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Ch 13 Bontrager

Lower GI System

QuestionAnswer
How long is the average small bowel if removed and stretched out during autopsy? 23 feet (7 m)
In a person with good muscle tone, the entire length of the small intestine is _____. 15 - 18 feet
The average length of the large intestine is _____. 5 feet
Which division of the small intestine is the shortest? duodenum
In which two abdominal quadrants would the majority of the jejunum be found? LUQ, LLQ
Which division of the small intestine has a feathery or coiled spring appearance during a small bowel series? jejunum (2/5 of small intestine); feathery appearance from villi
Which division of the small intestine is the longest? ileum (3/5 of small intestine)
Which two aspects of the large intestine are not considered part of the colon? rectum, cecum
The colon is divided into _____ sections and has _____ flexures. four sections; two flexures
List the functions of the ileocecal valve. 1) sphincter governing passage of material into the large intestine from the small intestine; 2) prevents reflux (backward motility)
What is another term for appendix? vermiform appendix
Name the aspect of the small and/or large intestine: longest aspect of large intestine transverse colon
Name the aspect of the small and/or large intestine: widest portion of the large intestine cecum
Name the aspect of the small and/or large intestine: a blind pouch inferior to the ileocecal valve. appendix
Name the aspect of the small and/or large intestine: aspect of small intestine that is smallest in diameter, longest in length ileum
Name the aspect of the small and/or large intestine: distal part; also called the iliac colon. descending colon
Name the aspect of the small and/or large intestine: shortest aspect of small intestine duodenum
Name the aspect of the small and/or large intestine: lies in pelvis but possesses a wide freedom of motion. sigmoid colon
Name the aspect of the small and/or large intestine: makes up 40% of the small intestine. jejunum
Name the aspect of the small and/or large intestine: found between the cecum and the transverse colon. ascending colon
What is the term for the 3 bands of muscle that pull the large intestine into pouches? What are the pouches called? taeniae coli; Haustra
What is an older term for mucosal folds of jejunum? plicae circulares
Which portion of the small intestine is located primarily to the midline? jejunum
Which portion of the small intestine is located primarily in RLQ? ileum
Which portion of the small intestine is the most fixed in postion? duodenum
In which quadrant does the terminal ileum connect with the large intestine? RLQ
Which muscular band marks the junction between the duodenum and jejunum? duodenojejunal flexure
The widest portion of the large intestine is the _____. cecum (ascending colon)
Which flexure of the large intestine usually extends more superiorly? left colic flexure (splenic)
Inflammation of the vermiform appendix is called _____. appendicitis
Which of the following structures will fill with air during a double contrast barium enema with the patient supine? A) ascending colon B) transverse colon C) rectum D) sigmoid colon E) descending colon B) transverse colon D) sigmoid colon
Which aspect of the GI tract is primarily responsible for digestion, absorption and reabsorption? A) small intestine B) stomach C) large intestine D) colon A) small intestine
Which aspect of the GI tract is responsible for synthesis and absorption of vitamins B and K and amino acids? A) duodenum B) Jejunum C) large intestine D) stomach C) large intestine
Four types of digestive movements in the large intestine are listed here. Which movement types also occurs in small intestine? A. Peristalsis B. Haustral churning C. Mass Peristalsis D. Defecation A. Peristalsis
Which structures are retroperitoneal? Ascending colon; descending colon; Duodenum; upper rectum
Which structures are infraperitoneal? Lower rectum
Which structures are intraperitoneal? Cecum; transverse colon; Jejunum; Ileum; sigmoid colon
Which of the following factors/conditions pertains to radiographic study of the small intestine? A. May perform as a double contrast media study B. May be performed as enteroclysis procedure C. Timing of procedure is necessary D. All the above D. All the above
List 2 conditions that may prevent the use of barium sulfate during small bowel series. Possible perforated hollow viscus; Large bowel obstruction
Name the clinical indication for common birth defect found in ileum. Meckel's diverticulum
Name the clinical indication for common parasitic infection of the small intestine. Giardiasis
Name the clinical indication for obstruction of the large intestine. ileus
Name the clinical indication for lactose or sucrose sensitivities. malabsorption syndrome
Name the clinical indication for new growth. neoplasm
Name the clinical indication for a form of sprue. Celiac disease
Name the clinical indication for inflammation of the intestine. enteritis
Name the clinical indication for form of inflammatory disease of the GI tract regional enteritis
Name the pathology based on the radiographic appearance circular staircase or herringbone sign. Ileus - mechanical obstruction
Name the pathology based on the radiographic appearance cobblestone Crohn disease
Name the pathology based on the radiographic appearance apple core sign adenocarcinoma
Name the pathology based on the radiographic appearance dilation of intestine with thickening of circular folds Giardiasis
Name the pathology based on the radiographic appearance "beak sign" volvulus
How do you acquire Giardiasis? contaminated food/water or person to person contact
meckel's diverticulum is best diagnosed with which imaging modality? Nuclear medicine
Whipple's disease is a rare disorder of ? proximal small bowel
How much barium sulfate is generally given to an adult patient for a small bowel only series? 2 cups or 16 oz
When is a small bowel series deemed complete? When barium passes through the ileocecal valve (into cecum)
How long does it usually take to complete an adult small bowel series? 2 hours
When is the first radiograph generally taken during a small bowell series? 15-30 min after initial ingestion of contrast
True/False Fluoroscopy is sometimes used during a small bowel series to visualize the ileocecal valve. TRUE
The term enteroclysis describes what type of small bowel study? Double contrast study
What two types of contrast media are used for enteroclysis? Barium sulfate and air/methylcellulose
Which two pathologic conditions are best evaluated through an enteroclysis procedure? regional enteritis (Crohn's) and malabsorption syndrome
True/False It takes approximately 12 hours for Barium Sulfate to travel from mouth to rectum. False - 24 hours
The tip of the catheter is advanced to the _____ during an enteroclysis. duodenojejunal flexure (suspensory ligament or ligament of Treitz)
What is the purpose of introducing methylcellulose during a enteroclysis? to distend the bowel providing a double contrast effect
What is the recommended patient preparation before a small bowel series? NPO 8hrs food and fluid (additionally 48hrs prior patient should be on low-residue diet) No tobacco, gum, or nicotine products during fasting period. Patient should be asked to void prior to procedure.
Which position is recommeded for small bowel radiographs? Why? PRONE position because it compresses the bowel allowing better visibility of various loops of bowel
what is the clinical indication for a polyp? inward growth extending from the lumen of the intestinal wall
what is the clinical indication for a diverticulum? outpouching of mucosal wall
what is the clinical indication for a intussusception? telescoping of one part of intestine into another
what is the clinical indication for a volvulus? A twisting of a portion of the intestine on its own mesentery
what is the clinical indication for ulcerative colitis? severe form of colitis
what is the clinical indication for colitis? inflammatory condition of the large intestine
Which type of patient most often experiences intussusception? infant
A condition of numerous herniations of mucosal wall of large intestine is called _____. diverticulosis
Which pathologic condition may produce "tapered" or "corkscrew" radiographic sign during barium enema? A. diverticulosis B. Ulcerative colitis C. Volvulus D. Diverticulitis C. volvulus
Which condition may produce the "cobblestone" radiographic sign during barium enema? A. ulcerative colitis B. Appendicitis C. Diverticulosis D. Adenocarcinoma A. ulcerative colitis
What is the most common form of carcinoma found in the large intestine? A. simple-cell carcinoma B. basal cell carcinoma C. annular carcinoma D. Complex-cell carcinoma C. Annular carcinoma
True/False Intestinal polyps and diverticula are very similar in structure FALSE - they are opposite to each other
Ture/False Volvulus occurs more frequently in males than females. TRUE
True/False The barium enema is a commonly recommended procedure for diagnosing possible acute appendicitis. FALSE
True/False Any stool retained in the large intestine may require the postponement of a barium enema study. TRUE
Which four conditions would prevent the use of a laxative cathartic before a barium enema procedure? Gross bleeding; severe diarrhea; obstruction; inflammatory lesions
True/False An example of an irritant cathartic is magnesium citrate FALSE - castor oil is an irritant cathartic
List the 3 types of enema tips commonly used (all considered single use and disposable). a) plastic disposable; b) rectal retention tip; c)air contrast retention tip
True/False synthetic latex enema tips or gloves do not cause problems for latex-sensitive patients TRUE
What water temperature is recommended for barium enema mixtures? room temperature
To minimize spasm during a barium enema, _____ can be added to the contrast media mixture. lidocaine - however, patient can be given glucogon intravenously after spasm occurs
Describe the routine for UPPER GI: SMALL BOWEL COMBINATION 1. Routine Upper GI first 2. Notation of time first barium swallowed 3. Ingestion of second barium cup 4. 30 min PA (center high for proximal small bowel) 5. 30 min intervals (center to Iliac crest) until barium reaches cecum (approx 2hrs)
Describe the routine for SMALL BOWEL-ONLY SERIES 1. Plain abdomen x-ray (SCOUT) 2. 2 cups (16oz) barium ingested (notate time) 3. 15 to 30 min x-rays(center high for proximal small bowel) 4. 30 min interval x-rays (centered to iliac crest until barium reaches large bowel) approx 2 hrs
Describe the routine for ENTEROCLYSIS (DOUBLE-CONTRAST SMALL BOWEL SERIES) 1. Special guidewire and catheter advanced to duodenojejunal junction. 2. Thin mixture of Barium sulfate instilled 3. Air or methylcellulose instilled 4. Fluoro spot images and conventional x-rays 5. Upon completion of exam, remove guidewire/catheter
Describe the routine for INTUBATION METHOD (SINGLE-CONTRAST SMALL BOWEL SERIES) 1. Single lumen catheter advanced to proximal jejunum 2. Water soluble iodinated agent or thin barium instilled 3. Time contrast instilled notated 4. Conventional xray or fluoro spot images taken at specific time intervals
Describe the Barium Enema: AP or PA SID-40"; IR-14x17; Dbl - 90-100kV Sing 110-1250kV Iodine 80-90kV; Pt position: prone or supine; Part position: No rotation; CR - perpendicular IR and center to iliac crest; Expose suspended expiration
What anatomy is visualized on Barium Enema? Transverse colon - PA filled w/Barium on PA or AP air filled. Entire large intestine including left colic flexure visible. Include rectal ampulla at lower margin of xray.
What are the routine images for Barium Enema procedure? 1)PA or AP, 2)RAO, LAO, 3)LPO/RPO, 4)Lateral Rectum or Ventral Decub, 5)Right Lateral Decub, Left Lateral Decub, 6)PA (AP) Post evac, 7)AP Axial or AP Axial Oblique (LPO), 8)PA Axial or PA Axial Oblique (RAO)
What is the routine for Small Bowel series? PA Specials Enteroclysis or Intubation
What are other names for the Barium Enema series? BE or BaE and lower GI series
Describe the Barium Enema: RAO SID-40"; IR-14x17; Dbl - 90-100kV Sing 110-1250kV Iodine 80-90kV; Pt position: semiprone, 35-45'; Part position: RAO, left arm/knee flexed, right arm down; CR - perpendicular IR and center to iliac crest, 1" to left of MSP; Expose suspended expiration
What anatomy is visualized on Barium Enema: RAO? right colic flexure and ascending and sigmoid colon are "open", entire large intestine (except possibly left colic flexure), include rectal ampulla may need two images
Describe the Barium Enema: LAO. SID-40"; IR-14x17; Dbl - 90-100kV Sing 110-1250kV Iodine 80-90kV; Pt position: semiprone, 35-45'; Part position: LAO, right arm/knee flexed, left arm down; CR - perp to IR, center 1-2" above iliac crest, 1" to right MSP; Expose suspended expiration
What anatomy is visualized on Barium Enema: LAO? Left colic flexure open, descending colon and entire large intestine
Describe the Barium Enema: LPO and RPO SID-40"; IR-14x17; Dbl - 90-100kV Sing 110-1250kV Iodine 80-90kV; Pt position: semisupine, 35-45'; Part position: upside arm/knee flexed, downside arm down; CR - perp to IR, center to iliac crest, 1" lateral to upside MSP; Expose suspended expiration
What anatomy is visualized on Barium Enema: LPO? LPO - The RIGHT colic flexure (hepatic) and ascending/rectosigmoid portions appear open. Include rectal ampulla and entire large intestine.
What anatomy is visualized on Barium Enema: RPO? RPO - the LEFT colic flexure (splenic) and descending colon appear open. Include rectal ampulla and entire large intestine.
Describe the Barium Enema: Lateral Rectum or Ventral Decubitus Lateral. SID-40"; IR-14x17; 110-1250kV; Pt position: lateral recumbent or prone; Part position: knees flexed, arms up, no rotation; CR - perp to IR, center to ASIS and MCP; Expose suspended expiration Ventral Decub useful for double contrast study
What anatomy is visualized on Barium Enema: Lateral Rectum/Ventral Decubitus Lateral. Contrast filled rectosigmoid region.
Describe the Barium Enema: Right Lateral Decubitus (AP or PA) Double Contrast SID-40"; IR-14x17; 90-100kV; Pt position: right lateral; Part position: arms up, knees flexed, no rotation; CR - perp to IR (horizontal), center to iliac crest, and MSP; Expose suspended expiration
What anatomy is demonstrated with Barium Enema: Right Lateral Decub? Entire large intestine, including air filled left colic flexure and descending colon. Best demonstrates lateral descending colon, medial ascending colon (air up)
Describe the Barium Enema: Left Lateral Decubitus (AP or PA) Double Contrast SID-40"; IR-14x17; 90-100kV; Pt position: left lateral; Part position: arms up, knees flexed, no rotation; CR - perpendicular to IR (horizontal beam), center to iliac crest and MSP; Expose suspended expiration
What anatomy is demonstrated with Barium Enema: Left Lateral Decub? Entire large intestine, including air filled right colic flexure, ascending colon and cecum. Best demonstrates lateral ascending colon, and medial descending colon (air up)
What's the easiest way to get both the Left Lateral Decub and Right Lateral Decub during a barium enema study? Image one decub AP and one decub PA. Patient doesn't have to sit up and spin end to end to place head at other end of table.
Describe the Barium Enema: Post Evacuation PA (AP) SID-40"; IR-14x17; 90-100kV; Pt position: Prone (or supine); Part position: no rotation, MSP to midline of table; CR - perpendicular to IR, center to iliac crest and MSP; Image part after adequate evacuation Expose suspended expiration
What anatomy is demonstrated with Barium Enema: Post Evacuation? Entire large intestine with only a residual amount of contrast (able to see mucosal pattern without overexposure) (notate POST EVACUATION)
Describe Barium Enema: AP Axial or AP Axial Oblique (LPO) SID-40"; IR-11x14;Sing 110-125kV Dbl 90-100kV Iodine 80-90kV; Pt position: supine or LPO 30-40'; Part position: AP/Axial - no rotation, LPO 2" below, medial to Rt ASIS; CR - AP Axial-30-40' cephalad, LPO center 2" below ASIS/MSP; Expose susp expirat
What anatomy is demonstrated with Barium Enema: Post Evacuation Axial - AP and LPO? elongated views of rectosigmoid segment (less overlapping than 90' AP)
What are the angles for the alternate Barium Enema: PA Axial or PA Axial Oblique RAO? CR angle - 30-40' Caudad; RAO 35-45'
Describe Barium Enema: PA Axial or PA Axial Oblique (RAO) SID-40"; IR-11x14;Sing 110-125kV Dbl 90-100kV Iod 80-90kV; Pt position: prone/RAO 35-45'; Part position: PA-no rotation, RAO left arm up, left knee flexed; CR-PA-30-40' caudad, exit ASIS/MSP, RAO exit ASIS/2" left L-spinous processes; Expose susp expi
What anatomy is visualized with Barium Enema: PA Axial or PA Axial Oblique (RAO)? Elongated views of rectosigmoid segments of large intestine without excessive superimposition. Best demonstrates overlapping loops of bowel
Created by: Larobbins