Test 2 - Upper GI

Question 1

Positive CM

Answer 1

radiopaque barium sulphate
thick barium - 4:1
thin barium - 1:1

Question 2

negative CM

Answer 2

radiolucent CO2 gas producing crystals
- calcium citrate, magnesium citrate

Question 3

Single vs doble contrast

Answer 3

double contrast suses both radiopaque and radiolucent contrast

Question 4

Water soluble contrast uses

Answer 4

esophagus
stomach/duodenum
small bowel
colon

Question 5

water soluble contrast advantages

Answer 5

easily removed
non toxic
absrobed (excreted by kidneys + urinary tract)

Question 6

water soluble contrast disadvantages

Answer 6

taste
high osmolarity (hypertonic)

Question 7

Accessory organs

Answer 7

salivary glands
pancreas
liver
gall bladder

Question 8

Small bowel enema (2 reasons why)

Answer 8

Diagnostic – water soluble or barium injected to fill small bowel
Therapeutic – relieves distension post-op, double lumen catheter allows drainage

Question 9

SBFT

Answer 9

Follows routine UGI
Patient is given 2nd cup of barium
1st image is 30 mins after UGI starts (or 15 mins after 2nd cup)
Prone (helps barium spread out)
Timing and documentation important
Most transit times are 2-3 hours
Stop when barium reaches terminal ileum

Question 10

esophagram indications (7)

Answer 10

• Achalasia (esophagus fails to relax or open up, and dilates)
  
  • Anatomic anomalies (stroke)
  • Carcinoma (cancer of the throat or neck)
  • Dysphagia (painful swallowing)
  • Esophageal reflex (ulcers/stuff coming back up esophagus)
  • Esophageal varices (veins dilate)
• Zenker’s diverticulum (muscle wall above esophagus is weak)

Question 11

patient interview order

Answer 11

• Introductions
  
  • Verify patient/exam
  • NPO? (nothing by mouth)
  • Previous exams
  • Surgery
  • Reason for exam
  • Symptoms
  • Medications
  • LMP? (last menstrual period)
  • Explanation of procedure
    Introduce radiologist

Question 12

AP esophagus (pt. pos., CP, breathing, SID)

Answer 12

Recumbant (100cm) or erect (180cm)
CP T5/T6 (3” below JN)
suspended expiration

Question 13

RAO esophagus (pt. pos., CP, breathing, SID)

Answer 13

35-40 deg from prone
erect (72”) or recumbant (40”)
suspended respiration
CP T5/T6
Spine to the LEFT of esophagus

Question 14

LAT esophagus

Answer 14

recumbant or erect
arms raised
CP t5/T6
suspended expiration

Question 15

Upper GI indications

Answer 15

• Diverticula
  
  • Gastritis
  • Carcinoma
  • Hiatal hernia
  • Sliding hiatal hernia (Schatzaes)
  • Ulcers

Question 16

PA UGI

Answer 16

prone
CP L1
suspended exp.
kV 80-90
collimate to 8x10
fundus full of air

Question 17

RAO UGI

Answer 17

40-70 from prone
CP L1
duodenal bulb in profile
entire stomac hand c-loop of duodenum seen

Question 18

R LAT UGI

Answer 18

CP L1, 2.5-4cm anterior to mid coronal plane
retrogastric spcae

Question 19

LPO UGI

Answer 19

30-60 deg from supine
duodenal bulb free of superimposition by pylorus

Question 20

AP UGI

Answer 20

supine/trendelenburg
fundus full of barium

Question 21

SBFT PA

Answer 21

1st image 5cm above crest, all other @ crest
Suspended expiration
100cm SID
kV 110-125
prone