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Chapter 12/13. Upper GI & Small Bowel. Alimentary Canal. _______________ Pharynx Esophagus _______________ Small intestine ______________ Anus. Accessory Organs. Salivary Glands ___________ Submandibular __________ Pancreas ____________ Gallbladder. Digestion Terms. - PowerPoint PPT Presentation
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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 OpeningsProximal
• Esophagogastric junction (cardiac orifice)
– ___________– Opening into the Stomach
– ___________– Allows food to enter
– ____________- Superior indentation off cardiac orifice
Gastro OpeningsDistal
• Pyloric Orifice – _________
– _________– allows food to enter small intestine
Stomach Anatomy• ________
– Folds
• _________– Superior portion
• _________– Large middle portion
• ______ Curvature – Medial border,
Concave
• ______Curvature – Lateral border, Convex
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 ImagingRoutine
• 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.