Gastrointestinal imaging

The gastrointestinal system runs all the way from the mouth to the rectum and anus.
Gastrointestinal imaging is a diagnostic modality that helps in the identification of
an abnormality in the GIT. In some cases, it is not definitive but helps in the
determination of pathology. It is important that one knows the general anatomy of the
GIT and the various pathologies affecting it and how they present. As mentioned
earlier, gastrointestinal imaging in some cases does not lead to a definitive
diagnosis. Many GIT conditions can be spotted through imaging, but a detailed history
and examination are vital in determining the exact disease or its cause.
The common modalities of imaging that help in the diagnosis of GIT pathology are
abdominal radiography, abdominal ultrasound, computed tomography, magnetic
resonance imaging (MRI) and angiography. A method may be preferred to another
depending on the presenting complaint and the suspected organ damaged. For
example, a CT scan is preferred to and abdominal radiograph when the liver or
kidneys are suspected to be causes of disease. An abdominal ultrasound is the first
line diagnostic modality in instances of abdominal trauma. A FAST (Focused
Assessment with sonography for trauma) ultrasound is used in the assessment of
abdominal trauma.
Contrast material is sometimes needed to help in visualization of the GIT. Contrast
material may be administered orally, intravenously, or as enemas. Contrast medium
commonly used in GIT is Barium Sulphate, and it may be administered orally as a
swallow or as an enema. Gadolinium is used as contrast in magnetic resonance
imaging, and it is administered intramuscularly. Contrast studies are accurate, safe
and less expensive, but there are some contraindications to use of contrast.
Radiocontrast is contraindicated in patients who get a severe reaction from contrast
and those with renal failure. Patients on pharmacologic treatments, most notably beta
blockers, aminoglycosides, vancomycin, amphotericin B, metformin, NSAIDs and
interleukin 2, have to temporarily stop their medication before contrast imaging
because these agents are nephrotoxic and thus an increased risk of adverse reactions.
Low dose contrast should be used, and massive fluid intake should be encouraged
before and after contrast administration. Contrast-induced nephropathy is common
because contrast media are excreted majorly through glomerular filtration. High doses
of contrast are risky especially in patients who are at risk of kidney dysfunction, and it
has been isolated as a cause of mortality.
Imaging of the abdomen is very useful in the determination of an abnormal
abdomen. Imaging has been a massive breakthrough in the diagnosis of various
malignancies of the GIT such as gastric cancer, small intestine cancers, colorectal
malignancy, liver and biliary tract cancers and kidney cancers. Imaging is also used to
monitor the progress of therapy in malignancy. Gastrointestinal imaging is
essential when malignancy is involved. Not only neoplastic conditions are diagnosed
through radiography, but other non-neoplastic conditions such as congenital
abnormalities, inflammatory conditions of the GIT such as Crohns disease and
Ulcerative colitis, bleeding in the GIT and gas patterns in the abdomen.
The value of abdominal imaging in diagnosis should never be underestimated.