Digestive Procedures
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| show | term applied to the contraction waves by which the digestive tube propels its contents toward the rectum
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| How many waves of contractions (peristalsis) occur in the filled stomach? | show 🗑
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| Average empty time of a normal stomach???? | show 🗑
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| show | greatest in the upper part of the canal and gradually decreases toward the lower portion
3 to 4 second intervals in the duodenum and jejunum
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| show | 2 to 3 hours
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| show | Barium sulfate – water insoluble contrast
Water soluble, iodinated contrast media
Air
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| Barium Sulfate is available in what form? | show 🗑
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| Transit time for water-soluble contrast media???? | show 🗑
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| show | CO2 Gas crystals
“Fizzies”
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| show | 0.1 second or less for upright
Can be slightly longer for recumbent
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| show | No longer than 0.2 for normal peristaltic activity
No longer than 0.1 sec with hypermotility
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| show | Suspended at the end of expiration
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| show | Exposure made during drinking
“drink, drink, drink”
(respirations temporally suspend at the beginning of deglutition naturally)
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| Where is the gonadal shield placed during fluoroscopy? | show 🗑
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| show | Thin barium - 30% to 50% weight/volume
OR
Water-soluble iodinated contrast such as gastrograffin
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| show | Barium
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| show | Water-soluble iodinated contrast such as gastrograffin
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| What contrast mediums are used in a double contrast study of the esophagus and stomach? | show 🗑
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| What are the routine/essential projections of the esophagus? | show 🗑
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| show | Better filling effect due to gravity
Demonstrates esophageal varices better
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| What IR size/direction and collimation should be used for projections of the esophagus??? | show 🗑
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| show | T5/T6
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| show | Level with the mouth when head is in neutral position
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| show | On the MSP at the level of T5/T6
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| How much is the patient rotated for the AP/PA Oblique projection of the esophagus? | show 🗑
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| show | PA Oblique RAO or AP Oblique LPO
Makes it possible to obtain a wider space for an unobstructed image of the esophagus between the vertebrae and the heart
PA Oblique RAO best – better filling of the esophagus
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| Where is the center of the IR and CR positioned for the PA Oblique RAO or AP Oblique LPO projection of the Esophagus??? | show 🗑
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| show | On the MCP at the level of T5/T6
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| How is the patient positioned for the lateral projection of the esophagus? | show 🗑
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| What breathing instructions can be employed to better demonstrate esophageal varices??? | show 🗑
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| show | NPO for 8 to 9 hours
(including smoking, candy and gum – will stimulate gastric juices affecting the barium coating)
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| What can be employed to better demonstrate hiatal hernias and reflux | show 🗑
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| What are the routine/essential projections for the Stomach in an upper GI series? | show 🗑
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| show | 10 x 12 LW for stomach
14 x 17 LW to include distal esophagus or proximal small bowel (most common)
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| Where is the center of the IR and CR positioned for the PA stomach on a 10 x 12 LW??? (average patient) | show 🗑
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| show | Asthenic and hyposthenic
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| show | 10 x 12 LW collimated to a 10 x12 for a small patient
14 x 17 LW collimated to an 11 x 14 for others
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| show | 40 to 70 degrees
45 for average
Hypersthenic usually requires the higher amount of rotation
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| show | ½ way between the spine and the left lateral margin at the level of L1/L2 (1 to 2” above the inferior rib margin)
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| show | sthenic
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| What IR size/direction and collimation should be used for the AP Oblique projection of the stomach??? | show 🗑
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| How much is the patient rotated for the AP Oblique LPO Projection of the stomach? | show 🗑
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| Where is the Center of the IR and the CR positioned for the AP Oblique LPO projection of the stomach?? | show 🗑
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| show | 10x12 LW collimated to at least a 10x 12 for small patients
14x17LW collimated to 11 x 14 for others
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| show | ½ way between the MCP and the anterior margin of the abdomen
At the level of L1/L2 (1 to 2” above the inferior rib margin)
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| The right lateral projection demonstrates the pyloric canal and bulb best for what type of patient? | show 🗑
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| show | 10 x 12 LW for stomach
14 x17 LW for stomach, distal esophagus and proximal small bowel
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| Where is the center of the IR and the CR positioned for the AP projection of the stomach on a 10 x 12 LW IR | show 🗑
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| show | On the MSP at a level ½ way between the xyphoid tip and the inferior rib margin
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| show | L3
Stomach can move inferiorly 3 to 6 inches from the recumbent to the upright position
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| show | By mouth (most common)
Reflux filling (large volume BE)
Enteroclysis – enteroclysis catheter, Bilbao or Sellink tube.
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| What is the minimum gastric preparation for a small bowel series??? | show 🗑
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| Explain the SBS | show 🗑
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| How should the room be set up for “spotting” the TI under fluoro? | show 🗑
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| show | Have ambulatory patient walk in between images (non ambulatory patients should be placed in an RAO or Right lateral position)
Some radiologists will instruct to give ice water, coffee, tea or water soluble contrast medium (if dr advises)
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| show | 14x17 LW
14 x 17 CW may be necessary for the hypersthenic patient
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| Where is the center of the IR and the CR positioned for the early images in a small bowel series??? (within 30 minutes) | show 🗑
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| show | On the MSP at the level of the iliac crests
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| What are the two basic radiologic methods of examining the large intestine??? | show 🗑
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| show | Thin (12 to 25% weight/volume) barium
or
Water-soluble iodinated contrast such as gastrograffin
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| show | Possible perforation
Possible surgical candidate
Sometimes ordered as therapeutic for impaction
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| show | High density, low viscosity barium for coating the mucosal walls (75 to 90% weight/volume)
Air
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| What type of intestinal prep should be performed for contrast examination of the large intestine??? | show 🗑
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| show | Fecal material can cover up pathologies
Fecal material can mimic pathologies (polyps)
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| At what temperature should the barium be for administration into the large intestine? | show 🗑
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| show | Sims
Left lateral recumbent
Right leg flexed and drawn upward and resting in front of the left so that patient is in a slight oblique (35 to 40 degrees) and the left leg extended
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| show | No higher than 24 inches above the level of the anus
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| At what respiration phase should the enema tip be inserted? | show 🗑
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| At what direction is the enema tip inserted?? | show 🗑
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| show | AP
AP OBLIQUES (RPO AND LPO)
AP AXIAL SIGMOID
LATERAL RECTUM
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| show | AP and or PA
AP and or PA Obliques
AP or PA axial sigmoid
AP or PA right and left lateral decubs
Lateral Rectum (recumbent or cross table-decubs)
Possible AP upright
Possible Obliques upright
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| show | Suspend respiration
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| What is the IR size/direction for the AP/PA large intestine? | show 🗑
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| show | On MSP
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| What size IR is used for the PA Axial projection (sigmoid)? | show 🗑
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| How is the CR directed for the PA Axial projection large intestine (sigmoid)? | show 🗑
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| show | 10x12 LW
14x17 CW
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| show | 2” above the iliac crest
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| show | 30 to 40 degrees cephalad on the MSP and 2” below the level of the ASIS
at the inferior margin of the pubic symphysis when the rectosigmoid is needed
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| What size /direction IR should be used for the lateral projection of the rectum? | show 🗑
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| show | Can be R or L
Can be recumbent lateral
Can be lateral projection ventral or dorsal decub (ventral most common)
Some radiologists will require removal of the enema tip for the lateral projection
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| show | On the MCP at the level of the ASIS
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| show | 14 x17 LW
(2) 14 x17 CW may be needed for the hypersthenic patient
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| How much should the patient be rotated for the PA Oblique RAO projection of the large intestine? | show 🗑
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| Where is the center of the IR and the CR positioned for the PA Oblique RAO projection of the large intestine? | show 🗑
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| show | Open Right Colic Flexure
Ascending colon
Sigmoid colon
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| What size IR/Direction should be used for the PA Oblique LAO projection of the large intestine? | show 🗑
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| How much is the patient rotated for the PA Oblique LAO projection of the large intestine? | show 🗑
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| Where is the center of the IR and the CR positioned for the PA Oblique LAO projection of the large intestine? | show 🗑
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| show | Open Left colic flexure
Descending colon
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| What size/direction IR should be used for the AP Oblique (RPO/LPO) projection of the large intestine? | show 🗑
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| How much is the patient rotated for the AP Oblique (RPO/LPO) of the large intestine? | show 🗑
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| show | 1 to 2” lateral to the midline of the body on the elevated side at the level of the iliac crest
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| The AP Oblique LPO projection of the large intestine best demonstrates: | show 🗑
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| show | Open left colic flexure
Descending colon
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| show | 14 x 17 LW
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| show | MSP perpendicular to the IR
MCP parallel to the IR
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| show | Horizontal and perpendicular to the IR
Entering the MSP at the level of the iliac crests
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| The AP/PA Projection right lateral decubitus demonstrates: | show 🗑
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| show | Lateral wall of the ascending colon
Medial wall of the descending colon
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| show | General tem applied to the surgical procedure of forming an artificial opening to the intestine usually through the abdominal wall, for fecal passage.
Colostomy
Cecostomy
Ileostomy
jejunostomy
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rcervantes3