Chapter 12/13 Upper GI & Small Bowel

Alimentary Canal _______________ Pharynx Esophagus _______________ Small intestine ______________ Anus

Accessory Organs Salivary Glands –___________ –Submandibular –__________ Pancreas ____________ Gallbladder

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

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

Pharynx (Throat) ______________ –Posterior to Nasal Cavity ______________ –Posterior to Oral Cavity _______________ –Posterior to Larynx

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

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

Esophagus Posterior to the ___________ Anterior to _____________Vertebra Passes through the Diaphragm –_________________

Esophagus 2 Normal indentations (Stenosis) –___________ –______________

Esophagus Abdominal Segment –_____________ Attaches to the Stomach –Esophagogastric Junction _______________

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

MBS Assist _____________ Record Study –Tape –Digital

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

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

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

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

Gastro Openings Proximal Esophagogastric junction (cardiac orifice) –___________– Opening into the Stomach –___________– Allows food to enter –____________- Superior indentation off cardiac orifice

Gastro Openings Distal Pyloric Orifice –_________ –_________– allows food to enter small intestine

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

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

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

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

Small Bowel Anatomy _______________ – 1 st and shortest portion off of stomach (Pyloric sphincter) _____________ – 2 nd portion off Duodenum (Duodenojejunal flexure). Feathery appearance ____________ – 3 rd and longest portion. Terminates at ileocecal valve (RLQ) Smoother apperance

Duodenum First portion of small intestine 8-10 inches long ‘C’ shaped due to head of __________ ____________– 1 st portion of duodenum. –Must be seen on UGI study

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

UGI Prep NPO ___________ Flouro working Radiologist equipment ready –___________ –____________ –Paddle –Anything else Pt ___________________

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

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

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

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

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

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

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

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

Steep RAO __________ Center as Slight RAO

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

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

Small Bowel Series Patient prep –NPO ___________ –Bowel prep Have ready –_________________ –Unless UGI 1 st

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

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

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

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