Hepato test out

Where does the radiopharmaceutical collect (which cells)

hepatocytes

Recognize what acute chole, chronic chole, acalculus chole will present on a scan

Acute Chol : is inflammed GB due to blockage of the cystic duct by gallstones. the blockage of the duct causes bile to build up increasing pressure in GB and causing irritation

SCAN - will show good hepatic function and common bile duct excretion into small bowel but NO visualization of GB. NON-VISUALIZATION of GB after 3-4hrs post inj or 30 min after morphine = actue chole

Chronic Chole: most common reason for GB visualization more than 60 min post inj. it results from damage to GB repeated actue inflammation from gallstones where GB walls become thick and scarred. as a result GB shrinks in size. SYMPTOMS: occur after fatty meal and include bloating, vommiting, nausea, cramping. treat w cholecystecomy.

SCAN- GB is not visualized until 60min later/ 30min after morphine

Acalculus chole: Inflammation of GB without presence of gallstones. uncommon BUT life threatening disease often a comp of another medical or surgical condition.

SCAN - shows reduced GBEF after administration of sincalide

if there are high bilirubin levels which radiopharmaceutical is preferred

• fi the patient has hyperbilirubinemia, a higher administered dose may be needed. Mebrofenin has higher hepatic extraction (98%) and may be preferred in moderate to severe hepatic dysfunction..

What is the other name for sphincter of oddi dysfunction

Biliary dyskinesia????

Dosage for morphine

0.04mg/kg over 2-3min

Dosage for CCK

0.02ug/kg over 2-3min

What views do we take

• Ant views

  • Additional views include:

    • RL, RAO, & LAO- which separates GB from R renal pelvis or duodenal loop/common bile duct

Why might you take an oblique/ lateral view

• RL, RAO, & LAO- which separates GB from R renal pelvis or duodenal loop/common bile duct

How long do you image for biliary atresia

1-hr dynamic → delayed 3–4 hr → continue up to 24 hr if needed

calculate GBEF (know formula)

GBEF = [(max ct-backgd) - (min cts-backgd)] / (max cts-bckgd)

What does CCK do (which muscles does it affect)

• it causes gallbladder to contract so we can see how much it empties ( to calc GBEF)

• causes sphincter of oddi to relax, which helps bile reach the duodemun

• causes pyloric sphincter to contract which inhibits stomach emptying

Know patient prep and how long between eating/ receiving pain meds and getting the exam (how many half lives do you have to wait after receiving morphine)

NPO 4-6hrs before

• pt must have eaten within 24hrs or bile becomes thick and sluggish which fills up in GB

No opiates or morphine 4-12hrs before

• half life : 4

Why is morphine a contraindication

Opioids cause the sphincter of oddi to
constrict, resulting in increased CBD pressure
which forces bile into the GB and the GB wont empty

What drug allows us to determine GBEF

CCK makes the GB contract so we can see how it empties and we can calculate the EF

Where would you see the gallbladder in a liver/spleen study

you wouldnt????

What is enterogastric reflux

is the backflow of bile and intestinal contents from the small intestine (duodenum) into the stomach.

Know ductwork/ how bile/ RPX flows

hepatic duct -> cystic duct ->
gallbladder -> cystic duct ->
common bile duct -> passed
the sphincter of oddi ->
duodenum

Most common reason for acute chole

gallstones

other name for gallstones

Cholelithiasis

Why is eating a contraindication

food stimulates the GB to contract and it will empty contents so it wont fill while its emptying

List 4 clinical indications for hepatobiliary imaging

• Evaluate function of hepatobiliary system

• Evaluate integrity of the hepatobiliary system
  (post surgery, obstruction, bile leak,
  congenital abnormalities like biliary atresia)

• Acute or chronic cholecystitis

• Calculate gallbladder ejection fraction

• Evaluate enterogastric reflux

• Evaluate cold defects seen on liver image
  (hepatic adenoma is hot on this image)

Path the bile takes from production to excretion

hepatic duct -> cystic duct ->
gallbladder -> cystic duct ->
common bile duct -> passed
the sphincter of oddi ->
duodenum

how can recent meals affect hida imaging results?

food stimulates the GB to contract and it will empty contents so it wont fill while its emptying

How is mebrofenin processed in the body?

sctive transport

What is a reliable imaging characteristic of chronic cholecystitis in patients with symptoms?

delayed visualization of GB- prolonged biliary to bowel transit time - bowel appears before GB

If the gallbladder shows up and we give CCK, can we determine if the patient has chronic cholecystitis?

yes if GB is visualized 3-4hrs later

When given a normal patient, about what time should we visualize the gallbladder and intestinal activity?

30

What things can affect hepatocyte uptake?

high bilirubin levels

damaged hepatocytes

Describe the procedure for calculating GBEF

draw ROI around GB and draw ROI on liver for background and use the activity curve to get GBEF - normal: 30-35%

Would GBEF ever be 100%?

if you processed GBEF and got 100%, what would you do?

Will a diagnosis of chronic hepatitis affect how the RPx uptakes and clears?

yes because hepatocytes are damaged and inflammed and tracer takes longer to be excreted into bile ducts and intestine

What does non-visualization of the bowel with persistent liver uptake suggest?

common bile duct obstruction

What findings suggest acute cholecystitis?

no visualization of GB after 60min or after giving morphine. will have normal liver uptake and visualization of CBD and bowel - rim sign

When, if ever, would you perform a hepatobiliary study on a patient who doesn’t have a gallbladder?

yes to look at function of surrounding organs after surgery??

The patient is a 6-week-old male with symptoms of persistent jaundice, pale stools, and dark urine. The scan is a hida scan pretreated with phenobarbital for 5 days. The findings suggest normal liver uptake and no visualization of the bowel at 24 hours. 

Biliary Atresia

What do you think the diagnosis is?

Biliary Atresia

Why would they give phenobarbital?

In cases where biliary atresia is suspected, pretreatment with oral phenobarbital, 5 mg/kg per day divided into two doses daily, for a minimum of 3 to 5 days before hepatobiliary imaging, increases bile flow and biliary excretion of the radiopharmaceutical.

another name for cck 

Sincalides/Kinevac