Imaging of the Bowel

Question 1

Radiodense and radiolucent contrast choices

Answer 1

Dense - barium (water insoluble) and iodinated (water soluble)

lucent - air and CO2

Question 2

Barium types

Answer 2

Insoluble

Thin - more fluid for single contrast

Thick - coats mucosal surfaces and used in double contrast studies with air

Question 3

Barium contraindcated

Answer 3

Perforation

Chemical peritonitis or mediastinal fibrosis and may require a surgical washout

ALSO don’t use above obstruction

Question 4

Iodine contraind

Answer 4

Suspected aspiration…will giver pulm edema

Also risk of allergic rxns

Question 5

Single vs doublle contrast

Answer 5

Single - lumen filled with ocntrast alone…for mechanical problems and contour…no cooperation needed

Double - lume ndistended with something that is radiolucent and then mucosal surface coated with thick barium…better detection of lesions and polyps…pt must cooperate

Question 6

Modified barium swallow

Answer 6

Radiologist and sppech pathologist

Real time images captured in lateral and frontal positions

Mostly for oropharyngeal

Question 7

Esophagram

Answer 7

Radiologist alone

Pharynx to gastric cardia

Upright and prone

Question 8

Upper GI series

Answer 8

Pharynx to ligament of trietz

Includes full esophagram and imaigng of stomach and duodenem

Question 9

SBFT

Answer 9

Duodenal bulb to terminal ileum

H2O soblule or thin barium

Question 10

Contrast enema

Answer 10

Evaluates colon

Retrograde through rectal tube

Question 11

When to order mod swallow

Answer 11

Dysphagia related to storke or surgery

Suspected aspiration

Question 12

When to order esophagram

Answer 12

Dysphagia
Dysmotility
Pain, reflux, hernia

Question 13

When toorder UGI, SBFT, enema

Answer 13

UGI - esoph and stomach (ulcers, mass, leak)

SBFT - motlity, obstruction, mass IBD

Enema - large intestine

Question 14

Flueorscopy

Answer 14

Assesses bowl function
Exposure to radiation
Cannot biopsy

Question 15

Endoscopy

Answer 15

Direct visualization
Can biopsy
Entire jenunum and ileum cannot be endoscoped

Cannot see bowel wall or adjacent tissue
Need sedation

Question 16

CTE/MRE

Answer 16

Need to give glucagon to inhibt peristalsis

Question 17

Acute inflammation findings

Answer 17

Mural edema
Abnormal wall enhancmeent
Inc mesenteric vasculairyt

Question 18

Penetrating dz

Answer 18

Use CTE/MRE

For isnus tracts, fistulas, abscesses

Question 19

Adv of CTE/MRE

Answer 19

Entire thicknesso f bowel wall

Surrounding mesentery and perienteric fat

Images deep pelvic ileal loops witout superimposition