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Ch 12 Bontrager

Upper GI

Question	Answer
What is the weight of the average human liver?	3-4 lbs
Which abdominal quadrant contains the gallbladder?	Upper Right quadrant
What is the name of the soft tissue structure that separates the right from the left lobe of the liver?	Falciform ligament
Which lobe of the liver is the largest?	Right lobe
List the lobes of the liver.	Right lobe/left lobe/quadrate lobe/caudate lobe
True/False: the liver performs more than 100 functions.	TRUE
True/False: the average healthy adult produces 1 gallon of bile per day.	FALSE - it produces 1 quart
What are the 3 primary functions of the gallbladder?	STORE bile; CONCENTRATE bile; CONTRACT when stimulated
True/False: Concentrated levels of cholesterol in bile may lead to gallstones (choleliths).	TRUE
What is a common site for impaction (lodging) of gallstones (choleliths)?	Duodenal papillae
True/False: In about 40% of individuals, the end of the common bile duct and the end of the pancreatic duct are totally separated into 2 ducts rather than combining into one duct into the duodenum.	TRUE
True/False: Older terminology for the main pancreatic duct is the duct of Vater.	TRUE
The gallbladder is located more _____ (posterior/anterior) within abdomen.	Anterior
Cholecystocholangiography is a radiographic examination of _____.	Study of both gallbladder and biliary ducts
Which imaging modality produces cholescintigraphy?	nuclear medicine
True/False: Acute cholecystitis may produce a thickened gallbladder wall.	TRUE
Describe the location of the gallbladder based on body habitus.	Hypersthenic - high and well to right of MSP; Sthenic - less transverse and midway between lateral abdo wall and MSP; Hyposthenic/Asthenic - near MSP at level of iliac crest P458
Why is sonography better for imaging the gallbladder than the outdated oral cholecystogram?	1) No ionizing radiation; 2) detection of small calculi; 3) no contrast medium; 4) less patient preparation. P448
What is the biliary terminology for surgical removal of the gallbladder?	Cholecystectomy
What is the clinical indication for enlargement or narrowing of the biliary ducts because of the presence of stones?	Choledocholithiasis
What is the medical terminology for the condition of having gallstones?	cholelithiasis
what is the clinical indication for inflammation of the gallbladder?	Cholecystitis
What is the medical terminology for benign or malignant tumors of the gallbladder, biliary ducts, or liver?	Neoplasms
What is the clinical indication for the narrowing of the biliary ducts?	Biliary stenosis
List the seven major components of the alimentary canal.	1. Oral Cavity; 2. Pharynx; 3. esophagus; 4. Stomach; 5. Small Intestine; 6. Large Intestine; 7. Anus
List the four accessory organs of the digestive system.	1. Salivary Glands; 2. Pancreas; 3. Gallbladder; 4. Liver
What are the three primary functions of the digestive system?	INTAKE of food/digestion of food; ABSORB nutrients, water, vitamins, essential elements; ELIMINATE
What two terms refer to a radiographic examination of the pharynx and the esophagus?	ESOPHAGOGRAM or Barium Swallow
Which term describes the radiographic study of the distal esophagus, stomach and duodenum.	UPPER GI Series or UGI Series
Which three pairs of salivary glands are accessory organs of digestion associated with the mouth?	1. Parotid; 2. Submandibular; 3. Sublingual
The act of swallowing is called _____.	Deglutition
List the three divisions of the pharynx	Nasopharynx; Oropharynx; Laryngopharynx
What structures create the two indentations seen along the lateral border of the esophagus?	Aortic arch and left primary bronchus
List the three structures that pass through the diaphragm.	1. Esophagus 2. Inferior Vena Cava 3. Aorta
What part of the upper GI tract is a common site for ulcer disease?	Duodenal bulb or cap
What term describes the junction between the duodenum and jejunum? (This is a significant reference point in small-bowel studies.)	duodenojejunal flexure
The C-loop of the duodenum and pancreas are _____ (intraperitoneal or retroperitoneal) structures.	RETROPERITONEAL (located posterior to the parietal peritoneum) see ch 3 for more info
True/False: The body of the stomach curves inferiorly and posteriorly from the fundus.	FALSE; it curves anteriorly and inferiorly
The three main subdivisions of the stomach are _____.	A) Fundus B) Body C) Pylorus
The third distal portion of the stomach is divided into 2 subdivisions, what are they called?	1) Pyloric antrum 2) Pyloric canal
Another term for the mucosal folds of the stomach.	Rugae
Where will barium vs air show in the stomach if the patient is ERECT?	barium in pylorus and body of stomach, possibly in the duodenum. There will be a straight line (because of gravity) between barium and air in stomach.
Where will barium vs air show in the stomach if the patient is SUPINE?	Barium in fundus of stomach, possibly body and distal esophagus; air in inferior body and pylorus
Where will barium vs air show in the stomach if the patient is PRONE?	Barium in the pylorus, possibly the body and duodenum. Air will visualize in fundus
Name the two anatomic structures implicated in the phrase "romance of the abdomen".	Duodenum and head of pancreas
True/False: Mechanical digestion includes movements of the entire gastrointestinal tract.	TRUE
Peristaltic activity is not found in which of the following structures: A) Pharynx B) Esophagus C) Stomach D) Small intestine	A) Pharynx
Stomach contents are churned into a semifluid mass called _____.	Chyme
A churning or mixing activity that is present in the small bowel is called _____.	Rhythmic segmentation
List three groups of food that are ingested and must be chemically digested.	A) Carbohydrates B) Proteins C) Lipids
Biologic catalysts that speed up the process of digestion are called _____.	enzymes
What are the six different classifications of substances ingested:	A) carbohydrates or complex sugars B) proteins C) lipids or fats D) vitamins E) minerals F) water
Which three groups of food are ingested and are useful in the form the body absorbs them?	Vitamins, water, minerals
List the end products of digestion for CARBOHYDRATES.	simple sugars
List the end products of digestion for LIPIDS.	fatty acids and glycerol
List the end products of digestion for PROTEINS.	amino acids
What is the name of the liquid substance that aids in digestion, is manufactured in the liver, and stored in the gallbladder?	bile
How does bile assist in emulsification of fat?	It binds with the fat to create small fat droplets. The small droplets have a larger surface area providing more access for enzymes to continue breaking down the fat.
Absorption of nutrients primarily takes place in A) _____, although some substances are absorbed through the lining of the B) _____.	A) small intestine B) stomach
Of the three primary food substances, which does the body begin digesting in the mouth?	Carbohydrates
Any residues of digestion or unabsorbed digestive products are eliminated from the _____ as a component of feces.	large intestine
Peristalsis is an example of which type of digestion?	Mechanical
Which term describes food after it's mixed with gastric secretions in the stomach?	CHYME
A high and transverse stomach would be found in a _____ patient. A) hypersthenic B) Sthenic C) hyposthenic D) asthenic	HYPERSTHENIC -
A J-shaped stomach that is more vertical and lower in the abdomen, with the duodenal bulb at the level of L3-L4, would be found in a _____ patient. A) hypersthenic B) Sthenic C) hyposthenic/asthenic	C) Hyposthenic/Asthenic
In the erect position, how much will abdominal organs drop on average?	2.5 to 5 centimeters (even more with age and loss of muscle tone)
Would the fundus of the stomach be more superior or more inferior during deep inhalation? Why?	Inferior - because inhalation drops the diaphragm to expand the lungs to hold more air
What types of digestion occur in the oral cavity?	Mechanical, chemical Mastication, deglutition
What types of digestion occur in the Pharynx?	mechanical Deglutition
What types of digestion occur in the esophagus?	Deglutition, Peristalsis
What types of digestion occur in the Stomach?	Mechanical and chemical Peristalsis, Mixing
What types of digestion occur in the small intestine?	Peristalsis, rhythmic segmentation
True/False: With the use of digital fluoroscopy, the number of postfluoro radiographs ordered has greatly diminished.	TRUE
Another term for negative contrast medium is _____.	Radiolucent contrast medium (air or CO2)
What substance is most commonly ingested to produce carbon dioxide gas as a negative contrast medium for GI studies?	Calcium or magnesium citrate
What is the most common form of positive contrast medium used for studies of the GI system?	BARIUM
Is a mixture of barium sulfate a suspension or a solution?	SUSPENSION
True/False: Barium sulfate never dissolves in water.	TRUE
True/False: Certain salts of barium are poisonous to humans, so barium contrast studies require a pure sulfate salt of barium for human consumption during GI studies.	TRUE
What is the ratio of barium to water for a thin mixture of barium sulfate?	1 part barium to 1 part water
What is the chemical symbol for barium sulfate?	BaSO4
When is the use of barium sulfate contraindicated?	if there is any chance the mixture might escape into the peritoneal cavity
What patient condition prevents the use of a water-soluble contrast medium for an upper GI series?	severe dehydration or iodine intolerance
What is the major advantage of using a double-contrast medium for esophagograms and upper GI series?	better coating and visibility of mucosa. Polyps, diverticula and ulcers are better demonstrated
The speed with which barium sulfate passes through the GI tract is called gastric _____.	motility
What is the purpose of the gas with a double-contrast media technique?	Air fills organ and creates Ba lining against the mucosa for better visibility
What device (beneath the radiographic table when correctly positioned) greatly reduces exposure to the technologist from the fluoro x-ray tube?	bucky slot shield
How is the bucky slot shield activated before the exam?	Slide the bucky to the end of the table.
What is the minimum level of protective apron worn during fluoro?	.5 mm Pb/Eq apron
What is the major benefit of using a compression paddle during an upper GI study?	Reduces exposure to the arms and hands of the radiologist
What are the three cardinal principles of radiation protection?	A. Time B. Distance C. Shielding
Which of the three cardinal principles of radiation protection is most effective in reducing exposure to the tech?	Distance
List the 4 advantages of digital fluoro over conventional?	1) optional postfluoro overhead images 2) Multiple frames formatting and multiple original images 3) Cine loop capability 4) Image enhancement and manipulation
Which capability on most digital fluoro demonstrates a dynamic flow of contrast media through the GI tract?	Cine loop
Name the pathologic condition for difficulty in swallowing.	Dysphagia
Name the pathologic condition for replacement of normal squamous epithelium with columnar epithelium.	Barrett esophagus - nuclear medicine best choice to image this condition
Name the pathologic condition for may lead to esophagitis.	GERD - reflux of stomach contents into the esophagus
Name the pathologic condition for may be secondary to cirrhosis of the liver.	Esophageal varices - characterized by dilation of veins in distal esophagus and is often seen with acute liver disease
Name the pathologic condition for large outpouching of the esophagus	Zenker's diverticulum - believed to be caused by weakening of the muscle wall
Name the pathologic condition for cardiospasm	Achalasia - motor disorder of the esophagus where peristalsis is reduced
Name the pathologic condition for most common form is adenocarcinoma	carcinoma of esophagus
State the correct pathology for the upper GI series for blood in vomit	hematemisis
State the correct pathology for the upper GI series for inflammation in lining of stomach	gastritis
State the correct pathology for the upper GI series for blind outpouching of mucosal wall	Diverticula
State the correct pathology for the upper GI series for undigested material trapped in the stomach.	bezoar
State the correct pathology for the upper GI series for synonymous with gastric or duodenal ulcer.	peptic ulcer
State the correct pathology for the upper GI series for portion of the stomach protruding through the diaphragmatic wall.	hiatal hernia
State the correct pathology for the upper GI series for 5% of ulcers lead to this condition	perforating ulcer
State the correct pathology for the upper GI series for double contrast upper GI recommended for this type of tumor	Gastric carcinoma
State the name of the pathologic condition using the radiographic appearance: its presence indicates a possible sliding hiatal hernia	Schatzki's ring
State the name of the pathologic condition using the radiographic appearance: speckled appearance of gastric mucosa, absence of rugae	Gastritis
State the name of the pathologic condition using the radiographic appearance: "wormlike" appearance of the esophagus	Esophageal varices
State the name of the pathologic condition using the radiographic appearance: stricture of the esophagus	Achalasia
State the name of the pathologic condition using the radiographic appearance: gastric bubble above diaphragm	hiatal hernia
State the name of the pathologic condition using the radiographic appearance: irregular filling defect within stomach	bezoar
State the name of the pathologic condition using the radiographic appearance: enlarged recess in proximal esophagus.	Zenker diverticulum
State the name of the pathologic condition using the radiographic appearance: "lucent-halo" sign during upper GI	ulcers
Which procedure is often performed to detect early signs of gastroespohageal reflux disease?	endoscopy
Which specific stricture of the GI system is affected by hypertrophic pyloric stenosis?	hypertrophy of the antral muscle at the orifice of the pylorus
Which imaging modality is most effective in diagnosing HPS while reducing patient dose?	sonography
What does the acronym NPO stand for and what does it mean?	non per os; nil per os - nothing by mouth
True/False: The patient must be NPO 4-6 hours before an esophagogram.	FALSE - only if having an UPPER GI as well (NPO for 8hrs)
True/False: The esophagogram usually begins with fluoro with patient erect	TRUE
What materials may be used for swallowing to aid in the diagnosis of radiolucent foreign bodies in the esophagus?	1) cotton balls soaked in thin barium; 2) barium pills or gelatin capsules filled with barium; 3) marshmallows followed by thin barium
List the four radiographic tests that may be performed to detect signs of GERD?	1) Breathing exercises; 2) water test; 3)Compression technique; 4) toe-touch maneuver
A breathing technique in which the patient takes in a deep breath and bears down is called _____.	Valsalva maneuver
In what position is the patient usually placed during the water test?	Supine slightly LPO - puts the barium in the fundus of the stomach
Which region of the GI tract is better visualized when the radiologist uses a compression paddle during an esophagogram?	Esophagogastric junction
What type of contrast medium should be used if the patient has a history of bowel perforation?	Oral, water-soluble iodinated contrast medium
What is the minimum amount of time that the patient should be NPO before an upper GI?	8 hrs
Why should cigarette use and gum chewing be restricted before an upper GI?	these activities tend to increase gastric secretions
Why should the technologist review the patient's chart before the beginning of the upper GI?	A) to identify known allergies B) To ensure proper study has been ordered C) To look for pertinent clinical history
In which hand does the patient usually hold the barium cup during the start of the upper GI?	left hand
List the suggested dosages of barium sulfate during an upper GI exam for newborn to 1 yr?	2 - 4 oz
List the suggested dosages of barium sulfate during an upper GI exam for 1 to 3 years.	4 - 6 oz
List the suggested dosages of barium sulfate during an upper GI exam for 3 to 10 years.	6 - 12 oz
List the suggested dosages of barium sulfate during an upper GI exam for more than 10years old.	12 - 16 oz
What type of fluoro generator is recommended for pediatric procedures?	Pulsed, grid-controlled fluoro (reduces dose)
Which modality is an alternative to an esophagogram in detecting esophageal varices?	Endoscopy
Gastric emptying studies are performed using _____.	Radionuclides
Why is RAO preferred over LAO for an esophagogram?	RAO esophagus is clearly imaged between vertebrae and heart shadow; LAO superimposes esophagus over the hilum
How much rotation of the body should be used for the RAO projection of the esophagus?	35-40'
Which optional position should be performed to demonstrate the mid-to-upper esophagus located between the shoulders?	Optional swimmer's lateral
The three most common routine projections for an esophagogram are:	1. RAO (35-40'); 2. right lateral; 3. AP (PA)
Which aspect of the GI tract is best demonstrated with RAO position during upper GI?	the pylorus of stomach and C-loop
How much rotation of body is required for RAO position during upper GI on sthenic patient?	45-55'
What is the average kV range for an esophagogram and upper GI series when using barium sulfate (single contrast survey)?	110 - 125 kV
What is the purpose of the PA axial for the hypersthenic patient during an upper GI?	To prevent superimposition of the pylorus over the duodenal bulb and to see better the lesser and greater curvatures of the stomach
What CR angle is required for the PA axial position for a hypersthenic patient during an upper GI?	35 - 45' cephalad
Which projection taken during upper GI will best demonstrate the retrogastric space?	right lateral
What is the recommended kV range for a double-contrast upper GI projection?	90-100 kV
The upper GI usually begins with the table and patient _____.	UPRIGHT or ERECT
The five most common routine projections for an upper GI series are (not counting AP Scout)	1) RAO; 2) PA; 3) Right Lateral; 4) LPO; 5) AP
The major parts of the stomach on an average patient are usually confined to which abdominal quadrant?	Left Upper Quadrant
Most of the duodenum is usually found to the _____ of the midline on a sthenic patient.	right
True/False: Respiration should be suspended during inspiration for upper GI radiographic projections.	FALSE - expiration
Describe the RAO esophagogram exam.	SID - 40" ; IR - 14x17 ; 110-125kv Pt position: Recumbent (preferred) or erect; Part position: 35-40', left hold cup, left knee flexed; CR - perp to IR, to level of T6; Collimate to side to side to 5-6"; Suspend respiration on expiration
Describe the Esophagogram: Lateral	SID - 40" ; IR - 14x17 ; 110-125kv Pt position: Recumbent (preferred) or erect; Part position: True Lateral, arms folded front, aligned MCP CR - perp to IR, to level of T6; Collimate side to side to 5-6"; Suspend respiration Opt - swimmer's
What is the optional position for Esophagogram: Lateral?	recumbent Swimmer's lateral with upside arm down and behind; downside arm up and holding Ba - maintain true lateral P479
Describe the Esophagogram: AP (PA).	SID - 40" ; IR - 14x17 ; 110-125kv Pt position: Recumbent (preferred) or erect; Part position: MSP to midline IR, no rotation, right arm up w/Ba; CR - perp to IR, to MSP and sternal angle (T5-T6); Collimate side to side 5-6"; expose on expiration
What is the special position for Esophagogram?	LAO SID - 40" ; IR - 14x17 ; 110-125kv Pt position: Recumbent (preferred) or erect; Part position: 35-40' from PA, rt arm up, rt knee flexed; CR - perp to IR, level of T6); Collimate side to side 5-6"; expose on expiration
Where is the esophagus displayed for the special position Esophagogram?	between hilar region of lungs and spine
Describe the Upper GI: RAO	SID-40" ; IR-10x12 / 11x14; Dbl - 90-100kV water soluble 80-90kV; Pt position: Recumbent; Part position: rotate 40-70', left arm/knee flexed; CR - perp to IR, Sthenic-L1 (45-50'), Asthenic-2" below L1 (40'), Hypersthenic-2" above L1 (70') expose expi
What anatomy should be visualized with GI:RAO?	Entire stomach and C-loop of duodenum
What is the centering point for Upper GI:RAO?	Sthenic - duodenal bulb at level of L1; Midway between spine and lateral border of abdomen (45'-55' oblique) Asthenic - Center 2" below L1, (40' oblique) Hypersthenic - Center 2" above L1 and nearer midline (70' oblique)
What anatomy is visible on Esophagogram?	entire esophagus filled with Barium
Describe the Upper GI: PA.	SID-40" ; IR-10x12/11x14/14x17 w/small bowel; Dbl - 90-100kV Sing 80-90kV; Pt position: prone; Part position: MSP-no rotation; CR - perp to IR, Sthenic-L1, 1" left spine, Asthenic-2" below L1, Hypersthenic-2" above L1, nearer MSP expose on expiration
What anatomy is visualized on Upper GI: PA	Entire stomach and duodenum
What is an alternate position for Upper GI: PA for hypersthenic patient?	35-45' cephalic angle of tube will open the area between pylorus and duodenal bulb as well as better display the lesser and greater curvatures of the stomach
What is an alternate position for Upper GI: PA for infant patient?	20-25' cephalic angle on tube will open the body and pylorus of stomach
Describe the Upper GI: Right Lateral.	SID-40"; IR-10x12/11x14/; Dbl - 90-100kV Sing 80-90kV; Pt position: right lateral; Part position: True lateral; CR - perp to IR, Sthenic-L1, 1-1.5" anterior to MCP, Asthenic-2" below L1, Hypersthenic-2" above L1; expose on expiration
TRUE/FALSE Stomach is generally one vertebra higher in Right Lateral than in PA or Oblique position.	TRUE
What anatomy is visualized with Right Lateral?	Entire stomach and duodenum, retrogastric space, pylorus of stomach and C-loop of duodenum (hypersthenic patients)
Describe the Upper GI: LPO	SID-40"; IR-10x12/11x14; Dbl - 90-100kV Sing 80-90kV; Pt position: recumbent, LPO; Part position: 30-60', flex rt knee; CR - perp IR, Sthenic-L1; 45', Asthenic-2" below L1 30', Hypersthenic-2" above L1, 60'; expose expiration
What is the centering point for Upper GI: LPO?	Sthenic - Level L1; Midway between spine and lateral border of abdomen (45' oblique) Asthenic - Center 2" below L1, nearer midline (30' oblique) Hypersthenic - Center 2" above L1, (60' oblique)
What anatomy is visualized with Upper GI: LPO?	Entire stomach and duodenum with unobstructed view of duodenal bulb (no superimposition of pylorus)
Describe the Upper GI: AP.	SID-40"; IR-10x12/11x14; Dbl - 90-100kV Sing 80-90kV; Pt position: supine; Part position: no rotation; CR - perp IR, Sthenic-L1, midway btwn midline/lateral border, Asthenic-2" below L1, near midline, Hypersthenic-2" above L1; expose expiration
What is the alternate position for GI: AP?	AP Trendelenburg - head-down position helps fill fundus on thin asthenic patient. Full Trendelenburg facilitates demonstration of hiatal hernia, must install shoulder brace
What anatomy is visualized with UGI: AP?	Entire stomach and duodenum, including diaphragm and lower lung fields for possible hiatal hernia

Created by: Larobbins

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