Hepatobiliary Iminodiacetic Acid (HIDA) Scan Usage and Its Potential Limitations With Patient Care

Patients with upper abdominal pain, nausea, and vomiting are often evaluated with ultrasound to diagnose symptomatic cholelithiasis or cholecystitis. With a normal ultrasound, a hepatobiliary iminodiacetic acid (HIDA) scan with ejection fraction (EF) is recommended to evaluate gallbladder function. The purpose of this study was to evaluate whether the HIDA scan with EF was appropriately utilized in considering cholecystectomy. Over 18 months, we performed 1533 HIDA scans with EF. After exclusion, 1501 were analyzable, 438 of whom underwent laparoscopic cholecystectomy. Patients were divided into two groups: those with typical and atypical symptoms of biliary colic. Our primary endpoint was symptom resolution of those who underwent laparoscopic cholecystectomy. Symptom resolution was assessed by chart review of postop visits or readmissions. In patients with typical symptoms, resolution occurred in 66 per cent of patients with positive HIDA and 77 per cent with negative HIDA ( P = 0.292). In patients with atypical symptoms, resolution occurred in 64 per cent of patients with positive HIDA and 43 per cent with negative HIDA ( P = 0.013). A HIDA scan with EF was not useful in patients with typical symptoms of biliary colic and negative ultrasounds, and should not be used to make a decision for cholecystectomy. However, this test can be helpful in patients with atypical symptoms, as it does predict symptom improvement in this group.

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Recurrent Pyogenic Cholangitis: ‘Sump Syndrome’ following Choledochoduodenostomy

Tropical Doctor ◽

10.1177/004947559702700121 ◽

1997 ◽

Vol 27 (1) ◽

pp. 51-52 ◽

Cited By ~ 2

Author(s):

T F Toufeeq Khan ◽

Zaheer A Sherazi ◽

Suseela Muniandy ◽

Malik Mumtaz

Keyword(s):

Abdominal Pain ◽

Hospital Admissions ◽

Late Complication ◽

Iminodiacetic Acid ◽

Endoscopic Retrograde ◽

Percutaneous Access ◽

Intrahepatic Calculi ◽

Hida Scan ◽

Recurrent Pyogenic Cholangitis ◽

Upper Abdominal

An uncommon and late complication of side-to-side choledochoduodenostomy (CDD), the ‘sump syndrome’, developed in a patient 4 years after surgery. Recurrent right upper abdominal pain, fever with chills and rigors and latterly, mild jaundice made her seek repeated hospital admissions which were treated successfully with antibiotics. During the last admission, ultrasonography, endoscopic retrograde cholangiography (ERC), computerized scanning (CT) and hepatic iminodiacetic acid (HIDA) scan using Tc99m confirmed multiple intrahepatic calculi with proximal dilatation, debris in the distal blind segment and delayed excretion through the CDD. At surgery, the choledochoduodenostomy was taken down and a Rouxen-Y hepaticojejunostomy (RHJ) was fashioned after ductal clearance. The closed end of the Roux loop was placed subcutaneously for subsequent percutaneous access for cholangiography and removal of calculi. She is asymptomatic and well 28 months after surgery.

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Hyperkinetic Gallbladder: An Indication for Cholecystectomy?

The American Surgeon ◽

10.1177/000313481307900920 ◽

2013 ◽

Vol 79 (9) ◽

pp. 882-884 ◽

Cited By ~ 11

Author(s):

Erika B. Lindholm ◽

J. Brannon Alberty ◽

Faith Hansbourgh ◽

James R. Upp ◽

John Lopoo

Keyword(s):

Pediatric Patients ◽

Symptomatic Relief ◽

Iminodiacetic Acid ◽

Study Patient ◽

Biliary Colic ◽

Hida Scan ◽

Postoperative Symptoms ◽

Low Ejection Fraction ◽

Gallbladder Removal

Cholecystectomy may benefit children with biliary colic without stones on ultrasound (US) or low ejection fraction on cholecystokinin-hepatobiliary iminodiacetic acid (CCK-HIDA) scan. Children with symptomatic biliary colic and abnormal HIDA scan, specifically those with high ejection fractions, may benefit from cholecystectomy. All patients younger than 18 years old undergoing cholecystectomy from 2008 to 2012 in our practice were reviewed. Patients with a negative US and CCK-HIDA ejection fractions 80 per cent or greater were included in the study. Patient data were extracted from charts, whereas postoperative symptoms were obtained by phone interviews. Of 174 patients who underwent cholecystectomy, 12 (7%) met study criteria. All patients (12 of 12) had evidence of cholecystitis on the final pathology note. All 11 patients contacted had relief of colic after gallbladder removal with a mean follow-up of 16 months. A subset of pediatric patients with high ejection fractions on CCK-HIDA and symptomatic biliary colic may have symptomatic relief with cholecystectomy.

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Spontaneous Biliary Pericardial Tamponade: A Case Report and Literature Review

Current Cardiology Reviews ◽

10.2174/1573403x16666200611132045 ◽

2020 ◽

Vol 16 ◽

Author(s):

Ayman Battisha ◽

Ahmed M Altibi ◽

Bader Madoukh ◽

Omar Sheikh ◽

Khalid Sawalha ◽

...

Keyword(s):

Literature Review ◽

Iminodiacetic Acid ◽

Pericardial Tamponade ◽

Biliary Fistula ◽

Pericardial Fluid ◽

Rare Form ◽

Pericardial Space ◽

Hida Scan ◽

First Case ◽

Hispanic Male

Background: Biliary pericardial tamponade (BPT) is a rare form of pericardial tamponade, characterized by yellowish-greenish pericardial fluid upon pericardiocentesis. Historically, BPT reported to occur in the setting of an associated pericardio-biliary fistula. However, BPT in the absence of a detectable fistula is extremely rare. Case Presentation: A 75-year-old Hispanic male presenting with dyspnea and diagnosed with cardiac tamponade. Subsequent pericardiocentesis revealed biliary pericardial fluid (bilirubin of 7.6 mg/dl). Patient underwent extensive workup to identify a potential fistula between hepatobiliary system and the pericardial space, which was non-revealing. The mechanism of bile entry into the pericardial space remains to be unidentified. Literature Review: A total of six previously published BPT were identified: all were males, mean age of 53.3 years (range: 31-73). Mortality was reported in two out of the six cases. The underlying etiology for pericardial tamponade varied across the cases: incidental pericardio-biliary fistula, traumatic pericardial injury, and presence of associated malignancy. Conclusion: Biliary pericardial tamponade is a rare form of tamponade that warrants a prompt workup (e.g., Hepatobiliary Iminodiacetic Acid – HIDA scan) for an iatrogenic vs. traumatic pericardio-biliary fistula. As a first case in the literature, our case exhibits a biliary tamponade in the absence of an identifiable fistula.

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Optimal Management of the Hyperkinetic Gallbladder: A Comparison of Outcomes Between Operative and Nonoperative Approaches

The American Surgeon ◽

10.1177/0003134820966283 ◽

2020 ◽

pp. 000313482096628

Author(s):

Michael L. Williford ◽

Katherine T. Fay ◽

Francis J. Simpson ◽

Ann M. Defnet ◽

David M. Schuster ◽

...

Keyword(s):

Gallbladder Disease ◽

Iminodiacetic Acid ◽

Emergency Department Visits ◽

Symptom Improvement ◽

Optimal Management ◽

Hida Scan ◽

Symptom Profile ◽

Institutional Review ◽

Current Symptom ◽

Surgical History

Background A hyperkinetic gallbladder is defined as a hepatobiliary iminodiacetic acid (HIDA) scan ejection fraction (EF) of >80%. This condition is poorly described, and there is no current consensus on optimal management. The intent of this study was to determine if cholecystectomy improves symptoms in patients with a hyperkinetic gallbladder when compared to those managed nonoperatively and if there were variables predictive of symptom improvement with or without cholecystectomy. Materials and Methods This retrospective study included patients from 3 academic hospitals in the Atlanta metro area between the years 2006 and 2018. All patients with an EF >80% were included. Following voluntary exclusion patients were contacted by phone. Each patient was administered a questionnaire regarding their surgical history, medical management, and current symptom profile via Otago score. Institutional Institutional Review Board approval was obtained. Results 4785 HIDA scans were performed, and 194 reported an EF >80% (incidence 15.7%). 96% of these scans were reported as normal by the radiologist. 68 patients were able to be contacted by phone and completed the questionnaire. 18 patients underwent cholecystectomy, and 89% reported that their symptoms attributed to gallbladder disease were no longer present. 50 patients did not undergo cholecystectomy, and alternate diagnoses, medication prescriptions, diet modification, emergency department visits, and Otago score were higher in this cohort. Discussion Patients who undergo cholecystectomy for a diagnosis of hyperkinetic gallbladder, on average, report improvement in symptoms when compared to patients managed nonoperatively. This study supports the practice of reporting and managing hyperkinetic gallbladders as a pathologic entity.

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Gallbladder Ejection Fraction Declines with Age in Patients Undergoing Cholecystectomy for Acalculous Biliary Symptoms But Has Low Accuracy in the Prediction of Gallbladder Pathology

Digestive Surgery ◽

10.1159/000371455 ◽

2015 ◽

Vol 32 (1) ◽

pp. 68-72 ◽

Cited By ~ 1

Author(s):

Aled Jones ◽

Golnaz Shahtahmassebi ◽

David Stell

Keyword(s):

Ejection Fraction ◽

Predictive Accuracy ◽

Normal Values ◽

Normal Population ◽

Iminodiacetic Acid ◽

Biliary Colic ◽

Roc Curve Analysis ◽

Chi Square ◽

Gallbladder Ejection Fraction ◽

Hida Scan

Background/Aims: Hepatobiliary Iminodiacetic Acid (HIDA) scan provides a technique to quantify gallbladder ejection fraction (EF) in patients suffering acalculous biliary colic (ACBC). We wished to evaluate the accuracy of EF in the prediction of gallbladder pathology in patients undergoing cholecystectomy. Methods: Data were retrieved from a database of patients referred for HIDA scan for ACBC, including EF and the pathological outcome of those undergoing cholecystectomy, and compared to normal values obtained from a review of related studies. Significant associations were demonstrated by chi-square, Mann-Whitney test, and linear regression. The predictive accuracy of different cut-offs of EF was demonstrated by the ROC curve analysis. Results: Of 83 patients referred for HIDA scan for ACBC, 41 underwent cholecystectomy. The median EF of this group (33%) was significantly lower than the composite normal median value from previous studies (56%). Thirty-two patients revealed evidence of gallbladder pathology. The EF declined with age (coefficient = -0.51, 95% CI = -0.99 to -0.33), but the median value did not differ between those with gallbladder pathology (34%) and those with normal gallbladders (29%). Conclusion/Discussion: Although an EF cut-off of 35% had the greatest accuracy in the prediction of pathology of those tested (0.56), the poor negative predictive value (23.5%) was a major contributor to its low accuracy. Although patients with ACBC have reduced gallbladder EF compared to the normal population, its quantitative assessment is of limited value in the prediction of gallbladder pathology.

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False Negative Hepatobiliary Iminodiacetic Acid (HIDA) Scan in a Case of Gall Bladder Perforation

Cureus ◽

10.7759/cureus.14247 ◽

2021 ◽

Author(s):

Ramakanth Pata ◽

Shristi Lamichhane ◽

Nirajan Regmi ◽

Abolfazl Ahmady ◽

Roudabeh Kiani

Keyword(s):

Gall Bladder ◽

False Negative ◽

Iminodiacetic Acid ◽

Bladder Perforation ◽

Hida Scan

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Communications problems affecting patient care in hospitals

JAMA ◽

10.1001/jama.195.1.36 ◽

1966 ◽

Vol 195 (1) ◽

pp. 36-37 ◽

Cited By ~ 3

Author(s):

J. C. Quint

Keyword(s):

Patient Care

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Pit and fissure sealant in individual patient care programs

Journal of Dental Education ◽

10.1002/j.0022-0337.1984.48.2.tb01753.x ◽

1984 ◽

Vol 48 (2) ◽

pp. 42-44

Author(s):

RJ Simonsen

Keyword(s):

Patient Care ◽

Fissure Sealant ◽

Pit And Fissure Sealant

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Teletinnitus Program at the VA Gulf Coast Veterans Health Care System

Perspectives on Telepractice ◽

10.1044/teles4.1.23 ◽

2014 ◽

Vol 4 (1) ◽

pp. 23-29

Author(s):

Constance Hilory Tomberlin

Keyword(s):

Health Care ◽

Patient Satisfaction ◽

Patient Care ◽

Health Care System ◽

Gulf Coast ◽

New Technology ◽

Cost Effective ◽

Veterans Health ◽

Potential Benefits ◽

Care System

There are a multitude of reasons that a teletinnitus program can be beneficial, not only to the patients, but also within the hospital and audiology department. The ability to use technology for the purpose of tinnitus management allows for improved appointment access for all patients, especially those who live at a distance, has been shown to be more cost effective when the patients travel is otherwise monetarily compensated, and allows for multiple patient's to be seen in the same time slots, allowing for greater access to the clinic for the patients wishing to be seen in-house. There is also the patient's excitement in being part of a new technology-based program. The Gulf Coast Veterans Health Care System (GCVHCS) saw the potential benefits of incorporating a teletinnitus program and began implementation in 2013. There were a few hurdles to work through during the beginning organizational process and the initial execution of the program. Since the establishment of the Teletinnitus program, the GCVHCS has seen an enhancement in patient care, reduction in travel compensation, improvement in clinic utilization, clinic availability, the genuine excitement of the use of a new healthcare media amongst staff and patients, and overall patient satisfaction.

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