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NM By Myself > Gastro Classic NM > Flashcards

Gastro Classic NM Flashcards

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

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

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

A

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

25
Q

Non visualized gallbladder

A

Fast >24h or recently ate - - false positive
CBD obstruction or severe cholestasis
Cholecystectomy
Acute calculus cholecystitis
Chronic cholecystitis
Images at 4h

26
Q

GBEF procedure

A

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
Q

Sphincter of Oddi dysfunction

A

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
Q

Biliary atresia

A

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
Q

Postmorphine gallbladder visualized

A

No acute cholecystitis
Yes chronic cholecystitis

30
Q

Phenobarbital

A

Biliary atresia

31
Q

Morphine

A

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
Q

Sincalide

A

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
Q

Visualized gallbladder

A

No acute cholecystitis

34
Q

Tracer in small bowel within 60 min

A

No CBD obstruction

35
Q

Persistent in blood pool >20 min

A

Reduced hepatocellular function
Normal - - clear from blood pool within 5 min

36
Q

Salivary gland scan preparation and protocol

A

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
Q

Salivary gland scan interpretation

A

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
Q

Esophageal transit indication

A

Dysphagia after surgery
Mechanical obstruction
After radiotherapy
Manometry not possible
Response to treatment

39
Q

Esophageal transit preparation and protocol

A

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
Q

Single swallow

A

Poor sensitivity
Low specificity

41
Q

Assess reflux

A

Dynamic 120 sec
4-5 Valsalva maneuver - - increased intra abdominal pressure

42
Q

Gastric emptying lag phase

A

Frequent acquisition every 15 min in first hour

43
Q

GIBS indication

A

Mid or lower gastrointestinal bleeding
When upper gastrointestinal bleeding is excluded by nasogastric lavage
Anemia and sometimes melena

44
Q

Gastrointestinal bleeding classification and causes

A

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
Q

GIBS protocol and interpretation

A

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
Q

Meckel protocol

A

1 image every 30-60 sec for 30 min
Static
SPECT

47
Q

No bowel and no gallbladder

A

Stone in CBD

48
Q

Biliary dyskinesia

A

Biliary pain
No stones
Gallbladder dysmotility - - stasis - - chronic inflammation
Check GBEF
Benefit from Cholecystectomy

49
Q
A

Normal

50
Q
A

No bowel
Stone in CBD

51
Q
A

No gallbladder

52
Q
A

Duodeno-gastric reflux

53
Q
A

Dyskinesia of Sphincter Oddi
Gallbladder and choledochus fully distended
No stones
No duodenum

54
Q
A

Postmorphine gallbladder visualized
Delayed visualisation of gallbladder - - chronic cholecystitis

NM By Myself (25 decks)

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