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SEM II - Patient Care > GI Tract/Contrast > Flashcards

GI Tract/Contrast Flashcards

0
Q

Negative contrast media

A

Low atomic #
Decrease attenuation of the X-ray beam
-air
-carbon dioxide

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1
Q

Purpose of contrast media

A

To visualize detail of anatomy, area of interest must differ in density

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2
Q

Positive contrast media

A

High atomic #
Increase attenuation of the X-ray beam
-barium sulfate
-iodine

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3
Q

Barium

A

Atomic # 56
Positive contrast
Chalk like, not a solution, held in suspension
Subject to separation - flocculation

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4
Q

Barium

A

Various consistencies/concentration

  • very thin (swallowing evaluation)
  • thin (esophagus, stomach, small intestine)
  • moderate (dual contrast esophagus, stomach)
  • thick (large intestine)
  • very thick/paste (esophagus)
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5
Q

Contraindications for barium

A

Mixtures are contraindicated if any chance exists that the mixture might escape the peritoneal cavity.

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6
Q

When barium can’t be used

A

Water soluble iodinated contrast should be used if there is a chance of a barium mixture escaping the peritoneal cavity

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7
Q

Water soluble iodine is used in place of barium

A

For perforated bowel or pre-surgical procedures

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8
Q

A potential risk associated with water soluble contrast agents especially geriatric patient

A

Dehydration

Have patients push fluids for the next 48 hours post procedure

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9
Q

Advantage of dual contrast

A

Small lesions are not obscured

Mucosal lining of the stomach can be more clearly visualized

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10
Q

Studies preformed using contrast media

A 
IVP
Cystography
Biliary studies
Vascular imaging
Myelography
Arthrography
CT scanning
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11
Q

Lower concentrations of contrast media are required for

A

Bladder studies due to the large amount required to fill the bladder

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12
Q

Higher levels of contrast media are used for

A

Excretory urography

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13
Q

Non ionic contrast media

A

Less likely to cause an adverse reaction

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14
Q

Vein puncture and injection of contrast media

A

Is an invasive procedure
Patients must be aware of risk.
Underage and impaired require consent from guardian prior to procedure

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15
Q

Qualities of Iodinated contrast agents that contribute to discomfort

A

Viscosity
Toxicity
Osmolality

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16
Q

The concentration of iodine in ionic contrast is

A

50-70%

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17
Q

The higher the osmolality the greater

A

The chance of reaction

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18
Q

The lower the osmolality

A

The less the chance of reaction

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19
Q

As an act of caution with contrast media

A

Patients should not be left alone after an intravenous injection, most reactions occur immediately, within 5 minutes

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20
Q

The three most common reactions that occur in many patients and do not require medication

A

Warmth or temporary hot flash
Flushing
Metallic taste in mouth

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21
Q

The four general categories of contrast media reactions

A

Vasomotor
Anaphylactic reaction
Vasovagal reaction
Acute renal failure

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22
Q

Symptoms of vasomotor reaction

A

Anxiety, lightheaded, nausea, syncope, mild scattered hives

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23
Q

Anaphylactic reaction

A

True allergic reaction resulting from the introduction of iodinated contrast media.
Medical assistance must be provided without delay.

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24
Q

Symptoms of anaphylactic reaction

A 
Moderate to sever urticaria (hives)
Laryngospasm - choking from larynx closure
Angioedema - swelling of soft tissues
Hypotension - low blood pressure
Tachycardia - greater that 100bpm
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25
Q

Severe Anaphylactic reactions occur in approximately

A

1 in 14,000 contrast procedures

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26
Q

Vasovagal reaction

A

Life threatening allergic reaction resulting from the introduction of iodinated contrast media, which stimulates the vagus nerve

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27
Q

Signs of Vasovagal reaction

A

Hypotension - BP<50BPM

No detectable pulse - declare code

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28
Q

Acute renal failure

A

Anaphylactic reaction in which kidneys shut down, may not be obvious for as long as 48 hours after study.

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29
Q

Mild reactions include:

A 
Mild nausea and vommitting
Extravasation (leak)
Sneezing
Itching
Mild hives (urticaria)
Vasovagal (fainting)
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30
Q

Extravasation

A

Mild reaction at the injection site where contrast media leaks from the vein into the surrounding tissue. Pain, burning and numbing may occur.

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31
Q

Moderate reactions include:

A

Excessive urticaria (hives)
Tachycardia
Excessive vommitting

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32
Q

Severe reactions

A 
Very low blood pressure
Cardiac or respiratory arrest
Loss of consciousness
convulsions
Difficulty breathing
Cyanosis
Anaphylactic shock
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33
Q

Diabetic patients & geriatric patients

A

Should be kept well hydrated before exam to decrease dehydration and the chance of contrast induced renal failure

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34
Q

Metformin glucophage

A

Drug used to treat diabetes and is an absolute contraindications to the administration of iodinated contrast media, dues to the possibility of contrast induced renal failure.
Should be discontinued 48 hours before exam and resumed no earlier than 48 hours after.

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35
Q

Blood urea nitrogen (BUN)

A

Normal range is 8-25 mg/mL

Blood levels indicate the status of renal function

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36
Q

Creatinine blood level

A

Normal range is less than 0.6-1.5 mg/dL

Levels indicate the status of renal failure

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37
Q

GFR - glomerular filtration rate

A

Test used to check how well kidneys are functioning. Estimates how much blood passes through the glomeruli each minute.

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38
Q

Contrast studies other than GI tract

A 
Excretory urography
Nephrograms
Cystography
Retrograde urography
Oral cholecystography
Intravenous Cholangiogram
Percunaneous transhepatic cholangiography
T tube surgical cholangiography
ERCP - endoscopic retrograde cholangiopancreatography
Myelography
Contrast arthrography
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39
Q

Atomic weight determines the degree to which it will attenuate radiation

A

Air gasses absorbs less radiation that soft tissue, air appear black or very dark (negative contrast).
Common uses - arthrography, myelography, double contrast BE

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40
Q

Aqueous

A

Principle solvent for iodinated contrast, mix readily with blood, and only type of contrast suitable for IV injection

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41
Q

Bolus

A

Substantial amount of contrast delivered rapidly via IV catheter or butterfly set.

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42
Q

Iodine concentration determines X-ray attenuation

A

Higher concentration = greater contrast

Greater concentration = greater viscosity! greater osmolality and toxicity

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43
Q

Osmolality

A

The number of particles in a solution per kg of water

44
Q

Viscosity

A

Measure of resistance of fluid flow

45
Q

Toxicity

A

Relates to the chemical configuration of molecules

46
Q

Two common types of iodinated contrast

A

Diatrizoate Meglumine - less toxic

Diatrizoate sodium - small molecules with more iodine per molecule.

47
Q

Low osmolality contrast agents

A

Introduced in 80’s, less toxic and more comfortable for patient.
Used for most imaging needs

48
Q

Water soluble contrast injected how?

A

Intravascular. Excreted by kidneys.

49
Q

Toxicity can be caused

A

By the reaction of contrast to other medications.

Always flush catheter with saline before and after contrast injection to avoid reactions.

50
Q

History of patient

A

Carefully take their history and document all allergies, routine meds, etc.

51
Q

Asthma

A

Patients with asthma have a higher risk of reaction to contrast.

52
Q

Premedication

A

Patients per educate with Benadryl to reduce risk of reaction.

53
Q

IVP

A

intravenous pyelogram.

Signifies visualization of kidney pelvis

54
Q

IVU

A

Intravenous urogram

Entire urinary tract is visualized.

55
Q

Cystography

A

Contrast studies of the urinary bladder.

Bladder is filled by retrograde injection of water-soluble contrast.

56
Q

VCUG

A

Voiding cystourethrogram

Identifies vesicoureteral reflux (backflow of urine from the bladder into uterus)

57
Q

Retrograde urography

A

Long slender catheters inserted retrograde into the uterus to visualize anatomical form of pelvis, calyces and ureters.

Lower risk of contrast reaction versus IV injection.

58
Q

Biliary system - stones and cholecystitis

A

Before the 1990s were treated with open surgery

Now treated with laparoscopies and fiber optics - much easier on patient.

59
Q

Oral cholecystography

A

Images taken every 20-30 minutes after a fatty meal to identify stones and/or gallbladder function. Ultrasound is preferred method. Diet prep done prior to exam.

60
Q

IVC

A

Intravenous Cholangiography

61
Q

Myelography

A

Demonstrates internal surface of spinal canal, diagnoses conditions caused by deformity or crowding.

62
Q

Lumbar puncture

A

At level of L2-L3 interspace. Collect CSF to be delivered to lab stat.

63
Q

Contrast angiography

A

Contrast radiography of joints used to detect injury/disease in joint capsule. Shoulder most common. Joint May be stressed.

Post injection patients must perform range of motions to distribute contrast.

64
Q

Sequence

A

Order in which exams are to be preformed. Starting with any exams not requiring contrast, labs, fiber optic exams, ct exams, urinary tract exams, biliary exams, BE, esophageal exams, UGI, SBFT.

65
Q

Inpatients

A

Nurses are responsible for prepping patients. Take history and make sure prep was completed.

66
Q

Outpatients

A

Issue printed instructions! Have the patient repeat the instructions

67
Q

Scout exam

A

Initial image to evaluate patient prep, reveals any anatomical abnormalities in advance, helps fine tune technique

68
Q

GI prep

A

Most commonly CLEANSING

Diet
Cathartics
Suppositories
Enemas

69
Q

Diet prep for GI exam

A

Low residue for several days with high water intake - rapid waste output - less residue.

24hrs prior - clear liquids only, no carbonated drinks

NPO 8-12 hours prior

70
Q

Cathartics

A

Strong laxative (5 types)

Bulk - fiber
Lubricant - mineral oil
Emollient - stool softener
Saline - indirectly increases motor activity of bowel
Stimulant - dulcolex/exlax
71
Q

Suppositories

A

Stimulates peristaltic action of lower bowel. Deposited 2-3 inches into rectum. Patient should retain suppository for 30 minutes.

72
Q

Enemas

A

Filling of the colon with fluid to aid dislodging and flushing out fecal material.

Need enema bag, IV pole, 1000 mL of water.

Make sure enema bag is 18” above anus, not too high.

73
Q

Three groups of contrast media

A

Barium sulfate
Water soluble iodine
Gasses (air)

74
Q

Barium sulfate

A

Invert inorganic salt, very dense (56), not absorbed by soft tissue. Bone absorbs more radiation than surrounding tissues, way less dense (14). Comes in liquid suspension or powdered form to be mixed. Serve COLD.

75
Q

Viscosity

A

Thickness. Important for GI exams.

76
Q

Air contrast

A

Absorbs less radiation than either soft tissue of other contrast media.

77
Q

Glucagon

A

Slows peristalsis, used to relax and smooth muscles of GI tract.

78
Q

Defecogrpahy

A

Evacuation proctography
Evaluates defecation.
High density barium paste used mixed usually with potato buds

79
Q

Valsalva maneuver

A

Bearing down.

80
Q

Double contrast UGI

A

Patient takes gas producing tablets before drinking barium.

Have patient refrain from belching during exam.

81
Q

Hypotonic duodenography

A

Detects lesions in the duodenum distal to the duodenal bulb. Passage of a tube via the mouth or nose to the duodenum. Diagnoses pancreatic cancer.

82
Q

Aortography

A

Administered through the arterial catheter to visualize the abdominal and thoracic aorta, using omnipaque 350 or optiray 350

83
Q

Angioradiography

A

Administered through the arterial catheter to view the heart and surrounding great vessels using imagopaque 350, iomeron 350 or visipaque 350

84
Q

Digital subtraction angiography (DSA)

A

Administered through the arterial catheter to visualize the cerebral vasculature, aorta, and branches using lomeron 350, imagopaque 350 or omnipaque 140

85
Q

Digital subtraction angiography

A

Administered intravenously to view the cerebral vasculature, aorta and branches using iomeron 350 or conray 43

86
Q

Peripheral artiography

A

Administered via a arterial catheter to view the arteries of the extremities using visipaque, hexabrix, isovue300, md76

87
Q

Peripheral venography

A

Administered intravenously to view the veins of the extremities using conray43, imagopaque 200 or 250, or visipaque 270

88
Q

Cerebral angiography

A

Administered via an arterial catheter to view the cerebral vasculature using hexabrix, imagopaque 300, md76, or optiray 320

89
Q

Selective visceral arteriography

A

Administered via an arterial catheter to view renal, celiac, splenic, or coronary arteries for example, using hexabrix, imagopaque 300, md76, optiray 320

90
Q

Cholangiography, operative and postoperative

A

Administered injection direct via t tube to view the common bile duct

91
Q

Cholecystography

A

Administered orally to view the gallbladder

92
Q

Endoscopic retrograde cholangiopancreatography (ercp)

A

Administered via a catheter via endoscope to see the common bile duct and pancreatic duct

93
Q

Percunaneous transhepatic cholangiography (PTC)

A

Direct injection to view the common bile duct

94
Q

Myelography

A

Administered via intrathecal injection via lumbar puncture or view the spinal canal (subarachnoid space)

95
Q

Discography

A

Administered via a direct injections to see the intervertebral disk

96
Q

Excretory urography

A

Administered intravenously to view the kidneys, ureters, and bladder

97
Q

Retrograde urography

A

Administered ureteral catheters via cystoscope to view the kidney pelvis, calyces and ureters

98
Q

Cystourethrography

A

Administered via a direct injection via Foley catheter to view the urinary bladder and urethra

99
Q

Esophageal

A

Oral administration to view the esophagus

100
Q

Upper GI series

A

Orally administered to view the esophagus, stomach and duodenum

101
Q

Lower GI series

A

Administered via a rectal catheter to view the colon.

102
Q

Small bowel series

A

Orally administered or enteric lysis to view the small intestine.

103
Q

Arthrography

A

Administered via direct injection to see joint (knee, shoulder, etc)

104
Q

Computer tomography

A

Administered intravenously to view anatomy of interest using imagopaque or conray

105
Q

Computed tomography (2)

A

Oral administration for enhancement of GI tract using gastrografin, hypaque sodium oral powder, or MD-gastroview

106
Q

Hyaterosalpingograhpy

A

Administered directly via cervical cannula to view the uterus and Fallopian tubes.

107
Q

Lymphography

A

Administered via direct injection into lymphatic vessels in feet to view the lymph vessels and lymph nodes

108
Q

MRI

A

Intravenous administration to view brain, spinal cords and vascular structures.

SEM II - Patient Care (3 decks)

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