RAD-146 CH.13 LOWER GI

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anatomy12
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275604
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RAD-146 CH.13 LOWER GI
Updated:
2014-06-21 13:10:41
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  1. what is the purpose and what is a small bowel series
    this exam frequently followes what other exam
    • it is a radiographic examination of the small intestine
    • upper GI series
  2. list the quadrants of the following
    Duodenum:
    Jejunum:
    Ileum:
    Ileocecal valve:
    • RUQ and LUQ
    • LUQ and LLQ
    • RUQ, RLQ, and LLQ
    • RLQ
    • C= cecum
    • A = ascending colon
    • H = right (hepatic) flexure
    • U = Haustra
    • T = transversve colon
    • S = left splenic flexure
    • D = descending colon
    • G = sigmoid colon
    • R = rectum and anal canal
  3. what structure join at the terminal ileum and ileocecal valve
    cecum
  4. what are the three differences n the large instestine vs the small intestine
    • internal diameter
    • haustra (taenia coli)
    • relative location
  5. in a supine position the barium and air are where
    barium in ascending and descending colon air in recto sigmoid colon and transverse colon
  6. in the prone position where is the barium and air
    air ascending and descending colonbarium in rectosigmoid and transverse colon
  7. list the four Small bowel procedures
    • Upper GI/small bowel combination
    • SBS alone
    • Enteroclysis (radiographic or CT)
    • Intubation method
  8. One more what are the contraindications to using barium and water soluble iodinated contrast media like gastroview
    • barium:
    • presurgical pts
    • pts with perforated hollow viscus
    • large intestine obstructions
    • sensitivity

    • Iodinated contrast:
    • pts with history of sever dehydration or young pts
    • sensitivity (allergy) to iodine
  9. how much barium is needed for a SBS
    16oz
  10. an enteroclysis is used to diagnose what pathology in a SBS (3)
    • ileus (small bowel obstruction)
    • chrons disease
    • malabsorption syndrom
  11. Explain the enteroclysis procedure
    • a catheter place inside the duodenaljejunal flexure
    • then a thin barium is injected
    • if its double contrast study air or methylcellulose can be instilled
    • then fluoro and radiographic images are take n
  12. what is the pt prep for SBS, enteroclysis and intubation procedure
    • NPO - 8hrs
    • low residue diet for 48 hrs (jello)
    • no gum chewing
    • no smoking
    • and ask abt pregnancy
  13. What is the difference between polyps and diverticula?
    • diverticula form small outpuchings outwards on the areas of the haustra
    • polyps are fleshy growths that grow inward or on inside of the colon
  14. what pathology does a BE show (6)
    • ulcerative colitis
    • Diverticulosis
    • neoplasms (apple core or napkin ring lesions)
    • volvulus (which leads to necrosis)
    • intussusception
    • appendicitis
  15. what is a volvulus
    defined as a complete twisting of a loop of intestine around its mesenteric attachment site which leads to necrosis
  16. Intussusception
    Intussusception occurs when one portion of the bowel slides into the next, much like the pieces of a telescope
  17. what is the pt prep for a BE
    • light evening meal prior to exam - jello
    • bowel cleansing cathartics
    • NPO aftermidnight 8 hrs minimum
    • no gum chewing
    • no smoking
  18. what are cathartics
    list examples
    what are the two types
    • substance that produces frequent soft liquid bowel movements
    • dulcolax mirolax
    • irritant (rarely used)
    • saline
  19. what are the contraindications to using cathartics
    • gross bleeding
    • severe diarrhea
    • obstruction
    • inflammatory lesions
  20. how much barium is needed fir a BE single and double contrast
    • single 1500ml
    • double 500 ml
  21. what is the temperature of water used to mx barium for a BE
    warm room temperature never hot
  22. the balloon tip that is inserted into the rectume can only blown to how much air
    1 squeeze gives 90ml of air
  23. what is the position of the pt for a BE procedure
    modified sims position lying on left side with right leg flexed to expose the rectum
  24. what four things must we keep in mind when inserting the tip in the rectume
    • 1.communicate with patient
    • 2.ear gloves
    • 3.drain air from enema tubing
    • 4.lubricate enema tip
  25. what barium is used for a double contrast BE
    thick barium (1:1 ratio) and room air temp for air administered
  26. which lower GI procedure is uncommon and what are its clinical indications
    evacuative proctogram (defecography)- functional study of the anus and rectume during evacuation phases and rest phases of defecation

    • clinical indications:
    • rectoceles
    • rectal intussusception
    • prolapse of rectum
  27. what are the 5 safety concerns of a BE procedure
    • 1. review chart history
    • 2.never for an enema tip it should be sucked in once inserted 
    • 3.height of enema bag should be no higher than 2 in above the table
    • 4.verify the water temp of the contrast media
    • 5.escort pt to the restroom
  28. what is the routine and special procedures for an SBS
    • routine: PA
    • special: Intubation method, enteroclysis
  29. why is a pa the routine for a SBS
    b/c it helps compress the intestines and spread them when pt is lying on their stomach
  30. where is the CR for SBS pa projection for a 15-30min radiographs
    and hourly radiographs?
    • 2in above iliac crests
    • iliac crests
  31. what is the purpose of the ileocecal valve
    The purpose of this valve is to “prevent backflow” from the Large Intestine, once any material leaves the Small Intestine.
  32. what is the routine and specials positions for a BE
    • pa and/or ap
    • RAO and LAO
    • LPO and/or RPO
    • LAt. rectum
    • R and L lat. decubs (double contrast study)
    • PA post evac

    • Special:
    • ap axial or ap axial oblique
    • Pa axial or pa axial oblique
  33. where is CR for a PA and/or AP BE
    what does this position visualize
    • iliac crest
    • ensure no rotation
  34. where is the CR what is the obliquity for an RAO BE
    • CR to iliac crests and 1inch to left of MSP
    • 35-45 oblique
  35. the RAO position of a BE demonstrates what anatomy
    what other position will demonstrate the right colic flexure in profile as the RAO
    right hepatic flexure in profile ascending and descending colon are open w/o superimposition splenic flexure is not viewed

    LPO b/c it is opposite
  36. where is the CR what is the obliquity for an LAO BE
    what other position visualizes the same thing
    • CR at 1-2 in above crests and 1in to the right
    • 35-45 deg
    • RPO
  37. Bag of contrast should be suspended at what height to prevent faster flow of barium into rectum causing pt discomfort
    24-30in above the table
  38. all BE radiographs except for the what 2 projections are take on a 14x17
    for hypersthenic pts what must be done to include appropriate anatomy
    • lateral rectum and butterfly positions 
    • 2 14x17 crosswise cassettes
  39. what are the technical factors for a single contrast and double
    what is the breating
    what cells should be selected when using AEC
    • 100-125 single contrast
    • 80-90 kvp for a double contrast
    • Suspend respiration and expose on expiration
    • all cells selected when using aec
  40. why must we or could we use two films on an ap or pa of the colon
    to make sure we include the splenix flexure b/c it is located higher up and rectal ampulla (area where feces is stored)
  41. Methylcellulose is introduced into the smallintestine during enteroclysis to _____
    A.Dilate the loops of small intestine
    B.Reduce bowel spasm
    C.Reduce peristalsis
    D.Increase peristalsis
    a
  42. the transverse and sigmoid colon are located where than the other parts of the colon
    more anterior
  43. what structures are best shown in a PA/AP BE
    transverse colon and portion of sigmoid colon BA filled
  44. what structures are best visualized in an LAP or RPO BE
    the splenic flexure should be seen w/o supoerimposition
  45. where is the CR for a RPO BE
    1-2in above crests and 1in to the left of MSP
  46. where is the CR for a LPO BE
    • cr to level of iliac crests cr 1in to right of MSP
    • visualizes the right hepatic flexure as an RAO would
  47. where is the CR for a lateral rectum
    what casette would you use
    • CR to level of ASIS and midcoronal plane (midway between asis and posterior sacrum)
    • 10x12 length wise
  48. what is the alternative position to the lateral rectum
    why is the position done for
    • ventral decub (cross table or xtable lateral)
    • to visualize air in the rectum in a double contrast study
  49. what structure does the right lateral decub position show
    entire colon and an air filled splenic flexure and descending colon
  50. where is the CR for a right lateral decub BE (only for a double contrast study)
    1-2 in above crests because splenic flexure is lcoated higher in abdomen
  51. if we are doing a single contrast BE are decubs R & L necessary
    no
  52. which position in a double contrast study visualizes the an air filled hepatic flexure and ascending colon and cecum
    where is the CR for this position
    • left lateral decub BE
    • at level of crests
  53. what size cassette is needed for a ap axial or ap axial oblique (LPO) Butterfly positions
    what is the tube angle
    where is the CR for the ap axial and ap axial oblique
    • 11x14
    • 30-40 deg cephalad
    • AP: 2" inferior to ASIS at MSP
    • LPO:2'' inferior and 2in medial to right ASIS
  54. what is pt prep for a be
    • alimentary canal must be completely empty by using saline cathartics to fully cleanse the colon
    • gowning remove all clothing including shoes socks or panty hose
  55. cobblestone appearance indicate what pathology
    dilated intestines with thick circular folds
    extended loops of small bowel
    napkin ring or appl core sign pathology
    • chrons disease
    • giardiasis
    • ileus of S.I.
    • neoplasm
  56. during a lateral rectum radiograph what must you do to the tube in the rectum
    how do you deflate the balloon
    • you must first drain all the barium out of the tip and back into the bag then tell pt you will be taking the tube out you have to deflate it and remove the tip
    • unclamp it first to deflate it air drains out
    • then proceed with the xray
  57. what is important to do before tip insertion to the barium bag
    shake it briefly it reduce colloidal suspension
  58. Before the tip insertion the patient should be instructed to
    a.
    b.
    c.
    not to push the tip out of the rectum by bearing down once the tip is inserted

    relax abdominal muscles to prevent increased intra abdominal pressure

    concentrate on breathing by the mouth to reduce spasms and cramping
  59. the initial insertion toward the _____. After the initial insertion the rectal tube is directed _____ and slightly _______ to follow the normal curvature of the rectum
    the whole process of insertion should not exceed how many inches
    • umbilicus
    • superior and anteriorly

    1.25-1.5inches

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