Fluoro Part 1: UGI/Esophagus

Accessory Glands

Salivary glands, liver, gallbladder and pancreas; secrete digestive enzymes into alimentary canal

Alimentary Canal

Mouth, pharynx, esophagus, stomach, small intestine, large intestine (colon) and anus

Uvula

Center of soft palate

Mastication

Chewing

1?

Sublingual gland

2?

Submandibular gland

3?

Parotid gland

Pharynx

Passageway for air and food; extends from portions of sphenoid/occipital bones to C6-C7

Nasopharynx

Above hard/soft palates

Oropharynx

Extends from soft palate to hyoid bone

Laryngeal Pharynx

Posterior to larynx; extends inferior to esophagus

Green?

Nasopharynx

Blue?

Oropharynx

Purple?

Laryngeal pharynx

Larynx

Organ of voice; air passage between pharynx and trachea

Epiglottis

Serves as trap to prevent leakage into larynx between acts of swallowing

Piriformis Recess

Each side of larynx; visualized on AP projections of esophagus study when puffing cheeks with air

Esophagus

Runs C6-T11 (cardiac opening of stomach); 4 layers, anterior to spine, posterior to trachea and lies in midsagittal plane

Esophageal Hiatus

Passes through diaphragm around T10

Esophagogastric Junction

Joins the stomach around T11; opening is called the cardiac orifice

Cardiac Antrum

Wide, distal end of esophagus; lies in abdomen

Upper Esophageal Sphincter (UES)

Junction with pharynx; prevents air from entering esophagus during respiration

Lower Esophageal Spincter (LES)

Relaxes to allow food to pass into the stomach; closes to prevent stomach acid and digestive juices from flowing back into the esophagus

Stomach

Storage area for food until digested; acids, enzymes and chemicals are secreted to break down food chemically, mechanically broken down by churning (peristalsis)

Chyme

Mechanically and chemically broken down food in stomach to duodenum

1?

Cardia

2?

Pylorus

3?

Body

4?

Fundus

1?

Duodenal bulb

2?

Pyloric sphincter

3?

Cardiac sphincter

4?

Rugae

Hypersthenic

Sthenic

Hyposthenic

Asthenic

Around what level does the pylorus and duodenal bulb lie on a hypersthenic patient?

T11-12

Around what level does the pylorus and duodenal bulb lie on a sthenic patient?

L2

Around what level does the pylorus and duodenal bulb lie on a hyposthenic/asthenic patient?

L3-4

White is barium: what position is the patient in?

Supine

White is barium: what position is the patient in?

Prone

White is barium: what position is the patient in?

Erect

Federal regulations tabletop exposure rates should not exceed ________ mGy per minute

88

SSD Fixed Fluoro

15 in (38 cm)

SSD Mobile Fluoro

12 in (30 cm)

Purpose of Contrast

Better anatomic definition and to assess function

Positive Contrast Agents

Barium sulfate and iodinated contrast (omnipaque or gastrografin)

Negative Contrast Agents

Air; EZ Gas, CO₂, O₂

What age do you use thick barium?

12+

Single Contrast Study

One type of contrast used; typically barium, shows overall function/motility of body part

Double Contrast Study

Two types of contrast used; typically barium (+) and air (-), shows both function/motility and more detail of the organ

What study requires no patient prep?

Esophagus

How long must a patient be NPO before studies?

Typically 8 hours

When is a scout image done?

When a patient had to prep their body prior to the exam

RAO Esophagus Obliquity

35-40 degrees

RAO Esophagus Collimation

12×17

RAO Esophagus: If esophagus is over the spine what positioning error occured?

Under obliqued

RAO Esophagus: If esophagus is over the heart what positioning error occured?

Over obliqued

What does a PA UGI best visualize?

Body of stomach, medial and lateral margains

PA UGI collimation

14×17

What does a right lateral UGI best visualize?

Retrogastric area and duodenal loop in profile, anterior and posterior margains

Right lateral UGI collimation

11×14

PA oblique UGI obliquity

RAO 40-70 degrees

What does a PA oblique stomach UGI best visualize?

Duodenal bulb filled with barium

Reflux  

Stomach contents leak backwards from the stomach into the esophagus  

Esophagitis  

Inflammation of the esophagus  

Reflux esophagitis  

Most common type; Occurs when acids and digestive agents escape your stomach and reflux into your esophagus irritating and eroding the mucous lining  

Drug-induced esophagitis 

Also called “pill esophagitis”; Occurs when medications lodge into the esophagus, dissolve there and cause ulcers, inflammation and other damage to the esophageal line  

Infectious esophagitis  

Occurs due to fungal and viral infections most common in esophagus, yet rare 

Eosinophilic esophagitis  

Types of overreactions of the immune system (too many WBCs)  

Barrett’s Esophagus  

Cell lining of the lower esophagus is replaced by columnar epithelium due to repeated exposure to stomach acid, occurs after a lot of reflux, associated with cancer and will typically have a hiatal hernia; appears as a “ringed” esophagus  

Achalasia  

Inability of the lower esophageal sphincter to open and let food pass into the stomach; Rat tail or beak-like appearance  

Diverticula  

Outpouching of the lining in weakened spots of the GI tract  

Killian-Jamieson  

Diverticula located on anterolateral wall of upper esophagus below cricopharyngeal muscle  

Zenker's  

Diverticula located in posterior wall of upper esophagus above the cricopharyngeal muscle  

Esophageal Varices  

Dilated veins in the wall of the esophagus; normal blood flow to the liver is blocked, one of the most common causes of GI bleeds; Appears as a wavy border with thickened folds  

Perforation  

Hole or punctured area  

Mallory-Weiss tear  

Split in the inner layer of your esophagus caused by forceful vomiting or straining  

Gastritis  

Inflammation of the mucous lining of stomach; thickened gastric folds  

Gastric Ulcer  

Also called peptic ulcer; localized area of erosion in the stomach lining from acid eating through protective lining of stomach  

Hiatal Hernia  

Portion of the stomach protrudes through the diaphragm and up into the chest  

Pyloric Stenosis  

Infant's pylorus muscles thicken and narrows; food unable to pass through  

Diabetic Neuropathy  

A type of nerve damage that can happen with diabetes; most often damages nerves in the legs and feet, slow emptying stomach on UGI  

Esophagus RAO technique

120 kVp, center cell (6 mAs)

UGI single contrast images

Scout, PA, RAO, Right lateral

UGI double contrast images

Scout, PA, Right lateral

Scout image technique

90 kVp, all cells (10 mAs)

UGI PA and right lateral single contrast technique

120 kVp, center cell (5 mAs)

UGI PA and right lateral double contrast technique

90 kVp, center cell (5 mAs)

UGI RAO single contrast technique

120 kVp, center cell (7.5 mAs)