intravenous pylography procedure
IVP which is also done by intravenous pylography. In this series of X-ray radiographs of Kidney, ureters and Bladder system are taken.
Indication
This is done to detect the suspected pathology of the urinary tract, it is also used to detect the functioning of the kidney. Kidney stone and hydronephrosis are detected by this.
Contraindications
In this, with the help of a catheter, the contrast media is injected into the patient's vein, sometimes the contrast media becomes allergic to the patient. So if the patient is allergic to water soluble contrast media, this test is not done.
Although the overall rate of these adsorption reactions is low.
IVP test of pregnant women is not done, as it uses non-ionic radiation, X Rage, which is harmful to unborn baby. IVP test of a patient who is known kidney disease or kidney spread is not done. Because contrast media can cause kidney function to deteriorate.
Elderly patients and patients who are suffering from diabetes, high blood pressure, heart disease, or are in a state of patient dehydration, are prone to kidney failure due to contrast media.
To prevent contrast media compaction, the patient is asked to undergo some blood tests of urea, creatine, to check kidney function.
And their values are compared with the normal range.
Patients suffering from diabetes who are taking metformin are asked to stop taking metformin 2 days before the examination and 2 days after the examination.
CONTRAST MEDIA
HOCM or LOCM 370 contrast media are used in this.
But the following high risk groups are ensured that they receive only LOCM contrast media - Infant Small Children and Elderly Patients.
Patients who are renal or cardiac failure.
Poorly Hydrated Patients
Patients with diabetes, myelometosis, sickle cell anemia.
Patients who have previously had severe contrast medium reaction or a strong allergic history from LOCM. Adult is given intravenously at 50ml and 1ml of contrast media for children.
Patient Preparation
This procedure can be done on an emergency procedure or on an outpatient basis.
But in most of the cases it is done on an emergency basis, because the patient brings a complex of abdomen and back pain.
In these circumstances this test is done without any bowl preparation.
In the outpatient procedure, the patient is forbidden to eat anything 5 hours before the examination.
The patient is kept ambulant 2 hours before the examination, so that the bowl gas can be reduced.
If the patient is already allergic to severe contrast media, orally methyl prednisolone 32 mg is given 2 hours before the 12 hours after the examination.
And then contrast media is injected.
Preliminary Film
For this, anti-poster image of supine full length abdomen is taken.
The cassette or image receptor is placed at the lower level of the symphysis pubis.
And the X-ray beam is placed at the midline at the iliac crist level.
If the radiograph is found to be satisfactory, then the procedure is continued further.
Technique
The patient is placed supine on the X-ray table. With the help of 19 G Needle, the contrast media is inserted in the form of Rapidly Walls in Anti Cubital Van.
During this period, the stasis of the contrast media in the van may cause a pen in the upper arm or solder, which goes away from the abduction of the arm.
Films
In this, several radiographs are taken at different time intervals which are as follows-
Immediate Film
It is an anti-poster film of the renal area. The film is exposed after 10 to 14 seconds on reaching the kidney from the arm of the contrast media.
The film is taken to view the nephrogram.
During this time the contrast media is in the renal tubules, which makes the renal parenchyma opacified.
5 minute film
This is also an anti-poster film of the renal area.
The film is taken 5 minutes after the contrast media administration, in this film it is seen whether the excretion is symmetrical or not.
After this a compression band is tied around the abdomen of the patient, and the balloon of the band is placed in the middle of the anterior superior iliac spine.
This compression band compresses the ureters in the pelvic brim.
If a recent abdominal surgery is performed,
Or have a romantic romance,
If there is a large abdominal mass, the compression band is not tied.
Compression bands do not apply even if the calyces appear distanced in a 5 minute film.
15 minute film
It is also an antero-posterior film of the renal area, in which the distended pelvic calyceal system is seen. The compression band is removed when satisfactory film is obtained.
Release film
This film is taken after the release of Compression Band.
This suppine is the anti-poster image of full length abdomen.
It is also called pre void film.
Upon receiving this film satisfactory, the patient is asked to evacuate the bladder.
After micturition film
It is also called post void film.
Depending on the clinical and abdominal finding of the earlier film, the film may be a full-length abdominal or bladder coned view film. In this, the tube is given a 15 degree codal angle,
And the centering symphysis is placed 5 cm above the pubis.
The film describes Blader's emptying capacity.
It is taken to diagnose blood tumor and ureteroveseal junction.
The 35 degree posterior oblique film of kidney ureter bladder is taken as an additional film.
If only one kidney appears in the image, then 4 hour, 12 hour, and 24 hour films are also taken. After the procedure, the radiologist reviews the film.
