Chapter 12/13 Upper GI and Small Bowel

Alimentary Canal Oral cavity Pharynx ______________ Small Intestine Large Intestine Anus

Accessory Organs Salivary Glands _________ Submandibular Sublingual _________ Liver __________

Digestion Terms ____________ Chewing ____________ Swallowing ___________ Wavelike involuntary muscle contractions

Oral Cavity Teeth Hard and Soft Palate _________ Tongue

Pharynx Nasopharynx Oropharynx Laryngopharynx

Deglutition Bolus to posterior oral cavity _______closes off nasopharynx _______ elevates and epiglottis folds over Food enters esophagus

Esophagus Location Starts _______ to cricoid (C5-6) Ends at stomach _________ Posterior to trachea ________ Anterior to vertebrae

Esophagus Crosses over _________ _________Primary Bronchus Passes through diaphragm ____________ Cardiac antrum ______________ junction (cardiac orifice)

Modified Barium Swallow (MBS) Assist ______________ Evaluates ______________ Focus is on Proximal esophagus at the area of the Laryngopharynx Watch for aspiration with various consistencies. _____________

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

PA Esophagus PA (upright or prone) CR mid-sagittal at _________ Have top of cassette at __________and center to film Have pt take 3 swallows of barium. Expose on ______ Collimate to approx. 4” transverse field

RAO Esophagus __________ RAO CR to T5-6 ___________of spine Expose during 3 rd swallow Collimate to approx ____________field Esophagus should be between vertebral column and heart

Lateral Esophagus Rt or Lt however pt can look at you Center ________ Mid coronal Collimate to approx. 5-6” transverse field

Gastro Openings (Proximal) Esophagogastric junction (cardiac orifice) Cardiac orifice Cardiac sphincter Cardiac Notch

Stomach Rugae Fundus Body Pylorus Lesser Curvature Greater Curvature

Stomach Anatomy Pyloric Portion Pyloric antrum Pyloric canal Pyloric orifice (Pylorus) Angular Notch – Separates the Body from Pyloric

Air-Barium Distribution Supine – Barium in ____________Body/Pylorus Prone – Barium in _____________ Erect – Barium in ________________, Air in Fundus

Body Habitus Watch __________ for position of stomach ____________ – Higher stomach (T9-12) Sthenic – Mid range (T10-L2) ___________ – Lower (T11-L4)

Small Bowel Anatomy Duodenum – 1 st segment off stomach - Duodenal bulb Jejunum – 2 nd segment off duodenum (Duodenojejunal flexure). Ileum – 3 rd and longest segment. - Terminates at ileocecal valve (RLQ)

Duodenum Descending portion – _____________and pancreatic enzymes Horizontal and ascending portion – Forms remainder of ‘C’ shape Duodenojejunal flexure – Duodenal and jejunum transition

UGI Prep NPO 8 hours _____________ Radiologist equipment ready Barium _______________ Paddle Anything else Pt undressed in gown

UGI If possible patient _______________ If dual contrast patient _____________ Instruct the patient not to _________

UGI _______________ Coats the esophagus and stomach Lay the table down and assist the patient _____________ To fill the stomach

UGI with NG Thin 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 prep Gives an overview prior to barium

AP & Scout (High KUB) Supine CR Midline ______________crest Expose on _____________

PA UGI Prone Center at ______________ ___________of mid-line Watch fluoro

Slight RAO _______________ Center at L- 1 or 2 Halfway between spine and left _________________

Steep RAO __________ Center as Slight RAO

Rt Lateral Pt on Rt side Center at L-1 or 2 ____________to mid-coronal plane Bend knees for stability

Small Bowel Series Patient prep NPO 8 hours Bowel prep Have ready 2 cups thin barium Unless UGI 1 st

Small Bowel Series Sometimes done in conjunction _____________ SBS occurs following UGI overheads with timed PA SBS only. After pt drinks 2 cups of Barium timed PA

SBS Timed films are usually ___________________unless rad says otherwise Continues until contrast reaches large bowel. Spot film of the _____________concludes SBS

PA KUB Place pt prone CR for early films (15-30 min) ___________iliac crest CR for late films (after 30 min) _____ iliac crest