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Name the major organs that make up the alimentary canal:
- oral cavity
- pharynx
- esophagus
- stomach
- small intestines
- large intestines
- anus
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what is the alimentary canal?
a musculomembranous tube that goes through the mouth all the way to the anus
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name three functions of the digestive system:
- intake and/or digestion of food
- absorption of digested food particles, water, vitamins, and other essential elements
- elimination of unused material as semisolid waste products
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name two common radiographic procedures of the upper GI system:
- esophogram or barium swallow
- upper gastrointestinal series (upper GI)
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describe the esophagus's location, dimensions, etc:
- muscular, collapsible canal
- approx 10" long
- 3/4" around
- extends from C6-T11
- posterior to trachea
- narrowest part of alimentary canal
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a flap that covers the trachea to protect it from aspiration of food and other foreign objects:
epiglottis
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What is the opening where the esophagus passes through the diaphram, and at what vertebral level does this occur?
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Name the four normal constrictions of the esophagus:
- proximally where it enters the thorax
- distally where it passes through diaphragm
- indentation at the aortic arch
- indentation where it crosses the left primary bronchus
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list the layers of the esophageal wall from outer to inner:
- fibrous layer
- muscular layer
- submucosal layer
- mucosal layer
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the dilated portion of the alimentary canal located between the esophagus and the small intestines:
the stomach
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how long does it take the stomach to empty a normal meal?
2-3 hours
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where is the gastric canal, and what is its purpose?
- along the medial border of the stomach
- funnels liquid past the stomach
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- A. cardia
- B. cardiac notch
- C. Fundus
- D. Body
- E. Greater Curvature
- F. Lesser Curvature
- G. Angular Notch
- H. Pylorus
- I. Duodenum
- J. Pyloric Canal
- K. Pyloric Antrum
- L. Pyloric Portion
- M. Sulcus Intermedius
- N. Pyloric Sphincter
- O. Cardiac Sphincter
- P. Esophagus
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how is the stomach positioned in a hypersthenic patient?
high and transverse
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how is the stomach positioned in an asthenic patient?
vertical and low (more J-shaped)
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where is the stomach located (sthenic, average)?
midway between the xiphoid process and lower costal margin on the left side of the abdomen
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name some factors that affect the location of the stomach:
- body habitus
- stomach contents
- respiration
- body position
- age
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name 3 functions of the stomach:
- storage reservoir
- chemical digestion
- mechanical digestion
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a ball of masticated food prepared to be swallowed:
a bolus
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the term used for the masticated food that is traveling through the proximal part of the alimentary canal:
chyme
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name the patient positions for pictures A, B, and C:
- A. Supine
- B. Prone
- C. Erect
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What position looks radiographically identical to the RAO position exept for reversed air/barium levels?
LPO (LPO barium in fundus, RAO air in fundus)
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______ fills the fundus of the stomach when in the prone position.
- air
- because of its posterior location
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________ fills the fundus of the stomach when in the supine position.
- barium
- because of its posterior location
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contractions of the stomach:
peristalsis
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describe peristalsis of the stomach:
- 3-4 waves per minute
- waves begin in upper part of stomach & travel distally
- waves become weaker as they flow distally
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give descriptions of the duodenum (dimensions, location, etc):
- the most proximal portion of small intestine
- 8-10" long
- contains the C-shaped portion of the small intestine
- retroperitoneal
- shortest, widest, most fixed portion
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name the four sections of the duodenum:
- pyloric region (superior portion, duodenal bulb)
- descending portion (common bile & pancreatic ducts empty)
- horizontal portion
- ascending portion (fixed in place by ligament of treitz)
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Where is a common site for ulcers in the duodenum?
the pyloric region (duodenal bulb/cap)
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Where is the duodenal papilla located and what is it?
- in the descending portion of the duodenum
- a nipple-like projection; the opening where the common bile duct and pancreatic duct empty into duodenum
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What is the name of the sphincter at the duodenal papilla?
sphincter of odie
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- A. Gallbladder
- B. Cystic Duct
- C. Common Hepatic Duct
- D. Common Bile Duct
- E. Superior Portion of Duodenum
- F. Pancreatic Duct
- G. Ligament of Treitz
- H. Duodenojejunal Flexure
- I. Ascending Portion
- J. Romance of the Abdomen
- K. Horizontal Portion
- L. Head of Pancreas
- M. Duodenal Papilla
- N. Descending Portion
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Name the radiolucent contrast agents commonly used for UGI studies:
- air
- CO2 gas crystals
- gas bubble in stomach
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Name the two classes of radiopaque contrast agents commonly used for UGI studies, and examples in each class:
- water soluble iodinated contrast: gastrograffin or gastroview
- barium sulfate: thin (1 part BaSO4 to 1 part water) or thick (3-4 parts BaSO4 to 1 part water)
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name factors affecting the speed of contrast media coating:
- suspending medium
- temperature of medium (room temp faster, cold tastes better)
- consistency of preparation
- mobile function of the alimentary canal
- pathological conditions
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a radiographic examination of the pharynx and esophagus:
esophagram (barium swallow)
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What position is the pt usually in for the beginning of an esophagram?
erect, LPO
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Which contrast is negative, and which is positive?
- negative contrast: air (looks dark/black)
- positive contrast: barium (looks light/white)
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What three projections are included in a routine esophagram?
- RAO
- Lateral (R or L)
- AP
- *sometimes special: LAO to better see the esophagus between heart and spine
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What would you have the pt do if the radiologist asks for a "water test" for an esophagram, and why might he order it?
- drink water after fluoro and bend down to reach for toes
- to see if the barium comes back up
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What is the valsalvia maneuver and why might it be done?
- straining
- sometimes used to show constrictions/dilations of the esophagus or esophageal reflux
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What is the mueller maneuver and why might it be done?
- exhale, then try to breathe in with the epiglottis closed
- looking for esophageal reflux
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Why are post fluoro projections for esophagrams usually done supine?
- allows for more complete filling, slowing blood flow
- to see esophageal varices which appear as filling defects (vericose veins of esophagus, usually associated with liver disease)
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How much is a pt obliqued for an RAO esophagram?
35-40°
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where do you center for esophagram projections?
T5-T6
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which projection for an esophagram provides more visibility of pertinent anatomy between vertebrae and heart?
RAO
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Name some specifics when centering the lateral projection for an esophagram:
- top of cassette lined with teeth
- ribs superimposed
- intervertebral spaces open
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What are the instructions for a pt to follow when shooting a post-fluoro esophogram projection?
2-3 swallows of barium, tell pt when to swallow, expose on last swallow
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When centering to T5-T6 for the AP esophagram, what is your positioning landmark?
about 3" inferior to manubrial notch
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name the study and position:
RAO Esophagram (PA oblique)
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name the study and position:
Left Lateral Esophagram
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name the study and position:
AP Esophagram
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name some aspects to recognize on an AP esophagram:
- esophagus superimposed over thoracic spine
- rotation of body evidenced by symmetry of SC joints
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a radiographic procedure that examines the distal esophagus, stomach, and duodenum:
Upper GI
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What is often the primary interest of an Upper GI procedure?
the duodenal bulb because it is a common site for ulcers
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what are patient prep instructions for an Upper GI?
- NPO after midnight the night before
- no smoking
- no chewing gum
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What position does the pt begin in for an Upper GI?
erect, LPO
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basic routine projections for an UGI:
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what should be done before the radiologist arrives for an upper GI?
KUB scout film
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for an upper gi, which post-fluoro projection is the only one that is taken crosswise?
PA
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How do you center for Upper GI projections?
CR to L1-L2: about midway between xiphoid process and lower costal margin (also, 2" superior to lower costal margin)
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describe the air/barium levels for a PA projection during upper GI?
- body and pylorus filled with barium
- fundus is air-filled
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what orientation does the stomach take on in the PA projection for a UGI?
more horizontal
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what might be necessary for a PA projection of a hypersthenic pt for a UGI?
- PA axial: CR 35-45° cephalic
- ** greater and lesser curvatures also better seen w/ axial
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what might be necessary for a PA projection of an infant for a UGI?
PA axial: CR 20-25° cephalic (to open body and pylorus)
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Name a distinction to recognize a PA projection for an UGI?
the pyloric region and duodenal bulb are separated (though the hypersthenic pt may need an angle to see this separation)
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why is the lateral projection for a UGI always a right lateral?
to see the retrogastric space
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what oblique angle should a pt be rotated to for an LPO UGI projection?
30-60° (ave is 45°)
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how are the barium/air levels visualized in an LPO position for a UGI?
- fundus filled with barium
- body, pylorus air-filled (& sometimes duodenal bulb)
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For the AP projection during a UGI, what might be necessary for an asthenic pt.?
- a partial trendelenberg position may be needed to fill the fundus
- ** also helps demonstrate a hiatal hernia
- ** also helps to see gastric reflux
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name the study and position:
UGI RAO (PA Oblique Position)
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name the study and position:
UGI PA
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name the study and position:
UGI Right Lateral
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name the study and position:
UGI LPO (AP Oblique)
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name the study and position:
UGI AP
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