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Radiography Of The GI System

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Radiography Of The GI System Kyle Thornton DMI 63 Pertinent Anatomy Of The Digestive System Accessory glands Salivary glands Liver Gallbladder Pancreas Alimentary ... – PowerPoint PPT presentation

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Title: Radiography Of The GI System


1
Radiography Of The GI System
  • Kyle Thornton
  • DMI 63

2
Pertinent Anatomy Of The Digestive System
  • Accessory glands
  • Salivary glands
  • Liver
  • Gallbladder
  • Pancreas
  • Alimentary Canal
  • Mouth
  • Pharynx
  • Esophagus
  • Stomach
  • Small / Large Intestine

3
Esophagus
  • Long muscular tube that carries food and saliva
    from laryngopharynx to stomach
  • Approximately 10 in. long in adult
  • Lies in the midsagittal plane
  • Originates around C-6
  • In the thorax, it is anterior to the spine,
    posterior to trachea and heart
  • Passes through diaphragm through esophageal hiatus

4
Esophagus
  • Inferior to diaphragm curves sharply left
  • Increases in diameter
  • Joins stomach at esophagogastric junction
  • Cardiac antrum
  • At level of xyphoid tip
  • 4 layers of the esophagus
  • Outermost - fibrous
  • Muscular
  • Submucosal
  • Innermost - Mucosal

5
Stomach
  • Dilated saclike portion of digestive tract
  • Composed of same 4 layers as esophagus
  • Divided into 4 parts
  • Cardia
  • Fundus
  • Body
  • Pyloric portion

6
Stomach
  • Cardia
  • Immediately surrounding esophageal opening
  • Fundus
  • Superior portion
  • Fills dome of left hemidiaphragm
  • Generally contains gas
  • Body
  • Begins at cardiac notch
  • Contains rugae
  • Terminates at angular notch
  • Pyloric portion
  • Consists of pyloric antrum and canal

7
Stomach
  • Anterior and posterior surface
  • Right border marked by lesser curvature
  • Left border marked by greater curvature
  • Begins at esophogogastric junction, terminates at
    pylorus
  • 4-5 times longer than lesser curvature
  • Entrance to stomach is the cardiac orifice
  • Controlled by cardiac sphincter
  • Exit is the pyloric orifice
  • Controlled by pyloric sphincter

8
Body Habitus And Its Effect On Positioning
  • Hypersthenic
  • Horizontal and superior
  • Dependent portion above umbilicus
  • Asthenic
  • Vertical and inferior
  • Sthenic
  • Generally found between xyphoid process and iliac
    crest

9
Functions Of The Stomach
  • Storage area for further digestion
  • Food is chemically broken down
  • This broken down material is called chyme

10
Small Intestine
  • Extends from pyloric sphincter to ileocecal valve
  • Joins large intestine at right angle
  • Digestion and absorption of food occur in small
    intestine
  • Approximately 22 feet in length in adult
  • Contains same four layers as stomach and
    esophagus
  • The mucosa contains projections called villi to
    facilitate digestion and absorption
  • Divided into three parts
  • Duodenum
  • Jejunum
  • Ileum

11
Duodenum
  • 8 - 10 inches in length
  • Widest portion of small intestine
  • Follows a C-shaped course
  • Contains 4 regions
  • Superior, descending, horizontal, ascending
  • The first region is known as the duodenal bulb
  • The fourth portion joins the jejunum and is
    supported by the ligament of Trietz
  • The head of the pancreas is contained in the
    duodenal loop - second portion

12
Jejunum And Ileum
  • Jejunum
  • Upper remaining two-fifths of small bowel
  • Ileum
  • Terminates at ileocecal valve
  • Both are gathered into freely movable loops
    (gyri)
  • Attached to posterior abdominal wall by mesentary
  • Generally found in central and lower part of abd.
    cavity within arch of large intestine

13
Large Intestine
  • Begins at right iliac region
  • Joins ileum of small intestine
  • Forms an arch around the small intestine
  • Four main parts
  • Cecum
  • Colon
  • Rectum
  • Anal canal

14
Large Intestine
  • About 5 feet in length in adult
  • Greater in diameter than small intestine
  • Contains same four layers as esophagus, small
    intestine, and stomach
  • The muscular portion contains external bands of
    muscle known as taeniae coli
  • These bands create a series of pouches known as
    haustra
  • The large intestine functions to reabsorb fluids
    and eliminate waste products

15
Portions Of The Large Intestine
  • Cecum
  • Ascending
  • Joins transverse colon at right colic flexure
  • Transverse
  • Descending
  • Joins transverse colon at left colic flexure
  • Sigmoid
  • Rectum
  • Anal canal

16
Variations In Body Habitus
  • Hypersthenic
  • The colon generally lies in the periphery of the
    abdomen
  • May require more films to adequately display the
    anatomy
  • Asthenic
  • Intestines are bunched together
  • Lie low in the abdomen

17
Contrast Media
  • Barium sulfate
  • Water insoluble
  • Iodinated contrast media
  • Water soluble
  • Horrible taste
  • Does not adhere to wall of alimentary tract
  • Indicated in case of perforation
  • Air
  • Considered a negative contrast
  • Generally administered by carbon dioxide crystal
    ingestion
  • Barium and Air are often used as a double
    contrast agent

18
Imaging Notes/Preparation
  • Have contrast agents mixed and ready
  • Explain examination to patient
  • Ensure that patient has followed preparation
    instructions
  • Ensure that footboard is securely on table
  • Use short exposure times
  • Use high kVp to penetrate barium
  • Take exposures at the end of full expiration

19
Radiography Of The Esophagus
  • Can use double or single contrast
  • The barium should flow to sufficiently coat the
    esophagus
  • Examinations can be done in the upright or
    recumbent position
  • The exam will usually be started with fluoroscopy

20
AP or PA Projection
  • Place patient supine or prone
  • Center the midsagittal plane to the film
  • Bottom of film should be placed just below tip of
    xyphoid
  • Patient should commence drinking contrast before
    exposure and continue drinking during exposure
  • Use shielding for every exposure

21
RAO or LAO Positions
  • Patient should be rotated 35 - 40 degrees
  • Center about two inches lateral to MSP
  • Bottom of film below xyphoid
  • Patient must drink before and during the exposure
  • Use shielding

22
Lateral Projection
  • Place patient in lateral position
  • Center the midcoronal plane to the film
  • Bottom of film below xyphoid process
  • Patient must drink continuously before and during
    exposure
  • Use shielding

23
Structures Shown/Film Evaluation
  • Entire barium filled esophagus from lower neck to
    stomach
  • Barium should be sufficiently penetrated
  • Surrounding structures should be visible, not
    overpenetrated
  • No rotation on AP, PA, or lateral projections
  • Esophagus should be displayed between heart and
    spine on oblique projections

24
Valsalva Maneuver
  • Useful in demonstrating esophageal varices
  • Have patient first deeply inspire
  • Swallow contrast
  • Bear down
  • This should be done in the recumbent position

25
Radiography Of The Stomach
  • Referred to as the Upper GI Series
  • Generally consists of fluoroscopy and serial
    radiographs
  • Single or double contrast is used
  • Patient should follow a low residue diet for 2
    days prior to the examination
  • Patient must be NPO after midnight
  • AP scout generally obtained prior to exam

26
Single v. Double Contrast
  • Single Contrast
  • Shows size, shape, and position of the stomach
  • Examines changing contour of stomach during
    peristalsis
  • Observe filling and emptying of duodenal bulb
  • Double Contrast
  • Mucosal lining is well visualized
  • Small lesions are less easily obscured

27
UGI Positioning - PA Projection
  • Position
  • Prone
  • Center between MSP and Mid-Axillary line if using
    small film
  • Center at MSP if using 14 X 17
  • CR
  • Perpendicular to plane of film at level of L1-L2
  • Structures
  • Size, shape, and relative position of stomach
  • Pyloric canal and duodenal loop in hypo or
    asthenic patients
  • Evaluation
  • All pertinent anatomy
  • No rotation
  • Exposure sufficient to penetrate barium
  • Surrounding structures visible

28
UGI Positioning - PA Oblique Projection
  • Position
  • Recumbent
  • Body rotated 40 - 70 degrees
  • Hypersthenic patients require more rotation
  • CR
  • Perpendicular to L1-L2
  • Between vertebral column and elevated lateral
    border of the abdomen
  • Structures
  • Entire duodenal loop
  • Best image of pyloric canal and duodenal bulb
  • Evaluation
  • All pertinent anatomy
  • No superimposition of pylorus and duodenal bulb
  • Duodenal bulb and loop in profile

29
UGI Positioning - AP Oblique Projection
  • Position
  • Supine
  • Right side elevated 30 - 60 degrees
  • Average about 45 degrees
  • CR
  • Between vertebral column and left lateral border
    at L1-L2
  • Structures
  • Fundic portion of stomach filled with barium
  • Evaluation
  • All pertinent anatomy
  • No superimposition of pylorus and duodenal bulb
  • Barium filled fundus

30
Lateral Projection
  • Position
  • Lateral recumbent - right side
  • CR
  • Level of L1-L2
  • Between midcoronal and anterior of abdomen
  • Structures
  • Anterior/posterior portions of stomach
  • Pyloric canal and duodenal bulb in hypersthenic
    patients
  • Evaluation
  • No rotation
  • All pertinent anatomy

31
UGI Positioning - AP Projection
  • Position
  • Supine
  • CR
  • MSP at L1-L2
  • Between MSP and left side if using small film
  • At MSP if using 14 X 17
  • Structures
  • Barium filled fundic portion
  • Hiatal hernias, if present

32
Wolf Method - Hiatal Hernia
  • Patient rotated 40-45 degrees
  • Patient lies on compression sponge
  • CR angled about 20 degrees caudal
  • Patient must drink during exposure
  • Very useful in diagnosing hiatal hernia

33
Radiography Of Small Intestine
  • Contrast administration
  • Orally
  • Retrograde
  • Reflux filling via barium enema
  • Direct injection of contrast through NG tube
  • Enteroclysis

34
Small Intestine
  • Preparation
  • Low residue diet for 2 days prior when possible
  • NPO after midnight before the exam
  • Examination Procedure
  • Scout film obtained
  • Patient drinks barium
  • Films obtained in prone or supine position
  • Films begin at 15 minutes after barium
  • Barium usually reaches ileocecal valve in about 2
    -3 hours

35
Small Bowel - AP/PA Projection
  • Patient supine or prone
  • CR centered to level of L2 for early films
  • Iliac crest for later films
  • Continue taking radiographs until barium reaches
    terminal ileum
  • Fluoroscopic spot films may be taken of terminal
    ileum

36
Radiography Of The Colon
  • Single or double contrast
  • Single demonstrates the anatomy and tonus of the
    colon, along with most abnormalities
  • Double allows visualization of the intestinal
    lumen along with any polyps or lesions

37
Preparation Of The Colon
  • Patient must take a laxative on the day prior to
    the examination
  • Patient may have a clear liquid on the day prior
    to the exam
  • NPO after midnight
  • Cleansing enemas may also be indicated

38
Patient Preparation
  • Explain the examination fully to the patient
  • Use care when inserting the enema tip
  • Retention-type balloon tips should only be
    inflated under fluoroscopic control
  • Barium should only be administered under
    fluoroscopic control

39
PA Projection - Barium Enema
  • Pt. prone
  • MSP centered to film
  • CR at iliac crest
  • Entire colon must be visualized
  • The barium should be sufficiently penetrated with
    surrounding structures visible

40
PA Axial Projection - BE
  • Pt. prone
  • MSP centered to film
  • CR directed 30 - 40 degrees caudal to ASIS
  • Demonstrates rectosigmoid area of colon
  • This area must be centered to film

41
PA Oblique Projection (RAO)- Barium Enema
  • Pt. prone
  • Left side elevated 35 - 45 degrees
  • CR at iliac crest, 1 -2 inches lateral to midline
    of body
  • Best demonstrates right colic flexure
  • Ascending and sigmoid portion
  • Entire colon must be visualized

42
PA Oblique (LAO) - BE
  • Pt. prone
  • Right side elevated 35 - 45 degrees
  • CR to iliac crest, 1 - 2 inches lateral to
    midline
  • Best demonstrates left colic flexure
  • Descending portion of colon
  • Entire colon must be visualized

43
Lateral Projection - Barium Enema
  • Lt. or Rt. lateral recumbent position
  • Center midcoronal plane to film
  • CR enters midcoronal plane at level of ASIS
  • Best demonstrates rectum and distal sigmoid
    portions of colon
  • There should be no rotation
  • Rectosigmoid area should be centered

44
AP Projection - Barium Enema
  • Supine position
  • MSP centered to cassette
  • CR at iliac crest
  • Demonstrates entire colon
  • Entire colon must be included
  • Two cassettes are sometimes necessary

45
AP Axial Projection - BE
  • Pt. supine
  • MSP centered to film
  • CR to 2 in. above iliac crest
  • 30 - 40 degrees cephalic
  • Demonstrates rectosigmoid area of colon
  • Rectosigmoid area should be free of
    superimposition
  • Rectosigmoid area centered to film

46
AP Oblique Projection - BE
  • Pt. supine
  • Body rotated 35 - 45 degrees
  • CR 1 - 2 in. lateral to midline at iliac crest
  • LPO - Right colic flexure, ascending and sigmoid
    portions of colon
  • RPO - Left colic flexure, descending colon
  • Must demonstrate entire colon

47
Lateral Decubitus Positions - BE
  • Lateral recumbent position
  • Horizontal CR to MSP at level of iliac crest
  • Demonstrates AP or PA projection
  • Dependent side is barium filled
  • Up side is air-filled
  • Must include entire colon
  • Air-filled portion must not be overpenetrated

48
Upright Positions - Barium Enema
  • Cassette must be lowered to compensate for the
    drop of the bowel in this position
  • Demonstrates air-filled flexures and transverse
    colon
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