fluoroscopy exam 2

deglutition

inhibits respiration for several seconds

(swallowing)

peristalsis

contraction waves by which the digestive tube propels contents toward the rectum

alimentary canal

musculomembranous tube that extends from the mouth to the anus.

esophageal atresia

incomplete development of the esophagus

esophageal varices

enlarged tortuous veins or lower esophagus, resulting from portal hypertension

hiatal hernia

protrusion of the stomach through the esophageal hiatus of the diaphragm.

gastroesophageal reflux

backward flow of stomach contents into the esophagus.

irritable bowel syndrome

abnormal increase in small and large bowel motility.

peptic ulcer disease

loss of mucous membrane in a portion of the GI system.

pyloric stenosis

narrowing of pyloric sphincter

small bowel obstruction

seen as distended loops of bowel filled with gas

bowel proximal to obstruction may be filled with fluid

extent of obstruction determines ease or difficulty of penetration

volvulus

the twisting of a bowel loop on itself.

intussusception

prolapse of a portion of the bowel into the lumen of an adjacent part.

hygroscopic

absorbs water from the bowel which can lead to constipation and obstruction.

uses for barium

penetrate and visualize walls of inner structures

uses for glucagon

a hormone that your pancreas makes to help regulate your blood glucose (sugar) levels

uses for CO2 crystals

to put air in the stomach

uses for double contrast examinations

to better visualize gastric or bowel mucosal lining.

one of the most important technical/ technique considerations in gastrointestinal radiography

motion, need to use short exposure time

large intestine abdominal structures body habitus

sthenic - spread evenly with a slight dip in the transverse colon

hypersthenic - around the periphery of the abdomen

asthenic - low; folds on itself

hyposthenic - close to asthenic, a little higher

stomach abdominal structures body habitus

hypersthenic - stomach almost completely transverse

asthenic/ hyposthenic - stomach more “j” shaped; lower in abdomen.

sthenic - stomach still somewhat “j” shaped

hypersthenic

higher and more horizontal

asthenic

lower and more midline

stomach functions

storage of food, and chemical breakdown of food

portions of the small bowel in order

duodenum, jejunum, and ileum

timing of images first to last

15 to 30 minute intervals

2 hours is entire exam

when does timing start for small bowel procedure?

15 minutes after ingestion of barium

length of the small intestine

22 feet

small intestine main functions

digestion and absorption of food

divisions of large intestine

cecum, colon, rectum, anal canal

order of the divisions of colon

ascending, transverse, descending, sigmoid

length of the large intestine

5 feet

large intestine main functions

reabsorption of fluids and elimination of waste products

what/ where is the cecum?

pouchlike portion below the junction of the ileum and colon

rotation for obliques - esophagus procedures

35 to 40 degrees

location - esophagus procedures

C6 - T11 at MSP

esophagus procedures - anatomy

originates at C6

passes through diaphragm at T10

joins stomach at esophagogastric junction at T11

expanded terminal end = cardiac antrum

what position and projection to look for esophageal varices?

RAO position

PA oblique

what action by the patient will aid in identifying esophageal varices?

valsalva maneuver

where is the top of the IR placed for most esophagram images?

at the mouth

what POSITION shows duodenal bulb motility best? - UGI procedure

RAO

LPO

what position shows retrogastric anatomy best? - UGI procedure

right lateral

central ray for UGI images

PA/AP 1 -2 above lower rib margin (level of L1-L2)

AP supine - sagittal plane passing midway between MSP and left lateral margin of abdomen

R Lateral - level of L1-L2 for recumbent position; L3 for upright position

LPO - midway between xiphoid process and lower rib margin

prep for UGI

patient is NPO at least 8 hours

degree of obliquity for obliques (UGI)

RAO:40-70 degrees

LPO: 30-60 degrees

hiatal hernia imaging position and projection

trendelenburg position

AP projection

how do we know a small bowel study is complete?

barium reaches ileocecal valve

how many cups of barium?

UGI: 1 cup

small bowel series: 2 cups

appropriate history for BE

pain

constipation

diarrhea

previous colon surgeries

any cancer history

any blood in stool

how many BE methods are there?

single or double contrast

central ray for majority of BE images?

usually at MSP & around level of crests

enema tip insertion procedure

instruct patient to take deep breaths; exhaling relaxes sphincter.

insert tip slowly, steadily, and gently during expiration of deep breath

direct anteriorly 1 to 1½ inches, then slightly superiorly

total distance no more than 4 inches

enema bag height above table range

18-24 inches

what image shows entire colon?

AP and PA

AP imaging-angulation

CR: 30-40 degrees CEPHALAD; MSP and 2 inches below ASIS

PA axial imaging-angulation

30-40 degrees caudal

CR to enter at level of iliac crest, make certain CR exits at level of ASIS

patient preparation before exam

1. restricted diet for 2-3 days

2. cleansing enemas

3. laxatives

how many cups of barium

BE is usually retrograde so no cups of barium are drank—usually 1,000-2,000 mL barium suspension used

is prep different than normal? - ostomy imaging

yes, get pt dresses, prone position, cleanse the area, place gauze and lubricate

stoma - ostomy imaging

the opening leading into the intestine for the patient with a colostomy

order to perform multiple exams

1. non-contrast studies before contrast (KUB)

2. any lab studies for iodine uptake done before using iodinated contrast

3. endoscopy exams

4. iodinated contrast studies before barium contrast studies

5. BE before UGI - barium

6. UGI/ CTs involving oral contrast always last - barium could take days to pass though digestive system (cleans pretty quickly from lower GI system.