RADR 2401 Exam 2 - contrast reactions and pathologies

Normal blood chemistry levels

Creatinine level (adult)— Range 0.6-1.5 mg/dL

BUN (Blood Urea Nitrogen) levels (adult) — Range between 8-25 mg/100 mL

Special instructions for diabetic patients

If taking metformin/glucophage, must not be taken for 48 hours after injected contrast. Normal kidney function must be verified before resuming medication.

Side effect vs Reaction

Side effect - an expected outcome of injected contrast (hot flashes, metallic taste)

Reaction - unexpected outcome of injected contrast

Pre-medication procedure

Give combination of Benadryl and prednisone over a period of 12 or more hours before the procedure.

Patients who have a history of hay fever, asthma, food allergies, or previous contrast media reaction may be candidates for the pre-medication procedure.

Vasomotor reaction

Mild; typically does not need intervention. Non-allergic.

-Anxiety

-Light-headedness

-Nausea

-Vomiting

-Mild erythema

-Itching

-Mild, scattered hives

Anaphylactic reaction

Moderate - allergic. Call doctor ASAP.

- Urticaria (moderate-severe hives)

- possible laryngeal swelling

- bronchospasm

- tachycardia

- bradycardia

- angioedema

- hypotension

Vasovagal reaction

Severe - life-threatening.

-Hypotension (systolic blood pressure <80 mm Hg)

-Bradycardia (<50 beats/min)

-Cardiac arrhythmias

-Laryngeal swelling

-Possible convulsions

-Loss of consciousness

-Cardiac arrest

-Respiratory arrest

-No detectable pulse

Organ-specific reaction

Only occurs in severe reactions; specific organs affected by contrast.

-Cardiac system—pulseless electrical activity

-Respiratory system—pulmonary edema

-Vascular system—venous thrombosis

-Nervous system—seizure induction

-Renal system—temporary failure or complete shutdown

-Extravasation—leakage of contrast media outside of the vessel into the surrounding soft tissues

Local vs systemic reactions

Systemic - affects the entire body or entire organ system

Local - affects only a specific region.

Examples of local reactions:

- Phlebitis - inflammation of vein. Notify doctor/nurse and discontinue use of venous access site.

- Extravasation - leakage of contrast into soft tissue, aka infiltration. Notify doctor/nurse, elevate extremity above the heart, use cold compresses followed by warm compresses.

Esophagus Pathologies

Esophageal varices - dilation of veins, has a cobblestone appearance. Often seen with acute liver disease like cirrhosis.

Foreign bodies - don't eat fish bones please.

Zenker's diverticulum - large outpouching of the esophagus just above the upper esophageal sphincter, caused by weakening of walls

UGI pathologies (part 1)

Peptic ulcer - Ulceration of the mucous membrane of the esophagus, stomach, or duodenum, caused by the action of acid gastric juice

Hiatal hernia - A condition in which a portion of the stomach herniates through the diaphragmatic opening.

Bezoar - mass of undigested material trapped in stomach; can cause obstruction.

- Trichobezoar - made of hair

- Phytobezoar - made of vegetable fibers/seeds

UGI pathologies (part 2)

Duodenal diverticulum - Pouchlike herniations of a portion of the mucosal wall. They can occur in the stomach or small intestine. In stomach, typically in posterior portion of fundus, can be seen on lateral.

Sliding hiatal hernia - hernia caused by weakening of esophageal sphincter. May show on image with a Schatzki's Ring.

Gastritis - Inflammation of the stomach lining; best seen with double contrast study.

Small bowel pathology

Enteritis - inflammation of the bowel/thickening of mucosal folds.

- Regional enteritis - Crohn's diseases, shows with a cobblestone appearance, most common in ileum

Ileus - obstruction of small bowel. Can be paralytic (no peristalsis) or mechanical (physical obstruction).

Giardiasis - dilated intestine with thick folds. Caused by giardia lamblia and spread by contaminated food/water.

Large intestine pathology (part 1)

Ulcerative colitis - A severe form of colitis (colon inflammation) that is most common among young adults. It is a chronic condition that often leads to development of coinlike ulcers within the mucosal wall. Haustral markings and flexures are absent

Diverticulosis - blind out-pouchings of the mucosal lining - more common in the large intestine

Large intestine pathology (part 2)

Neoplasm - cancerous tumor, encircles the lumen of the colon. Has a ring or "apple core" appearance.

Intussusception - telescoping of the bowel (part of it slides into an adjacent section)

Polyp - an abnormal growth in the lining, extends into the intestine. Can be cancerous.

Diverticulum vs polyp

Diverticulum - an outpouching of the membrane, extends outward.

Polyp - an internal growth, extends inward.

Urinary pathologies

Calculi - stones. Can be in kidney, ureter, or bladder.

Hydronephrosis - distention of the renal pelvis and calyces of the kidneys that results from obstruction of the ureters or renal pelvis

Pyelonephritis - urinary tract infection

Nephroptis - floating kidney, renal ptosis. Downward displacement or dropping of a kidney.