Unit 4 (Upper GI)

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Unit 4 (Upper GI)
2013-01-14 00:09:44
Procedures II

Unit 4. Do not rely solely upon these cards. last revised spring2012.
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  1. Name the major organs that make up the alimentary canal:
    • oral cavity
    • pharynx
    • esophagus
    • stomach
    • small intestines
    • large intestines
    • anus
  2. what is the alimentary canal?
    a musculomembranous tube that goes through the mouth all the way to the anus
  3. name three functions of the digestive system:
    • intake and/or digestion of food
    • absorption of digested food particles, water, vitamins, and other essential elements
    • elimination of unused material as semisolid waste products
  4. name two common radiographic procedures of the upper GI system:
    • esophogram or barium swallow
    • upper gastrointestinal series (upper GI)
  5. describe the esophagus's location, dimensions, etc:
    • muscular, collapsible canal
    • approx 10" long
    • 3/4" around
    • extends from C6-T11
    • posterior to trachea
    • narrowest part of alimentary canal
  6. a flap that covers the trachea to protect it from aspiration of food and other foreign objects:
  7. What is the opening where the esophagus passes through the diaphram, and at what vertebral level does this occur?
    • esophageal hiatus
    • T10
  8. Name the four normal constrictions of the esophagus:
    • proximally where it enters the thorax
    • distally where it passes through diaphragm
    • indentation at the aortic arch
    • indentation where it crosses the left primary bronchus
  9. list the layers of the esophageal wall from outer to inner:
    • fibrous layer
    • muscular layer
    • submucosal layer
    • mucosal layer
  10. the dilated portion of the alimentary canal located between the esophagus and the small intestines:
    the stomach
  11. how long does it take the stomach to empty a normal meal?
    2-3 hours
  12. where is the gastric canal, and what is its purpose?
    • along the medial border of the stomach
    • funnels liquid past the stomach
    • A. cardia
    • B. cardiac notch
    • C. Fundus
    • D. Body
    • E. Greater Curvature
    • F. Lesser Curvature
    • G. Angular Notch
    • H. Pylorus
    • I. Duodenum
    • J. Pyloric Canal
    • K. Pyloric Antrum
    • L. Pyloric Portion
    • M. Sulcus Intermedius
    • N. Pyloric Sphincter
    • O. Cardiac Sphincter
    • P. Esophagus
  13. how is the stomach positioned in a hypersthenic patient?
    high and transverse
  14. how is the stomach positioned in an asthenic patient?
    vertical and low (more J-shaped)
  15. where is the stomach located (sthenic, average)?
    midway between the xiphoid process and lower costal margin on the left side of the abdomen
  16. name some factors that affect the location of the stomach:
    • body habitus
    • stomach contents
    • respiration
    • body position
    • age
  17. name 3 functions of the stomach:
    • storage reservoir
    • chemical digestion
    • mechanical digestion
  18. a ball of masticated food prepared to be swallowed:
    a bolus
  19. the term used for the masticated food that is traveling through the proximal part of the alimentary canal:

  20. name the patient positions for pictures A, B, and C:
    • A. Supine
    • B. Prone
    • C. Erect
  21. What position looks radiographically identical to the RAO position exept for reversed air/barium levels?
    LPO (LPO barium in fundus, RAO air in fundus)
  22. ______ fills the fundus of the stomach when in the prone position.
    • air
    • because of its posterior location
  23. ________ fills the fundus of the stomach when in the supine position.
    • barium
    • because of its posterior location
  24. contractions of the stomach:
  25. describe peristalsis of the stomach:
    • 3-4 waves per minute
    • waves begin in upper part of stomach & travel distally
    • waves become weaker as they flow distally
  26. give descriptions of the duodenum (dimensions, location, etc):
    • the most proximal portion of small intestine
    • 8-10" long
    • contains the C-shaped portion of the small intestine
    • retroperitoneal
    • shortest, widest, most fixed portion
  27. name the four sections of the duodenum:
    • pyloric region (superior portion, duodenal bulb)
    • descending portion (common bile & pancreatic ducts empty)
    • horizontal portion
    • ascending portion (fixed in place by ligament of treitz)
  28. Where is a common site for ulcers in the duodenum?
    the pyloric region (duodenal bulb/cap)
  29. Where is the duodenal papilla located and what is it?
    • in the descending portion of the duodenum
    • a nipple-like projection; the opening where the common bile duct and pancreatic duct empty into duodenum
  30. What is the name of the sphincter at the duodenal papilla?
    sphincter of odie
    • A. Gallbladder
    • B. Cystic Duct
    • C. Common Hepatic Duct
    • D. Common Bile Duct
    • E. Superior Portion of Duodenum
    • F. Pancreatic Duct
    • G. Ligament of Treitz
    • H. Duodenojejunal Flexure
    • I. Ascending Portion
    • J. Romance of the Abdomen
    • K. Horizontal Portion
    • L. Head of Pancreas
    • M. Duodenal Papilla
    • N. Descending Portion
  31. Name the radiolucent contrast agents commonly used for UGI studies:
    • air
    • CO2 gas crystals
    • gas bubble in stomach
  32. Name the two classes of radiopaque contrast agents commonly used for UGI studies, and examples in each class:
    • water soluble iodinated contrast: gastrograffin or gastroview
    • barium sulfate: thin (1 part BaSO4 to 1 part water) or thick (3-4 parts BaSO4 to 1 part water)
  33. name factors affecting the speed of contrast media coating:
    • suspending medium
    • temperature of medium (room temp faster, cold tastes better)
    • consistency of preparation
    • mobile function of the alimentary canal
    • pathological conditions
  34. a radiographic examination of the pharynx and esophagus:
    esophagram (barium swallow)
  35. What position is the pt usually in for the beginning of an esophagram?
    erect, LPO
  36. Which contrast is negative, and which is positive?
    • negative contrast: air (looks dark/black)
    • positive contrast: barium (looks light/white)
  37. What three projections are included in a routine esophagram?
    • RAO
    • Lateral (R or L)
    • AP
    • *sometimes special: LAO to better see the esophagus between heart and spine
  38. What would you have the pt do if the radiologist asks for a "water test" for an esophagram, and why might he order it?
    • drink water after fluoro and bend down to reach for toes
    • to see if the barium comes back up
  39. What is the valsalvia maneuver and why might it be done?
    • straining
    • sometimes used to show constrictions/dilations of the esophagus or esophageal reflux
  40. What is the mueller maneuver and why might it be done?
    • exhale, then try to breathe in with the epiglottis closed
    • looking for esophageal reflux
  41. Why are post fluoro projections for esophagrams usually done supine?
    • allows for more complete filling, slowing blood flow
    • to see esophageal varices which appear as filling defects (vericose veins of esophagus, usually associated with liver disease)
  42. How much is a pt obliqued for an RAO esophagram?
  43. where do you center for esophagram projections?
  44. which projection for an esophagram provides more visibility of pertinent anatomy between vertebrae and heart?
  45. Name some specifics when centering the lateral projection for an esophagram:
    • top of cassette lined with teeth
    • ribs superimposed
    • intervertebral spaces open
  46. What are the instructions for a pt to follow when shooting a post-fluoro esophogram projection?
    2-3 swallows of barium, tell pt when to swallow, expose on last swallow
  47. When centering to T5-T6 for the AP esophagram, what is your positioning landmark?
    about 3" inferior to manubrial notch

  48. name the study and position:
    RAO Esophagram (PA oblique)

  49. name the study and position:
    Left Lateral Esophagram

  50. name the study and position:
    AP Esophagram
  51. name some aspects to recognize on an AP esophagram:
    • esophagus superimposed over thoracic spine
    • rotation of body evidenced by symmetry of SC joints
  52. a radiographic procedure that examines the distal esophagus, stomach, and duodenum:
    Upper GI
  53. What is often the primary interest of an Upper GI procedure?
    the duodenal bulb because it is a common site for ulcers
  54. what are patient prep instructions for an Upper GI?
    • NPO after midnight the night before
    • no smoking
    • no chewing gum
  55. What position does the pt begin in for an Upper GI?
    erect, LPO
  56. basic routine projections for an UGI:
    • RAO
    • PA
    • Right Lateral
    • LPO
    • AP
  57. what should be done before the radiologist arrives for an upper GI?
    KUB scout film
  58. for an upper gi, which post-fluoro projection is the only one that is taken crosswise?
  59. How do you center for Upper GI projections?
    CR to L1-L2: about midway between xiphoid process and lower costal margin (also, 2" superior to lower costal margin)
  60. describe the air/barium levels for a PA projection during upper GI?
    • body and pylorus filled with barium
    • fundus is air-filled
  61. what orientation does the stomach take on in the PA projection for a UGI?
    more horizontal
  62. what might be necessary for a PA projection of a hypersthenic pt for a UGI?
    • PA axial: CR 35-45° cephalic
    • ** greater and lesser curvatures also better seen w/ axial
  63. what might be necessary for a PA projection of an infant for a UGI?
    PA axial: CR 20-25° cephalic (to open body and pylorus)
  64. Name a distinction to recognize a PA projection for an UGI?
    the pyloric region and duodenal bulb are separated (though the hypersthenic pt may need an angle to see this separation)
  65. why is the lateral projection for a UGI always a right lateral?
    to see the retrogastric space
  66. what oblique angle should a pt be rotated to for an LPO UGI projection?
    30-60° (ave is 45°)
  67. how are the barium/air levels visualized in an LPO position for a UGI?
    • fundus filled with barium
    • body, pylorus air-filled (& sometimes duodenal bulb)
  68. For the AP projection during a UGI, what might be necessary for an asthenic pt.?
    • a partial trendelenberg position may be needed to fill the fundus
    • ** also helps demonstrate a hiatal hernia
    • ** also helps to see gastric reflux

  69. name the study and position:
    UGI RAO (PA Oblique Position)

  70. name the study and position:
    UGI PA

  71. name the study and position:
    UGI Right Lateral

  72. name the study and position:
    UGI LPO (AP Oblique)

  73. name the study and position:
    UGI AP