You are on page 1of 48

Radiography Of The GI System

Kyle Thornton DMI 63

Pertinent Anatomy Of The Digestive System




Accessory glands
Salivary glands Liver Gallbladder Pancreas

Alimentary Canal Mouth Pharynx Esophagus Stomach Small / Large Intestine

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

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

Stomach
  

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

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


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

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

Functions Of The Stomach


  

Storage area for further digestion Food is chemically broken down This broken down material is called chyme

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

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

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

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

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

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

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

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


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

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

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

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

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

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

Valsalva Maneuver
    

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

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

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

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

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

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

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


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

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

Radiography Of Small Intestine




Contrast administration
Orally Retrograde
Reflux filling via barium enema

Direct injection of contrast through NG tube


Enteroclysis

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

You might also like