Plain and Contrast X-ray Studies Flashcards
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
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)
Difference between abdominal and kidney, ureter, bladder (KUB) plate
Captured structures
Structures captured on abdominal plate
Hemidiaphragm up to part of pelvis
Structures captured on KUB plate
Whole pelvic cavity
Summation effect
May be present with large organs as they approach the appearance of bone
Main consideration in preparing for an abdominal x-ray
Bowel preparation to minimize feces and gas
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
T
Prepartion wherein there is no food nor liquid intake for 4 to 6 hours prior to an abdominal x-ray
Nothing per orem (NPO)
Function of NPO preparation
Needed in contrast studies because dehydration will result in easier absorption of contrast media
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
Usual presence of extraluminal air when an x-ray is taken in the upright position
Below the hemidiaphragm
Possible causes of the presence of extraluminal air
Diseases, trauma, surgery
Normal gas pattern of stomach
Always with gas, producing a gastric bubble
Normal gas pattern of small bowel
2 to 3 loops of non-distended bowel
Normal gas pattern of large bowel
Gas almost always present in rectum and sigmoid colon
Primary structures outlined in the abdomen
Solid organs (liver, kidney, spleen), hollow organs (GI tract), and bones
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
Air on both sides of the intestine/stomach (luminal and peritoneal side)
Rigler’s sign / double wall sign
Common contrast materials used in abdominal x-rays
1) Sodium bicarbonate
2) Barium sulfate/sulfide
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)
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
Quantities of barium sulfate used in contrast studies
Initial 1 L of barium is ingested with an additional 250 cc introduced midway
Characteristics of large bowel in an x-ray
Peripheral; haustral markings don’t extend from wall to wall
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
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
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
T or F: The left kidney is higher than the right kidney and is about 1.5 cm bigger
T
T or F: Normal livers have a homogenous nature
T
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
F
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
T
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
F
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
