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Applied CP 2 > Hepatobiliary Imaging > Flashcards

Hepatobiliary Imaging Flashcards

1
Q

purpose

A

trace formation and flow of bile from liver to small intestine

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2
Q

indications

A
  • RUQ pain
  • cholecystitis
  • biliary obstruction
  • gallbladder function (GBEF)
  • biliary leakage
  • biliary atresia vs. neonatal hepatitis
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3
Q

what causes gallbladder to contract?

A

fat as it stimulates the release of CCK

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4
Q

what does bilirubin indicate?

A

decrease in liver function
and/or
indication for CBD blockage

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5
Q

RPs

A
  • Mebrofenin (BRIDA)
  • Disofenion (DISIDA)
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6
Q

trade name for BRIDA

A

Choletec

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7
Q

trade name for DISIDA

A

Hepatolite

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8
Q

which RP is least affected by hyperbilirubinemia?

A

BRIDA/Mebrofenin

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9
Q

prep

A
  • NPO min 4H but eaten within last 24H
  • no opiates within 6H
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10
Q

if a patient is TPN, what needs to be done?

A

pre-treat with CCK

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11
Q

dose of RP

A

111-370 MBq (typically, 185 MBq)

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12
Q

why do we give a higher dose to those with higher levels of bili?

A

bili competes with the RP for uptake

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13
Q

dose of CCK

A

0.02 ug/kg administered over 60 mins

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14
Q

common names for CCK

A

sincalide (kinevac)

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15
Q

when do you inject the RP when using CCK?

A

30 mins post CCK infusion

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16
Q

FOV

A

liver in top FOV

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17
Q

normal results

A

liver, biliary ducts, GB and bowel seen by 60 min and GBEF >50%

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18
Q

normal variant

A
  • reflux of bile
  • delayed biliary to bowel transit (bowel not at >60 min)
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19
Q

false positives

A
  • didn’t fast long enough
  • fasted more than 24H
  • TPN
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20
Q

what does morphine do?

A

contracts the sphincter of oddi = forces bile back into the GB

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21
Q

what can hepatic insufficiency cause?

A

it can lead to delayed GB filling due to poor uptake of RP

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22
Q

what does TPN do?

A

it can cause non-visualization of GB due to no stimulation of contraction

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23
Q

when can you calculate GBEF?

A

when you see GB, duct and small bowel

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24
Q

what does CCK do?

A

contracts the GB and relaxes the Sphincter of Oddi

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25
Q

what is an alternative to CCK?

A

fatty meal
ensure

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26
Q

what is done if small bowel is seen but no GB?

A

administer morphine

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27
Q

dose of morphine

A

0.04 mg/kg over 1-3 mins

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28
Q

delayed images when…

A

when no gb at 60 mins
when no bowel at 60 mins

29
Q

morphine when…

A

when no gb at 60 mins

30
Q

cck when…

A

when no bowel at 60 mins

31
Q

normal GBEF

A

=>38%

32
Q

formula for GBEF

A

[(decayed NET pre-CCK - NET post-CCK)/decayed NET pre-CCK] * 100

33
Q

acute cholecystitis

A
  • no GB after morphine
  • delayed imaging up to 4H and still no GB
34
Q

chronic cholecystitis

A
  • GB after morphine
    or… delayed GB visualization between 1H-4H
35
Q

partial CBD (common bile duct)

A
  • GB but no bowel after 60 mins
36
Q

high grade CBD obstruction

A

no GB, biliary ducts or bowel but has prominent liver activity

37
Q

view good for GB separation

A

LAO
GB sep from duodenum

38
Q

rim sign

A

increased hepatic uptake or uptake beside GB fossa due to inflammation of liver

39
Q

cystic duct sign

A

dilation proximal to obstruction that can be misinterpreted as GB

40
Q

liver scan sign

A

no biliary tree but good visualization of liver

41
Q

prep for biliary atresia

A
  • pretreat with phenobarbital 5mg/kg/day for 5 days prior to scan
42
Q

abnormal biliary atresia

A

no biliary clearance into bowel by 24H

43
Q

positives for biliary leaks

A

progressive increasing pool of RP in area of GB fossa or hepatic hilum

44
Q

liver parenchyma visualization by ______

A

5-10 mins

45
Q

bile ducts and GB visualization by ______

A

10-20 mins

46
Q

small intestines visualization by ______

A

30-60 mins

47
Q

Which of the following would not be a cause of acute acalculous cholecystitis?
A. Inflammatory debris
B. Cholelithiasis
C. Local edema
D. Inspissated bile

A

b
key is no stones!

48
Q

A dilated cystic duct proximal to a site of obstruction can be misinterpreted as the following:
A. False-positive for acute cholecystitis
B. Inflammation in the gallbladder fossa
C. Radiotracer activity in the bowel
D. Gallbladder filling

A

d

49
Q

RP dose if bili 2-10 mg/dL

A

278 MBq

50
Q

RP dose if bili 10 mg/dL

A

370 MBq

51
Q

preferred RP for neonates

A

BRIDA

52
Q

during blood flow imaging, what organ(s) are seen during the arterial flow phase?

A

spleen and kidneys

53
Q

during blood flow imaging, what organ(s) are seen during the venous flow phase?

A

liver

54
Q

what does increased blood flow to the gallbladder fossa indicate?

A

severe acute cholecystitis

55
Q

by 60 mins, ductal activity should decreased by …

A

> 50% of peak activity

56
Q

adverse reactions to CCK

A

nausea, vomiting, abdominal pain, urge to defecate

57
Q

adverse reactions to morphine

A

resp depression, dizzy, sedation, nausea, vomiting, sweaty, constipation, tolerance, dependence

58
Q

why do you not admin CCK if no bowels are seen?

A

because it can indicate obstruction

59
Q

nm appearance of acute cholecystitis vs. acute acalculous cholecystitis

A

no visualization of GB
but with acute acalculous = no gallstones in anatomic imaging modalities and sometimes slight slight GB filling?

60
Q

false positives for acute cholecystitis

A
  • chronic cholecystitis
  • partial cystic duct obstruction (rmr cystic duct to common bile duct to duodenum)
  • viscous bile
  • poor liver function
61
Q

false negs for acute cholecystitis

A
  • cystic duct sign/nubbin = dilation of cystic duct
  • acute acalculous cholecystitis
62
Q

how can you differentiate between chronic ACALCULOUS cholecystitis and calculous cholecystitis?

A

GBEF being normal = acalculous

63
Q

symptoms of biliary duct obstruction

A

abdominal pain, jaundice, elevated ALP and bilirubin, fever IF infection is present

64
Q

which pathology describes a congenital dilation of the bile ducts?

A

choledochal cyst

65
Q

how does choledochal cysts present in kids?

A

biliary obstruction, pancreatitis or cholangitis

66
Q

appearance of non obstructed choledochal cysts

A

GB filling slower with prolonged retention and then slow clearance

67
Q

appearance of obstructed choledochal cysts

A

no filling due to high back pressure

68
Q
A

Applied CP 2 (12 decks)

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