Which part of the small intestine has a feathery appearance when filled with barium? Show
A) Ileum B) Jejunum pg. 489: The jejunum contains numerous mucosal folds (plicae circulares), which increase the surface area to aid with absorption of nutrients. These numerous mucosal folds produce the "feathery appearance of the jejunum". Which part of the small intestine has the largest diameter? A) Duodenum A) Duodenum pg. 489: the duodenum is the first part of the small intestine. It is the shortest, widest, and most fixed portion of the small bowel. Which part of the small intestine is the shortest? A) Duodenum A) Duodenum pg. 489: the duodenum represents the shortest aspect of the small intestine and averages 20 to 25 cm in length. Which part of the small intestine makes up three fifths of its entirety? A) Duodenum C) Ileum pg. 489: The ileum makes up the distal three-fifths of the remaining aspect of the small intestine and is the longest portion of the small intestine. Which aspect of the large intestine is located highest, or most superior, in the abdomen? A) Right colic flexure B) Left colic flexure Which of the following structures is not considered part of the colon? A) Transverse colon C) Rectum pg. 490: the colon consists of four sections and two flexures and does not include the cecum and rectum. Colon sections: The right (hepatic) and left (splenic) colic flexures are also included as part of the colon. Which part of the large intestine is located between the rectum and the descending colon? A) Left colic flexure C) Sigmoid colon Which part of the large intestine has the widest diameter? A) Descending colon C) Cecum pg. 490: The cecum, the widest portion of the large intestine, is fairly free to move about in the RLQ. Which part of the colon has the greatest amount of potential movement? A) Descending colon B) Transverse colon pg. 490: the transvers colon has a wide range of motion and normally loops down farther. What is the term for the three bands of muscle that pull the large intestine into pouches? A) Haustra D) Taenia coli pg. 491: the muscular portion of the intestinal wall contains three external bands of longitudinal muscle fibers of the large bowel that form three bands of muscle called taenia coli, which tend to pull the large intestine into pouches (haustrum).
Which structure is labeled 6? A) Cecum C) Vermiform appendix pg. 490: see figure 13.8 Which structure is labeled 1? A) Ascending colon B) Left colic flexure pg. 490: see figure 13.8 Which structure is labeled 7? A) Descending colon C) Cecum pg. 490: see figure 13.8 True/False: The ascending colon and upper rectum are intraperitoneal structures. A.) True B.) False pg. 491: table 13.1 = the ascending colon and upper rectum are retroperitoneal structures. Which sections of the large intestine will most likely be filled with air with the patient in the prone position during a double-contrast barium enema (BE)? A) Ascending colon, descending colon, and rectum B) Transverse and sigmoid colon C) Rectum only D) Right and left colic flexure and sigmoid colon A) Ascending colon, descending colon, and rectum pg. 491: when a patient is prone, air rises to fill the rectum, ascending colon, and descending colon. All of these are retroperitoneal structures. Fig. 13.13: barium = white, air = black Which part of the gastrointestinal (GI) tract synthesizes and absorbs vitamins B and K? A) Ileum D) Large intestine pg. 493: table 13.2 Large intestine functions: some reabsorption of water, inorganic salts, vitamins B & K, and certain amino acids. Primary function is deification. True/False: The circular staircase, or herringbone pattern, is a common radiographic sign for a mechanical ileus. A.) True A.) True pg. 495: mechanical obstruction = The loops of the intestine proximal to the site of obstruction are markedly dilated with gas. This dilation produces the radiographic sign commonly called the "circular staircase" or "herringbone" pattern. True/False: Meckel diverticulum is best diagnosed with a radionuclide (nuclear medicine) scan. A.) True A.) True pg. 496: Meckel diverticulum = is rarely seen on barium studies of the small bowel because of rapid emptying during a barium study. It is best diagnosed with a radionuclide (nuclear medicine) scan. Which of the following conditions may lead to an adynamic ileus? A) Small bowel tumor C) Peritonitis pg. 495: adynamic ileus is due to the cessation of peristalsis. Causes include: infection (such as peritonitis or appendicitis); the use of certain drugs; and postsurgical complications. Which of the following conditions may produce the "cobblestone" or "string" sign? A) Whipple disease B) Regional enteritis (Crohn's disease) pg. 494: regional enteritis = segments of lumen narrowed and irregular; "cobblestone" appearance and "string sign" common Which of the following procedures is considered as a functional study? A) Barium enema D) Small bowel series pg. 494: the purpose of the small bowel series are to study the form and function of the three components of the small bowel and o detect any abnormal conditions. Because this study also examines function of the small bowel, the procedure must be timed. When are small bowel series deemed to be complete? A) Two hours after the ingestion of barium B) Once the contrast media passes the ileocecal valve pg. 497: For the first two hours in the small bowel series, radiographs are obtained at 15-minute to 30-minute intervals. If the examination needs to be continued beyond the 2-hour time frame, radiographs are usually obtained every hour until barium passes through the ileocecal valve. The term describing a double-contrast small bowel procedure is: A) two-stage small bowel procedure. C) enteroclysis. pg. 497: box 13.3 Enteroclysis = double-contrast small bowel series True/False: The enteroclysis procedure is indicated for patients with regional enteritis. A.) True A.) True pg. 498: enteroclysis is indicated for patients with clinical histories of small bowel ileus, regional enteritis (Crohn disease), or malabsorption syndrome. True/False: For an average adult, the amount of barium ingested is one 16-oz cup for a small-bowel-only series. A.) True A.) True pg. 498: For the small bowel-only series, the patient generally ingests two cups (16 oz) of barium. The patient must be NPO a minimum of ____ hours before the small bowel series. A) 4 C) 8 pg. 499: The goal of patient preparation is an empty stomach. Food and fluid must be withheld for at least 8 hours before the exam is performed. The tip of the catheter is advanced to the ____ during an enteroclysis. A) duodenojejunal junction (ligament of Treitz) A) duodenojejunal junction (ligament of Treitz) pg. 498: Enteroclysis = the catheter is passed through the stomach into the duodenojejunal junction (ligament of Treitz). A twisting of the intestine on its own mesentery is termed: A) intussusception. B) volvulus. pg. 501: volvulus = a twisting of a portion of the intestine on its own mesentery. A telescoping, or invagination, of one part of the intestine into another is termed: A) diverticulosis. C) intussusception. pg. 501: intussusception is a telescoping, or invagination, of one part of the intestine into another. The "stovepipe" radiographic sign is often seen with: A) volvulus. D) chronic ulcerative colitis. pg. 500: ulcerative colitis = patients with long-term bouts of ulcerative colitis may develop "stovepipe" colon, in which haustral marking and flexures are absent. The "tapered," or "corkscrew," radiographic sign is often seen with: A) diverticulosis. C) volvulus pg. 500: table 13.5 Volvulus = tapered or "corkscrew" appearance, with air filled distended region of intestine. Which radiographic sign is frequently seen with adenocarcinoma of the large intestine? A) "Sail" sign C) "Napkin ring" or "apple core" sign pg. 501: annular carcinoma (adenocarcinoma) = one of the most typical forms of colon cancer, may form an "apple core" or "napkin ring" appearance as the tumor grows. True/False: Ultrasound, with graded compression, can be used in diagnosing acute appendicitis. A.) True A.) True pg. 500: a barium enema generally is not performed in cases of acute appendicitis because of the danger of perforation. High resolution ultrasound with graded compression and CT have become the modalities of choice for the diagnosis of acute appendicitis. True/False: CT may be performed to diagnose acute appendicitis. A.) True A.) True pg. 500: a barium enema generally is not performed in cases of acute appendicitis because of the danger of perforation. High resolution ultrasound with graded compression and CT have become the modalities of choice for the diagnosis of acute appendicitis. Which of the following is classified as an irritant laxative? A) Magnesium citrate C) Castor oil pg. 503: two classes of laxatives: 1.) Irritant: 2.) Saline: Which of the following conditions would contraindicate the use of a cathartic (laxative) before a barium enema? A) Colitis C) Obstruction (ileus) pg. 502: certain conditions contraindicate the use of the very effective cathartics or purgatives needed to cleanse the large bowel. These conditions
include: True/False: Synthetic latex enema tips are safe to use for latex-sensitive patients. A.) True B.) False pg. 503: patients with sensitivity to latex experience anaphalactoid-type reactions that include severe sneezing, redness, rash, difficulty breathing, and even death. If the patient has a history of latex sensitivity, the technologist must ensure that the enema tip, tubing, and gloves are latex-free. True/False: Rectal retention enema tips should be fully inflated by the technologist before beginning a barium enema. A.) True B.) False pg. 503: Rectal retention catheters should be fully inflated only under fluoroscopic guidance provided by the radiologist because of the potential danger of intestinal rupture. To prevent discomfort for the patient, the balloon should not be fully inflated until the fluoroscopic procedure begins. At what stage of respiration should the enema tip be inserted into the rectum? A) During deep breaths D) Suspended expiration pg. 505: because the abdominal muscles relax on expiration, the tip should be inserted during the exhalation phase of respiration. In what position is the patient placed for the enema tip insertion? A) Sims' A) Sims' pg. 504: Sim's position relaxes the abdominal muscles and decreases pressure within the abdomen. The patient is asked to roll onto the left side and lean forward. The right leg is flexed at the knee & hip and is placed in front of the left leg. The left knee is comfortably flexed. During the initial enema tip insertion, the tip is aimed: A) toward the coccyx. B) toward the umbilicus. pg. 505: the rectum and anal canal present a double curvature; the tube is inserted first in a forward direction (1" to 1.5"). This initial insertion should be aimed toward the umbilicus. Which of the following pathologic conditions is best demonstrated with evacuative proctography? A) Intussusception C) Rectal prolapse pg. 508: clinical indications for evacuative proctography (defecography) include: rectoceles, rectal intussusception, and prolapse of the rectum. Which specific aspect of the large intestine must be demonstrated during evacuative proctography? A) Sigmoid colon C) Anorectal angle pg. 509: the anorectal angle or junction must be demonstrated during the procedure. This angle represents alignment between the anus and the rectum that shifts between the straining, and evacuating phases. The ideal kV range for a double-contrast barium enema is: A) 70 to 80. B) 90 to 100. pg. 515: analog & digital Double contrast = 90 to 100 kV Single contrast = 110 to 125 kV Iodinated, water-soluble contrast = 80 to 90 kV True/False: Evacuative proctography is most commonly performed on geriatric patients. A.) True B.) False pg. 508: Evacuative proctography is a more specialized procedure that is performed in some departments, especially in children or younger adult patients. True/False: During a colostomy barium enema, a double-contrast retention enema tip is used. A.) True B.) False pg 510: because the stoma has no sphincter with which to retain the barium, a tapered irrigation tip is inserted into the stoma. True/False: The opening leading into the intestine for the patient with a colostomy is termed the stoma. A.) True A.) True pg. 509: the terminal end of the intestine is brought to the anterior surface of the abdomen, where an artificial opening is created. This artificial opening is termed a stoma. True/False: The height of the enema bag should not exceed 36 inches (92 cm) above the radiographic table at the beginning of the study. A.) True B.) False pg. 505: ensure that the intravenous pole/enema bag is no more than 60 cm (24") above the table. Which imaging modality can demonstrate abscesses in the retroperitoneum? A) MRI A) MRI pg. 512: abscesses in the mesentery or retroperitoneum can be demonstrated easily on T2-weighted MRI. Which one of the following imaging modalities and/or procedures is very effective in detecting the Meckel diverticulum? A) CT D) Nuclear medicine pg. 512: the use of radionuclides can assist in the diagnosis of Meckel diverticulum Which of the following statements is NOT true in regard to a pediatric small bowel series? A) The transit time for barium through the small intestine is longer than that of an adult. B) Barium sulfate is the contrast medium of choice. C) The small bowel series should be scheduled early in the morning. D) A gonadal shield often cannot be used during the later stages of the study. A) The transit time for barium through the small intestine is longer than that of an adult. pg. 511: The pediatric small bowel series and the barium enema are similar in many ways to the procedures in adults. However, the transit time of barium from the stomach to the ileocecal region is faster in children compared with adults. What type of enema tip is recommended for a barium enema on an infant? A) Rectal retention C) 10 Fr, flexible silicone catheter pg. 511: for an infant, often a 10F, flexible silicone catheter is used. Central ray and image receptor centering for a 1-hour small bowel radiograph should be: A) 2 inches (5 cm) above level of the iliac crest. B) at the level of the iliac crest. pg. 513: CR ⊥ IR 1.) 15 or 30 minutes: center CR 2" above iliac crest (center here to include stomach) 2.) Hourly: center CR to iliac crest Which projection and/or position is most commonly performed during an evacuative proctogram? A) Anteroposterior (AP) erect B) Lateral pg. 509: the lateral rectum position usually is preferred by most radiologists. Position patient on the commode and take radiographs in the strain and evacuation phases, with patient in a lateral position. Why is the posteroanterior (PA) rather than the AP projection recommended for a small bowel series? A) Less gonadal dose for female patients D) Better separation of loops of small intestine pg. 499: the prone position is most appropriate for a small bowel series. The prone position allows abdominal compression to separate the various loops of bowel, creating a higher degree of visibility. Asthenic patients may be placed in the Trendelenburg position to separate overlapping loops of ileum. Which of the following positions best demonstrates the left colic flexure? A) LPO D) Left anterior oblique (LAO) pg. 517: LAO = the left colic flexure should be seen as "open" without significant superimposition. RAO demonstrates the right colic flexure "open" without significant superimposition. During a double-contrast barium enema (BE) procedure, the radiologist suspects a polyp in the descending colon. Which position would best demonstrate this? A) Supine for AP projection C) Right lateral decubitus pg. 520: Note - the descending colon is located anatomically on the left side. Right lateral decubitus demonstrates polyps of the left side or air filled portions of the large intestine. Both R and L decubitus positions generally are taken with the double-contrast study. Entire large intestine is demonstrated to include air-filled left colic flexure and descending colon. A radiograph of an AP barium enema (BE) projection reveals poor visualization of the sigmoid due to excessive superimposition of the sigmoid colon and rectum. How can this area be better visualized on the repeat exposure? A) Angle the central ray (CR) 30° to 40° cephalad with AP projection. B) Increase kV. C) Take a PA projection with the patient in the left lateral decubitus position. D) Take a PA projection with a 30° to 40° cephalad CR angle. A) Angle the central ray (CR) 30° to 40° cephalad with AP projection. pg. 523: AP axial barium enema = elongated views of the rectosigmoid segments should be visible with less overlapping of sigmoid loops than with a 90° AP projection. Angle CR 30° to 40° cephalad, directed 2" inferior to level of ASIS. A patient comes to radiology for a barium enema (BE). He has a possible fistula extending from the rectum to the urinary bladder. Which one of the following projections and/or positions would best demonstrate the fistula? A) Lateral rectum position A) Lateral rectum position pg. 519: Lateral rectum/ventral decubitus lateral = demonstrates polyps, strictures, and fistulas between the rectum and bladder/uterus. A patient comes to radiology with possible diverticulosis. Which of the following studies is most diagnostic for detecting this condition? A) Single-contrast barium enema B) Double-contrast barium enema pg. 500: table 13.5 - most common radiographic examination for Diverticula (diverticulosis/diverticulitis) = double contrast barium enema recommended pg. 515: Double contrast barium enema is ideal for demonstrating diverticulosis, polyps, and mucosal changes. A patient comes to radiology for a double-contrast barium enema. The patient cannot lie on her side during the study. Which of the following projections could replace the lateral rectum projection? A) AP axial C) Ventral decubitus pg. 519: alternative ventral decubitus lateral horizontal beam positions are beneficial for double-contrast studies. During a single-contrast barium enema, the radiologist detects a possible defect within the right colic flexure. Which of the following projections and/or positions best demonstrates this region of the colon? A) RPO D) LPO pg. 517: LAO demonstrates left colic flexure (demonstrating the down-side) pg. 518: RPO demonstrates left colic flexure (demonstrating the up-side) pg. 517: RAO demonstrates right colic flexure (demonstrating the down-side) pg. 518: LPO demonstrates right colic flexure (demonstrating the up-side) A patient comes to radiology with a history of rectocele. Which of the following procedures best demonstrates this condition? A) Single-contrast barium enema B) Evacuative proctogram pg. 508: clinical indications for evacuative proctography include rectoceles, rectal intussusception, and prolaps.
An infant is brought to the ED with a possible intussusception. Which of the following procedures may actually correct this condition? A) Small bowel enema D) Barium or air enema pg. 501: intussusception - a barium enema or an air/gas enema may play a therapeutic role in re-expanding the involved bowel. Which of the following barium enema projections and/or positions provides the greatest amount of gonadal dosage to both male and female patients? A) AP/PA B) Lateral rectum What is another term for the AP axial projection taken during a barium enema procedure? A) Sims' position B) Butterfly position How much CR angulation is required for the AP axial projection? A) 10° to 15° C) 30° to 40° pg. 523: angle CR 30° to 40° cephalad While attempting to insert an enema tip into the rectum, the technologist experiences resistance. What should be the next step taken by the technologist? A) Retry the insertion using more lubrication. C) Have the radiologist insert it using fluoroscopic guidance. pg. 502: box 13.5 = never force enema tip into rectum. This action may lead to a perforated rectum. The radiologist inserts the enema tip under fluoroscopic guidance, if needed. Why is it important for the technologist to review the patient's chart and inform the radiologist before beginning the barium enema examination if a biopsy was performed as part of a prior sigmoidoscopy or colonoscopy procedure? A) A sigmoidoscopy or colonoscopy would make the BE examination unnecessary. B) The biopsy of the colon may weaken that portion of the colon, which could lead to a perforation during the BE examination. C) The radiologist would want to confer with the referring physician to see whether the biopsy revealed a malignancy. D) None of the above; the radiologist does not need to know this information before the BE examination. B) The biopsy of the colon may weaken that portion of the colon, which could lead to a perforation during the BE examination. pg. 500: It is important to review the patient's chart to determine whether the patient has had a recent sigmoidoscopy or colonoscopy before undergoing the barium enema. If a biopsy of the colon was performed during these procedures, the involved section of the colon wall may be weakened. This may lead to perforation during the barium enema. True/False: Overhead, radiographic projections are often not taken when using digital fluoroscopy. A.) True A.) True pg. 505: routine "overhead" radiographs may be requested within the bowel filled. pg. 506: "spot" radiographs may be obtained to document any suspicious areas ... with digital fluoroscopy these "spot" images are obtained digitally rather than with separate IRs. True/False: A single-stage, double-contrast barium enema involves instilling both the negative and positive contrast media at the same time. A.) True A.) True pg. 506: in a single-stage, double contrast procedure, barium & air are instilled in a single procedure that reduces time and radiation exposure to the patient. During barium enema fluoroscopy, the radiologist detects a possible defect in the right colic flexure. He asks the technologist to produce a radiograph that will best demonstrate this region of the large intestine. Which one of the following positions will accomplish this goal? A) LAO D) LPO pg. 517: LAO demonstrates left colic flexure (demonstrating the down-side) pg. 518: RPO demonstrates left colic flexure (demonstrating the up-side) pg. 517: RAO demonstrates right colic flexure (demonstrating the down-side) pg. 518: LPO demonstrates right colic flexure (demonstrating the up-side) True/False: Computed tomography colonography (CTC) is considered as an effective alternative to endoscopic colonoscopy. A.) True A.) True pg. 511: CT colonography = "virtual colonoscopy". CT colonography is reported to be an effective diagnostic tool in detecting polyps, tumors, diverticula, defects, and strictures within the large intestine. It is considered to be an alterative to endoscopic colonoscopy. Why is oral contrast media sometimes given during computed tomography colonography? A) To determine if a fistula is present B) To mark or "tag" possible fecal matter pg. 512: a small rectal tube is inserted through which air or CO2 gas is instilled into the large intestine. The purpose of the gas is to distend the large intestine so that the intestinal wall is completely visualized. In some cases, oral contrast material may be given to mark or "tag" fecal matter. The average time to scan the large intestine during a computed tomography colonography is: A) 1 hour. D) 10 minutes. pg. 512: the scan itself takes approximately 10 minutes to complete. MATCHING Match each of the definitions or descriptions with the corresponding pathologic indication for the small bowel series. (Use each option only once.) - Inflammation of the intestine a. Ileus e. Enteritis pg. 494: Enteritis = inflammation of the intestine, primarily of the small intestine. MATCHING Match each of the definitions or descriptions with the corresponding pathologic indication for the small bowel series. (Use each option only once.) - Chronic inflammatory disease of the GI tract a. Ileus f. Regional enteritis (Crohn's disease) pg. 494: Regional enteritis (Crohn's disease) = a form of inflammatory bowel disease of unknown origin ... in advance cases segments of the intestine become narrowed as the result of chronic spasm ... this disorder has a high rate of reoccurrence after treatment. MATCHING Match each of the definitions or descriptions with the corresponding pathologic indication for the small bowel series. (Use each option only once.) - Patient with lactose or sucrose sensitivities a. Ileus d. Malabsorption syndrome (sprue) pg. 496: Malabsorption syndrome (sprue) = GI tract is unable to process and absorb certain nutrients ... Malabsorption syndrome is often experienced by patients with lactose and sucrose sensitivities. MATCHING Match each of the definitions or descriptions with the corresponding pathologic indication for the small bowel series. (Use each option only once.) - New growth observed in intestine as filling defects a. Ileus b. Neoplasm pg. 496: Neoplasm = "new growth" ... this growth may be benign or malignant. MATCHING Match each of the definitions or descriptions with the corresponding pathologic indication for the small bowel series. (Use each option only once.) - Obstruction of the small intestine a. Ileus a. Ileus pg. 495: Ileus = is an obstruction of the small intestine MATCHING Match each of the definitions or descriptions with the corresponding pathologic indication for the small bowel series. (Use each option only once.) - Are often found 50 to 100 cm proximal to the ileocecal valve a. Ileus c. Meckel diverticulum pg. 496: Meckel diverticulum = a common birth defect caused by persistence of the yoke sac (umbilical vesicle) resulting in a saclike outpouching of the intestinal wall. This outpouching is seen in the ileum of the small bowel. It is usually 50 to 100 cm proximal to the ileocecal valve. MATCHING Match each of the definitions or descriptions with the corresponding pathologic indication for the small bowel series. (Use each option only once.) - Common parasitic infection of the small intestine a. Ileus g. Giardiasis pg. 495: Giardiasis = a common infection of the lumen of the small intestine that is caused by the flagellate protozoan Giardia lambila. MATCHING Match each of the definitions or descriptions with the corresponding pathologic indication for the small bowel series. (Use each option only once.) - Obstruction of the small intestine due to the cessation of peristalsis a. Ileus h. Adynamic or paralytic ileus pg. Adynamic (paralytic ileus) = ileus due to the cessation of peristalsis. In which of the following positions or projections for an air contrast colon would air be demonstrated in the lateral portion of the ascending colon?Positioning LGI. Which of the following positions would the patient be in during the insertion of an enema tip?Position the patient on left side, lying with the knees drawn to the abdomen (Fig 2). This eases the passage and flow of fluid into the rectum.
What is cecum in the colon?A pouch that forms the first part of the large intestine. It connects the small intestine to the colon, which is part of the large intestine. The cecum connects the small intestine to the colon.
Which part of the colon has the widest diameter?In terms of diameter, the cecum is the widest, averaging slightly less than 9 cm in healthy individuals, and the transverse colon averages less than 6 cm in diameter. The descending and sigmoid colon are slightly smaller, with the sigmoid colon averaging 4–5 cm (1.6–2.0 in) in diameter.
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Which part of the colon will most likely be filled with air with the patient in the prone position?
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