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JEJUNUMAND ILEUM
◾ This the radiographic examination of the small ◾ The remainder of the small
bowel. intestine is arbitrarily divided
◾ Also known as “SMALL BOWEL SERIES (SBS)” into two portions, with the
◾ The upper GI and the SBS are often combined upper two fifths referred to as
thus, this are termed as small bowel follow-
through. the jejunum and the lower three
fifths as the ileum.
◾ CONTRAST MEDIA: Radiopaque contrast media
(BaSO4 or Iodinated) SMALL INTESTINAL SERIES
ANATOMY AND PHYSIOLOGY ◾The purpose of this is to study the form and
function of the three components of the small
◾Small intestine - Digestion and absorption of food
bowel, as well as detect any abnormal conditions.
occur in this portion of the alimentary canal. The
Since this study also examines function of the small
length of the adult small intestine averages about
bowel, the procedure must be timed. The time
22 feet (6.5 m), and its diameter gradually
should be noted when the patient finished drinking
diminishes from approximately I 1⁄2 inches (3.8
the last of the contrast media.
cm) in the proximal part to approximately I inch
(2.5 cm) in the distal part. INDICATIONS
◾Contrast Media: Thin mixture of BaSO4 ◾ Regional Enteritis
◾The small intestine is divided into ◾ Neoplasm
three portions: ◾ Malabsorption syndrome
Duodenum
◾ Ileus*
Jejunum
◾ Fistula
Ileum
◾ Meckel’s diverticulum
◾ Sprue
◾ Malabsorption
DUODENUM
CONTRAINDICATIONS
◾ 8 to 10 inches (20 to 24 cm) in
◾ Perforated, hollow viscus
length and is the widest portion of the
◾ Large bowel obstruction
small intestine. Its four regions are
◾ Presurgical patients
described as the first (superior), second
PATIENT PREPARATIONS ◾ 30 minutes after the initial barium ingestion –
take PA projection of the proximal SB
◾ Soft or low- reside diet for two days before the
examination ◾ For first two hours, radiographs are obtained at
15 – 30 minutes interval
◾ NPO after evening meal and the morning before
the examination ◾ One-hour interval radiographs, if more time is
needed after 2 hours
◾ Cleansing enema may be administered but not
always recommended for ◾ Termination: Ileocecal valve
enteroclysis (enema fluid may be retained in the ◾ Plain abdomen radiograph (scout)
small intestine)
◾ 2 cups (16 oz.) of barium ingested – note time
◾ Patient’s bladder should be empty before and
during the procedure to ◾ 15-to-30-minute radiograph – centered high for
prox. SB
avoid displacing or compressing the ileum.
◾ Half-hour interval radiographs until barium
RATIONALE: to avoid displacing and compressing reaches large bowel (2 hrs.)
ileum.
◾ One-hour interval radiographs, if more time is
PRELIMANARY PROCEDURE needed
PLAIN ABDOMEN (KUB X-RAY) PROJECTIONS
◾Performed by: PROJECTION
UG-SB combination(mouth) AP or PA
Complete reflux filling (large volume BE) POSITION
Enteroclysis/small bowel enema
Supine
- Direct Injection into bowel through an intestinal
Prone
tube.
Trendelenburg Perpendicular
- Difficult to performed
CENTRAL RAY
Intubation Method
Perpendicular
◾ Second cup
PURPOSE OF SUPINE: INTUBATION METHOD
-To take advantage of the superior and lateral shift ◾ Nasogastric tube is inserted
of the barium filled stomach
-A long, specifically designed tube is inserted
* for visualization of retro gastric portions of the through the nose and passed into the stomach.
duodenum and jejenum. (Peristaltic action carries the tube inferiorly).
SUBMUCOSA OMENTUM
with blood vessels, nerve Extends between two
endings, and lymphatics organs.
MUSCULARIS GI TRACT
muscle area
MOUTH
SEROSA Is formed by the lips, cheeks, hard and soft
is the superficial layer palates, and
tongue.
PERITONEUM
DIVISIONS: VESTIBULE
Is a space bounded externally by the
PARIETAL cheeks & lips and
PERITONEUM internally by the gums and teeth.
VISCERAL FAUCES
PERITONEUM Opening between the oral cavity and the
pharynx
LESSER OMENTUM
Connects the lesser UVULA
curvature of the stomach Hanging from the free border of the soft
to liver and diaphragm palate.
MESENTERY
Is fan shaped and binds the
small intestine to the
posterior abdominal wall.
MOUTH: FUNCTION GI TRACT
Lacteals
lymphatic capillaries that absorbs milky
fatty lymph (CHYLE)
LARGE INTESTINE: PARTS SEMILUNAR FOLDS
are the folds visible on the inner surface of
ASCENDING PORTION the large intestine that pass
- RETROPERITONEAL POSITION part way around the intestine between
TRANVERSE PORTION- LONGEST PART OF THE haustra.
LI AND MOST MOVABLE
- INTRA PERITONEAL POSITION (WITHIN THE ACCESSORY ORGANS
PERITONEAL CAVITY)
• DESCENDING COLON Teeth
-RETROPERITONEAL Are accessory digestive organs located in
• SIGMOID COLON- INTRAPERITONEAL POSITION. sockets
- ENDS AT RECTUM(S3) of the alveolar process of the mandible and
maxillae.
LARGE INTESTINE: PARTS
TEETH: REGIONS
SIGMOID COLON
Is the “s” shaped curved part of the distal CROWN
colon is the visible portion above the level of the
gums
RECTUM NECK
Strong contraction to expel feces. Anterior to is the constricted junction of the crown
the sacrum and coccyx and root near the gum line
ANUS- anal canal ends, has two valves ROOT
- the internal anal sphincter
- the external anal sphincter. THE TOUNGE
- is an accessory digestive organ
LARGE INTESTINE: FEATURES composed of skeletal muscle covered with
mucous membrane. Together with its
TENIAE COLI associated muscles, it forms the floor of the
these are three bands of muscle fibers that oral cavity.
pass lengthwise along the
length of the large intestine. SALIVARY GLANDS
Replace the layer of longitudinal muscle Is any cell or organ that releases a secretion
found in other parts of this called saliva into the oral cavity.
tract, cause the puckering of the colon.
HAUSTRA
these are sac like pouches in the wall of the
large intestine resulting
from the puckering due to the teniae coli.
SALIVARY GLANDS GALLBLADDER
SUBLINGUAL GLAND
lies in the floor of the PANCREAS
mouth. Superior to the
submandibular gland. Approx. 12 – 15 cm (5-6 inches) long,
Produces digestive enzymes that drains to
LIVER duodenum by ducts
LIVER
Produces BILE
Function of Bile:
Emulsification
of fats
UPPER GASTRO INTESTINAL SERIES STOMACH CURVATURE
(BARIUM MEAL)
Lesser curvature- medial (concave)
Definition and purpose: border of the stomach extends
between cardiac and pyloric orifice
Radiographic examination
(ana/physio) of the: Greater curvature -lateral (convex)
1) distal esophagus, border of the stomach. 4-5 times
2) stomach, and longer than lesser
3) duodenum. curvature. It extends between the
cardiac notch to pylorus.
ANATOMY OF THE STOMACH
Esophagastric junction- aperture
G. gaster means between esophagus and stomach
stomach/gastro
Located between Cardiac sphincter- small circular
esophagus and small intestine muscle between esophagus and
Most dilated portion of alimentary stomach that allows bolus to pass
track. through cardiac orifice
Serves as food reservoir
Pyloric sphincter- circular muscle
STOMACH SUBDIVISION: between stomach and duodenum
1. FUNDUS-upper portion that controls the chyme to pass
of the stomach. Gas in through the duodenum.
this portion is called
“gas bubble” or Cardiac orifice – opening between
“magemblase” esophagus and stomach
2. BODY- largest portion of
the stomach, between Pyloric orifice- opening between
fundus and pylorus stomach and duodenum
3. PYLORUS- small terminal
portion of the stomach Cardiac notch /incisura cardiac-
right or medial to notch superior to cardiac orifice
angular notch. Angular notch/incisura angularis-
notch or constricted ring- like area
which separate body to pylorus.
Cardiac antrum- dilated distal C shaped “c-loop”
portion of the esophagus Relationship with the head
of the pancreas “romance of the
Pyloric antrum- dilated portion of the abdomen”
pylorus immediately distal to angular
notch CONSIST OF 4 PARTS
STRUCTURE SHOWN: .
1. Greater and lesser curvature SS: This is use to demonstrate the right
2. Antral portion of the stomach angle view of the
3. Pyloric Canal and duodenal bulb stomach and the retro gastric space
and at the same
RATIONALE: to demonstrate pyloric time, for the evaluation of pancreatic
canal and duodenal bulb in INFANT pathology, such
PATIENT
as Pancreatic Mass, Pancreatic CA, 1. WOLF METHOD
and Pancreatitis.
PP: Place the patient in the prone
RADIOGRAPHIC DEMONSTRATION OF position on the radiographic table.
MINIMAL HIATAL HERNIAS Modified knee chest position.
Instruct the patient to assume a
The modification or procedures modified knee-chest position during
described are placement of the compression device.
modification of TRENDELENBURG Place the compression device
POSITION. horizontally under the abdomen and
This technique were evolved for the adjust below the costal margin.
purpose of applying greater intra- Adjust the patient in a 40 to 50
abdominal pressure that is degrees RAO position, with the thorax
provided by the body angulations. And centered to the midline of the grid.
thereby ensuring more consistent Instruct the patient to ingest the
results in the radiographic barium suspension in rapid
demonstration of small sliding gastro continuous swallow.
esophageal herniation through the To allow for complete filling of the
esophageal hiatus. esophagus make the exposure during
the 3rd or 4th swallow.
1. WOLF METHOD Respiration: Suspend at the end of
This requires the use of a semi expiration.
cylindrical radio parent
compression device measure 22” in RP: T6 or T7
length, 10 “ in width, and 8” in height. CR: Perpendicular o the long axis of
the patient’s back.
This device provides: This position usually results in 10 to
1. Trendelenburg angulations of the 20 degrees caudad angulations of the
patient’s trunks. central ray. ( take note!)
2. Increase intra-abdominal pressure Demonstrate the relationship of the
enough to permit stomach to the diaphragm and is
adequate contrast filling and useful in diagnosing a hiatal hernia.
maximum distention Compression device placement:
of the entire esophagus. - Horizontally under the abdomen
- Below costal margin
BARIUM INGESTION: Rapid, continuous - C.R. – Directed at the right angles in
swallow. relation to the film.
MAKE EXPOSURE DURING 3rd and 4th - R.P. – Xyphoid process.
swallow. - Exposure is made during the MULLER
To allow complete filling of the MANEUVER.
esophagus
2. SOMMER-FOEGELLE METHOD
This requires the use of a special
constructed 34 degrees
angle board which the patient is flexed
to place his trunk in
a Trendelenburg position. The upper
edge of the board is thickly padded to
exert pressure on the lower abdomen
and to further increase abdominal
pressure.
POSITIONING:
- Angle board is place on the
examining table with the film.
- Assist the patient in getting into the
table in kneeling position.
- Both thighs are placed against the
board.
- Ask the patient to lean straight
forward and rest his full
weight on the board.
UROGRAPHY - 25 cm long muscular ducts • Urethra – the organ which conveys the
- retroperitoneal and run over the urine out of the body, is a
• This is the general term for the radiologic psoas muscle, 5 cm from midline narrow, musculomembranous tube with a
investigation of the renal drainage, - lies anterior to the kidney sphincter type of muscle at the neck of the
or collecting, system. bladder.
• Urography is not synonymous to • Reservoir for urine
Pyelography • Total capacity: 350- 500ml Preparation
• The desire for micturation(urination)
ANATOMY AND PHYSIOLOGY occurs when about 250ml of urine is • Intestinal tract be free of gas and solid
in the bladder. fecal materials, bowel preparations are not
• Urinary System - includes the attempted in infants and children.
two kidneys, two ureters, one urinary Trigon (a.k.a. vesical trigone)- triangular • Low- residue diet for 1 to 2 days.
bladder, and one urethra. inner, posterior surface of the bladder. • Light evening meal
Muscular area formed by the entrance of 2 • When indicated, administer a non- gas
• Kidney - The functions of the kidneys ureters and exit of the urethra. forming laxative the evening before the
include removing waste products from - Area where there is no rugae examination.
the blood, maintaining fluid and • NPO at midnight but should not be
electrolyte balance, and excreting Kidney orientation dehydrated especially with
substances that affect blood pressure patients with multiple myeloma, high uric
and other important body functions. • 30° LPO position the right kidney parallel acid levels, and diabetes
The kidneys normally excrete 1 to 2 L to the IR because of increased risk of renal failure.
of urine per day. • 30° RPO position the left • For patient to undergone retrograde
kidney parallel to the IR urogram, have them drink a
• Kidneys lies on either side of the vertebral large amount of water (4 or 5 cups) for
column in the upper posterior abdomen. • Urinary Bladder - is a several hours before the
• Posterior to the lower portion of the liver musculomembranous sac that serves examination to ensure excretion of urine in
on the right kidney and posterior as a reservoir for urine. The adult an amount sufficient
to the lower spleen of the left kidney. bladder can hold approximately 500 for bilateral catheterized specimens and
T12 – superior border of the kidney. ml of fluid when completely full. renal function tests.
L3- inferior border of the kidney The desire for micturition • Note that no patient preparation is usually
Left kidney is 1cm higher than the right. (urination) occurs when about 250 necessary for
ml of urine is in the bladder. examinations of the lower urinary tract.
• Ureters - convey the urine from Uremia- "urea in the blood“ an abnormal
the renal pelves to the bladder by accumulation of nitrogenous wastes
slow, rhythmic peristaltic in the blood which may indicates renal
contractions. dysfunction.
CREATININE- 0.6-1.5 mg/dl 2. Berdon, Baker, and Leonidas – prone EXCRETORY UROGRAPHY
(BUN) Blood Urea nitrogen- 8-20 mg/dl position resolves the problem of obscuring • True functional test of the urinary system
gas in majority of patients (TAKE NOTE!!!)
• “patient currently taking metformin can • By exerting pressure on the abdomen, the PURPOSE:
be given iodinated contrast media only prone position moves the gas laterally away -Visualize collecting portion of the urinary
if their kidney function levels are within from the pelvicalyceal structures. system.
normal limits” • Although noted to overcome the dilemma -Assessed the functional ability of the
in patients with obscuring gas, this kidneys.
• Metformin is withheld for at least 48 hrs. occasionally fails to produce the desired - Empty bladder before examination:
after the administration of iodinated result in small infants when the small -Bladder that is full could rupture.
contrast media. Combination of the intestine is dilated. - Urine dilutes the CM.
metformin and iodinated contrast media
may increase the risk for contrast-induced • The contrast medium may be INDICATIONS
acute renal failure and or lactic administered by rapid injection or
acidosis. infusion namely: -Renal calculi- -Renal Cell Carcinoma
Bolus injection nephrotomography -Bladder Carcinoma - Wilm’s Tumor
• Metformin + iodinated contrast media= Infusion nephrotomography -Congenital Anomalies - Pyelonephritis
acute renal failure and or lactic acidosis - Cystitis - Renal Hypertension
TYPES OF EXAMINATION - Glomerulonephritis- - Bladder diverticula
Recommendations • Excretory Urography - Obstruction - Neurogenic Bladder
• Retrograde Urography - Strictures
1. Hope and Campoy – infants and children - Polycystic Kidney Disease
be given carbonated soft EXCRETORY UROGRAPHY - Hydronephrosis
drink to distend the stomach with gas.
• The gas- containing intestinal loops are • Or the “ANTEGRADE FILLING” • Benign Prostatic Hyperplasia (BPH)
usually pushed inferiorly and the • The contrast medium enters the system in Also called Benign Prostatic Hypertrophy
upper urinary tracts, particularly those on the normal direction of blood flow Is an enlargement of prostate gland
the left side of the body, are • Excretory technique of urography used in
then clearly visualized through the outline examinations of the upper urinary tracts in • Duplication of ureter and renal pelvis
of the gas- filled stomach. infants and children. • Most common congenital anomaly of the
• At least 2 ounces for newborn infants; full • Preferred technique in adults unless urinary system.
12 ounces for child 7 or 8 retrograde technique is indicated. • Involves 2 ureters and / renal pelvis
years old. • Excretory technique is correctly referred originating in the same kidney.
• Highly- concentrated contrast medium as intravenous urography.
b. Ectopic kidney some obstruction of the ureter or renal URETERAL COMPRESSION
-describes a normal kidney that fails to pelvis
ascend into the abdomen but rather • TRENDELENBURG -Same result to
remains in the pelvis. • Renal obstruction compression device without risk to
-this type of kidney has a shorter than - Caused by necrotic debris, calculus, the patient whose symptoms contraindicate
normal ureter. thrombus, or trauma. ureteric compression.