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 3rd 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 OpeningsProximal

• Esophagogastric junction (cardiac orifice)

– ___________– Opening into the Stomach

– ___________– Allows food to enter

– ____________- Superior indentation off cardiac orifice

Gastro OpeningsDistal

• 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

• _______________– 1st and shortest portion off of stomach (Pyloric

sphincter)• _____________

– 2nd portion off Duodenum (Duodenojejunal flexure).

Feathery appearance• ____________

– 3rd 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 __________• ____________– 1st 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 1st

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.