Centering of
the stomach
is the pyloric Hypersthenic (5%)
canal/bulb.
Sthenic (50%)
Note the Hyposthenic (35%)
change in
position. Asthenic (10%)
Atlas of Human Anatomy
Second edition (258)
Need to know
Gastroesophageal junction
Fundus
Pylorus (sphincter)
Jejunum
Head of pancreas
Atlas of Human Anatomy
Second edition (263)
Need to know
Jejunum
Ileum
Mesentary
Left
hemidiaphragm
Greater
Lesser curvature of s.
curvature of s. body of s.
Incisure angularis
Duodenal bulb
(or cap) etc. Pyloric canal Pyloric orifice
&
(surrounded by sphincter)
2nd or descending Antrum
part of d.
3rd or horizontal
part of d. Jejunum
Area of detail
Left
hemidiaphragm
Peristalic
contraction from
distal to abdominal
part of esophagus
Anatomy
Review Know for lab
Contrast media for the alimentary tract
and examination procedures
Fluoroscopy
Spot films Vs. Overheads
Contrast media
Barium
Water soluble iodine preparations
AP stomach
PA stomach
RAO stomach
LPO stomach
Right lateral stomach
and the
Motility series
including
Film Critique
Film Critique Reminder
In addition to criteria
specific to each
projection, all films
are evaluated for:
including
* Patient ID
* Rt/Lt, special marker
* Contrast & density
* Motion
* Artifacts
Standard UGI Positioning
Preparation
1. Evaluate the order
2. Greet the patient
3. Take History
What is pertinent Hx?
Abdominal, epigastric, or chest
pain (RO/MI), acid reflux, dyspepsia
(indigestion), ercuctation, anemia
from GI bleed, abdominal mass,
N/V, hematemesis.
1. 14 x 17
2. Midsagittal plane
straight, no rotation
3. CR between xiphoid
tip and lower margin
of ribs (inferior costal margin)
* 1 higher for hypersthenic,
* 2 lower for asthenic.
4. Favor left side if needed.
5. Suspend breathing on
expiration.
Routine AP Positioning On a 14 x 17 film, the
Criteria entire stomach, duodenum,
and the proximal jejunum
(whatever may fill) should
be included.
In the supine position the
fundus is inferior to the
pylorus. Barium fills the
fundus, and if double
contrast, air fills the body
and duodenum.
1. In PA position landmarks
are less accessible. In
addition to 1-2 above
lower margin of lateral
ribs (Bontrager), 6 above
the iliac crest is often
used to localize the level
of the pylorus and
duodenal bulb (center)
Higher for hypersthenic, lower for asthenic.
or 11 x 14 (dependant on
department protocol)
or 11 x 14 (dependant on
department protocol)
2. 300-600 LPO (steeper for
hypersthenic habitus)
3. CR same as AP
1. PA
On all films 2. RAO
Patient ID
3. Rt. Lateral
Rt or Lt marker
Contrast & density 4. AP
Motion 5. LPO
Artifacts
However, for double contrast
Know where the barium exams the order may
and air will be on the: purposefully roll the patient
back and forth to keep the
1. RAO mucosal surface coated
2. PA with barium.
3. LPO
4. AP
5. Rt Lateral
Motility Series: Chap. 15 (492-493) in Bontrager
The small intestine is studied less frequently than other
other parts of the GI tract, but when indicated, is usually
done in conjunction with the UGI.
Thoracic stomach
Diverticula
Ulcerations
Hiatal Hernia & Herniation of the stomach through the
Thoracic Stomach esophageal hiatus of the diaphragm.
The degree of herniation varys.
Sliding hiatal hernia: Small portion of the stomach protrudes though the hiatus
due to a weakening of the esophageal sphincter muscle. Herniation changes
positions, and may be demonstrated by the valsalva maneuver. Reflux,
common to hiatal hernias, may be demonstrated in the trendelenburg
position. Schatzkes ring is a radiographic sign of a sliding hernia.
Thoracic stomach:
Shown on these
images. The
majority of the
stomach
herniates into
the thoracic
cavity.
Thoracic
stomach
on CXR
Diverticula Diverticula are outpouching caused by weakness
in the wall of a hollow organ. They are benign
and generally asymptomatic, though the weakened area may
perforate, and materials in blind pouches can cause
inflammation, ulceration, or infection.
This 4 CM diverticula of
the first part of
the duodenum
contains fibrous
materials,
creating a mass
known as a
bezoar.
Accumulations
include hair,
cellulose, and
seeds
It starts
here
Spot films, from the spot film device,
What in the World? may be difficult to identify and hang
properly. If they are always in the
Hows it hangin? device the same way the ID marker
is used for orientation. If that is
Things to look for Ribs unknown the recognition of anatomy
is the key.
Vertebral bodies
and disk spaces
Diaphragm &
lung
Esophagus
Pylorus
Cap of d.
C D Answers follow
What in the World?
Hows it hangin?
Screen 2
A B
C D
What in the World?
Hows it hangin?
Screen 3
A B
C D
Screen 2
What in the World?
Hows it hangin? Answers Cap of d.
Sweep of
duodenum
3. AP
4. PA 5. RAO
6. What is the range of obliquity for an RAO stomach? 40-700
7. What body habitus requires the steepest obliquity?
Hypersthenic