Biliary Tract and Upper Gastrointestinal System Radiographic procedures involving the administration of some form of contrast media are deseribed in the next four chapters. These include common procedures, which may make up 20% to 30% of the radiology department casefoad. ‘You will likely be performing these examinations early in your clinical training. If you learn and understand the funds- ‘mentals provided in these next four chapters, combined with clinical experience, you will soon become a proficient technologist of these organ systems. CHAPTER OBJECTIVES, After you have successfully completed the activities in this chapter, you will be able to: |. Identify specific anatomy and functions of the liver, gallbladder, and biliary ductal system, 2. Deseribe the production, storage, and purpose of bile. —— 3. On drawings and radiographs, identify specific anatomy of the biliary system, — 4. Describe the effect of body habitus on the location of the gallbladder. 5. Define specific terms related to conditions and procedures of the biliary system, 6. Define specific pathologies of the biliary system, _— 7. Match specific biliary pathologies to the correct radiographic appearances and signs. 8. List the major organs of the upper gastrointestinal (GI) system and specific accessory organs. 9. List the three primary functions of the digestive system. 10. List three divisions of the pharynx. 11. Identify the anatomic location, function, and features of the esophagus, stomach, and duodenum, 12, Identify the effect of body position on the distribution of air and contrast media in the stomach, 13, Describe the effect of body habitus on the position and shape of the stomach 14. Using drawings and radiographs, identify specific anatomy of the upper GI system. 15. Identify differences between mechanical digestion and chemical digestion 16, Identify the contrast medi, pationt preparation, room preparation, and fueroscopie procedure for esophagography and an upper GI series. 17. List and define the specific clinical indications and contraindications for esophagography and an upper GI series. 18, Match specific types of pathology to the correct radiographic appearances and signs, 301 yt 2 have eA (oper 12 Bary Wact ané Upper Gastantestina System19. Describe specific breathing maneuvers and positioning techniques used to detect esophageal reflux. 20, List the routine and special positions or projections for esophagography and an upper GI series to include size and type of image receptor (IR), central ray (CR) location, direction and angulation of the central ray, and anatomy best demonstrated, [Identify the anatomy thar is best demonstrated with specific projections of esophagography and an upper Gl 22. Given various hypothetic situations, identify the correct modification of a position and/or exposure factors lo improve the radiographic image. POSITIONING AND RADIOGRAPHIC TECHNIQUE |, Using a peer, position for routine and special projections for esophagography and an upper GI series. — 2. Critique and evaluate esophagography and upper GI series radiographs based on the five divisions of radiographic criteria: (1) anatomy demonstrated, (2) position, (3) collimation and CR, (4) exposure, and (5) anatomic side markers. 3, Distinguish between acceptable and unacceptable esophagography and upper GI series radiographs that result from exposure factors, motion, collimation, positioning, of other errors. LEARNING EXERCISES Complete the following review exercises after reading the associated pages in the textbook as indicated by each exercise Answers to each review exercise are given at the end of the review exercises. PART I: RADIOGRAPHIC ANATOMY. REVIEW EXERCISE A: Radiographic Anatomy and Clinical Indications of the Gallbladder and Biliary System (see textbook pp. 450-453) 1, What is the average weight of the, adult human Tiver? 2. Which abdominal quadrant contains the gallbladder? 3. What is the name ofthe soft tissue structure that separates the right from the left lobe of the liver? 4, Which lobe of the liver is larger, the right or the left 5. List the minor lobes of the liver (the right and Teft Lobes are the major lobes). PACER PEE EG [ HAnABSDSIARROaS 6. True(Palse: The liver performs more than 100 functions, 7, True/False: The average healthy adult liver produces 1 gallon, or 3000 to 4000 mL, of bile per day. 8, List the three primary functions of the gallbladder f opssssnsiasenaasy Bo (Geet 302 Cap 12 Bilary Tact and Upper Gastrinestnal System, appt © 202 ese A et9. ‘ThefFalse: Concentrated levels of cholesterol in bile may lead to gallstones, 10, What is a cormmon site for impaction, or lodging, of gallstones? 1], True/False: In about 40% of individuals, the end of the common bile duct and the end of the pancreatic duct are totally separated into two ducts rather than combining into one single passageway into the duodenum, 12, True/False: Older terminology for the main pancreatic duct is the duct of Vater. 13, ‘The gallbladder is located more (posteriorly or anteriorly) within the abdomen, 14, Match the following structures to their primary location within the abdomen, 1. Liver A, Near the midsagital plane 2. Gallbladder on asthenic patient B. To the left ofthe midsagital plane C. To the right of the midsagittal plane 3, Gallbladder on hypersthenic patient came 4, Gallbladder on hyposthenic patient 15. Identify the major components of the gallbladder and biliary system labeled in Fig. 12.1 A B. c dD, E. R G. i. Fig. 12.1 Components of the gallbladder and biliary system. 16, List four advantages of sonography as & noninvasive means to study the gallbladder and biliary duets, A B. c D. 17. A cholecystocholangiogram is a radiographic examination of 303 epp m2 en e een (tt 12. iar Tact and Upper Gastrointestinal Systm18. Which imaging modality produces cholescintigraphy’? ‘A. Computed tomography (CT) B. Magnetic resonance imaging (MRI) 19, True/False: Acute cholecystitis may produce a thickened gallbladder wall 20. Match each of the following clinical indications with its correct definition C. Radiography D. Nuclear medicine 1. Cholelithiasis A. Surgical removal of the gallbladder 2. Cholecystitis B. Enlargement or narrowing of the biliary ducts because of the presence of stones ____ 3. Biliary stenosis . Condition of having gallstones 4, Cholecystectomy D. Inflammation of the gallbladder 5. Neoplasm E, Benign or malignant tumors 6. Choledocholithiasis F. Narrowing of the biliary ducts REVIEW EXERCISE B: Specific Anatomy of the Upper Gastrointestinal System (see textbook pp. 454-460) 1. List the seven major components of the alimentary canal A B ©. D. 2. List the four accessory organs of digestion, A. B, E, c D, 3, What are the three primary functions of the digestive system? A B c 4, What two terms refer to a radiographic examination of the pharynx and esophagus? or 5. Which term deseribes the radiographic study of the distal esophagus, stomach, and duodenum? or 304 hep Bory Tact and Upper Gastrointestinal System i 202 nen. opts6. Which three pairs of salivary glands are accessory organs of digestion associated with the mouth? A B. c 7. The act of swallowing is called 8. List the three divisions of the pharynx rap eee B. c | 9. What structures create the two indentations seen along the lateral border of the esophagus? | A B. 10. List the three structures that pass through the diaphragm, f Vsseessssaassaay B. c 1, What part of the upper GI tract is a common site for ulcer disease? i 12, What term describes the junction between the duodenum and jejunum? (This is a significant reference point in small-bouel studies.) 13. The C-loop of the duodenum and pancreas are (ntraperitoneal or retroperitoneal) structures. 14. Name the structures of the mouth and pharynx (Fig. 12.2) ro Ap > Fig, 12.2 Structures of the mouth and fee pharynx. 15. True/False: The body of the stomach curves inferiorly and posteriorly from the fundus. 305 xp ©2021 Ba eno (taps 12. Bilary Tact and Upper Gatrontestial System16, Identify the parts labeled in Fig. 12.3. poe (Gormed by rugae along the lesser curvature) m oy Fig. 12.3 Sectional anatomy of the stomach, zo (abdominal segment of the esophagus) K 17, The three main subdivisions of the stomach are: A B, c 18. The division of the stomach labeled £ in Fig. 12.3 is divided into two parts: and 19, Another term for mucosal folds of the stomach is 20. Identify the correct body position (erect, prone, or supine) for each of the drawings of the stomach filled with air and barium (Fig, 12.4). (Bariurn = white; air = black) A, B. c. ame} |- — Fig. 12.4 Body position identification based on a stomach filled with air or barium. 306 halt 12 Bory Tac nd Upper Gestonestinal System xp 212 see es(ale 21, Identify the parts labeled in Fig, 12.5, A moo @ zo Region of A 23. Identify the GI structures labeled in Fig. 12.6, A anmona es Ez iret 212 Be, se, ig. 12.5 Anatomy of the duodenum and pancreas. 22. Name the two anatomic structures implicated in the phrase “romance of the abdomen” illustrated in Fig. 12.5. B. Be | a Fig. 12.6 Radiograph of gastrointestinal structures 307 Chop 12_ Bilary Tact ane Upper Gaston SystemsREVIEW EXERCISE C: Mechanical and Chemical Digestion and Body Habitus (see textbook pp. 461-463) 1. TruefFalse: Mechanical digestion includes movements of the entire GI tract. 2. Peristalic activity is not found in which of the following structures? A. Pharynx . Stomach B. Esophagus D. Sinall intestine 43, Stomach contents are churned into a semifiuid mass called 4. A churning or mixing activity that is present in the small bowel is called 5, List the three groups of food that are ingested and must be chemically digested A B. c 66. Biologie catalysts that speed up the process of digestion are called 1. List the end products of digestion for the Following classes of food. A. Carbohydrates: B. Lipids: C. Proieins: ‘What is the name of the liquid substance that aids in digestion, is manufactured in the liver, and is stored in the gallbladder? How does the material from question 8 assist in emulsification in fat? 10, Absorption of nutrients primarily takes place in the (A) , although some substances are absorbed through the lining of the (B) 11. Of the three primary food substances listed in question 7, for which one does the digestion begin in the mouth? 12. Any residues of digestion or unabsorbed digestive products are eliminated from the ‘as a component of feces, 13, Peristal is an example of which type of digestion? 14. Which term describes food after itis mixed with gastric secretions in the stomach? 15. A high and transverse stomach would be found in a(n) _ patient A. Hypersthenie ©. Hyposthenic B. Sthenic D. Asthenic 308 rape 12. Bian aot and Upper Gates Systm mig © 20 Bon. Agee16. A J-shaped stomach thet is more vertical and lower in the abdomen, with the duodenal bulb at the level of L3-L4, ‘would be found in a(n) patient A. Hypersthenic C. Hyposthenic/asthenic B. Sthenic D. None of the above 19. In the erect postion, how much will abdominal orgens drop on average? 18 Name the two Gl organs most dramatically affected, in relation to location, by body habitus. A. B. 19. Would the fundus ofthe stomach be more supetier or more inferior during deep inhalation? _Why? 20. Match the types of mechanical digestion and/or movement that occur in each of the following anatomie sites. (Ezch anatomic site may have more than one type of digestion.) Anatomie sites Types of mechanical digestion 1. Oral cavity A. Mastication —— 2. Pharynx B. Deglutition ____. 3. Esophagus C. Peristalsis 4. Stomach D. Mixing __ 5. Small intestine E. Rhythmic segmentation PART Ii: RADIOGRAPHIC POSITIONING REVIEW EXERCISE D: Contrast Media, Fluoroscopy, and Clinical indications and Contraindications for Upper Gastrointestinal Studies (see textbook pp. 464-472) 1. True/False: With the use of digital fluoroscopy, the number of postfluoroscopy radiographs ordered has greatly diminished. 2. Another term for a negative contrast medium is 3. What substance is most commonly studies? igested to produce carbon dioxide gas as @ negative contrast medium for GI 4, What is the most common form of positive contrast medium used for studies of the GI system? 5. Is a mixture of barium sulfate a suspension or a solution? _ 6. True/False: Barium sulfate never dissolves in water, 7. True/False: Certain salts of barium are poisonous to humans, so barium contrast studies require a pure sulfate salt of barium for human consumption during GI studies. 309 un © 201 Ber eA eee (Gupte 12 Bian Tract and Upper Sastroietstinal Syston'8, What is the ratio of water to barium for a thin mixture of basium sulfate? 9. What is the chemical symbol for barium sulfate? 10. When is the use of barium sulfate contraindicated? 11, What patient condition prevents the use of a water-soluble contrast medium for an upper GI series? 12, What is the major advantage for using a double-contrast medium technique for esophagography and upper GL series? 13, The speed with which barium sulfate passes through the GI tract is called gastric 14, What is the purpose of the gas with a double-contrast media technique? 15, Which of the following devices on a digital fluoroscopy system converts the analog into a digital signal? A, Picture archiving and communication system. C. Charge-coupled device (CCD) (PACS) B. Light converter D, Optical tracking system (OTS) 16. What device (found beneath the radiographic table when correctly positioned) greatly reduces exposure to the technologist from the fluoroscopic x-ray tube? A. Lead skirt C. Bucky slot shield B. Lead drape D. Fluoroscopy tube shield 17, How is the device referred to in quiestion 16 activated or placed in its correct position for fluoroscopy’? 18, What is the minimum level of protective apron worn during fluoroscopy? A. 0.25 mm Pb/Eq apron C. 1.0 mm PovEg apron B. 0.5 mm Pb/Eq apron D. 1.5 mm Pb/Eq apron 19, ‘What isthe major benefit of using a compression paddle during an upper GI study? A, Reduces exposure to the patient B, Reduces exposure to the eyes of the fluoroscopist ©, Reduces exposure to arms and hands of the fluoroscopist D. Reduces exposure to the torso ofthe fluoroscopist 20. During an upper Gl fluoroscopy procedure, ifthe technologist stands directly beside the radiologist next f0 the patient’s head and shoulders (see textbook, p. 65 zone C in Fig. 1.194), how much radiation would the technologist receive to the lead apron at waist evel during each fluoroscopic exam if the radiologist averaged 5 minutes of fluoroscopy exposure per patient? (Hint: Determine the exposure dose range in mR/min in zone C and multiply by 5 minutes.) 310 (ae Billy Tact end UperGastroinestna Sytem rest © 212 a ne. eg eH21. List the three cardinal principles of radiation protection, A B. c 22, Which of the three cardinal principles is most effective in reducing exposure to the technologist during a fluoroscopic procedure? 23, List the four advantages or unique features and capabilities of digital Ruoroscopy over conventional fluoroscopic recording systems. A. Ci B. D, 24, Which capability on most digital fluoroscopy systems demonstrates a dynamic flow of contrast media through the Gr tract? 25, Match the following definitions or descriptions to the correct pathologic condition for esophagography. A. Difficulty in swallowing 1. Achatasia B. Replacement of normal squamous epithelium with 2. Zenker diverticulum columnar epithelium 3. Esophageal varices May lead to esophagitis 4, Carcinoma of esophagus May be secondary to cirthosis of the liver, 5, Barrett esophagus 6. Gastroesophageal reflux ee —». ___B. Large ompouching of the esophagus ___ F. Also called cardiospasm disease (GERD) G, Most common form is adenocarcinoma 7. Dysphagia 26. Match the following definitions or descriptions to the correct pathology for the upper GI series, ____A. Blood in vomit 1. Hiatal bene __ B. Inflammation of lining of stomach 2, Gastric carcinoma __ C. Blind outpouching of the mucosal wall 3, Bezoar __—D. Undigested material trapped in stomach 4. Hematemesis ___— F. Synonymous with gastric or duodenal ulcer 5. Gastritis __ F. Portion of stomach protruding through the diaphragmatic opening 6. Perforating wleer —-.G. Only 5% of ulcers lead to this condition 7. Peptic ulcer ____H. Double-contrast upper GI is recommended for this type of tumor 8. Diverticula an Cait © 202 eh ee tape 12. Bary Tact and Upper Gatrointstial System27. Match the following pathologic conditions or diseases to the correct radiographic appearance, A. Its presence indicates a possible sliding hiatal hernia 1. Uleers, ___B. Speckled appearance of gastric mucus 2, Hiatal hernia _—C. “Wormlike” appearance of esophagus 3. Achelasia __D. Stricture of esophagus 4, Zenker’s diverticulum _E. Gastric bubble above diaphragm 5, Schatzki’s ring ___ F. Irregular filling defect within stomach 6, Gastritis ____G. Enlarged recess in proximal esophagus 7. Esophageal varices —_H. “Lucent-halo” sign during upper GI 8. Gastric carcinoma 28. Which procedure is often performed to detect carly signs of GERD? 29. Which specific structure of the GI system is affected by hypertrophic pyloric stenosis (HPS)? 30, Which imaging modality ‘most effective in diagnosing HPS while reducing dose to the patient? REVIEW EXERCISE E: Patient Preparation and Positioning for Esophagography and Upper Gastrointestinal Study (see textbook pp. 473-490) 1, What does the aeronym NPO stand for, and what does it mean’? 2, True/False: The patient must be NPO 4 to 6 hours before esophagography. 43. True/False: Esophagography usually begins with fluoroscopy with the patient in the erect position 4, What materials may be used for swallowing to aid in the diagnosis of radiolucent foreign bodies in the esophagus? 5. List the four radiographic tests that may be performed to detect signs of GERD. A c B. D. 6. A breathing technique in which the patient takes in a deep breath and bears down is called the 7. tn what position is the patient usually placed during the water test? 8. Which region of the GI tract is better visualized when the radiologist uses a compression paddle during. esophagography? 312 Chane 12 Biary Tae and Upper Gastlntestial System cay © 2021 ee. EP9. What type of contrast medium should be used if the patient has a history of bowel perforation? 10. What is the minimum amount of time that the patient should be NPO before an upper GI? 1, Why should cigarette use and gum chewing be restricted before an upper GI? 12, Why should the technologist review the patient's chart before the beginning of an upper GI? A. To identify any known allergies C. To look for pertinent clinical history B. To ensute thatthe proper study bas been ordered ——_D. Al ofthe above 13. In which hand does the patient usually hold the barium cup during the start of an upper GI? 4. List the suggested dosages of barium sulfate during an upper GI for each of the following pediatric age groups. Newborn to 1 year 310 3 years 3 10 10 years: More than 10 years: 15. What type of fluoroscopy generator is recommended for pediatric procedures? 16. Which of the following modalities is an alternative to esophagography in detecting esophageal varices? A, Nuclear medicine CC. Sonography B. CT D. Endoscopy 17. Gastric emptying studies are performed using: ‘A. Intraesophageal sonography C. MRI B. Radionuclides DCT 18. Why is the tight anterior oblique (ROA) preferred rather than the left anterior oblique (LAO) for esophagography? 19, How much rotation of the body should be used for the RAO projection of the esophagus? 20. Which optional position should be performed to demonstrate the mid-to-upper esophagus lacated between the shoulders? 313 (ope: na eA tae (apr 12 Bitar Tract and Upper Gatointestinl yet21, The three most common routine projections for esophagography are: PACH eee Bee eee c 22, Which aspect of the GI tract is best demonstrated A. Fundus of stomach C. Body of stomach B. Pylorus of stomach and C-loop 1. Fourth (ascending) portion of duodenum an RAO position during an upper GI? 23, How much rotation of the body is tequited for the RAO position during an upper GI on a sthenic patient? A. 30° to 35° C. 40° to 70° B, 15° t0 20° D. 10° to 15° 24. What is the average kVp range for esophagography and an upper GI when using barium sulfate (single-contrast study)? 25. Which aspects of the upper GI tract will be filled with barium in the posteroanterior (PA) projection (prone position)? 26. What is the purpose of the PA axial projection for the hypersthenic patient ducing an upper GI? 27. What CR angle is required for the PA axial projection for a hypersthenic patient during an upper GI? A. 10° to 15° caudad ©. 35° t0 45° cephalad B. 20° to 25° cephalad 1D. 60° to 70° cephalad 28. Which projection taken during an upper GI will best demonstrate the retrogastric space? A. RAG c. LPO B. Lateral D, PA 29. What is the recommended kVp range for a double-contrast upper GI projection? 30. The upper Gl series usually begins with the table and patient in the position 31. The five most common routine projections for an upper GI series are: A cee E B. D. 32, The major parts of the stomach on an average patient are usually confined to which abdominal quadrant? 33. Most of the duodenum is usually found to the ight or left) of the midline on a sthenic patient. 34. True/False: Respiration should be suspended during inspiration for upper GI radiographic projections. 314 Ces 12 Blan Hac ane Upper Gasvointestat System en © 2021 a Ie ne esi Eeay / REVIEW EXERCISE F: Problem Solving for Technical and Positioning Errors |. Situation: A radiograph of an RAO projection taken during esophagography demonstrates incomplete filing of the esophagus with barium, What can the technologist do to ensure better filling of the esophagus during the repeat exposure? 2, Situation: A series of analog radiographs taken during an upper GI shows that the stomach mucosa is not well visualized, The following factors were used during this positioning routine: Bucky, 40-inch (100-cm) SID, 80 kVp, 30 mAs, and 300 mL of barium sulfate ingested during the procedure. Which exposure factor shoule be changed to produce a more diagnostic study? 3. Situation: A radiograph taken during an upper GI (double-contrast study) shows that the anatomic side marker is missing, The technologist is unsure whether itis a recumbent anteroposterior (AP) or PA projection, The fundus Of the stomach is filled with barium. Which position does this radiograph represent? 4 Situation: A radiograph of an RAO projection teken dusing an upper GI shows that the duodenal bulb is not well demonstrated and is not profiled. The RAO was a 45° oblique performed on a bypersthenic type of patient. What positioning modification needs to be made to produce a better image of the duodenal bulb? 5. Situation: 4 radiograph of an upper GI was taken, but the student technologist is unsure of the position. The radiograph demonstrates thatthe fundus is filled with barium, but the duodenal bulb is ar filled and is seen in profile. Which position does this radiograph represent? 6. Sitmation: 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? 7. Situation: A patient with a possible lacerated duodenum enters the emergency room. The ER physician orders an "upper GI to determine the extent of the injury. What type of contrast medium should be used For this examination? 315 Ci © 201 evr A es hole 12. Bilary Tact and Upper Gaston sem8. Situation: A patient with a fish bone stuck in his esophagus enters the emergency room. What modification to standard esophagograpby may be needed to locate the foreign body? 9. Situation: An upper Gl is being performed on a thin, asthenic-type patient, Because of room-scheduling conflicts, this patient was brought into your room for the overhead follow-up images following fluoroscopy. Where would you center the CR and the 11- x 14-inch (30- x 35-em ) TR (© ensure that you included the stomach and the duodenal regions? 10. Situation: A patient with a clinical history of a possible bezoar comes to the radiology department, What is @ bbezosr, and what radiographic study should be performed to demonstrate this condition? 11, Situation: A radiograph of an RAO position taken during esophagography shows that the esophagus is, superimposed over the vertebral column. What positioning error led to this radiographic outcome? What must be altered to eliminate this problem during the repeat exposure? 12, Situation: A PA projection taken during an upper GI series performed on an infant shows thatthe body and pylorus ofthe stomach are superimposed. What modification needs to be used during the repeat exposure to separate these two regions? 13, Situation: A patient comes to radiology with « clinical history of possible gastric diverticulum in the posterior aspect of the fundus. Which projection taken during the upper GI series best demonstrates this defect? 14, Situation: A patient comes to radiology with a clinical history of Barrett esophagus. In addition to esophagogrsphy, what other imaging modality is ideal in demonstrating this condition? 15, Situation: A patient has a clinical history of hemochromatosis. Which imaging modality is most effective in diagnosing this condition? 316 Cgie¥2_ Bay act and Upper Gestointetins! Stam expr © 2021 Rana re A ee| PART lI: LABORATORY EXERCISES ‘You must gain experience in positioning each part of the esophagography and upper GI procedures before pesforring the following exams on actual patients. You can obtain experience in positioning and radiographic evaluation ofthese projections by performing exercises using radiographic phantoms and practicing on other students (although you will not be taking actual exposures) Laboratory Exercise A: Radiographic Evaluation 1, Evaluate and ritique the radiographs produced during the previous experiments, additional radiographs of esophagography and upper GI procedures provided by your instructor, or both. Evaluate éach position for the following points (check off when completed). Evaluate the completeness of the study. (Are all the pertinent anatomic structures inluded on the radiograph?) _. Bvaluate for positioning or centering errors (e.g, rotation, off centering). _—. Bvaluate for cosrect exposure factors and possible motion. (Are the density and contrast of the images acceptable?) Determine whother anatomic side markers and an acceptable degree of collimation and/or area shielding are visible on the images. Laboratory Exercise B: Physical Positioning ‘On another person, simulate performing all routine and special projections of the upper GI as follows. Include the six steps listed in the following and described in the textbook. (Check off each step when it is completed satisfactorily.) Step |. Appropriate size and type of IR holder with correct markers Step 2. Correct CR placement and centering of part to central ray and/or IR Step 3. Accurate collimation ‘Step 4. Area shielding of patient where advisable Step 5. Use of proper immobilizing devices when needed ‘Step 6. Approximate correct exposure factors, breathing instructions where applicable, and initiating exposure Projections Step 1 Step 2 Step 3 Step 4 Step S Step 6 @ RAO esophagography SE ee eee eee eect © Left lateral esophagography CE eee eee eee © AP (PA) esophagograpty SESS esieee ces erecteet eereeseeey a azese © LAO esophagography SPE HEY EEE Eee o eae eee eee eee © Soft tissue lateral esophagography EEE Ee eee eee eee ed eee eee ee © RAO upper GI EERE Ee ere eee eee © PA upper GI SEITE FSC er er eee ‘© Right lateral upper GI EEE Eee eee Pere ere Hee © LPO upper GI genes ae usu sssasadagcsnasassEiEsasasa?EayasazEny © AP upper GI SE ee ee a7 Capt 02 Gene ne. eee Conte 12. Bary Tract and Upper Gastointestina Systmge SELF-TEST MY SCORE = % ‘This self-test should be taken only after completing all of the readings, review exercises, and laboratory activities for a Particular section, The purpose of this test is not only to provide a good learning exercise but also to serve as a strong Indicator of what your final evaluation exam for this chapter will cover. Itis strongly suggested that if you do not get at least a 90% to 95% grade on each self-test, you should review those areas in which you missed questions before going to your instructor for the final evaluation exam, 1. The gallbladder is located in the margin of the fiver: A, Posterior inferior C. Midaspect B. Posterior superior D. Anterior superior 2. Which of the following is nota recognized lobe of the liver? A. Caudate . Inferior B. Quadrate D. Left 3. In which quadrant is the liver located in the sthenie patient? A, Right lower quadrant ©. Left upper quadrant B. Left lower quadrant D. Right upper quadrant 4. What is the name of the soft tissue structure that divides the liver into left and right lobes? 5. What is the primary function of bile? 6. Tae union of the left and right hepatic duets form which duct? 7. Which duct cartes bile from the cystic duct to the duodenum? 8. What is the average capacity of the adult gallbladder? 9. Which process leads to 2 concentration of bile within the gallbladder? 10, Which hormone leads to contraction of the gallbladder to release bile? 318 ‘Shape 18 Bory Tact and Upper Gastrointest System Se Test Ct © ona Cee AA ee sifq L 2 6 12, Identify the labeled parts and/or structures on the radiograph of an oral cholecystogram (Fig. 12 A Pancreatic duet Fundus Hepatopanereatic ampulla Spiral valve Hepatopancreatic sphincter Doodenal papilla Cystic duct Neck Body A yop » 11. Match each of the following biliary structures to its correct description or definition, Series of mucosal folds in eystie duct {A protrusion into the duodenum Middle aspect of gallbladder Duct connected directly to gallbladder Narrowest portion of gallbladder Broadest portion of gallbladder Enlarged chamber in distal aspect of common bile duct Duct of Wirsung Cireular muscle fibers adjacent to duodenal papilla Fig. 12.7. Ra cholecystogram and of biliary ducts. | 13, Which of the following terms describes the condition of having gallstones? A. Cholecystitis B. Cholelithiasis A. Intake and digestion of food ik B. Absorption of nutrients yt © 20% ern. A pero C. Cholecystectomy D. Choleliths 14. Which of the following is not a function of the GI system? C. Production of hormones D. Elimination of waste products 319 Chole 12 lary Tract and Upper Gastonia Syste Se Test15, What is another term for esophagography’? 16, Which of the following is aot a salivary gland? A. Parotid . Vallecula B. Sublingual D. Submandibular 17, What is the name of the condition that results from a viral infection of the parotid gland? 18. Which structure in the pharynx prevents aspiration of food and fluid into the laryax? A. Uvula C. Soft palate B. Epiglottis D. Laryngopharynx. 19, The esophagus extends from C5-C6 to ATS c m0 BOLI DTH 20. Which of the following structures does not pass through the diaphragm? A, Trachea C. Aorta B. Esophagus D, Inferior vena cava 21. Wavelike involuntary contractions that help propel food dowa the esophagus are called 22, The Greek term gaster, or gastro, means 23, Which of the following aspects of the stomach is defined as an indentation between the body and pylorus? A. Cardize antrum C. Cardiae notch (incisura cardiaca) B. Pyloric antrum D. Angular notch (incisura angutaris) 24, True/False: ‘The numerous mucosal fates fonnd in the small howel are called rage 25, Which aspect of the stomach fills with air when the patient is prone during a double-contrast upper gastrointestinal series? A. Fundus. ©. Duodenal bulb B. Body D. Pylorus 26. True/False: The lateral margin of the stomach is called the lesser curvature, 27. To which aspect of the stomach does barium gravitate when the patient is in the supine position? 28, Which two structures create the romance of the abdomen? 320 Chop 2. Bilary Tac ard Upper Gastrointestinal Stan Safest Cn © 2021 or sea.bh 29. Match each of the following aspects of the upper GI with the correct definition. 1, Pylotie orifice 2. Cardiae notch 3, Fundus Fourth portion of duodemam 5. Mucosal folds 6. Body 7. Esophagogastric junction 8, Angular notch 9. Third portion of duodenum 30. the structures labeled in Fig. 12.8, G #. 1 31. A. Whi B. How could you determine this? Cape 200 Bei ne MeN eee, A " 2 Middle aspect of stomach Horizontal portion of duodenum Rugae Opening between esophagus and stomach Opening leaving the stomach Found along superior aspect of fundus Indentation found along lesser curvature Ascending poston of duodenum Most posterior aspect of stomach ig. 12.8 Radiograph of gastroinestinz! structures, demonstrating body posi radiographic position does Fig. 12.8 represent? 32 Caper 12_Bitary Tact ané Upper Gastrointestinal Ste Stet32. Which radiographic position does Fig, 12.9 represent? 33. A. Which radiographic position does Fig. 12.10 represent? B, How could you determine this? 322 hans 2. lary Tat an Upper Gastrointestinal Systane Sa¥-Tost Fig. 12.9 Gastrointestinal radiograph demonstrating body position 12.10 Gastrointestinal radiograph demonstrating body position, amen ©2101 Hee Maen34, A. Fig. 12.11 represents a(n) ior) oblique position. B. How could you determine this? Fig. 12.11 Oblique radiograph of gastrointestinal structures, C. Which specific radiographie position does Fig. 12.12 represent? 1D. How could you determine this? Fig. 12.12 Oblique radiograph of gastrointestinal structures. 323 | Ceaoh © 20% Hor na. san (vl 12_ Bary eet and Upper Gaston! System: Sot Test35, The aet of chewing is termed: A. Mastication C. Aspiration B. Degiutition D, Peristalsis 36, Which term describes food after it enters the stomach and is mixed with gastric secretions? 37. The churning or mixing activity of chyme in the small intestine is called A. Peristalsis, C. Rhythmic segmentation B. Deglutition D. Digestion 38. Which of the following nutrients is not digested? A, Vitamins C. Carbohydrates B. Lipids D, Proteins 39. A high and transverse stomach indicates a body type with the duodenal bulb at the vertebral level of Ey a yeitesdasssaaseessesssessiaaaat type of body habitus usualy includes a low and vertical stomach with the duodenal bulb at the vertebral level of 41, What is the most common radiopaque contrast media used in the GI system? 42. What ype of radiolucent contrast medium is most commonly used for double-contrast GI studies? 43. A. What is the ratio of barium to water for a thick mixture of barium sulfate? B. What is the ratio for a thin barium mixture? 44. During an upper Gl, when should a water soluble contrast medium be used rather than barium sulfate? 45. Which of the following conditions may prevent the use of water-soluble contrast agents for a geriatric patient? A. Bowel obstruction C. Dehydration 3. Pre-surgical imaging D. Perforated ulcer 46, Truc/Palse: Water-soluble contrast agents pass through the GI tract faster than barium sulfate 47. TruefFalse: Digital fluoroscopy does not require the use of IR cassettes. 48, Which of the cardinel principles of radiation protection is most effective in reducing exposure to the technologist during fluoroscopy? 824 hap 12 Bar Watt and Upper GastrolnestintSyeton: Set- Test yg © 0 en ne Ae coe aa say49. Protective aprons of what lead equivalency must be worn during fluoroscopy’? A. 1.0 mm Pb/Eq C. 0.25 mm Pb/Eq B. 0.50 mm PbiEq D. 0.15 mm Po/Eq 50, Which of the following is the older term for GERD? A. Esophageal reflux C. Esophageal varices B. Barrett esophagus D. Zenker diverticulum SI. A large outpouching of the mid-to-upper esophagus is termed A. Zenker diverticulum C. Barrett esophagus B. Achalasia D. Esophageal varices 52. A phytobezoar is A. An outpouching of the mucosal wall C. A rare tumor B. Trapped mass of hair in the stomach 1D, Trapped vegetable fiber in the stomach 53. What can be added to barium sulfate and swallowed to detect a radiolucent foreign body lodged in the esophagus? 54, What is the reason that the patient may be asked! to swallow a mouthful of water drawn through a straw during esophagography? 55. How much rotation of the body should be used for an RAO esophagography projection? 56. Why is an RAO position preferred rather than an LAO during esophagography? is the AP projection of the esophagus not a preferred projection for the esophagography series? 58. What criterion is used with ultrasound in determining whether a patient has HPS ‘A. Abnormally Jong pylorus CC. Presence of air-uid fevel in the duodenum B. Absence of rugae D. Antral muscle thickness exceeding 4 mm 59, Other than esophagography, what other imaging modality is performed to diagnose Barret esophagus? ACT CMRI B. Nuclear medicine D. Sonography 60. Which upper GI position best demonstrates a possible gastric diverticulum in the posterior wall of the fundus of the stomach? 325 Co © 202 ee ee (hte 12 ilar Tact and Upper Gastrlnestnal Stem: St-est6 Situation: An upper Gl series is performed on an asthenic patient, A radiograph of the RAO position shows the duodenal bulb and the C-loop are not in profile. The technologist rotated the patient 70°. What modification of the position is required during the repeat exposure? 62, Situation: A radiograph taken during a double-contrast upper GI demonstrates the fundus is barium filled and the boii is air filled. This was either an AP or a PA radiograph, wich needs to be repeated, Which specific position : does this radiograph represent? 63. Situation: A patient with a clinical history of cirshosis of the liver with acute GI bleeding comes to the radiology department, What may be the most likely reason that esophagography was ordered for this patient? 64. Situation: During esophagography, the radiologist asks the patient to try to bear down as if having a bowel ‘movement. What is this maneuver celled, and why did the radiologist make such a request? 65, Situation: During an upper GI, the radiologist reports that she sees a lucen-halo signin the duodenum, What form of pathology did the radiologist observe? 66. Which of the following technicaljpositioning factors does not apply to an water soluble oral contrast media upper GI study? A, 125 kVp C, 40-inch (100-em) SID B. Exposure made on ex; 1D, Erect and recumbent positions performed 67. Situation: A radiograph of an upper GI is not labeled correctly, but the technologist is unsure of the position that ‘was performed. A double-contrast GI study was completed with all positions performed recumbent. The radiograph demonstrates barium in the fundus and air/gas in the body and pylorus and duodenal bulb in profile. Which position was performed? ‘68. Which of the following shielding devices best reduces exposure (0 the lower torso of the luoroscopist?” A, Lead drape C. Lead gloves B. Bucky slot shield D, Grid tation: During esophagography, the radiologist remarks that Schatzki ring is present. Which condition or © process is indicated by the presence of this radiographic sign? 70. Situation: A patient comes to radiology with a clinical history of a possible trichobezoar. What isa trichobezoar ‘and which radiographic procedure is best to diagnose it? 926 Ghuie 12 lay Tc nd Upper Gastroinotina Speen Sa-Test rer © 2021 se eA pt tn