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Chapter 12/13 Upper GI and Small Bowel
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Alimentary Canal Oral cavity Pharynx ______________ Small Intestine Large Intestine Anus
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Accessory Organs Salivary Glands _________ Submandibular Sublingual _________ Liver __________
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Digestion Terms ____________ Chewing ____________ Swallowing ___________ Wavelike involuntary muscle contractions
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Oral Cavity Teeth Hard and Soft Palate _________ Tongue
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Pharynx Nasopharynx Oropharynx Laryngopharynx
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Deglutition Bolus to posterior oral cavity _______closes off nasopharynx _______ elevates and epiglottis folds over Food enters esophagus
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Esophagus Location Starts _______ to cricoid (C5-6) Ends at stomach _________ Posterior to trachea ________ Anterior to vertebrae
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Esophagus Crosses over _________ _________Primary Bronchus Passes through diaphragm ____________ Cardiac antrum ______________ junction (cardiac orifice)
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Modified Barium Swallow (MBS) Assist ______________ Evaluates ______________ Focus is on Proximal esophagus at the area of the Laryngopharynx Watch for aspiration with various consistencies. _____________
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Esophagus Imaging Routine PA RAO Lateral Recumbent or Erect Expose during 3 rd swallow of Barium 90 kVp
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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
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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
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Lateral Esophagus Rt or Lt however pt can look at you Center ________ Mid coronal Collimate to approx. 5-6” transverse field
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Gastro Openings (Proximal) Esophagogastric junction (cardiac orifice) Cardiac orifice Cardiac sphincter Cardiac Notch
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Stomach Rugae Fundus Body Pylorus Lesser Curvature Greater Curvature
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Stomach Anatomy Pyloric Portion Pyloric antrum Pyloric canal Pyloric orifice (Pylorus) Angular Notch – Separates the Body from Pyloric
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Air-Barium Distribution Supine – Barium in ____________Body/Pylorus Prone – Barium in _____________ Erect – Barium in ________________, Air in Fundus
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Body Habitus Watch __________ for position of stomach ____________ – Higher stomach (T9-12) Sthenic – Mid range (T10-L2) ___________ – Lower (T11-L4)
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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)
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Duodenum Descending portion – _____________and pancreatic enzymes Horizontal and ascending portion – Forms remainder of ‘C’ shape Duodenojejunal flexure – Duodenal and jejunum transition
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UGI Prep NPO 8 hours _____________ Radiologist equipment ready Barium _______________ Paddle Anything else Pt undressed in gown
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UGI If possible patient _______________ If dual contrast patient _____________ Instruct the patient not to _________
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UGI _______________ Coats the esophagus and stomach Lay the table down and assist the patient _____________ To fill the stomach
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UGI with NG Thin Barium Large Syringe Draw up thin barium and inject through NG ___________________
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UGI Imaging Routine AP Scout PA Slight RAO Steep RAO Rt Lateral AP 100kVp 40”SID
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The Scout Film Prior to most fluoro procedure Assesses prep Gives an overview prior to barium
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AP & Scout (High KUB) Supine CR Midline ______________crest Expose on _____________
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PA UGI Prone Center at ______________ ___________of mid-line Watch fluoro
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Slight RAO _______________ Center at L- 1 or 2 Halfway between spine and left _________________
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Steep RAO __________ Center as Slight RAO
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Rt Lateral Pt on Rt side Center at L-1 or 2 ____________to mid-coronal plane Bend knees for stability
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Small Bowel Series Patient prep NPO 8 hours Bowel prep Have ready 2 cups thin barium Unless UGI 1 st
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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
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SBS Timed films are usually ___________________unless rad says otherwise Continues until contrast reaches large bowel. Spot film of the _____________concludes SBS
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PA KUB Place pt prone CR for early films (15-30 min) ___________iliac crest CR for late films (after 30 min) _____ iliac crest
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