lower GI

• The Large intestine begins in the right iliac region.

  Ileocecal valve (right lower quadrant)
• Large intestine Is made up a 4 main parts:

    -Cecum, colon, rectum, anal canal
• The large intestine is Approximately 5 feet in length

  Processes 50 tons of food in a life time

  Main purpose is to absorb water and eliminate wastes
• Terminal end of the small bowel is

  the ileum

  Proximal portion = cecum

  Distal portion = rectum/ anal canal
• Right colic flexure is also called the

  Hepatic flexure (liver right)

  Left colic flexure is also called.

  Splenic flexure (Spleen Left)
• Outside folds = haustra folds

  Long strip = taenia coli (shape of the colon)
• Most moveable portion of the colon = transverse colon
• Hypersthenic colon =High & transverse     Sthenic colon = average
• Hyposthenic colon- below sthenic   Asthenic colon= way below in pelvis
• The cecum is a pouch-like portion of the large intestine where the terminal ileum joins into the large intestines.
• Issues of the cecum and terminal ileum include   appendicitis, Crohn's disease, intussusception (telescope within itself),
• Vermiform appendix is attached to the posteromedial side of the cecum.
• Ascending colon location – right side of the body

  Hepatic flexure location – under the liver

  Transverse colon - Right to Left side of the body (most moveable)

  Splenic flexure – Under the spleen, in the left upper quadrant (highest portion)

  Descending colon – left side of the body

  Sigmoid colon – shaped as an “S” curve, stores the wastes.

  Rectum – where the wastes are packaged and ready to come out.
• Appendicitis- inflammation of the appendix

  If the appendix does not fill with barium, then the patient has appendicitis, or it was removed.
• Polyps – growth or mass protruding from a mucous membrane

  (in pouching)
• Diverticulum – outpouching herniation of the colon wall

  Diverticulitis – inflammation of the diverticula

  Diverticulosis – a condition of having diverticulum without inflammation.
• Apple core appearance of the colon means the patient has cancer
• Colitis- Inflammation of the colon
• Ulcerative colitis – recurrent disorder causing inflammatory ulceration within the colon.
• Hirsch sprung Disease / Mega Colon

  Absence of parasympathetic ganglion, resulting in the absence of peristalsis. common in children
• Inguinal Hernia- Protrusion of the bowel into the groin
• Intussusception – Prolapse of a portion of the bowel into the lumen of an adjacent part.
• Volvulus – Twisting of a bowel section upon itself
• Adhesions is a band of scar tissue

  that joins two internal body surfaces

  that are not usually connected
• Single Contrast LGI (barium only or gastrograffin only – water based/iodine contrast)
• Any leakage of the colon you would use gastrograffin-water based iodine 
• • Diverticulum/Diverticulitis, Intussusception, Volvulus, Anatomy/Appendicitis DIVA - for single contrast
• Double Contrast LGI

  Apple Core, Polyps, Ulcerative Colitis - APU
• Explain the procedure to patient

  Involves the insertion of the enema tip Any Contrast allergies

  Get a “good” history
• Previous surgeries to the GI tract Ask about how colon preparation(Important to be completely cleaned out to prevent misdiagnosis with pathology)-cleansing kits, lavage preparations, cleansing enemas
• Explain the insertion of the enema tip

  Body position-sims position (LAO)

  Preparation of Contrast on the colder side
• IV pole height 24” above the anus

  1st x-ray image taken -scout abdomen (MSP & IC)

  Glucagon intramuscular injection- medicine that relaxes the colon.
• 1st Image – Scout Abdomen The doctor starts the exam & Fluoroscopy portion. Turn the patient around on the table
• Keep patient comfortable Breath slow breathe in and out through their mouths, don’t push

  Radiographers take overheads when Dr. is finished

  Last image – Post-evacuation 
• Single Contrast LGI

  Gastrograffin (water soluble, iodinated)

   or Barium (colloidal solution)
• Double Contrast LGI

  Barium & Air or Carbon Dioxide
• single contrast Sthenic patient

  
• Double Contrast LGI

  Asthenic

  Ap projection

  Supine position

  
• Welin Method – Double Contrast Study

  Colon must be cleaned completely Dr. uses thick barium first Uses air to expand the colon Used to see the lining of the colon
• Upright Positions (double contrast only)

  Used to see air/fluid levels & mobility of the colon.