees rotation

  • CR @ crests, 1: lateral to upside LEFT
  • left splenic (colic) flexure
  • may have to center higher to include high left flexure
131
Q

LPO barium enema

A

35-45 degrees rotation
CR @ crests, 1” lateral to upside (RIGHT)
-right hepatic (colic) flexure

132
Q

Right lateral Decubitus Barium enema

A
  • CR @ crests
  • barium gravitates to right side
  • air: medial ascending and lateral descending
  • use a grid*
  • double contrast demonstrates more
  • expiration
  • include entire colon
133
Q

Left lateral decubitus barium enema?

A
  • CR @ crests
  • barium gravitates to left side
  • Air: medial descending and lateral ascending
  • use a grid*
  • expiration
  • include entire colon
134
Q

Lateral Rectum

A

CR @ level of ASIS and MCP

-rectum and distal sigmoid demonstrated

135
Q

What position is better for a double contrast lateral rectum? True laterals or decubitus?

A

Ventral decubitus

136
Q

What is seen in a ventral decubitus lateral rectum?

A

-posterior rectum air filled

137
Q

AP axial or axial oblique (LPO) for sigmoid

A

“Butterfly projection”

  • AP: CR @ 2” below ASIS
  • LPO: CR to exit at ASIS 2” medial to right ASIS (upside)
  • AP: 30-40 degrees cephalad
  • LPO: 30-40 degrees cephalad
  • rectosigmoid viewed with less overlap of sigmoid loops
138
Q

PA axial or axial oblique (RAO) sigmoid

A 
PA: CR to exit at ASIS
RAO: CR @ ASIS, 2” left of MSP (upside)
30-40 degrees caudad
**better than AP**
-elongated view of rectosigmoid area
139
Q

Post evacuation barium enema

A
  • CR @ crests
  • demonstrates mucosal pattern of the large intestine with residual contrast media for identifying small polyps/defects
  • can be AP or PA (PA common)
  • if not enough evacuation, wait and take image again
  • coffee and tea can help move things along
  • lower kVp to prevent over penetration with only residual contrast remaining
140
Q

Additional Sigmoid projection for barium enema (LPO)

A
  • CR 10cm below and 10cm medial to right ASIS

- this view provides more elongation and less superimposition of rectosigmoid segments

141
Q

Urinary procedures prep?

A

-NPO 8hrs before procedures so that no fecal material/gas is in the way

142
Q

Purpose of KUB?

A
  • verify patient prep was successful
  • determine acceptable exposure factors
  • verify positioning of structures
  • detect any abnormalities prior to contrast given
143
Q

KUB

A
  • CR @ crests
  • include T11-symph
  • expose on expiration
144
Q

IVU: intravenous urography purpose

A
  • to visualize collecting portion of the urinary system
  • to assess the functional ability of the kidneys
  • to evaluate the urinary system for pathology or anatomic anomalies
145
Q

IVU contraindications?

A
  • renal failure
  • diabetes with renal insufficiency
  • renal hypertension
  • CHF
  • prior reaction to contrast media
146
Q

Indications for an IVU?

A
  • abdominal masses
  • renal tumors/cysts
  • urolithiasis, pyelonephritis, hydronephrosis
  • trauma
  • pre-op evaluation
147
Q

IVU procedure

A
  • scout KUB taken
  • contrast injected via IV, note injection start time
  • 30s or 1min AP (kidneys)
  • 5min AP (kidneys)
  • 10 min AP full length
  • 20 Min obliques (30deg) CR at crests, 10cm lat to MSP
  • Post void PA or erect AP
  • radiologist assess after obliques and decides if ready for post void
148
Q

How do we enhance visualization of the renal pelvis and calyceal filling and proximal ureters during and IVU?

A

Compression applied at level of ASIS

149
Q

Purpose of retrograde urography?

A
  • non-functional exam to determine the location of the undetected calculi/other obstruction
  • to view renal pelvis and calyces for signs of infection or structural defects
150
Q

Retrograde urography procedure?

A
  • can be unilateral or bilateral filling of ureters
  • uretercystoscope used by urologist
  • performed in OR
  • under sedation
  • surgical asepsis
  • AP image taken after contrast (water soluble) injection
151
Q

Purpose of retrograde cystography

A
  • performed to rule out tumours, calculi, trauma, inflammatory disease of the bladder
  • non-functional
  • performed in x-ray department
152
Q

retrograde cystography procedure and projections?

A
  • contrast administered by urinary catheter and aided by gravity only
  • AP axial bladder
  • Posterior oblique
  • PA axial bladder
  • Lateral
153
Q

Indications for retrograde cystography?

A
  • cystitis
  • obstruction
  • vescoureteral reflux
  • bladder calculi
154
Q

AP axial bladder

A
  • CR 2” superior to symph
  • 10-15 deg caudad
  • to demonstrate urinary reflux center higher @ iliac crests
155
Q

Posterior oblique bladder

A
  • CR 2” above symph and 2” medial to ASIS on the upside
  • 40-60 deg rotation
  • UV junction shown where ureter enters bladder on upside
156
Q

Lateral bladder

A
  • CR 2” superior and 2” posterior to symph
  • possible fistulas between the bladder and uterus/rectum can be visualized
  • demonstrated anterior and posterior walls of the bladder as well as the trigone (base)
  • not done often due to gonadal dose
157
Q

Voiding cystourethrogram purpose and indications

A
  • functional, evaluates patients ability to urinate/void

- incontinence, trauma, chronic UTIs, kidney infection, suspicious of reflux, bedwetting, difficulty toilet training

158
Q

Voiding Cystourethrogram procedure and projections

A
  • contrast into bladder through catheter by gravity only (no pressure)
  • Females: AP or slight oblique
  • Males: 30 deg RPO to superimpose urethra over soft tissue of thigh
  • post void AP may be requested
  • radiologist looking for reflux during voiding
159
Q

Percutaneous Catheter Nephrostomy purpose

A
  • invasive, therapeutic, establishes opening between the renal pelvis and patients skin
  • surgical asepsis
  • drainage, drug administration, instrumentation insertion
160
Q

PCN procedure?

A
  • guidewire inserted by needle into the calyces and sometimes down the ureter
  • dilators used to expand opening until catheter will fit
  • drainage bag attached
161
Q

Risks of PCN

A
  • infection
  • catheter dislodgement
  • catheter obstruction
  • hermorrhage
162
Q

What is the follow up of a PCN?

A

Nephrostography: contrast is injected through the catheter

163
Q

Extracorporeal Shock Wave Lithotripsy procedure

A
  • non-invasive
  • shock waves from an electrical source to pulverize calculi
  • stones must be greater than 2mm in size
  • fragments pass down ureter (must not be obstructed)
164
Q

Laser Stone Fragmentation precedure

A
  • done in urology suite under general anesthetic
  • guidewire inserted into affected ureter
  • long scope inserted, stone disintegrated using laser
165
Q

Percutaneous Nephrolithotripsy procedure

A
  • invasive
  • incisions made into kidney for the removal of renal calculus
  • basket extraction: removed small, free floating calculi in kidney
  • ultrasonic lithotripter: rests against and vibrates to break it up
166
Q

Hystersalpingography

A
  • infertility
  • size, shape, and position of uterus and tubes
  • lesions, masses, and fistulas
  • performed by gynaecologist
  • contrast should spill into peritoneal cavity
  • ovaries not seen
167
Q

ERCP: Endoscopic Retrograde Cholangiopancreatography purpose and procedure

A
  • to diagnose biliary/pancreatic pathologies
  • can be diagnostic/therapeutic
  • gastroenterologist passes endoscope through mouth to duodenum
  • inserts cannula into ampulla of vater and injects contrast into CBD
  • “clean procedure” not sterile
  • should see spilling of contrast into duodenal bulb
168
Q

Contraindications for an ERCP

A
  • pancreatitis
  • pseudocyst of the pancreas
  • elevated creatinine/BUN
  • possible hypersensitivity to contrast
169
Q

What position is patient in for insertion of endoscope? Cannula insertion?

A

LAO, moved into SIMS for cannula insertion

170
Q

What images do we do if there is overlap of the CBD and pancreatic duct when doing an ERCP??

A

Oblique images

171
Q

What is a therapeutic ERCP for

A
  • stent placement
  • stone removal
  • expand narrowing of ducts
172
Q

How is a tumour of the head of the pancreas indicated/demonstrated?

A

Displacement of the descending duodenum

173
Q

PTC: Percutaneous Transhepatic Cholangiogram

A
  • pre-operative
  • surgical asepsis
  • INR and PT known before
  • chiba needle inserted into biliary system to demonstrate hepatic ducts
  • contrast injected
  • AP spot films taken
174
Q

What can be done if ERCP is contraindicated?

A

PTC

175
Q

What are INR and PT for?

A

Blood clotting ability

176
Q

Therapeutic PTC?

A
  • if dilated ducts are identified by diagnostic PTC
  • drainage catheter inserted
  • used to drain or extract stones
177
Q

Risk of a PTC?

A
  • pneumothorax
  • liver hemorrhage
  • peritonitis
178
Q

Operative cholangiogram purpose?

A

Investigates the patency of the biliary ducts, functional status of sphincter of oddi, presence of stones or lesions, strictures/dilatations of ducts

179
Q

Operative cholangiogram procedure?

A
  • performed in OR by surgeon
  • if surgeon is unsure if all stones removed, T-tube left in place
  • AP
  • RPO 15-20 trendelenberg to get ducts to fill
  • T-tube put in where gallbladder used to be

MRT Year 2 (18 decks)

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