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RADT 313-Biliary/UGI
Covers the UGI and biliary systems for radiographic positioning
| Question | Answer |
|---|---|
| Largest solid organ in the human body | liver |
| where is liver located? | RUQ |
| where is gallbladder located in relation to the liver? | inferior and posterior surfaces |
| two major lobes of the liver | Right and left |
| what divides the major lobes of the liver | falciform ligament |
| two minor lobes of the liver | caudate and quadrate |
| what function of the liver is important in radiographic study? | production of bile |
| how much bile is produced each day? | 800-1000 mL |
| what is bile's function? | emulsify fats |
| what structures drain bile from the liver? | right and left hepatic ducts |
| the right and left hepatic ducts join to form what? | common hepatic duct |
| how does bile get from the common hepatic duct to the gallbladder? | cystic duct |
| the cystic duct and common hepatic duct join to form what? | common bile duct |
| what are the three parts of the gallbladder | fundus body and neck |
| is the fundus at the proximal or distal end of the gallbladder | distal |
| how much bile will the gallbladder normally hold? | 30-40 mL |
| what are the three functions of the gallbladder? | store bile, concentrate bile, contract when stimulated |
| what forms the most common type of gallstones? | cholesterol |
| what hormone causes gallbladder to contract? | CCK |
| where does the common bile duct enter the digestive track? | descending portion of duodenum |
| in what percent of individuals do the pancreatic duct and common bile duct enter separately into the duodenum? | 40 |
| In what percent of individuals do the pancreatic duct and common bile duct join before entering the digestive track? | 60 |
| When the common bile duct and pancreatic duct join, what is the common passageway called? | ampulla |
| what are some names for the ampulla formed by the pancreatic and common bile duct? | hepatopancreatic ampulla or ampulla of Vater |
| what is the name of the circular muscle fiber at the opening of the hepatopancreatic ampulla? | hepatopancreatic sphincter or sphincter of Oddi |
| what causes the sphincter of Oddi to relax? | CCK |
| if you want to get the gallbladder as close to the IR as possible, what position would you place the patient? | prone |
| If you wanted to assist the gallbladder in draining, what position would you place the patient? | supine |
| what is an older radiographic study that involved the patient takin an oral contrast to study the gallbladder? | oral cholecystogram |
| what imaging modality is typically used today for imaging the gallbladder? | sonography |
| why would sonography be better for imaging the gallbladder compared to traditional radiographic imaging methods? | no radiation, can detect small calculi, no contrast necessary, less patient prep |
| chole | bile |
| cysto | bladder or sac |
| choledocho | common bile duct |
| cholangio | bile ducts |
| cholecyst | gallbladder |
| cholangiography | study of biliary ducts only |
| cholecystocholangiogram | study of both the gallbladder and biliar ducts |
| cholecystography | radiographic exam of the gallbladder |
| cholegraphy | radiographic exam of the biliary system |
| location of hypersthenic gallbladder | high and away from midline |
| location of an asthenic gallbladder | low and near spine |
| which part of the gallbladder is most posterior? | neck |
| choledocholithiasis | stones in ducts |
| cholelithiasis | stones in gallbladder |
| cholecystitis | inflammation of the gallbladder |
| what are the accessory organs for the digestive system? | salivary glands, pancreas, liver, gallbladder |
| what are the functions of the digestive system? | ingestion/digestion, absorption, elimination |
| what are the three salivary glands? | parotid, submandibular, and sublingual |
| where is the parotid gland located? | near the ear |
| where is the submandibular gland located? | below the mandible |
| where is the sublingual gland located? | below the tongue |
| how much saliva may be produced daily? | 1000-1500 mL |
| what enzyme in saliva begins the digestion of starches? | amylase |
| act of chewing | mastication |
| act of swallowing | deglutition |
| what covers the trachea during deglutition to prevent food from entering airway? | epiglottis |
| the motility through digestive system (wavelike series of involuntary muscular contractions that propel solid and semisolid material through alimentary canal) | peristalsis |
| trachea is located ______ to the esophagus | anterior |
| the esophagus is located _____to the larynx and _____ to the stomach | inferior; superior |
| at what vertebral level does the esophagus go through the diaphragm? | T10 |
| at what vertebral level does the esophagus start | C5-6 |
| what are the four layers of the esophagus | fibrous, muscular, submucosal, mucosal |
| three parts of the stomach | fundus, body, pylorus |
| where is the cardia of the esophagus? | area surrounding the esophageal opening |
| what are the longitudinal mucosal folds that line the inner layer of the stomach body? | rugae |
| what are the two curvatures of the stomach | greater and lesser |
| which curvature is on the lateral border of the stomach | greater |
| which curvature is on the right side or medial border of the stomach? | lesser |
| what are the sphincters in the stomach? | cardiac and pyloric |
| which sphincter is between the stomach and esophagus? | cardiac |
| which sphincter is between the stomach and small intestine | pyloric |
| food mixed with gastric secretions | chyme |
| what is the angular notch? | separates the body from the pyloric portion |
| compared to the body of the stomach, the fundus and pylorus are generally more _______. | posterior |
| air would fill the fundus in what radiographic position(s)? | prone, erect, anterior oblique |
| what position would demonstrate fundus filled with barium? | supine, posterior oblique |
| what are the 6 categories of ingested substances? | carbohydrates, proteins, lipids, viatmins, minerals, water |
| of the 6 categroies of ingested substances, what are not chemically digested? | vitamins, minerals, water |
| what is another name for enzymes? | biologic catalysts |
| what does the term biologic catalyst imply? | accelerate reactions to digest substances |
| what are the three parts of the pancreas | head, body, tail |
| what part of the pancrease is furthest from the duodenum? | tail |
| what type of contrast is barium (radiopaque/radiolucent)? | radiopaque |
| what does it mean that barium is a colloidal susspension? | it will not dissolve in water |
| Is barium a positive or negative contrast medium? | positive |
| barium is considered an _____ substance meaning that it does not react ehemically | inert |
| how does barium get out of the GI system? | expelled rectally |
| what type of contrast should be used if perforation is suspected? | water soluble |
| why is water soluble preferred over barium for patients who will be having surgery? | water soluble, if leaked into peritoneal cavity, can be reabsorbed |
| what are common forms of watersoluble contrast used? | gastrografin, gastroview |
| how is double contrast exams accomplished for UGI? | room air or carbon dioxide gas is ingested |
| why use double contrast for the GI system? | allows for visualization of mucosal walls |
| why do we need to encourage fluid intake following barium administration? | It can harden and have to be removed surgically |
| what is the purpose of the esophagram? | study the form and function of the pharynx and esophagus |
| what is the purpose of the UGI exam? | study the form and function of the distal esophagus, stomach, and duodenum |
| where is the stomach on a hypersthenic body type? | high and transverse; level T11-T12 and to right of midline |
| where is the stomach on an asthenic body type | J shaped and low; at midline level of L3-L4 |
| what are the three cardinal principles of radiation protection in fluoroscopy? | time, distance, shielding |
| of the three cardinal principles of radiation protection, which is most effective at reducing dose in fluoroscopy? | distance |
| what are some other items of radiation protection consideration in fluoro? | bucky slot cover, protective drape, lead gloves, lead goggles, pulsed fluoro |
| condition where peristalsis is reduced along distal esophagus | achalasia |
| another name for achalasia | cardiospasm |
| chronic irritation from stomach acid that changes the lining of the esophagus and is considered pre-cancerous | barrett's esophagus |
| difficulty swallowing | dysphagia |
| condition in esophagus that correlates with cirrhosis of the liver and heart failure | esophageal varices |
| GERD stands for | gastroesophageal reflux disease |
| how is GERD commonly diagnosed? | endoscopy |
| a large outpouching of the esophagus just above the upper esophageal sphincter | zenker's diverticulum |
| what is the prep for esophagram? | none |
| How is your fluoro table positioned typically to start an esophagram | in the vertical position |
| what hand should the patient hold the barium cup in to start the esophagram procedure | left |
| what are some methods to demonstrate esophageal reflux? | valsalva maneuver, mueller maneuvar, water test, compression technique, toe-touch maneuver |
| what degree of obliquity is used for esophagrams? | 35-40 |
| True/False: Gonadal shielding should be used on all esophagram and UGI procedures | true |
| what film size is used for esophagram? | 14x17 lengthwise |
| which oblique is preferred for esophagram studies? | RAO |
| why is one oblique preferred more than another? | the RAO increases visibility of the esophagus between the vertebrae and heart |
| how wide should you collimate your field size to for an esophagram? | 5-6" |
| what respiration is used on esophagram and UGI imaging? | expose on expiration |
| what is recommended for complete esophageal filling on radiographic images? | have patient continue drinking during exposure |
| what vertebral level is the CR centered for esophagram | T5-T6 |
| why do a swimmer's lateral | better visualization of proximal esophagus |
| Why would AP or PA not be a preferred image for esophagus imaging? | projects majority of esophagus over spine |
| undigested material stuck in the stomach | bezoar |
| condition where part of the stomach protrudes through the diaphragmatic opening | hiatal hernia |
| outpouching of the mucosal wall | diverticula |
| the act of vomiting blood | hematemesis |
| the act of vomiting | emesis |
| creates large irregular filling defect within the stomach with marked or nodular edges of the stomach lining | carcinoma |
| inflammation of the linig of the stomach | gastritis |
| what does HPS stand for | Hypertrophic pyloric stenosis |
| what does HPS cause | gastric obstruction most commonly in infants |
| erosions of the stomach or duodenal mucosa that are caused by various physiologic or environmental conditions | ulcers |
| what is rapunzel syndrome? | trichobezoar that follows the intestinal track |
| what is schatzki's ring? | finglike constriction at the distal esophagus from a sliding hiatal hernia |
| what prep is necessary for UGI? | NPO after midnight |
| what vertebral level is the CR directed for a sthenic patient for most UGI positions? | L1 |
| what vertebral level is the CR directed for a hypersthenic patient for most UGI positions? | 2" above L1 |
| what vertebral level is the CR directed for an asthenic patient for most UGI positions? | 2" below L1 |
| Placing the patient in a trendelenburg would demonstrate what on the finished radiograph? | barium filled fundus, hiatal hernia |
| what is the common IR sizes for UGI? | 10x12 or 11x14; PA axial uses 14x17 as well as any UGI position requiring visualization of the small bowel |
| for single contrast exams of the esophagus and ugi, what kv range is used? | 110-125 |
| for double contrast exams of the esophagus and ugi, what kV range is used? | 90-100 |
| what mAs is used for AP/PA esophagus | 3 |
| what mAs is used for LAO/RAO esophagus | 3 |
| what mAs is used for lateral esophagus | 4 |
| what mAs is used for AP/PA stomach | 4 |
| what mAs is used for PA Axial stomach | 4 |
| what mAs is used for RAO/LAO stomach | 5 |
| what mAs is used for lateral stomach | 7 |
| what degree of obliquity is necessary for the RAO position for UGI? | 40-70 |
| who would generally require more rotation for the RAO position for UGI - hypersthenic or asthenic? | hypersthenic |
| ideally what are you trying to get in profile on the RAO UGI position? | duodenal bulb |
| what patient types would the PA axial UGI position typcially be used on? | hypersthenic and infants |
| why is the PA axial UGI position performed? | to open up the high horizontal stomach |
| what might the lateral UGI position be used to demonstrate? | retrogastric space |
| what degree of obliquity may be necessary for the LPO UGI position? | 30-60 |
| what patient type requires more rotation for the LPO UGI position? | hypersthenic |
Created by:
hschmuck1
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