Chapter 12: Biliary Tract and Upper Gastrointestinal System

The liver is located primarily in the ____ of the abdomen.

A) LLQ

B) RLQ

C) RUQ

D) LUQ

C) RUQ

The liver is divided into ____ major and minor lobes.

A) three

B) four

C) two

D) six

B) four

The liver secretes approximately ____ mL of bile per day.

A) 100 to 250

B) 500 to 700

C) 800 to 1000

D) 1200 to 1500

C) 800 to 1000

The main function of bile is to:

A) break down cholesterol.

B) emulsify fats.

C) begin the digestion of proteins.

D) begin the digestion of complex sugars.

B) emulsify fats.

Which aspect of the gallbladder is located most posterior within the abdomen?

A) Fundus

B) Body

C) Neck

D) Apex

C) Neck

The average adult gallbladder is ____ cm long and ____ cm wide.

A) 7 to 10; 3

B) 4 to 6; 2

C) 12 to 15; 5 to 6

D) 2 to 3; 1

A) 7 to 10; 3

What is the primary purpose of the membranous folds located within the cystic duct?

A) Produces cholecystokinin

B) Prevents gallstones from entering the gallbladder

C) Provides blood supply to the gallbladder

D) Prevents distention or collapse of the cystic duct

D) Prevents distention or collapse of the cystic duct

Where is bile formed?

A) Gallbladder

B) Duodenal mucosa

C) Liver

D) Pancreas

C) Liver

Which of the following functions are performed by the gallbladder?

A) Storage of bile

B) Concentration of bile

C) Contraction and release of bile

D) All of the above

D) All of the above

What is a primary function of cholecystokinin?

A) Serves as an enzyme to break down certain food nutrients

B) Stimulates the production of bile

C) Stimulates the gallbladder to contract

D) Inhibits the formation of gallstones.

C) Stimulates the gallbladder to contract

Where is cholecystokinin produced?

A) Duodenal mucosa

B) Liver

C) Gallbladder

D) Pancreas

A) Duodenal mucosa

What is an older term for the pancreatic duct?

A) Duct of Wirsung

B) Hepatopancreatic duct

C) Duct of Langerhans

D) Ampulla of Vater

A) Duct of Wirsung

What is an older term for the hepatopancreatic sphincter?

A) Duodenal papilla

B) Sphincter of Vater

C) Duodenal sphincter

D) Sphincter of Oddi

D) Sphincter of Oddi

"Chole-" is a prefix for terms pertaining to the:

A) gallbladder.

B) ducts.

C) bile.

D) liver.

C) bile.

Radiographic examination of the biliary ducts only is termed:

A) cholecystography.

B) cholangiography.

C) cholelithiasis.

D) cholecystocholangiography.

B) cholangiography.

Which of the following structures is not considered to be an accessory organ of digestion?

A) Liver

B) Pancreas

C) Salivary glands

D) Kidneys

D) Kidneys

Saliva contains certain enzymes to begin the digestion of:

A) starch.

B) minerals.

C) proteins.

D) lipids.

A) starch

The act of swallowing is termed:

A) mastication.

B) digestion.

C) deglutition.

D) aphasia.

C) deglutition.

Which of the following structures is not one of the salivary glands?

A) Parotid

B) Sublingual

C) Submandibular

D) All of the above are salivary glands.

D) All of the above are salivary glands.

The esophagus is located ____ to the larynx.

A) anterior

B) posterior

C) inferior

D) proximal

B) posterior

The aortic arch and the _____ create a normal indentation seen along the lateral border of the esophagus.

A) pulmonary artery

B) left primary bronchus

C) pulmonary veins

D) superior vena cava

B) left primary bronchus

Which two forces or processes propel food down the esophagus?

A) Peristalsis and gravity

B) Peristalsis and rhythmic segmentation

C) Gravity and deglutition

D) Deglutition and mastication

A) Peristalsis and gravity

The opening between the stomach and esophagus is termed the:

A) cardiac antrum.

B) cardiac notch.

C) esophagogastric junction.

D) esophagocardiac junction.

C) esophagogastric junction.

The dilated portion of the distal esophagus is termed the:

A) cardiac antrum

B) cardiac notch.

C) fundus.

D) incisura cardiaca.

cardiac antrum.

Which of the following is not a main subdivision of the stomach?

A) Fundus

B) Cardium

C) Pylorus

D) Body

B) Cardium

Which term describes the outer, lateral border of the stomach?

A) Lesser curvature

B) Incisura angularis

C) Gastric border

D) Greater curvature

D) Greater curvature

What is the term for the longitudinal mucosal folds found within the stomach?

A) Gastric canal

B) Valvulae conniventes

C) Haustra

D) Rugae

D) Rugae

Toward which aspect(s) of the stomach will barium gravitate with the patient in a prone position?

A) Body and pylorus

B) Fundus

C) Cardiac

D) Fundus and body

A) Body and pylorus

Which aspect of the stomach is attached to the duodenum?

A) Fundus

B) Body

C) Pylorus

D) Cardiac

C) Pylorus

Which specific part of the pancreas is adjacent to the C-loop of the duodenum?

A) Tail

B) Body

C) Head

D) Neck

C) Head

Which division of the duodenum contains the duodenal bulb or cap?

A) First (superior)

B) Third (horizontal)

C) Second (descending)

D) Fourth (ascending)

A) First (superior)

What structure indicates the junction between the duodenum and jejunum?

A) Duodenal cap

B) Suspensory muscle of the duodenum

C) Valvulae conniventes

D) C-loop of the duodenum

B) Suspensory muscle of the duodenum

Once food enters the stomach and is mixed with gastric secretions, it is termed:

A) bile.

B) lipids.

C) chyme.

D) biologic catalysts.

C) chyme

Which of the following substances are not digested chemically?

A) Minerals

B) Carbohydrates

C) Proteins

D) Lipids

A) Minerals

Enzymes that aid in chemical digestion are classified as:

A) lipids.

B) biologic catalysts.

C) digestive acids.

D) amino acids.

B) biologic catalysts.

Lipids (fats) are broken down into fatty acids and glycerol as they are digested and absorbed by the:

A) stomach and small bowel.

B) stomach only.

C) small bowel only.

D) None of the above (are not digested).

C) small bowel only.

Which aspect of the gastrointestinal (GI) tract is primarily responsible for the absorption of digestive end products along with water, vitamins, and minerals?

A) Stomach

B) Small intestine

C) Large intestine

D) Pancreas

B) Small intestine

A high and transverse stomach would be found in a(n) ____ patient.

A) hyposthenic

B) asthenic

C) sthenic

D) hypersthenic

D) hypersthenic

A stomach with the duodenal bulb at the level of L1-2 would be found in a(n) ____ patient.

A) hyposthenic

B) asthenic

C) sthenic

D) hypersthenic

C) sthenic

What is the classification of barium sulfate as a contrast media?

A) Radiopaque

B) Radiolucent

C) Isodense

D) Negative contrast media

A) Radiopaque

What type of solution is formed when barium is mixed with water?

A) Water-soluble solution

B) Isotonic solution

C) Hypotonic solution

D) Colloidal suspension

D) Colloidal suspension

Which of the following statements is true about barium sulfate?

A) It should be discarded if not used within an hour after mixing.

B) The patient may become ill if it is not prepared with sterile water.

C) It rarely produces an allergic reaction.

D) It is soluble in water.

C) It rarely produces an allergic reaction

Which of the following clinical indications would mandate the use of an oral, water-soluble contrast agent?

A) Patient with esophageal reflux

B) Patient with a bezoar

C) Patient with a possible perforated bowel

D) Patient with a possible peptic ulcer

C) Patient with a possible perforated bowel

What type of contrast media is ideal for demonstrating a diverticulum within the stomach?

A) Double-contrast barium/negative contrast agent

B) Single-contrast barium sulfate

C) Water soluble

D) Radiolucent

A) Double-contrast barium/negative contrast agent

Which of the following patient care concerns would prevent the use of an oral, water-soluble contrast medium?

A) The patient has a possible ulcer.

B) The patient is sensitive to iodine.

C) The patient has esophageal reflux.

D) The patient has dysphasia.

B) The patient is sensitive to iodine.

Which of the following is not one of the cardinal principles of radiation protection?

A) Time

B) Distance

C) Intensity

D) Shielding

C) Intensity

Which one of the following cardinal principles of radiation protection is most effective in reducing the dose to the technologist during fluoroscopy?

A) Time

B) Distance

C) Intensity

D) Shielding

B) Distance

Which of the following devices reduces scatter exposure during fluoroscopy from the fluoroscopy tube?

A) Compression paddle

B) Bucky tray

C) Bucky slot shield

D) Lead gloves

C) Bucky slot shield

Protective aprons worn during fluoroscopy must possess at least ____ mm lead equivalency (Pb/Eq.).

A) 0.25

B) 0.5

C) 0.75

D) 1

B) 0.5

Which of the following conditions involves dilated veins in the distal aspect of the esophagus, which in some cases can lead to internal bleeding?

A) Esophageal varices

B) Esophageal reflux

C) Esophageal hypertension

D) Esophageal thrombosis

A) Esophageal varices

A large outpouching of the proximal esophagus above the upper esophageal sphincter is termed:

A) Barrett esophagus.

B) esophageal varices.

C) esophageal reflux.

D) Zenker diverticulum.

D) Zenker diverticulum.

Achalasia is generally defined as:

A) difficulty in swallowing.

B) a common malignancy of the esophagus.

C) motor disorder of the esophagus.

D) large outpouching of the esophagus.

C) motor disorder of the esophagus.

.

Which of the following definitions would describe a bezoar?

A) Inflammation of the gastric lining

B) Outpouching of the stomach wall

C) Mass of undigested material

D) Stomach neoplasm

C) Mass of undigested material

Research suggests that peptic ulcers may be caused by:

A) smoking.

B) bacteria.

C) alcohol.

D) antibiotics.

B) bacteria.

Gastritis is defined as inflammation of the:

A) pancreas.

B) large intestine.

C) small intestine.

D) stomach.

D) stomach.

Which of the following conditions is an example of GERD?

A) Esophageal varices

B) Gastric carcinoma

C) Esophageal reflux

D) Bezoar

C) Esophageal reflux

What is the most common radiographic procedure performed to diagnose GERD?

A) Endoscopy

B) Esophagogram

C) Upper GI series

D) CT

A) Endoscopy

Which of the imaging modalities or procedures is most effective and preferred in diagnosing HPS?

A) Nuclear medicine

B) CT

C) Upper GI series

D) Ultrasound

D) Ultrasound

What is a potential risk associated with the use of water-soluble contrast agents, especially for geriatric patients?

A) Bowel obstruction

B) Cardiac arrest

C) Dehydration

D) Shock

C) Dehydration

When using computed radiography (CR), inadequate kV or mAs will produce a ____ image.

A) dark

B) light

C) blurry

D) mottled

D) mottled

Which of the following technical factors will best enhance a digital image taken during an upper GI series?

A) Collimation

B) Low kV techniques

C) Long SID

D) Use of compensation (wedge) filter

A) Collimation

Patient preparation for an esophagogram includes NPO _____ before the procedure.

A) 4 to 6 hours

B) 30 minutes to 1 hour

C) 4 to 6 hours and no gum chewing or smoking

D) None of the above; patient preparation is not needed as long as an upper GI series is not scheduled to follow.

D) None of the above; patient preparation is not needed as long as an upper GI series is not scheduled to follow.

Most esophagograms begin with the patient:

A) recumbent-supine.

B) erect.

C) recumbent-prone.

D) in a left lateral decubitus position.

B) erect.

Why would a patient undergo Valsalva maneuver during an esophagogram?

A) To demonstrate possible esophageal varices

B) To demonstrate possible esophageal reflux

C) To demonstrate possible esophagitis

D) To demonstrate a possible bezoar

B) To demonstrate possible esophageal reflux

Which of the following procedures will not demonstrate possible esophageal reflux?

A) Toe-touch maneuver

B) Water test

C) Reverse Trendelenburg method

D) Compression technique

C) Reverse Trendelenburg method

Which of the following positions is not normally considered to be part of the esophagogram basic routine?

A) Posteroanterior (PA)

B) Left lateral

C) Right anterior oblique (RAO)

D) Anteroposterior (AP)

D) Anteroposterior (AP)

Patient preparation for an adult upper GI series includes:

A) nothing; no patient preparation is required.

B) NPO 4 hours before the procedure.

C) NPO 8 hours before the procedure.

D) NPO 24 hours before the procedure.

C) NPO 8 hours before the procedure.

Which of the following kV ranges should be used for an upper GI series using barium sulfate (single-contrast study)?

A) 80 to 90 kV

B) 90 to 100 kV

C) 110 to 125 kV

D) 125 to 140 kV

C) 110 to 125 kV

Which of the following imaging modalities is an alternative to an esophagogram for detecting esophageal varices?

A) Sonography

B) CT

C) Nuclear medicine

D) MRI

A) Sonography

Which of the following imaging modalities is ideal for demonstrating signs of Barrett esophagus?

A) Nuclear medicine

B) MRI

C) Sonography

D) CT

A) Nuclear medicine

How much barium is typically given to a 3- to 10-year-old child during an upper GI series?

A) 4 to 6 ounces

B) 14 to 16 ounces

C) 6 to 12 ounces

D) 1 cup

C) 6 to 12 ounces

Gastric emptying studies are performed using:

A) intraesophageal sonography.

B) radionuclides.

C) MRI.

D) CT.

B) radionuclides.

CR centering for an esophagogram should be to the vertebral level of:

A) the sternal angle.

B) T3 or T4.

C) T5 or T6.

D) T7.

C) T5 or T6.

How much obliquity is required for the RAO position for the esophagus?

A) 10° to 15°

B) 20° to 30°

C) 35° to 40°

D) 45° to 60°

C) 35° to 40°

The RAO position of the esophagus is preferred over the left anterior oblique (LAO) because it:

A) is a more comfortable position for the patient.

B) increases the visibility of the esophagus between the vertebrae and heart.

C) reduces thyroid exposure to the patient.

D) is easier for the patient to hold the cup of barium in his or her left hand.

B) increases the visibility of the esophagus between the vertebrae and heart.

What type of breathing instructions should be given to the patient during an esophagogram using a thin barium mixture?

A) Suspended respiration while continuing to swallow

B) Suspended inspiration after the last swallow

C) Shallow breathing and continued swallowing during exposure

D) Exposure immediately after last bolus is swallowed (patient will not be breathing immediately after swallow)

C) Shallow breathing and continued swallowing during exposure

Other than the esophagogram, what imaging modality is performed to diagnose Barrett's esophagus?

A) Computed tomography

B) Nuclear medicine

C) Magnetic resonance

D) Sonography

B) Nuclear medicine

Which of the following upper GI projections and/or positions will best fill the body and pylorus with barium?

A) AP

B) Right lateral

C) Left posterior oblique (LPO)

D) PA

D) PA

Which of the following upper GI projections and/or positions will best demonstrate the pylorus and duodenal bulb in profile during a double-contrast study?

A) AP

B) LAO

C) PA

D) LPO

D) LPO

At what level should the CR and image receptor be centered for the RAO or PA upper GI projection and/or position on a sthenic body type of patient?

A) Lower costal margin

B) L2

C) L3-4

D) iliac crest

B) L2

A radiograph taken during an upper GI series demonstrates poor visibility of the gastric mucosa. The following factors were used: 80 kV, 30 mAs, and 1/40-second exposure time. Barium sulfate was used during the procedure. Which of the following factors needs to be modified during the repeat exposure?

A) Use of detail-speed screens (adjust mAs accordingly)

B) Shortened exposure time (increase mAs accordingly)

C) Use of a water-soluble contrast medium

D) Increased kV (decrease mAs as needed)

D) Increased kV (decrease mAs as needed)

A radiograph taken during an esophagogram using thin barium mixture demonstrates that there is very little contrast media in the esophagus. Which of the following points will improve filling of the esophagus? (The exposure was made on inspiration after the last swallow.)

A) Have the patient drink during the exposure.

B) Have the patient perform the Valsalva maneuver during the exposure.

C) Have the patient perform the Müller maneuver during the exposure.

D) Shorten the exposure time.

A) Have the patient drink during the exposure.

A PA radiograph taken on a hypersthenic patient during an upper GI series reveals that the pylorus and duodenal bulb are superimposed. Which of the following modifications will best eliminate the superimposition between these structures?

A) Roll the patient into a slight RAO position.

B) Angle the CR 35° to 45° cephalad.

C) Place a rolled towel or a filled compression paddle under the patient's abdomen before exposure.

D) Increase the kV.

B) Angle the CR 35° to 45° cephalad.

A patient comes to radiology for an upper GI series. Her clinical history indicates that there may be a tumor posterior to the stomach. Which one of the following projections and/or positions will best demonstrate this condition?

A) RAO

B) PA

C) Right lateral

D) LPO

C) Right lateral

A pediatric patient enters the emergency department (ED) with a small, plastic object stuck in her esophagus. PA and lateral chest radiographs fail to demonstrate the foreign body. Which of the following procedures would be most effective in demonstrating the location of the object?

A) Upper GI series

B) Esophagogram with the water test

C) Esophagogram using very thick barium

D) Esophagogram using shredded cotton soaked in barium

D) Esophagogram using shredded cotton soaked in barium

A patient comes to radiology with a history of a gastric ulcer. Which of the following procedures would be most diagnostic to demonstrate this lesion?

A) Double-contrast upper GI series

B) Single-contrast barium sulfate upper GI series

C) Oral, water-soluble upper GI series D) Carbon dioxide upper GI series

A) Double-contrast upper GI series

A patient comes to radiology for an esophagogram. The radiologist is concerned about the upper portion of the esophagus, near the level of T1, which did not visualize well on the previous routine projection-position esophagogram. Which of the following special projections and/or positions would be most helpful in demonstrating this region?

A) Soft tissue lateral

B) LAO

C) Cervicothoracic (swimmer's) lateral position

D) AP with 25° to 30° cephalad CR angle

C) Cervicothoracic (swimmer's) lateral position

One radiograph of an upper GI series needs repeating. The technologist is unsure which projection and/or position is seen on this radiograph. The fundus is filled with barium, and the pylorus and duodenal bulb are profiled and air filled. The patient was recumbent for all projections. Which projection and/or position needs to be repeated?

A) PA

B) LPO

C) RAO

D) Right lateral

B) LPO

A patient comes to radiology for an upper GI series. The patient has a clinical history of hiatal hernia. Which of the following positions may be helpful in demonstrating this condition?

A) AP Trendelenburg position

B) Left lateral decubitus, AP projection

C) Dorsal decubitus, lateral projection

D) LAO with compression technique

A) AP Trendelenburg position

A PA projection taken during an upper GI series performed on an infant reveals that the body and pylorus of the stomach are superimposed. What modification needs to be made during the repeat exposure to separate these two regions?

A) Perform the AP projection instead.

B) Angle the CR 20° to 25° cephalad.

C) Angle the CR 30° to 45° cephalad.

D) Use the AP Trendelenburg position.

B) Angle the CR 20° to 25° cephalad.

During an upper GI series, the "halo" sign appears in the duodenum. Which of the following conditions will produce this radiographic sign?

A) Ulcer

B) Bezoar

C) Diverticulum

D) Tumor

A) Ulcer

A patient comes to radiology with a clinical history of HPS. Which of the following imaging modalities will best demonstrate this condition?

A) CT

B) Nuclear medicine

C) Ultrasound

D) Upper GI series

C) Ultrasound

MATCHING Match each radiographic appearance or description with the corresponding disease or condition.(Use each selection only once.)

-Presence indicates a possible sliding hiatal hernia

a. Ulcers

b. Hiatal hernia

c. Achalasia (cardiospasm)

d. Zenker diverticulum

e. Schatzki ring

f. Gastritis

g. Esophageal varices

h. Gastric carcinoma

e. Schatzki ring

MATCHING Match each radiographic appearance or description with the corresponding disease or condition.(Use each selection only once.)

-Punctate collection of barium surrounded by a "halo" appearance during upper GI series

a. Ulcers

b. Hiatal hernia

c. Achalasia (cardiospasm)

d. Zenker diverticulum

e. Schatzki ring

f. Gastritis

g. Esophageal varices

h. Gastric carcinoma

a. Ulcers

MATCHING Match each radiographic appearance or description with the corresponding disease or condition.(Use each selection only once.)

-Narrowing and wormlike appearance of distal esophagus

a. Ulcers

b. Hiatal hernia

c. Achalasia (cardiospasm)

d. Zenker diverticulum

e. Schatzki ring

f. Gastritis

g. Esophageal varices

h. Gastric carcinoma

g. Esophageal varices

MATCHING Match each radiographic appearance or description with the corresponding disease or condition.(Use each selection only once.)

-Irregular filling defect within the stomach

a. Ulcers

b. Hiatal hernia

c. Achalasia (cardiospasm)

d. Zenker diverticulum

e. Schatzki ring

f. Gastritis

g. Esophageal varices

h. Gastric carcinoma

h. Gastric carcinoma

MATCHING Match each radiographic appearance or description with the corresponding disease or condition.(Use each selection only once.)

-Gastric bubble seen above the diaphragm

a. Ulcers

b. Hiatal hernia

c. Achalasia (cardiospasm)

d. Zenker diverticulum

e. Schatzki ring

f. Gastritis

g. Esophageal varices

h. Gastric carcinoma

b. Hiatal hernia

MATCHING Match each radiographic appearance or description with the corresponding disease or condition.(Use each selection only once.)

-Dilated distal esophagus due to reduced peristalsis

a. Ulcers

b. Hiatal hernia

c. Achalasia (cardiospasm)

d. Zenker diverticulum

e. Schatzki ring

f. Gastritis

g. Esophageal varices

h. Gastric carcinoma

c. Achalasia (cardiospasm)

MATCHING Match each radiographic appearance or description with the corresponding disease or condition.(Use each selection only once.)

-Enlarged recess in the distal esophagus

a. Ulcers

b. Hiatal hernia

c. Achalasia (cardiospasm)

d. Zenker diverticulum

e. Schatzki ring

f. Gastritis

g. Esophageal varices

h. Gastric carcinoma

d. Zenker diverticulum

MATCHING Match each radiographic appearance or description with the corresponding disease or condition.(Use each selection only once.)

-Speckled appearance of the gastric mucosa and absence of rugae

a. Ulcers

b. Hiatal hernia

c. Achalasia (cardiospasm)

d. Zenker diverticulum

e. Schatzki ring

f. Gastritis

g. Esophageal varices

h. Gastric carcinoma

f. Gastritis