-
Small Intestine is made up of what 3 parts, and how big is it?
- Duodenum, Jejunum, and Ileum.
- Size - approximately 7 m in length (23 feet) on average
-
bile from the liver/GB & pancreatic enzymes (amylase, lipase, trypsin) break down carbohydrates, proteins, & fats. Some absorption occurs here?
Duodenum
-
“fingerlike” projections (villi & microvilli) in the walls increases the surface area for absorption. Most absorption takes place here?
Jejunum
-
Some absorption here. Unabsorbed & undigested food passes from the ileum into the cecum, the beginning of the large intestine. This food residue is full of bacteria.
Ileum
-
Small intestine glands secrete enzymes to break down food: ______, ______, & ______ (breaks down sugars), & the _______ (breaks down simple proteins to amino acids).
sucrase, maltase, lactase, peptidases
-
Common Disorders
____ - Inflammation of the intestines caused by bacteria & other organisms or from environmental conditions
enteritis
-
Common Disorders
_________ (_____) – scarring & thickening of the bowel that leads to obstruction, abscess & fistula formation. Cause of Crohn’s is unknown.
Segmental enteritis (Crohn’s disease)
-
Common Disorders
_______ – infection of the SB caused by protozoa (Giardia lamblia). Spread by contaminated food & water & personal contact. Diarrhea, nausea, pain, & weight loss are common symptoms.
Giardiasis
-
Common Disorders
________ (____) – GI tract unable to absorb certain nutrients
Malabsorption syndromes (sprue & celiac disease)
-
Common Disorders
______ - various tumors (lymphoma & adenocarcinoma)
Cancers
-
Ileus
- Obstruction of the small intestines
- First diagnosed on a flat & erect abdomen x-ray
- Dilated loops of SB & air-fluid levels within intestines
- 2 main types of blockages:
- Paralytic – cessation of peristalsis
- Mechanical – physical blockage (tumor, adhesions, hernia)
-
________________ *procedure*
- Routine UGI done first
- Patient drinks additional cup (8 oz.) of thin barium
- 30-minute PA abdominal image taken centered high, about 2” above the iliac crest.*The 30-minute image is timed from the initial ingestion of barium (i.e., from when the UGI started).
- 60-minute PA abdominal image taken centered to the iliac crest
- Continue with half-hour interval images (PA, centered to the iliac crest) until the barium reaches the large intestine (usually by about 2 hours)
- If the contrast is moving slowly, delay images will be ordered
- Fluoroscopy & spot images of the terminal ileum (optional)
Small Bowel Series (SBS) Following an UGI
-
_______________ *procedure*
- Scout KUB done to rule out residual contrast or pathology
- Patient drinks 2 cups (16 oz.) of thin barium
15-minute or 30- minute PA abdominal image taken centered high, about 2” above the iliac crest.*
- Continue with 15-minute or 30- minute interval images (PA, centered to the iliac crest) until the barium reaches the large intestine (usually by about 2 hours).
- If the contrast is moving slowly, delay images will be ordered
- Fluoroscopy & spot images of the terminal ileum (optional)
Small Bowel Series (SBS)
-
__________ *procedure*
- Variation where contrast is instilled through an NG tube rather than having the patient drink
- Patient usually has an indwelling NG tube that was placed to relieve pressure from an ileus, or was placed after a surgical procedure
- Contrast injected into the tube under fluoroscopic guidance
- Be sure to have patient on their right side or in a semi-Fowler position to help prevent reflux & aspiration!
- Often done with iodinated media or a 50/50 mixture of thin barium & iodinated media
Small Bowel Series Through an NG Tube
-
___________ *procedure*
- Detailed study of the SB for patients with history of ileus, Crohn’s disease, or malabsorption syndrome
- Scout KUB done to rule out residual contrast or pathology
- Radiologist inserts catheter through the esophagus, stomach, & into the duodenojejunal junction under fluoroscopic guidance
- Mixture of thin barium & air or methylcelluose injected through the catheter (used to distend the bowel)
- Fluoroscopic spot images & abdominal images taken
- CT scan may be done following administration of contrast
Enteroclysis (Double-Contrast SB Series)
-
Intubation Method (SBS)
______ – NG tube passed into the nose, through the esophagus & stomach into the duodenum & jejunum under fluoroscopic guidance. Contrast injected through tube & images obtained at different time intervals
Diagnostic
-
Intubation Method (SBS)
______ - done to help relieve postoperative distention or decompress a small bowel obstruction. Double-lumen tube (Miller-Abbott) advanced into the stomach & duodenum. Catheter has a radiopaque marker on it – contrast not needed to see its position. Tube moves into jejunum via peristalsis. Gas & excessive fluids can be withdrawn from the tube.
Therapeutic
-
Air-Barium Distribution
____ - barium in ascending & descending colon & parts of the sigmoid colon; air in transverse colon & loops of sigmoid colon
Supine
-
Air-Barium Distribution
____ - barium in transverse colon & loops of sigmoid colon; air in ascending & descending colon & parts of the sigmoid colon
Prone
-
RPO BE
- - Entire large intestine demonstrated
- - Splenic (left colic) flexure &descending colon open
-
LPO BE
- - Entire large intestine demonstrated
- - Hepatic (right colic) flexure & ascending colon open
-
AP Axial Oblique BE
- - Elongated views of the rectosigmoid segments of the large intestine
- - Pictured: AP axial oblique (LPO) demonstrates less superimposition of the rectosigmoid segments
-
Lateral Rectum BE
- Rectosigmoid region demonstrated with no rotation
-
-
AP Axial Double Contrast BE
-
Left Lateral Decubitus Double Contrast BE
-
Right Lateral Decubitus Double Contrast BE
-
Ventral Decubitus Double Contrast BE
-
Common Pathological Conditions
Small bowel obstruction (ileus)
-
Common Pathological Conditions
Crohn’s disease – “string sign”
-
Common Pathological Conditions
Ulcerative colitis – “cobblestone”
-
Common Pathological Conditions
Diverticulosis
-
Common Pathological Conditions
Polyps
-
Common Pathological Conditions
Colon cancer
-
PA or AP BE
- Patient prone or supine on table
- Arms up by head or down by the side
- CR to IR at level of iliac crest
- Expose on expiration
-
RPO BE
- Patient supine on table
- Rotate body 35°-45° RPO (45° most common)
- Right arm down by side; left arm across chest on left shoulder or by head
- Flex L knee for support
- CR to IR at level iliac crest – enters about 1” lateral to the elevated side of MSP
- - If splenic (left colic) flexure is high, CR enters 2”-3” above iliac crest
- Expose on expiration
-
LPO BE
- Patient supine on table
- Rotate body 35°-45° LPO (45° most common)
- Left arm down by side; right arm across chest on left shoulder or by head
- Flex R knee for support
- CR to IR at level iliac crest – enters about 1” lateral to the elevated side of MSP
- - If splenic (left colic) flexure is high, CR enters 2”-3” above iliac crest
- Expose on expiration
-
AP Axial & AP Axial Oblique (LPO) BE(“Butterfly Projections”)
- AP Axial:
- Patient supine on table with arms down by the side
- CR angled 30º-40º cephalad, enters 2” inferior to ASIS at MSP
- AP Axial Oblique:
- Patient supine on table
- Rotate body 30°-40° LPO
- Left arm down by side; right arm across chest on left shoulder or by head
- Flex R knee for support
- CR angled 30º-40º cephalad, enters 2” inferior & 2” medial to R ASIS
-
Lateral Rectum BE
- Patient in a true L lateral recumbent position
- Knees flexed; arms up by head
- CR to level of ASIS and midcoronal plane (midway between ASIS & posterior sacrum)
- Expose on expiration
-
______ - (reconnection) of colon
anastomosis
|
|
