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Radiographic Procedures 2 > Systems-GI procedures of esophagus and stomach > Flashcards

Systems-GI procedures of esophagus and stomach Flashcards

1
Q

What is the concentration of barium for the esophagus?

A

30-50%

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2
Q

What is the concentration of barium for the Stomach: Upper GI series?

A

30-50%

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3
Q

What is the concentration of barium for the Small Intestine: Small bowel series?

A

40-60%

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4
Q

What is the concentration of barium for the Large intestine: Barium enema?

A

12-25%

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5
Q

What is the concentration of barium of the GI for CT?

A

12-25%

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6
Q

What are the proceedures where barium can be administered orally?

A
  1. Esophagus
  2. Stomach: Upper GI series
  3. Small Intestine: Small bowel series
  4. GI for CT
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7
Q

What is the method of administration for the Small Intestine: Small bowel series

A

Oral or Naso-duodenal

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8
Q

What proceedure is this for?

Large amount of fluids day before exam. NPO after midnight before exam. Cleansing enema prior to exam

A

Large intestine: Barium enema

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9
Q

What proceedure is this for?

NPO after midnight before exam

A

GI for CT and Stomach: Upper GI series

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10
Q

What proceedure is this describing?

Low residue diet eaten for 2 days prior to exam

A

Small Intestine: Small bowel series

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11
Q

What patient prep needs to be done for esophagus imaging?

A

None

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12
Q

T/F

Higher concentrations are needed for double contrast enemas

A

True

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13
Q

Is barium sulfate positive or negative contrast?

A

Positive

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14
Q

What is this substance?

BaSO4

A

Baruim

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15
Q

What is one contraindication to Water-Soluble Iodinated Contrast Media?

A

Hypersensitivity to iodine

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15
Q

What are indications for imaging with Water-Soluble Iodinated Contrast Media?

A
  1. Perforated viscus
  2. Presurgical procedure
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16
Q

What type of contrast is used here?

A

Single-Contrast UGI (barium only)

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17
Q

What type of contrast has been used here?

A

Double-Contrast UGI

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18
Q

What is double contrast?

A

Barium sulfate (positive contrast) and
Carbon dioxide gas or room air (negative contrast)

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19
Q

T/F

CO2 or air can be administered with tablets/crystals or a pump

A

True

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20
Q

Where is the esophagus located in relation to the trachea?

A

Posterior to the trachea

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21
Q

What are the indentations in the esophagus caused by?

A

-2 indentations for the arch of aorta
-1 indentation left primary bronchus
-1 partial indentation from the heart

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22
Q

What is reflux into the esophagus?

A

Reflux involves the cardiac sphincter relaxing or not fully closing, allowing stomach contents to regurgitate back into the esophagus.

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23
Q

What are varices in the esophagus?

A

Blood vessels around the esophagus becoming enlarged

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24
Q

What are the Technologist Responsibilities for imaging of the stomach and the esophagus?

A
  1. Prepare fluoro room (Equipment set up, Contrast, supplies)
  2. Obtain clinical history
  3. Explain procedure
  4. Observe and support patient throughout
  5. Introduce and assist the fluoroscopist
  6. Assist the patient
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25
Q

What is “Deglutition”

A

The act of swallowing

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26
Q

What is Peristalsis most prevelent?

A

The greatest motility in stomach and proximal portion of small intestine

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27
Q

T/F

Peristaltic activity decreases along the intestinal tract

A

True

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28
Q

Why are shorter exposure times for upright and hypermotile pts?

A

Shorter exposure times are required for upright imaging because gravity helps the contrast agents move quicker through the esophagus

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29
Q

What is motility?

A

The speed at which the GI tract moves material through it

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30
Q

Why are exposures of the stomach and esophagus done at the end of expiration?

A

Imaging at the end of expiration delays the barium at the distal end of the esophagus for a few seconds, making it easier to catch in imaging.

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31
Q

What are some contraindications to esophageal imaging?

A
  1. Allergy to contrast
  2. Perforation (possibly)
  3. High risk of aspiration
  4. Uncooperative patient
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32
Q

What are the two body positions for imaging of the esophagus?

A

Erect and recumbent

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33
Q

What modality is used for imaging of the esophagus?

A

Floro

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34
Q

What are the different studies done during imaging of the esophagus for a patient step by step?

A
  1. Fluoro with patient erect
  2. Administer Barium thick and thin
  3. Place patient horizontal (drink with straw)
  4. Possible Trendelenburg
  5. Phonation or breathing maneuvers
  6. Recumbent studies
  7. Coughing
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35
Q

What is the purpose of doing trandelenberg imaging for the esophagus?

A

To image for hiatus hernia, reflux

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36
Q

What is the purpose of doing recumbent imaging for the esophagus?

A

Demonstration of esophageal varices

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37
Q

What is the purpose of doing a coughing study for imaging of the esophagus?

A

Demonstrates reflux through cardiac sphincter

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38
Q

T/F

Esophageal imaging is only done with double contrast.

A

False; done with either single or double contrast

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39
Q

What are the projections done for the esophagus imaging?

A

AP, PA, OBL’s, Lateral projections

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40
Q

What is the centering point for the esophagus projections?

A

CP is C4-C5 examining high in respiratory tract or CP is T5–T6 if digestive tract

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41
Q

For the oblique images of the esophagus, how much should the patient be obliquied?

A

35º-40º

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42
Q

What projection is this?

A

AP or PA esophagus

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43
Q

What position and projection is this?

A

RAO esophogram

44
Q

What are the 4 tests that are used for diagnosis of esophageal reflux?

A
  1. Valsalva maneuver
  2. The water test
  3. Compression paddle technique
  4. The toe-touch test
45
Q

Why is the Valsalva Maneuver done when looking for pathologies in the esophagus?

A

Valsalva increases venous pressure; can demonstrate esophageal varices

46
Q

What is the valsalva maneuver?

A

Patient takes in deep breath and holds breath in while bearing down as if trying to move the bowels.

47
Q

What is the Müller Maneuver?

A

Patient exhales then tries to inhale against closed glottis

48
Q

What does the Müller Maneuver demonstrate?

A

R/O (rule out) aspiration or incompetent valves

49
Q

When is the waters test positive?

A

Positive if barium regurgitates into esophagus

50
Q

What pathology is being shown here?

A

GERD (contrast regurgitating)

51
Q

Where is the compression paddle placed in esophageal imaging?

A

Paddle inflated under stomach with patient in prone position

52
Q

What is the purpose of the compression paddle in esophageal imaging?

A

To create pressure applied to stomach region to create reflux

53
Q

What does the toe-touch maneuver demonstrate?

A

Effective to demonstrate reflux and hiatal hernia

54
Q

What is a Modified Barium Swallow done for?

A

Done for dysphagia or rehabbing patients (strokes)

55
Q

T/F

Modified barium swallows can be done wtih the patient sitting or standing, but mostly sitting

A

True

56
Q

T/F

When evaluating dysphagia you typically start with thinner materials, to see what kinds of food the patient can tolerate

A

True

57
Q

T/F

UGI’s are typically done with liquids, even though it can be referred to as a Barium Meal

A

True

58
Q

What does the UGI proceedure evaluate?

A
  1. Mouth and upper esophagus
  2. Distal esophagus
  3. Stomach
  4. Some of the small intestine
59
Q

Label 1-4

A
  1. Cardiac notch
  2. Fundus
  3. Body
  4. Pyloric portion
60
Q

Label 1-7

A
  1. Descending duodenum
  2. Pyloric sphincter
  3. Pyloric antrum
  4. Greater curvature
  5. Fundus
  6. Duodenal bulb
  7. Lesser curvature
61
Q

What is the Shortest and widest portion of the duodenum?

A

The C loop

62
Q

What part of the duodenum is retroperitaneal?

A

The descending and ascending

63
Q

Label 1-5

A
  1. Superior duodenum
  2. Descending duodenum
  3. Horizontal duodenum
  4. Ascending duodenum
  5. Ligament of Tritez
64
Q

Label 1-5

A
65
Q

What is the most posterior part of the stomach?

A

The fundus

66
Q

Where is the body of the stomach located in relation to the fundus?

A

Anterior/inferior to fundus

67
Q

Where is the pylorus located in relation to the body of the stomach?

A

Posterior/distal to body

68
Q

What is the difference in stomach position in hypersthenic patients vs. asthenic patients?

A

Hypersthenic tends to be wider and flatter, while asthenic tends to be narrow stretched downwards.

69
Q

What body habitus is this patient?

A

Hypersthenic

70
Q

What body habitus is this patient?

A

Asthenic or hyposthenic

71
Q

What is the body habitus of this patient?

A

Sthenic

72
Q

Where is the stomach located at in hypersthenic patients?

A

T11-T12

73
Q

Where is the stomach located in asthenic/hyposthenic patients?

A

L3-L4

74
Q

Where is the stomach located in sthenic patients?

A

f L1-L2

75
Q

What are the 4 methods for imaging the stomach?

A
  1. Single Contrast (SC)
  2. Double Contrast (DC)
  3. Biphasic
  4. Hypotonic Duodenography
76
Q

What is
Biphasic imaging for the stomach?

A

Combination of single and double contrast methods

77
Q

Give 3 examples of indications for imaging the stomach:

A
  1. Gastric cancer
  2. Polyps
  3. Diverticula
78
Q

What are the contraindications to imaging of the stomach (UGI)?

A
  1. Complete large bowel obstruction
  2. Perforations (possibly)
  3. Patients aspirating contrast instead of swallowing it
  4. Contrast allergy
79
Q

What patient prep needs to be done prior to imaging the stomach?

A
  1. NPO 8-9 Hrs.
  2. No smoking or chewing of gum after midnight
  3. Remove all clothing, hospital gown
  4. Sometimes laxative or enema to cleanse the large bowel
80
Q

T/F

Single contrast has low density

A

True

81
Q

What is the single contrast used in UGI imaging?

A

Ba Suspension 30%-50%

82
Q

Why is the trandelenberg position used in UGI imaging?

A

To detect any abnormal alteration in the function, position, shape or contour of the esophagus, stomach or duodenum

83
Q

What is the advantage of using double contrast is UGI imaging?

A

Advantage – small lesions less obscured, mucosal lining clearly visualized

84
Q

T/F

Double contrast has high density.

A

True

85
Q

What is the double contrast used in UGI imaging?

A

Ba Suspension 250% wt./vol range, and CO2 producing crystals

86
Q

What type of medications can be used for reducing peristalsis and relaxing the smooth muscles for UGI imaging?

A

Hyoscine Buscopan, Glucagon

87
Q

When in the PA -recumbent position, what parts of the stomach will contain the barium?

A

Body, pylorus, and duodenal bulb are barium filled

88
Q

When in the AP -recumbent position, what parts of the stomach will contain the barium?

A

Fundus

89
Q

What post care instructions should be given to patients after UGI imaging?

A
  1. White bowel movements
  2. To avoid impaction – plenty of fluids
90
Q

Watch video

A

http://www.youtube.com/watch?v=PiYEy2Rz77s -

91
Q

Is this taken prone or supine?

A

prone

92
Q

Is this taken prone or supine?

A

Supine

93
Q

Picture for understanding

A

Keep going :)

94
Q

What is shown in a right lateral UGI?

A

Retrogastric space, duodenal loop, and duodenojejunal junction

95
Q

What is shown in a left lateral UGI?

A

Left retrogastric space

96
Q

What part of the stomach will be filled with barium in an LPO UGI?

A

Fundus filled with barium

97
Q

What projection is this?

A

LPO UGI

98
Q

How was this image acquired?

A

AP supine

99
Q

How was this image acquired?

A

RAO prone

100
Q

What is the purpose of the compression paddle in UGI imaging?

A

Can use compression paddle to visualize the duodenal bulb in various stages of filling

101
Q

Which position will show Dynamic emptying of the stomach?

A

40°-70° oblique RAO UGI

102
Q

Should the Duodenal bulb and C-loop be in profile for the RAO position of the stomach?

A

Yes

103
Q

What projection can be done to\ open up hypersthenic patients’ stomachs to show the greater and lesser curvatures, the antral portion of the stomach, the pyloric canal, and the duodenal bulb?

A

PA Axial projection with a 35-45° cephalad angle

104
Q

What projections are done in UGI imaging?

A
  1. PA -recumbent
  2. AP -recumbent
  3. RAO - 45°
  4. LPO - 45 °
  5. Right Lateral
105
Q

What parts of the stomach are visualized in an RAO 45 degree oblique?

A

Entire duodenal C - loop –image of pyloric canal & duodenal bulb

106
Q

What parts of the stomach are filled with barium in an LPO - 45 ° O?

A

Fundus

107
Q

What parts of the stomach are being examined in a right lateral?

A

Pyloric canal and the duodenal bulb

Radiographic Procedures 2 (18 decks)

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