Precancerous saclike projections that project INWARD into the lumen of the bowel
May appear radiographically as an "apple core" lesion
Telescoping of one part of the intestine into another.
"Mushroom shaped" dilation at distal aspect
Blind pouch of the rectum best demonstrated by defecography
Infected OUTPOUCHINGS of the mucosal wall due to herniation
Im what position will you find Barium in the fundus of the stomach? Where will air be?
Supine position- fundus is superior and posterior to the body. Air will be in the body
In what position will you find Barium in the body of the stomach? Where will the air be?
Prone position - because the body is more anterior. Air with be in the fundus
- Supine
- Prone
- Erect (note mostly flat line)
Functions of the digestive system
- Intake/digestion of food, water, vitamins and minerals
- Absorb digested particles into blood and lymph
- Eliminate waste
Type of Barium that is:
1 part BaSO4 to 1 part water.
Consistency of cream or thin milkshake
Type of barium that is:
3 to 4 parts BaSO4 to 1 part water.
Suited for visualizing the esophagus because it descends slowly and coats lining.
Contraindications to Barium
- Perforation or anytime barium may escape into the peritoneal cavity.
- If surgery is to follow exam.
- Obstruction
(BE)
What can you substitute Barium with if it is contraindicated?
Water-soluble iodinated contrast- Gastrografin
Should not be used on patients with iodine sensitivity.
- Hypersthenic (5%)
- Sthenic (50%)
- Hypothenic (35%)
- Asthenic
(10%)
KV range for water-soluble contrast
- NPO 8 hours prior to study
- No gum
- No Smoking
- Pregnancy?
- Infant younger than 1yr: NPO for 4 hrs
- Children older than 1yr: NPO for 6hrs
"Heartburn"
Gastric contents reflux into esophagus causing irritation.
May lead to
esophagitis
aka cardiospasm.reduced peristalsis, inability of esophagogastic sphincter to relax
dilated appearance
Stricture or streaking at the distal esophagus
Dilation of veins of distal esophagus. Often with cirrhosis of liver.
Cobblestone appearance
Large outpouching of the esophagus just above the esophagogastric sphincter
Gastroesophageal Reflux Disease
- catheter advanced to duodenojejunal flexure
- thin barium mixture injected
- air instilled
- fluoro and radiographic images taken
- intubation tube removed
-Contrast (thin) prepped and ready
-Control panel set for
fluoro
-footboard secure
-table upright
-lead aprons, gloves, compression paddle available
-bucky tray at foot of table
-radiation foot switch in place
-towels, waste bins, cups and straws ready
-fluoro timer set for 5 minutes
-exam explained, history taken
Mass of undigested material trapped in the stomach
- Supine
- Prone
- Internal Diameter- large intestine has greater diameter
- Haustra Relative location- Large along the periphery
- Colitis
- (ulcerative)diverticulosis/itis
- neoplasms
- Volvulus (twisting) can lead to necrosis
- intussusception
- Appnedicitis
- Bowel cleansing carthatics
- NPO after midnight (8 hours min.)
- No gum or smoking
- Enema morning of exam
- PA and/or AP
- RAO and LAO
- LPO and/or RPO
- Lat. rectum
- R and L lat decub (double-contrast)
- PA postevac
- Communicate with patient
- Wear gloves
- Drain air from enema tubing
- Place pt in Sim's position
- Lubricate enema tip
- Insert 1 1/2" toward umbilicus, then slightly superior
What side of the body is viewed in Anterior Oblique positions?
Downside anatomy
RAO = right side
LAO = left side
What side of the body is viewed in Posterior Oblique
positions?
Upside anatomy
LPO = right side
RPO = left side
Common birth defect in the ileum.
Saclike outpouchings of the intestinal wall
- Produce 800-1000mL of bile.
- Has over 100 functions but bile production is the function of interest in radiology
- Fundus - distal end and broadest part
- Body - middle section
- Neck - narrow proximal end continues as the cystic duct
Two parts of the large intestine that are not included in the colon
Contraindications for barium enema
- Perforation
- Post-op
- Following biopsy
- Large bowel obstruction
- Pregnancy
Pt placed in what position for insertion of enema tip?
The taeniae coli pull the large intestine into sacculations called ___
Two positions that are required for a double contrast BE that are not required when performing a single contrast BE
The RPO BE position should be centered (CR location) ___ to best demonstrate the ___
1" left of MSP, 2" above iliac crest;
Left colic (splenic) flexure
What is the importance of the bowel prep prior to the BE study?
Make sure bowels are clear;
residual stool can mimic pathology
- Cassettes ready with grid
- Chuck pad
- Get all BE supplies (tip, barium etc)
- Set up tip
- horizontal table
- Set fluoro
- towels, linen available
Can a BE be performed immediately following a colonoscopy?
Why?
Yes (if biopsy had not been performed)
Preferred to be last step, so can focus on what colonoscopy found
Recommended KVP for Single contrast barium enema? Double contrast?
Sng = 110-120KV
Dbl = 80-90KV
Disease
process that may result in the loss of haustal markings and a "stovepipe" appearance to the colon
Explain Defecography, also called Evacuative Proctography procedure
- Soap suds enema
- special commode with filter
- high density barium paste introduced via caulk gun apparatus
- video study during straining and rest
What special type of barium enema is performed to assess an anastomosis?
A surgical connection between two hollow or tubular structures
What position requires the central ray to be angled 30-40° cephalad and enters 2" medial and 2" inferior to the right ASIS?
LPO double angle
"Butterfly"
What anatomy is demonstrated on the Right lateral decubitus radiograph?
- Air filled descending colon
- Left colic (splenic) flexure
What anatomic structure is located on the posteromedial
aspect of the cecum?
Postoperative (T-tube or delayed) Cholangiogram procedure
- T-tube placed in common bile duct during surgery and extending outside body clamped off
- Contrast media injected into T-tube catheter
- Visualize biliary ducts
Endoscopic Retrograde
Cholangiopancreatography
- Endoscopic inspection
- cannulation
- injection of the biliary duct with the use of a duodenoscope
Pathologic indications of ERCP
- patency (openness) of biliary/pancreatic ducts
- undetected choleliths
- small lesions or strictures within the biliary/pancreatic ducts
- Sphincterotomy
- Stone removal
- Duct dilation and stenting
Cutting the muscular sphincter to enlarge the opening
Using a basket or balloon catheter to remove stones from a duct
Stretching of a partial blockage or stenosis and the placement of a small tube in the duct to keep it patent
Duct dilation and stenting
Ingestion and/or digestion takes place in: (5)
- oral cavity
- pharynx
- esophagus
- stomach
- small intestine
Absorption takes place in:
Small intestine and stomach
Elimination takes place in:
Exam performed to study the form and function of the pharynx and the esophagus
Exam performed to study the form and function of the distal esophagus, stomach and duodenum
Radiographic exam of the small intestine
Radiographic examination of the large intestine
The distal end of the gallbladder is termed the ___
The valves found
within the cystic duct are termed ___
Another term for the hepatopancreatic sphincter is the ___
Condition of having gallstones
Inflammation of the parotid gland results in ___
Preferred view to demonstrate the esophagus
Places esophagus between the spine and the
heart shadow
CR: T5-T6
If a patient lies supine during an upper GI series, where would most of the barium settle within the stomach?
What structures help create the romance of the abdomen?
head of the pancreas and C-loop of the duodenum
What pathologic condition is often secondary to acute liver disease such as cirrhosis?
Which upper GU projection will best demonstrate the retrogastric space
What is the degree of obliquity on UGI obliques?
Indications for UGI radiography (9)
- Anatomic anomalies
- Esophageal reflux
- Esophageal varices
- Foreign body obstruction
- Impaired swallowing
- Peptic ulcer disease
- Abdominal pain
- Nausea, vomiting
- Post-surgical leaks - water soluble contrast (bariatric surgery)
Maneuvers for diagnosing Esophageal reflux (6)
- Valsalva maneuver
- Modified Valsalva maneuver
- Mueller maneuver
- Water test
- Compression technique
- Toe-touch maneuver
Maneuver for diagnosis of esophageal reflux: bearing down as if having a bowel movement
Maneuver for diagnosis of esophageal reflux: pinches off nose,
closes mouth, tries to blow mose
Modified valsalva maneuver
Maneuver for diagnosis of esophageal reflux: Exhales and then inhales against a closed glottis
Maneuver for diagnosis of esophageal reflux: swallows water, radiologist observes for regurgitation of Ba into esophagus from stomach
Maneuver for diagnosis of esophageal reflux: inflated paddle placed under prone patient to demonstrate esophagastric junction
Maneuver for diagnosis of esophageal reflux: Esophagastric junction observed as pt touches toes. May demonstrate reflux and hiatal hernias
- Light evening meal prior
- Bowel cleansing cathartics
- NPO after midnight (8hrs)
- No gum
- No smoking
- Enema morning of exam
Why no smoking or chewing gum during the NPO period of Upper and Lower GI exam prep?
Increase gastric secretions and salivation - prevents proper coating of the gastric mucosa
The typical
adult's small intestine (intact) measures ___
What is the longest segment of the small intestine?
Pouches or sacculations found along the mucosal wall of the large intestine are termed ___
Which regions of the large intestine would be barium filled during a double contrast BE with the patient lying prone?
May present with cobblestone appearance and a string sign
Crohn's disease
(Regional enteritis)
Methylcellulose and barium is introduced via nasoduodeno tube during a(n) ___
- Communicate with patient
- Wear gloves
- Drain air from enema tubing
- Lubricate enema tip
- Initial insertion towards umbilicus
- Final placement slightly anterior, then superior
Indications for Lower GI (9)
- Diverticular disease
- Inflammatory bowel disease
- Colon cancer screening
- Abdominal pain
- Diarrhea/Constipation
- Change in bowel habits
- GI Bleeding
- Weight loss
- Fistula
A-bnormal passage from a hallow organ to the surface or from one organ to another
Functional study of the anus and rectum during the evacuation and rest phases of defecation
Evacuative proctogram
(Defecography)
Clinical indications for Evacuative proctogram
- Rectoceles
- Rectal intussusception
- Prolapse of rectum
Surgical anastomosis between two portions of the large bowel
Opening created on the
surface of the abdomen
Colostomy performed to assess for: (4)
- Proper healing
- obstruction
- leakage
- presurgical evaluation
What types of contrast are used for the enteroclysis procedure?
high density barium (methylcellulose)
Type of digestion (movement) that takes place in the stomach
Hormone that causes the gallbladder to contract
Effect of residual Barium in the GI tract
How can the technologist
speed up the small bowel procedure?
5 routine UGI projections (not counting AP scout)
- RAO
- PA
- right lateral
- LPO
- AP
Routine projections for a BAS
- RAO
- R Lateral
- AP
Routine projections for the SBS
- AP scout
- Prone KUB (high)
- KUB every 15-30 mins after
Routine projections for a BE
- AP scout
- Obliques
- Sigmoid
- Lateral
Routine projections for ACBE
- AP/PA
- R and L Lateral Decub
- XTL Lateral
Stricture or narrowing of esophagus
A - Left hepatic
duct
B - Common hepatic duct
C - Common bile duct
D -Pancreatic duct
E - Portion of descending duodenum
F - Gallbladder
G - Cystic duct
H - Right hepatic duct
Shows as irregular filling within stomach on x-ray
Appears with absense of rugae, thin gastric wall, and "speckled" appearance of mucosa with acute cases
Gastric bubble or protruding aspect of stomach above diaphragm or Schlatzki's ring
Distention of stomach owing to obstruction of pylorus
Hypertrophic pyloric stenosis
Punctate collection of barium and "halo" sign in stomach
Thickening of mucosal folds and poor definition of circular folds in small intestine
Inflammatory condition of the large intestine. Chronic inflammation and spasm give the intestinal wall a "saw-tooth" or jagged appearance
Mechanical part of digestion - chewing. Reduces size of food particles and mixes them with saliva
Positive = radiopaque
- appears white in radiographs
-- barium sulfate (BaSO4)
Negative = radiolucent
- appears black in radiographs
-- air, CO2, gas crystals
Location of biliary and GI organs for a Hypersthenic patient
- Transverse colon = high
- Lg Intestine extends around the periphery or abdominal cavity
- Gallbladder = high, almost transverse, well to the right of the midline
- Stomach = high, transverse
Location of Biliary and GI organs for a Hyposthenic/Asthenic patient
- Low diapghragm pushes large intestine down into low abdominal and pelvic cavities
- Stomach = low and J-shaped, vertical portion to the left of midline, duodenal bulb near midline lower down
- Gallbladder = near midline at iliac crest
When the pt is in the PRONE position, where is the barium located in the stomach?
When the pt is in the SUPINE position, where is the barium located in the stomach?
When the pt is in the ERECT position, where is the barium located in the stomach?
Pylorus (flat line between barium and air)
When the pt is in the PRONE position, where is the barium located in the Large Intestine?
Transverse and Sigmoid colon
When the pt is in the SUPINE position, where is the barium located in the Large Intestine?
Rectum, ascending colon, descending colon
How may the radiologist induce esophageal reflux?
- Valsalva maneuver
- Mueller maneuver
Indications for a barium swallow?
1.) suspected esophegal malignancy
2.) Dysphagia
3.) Congenital defects
4.) Gastric reflux
Indications for barium enema
alteration in bowel habit
chronic diarrhea/constipation
obstruction
rectal bleeding
abd pain
suspected mass
What's the kVp range for iodinated contrast?
Intestine twists on it's own mesentary, leading to mechanical obstruction.
Tapered, or "corkscrew" appearance
with classic "beak" sign
1. Cardiac notch 2. Fundus 3. Body
4. Greater curvature 5. Pyloric portion
6. Pyloric antrum 7. Pyloric canal
8. Pyloric orifice 9. Angular notch
10. Lesser curvature 11. Cardiac antrum
12. Esophagogastric junction
A - Common bile duct
B - Pancreatic duct
C - Hepatopancreatic ampulla
D -
Hepatopancreatic Sphincter
E - Region of duodenal papilla
F - Descending duodenum
A. Nasal cavity B. Soft palate C. Tongue
D. Epiglottis E. Larynx F. Nasal cavity
G. Soft palate H. Uvula I. Epiglottis
J. Trachea K. Trachea L. Esophagus
1. Nasopharynx
2. Oropharynx
3. Laryngopharynx
PA esophagram
(slight RAO obl)
Distinctive ring caused when portion of the stomach herniates through a weakened part of the esophageal sphincter.
Hiatal hernia - Schatzki's ring