Nukes Hepatobiliary Flashcards
over what time perioid should you administer CCK
inject over 5-10 min or will cause abdominal pain
HIDA scan: if the gallbladder isn’t seen at 1 hr, next step?
either give morphine or wait 4 hrs (both are equivalent). IF no GB after 30 min after morphine…it’s acute cholecystitis
can you give CCK after morhpine?
NO!!!!! causes GB contraction against a closed sphincter of Oddi
Can you give morphine before you see the gut?
NO!!! morphine closes the sphincter of Oddi, and then you will never see the bowel. If ED has given morphine and you don’t see the bowel on the HIDA scan –> give the patient Narcan
If ED has given morphine and you don’t see the bowel on the HIDA scan. Next step?
given Narcan
morphine dose for HIDA
0.04 mg/kg IV
phenobarbital dose
5 mg/kg/day orally for 5-7 days before examination used to prime hepatic enzymes to increase IDA excretion in distinguishing between biliary atresia and neonatal hepatitis
when you you use phenobarbital
PEDIATRIC use. used to prime hepatic enzymes to increase IDA excretion in distinguishing between biliary atresia and neonatal hepatitis
sincalide dosing
sincalide (CCK) dosing: 0.02 mcg/kg in 10 mL of saline SINCALIDE is MICROgrams MORPHINE is MILIgrams 0.04 mg/kg IV
late visualization of the GB strongly suggests:
chronic cholecystitis
imaging findings of chronic cholecystitis on HIDA scan
late visualization of the GB
GB ejection fraction < ____% is abnormal
35%
what two things can be used to cause the GB to contract?
fatty foods or CCK (sincalide)
recent cholecystectomy. Risk factors for the main finding?
neonate with hyperbilirubinemia
biliary atresia
ED is worried about acute cholecystitis so got an US and MRCP before getting the HIDA scan. But…they didn’t want the patient uncomfortable so they gave them a shit ton of morphine. Based on the imaging, what do you do next?
Don’t see CBD because ER gave them morphine (that’s the first thing you should think if you don’t see CBD). Give them narcan, you’ll see the gut immediately.
don’t worry abou the diagnosis in this case…teaching point is reversing the effects of morphine
hepatocellular dysfunction
tracer is in the BLOOD POOL. Liver is angry and refusing to take up tracer.
rim sign!!
means hyperemia in the liver parenchyma in the GB fossa.
Very sensitive for acute cholecystitis
adult with RUQ pain
Liver scan sign: HIDA scan of CBD obstruction
hepatocytes are functioning!! so they uptake radiotracer –> they just can’t get it out
rim sign = acut cholecystitis
trauma
reappearing liver sign = bile leak
