RAD-146 CH.13 LOWER GI

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what is the purpose and what is a small bowel series
this exam frequently followes what other exam
- it is a radiographic examination of the small intestine
- upper GI series
list the quadrants of the following
Duodenum:
Jejunum:
Ileum:
Ileocecal valve:
- RUQ and LUQ
- LUQ and LLQ
- RUQ, RLQ, and LLQ
- RLQ
- C= cecum
- A = ascending colon
- H = right (hepatic) flexure
- U = Haustra
- T = transversve colon
- S = left splenic flexure
- D = descending colon
- G = sigmoid colon
- R = rectum and anal canal
what structure join at the terminal ileum and ileocecal valve

cecum
what are the three differences n the large instestine vs the small intestine
- internal diameter
- haustra (taenia coli)
- relative location
in a supine position the barium and air are where

barium in ascending and descending colon air in recto sigmoid colon and transverse colon
in the prone position where is the barium and air

air ascending and descending colonbarium in rectosigmoid and transverse colon
list the four Small bowel procedures
- Upper GI/small bowel combination
- SBS alone
- Enteroclysis (radiographic or CT)
- Intubation method
One more what are the contraindications to using barium and water soluble iodinated contrast media like gastroview
- barium:
- presurgical pts
- pts with perforated hollow viscus
- large intestine obstructions
- sensitivity
- Iodinated contrast:
- pts with history of sever dehydration or young pts
- sensitivity (allergy) to iodine
how much barium is needed for a SBS

16oz
an enteroclysis is used to diagnose what pathology in a SBS (3)
- ileus (small bowel obstruction)
- chrons disease
- malabsorption syndrom
Explain the enteroclysis procedure
- a catheter place inside the duodenaljejunal flexure
- then a thin barium is injected
- if its double contrast study air or methylcellulose can be instilled
- then fluoro and radiographic images are take n
what is the pt prep for SBS, enteroclysis and intubation procedure
- NPO - 8hrs
- low residue diet for 48 hrs (jello)
- no gum chewing
- no smoking
- and ask abt pregnancy
What is the difference between polyps and diverticula?
- diverticula form small outpuchings outwards on the areas of the haustra
- polyps are fleshy growths that grow inward or on inside of the colon
what pathology does a BE show (6)
- ulcerative colitis
- Diverticulosis
- neoplasms (apple core or napkin ring lesions)
- volvulus (which leads to necrosis)
- intussusception
- appendicitis
what is a volvulus

defined as a complete twisting of a loop of intestine around its mesenteric attachment site which leads to necrosis
Intussusception

Intussusception occurs when one portion of the bowel slides into the next, much like the pieces of a telescope
what is the pt prep for a BE
- light evening meal prior to exam - jello
- bowel cleansing cathartics
- NPO aftermidnight 8 hrs minimum
- no gum chewing
- no smoking
what are cathartics
list examples
what are the two types
- substance that produces frequent soft liquid bowel movements
- dulcolax mirolax
- irritant (rarely used)
- saline
what are the contraindications to using cathartics
- gross bleeding
- severe diarrhea
- obstruction
- inflammatory lesions
how much barium is needed fir a BE single and double contrast
- single 1500ml
- double 500 ml
what is the temperature of water used to mx barium for a BE

warm room temperature never hot
the balloon tip that is inserted into the rectume can only blown to how much air

1 squeeze gives 90ml of air
what is the position of the pt for a BE procedure

modified sims position lying on left side with right leg flexed to expose the rectum
what four things must we keep in mind when inserting the tip in the rectume
- 1.communicate with patient
- 2.ear gloves
- 3.drain air from enema tubing
- 4.lubricate enema tip
what barium is used for a double contrast BE

thick barium (1:1 ratio) and room air temp for air administered
which lower GI procedure is uncommon and what are its clinical indications
evacuative proctogram (defecography)- functional study of the anus and rectume during evacuation phases and rest phases of defecation
- clinical indications:
- rectoceles
- rectal intussusception
- prolapse of rectum
what are the 5 safety concerns of a BE procedure
- 1. review chart history
- 2.never for an enema tip it should be sucked in once inserted
- 3.height of enema bag should be no higher than 2 in above the table
- 4.verify the water temp of the contrast media
- 5.escort pt to the restroom
what is the routine and special procedures for an SBS
- routine: PA
- special: Intubation method, enteroclysis
why is a pa the routine for a SBS

b/c it helps compress the intestines and spread them when pt is lying on their stomach
where is the CR for SBS pa projection for a 15-30min radiographs
and hourly radiographs?
- 2in above iliac crests
- iliac crests
what is the purpose of the ileocecal valve

The purpose of this valve is to “prevent backflow” from the Large Intestine, once any material leaves the Small Intestine.
what is the routine and specials positions for a BE
- pa and/or ap
- RAO and LAO
- LPO and/or RPO
- LAt. rectum
- R and L lat. decubs (double contrast study)
- PA post evac
- Special:
- ap axial or ap axial oblique
- Pa axial or pa axial oblique
where is CR for a PA and/or AP BE
what does this position visualize
- iliac crest
- ensure no rotation
where is the CR what is the obliquity for an RAO BE
- CR to iliac crests and 1inch to left of MSP
- 35-45 oblique
the RAO position of a BE demonstrates what anatomy
what other position will demonstrate the right colic flexure in profile as the RAO

right hepatic flexure in profile ascending and descending colon are open w/o superimposition splenic flexure is not viewed

LPO b/c it is opposite
where is the CR what is the obliquity for an LAO BE
what other position visualizes the same thing
- CR at 1-2 in above crests and 1in to the right
- 35-45 deg
- RPO
Bag of contrast should be suspended at what height to prevent faster flow of barium into rectum causing pt discomfort

24-30in above the table
all BE radiographs except for the what 2 projections are take on a 14x17
for hypersthenic pts what must be done to include appropriate anatomy
- lateral rectum and butterfly positions
- 2 14x17 crosswise cassettes
what are the technical factors for a single contrast and double
what is the breating
what cells should be selected when using AEC
- 100-125 single contrast
- 80-90 kvp for a double contrast
- Suspend respiration and expose on expiration
- all cells selected when using aec
why must we or could we use two films on an ap or pa of the colon

to make sure we include the splenix flexure b/c it is located higher up and rectal ampulla (area where feces is stored)
Methylcellulose is introduced into the smallintestine during enteroclysis to _____

A.
the transverse and sigmoid colon are located where than the other parts of the colon

more anterior
what structures are best shown in a PA/AP BE

transverse colon and portion of sigmoid colon BA filled
what structures are best visualized in an LAP or RPO BE

the splenic flexure should be seen w/o supoerimposition
where is the CR for a RPO BE

1-2in above crests and 1in to the left of MSP
where is the CR for a LPO BE
- cr to level of iliac crests cr 1in to right of MSP
- visualizes the right hepatic flexure as an RAO would
where is the CR for a lateral rectum
what casette would you use
- CR to level of ASIS and midcoronal plane (midway between asis and posterior sacrum)
- 10x12 length wise
what is the alternative position to the lateral rectum
why is the position done for
- ventral decub (cross table or xtable lateral)
- to visualize air in the rectum in a double contrast study
what structure does the right lateral decub position show

entire colon and an air filled splenic flexure and descending colon
where is the CR for a right lateral decub BE (only for a double contrast study)

1-2 in above crests because splenic flexure is lcoated higher in abdomen
if we are doing a single contrast BE are decubs R & L necessary

no
which position in a double contrast study visualizes the an air filled hepatic flexure and ascending colon and cecum
where is the CR for this position
- left lateral decub BE
- at level of crests
what size cassette is needed for a ap axial or ap axial oblique (LPO) Butterfly positions
what is the tube angle
where is the CR for the ap axial and ap axial oblique
- 11x14
- 30-40 deg cephalad
- AP: 2" inferior to ASIS at MSP
- LPO:2'' inferior and 2in medial to right ASIS
what is pt prep for a be
- alimentary canal must be completely empty by using saline cathartics to fully cleanse the colon
- gowning remove all clothing including shoes socks or panty hose
cobblestone appearance indicate what pathology
dilated intestines with thick circular folds
extended loops of small bowel
napkin ring or appl core sign pathology
- chrons disease
- giardiasis
- ileus of S.I.
- neoplasm
during a lateral rectum radiograph what must you do to the tube in the rectum
how do you deflate the balloon
- you must first drain all the barium out of the tip and back into the bag then tell pt you will be taking the tube out you have to deflate it and remove the tip
- unclamp it first to deflate it air drains out
- then proceed with the xray
what is important to do before tip insertion to the barium bag

shake it briefly it reduce colloidal suspension
Before the tip insertion the patient should be instructed to
a.
b.
c.

not to push the tip out of the rectum by bearing down once the tip is inserted

relax abdominal muscles to prevent increased intra abdominal pressure

concentrate on breathing by the mouth to reduce spasms and cramping
the initial insertion toward the _____. After the initial insertion the rectal tube is directed _____ and slightly _______ to follow the normal curvature of the rectum
the whole process of insertion should not exceed how many inches
- umbilicus
- superior and anteriorly
1.25-1.5inches

Author

anatomy12

275604

Card Set

RAD-146 CH.13 LOWER GI

Description

xray

Updated

2014-06-21T17:10:41Z