Synonym/Acronym
Liver and spleen scintigraphy, radionuclide liver scan, spleen scan.
Rationale
To visualize and assess the liver and spleen related to tumors, inflammation, cysts, abscess, trauma, and portal hypertension.
Patient Preparation
There are no food, fluid, activity, or medication restrictions unless by medical direction. No other radionuclide tests should be scheduled within 24 to 48 hr before this procedure. Protocols may vary among facilities.
Normal Findings
- Normal size, contour, position, and function of the liver and spleen.
Study type: Nuclear scan; related body system: Digestive system.
The liver and spleen scan is performed to help diagnose abnormalities in the function and structure of the liver and spleen. It is often performed in combination with lung scanning to help diagnose masses or inflammation in the diaphragmatic area. This procedure is useful for evaluating right-upper-quadrant pain, metastatic disease, jaundice, cirrhosis, ascites, traumatic infarction, and radiation-induced organ cellular necrosis. Technetium-99m (Tc-99m) sulfur colloid is injected by IV access and rapidly taken up through phagocytosis by the reticuloendothelial cells, which normally function to remove particulate matter, including radioactive colloids in the liver and spleen. Radionuclide uptake in the spleen should always be less than uptake in the liver. False-negative results may occur in patients with space-occupying lesions that prevent normal hepatic filling (e.g., tumors, cysts, abscesses) smaller than 2 cm. For evaluation of a suspected hemangioma, the most common benign cause of a hepatic filling defect, the patient’s red blood cells are combined with Tc-99m and images are recorded of the liver. This scan can detect portal hypertension, demonstrated by a greater uptake of the radionuclide in the spleen than in the liver.
Liver and spleen scans are generally being ordered with less frequency and are in some cases being replaced by more advanced technology, including computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US), and single-photon emission computed tomography (SPECT) scans. SPECT has significantly improved the resolution and accuracy of liver scanning. SPECT enables images to be recorded from multiple angles around the body and reconstructed by a computer to produce images, or slices, representing the organ at different levels. Diagnostic test results are interpreted in light of the results of liver function tests (ALT, Alb, Alp, AST, Tbil, TP). Liver scans are also used to assist with tumor staging, monitor disease progress, and follow response to therapeutic interventions.
Contraindications
Pregnancy is a general contraindication to procedures involving radiation.
Factors That May Alter the Results of the Study
- The scan may fail to detect focal lesions smaller than 2 cm in diameter.
- Metallic objects (e.g., jewelry, body rings) within the examination field, other nuclear scans done within the previous 24 to 48 hr, or retained barium from a previous radiological procedure, which may inhibit organ visualization and cause unclear images.
- Improper injection of the radionuclide that allows the tracer to seep deep into the muscle tissue can produce erroneous hot spots.
- Inability of the patient to cooperate or remain still during the procedure because movement can produce blurred or otherwise unclear images.
Abnormal Findings Related to
The radioactive tracer accumulates in abnormal tissue, and “hot spots” identify specific areas of concern. “Cold spots,” or the absence of tracer in areas where uptake is expected, also can identify specific areas of concern. Images can identify abnormalities in anatomical structures with regard to size, shape, and function (e.g., unexpected cold spots may inform with regard to dysfunctional tissue, filling defects).
- Abscesses
- Cirrhosis
- Cysts
- Hemangiomas(evidenced by immediate uptake of the radionuclide by the filling defect)
- Hematomas
- Hepatitis
- Hodgkin disease
- Infarction
- Infection
- Infiltrative process (amyloidosis and sarcoidosis)
- Inflammation of the diaphragmatic area
- Metastatic tumors
- Nodular hyperplasia
- Portal hypertension (related to a reversal in the radionuclide uptake ratio [liver to spleen], which indicates a reversal in blood flow as a result of portal hypertension)
- Primary benign or malignant tumors
- Traumatic lesions
Potential Nursing Problems: Assessment & Nursing Diagnosis
| Problems | Signs and Symptoms |
|---|
| Fluid volume (excess—related to changes in portal pressure, low albumin, imbalanced aldosterone) | Visual notation of increased abdominal girth, edema, shortness of breath, tachycardia, hypertension, positive jugular vein distention, electrolyte imbalance (potassium, sodium) | | Nutrition(insufficient—related to pain, nausea, vomiting, inadequate metabolic function) | Self-report of pain, nausea, vomiting, refusal to eat | | Pain (related to inflammation, distention, obstruction, infection, infarction, tumor, trauma) | Self-report of pain, facial grimace, crying, moaning, elevated heart rate, elevated blood pressure |
|
Before the Study: Planning and Implementation
Teaching the Patient What to Expect
- Discuss how this procedure can assist in evaluating liver and spleen function.
- Explain that the procedure takes about 30 to 60 min and is performed in a nuclear medicine department.
- Review the procedure with the patient.
- Explain that pregnancy testing may be required.
- Discuss how there may be moments of discomfort or pain when the IV line is inserted, allowing for infusion of fluids such as saline, anesthetics, sedatives, medications used in the procedure, or emergency medications.
- Reassure the patient that the radionuclide poses no radioactive hazard and rarely produces adverse effects.
Procedural Information
- Policies regarding breastfeeding before and after an imaging procedure may vary among facilities. For additional information see Appendix A: Patient Preparation and Specimen Collection, subsection: Potential Contraindications and Complications Associated with Diagnostic Procedures.
- Baseline vital signs will be recorded and monitored throughout the procedure.
- Positioning for the procedure is in a supine position on a flat table with foam wedges to help maintain position and immobilization.
- IV radionuclide is administered and the abdomen is scanned immediately to screen for vascular lesions with images taken in various positions.
- Once the study is completed, the needle or catheter will be removed and a pressure dressing applied over the puncture site.
- The patient may be imaged by SPECT techniques to further clarify areas of suspicious radionuclide localization.
Potential Nursing Actions
Make sure a written and informed consent has been signed prior to the procedure and before administering any medications.
After the Study: Implementation & Evaluation Potential Nursing Actions
Avoiding Complications
- Monitor the patient for complications related to the procedure.
- Establishing an IV site and injection of radionuclides are invasive procedures that can cause rare complications. For additional information see Appendix A: Patient Preparation and Specimen Collection, subsection: Potential Contraindications and Complications Associated with Diagnostic Procedures.
- Explain the importance of immediately reporting symptoms such as fast heart rate, difficulty breathing, skin rash, itching, or chest pain.
- Observe/assess the needle insertion site for bleeding, inflammation, or hematoma formation.
Treatment Considerations
- Follow postprocedure vital sign and assessment protocol.
- Explain that the radionuclide is eliminated from the body within 6 to 24 hr.
- Advise drinking increased amounts of fluids for 24 to 48 hr to eliminate the radionuclide from the body, unless contraindicated.
- Resume usual medication and activity, as directed by the HCP.
Fluid Volume-excess
- Monitor fluid and electrolytes, heart rate, blood pressure, and perform a daily weight.
- Consider a low-sodium diet.
- Administer ordered diuretics and evaluate urinary output response.
- Institute fluid restrictions.
- Administer ordered antihypertensives and spironolactone.
- Consider the use of an abdominal binder for support.
- Monitor for symptoms of fluid overload: shortness of breath, increasing weight, decreased Hgb and Hct without blood loss.
- Trend laboratory values that reflect alterations in fluid status: K+, BUN, Cr, Ca, Hgb, and Hct.
- Perform accurate intake and output; perform and record daily weight.
Nutrition
- Complete a culturally appropriate nutritional assessment.
- Monitor and trend specific laboratory studies: lipase, amylase, Alb, TP, electrolytes, glucose, Ca, iron, and folic acid.
- Administer ordered IV fluids with supplements such as electrolytes as well as ordered antiemetics and antacids.
- Facilitate a dietary consult and administer ordered dietary supplements.
Pain
- Assess pain character, location, duration, and intensity using an easily understood pain rating scale.
- Place the patient in a position of comfort and administer ordered medications: analgesics, narcotics, and anti-inflammatory.
- Consider alternative measures for pain management (imagery, relaxation, music, etc.).
- Instruct the patient in the care and assessment of the injection site.
- Explain that application of cold compresses to the puncture site may reduce discomfort or edema.
Safety Considerations
- Refer to organizational policy for additional precautions that may include instructions on temporary suspension of breastfeeding, hand washing, toilet flushing, limited contact with others, and other aspects of nuclear medicine safety.
Nutritional Considerations
- A low-fat, low-cholesterol, and low-sodium diet should be consumed to reduce current disease processes.
- High fat consumption increases the amount of bile acids in the colon and should be avoided.
- Discuss the benefit of small frequent meals toward nutritional health.
Clinical Judgement
- Consider how to get buy-in for lifestyle changes that can improve liver and spleen health.
Follow-Up and Desired Outcomes
- Recognizes the importance of adequate caloric intake for positive health as well as the value of taking dietary supplements.