Gastro II Flashcards
Gastric Emptying Scan measures what?
determines rate of gastric emptying ( mostly through the stomach to the small intestine)
Types of GI Imaging?
Gastric Emptying Scan Gastroesophageal reflux scan Barium swallow EGD Abdominal Scintigraphy Arteriography
Indications for Gastric Emptying Scan?
Determines the rate of gastric emptying
Delays show pathology
Gastric Emptying Scan is useful in diagnosing?
Gastroparesis ( surgery or DM)
Postprandial nausea
Vomiting
Early satiety
Abd pain (unexplained and related to food)
Post- GI anastamosis
Gastric emptying scan: Test Explanation?
- ) Pt eats meal containing radionuclide (Tc)
- ) 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)
Gastric emptying scan NL?
NL = 40% retained after 2 hours and 60% is left in the stomach
Gastric emptying scan: Contraindications?
Pregnant or lactating females
Gastric emptying scan: interfering factors?
Anticholinergics ( slows everything down), opiates ( constipation), sedatives ( constipation = slow down GI transit )
Should be withheld for 2 days before testing
Indications for Gastresophageal Reflux Scan?
Heartburn
Reflux symptoms
Aspiration
GE Reflux Scan: Test explanation?
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 *
Aspiration Scan: Test explanation?
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 *
Contraindications to GE reflux scan?
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 *
Indications for Barium Swallow?
Provides visualization of the lumen of the esophagus
Barium swallow is used to investigate what?
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 *
Test explanation for barium swallow?
More thorough exam for the esophagus than the upper GI series
Anatomic abnormalities seen on barium swallow?
Hiatal hernia ( lower esophagus) Zenker diverticulum Schatzki ring ( rings where people get strictures)
Defects in filling examples seen on a barium swallow?
Tumor
Strictures
Extrinsic compression - tumor outside the esophagus putting pressure on it
Enlarged heart - inducing pressure on the esophagus
Considerations when using Barium?
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
Contraindication to a Barium Swallow?
Bowel obstruction - barium may cause fecal impaction
Perforated viscus
Unstable vital signs
Pts unable to cooperate during the exam
Complications with Barium swallow?
Could include barium-induced fecal impaction
Indications for upper GI series?
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)**
Indications for Esophagogastroduodenoscopy (EGD)? to evaluate for ?
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
*
EGD test explanation?
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*
EGD Procedure?
Left lateral decubitus position (LLD)
Throat is anesthetized with topical lidocaine ( spray)
Sedate patient
Bite block placed - so they cannot bite the tubing
Abdominal Scintigraphy (GI Bleeding Scan) Indications?
“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
*
Abdominal Scintigraphy (GI Bleeding Scan) is used for ____ but __________ GI hemorrhage?
✪ slow but persistent GI hemorrhage
Abdominal Scintigraphy (GI Bleeding Scan) uses __-_______ RBCs or ______ _______ injected into the vascular system.
Uses Tc-labeled RBCs or sulfur colloid injected into the vascular system
Contraindications to Abdominal Scintigraphy?
Pregnant or lactating females
Medically unstable patients
Implications for Abdominal Scintigraphy ?
Used for bleeding between 0.03 mL/min and up to 1mL/min
Abdominal Scintigraphy can find possible causes of bleeding like what?
Ulcers
Tumors
Vascular malformations
Diverticulosis
Inflammatory Bowel Disease
Indications for Arteriography?
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 *
Contrindications to Arteriography?
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
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?
she might have gastropuresis - so start with gastric emptying scan if it is normal then do an EGD
