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RADT 313-Biliary/UGI

Covers the UGI and biliary systems for radiographic positioning

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