Plain and Contrast X-ray Studies Flashcards by Bianca de la Vega

5 densities normally present on x-rays

1) Gas - black
2) Fat - dark gray
3) Soft tissue/fluid - light gray
4) Bone/calcifications - white
5) Metal - intense white

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T or F: It is only necessary to obtain an x-ray from either the upright or supine position for adequate examination

F (Both should always be done)

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Difference between abdominal and kidney, ureter, bladder (KUB) plate

Captured structures

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Structures captured on abdominal plate

Hemidiaphragm up to part of pelvis

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Structures captured on KUB plate

Whole pelvic cavity

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Summation effect

May be present with large organs as they approach the appearance of bone

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Main consideration in preparing for an abdominal x-ray

Bowel preparation to minimize feces and gas

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T or F: Patients should be discouraged from talking or screaming prior to an abdominal x-ray to minimize accumulation of gas in abdominal cavity

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Prepartion wherein there is no food nor liquid intake for 4 to 6 hours prior to an abdominal x-ray

Nothing per orem (NPO)

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Function of NPO preparation

Needed in contrast studies because dehydration will result in easier absorption of contrast media

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What to examine in abdominal x-rays

1) Gas pattern
2) Presence or absence of extraluminal air
3) Soft tissue masses
4) Calcifications
5) Foreign bodies

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Usual presence of extraluminal air when an x-ray is taken in the upright position

Below the hemidiaphragm

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Possible causes of the presence of extraluminal air

Diseases, trauma, surgery

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Normal gas pattern of stomach

Always with gas, producing a gastric bubble

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Normal gas pattern of small bowel

2 to 3 loops of non-distended bowel

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Normal gas pattern of large bowel

Gas almost always present in rectum and sigmoid colon

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Primary structures outlined in the abdomen

Solid organs (liver, kidney, spleen), hollow organs (GI tract), and bones

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Possible descriptions of abdominal structures

1) Visible or not visible
2) Too large or too small
3) Distorted or displaced
4) Abnormally calcified
5) Containing abnormal gas or fluid

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Air on both sides of the intestine/stomach (luminal and peritoneal side)

Rigler’s sign / double wall sign

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Common contrast materials used in abdominal x-rays

1) Sodium bicarbonate

2) Barium sulfate/sulfide

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T or F: Barium sulfate can be combined with Sprite for use in double-contrast studies

T (This combination provides both liquid and gas contrast)

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Function of barium sulfate

Coats GI tract to see patterns and areas of obstruction, to establish integrity and deficiencies of the GI tract, and to locate areas of ulcers, craters, and polyps

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Quantities of barium sulfate used in contrast studies

Initial 1 L of barium is ingested with an additional 250 cc introduced midway

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Characteristics of large bowel in an x-ray

Peripheral; haustral markings don’t extend from wall to wall

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Characteristics of small bowel in an x-ray

Central; valvulae extend across the lumen; maximum diameter of 2 inches

Indication of large bowel obstruction (LBO)

Haustrations are almost gone

Indications of small bowel obstruction (SBO)

Stretched small bowel and may have dilated tube-like structures due to the obstruction

T or F: For gas-containing GI tract, ultrasound is the best modality

F (X-ray is the best modality for the gas-containing GI tract)

T or F: On normal film, any structure in the abdomen outlined by gas is part of the GI tract

T or F: On a supine AP radiograph, fluid lies posteriorly in the gut while gas in the bowel will float anteriorly on it

T or F: Fluid levels appear on supine AP films

F (Fluid levels do not appear on supine AP films)

Indications of a normal esophagogram

Smooth esophageal wall with clear border, no wrinkling nor obstruction, and which is collapsed if not swallowing anything

3 indentations/constrictions of the esophagus

1) Cervical constriction 2) Thoracic/broncho-aortic constriction 3) Diaphragmatic constriction

Location and cause of cervical constriction

At pharyngoesophogeal junction, caused by cricopharyngeus muscle

Cause of thoracic constriction

At arch of aorta (seen in AP view) and left main stem bronchus (seen in lateral view)

Location of diaphragmatic constriction

At esophageal hiatus

Structure to be checked for patients with recurring acid reflux

Cardiac/gastroesophageal sphincter

Structures outlined by gas in the stomach in supine position

Body and antrum of stomach

Location of pool of resting gastric fluid in supine position

Fundus of the stomach beneath the diaphragm

Circular outline created by pool of resting gastric fluid in fundus of the stomach

Gastric pseudotumor

T or F: C-loop of the duodenum goes around the spleen

F (The C-loop goes around the head of the pancreas)

Location where the major pancreatic duct and common bile duct exits

Ampulla of Vater (2nd part of duodenum)

Location where the minor pancreatic duct enters

Minor duodenal papilla (2nd part of duodenum)

Importance of the ileocecal valve

Landmark of origin of certain diseases (such as TB) and common site of seed being lodged

Calcified fecal matter that may predispose the patient to appendicitis

Appendecolith

Most distensible part of the colon that receives fluid directly from the ileum

Caecum

Highest fixed point of the colon on the right

Hepatic flexure

Highest fixed point of the colon on the left

Splenic flexure

T or F: Hepatic flexure is usually higher than the splenic flexure

F (Hepatic flexure is usually lower than splenic flexure)

Location where contrast for imaging of the colon may be inserted

Rectum

2 mobile areas of the colon

1) Transverse colon | 2) Sigmoid colon

Reason for the mobility of transverse and sigmoid colon

Longer mesenteric attachments compared to ascending and descending colon

2 important retroperitoneal landmarks; 2 of the few straight lines of the body

Psoas muscle

Vertical limits of the kidneys

Upper border of T12 on the left to the lower border of L3 on the right

Characteristics of the kidneys

Bean-shaped soft tissue density high in the upper part of the abdomen

T or F: The kidney is very mobile and moves down with inspiration in the upright position

T or F: The left kidney is higher than the right kidney and is about 1.5 cm bigger

T or F: Normal livers have a homogenous nature

Hepatomegaly

Upper margin of the liver is above the subcostal margin

Characteristics of the liver

Located in the RUQ, presenting as a large area of soft tissue density

Characteristics of the spleen

Located in the LUQ, about the size of the patient's heart or fist

Enlargement of the spleen

Hepatosplenomegaly

T or F: The bladder appears as a hollow organ on x-ray

F (Bladder appears solid because it is full of fluid)

T or F: The uterus can be identified on plain films

Best modality for solid organs (gallbladder, spleen, liver, pancreas)

Ultrasound

Limitation of ultrasound

Abdomen must not be gassy for proper visualization

T or F: Stones in the large intestine appear black on ultrasound

F (Stones in the large intestine appear white on ultrasound)

T or F: Since the gallbladder is flattened after eating fatty foods, patients must fast before imaging to preserve the gallbladder's bile content

Components of double contrast studies

Liquid contrast (barium sulfate) and air

T or F: Lymph adenopathies, usually found in the rectal area, can be seen in both AP and lateral views

F (Only in lateral view)

Outpouchings of mucosa and muscularis mucosa at sites of blood vessel penetration

Diverticula

Enlargement in the retropharyngeal space indicates the presence of what?

Retropharyngeal abscess

Appearance of an esophageal carcinoma

Irregular/nodular and eccentric esophageal narrowing

Concentric constriction of colorectal cancer in the rectum or sigmoid colon

Apple core deformity

Use of x-rays when dealing with ingested foreign bodies

Shots taken every few hours to monitor the progress of foreign bodies

Intussuception

Process by which a segment of intestine invaginates into the adjoining intestinal lumen, causing bowel obstruction

Hirschprung's disease

Loss of innervation of myenteric ganglia at distal colon (commonly at the rectosigmoid), resulting in inability to push out feces

Gallstones

Accumulations of salt, fat, and cholesterol due to nutritional habits

T or F: Smaller gallstones have a better prognosis than larger gallstones

Blockage of the biliary tree by small gallstones

Choledocholithiases

Progressive luminal narrowing due to ingestion of caustic substance

Caustic esophageal stricture

Hampton's line

Represents the thin rim of undermined gastric mucosa

Smooth, sharply delineating soft tissue mass surrounding a benign ulcer

Ulcer mound