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NM By Myself > Gastro Classic NM > Flashcards

Gastro Classic NM Flashcards

(54 cards)

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1
Q

After I131 therapy

A

10% decline in stimulated saliva flow

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2
Q

Functioning salivary gland tumor

A

Warthin tumor (history of smoking)
Oncocytoma
Oxyphilic adenoma

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3
Q

Primary salivary tumor

A

Increased perfusion
Decreased uptake

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4
Q

Multi swallow approach

A

6 liquid bolus
Regular peristaltic waves at swallow intervals 10-15 sec
Condensed image

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5
Q

Quantitative indices of esophageal transit scan

A

Oral transit time - <1 sec normal, <5% residual activity
Pharyngeal TT - <1.2 sec, <5%
Esophageal TT - <10 sec, <20%
Esophageal emptying rate =
(Emax - E10s)/Emax * 100 >80% normal

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6
Q

Nutcracker esophagus

A

Chest pain, dysphagia, peristaltic waves in distal esophagus

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7
Q

Achalasia

A

Degeneration of neurons in the wall of esophagus
Relaxation - - LES pressure rise
Impaired clearance and delayed transit times
Most sensitive esophageal transit scan

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8
Q

Diffuse esophageal spasm

A

Simultaneous contractions induced by liquid swallows
100% sensitivity
10% Manometry

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9
Q

Scleroderma

A

Fibrosis and vascular obliteration of muscle
Retention in lower esophagus
Clearance after upright or glass of water

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10
Q

Neurogenic dysphagia

A

Stroke
Brain tumor
Brain injury
Paralysis
Neurodegenerative disease

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11
Q

Gastric emptying scan preparation

A

Fast 4 hours
Stop prokinetics, opiates, antispasmodic, atropine, nifedipine, progesterone, octreotide, benzodiazepine for 2 days
Diabetes - - glucose <270 mg/dL
No smoke

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12
Q

Gastric emptying tracer

A

Tc-Sulfur colloid 0.5-1 mCi mix with 2 liquid eggs white - - cook in microwave
+ 2 slices of white bread, 30g jam, 120 ml water
Eat within 10 min
Contra - - food allergy and hypoglycemia
Anterior and posterior for 1 min - - geometric mean

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13
Q

Gastrointestinal bleeding scan = GIBS
Bleeding flow

A

Monitor GIT up to 24h
Detect bleeding at low flow rate 0.04mL/min
No preparation

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14
Q

Gastrointestinal bleeding scan radiopharmaceutical

A

Tc-labeled RBC - intravascular half-life allows continuing imaging over many hours
Tc-Sulfur colloid

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15
Q

RBC label
Tc bind

A

In vitro - recommended - least pert free - - 15-30 mCi in adult, 1.51*weight of child
Modified in vivo
In vivo
Tc bind beta chain of Hemoglobin

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16
Q

Poor RBC labeling caused by

A

Heparin
Iodine contrast
Doxorubicin
Lidocaine

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17
Q

Dd rectal from bladder activity

A

Lateral views

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18
Q

Meckel diverticulum

A

80-100 cm of ileocaecal valve
2 cm length
57% contain Ectopic gastric mucosa
50% at age of 2 years
Gross rectal bleeding +- abd symptoms

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19
Q

Meckel scan

A

When no active bleeding (unlike RBC)
Tc-pert 10 mCi adult, min 20 MBq child
Pretreatment with cimetidine, pentagastrin, glucagon (prevent release of pert from gastric mucosa)
Potassium perchlorate block secretion from gastric mucosa - - false negative
False - positive - genitourinary uptake - - SPECT
>1 cm diameter - - 90% accuracy

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20
Q

Hepatobiliary scan preparation

A

Fast 2-6h, children 2-4h, infant 2h with clear liquids possible (not milk)
Fast >24h–false positive , gallbladder don’t fill - - treat with sincalide
Stop opioids 4 half lives or give naloxone
No fast - - false positive, no gallbladder within 1h
Most common indication - - acute cholecystitis

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21
Q

Hepatobiliary scan
Tracer, mechanism

A

Tc-labeled HIDA bind to albumin - - extracted by hepatocyte similar to bile salts, free fatty acids, bilirubin - - secreted in biliary canaliculi without conjugation
2/3 enter gallbladder via cystic duct
1/3 into duodenum via CBD and sphincter Oddi
Dynamic 60 min - - activity in biliary ducts 10-30 min, in bowel by 60 min

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22
Q

HIDA

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A

Tc-Disofenin - even when bilirubin >25 mg/dL
Tc-mebrofenin - higher liver extraction 98% vs 89%, more rapid biliary clearance 17 min vs 19 min - - preferred if moderate-severe hepatic dysfunction, in neonates with hyperbilirubinemia min 1 mCi
Adult 3-5 mCi - - more if high bilirubin
Child 0.05 mCi/kg, min 0.5 mCi

23
Q

Acute cholecystitis

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A

Non visualized gallbladder - - acute or chronic cholecystitis
Acute acalculous cholecystitis sensitivity 70-80% vs calculous 95%
Gallbladder not seen after 60 min - - morphine sulfate 0.04 mg/kg IV over 2-3 min only when tracer in small bowel (or second injection of Tc) - - continue for 30-60 min
False negative - 25% acalculous have no cystic duct obstruction, only inflammation of gallbladder wall

24
Q

Contra morphine

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A

Abs - increased intracranial pressure in children, respiratory depression
Rel - acute pancreatitis

25
Non visualized gallbladder
Fast >24h or recently ate - - false positive CBD obstruction or severe cholestasis Cholecystectomy Acute calculus cholecystitis Chronic cholecystitis Images at 4h
26
GBEF procedure
Gallbladder not filled by 60 min - - acute or chronic cholecystitis Gallbladder filled - - gamma camera 35-40° LAO Sincalide 0.02 microg/kg into 30-50 mL syringe dilute with saline - - infusion pump for 60 min Dynamic imaging starts simultaneously frame/min GBEF = (max-min)/max*100 GBEF <38% = abnormal
27
Sphincter of Oddi dysfunction
Pain after Cholecystectomy Delay in bile flow into duodenum (>10 min) Delayed entry of tracer into bowel (>30-60 min) Failure of sincalide Morphine immediately after HIDA injection - - sensitivity >80%
28
Biliary atresia
Neonatal jaundice Early diagnosis within 60 days Kasai procedure - hepato porto enterostomy Unresponsive - - liver transplant DD neonatal hepatitis Phenobarbital to increase bile flow and specificity Persistent hepatogram and no biliary-to bowel transit over 24h
29
Postmorphine gallbladder visualized
No acute cholecystitis Yes chronic cholecystitis
30
Phenobarbital
Biliary atresia
31
Morphine
After HIDA to speed the study for suspected acute cholecystitis Spasm of sphincter Oddi - - raise CBD pressure - - facilitate gallbladder filling Only when tracer in liver, CBD and small bowel
32
Sincalide
Synthetic cholecystokinin Longer delay in bowel because of accumulation in empty gallbladder Severely prolonged - - biliary obstruction (stone) Indication: Biliary dyskinesia, fast >24h, Sphincter Oddi dysfunction, Calculate GBEF, TPN Action: contraction of gallbladder and relaxation of sphincter Oddi Contra - - allergy, pregnancy
33
Visualized gallbladder
No acute cholecystitis
34
Tracer in small bowel within 60 min
No CBD obstruction
35
Persistent in blood pool >20 min
Reduced hepatocellular function Normal - - clear from blood pool within 5 min
36
Salivary gland scan preparation and protocol
Fast Stop smoking No thyroid blocking agents 48h Tc pert - - dynamic frame/sec 1-2 min - - sialagogue - - frame/2-3 min for 20 min
37
Salivary gland scan interpretation
Acute Sialoadenitis - - hyperemia and edema - - increased uptake and retention Chronic Sialoadenitis - - variable uptake - - little or no uptake in late stage Sialolithiasis - - 80-90% Submandibular - - poor or absent excretion, dilated ducts possible Early dry mouth - - affects excretion phase Mass lesion - - increased perfusion, decreased uptake - - кроме Warthin tumor, Oncocytoma, Oxyphilic adenoma
38
Esophageal transit indication
Dysphagia after surgery Mechanical obstruction After radiotherapy Manometry not possible Response to treatment
39
Esophageal transit preparation and protocol
Fast 3h or overnight Test - swallow water 10 ml Stand, face 80° oblique to the left Low energy high resolution parallel hole collimator FOV - from mouth to epigastric area Keep in mouth 10 ml 1 mCi Tc-colloid - - swallow 2 sec after start dynamic - - frame/0.125 sec 1 min, 64*64, zoom 1 - - static 60 sec After 30 min repeat with semisolid bolus jellied drink 10 ml 1 mCi - - static 60 sec
40
Single swallow
Poor sensitivity Low specificity
41
Assess reflux
Dynamic 120 sec 4-5 Valsalva maneuver - - increased intra abdominal pressure
42
Gastric emptying lag phase
Frequent acquisition every 15 min in first hour
43
GIBS indication
Mid or lower gastrointestinal bleeding When upper gastrointestinal bleeding is excluded by nasogastric lavage Anemia and sometimes melena
44
Gastrointestinal bleeding classification and causes
Upper - - above ampulla of Vater Mid - - from ampulla of Vater to terminal ileum - - angiodysplasia, Crohn, diverticul, Meckel Lower - - colonoscopy - - angiodysplasia, diverticulosis, neoplasm, adenomatous polyp, IBD, infection
45
GIBS protocol and interpretation
Dynamic - - frame/1-5 sec for 1-2 min - - vascular mass Frame/min for 60-90 min No bleeding - - delayed image 2-6h or 18-24h - - better accuracy Bleeding - - area of extravascular activity increase over time or focus of activity that move - - SPECT
46
Meckel protocol
1 image every 30-60 sec for 30 min Static SPECT
47
No bowel and no gallbladder
Stone in CBD
48
Biliary dyskinesia
Biliary pain No stones Gallbladder dysmotility - - stasis - - chronic inflammation Check GBEF Benefit from Cholecystectomy
49
Normal
50
No bowel Stone in CBD
51
No gallbladder
52
Duodeno-gastric reflux
53
Dyskinesia of Sphincter Oddi Gallbladder and choledochus fully distended No stones No duodenum
54
Postmorphine gallbladder visualized Delayed visualisation of gallbladder - - chronic cholecystitis

NM By Myself (25 decks)

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