Thursday, June 18, 2015

Oral contrast for abdominal CT?


PO, IV contrast for abdominal CT
This material is educational, and is not intended to serve as hospital protocol.
 
Mostly, it's here to serve a quick reference for myself, and for impromptu discussions with PAs and residents.

SUMMARY

Suspected SBO
Oral contrast is contraindicated in suspected SBO.
IV contrast is preferred, but not required.

Suspected appendicitis
Oral contrast is not required, but may be beneficial in extremely thin individuals (e.g. BMI < 18), or non-obese children.

Suspected diverticulitis
Oral contrast is not required

Unclear etiology
PO contrast is suggested by some experts in undifferentiated abd pain if the patient
1)   Is very thin (e.g. < 120 pounds, BMI < 18);
2)   Has had a Roux-en-Y gastric bypass; or
3)   Has and inflammatory bowel disease that could produce a fistula

Discussion and References

SBO
Per the American College of Radiology guidelines, in a patient with suspected SBO, PO contrast is contraindicated. They explain that: “Oral contrast will not reach the site of obstruction, wastes time, adds expense, can induce further patient discomfort, will not add to diagnostic accuracy, and can lead to complications, particularly vomiting and aspiration.”    

Appendicitis
Multiple studies have shown that the use of PO contrast does not increase the accuracy of the diagnosis of appendicitis (references below). An editorial in a recent radiology journal concluded that “routine administration of oral contrast medium may not be necessary in the setting of suspected acute appendicitis.” American College of Radiology guidelines state that PO contrast “may not be needed,” leave the decision to use PO contrast to “institutional preference.”
Some have suggested that PO contrast might be needed in extremely thin individuals (e.g. BMI < 18). See the discussion below in "Unclear etiology."

A 2005 systematic review from the American Journal of Surgery concluded that: “Noncontrast CT techniques to diagnose appendicitis showed equivalent or better diagnostic performance compared with CT scanning with oral contrast.”

A 2009 randomized study in the American Journal of Radiology found that “nontraumatic abdominal pain imaged using 64-MDCT with isotropic reformations had similar characteristics for the diagnosis of appendicitis when IV contrast material alone was used and when oral and IV contrast media were used.”

A 2011 retrospective study in the Journal of Surgical Research found that oral contrast did not reach the cecum in 1/3 of patients. Furthermore, “there appears to be no diagnostic compromise in those without contrast in the terminal ileum.
A 2014 prospective study in the Annals of Surgery concluded that: “Enteral contrast should be eliminated in IV-enhanced CT scans performed for suspected appendicitis.”

Diverticulitis
The American College of Radiology guidelines state that PO contrast “may be helpful for bowel luminal visualization.” Despite this, they conclude that “regardless of the [the use or lack of IV or PO contrast], the accuracy is high for depicting findings of acute diverticulitis.”

A 2006 prospective study in Emergency Radiology looked at patients with undifferentiated abdominal pain in the ED; 1/5 of them had LLQ tenderness, and diverticulitis was the second-most common suspected diagnosis. All patients had CT scans with and without PO contrast; no IV contrast was used. Although there were discordant interpretations between the (+) PO and (-) PO CT scans, the authors found that a “significant portion of the discordance was attributable to interobserver variability.” Thus, it would appear that a CT scan without either PO or IV contrast could be accurate in the diagnosis of diverticulitis.

Unclear etiology
Oral contrast may not be needed for undifferentiated abdominal pain, as per the discussion of the study in Emergency Radiology noted above.

However, in a 2012 study in Emergency Radiology that examined the use of PO contrast in undifferentiated non-traumatic abd pain, the authors excluded 2 groups of patients.  They excluded all “subjectively thin” patients, but did not provide cut-offs. They noted the research that suggests this exclusion is unnecessary, and may be dropped in the future.  They also excluded patients at high risk for having an intra-abdominal fistula. Primarily, they targeted patients who had had a Roux-en-Y gastric bypass, or who had IBD, disposing them to fistula formation.

31 comments:

  1. ACR recommendations you cite are for "high-grade SBO". For completeness, the ACR further says that for intermittent or low-grade SBO, "in contrast to a high-grade obstruction, oral contrast is not necessarily contraindicated and may add functional information."

    As a radiologist (having seen one or two CT scans) I find the use of enteric contrast with CT to be often helpful in problem solving.

    ReplyDelete
    Replies
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       kindly contact him via email: healthylifeherbalcentre@gmail.com or whatsapp +2348074216045
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  7. I was diagnosed of HERPES in 2015, i have tried everything possible in life from one doctor to another, one hospital to another, series of tests different kinds of medication i had already lost hope until i meet Great DR OBUDU online testimonies, a specialist in herbal medication from Africa, i contacted him true his email OBUDU.MIRACLEHERBALHOME@GMAIL.COM and he prepared HERPES herbal medication for me which i took for 14days and now i am completely cured i want to use this medium to express my gratitude to him for saving my life and curing me from HERPES VIRUS for taking away all my pains and sorrows, I''m indeed grateful and i am so happy I''m now cured totally, I will continue to tell the good news of your great works to everyone, if you have HERPES or other disease contact him true his Email: OBUDU.MIRACLEHERBALHOME@GMAIL.COM Or whatsApp him via +2347035974895 thank you my great DR OBUDU for curing me keep up your great work

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    1. Do anyone still doubt natural herbs? I've seen the great importance of natural herbs and the wonderful work they have done in people's lives. I wonder why people still spend their money on injections and drugs each time they are sick. Natural herbs can cure all kinds of illness including herpes, diabetes, asthma, HIV, HSV1&2, hepatitis, HPV etc. I've seen it with my own eyes. I was cured from Herpes and HPV and my aunt and her husband were cured from Hiv too by DR. Chukwu madu herbs. He uses natural herbs to cure different kind of virus. Dr. CHUKWU,prove to the world that natural herbs can cure all illness and he cured countless people using herbs. I know is hard to believe but am a living testimony. I was diagnose of Herpes and HPV in 2016 and i believe there is cure even when the doctors said there is no cure yet. I strongly believe in herbs and i came across a comment on a blog written by Lisa Pierre, saying she was cured from HERPES by Dr. CHUKWU MADU and i contacted his herbal hom on the email that was provided on the comment and order one for myself and he send it to me through UPS and gave me instructions on how to use it and after i finish taken it i went for checkup and the result shows am Herpes and HPV NEGATIVE. The doctor said that the virus is completely gone from my body. There is no harm trying herbs it work perfectly and it has no effect. You can contact Dr. CHUKWU MADU to get yours.. His email is dr.chukwumaduherbalhome@gmail.com.
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  9. FINALLY FREE FROM HERPES VIRUS.
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    ReplyDelete
  10. I'm 61 years old, I contracted hpv in 2011' I has be taking lot treatment for it and embarrassed some months ago the wart stated coming out seriously, I used lot recommendation because there was lot warts around my anus and was so . but today I'm totally happy I got the virus eliminated by using natural treatment from Dr Onokun herbal center after his treatment I got cured. all the warts went away' seriously believed Dr Onokun he have the cure for human papillomavirus because he has eliminated hpv been in my body since 2011, Dr Onokun make it possible for me. Here is Dr Onokun email to reach him: Dronokunherbalcure@gmail.com or www.Dronokunherbalcure.wordpress.com he is welled capable of curing terrible diseases.

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    ReplyDelete
    Replies
    1. Do anyone still doubt natural herbs? I've seen the great importance of natural herbs and the wonderful work they have done in people's lives. I wonder why people still spend their money on injections and drugs each time they are sick. Natural herbs can cure all kinds of illness including herpes, diabetes, asthma, HIV, HSV1&2, hepatitis, HPV etc. I've seen it with my own eyes. I was cured from Herpes and HPV and my aunt and her husband were cured from Hiv too by DR. Chukwu madu herbs. He uses natural herbs to cure different kind of virus. Dr. CHUKWU,prove to the world that natural herbs can cure all illness and he cured countless people using herbs. I know is hard to believe but am a living testimony. I was diagnose of Herpes and HPV in 2016 and i believe there is cure even when the doctors said there is no cure yet. I strongly believe in herbs and i came across a comment on a blog written by Lisa Pierre, saying she was cured from HERPES by Dr. CHUKWU MADU and i contacted his herbal hom on the email that was provided on the comment and order one for myself and he send it to me through UPS and gave me instructions on how to use it and after i finish taken it i went for checkup and the result shows am Herpes and HPV NEGATIVE. The doctor said that the virus is completely gone from my body. There is no harm trying herbs it work perfectly and it has no effect. You can contact Dr. CHUKWU MADU to get yours.. His email is dr.chukwumaduherbalhome@gmail.com.
      WhatsApp +2347030936239.

      Delete
  13. I am bold enough among many others to state that there is now a potent cure to this sickness but many are unaware of it. I discovered that I was infected with the virus 3 months ago, after a medical check-up. My doctor told me and I was shocked, confused and felt like my world has crumbled. I was dying slowly due to the announcement of my medical practitioner but he assured me that I could leave a normal life if I took my medications (as there was no medically known cure to Herpes). I went from churches to churches but soon found that my case needed urgent attention as I was growing lean due to fear of dying anytime soon. In a bid to look for a lasting solution to my predicament, I sought for solutions from the herbal world. I went online and searched for every powerful trado-medical practitioner that I could severe, cos I heard that the African Herbs had a cure to the Herpes syndrome. It was after a little time searching the web that I came across one Dr Afrid (A powerful African Herbal Doctor), who offered to help me at a monetary fee. I had to comply as this was my final bus-stop to receiving a perfect healing. My last resolve was to take my life by myself, should this plan fail. At last it worked out well. He gave me some steps to follow and I meticulously carried out all his instructions. Last month, to be precise, I went back to the hospital to conduct another test and to my amazement, the results showed that negative,Dr Afrid Can As Well Cure The Following Disease…Cancer,Hiv,Herpes, Hepatitis B,Liver Inflammatory,Diabetics,Fribroid, Dercum,fibromyalgia,Get Your Ex Back,Als,SYPHILLIS,Genetic disease, Parkinson's disease.Fibrodysplasia Ossificans Progressiva.You can free yourself of this Herpes virus by consulting this great African Herbal Doctor via this e-mail:  drafridherbalhome@gmail.com or call and whatsapp him on +2349057260738 He will help you and his herb medication is sure. he has the cure on all disease...

    ReplyDelete
  14. So happy right now.Words are not enough to thank you Dr.Chukwu madu herbal home, for healing me of the deadly disease that have been disturbing me for 9 years now, I have promise to share testimony about you if you are really able to cure me of my HSV2 which you really cured. I am here to tell the whole world that there are real powerful herbal doctor who can cure any disease because i am a living testimony to your work. You have wiped away the shame on my face and brought Joy back to my life that i have wish for over 9 years now. I was reading a testimony in a forum of a lady who said you cured her from the deadly Herpes Simplex virus, and i never believed not until i gave you a try and you really cured me. You are really a God sent to people and i will continue to spread the good thing you are doing to other people in the world who might also be having same problem cause i know you will also be of help. Anyone who is suffering from any kinds of disease should contact this great herbal Man called Dr.Chukwu madu on his email[ dr.chukwumaduherbalhome@gmail.com] . or call his mobile number or whatsapp him  +2347030936239,
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    ReplyDelete

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  16. How to have your husband back home with your kids again I'm a lady with 2 kids i am from Houston Texa, my husband leave me and his 2 kids for about 10 months i go through a lot of pain i do all i could to make him returned to me and to his kids but nothing works out. it was really a stressful period to me because i could dint go through the heartbreak. i was told to get a love spell doctor contacted to help me out which i did i was lucky to get Dr Abumere Contact who was able to help me out, he cast up a love spell that brought back my husband to me and to his kids thanks so much DR. Abumere I really appreciate what you have done for me. here he his contact if you may required for it by solving your relationship email. doctorabumrer6@gnail.com call or whatssap +2349021975055...

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    ReplyDelete
  18. I was diagnosed of herpes virus, I have tried all possible means to get cure but all my effort proved abortive, until a friend of mine introduced me to a herbal doctor called Dr Agaba, who prepare herbal medicine to cure all kind of diseases including herpes virus (Herpes), when i contacted this herbal doctor via email, he sent me herpes virus herbal medicine via courier service, when i received the herbal medicine he gave me step by step instructions on how to apply it, when i applied it as instructed i was totally cured from the virus within 3 weeks of usage. Contact this great herbal doctor today to get your cure. 
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    ReplyDelete
  19. Having herpes is not the end of life there is a treatment that can get rid of Genital herpes with traditional herbs from Dr Kham. I was positive to this infection (HERPES) and I lost hope because I was outcast and rejected even by my closet friends. I searched on-line to know an enquirer cure for HERPES and I got a testimony posted by a patient on how she was cured from HSV by Dr. Kham herbal product, So i decided to contact the same herbalist Dr. Kham because i know that nature has the power to heal everything. i contacted him to know how he can help me and he told me never to worry that he will help me with the natural herbs created by God Almighty! After contacting him, he told me that the cure has to be prepared and he will send it to me via (UPS Delivery service) and unfortunately it got to me after 5 days! i used the medicine as he instructed me (MORNING and EVENING) and i was cured! it's really like a dream but I am so happy now! That's the reason I decided to also add more comments on Him so that more can be saved just like me! and if you need his help, you can email him on dr.khamcaregiver@gmail.com or whats-app +23478159922297 for more information about his herbal medication visit his website via: https://herbal-dr-kham.jimdosite.com/

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    ReplyDelete
  22. I was infected with genital herpes in 2019 and I have been on the quest for a cure right from the day I discovered I had the virus. In October last year, I stumbled upon a post on the internet where I copied the email of a man named Kham care giver who provides herbal solutions to diseases. I contacted him and got to an agreement with him and he sent me herbal remedy through the united parcel service alongside instructions on how to use it. To my greatest surprise, I got cured after two weeks of using the remedy as assured by the Kham care giver. I decided to share this because I know that there are lots of people out there that need help. contact the doctor via dr.khamcaregiver@gmail.com  .........https://herbalistdrkhamcaregiver.simdif.com/

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