Procedures 1 Unit 3 UGI Flashcards

Name the accessory glands for digestion

liver, pancreas, salivary gland, gallbladder

The esophagus is posterior to which structure

trachea

The esophagus enters which portion of the stomach

cardia (esophageal gastric junction)

Which portion of the digestive system absorbs nutrients?

Small intestines/small bowel

How many tonsils do we have; name them

3 (pharyngeal- adenoids, lingual, palatine)

How many salivary glands do we have; name them

3 (parotid, submandibular, sublingual)

Which salivary gland is the largest

parotid

Is the parotid gland a salivary gland or a tonsil?

Salivary

Where is the parotid gland located

By the gonion of the mandible (C1/C2)

What pathology does a swollen parotid gland indicate

mumps

What structure holds to the floor of the oral cavity?

Frenulum web of the tongue

Which bone does the tongue attach to?

Hyoid bone

Which layer of the digestive tract is the tough outermost layer?

Fibrous

Which layer is the innermost layer?

Mucosal

Which sphincter is located at the distal portion of the stomach?

Pyloric sphincter (empties the stomach into the duodenum)

Which portion of the stomach is the proximal portion?

Cardia

Which portion of the stomach is the most superior portion?

Fundus

What are the folds inside the stomach called?

Rugae

How is food moved along the digestive tract?

Peristalsis

Which curve of the stomach is located toward the left side of the abdomen?

Greater curvature

What is the proximal portion of the small intestines termed:

Duodenum

Which part of the small intestine is the smallest in length and considered as a C loop

duodenum

What vertebrae level is the umbilicus at

L4/L5

What pathology matches the following description: Failure of the smooth (cardiac sphincter) muscle of the alimentary canal to relax to allow food to pass into the stomach

achalasia

True/False: when a rad is performing a procedure for achalasia, they must start the patient in an upright position to prevent aspiration of contrast media

true

Which part of the small intestine consists of the most villi

jejunum (why is looks "feathery")

Which section of the small intestine is considered the longer

ileum

The ______ absorbs the last of the nutrients

ileum

What is the distal portion of the small intestines termed:

ileum

Where do the small intestines terminate?

At the ileocecal valve (RLQ) (where the ileum meets the cecum)

Achalasia

failure of the esophageal-gastric junction to open.

Hiatal Hernia

a portion of the stomach protruding into the chest.

GERD (Gastroesophageal reflux disease)

stomach contents backflowing in the esophagus

When a patient has GERD (gastroesophageal reflux disease), which structure fails to completely close

the lower esophgeal/cardiac sphincter muscle

Gastritis

inflammation of the stomach lining.

Malabsorption disease / celiac disease

a disorder of the intestines to absorb nutrients

Crohn's disease

inflammation of the terminal ileum

Where is the top of the IR placed for all esophagram overheads?

Mouth

For esophagrams, the CR enters at which vertebral level?

T5

Why do we perform all esophagram studies recumbent?

To allow gravity to fill the esophagus with barium

Where does the CR enter for an AP/PA projection during an esophagram?

MSP and T5

AP/PA projections demonstrate _______/________ placement

medial; lateral

True/False: A shield can be applied for both males and females during esophageal studies

true

For an esophagram, collimate to the

sides of the neck

Where does the CR enter for a lateral projection during an esophagram?

MCP and T5

Lateral projections demonstrate ________/_______ placement

anterior/ posterior

Which position do we use for a lateral projection during an esophagram?

Left or right lateral recumbent (we want to see the patient drink)

Where does the CR enter for all obliques of the esophagus?

Oblique plane (2" lateral from the VC on the elevated side) and T5

In LPO (AP oblique projection), the esophagus is placed

off the vertebral column between the vertebral column and the heart

Which projections will place the esophagus between the heart and the vertebral column?

AP oblique - LPO; PA oblique - RAO; Rt or Lt lateral recumbent

Which projection will place the esophagus anterior to the vertebral column?

Lateral

Which projection will show the medial/lateral placement of the esophagus?

AP or PA recumbent

Why do we perform oblique projections during an esophagram

to move the esophagus off the vertebral column

What are the breathing instructions for all esophagram images?

Keep drinking

What instructions are given to show esophageal varices?

Bear down (valsalva maneuver) increases venous pressure and fills the esophageal vein full of blood

What position will demonstrate hiatal hernias?

Trendelenburg

Other than esophageal varices, the Valsalva can be used to demonstrate which pathology

hiatal hernias

What will the doctor give the patient to demonstrate GERD?

Barium first to drink, then water

Hiatal hernias can sometimes be seen in a chest X-ray as an

air bubble in the heart

A diverticulum is located within the upper or lower esophagus; however, Zenker's diverticulum is specifically located ____ in the esophagus

high

How many degrees is the patient rotated for the oblique projections (LPO and RAO) during an esophagram?

35-40 degrees

Where are the arms placed for a lateral projection?

Up by their head

Which body oblique positions are performed for esophagram studies?

RAO and LPO

Where does the CR enter for an AP/PA projection of the stomach?

MSP and L1/L2

L1/L2 can be found by measuring

one hand above the iliac crest

Which structure will be filled with air for a PA projection of the stomach?

Fundus (most posterior and superior aspect of the stomach)

In order for a UGI PA projection to be considered diagnostic, it must include the

entire stomach and duodenal loop

UGI exam technical factors

100-120 kVp (to penetrate through the stomach and contrast media)

Which type of body habitus will cause the stomach to be more horizontal across the abdomen?

Hypersthenic

How can you tell if a UGI exam is double contrast

either the fundus/upper body (AP) or the duodenum bulb/pylorus/lower body (PA) of the stomach is filled with air

How can you tell if a UGI exam is single contrast

the entire stomach will be filled with contrast

Which kind of body habitus will the stomach be located lower in the abdomen and dip down low into the pelvis?

Asthenic

For UGI overheads, center _____ for asthenic patients

lower

For UGI overheads, center ______ for hypersthenic patients

higher

If the doctor requests a PA axial projection for a UGI procedure, what is the tube angle and which direction?

35-45 degrees cephalic (up the gut)

Why do we perform axial projections for a UGI procedure?

To open all parts of the stomach

What is the angulation for a UGI axial projection for children

20-25 degrees cephalic (half of adult)

Where does the CR enter for an axial projection during a UGI procedure?

MSP and L1/L2 (stomach will overlap on top of the spine)

During a double contrast study, a PA axial projection will show air in the

fundus

Which projection for an esophageal study will demonstrate the esophageal gastric junction

RAO

__ views of the esophagus are usually needed

3

What is the typical kVp for an esophagram

100-110 (higher to penetrate through the barium)

Why would a patient need to do an AP axial projection (UGI) instead of PA axial

if the patient is too sick to lie prone

What is demonstrated in an AP/PA axial projection of the UGI tract

entire stomach and duodenum

Which position for a UGI will demonstrate the esophageal gastric junction?

RAO

How many degrees is the patient rotated for an RAO during a UGI procedure?

40-70 degrees

How many degrees is the patient rotated for an LPO during a UGI procedure?

30-60 degrees

In an LPO position, barium will be found in the

fundus

True/False: in order for UGI images to be diagnostic, you need the entire stomach on the IR

true

How can you tell if a UGI image is obliqued

the stomach is off the spine, only one side of the abdomen is seen (left), and the ribs are elongated

Name all the structures that RAO demonstrates in an UGI exam

esophageal gastric junction, duodenum blub, duodenum loop, and the stomach off of the spine

Where does the CR enter for all UGI oblique projections

oblique plane (halfway between the vertebral column and the left side of the patient) and L1/L2

Which oblique will demonstrate barium in the fundus during a UGI procedure?

LPO (laying partially on your back, gravity will put the barium posteriorly)

Which lateral position is performed for UGI exams?

Right lateral recumbent position

Why is only the right lateral recumbent position used during a lateral UGI procedure?

To see barium in the body of the stomach and air in the fundus

Where does the CR enter for a (right) lateral projection of the stomach?

Coronal plane (halfway between the VC and the anterior border of the body) and L1/L2

How can you tell if there is rotation on a lateral UGI?

From the vertebral bodies of the spine, posterior ribs, or intervertebral foramen

Which structures are placed in profile (lateral)?

Duodenum loop/ant.-pos. placement of the stomach (entire stomach)

Why is a PA projection preferred over an AP projection (UGI)?

The small intestine is closer to the IR/less OID/less gonadal dose for females

If your patient is unable to perform a PA axial projection and an AP axial projection is needed, what is the tube angle and which direction?

35-45 degrees caudad (flip your patient, flip your tube)