Lower Gastrointestinal System Radiographic Procedure PDF

LOWER GASTROINTESTINAL SYSTEM RADIOGRAPHIC PROCEDURE Prof. Akram Asbeutah, PhD Department of Radiologic Sciences Faculty of Allied Health Sciences Kuwait University Objectives • Radiographic anatomy of lower GIS • Radiographic procedures of lower GIS • Radiographic positioning of lower GIS A- Ra...

LOWER GASTROINTESTINAL SYSTEM RADIOGRAPHIC PROCEDURE Prof. Akram Asbeutah, PhD Department of Radiologic Sciences Faculty of Allied Health Sciences Kuwait University Objectives • Radiographic anatomy of lower GIS • Radiographic procedures of lower GIS • Radiographic positioning of lower GIS A- Radiographic AnatomyLower GIS Radiographic Anatomy- Lower GIS • Small intestine – 7 m (23 feet) – 1.5-2.5 cm in diameter – Three parts: duodenum, jejunum, & ileum • Large intestine – 1.5 m (6 feet) – 4-6cm in diameter – Cecum, colon (ascending, hepatic & splenic flextures, transverse, descending, sigmoid), rectum & anus Radiographic Anatomy- Small Intestine • 7 m (23 feet) long-1-2.5” in diameter • Large surface area for majority of absorption • 3 parts – Duodenum-1 feet (RUQ & LUQ), shortest, widest, & most fixed. – Jejunum-10 feet (LUQ & LLQ), – Ileum-12 feet (RLQ &LLQ) • ends at ileocecal valve Radiographic Anatomy- Small Intestine: Duodenum, Jejunum, & Ileum • Various sections of small intestine can be identified by their location & appearance • Duodenum: C shaped and distal to stomach and largest diameter than jejunum & ileum • Jejunum: distal to duodenum and feathery appearance in barium and smaller diameter than dudoenum • Ileum: distal to jejuneum and smooth appearance with smaller diameter Radiographic Anatomy- Large Intestine • 1.5 m (6 feet) long by 2½” in diameter • Four parts: – Cecum-vermiform appendix+ ileocecal valve – Colon- 4 sections & 2 flexures – Rectum – Anus Radiographic Anatomy- Large Intestine Cecum & Appendix • Cecum is the widest portion of large intestine & located in the RLQ • Attached to it is appendix • Ilium joins the cecum at ileocecal valve • Ileocecal valve acts as a sphincter to prevent the contents of the ileum from passing too quickly into the cecum and prevent reflux from cecum to ileum • Appendix is 2-20cm and it vary in its position and location to the cecum Radiographic Anatomy- Large Intestine Rectum & Anal Canal • Rectum= last 12 cm of large intestine anterior to the sacrum (S3) & coccyx • Two anteriposterior curves • Anal canal= last 3 cm of large intestine – internal sphincter-smooth muscle & involuntary – external sphincterskeletal muscle & voluntary control Radiographic Anatomy- Large Intestine VS Small Intestine • Internal diameter of large intestine is grater than small intestine • Haustraution present in large intestine due to Taeniae coli muscle • The large intestine is located peripherally Air-Barium Locations in Large Intestine • Supine position: air in transverse colon and loops of sigmoid colon and barium will fill ascending, descending and parts of the sigmoid colon • Prone position: barium and air will reverse position. Barium in transverse colon and loops of sigmoid colon and air will fill ascending, descending and parts of the sigmoid colon Review Radiographic AnatomySmall Intestine Review Radiographic AnatomyLarge Intestine Review Radiographic AnatomyLarge Intestine Radiographic Anatomy- Small Intestine Vs Large Intestine; Sectional Differences Digestive Functions of the Lower GIS Movements of Lower GIS B- Radiographic Procedures of Lower GIS Small Bowel Series Radiographic Procedure Small Bowel Series Indications Small Bowel Series Contraindications Small Bowel Procedures Upper GI-Small Bowel Combination • Upper GI (barium meal) study followed by follow-through • Iodinated contrast media can be used • If patient has hypomotility of the bowel, ice water or any stimulant can be given to increase transmit time of barium or iodinated contrast can be added to barium to increase peristalsis Small Bowel Only SeriesBarium Meal Follow-Through • Palin radiograph of the abdomen • 2 cups of barium 2:1 ratio • Every 15 minutes a radiograph of the abdomen. Some times every ½ or 1 hour • Study finish when the cecum and ascending colon is visualized Enteroclysis- Double Contrast Small Bowel Procedure Intubation Method- Single Contrast Media StudySmall Bowel Enema • Nasogastric tube is passed to the jejunum • The diagnostic procedure may be called small bowel enema a single-lumen tube is used • The therapeutic procedure is performed to decompress a small bowel obstruction and a double-lumen catheter such as a Miller-Abbot tube is passed to stomach Patient Preparation For Small Bowel Series Method of Imaging Small Bowel Series • Single contrast- kV=100-120 • Double contrast kV=80-90 • Prone PA projection is good for many reasons – Reduce kV – Reduce thickness – Less patient dose – Better contrast & spatial resolution Large Bowel/Enema Radiographic Procedure Barium Enema Contraindications Pathologic Indications for Barium Enema Pathologic Indications for Barium Enema Patient Preparation For Barium Enema Contraindications to Laxatives for Barium Enema Preparation Radiographic Room Preparation for Barium Enema Procedure Equipment & Supplies for Barium Enema Procedure Equipment & Supplies for Barium Enema Procedure Barium Enema Procedure Preparation Preparation for Rectal Tip Insertion Barium Enema Fluoroscopy Procedure Types of Barium Enema Procedure Types of Barium Enema Procedure Types of Barium Enema Procedure Colostomy Barium Enema Safety Concerns During All Barium Enema Procedures Pediatric, Geriatric Applications & Digital Imaging Considerations • Early appointment • Upper GI the barium administered using baby bottle • Careful insertion of enema tip • Post study care C- Radiographic Positioning of Lower GIS PA Projection- Small Bowel Series Barium Enema Series PA /AP Projection Barium Enema RAO Position- Barium Enema LAO Position- Barium Enema LPO/RPO Positions Barium Enema Lateral or Ventral decubitus Lateral barium Enema Right Lateral Decubitus AP or PA Projection Barium Enema Left Lateral Decubitus AP or PA Projection Barium Enema AP/PA Post-Evacuation Barium Enema AP/PA Axial/Axial Oblique Projections Barium Enema “Butterfly” Positions- “Hampton’s” Positions Alternative Modalities & procedures for GI Examinations • • • • US CT MRI NM Alternative Modalities & procedures for GIT- Role of US Alternative Modalities & procedures for GIT- Role of US Alternative Modalities & procedures for GIT- Role of US Alternative Modalities & procedures for GIT- Role of CT Alternative Modalities & procedures for GIT- Role of CT Alternative Modalities & procedures for GIT- Role of CT Alternative Modalities & procedures for GIT- Role of CT Alternative Modalities & procedures for GIT- Role of MRI Alternative Modalities & procedures for GIT- Role of MRI Alternative Modalities & procedures for GIT- Role of NM Alternative Modalities & procedures for GIT- Role of NM