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39 Cards in this Set

  • Front
  • Back
What are the 2 HIDA agents that are used
99 tc-disofenin

99 tc mebrofenin
What is the path of the hida agent
liver to bile to small bowel
What does it mean if the GB fills
we prove the cystic duct is patent and there is no cholecystitis
What does it mean if the GB doesnt fill
probably acute chole but may be other possibilities
What are reason besides cholecystiis wc may cause the GB not to fill
not enough liver function

GB is contracted or overly distended (sludge filled in a fasting patient)
What is a marker of good liver function
bilirubin (if less than 10 excretion is usually seen)
What is the appropiate time to fast prior to a hida scan
4 -24 h (not more than 24h)
What are medications to cause contraction of the gallbladder
morphine (contracts sphincter of oddi) or sincalide.
How id sincalide given
at least 30min prior via slow infusion
Is there going to more or less tracer in the bowel after giving sincalide
less, bc the gallbladder contracts and empties and now has greater ability to hold tracer.
What is seen in a normal hida scan
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
What is commonly mistaken for the GB

2nd and 3rd segment of the doudenum

gastric reflux
What is done if the GB doesnt fill
use morphine-augmented approach
How does morphine work
contracts S of O and increases CBD pressure
What is the dosage of morphine given
0.04mg/kg (2-3 mg total)
When is morphine give
45-60 min if no GB
tracer is in the bowel.
What are 2 benificial reasons to give morphine
fewer false positives (some peoples gb normally dont fill)

What additional organs besides the GI tract, liver and biliary system may be seen
the kidneys and bladder (left seen better than right)

less than 5% excreted this way
Why would the kidney excrete more
if the liver is not excreted correctly
If the morphine is delayed and there is not enough tracer what should be done
give tracer again
If there is enterogastric reflux where will it me seen
lateral to the left lobe of the liver
What is the rim sign
rim of increaseed activity adjacent to empty GB foss
When is the rim sign seen
acute cholecystitis
Is a hida scan useful in chronic cholecytitis
What is a false positive scan
one in which the gb doesnt fill
What are some causes of a false positive hida
prolonged fasting (dilated)
recent meal (less than 4 h) (contracted)
critically ill patient
inadequate liver function
CBD (prior to cystic duct) obstruction
absent GB
What are causes of a false negative
(GB fills despite acute cholecystitis)
rare but occurs in cholecytitis wihout cystic duct obstruction
What is the likely causes of a liver with good uptake of tracer but none in the GB or SB
Common duct obstruction
Why is a hida scan given to kids with suspected biliary atresia bc of persistent neonatal jaundice
bc if it excretion to the bowel occurs this excludes biliary atresia and is probably neonatal hepatitis
How does imaging for biliary atresia typically last
up to 24 hours
What is another technique to increase excretion
phenobarbital (to increase rate of tracer excretion)

standard sz dosage for 5-7 days prior
If you see shadowy tracer above the liver what is it
blood pool activity in the heart
What if a baby has a large amount of tracer below the bladder
its in the diaper
What are additional applicatons of hida scan besides cholecystis and biliary atresia
bile leaks
choledochal cyst
biliary enteric fistula
chronic GB dysfunction
Where does the bile go if there is a large leak
paracolic gutter on the right (may outline the peritoneal cavity)
What is another name for biliary dyskinesia
chronic acalculous GB dysfunction
How is biliary dyskinesia evaluated
give sineclide and measure the EF of the gallbladder
What is considered a reduced GB EF?
less than 30-35%
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