Chapter 13 Lower Gastrointestinal System

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1

1. How long is the average small bowel if removed and stretched out during autopsy?

23 feet or 7 m =

2

2. In a person with good muscle tone, the length of the entire small intestine is

15 to 18 ft or 4.5 to 5.5

3

3. The average length of the large intestine is

5 feet or 1.5 m

4

4. List the three divisions of the small intestine in descending order, starting with the widest division.

Duodenum, Jejunum, Ileum

5

5. The colon is divided into ___ sections and has ___ flexures

4 sections, 2 flexures

6

6. In which two abdominal quadrants would the majority of the jejunum be found?

LUQ and LLQ

7

7. Which division of the small intestine has a feathery or coiled spring appearance during a small bowel series?

Jejunum

8

8. Which division of the small intestine is the longest?

Ileum

9

9. Which two aspects of the large intestine are not considered part of the colon?

cecum and the rectum

10

10. List the two functions of the ileocecal valve?

Prevents contents of the ileum from passing too quickly into the cecum and it prevents reflux back into the ileum.

11

11. What is another term for the appendix?

Vermiform appendix

12

12. Longest aspect of the large intestine

Transverse colon

13

13. Widest portion of the large intestine

Cecum

14

14. A blind pouch inferior to the ileocecal valve

Appendix

15

15. Aspect of the small intestine that is the smallest in diameter but longest in length?

Ileum

16

16. Distal part; also called iliac colon

Descending colon

17

17. Shortest aspect of small intestine

Duodenum

18

18. Lies in pelvis but possesses a wide freedom of motion

Sigmoid colon

19

19. Makes up 40% of the small intestine

Jejunum

20

20. Found between the cecum and transverse colon

Ascending colon

21

21. What is the term for the three bands of muscle that pull the large intestine into pouches

Taeniae coli

22

22. Pouches, or sacculations, seen along the large intestine wall are called?

Haustra

23

23. What is an older term for the mucosal folds found within the jejunum?

Plicae circulares

24

25. What portion of the small intestine is located primarily to the left of the midline?

Jejunum

25

26. Which portion of the small intestine is located primarily in the RLQ

Ileum

26

27. Which portion of the small intestine has smoothest internal lining and does not present a feathery appearance when barium filled

Ileum

27

28. Which aspect of the small intestine is most fixed in position?

Duodenojejunal junction

28

29. In which quadrant does the terminal ileum connect with the large intestine?

RLQ

29

30. Which muscular band marks the junction between the duodenum and jejunum

ligaments of treitz

30

31. The widest portion of the large intestine is the

Cecum

31

32. Which flexure of the large intestine usually extends more superiorly

left colic

32

33. Inflammation of the vermiform appendix is called?

Appendicitis

33

34. Which structures will fill up with air during a double contrast barium enema with the patient supine?

Transverse colon, sigmoid colon

34

35. Which aspect of the GI tract is primarily responsible for digestion, absorption, and reabsorption?

Small intestine

35

36. Which aspect of the GI tract is responsible for the synthesis and absorption of vitamins B and K and amino acids?

Large intestine

36

37. The cecum is located in the intraperitoneal, retroperitoneal, or infraperitoneal

intraperitoneal

37

38. The ascending colon is located in the is in the intraperitoneal, retroperitoneal, or infaperitoneal?

Retroperitoneal

38

39. The transverse colon is located in the intraperitoneal, retroperitoneal, or infraperitoneal?

intraperitoneal

39

40. The Descending colon is located in the intraperitoneal, retroperitoneal, or infraperitoneal?

retroperitoneal

40

41. The sigmoid colon is located in the intraperitoneal, retroperitoneal, or infraperitoneal?

intraperitoneal

41

42. The upper rectum is located in the intraperitoneal, retroperitoneal, or infraperitoneal?

retroperitoneal

42

43. The lower rectum is located in the intraperitoneal, retroperitoneal, or infraperitoneal?

infraperitoneal

43

44. The C-loop of the duodenum is located in the intraperitoneal, retroperitoneal, or infraperitoneal?

retroperitoneal

44

45. The jejunum is located in the intraperitoneal, retroperitoneal, or infraperitoneal?

intraperitoneal

45

46. The ileum is located in the intraperitoneal, retroperitoneal, or infraperitoneal?

intraperitoneal

46

47. Which of the following conditions pertains to a radiographic study of the small intestine?

A. May perform as a double-contrast media study?

B. An enteroclysis procedure

C. Timing of the procedure is necesssary

D. All of the above are correct

All of the above

47

48. Two conditions that may prevent the use of sulfate during a small bowel series

Possible perforated hollow viscus or large bowel obstruction

48

49. What type of patients should be given extra care when given water-soluble contrast medium?

Young and dehydrated

49

50. Common birth defect found in the ileum?

Meckel's diverticulum

50

51. Common parasitic infection of the small intestine?

Giardiasis

51

52. Obstruction of the small intestine?

ileus

52

53. Patient with lactose or sucrose sensitivities/.

malabsorption syndrome

53

54. New growth?

Neoplasm

54

55. A form of sprue

celiac disease

55

56. Inflammation of the intestine

enteritis

56

57. Form of inflammatory disease of the GI tract

regional enteritis

57

58. Adenocarcinoma

apple core sign

58

59. Meckel's diverticulum

large diverticulum of the ileum

59

60. Ileus

circular staircase or herringbone sign

60

61. Giardiasis

dilation of the intestine with thickening of circular folds

61

62. Regional enteritis

cobblestone appearance

62

63, Volvulus

Beak sign

63

64. Giardiasis is a condition acquired through

contaminated food, contaminated water, person-to-person contact

64

65. Meckels diverticulum is best diagnosed with which imaging modality

nuclear medicine

65

66. Whipple's disease is a rare disorder of the?

proximal small intestine

66

67. How much barium sulfate is generally given to an adult patient for small bowel only series

2 cups or 16 ounces

67

68. When is a small bowel series deemed completed?

when the contrast medium passes through the ileocecal valve

68

69. How long does it usually take to complete an adult small bowl series?

2 hours

69

70. When is the first radiograph generally taken during a small bowel series?

15 to 30 mins after ingesting the contrast medium

70

71. True or False: Fluoroscopy is sometimes used during a small bowel series to visualize ileocecal valve?

true

71

72. The term enteroclysis describes what type of small bowel study?

double contrast study

72

73, What two types of contrast media are used for an enteroclysis?

High-density barium sulfate

73

74. Which two pathological conditions are best evaluated through an enteroclysis procedure?

regional enteritis (chrons disease) malabsorption syndromes

74

75. True or False: It takes approximately 12 hours for barium sulfate in a healthy adult, given orally, to reach the rectum.

false

75

76. The tip of the catheter is a advanced to the _______ during an enteroclysis

duodenojejunal flexure (suspensory ligament)

76

77. What is the purpose of introducing methylcellulose during an entrocclysis

it dilates the intestinal lumen to produce a more diagnostic study

77

78. A procedure to alleviate postoperative distention of a small intestine obstruction is called?

therapeutic intubation

78

79. What is the recommended patient preparation before a small bowel series?

NPO for at least 8 hrs before procedure; no smoking or gum chewing

79

80. Which position is recommended for small bowel radiographs? why?

prone. to separate the loops of intestine

80

81. A twisting of a portion of the intestine on its own mesentery

volvulus

81

82. Outpouching of the mucosal wall

diverticulum

82

83. Inflammatory condition of the large intestine

colitis

83

84. Severe form of colitis

ulcerative colitis

84

85. Telescoping of the one part if the intestine into another

intussusception

85

86. Inward growth extending from the lumen of the intestinal wall

polyp

86

87. Which type of patient usually experiences intussusception?

infants

87

88. A condition of numerous herniation of the mucosal wall of the large intestine is called?

diverticulosis

88

89. Which pathologic conditions may produce a "tapered or corkscrew: radiographic sign during a barium enema.

volvulus

89

90. Which of the following conditions may produce the "cobblestone: radiographic sign during a barium enema?

ulcerative colitis

90

91. What is the most common form of a carcinoma found in the large intestine

annular carcinoma

91

92. True or False: Intestinal polyps and diverticula are very similar in structure

false

92

93. True or False: Volvulus occurs more frequently in males than females

true

93

94. True or False: The barium enema is commonly recommended procedure for diagnosing possible acute appendicitis

false

94

95. True or False: Any stool retained in the large intestine may require postponement of barium enema study

true

95

96. What 4 conditions would prevent the use of a laxative cathartic before barium enema procedure

gross bleeding, severe diarrhea, obstruction, inflammatory lesions

96

97. True or False: An example of an irritant cathartic is magnesium citrate.

false

97

98. Three types of enema tips commonly used

plastic disposable, rectal retention, air-contrast retention

98

99. True or False: Synthetic latex enema tips or gloves do not cause problems for latex-sensitive patients.

true

99

100. What water temperature is recommended for barium enema mixtures?

room temp 85-90

100

101. To minimize spasm during a barium enema _________ can be added to the contrast media mixture?

lidocaine

101

102. What is the name od the patient position recommended for insertion of the rectal enema tip?

sims position

102

103. The initial insertion of the rectal enema tip should be pointed toward the?

umbilicus

103

104. Which procedure is most effective to demonstrate small polyps in the colon?

double - contrast barium enema

104

105. Which aspect of the large intestine must be demonstrated during evacuative proctography?

anorectal angle

105

106. Which procedure uses the thickest mixture of barium sulfate?

evacuative proctogram

106

107. Into which position is the patient placed for imaging during the evacuative proctogram?

lateral

107

108. True or False: A special tapered enema tip is inserted into the stoma before a colostomy barium enema

true

108

109. True or False: The enema bag should not be more than 36 inches above the table top before the beginning of the procedure/

false

109

110. True or False: The technologist should review the patient's chart before a barium enema to determine whether a sigmoidoscopy or colonoscopy was performed recently.

true

110

111. True or False: Both computed tomography and sonography may be performed to aid in diagnosing appendicitis

true

111

112. True or False: Because of the density and the amount of barium within the large intestine, computed radiography should not be used during a barium enema.

false

112

113. Which one of the following statements is true regard to CT enteroclysis.

a. a duodenojejunal tube does not have to be inserted for this procedure

b. 0.1% barium sulfate suspension is often instilled before the procedure

c. Does not detect obstruction of the small intestine

d. Is rarely performed today

0.1% barium sulfate suspension is instilled before the produre

113

114. Another term for CT colonography (CTC) is

virtual colonoscopy

114

115. True or False: a cleansing bowel prep is not required before a CTC.

false

115

116. Why is oral contrast medium sometimes given during a CTC.

to mark or "tag" fecal matter

116

117. What is the chief disadvantage of a CT colonography (CTC)

can not remove polyps discovered during ct

117

118. True or False: Single-contrast barium enemas are performed commonly on patients with a clinical history of diverticulosis.

false

118

119. Which projections is recommended to be taken during a small bowel series?

prone pa

119

120. True or False: Shielding is not recommended during studies of the lower GI tract.

false

120

121. Due to faster transit time of barium from the stomach to the ileocecal valve in pediatric patients, how frequently should images be taken during a small bowel series to avoid missing critical anatomy and possible pathology?

every 20 - 30 min

121

122. True or False: If a retention-type enema tip is used, it should be removed after fluoroscopy is completed and before overhead projections are taken to better visualize the rectal region.

false

122

123. The ____ position is a recommended alternative for the lateral rectum projection during a double - contrast BE procedure.

ventral decubitus

123

124. What kv is recommended for a small bowel series (single contrast study)

100 to 125 kV

124

125. Where is the CR centered for the 15-minute radiograph during a small bowel series?

2 inches above iliac crest

125

126. What are the breathing instructions for a projection taken during a small bowel series?

make exposure on expiration

126

127. Generally, a small bowel series is complete once the contrast media reaches the ________

ileocecal valve

127

128. What type of patient habitus may require two 14X17 cross wire cassettes or an AP barium enema projection?

hypersthenic

128

129. Which projection taken during a barium enema best demonstrate the right colic flexure?

RAO or LPO

129

130. How much body rotation is required for oblique barium enema projections?

35 - 45 degrees

130

131. Which position should be performed if the patient cannot lie prone on the table to visualize the left colic flexure

RPO

131

132. Which projection, taken during a double-contrast barium enema, produces an air-filled image of the right colic flexure, ascending colon, and cecum.

left lateral decubitus

132

133. Where is the CR centered for a lateral projection of the rectum

level of ASIS at the midcoronal

133

134. Which projection during a double - contrast barium enema series best demonstrates the descending colon for possible polyps?

right lateral decubitus

134

135. Which aspect of the large intestine is best demonstrated with an AP axial projection?

rectosigmoid region

135

136. What is the advantage of performing an AP axial oblique projection rather than an AP axial

creates less superimposition o the rectosigmoid segments

136

137. What is another term describing the AP and PA axial projections

butterfly projections

137

138. What CR angle is required for the AP axial?

cr 3o to 40 cephalad

138

139. What CR angle is required for the PA axial?

CR 30 to 40 caudad

139

140. What position is recommended for the postevacuation projection taken following a barium enema?

PA prone

140

141. What kV range is recommended kV range for oblique projections taken during a single - contrast barium enema study

100-125 kV

141

142. What is the recommended kV range for oblique projections taken during a double contrast study?

90-100 kV

142

143. What medication can be given during a barium enema to minimize colonic spasms during a barium enema>

glucagon

143

144. A radiograph of a double - contrast barium enema projections reveals an obscured anatomic side marker. The tech is unsure whether it is an AP or PA recumbent projection. The transverse colon is primarily filled with barium, with the ascending and descending colon containing a lesser amount. Which position does the radiograph represent?

...

144

145. A radiograph of a lateral decubitus projection taken during an air-contrast barium enema reveals that the upside aspect of the colon is overpenetrated. The following factors were used during this analog exposure: 120 kV, 30 mAs, 40 inch SID, and compensating filter for air-filled aspect of the large intestine. Which one of these factors must be modified during the repeat exposure.

...

145

146. A radiograph of an AP axial barium enema projection of the rectosigmoid region reveals that there is considerable superimposition of the sigmoid colon and rectum. The following factors were used during this analog exposure: 120 kV, 20 mAs, 40 SID 35 degree caudad CR angle, and collimation. Which of the factors must be modified or corrected for the repeat exposure?

...

146

147. A barium enema study performed on a hypersthenic patient reveals that the majority of the radiographs demonstrate that the left colic flexure was cut off. What can be done during the repeat exposures to avoid this problem?

...

147

148. A technologist has inserted an air-contrast retention tip for a double- contrast BE study. He is not sure how much to inflate the retention balloon. Should he inflate it as much as the patient can tolerate, or is there a better alternative?

...

148

149. A student tech is told to place the patient on the x-ray table in a sim's position in prep for the barium enema. How should the patient be positioned.

...

149

150. A patient with a clinical history of regional enteritis comes to the radiology department. What type of procedure would be most diagnostic for this condition?

...

150

151. A patient is referred to the radiology department for a presurgical small bowel series. What modification to the standard study needs to be made for this particular patient?

...

151

152. A patient comes to the radiology department for a small bowel series. However, because of a stroke, the patient is unable to swallow the contrast medium. What type of the study should be performed for this patient?

...

152

153. An infant with a possible intussusception is brought the ER. Which radiographic procedure may serve a therapeutic role in correcting this condition?

...

153

154. Before a barium enema, the tech experienced difficulty in inserting the enema rectal tip. What should the tech do to complete this task?

...

154

155. During the fluoroscopy aspect of a barium enema, the radiologist detects an unusual defect within the right colic flexure. She asks that the tech provides the best images possible of this region. Which two projections will best demonstrate the right colic flexure?

...

155

156. A patient with a clinical history of possible enteritis comes to the radiology department. Which type of radiographic GI study would most likely be indicated for this condition?

...

156

157. A patient's clinical history includes possible giardiasis. What radiographic procedure would likely be indicated for this condition?

...

157

158. A patient is scheduled for a CTC. What is the recommended patient prep for this procedure?

...

158

159. Which division of the small intestine is the shortest?

Duodenum