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Rad Pro Ch.13
Lower GI
| Question | Answer |
|---|---|
| Small Bowel Series | Often combined with an upper GI series and may be called a small bowel follow through. |
| Barium Enema (BE) | Radiographic procedure designed to study the large intestine. |
| Small Intestine | Begins at the pyloric valve of the stomach. |
| Small Intestine: | 1. Duodenum. 2. Jejunum. 3. Ileum. |
| Large Intestine | Begins at the RLQ with its connection to the small intestine and extends around the periphery of the abdominal cavity to end at the anus. |
| Situs Inversus | Abdominal and thoracic organs are reserved from their normal orientation. |
| Parts of the small intestine: | 1. Duodenum. 2. Jejunum. 3. Ileum. |
| Duodenum | is the first part of the small intestine,shortest and widest most fixed portion of the small bowel. |
| Jejunum | Contains numerous mucosal folds (plicae circulares). |
| Ileum | Is located primarily in the RUQ RLQ & LLQ; makes up the distal 3/5 of the remaining aspect of the small intestine and is the longest-portion. |
| Ileoceal Valve | Consists of 2 lips that extend into the large bowel. |
| Large Intestine: | 1. Cecum. 2. Colon. 3. Rectum. 4. Anal Canal. |
| Duodenum location: | RUQ and LUQ. |
| Jejunum location: | LUQ and LLQ. |
| Ileum location: | RUQ, RLQ, and LLQ. |
| Ileocecal valve location: | RLQ. |
| Cecum | Widest portion of the large intestine, free to move about in the RLQ. At the proximal end of the large intestine; a large blind pouch located inferior to the level of the ileocecal valve. |
| Appendix | Is a long narrow "wormlike" tube that extends from the cecum. |
| Terminal Ileum | The internal appearance of the cecum. |
| Appendicitis | Inflamed appendix. |
| Appendectomy | Surgical removal of appendix. |
| Colon consists of 4 sections and 2 flexures: | 1. Ascending Colon. 2. Transverse Colon. 3. Descending Colon.. 4. Sigmoid Colon. 1. Right (hepatic flexure). 2. Left (hepatic flexure). |
| Rectum | Extends fro the sigmoid colon to the anus; begins at S3 and is about 12 cm long. |
| The end of the large intestine is constricted to form the ________________. | Anal canal. |
| Rectal Ampulla | Is a dilated portion of the rectum located anterior to the coccyx. |
| The rectum presents ________________________. | Two anteroposterior curves. |
| Haustrum | pouches; most of the large intestine except rectum possess it. |
| Taeniae Coil | The muscular portion of the intestine wall contains 3 external bands of muscle. |
| Large Intestine vs. Small Intestine | - Large- extends around periphery of abdominal cavity. - Small- is more centrally located. |
| Small intestine Digestion: | Chemical & mechanical. |
| Small intestine Absorption: | Nutrient, H2O, salts, proteins. |
| Small intestine Reabsorption: | 95% of H2O and salts. |
| Large intestine Reabsorption: | Some of H2O and inorganic salts; vitamins B & K; amino acids. |
| Large Entestine Elimination: | Defecation. |
| Bacterial Action | Converts the remaining proteins into amino acids. |
| Vitamins B and K/Amino Acids | Produced by bacterial action, releases gases (flatus). |
| Flatus | Helps break down remaining proteins to amino acids. |
| Small Intestine Movements/Elimination | 1. Peristalsis. 2. Rhythmic segmentation. |
| Lare Intestine Movements/Elimination | 1. Peristalis. 2. Haustral Churning. 3. Mass Peristalsis. 4. Defecation. |
| Small Bowel Series | Study the form and function of the 3 components of the small bowel and detect any abdominal conditions. |
| Enteritis | Inflammation of the intestine (mainly SI); caused by bacterial or protozoan organisms and other environmental factors. |
| Gastroenteritis | When the stomach is involved; chronic irritation may cause the lumen of the intestine to become thickened, irregular, and narrowed. |
| Meckel's Diverticulum | Is a common birth defect caused by the persistence of the yolk sac (umbilical vesicle) resulting in a sac like outputting of the intestinal wall. *Nuclear Medicine Study. |
| Neoplasm | "new growth" may begin malignant . Common tumors: Adenomas and Leiomyomas. |
| Malabsorption Syndrome | Are conditions in which the gastrointestinal tract is unable to process and absorb certain nutrients. |
| Ileus | Is an obstruction of the small intestine where in the proximal jejunum is markedly expanded with air. |
| Adynamic or Paralytic | Usually involves the entire gastrointestinal tract; no fluid levels are demonstrated on the erect abdomen projection; destened with a thin bowel wall. |
| A Mechanical Obstruction | Is a physical blockage of the bowel that may be caused by tumors, adhesions, or hernia. |
| Crohn's Disease | "Cobblestone" appearance. |
| Regional enteritis (Crohn's Disease) | Is form on inflammatory bowel disease of unknown origin involving any portion of the gastrointestinal tract but commonly involving the terminal ileum; leads to scaring & thickening of the bowel wall. |
| Giardiasis | Is a common infection of the lumen of the small intestine that is caused by the flatulant protozoan giardia lamblia; spread by contaminated food or water. |
| Giardiasis | Dilated intestine with thick circular folds. |
| Small Bowel Procedures: | 1. Upper GI/small bowel combination. 2. Small bowel series alone. 3. Enteroclysis (radiographic or CT). 4. Intubation method. |
| Contraindications to BaSO4: | - Presurgical patients. - Perforated hollow viscus. - Large intestine obstruction. |
| Contraindications to water-soluble iodinated contrast media: | - Young or dehydrated patients. - Sensitivity to iodine. |
| Upper GI-Small Bowel Combination: | - Routine upper GI first (note time of first cup ingestion). - Ingest second cup. - 30-minute interval radiographs. - 1-hour interval radiographs (if needed). - Spot ileocecal valve (optional). |
| Small Bowel ONLY Series: | - Scout radiograph. - 16 ounces of BaSO4 (note time). - 15- to 30-minute radiograph (first). - 30-minute interval radiographs. - Spot ileocecal valve (optional). |
| Enteroclysis Procedure | Is a double-contrast method used to evaluate the small bowel. - Catheter advanced to duodenojejunal flexure.. - Thin barium mixture injected. - Air or methylcellulose instilled. - Fluoro and radiographic images taken.. - Intubation tube removed. |
| Enteroclysis is indicated for patients with clinical histories of: | - Ileus (small bowel obstruction). - Crohn's disease. - Malabsorption syndrome. |
| Intubation | "Small Bowel Enema". |
| Diagnostic Intubation | "Small Bowel Enema"; A single lumen tube is passed into the proximal jejunum. |
| Therapeutic Intubation | Procedure is performed often to relieve postoperative distention or to decompress a small bowel obstruction. |
| Double-lumen Catheter | Is termed a Miller-Abbott (M-A) Tube that is advanced into the stomach. |
| Intubation Room Prep: | - Fluoroscopy and radiographic imaging equipment. - Contrast media prepared. - Image receptors. - Catheters (enteroclysis and intubation). |
| Intubation Patient Prep: | - NPO—8 hours. - Low-residue diet—48 hours. - No gum chewing. - No smoking. - Ask about pregnancy. |
| Colitis | Is an inflammatory condition of the large intestine caused by bacterial infections, diet, stress, and other environmental conditions. |
| Ulcerative Colitis | Is a severe form of colitis that is most common among young adults . Coin like ulcers in the mucosal wall. |
| Diverticulosis/ Diverticulitis | Is an outpouching of the mucosal wall that results from herniation of the inner wall of the colon. |
| Neoplasms | Are common in the large intestine; carcinoma of the large intestine is the leading cause of death among both men & women; most occur in the rectum and sigmoid colon. * "Napkin-ring" or "apple-core" sign |
| Volvulus | Is a twisting of a portion of the intestine on its own mesentery leading to a mechanical type of obstruction. |
| Intussusception | Is a telescoping or invagination of one part of the intestine into another. |
| Polyps | Saclike projections; project inward into the lumen. |
| BE Patient Prep: | - Light evening meal prior to exam. - Bowel-cleansing cathartics. - NPO after midnight (8 hours minimum). - No gum chewing. - No smoking. - Enema morning of exam. |
| Cathartics | Substance that produces frequent, soft, or liquid bowel movements. |
| Contraindications to cathartics: | -Gross bleeding. - Severe diarrhea. - Obstruction. - Inflammatory lesions. |
| BE Room Prep | -Fluoroscopy room setup. -Table horizontal. -Cassettes available. -Contrast media prepared. -Towels and linen available. |
| Contrast Media for BE | - Single-use, closed-system kit. - Cold versus room temperature water. - Colloidal suspension— mix well before use. - Glucagon optional (if spasm occurs). - Topical anesthetic may be added to contrast media. |
| BE are done with the patient in the __________ position. | Sims. |
| Enema Tip Insertion: | - Communicate with patient. - Wear gloves. - Drain air from enema tubing. - Lubricate enema tip. |
| BE Insertion | Aimed toward the umbilicus; superiorly and slightly anteriorly. |
| Lower GI Procedures: | 1. Single-contrast barium enema. 2. Double-contrast barium enema. 3. Evacuative proctography (defecography). |
| Single-Contrast BE | Only positive contrast media are used. |
| Double-Contrst BE | - BaSO4 and room air. - Thicker barium used. |
| Single-Stage Procedure: | Barium and air are instilled in a single procedure that reduces time and radiation exposure to patient. |
| Two-Stage Procedure: | Preferred method used to coat the bowe; double-contrast procedure; barium is swallowed and fills the left side of the intestine including the left colic flexure. |
| Evacuative Proctography (Defecography) | Functional study of the anus and rectum that is conducted during the evacuation and rest phases of defecation (bowel movement). |
| Defecogram Contrast Media | - High-density barium. - Mechanical applicator. - Rectal tubing and tip. |
| Safety Concerns for BE: | - Review chart. - Never force enema tip. - Height of enema bag should be no higher than 24 inches above the table. - Verify the water temperature of the contrast media. - Escort patient to the restroom. |
| 15- to 30-minute radiographs- PA Small Bowel | CR 2 inches (5 cm) above iliac crest. |
| Hourly radiographs- PA Small Bowel | CR to iliac crest. |
| PA/AP BE | - No body rotation. - CR to iliac crest. |
| RAO BE | - 35°-45° oblique. - CR to iliac crest and 1 inch (2.5 cm) to left of MSP. |
| LAO BE | - 35°-45° oblique. - CR to iliac crest and 1 inch (2.5 cm) to right of MSP. |
| LPO & RPO BE | - 35°-40° R and L oblique. - CR to iliac crest and 1 inch (2.5 cm) lateral to elevated side of MSP. |
| Lateral or Ventral Decubitus | - True lateral. - CR level of ASIS and midaxillary plane. - Prone. - Horizontal beam. |
| Right Lateral Decubitus | - On cart or table. - CR to iliac crest. |
| Left Lateral Decubitus | - On cart or table. - CR to iliac crest and MSP. |
| PA (AP) Postevac | - On cart or table. - CR to iliac crest. |
| AP & AP Axial Oblique | - LPO: rotate 30°-40°. - 30°-40° cephalad. |
| PA Axial & PA Axial Oblique | - 30°-40° caudad. - CR at level of ASIS and MSP. * RAO: rotate 35°-45°. |
Created by:
sassyrad
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