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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 3rd 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 3rd 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 – 1st segment off stomach - Duodenal bulb • Jejunum – 2nd segment off duodenum (Duodenojejunal flexure). • Ileum – 3rd 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 1st 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
