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Chap 13 Lower GI

Procedures 2.

QuestionAnswer
How long is the small intestine? What about with good muscle tone? 23ft, 15-18ft
How long is the large intestine? 5ft.
Diameter of small and of large? 1-1.5 inches, 2.5 inches.
The first part of the small intestine, ________, is primarily located in what quadrant? RUQ
What portion of the small intestine is the shortest, widest, and most fixed in place? duodenum
The _____ is located primarily to the left of the midline in the LUQ and LLQ, making up about ______ of the small intestine. jejunum, two-fifths
The ilium is primarily located in the ___, _____, and ____. RUQ, RLQ, LLQ
Longest portion of small intestine? ilium
The internal lining of the 2nd and 3rd portions of the duodenum (descending and horizontal) appears how when barium filled? "feathery" due to the small finger-like projections called villi
what are villi? Where are they primarily located? In intestines, small finger-like projections, result in a feathery appearance. Mostly in duodenum.
How to tell the jejunum from ilium? jejunum has some mucosal folds and villi, "feathery" appearance, the lining of the ilium is much smoother and less feathery.
The duodenum is located immediately _____ to the stomach. distal
The large intestine consists of what parts? Cecum, colon, rectum, anal canal
The colon consists of ___ sections and ____ flexures, and does not include the ____ or ____. 4 sections, 2 flexures, cecum or rectum.
The ileocecal valve has 2 functions: prevent contents of ilium passing too quickly into cecum, and prevent reflux.
The cecum is in which quadrant? RLQ
The appendix is usually attached to the ______ aspect of the cecum and commonly extends toward the pelvis. posteromedial
The rectum extends from the _____ to the ____. sigmoid colon to the anus.
The rectum begins are the level of ___, and the final 4 cm is constricted to form the _____, which ends at the external opening called the anus. S3, anal canal
The ______ is a dilated portion of the rectum located anterior to the coccyx. rectal ampulla
The first curve of the rectum? 2nd? changes to inferior and anterior, 2nd is in area of anal canal and is inferior and posteriorly.
The rectum has 2 _____ curves. anteroposterior
3 characteristics to differentiate the large intestine from the small? Internal diameter, presence of hausfrau, and positions. (large is peripheral, small is more central)
3 bands of longitudinal muscle that pull the large intestine into pouches? taeniae coli
Each of these pouches (from the taeniae coli) is termed a ______. haustrum
What part of the large intestine does not have haustra? rectum
The ____, ______, and _____ are more anterior than other aspects of the large intestine cecum, transverse colon, and sigmoid colon
When a person is supine, air would be found in the ____ and ________. transverse colon and loops of the sigmoid
When a person is supine, barium would be found in the ______, ______, and ______. ascending, descending, and aspects of the sigmoid
What portions of large intestine are intraperitoneal? cecum, transverse, sigmoid
What portions of large intestine are retroperitoneal? ascending, descending, upper rectum
Digestion and absorption take place within the _____. small intestine
Most salts and 95% of water are reabsorbed in the _____. small intestine
The last stage of digestion occurs in the large intestine, it is called _____. bacterial action
what is bacterial action? last stage of digestion, converts remaining proteins into amino acids.
What is flatus? A by-product of bacterial action, gases (hydrogen, carbon dioxide, methane gas) help break down remaining proteins into amino acids
what digestive movements take place in the large intestine? peristalsis, haustral churning, mass peristalsis, and defecation.
enteritis, and regional enteritis? inflammation of the intestine. Regional is unknown origin, usually involving the terminal ilium. Scarring produces the "cobblestone" appearance.
A common infection of the lumen of the small intestine? spread by contaminated food/water. (dilation of the intestine) giardiasis
An obstruction is called? ileus
Describe and name the 2 types of ileus'. adynamic/paralytic- due to cessation of peristalsis, bowel is unable to propel content due to not having contractions. Mechanical- physical blockage caused from tumors, adhesions, hernia.
With what ileus (mechanical or adynamic) would no fluid levels be demonstrated on an erect abdomen projection? adynamic
what is a common birth defect that results in an saclike outpouching of the intestinal wall? (usually ileum) meckels diverticulum
what is a sprue? GI tract unable to process and absorb certain nutrients
what is celiac disease? form of sprue/malabsorption that affects the proximal small bowel
4 methods used to study the small intestine? upper GI-small bowel combination, small bowel only series, enteroclysis, intubation method. (last two only performed when first two dont work)
Upper GI small bowel combo: After the initial barium cup, how long until the first PA is obtained? 30 minutes. (so about 15 minutes after 2nd cup of barium is done..) *mark 30 min*
How often are images taken in a small bowel? Interval? 15-30 minute intervals until the contrast is at the ileocecal valve, if it takes longer than 2 hours then image every hour.
For a small bowel series, is a scout taken? yes
what is enteroclysis procedure? who is it recommended for? double contrast method where nutrient/medicine is injected into the bowel. Indicated for patients with histories of crohns/regional enteritis, or malabsorption/celiac.
Brief explanation of eneroclysis procedure: Cather into duodenojejunal junction, mixture of barium instilled, air or methylcellulose instilled to distend bowel.
Intubation AKA small barium enema, brief explanation: nasogastric tube/single lumen catheter ( double-lumen for therapeutic) passed from nose into jejunum, Patient is RAO, water soluable iodinated agent or thin barium injected.
why prone for small bowels? abdominal compression helps to separate various loops of the bowel.
Barium enema generally is not performed in cases of _________ because of the danger of perforation. acute appendicitis
Inflammation of the large intestine? colitis (wall has jagged or "sawtooth" appearance.) (Ulcerative is more severe, looks coblestone like)
Outpouching of the mucosal wall of large intestine? diverticulum
Condition of having numerous diverticula is called what? If these diverticula become infected, the condition is called what? diverticulosis, diverticulitis
What is intussesception? telescoping of part of intestine into another part. Most common in infants under 2.
Applecore or napkin-ring? what is it? neoplasms... could be form of annular carcinoma
Saclike projections that go inward into the lumen? polyps
_____ is a twisting of a portion of the intestine, leading to a mechanical obstruction. volvulus
cecal volvulus is what? describes the ascending colon and cecum as having a long mesentary, makes them more susceptible to having a volvulus.
4 contraindications to laxatives: gross bleeding, severe diarrhea, obstruction, inflammatory conditions such as appendicitis.
How do laxatives work? increase paristalsis of large bowel and occasionally small bowel by irritating sensory nerve endings in the intestinal mucosa.
2 classes of laxatives and one example of each irritant- castor oil. Saline- magnesium citrate
3 kinds of enema tips? plastic disposable (no balloon), rectal retention, air-contrast retention
kV range for a water soluble, negative contrast agent? 85-95 kVp
Tip placement: toward umbilicus, then superior and slightly anteriorly. Should not exceed 1 1/4- 1.5 inches total.
BE bag should not exceed what height? 24 inches
Why PA projection for lower GI exams? compression results in a more uniform density
two-stage double contrast barium enema brief explanation: thick barium fills left side of intestine (to flexure), then air is instilled, pushing the barium through to the right side. RAD may ask to drop bag to drain excess barium. Then bowel is inflated with more air/gas that moves the barium bolus.
single stage double contrast barium enema brief: Instilled while patient is in trendelenburg position.
Definition and purpose of defecography or evacuative proctography: study of the anus and rectum that is conducted during the evacuation and rest phases of defecation.
For a PA small bowel, where do you center? 2 inches above crest for first image, interval 30 min images CR at crest.
What must be demonstrated on PA small bowel? Entire small intestine, *stomach is included on the first 15 or 30 min image!*
PA barium enema, CR? Anatomy demonstrated? CR at crest. Transverse colon barium filled, (air filled if AP w/ double contrast). Entire large intestine visible.
RAO BE, the ____ colic flexure and the _____ colon and sigmoid colon are open. right, ascending
RAO or LAO: include rectal ampulla. RAO.
RAO centering: LAO centering: RAO at crest & 1 in LEFT of MSP. LAO 2 inches above crest & 1 in RIGHT (2 inches above to include left colic flexure)
LAO, the ____ colic flexure is "open" left
LPO and RPO, what is "open"? LPO- right flexure, ascending and rectosigmoid portions. RPO- left flexure, descending.
LPO, what ala is elongated? LAO? LPO- left if elongated, LAO- right is elongated.
LPO or RPO: center higher to include left flexure. RPO (LAO center higher)
Lateral rectum: Best demonstrates what region? CR where? between rectum and bladder/uterus. CR as ASIS and midcoronal plane.
Right lateral decub best demonstrates what? Air filled left colic flexure and descending colon. (Left lateral decub best demonstrates right flexure, ascending, and cecum)
AP axial and AP LPO oblique projection (butterfly), CR? CR angled 30-40 cephalad. 2 inches below ASIS. LPO 2 inches below ASIS and 2 inches medial/to right of ASIS. (similar view obtained with PA axial and RAO with a 30-40 caudal angle)
Duodenum length? 10in
Which portion of the small intestine has a "coiled spring" or "feathery" look? jejunum
Which portion has the function of absorption of nutrients, h20, salts and proteins? duodenum and jejunum
Which portion has the function of reabsorption of vitamins B and K, and amino acids? large intestine
Contraindications for water soluable iodinated contrast? Young or dehydrated, or sensitive to iodine.
When is the first image taken during a small bowel series? 15-30 min after contrast
enteroclysis is a term that describes what type of small bowel study? double contrast
Barium enemas, obliques are what degree? 35-45
Lateral rectum, CR at? ASIS, midcoronal plane
AP Axial CR at? PA axial CR at? 2 inches below ASIS with 30-40 CEPHALIC angle. "" CAUDAL angle.
AP Axial, LPO. CR and angle? PA Axial, RAO. CR and angle? LPO 30-40 obliqued, 2 inches below ASIS and 2 inches medial to right ASIS. . . RAO 35-45 obliqued, CR to exit level of 2 inches below ASIS, and 2 inches left of spinous processes.
Created by: Zoest35