UNIT 3: Upper Gastro-Intestinal Tract (UGI) Stomach, Duodenum and Esophagus Flashcards
Divisions of the Abdomen
Purpose of an Upper GI exam
•UPPER GI:
Radiologic examination of the distal esophagus, stomach & duodenum
•PURPOSE:
To radiographically study the form & function of the distal esophagus, stomach & duodenum in order to detect abnormalities.
Stomach
-Collapsible reservoir
-LUQ
-J-shaped
-Rugae line the stomach
-Folds of gastric mucosa
-Digest & transport food via gravity and peristalsis
Stomach labeling
STOMACH: Cardiac Orifice
the superior opening of the stomach Joins the distal esophagus to the proximal stomach (inlet)
STOMACH: Cardiac Sphincter
-Regulates cardiac orifice
-This region is known as the Gastro-Esophageal Junction
-This is often an area for pathology
STOMACH: Pyloric Orifice
-Distal opening of the stomach
-Joins the distal stomach to the proximal duodenum (outlet)
STOMACH: Pyloric Sphincter
-Regulates the pyloric orifice
-This area is known as the Gastro-Duodenal Junction
STOMACH: Fundus
• Upper most portion of the stomach
• Extends above the cardiac orifice
• Lies POSTERIOR to the body of the stomach
• Contains gastric air when patient is erect or prone
STOMACH: Body
Extends from cardiac orifice to level of incisura angularis
STOMACH: Pylorus
-Also known as pyloric antrum
-Most distal part of stomach
-Extends from incisura angularis to pyloric orifice
STOMACH: Greater Curvature
Left, lateral, convex border
STOMACH: Lesser Curvature
Right, medial concave border
STOMACH: Incisura Angularis
Sharp bend below the midpoint of the lesser curvature dividing body from the pylorus
Stomach according to body habitus
PATIENT SYMPTOMS (reasons for UGI exam)
• Dysphagia
• Pain in stomach alleviated by eating; pain returns 2 – 3 hours later
• Awakened @ the same time every night by stomach pain
• Sour taste in throat shortly after eating
• Severe abdominal cramps, possible perforated ulcer
UPPER GI INDICATIONS
• Peptic Ulcers
• Hiatal hernia
• Acute/chronic gastritis
• Diverticulae
CONTRAINDICATIONS TO BARIUM USE (when not to use barium)
-MUST USE WATER BASED Contrast Media
• Bowel perforations
• Lacerations
• Visceral ruptures
CONTRAST MEDIA Types
• Barium Sulfate (BaSO4)
• Aqueous Iodinated contrast media (if suspected perforation)
-Ex: Gastrovist (liquid), Gastrografin (liquid), Oral Hypaque (powder)
Single Contrast Exam
Utilizes thick and/or thin barium depending on part being evaluated
Double Contrast Exam:
Barium and gas crystals
Air and Barium distribution: Supine, Prone, Erect
PATIENT PREP
• NPO after midnight or 8 hours before the exam
• NO smoking
– Causes excess acid to accumulate.
– Smoking over stimulates peristalsis
– Makes stomach empty faster
• NO gum chewing
– Causes excessive fluids to accumulate in stomach
– May cause barium dilution
– Also causes increased peristalsis
POST UGI
• It is recommended that patients drink lots of fluid after the examination
• Stool may be white until all the barium is out of the system
PA UPPER GI Positioning
-IR: 10 x 12 or 14 x 17 LW collimate 10 x 12 or 11 x 14
-SID: 40”
-CR: Approx. L1-L2, to the midpoint of IR (halfway between spine and lateral margin of body)
-PT. POSITION: Prone
-PART POSITION:
-Center longitudinally half-way between the vertebral column and the lateral border of the abdomen
-Prone: Center IR at level of L1-L2, approx. Level of the elbow. Halfway between inferior angle of scapula and top of iliac crest
-Upright: Center IR 3-6 inches lower than L1-L2
-BREATHING: Suspend on exhalation
-SHIELD
AP UPPER GI
-PT. POSITION: Supine
-PART POSITION:
-Center longitudinally half-way between the vertebral the lateral border of the abdomen
-Center IR at approx. level of L1-L2, midway between xiphoid process and lower rib margin
-All else the same as PA
PA/AP UPPER GI Evaluation Criteria
-STRUCTURES DEMONSTRATED:
-Entire stomach and duodenal loop (review textbook)
-Barium filled stomach and duodenal bulb
-EVALUATION CRITERIA:
-Entire stomach and duodenal loop/bulb
-Stomach centered at level of pylorus
-No rotation
UPPER GI PA Projection Barium and Air
• Pyloric antrum/canal and bulb are filled with barium
• Fundus is air filled
• Stomach moves 11⁄2 - 4” superiorly according to body habitus.
UPPER GI AP Projection Barium and Air
• Pyloric antrum & bulb are air filled
• Fundus is filled with barium
• Stomach lies transverse in hypersthenic patients
RAO UPPER GI Positioning
-PROJECTION: LPO
-IR: 10X12 or 14 x 17 LW; collimate 10 x 12 or 11 x 14
-CR: perpendicular to 1 to 2 inches above the lower rib margin at the level of L1-L2 midway between the spine and the lateral border of the body (elbow flexion) OR Approximately L1-L2, to the midpoint of IR
-PT POSITON: Recumbent
-BREATHING: Suspend on Exhalation
-PART POSITION:
-RAO, approx 40-70 degrees.
-NOTE: Rotate hypersthenic (larger) patients more
-From the prone position, place right arm down by patient’s side
-Elevate patient’s left side 40-70 degrees
-Mark side up
NOTE:
-Gastric peristalsis is generally more active in this position
-Air is in the fundus & barium is located in the duodenum
RAO UPPER GI Evaluation Criteria
-STRUCTURES DEMONSTRATED:
•Entire stomach and duodenal loop
•Best image for DUODENAL BULB & PYLORIC CANAL (especially in sthenic patients)
-EVALUATION CRITERIA:
•Entire stomach and duodenal loop
•Pylorus and duodenal bulb in PROFILE WITHOUT superimposition
-Air is in the fundus & barium is located in the duodenum
-Stomach centered at the level of the pylorus
RIGHT LATERAL UPPER GI Positioning
-IR: 10 x 12 or 14 x 17 LW; collimate 10 x 12 or 11 x 14
-CR: Approx. L1-L2, to the midpoint of IR, At level of the elbow
-PT. POSITION:
*Right Lateral (Recumbent) with knees slightly bent
*Left Lateral (Upright)
-PART POSITION:
-Patient in true lateral
-Center longitudinally, midway between the MCP and the anterior wall of the abdomen to the center of the IR
-IR centered midway between inferior scapular angle and top of iliac crest
-Shield Patient
RIGHT LATERAL UPPER GI Evaluation Criteria
-STRUCTURES DEMONSTRATED:
-Anterior & Posterior aspects of stomach
-Best projection for PYLORIC CANAL and DUODENAL BULB (especially in hypersthenic patients)
-EVALUATION CRITERIA:
-No rotation
-Stomach centered at the level of pylorus
-Air in fundus
-Duodenojejunal junction
LPO UPPER GI Positioning
-PROJECTION: RAO
-IR: 10X12 or 14 x 17 LW; collimate 10 x 12 or 11 x 14
-CR: perpendicular to 1 to 2 inches above the lower rib margin at the level of L1-L2 midway between the spine and the lateral border of the body (elbow flexion) OR approximately L1-L2, to the midpoint of IR
-PATIENT POSITION: Recumbent
-BREATHING: Suspend on Exhalation
-PART POSITION:
-LPO, approx 30-60 degrees, average is 45 degrees
-From the supine position, abduct left arm and place left hand near patient’s head
-Place right arm across chest or along side the body
-Bend right knee toward the left for support
LPO UPPER GI Evaluation Criteria
-STRUCTURES DEMONSTRATED:
-Entire stomach and duodenal loop
-Barium is in the fundus & air is located in the pylorus.
-Stomach centered at the level of the pylorus
-EVALUATION CRITERIA:
-Entire stomach and duodenal loop
-PYLORUS and DUODENAL BULB visualized without superimposition in PROFILE
-Fundus portion of the stomach
Pathology: Gastritis
-Inflammation of mucosa of the stomach
-Acute: thickening of the rugae
-Chronic: thinning or loss of rugal folds
Pathology: Tumors
-Tumors: in stomach or duodenum
-Adenocarcinoma: cancer that begins in the mucus producing cells that line the stomach
Pathology: Polyp
-Small mass of tissue growth
-Grows on tissue wall
-Can be benign or cancerous
Pathology: Diverticula(e)
-Weakening & outpouching of the mucosal wall.
-Radiographic appearance: saccular outpouching from the gastric wall
Pathology: Bezoar
-Mass of undigested matter trapped in stomach and/or intestinal tract
-May consist of hair, vegetable fibers, orange sections, or wood products, milk curds, medication
• Radiographic appearance:
• Intraluminal filling defect
• Upright view may show a mass at the air/ fluid level
• Obstruction
Pathology: Pyloric Stenosis
-Thickening of pyloric musculature
-String or “mushroom” sign
Pathology: Peptic Ulcers
-Occur in distal esophagus, stomach or duodenum
-Mucosa is eroded, leaves a round or oval sore in the mucosal lining
Pathology: Perforated Ulcer
-Acid has eaten a hole through the stomach wall
-Atmospheric air is swallowed with food and escapes through the hole into the peritoneal cavity
-Free air in the peritoneal cavity is demonstrated under the diaphragm
Pathology: Hiatal Hernia
-Portion of stomach herniates through diaphragmatic opening
-May be used during UGI studies to demonstrate hiatal hernia:
-Valsalva Maneuver:
-Forcing a deep breath through a closed glottis
-Straining as if having a bowel movement
-Trendelenburg: Patient supine or prone and place head lower than the feet, approx. 45 degrees
Images
In which position is gastric peristalsis more active?
RAO
In the RAO POSITION, air is in the _________ and barium is in the _________
fundus, duodenum
In what position(s) is the pylorus and duodenal bulb visualized without superimposition?
LPO and RAO
In the Right Lateral position, where is the air?
In the fundus
In what position is the duodenal bulb in profile?
RAO and LPO
What position best show the right retro-gastric space?
Right lateral recumbent
What position best show the left retro-gastric space?
Upright left lateral
To show esophageal regurgitation and hiatal hernias, the head end of the table is lowered ___ to ___ degrees
10 to 15
Are small lesions less easily obscured with the single or double contrast exam?
Double
What position is best to show hiatal hernia?
RAO
