Gastric Emptying
Created by
December 2, 2009
Amber Spivey
Links
Practice guidelines
http://interactive.snm.org/docs/Guideline%20for%20Adult%20Gastric%20Emptying.pdf
Package insert
http://www.capitalpharmacy.com/pimsds/pi-sulfcoll.pdf
Therapy for gastroparesis
Diet
Avoid high fiber, high fat meals
Small frequent meals
Diabetics
maintain glucose levels <200 mg/dL
Domperidone
Erythromycin
Metoclopramide
Causes of Delayed Gastric Emptying
Drugs
Levodopa
Calcium Channel Blockers
Nicotine
Idiopathic
Previous gastric surgery
Scleroderma
Diabetes Mellitus
Mechanical obstruction should always be excluded
Symptoms of Delayed Gastric Emptying
Abdominal discomfort/bloating
Post Pradnial Fullness
Early Satiety
Nausea/Vomting
What should the patient do?
Diabetics should have a fasting glucose level <275 mg/dL
After meal is ingested, diabetic pt should administer 1/2 of normal insulin
Discontinue drugs that may interfere with gastric emptying
Anticholinergics/antispasmodics
Prokinetic Agents
Narcotic/Opiate analgesics
No Tabacco or Alcohol for 24 hours before test
Smoking slows gastric emptying
Fast for 8 hours
Notify doctor if allergic to eggs
What can affect the scan?
The meal provided
Upright positioning/Ambulation
Male vs Female
The time of day
More rapid after overnight fast
Delayed gastric retention
<34% gastric emptying at 90 minutes
Imaging Technique
Alternative
Simplified 4 hour protocol
simultaneous 1 minute acqusition
determine geometric mean
acquired at 1,2,4 hours
Static images every 10-15 minutes
Simultaneous anterior and posterior images
Patient supine
Continuous data acquisition
Images over stomach in the LAO position
Lag phase my appear longer
Duration of at least 90 minutes
30-60 seconds per image
Radiopharmaceutical used
0.5-1 mCi Tc-99m Sulfer Colloid
Chicken Liver
Oatmeal
Scrambled eggs
Most Common
Tasteless
Sulfer Colloid
Heating required
3 vials
Sodium Hydroxide
HCL Acid
sodium thiosulfate,gelatin, EDTA
What does a Gastric Emptying scan do?
uses a radioactive meal that identifies abnormalities related to emptying of the stomach
