Chapter 13 Small Bowel Series

What is the purpose of a small bowel series?

To study the form and function of the small intestine and any abnormalities occurring

The Small Bowel Series is a _____ study.

timed

How long is the small intestine stretched out?

23 feet long or 7 meters

How long is the large intestine stretched out?

5 feet long

What exam does a Small Bowel Series frequently follow?

Upper GI Series

Does the Small Bowel Series require contrast media?

yes

What is the purpose of a Lower GI Series/Barium Enema (BE)?

To study the form and function of the large intestine

What type of study is a Barium Enema?

Double-contrast using air and barium

Where is contrast administered in a Barium Enema exam?

through the rectum

What quadrant(s) is the duodenum located in?

RUQ and LUQ

What quadrant(s) is the jejunum located in?

LUQ and LLQ

Where do the duodenum and jejunum meet?

duodenojejunal flexure

What are the mucosal folds that make a feathery appearance on the jejunum when barium is administered?

villi

What do the villi aid in?

absorption of nutrients

Jejunum makes up _____ of the small intestine.

two fifths

Ileum makes up _____ of the small intestine.

three fifths

What quadrant(s) is the ileum located in?

RUQ, RLQ, LLQ

What is the longest portion of the small intestine?

ileum

What is the shortest, widest, and most fixed portion of the small intestine?

duodenum

What quadrant(s) is the ileocecal valve located in?

RLQ

What is the ileocecal valve?

a sphincter that controls the flow of material from the ileum into the cecum

How do we know if the Small Bowel Series has been completed?

contrast media has reached the terminal ileum/ileocecal valve

What types of mechanical digestion occurs in the small intestine?

peristalsis and rhythmic segmentation

What types of mechanical digestion occurs in the large intestine?

peristalsis, haustral churning, mass peristalsis, and defecation

Where does most absorption and digestion take place?

small intestine

What are the functions of the small intestine?

-digestion

-absorption (nutrients, H20, salts, proteins)

-reabsorption (95% of H20 and salts)

Where does the 95% reabsorption of H20 and salts primarily occur at within the small intestine?

duodenum and jejunum

What are the functions of the large intestine?

-some reabsorption of H20 (5%) and inorganic salts

-releases flatus (gases)

-elimination (defecation)

What is enteritis?

inflammation of the intestine

What is gastroenteritis?

inflammation of the stomach and intestines

What is Meckel's diverticulum?

outpouching or bulge in lower part of SI; congenital condition

What patients do we see Meckel's diverticulum in?

newbowns, leftover from umbilical cord

What is Malabsorption syndrome?

GI tract is unable to process and absorb certain nutrients

What is another name for Crohn's Disease?

regional enteritis

What is Crohn's disease?

Inflammatory bowel disease with unknown origin

What part of the body do we typically see Crohn's disease?

terminal ileum

What type of appearance does Crohn's disease cause?

cobblestone appearance

What is the cobblestone appearance caused from in Crohn's disease?

scarring or thickening of the bowel wall

In advanced cases of Crohn's disease, strictures may produce what?

a string sign

Does Crohn's disease have a high reoccurrence rate?

yes

What is giardiasis?

Infection within the lumen of the SI

What is the cause of giardiasis?

contaminated food and water or person-to-person contact

What does giardiasis look like?

Dilated intestine with thick circular folds

What do we see most often as a clinical indication for a patient getting a Small Bowel Series?

Ileus of the small intestine

Ileus of the small intestine can either be:

mechanical or adynamic/paralytic

What is mechanical ileus of the small intestine?

physical blockage in the small bowel cause by tumor or twisting of the bowel, hernia, Intussusception

What is adynamic/paralytic ileus of the small intestine?

motility disorder, or failure of peristalsis to occur

When is adynamic or paralytic ileus of the small intestine commonly seen?

post-surgery when the bowel doesn't wake up from sedation

What is the look of ileus of the small intestine?

circular staircase with air/fluid levels

What are the common Small Bowel procedures?

Upper GI/Small Bowel combo or Small Bowel series alone

What are the contraindications to BaSO4?

-presurgical patients

-perforated hollow viscus

-large intestine obstruction

What are the contraindications to water-soluble contrast media?

-allergy to iodine

-severe dehydration

Why is a scout radiograph taken?

To ensure that the patient completed the preparation for the exam properly.

When does the Small bowel series officially start?

When the patient begins drinking the first cup of barium

If a patient is having issues with getting the contrast to move throughout their body quickly, how can you help it move quicker?

Have them think about foods that they like to produce more saliva, and get up and walk around

What is a compression cone?

It is attached to the Fluoroscopy machine, and it comes down to separate the loops of the bowel on the patient by applying pressure to see the ileocecal valve.

What is the preparation for a small bowel series?

-NPO 8 hours prior to study

-Low residue diet 48 hours prior to study

-No gum chewing

-No smoking

Which projection provides natural compression to the small intestine?

PA

For the first radiograph, where is the CR?

2 inches above iliac crest

For the rest of the radiographs, where is the CR?

iliac crest

What kVp range is used for the SBS exam?

110-125 kVp