Help
Options
Question
Peristalsis:
click to flip
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't know
Question
How many waves of contractions (peristalsis) occur in the filled stomach?
Remaining cards (100)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Digestive Procedures
| Question | Answer |
|---|---|
| Peristalsis: | term applied to the contraction waves by which the digestive tube propels its contents toward the rectum |
| How many waves of contractions (peristalsis) occur in the filled stomach? | three or four waves per minute |
| Average empty time of a normal stomach???? | 2 to 3 hours |
| Peristaltic frequency of the intestines????? | 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 |
| How long does it take the first part of a barium meal to reach the ileocecal valve? | 2 to 3 hours |
| Types of contrast used for imaging the Alimentary Canal | Barium sulfate – water insoluble contrast Water soluble, iodinated contrast media Air |
| Barium Sulfate is available in what form? | Dry powders (requires mixing with water) Prepared liquid form |
| Transit time for water-soluble contrast media???? | Faster than barium Normally clears the stomach in 1 to 2 hours, and the entire iodinated contrast column reaches and outlines the colon in about 4 hours |
| What contrast medium is used to inflate the esophagus and stomach with air? | CO2 Gas crystals “Fizzies” |
| Exposure time for Esophagus images???? | 0.1 second or less for upright Can be slightly longer for recumbent |
| Exposure time for stomach and small intestine????? | No longer than 0.2 for normal peristaltic activity No longer than 0.1 sec with hypermotility |
| Breathing instructions for ALL images of the stomach and small intestine | Suspended at the end of expiration |
| Breathing instructions for images of the esophagus??? | Exposure made during drinking “drink, drink, drink” (respirations temporally suspend at the beginning of deglutition naturally) |
| Where is the gonadal shield placed during fluoroscopy? | Between the patient and the table The x-ray source is emitted from behind the table and the fluoro tower is an intensification screen that receives the radiation) |
| Contrast medium used for single-contrast study of the esophagus and stomach????? | Thin barium - 30% to 50% weight/volume OR Water-soluble iodinated contrast such as gastrograffin |
| What contrast medium should be used when aspiration is a concern? | Barium |
| What contrast medium should be used when perforations are of concern?????? | Water-soluble iodinated contrast such as gastrograffin |
| What contrast mediums are used in a double contrast study of the esophagus and stomach? | Thin barium – fills the lumen Thick barium – high density, low viscosity barium used to coat the mucosal walls AIR – carbon dioxide crystals (fizzies) used to inflate the esophagus and stomach (contraindicated with gastric banding or bypass) |
| What are the routine/essential projections of the esophagus? | AP/PA Oblique (RAO/LPO) Lateral |
| Why are projections of the esophagus typically performed in the recumbent position??? | Better filling effect due to gravity Demonstrates esophageal varices better |
| What IR size/direction and collimation should be used for projections of the esophagus??? | 14 x 17 LW Collimation - Minimum of 12 x 17 LW May be able to collimate more than 12 side to side |
| At what level is the CR positioned for ALL projections of the esophagus??? | T5/T6 |
| Where is the superior margin of the IR positioned for all projections of the esophagus???? | Level with the mouth when head is in neutral position |
| Where is the center of the IR and the CR positioned for the AP/PA projection of the esophagus? | On the MSP at the level of T5/T6 |
| How much is the patient rotated for the AP/PA Oblique projection of the esophagus? | 35 to 40 degrees |
| Which oblique will best demonstrate the esophagus??? | 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 |
| Where is the center of the IR and CR positioned for the PA Oblique RAO or AP Oblique LPO projection of the Esophagus??? | 2 inches lateral from the MSP toward the elevated side and at the level of T5/T6 |
| Where is the center of the IR and CR positioned for the Lateral Projection of the Esophagus???? | On the MCP at the level of T5/T6 |
| How is the patient positioned for the lateral projection of the esophagus? | Right or left lateral recumbent (facing you is best) MCP is perpendicular to the IR Arms: Both forward or the dependent arm forward and the independent arm positioned posteriorly |
| What breathing instructions can be employed to better demonstrate esophageal varices??? | to expirate fully and then swallow the barium bolus and avoid inspiration until the exposure has been made or to take a deep breath and, while holding the breath, swallow the bolus and then perform the Valsalva maneuver |
| What gastrointestinal prep is required for an Upper GI series???? | NPO for 8 to 9 hours (including smoking, candy and gum – will stimulate gastric juices affecting the barium coating) |
| What can be employed to better demonstrate hiatal hernias and reflux | Trendelenburg Valsalva maneuver |
| What are the routine/essential projections for the Stomach in an upper GI series? | AP AP Oblique LPO Right Lateral PA PA Oblique RAO |
| What film size and direction should be used for the PA stomach??? | 10 x 12 LW for stomach 14 x 17 LW to include distal esophagus or proximal small bowel (most common) |
| Where is the center of the IR and CR positioned for the PA stomach on a 10 x 12 LW??? (average patient) | On the MSP and at the level L1/L2 (1 to 2 Inches above the Inferior rib margin |
| The PA projection are will demonstrate the pyloric canal and duodenal bulb well on which types of patients? | Asthenic and hyposthenic |
| What IR size/direction and collimation should be used when performing the PA Oblique RAO projection of the Stomach | 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 |
| How much is the patient rotated from the PA position for the PA Oblique projection of the stomach? | 40 to 70 degrees 45 for average Hypersthenic usually requires the higher amount of rotation |
| Where is the center of the IR and The CR positioned for the PA Oblique RAO stomach average patient ? | ½ way between the spine and the left lateral margin at the level of L1/L2 (1 to 2” above the inferior rib margin) |
| The RAO best demonstrates the pyloric portion and bulb for which type of patient? | sthenic |
| What IR size/direction and collimation should be used for the AP Oblique projection of the stomach??? | 10x12 LW collimated to 10x12 for small patients 14x17 LW collimated to 11 x14 for others |
| How much is the patient rotated for the AP Oblique LPO Projection of the stomach? | 30 to 60 degrees from AP 45 for average |
| Where is the Center of the IR and the CR positioned for the AP Oblique LPO projection of the stomach?? | On a sagittal plane approximately midway between the vertebrae and the left lateral margin of the abdomen ½ way between the xyphoid tip and the inferior margin of the ribs |
| What size/direction IR and collimation should be used for the Right lateral projection of the stomach | 10x12 LW collimated to at least a 10x 12 for small patients 14x17LW collimated to 11 x 14 for others |
| Where is the center of the IR and CR positioned for the Right lateral projection of the stomach??? | 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) |
| The right lateral projection demonstrates the pyloric canal and bulb best for what type of patient? | hypersthenic |
| What IR size/direction and should be used for the AP stomach | 10 x 12 LW for stomach 14 x17 LW for stomach, distal esophagus and proximal small bowel |
| 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 | On a sagittal plane passing ½ way between the MSP and the left lateral margin of the body and at a level midway between the xyphoid tip and the inferior rib margin |
| Where is the center of the IR and the CR positioned for the AP projection of the stomach on a 14x17LW IR | On the MSP at a level ½ way between the xyphoid tip and the inferior rib margin |
| AT what level should the CR be if taking stomach images in the upright position? | L3 Stomach can move inferiorly 3 to 6 inches from the recumbent to the upright position |
| What are the 3 methods of filling the small intestine for radiographic imaging? | By mouth (most common) Reflux filling (large volume BE) Enteroclysis – enteroclysis catheter, Bilbao or Sellink tube. |
| What is the minimum gastric preparation for a small bowel series??? | 8 to 9 hours NPO Preferable to have a low residue diet the 2 days prior but not often ordered. |
| Explain the SBS | Scout KUB DR checks scout Pt. drinks 2 cups Barium Abdomen x-rays are taken every 15 mins. the first hour then every thirty minutes after that until the barium transmits through the ileocecal valve. (Dr. checks each image) Dr will find terminal ileum |
| How should the room be set up for “spotting” the TI under fluoro? | Table in recumbent position Bucky tray moved to the extreme end Protective lead placed on the fluoro tower Fluoro tower pulled across table and patient Fluoro pedal where Dr can reach Monitor placed where Dr can see it Lead glove/paddle ready |
| What can be done to speed up the barium transit time for a SBS??? | 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) |
| What size/direction IR should be used for SBS images??? | 14x17 LW 14 x 17 CW may be necessary for the hypersthenic patient |
| Where is the center of the IR and the CR positioned for the early images in a small bowel series??? (within 30 minutes) | On the MSP at the level of L2 (1 to 2” above the inferior rib margin) |
| Where is the center of the IR and the CR positioned for the delayed images in a small bowel series??? (after 30 minutes) | On the MSP at the level of the iliac crests |
| What are the two basic radiologic methods of examining the large intestine??? | Single contrast, solid column, BE Double-contrast, air-contrast, ACBE |
| What type of contrast is used in the single contrast enema??? | Thin (12 to 25% weight/volume) barium or Water-soluble iodinated contrast such as gastrograffin |
| Under what conditions would the water soluble iodinated contrast media be used for a single contrast enema? | Possible perforation Possible surgical candidate Sometimes ordered as therapeutic for impaction |
| What contrast medium is used for a double contrast enema? | High density, low viscosity barium for coating the mucosal walls (75 to 90% weight/volume) Air |
| What type of intestinal prep should be performed for contrast examination of the large intestine??? | Large intestine needs to be cleaned out Varies, but typically Low residue diet 2 days prior, clear liquids the day before, mild laxatives the night before and cleansing enema the morning of. However, patient condition must be considered |
| What could be the resultant image of a large intestine that has not been cleansed? | Fecal material can cover up pathologies Fecal material can mimic pathologies (polyps) |
| At what temperature should the barium be for administration into the large intestine? | Warm 85 to 90 degrees, but below body temperature |
| In what position should the patient be in for insertion of the enema tip? | 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 |
| How high should the Barium/Contrast bag be adjusted? | No higher than 24 inches above the level of the anus |
| At what respiration phase should the enema tip be inserted? | Ask patient to relax and take slow deep breaths and insert tip during the expiration phase. |
| At what direction is the enema tip inserted?? | Superiorly and anteriorly toward the umbilicus (1 to 1 ½” anteriorly) Insertion should not exceed 4” and should never be forced |
| What projections are performed for a single contrast enema? | AP AP OBLIQUES (RPO AND LPO) AP AXIAL SIGMOID LATERAL RECTUM |
| What projections may be performed for a double contrast enema (ACBE) | 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 |
| What is the respiration phase for exposures during a contrast study of the large intestine? | Suspend respiration |
| What is the IR size/direction for the AP/PA large intestine? | 14x17 LW May need 2 14x17 CW for the hypersthenic patient |
| Where is the IR center and CR positioned for the AP/PA projection of the large intestine? | On MSP |
| What size IR is used for the PA Axial projection (sigmoid)? | 14x17 LW Or 10x12 LW |
| How is the CR directed for the PA Axial projection large intestine (sigmoid)? | 30 to 40 degrees caudad entering the midline and exiting the level of the ASIS |
| What size/direction IR should be used for the AP Axial Projection of the large intestine (sigmoid) | 10x12 LW 14x17 CW |
| Where is the center positioned for the AP Axial Projection of the large intestine (sigmoid)? | 2” above the iliac crest |
| How is the CR directed for the AP Axial projection of the large intestine (sigmoid)? | 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 |
| What size /direction IR should be used for the lateral projection of the rectum? | 10 x 12 LW |
| What position should the lateral projection of the rectum be performed? | 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 |
| Where is the center of the IR and CR positioned for the lateral projection of the large intestine (rectum)? | On the MCP at the level of the ASIS |
| What size/direction IR is used for the PA Oblique RAO projection of the large intestine? | 14 x17 LW (2) 14 x17 CW may be needed for the hypersthenic patient |
| How much should the patient be rotated for the PA Oblique RAO projection of the large intestine? | 35 to 45 degrees |
| Where is the center of the IR and the CR positioned for the PA Oblique RAO projection of the large intestine? | 1 to 2” lateral to the midsagittal plane toward the elevated side (left) and level with the iliac crest. |
| The PA Oblique RAO projection of the large intestine best demonstrates: | Open Right Colic Flexure Ascending colon Sigmoid colon |
| What size IR/Direction should be used for the PA Oblique LAO projection of the large intestine? | 14x17 LW (2) 14x17CW may be needed for the hypersthenic patient |
| How much is the patient rotated for the PA Oblique LAO projection of the large intestine? | 35 to 45 degrees from the PA |
| Where is the center of the IR and the CR positioned for the PA Oblique LAO projection of the large intestine? | 1 to 2” lateral from the MSP toward the elevated side (right) at the level of the iliac crests. |
| The PA Oblique LAO projection of the large intestine best demonstrates: | Open Left colic flexure Descending colon |
| What size/direction IR should be used for the AP Oblique (RPO/LPO) projection of the large intestine? | 14x17 LW (2) 14x17 CW may be needed for the hypersthenic patient |
| How much is the patient rotated for the AP Oblique (RPO/LPO) of the large intestine? | 35 to 45 degrees from AP |
| Where is the center of the IR and CR positioned for the AP Oblique (RPO/LPO) | 1 to 2” lateral to the midline of the body on the elevated side at the level of the iliac crest |
| The AP Oblique LPO projection of the large intestine best demonstrates: | Open right colic flexure Ascending colon Sigmoid colon |
| The AP Oblique RPO projection of the large intestine best demonstrates: | Open left colic flexure Descending colon |
| What size IR/direction IR should be used for the AP/PA projection (Right or Left lateral decubitus) of the large intestine? | 14 x 17 LW |
| How is the MSP and MCP positioned for the AP/PA projection (right or left lateral decubitus)? | MSP perpendicular to the IR MCP parallel to the IR |
| How is the CR directed for the AP/PA projection (Right or Left lateral decubitus)? | Horizontal and perpendicular to the IR Entering the MSP at the level of the iliac crests |
| The AP/PA Projection right lateral decubitus demonstrates: | Medial wall of the ascending colon Lateral wall of the descending colon |
| The AP/PA projection Left lateral decubitus best demonstrates: | Lateral wall of the ascending colon Medial wall of the descending colon |
| Enterostomy | 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 |
Created by:
rcervantes3