GI pathway
pharynx-> esophagus-> stomach-> small intestine -> large intestine
accessory organs of GI
salivary glands, pancreas, gall bladder
what's should prevent reflux
angle of his in-stomach fundus
pt. symptoms for gastric emptying
-vomiting -nausea-discomfort-aspiration -reflux -therapy
speed of emptying from fastest to slowest
-water-clear liquids-liquid supplement-semi solid-solid(least to most viscatious)
liquid GI emptying studies use
Tc SC in water or juice and In111 for dual study
normal T 1/2 of food in emptying
90 minitues or 60% by 2 hrs
patient prep for gastric emptying exam
NPO after midnight or at least 4 hrs- adjust insulin -no smoking- get hx
contraindications to gastric emptying
-allergy to Reglan-GI hemorrhage -obstruction - opiates/ prokinetic stopped (reglan )for 2 days - NPO 4 hrs -
meal for GI empty
-2 eggs-30g jelly/ jam-120 ml water (microwave and stir in-between till omelet consistency, toast the bread and spread jelly over)
GI empty protocol
- make meal and pt eat it within 10 minutes - take anterior images for 2-4hrs (1 min, 30min, 1 -2 hr)-ROI around the stomach and background (can take post. too on dual head but get geo mean)
drug used to induce emptying in GI emptying
10mg Reglan/ metoclopramide over 1-2 min IV
normal esophagus transport time to stomach
4-8 sec solid or 1 sec for liquid - 90% by 8 swallows or 2 minutes -if delayed to 20 = spasms
indications of esophageal transit
-difficulty swallowing-motility or motor disorder /spasms (achlasia)-scleroderma
esophageal transit procedure
-NPO 8 hrs- camera anterior-rehearse pt. swallow then drink--> dry swallow every 15 sec for 4-10 min. -flow for 2 min. -ROI over esophagus and BKG -(if reflux, do transit first)
drug used in esophageal transit
5.5 to 20 MBq SC in 10- 15 ml water through straw
esophageal reflux used for
- confirm GERD/ bad reflux or heartburn- reflux can burn lining leading to barrettes with scar tissue taking over - can lead to aspiration
patient prep for reflux
NPO after midnight- No contrast / NG tubes unless known issue then can give through NG
factors that effect reflux studies
-acidity- abdominal pressure-laying down - at least 300 ml
reflux drug
300 uci SC iin 150 ml OJ and 150ml HCL rinsed down with water
reflux procedure adult
300 uci SC iin 150 ml OJ and 150ml HCL rinsed down with water - patient upright with binder and 30 sec statics taken while binder increased in 20 hg increments for 30 sec. per series till 100- ROI over stomach and esophagus - normal is under 4%, abnormal are normally over 10%
reflux procedure for PEDS
150 uci in milk at 5uci per ml -2 sec dynamics for 120 sec '-wash with unlabeled milk -take anterior images at 1 min per frame for 60 minutes -statics every 2 hrs -GERD for 5 min is normal
what is Meckels
stomach tissue in small intestestines that burns the surrounding tissue
causes of GI bleeds
- esophageal varices (swollen BV)-ulcers- inflammation (crones)-inflammation- tearing due to diet- neoplasms- Meckel's
RPX for GI bleed
- TC tagged RBC 20-30mci (ultra-tag or PYP method) for active bleeds-SC 5-10 mCI for inactive bleeds (lower backgroud ratio so more sensitive and less false +)
GI bleed procedure
- monitor vitals throughout with large bore IV for hypotension - abdominal images over stomach via flow for 1 min and 1 min frames for 60-90 min. - once positive stop and send to surgery - delayed can be done for 24 hrs
rule of 2 with meckels
-2% pop. by 2 y/o and 2 types of mucosa 2 feet from ileocecal valve
drug for Meckel's
TcO4 / free tech 8-12 mCi in adults and 100uci per lbs in PED(Can giver H2 blocker glucagon, pentagastirin for higher sensitivity)-take images for 30 minutes with flow and statics -can use other views to differentiate bladder
how many lobes in the liver
4 lobes
liver cells name
-15% Kupffer cells which degrade toxins- 85% hepatocytes for metabolic functions
drug for liver spleen imaging
4-6 mci SC under 1 x 10^-6 size (colloidal shift towards liver with increased parts size)- 85% go to liver-10% to spleen-5% gos bone marrow
pt. prep for liver spleen
no contrast
procedure for liver spleen
4-6 mci SC to optional flow-liver spleen in center with heart blood flow in FOV- marker on right for ascites check - after 15 minutes statics for 500k to 1 mill ant. -take RAI, R lat, Post, LT lat for same time (all but LAO and Post O)-done within 15 minutes
focal cold lesion on liver spleen
-metastasis (multiple cold spots ), cyst, hepatoma, -cirrhosis (patchy uptake), hemangiomas or abscess
hot spots in liver spleen
-sup/inf vena cave syndrome -hyperplasia -budd Chiari / hepatic vein thrombo
functions of the spleen
-blood bank - forms blood elements and platelets
splenic sequestration rpx
TC tagged and denatured RBC
usage of splenic study
- rule out poly (accessory) or asplenia -prep for splenectomy
what is thrombocytopenia
excessive trapping of cellular components in spleen and leads to low RBC counts or platelets
rpx prep and procedure for splenic sequestering
10-25 mci tc with rbc then heat for 15 minutes - statics for 300-750k of ant poste and LAO
hemangiomas are...
vascular malformation aka bunched up blood
how will hemangiomas be seen
decreased to normal flow but increased pool (opposite of tumors)
liver imaging procedure
15-25 mci tagged RBCs -flow for 1 min and do pool of 1-2 mill after -repeat for up to 3 hrs
hepatic artery perfusion procedure
inject into infusion cath. 200k parts (1-4 mci) of MAA n 5 ml over 1-2 min - represents Y90 chemo to make sure ports in correctly
how will a failed port be seen in hepatic artery perfusion exam
extra hepatic activity and will need to replaced and tested
shunt patency test usage
test peritoneal shunt that should shunt ascitic fluid towards lungs - if lungs dont show can inject 2mci maa into shunt itself and see where it is going
normal colloidal shift if spleen liver stury
1-1 abnormal is above with excess in cr51 in spleen
urea breath sampling use
gram negative bacteria in spinal cord (HP) diagnoses
Urea breath test
Patient ingests Urea with radio labeled CarbonMeasures exhaled radio labeled Carbon (carbon 14 capsole)
urea breath test pre reqs
-NPO for 6 hrs- no antibiotics or proton pumps meds for 30 days
urea breath test procedure
-swallow 1 uci C14 capsule with 20 ml warm water - another 20ml water after 3 min.- at 10 min. take deep breath and hold, exhale to balloon-