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Ch 12 Bontrager
Upper GI
| Question | Answer |
|---|---|
| What is the weight of the average human liver? | 3-4 lbs |
| Which abdominal quadrant contains the gallbladder? | Upper Right quadrant |
| What is the name of the soft tissue structure that separates the right from the left lobe of the liver? | Falciform ligament |
| Which lobe of the liver is the largest? | Right lobe |
| List the lobes of the liver. | Right lobe/left lobe/quadrate lobe/caudate lobe |
| True/False: the liver performs more than 100 functions. | TRUE |
| True/False: the average healthy adult produces 1 gallon of bile per day. | FALSE - it produces 1 quart |
| What are the 3 primary functions of the gallbladder? | STORE bile; CONCENTRATE bile; CONTRACT when stimulated |
| True/False: Concentrated levels of cholesterol in bile may lead to gallstones (choleliths). | TRUE |
| What is a common site for impaction (lodging) of gallstones (choleliths)? | Duodenal papillae |
| True/False: In about 40% of individuals, the end of the common bile duct and the end of the pancreatic duct are totally separated into 2 ducts rather than combining into one duct into the duodenum. | TRUE |
| True/False: Older terminology for the main pancreatic duct is the duct of Vater. | TRUE |
| The gallbladder is located more _____ (posterior/anterior) within abdomen. | Anterior |
| Cholecystocholangiography is a radiographic examination of _____. | Study of both gallbladder and biliary ducts |
| Which imaging modality produces cholescintigraphy? | nuclear medicine |
| True/False: Acute cholecystitis may produce a thickened gallbladder wall. | TRUE |
| Describe the location of the gallbladder based on body habitus. | Hypersthenic - high and well to right of MSP; Sthenic - less transverse and midway between lateral abdo wall and MSP; Hyposthenic/Asthenic - near MSP at level of iliac crest P458 |
| Why is sonography better for imaging the gallbladder than the outdated oral cholecystogram? | 1) No ionizing radiation; 2) detection of small calculi; 3) no contrast medium; 4) less patient preparation. P448 |
| What is the biliary terminology for surgical removal of the gallbladder? | Cholecystectomy |
| What is the clinical indication for enlargement or narrowing of the biliary ducts because of the presence of stones? | Choledocholithiasis |
| What is the medical terminology for the condition of having gallstones? | cholelithiasis |
| what is the clinical indication for inflammation of the gallbladder? | Cholecystitis |
| What is the medical terminology for benign or malignant tumors of the gallbladder, biliary ducts, or liver? | Neoplasms |
| What is the clinical indication for the narrowing of the biliary ducts? | Biliary stenosis |
| List the seven major components of the alimentary canal. | 1. Oral Cavity; 2. Pharynx; 3. esophagus; 4. Stomach; 5. Small Intestine; 6. Large Intestine; 7. Anus |
| List the four accessory organs of the digestive system. | 1. Salivary Glands; 2. Pancreas; 3. Gallbladder; 4. Liver |
| What are the three primary functions of the digestive system? | INTAKE of food/digestion of food; ABSORB nutrients, water, vitamins, essential elements; ELIMINATE |
| What two terms refer to a radiographic examination of the pharynx and the esophagus? | ESOPHAGOGRAM or Barium Swallow |
| Which term describes the radiographic study of the distal esophagus, stomach and duodenum. | UPPER GI Series or UGI Series |
| Which three pairs of salivary glands are accessory organs of digestion associated with the mouth? | 1. Parotid; 2. Submandibular; 3. Sublingual |
| The act of swallowing is called _____. | Deglutition |
| List the three divisions of the pharynx | Nasopharynx; Oropharynx; Laryngopharynx |
| What structures create the two indentations seen along the lateral border of the esophagus? | Aortic arch and left primary bronchus |
| List the three structures that pass through the diaphragm. | 1. Esophagus 2. Inferior Vena Cava 3. Aorta |
| What part of the upper GI tract is a common site for ulcer disease? | Duodenal bulb or cap |
| What term describes the junction between the duodenum and jejunum? (This is a significant reference point in small-bowel studies.) | duodenojejunal flexure |
| The C-loop of the duodenum and pancreas are _____ (intraperitoneal or retroperitoneal) structures. | RETROPERITONEAL (located posterior to the parietal peritoneum) see ch 3 for more info |
| True/False: The body of the stomach curves inferiorly and posteriorly from the fundus. | FALSE; it curves anteriorly and inferiorly |
| The three main subdivisions of the stomach are _____. | A) Fundus B) Body C) Pylorus |
| The third distal portion of the stomach is divided into 2 subdivisions, what are they called? | 1) Pyloric antrum 2) Pyloric canal |
| Another term for the mucosal folds of the stomach. | Rugae |
| Where will barium vs air show in the stomach if the patient is ERECT? | barium in pylorus and body of stomach, possibly in the duodenum. There will be a straight line (because of gravity) between barium and air in stomach. |
| Where will barium vs air show in the stomach if the patient is SUPINE? | Barium in fundus of stomach, possibly body and distal esophagus; air in inferior body and pylorus |
| Where will barium vs air show in the stomach if the patient is PRONE? | Barium in the pylorus, possibly the body and duodenum. Air will visualize in fundus |
| Name the two anatomic structures implicated in the phrase "romance of the abdomen". | Duodenum and head of pancreas |
| True/False: Mechanical digestion includes movements of the entire gastrointestinal tract. | TRUE |
| Peristaltic activity is not found in which of the following structures: A) Pharynx B) Esophagus C) Stomach D) Small intestine | A) Pharynx |
| Stomach contents are churned into a semifluid mass called _____. | Chyme |
| A churning or mixing activity that is present in the small bowel is called _____. | Rhythmic segmentation |
| List three groups of food that are ingested and must be chemically digested. | A) Carbohydrates B) Proteins C) Lipids |
| Biologic catalysts that speed up the process of digestion are called _____. | enzymes |
| What are the six different classifications of substances ingested: | A) carbohydrates or complex sugars B) proteins C) lipids or fats D) vitamins E) minerals F) water |
| Which three groups of food are ingested and are useful in the form the body absorbs them? | Vitamins, water, minerals |
| List the end products of digestion for CARBOHYDRATES. | simple sugars |
| List the end products of digestion for LIPIDS. | fatty acids and glycerol |
| List the end products of digestion for PROTEINS. | amino acids |
| What is the name of the liquid substance that aids in digestion, is manufactured in the liver, and stored in the gallbladder? | bile |
| How does bile assist in emulsification of fat? | It binds with the fat to create small fat droplets. The small droplets have a larger surface area providing more access for enzymes to continue breaking down the fat. |
| Absorption of nutrients primarily takes place in A) _____, although some substances are absorbed through the lining of the B) _____. | A) small intestine B) stomach |
| Of the three primary food substances, which does the body begin digesting in the mouth? | Carbohydrates |
| Any residues of digestion or unabsorbed digestive products are eliminated from the _____ as a component of feces. | large intestine |
| Peristalsis is an example of which type of digestion? | Mechanical |
| Which term describes food after it's mixed with gastric secretions in the stomach? | CHYME |
| A high and transverse stomach would be found in a _____ patient. A) hypersthenic B) Sthenic C) hyposthenic D) asthenic | HYPERSTHENIC - |
| A J-shaped stomach that is more vertical and lower in the abdomen, with the duodenal bulb at the level of L3-L4, would be found in a _____ patient. A) hypersthenic B) Sthenic C) hyposthenic/asthenic | C) Hyposthenic/Asthenic |
| In the erect position, how much will abdominal organs drop on average? | 2.5 to 5 centimeters (even more with age and loss of muscle tone) |
| Would the fundus of the stomach be more superior or more inferior during deep inhalation? Why? | Inferior - because inhalation drops the diaphragm to expand the lungs to hold more air |
| What types of digestion occur in the oral cavity? | Mechanical, chemical Mastication, deglutition |
| What types of digestion occur in the Pharynx? | mechanical Deglutition |
| What types of digestion occur in the esophagus? | Deglutition, Peristalsis |
| What types of digestion occur in the Stomach? | Mechanical and chemical Peristalsis, Mixing |
| What types of digestion occur in the small intestine? | Peristalsis, rhythmic segmentation |
| True/False: With the use of digital fluoroscopy, the number of postfluoro radiographs ordered has greatly diminished. | TRUE |
| Another term for negative contrast medium is _____. | Radiolucent contrast medium (air or CO2) |
| What substance is most commonly ingested to produce carbon dioxide gas as a negative contrast medium for GI studies? | Calcium or magnesium citrate |
| What is the most common form of positive contrast medium used for studies of the GI system? | BARIUM |
| Is a mixture of barium sulfate a suspension or a solution? | SUSPENSION |
| True/False: Barium sulfate never dissolves in water. | TRUE |
| True/False: Certain salts of barium are poisonous to humans, so barium contrast studies require a pure sulfate salt of barium for human consumption during GI studies. | TRUE |
| What is the ratio of barium to water for a thin mixture of barium sulfate? | 1 part barium to 1 part water |
| What is the chemical symbol for barium sulfate? | BaSO4 |
| When is the use of barium sulfate contraindicated? | if there is any chance the mixture might escape into the peritoneal cavity |
| What patient condition prevents the use of a water-soluble contrast medium for an upper GI series? | severe dehydration or iodine intolerance |
| What is the major advantage of using a double-contrast medium for esophagograms and upper GI series? | better coating and visibility of mucosa. Polyps, diverticula and ulcers are better demonstrated |
| The speed with which barium sulfate passes through the GI tract is called gastric _____. | motility |
| What is the purpose of the gas with a double-contrast media technique? | Air fills organ and creates Ba lining against the mucosa for better visibility |
| What device (beneath the radiographic table when correctly positioned) greatly reduces exposure to the technologist from the fluoro x-ray tube? | bucky slot shield |
| How is the bucky slot shield activated before the exam? | Slide the bucky to the end of the table. |
| What is the minimum level of protective apron worn during fluoro? | .5 mm Pb/Eq apron |
| What is the major benefit of using a compression paddle during an upper GI study? | Reduces exposure to the arms and hands of the radiologist |
| What are the three cardinal principles of radiation protection? | A. Time B. Distance C. Shielding |
| Which of the three cardinal principles of radiation protection is most effective in reducing exposure to the tech? | Distance |
| List the 4 advantages of digital fluoro over conventional? | 1) optional postfluoro overhead images 2) Multiple frames formatting and multiple original images 3) Cine loop capability 4) Image enhancement and manipulation |
| Which capability on most digital fluoro demonstrates a dynamic flow of contrast media through the GI tract? | Cine loop |
| Name the pathologic condition for difficulty in swallowing. | Dysphagia |
| Name the pathologic condition for replacement of normal squamous epithelium with columnar epithelium. | Barrett esophagus - nuclear medicine best choice to image this condition |
| Name the pathologic condition for may lead to esophagitis. | GERD - reflux of stomach contents into the esophagus |
| Name the pathologic condition for may be secondary to cirrhosis of the liver. | Esophageal varices - characterized by dilation of veins in distal esophagus and is often seen with acute liver disease |
| Name the pathologic condition for large outpouching of the esophagus | Zenker's diverticulum - believed to be caused by weakening of the muscle wall |
| Name the pathologic condition for cardiospasm | Achalasia - motor disorder of the esophagus where peristalsis is reduced |
| Name the pathologic condition for most common form is adenocarcinoma | carcinoma of esophagus |
| State the correct pathology for the upper GI series for blood in vomit | hematemisis |
| State the correct pathology for the upper GI series for inflammation in lining of stomach | gastritis |
| State the correct pathology for the upper GI series for blind outpouching of mucosal wall | Diverticula |
| State the correct pathology for the upper GI series for undigested material trapped in the stomach. | bezoar |
| State the correct pathology for the upper GI series for synonymous with gastric or duodenal ulcer. | peptic ulcer |
| State the correct pathology for the upper GI series for portion of the stomach protruding through the diaphragmatic wall. | hiatal hernia |
| State the correct pathology for the upper GI series for 5% of ulcers lead to this condition | perforating ulcer |
| State the correct pathology for the upper GI series for double contrast upper GI recommended for this type of tumor | Gastric carcinoma |
| State the name of the pathologic condition using the radiographic appearance: its presence indicates a possible sliding hiatal hernia | Schatzki's ring |
| State the name of the pathologic condition using the radiographic appearance: speckled appearance of gastric mucosa, absence of rugae | Gastritis |
| State the name of the pathologic condition using the radiographic appearance: "wormlike" appearance of the esophagus | Esophageal varices |
| State the name of the pathologic condition using the radiographic appearance: stricture of the esophagus | Achalasia |
| State the name of the pathologic condition using the radiographic appearance: gastric bubble above diaphragm | hiatal hernia |
| State the name of the pathologic condition using the radiographic appearance: irregular filling defect within stomach | bezoar |
| State the name of the pathologic condition using the radiographic appearance: enlarged recess in proximal esophagus. | Zenker diverticulum |
| State the name of the pathologic condition using the radiographic appearance: "lucent-halo" sign during upper GI | ulcers |
| Which procedure is often performed to detect early signs of gastroespohageal reflux disease? | endoscopy |
| Which specific stricture of the GI system is affected by hypertrophic pyloric stenosis? | hypertrophy of the antral muscle at the orifice of the pylorus |
| Which imaging modality is most effective in diagnosing HPS while reducing patient dose? | sonography |
| What does the acronym NPO stand for and what does it mean? | non per os; nil per os - nothing by mouth |
| True/False: The patient must be NPO 4-6 hours before an esophagogram. | FALSE - only if having an UPPER GI as well (NPO for 8hrs) |
| True/False: The esophagogram usually begins with fluoro with patient erect | TRUE |
| What materials may be used for swallowing to aid in the diagnosis of radiolucent foreign bodies in the esophagus? | 1) cotton balls soaked in thin barium; 2) barium pills or gelatin capsules filled with barium; 3) marshmallows followed by thin barium |
| List the four radiographic tests that may be performed to detect signs of GERD? | 1) Breathing exercises; 2) water test; 3)Compression technique; 4) toe-touch maneuver |
| A breathing technique in which the patient takes in a deep breath and bears down is called _____. | Valsalva maneuver |
| In what position is the patient usually placed during the water test? | Supine slightly LPO - puts the barium in the fundus of the stomach |
| Which region of the GI tract is better visualized when the radiologist uses a compression paddle during an esophagogram? | Esophagogastric junction |
| What type of contrast medium should be used if the patient has a history of bowel perforation? | Oral, water-soluble iodinated contrast medium |
| What is the minimum amount of time that the patient should be NPO before an upper GI? | 8 hrs |
| Why should cigarette use and gum chewing be restricted before an upper GI? | these activities tend to increase gastric secretions |
| Why should the technologist review the patient's chart before the beginning of the upper GI? | A) to identify known allergies B) To ensure proper study has been ordered C) To look for pertinent clinical history |
| In which hand does the patient usually hold the barium cup during the start of the upper GI? | left hand |
| List the suggested dosages of barium sulfate during an upper GI exam for newborn to 1 yr? | 2 - 4 oz |
| List the suggested dosages of barium sulfate during an upper GI exam for 1 to 3 years. | 4 - 6 oz |
| List the suggested dosages of barium sulfate during an upper GI exam for 3 to 10 years. | 6 - 12 oz |
| List the suggested dosages of barium sulfate during an upper GI exam for more than 10years old. | 12 - 16 oz |
| What type of fluoro generator is recommended for pediatric procedures? | Pulsed, grid-controlled fluoro (reduces dose) |
| Which modality is an alternative to an esophagogram in detecting esophageal varices? | Endoscopy |
| Gastric emptying studies are performed using _____. | Radionuclides |
| Why is RAO preferred over LAO for an esophagogram? | RAO esophagus is clearly imaged between vertebrae and heart shadow; LAO superimposes esophagus over the hilum |
| How much rotation of the body should be used for the RAO projection of the esophagus? | 35-40' |
| Which optional position should be performed to demonstrate the mid-to-upper esophagus located between the shoulders? | Optional swimmer's lateral |
| The three most common routine projections for an esophagogram are: | 1. RAO (35-40'); 2. right lateral; 3. AP (PA) |
| Which aspect of the GI tract is best demonstrated with RAO position during upper GI? | the pylorus of stomach and C-loop |
| How much rotation of body is required for RAO position during upper GI on sthenic patient? | 45-55' |
| What is the average kV range for an esophagogram and upper GI series when using barium sulfate (single contrast survey)? | 110 - 125 kV |
| What is the purpose of the PA axial for the hypersthenic patient during an upper GI? | To prevent superimposition of the pylorus over the duodenal bulb and to see better the lesser and greater curvatures of the stomach |
| What CR angle is required for the PA axial position for a hypersthenic patient during an upper GI? | 35 - 45' cephalad |
| Which projection taken during upper GI will best demonstrate the retrogastric space? | right lateral |
| What is the recommended kV range for a double-contrast upper GI projection? | 90-100 kV |
| The upper GI usually begins with the table and patient _____. | UPRIGHT or ERECT |
| The five most common routine projections for an upper GI series are (not counting AP Scout) | 1) RAO; 2) PA; 3) Right Lateral; 4) LPO; 5) AP |
| The major parts of the stomach on an average patient are usually confined to which abdominal quadrant? | Left Upper Quadrant |
| Most of the duodenum is usually found to the _____ of the midline on a sthenic patient. | right |
| True/False: Respiration should be suspended during inspiration for upper GI radiographic projections. | FALSE - expiration |
| Describe the RAO esophagogram exam. | SID - 40" ; IR - 14x17 ; 110-125kv Pt position: Recumbent (preferred) or erect; Part position: 35-40', left hold cup, left knee flexed; CR - perp to IR, to level of T6; Collimate to side to side to 5-6"; Suspend respiration on expiration |
| Describe the Esophagogram: Lateral | SID - 40" ; IR - 14x17 ; 110-125kv Pt position: Recumbent (preferred) or erect; Part position: True Lateral, arms folded front, aligned MCP CR - perp to IR, to level of T6; Collimate side to side to 5-6"; Suspend respiration Opt - swimmer's |
| What is the optional position for Esophagogram: Lateral? | recumbent Swimmer's lateral with upside arm down and behind; downside arm up and holding Ba - maintain true lateral P479 |
| Describe the Esophagogram: AP (PA). | SID - 40" ; IR - 14x17 ; 110-125kv Pt position: Recumbent (preferred) or erect; Part position: MSP to midline IR, no rotation, right arm up w/Ba; CR - perp to IR, to MSP and sternal angle (T5-T6); Collimate side to side 5-6"; expose on expiration |
| What is the special position for Esophagogram? | LAO SID - 40" ; IR - 14x17 ; 110-125kv Pt position: Recumbent (preferred) or erect; Part position: 35-40' from PA, rt arm up, rt knee flexed; CR - perp to IR, level of T6); Collimate side to side 5-6"; expose on expiration |
| Where is the esophagus displayed for the special position Esophagogram? | between hilar region of lungs and spine |
| Describe the Upper GI: RAO | SID-40" ; IR-10x12 / 11x14; Dbl - 90-100kV water soluble 80-90kV; Pt position: Recumbent; Part position: rotate 40-70', left arm/knee flexed; CR - perp to IR, Sthenic-L1 (45-50'), Asthenic-2" below L1 (40'), Hypersthenic-2" above L1 (70') expose expi |
| What anatomy should be visualized with GI:RAO? | Entire stomach and C-loop of duodenum |
| What is the centering point for Upper GI:RAO? | Sthenic - duodenal bulb at level of L1; Midway between spine and lateral border of abdomen (45'-55' oblique) Asthenic - Center 2" below L1, (40' oblique) Hypersthenic - Center 2" above L1 and nearer midline (70' oblique) |
| What anatomy is visible on Esophagogram? | entire esophagus filled with Barium |
| Describe the Upper GI: PA. | SID-40" ; IR-10x12/11x14/14x17 w/small bowel; Dbl - 90-100kV Sing 80-90kV; Pt position: prone; Part position: MSP-no rotation; CR - perp to IR, Sthenic-L1, 1" left spine, Asthenic-2" below L1, Hypersthenic-2" above L1, nearer MSP expose on expiration |
| What anatomy is visualized on Upper GI: PA | Entire stomach and duodenum |
| What is an alternate position for Upper GI: PA for hypersthenic patient? | 35-45' cephalic angle of tube will open the area between pylorus and duodenal bulb as well as better display the lesser and greater curvatures of the stomach |
| What is an alternate position for Upper GI: PA for infant patient? | 20-25' cephalic angle on tube will open the body and pylorus of stomach |
| Describe the Upper GI: Right Lateral. | SID-40"; IR-10x12/11x14/; Dbl - 90-100kV Sing 80-90kV; Pt position: right lateral; Part position: True lateral; CR - perp to IR, Sthenic-L1, 1-1.5" anterior to MCP, Asthenic-2" below L1, Hypersthenic-2" above L1; expose on expiration |
| TRUE/FALSE Stomach is generally one vertebra higher in Right Lateral than in PA or Oblique position. | TRUE |
| What anatomy is visualized with Right Lateral? | Entire stomach and duodenum, retrogastric space, pylorus of stomach and C-loop of duodenum (hypersthenic patients) |
| Describe the Upper GI: LPO | SID-40"; IR-10x12/11x14; Dbl - 90-100kV Sing 80-90kV; Pt position: recumbent, LPO; Part position: 30-60', flex rt knee; CR - perp IR, Sthenic-L1; 45', Asthenic-2" below L1 30', Hypersthenic-2" above L1, 60'; expose expiration |
| What is the centering point for Upper GI: LPO? | Sthenic - Level L1; Midway between spine and lateral border of abdomen (45' oblique) Asthenic - Center 2" below L1, nearer midline (30' oblique) Hypersthenic - Center 2" above L1, (60' oblique) |
| What anatomy is visualized with Upper GI: LPO? | Entire stomach and duodenum with unobstructed view of duodenal bulb (no superimposition of pylorus) |
| Describe the Upper GI: AP. | SID-40"; IR-10x12/11x14; Dbl - 90-100kV Sing 80-90kV; Pt position: supine; Part position: no rotation; CR - perp IR, Sthenic-L1, midway btwn midline/lateral border, Asthenic-2" below L1, near midline, Hypersthenic-2" above L1; expose expiration |
| What is the alternate position for GI: AP? | AP Trendelenburg - head-down position helps fill fundus on thin asthenic patient. Full Trendelenburg facilitates demonstration of hiatal hernia, must install shoulder brace |
| What anatomy is visualized with UGI: AP? | Entire stomach and duodenum, including diaphragm and lower lung fields for possible hiatal hernia |
Created by:
Larobbins
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