UNIT 3: Esophagram Flashcards
Functions of the Digestive System
-INGESTION: taking in food and drink
-PERISTALSIS: contractual waves used to move food along digestive tract
-DIGESTION: convert food into chemical substances
-ABSORPTION: intake of chemical substances
-Ex: simple sugars, amino acids
-DEFACATION: elimination of indigestible solid substances
INGESTION
taking in food and drink
PERISTALSIS
contractual waves used to move food along digestive tract
DIGESTION
convert food into chemical substances
ABSORPTION
intake of chemical substances
Ex: simple sugars, amino acids
DEFACATION
elimination of indigestible solid substances
Key points about the oral cavity
-Teeth: 32 (molars, premolars, canine, incisors)
-Tongue: muscle with taste receptors for sweet, sour, salty
-Roof of oral cavity: hard and soft palate
-Mastication: chewing and grinding food into small pieces
-Salivary Glands: produce saliva that moistens and breaks down food:
-parotid
-sublingual
-submandibular
Mastication
chewing and grinding food into small pieces
Deglutition
act of swallowing
Pharynx
passageway for air and food
Valves that control passage of food
-Uvula
-Epiglottis
The esophagus is also known as
the gullet
The esophagus
-Hollow, muscular tube
-10 inches long, 3/4 Inch in diameter
-Extends from the pharynx (C6) to the stomach (T11)
-Transports food by gravity and peristalsis
Normal dents in the esophagus
Distal Esophagus
-Esophagus passes through the diaphragm at the esophageal hiatus (T10) and joins the stomach (T11)
-Cardiac antrum: expanded portion of the distal esophagus
-Cardiac orifice: opening between esophagus and stomach
-Cardiac sphincter: muscle controlling cardiac orifice
Pathology
-ESOPHAGEAL STRICTURE: Narrowing of the esophagus. Barium tablet can be given to demonstrate site of lumen narrowing.
-ESOPHAGEAL VARICES: Enlarged tortuous veins. Patients with liver disease.
-ACHALASIA: Failure of esophageal peristalsis. Lower esophageal sphincter does not relax. Dilation of the distal esophagus. Bird beak appearance.
-SCHATZKI RING: Narrowing of the lower part of the esophagus due to changes in the mucosa. Associated with hiatal hernias.
-ZENKER’ S DIVERTICULUM: Hypopharyngeal diverticulum. Pouch forms at the junction of the pharynx and esophagus. Patients complain of difficulty swallowing, feeling lump or fullness in throat, regurgitation of food.
Dysphagia vs Disphasia
-Dysphagia: difficulty swallowing
-Disphasia: difficulty speaking
Fluoroscopic Procedure
-Fluoroscopy Needed
-Slide bucky to foot of table
-If overheads are requested, they can be done recumbent or erect
-Recumbent is routine (It allows for more complete filling of esophagus, especially in the proximal portion)
-No formal preparation needed for routine esophagus/barium swallow
-Patient prep only needed if UPPER GASTOINTESTINAL SERIES to follow
Single vs Double Contrast media
-SINGLE CONTRAST: consists of a high density barium (BaSO4) only
-DOUBLE CONTRAST: consists of barium & carbon dioxide (CO2) crystals
-CO2 administered before barium
-Ask them NOT to belch(burp)
During imaging
-Instructions: “DRINK, DRINK, DRINK”
-After positioning, patient should begin drinking barium, continuously
-Make exposure after 3 – 4 swallows.
-Allows more complete filling of esophagus
-RESPIRATION is inhibited approx 2 secs after swallowing. The patient does NOT need to be instructed to hold his/her breath.
Esophagus PA positioning
-SID: 40”
-IR: 14”x17” LW in Table Bucky
-Top of IR at level of chin
-Position: Prone
-MSP centered
-Turn head to facilitate drinking
-CR: ⟂ to center of IR at T5-T6
-Collimation: 12”x17”
-Marker in light field, Shield patient
-Instructions: Drink, Drink, Drink
Esophagus AP Positioning
-SID: 40”
-IR: 14”x17” LW in Table Bucky
-Top of IR at level of chin
-Position: Supine
-MSP centered
-Turn head to facilitate drinking
-CR: ⟂ to center of IR at T5-T6
-Collimation: 12”x17”
-Marker in light field, Shield patient
-Instructions: Drink, Drink, Drink
PA/AP Esophagus Evaluation Criteria
-Evidence of proper collimation
-Esophagus from lower neck to its entrance in the stomach
-Esophagus filled with barium
-Penetration of barium
-Brightness and contrast to visualize esophagus through spine
-No rotation of patient
Esophagus PA Oblique (RAO) Positioning
-SID: 40”
-IR: 14”x17” LW in Table Bucky
-Top of IR at level of chin
-Position: RAO
-Rotate patient 35-40º
-Right arm down, Left arm up
-CR: ⟂ to center of IR at T5-T6, 2” lateral to MSP on elevated side
-Collimation: 12”x17”
-Marker in light field, Shield patient
-Instructions: Drink, Drink, Drink
-RAO preferred over LAO
Oblique Esophagus Evaluation Criteria
-Evidence of proper collimation
-Esophagus from lower neck to its entrance in the stomach
-Esophagus filled with barium
-Penetration of barium
-Esophagus between heart and vertebrae
Right Lateral positioning
-S.I.D: 40”
-IR SIZE: 14 x 17 (LW)
-C.R: Perpendicular to midpoint of IR (approx. T5-T6)
-Place top of IR to approx level of chin.
-PATIENT POSITION: Right lateral recumbent so you can watch them drink (left lateral if they are upright)
-Shield patient if possible
-PART POSITION:
-Center MCP to IR
-Be sure arms are up and out of the way, near face
-Holding cup of barium with straw
Barium swallow Esophagram Lateral Evaluation Criteria
-STRUCTURES DEMONSTRATED:
-Entire esophagus filled with barium from the neck to gastro-esophageal junction
-EVALUATION CRITERIA:
-Proximal esophagus without superimposition of the patient’s arm
-Ribs posterior to the vertebrae superimposed to show true lateral position
MBS – MODIFIED BARIUM SWALLOW WITH SPEECH THERAPIST
-Soft palate, pharynx, larynx, and cervical esophagus
-Swallowing dysfunction study
-Performed in conjunction with a speech therapist
-Fluoroscopy only
-No overheads
-Typically done in lateral position
Esophagram normal indentations in anatomy
Aortic arch, Left main stem bronchus, Left atrium
