Chp 12 Biliary Tract And Upper Gi System

Front 1

What is the functions of the Biliary System?

Back 1

Manufacturing Bile (Liver), Transporting Bile (Various Ducts), and Storing Bile (Gall Bladder)

Front 2

Where is the liver and gall bladder located?

Back 2

Under right hemidiagphragm

Front 3

What parts of the liver and gall bladder in the anterior view?

Back 3

Two Major Lobes (Larger lobe on the right, the smaller on the left) and the Falciform Ligament that separates the two lobes. Common Bile duct of the gallbladder

Front 4

What parts of the liver and gall bladder in the posterior view?

Back 4

Two Minor lobes (Quadrate lobe and Caudate Lobe), Inferior Vena Cava is on surface of Caudate Lobe. The Gallbladder

Front 5

How many different functions of the liver and name one that deals with the biliary system?

Back 5

Over 100 functions; production of bile (about 800-1000mL a day)

Front 6

What does bile do?

Back 6

aids in digestion of fats and absorption of fats

Front 7

Where are the gall bladder and biliary ducts located?

Back 7

outside the liver.

Front 8

What does the spiral valve do?

Back 8

prevent distention or collapse of the cystic duct

Front 9

What is the entire bile route?

Back 9

Right/Left Hepatic Duct -> Common hepatic duct -> common bile duct -> pancreatic duct -> Duodenum

Front 10

What is the shape of the gallbladder and what are the 3 parts?

Back 10

Pear Shaped; Fundus, body, neck

Front 11

Name functions of the Gall Bladder:

Back 11

1. Storage of Bile

2. Concentration of bile

3. Contraction When Stimulated

Front 12

How is bile concentrated?

Back 12

by hydrolysis, which is the removal of water

Front 13

What does and what is Cholecystikinin (CCK) do?

Back 13

Increased levels of cck in the blood cause the gall bladder to contract and distal end of common bile duct to relax; a hormone secrected by duodenal mucosa when stimulated by food)

Front 14

pancreatic duct and common bile duct join to form this

Back 14

Hepatopancreatic Ampulla

Front 15

Circular muscle fiber that relaxes when cck increases in the blood

Back 15

Sphincter of Oddi

Front 16

Protusion of muscle into duodenum from sphincter of oddi

Back 16

duodenal papilla

Front 17

What are Choleliths and how are they formed?

Back 17

they are gall stones; formed In abnormal situation when too much water is absorbed or cholesterol becomes too concetrated

Front 18

What position is necessary to get the gallbladder as close to the ir as possible?

Back 18

Prone position

Front 19

What position would best assist the drainage of the gallbladder?

Back 19

supine posititon

Front 20

Label A-F

Back 20

A.Left Hepatic Duct

B.Common Hepatic Duct

C. Common Bile Duct

D. Pancreatic Duct

E. Hepatopancreatic Ampulla (ampulla of Vater)

F. Duodenal papilla

Front 21

Label G-L

Back 21

G. Duodenum

H. Fundus of Gallbladder

I. Body of Gallbladder

J. Neck of Gallbladder

K. Cystic Duct

L. Right Hepatic Duct

Front 22

What is the average weight of the adult human liver?

Back 22

3-4 pounds

Front 23

What is the act of swallowing called?

Back 23

Degluttition

Front 24

What two structures create the indentations seem along the lateral border of the esophagus?

Back 24

Aortic arch; left primary bronchus

Front 25

List 3 structures that pass through the diaphragm

Back 25

1. Esophagus

2. Inferior Vena Cava

3.Aorta

Front 26

What part of the Upper GI tract is a common site for ulcer disease?

Back 26

Duodenal bulb (or cap)

Front 27

The C- Loop of the duodenum and the pancreas are ______ (intraperitoneal or retroperitoneal) structures.

Back 27

Retroperitoneal (behind peritonium)

Front 28

Label A-F

Back 28

A. Tongue

B. Oral Cavity (Mouth)

C.Hard Palate

D.Soft Palate

E.Uvula

F.Nasopharynx

Front 29

Label G-L

Back 29

G. Oropharynx

H. Epiglottis

I. Laryngopharynx

J. Larynx

K. Esophagus

L. Trachea

Front 30

T or F: the body of the stomach curves inferiorly and posteriorly from the fundus.

Back 30

False; anteriorly and inferiorly

Front 31

Label A-F

Back 31

A. Fundus

B.Greater Curvature

C.Body

D. Gastric Canal

E. Pyloric Portion (pylorus)

F. Pyloric Orifice

Front 32

Label G-K

Back 32

G. Angular Notch

H. Lesser Curvature

I. Esophagogastric Junction (Cardiac Orifice)

J. Cardiac Antrum

K.Cardiac Notch (incisura cardiaca)

Front 33

The division of the stomach labeled E in figure 12.3is divided into two parts, what are they?

Back 33

Pyloric antrum and Pyloric Canal

Front 34

Another term for mucosal folds of the stomach is _____.

Back 34

Rugae

Front 35

Identify the correct body position for A, B, and C.

Back 35

A. Supine B. Prone C. Erect

Front 36

Label A-H

Back 36

A. Pylorus (pyloric sphincter)

B. Bulb (or cap) of duodenum

C. First (superior) portion of Duodenum

D. Second (descending) portion of duodenum

E. Third (horizontal) portion of duodenum

F. Fourth (ascending) portion of duodenum

G.Head of pancreas

H. Suspensory muscle of duodenum or ligament of Trietz

Front 37

Which two anatomic structures are known as the "Romance of the Abdomen"?

Back 37

Head of Pancreas and C-Loop of Duodenum

Front 38

Label A-F

Back 38

A. Distal Esophagus

B. Area of Esophagogastric junction

C. Lesser curve of the stomach

D. Angular notch

E. Pyloric region of stomach

F. Pyloric Valve or sphincter

Front 39

Label G-L

Back 39

G. Duodenal bulb

H. Second descending portion of duodenum

I. Body of stomach

J. Greater curvature of stomach

K. Rugae of stomach (mucosal folds)

L. Fundus of stomach

Front 40

Where is Peristaltic activity not found?

Back 40

Pharynx

Front 41

List the 3 classes of substances that are ingested that must be chemically digested

Back 41

Carbohydrates, Proteins, Lipids (fats)

Front 42

What is the end product for:

1. Carbohydrates

2. Lipids

3. Proteins

Back 42

1. Simple sugars

2. Fatty acids and glycerol

3. Amino Acids

Front 43

Absorption of nutrients primarily takes place in _______, although some substances are absorbed through the lining of the _____.

Back 43

Small intestine; stomach

Front 44

What food substance's digestion begins in the mouth?

Back 44

Carbohydrates

Front 45

Which term describes food once it is mixed with gastric secretions in the stomach

Back 45

Chyme

Front 46

Name the two abdominal organs that most dramatically affected, in relation to location, by body habitus.

Back 46

Stomach and Gallbladder

Front 47

Would the fundus be more superior or more inferior when one takes in a deep breath? Why?

Back 47

Inferior, because of its proximity to the diaphragm

Front 48

Another term for negative contrast media is:

Back 48

Radiolucent contrast medium

Front 49

Is the mixture of barium sulfate a suspension or a solution?

Back 49

Suspension (colloidal)

Front 50

What is the barium to water ratio for thin barium?

Back 50

One to one ration of barium and water

Front 51

What is the chemical symbol for barium sulfate?

Back 51

BaSO4

Front 52

The speed which barium sulfate travels through the GI Tract is called:

Back 52

Motility

Front 53

T or F: The esophagram usually begins with fluoroscopy with the patient in the erect position

Back 53

True

Front 54

List 4 radiographic tests that may be performed to detect signs of GERD.

Back 54

1. Breathing exercises

2. Water Test

3. Compression (paddle) technique

4. Toe-touch maneuver

Front 55

A breathing technique in which the patient takes in a deep breath and bears down is called the _____

Back 55

Valsalva Maneuver

Front 56

What position is the patient usually placed in during the water test?

Back 56

LPO (slight)

Front 57

Which region of the GI tract better visualized when the radiologist uses a compression paddle during an esophagram?

Back 57

Esophagogastric Junction

Front 58

What type of contrast medium should be used if the patient has a history of bowel perforation?

Back 58

Oral, water-soluble iodinated contrast media

Front 59

What is the minimum amount of time that the patient should be NPO before and upper GI?

Back 59

8 Hours

Front 60

Why should cigarette use and gum chewing be restricted before and Upper GI?

Back 60

Both increase gastric secretions

Front 61

List suggested barium dosages during an Upper GI for each of the following pediatric age groups?

1. Newborn-1yr

2. 1-3 years

3. 3-10yrs

4. More than 10yrs

Back 61

1. 2-4 oz

2. 4-6oz

3.6-12oz

4.12-16oz

Front 62

Why is the RAO preferred over the LAO for an esophagram?

Back 62

Places esophagus between the vertebral column and heart

Front 63

How much rotation of the body should be used for the RAO projection of the esophagus?

Back 63

35-40 degrees

Front 64

Which optional position should be performed to demonstrate the upper esophagus located btwn/ the shoulders?

Back 64

Optional Swimmer's Lateral

Front 65

The 3 most common routine projections for an esophagram are:

Back 65

1. RAO

2. Left Lateral

3. AP

Front 66

Which aspect of the GI tract is best demonstrated with an RAO position during an upper GI?

Back 66

Pylorus of Stomach and C-Loop

Front 67

How much rotation of the body is required for the RAO position during an upper GI on a sthenic patient?

Back 67

40-70 degrees

Front 68

What is the average kV range for an esophagram and upper GI when using barium sulfate (single-contrast study)?

Back 68

100-125 kV

Front 69

What is the purpose of the PA axial projection for the hypersthenic patient during an upper GI?

Back 69

To prevent superimposition of the pylorus over the duodenal bulb and better visualize the lesser and greater curvatures of the stomach

Front 70

What CR angle is required for the PA axial projection for a hypersthenic patient during an upper GI?

Back 70

35-45 degrees cephlad

Front 71

Which projection taken during an upper GI will best demonstrate the retrogastric space?

Back 71

Lateral

Front 72

What is the recommended kV rang for a double contrast upper GI projection?

Back 72

90-100kV range

Front 73

The upper GI series usually begins with the table and patient in the ____ position.

Back 73

Upright (erect)

Front 74

The 5 most common routine projections for an upper GI series are (not counting AP Scout projection) are:

Back 74

1. RAO

2. PA

3. Right Lateral

4. LPO

5. AP

Front 75

The major parts of the stomach on an average patient are usually confined to which abdominal quadrant?

Back 75

Left Upper Quadrant

Front 76

Most of the duodenum is usually found to the ____ of the midline on a sthenic patient

Back 76

Right

Front 77

T or F: Respiration should be suspended during inspiration for Upper GI radiographic projections

Back 77

False (expiration)

Front 78

Situation: A radiograph of an RAO projection taken during an esophagram demonstrates incomplete filling of the esophagus with barium. What can the technologist do to ensure better filling of the esophagus during the repeat exposure?

Back 78

When using thin barium, have the patient drink continuously during the exposure. With thick barium, have the patient hold 2-3 spoonfuls in the mouth and make the exposure immediately after swallowing

Front 79

Situation: A series of radiographs taken during an Upper GI reveals that the stomach mucosa is not well visualized. The following factors were used during positioning routine: high-speed screens, bucky, 40 in SID, 80 kV, 30 mAs, and 300mL of Barium Sulfate ingested during the procedure. Which exposure factor should be changed to produce a more diagnostic study?

Back 79

When using barium sulfate as a contrast medium, 100-125 kV should be used to ensure proper penetration of the contrast-filled stomach and visualize the mucosa; 90-100 kV would be adequate for a double contrast study

Front 80

A radiograph taken during an upper GI (double-contrast study) reveals that the anatomic side marker is missing. The technologist is unsure whether it is a recumbant AP or PA projection. The fundus of the stomach is filled with barium. which position does this radiograph represent?

Back 80

AP because the fundus is more posterior that the body or pylorus, it ill fill with barium when that patient is in a supine (AP) position

Front 81

A patient with a clinical history of hiatal hernia comes to the radiology department. Which procedure should be performed on this patient to rule out this condition?

Back 81

Upper GI series

Front 82

A patient with a possible lacerated duodenum enters the emergency room. The ER physician orders an upper GI to determine the extent of the injury. What type of contrast medium should be used for this examination?

Back 82

An oral, water soluble contrast media should be used for an upper GI when ruptured viscus or bowel is suspected. Not barium because barium is not water soluble

Front 83

Situation: A patient with a fish bone stuck in his esophagus enters the emergency room. What modifications to a standard esophagram may be needed to locate the foreign body?

Back 83

With radiolucent foreign bodies in the esophagus. shredded cotton soaked barium may be used to help locate it. But today, most foreign body studies of the esophagus are located and removed through endoscopy

Front 84

Situation: An Upper GI is being performed on a thin, asthenic-type patient. Because of room scheduling conflicts. this patient was brought into your room for the overhead follow-up images following fluoroscopy. Where would you center the CR and the 30- x 35- cm (11 x14 inch) image receptor to ensure taht you included the stomach and duodenal region

Back 84

Would center lower than usual, to the mid-L3 to L4 region or 1.5-2 inches (4-5cm) above the level of the iliac crest

Front 85

A patient with a clinical history of a possible bezoar comes to the radiology department. What is a bezoar, and what radiographic study should be performed to demonstrate this condition?

Back 85

A mass of undigested material that gets trapped in the stomach; a rare condition that can be diagnosed with an upper GI study

Front 86

Situation: A radiograph of an RAO position taken during an esophagram reveals that the esophagus is superimposed over the vertebral column. What positioning error led to this radiographic outcome? What must be altered to eliminate this problem during repeat exposure?

Back 86

Under-rotation of the body into the RAO position led to the esophagus being superimposed

Front 87

Situation: A patient comes to radiology with a clinical history of possible gastric diverticulum in the posterior aspect of the fundus. Which projection taken during the upper GI series best demonstrates this defect?

Back 87

The lateral position best demonstrates a gastric diverticulum located in the posterior region of the stomach.

Front 88

What is the breakdown of saliva an how much is produced daily?

Back 88

99.5% Water .5% Solutes/salts and digestive enzymes; 1000-1500mL daily

Front 89

What is the cardiac antrum?

Back 89

Abdominal segment of the esophagus

Front 90

Where is the CR located for a RAO esophagram?

Back 90

t5-t6, 2inches inferior to jugular notch.

Front 91

In a LPO for an asthenic patient where is the CR located and what degree of obliquity?

Back 91

2inches below L1; 30 degree obliquity