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AP 2 - Book
Lecture 6 - Esophogram
| Question | Answer |
|---|---|
| Another name for an Esophogram? | Barium Swallow |
| What is the purpose of an Esophogram? | Form and function of the Pharynx and Esophagus |
| Gastric contents reflux into the Esophagus "Heartburn" | Gastroesophageal Reflux Disease (GERD) |
| Inflammation of the Esophagus, seen as irregular or ulcer filled defects of the Esophagus when filled with Barium. | Esophagitis |
| Also known as a "Cardio spasm", Peristalsis along distal 2/3rds of the Esophagus (damaged nerves), causing difficulty passing food or liquid into the Stomach, Rare. | Achalasia |
| Stricture or narrowing in the Esophagus (lower), abnormal cell change associated with adenocarcinoma (most common esophageal cancer). | Barrett's Esophagus |
| Dilation of veins in distal Esophagus - cobble stone appearance | Esophageal Varices |
| Clinical Indications of an Esophogram: 1. 2. 3. 4. 5. 6. | 1. Esophageal Reflux (Heartburn) 2. Hiatal Hernia 3. Dysphagia (difficulty swallowing) 4. Abnormalities (Congenital Birth Defects, strictures, lesions, Varices) 5. External Esophageal masses (Compression) impaired swallowing 6. Foreign Body |
| Refluxed Gastric contents, Heartburn, irritation of Esophageal lining | Esophageal Reflux |
| Stomach protrusion through Esophageal Hiatus into Thoracic Cavity | Hiatal Hernia |
| Difficulty or Dysfunctional Swallowing | Dysphagia |
| Impaired Swallowing | Deglutition |
| Thick Barium mixture | 3-4 parts BaS04 (Barium) → 1 part water |
| What does thick barium better visualize? | the mucosal lining of the Esophagus and Lesions |
| Thin Barium mixture | 1 part BaS04 (Barium) → 1 part water |
| 100% Barium Sulfate, no water | Esophotrast |
| Negative contrast media - if Air is requested in an Esophogram, causes patient to feel the need to burp. | E-Z Gas Crystals |
| A Combination of which of the following Contrast Media is used for an Esophogram procedure and prepped before the procedure? 1. 2. 3. 4. | 1. Thick Barium 2. Thin Barium 3. E-Z Gas Crystals 4. Esophotrast |
| What are the GI preparation instructions for an Esophogram? What are the instructions if a UGI is ordered along with an Esophogram? | No Preparation instructions; with a UGI ordered, NPO after midnight |
| Why is there no GI preparation requirements for a patient prior to an Esophogram procedure? | Because the Esophagus is a collapsible tube and does not retain contents within, therefore the typical bowel preparation or clear liquid diet prior is not necessary |
| Supplies needed for an Esophogram: 1. 2. 3. 4. 5. 6. 7. | 1. Thick/Thin Barium (1 cup each) 2. Esophotrast 3. E-Z Gas Crystals 4. Small Glass of Water - Straw 5. Emesis Basin 6. Lead Apron 7. 14x17 IR's (not in room, per request) |
| Steps to preparing Equipment for an Esophogram: 1. 2. 3. 4. 5. 6. | 1. Table upright, footboard attached 2. Bucky tray at end of table, locked 3. Place Bucky Slot Cover Shield (curtain) up on side of x-ray table 4. Fluoro foot pedal and tv monitor placed in position for Radiologist 5. Control Panel 6. Cineloop (opt.) |
| What is the Control Panel setup when preparing equipment for an Esophogram? 1. 2. 3. | 1. Fluoro timer - 5 minutes 2. High kV 90-125 3. Patient info, Radiologist name, and exam being performed |
| Why is high kV needed for an Esophogram procedure? | For thorough penetration of the Barium filled structures being viewed and imaged |
| Patient preparation prior to the exam: 1. 2. 3. 4. | 1. Gown patient → clothes off from the waist up 2. Explain procedure and obtain patient history 3. Question females → possible pregnancy 4. No SCOUTS prior - unless requested by Radiologist |
| Put in Proper Order the Steps that are Taken When Performing an Esophogram Procedure | 1-10 |
| Procedure begins with the patient standing in the Vertical position | Step 1 |
| Technologist places Thin Barium in the patient's hand. Radiologist does a general survey, no Barium, of the Pharynx, Esophagus, Chest and Diaphragm. | Step 2 |
| Radiologist tells patient to hold Barium in their mouth until swallow instructions are given. | Step 3 |
| Radiologist observes various positions while patient is swallowing Barium. | Step 4 |
| Spot images taken to observe (Hypopharynx (motor control), Aspiration into Lungs -Causes - Fistula, Esophagus/Trachea connection abnormal) | Step 5 |
| Upright complete → remove Barium, table horizontal (patient recumbent assist with pillow) | Step 6 |
| Radiologist will instruct technologist to assist the patient in the Prone or RAO position when in the horizontal position | Step 7 |
| Straw is placed in the cup of Thick Barium and placed in patient's Hand | Step 8 |
| Radiologist may place table in slight Trendelenberg position to demonstrate the presence of a Hiatal Hernia | Step 9 |
| Different imaging techniques are performed to detect Esophageal Reflux including which of the following? 1. 2. 3. | Step 10 1. Breathing Exercises (Valsalva Maneuver most common) 2. Water test 3. Compression Paddle Technique |
| What are the possible imaging techniques the Radiologist may perform during an Esophogram to detect Esophageal Reflux? 1. 2. 3. | 1. Valsalva Maneuver 2. Water test 3. Compression Paddle Technique |
| Most common breathing technique, patient instructed to take deep breath, while holding the breath in, bear down as if trying to move the bowels - forces air against closed glottis, increasing abdominal pressure refluxes barium into Esophagus from Stomach | Valsalva Maneuver |
| Patient is placed in a slight LPO position so the Fundus of the Stomach fills with Barium, patient is instructed to swallow a mouthful of water through a straw. | Water test |
| Located on the underside of the Fluoro table or separate device; compression used to provide pressure in the Stomach region to detect possible Esophageal Reflux. | Compression Paddle Technique |
| SPOT images during an Esophogram may be performed of the following areas of the Esophagus: 1. 2. 3. 4. 5. | 1. Indentations of the Esophagus 2. Esophageal Hiatus 3. Cardiac Antrum 4. Cardiac Orifice 5. Cardiac Sphincter |
| Routine Overheads preparation steps for imaging: 1. 2. 3. 4. 5. 6. | 1. Remove fluoro tower - slide back 2. Center overhead x-ray tube over patient 40in SID 3. Bring Bucky Tray back to center (from feet) 4. 14x17 IR Lengthwise 5. Switch Control Panel to Radiographic Exposure 90-125 kV 6. Select Exam, AEC (part imaged) |
| What are the routine images than are performed after an Esophogram? 1. 2. 3. | 1. Bilateral/Unilateral Oblique Positions → 35-40 degrees RAO/LAO - RPO/LPO (preference or patient condition) 2. Lateral (not common) 3. AP (not common) |
| If patient is placed Unilateral → RAO or LPO, where is the Esophagus placed? | Between the Thoracic Spine and the Heart Shadow |
| What is best demonstrated on a 35–40-degree RAO/LPO Oblique Position? | The Esophagus visible between the Thoracic Vertebrae and Heart |
| What is best demonstrated on a 35–40-degree LAO/RPO Oblique Position? | The Esophagus visible between the Hilar Region of the Lungs and the Thoracic Spine |
| Post Examination Procedures after an Esophogram is performed: 1. 2. 3. | 1. Manipulate/Enhance images for Radiologist review 2. Inform patient → white stools for a few days, drink plenty of water to help eliminate the Barium, take laxatives if constipation occurs. 3. Patient may leave after image review and Radiologist Ok |
Created by:
teresachristensen
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