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Diagnostic Imaging 3 > GU imaging - INTERVENTIONAL > Flashcards

GU imaging - INTERVENTIONAL Flashcards

1
Q

Cystogram

A

Fluoroscopic study that images the bladder

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2
Q

Patient indications for a cystogram

A
  • Bladder outlet obstruction
  • Haematuria
  • Trauma
  • Congenital anomalies of the GU tract
  • Postoperative evaluation of urinary tract
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3
Q

Contraindications of a cystogram

A
  • Recent bladder surgery
  • Blockage of the urethra, or damage or tearing of the urethra
  • Acute phase of UTI
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4
Q

Complications of a Cystogram

A
  • UTI
  • Trauma to tissues during catheterisation
  • Bleeding
  • Pain
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5
Q

Patient Prep for a Cystogram

A
  • Patient wears a gown
  • Privacy and Dignity of the patient are upheld
  • Patient is warned about sticky contrast
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6
Q

AP Cystogram procedure

A
  • patient is catheterised (if a catheter is not in situ)
  • patient is given 200ml of Omnipaque contrast
  • start contrast flow and take images to show the bladder filling
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7
Q

Cystogram - 45 degrees oblique

A
  • the detector is angled to the right of the patient and an image is taken
  • the detector is angled to the left of the patient and an image is taken
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8
Q

Cystogram left lateral

A
  • the detector is by the patient’s left side
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9
Q

Cystogram AP single shot

A

AP view taken after bladder is filled

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10
Q

Micturating Cystourethrogram

A
  • A fluoroscopic procedure to show filling AND emptying of the bladder
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11
Q

micturating cystourethrogram (MCUG) child indications

A
  • recurrent UTI’s
  • Congenital abnormalities
  • post op evaluation
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12
Q

micturating cystourethrogram (MCUG) adult indications

A
  • Recurrent UTI’s
  • Dysfunction
  • Fistula
  • Post op evaluation
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13
Q

micturating cystourethrogram (MCUG) contraindications

A
  • Recent bladder emergency
  • Blockage of the urethra, or damage or tearing of the urethra
  • Acute phase of urinary tract infection
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14
Q

micturating cystourethrogram (MCUG) complications

A
  • patient can develop a Urinary tract infection
  • There may be trauma to tissues during catheterisation
  • bleeding
  • pain
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15
Q

micturating cystourethrogram (MCUG) patient prep and care

A
  • patient is given a gown
  • privacy and dignity is upheld
  • contrast warning is given
  • consider room temperature
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16
Q

Female Paediatric MCUG imaging views

A
  • AP view
  • Oblique view
  • Renal area
  • Bladder emptying
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17
Q

Male Paediatric MCUG views

A
  • Bladder filling

- Oblique view - Reflux of contrast and hydroureter demonstrated

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18
Q

Urethrogram

A

A contrast study of the urethra under fluoroscopic control

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19
Q

Urethrogram Indications

A
  • Fistula
  • Strictures
  • Obstruction
  • Trauma
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20
Q

Urethrogram complications

A
  • Patient can develop a Urinary tract infection (UTI)
  • Trauma to tissues during Catheterisation
  • Bleeding
  • Pain
  • Contrast Intravasation
21
Q

Contrast Intravasation

A

Backflow of injected contrast into the adjoining vessels (mostly veins)

22
Q

Urethrogram contraindications

A
  • Recent bladder surgery

- Acute phase of UTI

23
Q

Urethrogram patient prep and care

A
  • Patient is given a gown

- privacy and dignity are upheld

24
Q

Urethrogram patient care

A
  • communication
  • consent
  • modest covering
  • Aseptic technique
  • reassurance
  • privacy dignity
  • Gown
25
Q

Urethrogram after care

A
  • give warnings about sticky contrast
  • patient should drink loads of fluids
  • Information about where and how to get results
  • How to deal with any possible issues post procedure
  • paperwork
26
Q

Percutaneous Nephrostomy

A

The insertion of a catheter through the skin and into the renal pelvis under the guidance of fluorography and/or ultrasound. to drain kidney externally

27
Q

Nephrostomy indications

A
  • Relief of urinary obstruction
  • Access- therapeutic treatment
  • Urinary diversion
  • to drain kidney externally, if there is injury to the ureter
28
Q

Nephrostomy contraindications

A
  • coagulation INR >1.4
  • Contraindications to contrast
  • Contraindication to sedation
  • Patient must be cooperative
29
Q

Nephrostomy complications

A
  • pain
  • tube displacement
  • Urine leak into abdomen
  • pneumothorax
  • infection/sepsis
  • bleeding
  • injury to other abdominal organs and structure
30
Q

Nephrostomy patient presentation

A
  • Hydronephrosis
  • pain in flank
  • nausea
  • vomiting
  • tiredness
  • pain on urination
  • UTI
  • Sepsis/fever
31
Q

Nephrostomy pre-imaging

A
  • Ultrasound

- CT (“stone prone” - non contrast, ?leak = contrast)

32
Q

Nephrostomy patient preparation

A
  • recent blood tests including INR
  • overnight monitoring
  • Nil by mouth for previous 6 hrs
  • Appropriate antibiotics
  • gown
  • patent cannula in either arm
  • completed consent form
33
Q

nephrostomy procedure 1

A
  • patient is positioned prone oblique, with affected side raised
  • patient is monitored
  • area is cleaned and prepped
  • local anaesthetic…
  • needle is positioned and probe is parallel, to image needle fully
  • WHO check
34
Q

Nephrostomy procedure 1- ultrasound of kidney

A
  • is the renal pelvis dilated enough?
  • Assess and mark access point
  • position of ribs/ major vessels
  • choose an avascular plane into minor calyx
35
Q

Ureteric Stenting

A

The placing of a catheter between the kidney and the bladder, to affect the internal drainage of the urinary system.
- can be done retrograde or antegrade

36
Q

The radio-opaque marker at the proximal end of the Ureteric stent aids..?

A

aids with positioning

37
Q

Nephrostomy- fluoroscopy

A
  • Access needle is moved into position, with guidance from fluoroscopy/nephrostogram - contrast is used
  • A guidewire is inserted and the needed is taken out
  • a dilator is put on
  • A catheter is inserted over the guidewire
  • once access hole is dilated, the dilator is taken off
  • the nephrostomy catheter is put on and manipulated into position
  • nephrostogram is checked and pigtail catheter is locked in place
  • the site is cleaned and dried
  • drainage bag is attached
38
Q

Ureteric stenting procedure

A
  • nephrostogram is taken
  • contrast is injected, to see the level of the stricture/blockage
  • wire and catheter are manipulated into PUJ
  • then down the ureter and into the bladder
  • stent is then deployed
  • image is checked
39
Q

Retrograde ureteric stenting performed under….

A

general anaesthetic

40
Q

Retrograde ureteric stenting patient is positioned

A

supine, with leg rests

41
Q

Retrograde ureteric stenting contrast is injected

A

in retrograde- against the flow

42
Q

Retrograde ureteric stenting urologists do

A

a cystoscopy

43
Q

Retrograde ureteric stenting - stent deploy

A

urologist deploys stent under fluoro control

44
Q

Retrograde ureteric stenting procedure

A
  • nephrostogram is checked - retrograde contrast injection
  • wire is manipulated into renal pelvis
  • stent is positioned over the wire under fluoro control
45
Q

P.C.N.L - Percutaneous nephrolithotomy

A

this is where the lithotripter is passed through a small incision into the kidney

46
Q

lithotripter

A

a noninvasive device that breaks up kidney stones - by passing electromagnetic shock waves.

47
Q

P.C.N.L professionals involved

A

Radiologist, radiographer and IR Nurses.
Urologists and their team
Anaesthetics team

48
Q

P.C.N.L

A
  • Urologists cannulate the kidney via cystoscopy and contrast is injected
  • The radiologist performs the nephrostomy under U/S guidance
  • Dilators are passed over the wire
  • An access cannula is positioned over the wire
  • The stone is then broken up using a laser fibre, a lithoclast (small pneumatic drill) or an ultrasonic suction probe
  • The fragments are then removed and the nephrostomy tube is placed and left for about 3 days

Diagnostic Imaging 3 (18 decks)

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