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reviews the large intestine, its anatomy and its radiographic positioning.

cecum, colon, rectum, anal canal

name the 4 parts of the Large intestine

about 5 feet, 1.5 meters

what is the length of the L.I.?

taeniae coli

external band of of longitudinal muscle that forms 3 thickened bands

haustra

series of pouches in the LI

reabsorption of fluids and elimination of waste products

main function of LI

cecum

pouch like portion of the LI below the junction of the ileum and the colon

vermiform appendix

what is attached to the posteromedial side of the cecum?

ileocecal valve

what is just below the junction of the ascending colon and the cecum?

ascending, transverse, descending and sigmoid portions

what divisions are there in the colon?

right colic flexture, or hepatic flexture

what colic flexture is under the liver?

transverse colon

what is the longest, most moveable part of the colon?

left colic flexture, or splenic flexture

what colic flexture is under the spleen?

superior aperture of the lesser pelvis

at what point does the descending colon junction with the sigmoid portion?

sigmoid (think s for sigmoid)

what portion of the colon makes an s shaped loop and ends at the rectum?

3rd sacral segment

what level is the start of the rectum?

anus

what is the terminal aperture of the large intestine?

rectal ampula

what amupula (dilation)is just above the anal canal?

rectum and anal canal

what structures have two ap curves?

hypersthenic patients

what type of patient has L.I. around the periphery of the abdomen and may require more radiographs to show its entire length?

asthenic patients

what type of patient has L.I. which is bunched together and positioned low in the abdomen?

single contrast

L.I. radiographic procedure in which the colon is examined with a barium solution or iodine solution only

two stage double contrast

colon is examined with a barium suspension and then immediately following evacuation, the colon is examined with air enema or another gaseous enema

single stage double contrast

the fluoroscopist selectively injects barium suspension and gas

positive contrast media

reveals anatomy and tonus of colon and most of the abnormalities to which it is subject

gaseous media

serves to distend the lumen of the bowel and render it visible, through the transparency of its shadow, all parts of the barium-coated mucosal lining of colon and any small intraluminal lesions

ctc

computed tomography colonoscopy (same as vc) in 3d and multiplanar views

vc

virtual colonoscopy, used as a screening tool for colorectalcancer after a failed conventional colonscopy. (also called ctc)

MPR

multiplanar reformatted view

high density barium sulfate

absorb a greater percentage of radiation, particularly useful for double contrast studies, in which uniform coating of the lumen is required

more rapidly absorbed than nitrogen in regular air when evacuation of the gaseous medium is incomplete

why is carbon dioxide used in air contrast studies?

iodized contrast media

what is used when colon perforation or leak is suspected(selectively used when retrograde filling with barium is impossible or contraindicated)

evacuation is often insufficient for double contrast visualization of the mucosal pattern

what is a disadvantage of using iodized contrast solution?

oral admininstration of iodine allows for satisfactory examination of the colon

what is an acceptable use of iodine for uncoperative patients for colon exams?

3-4 hours (fast)

what is transit time from ingestion to colonic filling?

iodized solutions are practically nonabsorbable

what allows oral dose of iodized contrast to outline the entire large bowel?

barium sulfate suspension

what ingested contrast solution is subject to drying, flaking and uneven distribution in the colon?

L.I. must be completely empty of contents to not be confused with polypoid or tumor masses

what is agreeable for preping L.I. Examination by all profesionals?

clear liquids only, and bowel cleansing regimen

what bowel prep is done?

complete intestinal tract cleansing kits, gastrointestinal lavage preparations, cleansing enema

methods of of bowel cleansing

smaller caliber rectal catheter

what should be used on patients who have inflamed hemorrhoids, fissures, a stricture or other abnormalities of the anus?

90 ml

what is the recommended limit on the air capacity for inflatable tips?

one complete squeeze

what provides adaquate distention of the retention balloon without danger of overinflation?

3 quarts

what is the capacity of most enema bags when completely filled?

6 feet long

what is the tube length for enema bags?

500 ml

what is the capacity for smaller enema bags with short, large diameter tubes for double-contrast BE procedures?

12% to 25% weight/volume ratio

What concentration of Barium sulfate is recommended for single contrast colonic enemas?

75%-95% weight/volume ratio

What concentration of Barium sulfate is recommended for double contrast colonic enemas?

85-90 degrees F

If warm BE are administered what temp should it be? (below body temp)

damaging to tissues, causes irritation and difficult or impossible for patient to hold for examination

what happens if BE solution is too warm?

RUQ, LUQ

Duodenum quadrant locations

LUQ,LLQ

jejunum quadrant locations

RUQ, RLQ, LLQ

Ileum quadrant locations

RLQ

ileocecal valve quadrant location

PA and or AP, RAO,LAO, LPO and or RPO, lateral rectum, right and left lateral decube, (double contrast)PA post evac

BE series basic order

Ap axial, or ap axial oblique, PA axial or PA axial oblique

Special enema series

welin method

barium introduced to left colic flexure, then tip removed and patient evacuates,tip reinserted and barium introduced to sigmoid and air instilled, position altered to coat mucosa, spot radiographs taken as needed

closed system in which patient remains on table for entire procedure

does not require removal and reinsertion of enema tip

single stage closed system method

barium introduced by bag position, air introduced by bag inversion or by manual compression of sphygmoanometer bulb

PA or AP Barium enema

no body rotation, cr to iliac crest

PA axial large intestine

cr angled 30-40 degrees caudad, enters level of ASIS

RAO

oblique that best demonstrates right colic flexure, ascending colon, and sigmoid

LAO

obliqe that best demonstrates left colic flexure and descending colon

pa oblique large intestine

35-45 degree RAO or LAO, cr to iliac crest, and 1 inch from msp

ap oblique large intestine

35-40 degree lpo, rpo, cr to iliac crest, 1 inch lateral to elevated side of msp

AP axial large intestine

supine, IR centered 2 inches above iliac crest, CR angled 30-40 cephalic, entering inferior margin of pubic symphysis

Ap axial oblique L.I.

LPO rotate 30-40 degrees, 30-40 degrees cephalic. ONLY position with body rotation and tube angle

PA axial, and Pa Axial oblique

RAO rotate body 35-45 degrees, 30-40 caudad, cr at level of asis, and msp

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