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What are the breathing instructions for a UGI/BE?
where is CR for a PA and/or AP BE
- Suspend respiration and expose on expiration
- iliac crest
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List the routine positions/projections for a single contrast BE.
- pa and/or ap
- RAO and LAO
- LPO and/or RPO
- LAt. rectum
- PA
- post evac
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List the routine positions/projections for a double-contrast BE.
- pa and/or ap
- RAO and LAO
- LPO and RPO
- LAt. rectum
- R and L lat. decubs (double contrast study)
- PA post evac
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What is the kVp range for a single contrast study?
What is the kVp range for a double contrast study?
What positions best demonstrates the hepatic flexure?(2)
100-125 single contrast
80-90 kvp for a double contrast
RAO or LPO
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What positions best demonstrate the splenic flexure? (2)
How does the CR change for each?
LAO or RPO
- RPO = 1-2in above crests and 1in to the left of MSP (cr is high because of splenic flexure)
- LAO = 1-2in above crests and 1in to the right of MSP (cr is high because of splenic flexure)
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What is the CR for a lateral rectum and ventral decub. rectum?
lat. rectum = CR to level of ASIS and midcoronal plane (midway between asis and posterior sacrum)
same for decub rectum (2 inches up from greater trochanter)
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What is best demonstrated on a right lateral decubitus radiograph?
entire colon and an air filled splenic flexure and descending colon
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Why is a post evac. film taken?
Why are butterfly (axial) positions taken?
- to see residual contrast
- to elongate the rectosigmoid region b/c it is very squished
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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
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what size cassette is needed for a ap axial or ap axial oblique (LPO) Butterfly positions
what is the tube angle ap axial
where is the CR for the ap axial and ap axial oblique
what is the obliquity of the LPO
- 11x14
- 30-40 deg cephalad
- AP axial: 2" inferior to ASIS at MSP
- LPO:2'' inferior and 2in medial to right ASIS
- 30-40
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what size cassette is needed for a pa axial or pa axial oblique (RAO) Butterfly positions
what is the tube angle for pa axial
where is the CR for the pa axial and pa axial oblique
what is the obliquity of the RAO
- 11x14 lengthwise
- angle cr 30-40 caudal
- PA: at ASIS at MSP
- RAO:cr at level of asis and 2in to left of spinous process
- 35-45 deg
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what are polyps?
What is volvulus?
What is a neoplasm?
sac like projection similar to diverticula except they project inward
a loop of bowel twisting upon itself
- "new growth" and is another word for tumor
- they are malignant or benign
- it is most common cancer of large intestine in sigmoid and rectum
- it commonly encircles the lumen of the colon and causes "apple core" or napkin ring lesions
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a pa post evac use what IR and where is the cr
do we need more or less penetration
- 14x17
- cr at the crests
- less penetration because there is less barium
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Bile is formed in the liver and travels by the right and left _______ ducts to the _____ ducts. Bile is either carried to the ______ via the ______ duct for temporary storage or pour directly into the duodenum by way of the _____ duct which is joined by the main ______ duct
- hepatic
- common hepatic
- GB
- cystic
- common bile
- main pancreatic
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the ______ duct is 3-4 cm long containing several membranous folds along its length. These folds are termed the _____ which functions to prevent distention or collapse of the cystic duct
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What are the three primary function of the gallbladder?
what are the three main parts of the gallbladder
which portion is most distal and broader
storage: if bile is not needed for digestive purposes it is stored for future use in the GB
concentration: bile is concentrated in the GB due to hydrolysis
contraction:the GB normally contracts when foods such as fats or fatty acids are in the duodenum
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In 60% of individuals the ________ duct joins the pancreatic duct to form an enlarged chamber just proximal to the terminal opening termed the ____ ampulla or ampulla of _______near the terminal opening the duct walls contain circular muscle fiber termed the ______ sphincter or the sphincter of ______the sphincter relaxes when there are increased levels of ______ in the bloodstream
- common bile
- hepatopancreatic
- vater
- hepatopancreatic sphincter
- Oddi
- CCK
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the presence of the ring muscle causes a protrusion into the lumen of the duodenum this protrusion is termed the ______ which is the narrowest part of the passageway and therefore a common site for impaction of gallstones
duodenal papilla (papilla of vater)
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What is another name for gallstone?
choleliths
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cholecystectomy
cholelithiasis
cholecystitis
- surgical removal of gallbladder
- condition of having gallstones
- inflammation of the galbladder
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cholangiogram
cholecystocholangiogram
choleliths
- radiographic examination of biliary ducts
- study of both the gallbladder and the biliary ducts
- gallstones
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What is a operative cholangiogram done for? (4things)
- to find undetected choleliths
- to see if biliary ducts are open and clear no blockage
- function of the hepatopancreatic ampulla locate small lesions or strictures in biliary ducts
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what is a post operative t-tube cholangiogram done for
to keep place just in case there is an obstruction and can go into it later
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what is PTC,why would it be used (3 things)
percutaneous transhepatic cholangiography an xray of the biliary ducts
for people who cannot handle anesthesia
obstructed jaundice: if patient biliary ducts are suspected to be dilated or obstruction to biliary ducts cause by a stone or stenosis
stone extraction and biliary drainage
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what does ERCP stand for
is anesthesia used for a PTC
endoscopic retrograde cholangiopancreatography
- no because it is an outpatient test
- it is less invasive and cost less
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Explain body habitus variation when referring to the GB?
what are the four advantages of medical sonography over an conventional OCG (operative cholangiogram)
- hypersthenic pt = GB will be higher and more transverse
- asthenic = GB will much lower on top of the spine
- no ionizing radiation
- no contrast media administered
- detects small calculi
- less pt prep (less time consuming)
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What position demonstrates the stratification
of possible choleliths?
rt. lateral decub or pa erect
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What is a biliary calculi
gallstones
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the _____ kidney is slightly lower due to the presence of the liver
right
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what is the latin designation for kidney
Most of each ______ lies anterior to its respective kidney
The ______ muscles on either side of the vertebral column cause the
longitudinal plane of the kidneys to form a vertical angle of about 20
deg with the midsagittal plane
ren
ureter
psoas
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these large muscles also cause the kidneys to rotate backward approx. ____ degrees
a 30 degree RPO will cause the ______ kidney to be parallel to the film
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Each kidney is surrounded by a mass of fatty tissue called the
The kidneys normally lie halfway betweenthe xiphoid process and the _______
- adipose capsule or perirenal fat
- iliac crests
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What are the functions of the urinary system?(3)
is the production of urine and its elimination from the body
- removes nitrogenous wastes
- regulates water levels in the body
- regulates acid base balance and electrolyte levels
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Along the medial border of each kidney is a centrally located, longitudinal fissure termed the _____
hilum
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From the large amount of blood flowing through the kidneys daily, about 1.5 liters of _______ cc’s of urine are formed.
1500
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The structural and functional unit of the kidney
is the microscopic
The major calyces unite to form the
The term ________ is a general term used to describe the total functional portions of the kidneys.
- nephron
- renal pelvis
- renal parenchyma
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Directly under the fibrous capsule surrounding each kidney is the
There are three constricted points along the course of each ureter (where stones get stuck). They are…
The triangular portion of the bladder along the inner, posterior surface is termed the
renal cortex
- ureteropelvic junction (UP)
- pelvic brim
- uereterovesical junction (UV)
trigone
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Involuntary urination is termed
The act of voiding is called urination or
incontinence
micturation or voiding
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What questions should be asked when taking a pt. history for urography?
- Have you ever had hay fever, asthma or hives?
- Are you allergic to any drugs or medication?
- Are you allergic to iodine?
- Are you allergic to any foods?
- Are you currently taking Glucophage?
- Have you ever have an xray exam that required an
- injection into an artery or vein?
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List examples of mild, moderate and severe reactions of contrast media.
- mild = hives, itching sneezing
- moderate = excessive urticaria, giant hives, excessive vomiting
- severe = low bp, cyanosis, laryngeal edema, profound shock, cardiac arrest
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What is the pt. prep for an IVP?
- light evening meal prior to procedure
- bowel cleansing cathartic
- npo after midnight
- enema morning of examination
- void prior to procedure
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Why use ureteric compression?
enhances the filling of contrast in the kidneys and pelvicalyceal system
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What are contraindications to ureteric compression?
where are the uteric compression pads placed when in use
- possible uteric stones
- abdominal mass
- abdominal aortic aneurysm
- recent abdominal surgery
- severe abdominal pain
- acute abdominal trauma
over the pelvic brim just medial to ASIS
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What is the basic filming routine for an IVP?
- Ap scout
- nehprogram (at injection time)
- ap 5 min
- ap 15 min
- 20 min RPO LPO
- PA
- Post void (pa or erect)
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Nephrogram vs. nephrotomogram.
Nephrograms are the early radiographs taken after injection during an ivp
nephrotomogram is a tomographical image and is a slice as to where the kidneys
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What is the purpose of retrograde urography? (2)
radiographic examination of the urinary system
- visualizes the collecting portion of the urinary system
- assess the functional ability of the kidneys (timed procedure)
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What is the purpose of retrograde cystography?
radiographic study of the bladder after instillation of an iodinated contrast medium via a urethral catheter
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What is the purpose of voiding cystourethrography?
What is the kVp range during IVP’s? Why?
what two studies involve the function of the kidneys
Which studies are non functional of the urinary system
provides a study of the urethra and evaluates the patients ability to urinate
70-75kv, to not burn through a stone
IVP/VCUG
Retrograde urogram/cystogram
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What structure is best demonstrated on
a RPO radiograph during an IVP?
- left kidney
- right downside ureter
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What position will demonstrate nephroptosis?
erect
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What will a PA projection during an IVP best demonstrate?
it shows filled mid-distal ureters
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What are the routine projections/positions for
cystography?
what is the routine for a vcug male and female
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what cassette do you need for a cystogram
what is the breathing
where is the cr for an ap
what is the tube angle
- 11x14 crosswise
- on expiration
- 2in above pubic symphysis
- 10-15deg caudad angle
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What are the contraindications for contrast media for an IVP?
- if pt is taking gluocophage metformin
- has had a history of allergies hives hay fever
- and all the rest of pt history questions
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What is anuria?
What is a diuretic?
- complete cessation of urinary secretion by the kidneys
- an agent that increases excretion of urine
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What is uremia?
What is urinary reflux?
renal agenesis?
the abscence of a functioning kidney
a backward return or flow of urine from the bladder into the ureter and kidney
an excess in the blood of urea creatinine and other nitrogenous waste of protein and amino acids metabolties
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