Ouhsc Film Critique Test 2

Front 1

What needs to be included on an esophogram x-ray?

Back 1

GI structures of interest & cortical outline of the bony anatomy

Front 2

RAO Esophogram

Back 2

- Esophagus should be between the spine & heart shadow
- CR 3" lateral of spinous process, 2" below jugular notch

Front 3

How should the lower arm be positioned on a lateral esophogram x-ray?

Back 3

90 degrees to the body (similar to Swimmer's)

Front 4

If the patient's elevated side is rotated posteriorly on a lateral esophogram...

Back 4

Posterior ribs will have more than 1/2" between them

Front 5

If the patient's elevated side is rotated anteriorly on a lateral esophogram...

Back 5

Posterior ribs are superimposed

Front 6

What kVp is usually used for a single contrast UGI?

Back 6

> 100 kVp

Front 7

What kVp is usually used for a double contrast UGI?

Back 7

80-90 kVp

Front 8

Patient Prep for UGI

Back 8

NPO after midnight (or 8 hours), no gum or tobacco

Front 9

RAO UGI

Back 9

- air in fundus for double contrast
- barium in pylorus, duodenal bulb, & descending duodenum

Front 10

Normal Sthenic RAO Rotation

Back 10

45 degrees

Front 11

Normal Hypersthenic RAO Rotation

Back 11

As much as 70 degrees

Front 12

Normal Asthenic RAO Rotation

Back 12

As little as 40 degrees

Front 13

What should be seen on RAO UGI?

Back 13

- duodenal bulb & descending duodenum in profile
- long axis of stomach is foreshortened w/ closed lesser curvature
- pylorus centered, entire stomach & duodenal loop included

Front 14

What should be seen on a hypersthenic right lateral UGI?

Back 14

Same things as seen on an RAO UGI

Front 15

What should be seen on an asthenic right lateral UGI?

Back 15

- duodenal bulb & descending duodenum in profile
- long axis of stomach is not foreshortened, lesser curvature open

Front 16

What should be seen on a LPO UGI?

Back 16

- pylorus centered
- stomach & duodenal loop included
- air in pylorus, duodenal bulb & descending duodenum
- barium in fundus
- exactly opposite from RAO

Front 17

Hypersthenic LPO UGI

Back 17

- 60 degree rotation
- PYLORUS OVER THE SPINE

Front 18

Sthenic LPO UGI

Back 18

- 45 degree rotation
- vertebrae are demonstrated with little if any pyloric superimposition

Front 19

Asthenic LPO UGI

Back 19

- 30 degree rotation
- little pyloric superimposition

Front 20

Where is the stomach in a sthenic AP UGI?

Back 20

Almost vertical to pyloric section

Front 21

Where is the stomach in a sthenic AP UGI?

Back 21

Nearly horizontal to pyloric section

Front 22

What should be seen on a small intestine AP?

Back 22

- spinous processes in middle of image
- no rotation as shown by spine & pelvis

Front 23

How do you know when a small bowel study is finished?

Back 23

Barium in the cecum

Front 24

Tracheoesophageal Fistula

Back 24

- congenital: results from failure of esophagus to completely separate from trachea
- acquired: 50% due to malignancy in mediastinum (80% die within 3 months)
- contrast through feeding tube goes into trachea

Front 25

Esophagitis

Back 25

- result of GERD, infection, injury from chemical or radiation, medication
- burning chest pain
- can cause superficial ulcerations, dilated esophagus, loss of peristalsis

Front 26

Esophageal Reflux

Back 26

- lower esophageal sphincter fails to block gastric acid from entering esophagus
- can erode esophagus if untreated

Front 27

Barrett's Esophagus

Back 27

- severe reflux that destroys normal squamous lining & replaces it w/ columnar epithelium
- tissue looks ragged
- may have hiatal hernia below ulceration

Front 28

Esophageal Cancer

Back 28

- difficulty in swallowing over age 40
- symptoms don't appear until late
- ulceration of esophageal wall (irregular), annular constrictions
- more men than women
- Shelf Sign: looks like the esophagus is missing a section

Front 29

Esophageal Diverticulum

Back 29

- common
- contains all layers (traction or true diverticula [lower 1/3 of esophagus])
- only mucosa & submucosa herniating through muscular layer (pulsion or false diverticula [middle 1/3 of esophagus])

Front 30

Zenker's Diverticulum

Back 30

- posterior wall of upper cervical esophagus
- may be large enough to block lumen
- infection of mediastinal lymph nodes cause adhesions which causes traction diverticulum

Front 31

Esophageal Varices

Back 31

- dilated veins due to increased pressure in portal venous system (from cirrhosis of liver)
- blood flow through liver to inferior vena cava is inhibited causing it to go through veins in stomach & esophagus
- have wavy borders, thickened folds; looks like rosary beads

Front 32

Hiatal Hernia

Back 32

- happens in 50% of population
- small ones only appear when pressure is applied, large ones may cause much of stomach to be above diaphragm
- may cause reflux

Front 33

Schatzki's Ring

Back 33

- gastroesophageal junction above diaphragm
- result of sliding hiatal hernia
- can see when the patient is in Trendelenburg during UGI
- symptoms: heartburn, dysphasia

Front 34

Rolling/Paraesophageal Hernia

Back 34

- stomach protrudes through another space close to hiatus
- gastroesophageal junction still in normal place

Front 35

Achalasia

Back 35

- obstruction of distal esophagus w/ proximal dilation caused by incomplete relaxation of esophageal sphincter
- meds to relax sphincter are taken before meals
- esophagus just seems to stop

Front 36

Esophageal Tear

Back 36

- caused by esophagitis, neoplasm, ulcer, or external trauma
- symptoms: severe vomiting
- large tear can cause free air in mediastinum

Front 37

Corkscrew Esophagus

Back 37

- asynchrony of peristalsis (tertiary contractions)
- happens in elderly patients

Front 38

Leiomyomata

Back 38

- benign neoplasm
- intraluminal polypoid defect w/ smooth narrowing of lumen

Front 39

Peptic Ulcer

Back 39

- caused by inflammation of stomach & duodenum from acid & pepsin in stomach
- most frequently seen = lesser curvature
- duodenal ulcer is most common (95% in duodenal bulb)

Front 40

Stomach Cancer

Back 40

- infiltrating carcinoma causes narrowing of pyloric canal (most are adenomas)
- as tumor advances towards fundus, stomach becomes narrower & stiffer
- survival rate = 10%
- high in Japan, Chile, & Eastern Europe
- sign -- absence of hydrochloric acid (achlorhydria)

Front 41

Pyloric Stenosis

Back 41

- congential abnormality
- STRING SIGN: narrowing of lumen of pylorus caused by hypertrophy of muscle (stomach becomes distended)
- symptom: projectile vomiting after feeding 2-4 weeks after birth

Front 42

Duodenal Diverticula

Back 42

- incidental findings in 1-5% of UGIs
- "BAYONET" STOMACH
- small outpouching of bowel lumen filled with contrast around the junction of 1st & 2nd portions of duodenum

Front 43

Menetrier's Disease

Back 43

- giant hypertrophic gastritis (giant folds of tissues within stomach)
- rare chronic disease seen in men aged 30-60
- symptoms: pain, loss of appetite, vomiting w/ blood, ulcer-like pain after eating

Front 44

Bezoar

Back 44

- foreign body reaction
- Phytobezoar: vegetable material
- Trichobezoar: hair & fingernails

Front 45

Regional Enteritis

Back 45

- chronic inflammatory disorder (unknown cause)
- most common area: terminal ileum
- young adults most common (stress & emotional upsets related to onset or relapse)
- *cobblestone pattern*

Front 46

Crohn's Disease (Regional Enteritis)

Back 46

- irregular thickening of mucosal folds caused by submucosal inflammation & edema
- transverse & longitudinal ulcerations separate islands of thickened mucosa
- may have normal sections of bowel in between inflamed sections

Front 47

Celiac Disease

Back 47

- genetic disease caused by gluten
- damages small intestine
- barium looks clumped together & broken up

Front 48

Meckel's Diverticulum

Back 48

- found in ileum
- rounded persistent yolk sac
- rapidly empties so it's difficult to image
- shown best in nuclear med

Front 49

What filters the blood in a nephron?

Back 49

Glomerulus

Front 50

Where are the ureters located when looking laterally?

Back 50

Medially between kidney & spine

Enter bladder posteriorly & laterally

Front 51

How much urine can the bladder hold?

Back 51

800 mL

"Need to go" when there's 300 mL

Front 52

What will be seen on a 5 min KUB film of an IVP?

Back 52

Kidneys, most of ureters, & contrast starting to fill bladder

Front 53

What does a retrograde IVP show?

Back 53

The form of the kidneys, not the function

Front 54

Renal Agenesis

Back 54

- only 1 kidney
- congenital

Front 55

Hypoplastic Kidney

Back 55

- smaller than normal, but not atrophic
- still functions properly

Front 56

Ectopic Kidney

Back 56

- left kidney low in pelvis
- renal ectopia (misplaced kidney)
- crossed ectopic kidneys (1 kidney is lower, & fused w/ lower pole of other kidney)

Front 57

Horseshoe Kidney

Back 57

- congenital fusion anomaly
- both kidneys malrotated, lower poles joined by a band of normal parenchyma
- renal pelvis may be large & flabby; ureters anterior not medial

Front 58

Bifid Collecting System

Back 58

Multiple ureters and/or kidneys (no symptoms)

Front 59

Ureterocele

Back 59

Cystic dilation of distal ureter at or near insertion into bladder

Cobra head sign

Front 60

Bright's Disease (Glomerulonephritis)

Back 60

- inflammatory disease
- glomerulus becomes permeable which causes blood & albumin leak into urine
- small, smooth underdeveloped kidneys

Front 61

Pyelonephritis

Back 61

- occurs b/c of obstruction of urinary tract due to enlarged prostate, kidney stone, or congenital defect
- may not see acute on x-ray

Front 62

Emphysematous Pyelonephritis

Back 62

- only occurs in diabetics
- gas-forming bacteria
- will cause necrosis of entire kidney

Front 63

Papillary Necrosis

Back 63

- destructive process involving the medullary papillae & the terminal portion of the renal pyramids
- cavitation occurs
- looks like white oval spots on kidney

Front 64

Kidney Stones

Back 64

- abnormal accumulation of mineral salts within urinary system
- 80% radiopaque, can be seen on plain x-ray (CT at 95%)

Front 65

Staghorn Kidney Stones

Back 65

- large stone takes the shape of the renal pelvis, which blocks the flow of urine
- have to drain kidney with a tube

Front 66

Renal Diverticulum

Back 66

- abnormal pouches, variable size
- stagnant urine causes stones & infections
- best seen on a retrograde exam

Front 67

Polycystic Kidney

Back 67

Multiple cysts replace the normal parenchyma of the kidney, which causes obstruction

Front 68

Renal Cell Carcinoma

Back 68

- occurs in over 40 year olds
- symptoms: painless hematuria, localized bulging or general enlargement

Front 69

Wilm's Tumor (Nephroblastoma)

Back 69

- most common renal malignancy in children under 5
- malignant

Front 70

Grawitz Tumor (Adenocarcinoma, Hypernephroma)

Back 70

- malignant
- destroys kidney & invades vascular system, particularly the renal vein & inferior vena cava

Front 71

Hydronephrosis

Back 71

Distention of renal pelvis & calices caused by obstruction

Front 72

Patient Prep for Lower GI Exams

Back 72

- NPO after midnight
- low residue diet 2-4 days before
- may take laxative, cleansing enema day before

Front 73

What would you be looking for in a double contrast lower GI study?

Back 73

Polyp

Front 74

Intussusception

Back 74

- most common cause of bowel obstruction in babies & young children
- part of bowel telescopes in on itself, restricts blood flow
- due to some kind of mass in adults

Front 75

Hirschsprung's Disease

Back 75

- typically seen in children
- Aganglionic megacolon
- absence of peristalsis

Front 76

Diverticulosis

Back 76

- development of pouches on colon which balloon outward
- can cause swelling & partial stenosis
- fecal matter hangs out in pouches, causes infection

Front 77

Volvulus

Back 77

- occurs when part of the intestine twists on itself
- looks like lines across abdomen area

Front 78

Polyps

Back 78

- malignant: sessile (no stalk), large & flat
- benign: pedunculated (have a stalk), mushroom shaped

Front 79

Colon Cancer

Back 79

- rectosigmoid cancer can spread to liver if not treated early, then metastasizes
- no early symptoms
- often results from untreated polyp

Front 80

Where does ulcerative colitis usually begin?

Back 80

Recto-sigmoid end of colon