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Ch. 13 Lower GI
Positioning
| Question | Answer |
|---|---|
| If the entire small intestine were removed from the body at autopsy, how long would it average? | 7 m (23 feet) |
| In one series of 100 autopsies, what did the small bowel range in length? | 15 to 31 feet |
| Where does the large intestine begin? | RLQ |
| How long is the large intestine? | About 1.5 m (5 feet) |
| What are the 2 common radiographic procedures that involve the lower GI system? | Small Bowel Series-Study of Small Intestine Barium Enema-Study of Large Intestine |
| What are the 3 parts of the small intestine in order? | Duodenum, jejunum, & ileum |
| What is the first part of the small intestine that is described as the shortest, widest, & most fixed portion of the small bowel? | Duodenum |
| *What makes up about two-fifths of the remaining aspect of the small intestine? | Jejunum |
| What does the jejunum contain? | Numerous mucosal folds. |
| What do the numerous mucosal folds of the jejunum produce? | "Feathery appearance of the jejunum" |
| What makes up the distal three-fifths of the remaining aspect of the small intestine? | Ileum |
| Where does the terminal ileum join the large intestine? | At the ileocecal valve. |
| What is an observable difference in the 3 sections of small intestine? | The internal diameter gets progressively smaller from duodenum to ileum. |
| What are the four parts the large intestine consists of? | Cecum, colon, rectum, & anal canal. |
| Are the terms large intestine & colon synonyms? | No |
| What does the colon consist of | Four sections & two flexures. |
| What is not included in the colon? | Cecum & rectum |
| What are the four sections of the colon? | 1. Ascending colon 2. transverse colon 3. descending colon 4. sigmoid colon |
| What flexures are included as part of the colon? | Right (hepatic) & left (splenic) flexures |
| What is at the proximal end of the large intestine? | Cecum |
| What is attached to the cecum? | The vermiform appendix |
| Where does the ileum join the cecum? | At the ileocecal valve. |
| What shape is the vermiform appendix? What does it extend from? | Narrow, worm-shaped tube that extends from the cecum. |
| What type of ending does the appendix have? What does this do to the appendix. | Blind; Because of this, infectious agents may enter the appendix, which cannot empty itself. |
| What may lead to narrowing of the blood vessels that feed the appendix? | Obstruction of the opening into the vermiform appendix caused by a small fecal mass. |
| What is an appendectomy? | Surgical removal of the appendix. |
| What is appendicitis? | An inflamed appendix. |
| What may lead to an appendectomy? | Appendicitis. |
| What accounts for about 50% of all emergency abdominal surgeries & is 1.5 times more common in men than in women? | Acute appendicitis. |
| What does the rectum extend from? | The rectum extends from the sigmoid colon to the anus. |
| What curves does the rectum present? | two anteroposterior curves. |
| When must the curves of the remembered? | When a rectal tube or enema tip is inserted. |
| Serious injury can occur if the enema tip is forced at the ____________ __________ into the anus & anal canal. | wrong angle |
| How many characteristics differentiate the large intestine from the small intestine? | Three. |
| What are the characteristics of the large intestine? | 1. Internal diameter of large intestine is greater than diameter of small bowel. 2. The muscular portion of the intestinal wall contains 3 external bands of longitudinal muscle fibers of the large bowel. 3. Relative position. |
| What is the taeniae coli? | 3 bands of muscle formed of longitudinal muscles. |
| What does the taeniae coli do? | Tends to pull the large intestine into pouches. |
| What are the pouches that taeniae coli produce called? | Haustrum. |
| Where does the large intestine extend? | Around the periphery of the abdominal cavity. |
| Where is the small intestine? | More centrally located. |
| What are the four primary digestive functions? | Digestion, absorption, reabsorption, & elimination. |
| Where does most digestion & absorption take place? | Within the small intestine. |
| Most salts & approximately _____ of water are reabsorbed in the small intestine. | 95% |
| T or F: Minimal reabsorption of water & inorganic salts occurs in the large intestine, as does the elimination of unused or unnecessary materials. | True. |
| What is the primary function of the large intestine? | Elimination of feces (defecation). |
| What are other functions of the large intestine? | Absorption of water, inorganic salt, vitamin K, & certain amino acids. |
| What vitamins are synthesized by bacteria & absorbed by the large intestine? | B and K |
| What digestive movements throughout the length of the small bowel consist of? | Peristalsis & rhythmic segmentation. |
| In the large intestine, what do digestive movements continue as? | Peristalsis, haustral churning, mass peristalsis, & defecation. |
| What happens during haustral churning? | A particular group of haustra remains relaxed & distended while the bands are filling up with material. |
| In haustral churning, what happens when distention reaches a certain level? | The intestinal walls contract or "churn" to squeeze the contents into the next group of haustra. |
| What does mass peristalsis tend to do? | Move the entire large bowel contents into the sigmoid colon & rectum, usually once every 24 hours. |
| What is defecation? | A so-called bowel movement, or emptying of the rectum. |
| What is a small bowel series? | A radiographic study specifically of the small intestine. |
| What are the purposes of the small bowel series? | To study the form & function of the 3 components of the small bowel & to detect any abnormal conditions. |
| Because the small bowel series examines function of the small bowel, what must the procedure be? | Timed. |
| What are contraindications to contrast media studies of the intestinal tract? | Presurgical patients & patients expected to have a perforated hollow viscus (shouldn't receive barium). Barium by mouth is contraindicated in patients with a possible large bowel obstruction. |
| What is enteritis? | Inflammation of the intestine. |
| What is gastroenteritis? | Enteritis when the stomach is also involved. |
| What is regional enteritis (segmental enteritis or Crohn's disease)? | A form of inflammatory bowel disease of unknown origin, involving any part of the GI tract but commonly involving the terminal ileum. |
| What appearance does regional enteritis produce? | "cobblestone" |
| What happens in advanced cases of regional enteritis? | Segments of the intestine become narrowed, producing the "string sign". |
| What does regional enteritis lead to? | Intestinal obstruction, fistula, & abscess formation. Also has a high rate of recurrence after treatment. |
| What is Giardiasis? | A common infection of the lumen of the small intestine that is caused by the flagellate protozoan. AKA food poisoning. |
| How is giardiasis often spread? | By contaminated food & water. |
| What can confirm the presence of the Giardia organism? | Laboratory analysis of a stool speci?men. |
| What is an ileus? | An obstruction of the small intestine. |
| What are the two types of ileus? | Adynamic or paralytic & mechanical |
| What is adynamic, or paralytic, ileus due to? | The cessation of peristalsis. |
| What are causes for adynamic ileus? | infection, the use of certain drugs, & postsurgical complications. |
| What is a mechanical obstruction? | A physical blockage of the bowel that may be caused by tumors, adhesions, or hernia. |
| What is Meckel's diverticulum? | A common birth defect caused by the persistence of the yolk sac resulting in a saclike outpouching of the intestinal wall. |
| Meckel's diverticulum does not typically cause symptoms unless _________________ or __________________ develops. | inflammation (diverticulitis) or bowel obstruction |
| Neoplasm | "new growth," may be benign or malignant |
| Radiographic appearance of neoplasm | Narrowed segments of intestine; "apple-core" or "napkin-ring sign"; partial or complete obstruction. |
| Sprue & malabsorption syndromes | Conditions in which the GI tract is unable to process & absorb certain nutrients |
| Celiac disease | A form of sprue or malabsorption disease; commonly involves the insoluble protein (gluten) found in cereal grains. |
| Whipple's disease | A rare disorder of the proximal small bowel whose cause is unknown. Symptoms include dilation of the intestine, edema, malabsorption, deposits of fat in the bowel wall, & mesenteric nodules. |
| Four methods used to study the small intestine. | Upper GI-small bowel combination, small bowel-only series, enteroclysis, intubation method. |
| For an upper GI-small bowel combination, what routine is performed first? | Upper GI series. |
| During a routine upper GI series, the patient generally should ingest | One full cup, or 8 oz of barium. |
| What is the patient given after completion of fluoroscopy & routine radiography of the stomach? | 1 additional cup of barium to ingest. |
| Upper GI-small bowel combo, what is noted? | Time, after completion of fluoro & patient has been given one additional cup of barium. |
| What is obtained 30 minutes following the initial barium ingestion? (Upper GI-small bowel combo) | A PA radiograph of the proximal small bowel. |
| How long are radiographs obtained at specific intervals throughout the small bowel series? | Until the barium sulfate column passes through the ileocecal valve. |
| For the first 2 hours in the small bowel series, radiographs are usually obtained at ______________________________________. | 15-minute to 30-minutse intervals. |
| If the small bowel series needs to be continued beyond the two hour time frame, how often are radiographs obtained? | Every hour until barium passes. |
| What should happen as soon as each radiograph in the small bowel series is processed? | It should be reviewed by the radiologist. |
| The region of the terminal ileum & the ileocecal valve generally is studied ___________________. | Fluoroscopically. |
| ______________ of the terminal ileum usually indicates completion of the examination. | Spot filming |
| The radiologist may request ____________ radiographs to follow the barium through the entire large bowel. | delayed |
| A barium meal given by mouth usually reaches the rectum within _____________. | 24 hours |
| What type of radiograph should be obtained before the contrast medium is introduced in a small-bowel only series? | Abdomen |
| For the small bowel-only series, how much barium does the patient ingest? | Two cups (16 oz) & the time is noted. |
| In a small bowel-only series, when is the first radiograph taken? | 15 minutes or 30 minutes after completion of barium ingestion. |
| What does the first radiograph of the small bowel-only series require? | High centering to include the diaphragm. |
| Small bowel-only series: when are radiographs taken after the initial image? | Generally, every half-hour for 2 hours followed by radiographs every hour thereafter until barium reaches the cecum or ascending colon. |
| In the routine small bowel series, how long does it take for barium to reach the large intestine? | 2 or 3 hours, but this time varies among patients. |
| What is a enteroclysis procedure? | A double-contrast method that is used to evaluate the small bowel. |
| What does enteroclysis describe? | The injection of a nutrient or medicinal liquid into the bowel. |
| What does enteroclysis refer to? | A study wherein the patient is intubated under fluoroscopic control with a special enteroclysis catheter. |
| How is a duodenojejunal tube placed into the terminal duodenum? | With fluoroscopy guidance. |
| What is the first step of the enteroclysis procedure? | A high-density barium is injected through this catheter at a rate of 100 mL/min. |
| Enteroclysis-what is injected into the bowel to distend it, which provides a double-contrast effect? | Air or methylcellulose |
| *What are the disadvantages of enteroclysis? | Increased patient discomfort & the possibility of bowel perforation during catheter placement. |
| What happens when the enteroclysis procedure is completed? | The catheter is removed, & the patient is encouraged to increase his or her water intake for the day. Laxatives may also be recommended to promote evacuation of the barium sulfate. |
| Enteroclysis-Many departments perform a _____________ procedure. | dual-modality |
| What is the purpose of the barium enema? | To demonstrate radiographically the form & function of the large intestine to detect any abnormal conditions. |
| What are the two strict contraindications for the barium enema? | A possible perforated hollow viscus & a possible large bowel obstruction. |
| What may help prevent problems during the barium enema procedure? | Careful review of the patient's chart & clinical history. |
| What is it important to determine before undergoing the barium enema? | Whether the patient has had a recent sigmoidoscopy or a colonoscopy. |
| *If a biopsy of the colon was performed during sigmoidoscopy or colonoscopy, what may be weakened? | The involved section of the colon wall. |
| When is the barium enema generally not performed? | In cases of acute appendicitis because of the danger of perforation. |
| Colitis | An inflammatory condition of the large intestine that may be caused by many factors, including bacterial infection, diet, stress, & other environmental conditions. |
| Ulcerative colitis | A severe form of colitis that is most common among young adults. Often leads to coinlike ulcers within the mucosal wall. Along with Crohn's disease, it's one of the most common forms of inflammatory bowel disease. |
| What may patients with long-term bouts of ulcerative colitis develop? | "stovepipe" colon, in which haustral markings & flexures are absents. |
| Diverticulum | An outpouching of the mucosal wall that may result from herniation of the inner wall of the colon. |
| Numerous diverticula | diverticulosis |
| If any of the diverticula become infected | diverticulitis |
| *How do diverticula appear? | As small, barium-filled, circular defects that project outward from the colon wall. |
| Intussusception | A telescoping of one part of the intestine into another. Most common in infants younger than 2 but can occur in adults. A BE or an air/gas enema may play a therapeutic role in re-expanding the involved bowel. |
| What must intussusception be resolved quickly? | So that it does not lead to obstruction & necrosis of the bowel. |
| Where are neoplasms common? | In the large intestine. |
| What do neoplasms of the colon do? | These tumors often encircle the lumen of the colon, producing an irregular channel through it. "apple-core" or "napkin-ring" lesions. |
| Annular carcinoma (adenocarcinoma) | An "apple-core" or "napkin-ring" appearance |
| *Polyps | Projections similar to diverticula except that they project inward into the lumen rather than outward |
| Volvulus | A twisting of a portion of the intestine on its own mesentery, leading to a mechanical type of obstruction. |
| BE: The section of the alimentary canal to be examined must be _____________. | empty |
| *Contraindications to laxatives (cathartics) | Gross bleeding, severe diarrhea, obstruction, & inflammatory conditions such as appendicitis. |
| Classes of laxatives | Irritant laxatives, such as castor oil; Saline laxatives, such as magnesium citrate or magnesium sulfate. |
| Why can the importance of a clean large intestine for a double-contrast BE not be overstated? | Any retained fecal matter may obscure the normal anatomy or may yield false diagnostic information, leading to rescheduling of the procedure after the large intestine has been properly cleaned. |
| For BE room prep, how should the fluoro room, table, & control panel be? | Room & table-clean & tidy for each patient; Control panel-set for fluoroscopy, with the appropriate technical factors selected. |
| For BE room prep, what should be set aside? | The anticipated number of needed IRs for postprocedure "overhead" images. Protective lead aprons & lead gloves. |
| How should the fluoro table be set for BE room prep? | Placed in the horizontal position, with waterproof backing or disposable pads placed on the tabletop. |
| BE room prep: Where must the Bucky tray be positioned? | At the foot end of the table. |
| What should be readily available (BE room prep)? | Tissues, towels, replacement linen, bedpan, extra gowns, a room air freshener, & a waste receptacle. Appropriate contrast medium or media, container, tubing, & enema tip should be prepared. Proper lubricant should be provided. |
| After the BE has been completed, what may happen to the barium? | Much of the barium can be drained back into the bag by lowering the system to below tabletop level. The entire bag & tubing are disposed of after a single use. |
| Three most common enema tips. | Plastic disposable, rectal retention, & air-contrast retention enema tips. |
| Enema tips: What happens after rectal insertion? | The balloon is carefully inflated with air through a small tube to assist the patient in retaining the barium enema. |
| How should retention catheters be fully inflated? | Only under fluoroscopic guidance provided by the radiologist. |
| Most common forms of negative-contrast media. | Room air, nitrogen, & carbon dioxide. |
| *kV range for a water-soluble, negative-contrast agent. | 85 to 95 kVp |
| Why do some experts recommend the use of cold water in the prep of contrast media? | It's reported to have an anesthetic effect on the colon & to increase the retention of contrast media. |
| Room temperature water is recommended by most experts for completion of _____________________________. | a more successful exam with maximal patient comfort. |
| T or F: The tech should use hot water to prepare contrast media. | False |
| Because barium sulfate produces a colloidal suspension, what is important? | Shaking the enema bag before tip insertion. |
| What is a common side effect during the barium enema? | Spasm |
| What type of gown is used for a barium enema? | A cotton gown with the opening & ties in the back is preferable. The type of gown that must be pulled over the patient's head for removal should never be used. |
| What happens after the fluoroscopic room & contrast media have been prepared? | Patient is escorted to the exam room. Pt history should be taken & exam should be carefully explained. |
| Sim's position | Patient is asked to roll onto the left side & lean forward. The right leg is flexed at the knee & hip is placed in front of the left leg. |
| What should happen before insertion of the enema tip? | The barium sulfate solution should be well mixed & a little of the barium mixture run into a waste receptacle to ensure no air remains in the tubing or enema tip. |
| Prep for rectal tip insertion: | Tech must don protective gloves. Rectal tip is well lubricated with a water-soluble lubricant. |
| Patient instructions prior to rectal tip insertion | 1. Not to push the tip out of the rectum by bearing down once the tip is inserted. 2. To relax the abdominal muscles to prevent increased intra-abdominal pressure. 3. To concentrate on breathing by mouth to reduce spasms & cramping. |
| The opening in the back of the patient's gown should be adjusted to expose only __________________. | the anal region |
| What should be protected in every way possible during the barium enema? | Patient's modesty |
| *If the tip will not enter with gentle pressure, what should the patient be asked to do? | Relax & assist if possible. |
| *The tip should never be __________. | Forced in a manner that could cause injury to the patient. |
| During what phase of respiration should the tip be inserted? | Expiration, Because the abdominal muscles relax on expiration, the tip should be inserted during the exhalation phase of respiration. |
| Initial insertion should be aimed __________. | Toward the umbilicus. After the initial insertion, the rectal tube is directed superiorly & slightly anteriorly. |
| The total insertion of the tip should not exceed _____________. | 3 to 4 cm ( 1 1/4 to 1 1/2 inches) |
Created by:
Casinger2015