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Chapter 12/13

Chapter 12/13. Upper GI & Small Bowel. Alimentary Canal. _______________ Pharynx Esophagus _______________ Small intestine ______________ Anus. Accessory Organs. Salivary Glands ___________ Submandibular __________ Pancreas ____________ Gallbladder. Digestion Terms.

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Chapter 12/13

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  1. Chapter 12/13 Upper GI & Small Bowel

  2. Alimentary Canal • _______________ • Pharynx • Esophagus • _______________ • Small intestine • ______________ • Anus

  3. Accessory Organs • Salivary Glands • ___________ • Submandibular • __________ • Pancreas • ____________ • Gallbladder

  4. Digestion Terms • _____________ – Chewing • ____________ – Swallowing • _________ – Wavelike involuntary muscle contractions

  5. Oral Cavity(Mouth) • ___________ • Hard and Soft Palate • __________ • Tongue

  6. Pharynx(Throat) • ______________ • Posterior to Nasal Cavity • ______________ • Posterior to Oral Cavity • _______________ • Posterior to Larynx

  7. Deglutition • Bolus to __________ oral cavity • Soft palate closes off ____________ • Trachea elevates and ________ folds over • Food enters ___________

  8. Esophagus • Muscular canal • Approx. 10 inches long • Starts posterior to _____________ • Ends at _____________

  9. Esophagus • Posterior to the ___________ • Anterior to _____________Vertebra • Passes through the Diaphragm • _________________

  10. Esophagus • 2 Normal indentations (Stenosis) • ___________ • ______________

  11. Esophagus • Abdominal Segment • _____________ • Attaches to the Stomach • Esophagogastric Junction _______________

  12. Modified Barium Swallow(MBS) • Evaluates ___________ • Focus is on _____________ esophagus at the area of the _____________ • Watch for __________ with various consistencies. • Epiglottis Movement

  13. MBS • Assist _____________ • Record Study • Tape • Digital

  14. Esophagus Imaging Routine • PA • RAO • Lateral • Recumbent or Erect • Expose during 3rd swallow of Barium • 90 kVp

  15. 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

  16. RAO Esophagus • ____________ • CR to T5-6 • _____________of spine • Expose during ____________ • Collimate to approx 4” transverse field • Esophagus should be between vertebral column and __________

  17. Lateral Esophagus • Rt or Lt however pt _________________ • Center at T5-6 • Mid _______________- • Collimate to approx 5-6” transverse field

  18. Gastro OpeningsProximal • Esophagogastric junction (cardiac orifice) • ___________– Opening into the Stomach • ___________– Allows food to enter • ____________- Superior indentation off cardiac orifice

  19. Gastro OpeningsDistal • Pyloric Orifice • _________ • _________– allows food to enter small intestine

  20. Stomach Anatomy • ________ – Folds • _________ – Superior portion • _________ – Large middle portion • ______ Curvature – Medial border, Concave • ______Curvature – Lateral border, Convex

  21. Stomach Anatomy • Pyloric Portion • Pyloric __________ • Pyloric _________ • Pyloric _______________ • Angular Notch – Separates the Body from Pyloric

  22. 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

  23. Body Habitus • Watch _________ for position of stomach • Hypersthenic – Higher stomach __________ • Sthenic – Mid range __________ • Hyposthenic – Lower ______________

  24. 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

  25. 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

  26. Duodenum • ________________ portion – Receives bile and pancreatic enzymes • Horizontal and ascending portion – Forms remainder of ‘C’ shape • ________________ flexure – Duodenal and jejunum transition

  27. UGI Prep • NPO ___________ • Flouro working • Radiologist equipment ready • ___________ • ____________ • Paddle • Anything else • Pt ___________________

  28. UGI • If possible pt starts ___________ • If dual contrast pt swallows ________________ • Instruct the patient not to ________

  29. UGI • ______________ Barium • Coats the esophagus and stomach • Lay the table down and assist the patient • _____________ Barium • To fill the stomach

  30. UGI with NG • ___________Barium • Large Syringe • Draw up thin barium and inject through NG • ________________

  31. UGI Imaging Routine • AP Scout • PA • Slight RAO • Steep RAO • Rt Lateral • AP • 100kVp • 40”SID

  32. The Scout Film • Prior to most fluoro procedure • Assesses _______________ • Gives an overview prior to barium

  33. AP & Scout High KUB • Supine • CR Midline • ______________iliac crest • Expose on _________________

  34. PA UGI • Prone • Center at duodenal bulb ___________ • ____________of mid-line • Watch fluoro

  35. Slight RAO • ______________ • Center at L- 1 or 2 • Halfway between ______________lateral aspect of body

  36. Steep RAO • __________ • Center as Slight RAO

  37. Rt Lateral • Pt on Rt side • Center at __________ • _______________to mid-coronal plane • Bend knees for stability

  38. Tip for L-2 finding • Level of ________________is extended • _____________!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

  39. Small Bowel Series • Patient prep • NPO ___________ • Bowel prep • Have ready • _________________ • Unless UGI 1st

  40. Small Bowel Series • Sometimes done in conjunction _______ • SBS occurs _______________overheads with timed PA • SBS only. • After _______________of Barium timed PA

  41. SBS • _____________are usually 15 min, 30 min and every 30 unless rad says otherwise • Continues until contrast reaches ___________ • Spot film of the _____________concludes SBS

  42. PA KUB • Place pt prone • CR for early films _______________iliac crest • CR for late films (after 30 min) _________

  43. Enteroclysis • _____________Small Bowel study • Requires • ____________ • Barium • Air or Methylcellulose • _________ • Rad inserts _____________to duodenum followed by solutions with spot films and rad preference overheads.

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