Diseases of the Stomach and Patient Assessments

Abstract

Diseases and conditions that affect organs, vessels, and tissues of the abdomen may be difficult to diagnose due to the complex anatomical structure of this area. However, many diseases of the abdomen can be life-threatening, and thus, timely diagnostics is essential. The present paper focuses on explaining the value of X-ray radiography and patient assessments in the diagnostics of conditions affecting the abdominal area. The analysis focused on three conditions: nephrocalcinosis, peritonitis, and renal artery stenosis, which allowed examining the diverse applications of X-ray imaging and patient assessments. Based on the information gathered from scholarly research, these diagnostic methods are vital because they help to establish the source, localization, and degree of the condition.

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Introduction

X-ray radiography and patient assessments have a primary role in the diagnostics of diseases of the abdominal area since they help to determine the localization and source. The purpose of the paper is to explore the role of X-ray imaging and patient assessment in diagnosing diseases in the abdominal area. In particular, the paper will focus on nephrocalcinosis, peritonitis, and renal artery stenosis. These conditions can have a significant impact on a person’s health and wellbeing, which is why timely diagnosis is necessary. The use of appropriate assessment methods is crucial to starting treatment promptly and preventing dangerous complications. Hence, it is important for care providers to understand the nature of these diseases, as well as the procedures required for diagnosing them in patients.

Nephrocalcinosis

Nephrocalcinosis refers to “the generalized deposition of calcium oxalate (CaOx) or calcium phosphate (CaPi) in the kidney” (Shavit, Jaeger, & Unwin, 2015). The same term can also be used to describe the interstitial deposition of CaOx and CaPi (Shavit et al., 2015). There are three recognized types of CaOx and CaPi deposition, depending on the degree of severity: molecular or chemical, microscopic, and macroscopic. The term nephrocalcinosis usually refers to the macroscopic type, when the deposition is visible on the X-ray (Oliveira, Kleta, Bockenhauer, & Walsh, 2016). Nephrocalcinosis is connected with many disorders and conditions, including distal renal tubular acidosis (RTA), autonomous hyperparathyroidism, and medullary sponge kidney (MSK) (Shavit et al., 2015).

When nephrocalcinosis is suspected, the patient assessment includes questions about the symptoms and the general health condition. This information is necessary to determine the severity of the condition, its impact on kidney function, and the possible causes of calcium deposition. For example, symptoms such as renal colic, hematuria, and fever may indicate the severe stage of calcium deposition or the associated chronic kidney failure (Oliveira et al., 2016).

Questions about the patient’s general health condition can also highlight the possibility of nephrocalcinosis by identifying health conditions that are known to increase calcium in blood or urine (Shavit et al., 2015). However, imaging remains the most important aspect of nephrocalcinosis diagnostics since it provides a clear picture of the condition, its localization, and scale. Usually, computer tomography, ultrasound, and X-ray are used in the diagnostics of nephrocalcinosis (Oliviera et al., 2016).

The sensitivity of plain radiography to calcium formations is estimated to be between 66 and 82 percent, which provides a sufficient level of certainty in most cases (Oliviera et al., 2016). However, when a CT scan is possible, it should be prioritized due to the higher sensitivity level of 86-92% (Oliviera et al., 2016). Overall, patient assessment can help care providers identify nephrocalcinosis as a possible diagnosis, whereas X-ray imaging is used for confirmation and provides more specific information.

Peritonitis

Peritonitis is an inflammation of the peritoneum, which is usually associated with an infection. There are three different types of peritonitis: primary, secondary, and tertiary (Mishra, Tiwary, Mishra, & Gupta, 2014). Primary peritonitis usually develops as a result of spontaneous bacterial peritonitis and is rare and poorly studied (Mishra et al., 2014). Secondary peritonitis is the most common type, which results from “hollow viscus perforation, anastomotic leak, ischemic necrosis, or other injuries of the gastrointestinal tract” (Mishra et al., 2014, p. 121).

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Lastly, tertiary peritonitis is the return of inflammation after adequate treatment of secondary peritonitis. According to Mishra et al. (2014), peritonitis is among the most common diagnoses in surgical intensive care, and it has dangerous consequences, including sepsis. The fast treatment of peritonitis and its source is necessary to save the patient’s life, and prompt diagnosis is thus vital.

Due to the varying causes and types of peritonitis, it is essential for doctors to determine the possible source of peritonitis prior to surgery. Hence, as part of patient assessment, is it crucial for doctors to ask questions about the patient’s symptoms. In particular, patient assessment is usually focused on pain evaluation. The information about the onset, frequency, duration, size, and character of pain, as well as about various aggravating or relieving factors, can provide doctors with more information on the possible cause of inflammation (Shukla, Bharti, Chaudhary, & Sharma, 2015).

The role of radiography is also crucial since it allows surgeons to determine the presence of gas, bowel fluid levels, localized ileus, appendicitis fecolith, pancreatic calcifications, and pneumoperitoneum (Shukla et al., 2015). This information is essential for determining the source of peritonitis and developing a treatment strategy. Without patient assessment and X-ray images, surgeons could fail to either diagnose peritonitis or determine its cause, resulting in ineffective treatment and an increased risk of complications.

Renal Artery Stenosis

Renal artery stenosis is another condition that relies on a type of X-ray imaging for diagnostics and treatment. According to the definition by Weber and Dieter (2014), renal artery stenosis “is a general term that refers to any vascular lesion causing narrowing of the renal artery thereby impairing blood flow to the kidney” (p. 169). The two most common patterns of renal artery stenosis development are fibromuscular dysplasia (FMD) and atherosclerotic renal artery disease, with the latter accounting for the vast majority of cases (Weber & Dieter, 2014). If left untreated, RAS can lead to hypertension, ischemic nephropathy, destabilizing cardiac syndromes, and pulmonary edema (Weber & Dieter, 2014). Hence, prompt diagnostics and treatment are necessary for improving patients’ health and wellbeing and preventing complications.

In order to suggest a diagnosis of renal artery stenosis, it is crucial for care providers to collect information about the patient’s general health. This is because, in many cases, renal artery stenosis does not produce any specific symptoms that patients would note to their doctor or nurse (Weber & Dieter, 2014). The most important questions for identifying the possibility of renal artery stenosis are those about blood pressure and fluid retention. Any unexplained deviations from the norm in these two variables can indicate the possibility of renal artery stenosis and the need for further examination (Weber & Dieter, 2014).

The diagnosis of renal artery stenosis relies on various methods of imaging, including X-ray imaging. First of all, computed tomographic angiography (CTA) is a type of imaging that uses the projections of X-rays to create an accurate representation of vessel structure (Weber & Dieter, 2014). This method of diagnostics is recommended by the American College of Cardiology and the American Heart Association as the first-line diagnostic measure. Another method of diagnostics that uses X-rays is X-ray densitometry, which is used in conjunction with angiography to allow for stenosis grading (Schäberle, Leyerer, Schierling, & Pfister, 2016).

A combination of the two methods provides for a more accurate diagnosis, thus supporting treatment decisions. Overall, patient assessment and X-ray imaging are both essential for establishing the diagnosis of renal artery stenosis.

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Conclusion

Based on the analysis, the information obtained from research supports the thesis, showing that radiography and patient assessments have a primary role in the diagnostics of diseases of the abdominal area since they help to determine the localization and source. Although only three diseases were considered, a common theme that emerged in the analysis is the importance of identifying the source of symptoms.

Indeed, conditions that affect abdominal organs, vessels, or tissues may be hard to diagnose due to the multitude of possible causes. As explained in the body of the paper, patient assessment is the first step in narrowing down the possible diagnosis because it involves asking questions about pain characteristics and other relevant symptoms. Additionally, the use of X-ray imaging is highly beneficial because it provides accurate information about the structure of the affected area, thus enabling care providers to determine the source of the condition. On the whole, the paper fulfilled the identified purpose and presented support for the thesis based on scholarly research.

References

Mishra, S. P., Tiwary, S. K., Mishra, M., & Gupta, S. K. (2014). An introduction of tertiary peritonitis. Journal of Emergencies, Trauma, and Shock, 7(2), 121-123.

Oliveira, B., Kleta, R., Bockenhauer, D., & Walsh, S. B. (2016). Genetic, pathophysiological, and clinical aspects of nephrocalcinosis. American Journal of Physiology-Renal Physiology, 311(6), F1243-F1252.

Schäberle, W., Leyerer, L., Schierling, W., & Pfister, K. (2016). Ultrasound diagnostics of renal artery stenosis. Gefässchirurgie, 21(1), 4-13.

Shavit, L., Jaeger, P., & Unwin, R. J. (2015). What is nephrocalcinosis? Kidney International, 88(1), 35-43.

Shukla, A., Bharti, R., Chaudhary, R., & Sharma, M. (2015). Diagnostic value of plain abdominal radiograph, ultrasonography and clinical impression of the surgeon in acute peritonitis. Annals of International Medical & Dental Research, 1(2), 66-71.

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Weber, B. R., & Dieter, R. S. (2014). Renal artery stenosis: Epidemiology and treatment. International Journal of Nephrology and Renovascular Disease, 7, 169-181.

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