Gastric Emptying

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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