11/26/2001 Requirements for DISIDA Scan Patient preparation: fasted for 4 hours Radiotracer: Tc-99m IDA compounds i.v. Imaging: serial anterior/lateral views for 60 minutes Every 5 minutes for 30 minutes Once at 45 minutes Once at 1 hour Delayed views of the gall bladder 2 hours, 4 hours, 6 hours or 24 hours after injection
11/26/2001 Requirements for DISIDA Scan Morphine Injection at one hour to help force the gall bladder to fill Water CCK Injection prior to the test to empty the gall bladder Suspected chronic cholecystitis Injection to measure how well the gall bladder empties.
11/26/2001 Acute Cholecystitis The most common indication S\S Nausea, vomiting, fever Right upper quadrant pain post-prandially Mild to moderate leukocytosis Abnormal liver function test Pain radiates to the back (scapula) Usually blockage of the cystic duct by a gallstone
11/26/2001 Acute Cholecystitis If hepatic scintigraphy reveals adequate filling of the gallbladder, acute cholecystitis is effectively excluded. Within 30 minutes, the gallbladder fails to visualize Wait for one whole hour Differential diagnosis for non-visualization of the gallbladder Relaxation of the sphincter of Oddi Inject morphine (3-5 milligrams) and continue the study for another half an hour
11/26/2001 Chronic Cholecystitis Ultrasound is the primary modality of choice S\S Usually having gall stones The cystic duct is not blocked More chronic pain Delayed visualization of the gall bladder Biliary dyskinesia in response to administration of CCK
11/26/2001 Bile leaks Most appropriate non-invasive imaging technique for evaluation of bile leaks Sensitivity: 87%, Specificity: 100% (2-3 ml of labeled bile) Radiopharmaceutical activity In an extrahepatic and extraluminal location More intense with time Differentiating intraluminal activity from a leak Ingestion of water Standing views in addition to anterior oblique views