Fluoro + GI + Digestive Flashcards by Naomi Ngo

Fluoroscopy is a ____ radiation

continuous

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During the examination, what can fluoroscopy do?

record or produce radiograph

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What is the benefit of digital fluoro?

decrease the need for post-fluoroscopic image

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5 ways to protect yourself when performing a fluoro exam

-wear lead
-thyroid shield
-gloves
-glasses
-stand behind radiologist

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What are the responsibility for tech fluoro

verify orders
obtain clinical history
make sure the equipment works
have all equipment ready

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Which contrast media is negative? what does it do?

Air or CO2
expands organs for coating

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Air or CO2 is radio___

radiolucent

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Which contrast media is positive? Mixing it with water will form _____

Barium Sulfate
colloidal suspension

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What is the consistency for barium sulfate

thick & thin

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Thin barium is used for ____
Thick barium is used for _____

studying of entire GI tract
studying of esophagus

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Does colloidal suspension dissolve in water?

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When not to use Barium for contrast media ?

bowel perforation
allergic reaction

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If contraindications happen with Barium, what is the alternative positive contrast media?

Iodinated contrast

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Gastroview/Gastrografin is ____ contrast medium

radiopaque

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Which contrast media can escape into peritoneal cavity without causing pertonitis?

Iodinated contrast

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Which contrast is more water-soluble?

Iodinated contrast

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Which contrast travel faster through the GI tract

Iodinated contrast

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Iodinated contrast should not be used if patient experiences ____

dehydration

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[FLUORO] What is the kVp for
single contrast: ?
double contrast: ?
water-soluble contrast: ?

110+
100
90

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Thick Barium contrast media ____

coats internal organs (esophagus & stomach)

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Thin Barium contrast media _____

fills internal organs (stomach)

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What are the 4 lobes of liver?

Right
Left
Caudate
Quadrate

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terminology for bile

Chole

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terminology for sac/bladder

cysto

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-Lith means

Stone

-Ectomy means

removal

-Gram means

Picture

The liver is in which quadrant

RUQ

What separate the left and right lobe

falciform ligament

What is the main function of liver that makes it applicable to radiographic study

production of biles

What is the function of biles

emulsify (break down) fat

What are 3 anatomic parts of the gallbladder

neck body fundus

what are the 3 functions of gallbladder

store bile concentrate bile contracts when stimulated by CCK

What happens to gallbladder when there is food in the duodenum

gallbladder contracted by the stimulation of food to secrete hormone CCK

Left and Right hepatic duct join to form ____

common hepatic duct

Bile is carried to the gallbladder through ___

cystic duct

Bile secreted into the duodenum through

common bile duct

what 2 biliary ducts joined at the hepatopancreatic sphincter

common bile duct & pancreatic duct

What is the passageway that formed by the pancreatic duct and common bile duct into duodenum?

Hepatopancreatic ampulla (ampulla of Vater)

What is the muscle surround the opening of ampulla of Vater called?

Hepatopancreatic sphincter (Sphincter of Oddi)

What is the protrusion into the lumen of duodenum called?

Duodenal papilla (papilla of Vater)

What are the surgical radiographic procedure for biliary duct

Operative cholangiogram T-tube Endoscopic Retrograde Cholangiopanreatography(ERCP)

Which surgical radiographic procedure use C-arm in OR

operative cholangiogram

The T-tube is placed into the ____ during ____

common bile duct cholecystectomy

What is the purpose of T-tube?

determine location of stones & remove them

What is an endoscope

medical equipment that allows illumination of internal lining of an organ

The injection process through endoscope for ERCP

mouth --> duodenum --> duodenal papilla --> insert catheter into hepatopancreatic ampulla --> inject contrast to fill CBD

Which specialist mainly performed the ERCP procedure

gastroenterologist

Who are involved in ERCP procedure

gastroenterologist ED tech ED nurse Anesthesiologist

A scout method is done in which position

high KUB

A cystogram is ___

taken picture of the bile sac/gallbladder

What is cholecystectomy

removal of gallbladder

Gallbladder store and secrete bile through process of ____

hydrolysis

What is the function of CCK

contract gallbladder to secrete bile

From the liver, bile is filtered from ___ to____

RT & LT hepatic duct common hepatic duct

Which duct provides the border between the common hepatic and common bile duct?

cystic duct

Superior to cystic duct is ____ Inferior to cystic duct is ____

common hepatic duct common bile duct (CBD)

When doing an ERCP, which structure does the doctor first look for?

papilla of vater

What stimulates the Sphincter of Oddi to open?

CCK

What structure of distal CBD can be seen on endoscopy

duodenal papilla

which part of the duodenum is directly connect to papilla of Vater

descending

What is cholangiogram

taking picture of the vessels of the biliary ducts

What is laparoscopic Cholecystectomy (Lap Chole)

removal of gallbladder

What is Cholangiopancreatography?

taken picture of Bile + vessels + pancreatic duct

When are rad tech needed while doing lap chole? to do what?

at the end of the procedure to make sure the CBD is intact and bile is not leaking

T-Tube is post ____

cholecystectomy

Which procedure has drainage bag outside the patient

T-tube

T-tube is placed in ____ duct

common bile

ERCP is done in which position

SCOUT (HIGH KUB) OR RAO or LAO

If gastroenterologist wants to look at proximal CBD, where do we go

up the common bile duct

The digestive system includes ____ & ____

alimentary canal accessory organs

What organs are involved in the alimentary canal (7)

oral cavity pharynx esophagus stomach small intestine large intestine anus

What organs are accessory organs (4)

Salivary glands Pancreas Liver Gallbladder

Medical term for chewing

mastication

medical term for swallowing

deglutition

medical term for involuntary muscle contraction

peristalsis

What is the function of digestive system

intake & digest absorption elimination

Anatomy of oral cavity

Teeth Hard & Soft Palate Uvula Tongue

what are the 3 glands that secrete saliva

Parotid Submandibular Sublingual

Where does each salivary gland located?

parotid - anterior to external ear submandibular - below mandible sublingual - below the tongue

Location of pharynx in aspect to oral cavity

pharynx is posterior to oral cavity

what are the 3 parts of pharynx (from superior to inferior)

nasopharynx oropharynx laryngopharynx

which part of the pharynx is not a part of digestive system

nasopharynx

The Nasopharynx is posterior to _____

bony nasal septum, nasal cavities, and soft palate

Oropharynx extends from _____ to _____

soft palate epiglottis

Epiglottis cover the opening of _____ during ___

larynx swallowing

Which part of the pharynx continues as the esophagus

laryngopharynx

Trachea is ____ to esophagus

During deglutition, bolus moves ______ to oral cavity

posterior

Process of deglutition (4)

1. bolus moves posterior oral cavity 2. soft palate closes off nasopharynx as we swallow 3. Trachea elevates and epiglottis folds over 4. Food enters esophagus

_____ has specific nerves that can be affected if there is a stroke.

epiglottis

what do radiologist look for when doing MBS if a patient has a stroke?

see if epiglottis folds over --> danger if not fold as it can go the lungs.

During deglutition, what action can prevent swallowed substance to go up to the nose

soft palate closes off nasopharynx

During deglutition, what are the 3 main thing that happened?

soft palate closes off nasopharynx Trachea elevate and epiglottis is folded to cover laryngeal opening food enters esophagus

What is inhibited during deglutition to prevent swallowed substance from entering the trachea and lungs

respiration

If swallowed substance pass into larynx and trachea during deglutition, what happened?

coughing

Esophagus extends from _____ to ____?

cricoid cartilage(C5-C6) stomach (T11)

what are the topographic landmark help to determine the start and end of esophagus?

C7 xiphoid process (T9-10)

Esophagus is located ____ to trachea & Heart

posteriorly

Esophagus is located ____ to vertebrae

anteriorly

Esophagus crosses over _____ & _____

aortic arch left primary bronchus

Esophagus passes thru diaphragm at ___

esophagus hiatus

What are the 3 indentations when the esophagus cross over?

aortic arch left primary bronchus Left atrium

The abdominal segment of esophagus is called ___

cardiac antrum

What is hiatal hernia

portion of stomach go through diaphragm opening.

What is the esophagogastric junction (cardiac orifice)

opening between esophagus and stomach

What is MBS? its purpose?

modified barium swallow evaluate deglutition

Where is the focus for MBS

proximal esophagus at the area of the laryngopharynx

What do you need to watch for when doing MBS

aspiration with different consistencies

Swallowing of barium is observed in which position

PA RAO Lateral Recumbent or Erect

What is the kVp for esophagus imaging

When do we expose for esophagus imaging

during 3rd swallow of barium

Why do we expose during 3rd swallow of barium

make sure entire esophagus is seen

Where is CR for PA Esophagus

mid-sagittal at T5-6

What is collimation for PA Esophagus

4" transverse field

Why position pt 35-40 RAO to image esophagus

so esophagus is between vertebra and heart

Where is CR for RAO Esophagus

T5-T6

Where is CR for RAO Esophagus

T5-T6 1-2" left of spine

Where is CR for Lateral Esophagus

T5-T6

What is collimation for Lateral Esophagus

5-6" transverse field

Stomach is located between ____ and ___

esophagus small intestine

esophagogastric junction is also called __

cardiac orifice

cardiac orifice refers to the relationship of ___

diaphragm near the heart

Cardia consists of which parts? They are ___ to the heart

cardiac orifice cardiac sphincter cardiac notch proximal

SUperior to cardiac orifice is ___

cardiac notch

What is pyloric orifice

opening of distal stomach

The lesser curvature is ____ The greater curvature is ___

medial border lateral border

The angular notch separated ___ from ____

body of stomach pyloric portion of stomach

what is the chain of actions that push food along the GI tract down the pharynx to esophagus

Mastication --> Deglutition --> peristalsis

Food and air enters which part of the pharynx

oropharynx --> laryngopharynx --> esophagus

What are the parts of the stomach? (6)

Rugae Fundus Body Pylorus Lesser Curvature Greater Curvature

What is the function of rugae

allow stomach to contract & expand

The fundus is most ___ & ___ portion of stomach

superior posterior

Contents of the stomach go through ___ to reach duodenum

pylorus

distal to angular notch is ___

pyloric antrum

____ ends at the pyloric sphincter

pyloric canal

angular notch separates ___ from ___

stomach body from pyloric

What separates stomach body from pyloric

angular notch

What structure of the stomach is important for radiologists to look at

duodenal bulb

In SUPINE position, the fundus is _____. Therefore, ___ settles in there

most posterior barium

In PRONE position, the fundus is _____. Therefore, ___ settles in there

most ANTERIOR air

In supine position, barium settles in ___, air in ___

fundus body/pylorus of stomach

in which position does barium settles in the fundus

supine

in which position does barium settle in the body/pylorus of the stomach?

prone, RAO

In erect position, air is ____ barium is ___ in ___

filling fundus leveling off in body/pylorus

Difference between substracted and non-substracted image. Which is our routine image?

subtracted image: positive contrast (barium) is black non-substracted image: barium is white routine: non-subtracted image

What is substraction in fluoro?

Radiopaque structures such as bones are eliminated ("subtracted") digitally from the image, thus allowing for an accurate depiction of the blood vessels.

Position of stomach for each body habitus: hypersthenic: ____ sthenic: _____ hyposthenic: _____

higher stomach ( T9-12) mid (T10-L2) lower (T11-L4)

Which body habitus has a stomach that is more transverse

hypersthenic

Which body habitus has a stomach that is more longitudinal

hyposthenic

The location of duodenal bulb in each body habitus? hypersthenic: ____ sthenic: _____ hyposthenic: _____

T11-12 L1-L2 L3-4

the first portion of the small intestine is ____

duodenum

C-shaped duodenum is closely related to the head of ____

pancreas

C-loop of duodenum & pancreas are ____ structures

retroperitoneal

the superior portion of the duodenum is ____

duodenal bulb

What are the 3 portions of the small bowel? (list in order from beginning to end)

duodenum jejunum ileum

____ is the junction between duodenum and jejunum

duodenojejunal flexture

The ileum ends at _____

Ileocecal valve

The ileum ends at ileocecal valve in which quadrant

RLQ

the duodenum is divided into 4 parts: ____

1. duodenal bulb 2.descending portion 3. horizontal portion 4. ascending portion

which portion of the duodenum receive bile and pancreatic enzymes

descending portion

The duodenal papilla is in which portion of the duodenum? what is its function

descending portion opening for common bile and pancreatic ducts into duodenum

Which portion of the duodenum form the C-loop ?

horizontal and ascending portion

which portion of the duodenum is most important for ERCP ?

descending portion

How do you prep patient for UGI?

NPO 8 hours Pt undressed in gown

Why NPO 8 hours for UGI?

prevent filling defect that can be confused with pathology

UGI is radiographic examination of ____ (3)

distal esophagus, stomach, and duodenum

for UGI, patient starts ____

upright

if dual contrast for UGI, patient _____

swallows negative contrast

What is the important instruction when doing dual contrast for UGI

instruct patient not to burp (belch)

For UGI, we start with ___ barium which ____ the esophagus & stomach until we see the _____ opens. Then we give _____ barium on the radiologist's instruction to ___ stomach

thick coats esopharyngeal sphincter thin fill

when patient drinking thin barium, its important that _____

they take big gulp

which barium is used for UGI with NG?

thin

What is the important step to do after UGI with NG? why?

flush NG with water barium can dry out in the NG --> NG replacement --> hassle --> nurse get mad !

what are the routines for UGI imaging (4)

AP Scout (high KUB) PA RAO (slight vs steep) RT Lateral

kVp for UGI; SID?

100; 40

Purpose of scout film?

gives overview prior to barium (before fluoro procedure) to make sure there are no obstructions

[BE] Position patient for AP & Scout (HIGH KUB) CR? expose?

supine CR: MSP & iliac crest expiration

how to position patient for PA UGI CR? expose?

prone duodenal bulb (L1-2) 2" left of midline Expiration

what kind of projection is slight RAO

Position patient for slight RAO CR?

15-20 RAO CR: L1-L2 (duodenal bulb area) halfway bw spine & left lateral aspect of body

Position patient for steep RAO CR? purpose?

45-70 RAO CR same as slight RAO to see different profile of stomach & duodenum

how to distinguish STEEP RAO from Lateral

rib superimpose vertebral

Why we do RIGHT lateral instead of LEFT lateral [UGI]

normal progression of emptying the stomach starts from the right

CR for RT lateral [UGI]

1-2" anterior to MCP

Patient prep for SMALL BOWEL SERIES without UGI

NPO 8hrs bowel prep 2 cups of thin barium

Patient prep for SMALL BOWEL SERIES with UGI

1 additional thin barium ready

what is timed PA

procedure after UGI overheads

Timed PA starts after ____

pt drinks 2 cups of thin barium

What are the "typical time" films for Timed PA

15min, 30min every 30min

time films continues until contrast reached

large bowel

Spot film is used to take image of _____

ileocecal valve

Duodenum located in ____ quadrant and extends to ____ quadrant

RUQ LUQ

first portion of large intestine is called ____

cecum

function of ileocecal valve

allow contents from small intestine to cecum

___ is the area we look at for final image on SBS

terminal ileum (TI)

routine for SBS

PA KUB

position pt for PA KUB [SBS]

prone

CR for PA KUB [SBS]

early film (15-30min): 2" above iliac crest late films (after 30min): at iliac crest

ileocecal valve is in which quadrant

RLQ

After terminal ileum, the next structure of large intestine is ___

cecum

What structure coming off of the cecum?

appendix

Appendix isnt influenced by ____

peristalisis

Pain in RLQ indicated ___

appendicitis

what are the 4 sections of the colon?

ascending transverse descending sigmoid

the cecum is in which quadrant

RLQ

name the flexure from right to left

hepatic --> splenic

Which colic is lower? [LARGE INTESTINE]

right

What is the role of ileocecal valve?

acts as a sphincter to prevent contents of ileum from passing too quickly into the cecum prevent reflux into TI

How does appendicitis happen?

Appendix has no exit. When infectious agents enter, it cannot empty itself.

If appendicitis not treated before rupture, it can cause ___

peritonitis

If appendicitis is not treated before rupture, it can cause ___

peritonitis

___ is a control muscle that surrounds the anal canal

anal sphincter

___ are the pockets within the large intestine

haustrum

most of the large intestine possess haustrum, except for ___

rectum

what is the band of longitudinal muscle of large bowel?

taeniae coli

What structures distinguish the large intestine from small intestine

taeniae coli haustrum

4 purposes of intestine

digestion absorption reabsorption elimination

Small intestine's purpose: ___ Large intestine's purpose: ____

digestion/absorption/reabsorption elimination

[GI] Small in diameter, longer in length is ____

small intestine

[GI] large in diameter, short in length is ___

large intestine

medical term for elimination [large intestine]

defecation

Which parts of colon are anterior?

transverse & sigmoid

which parts of colon are posterior

ascending, descending, rectum

[LARGE INTESTINE] in supine, air rises in ___, barium settles in ___

transverse & sigmoid rectum, ascending, descending

[LARGE INTESTINE] in prone, air rises in ___, barium settles in ___

rectum, ascending, descending transverse & sigmoid

Patient prep for BE of Large Intestine

NPO full day prior Bowel prep

the importance of bowel prep for BE of Large Intestine

avoid confusing bw polyps and stools

What are used for BE bowel prep

laxatives/cathartics

What are the condition that contraindicate the use of laxative?

gross bleeding severe diarrhea obstruction appendicitis

What is the temperature for barium used in BE

room temperature

for BE tip insertion, patient is placed in which position

Sim's

insert enema tip on ___ into anal canal

expiration

enema tip is inserted toward ___ then ___

umbilicus superior

It's important enema tip inserted do not exceed ___

1 1/2"

Tech's role during BE exam

assist radiologist control barium flow assist paient

Tech's role after exam

obtain & overhead needed check with radiologist drain barium into bag remove tip assist patient to restroom

BE is not performed in case of ___

acute appendicitis because of perforation

[BE] kVp for Scout

75 - 80

[BE] We can see flexure of large intestine in which position

RPO (LAO) LPO (RAO)

kVp for routine BE

100

kVp for BE postevac

75-80

[BE] how do you know if scout image is PA or AP

AP: wide pelvis PA: narrow pelvis

[BE] Which positions both show splenic flexure? CR?

RPO & LAO CR: mid body and at crest or higher

[BE] CR? LAO: ___ RAO: ___

RAO: at iliac crest & MSP LAO: at crest or 1-2" above iliac rest & MSP

[BE] Which positions both show hepatic flexure? CR?

LPO & RAO

[BE] If doing lateral rectum, which side the patient lies on

LEFT

[BE] lateral decub CR?

horizontal & perpendicular Iliac crest & MSP

[BE] lateral rectum CR?

CR: MCP & ASIS

[BE] AP axial CR?

30-40 cephalad MSP & 2" inferior to ASIS

[BE] PA axial CR?

30-40 caudal exit ASIS & MSP

[BE] which position is done for Postevac

KUB ( AP or PA)

Position for air contrast BE

routines + RT/LT decub

Alternative position to routine abdomen decub for air contrast BE

X-table rectum

[DOUBLE CONTRAST BE] PA: transverse colon is ___ filled AP: transverse colon is ___ filled

barium air

[LAO/RPO] Ala of left ilium is ___ [RAO/LPO] Ala of right ilium is

foreshortened foreshortened