1. Chapter 12/13 Upper GI & Small Bowel

2. Alimentary Canal _______________ Pharynx Esophagus _______________ Small intestine ______________ Anus

3. Accessory Organs Salivary Glands –___________ –Submandibular –__________ Pancreas ____________ Gallbladder

4. Digestion Terms _____________ – Chewing ____________ – Swallowing _________ – Wavelike involuntary muscle contractions

5. Oral Cavity (Mouth) ___________ Hard and Soft Palate __________ Tongue

6. Pharynx (Throat) ______________ –Posterior to Nasal Cavity ______________ –Posterior to Oral Cavity _______________ –Posterior to Larynx

7. Deglutition Bolus to __________ oral cavity Soft palate closes off ____________ Trachea elevates and ________ folds over Food enters ___________

8. Esophagus Muscular canal –Approx. 10 inches long –Starts posterior to _____________ –Ends at _____________

9. Esophagus Posterior to the ___________ Anterior to _____________Vertebra Passes through the Diaphragm –_________________

10. Esophagus 2 Normal indentations (Stenosis) –___________ –______________

11. Esophagus Abdominal Segment –_____________ Attaches to the Stomach –Esophagogastric Junction _______________

12. Modified Barium Swallow (MBS) Evaluates ___________ Focus is on _____________ esophagus at the area of the _____________ Watch for __________ with various consistencies. –Epiglottis Movement

13. MBS Assist _____________ Record Study –Tape –Digital

14. Esophagus Imaging Routine PA RAO Lateral Recumbent or Erect Expose during 3 rd swallow of Barium 90 kVp

15. 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

16. RAO Esophagus ____________ CR to T5-6 _____________of spine Expose during ____________ Collimate to approx 4” transverse field Esophagus should be between vertebral column and __________

17. Lateral Esophagus Rt or Lt however pt _________________ Center at T5-6 Mid _______________- Collimate to approx 5-6” transverse field

18. Gastro Openings Proximal Esophagogastric junction (cardiac orifice) –___________– Opening into the Stomach –___________– Allows food to enter –____________- Superior indentation off cardiac orifice

19. Gastro Openings Distal Pyloric Orifice –_________ –_________– allows food to enter small intestine

20. Stomach Anatomy ________ – Folds _________ – Superior portion _________ – Large middle portion ______ Curvature – Medial border, Concave ______Curvature – Lateral border, Convex

21. Stomach Anatomy Pyloric Portion –Pyloric __________ –Pyloric _________ –Pyloric _______________ Angular Notch – Separates the Body from Pyloric

22. 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

23. Body Habitus Watch _________ for position of stomach Hypersthenic – Higher stomach __________ Sthenic – Mid range __________ Hyposthenic – Lower ______________

24. Small Bowel Anatomy _______________ – 1 st and shortest portion off of stomach (Pyloric sphincter) _____________ – 2 nd portion off Duodenum (Duodenojejunal flexure). Feathery appearance ____________ – 3 rd and longest portion. Terminates at ileocecal valve (RLQ) Smoother apperance

25. Duodenum First portion of small intestine 8-10 inches long ‘C’ shaped due to head of __________ ____________– 1 st portion of duodenum. –Must be seen on UGI study

26. Duodenum ________________ portion – Receives bile and pancreatic enzymes Horizontal and ascending portion – Forms remainder of ‘C’ shape ________________ flexure – Duodenal and jejunum transition

27. UGI Prep NPO ___________ Flouro working Radiologist equipment ready –___________ –____________ –Paddle –Anything else Pt ___________________

28. UGI If possible pt starts ___________ If dual contrast pt swallows ________________ –Instruct the patient not to ________

29. UGI ______________ Barium –Coats the esophagus and stomach Lay the table down and assist the patient _____________ Barium –To fill the stomach

30. UGI with NG ___________Barium Large Syringe Draw up thin barium and inject through NG ________________

31. UGI Imaging Routine AP Scout PA Slight RAO Steep RAO Rt Lateral AP 100kVp 40”SID

32. The Scout Film Prior to most fluoro procedure Assesses _______________ Gives an overview prior to barium

33. AP & Scout High KUB Supine CR Midline ______________iliac crest Expose on _________________

34. PA UGI Prone Center at duodenal bulb ___________ ____________of mid-line Watch fluoro

35. Slight RAO ______________ Center at L- 1 or 2 Halfway between ______________lateral aspect of body

36. Steep RAO __________ Center as Slight RAO

37. Rt Lateral Pt on Rt side Center at __________ _______________to mid-coronal plane Bend knees for stability

38. Tip for L-2 finding Level of ________________is extended _____________!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

39. Small Bowel Series Patient prep –NPO ___________ –Bowel prep Have ready –_________________ –Unless UGI 1 st

40. Small Bowel Series Sometimes done in conjunction _______ –SBS occurs _______________overheads with timed PA SBS only. –After _______________of Barium timed PA

41. SBS _____________are usually 15 min, 30 min and every 30 unless rad says otherwise Continues until contrast reaches ___________ Spot film of the _____________concludes SBS

42. PA KUB Place pt prone CR for early films _______________iliac crest CR for late films (after 30 min) _________

43. Enteroclysis _____________Small Bowel study Requires –____________ –Barium –Air or Methylcellulose –_________ Rad inserts _____________to duodenum followed by solutions with spot films and rad preference overheads.