Loops. (No Quiz) Hand in Assignment #1 Last chance for Q+A on the midterm Loops 2.
Quiz 1 midterm 15 items
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Transcript of Quiz 1 midterm 15 items
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QUIZ 1 MIDTERM 15 ITEMS
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Problem solving A patient with a clinical history
of hiatal hernia comes to the radiology department. Which procedure should be performed on this patient to rule out this condition? (5pts)
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Problem solving What projection if the
radiograph of the stomach demonstrates the fundus if filled with contrast media and the body and duodenal bulb is filled with air with the lesser curvature en face is best visualized seen. Why? (5pts)
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11.- 12. Two Types of Ileus
13. – 15 Division of the small intestine
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PASS YOUR PAPERS
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LARGE INTESTINE/BARIUM
ENEMA
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ANATOMY REVIEW OF THE LARGE
INTESTINE
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LARGE INTESTINE
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It begins in right iliac region when it joins the ileum of the small intestine.
The length is approximately 5 ft. (152cm) long and is greater in diameter than the small bowel.
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Functions The large intestine takes about 32 hours
to finish up the remaining processes of the digestive system.
The large intestine simply absorbs vitamins that are created by the bacteria inhabiting the colon. It also absorbs water and compacts feces, and stores faecal matter in the rectum until eliminated through the anus
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Location It starts in the right iliac region of the pelvis,
just at or below the right waist, where it is joined to the bottom end of the small intestine.
From here it continues up the abdomen, then across the width of the abdominal cavity, and then it turns down, continuing to its endpoint at the anus.
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Large Intestine Anatomy CECUM COLON RECTUM ANUS
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Cecum The cecum or caecum (from the Latin
caecus meaning blind) is a pouch, connecting the ileum with the ascending colon of the large intestine.
It is separated from the ileum by the ileocecal valve (ICV) or Bauhin's valve, and is considered to be the beginning of the large intestine.
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Ascending colon The ascending colon, on the
right side of the abdomen, is about 25 cm long
It is the part of the colon from the cecum to the hepatic flexure (the turn of the colon by the liver).
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Transverse colon The transverse colon is the part of
the colon from the hepatic flexure to the splenic flexure (the turn of the colon by the spleen).
The transverse colon is encased in peritoneum, and is therefore mobile (unlike the parts of the colon immediately before and after it).
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Descending colon The descending colon is the part
of the colon from the splenic flexure to the beginning of the sigmoid colon.
The function of the descending colon in the digestive system is to store food that will be emptied into the rectum.
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Sigmoid colon The sigmoid colon is the part of the
large intestine after the descending colon and before the rectum. The name sigmoid means S-shaped
The walls of the sigmoid colon are muscular, and contract to increase the pressure inside the colon, causing the stool to move into the rectum.
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*Rectum and Anal Canal* Rectal Ampulla Anus Anal canal
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Rectum The rectum (from the Latin rectum
intestinum, meaning straight intestine) is the final straight portion of the large intestine and terminating in the anus. The human rectum is about 12 cm long
Its caliber is similar to that of the sigmoid colon at its commencement, but it is dilated near its termination, forming the rectal ampulla.
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Colon subdivision Ascending Transverse Descending Sigmoid
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BARIUM ENEMA
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Barium Enema (BE or Lower GI series) It is a Radiographic study of
the large intestine. Purpose:
to study Radiographically the form and function of the large intestine, as well as to detect any abnormal conditions.
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Clinical indications Colitis Diverticulosis Neoplasm Volvulus Intussusceptions Appendicitis
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Colitis Inflammation of the colon Image – thickening of mucosal wall
and loss of haustral markingsDiverticulum
outpouching of the mucosal wall resulting from herniation of the inner wall of the colon.
Image – jagged or sawtooth appearance of the mucosa
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Neoplasm tumors in large intestine. Image - narrowness or tapering of
lumen “apple core” or “napkin-ring” lesions
Volvulus twisting of a portion of the intestine
on its own mesentery. Image – corkscrew in appearance
with air-filled distended region of the intestine
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Intussusceptionstelescoping of one part of the
bowel into another.Image – mushroom-shaped
dilation at the distal aspect of the intussusception with little or no gass passing beyond it.
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Colitis
DiverticulaeApple core
Volvulus “coffe bean”
Intussusceptions
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Preparation of the Patient The final objective is that the
section of alimentary canal to be examined must be empty.
2 – classes of Cathartics (laxative) Irritant cathartic – castor oil Saline cathartic – magnesium
citrate or sulfate
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Contraindications to Cathartics
Gross bleeding Severe diarrhea Obstruction Inflammatory lesions
(appendicitis)
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Contrast Media High – density Barium Sulfate
It is excellent for use in double-contrast studies of the alimentary tract in which uniform coating of the lumen is required.
Air contrastCarbon dioxide may also be used
because it is more rapidly absorbed than nitrogen of air when evacuation.
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Mixture of Barium suspensions
12 % - 25% weight / volume – Single contrast
75% - 95% weight / volume – Double contrast
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Barium Containers Closed system type
enema Open system type
enema
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Close system type
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Enema Tips 3 – common enema
tipsPlastic disposableRectal retentionAir contrast retention
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Enema tips
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Enema tips insertion Sims position – relaxes the abdominal muscles and decreases pressure within the abdomen.
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Sims Position
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Summary of Enema tip insertion1. Describe the tip insertion to pt. 2. Place pt in sims position. (pt
should lie on the left side, with the right leg flexed at the knee and hip
3. Shake and inspect the enema container to provide good mixture. Allow the barium to flow through the tubing and from tip to remove any air in the system
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4. Wearing gloves, coat enema tip with water-soluble lubricant.(KY jelly or any sterile lubricant)
5. On expiration, direct enema tip toward the umbilicus proximally 1 to 1.5 inches
6. After initial insertion, advance up superiorly and slightly anteriorly. Do not force enema tip.
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7. Tape tubing in place to prevent slippage. Do not inflate unless directed by radiologist
8. Ensure IV pole/enema bag is no more than 24 inches (60cm) above the table. Ensure tubing stopcock is in the closed position and no barium flows into the pt.
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Procedures 3 – Types of Examinations
of ColonSingle – contrast Ba. EnemaDouble – contrast Ba. Enema
Defecogram
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Single Contrast Barium Enema
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Double Contrast Ba. Enema
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Defecogram
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Cont…Single – contrast
utilizes only a positive contrast medium.
Double – contrastDifference is that in an examination there is both air and barium.
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2 - APPROACHES OF DOUBLE-CONTRAST
ADMINISTERING
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Two-stage procedure described “by Welin”
A. In which the entire colon is filled with a barium suspension.
B. Patient evacuates the barium and immediately returns to the fluoroscopic table for injection of air or other gaseous contrast into the colon.
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Single-stage double contrast examination The barium and the air
are instilled in a single procedure as compared to the two-stage which reduces time and radiation to patient.
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7 – pump method (by Miller)1) 7 pumps, left lateral position2) 7 pumps, LAO position(left PA-
oblique)3) 7 pumps, prone position4) 7 pumps, RAO position5) 7 pumps, right lateral position6) 7 pumps, RPO position7) +7 pumps, supine position
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“PRIOR TO ANY SPECIAL PROCEDURE A SCOUT
FILM SHOULD BE TAKEN FIRST.”
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POSITIONING AND FILMING
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10 – Routine Sequence of Radiographs1) AP – Rectosigmoid area2) Left lateral – Rectum 3) AP/PA – Full Barium whole
abdomen4) AP/PA – Double Contrast
study5) Left & Right Oblique –
Flexures
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Cont…6) Left Lateral Decubitus – Air
Filled Colon7) Right Lateral Decubitus – Air
Filled Colon8) Pt. In Prone W/ Cross Table
Projection – Rectosigmoid Area
9) Angle Prone – Rectosigmoid Area
10)Post Evacuation