Special Procedures Flashcards by Courtney W

Medical imaging used to help evaluate and diagnose joint conditions and unexplained pain
Very effective at detecting disease within the ligaments, tendons and cartilage
Contrast material is injected into the joint
Fluoroscopy is used first
Contrast injected into joint
Followed by CT or MRI (MRI more common unless they can’t have one)

Arthrogram

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6 joints arthrogram is most often used to identify abnormalities within

Shoulder 
Elbow
Wrist 
Hip 
Knee 
Ankle

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2 reasons for doing arthrogram

Arthrographic images help physicians evaluate alterations in structure and function of a joint and help to determine the possible need for treatment, including arthroscopy, open surgery or joint replacement
The procedure is also used to help diagnose persistent, unexplained joint pain or discomfort, or recurrent dislocations; in some cases, local anesthetic medications or steroids may be injected into the joint along with the contrast material, these medications may temporarily decrease joint-related pain or inflammation and provide physicians additional information about possible sources of joint pain

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4 risks of arthrograms

Any procedure where the skin is penetrated carries a risk of infection; the chance of infection requiring antibiotic treatment appears to be less than one in 1,000
There is always the possibility of injuring a vessel or a nerve adjacent to the joint
Possible contrast reaction
Not recommended for people who have joint infections or woman who are pregnant

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4 rotator cuff muscles

Supraspinatous muscle
Subscapularis muscle
Infraspinatous muscle
Teres minor muscle

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Ring of fibrocartilage around the edge of the articular joint

Labrum

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Superior Labrum tear from anterior to posterior; occurs where the biceps tendon anchors to the labrum

SLAP tear

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Injury of the anterior (inferior) glenoid labrum of the shoulder due to anterior shoulder; occurs in lower part of lebrum

Bankart tear

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What is the most common hip tear?

Labrum

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What is the most common wrist tear?

Triangular Fibrocartilage Complex (TFCC)

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Syndrome usually located posteriorly or posterolateral following an ankle sprain, area of inflammation

Posterior impingement syndrome

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Important test of female fertility potential
Radiology procedure usually done in the radiology department of a hospital or outpatient radiology facility
Radiographic contrast is injected into the uterine cavity through the vagina and cervix
The uterine cavity fills with dye and if the fallopian tubes are open, dye fills the tubes and spills into the abdominal cavity
This shows whether the fallopian tubes are open or blocked

Hysterosalpingogram (HSG)

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4 reasons to do an HSG

Infertility (In Vitro Fertilization first steps)
The uterus is evaluated for the presence of fibroids, scar tissue, polyps, or congenital uterine anomalies
The fallopian tubes are also examined for defects within them, for suggestion of partial blockage, and for evidence of pelvic scar tissue in the abdominal cavity near the tube
Confirm Tubal Ligation

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Egg production stimulated by hormone therapy
Egg retrieved from ovary
Sperm retrieved
Egg & sperm combined to allow fertilization via intracytoplasmic sperm injection (ICSI) = where sperm is injected into egg
Embryos are grown out to day five then transferred into the uterus

In Vitro Fertilization (IVF)

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When is an HSG performed?

Best performed one week after menstruation but before ovulation to make certain that you are not pregnant during the exam = 7-10 days from the first day of their last period

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What is the patient position for an HSG?

AP lithotomy

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Diagnostic and/or therapeutic procedure performed by a doctor inserting a hollow needle into the subarachnoid space in the lumbar area of the spinal column

Lumbar puncture (LP)
Spinal tap

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Canal in the spinal column that carries cerebrospinal fluid (CSF) between the brain and the spinal cord

Subarachnoid space

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How many cervical nerve pairs are there?

8, nerve above C1

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Ligaments of the spine that connect the lamina of adjacent vertebrae, all the way from the second vertebra, axis, to the first segment of the sacrum

Ligamentum Flavum

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3 reasons lumbar punctures are performed

Most common reason is to remove a small amount of CSF for examination and diagnosis of various disorders
CSF is tested for red and white blood cells, protein, glucose (sugar), clarity, color, and the presence of bacteria, viruses, or abnormal cells
Excess CSF may also be removed in patients who have an overproduction or decreased absorption of the fluid

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8 things lumbar punctures are helpful in diagnosing

Meningitis
Encephalitis
Certain cancers involving the brain and spinal cord 
Bleeding in the subarachnoid space 
Myelitis
Neurosyphilis
Demyelinating diseases
Headaches of unknown cause (after appropriate evaluation by a doctor and appropriate head imaging if necessary, certain inflammatory conditions that can result in a headache may be diagnosed by lumbar puncture and CSF analysis)

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Inflammation of the membrane covering the brain and spinal cord usually the result of a viral, bacterial, or fungal infection, or the result of exposure to toxins or abnormal cells

Meningitis

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Inflammation of the brain that is usually caused by a virus; may have to fracture skull so brain isn’t in too tight

Encephalitis

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Inflammation of the spinal cord or bone marrow

Myelitis

Stage of syphilis during which the bacteria invades the central nervous system

Neurosyphilis

Diseases that attack the protective coating that surrounds certain nerve fibers (Multiple Sclerosis)

Demyelinating diseases

How long should a person not eat or drink before a lumbar puncture?

Do not eat or drink anything three hours prior to a lumbar puncture

Why will the patient lie flat for about one hour after the lumbar puncture?

This helps reduce the incidence of a headache, since there has been a disruption of CSF

What are spinal headaches caused by?

Spinal headaches are caused by leakage of spinal fluid through a puncture hole in the tough membrane (dura mater) that surrounds the spinal cord; this leakage decreases the pressure exerted by the spinal fluid on the brain and spinal cord, which leads to a headache

Some of your own blood is injected into your back; the aim is that the blood seals the hole in the dura and stops the leak of fluid Great care is taken to clean your arm and take blood in a fully sterile manner (his reduces the risk of infection) Blood is carefully injected into your back using an epidural needle, near to the hole in the dura The blood will clot and tend to seal the hole that has been made in the dura As the fluid leak is stopped, the pressure around the brain will increase and the headache should improve

Blood patch for headache after an LP

An invasive procedure requiring the introduction of contrast into the spinal subarachnoid space to outline the spinal cord and nerve roots Using Fluoroscopic Procedure followed by CT Performed when accurate diagnosis or anatomic abnormalities or pathological processes of the spinal cord and spinal canal are required. Can be done on the C, T, of L Spine Most Radiologists will want MRI of that area prior

Myelogram

Inner jelly like substance tears through annulus fibrosis and usually requires surgery

Herniated disc

7 reasons a myelogram is needed

Herniated disc Spinal cord Tumors Infection and/or inflammation of tissues around the spinal cord and brain Spinal stenosis Bone spur Degenerative disc disease Tearing away or injury of spinal nerve roots

Fluoroscopic procedure to evaluate the salivary glands

Sialography

3 pairs of major salivary glands located on each side of the face

Parotid glands/Stensons Duct Submandibular glands/Whartons Duct Sublingual glands/Ducts of Rivinus

Largest salivary glands located inside each cheek above the jaw in front of the ears

Parotid glands/Stensons Duct

Salivary glands located below the jawbone on both sides of the jaw

Submandibular glands/Whartons Duct

Smallest salivary glands on the bottom of the mouth under the tongue

Sublingual glands/Ducts of Rivinus

Glands release saliva into the mouth through salivary ducts | Free flow of saliva to the mouth is important for digestion and general oral health

Salivary glands

10 reasons to do a sialogram

May be done when your provider thinks you might have a disorder of the salivary ducts or glands Evaluate for narrowing of the salivary ducts Evaluate for salivary gland infection or inflammation Evaluate for salivary duct stones An inability to fully open your mouth Discomfort or pain when opening your mouth Dry mouth Mouth or face pain Swelling over your jaw in front of your ears Swelling of your face or neck

4 x-ray views taken during a sialogram

AP or PA Lateral SMV Oblique (rotate head with affected side down about 30 degrees)

Stones within a salivary gland

Sialolithiasis

Specialized technique used to study the bile ducts, pancreatic duct and gallbladder

Endoscopic retrograde cholangiopancreatography (ERCP)

Inflammation of the pancreas

Pancreatitis

Involves placement of a catheter in the aorta and injection of contrast material while taking x-rays of the aorta Done to detect blood flow problems within the aorta Getting replaced by CTA and MRA

Aortography/aortic angiography

7 reasons aortograms are done

Aneurysm Aortic dissection Aortic regurgitation or aortic stenosis Congenital heart defects (such as double aortic arch) Inflammation of the aorta Injury to the aorta from trauma or other problems Recurring chest pain

Bleeding occurs in the walls of the aorta, peels the layers

Aortic dissection

Blood returns back to the ventricle of the heart

Aortic regurgitation or aortic stenosis

This artery supplies oxygenated blood to the liver, stomach, abdominal esophagus, spleen and the superior half of both the duodenum and the pancreas

Celiac artery

Artery that arises from the anterior surface of the abdominal aorta, just inferior to the origin of the celiac trunk, and supplies the intestine from the lower part of the duodenum through two-thirds of the transverse colon, as well as the pancreas

Superior mesenteric artery (SMA)

Artery that is the third main branch of the abdominal aorta and arises at the level of L3, supplying the large intestine from the left colic (or splenic) flexure to the upper part of the rectum, which includes the descending colon, the sigmoid colon, and part of the rectum

Inferior Mesenteric Artery (IMA)

Arteries that normally arise off the side of the abdominal aorta, immediately below the superior mesenteric artery, and supply the kidneys with blood

Renal arteries

The abdominal aorta divides to form these arteries in the lower abdomen, and these vessels supply blood to the pelvic organs, gluteal region, and legs; each one descends a short distance and divides into an internal and an external branch

Common iliac arteries

Examination by X-ray of blood or lymph vessels, carried out after introduction of a radiopaque substance A thin tube, catheter, is placed into a blood vessel in the groin The catheter is guided to the area to by studied then contrast is injected into the vessel to make the area show clearly on the fluoroscopic images

Angiography

6 types of angiography

``` Splenic Mesenteric Iliac Cerebral (brain) Coronary (heart) Carotid ```

2 things an agiogram can find

Aneurysm | Narrowing or blockage in a blood vessel that affects blood flow

5 reasons an angiogram is done

Detect problems with blood vessels that affect blood flow Look for changes in the blood vessels of injured or damaged organs Show the pattern of blood flow to a tumor Look for source of bleeding Check for atherosclerosis

Procedure to open narrowed or blocked blood vessels that supply blood to your legs (fatty deposits can build up inside the arteries and block blood flow)

Angioplasty

Small, metal mesh tube that keeps the artery open

Stent

2 ways to open blocked peripheral arteries

Angioplasty | Stent placement

Arteries that supply the pons

Pontine arteries

Local coagulation or clotting of the blood in a part of the circulatory system; stationary blood clot in vessel

Thrombosis

A blood clot, air bubble, piece of fatty deposit, or other object that has been carried in the bloodstream to lodge in a vessel and cause an embolism, travels

Embolus

Serious condition that occurs when a blood clot forms in a vein located deep inside your body Blood clot is a clump of blood that is in a gelatinous, solid state Form in the thigh or lower leg, but they can also develop in other areas of the body

Deep vein thrombosis (DVT)

9 risks for DVT

Most common in people who are over 50 years in age Having an injury that damages your veins Being overweight, which puts more pressure on the veins in your legs and pelvis Having a family history of DVT Having a catheter placed in a vein for a long time Taking birth control pills or undergoing hormone therapy Smoking (especially heavy usage) Staying seated for a long time while you’re in a car or on a plane, especially if you already have at least one other risk factor After having surgery

5 symptoms of DVT

Swelling in the foot, ankle, or leg, usually on one side Cramping pain in the affected leg that usually begins in the calf Severe, unexplained pain in the foot and ankle An area of skin that feels warmer than the skin on the surrounding areas Skin over the affected area turning pale or a reddish or bluish color

What is the modality of choice to detect a DVT?

Ultrasound

3 treatments for DVT

Medication Compression stockings Filters

Major complication of DVT where a blood clot moves to the lungs and blocks a blood vessel, can cause serious damage to the lungs and other parts of the body

Pulmonary embolism

6 signs of a pulmonary embolism

``` Dizziness Sweating Chest pain that gets worse with coughing or inhaling deeply Rapid breathing Coughing up blood Rapid heart rate ```

Filtering device is placed within the inferior vena cava (IVC) Blood clots in the veins of the legs and pelvis can occasionally travel to the lungs where they may cause a pulmonary embolism or blockage Can help reduce the risk of pulmonary embolism by trapping large clots and preventing them from reaching the heart and lungs; have a high rate of success in patients who don’t respond to or cannot be given conventional medical therapy

Vena Cava Filter

Large vein in the abdomen that returns blood from the lower body to the heart

Inferior vena cava (IVC)

Involves therapeutic introduction of various substances to occlude or drastically reduce blood flow within the vessel

Embolization

3 main purposes of embolization

Stop active bleeding sites Control blood flow to diseased or malformed vessels Stop or reduce blood flow to a particular area before surgery

Minimally invasive procedure used to treat fibroid tumors of the uterus which can cause heavy menstrual bleeding, pain, and pressure on the bladder or bowel Uses fluoroscopy to guide the delivery of embolic agents to the uterus and fibroids These agents block the arteries that provide blood to the fibroids and cause them to shrink Studies have shown that nearly 90 percent of women who undergo this experience significant or complete resolution of their fibroid-related symptoms The procedure involves inserting a catheter through the groin, maneuvering it through the uterine artery, and injecting the embolic agent into the arteries that supply blood to the uterus and fibroids As the fibroids die and begin to shrink, the uterus fully recovers

Uterine fibroid embolization (UFE)

X-ray examination that uses an injection of contrast material to show how blood flows through your veins Doctor may use it to find blood clots, identify a vein for use in a bypass procedure or dialysis access, or to assess varicose veins before surgery Involves injecting x-ray contrast material into a vein to shows how blood flows through your veins; allows a physician to determine the condition of the veins

Venography

6 things venography is commonly used for

Assess the status of a vein or system of veins Find blood clots within the veins Assess varicose veins before surgery Find a vein in good condition to use for a bypass procedure or dialysis access Help a physician place an IV or a medical device, such as a stent, in a vein Guide treatment of diseased veins