Lower GI System - Chapter 13 Bontrager

A small bowel series (SBS) radiographic examination combined with an upper gastrointestinal (UGI) radiographic examination

What is a small bowel follow-through?

23 ft (7m)

How long is the average small bowel if removed and stretched out during autopsy?

15 - 18 ft (4.4 - 5.5m)

In a person with good muscle tone the lenth of the entire small intestine is _______.

5ft (1.5m)

The average length of the large intestine is ______.

Duodenum, jejunum, ileum

List the 3 divisions of the small intestine is descending order, starting with the widest division

Duodenum

Which division of the small intestine is the shortest?

LUQ & LLQ

In which two abdominal quadrants would the majority of the jejunum be found?

Jejeunum

Which division of the small intestine has a feathery or coiled spring appearance during a small bowel series?

Ileum

Which division of the small intestine is the longest?

1. Cecum

2. Colon

3. Rectum

4. Anal canal

What are the 4 major sections of the large intestines?

Cecum & rectum

Which two aspects of the large intestine are not considered part of the colon?

4 sections, 2 flexures

The colon is divided into ____sections and has _____ flexures.

1. Ascending colon

2. Hepatic (right colic) flexure

3. Transverse colon

4. Splenic (Left colic) flexure

5. Descending colon

6. Sigmoid colon

What are the 4 sections and 2 flexures of the colon?

1. Prevents contents of the ileum from passing too quickly into cecum

2. Prevents reflux back into the ileum

List the two functions of the ileocecal valve.

Transverse colon

The longest aspect of the large intestine

Cecum

Widest portion of the large intestine

Appendix

A blind pouch inferior to the ileocecal valve

To the posteromedial surface of the cecum

Where is the vermiform appendix usually attached?

appendicitis

Inflammation of the vermiform appendix is called_____.

Ileum

Aspect of small intestine that is the smallest in diameter but longest in length.

Descending colon

Distal part, also called the iliac colon

Duodenum

Shortest aspect of small intestine

Sigmoid colon

Lies in pelvis but possesses a wide freedom of motion

jejunum

Makes up 40% of the small intestine

Ascending colon

Found between the cecum and transverse colon

Taeniae coli

What is the term for the three bands of muscle that pull the large intestine into pouches?

Haustra

These pouches, or sacculations, seen along the large intestine wall are called________.

Plicae circulares

What is the older term for the mucousal folds found within the jejunum?

Jejunum

Which portion of the small intestine is located primarily to the left of the midline?

Ileum

Which portion of the small intestine is located primarily in the RLQ?

Ileum

Which portion of the small intestine has the smoothest internal lining and does not present a feathery appearance when barium filled?

Duodenojejunal junction

Which aspect of the small intestine is most fixed in position?

Suspensory muscle of the duodenum (ligament of Treitz)

Which muscular band marks the junction between the duodenum and jejunum?

Cecum

The widest portion of the large instestine is the _____.

Left colic (splenic) flexure

Which flexture of the large intestine usually extends more superiorly?

Transverse colon & sigmoid colon

Which structures will fill with air during a double contrast barium enema with the patient supine ?

Small intestine

Which aspect of the GI tract is primarily responsible for digestion , absorption, and reabsorption?

large intestine

Which aspect of the GI tract is responsible for the synthesis and absorption of vitamins B and K and amino acids?

1. Peristalsis

2. Haustral churning - squeezing into the next group of haustra

3. Mass peristalsis - every 24 hours

4. Defecation

What are the 4 movements throughout the large intestines?

Peristalsis

Four types of digestive movements occurring in the large intestines. Which one of these movement types also occurs in the small intestines.

1. Internal diameter of the large bowels is greater

2. Large bowel contains taeniae coli & haustra

3. Large bowel is located along the periphere of abdomen while small bowel is located centrally

What is the major differences between the large and small bowels?

Cecum

Transverse colon

Sigmoid colon

Jejunum

Ileum

Name the Intraperitoneal structures of the lower abdomen.

Lower rectum

Name the Infraperitoneal structures of the lower abdomen.

Ascending colon

Descending colon

Upper rectum

C-loop of duodenum

Name the retroperitoneal structures of the lower abdomen.

1. Cecum

2. Transverse colon

3. Sigmoid colon

Which parts of the colon is found more anteriorly?

1. Ascending colon

2. Descending colon

Which parts of the colon is found more posteriorly?

S3 and is about 4.5 in. long.

What is the anatomical landmark where the rectum is found?

Constricted anal canal

What is the last 1 - 1.5 in. of the rectum called?

1.Timing of the procedure is necessary

2. May be performed as a double contrast media study

3. An enterolyctic procedure

Which conditions pertains to the radiographic study of small intestines?

Rectal ampulla

What dilated portion of the rectum is located anterior to the coccyx?

Possible perforated hollow viscus

Large bowel obstruction

List the two conditions that may prevent the use of barium sulfate during a small bowel series.

Young and dehydrated

What type of patients should be given extra care when using a water soluble contrast medium?

Meckel's diverticulum

Common birth defect found in the ileum

Giardiasis

Common parasitic infection of the small intestine

Ileus

Obstruction of the small intestine

Malabsorption syndrome

Patient with lactose or sucrose sensitivities

Neoplasm

New growth

Celiac disease

A form of sprue

Enteritis

Inflammation of the intestine

Regional enteritis (Crohn's)

Form of inflammatory disease of the GI tract

Ileus

Circular staircase or herringbone sign

Regional enteritis (Crohn's)

Cobblestone appearance

Adenocarcinoma

Apple core sign

Giardiasis

Dilation of the intestine with thickening of circular folds

Meckel's diverticulum

Larger diverticulum of the ileum

Volvulus

"Beak Sign"

1. Contaminated food

2. Contaminated water

3. Person to person contact

Giardiasis is a condition acquired through____.

Nuclear medicine

Meckel's diverticulum is best diagnosed with which imaging modality?

Proximal small intestine

Whipple's disease is a rare disorder of the _________, that causes malabsorption

2 cups (16 0z.)

How much barium sulfate is generally given to an adult patient for a small bowel-only-series?

When the contrast medium passes through the ileocecal valve

When is a small bowel series deemed completed?

2 hours

How long does it usually take to complete an adult small bowel series?

15 to 30 minutes after ingesting contrast medium

When is the first radiograph generally taken during a small bowel series?

True

(T or F) Fluoroscopy is sometimes used during a small bowel series to visualize the ileocecal valve.

double contrast

The term enteroclysis describes what type of a small bowel study?

High density barium and air or methylcellulose

What types of contrast media are used for a enteroclysis?

1. Regional enteritis (Crohn's)

2. Malabsorption

Which two pathological conditions are best evaluated through an enteroclysis procedure?

False - 24 hours

(T or F) It takes approximately 12 hours for barium sulfate in a healthy adult, given orally to the reach the rectum.

Duodenojejunal flexure

The tip of the catheter is advanced to the ___during an enteroclysis

It adheres to the bowels while distending it

What is purpose of introducing methylcellulose during an enteroclysis?

Therapeutic intubation

A procedure to alleviate postoperative distention of a small intestine obstruction is called ___________

NPO for at least 8 hours before procedure, no smoking or gum chewing

What is the recommended patient preparation before a small bowel series:

Prone, it separates loops of intestine

Which position is recommended for small bowel radiographs? Why?

Volvulus

A twisting of a portion of the intestine on its own mesentary

Diverticulum

Outpouching of the mucousal wall

Colitis

Inflammatory condition of the large intestine

Ulcerative colitis

Sever form of colitis

Intussusception

Telescoping of one part of the intestine into the other

Polyps

Inward growth extending from the lumen of the intestinal wall.

Infants younger than 2 years.

Which type of patient usually experiences intussusception?

Diverticulitis

A condition of numerous herniations of the mucousal wall of the large intestine is called______.

Volvulus

Which pathological conditions may produce a tapered or corkscrew radiographic sign during a barium enema?

Ulcerative colitis

Which pathological conditions may produce a cobblestone radiographic sign during a barium enema?

Annular carcinoma

What it the most common form of carcinoma found in the large intestine?

False

T/F - Intestinal polyps and diverticula are very similar in structure

True

T/F -Volvulus occur more frequently in males than females

False

T/F - The barium enema is a commonly recommended procedure for diagnosing possible acute appendicitis.

True

T/F - Any stool retained in the large intestine may require postponement of a barium enema study.

1. Gross bleeding

2. Severe diarrhea

3. Obstruction

4. Inflammatory lesions

Which four conditions would prevent the use of a laxative cathartic before a barium enema procedure?

False

T/F - An example of an irritant cathartic is magnesium citrate