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301 MEDIMAGE > 9. Fluoroscopy 2 > Flashcards

9. Fluoroscopy 2 Flashcards

1
Q

what separates the left and right liver lobes

A

falciform ligament

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2
Q

what are the 3 organs involved in the biliary ductal system

A

pancreas
liver
gall bladder

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3
Q

what does the pancreas do

A

produces enzymes which assist in breakdown of food for the digestive system

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4
Q

what does the liver do

A

produce bile as a digestive function

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5
Q

what does the gall bladder do

A

collects, stores and concentrates bile

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6
Q

what are 3 structures taht ERCP is interested in

A

common bile duct, pancreatic duct and sphincter of oddi

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7
Q

what is the ampulla vata

A

where the common bile duct feeds into 2nd part of duodenum

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8
Q

what are the 3 hepatic ducts

A

left right and central

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9
Q

what are the 4 ducts involved in the biliary ductal system

A

hepatic duct
cystic duct
common bile duct
pancreatic duct

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10
Q

where is the cystic duct from

A

from gall bladder

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11
Q

where does the common bile duct enter

A

enters duodenum

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12
Q

what duct does the pancreatic common bile duct join

A

common bile duct

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13
Q

what are 9 clinical indicates affecting the biliary system

A 
assessment/treatment of biliary obstruction
congenital anomalies
cholecystitis
choledocholithiasis
polyps
cholelithiasis 
strictures
malignant tumors
jaundice
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14
Q

what is cholecystitis

A

gall bladder inflammation

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15
Q

what is choledocholithiasis

A

gall bladder stones

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16
Q

what is doledocholithiasis

A

common biliary duct stone

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17
Q

what does ERCP stand for

A

endoscopic retrograde cholangiopancreatography

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18
Q

what are the 2 fluro procedures of the biliary systems

A

ERCP

T tube cholangiogram

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19
Q

what is an ERCP

A

endoscope into duodenum to access biliary system, diagnostic or therapeutic

Retrograde = going against the system/backwards

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20
Q

when is T tube cholangiogram used

A

during surgery when patient has gall bladder removed

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21
Q

what is the procedure of ERCPs

A

1/ endoscopic cannulation of ampulla vater

2/ retrograde injection of ICM into common bile duct

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22
Q

in ERCPs where is the endoscope cannulated into

A

ampulla vater

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23
Q

in ERCPs where is ICM injected into

A

common bile duct

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24
Q

what are the 2 types of ERCPs

A

diagnostic or therapeutic

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25
Q

where is the sphincter of oddi

A

valve is where pancreatic and common bile ducts meet

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26
Q

what are 3 conditions that are contraindications for ERCPs

A

unstable cardiopulmonary/neurologic/cardiovascular status

GI conditions that impede access

presence of acute pancreatitis

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27
Q

what are 2 tests that are done before ERCPs to prepare the patient

A

coagulation studies

liver function tests

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28
Q

what are dietary requirements for ERCP patient preparation

A

NPM overnight

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29
Q

what are the 3 premedications given to patients before ERCP

A

atropine
throat anesthetized (xylocaine spray)
glucagon IV

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30
Q

when is atropine given before a ERCP

A

1hr prior

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31
Q

when is glucagon given before a ERCP

A

10min prior to exam

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32
Q

what is atropine used for when its premedicated in ERCPs

A

to clear up saliva

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33
Q

what is glucagon used for when its premedicated in ERCPs

A

cause release of glucose from liver so drug reduces spasms in bowel and sphincter of oddi

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34
Q

what contrast media is used in ERCPS

A

omnipaque 350 diluted

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35
Q

why is omnipaque diluted in ERCPs

A

Diluted with saline as it goes into small ducts so need to make sure its not too dense or radiopaque as it may obscure a small calcificaiton

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36
Q

can stones in the common bile duct be removed

A

easily via ERCP but some can be too large to be pulled through spincter of oddi

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37
Q

what happens if the stone is too large in the common bile duct to pull out from the sphincter of oddi

A

sphincterotomy of the sphincter of oddi to widen the opening into the duodenum to remove larger stones

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38
Q

what is the procedure from start to finish of an ERCP

6 steps

A

1/ patient sedated and back of throat sprayed to numb the gag reflex

2/ antispasmodic drug is given to reduce spasms of the duodenum and relax sphincter of oddi for passage of endoscope and cannula insertion

3/ endoscope passed through mouth down esophagus into the stomach

4/ gastroenterologist observes the GI tract through the endoscope allowing advancement of scope through pyloric sphincter into descending duodenum

5/ cannula threaded through duodenoscope into ampulla of vater into the common bile/main pancreatic duct

6/ placement of cannula verified under fluoroscopy

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39
Q

what do staples in the bowels suggest in an ERCP

A

previous surgery - patient had gall bladder removed and there is a cystic shunt

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40
Q

how can ERCP be therapeutic in addition to diagnostic

A

if there is a tumor that obstructs flow of bile into duodenum, stent holds bile duct open to restore flow

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41
Q

what are 2 important things for the patient to know after the ERCP procedure

A

NBM following procedure as throat is numb

will be in recovery area until full consciousness regained

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42
Q

what are 7 imaging options for the urinary system

A 
plain film KUB
fluoro - MCU/cystogram/urethrogram
Ultrasound
CT urography
Nuc Med
MRI urography
angiography
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43
Q

what is the collimation vertically and horizontal for KUB

A

T12-lower border of symph pubis

ASIS laterally

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44
Q

what are important structures to get on KUB

A

upper border of kidney and need bladder on

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45
Q

if you cant see both kidneys in KUB what do you do

A

coned renal view

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46
Q

what is the centering for coned renal view

A

center midway between xiphisternum and lower costal margin in midline

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47
Q

when do you take a coned bladder view

A

if you havent got upper symphysis pubis

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48
Q

what is urolithiasis

A

very big kidney stone

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49
Q

what is the angulation for coned bladder view

A

15 degree caudal angulation

50
Q

what is the centering point for coned bladder

A

midway between symphysis pubis and ASIS in the midline

51
Q

why is there caudal angulation in coned bladder view

A

pelvic inlet is on angle so get pubic symphysis out of the way to see bladder

52
Q

what is cystography

A

radiographic exam of urinary bladder and lower end of ureters

53
Q

what 3 things is cystography used to demonstrate/detect

A

demonstrate bladder pathology

detect bladder injury post trauma

preliminary to micturating studies of vesico-ureteric reflux

54
Q

what is micturating cystourethrogram used for and what kind of contrast media is used

A

low osmolar (150mg/L) water soluble contrast imaging of bladder and urethra during micturation

55
Q

what is done to the CM befure a micturating cystourethrogram

A

CM is warmed up prior to administration

56
Q

what is the control image in a micturating cystourethrogram

A

coned bladder

57
Q

what are the 3 queries for early filling image in a micturating cystourethrogram

A

catheter position
bladder abnormalities
ureterocele

58
Q

what are the 5 images taken in a micturating cystourethrogram

A 
control image
early filling image
full bladder image
voiding urethral images
post void full length abdomen
59
Q

what view is taken for a voiding urethral image in a micturating cystourethrogram

A

anterior oblique

60
Q

what 2 queries are there for a post void full length abdomen image in a micturating cystourethrogram

A

bladder residue

vesico-ureteric reflux

61
Q

what is vesico ureteric reflux

A

stricture affects flow and forces urine and contrast back up towards kidney

62
Q

what is ureteric reflux associated with

A

urinary tract infection

63
Q

what is a consideration for retrograde urethrogram

A

limited number of people in room as its a very private examination

64
Q

who is retrograde urethrogram performed on

A

male patients to demonstrate full length of urethra

65
Q

how is CM used in a retrograde urethrogram

A

CM injected retrograde into the distal urethra until the entire urethra is filled

66
Q

what is a clinical indication for retrograde urethrogram

A

trauma and/or obstruction of the urethra

67
Q

what are three things that US is used to demonstrate or exclude

A

hydronephrosis
renal tumors
cysts and abscesses

68
Q

what are 4 things that CT is used for in evaluating the urinary system

A

staging renal tumors
evaluating trauma to urinary tract
showing pathology in retro-peritoneum
CT urography

69
Q

what is nuclear medicine used for in urinary systems

A

used for comparative renal function

70
Q

what is MRI used for in urinary systems

A

show soft tissues in detail - blood vessels or other structures

71
Q

when is MRI used in evaluating the urinary systems

A

if contrast is contraindicated

72
Q

what is arteriography used in evaluating the urinary system

A

assess arterial flow

73
Q

how is CM introduced in a hysterosalpingography

A

Introduce CM up vagina through cervix and into the uterus and look at flow into fallopian tubes

74
Q

what is hysterosalpingography used to demonstrate - 2 things

A

uterus

fallopian tube patency (spillage of CM into peritoneum)

75
Q

what are 4 clinical indications for hysterosalpingography

A

assessment of female infertility
pathology (unexplained utereine bleeding and pelvic pain)
assessment following tubal ligation
congenital anomalies

76
Q

what is primary infertility

A

When person tried to conceive in a year and can’t get pregnant

77
Q

what is secondary infertility

A

when you’ve been pregnant before but have trouble conceiving

78
Q

what are 3 contraindications for hysterosalpingography

A

pregnancy
acute/subacute pelvis inflammatory disease
active uterine bleeding

79
Q

what is patient preparation for hysterosalpingography

in terms of when booking is made, how interacted with patient etc

A

booking made to exclude possibility of pregnancy - ie in first 7-12 days of menstrual cycle

consent

explanation

reassurance

80
Q

what kind of CM is used for hysterosalpingography

A

water soluble ICM

81
Q

what is water soluble ICM used in hysterosalpingography

A

absorbed easily

doesn’t leave residue in uterus or peritoneal cavity

82
Q

historically what CM was used in hysterosalpingography

A

oil based ICM lipiodol

83
Q

why is oil based ICM no longer used in hysterosalpingography

A

slow absorption

oil embolus risk

84
Q

what is the procedure like for hysterosalpingography

5 steps

A

1/ patient placed in lithotomy position
2/ vaginal speculum placed in vagina
3/ cannula/catheter placed into cervical canal
4/ balloon catheter/suction cap may be used to prevent spillage of CM back into vagina
5/ CM filled syringe is attached to cannula/catheter

85
Q

how much CM is introduced into the uterus in a hysterosalpingography and how is it introduced

A

introduced slowly

5mls initially but 5mls more may be needed to complete filling of fallopian tubes and if patent spillage into peritoneal cavity

86
Q

what images are taken in a hysterosalpingography

A

fluoroscopic images with patient in supine position

87
Q

what is done in hysterosalpingography to clear overlying anatomy

A

turn patient into an oblique position for further imaging

88
Q

what is aftercare for a hysterosalpingography - 4 things

A

patient provided with sanitary pad and directed to bathroom

analgesics may be recommended

advise woman to protect against pregnancy before next period and to use contraception until that time

if heavy bleeding/extreme discomfort - advise to seek medical attention

89
Q

what is a bicornuate uterus

A

congenital anomaly

Instead of uterus being one cavity, its conjoined cavity of 2 parts

90
Q

what are 4 complications associated with ERCP

A

post ercp pancreatitis
bleeding
infection
perforation

91
Q

what are 4 other modalities that can be used to investigate the biliary system

A

US
CT
Magnetic resonance cholangio-pancreatography
radionuclide cholangiography - cholescintigraphy

92
Q

what is MRCP

A

non invasive magnetic resonance imaging exam that visualises entire gall bladder, biliary tree and pancreatic duct

93
Q

when is MRCP performed relative to ERCP and what is it used for

A

before ERCP to determine if therapeutic ERCP is needed

94
Q

is MRCP therapeutic and diagnostic

A

no only diagnostic

95
Q

what is MRCP used to diagnose

A

identify and remove biliary tract stones

96
Q

for whom is MRCP a good alternative

A

for patients who need biliary imaging but have renal complications or allergy to ICM

97
Q

how is T tube placed

A

placed into stump of cystic duct and advanced until cap of T extends up the common hepatic duct and down the common bile duct

98
Q

what does T tube allows

A

allows drainage of bile ‘sludge’ and any small stones remaining in biliary tree after surgical removal of gall bladder

99
Q

what does T tube use CM for

A

to visualize the bile duct after the removal of the gall bladder - bile ducts drain bile from the liver to the duodenum

100
Q

where is the T tube meant to go

A

common hepatic duct

101
Q

what are 2 clinical indications for T tubes

A

rule out presence of stones in biliary tree post operatively following cholestectomy

assessment of biliary leaks following biliary surgery

102
Q

what contrast media is used for T tube

A

Omnipaque 300/350

103
Q

how much omnipaque is used in T tube and how is it administered

A

20mls diluted CM is injected into T tube

104
Q

what images are taken in T tube

3 images

A

scout AP precontrast

spot films post contrast (generally AP, posterior obliques and lateral)

final image to see emptying

105
Q

what are 3 clinical indications for imaging the urinary system

A

haematuria

pyuria/proteinuria

renal colic

106
Q

what is hydronephrosis

A

swelling of kidney due to builds up of urine, since urine cant drain to bladder from kidney due to obstruction

107
Q

what is hydroureter

A

dilated ureter

108
Q

what is polycystic kidney

A

cysts on kidney

109
Q

what can happen in polycystic kidney

A

kidney can become enlarged and lose function

110
Q

what is staghorn calculi

A

big calculi that sits in the renal pelvis in at least 2 calyxes

111
Q

what is ectopic kidney

A

kidney not in typical normal position

112
Q

what is horseshoe kidney

A

2 kidneys fused as horseshoe across abdomen

113
Q

where do transplanted kidneys go

A

into pelvis as diseased kidney stays in same place

114
Q

what is pelvic ureteric obstruction

A

narrow Pelvic ureteric junction causing pelvis ureteric obstruction

115
Q

what can pelvic ureteric obstruction lead to

A

can cause problems with flow of urine

116
Q

what does renal artery stenosis lead to

A

kidney not getting enough blood supply so patients often have high blood pressure

117
Q

what is urolithiasis

A

stone in kidney or ureter in urinary system

118
Q

what is urinary reflux

A

urine goes against normal flow

119
Q

what is pyuria

A

increased presence of white blood cells

120
Q

what is renal colic

A

caused by obstruction such as stone (fine for short period of time and then pain)

301 MEDIMAGE (18 decks)

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