Specalist Radiographic Imaging - Case Study Example

Specialist radiographic imaging Introduction Radiographic imaging has emerged as the most predominant form of investigating diseases, due to the efficiency associated with the use of electromagnetic radiation in viewing the inner parts of the body (Bellows, Berger & Crass, 2005). This technology has been adapted in place of the use of visible light technology that was traditionally applied, which has proven ineffective in displaying the clarity of the internal organs’ details. There are different strategies that are applied under radiographic imaging, and their suitability is highly dependent on the nature of the disease that is being investigated. In this analysis, the case of a 68 years old male with jaundice and a history of pain in the upper right quadrant is under investigation. The patient also has a history of colonic cancer. The subsequent liver tests undertaken on the patient are deranged, thus unable to give a clear indication of the decease the patient is suffering from. Nonetheless, based on the initial symptoms as seen in the patient, the patient will be diagnosed with Cholelithiasis (Gallstones). Thus, the focus of this essay is to determine the most suitable imaging strategy applicable for diagnosing this patient, which will also entail the evaluation of the appropriate diagnosis procedure and the applicable disease management measures. Epidemiology The patient undergoing disease investigation and treatment in this case is a 68 year old male. The symptoms that have been demonstrated by the patient are jaundice and pain in the upper quadrant of the right hand. Jaundice refers to a yellowish discoloration that is observable on the skin, the white of the eyes and on the mucous membranes (Goresky & Fisher, 1975). Jaundice is caused by an elevated level of bilirubin in the blood, and is by itself not considered to be a disease per se. Thus, jaundice is a visible sign of another underlying disease process (Bateson, 1986). Most especially, jaundice is a disease that is associated with children and very rare with adults. Therefore, when jaundice appears in adults, it might indicate the presence of another threatening and potentially fatal health condition (Khan, Alcorn & Hanson, 2014). In adults, jaundice is caused by medical conditions that alter either the normal metabolism or the excretion of bilirubin, causing the dysfunction of these processes. Some of the major diseases associated with the dysfunction f the metabolism or the excretion of bilirubin includes pancreatic cancer, intensive liver parasite infection, for example fluke infection and Gallstones (Laddi, Kumar, Sharma & Kumar, 2013). However, the fact that one of the symptoms that are depicted by the patient in under evaluation is pain in the right upper quadrant, the diagnosis therefore points to the causes of jaundice having its origin from the bile transmission process (Taylor, Stapley & Hamilton, 2012). Pain in the right upper quadrant is usually caused by the blockage of the bile from flowing out of the gallbladder, with the possible blockage being as a result of gallstones (Taylor, Stapley & Hamilton, 2012). Therefore, the initial assessment of the patient has resulted in the patient being diagnosed with gallstones. Gallstones refer to the stones that are formed in the bile ducts of the gallbladder (NICE, 2014). The gallstones rarely cause any symptoms other than for the abdominal pain normally experienced in the right upper quadrant. However, some of the most common complications associated with gallstones are pancreatitis and jaundice (Weerakoon, et al., 2014). Gallstone is a common disease occurring among the Americans, affecting between 10 and 15% of the USA population, which translates to well over 25 million people (Vuppalanchi, Liangpunsakul & Chalasani, 2007). In the USA, nearly 1 million new cases of gallstones are diagnosed each year, with approximately 250,000 new cases of gallstones each year requiring treatment (Vuppalanchi, Liangpunsakul & Chalasani, 2007). Women are at a higher risk of suffering from gallstones, where the prevalence of gallstones is twice as much in women than in men. The prevalence of gallstones for women of the age between 20 and 55 years in the USA is 5–20%, but this risk increases with age, where above the age of 50 years, women have a risk of 25%-30% (Vuppalanchi, Liangpunsakul & Chalasani, 2007). Pregnant women above the age of 20 years are mostly affected by gallstones (Farrell & Turner, 2015). The prevalence of gallstones for men also increases with the increase in age, where individuals above the age of 40 years are at a risk of suffering gallstones, but those above the age of 60 years are at an even higher risk (Chen, Chiou, Lin & Lin, 2014). Diagnosis The first and primary test of gallstones is the liver blood tests, which investigates the flow of bile from the river, and assess whether the bile ducts may have been blocked and bile may have backed up into the liver (Jia, et al., 2014). A high content of bile in the river may indicate the presence of gallstones. The other diagnosis procedure for gallstones is the use of ultrasound. The abdominal ultrasound is the method mostly used to determine the presence of gallstones, and it is approximately 95% accurate (Pagliarulo, et al., 2004). This radiographic imaging modality applies a special instrument that is used to bounce back sound waves against had objects like gallstones (Pagliarulo, et al., 2004). Nevertheless, the limitation of this imaging strategy is that it is not accurate in indicating whether a stone has flowed out of the gallbladder into the bile duct (Thomas & Fuller, 2009). Endoscopic retrograde cholangiopancreatography (ERCP) is another radiographic imaging modality used in the diagnosis and also therapy of gallstones (Clavien & Baillie, 2006). The ECRP combines both endoscopy and fluoroscopy, allowing the physician to use the endoscope to see the inside of the abdomen, and then use fluoroscopy to radiographic contrast into the bile ducts and have the images seen radiographs (Clavien & Baillie, 2006). While this method can give an accurate diagnosis, its application is limited by the fact that it is more invasive and thus less adapted for diagnosis (Wang, Liu, Clegg & Portincasa 2009). Nuclear Medicine/HIDA scan is yet another method applied in the diagnosis of gallstones, through the process of injecting a radioactive tracer into the veins flowing into the liver, to have the tracer taken up and excreted by the liver or eliminated into the bile (NICE, 2014). The Nuclear Medicine/HIDA scan is a more accurate method of diagnosing gallstones, since it helps to tell whether the stones are present, while at the same time telling whether the stones have moved to the bile ducts (Farrell & Turner, 2015). Further, this method has less serious side effects, which may include allergic reactions to radio-active tracers, bruising the injection point and development of some rashes (Farrell & Turner, 2015). The NICE guidelines recommends the use of liver blood test and ultrasound scans as the most preferable method based on the costs, risks and invasion considerations, while the other methods should be applied if the two have not given desirable results (NICE, 2014). Treatment The treatment of gallstones is unnecessary, when they are causing no symptoms (Abrahamsson, 1995). However, certain gallstone condition may require treatment (Swobodnik, Ditschuneit & Soloway, 1990). CT scans can be applied to give a detailed structure of the gallstones, bile ducts and the liver during treatment, but it is less accurate in producing finer details (Brooks, 2009). The MRI) scans can give clearer details, due to its ability to differentiate between normal and diseased tissues (Johnston & Kaplan, 1993). However, the PET is even better, since it does not give an image of the structure of the inside organs but that of molecular movements, thus more capable of differentiating between normal and abnormal cells, and also between the live and dead components in the gall bladder (Wittenburg & Lammert, 2007). Cholecystectomy is a common treatment method that entails a surgical removal of the gallbladder (Bellows, Berger & Crass, 2005). This method is effective because once done correctly, it causes no further problems. However, the method is limited by its procedural timing requirements (Capocaccia, 1984). Endoscopic retrograde cholangiopancreatography (ERCP) is also a therapeutic method used in the treatment of gallstones, through opening wide the able duct and pulling out the gallstones into the intestines, where they are subsequently removed (Farrell & Turner, 2015). The method is the most appropriate, since it both less costly and highly effective at all stages of treatment. NICE guidelines recommend non-treatment for asymptomatic gallstones and the use of ECRP where treatment is necessary, since this method is both clinically and cost effective (NICE, 2014). Follow-up CT scans and MRI can be applied as follow-up modalities after the treatment of gallstones. CT scans are quicker, but limited by the lack of clarity of the finer detains in their radiographic image (Sherlock, 2002). On the other hand MRI scan are suitable for offering finer details and clarity, including detecting any abnormalities after the treatment (Adler, 2004). Conclusion The probable diagnosis of the 68 year old male patient based on the initial symptoms sis points to the patient suffering from gallstones. Various diagnostic modalities are available for this assessment, but the Medicine/HIDA scan is most suitable due to its high level of accuracy and low-related risks. Treatment for gallstones is not necessary if it is asymptomatic. However, endoscopic retrograde cholangiopancreatography (ERCP) is recommended for treatment, since it is more effective. References Abrahamsson, H. (1995). Gastrointestinal motility disorders in patients with diabetes mellitus. J Intern Med 237, 403–409. Adler, G. (2004). Gallstones: Pathogenesis and treatment : proceedings of the Falk Symposium 139 held in Freiburg, Germany, January 15-16, 2004. Dordrecht: Kluwer Academic. Bateson, M. C. (1986). Gallstone Disease and its Management. Dordrecht: Springer Netherlands. Bellows, C., Berger, D. & Crass, R. (2005). Management of Gallstones. 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