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AP 2 - Book
Lecture 7 - UGI
| Question | Answer |
|---|---|
| A Radiographic and Fluoroscopic procedure of the distal Esophagus, Stomach, and Duodenum using contrast medium | Upper Gastrointestinal (UGI) |
| A UGI is also referred to as? | An Upper GI Series or Stomach Exam |
| What is the purpose of a UGI? | To radiographically demonstrate the form and function of the distal Esophagus, Stomach, Duodenum and to detect any abnormal anatomic and/or functional conditions |
| An erosion of the Stomach lining caused by excessive hydrochloric acid secretions, commonly found in the Body of the Stomach | Ulcers |
| Radiographically, Ulcers may appear as ______ ______ _____ when the Stomach is filled with Barium during a Single Column UGI. | Negative Contrast Defects |
| Causes of an Ulcer? | Stress, diet, smoking, excessive caffeine consumption and Helicobacter Pylori |
| A cork-shaped bacteria that is commonly found in the Stomach | Helicobacter Pylori |
| The occurence of ulcerations in the Esophagus, Stomach, or Duodenum | Peptic Ulcers |
| Where are Gastric Ulcers located? | In the Mucosal Lining of the Stomach |
| A portion of the Stomach herniates through the Esophageal Hiatus | Hiatal Hernia |
| Two types of Hiatal Hernias? | Congenital and Sliding |
| Most common type of cancer found in the Stomach | Adenocarcinoma |
| Pouch-like herniation of a portion of the mucosal wall, most arising at the posterior aspect of the Fundus | Diverticula |
| An inflammation of the lining or mucosa of the Stomach | Gastritis |
| A Gastric Obstruction in infants caused by hypertrophy of the muscles at the Pyloric Orifice causing an obstruction | Hypertrophic Pyloric Stenosis |
| Clinical Indications for a UGI Procedure: 1. 2. 3. 4. 5. 6. 7. | 1. Gastric Ulcers 2. Hiatal Hernia 3. Intrinsic or Extrinsic masses or tumors - cancer of the stomach 4. Polyps 5. Diverticula 6. Gastritis 7. Hypertrophic Pyloric Stenosis (Gastric Obstruction in Infants) |
| What does the RAO position do in a UGI exam? | Stimulate Peristalsis |
| What does the use of Thick Barium allow? | Better visualization of the mucosal lining of the Esophagus and presence of any lesions within |
| A combination of what Contrast Media is used in a UGI Procedure? 1. 2. 3. | 1. Thick Barium (3-4 parts Barium BaS04 to 1 part water) 2. Thin Barium (1 part Barium BaS04 to 1 part water) 3. E-Z Gas Crystals |
| A Negative Contrast Media, used if air contrast effect is requested by the Radiologist | E-Z Gas Crystals |
| Contraindications to Barium Sulfate: 1. 2. 3. | 1. Suspected GI or bowel perforation 2. Pre-surgery 3. Post-surgery |
| In the event of contraindication to Barium Sulfate, what is used instead? | Oral Water Soluble Contrast Media |
| Characteristics of Oral Water Soluble Contrast Media: 1. 2. 3. | 1. 37% organically bound Iodine, opacities the GI Tract, can be absorbed by body 2. Travels faster through GI Tract than Barium Sulfate (may affect timing of Overhead image - UGI (SBFT) 3. Less radiopaque than Barium - does not coat mucosal lining |
| Contraindications to Oral Water Soluble Contrast Media: 1. 2. | 1. Patient sensitivity to iodine 2. Patient with severe dehydration |
| GI Preparation for a UGI Procedure: 1. 2. 3. | 1. NPO after midnight of the day of Exam 2. Food and Fluids should be withheld for at least 8 hours 3. No smoking or chewing gum during the NPO period |
| Articles necessary for a UGI Procedure: 1. 2. 3. 4. 5. 6. 7. 8. | 1. Thick/Thin Barium (1 cup) 2. Esophotrast 3.E-Z Gas Crystals 4. Small glass of water 5. Straw for patient to drink when table is horizontal 6. Emesis Basin 7. Protective Lead Apparel 8. 14x17 IR available for Overheads - Radiologist request |
| Steps taken to prepare the Fluoroscopic Equipment for a UGI Exam in order | 1-6 |
| Place the X-ray Table in the Upright Position with footboard attached | Step 1 |
| Position the Bucky Tray at the end of the table and lock in place | Step 2 |
| Place the Bucky Slot Cover Shield over the opening in the side of the X-ray table | Step 3 |
| Place Fluoroscopy Foot Pedal (if applicable) and TV Monitor in position for use by the Radiologist | Step 4 |
| Set Control Panel for Fluoroscopy, including setting the Fluoro timer for 5 minutes (Typically high kV 90-125 is used) | Step 5 |
| Enter the patient's name, medical record number, DOB, Radiologist name, and select examination to be performed | Step 6 |
| Why is high kV typically used for Barium Sulfate examinations? | To adequately penetrate barium-filled structures |
| Preparing the patient for the examination: 1. 2. 3. | 1. Provide patient with a gown, instructions to take everything off from the waist up 2. Explain UGI procedure and obtain patient history 3. Question females about possibility of pregnancy |
| Typically no SCOUT images are taken prior to a UGI examination unless requested by a Radiologist, if a SCOUT image is requested, what projection is performed? | AP Projection of the Abdomen |
| Where is the CR directed for an AP Projection of the Abdomen? | 2-inches above the Iliac Crest (higher to include the upper abdominal region) |
| UGI Fluoroscopic Procedure - Steps to performing the Exam | 1-14 |
| The examination begins with the patient standing | Step 1 |
| If an air contrast UGI is performed, provide E-Z Gas Crystals in a small cup for the patient to throw into the back of their throat, followed with a small amount of water and instruct the patient not to Burp to keep the gas crystals in the Stomach | Step 2 |
| Place a cup of thin barium in the patient's hand | Step 3 |
| The Radiologist will instruct the patient to take a mouth full of barium and hold it in her/his mouth until instructed to drink | Step 4 |
| SPOT Images are taken of the Cardiac Orifice | Step 5 |
| Once the upright examination is complete, the technologist will remove the glass of Barium from the patient and and the table is placed in the horizontal position | Step 6 |
| The technologist will assist the patient into the recumbent position by providing a pillow underneath the patient's head - typically the Radiologist will instruct the tech to position the patient in the RAO or prone when horizontal. | Step 7 |
| Provide a straw in the cup of Barium so that the patient is able to drink while lying down and place in patient's hand | Step 8 |
| Radiologist may place in Trendelenberg position to demonstrate presence of a Hiatal Hernia | Step 9 |
| Assist the patient as they are placed in various degrees of obliquity and positions in the recumbent position per the Radiologist's instructions | Step 10 |
| The RAO position is utilized to increase Peristalsis, allowing Barium to flow into the Duodenal Bulb | Step 11 |
| The Duodenal Bulb is investigated thoroughly as it is common place for ulcers to occur | Step 12 |
| If the patient's peristaltic contractions are limited as a result of nervousness or loss of appetite, the Radiologist may begin to discuss food with the patient (to activate peristalsis) or administor Glucagon to relax the Pyloric Sphincter | Step 13 |
| The Radiologist may use a compression device attached to the underside of the Fluoro tower, compression paddle or wooden spoon to visualize possible Esophageal reflux | Step 14 |
| Imaging Techniques to detect Esophageal Reflux may be performed (Valsalva technique/water test) | Step 15 |
| SPOT Images are taken of the Pylorus, Pyloric Sphincter, Duodenal Bulb and other areas of concern | Step 16 |
| Note the size, shape, and location of the Stomach during the Fluoroscopic procedure for Overhead imaging | Step 17 |
| Where is a common place for Ulcers to occur? | Duodenal Bulb |
| Why is Glucagon sometimes administered in a UGI procedure? | To relax the Pyloric Sphincter |
| Steps for Preparing Overhead Imaging 1. 2. 3. 4. 5. 6. | 1. Remove Fluoro Tower from over patient 2. Overhead Tube brought over patient - center to table 40" SID 3. Bucky Tray from foot end - center to patient 4. 14x17 IR Lengthwise 5. Control panel - Radiographic Exposure 6. Select Exam - Set AEC |
| Why is it important to perform Overhead images immediately after the fluoroscopic examination? | So patient is imaged before to much Barium has passed the Jejunum - patient may be required to drink a couple sips of Barium before each projection is performed |
| Routine UGI Overheads 1. 2. 3. 4. 5. | 1. PA 2. 30-60 Degree RAO 3. Right Lateral 4. 30-60 Degree LPO 5. AP |
| The PA may be performed as a PA Axial by angling the CR ____ to ____ degrees _______ | 35 to 40; Cephalad |
| What does angling the CR 35-40 degrees Cephalad due when performing a PA Axial Projection? | Open up the Greater/Lesser Curvatures, Pyloric Canal and Duodenal Bulb on the Hypersthenic patient's Stomach |
| The degree of Obliquity (30-60 degrees) for the Oblique positions depends upon the patient's body habitus: Sthenic: ______ Hypersthenic: ______ Asthenic/Hyposthenic: ______ | Sthenic: 45 degrees Hypersthenic: 50-60 degrees Asthenic/Hyposthenic: 30-Degrees |
| What is the location of the Duodenal Bulb? | L-2 |
| CR Location for Overheads according to Body Habitus: 1. Hypersthenic: 2. Sthenic: 3. Hyposthenic/Asthenic: | 1. Hypersthenic: Direct CR 2-inches below the Xiphoid Process 2. Sthenic: Center at L2 (Duodenal Bulb) by directing CR 2 inches above Iliac Crest 3. Hyposthenic/Asthenic: Center 1-inch above Iliac Crest |
| Patient position when Air is in the Fundus of the Stomach and Barium Sulfate is in the Body of the Stomach a. b. c. | a. Upright position b. RAO position c. PA projection |
| Patient position when Barium is in the Fundus of the Stomach and Air is in the Body of the Stomach a. b. | a. LPO position b. AP projection |
| Structures best demonstrated on an LPO | The Duodenal Bulb, with air in the body of the Stomach and Barium in the Fundus |
| Structures best demonstrated on an RAO | The Duodenal Bulb, with Barium in the Body of the Stomach and air in the Fundus |
| Structures best demonstrated on a Right Lateral | The Pylorus of the Stomach and the C-Loop of the Duodenum - the retro-gastric space (behind stomach) should be visible to demonstrate a Gastric Diverticula |
| Post-Exam Procedure: 1. 2. 3. | 1. Manipulate/Enhance images for review 2. inform patient of possible white stools for a few days, drink fluids to eliminate Barium, take laxatives if needed 3. Patient may leave after Radiologist reviews images and indicates the UGI is complete |
| Variations in UGI Imaging of the Upper Gastrointestinal Tract is examined under Fluoro frequently for the following reasons: 1. 2. 3. | 1. Confirmation of feeding tube placement 2. Nasogastric tube placement 3. Pediatric UGI on infants through a feeding tube |
| A fluoroscopic procedure to determine if there are complications from Bariatric Surgery or performed as a 24-hour postoperative examination for detection of leaks | Bariatric UGI |
| When is a Bariatric Surgery performed? 1. 2. | 1. performed under fluoroscopy at hospitals which specialize in Bariatric Surgery 2. Bariatric Surgery is an operation that is performed in order to help severly obese individuals lose weight |
| Clinical Indications for a Bariatric UGI: 1. 2. 3. 4. 5. 6. | 1. Symptoms of "dumping syndrome" 2. suspect leakage or slipping of the Gastric Band 3. Infection 4.Ulcerations around the band 5. Obstruction 6. Inadequate weight loss |
| Fluoroscopic Procedure (Bariatric UGI) Steps: 1. 2. 3. | 1, Typically table is placed upright during procedure while patient drinks small amount of Barium or Water-Soluble contrast - if leakage is suspected 2. Fluoro room prep is similar to the routine UGI 3. Perform Overhead images upon Radiologist request |
Created by:
teresachristensen
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