Therapeutic radiography

A 21-year-old woman comes with her parents to discuss therapeutic options for Crohn s disease. She was diagnosed with Crohn s disease 2 years ago, and it involves her terminal ileum and proximal colon, as confirmed by colonoscopy and small bowel radiography. She was initially treated with mesalamine and budesonide with good response but over the last 2 months she has had a relapse of symptoms. She is experiencing fatigue, cramping abdominal pains, and nonbloody diarrhea up to 10 times daily, and she has had a 15-lb weight loss. 

Adjuncts to therapeutic radiography, used under patient group directions, include analgesics, laxatives, anti-diarrhoeals, antiemetics and drugs for wound care and skin reactions. 

Bulk-forming laxatives are used to control diarrhoea associated with therapeutic radiography. 

Both domperidone and granisetron are used to counteract emetic effects of therapeutic radiography. 

Loperamide is an opiate drug that decreases motility of the intestine. It does not cross the blood-brain barrier easily and therefore does not have the central nervous system effects (euphoria, respiratory depression, nausea and vomiting and dependence) of other opiates. Loperamide is prescribed to counteract gastrointestinal side effects (diarrhoea) of therapeutic radiography. 

Following therapeutic radiography, antiemetics and loperamide may be necessary to counteract nausea and vomiting or diarrhoea respectively. Wound care may also be needed with topical antibacterials or with systemic antibiotics if severe with cellulitis (see Chapter 8). 

The first two case studies are patients who might be seen by a physiotherapist, although other health care professionals might see similar patients for different reasons. The third situation is where a radiographer might administer or prescribe drugs to counteract the effects of therapeutic radiography. 

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