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Procedures II Exam 2: Fluoroscopy & GI System, Exams of Human Physiology

Glasgow School of Art (GSA)Human Physiology

A comprehensive overview of the digestive system, focusing on the anatomy and function of the esophagus and stomach. It includes detailed descriptions of the various parts of the gi tract, their functions, and the procedures used for their examination. The document also covers essential projections for radiographic imaging of the esophagus and stomach, including positioning, collimation, and exposure time recommendations. It further explores the small intestine, its anatomy, functions, and procedures for examination, including patient preparation and imaging techniques.

Typology: Exams

2024/2025

Available from 03/13/2025

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Procedures II Exam 2: Fluoroscopy & GI System
Digestive system: Alimentary canal ✔✔mouth, pharynx, esophagus, stomach, small intestine, large
intestine, anus
Functions of the GI system ✔✔ingestion: mouth, esophagus
digestion: stomach, small bowel
absorption: small/large bowel
elimination: large bowel
accessory organs of the digestive system ✔✔•Mouth
•Teeth
•Salivary Glands
•Gallbladder
•Pancreas
•Liver
anatomy of esophagus ✔✔10 inches long
-Functions to convey food and saliva from laryngopharynx to stomach
Where does the esophagus begin? ✔✔C6 (approx level of cricoid cartilage)
where does the esophagus end? ✔✔T11 (joins stomach at esophogastric junction)
Anatomy of the stomach (4 parts) ✔✔cardia, fundus, body, pylorus
Dilated, saclike portion of the digestive tract extending between the esophagus and small intestine
cardia of stomach ✔✔where esophagus contacts medial surface of stomach, near heart
funds of stomach ✔✔dome-shaped region beneath diaphragm
-fills the left hemidiaphragm
body of stomach ✔✔located between fundus and pyloric portion
-Interior surface contains numerous longitudinal folds called rugae
pylorus of stomach ✔✔prevent intestinal contents from reentering the stomach when the small intestine
contracts and to limit the passage of large food particles or undigested material into the intestine
pyloric antrum ✔✔connects to the body of the stomach
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Procedures II Exam 2: Fluoroscopy & GI System

Digestive system: Alimentary canal ✔✔mouth, pharynx, esophagus, stomach, small intestine, large intestine, anus Functions of the GI system ✔✔ingestion: mouth, esophagus digestion: stomach, small bowel absorption: small/large bowel elimination: large bowel accessory organs of the digestive system ✔✔•Mouth •Teeth •Salivary Glands •Gallbladder •Pancreas •Liver anatomy of esophagus ✔✔10 inches long

  • Functions to convey food and saliva from laryngopharynx to stomach Where does the esophagus begin? ✔✔C6 (approx level of cricoid cartilage) where does the esophagus end? ✔✔T11 (joins stomach at esophogastric junction) Anatomy of the stomach (4 parts) ✔✔cardia, fundus, body, pylorus Dilated, saclike portion of the digestive tract extending between the esophagus and small intestine cardia of stomach ✔✔where esophagus contacts medial surface of stomach, near heart funds of stomach ✔✔dome-shaped region beneath diaphragm
  • fills the left hemidiaphragm body of stomach ✔✔located between fundus and pyloric portion
  • Interior surface contains numerous longitudinal folds called rugae pylorus of stomach ✔✔prevent intestinal contents from reentering the stomach when the small intestine contracts and to limit the passage of large food particles or undigested material into the intestine pyloric antrum ✔✔connects to the body of the stomach

pyloric canal ✔✔muscle that connects the stomach to the proximal duodenum lesser curvature of stomach ✔✔concave medial surface of the stomach greater curvature of stomach ✔✔convex lateral surface of the stomach Cardiac notch of stomach ✔✔sharp angle at esophagogastric junction cardiac orifice ✔✔opening of the esophagus into the stomach

  • controlled by cardiac sphincter pyloric orifice ✔✔opening between stomach and small intestine
  • controlled by pyloric sphincter hypersthenic body habitus ✔✔These individuals have thicker part sizes compared with sthenic or hyposthenic individuals, so exposure factors are higher. Sthenic Body Habitus ✔✔on average 50% hyposthenic body habitus ✔✔tall/slender 35% of population Asthenic Body Habitus ✔✔very thin or slender with a long and narrow body build what are functions of the stomach ✔✔-food storage (can stretch to fit about 2 liters)
  • mechanically breaks down food by churning and peristalsis
  • chemical digestion (pepsin: enzyme that breaks down proteins into amino acids) chyme ✔✔chemical and mechanically altered food that leaves stomach gastrointestinal transit (4) ✔✔-Peristalsis = contraction waves by which the digestive tube propels contents toward the rectum
  • Three to four waves per minute occur in the filled stomach
  • Average emptying time for stomach is 2 to 3 hours
  • Average transit time to ileocecal valve is 2 to 3 hours examination procedure for GI tract ✔✔-preparing the room/materials
  • assisting the patient
  • obtain/record patient history
  • obtain scout image of interest
  • communicate w/ patient before and after contrast administration
  • Head turned to side to facilitate drinking
  • IR is placed so that top is level with the mouth
  • Central ray (CR) perpendicular to midpoint of IR
  • Usually at level of T5-T
  • Collimated field 14 x 17 inches AP/PA Oblique Esophagus ✔✔Position: recumbent 35-40 degree (RAO) or (LPO) IR: 2 in lateral to MSP of elevated side CR: 2 in lateral to MSP at T5-T Collimation: 14x Lateral Esophagus ✔✔Position: left lateral, patient faces radiographer, arms forward CR: MCP at T5-T Collimation: 14x Stomach: GI Series ✔✔Examination often referred to as a gastrointestinal series (GI series) or upper gastrointestinal series (UGI series) May include:
  • Scout kidneys, ureters, and bladder (KUB)
  • Scout an xray of the esophagus/abdomen before barium is swallowed
  • Fluoroscopic and serial radiographic studies of the esophagus, stomach, and duodenum using ingested contrast (usually barium) Patient prep for stomach GI series ✔✔-Requires stomach to be empty
  • Desirable to have colon free of gas and fecal material --Food and water withheld 8 to 9 hours before examination (NPO)
  • If small intestine examined, food is withheld following evening meal --Nicotine and gum are thought to stimulate gastric secretions, so these are often restricted for same time frame biphasic examination ✔✔combination of single and double contrast during the same procedure Hypotonic duodenography ✔✔Requires intubation and is used for the evaluation of postbulbar duodenal lesions and the detection of pancreatic disease GI series procedure ✔✔-patient is upright
  • radiologist may examine patient using fluoro and check empty stomach
  • patient drinks barium
  • esophagus is examined w/ first 2-3 swallows
  • spot films made as needed
  • manual manipulation to used to coat gastric mucosa
  • patient drinks barium to fill stomach why is a GI series procedure used for? ✔✔Examination determines size, shape, and position of stomach; peristalsis; filling and emptying of duodenal bulb; and abnormalities in function or contour of anatomy Essential Projections: Stomach and Duodenum ✔✔PA PA oblique AP oblique Lateral (mediolateral) AP PA stomach and duodenum ✔✔SID: 40 in Position: recumbent or upright, align halfway btw vertebral column and left lat border of abdomen IR: centered 1-2 in above lower rib margin (L1-L2) upright- 3 - 6 in lower Breathing: suspended expiration CR: perp. to IR Collimation: 10x PA Oblique Stomach and Duodenum ✔✔SID: 40 in Position: Recumbent RAO 40-70 degrees, align halfway btw vertebral column and left lat border of abdomen IR: to lower rib margin (L1-L2) CR: perp to IR Collimation 10x Breathing: exposure made on suspended expiration AP oblique stomach and duodenum ✔✔SID: 40 in Position: recumbent LPO 30-60 degrees, align halfway btw vertebral column and left lat border of abdomen IR: midway btw xiphoid process and lower rib margin CR: perp. to IR Collimation 10x Breathing: exposure made on suspended expiration Lateral Stomach and Duodenum ✔✔SID: 40 in Position:
  • recumbent RIGHT lat. demonstrated RIGHT retrogastric space, duodenal loop, duodenojejunal junction
  • upright LEFT lat. demonstrates LEFT retrogastric space Align midway btw MCP and anterior surface IR: center at L1-L2, L3 for upright (1.5 in above crest)
  • To take advantage of superior and lateral shift of stomach, which improves visualization of duodenum and jejunum
  • To prevent compression of overlapping loops of intestine prone position for oral method (s.intestine) ✔✔used to... To compress abdomen and increase image quality image interval for oral method (s.intestine) ✔✔1st image: taken 15 minutes after ingestion of barium 2nd image: varies between 15 and 30 minutes
  • When barium reaches ileocecal region, radiologist uses fluoroscopy to obtain compression radiographs
  • examination complete when barium is seen in rectum (usually takes 2 hrs) Essential Projections: Small Intestine ✔✔PA or AP PA or AP small intestine ✔✔SID: 40 in Position: Prone or Supine, MSP centered IR: 30 min- center @ L2 (belly button) delayed- center @ iliac crest CR: perp. Collimation: 14x17in Breathing: end of expiration anatomy of large intestine ✔✔Four main parts
  • Cecum
  • Colon
  • Rectum
  • Anal canal How long is the large intestine? ✔✔5 feet haustra ✔✔pouches that form in the large intestine when the longitudinal muscles are shorter than the colon The taeniae coli are ✔✔muscular bands that form haustra Cecum function ✔✔absorb fluids and salts that remain after completion of intestinal digestion and absorption and to mix its contents with a lubricating substance, mucus vermiform appendix ✔✔hangs from the lower medial portion of the cecum Four portions of the colon ✔✔ascending, transverse, descending, sigmoid

right colic flexure ✔✔aka the hepatic flexure, the right-angle turn that continues from the ascending colon left colic flexure ✔✔aka the splenic flexure, point where the transverse colon curves below the inferior end of the spleen sigmoid colon ✔✔an S-shaped structure that continues from the descending colon above and joins with the rectum below function of large intestine ✔✔reabsorption of fluids and elimination of waste products Procedures of large intestine ✔✔-Examination methods

  • Contrast media
  • Preparation of intestinal tract
  • Barium enema (BE) apparatus
  • Preparation of BE suspensions contrast media ✔✔-Commercially prepared barium sulfate products generally used for routine retrograde examinations
  • High-density barium sulfate = newest product
  • Absorbs more radiation
  • Useful for double-contrast examinations When is air used as contrast? ✔✔-Air usually used in double-contrast studies
  • Carbon dioxide may also be used
  • More rapidly absorbed when is water soluble contrast used? ✔✔-Water-soluble iodinated agents may be orally administered when retrograde filling is contraindicated --Usually not satisfactory for double-contrast studies Preparation of Large Intestine for contrast studies ✔✔-Large intestine must be completely emptied of all contents
    • Retained fecal matter can simulate small masses
  • Restricted diet and bowel cleansing regimen standard for healthy patients
  • Preparation for patients with severe diarrhea, gross bleeding, or obstruction is limited bowel cleansing products (3) ✔✔-Complete intestinal cleansing kits
  • GI lavage preparations
  • Cleansing enema
  • insert tip slowly/steadily while patient expires breath
    • 1 to 1 1/2 anteriorly, then slightly superiorly (no more than 4 in)
  • hold in place while patient roles supine/prone
  • retention cuff inflated single contrast BE ✔✔-release clip to allow barium to flow
  • Flow is suspended periodically to reduce cramping and defecation impulse
  • Filling is viewed on fluoroscope
  • Radiologist instructs patient to rotate to visualize all portions of bowel
  • Radiologist takes spot radiographs, as needed
  • After all images acquired, remove enema tip
    • Deflate retention balloon first, if present
  • Assist patient to restroom and instruct to expel as much barium as possible
    • Provide bedpan for weakened patients
  • After patient has evacuated, another radiograph is taken to check mucosa double contrast BE ✔✔-Two methods
    • Closed system
    • Welin method
  • Closed system does not require removal and reinsertion of enema tip
  • Patient remains on table for entire procedure
  • Welin method recommended for early detection of small lesions single stage closed BE method ✔✔-For single-stage closed system method
    • Barium introduced and removed via bag position
    • Air introduced by bag inversion or by manual compression of sphygmomanometer bulb Welin Method BE ✔✔-Barium introduced to left colic flexure, then tip removed and patient evacuates
  • Tip reinserted, barium introduced to sigmoid, and air instilled
  • Patient position altered to coat mucosa
  • Spot radiographs taken as needed Essential Projections: Large Intestine ✔✔PA PA axial PA oblique
  • RAO position
  • LAO position

AP

AP axial AP oblique

  • RPO position
  • LPO position Lateral Rectum AP or PA
  • Right lateral decubitus position
  • Left lateral decubitus position AP or PA, oblique, lateral (upright) PA or AP Large Intestine ✔✔SID: 40 in Position: Prone or Supine IR: centered @ iliac crest CR: perp. to IR Collimation: 14x17in (basically a KUB) PA axial large intestine ✔✔SID: 40 in Position: Prone IR: centered @ iliac crest CR: angled 30-40 degrees caudad @ ASIS Collimation: 14x17in
  • Rectosigmoid area centered
  • Rectosigmoid demonstrated with less superimposition than PA PA Oblique Large Intestine ✔✔SID: 40 in Position: 35-45 degree RAO or LAO (supported by flexed knee and arm of elevated side) IR: centered @ iliac crest CR: 1-2 in lateral to midline of elevated side Collimation: 14x17in RAO demonstrates right colic flexure, ascending colon, and sigmoid LAO demonstrates left colic flexure and descending colon Lateral Large Intestine ✔✔SID: 40 in Position: left lateral recumbent (knees flexed, shoulders/hips/knees superimposed and perp.)
  • Ensure patient safety and comfort.
  • Prepare patient for procedure; removal of artifacts, gowns, robes slippers, patient to empty bladder..... special procedures: room set up ✔✔-Do pre-exam films.
  • Set control panel for digital and or conventional fluoroscopy.
  • Set table for initial patient position.
  • Set up sterile tray, contrast media and supplies; gloves, tape syringes....
  • Contrast reaction meds/supplies available special procedures: accessing manual ✔✔-Purpose for exam
  • Contrast used
  • Control panel settings
  • Room set up
  • Supplies
  • Patient position: Initial position and during exam
  • Film sequencing
  • Precautions myelogram ✔✔study of the spinal cord facet injection ✔✔Steroid or medication injection into the articular facts for pain management Lumbar Myelogram ✔✔to demonstrate extrinsic spinal cord compression caused by herniated disk , bone fragments. arthrography ✔✔-Contrast examination of joints or joint spaces of the knee, ankle, wrist, shoulder & TMJ.
  • Air & iodinated contrast media are used to examine soft tissues structures, ligaments, articular cartilage & bursae.
  • Patients may go to MRI after the injection. Broncography ✔✔Contrast study of the lungs & bronchial tree by injection of contrast media into the bronchi. Broncography indications ✔✔Hemoptysis, bronchiectasis, chronic pneumonia, obstruction, tumors, cysts, cavities, & bronchopleural cutaneous fistulae. Lung biopsies are also performed during this study. central line injection ✔✔Fluoroscopic visualization during contrast injections of indwelling lines in the major vessel. Done to check patency, position and integrity of the line. Defecography ✔✔Barium paste is inserted into the rectum; pt. is seated on a commode chair & placed in the lateral position to the fluoro unit. Lateral projections are obtained during defecation.
  • shows evacuation of the rectum endoscopic retrograde cholangiopancreatography (ERCP) ✔✔Evaluation of the bile ducts and/or pancreatic ducts through placement of a fiber optic scope to visualize and cannulate these ducts.
  • This study may be for either diagnosis or therapeutic treatment of conditions causing occlusion. hysterosalpingography ✔✔a radiographic examination of the uterus and fallopian tubes hysterosalpingography indications ✔✔-determine the size shape & position of the uterus & fallopian tubes;
  • to delineate lesions, polyps, tumors, or fistula tracts;
  • to investigate the patency of the fallopian tubes.
  • Contrast is injected via a uterine cannula.
  • Fluoroscopy, spot films & radiographs are utilized. sinus tract/ fistula tract exams ✔✔Cannulization and injection of any abnormal, draining opening anywhere in the body. Done to delineate/ define the extent of this tract and what structures are involved. Usually this tract is formed as a result of an infectious process that opens to the skin to drain the infectious material (abscess). fistula ✔✔abnormal passageway between two organs or between an internal organ and the body surface T-tube cholangiogram ✔✔-Post operative examination of the Common bile ducts in patients whose gallbladder was removed (usually because of gb stones).
  • A "T" shaped catheter is left inside the patient, with the horizontal portion of the T in the common bile ducts and the vertical portion in the cystic ducts.
  • done to check the CBD and see if there are any obstructions due to retained stones Venograms ✔✔Contrast examination of the veins of the extremities a, most commonly lower, to check for clots, narrowing, obstruction or inflammation. Arthrograms ✔✔Procedures where contrast medium is injected into a joint Esophageal dilation ✔✔Done to relieve esophageal stenosis.