Gastro II

Question 1

Gastric Emptying Scan measures what?

Answer 1

determines rate of gastric emptying ( mostly through the stomach to the small intestine)

Question 2

Types of GI Imaging?

Answer 2

Gastric Emptying Scan 
Gastroesophageal reflux scan
Barium swallow
EGD
Abdominal Scintigraphy
Arteriography

Question 3

Indications for Gastric Emptying Scan?

Answer 3

Determines the rate of gastric emptying

Delays show pathology

Question 4

Gastric Emptying Scan is useful in diagnosing?

Answer 4

Gastroparesis ( surgery or DM)

Postprandial nausea

Vomiting

Early satiety

Abd pain (unexplained and related to food)

Post- GI anastamosis

Question 5

Gastric emptying scan: Test Explanation?

Answer 5

1. ) Pt eats meal containing radionuclide (Tc)
2. ) Pt lies supine under gamma camera that takes images for 2 minutes Q 30-60 minutes until stomach is empty or up to 2 hours ( which ever occurs first)

Question 6

Gastric emptying scan NL?

Answer 6

NL = 40% retained after 2 hours and 60% is left in the stomach

Question 7

Gastric emptying scan: Contraindications?

Answer 7

Pregnant or lactating females

Question 8

Gastric emptying scan: interfering factors?

Answer 8

Anticholinergics ( slows everything down), opiates ( constipation), sedatives ( constipation = slow down GI transit )

Should be withheld for 2 days before testing

Question 9

Indications for Gastresophageal Reflux Scan?

Answer 9

Heartburn

Reflux symptoms

Aspiration

Question 10

GE Reflux Scan: Test explanation?

Answer 10

Pt in supine position and drinks tracer (ie; Tc)

Images are taken of the esophageal area in different positions and at various times

**other tests come up negative then you might want to consider a reflux scan

GERD scan looks at esophagus

even when you are laying flat everything should move down the stomach *

Question 11

Aspiration Scan: Test explanation?

Answer 11

Done overnight while pt is sleeping

Images taken over lung fields

Infants being evaluated for reflux

** Aspiration scan looks at the lungs to see if there has been an aspirate entered into the lung tissue from vomitting *

Question 12

Contraindications to GE reflux scan?

Answer 12

Pregnant or lactating females

Pts that cannot tolerate abdominal compression

**compression = induce reflux, if patients can not handle this then they can not do the scan *

Question 13

Indications for Barium Swallow?

Answer 13

Provides visualization of the lumen of the esophagus

Question 14

Barium swallow is used to investigate what?

Answer 14

Dysphagia
Noncardiac CP
GERD
Swallowing abnormalities

**upper GI series = lower esophagus, proximal small bowel and the stomach

barium is radiopaque

barium swallow is just esophagus *

Question 15

Test explanation for barium swallow?

Answer 15

More thorough exam for the esophagus than the upper GI series

Question 16

Anatomic abnormalities seen on barium swallow?

Answer 16

Hiatal hernia ( lower esophagus)
Zenker diverticulum
Schatzki ring ( rings where people get strictures)

Question 17

Defects in filling examples seen on a barium swallow?

Answer 17

Tumor

Strictures

Extrinsic compression - tumor outside the esophagus putting pressure on it

Enlarged heart - inducing pressure on the esophagus

Question 18

Considerations when using Barium?

Answer 18

Use Barium after other xray studies - cause it will occlude different structures

Cathartics should be administered after tests to prevent barium or fecal impaction

No administration with acute colitis

No administration with GI perforation

Question 19

Contraindication to a Barium Swallow?

Answer 19

Bowel obstruction - barium may cause fecal impaction

Perforated viscus

Unstable vital signs

Pts unable to cooperate during the exam

Question 20

Complications with Barium swallow?

Answer 20

Could include barium-induced fecal impaction

Question 21

Indications for upper GI series?

Answer 21

Visualizes the lower esophagus, stomach, duodenum

Can be performed in conjunction with a barium swallow

**Upper GI series is going to show you the lower esophagus and “everything”

Barium swallow is more for the esophagus ( same test just looking at different views)**

Question 22

Indications for Esophagogastroduodenoscopy
(EGD)? to evaluate for ?

Answer 22

Dysphagia

Weight loss

Early satiety - big red flag for CA

Upper abd pain

Dyspepsia

Suspected varices

Abnl barium swallow

**numb back of throat and sedate them but not completely
*

Question 23

EGD test explanation?

Answer 23

Direct visualization of the upper GI tract

Electrocautery can be used

Biopsies can be taken

Some surgical procedures can be done

**good thing about EGD is that Bx can be completed during process*

Question 24

EGD Procedure?

Answer 24

Left lateral decubitus position (LLD)

Throat is anesthetized with topical lidocaine ( spray)

Sedate patient

Bite block placed - so they cannot bite the tubing

Question 25

Abdominal Scintigraphy 
(GI Bleeding Scan) Indications?

Answer 25

“try and find the location of bleeding in the Gi system” - more for a slow persistent bleed Used to localize the site of a GI bleed Pictures taken with gamma camera at different time intervals. **know when we go back in for the colonoscopy and endoscopy then we kinda know were to look better cause we sort of have an idea where the bleed it at *

Question 26

Abdominal Scintigraphy 
(GI Bleeding Scan) is used for ____ but __________ GI hemorrhage?

Answer 26

✪ slow but persistent GI hemorrhage

Question 27

Abdominal Scintigraphy 
(GI Bleeding Scan) uses __-_______ RBCs or ______ _______ injected into the vascular system.

Answer 27

Uses Tc-labeled RBCs or sulfur colloid injected into the vascular system

Question 28

Contraindications to Abdominal Scintigraphy?

Answer 28

Pregnant or lactating females Medically unstable patients

Question 29

Implications for Abdominal Scintigraphy ?

Answer 29

Used for bleeding between 0.03 mL/min and up to 1mL/min

Question 30

Abdominal Scintigraphy can find possible causes of bleeding like what?

Answer 30

Ulcers Tumors Vascular malformations Diverticulosis Inflammatory Bowel Disease

Question 31

Indications for Arteriography?

Answer 31

GI bleeding at a rate > 1mL/min Uses contrast dye injected into an artery to look for arterial bleed Try and use a selective artery to identify the most likely site of bleeding **Find an artery close to the bleeding site and inject it with contrast dye *

Question 32

Contrindications to Arteriography?

Answer 32

Allergic to shellfish or iodinated dye Pregnant patients Renal disorders Pts at risk for bleeding Dehydrated patients Coiled and catheters - maybe a low INR then u need to weight the risk / benefits

Question 33

A 45 year old female with hx of IDDM presents to GI office with complaints of early satiety and abdominal bloating. What is the best test?

Answer 33

she might have gastropuresis - so start with gastric emptying scan if it is normal then do an EGD