Lower GI system & Minimally Invasive studies

what is the duodenum

“C-loop”

• 8-10 inches long

hystero should be scheduled approximately __ days after onset of menstruation

10

what is always given to a patient for a hystero that is ordered by the OBGYN

antibiotics

what are the muscles in the rotator cuff:

1. teres minor

2. infraspinatus

3. supraspinatus

4. subscapularis

what is the jejunum

feathery appearance. second section of the small bowel

what is the illeum

last portion of the small bowel, folowed by the large intestine

what is 1?

duodenum

what is 2?

jejunum

what is 3?

ileum

what is villi?

series of fingerlike projections in the SB mucosa assisting in digestion and absorption

what is terminal ileum

most distal portion of the ileum

what is the ileocecal valve

one way spincter located between ileum and cecm to prevent reflux of fecal matter from large instestine back into small intestine

preparation for small bowel

• NPO 8 hours prior

• RH NPO after midnight

is a scout necessary for a small bowel study

yes

Small bowel series info

• follows barium from the stomach to entrance of large intestine

  • timing is important

• images of the small bowel are teken approx. every 15-30 min

  • RH 20 min

  • must be time annotated

small bowel completion

• study is complete when the barium passes through ileocecal valve

• barium typically enters first part of the large intestine in about 2-3 hours

• when the barium reaches the cecum, the RA will spot fluoro over this area

  • focus will be at the terminal ileum entering into colon

technologist responsibilities of tech responsibilities

• take scout abdomen and show RA/radiologst

• give thin barium to patient

• take the over hear stomach images, monitoring time of images, continum to take SM thru images per RA/Rad

• assist pt and RA during fluoro portion of the study

if a pt cannot swallow the contrast or has pyloric difficulties, but small bowel needs to be evaluated you would do…

enteroclysis

what is enteroclysis

• instertion of a tube through the nose or mouth into the patient’s stomach and into the beginning of the small bowel

• stops at end of duodenum (duodenojejunal flexure)

what landmark is 1?

L4, L5 and iliac crest

what landmark is 2?

SI and ASIS

what landmark is 3?

pubic symphysis

what is 1?

right colic flexure

what is 2?

ascending colon

what is 3?

ileocecal valve

what is 4?

cecum

what is 5?

rectum

what is 6?

ileum

what is 7?

transverse colon

what is 8?

left colic flexure

what is 9?

descending colon

what is 10?

haustra

what is 11?

sigmoid colon

what is 1?

sacrum

what is 2?

rectum

what is 3?

rectal ampulla

what is 4?

anal canal

what is 6?

anus

on a lateral view of the large intestine what parts are anterior

transverse and most of the sigmoid colon

what patient position is the circle?

supine

what patient position is the rectangle?

prone

what is the patient prep for BE

clear liquids only day prior to and morning of exam

• no solid foods should be consumed

why are scout images important for BEs?

• RA- still looking to see if patient is cleaned out, and if there are any obvious abnormalities

• Techs- look at the gas pattern as well, how the intestine lay will determine whether or not you need to take images portrait, landscape or both

contrast needed for a single BE

2 bottle Vanilla SilQ HD mixed with 222mL of water

contrast needed for double BE

• 3 bottle vanilla SilQ, each mixed with 222 mL water

• 2 botles of Visacasure honey to each bottle of vanilla SilQ

never hang a BE bag more than _____ above tabletop

24”-30”

prior to insertion of the tip for a BE

• explain to the patient what you’re doing

• make sure the barium is clearned all the way to the enema tip

• GLOVES! Lubricant!

• have the patient in sims position

instering the enema tip

• lift upper buttock to see the rectal area

• instert tip on exhalation

• slide tip back to front

• inserting anteriorly and superiorly

  • no more than 4 inches

Who blows up the balloon for a BE

the RA does under fluoro guidance

• tech will clamp tubing with hemostats and remove the square sponge

what are the minimally invasive procedures

• arthrogram

• myelogram

• hysterosalpigograms

types of needle insertions:

• joint: intraarticular

• spine: intrathecal

what is an arthrogram

minimally invasive procedure using live imaging and a contrast material, such as dye, water, air, or a combo, to take images to visualize a joint

• in conjuction with CT and MRI

• shoulder, knee, hip, wrist, elbow

what type of contrast is used for pneumoarthrography

using gas as a contrast

what type of contrst is used for opaque arthrography

uses water-soluble iodinated contrast

what type of contrast is used for double contrast arthrography

using both (air/gas and contrast)

what are these images of?

arthrograms

post procedure by RA/RAD images per protocol (shoulder)

• neutral

• external

• internal

• axillary

where does the bowel sit in hypersthenic patients

periperally

where does the bowel sit in sthenic patients

right flexure lower

in hyposthenic patient where does the bowel sit

both flexures drop

in an asthenic patient where does the bowel sit

all low in abdomen

what is a myelogram

radiographic study of the spinal cord and its nerve root branches utilizing a contrast medium

what is the spinal cord

slender elongated structure consisting of an inner and outer section

• extends from medulla oblongata to approx L1-L2 disk space

for myelograms what body parts is Omnipaque 300 used for

• cervical

• complete

for myelograms what body parts is Omnipaque 240 used for

• thoracic

• lumbar

what is a hysterosalpingogram

procedure to visualize uterus nd fallopian tubes with the use of water-soluble contrast through a uterine cannula

• OBGYN with RA/RAD

what is a hysterosalpingogram for

• determine size, shape and position of uterus and tubes

• conception reasons

• polyps, submucosa tumor, fistula tracts

• successfulness of surgery to prevent conception

what is unicornuate uterus

• abnormally shaped uterus with only one uterine tube

• congenital abnormality

• increased difficulty getting pregnant and may have issues while pregnant

what is this a picture of

unicornuate uterus

what is this an example of

bicornuate uterus

what is a bicornuate uterus

• heart shaped uterus; paired uterine horns extending to uterine tubes

• congenital; Mullerian dicts not fusing in uterine cavity while developing in womb

• typically doesnt cause issues getting pregnant, but may have issues while pregnant

what is uterus didelphys

• rare congenital condiiton where a person develops two uteruses and cervixes

• increased risk of miscarriage or pre-term birthS

what is this an image of?

uterus didelphys

SIDE NOTE

STEP BY STEP PROCEDURES ARE NOT IN HERE, LOOK AT POWERPOINT

spinal nerves

• 31 pairs of spinal nerves

• each pair arises from 2 roots nerves transmitted through IV and sacral foramina

what is the conum medullaris

• pointed lower extremity of spinal cord

• L1-L2

what is the cauda equina

• spinal nerves below termination of cord

• extend inferiorly through vertebral canal

what are the meninges

protective membrane that enclose the brain and spinal cord

where is the pia mater

closest to brain/spinal cord

where is the arachnoid

central layer

• separated from the pia mater by the subarachnoid space

what is located in the subarachnoid space

CSF

myelogram injections are into the

subarachnoid space

where is the dura mater

outermost layer

what is the dura mater

strong, fibroid covering of brain and spinal cord

what is CSF

• clear, colorless

• surrounds and cushions the brain and spinal cord

where is CSF found

located in ventricles

what is 1?

conus medularis

what is 2?

cauda equina

what is 1?

dura mater

what is 2?

arachnoid

what is 3?

pia mater

what is 4?

subarachnoid space