RTE1513RadProceduresII

  1. The Alimentary Canal consists of?
    • Alimentary canal
    • - Oral cavity
    • - Pharynx
    • - Esophagus    
    • - Stomach             Parts of upper GI ↑


    • - Small intestine    Parts of lower GI ↓
    • - Large intestine
    • - Anus
  2. The Accessory Organs consist of?
    - Salivary Glands  (Digestive Organ System)

    - Pancreas (Organ of the Digestive & Endocrine Systems)

    • - Liver (Biliary Tract Organs) ↓
    • - Gallbladder
  3. Image Upload 1
    • Liver: large/triangular two-lobed organ located in the right upper quadrant just inferior to the right hemidiaphragm
    • - Extends to just below the body of the 10th rib
  4. Image Upload 2
    Gallbladder: small pear-shaped sac nested centrally in the posterior/inferior region of the right lobe of the liver
  5. Right & Left lobes of the Liver are separated by?
    falciform ligament

    Image Upload 3
  6. R lobe has 2 minor lobes on the posterior aspect:
    - ?
    - ?
    Quadrate lobe

    Caudate lobe – inferior vena cava (IVC) passes over the surface of this lobe

    Image Upload 4
  7. The main digestive function of the liver is to produce?
    • Bile
    • - critical for fat digestion & absorption of fats & fat-soluble vitamins in the small intestine
  8. Other functions of the Liver aside from producing Bile are?
    • - Excretion of bilirubin, cholesterol, hormones, & drugs
    • - Metabolism of fats, proteins, & carbohydrates
    • - Enzyme activation
    • - Storage of glycogen, vitamins, & minerals
    • - Synthesis of plasma proteins, such as albumin, & clotting factors
    • - Blood detoxification & purification
  9. The 3 parts of the Gallbladder are?
    Fundus – broad, distal end

    Body – main, middle section

    • Neck – narrow, proximal end that contains the cystic duct
    • - Has a spiral valve (folds) that prevent distention or collapse of the cystic duct

    Image Upload 5
  10. The 3 functions of the Gallbladder are?
    • 1.Store bile:
    • - Bile not needed for digestion is stored in the GB

    • 2.Concentrate bile:
    • - Stored bile is concentrated as a result of hydrolysis (removal of water). Too much concentration can result in gallstones (choleliths).

    • 3.Contraction to release bile:
    • - When fatty food enters the duodenum, the duodenal mucosa secretes the hormone cholecystokinin (CCK), which stimulates the gallbladder to contract & release bile.
  11. Bile produced in the liver cells travels through small ducts into the ___ & ___ hepatic ducts that exit the liver. These ducts join to form the ___ ___ ___.
    • Right, Left
    • Common Hepatic Duct
  12. The common hepatic duct unites with the ___ ___ from the gallbladder to form the ___ ___ ___.
    - Bile enters the gallbladder through the cystic duct for storage or continues down into the common bile duct
    Cystic Duct, Common Bile Duct
  13. Image Upload 6
    Biliary Ducts
  14. Bile & Enzyme Pathway

    The common bile duct is joined by the ___ ___ at the hepatopancreatic ampulla (___ ___ ___).

    *Bile & pancreatic enzymes enter into the duodenum through the hepatopancreatic sphincter (sphincter of Oddi) at the duodenal papilla

    *In about 40% of patients, the common bile duct & pancreatic duct pass into the duodenum separately
    • Pancreatic Duct,
    • Ampulla of Vader
  15. Image Upload 7
    Bile & Enzyme Pathway
  16. Pancreas
    Located in the ___ ___ of the abdomen between the curve (“C-loop”) of the duodenum & the spleen
    - The 3 parts are the ___, ___, & ___?
    • Upper Left,
    • Head, Body, Tail
  17. Pancreas
    Main digestive function is the production of pancreatic enzymes:
    _____ -  (breaks down carbohydrates)
    _____ -  (breaks down fats)
    _____ -  (breaks down proteins)
    • Amylase,
    • Lipase,
    • Trypsin
  18. Image Upload 8
    Pancreas
  19. Image Upload 9
    Erect abdomen showing liver shadow
  20. Image Upload 10
    T-tube cholangiogram showing hepatic ducts, common bile ducts, part of pancreatic duct, & spillage of contrast into duodenum
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    Oral cholecystogram showing cystic duct (A), neck (B), body (C), & fundus (D) – this exam is no longer done to evaluate the GB
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    GB sonogram – most common method to evaluate the GB
  23. The 4 organs of the Upper GI System are?
    • - Oral cavity (mouth)
    • - Pharynx
    • - Esophagus
    • - Stomach
  24. The ___ ___ is where food & liquids enter our mouth

    ___: hard & soft palates
    - Uvula – accessory organ of speech, produces some saliva, helps prevent food & liquid from entering the nose

    ____: tongue - taste buds, assists in chewing, & elevates backward to assist swallowing
    • oral cavity,
    • Roof,
    • Floor
  25. Accessory Organs of Oral Cavity

    ____ – cooperates with tongue for chewing (mastication)
    Food mixes with saliva – start of mechanical digestion

    Salivary glands:
    ____ - largest; located just below & anterior to the ears
    _______ - located just below the angles of the mandible
    ______ - located just below the tongue
        - Saliva is mostly water & some salts
        - Contains salivary amylase (breaks down starches) to begin chemical digestion
    • Teeth,
    • Parotids,
    • Submandibulars,
    • Sublinguals
  26. The 3 main parts of the Pharynx are?
    Nasopharynx – passageway for air only

    Oropharynx – passageway for air & food/liquid (but not at the same time!)

    Laryngopharynx – passageway for air & food/liquid (but not at the same time!)
  27. Image Upload 13
    Pharynx
  28. Swallowing

    _____ - the 2 lower parts of the pharynx (oropharynx & laryngopharynx) involved:

    - Food & liquid enters oral cavity
    - Tongue pushes food/liquid back while soft palate covers the nasopharynx
       •Prevents food/liquid from going up into nasal cavities
    - Epiglottis is depressed to cover the larynx & tracheal opening; vocal cords also contract to close off epiglottis
       •Prevents aspiration into the trachea & lungs
    Deglutition
  29. Image Upload 14
    Sialogram showing normal submandibular duct
  30. Image Upload 15
    CT showing parotid glands
  31. Image Upload 16
    Soft tissue neck x-ray
  32. Image Upload 17
    Barium swallow x-ray
  33. Esophagus Anatomy
    Muscular tube that extends from laryngopharynx to stomach
    - About 25 cm (10”) in length & 2 cm (3/4”) in diameter
    - Located posterior to the trachea & larynx; anterior to cervical & thoracic vertebrae
    - Begins at level of C5/C6 (upper margin of thyroid cartilage); enters stomach at level of T11
    - No digestion takes place in esophagus; collapsible tube that uses peristalsis (waves of muscular contraction) to push food into the stomach
    Esophagus Anatomy

    Image Upload 18
  34. Esophagus Pathway

    As the esophagus descends through the mediastinum, it is in contact with the aorta & bronchi:
    First indentation: ____ ____
    Second indentation: ___ ___ ___
    • aortic arch,
    • left primary bronchus
  35. Esophagus Pathway

    Esophagus passes through the diaphragm & into the abdomen slightly to the left, just behind the IVC & in front of the aorta

    - Abdominal part of esophagus that connects to the stomach is called the ___ ___
    cardiac antrum
  36. Image Upload 19
    Esophagus Pathway
  37. Connection to Stomach

    ___ (_) ___ – opening between esophagus & stomach

    Also called the cardiac orifice because it is near the part of the diaphragm on which the heart rests

    ___ ___ – between esophagus & stomach

    Acts as a one-way valve to prevent stomach contents from backing up into esophagus

    When this sphincter does not close properly, gastric contents will splash up into the esophagus, causing reflux (“heartburn”)

    ___ ___ – superior to cardiac orifice (EG junction)
    Esophagogastric (EG) junction,

    Cardiac sphincter,

    Cardiac notch
  38. Image Upload 20
    Esophagogram showing aortic arch indentation (A) & L main bronchus (B) indentation
  39. _____ Anatomy

    Muscular sac between the esophagus & small intestine located in the mid to upper left upper quadrant of the abdomen
    - Expands & contracts – serves as a reservoir for food/liquid
    - The holding capacity of the stomach allows us to forgo eating constantly for energy
    - Mechanical & chemical digestion takes place in the stomach
    Stomach
  40. The 3 main parts of the Stomach are ___, ____,& ____?
    Fundus, Body, Pylorus
  41. Parts of the Stomach

    ____ - ballooned-shaped upper portion superior & lateral to the cardiac orifice (EG junction) that connects to the esophagus

    In the erect position, the ___ is filled with air (“gastric bubble”)
    Fundus
  42. Parts of the Stomach

    ___ - large, curved middle section

    Has constricted ring-like area called the angular notch where it enters into the pylorus
    Body
  43. Parts of the Stomach

    ___ - end portion that connects to the duodenum of the small intestine; opening to small intestine is called the pyloric orifice

    ___ ___ – slight dilation just past the angular notch

    ___ ___ – narrowed part that connects to the duodenum
    - Between the pyloric canal & the duodenum is the pyloric sphincter, which prevents backflow of intestinal contents into the stomach
    • Pylorus,
    • Pyloric antrum,
    • Pyloric canal
  44. Curvatures & Parts of Stomach

    ____ ____:
    Along medial border
    Concave in shape
    Between cardiac & pyloric orifices
    Lesser curvature
  45. Curvatures & Parts of Stomach

    ___ ___:
    Along lateral border
    Convex in shape – up to 4x’s longer than lesser curvature
    Between cardiac notch & pylorus
    Greater curvature
  46. Image Upload 21
    Curvatures & Parts of Stomach
  47. Mucosal Folds

    Folds of mucosa called ____.
    - Flatten out when food arrives
    - Allows stomach to expand
    - Assists with mechanical digestion

    Gastric canal – formed by rugae along the ___ ____.

    - Shape provides a path for fluids to go directly from the body of the stomach to the pylorus
    • rugae,
    • lesser curvature
  48. Duodenum Anatomy

    First part of small intestine; 20-24 cm (8”-10”) long
    - Rests against head of the ____
    - Shaped like the letter “C”
           ___ ___ (__)* – short part just past pylorus
               *Common site for ulcer disease
           ___ ___ – contains duodenal papilla (opening for common bile & pancreatic ducts)
           ___ ___ – curves back
           ___ ___ – fixed bend where duodenum connects to the jejunum                     Fixed in place by the ligament of Treitz
    • pancreas,
    • Duodenal bulb (cap),
    • Descending portion,
    • Horizontal portion,
    • Duodenojejunal flexure
  49. Image Upload 22
    Duodenum Anatomy
  50. Image Upload 23
    Radiographic Anatomy – Stomach & Duodenum
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    Stomach Orientation
  52. Air-Barium Distribution
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    Supine: barium in fundus; air in body & pylorus

    Prone: air in fundus; barium in body & pylorus

    Erect: air in fundus; barium in lower body & pylorus
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    Prone – air in fundus; barium in body & pylorus
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    Erect – air in fundus; barium in lower body & pylorus
  55. Image Upload 28
    Supine – barium in fundus; air in body & pylorus
  56. Digestion

    ___ ___?
    - Mastication (mechanical digestion)
    - Salivary amylase (chemical digestion)

    ___ & ___?
    - Swallowing (peristalsis) – no digestion
      Liquids pass in about 1 second; food in about 4-8 seconds

    ____?
    - Mixing (mechanical & chemical digestion) & peristalsis 
         Chyme – stomach contents mixed with gastric juice & moved toward pyloric valve
         Gastric juice:
              Mucus (protects stomach lining)
              Pepsin (enzyme that breaks down proteins)
              Hydrochloric acid (destroys pathogens)
         Gastric emptying takes about 2-6 hours

    ___ ___?
    - Mixing & peristalsis (mechanical & chemical digestion)
    • Oral cavity,
    • Pharynx & esophagus,
    • Stomach,
    • Small intestine
  57. Image Upload 29
    Body Habitus & GI Organs
  58. Radiographic Anatomy of Stomach by Body Type

    Image Upload 30
    Hypersthenic: high & transverse
  59. Radiographic Anatomy of Stomach by Body Type

    Image Upload 31
    Sthenic: Typical J-shape
  60. Radiographic Anatomy of Stomach by Body Type

    Image Upload 32
    Hyposthenic/asthenic: low & J-shape
  61. Contrast Media

    Radiographic procedures of the biliary system & GI tract are usually done with contrast media

    _____ (+): barium sulfate & iodinated contrast media
    •Absorbs x-ray photons to a degree – structures show up light on image

    _____ (-): air & carbon dioxide (CO2) crystals •Allows x-ray photons to pass – structures show up dark on image
    • Radiopaque,
    • Radiolucent
  62. ___ ___ ___ - are those given by way of the intestines or GI tract. Barium sulfate is the most common enteral contrast media used for radiographic & CT exams. Iodinated contrast media can also be given via the enteral route (i.e., orally or rectally).
    Enteral contrast media
  63. ___ ___ ___ -  are those given by injection. Iodinated media are the most common types of contrast given parenterally for radiographic & CT exams. In MRI, gadolinium is a paramagnetic agent given parenterally. In nuclear medicine, radioisotopes are administered via this route.
    Parenteral contrast media
  64. _____ is a soft, alkaline metallic element with an atomic number of 56. Barium sulfate is a compound (salt) made of barium, sulphur, & oxygen (BaSO4)
    Barium
  65. “____” (low density) barium usually contains 1 part barium sulfate to 1 part water (liquid form)

    “____” (high density) barium usually contains 3-4 parts barium to 1 part water (liquid or paste form)
    • Thin,
    • Thick
  66. Double or Single contrast?
    Image Upload 33
    Single
  67. Double or Single Contrast?
    Image Upload 34
    Double Contrast
  68. ____ is a nonmetallic element with an atomic number of 53. Water-soluble iodinated contrast media such as MD-Gastroview® are a mixture of water & 37% organically bound iodine.
    Iodine
  69. Why water-soluble iodinated contrast media?
    Because barium is contraindicated if there is any chance that it might escape into the peritoneal cavity, such as in the case of a suspected perforation, or as a pre or post-operative test. Barium is a suspension & not water-soluble!
  70. The 3 types of Upper GI Procedures are?
    Esophagograms

    Video swallow

    Upper GI series
  71. Is another name for a Barium Swallow?
    Esophagogram
  72. For which procedure are these the main clinical indications:

    Anatomic anomalies – caused by diseases or a congenital condition
    Carcinoma – adenocarcinoma is the most common type
    Dysphagia – difficulty swallowing
    Esophageal varices – distended veins in distal esophagus causing narrowing
    Foreign bodies – food or other swallowed objects
    Gastroesophageal reflux disease (GERD) – esophageal reflux (heartburn) resulting in esophagitis
    Esophagogram/Barium Swallow
  73. Image Upload 35
    RAO Esophagogram

    • Patient prone or erect with body rotated 35°-45° RAO
    • Right arm down by side; left arm up to hold cup & straw
    • Left knee flexed
    • Top of IR 2” above shoulder (at level of mouth)
    • CR to IR at level of T5/T6 – enters midway between spine & left scapula
    • Expose while patient is taking large sips (mouthful after mouthful)
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    RAO Esophagogram

    • - Entire esophagus demonstrated down to EG junction
    • - Esophagus midway between spine and heart
    • - Optimal exposure factors
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    Lateral Esophagogram

    • Patient in a lateral recumbent or erect with
    • Arms up by head with cup between flexed elbows
    • Knees flexed to maintain lateral position
    • Top of IR 2” above shoulder (at level of mouth)
    • CR to IR at level of T5/T6 – enters midcoronal plane of patient
    • Expose while patient is taking large sips (mouthful after mouthful)
  76. Image Upload 38
    Lateral Esophagogram

    • - Entire esophagus demonstrated down to EG junction
    • - Esophagus midway between spine and heart
    • - Arms not superimposing esophagus
    • - True lateral position
    • - Optimal exposure factors
  77. Main clinical indications:

    Dysphagia
    •Coughing and/or choking while eating or drinking
    •Wet-sounding voice or changes in breathing when eating or drinking
    •Known or suspected aspiration pneumonia
    •Masses on the tongue, pharynx or larynx
    •Muscle weakness, or myopathy involving the pharynx (common in stroke patients)
    •Neurologic disorders likely to affect swallowing.

    Are the main reasons for having this exam?
    Video Swallow
  78. Which exam would be performed based on these main clinical indications?
    Ulcers
    Gastritis
    Hiatal hernia – a portion of the stomach herniates through the diaphragmatic opening
    Gastric carcinomas
    Pre-op & post-op evaluation for gastric bypass surgery
    Upper GI Series
  79. The routine post-fluoroscopic images if needed for a UGI Series are?
    Routine: AP, PA, RAO, LPO, R lateral
  80. Image Upload 39
    AP UGI

    • Patient supine on table
    • Arms down by sides
    • CR to IR at level of L1 – enters midway between xiphoid tip & lower margin of ribs
    • Expose on expiration
  81. Image Upload 40
    AP UGI

    • - Entire stomach & duodenum demonstrated
    • - Fundus is barium filled; body & pylorus is air filled (double contrast)
    • - Optimal exposure factors
  82. Image Upload 41
    PA UGI

    • Patient prone on table
    • Arms up by head
    • CR to IR at level of L1 – enters 1”-2” above lower lateral rib margin & 1” to the left of the spine
    • Expose on expiration
  83. Image Upload 42
    PA UGI

    • - Entire stomach & duodenum demonstrated
    • - Fundus is air filled; body & pylorus barium filled (double contrast)
    • - Optimal exposure factors
  84. Image Upload 43
    LPO UGI

    • Patient supine on table
    • Rotate body 30°-60° LPO (45° most common)
    • Left arm down by side; right arm across chest on left shoulder
    • Flex R knee for support
    • CR to IR at level of L1 – enters midway between xiphoid tip & lower margin of ribs; center midway between midline of body & L lateral margin of abdomen
    • Expose on expiration
  85. Image Upload 44
    LPO UGI

    • - Entire stomach & duodenum demonstrated
    • - Fundus filled with barium (double-contrast)
    • - Usually demonstrates duodenal bulb filled well with air
    • - Optimal exposure factors
  86. Image Upload 45
    RAO UGI

    • Patient prone on table
    • Rotate body 40°-70° RAO (45° most common)
    • Right arm down by side; left arm up by head
    • Flex L knee for support
    • CR to IR at level of L1 – enters midway between spine & upside (left) lateral border of abdomen
    • Expose on expiration
  87. Image Upload 46
    RAO UGI

    • - Entire stomach & duodenum demonstrated
    • - Body & pylorus barium filled (double-contrast)
    • - Usually demonstrates duodenal bulb filled well with barium
    • - Duodenal bulb and C-loop in profile
    • - Optimal exposure factors
  88. Image Upload 47
    R Lateral UGI

    • Patient in a R lateral recumbent position
    • Arms up by head Knees flexed to maintain lateral position
    • CR to IR at level of L1 – enters lower lateral margin of the ribs, 1”-1.5” anterior to the midcoronal plane
    • Expose on expiration
  89. Image Upload 48
    R Lateral UGI

    • - Entire stomach & duodenum demonstrated
    • - Pylorus & duodenum barium filled (double-contrast)
    • - Pylorus and C-loop visualized
    • - Optimal exposure factors
  90. The 2 types of Biliary Tract Procedures are?
    • T-Tube Cholangiogram & 
    • Endoscopic Retrograde Cholangiographic Pancreatography (ERCP)
  91. Image Upload 49
    T-Tube Cholangiogram

    • Postoperative procedure done after a cholecystectomy
    • - Rubber tube in the shape of a “T” left in the common bile duct after the GB is removed
    • - Tube allows for drainage of bile & functions as a portal to inject iodinated contrast media to look for stones that were undetected during surgery
    • - Stones can also be removed through the T-Tube if necessary
  92. Patient supine on table
    Radiologist injects iodinated contrast media (parenteral) into tube under fluoroscopic guidance
    Digital spot images taken in different positions to look for stones or blockage

    What procedure is this for?
    T-Tube Procedure
  93. Image Upload 50
    T-Tube
  94. _ _ _ _ - 
    Using an endoscope to access & visualize the biliary & pancreatic ducts. Performed by a gastroenterologist with fluoroscopic guidance.
    - Scope inserted into the mouth, down the esophagus & stomach, & into the duodenum to the duodenal papilla
    - Camera within scope used to take images
    - Catheter inserted through scope into the duodenal papilla; iodinated contrast media (parenteral) injected & digital spot images taken

    Diagnostic: to visualize the common bile duct and/or pancreatic duct

    Therapeutic: removal of choleliths & to repair narrowing (stenosis) of the hepatopancreatic sphincter or associated ducts
    ERCP

    Image Upload 51
  95. Image Upload 52
    ERCP showing GB, bile ducts & pancreatic duct
  96. Common Pathological Conditions


    Image Upload 53
    Hiatal hernia
  97. Common Pathological Conditions

    Image Upload 54
    Esophageal carcinoma
  98. Common Pathological Conditions

    Image Upload 55
    Achalasia distal esophagus
  99. Common Pathological Conditions

    Image Upload 56
    Zenker’s diverticulum in esophagus
  100. Common Pathological Conditions

    Image Upload 57
    Duodenal ulcer
  101. Common Pathological Conditions


    Image Upload 58
    Gastric carcinoma
Author
Marc817
ID
345797
Card Set
RTE1513RadProceduresII
Description
RTE1513RadProceduresIIBiliary&UpperGI
Updated