Medical Imaging Technology ေတြတိုးတက္ေၿပာင္လဲလာတဲ့အတြက္ IVC(Intravenous Cholangiography) ရဲ့ အခန္းက႑လည္းတေၿဖးေၿဖးေပ်ာက္ကြယ္သြားပါၿပီ။ USG, PTC(Percutaneous Cholangiography, ERCP,CT, MRCP and Cholescintigraphy စတဲ့ပိုမိုေကာင္းတဲ့ Method ေတြပဲအသံုးၿပဳလာႀကေတာ့တယ္။ ဒီ alternative method ေတြလက္လွမ္းမမီရင္ေတာ့ IVC ကိုဘဲအားထားရမွာပါ။ Indication for IVC…(1)Failure of Oral Cholecystography. (2)Suspected CBD disease in non –icteric patients. (3) Post cholecystomy biliary system. Absolute Contraindication are.. Pregnancy, Known Iodine sensitivity, Conbined Hepatic & renal failure. IVC should not be performed within 14 days of Oral Cholecystography.(OCG) ဘာေႀကာင့္လဲဆိုေတာ့…IVC contrast agent ၿဖစ္တဲ့ Meglumine Iodipamide ကို OCG ရိုက္ၿပီး ၂၄ နာရီ အတြင္း ရိုက္မိိရင္…adverse side effect မ်ားသိသိသာသာတိုးလာမယ္။ လူနာ14%ေလာက္မွာ Severe Reaction ၿဖစ္တဲ့ severe hypotension, sharp reduction in active transport mechanism of the liver function,& consequent retention of CM in vascular compartment.မ်ားၿဖစ္နိင္တယ္။ IVC contrast media ကို Bolus or drip infusion ေပးၿပီးရိုက္နိင္တယ္။ Bolus Injection…..over about 5—10 min. Slow drip Infusion for 30 to 60 min. Note that… (1) The excretion of CM by the liver is an active carrier-mediated transport process proceeding against large concentration gradient. (2)This excretion is limited by a transport medium. (3) The concentration of CM in bile depends on the rate of excretion, the choleresis which is stimulated and the basal bile flow. Iodipamide given in bolus inj: produces higher plasma concentration and greater renal excretion, but,less total biliary excretion than equal amount infused over a longer period of time.ဆိုလိုတာက Bolus Inj; ကို ၿမန္ၿမန္ထိုးမိရင္..liver ကို လိုသေလာက္ မေရာက္ေတာ့ဘဲ Kidney က Excrete လုပ္သြားမယ္. Drip infusion method နဲ့ ရိုက္ရင္ ပံုပိုေကာင္းတယ္။ ဒါေပမဲ့ infusion ေပးတဲ့method မွန္ဖို့အေရးႀကီးတယ္။ ဆရာ့ရဲ့ အေတြ့အႀကံုအရ… Ioglycamide ကို 4mg per kg per min နွုန္းနဲ့ ၁နာရီေလာက္infusion ေပးၿပီးရိုက္ရင္ ပံု ကိုေကာင္းတာကုိေတြ့ရတယ္။ Normal Radiographic technique……. Pt should be in fasting state,but well hydrate to reduce the nephrotoxicity of the CM. An initial prone LAO controle radiograph of GBA at low KV is takenbefore the administration of CM. A further prone oblique radiograph of GBA is taken 30 min after bolus inj of at the end of the infusion.. The radiographic examination is continued at 30 min interval for up to 2 hours after administration of CM in order to obtain GB concentration If the GB is visualized, ……. (1) Prone oblique film to show GB fundus. (2) Supine Oblique for Neck of GB & Hartmann’s pouch (3) Erect film to demonstrate the presence of gallstones.( Floating stone) ပံုေတြေကာင္းတယ္။ေႀကနပ္ၿပီဆိုရင္ Fatty meal ေကြ်းၿပီး . 15 min AFM 30 min AFM 45 min AFM 60 min AFM films မ်ားရိုက္ေပးရပါမယ္။( To see GB function) သတိ ****** IVC မွာသံုးတဲ့ CM ေႀကာင့္ လူနာ၅၀၀၀ မွာ….တစ္ေယာက္နွန္း ေသဆံုးနိင္ပါတယ္။ IVU ရိုက္တာထက္ ေသဆံုးမွဳ နုန္း (ဂ)ဆ ပိုမ်ားပါတယ္။
Posted on: Mon, 20 Jan 2014 09:01:00 +0000
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