Transcript Chapter 14
Chapter 12/13 Upper GI & Small Bowel Alimentary Canal • • • • • • • _______________ Pharynx Esophagus _______________ Small intestine ______________ Anus Accessory Organs • Salivary Glands – ___________ – Submandibular – __________ • Pancreas • ____________ • Gallbladder Digestion Terms • _____________ – Chewing • ____________ – Swallowing • _________ – Wavelike involuntary muscle contractions Oral Cavity (Mouth) • ___________ • Hard and Soft Palate • __________ • Tongue Pharynx (Throat) • ______________ – Posterior to Nasal Cavity • ______________ – Posterior to Oral Cavity • _______________ – Posterior to Larynx Deglutition • Bolus to __________ oral cavity • Soft palate closes off ____________ • Trachea elevates and ________ folds over • Food enters ___________ Esophagus • Muscular canal – Approx. 10 inches long – Starts posterior to _____________ – Ends at _____________ Esophagus • Posterior to the ___________ • Anterior to _____________Vertebra • Passes through the Diaphragm – _________________ Esophagus • 2 Normal indentations (Stenosis) – ___________ – ______________ Esophagus • Abdominal Segment – _____________ • Attaches to the Stomach – Esophagogastric Junction _______________ Modified Barium Swallow (MBS) • Evaluates ___________ • Focus is on _____________ esophagus at the area of the _____________ • Watch for __________ with various consistencies. – Epiglottis Movement MBS • Assist _____________ • Record Study – Tape – Digital Esophagus Imaging Routine • • • • • • PA RAO Lateral Recumbent or Erect Expose during 3rd swallow of Barium 90 kVp PA Esophagus • Place pt ____with head turned toward tech • Center mid-sagittal at _________ • Have top of cassette at ___________and center to film • Have pt take ______________of barium. Expose on _______ • Collimate to approx 4” transverse field RAO Esophagus • • • • • • ____________ CR to T5-6 _____________of spine Expose during ____________ Collimate to approx 4” transverse field Esophagus should be between vertebral column and __________ Lateral Esophagus • Rt or Lt however pt _________________ • Center at T5-6 • Mid _______________• Collimate to approx 5-6” transverse field Gastro Openings Proximal • Esophagogastric junction (cardiac orifice) – ___________– Opening into the Stomach – ___________– Allows food to enter – ____________- Superior indentation off cardiac orifice Gastro Openings Distal • Pyloric Orifice – _________ – _________– allows food to enter small intestine Stomach Anatomy • ________ – Folds • _________ – Superior portion • ______ Curvature – Medial border, Concave • ______Curvature – Lateral border, Convex • _________ – Large middle portion Stomach Anatomy • Pyloric Portion – Pyloric __________ – Pyloric _________ – Pyloric _______________ • Angular Notch – Separates the Body from Pyloric Air-Barium Distribution • _____________ – Barium in Fundus, Air in Body/Pylorus • ____________ – Barium in Body/Pylorus, Air in Fundus • ____________ – Barium in Body/Pylorus leveled off, Air in Fundus Body Habitus • Watch _________ for position of stomach • Hypersthenic – Higher stomach __________ • Sthenic – Mid range __________ • Hyposthenic – Lower ______________ Small Bowel Anatomy • _______________ – 1st and shortest portion off of stomach (Pyloric sphincter) • _____________ – 2nd portion off Duodenum (Duodenojejunal flexure). Feathery appearance • ____________ – 3rd and longest portion. Terminates at ileocecal valve (RLQ) Smoother apperance Duodenum • • • • First portion of small intestine 8-10 inches long ‘C’ shaped due to head of __________ ____________– 1st portion of duodenum. – Must be seen on UGI study Duodenum • ________________ portion – Receives bile and pancreatic enzymes • Horizontal and ascending portion – Forms remainder of ‘C’ shape • ________________ flexure – Duodenal and jejunum transition UGI Prep • NPO ___________ • Flouro working • Radiologist equipment ready – ___________ – ____________ – Paddle – Anything else • Pt ___________________ UGI • If possible pt starts ___________ • If dual contrast pt swallows ________________ – Instruct the patient not to ________ UGI • ______________ Barium – Coats the esophagus and stomach • Lay the table down and assist the patient • _____________ Barium – To fill the stomach UGI with NG • ___________Barium • Large Syringe • Draw up thin barium and inject through NG • ________________ UGI Imaging Routine • • • • • • • • AP Scout PA Slight RAO Steep RAO Rt Lateral AP 100kVp 40”SID The Scout Film • Prior to most fluoro procedure • Assesses _______________ • Gives an overview prior to barium AP & Scout High KUB • Supine • CR Midline • ______________iliac crest • Expose on _________________ PA UGI • Prone • Center at duodenal bulb ___________ • ____________of mid-line • Watch fluoro Slight RAO • ______________ • Center at L- 1 or 2 • Halfway between ______________lateral aspect of body Steep RAO • __________ • Center as Slight RAO Rt Lateral • Pt on Rt side • Center at __________ • _______________to mid-coronal plane • Bend knees for stability Tip for L-2 finding • Level of ________________is extended • _____________!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Small Bowel Series • Patient prep – NPO ___________ – Bowel prep • Have ready – _________________ – Unless UGI 1st Small Bowel Series • Sometimes done in conjunction _______ – SBS occurs _______________overheads with timed PA • SBS only. – After _______________of Barium timed PA SBS • _____________are usually 15 min, 30 min and every 30 unless rad says otherwise • Continues until contrast reaches ___________ • Spot film of the _____________concludes SBS PA KUB • Place pt prone • CR for early films _______________iliac crest • CR for late films (after 30 min) _________ Enteroclysis • _____________Small Bowel study • Requires – ____________ – Barium – Air or Methylcellulose – _________ • Rad inserts _____________to duodenum followed by solutions with spot films and rad preference overheads.