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39 Cards in this Set
- Front
- Back
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What are the 2 HIDA agents that are used
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99 tc-disofenin
99 tc mebrofenin |
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What is the path of the hida agent
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liver to bile to small bowel
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What does it mean if the GB fills
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we prove the cystic duct is patent and there is no cholecystitis
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What does it mean if the GB doesnt fill
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probably acute chole but may be other possibilities
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What are reason besides cholecystiis wc may cause the GB not to fill
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not enough liver function
GB is contracted or overly distended (sludge filled in a fasting patient) |
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What is a marker of good liver function
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bilirubin (if less than 10 excretion is usually seen)
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What is the appropiate time to fast prior to a hida scan
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4 -24 h (not more than 24h)
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What are medications to cause contraction of the gallbladder
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morphine (contracts sphincter of oddi) or sincalide.
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How id sincalide given
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at least 30min prior via slow infusion
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Is there going to more or less tracer in the bowel after giving sincalide
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less, bc the gallbladder contracts and empties and now has greater ability to hold tracer.
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What is seen in a normal hida scan
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clearance of blood pool
rapid liver uptake peak in 15 min bile duct visible within 10-30 min GB and SB visible with in 1 hour |
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What is commonly mistaken for the GB
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2nd and 3rd segment of the doudenum
gastric reflux |
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What is done if the GB doesnt fill
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use morphine-augmented approach
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How does morphine work
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contracts S of O and increases CBD pressure
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What is the dosage of morphine given
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0.04mg/kg (2-3 mg total)
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When is morphine give
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45-60 min if no GB
IF tracer is in the bowel. |
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What are 2 benificial reasons to give morphine
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fewer false positives (some peoples gb normally dont fill)
faster |
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What additional organs besides the GI tract, liver and biliary system may be seen
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the kidneys and bladder (left seen better than right)
less than 5% excreted this way |
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Why would the kidney excrete more
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if the liver is not excreted correctly
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If the morphine is delayed and there is not enough tracer what should be done
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give tracer again
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If there is enterogastric reflux where will it me seen
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lateral to the left lobe of the liver
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What is the rim sign
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rim of increaseed activity adjacent to empty GB foss
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When is the rim sign seen
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acute cholecystitis
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Is a hida scan useful in chronic cholecytitis
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yes
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What is a false positive scan
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one in which the gb doesnt fill
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What are some causes of a false positive hida
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prolonged fasting (dilated)
recent meal (less than 4 h) (contracted) critically ill patient inadequate liver function CBD (prior to cystic duct) obstruction absent GB |
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What are causes of a false negative
(GB fills despite acute cholecystitis) |
rare but occurs in cholecytitis wihout cystic duct obstruction
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What is the likely causes of a liver with good uptake of tracer but none in the GB or SB
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Common duct obstruction
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Why is a hida scan given to kids with suspected biliary atresia bc of persistent neonatal jaundice
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bc if it excretion to the bowel occurs this excludes biliary atresia and is probably neonatal hepatitis
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How does imaging for biliary atresia typically last
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up to 24 hours
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What is another technique to increase excretion
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phenobarbital (to increase rate of tracer excretion)
standard sz dosage for 5-7 days prior |
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If you see shadowy tracer above the liver what is it
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blood pool activity in the heart
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What if a baby has a large amount of tracer below the bladder
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its in the diaper
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What are additional applicatons of hida scan besides cholecystis and biliary atresia
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bile leaks
choledochal cyst biliary enteric fistula chronic GB dysfunction |
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Where does the bile go if there is a large leak
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paracolic gutter on the right (may outline the peritoneal cavity)
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What is another name for biliary dyskinesia
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chronic acalculous GB dysfunction
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How is biliary dyskinesia evaluated
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give sineclide and measure the EF of the gallbladder
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What is considered a reduced GB EF?
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less than 30-35%
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What is the technique for analysing
GB function |
give sincalide 1 hr Post hida given by 30 min infusion
during this time or 30 min after infusion draw ROI and calculate EF |
