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Chap. 12 Biliary/GI

Procedures 2

How much does the liver weigh? 3-4 lbs
In the average person, the right border of the liver extends from the diaphragm to just below what? the body of the 10th rib
The gallbladder is located where in proportion to the liver? nestled centrally in the posterior, inferior region of the liver
A much larger ___ lobe is separated from the smaller ___ lobe by the _________. right lobe, left lobe, falciform ligament
Where are the 2 minor lobes of the liver located? posterior aspect of the right lobe.
The quadrate lobe (first small lobe) is located on the posterior aspect of the right lobe, between the ___ and ___. between the gallbladder and falciform ligament
Where is the caudate lobe? posterior to the quadrate lobe. It extends superiorly to the diaphragmatic surface.
The large inferior vena cava counters over what lobe? caudate
how much bile is secreted by the liver each day? 800-1000mL, or 1 quart.
What does bile do? aids in the digestion of fats by emulsifying fat globules, and absorption of fat following its digestion.
Bile is formed in the small lobules of the liver, travels to the right or left ______ ducts, which join to continue as the __________. hepatic ducts, which join as the common hepatic duct.
Bile is carried to the ______ via the _________ for temporary storage, or it may be secreted directly into the _____ via the ________. gallbladder via the cystic duct, duodenum via the common bile duct.
The common bile duct is joined by the ________ at the __________, which empties into the duodenum via the ________. pancreatic duct at the hepatopancreatic sphincter. duodenal papilla.
Distal and broadest part of the gallbladder is called what fundus
the neck of the gallbladder is proximal, and continues as the ___. cystic duct
the cystic duct is how long? 3-4 cm
define spiral valve? and function? the cystic duct of contains several membranous folds called spiral valve, they prevent dissension or collapse of the duct.
gallbladder length? 7-10 cm, 3 cm wide
3 functions of the gallbladder? store bile, concentrate bile, contract when stimulated.
What hormone is secreted when the gallbladder contracts? cholecystokinin (CKK) is secreted by duodenal mucosa. CKK increases exocrine activity by the pancreas.
the common bile duct is about how long? 7.5cm
The common bile duct descends behind the superior portion of the _____ and the _______ to enter the ____________. duodenum and the head of the pancreas, to enter the second/descending portion of the duodenum.
the terminal end of the common bile duct is closely associated with the terminal end of the pancreatic duct, AKA _____. duct of Wirsung
In 60% of people, what ducts join to form one common passageway through the papilla into the duodenum? common bile and pancreatic.
Where is a common site for impaction of gallstones? (in the 60% of people that the common and pancreatic ducts join)... the single channel becomes narrower as it passes into the duodenum. Common passageway is called an ampulla, the heatopancreatic ampulla, of the term ampulla of vater.
ampulla of vater is aka? hepatopancreatic ampulla
what is the hepatopancreatic sphincter? muscle near terminal opening of ampulla of vater (duodenum..) that relaxes when levels of CCK increase in the blood stream.
hepatopancreatic sphincter is aka? sphincter of Oddi.
the presence of the sphincter of oddi causes a protrusion into the lumen of the duodenum termed the what duodenal papilla (papilla of Vater)
The gallbladder is ____ to the midcoronal plane, whereas the duct system is more ____. anterior, midline.
to put the gallbladder nearest the IR what position would be used? if the primary purpose is the drain the gallbladder into the duct system, the patient would be placed how? closest: prone. to drain: supine.
four advantages of sonography over cholecystogram (OCG). no ionizing radiation. detection of small calculi. no contrast. less patient prep.
Coledocholithiasis is what? Cholelithiasis is what? presence of stones in the biliary ducts. having abnormal calcifications or stones in the gallbladder.
Milk calcium bile is? the emulsion of biliary stones in the gallbladder.
acute or chronic cholecystitis is often what? a blockage of the cystic duct that restricts flow of bile from gallbladder to the common bile duct.
Chole- meaning? Cysto- meaning? chole- relationship to bile. cysto- sac or bladder
Cholangiogram? radiographic exam of biliary ducts
cholecystocholangiogram study of both the gallbladder and biliary ducts
The digestive includes the entire ______ and several ______. alimentary canal and several accessory organs.
Alimentary canal includes: oral cavity, pharynx, esophagus, stomach, small intestine, large intestine, anus.
The accessory organs of digestion include: salivary glands, pancreas, liver, gallbladder
3 functions of digestive system: intake, absorb, eliminate.
Upper GI is designed to study what? distal esophagus, stomach, duodenum.
3 pairs of glands in the oral cavity and locations? parotid (near the ear), submandibular (below the mandible), sublingual (below the tongue)
pharynx length? 12.5 cm
3 parts of pharynx? naso, oro, laryngopharynx.
laryngopharynx extends from the level of what to what? epiglottis to the level of the lower border of the larynx (c6) where it then continues as the esophagus.
Esophagus pierces the diaphragm at what level? And terminates at what level? T10 (slightly to the left and posterior), T11.
Two indentations of esophagus? one at aortic arch, one where the esophagus crosses the left primary bronchus.
The opening between the esophagus and the stomach is called? esophagogastic junction or cardiac orifice.
Where is the cardiac notch? directly superior to the cardiac orifice.
Cardiac antrum? the distal abdominal portion of the esophagus curves sharply into a slightly expanded portion called the cardiac antrum.
the opening or orifice of the distal stomach is called? pyloric orifice or pylorus
Lesser curve is where? extends between? along medial border of stomach, concave border extends between the cardiac and pyloric orifices
Greater curve is where? extends between? lateral border. extends from the cardiac notch and the pylorus
The fundus of the stomach is the portion that lies ___ and ____ to the cardiac orifice lateral and superior
angular notch? partially constricted area that separates the body from the pyloric portion of the stomach.
2 parts of the pyloric portion of stomach are: pyloric antrum, pyloric canal.
Which pyloric portion ends at the pyloric sphincter? pyloric canal.
What is the gastric canal? formed by rugae along lesser curvature, funnels fluids directly from body of stomach to pylorus
(lateral view) The body of the stomach can be seen to curve ____ and ____ from the fundus? inferior and anterior
The pylorus of the stomach is pointed which way? posteriorly
In the supine position, where will the barium settle? fundus
In an RAO recumbent position (prone), where would gas and barium settle? gas would be in fundus (highest portion), barium would settle in anterior body and pylorus portions
How does the air-barium line differ in prone verse erect studies? in erect position the air-barium line is straight.
What is the romance of the abdomen? head of pancreas in C-loop of duodenum
The first part of the superior portion of the duodenum is termed what? This is also a common site of ulcer disease. duodenal bulb/cap.
What portion of the duodenum is intraperitoneal? What is the remainder of the duodenum? the duodenal bulb, the rest is retro.
What and where is the duodenal papilla? opening for the common bile and pancreatic ducts into the 2nd portion of the duodenum
The junction of the duodenum with the jejunum is termed what? duodenojejunal flexure
what is the ligament of treitz? suspensory muscle of the duodenum. Holds the duodenaojejunal flexure area in place
What is rhythmic segmentation and where does it take place churning motion within segments of the small bowl.
Hypersthenic: stomach is _____ and _____, level ___ to ___ with the pyloric portion being level ___ to ___, at midline. Duodenal bulb location is level ___ to __, to the right of the midline. high and transverse, level T9-T12. Pyloric T11-T12. Duodenal bulb is T11-T12
Sthenic: stomach is level ___ to ___. Pyloric portion is level ___, near midline. Duodenal bulb is level ___ to ____. T10-L2. Pyloric is L2. Duodenal is L1-L2.
Hyposthenic/Asthenic: stomach is ____ and _____, level ___ to ___. Pyloric portion is level ___ to ___, and ____ to the midline. Duodenal bulb is level __ to ___. stomach is low and vertical, level T11-L5. Pyloric portion is level L3-L4, to left of midline. Duodenal is L3-L4.
Where is the gallbladder for each body habitus? level and midline. Hypersthenic: high and almost transverse, right of the midline. Hyposthenic/Asthenic: near the midline, level of iliac crest (L3-L4) Sthenic: less transverse and midway between the lateral abdomen wall and midline.
What is a colloidal suspension? particles will not dissolve in water, only settle. ex: barium
Thin barium is mixed how? Milkshake. 1 to 1.
Thick barium is mixed how? Oatmeal. 3 or 4 parts BaSO4 to 1 part water.
Thin barium and thick barium weight-to-volume? thin is 60%, thick might be 98%.
What contrast media would be used if barium was ruled out? water soluble, iodinated.
Gastroview is a water soluble contrast agent that contains ____% organically bound iodine. 37%
Two common forms of gas crystals? calcium and magnesium citrate.
Digital flouro is similar to conventional flouro with the addition of _______ and _____ for image manipulation and storage. a flat panel detector and a computer
Barium study kV: Double contrast kV: Gastro kV: barium: 110-120 double: 90-100 Gastro: 80-90
4 procedures to detect esophageal reflux breathing exercises, water test, compression paddle technique, toe-touch.
Most common breathing technical and how it is done? Valsalva maneuver. Pt is asked to take a deep breath, and while holding the breath in, bear down as though trying to move the bowels. (this forces air against glottis)
Barrets esophagus? What is it and where does it happen? Choice modality? Replacement of normal squamous epithelium with ulcer tissue in lower esophagus. Nuclear Med.
Esophageal varices? Dilation of the veins in the distal esophagus. (often seen with acute liver disease/cirrhosis)
What condition is often seen with cirrhosis of the liver? esophageal varices.
Zenkers diverticulum? What and where? large out pouching of the esophagus, just above the upper esophageal sphincter.
What two tests can be done for hiatal hernias? trandelenburg and toe-touch maneuver
What are the two breathing exercises? valsalva maneuver and mueller maneuver
What is a bezoar? mass of undigested material stuck in the stomach
Trichobezoar? Phytobezoar? hair, vegetable fiber
What kind of contrast is recommended to diagnose any tumors or diverticula? double contrast
Gastritis? Type of contrast recommended? inflammation in the stomach lining. double contrast.
Peptic ulcer contrast recommendation? double contrast
For an UGI, what is the patient prep? NPO from midnight until exam, or 8 hrs NPO. Also is instructed not to smoke or chew gum. (these increase gastric secretions which prevents proper coating of barium)
The stomach is ______ and _____ with a hypersthenic patient, but ____ and ____ with a hyposthenic. high and transverse, but low and vertical with a hypo.
Sthenic or average patient has the duodenum bulb near the ____ region/level. L2, or 2.5-5vm above the lower margin of the lateral rib cage.
Esophagus RAO degree? LAO degree? 35-40
UGI RAO degree? LPO degree? RAO= 40-70 LPO=30-60
RAO esophagus. If esophagus is situated over the spine, what needs to be done? Rotate more, further from board.
What position for esophagus gives you the best visual of the upper portion? Swimmers lateral position
RAO esophagus. Where is the esophagus? between the heart and spine
LAO esophagus, where is esophagus? between hilar region of lungs and spine
RAO UGI. rotation? 40-70. (more rotation for heavy hypersthenic, less for thin asthenic)
UGI series, CR for Sthenic? Asthenic? Hypersthenic? Sthenic- level of L1 (duodenal bulb... midway between spine and upside lateral border) Asthenic- 2 inches below L1. Hyper- 2 inches above L1.
In which UGI position is the C-loop of the duodenum in profile? * RAO
PA UGI. What must be demonstrated? body and pylorus filled with barium
Right lateral UGI, why right side? to empty stomach and fill duodenum
Right lateral UGI, what area is being demonstrated for possible pathology? * retrogastric space (space behind stomach)
LPO UGI, what must be demonstrated? fundus filled with barium.
Hypersthenic. stomach level? pyloric portion? duodenal bulb? stomach= T9-T10. Pyloric= T11-T12. Duodenal bulb= T11-T12. (all close because so transverse..)
Sthenic. stomach level? pyloric portion? duodenal bulb? stomach= T10-L2. pyloric- L2. Duodenal bulb= L1-L2. (average so a little less transverse... little more vertical..)
Hypo/asthenic. stomach? pyloric? duodenal bulb? stomach- T11-L5. pyloric= L3-L4. duodenal bulb= L3-L4. (tall, so very vertical)
In what position is the fundus in the highest position, which would cause the fundus to fill with air? RAO recumbent/prone.
Created by: Zoest35