Comprehensive examination of the gastrointestinal tract. Gastrointestinal tract methodology and features of direct examination of patients with diseases of the gastrointestinal tract Methods of examination of the digestive system

Diseases of the stomach and intestines - the organs that make up the gastrointestinal tract - occupy the 1st place among all diseases that occur in people of different ages. These pathologies bring patients many unpleasant minutes - from an uncomfortable state to excruciating pain. But the most dangerous thing is that it is the diseases of the gastrointestinal tract that give a huge number of complications - perforated ulcers, severe inflammation and cancerous tumors leading to disability and even death. That is why ultrasound of the gastrointestinal tract is recommended to be periodically performed by every person, even if he still does not have any pain.

And your digestive tract is healthy: stomach health is a matter of time

let's consider medical statistics on diseases of the stomach and intestines. Alas, it is scary, even without taking into account hidden patients who have not been examined and residents of the poorest countries where there is no access to medical services.

According to statistics:

• Almost 90% of the population of developed countries suffer from gastritis of varying degrees of neglect.
• 60% of the world's inhabitants are infected with Helicobacter pylori, a bacterium causing inflammation mucous membrane of the stomach and intestines, and the cause of gastritis is a stomach ulcer.
• In Western countries, up to 81% of citizens, according to statistics, periodically experience heartburn, which is a symptom of gastroesophageal reflux disease - a disease of the esophagus that leads to disruption of the digestive tract.
• About 14% of people have peptic ulcer stomach.

At the age of over 60, the quality and duration of life depends on the state of the stomach and intestines, but you can get rid of the existing pathology only on initial stages diseases. That is why it is so important to be attentive to your health and not bring the problem to a chronic stage.

How to check the stomach and intestines quickly, cheaply and informatively?

There are several types of examination of the intestines and stomach, but only has a full range of advantages that doctors consider invaluable and very effective in making a diagnosis.

• Ultrasound can be done urgently in any condition of the patient. The examination will take a maximum of 15-30 minutes.
• Ultrasound diagnostics is painless, without causing psychological discomfort. Unfortunately, other methods of examining the gastrointestinal tract require very unpleasant procedures - swallowing tubes, inserting sharp instruments into the anus, sometimes to a decent depth, taking liquids, causing vomiting and etc.
• Ultrasound is completely safe. The method is based on echolocation and does not require the involvement of X-ray and MRI equipment.
• This is one of the cheapest surveys. Examination of the gastrointestinal tract, together with the rest of the abdominal organs, will cost around 1 thousand rubles.

With all this, this technique is sometimes even more informative than other methods of examining the stomach and intestines. For example, unlike the endoscopic diagnostic method (using probes that are inserted inside), ultrasound reveals intestinal inflammation, thickening and protrusion of the walls, stenosis (expansion of the lumen), abscesses, fistulas, congenital anomalies(Crohn's disease), neoplasms in the early stages of the development of the disease.

The specifics of the study of the gastrointestinal tract: why the stomach and intestines need to be examined in detail

Despite the close relationship between the stomach and intestines, the doctor examines both organs in detail, since they have not only similar diseases. For example, ulcers can be localized in any part of the gastrointestinal tract or form immediately in all departments. The same applies to oncological tumors, inflammation and other processes.

Depending on the patient's complaints, the specialist examines the intestines and stomach separately. Having received data indicating dangerous processes, the doctor directs the patient for additional diagnostics.

Together with ultrasound, it is recommended to take a breath test for Helicobacter pylori at the same time. This analysis is also not traumatic - the patient will only need to exhale the air several times. The ultrasound plus complex will allow you to identify the cause of heartburn, pain and abdominal cramps, diarrhea or constipation, bloating and other symptoms in just 15-20 minutes, to establish the extent of the processes and prescribe treatment without resorting to in unpleasant ways diagnostics.

How the intestines are examined: ultrasound plus additional techniques

The intestine has three sections: the large intestine, small intestine and rectum, and the study of each of them has its own characteristics and nuances.

• Colon ultrasoundhelps to detect cancer at an early stage. To finally make sure, the patient is prescribed a contrast x-ray and colonoscopy. Also, irrigoscopy will be very effective - an X-ray examination using a contrast fluid. The method allows you to "see" areas that are invisible for colonoscopy and difficult to see for ultrasound, for example, areas of bends or accumulations of mucus.
• ultrasound small intestine makes it difficult to twist and deep, as well as the accumulation of gases that distort the image on the monitor. A special curved sensor and the latest high-precision equipment help to explore the small intestine. Ultrasound evaluates wall thickness, visualization of layers, patency, wall expansion, peristalsis.
• Ultrasound of the duodenumcarried out together with the study of the stomach. Allows you to 100% diagnose stomach ulcers, cancer, gastroduodenitis.

Depending on the department under investigation, the doctor uses a sensor with certain characteristics.

Ultrasound apparatus for examining the intestines

The intestine is examined using two types of sensors: transabdominal (through the abdominal wall) and endorectal. To study the colon, a 2D apparatus is sufficient, which produces a flat two-dimensional image. Such an examination already provides reliable information about the patient's health status. The endorectal method is more informative because the sensor is inserted into anus and examines the body from the inside.

The doctor decides which sensor to choose depending on the patient's complaints. In special cases, both methods are used.

• The transabdominal sensor in 15% of cases "does not see" the rectum, as well as the area of ​​the anal canal. Endorectal method is not possible with terminal stenosis gastrointestinal tract(abnormal narrowing).
• An endorectal sensor is usually used to examine the distal parts of the rectum. For a rectal examination, you need to be trained.

Preparation and performance of ultrasound of the intestine

Preparation for the procedure begins 3 days in advance, the patient refuses food, constipating or flatulence (legumes, sweets, flour products, smoked and spicy foods).

On the eve of 18.00, the patient completely refuses any food, having previously taken a laxative (Guttalax, Regulax, Duphalac, Bisacodyl). If there are problems with peristalsis, the patient is given an enema, and in special cases, a special cleansing enema is performed using the Bobrov apparatus (a glass vessel for injecting a large amount of liquid inside).

In the morning, the patient goes to the ultrasound examination until 11.00 am. This is due to the fact that the procedure is carried out only on a well-cleansed intestine and an absolutely empty stomach, while large breaks in eating are contraindicated.

In the ultrasound diagnostic room, the patient lies on the couch on his side with his back to the apparatus, having previously removed his clothes below the waist and lowered his underwear. The legs are tucked into the chest. Ultrasound starts from lower divisions to those above. In parallel with this, the doctor drives the sensor in such a way as to examine the intestine in the transverse, longitudinal and oblique planes. When the echogenic picture is not entirely clear, the doctor asks the patient to change his position (lean on his knees and elbows, stand up).

It is carried out using a transabdominal probe. Previously, a contrast liquid (solution of barium sulfate) is introduced into the empty intestine. Thanks to this, a clear picture is obtained on the monitor screen.

To examine the rectum, 3.5-5 MHz sensors are used. Ultrasound of a given length passes through the soft tissues of the intestine, reflecting back. The built-in receiving sensor picks up the signal and transmits it in processed form to the monitor screen. Various compactions, neoplasms and erosion are expressed as white, black or mixed areas of varying echogenicity. An experienced doctor does not make a diagnosis immediately, but correlates the data obtained with the results of analyzes and other studies.

Interpretation of the results of ultrasound of the intestine

A healthy intestine has two layers. External is muscle tissue with low echogenicity, the inner mucosa is in contact with gas, therefore it is visualized as a hyperechoic layer.

During the ultrasound examination, the following parameters are evaluated:

• Dimensions and shape. The wall thickness is 3-5 mm. The picture is distorted in the case of the formation of gases that deform ultrasound, and insufficient filling of the intestine with liquid.
• Intestine locationrelative to other organs.
• Wall structure (echogenicity). The outer layer is hypoechoic, the inner wall is hyperechoic. The contours are even, the intestinal lumen should not have expansions or narrowings. Noticeable peristalsis.
• The length and shape of the various departments.The thermal section is 5 cm, the middle section is 6-10 cm, and the middle ampulla is 11-15 cm.
• Lymph nodes.Should not be rendered.

Deviations from the norm indicate various pathologies:

• Enteritis (inflammation small intestine): intestinal expansion, increased peristalsis, accumulation of contents of various echogenicity;
• Hirschsprung's disease (congenital pathology of an increase in individual intestinal sizes): a significant expansion of the lumen, uneven contours, heterogeneous wall thickness, noticeable places of thinning, lack of peristalsis;
• If it is impossible to determine the layers of the intestine, we can talk about acute mesenteric thrombosis - a consequence of myocardial infarction, expressed in thrombosis of the mesenteric artery;
• Uneven internal contours (which is the cause of ulcerative lesions of the mucous surface), weak echogenicity, thickening of the wall - all this indicates ulcerative colitis;
• Chronic spastic colitis: areas of high echogenicity against the background of a hypoechoic surface, thickening of the walls;
• Ischemic colitis: inability to visualize layers, uneven thickening, reduced echogenicity;
• Acute appendicitis: the appendix 7 mm in diameter is visible on the monitor screen, the layers of the appendix do not differ from each other, the walls of the appendix are asymmetrically thickened, free fluid is visualized, increased echogenicity indicates an abscess;
• Diverticulitis (protrusion of the intestinal walls): at the site of the diverticulum, ultrasound “sees” wall thickening by more than 5 mm above normal, echogenicity indicates an abscess, the contours are uneven;
• Mechanical damage to the intestines: in addition to strong tension in the abdominal muscles, the echogenicity of the patient at the site of the hematoma is reduced, the walls at the site of damage are thickened;
• Oncology (cancerous or precancerous tumor): the outer contours are uneven, the lumen is narrowed, peristalsis is disturbed at the site of the neoplasm, lymph nodes of reduced echogenicity are visualized.

What are the advantages and disadvantages of ultrasound of the intestinal tract

Ultrasound diagnostics of the intestine is used for primary research in cases of suspected pathology, as well as in cases where endoscopic method contraindicated due to health conditionpatient (perforation (damage) of the intestine, inflammation).

Ultrasound examination of the intestine has several advantages:

• The patient does not experience psychological discomfort.
• The doctor receives information about the size of the organ, its structure, thickness, number of layers, without penetrating inside the organs.
• Ultrasound allows you to examine the inflamed intestine and clearly sees the upper gastrointestinal tract.
• Peristalsis is visualized in real time, it determines intestinal obstruction.
• On an ultrasound of the intestine, a specialist will see even small seals or changes in the echostructure of tissues.
• Ultrasound allows you to do screening (endorectal method), fully confirm or refute oncology.

In spite of a large number of advantages, the diagnosis of this organ by ultrasound has some disadvantages, the main of which is the impossibility of making an accurate diagnosis without additional examination.

Also, the disadvantages of the method include the following:

• Only functional disorders in the work of the organ are revealed.
• Are determined structural changes without defining change parameters.
• It is not possible to assess the state of the internal mucosal surface; if structural changes are detected, a colonoscopy is prescribed - an endoscopic method

Analyzes and studies that complement intestinal ultrasound

As mentioned above, intestinal ultrasound is not a 100% confirmation of a particular diagnosis, although in many ways the method is informative and accurate. Depending on the preliminary diagnosis, in addition to ultrasound, the patient is prescribed:

• Capsule examination. The patient swallows a capsule with a sensor inside, which conducts video surveillance and transmits the image to the monitor screen. The method allows you to see areas inaccessible to the endoscope. Significant advantages also include the absence of trauma (the walls of the intestine are not scratched) and radiation (unlike X-rays).

The disadvantages of the capsule technique include the low prevalence of capsule examination, because the method was first tested in the United States in 2001, and today it is still not widespread. Its cost is very high, and this limits the circle of customers. Among other disadvantages is the inability to conduct a capsule study with intestinal obstruction, infections, peritonitis. The method has age restrictions associated with the peculiarity of peristalsis.

• Colonoscopy. This is an endoscopic method that allows you to examine the internal mucosa for polyps, colitis, tumors, Crohn's disease, inflammation and other pathologies. The disadvantage of the method is the risk of injury to the intestine, perforation (punctures of the walls). Colonoscopy also does not see tumors between the walls of the intestine.
• Irrigoscopy. This is a special method aimed at identifying hidden tumors located between the inner and outer lining of the intestine. In addition, the method, unlike colonoscopy, sees areas on the folds of the intestine and its remote areas.

Irrigoscopy involves the introduction of a liquid solution of barium sulfate through the anus, which allows, upon contact with air, to obtain a clear contrast picture. The advantages of irrigoscopy are the ability to examine structural changes in tissues (scars, diverticula, fistulas). The method is carried out with diarrhea or constipation, mucus in the intestines, pain in the anus.

Ultrasound of the stomach is an important part of the examination of the gastrointestinal tract on ultrasound

For a long time ultrasound diagnostics not used in the study of the stomach. This is due to the fact that the stomach is a hollow organ, and the air does not allow the full use of a conventional ultrasound sensor - special sensors are needed to study the back walls. In addition, accumulated gases distort the displayed results. However, medicine does not stand still, and modern techniques already allow you to get enough information to make an accurate diagnosis.

Sensors for studying the stomach appeared relatively recently, in the late 2000s. However, the speed and safety of scanning makes ultrasound of the stomach more and more popular.

During an ultrasound examination, the doctor makes an assessment of the organ according to the main indicators:

• The volume of the stomach.It is a hollow muscular organ resembling a pouch. The volume of an empty stomach is 0.5 liters, and in a full form it stretches to 2.5 liters. In height, the stomach reaches 18-20 cm, width - 7-8 cm. When filled, the stomach stretches up to 26 cm in length and up to 12 cm in width.
• Structure.Near the heart is the cardiac region, in which the esophagus passes into the stomach. On the left, you can see the bottom of the organ, where the air that comes with food accumulates. The body of the stomach is the largest part, rich in glands that produce hydrochloric acid. The pyloric zone is the transition of the stomach to the intestines. There is a partial absorption of substances received with food.
• Structure.The walls of the stomach have a muscular membrane responsible for the contraction and promotion of the food coma. The serous membrane is intermediate between the muscular and mucous layers. It accumulates The lymph nodes and blood vessels. The mucous layer is covered with the finest villi that secrete gastric juice produced by the glands.
• Blood supply.The circulatory system covers the entire organ. The organ is supplied with venous blood by three main vessels: the left, hepatic and splenic. The venous network runs parallel to the arterial network. Various bleeding occurs when the gastric mucosa is damaged (ulcers, tumors).

How is an ultrasound of the stomach performed?

Preparation for an ultrasound of the intestine is similar: the patient adheres to a strict diet for 3 days, and does not eat any food the night before from 18.00. If there is a tendency to gas formation, the patient drinks 2 capsules of Espumizan before going to bed. In the morning, half an hour before the procedure, you should drink a liter of water so that the walls of the stomach straighten.

There is also a method of ultrasound with contrast. Water is an excellent conductor of ultrasound, and without it, scanning an organ is somewhat difficult.

The procedure is carried out on an empty stomach. The doctor evaluates the condition and thickness of the walls on an empty stomach, looks for the presence of free fluid. Then he asks the patient to drink 0.5-1 liter of liquid, and evaluates changes on the expanded stomach on an ultrasound machine. The third ultrasound scan is performed 20 minutes later, when the stomach begins to empty. The doctor evaluates the motility of the organ, the rate of fluid outflow. Normally, a glass of water (250 ml) leaves the stomach in 3 minutes.

The patient lies on the couch on his side, the specialist applies a gel to the peritoneal area and drives the sensor over the surface. Periodically, he tells the patient to change position or slightly change posture. The doctor pays attention to the following indicators:

• stomach position and size
• whether the mucous surface of the stomach has straightened
• is there any thickening or thinning of the walls
• what is the state of the circulatory system of the stomach
• contractility of the stomach
• whether there are inflammations and neoplasms

The entire study takes a maximum of 30 minutes, does not cause discomfort and pain. Ultrasound, unlike FGDS, is much easier to tolerate by children and the elderly.

Advantages and disadvantages of ultrasound of the stomach, when examining the gastrointestinal tract

The doctor prescribes an ultrasound examination of the stomach to the patient as a primary auxiliary diagnostic method.

The advantages of ultrasound are as follows:

• the output department, the most susceptible to diseases, is examined;
• ultrasound "sees" any foreign bodies in the cavity;
• Ultrasound accurately assesses the thickness of the walls of the organ;
• thanks to the method, venous blood flow is clearly visible;
• with the help of diagnostics, benign and malignant tumors of minimal size are detected;
• gastric ulcer is well evaluated;
• the degree of inflammation of the gastric mucosa varies;
• the method allows you to see reflux disease - throwing the contents of the lower sections back into the stomach;
• the organ is examined from different points and in different sections, which is impossible with x-rays;
• Ultrasound sees what is happening in the thickness of the stomach wall;
• thanks to the echostructure, ultrasound can easily distinguish a polyp from an oncological neoplasm;
• in addition to diagnosing the stomach, ultrasound diagnostics reveals concomitant pathologies of other organs (usually with gastritis, diseases of the biliary tract and pancreas develop);
• Ultrasound is done for newborns and young children who cannot do EGD or x-rays.

The main advantage of ultrasound over FGDS is the ability to detect forms of cancer developing in the thickness of the organ wall (infiltration forms), which cannot be detected using fibrogastroscopy.

Despite all the advantages, ultrasound has some drawbacks that do not allow the method to be widely used as an independent study of the stomach.

The disadvantages include the following:

• unlike endoscopic examination, ultrasound does not allow tissue samples to be taken for further study (for example, gastric juice;
• scraping of the mucous membrane, tissue biopsy);
• on ultrasound it is impossible to assess the degree of changes in the mucous membrane;
• limitation of the studied areas (it is possible to examine only the exit zone of the stomach).

What does ultrasound of the stomach reveal when examining the gastrointestinal tract

The ultrasound method is not the most popular in the study of the gastrointestinal tract, but it makes it possible to obtain very important information.

The stomach is an extension of the alimentary canal in the form of a bag. This is a hollow organ, the walls of which have an external muscular and internal mucous layer. The mucous membrane is rich in glands that produce gastric juice and hydrochloric acid, as well as enzymes. With their help, the incoming food is softened, processed with a natural antiseptic. The stomach is separated from the esophagus by the sphincter, and from the duodenum by the pylorus.

The organ is examined on ultrasound in two ways:

• Transabdominal (through the walls of the peritoneum). It is carried out by different sensors, but the results always require additional confirmation.
• Probe (sees the stomach from the inside). Used extremely rarely.

When conducting a study using a sensor, the specialist pays attention to the following:

• thickness, folding, structure of the mucous membrane (are there neoplasms, bulges, irregularities on it);
• the thickness of the muscle layer (expansion or thinning indicates pathology);
• the integrity of the gastric wall (whether there are perforations, ulcers or neoplasms on it);
• amount of free fluid (indicates inflammation);
• peristalsis, motility and contractility of the stomach;
• transitional sections of the stomach (sphincter and pylorus, features of their
• functioning).

It is worth noting that ultrasound of the stomach and duodenum with its informative value is significantly inferior to the more popular method known as FGDS. But in some cases, other research methods for the patient are unacceptable due to the state of health or fear of a traumatic procedure.

Transabdominal examination identifies three layers of the stomach wall: a hyperechoic mucosal layer (1.5 mm), a hypoechoic submucosal layer (3 mm), and a hyperechoic muscular layer (1 mm). With the probe method of research, 5 layers up to 20 mm thick are determined.

Ultrasound diagnosis of the stomach allows you to identify the following pathologies

Ultrasound scanning of different parts of the stomach

Thanks to ultrasound, the doctor assesses the condition of the following areas of the body:

Bulbar or bulb of the duodenum. This part of the organ is located in the area of ​​​​the exit of their stomach, and controls the flow of the contents processed by gastric juice into the intestinal lumen. With bowel diseases, ulcers and inflammation sites form on the bulb. The main prerequisites for a duodenal ulcer are increased acidity and the bacterium Helicobacter pylori, which begins to multiply actively under such conditions.

The study is carried out in real time with a linear or convex probe with a frequency of 3.5-5 MHz. To detail the state of the walls, sensors with a frequency of 7.5 MHz are used, but they are ineffective for obese patients with developed subcutaneous fat.

If the patient is diagnosed with a stomach ulcer and 12 duodenal ulcer, then in most cases the walls of the bulb are affected. On ultrasound, this is reflected by anechoic areas, because, unlike healthy walls, the ulcer does not reflect ultrasound.

The diagnosis of gastric and duodenal ulcer, if anechoic zones are established on ultrasound, is conditionally made. Additionally, the condition of the walls of the bulb is assessed (they have a mucous structure with longitudinal folds). The thickness should normally be no more than 5 mm, and in the antrum (the transition of the stomach into the duodenum 12) - up to 8 mm. With thickening, we are not talking about an ulcer, but about an oncological neoplasm. The patient will need additional research: endoscopic with sampling of material for biopsy.

Due to the fact that ultrasound is not able to establish an accurate diagnosis, the patient is given a preliminary diagnosis of "anechoic areas", and then he is sent for fibrogastroduodenoscopy. It is this method that makes it possible to take the tissue of the bulb wall to determine the nature of the pathology. FGDS also allows you to assess the state of the vessels of the body.

Pyloric canal or pylorus of the stomach.This is a slight narrowing at the junction of the bulb in the duodenum 12. It consists of smooth muscle walls 1-2 cm long, located both in the annular and in the transverse direction. Normally, there is some curvature of the canal. Ultrasound can detect diseases such as polyps, stenosis (narrowing), ulcers, pyloric spasm.

Sphincter (cardia)is the border between the peritoneum and the esophagus. Normally, the sphincter opens only after eating, and the rest of the time it is in a closed state. In connection with functional value the sphincter has a stronger muscle layer than that of the stomach, allowing it to open and close like a valve. When eating, the sphincter closes the exit from the stomach, allowing food to be digested. But as a result hyperacidity and other pathologies, the organ ceases to function normally, and the contents of the stomach enter the esophagus.

Pathology detected: is it necessary to double-check?

Ultrasound of the stomach and intestines is very informative, but only on the basis of the data obtained it is impossible to make a diagnosis. If problems are found, the patient undergoes an additional examination. The most popular methods for examining the gastrointestinal tract include:

• FGDS. This is an endoscopic method that allows you to see bleeding, neoplasms in the stomach and intestines.
• Sounding. It consists in taking the contents of the stomach for further laboratory research.
• Gastropanel. This is an innovative method, according to which the patient is taken blood from a vein, and certain markers reveal a possible ulcer, atrophy, cancer.
• CT scan. They take pictures of sections in different projections, reveal the location of tumors, hematomas, hemangiomas, etc.
• MRI. This is the most expensive and effective method research. It allows you to visualize not only the organ itself, but also nearby lymph nodes and blood vessels.
• Endoscopy. It is used for sampling material for biopsy.
• X-ray. It reveals the incorrect location of the stomach and intestines relative to other organs, the pathology of the form, various neoplasms.
• Parietography. It shines through the walls of the stomach and intestines due to the injected gas.
• Laboratory tests (blood, urine, feces).

After passing additional diagnostics The doctor decides on the methods of treatment. It is important to understand that the treatment of the gastrointestinal tract also cannot be in the "mono" mode - it is always a set of measures associated with restoring health and preventing relapses and complications. You can also track the quality of treatment on ultrasound, comparing the previous results of the examination of the gastrointestinal tract with the new ones.

Contrast studies of the gastrointestinal tract

The gastrointestinal tract (GIT) is often the object of X-ray examination with contrast. X-ray examination stomach, esophagus and small intestine is performed on an empty stomach, the patient is forbidden to drink and smoke on the day of the study. In the case of severe flatulence (gas in the intestines), which interferes with the study in patients with colitis and constipation, more thorough preparation is necessary (see page 19).

The main contrast agent for the study of the gastrointestinal tract - aqueous suspension of barium sulfate. Barium sulfate is used in two main forms. The first form is a powder mixed with water before use. The second form is a ready-to-use suspension for special X-ray studies. In clinical practice, two levels of barium concentration are used: one for conventional contrasting, the second for double contrasting.

For routine examination of the gastrointestinal tract, an aqueous suspension of barium sulfate is used. It has the consistency of semi-thick sour cream and can be stored in a glass container in a cool place for 3-4 days.

To conduct a study with double contrast, it is necessary that the contrast medium has a high degree dispersion and concentration of particles of barium sulfate at a low viscosity of the suspension, as well as good adhesion to the gastrointestinal mucosa. To do this, various stabilizing additives are added to the barium suspension: gelatin, carboxymethylcellulose, flax seed mucus, starch, marshmallow root extract, polyvinyl alcohol, etc. Ready-to-use finely dispersed barium suspension of high concentration is produced in the form of ready-made preparations with various stabilizers, astringents, and flavoring agents. additives: barotrast, baroloid, barospers, micropak, mixobar, microtrust, novobarium, oratrast, skiabary, sulfobar, telebrix, hexabrix, chytrast and others.

NB! Barium preparations are contraindicated in case of suspected perforation of the gastrointestinal tract, since their entry into the abdominal cavity leads to severe peritonitis. In this case, water-soluble contrast agents are used.

Classical x-ray examination necessarily includes three stages:

Examination of the relief of the mucous membrane;

Study of the shape and contours of organs;

Assessment of tone and peristalsis, elasticity of the walls.

Now contrasting only with barium suspension is gradually giving way double counterstaining with barium suspension and air. Double contrasting is in most cases much more effective and is considered as a standard method of x-ray examination of the gastrointestinal tract. Inflating the studied section of the gastrointestinal tract with air contributes to the identification of wall rigidity and the uniform distribution of a small amount of barium suspension, which coats the mucous membrane with a thin layer. Contrasting with barium alone is justified in elderly and debilitated patients, in postoperative period and for special purposes - for example, in the study of motility of the digestive tract.

NB! With double contrasting, as a rule, drugs are used to relax the muscles of the gastrointestinal tract (atropine, aeron; paralyzing glucagon and buscopan). They are contraindicated in patients suffering from glaucoma and prostate adenoma with impaired urination.

X-ray symptoms various pathologies digestive tract can be grouped into ten major syndromes.

1. Narrowing (deformity) of the esophagus, stomach, or intestines occurs in a large group of pathological processes. This syndrome can be caused by both pathological processes emanating from the wall of the esophagus, stomach or intestines, as well as diseases of adjacent organs, as well as some developmental anomalies (malformations). The narrowing of the lumen often occurs after surgical interventions on the esophagus, stomach and intestines. The cause of the narrowing of the lumen (spasm) of any part of the digestive canal can also be cortico-visceral and viscero-visceral disorders.

2. Lumen expansion(deformation) esophagus, stomach or intestines may be limited to a part of the organ (local) or capture the entire organ (diffuse) and reach varying degrees of severity. The expansion of the lumen of the body is often combined with a significant accumulation of contents in it, usually gas and liquid.

3. Filling defect can occur in any part of the digestive tract and may be due to various diseases of the organs or the presence of contents in their lumen.

4. barium depot(niche) often occurs in pathological processes accompanied by destruction of an organ (ulcer, tumor, actinomycosis, syphilis, tuberculosis, erosive gastritis, ulcerative colitis), local bulging of the wall (diverticulum) or its deformation (adjacent process, cicatricial changes, consequences of trauma or surgical interventions).

5. Change in the relief of the mucous membrane- a syndrome, the timely detection of which contributes to the early recognition of many diseases of the esophagus, stomach and intestines. A change in the relief of the mucous membrane can be manifested by thickening or thinning of the folds, excessive tortuosity or their straightening, immobility (rigidity), the appearance of additional growths on the folds, destruction (break), convergence (convergence) or divergence (divergence), as well as a complete absence ("bare plateau") folds. The most informative image of the mucosal relief is obtained in images under double contrasting conditions (barium and gas).

6. Violation of the elasticity of the wall and peristalsis usually due to inflammatory or neoplastic infiltration of the organ wall, a nearby process, or other causes. Often combined with a decrease in the lumen of the organ in the affected area or its diffuse expansion (atony, paresis), the presence of a pathological relief of the mucous membrane, a filling defect or barium depot (niche).

7. Violation of the position- displacement (pushing, pulling, pulling) of the esophagus, stomach or intestines may occur as a result of damage to the organ itself (scarring ulcer, fibroplastic form of cancer, gastritis, colitis) or be a consequence of pathology in adjacent organs (heart defects, tumors and cysts of the mediastinum, abdominal cavity and retroperitoneal space, aneurysm of the thoracic or abdominal aorta). Violation of the position of the esophagus, stomach or intestines can be observed with some anomalies and malformations of their development, as well as after surgical interventions on the organs of the chest and abdominal cavities.

8. Accumulation of gas and fluid in the intestines accompanied by the formation of single or multiple horizontal levels with gas bubbles above them - Cloiber bowls. This syndrome is found mainly in mechanical bowel obstruction, developing due to narrowing of the intestinal lumen due to tumors, cicatricial changes in the intestinal wall, volvulus, intussusception and other causes, as well as dynamic intestinal obstruction that occurs reflexively during various pathological processes in the abdominal cavity and retroperitoneal space (appendicitis, pancreatitis, peritonitis).

9. Free gas and/or fluid (blood) in the abdomen or retroperitoneum found in some diseases (gastric or duodenal ulcer, ulcerative colitis, acute appendicitis) and injuries (closed abdominal trauma, penetrating wound, foreign body), accompanied by a violation of the integrity of the wall of a hollow organ. Free gas in the abdominal cavity may be detected after blowing fallopian tubes and surgical interventions (laparotomy).

10. Gas in the wall of a hollow organ can accumulate in the lymphatic crevices of the submucosal and serous membranes of the stomach, small or large intestine in the form of small thin-walled cysts (cystic pneumatosis), which are visible through the serous membrane.

Examination of the esophagus

The essence of the method: the method is simple, painless, but its informativeness and diagnostic value are several times inferior fibrogastroscopy- endoscopic examination of the esophagus and stomach. The most common indication for using the method is the fear and active unwillingness of the patient to undergo fibrogastroscopy in the presence of certain complaints. Then an X-ray contrast study is performed, but with the slightest doubt and suspicion of the presence of a pathology, endoscopy is performed.

Indications for research: the main indication for the study is a violation of swallowing (dysphagia), the detection of intrathoracic lymphadenopathies, tumors and cysts of the mediastinum. Besides:

Anomalies of the aortic arch and its branches,

Chest pain of unknown origin

Foreign body in throat and esophagus

mediastinal compression syndrome

Bleeding from the upper parts of the alimentary canal,

Determining the degree of heart enlargement, especially with mitral defects,

Suspicion of cardiac insufficiency or esophageal achalasia,

Suspected hernia esophageal opening diaphragm.

Conducting research: The examination is carried out with the patient in a standing position. The patient is asked to drink

barium suspension, and then stand next to the x-ray machine; the doctor adjusts the position of the device depending on the height of the patient. Then the patient is asked not to move for several minutes and is told when the study is completed.

There are no contraindications to the study. There are no complications.

Preparation for the study: not required.

It should be carried out by a qualified radiologist, the final conclusion, based on all the data on the patient's condition, is made by the clinician who sent the patient for examination - a gastroenterologist, surgeon, oncologist, cardiologist.

Examination of the stomach and duodenum

The essence of the method: radiography of the stomach allows you to clarify the position, size, contours, relief of the walls, mobility, functional state of the stomach, to identify signs of various pathologies in the stomach and its localization (foreign bodies, ulcers, cancer, polyps, etc.).

Indications for research:

Abscess of the abdominal cavity;

Amyloidosis of the kidneys;

aspiration pneumonia;

Stomach ache;

Gastrinoma;

Gastritis is chronic;

Gastroesophageal reflux disease;

Hernia of the white line of the abdomen;

Hernia of the esophageal opening of the diaphragm;

dumping syndrome;

Benign tumors of the stomach;

Difficulty swallowing;

Foreign body of the stomach;

ovarian cystoma;

Nephroptosis;

Tumors of the liver;

Acute gastritis;

Belching, nausea, vomiting;

Polyps of the stomach;

portal hypertension;

Postoperative hernia;

Umbilical hernia;

Stomach cancer;

ovarian cancer;

Syndrome of "small signs";

Zollinger-Ellison syndrome;

Decrease in the level of hemoglobin in the blood (anemia);

Gastric ulcer.

Conducting research: the patient drinks a barium suspension, after which fluoroscopy, survey and targeted radiography are performed with a different position of the patient. Evaluation of the evacuation function of the stomach is carried out by dynamic radiography during the day. X-ray of the stomach with double contrast- a technique of contrast X-ray examination of the state of the stomach against the background of its filling with barium and gas. To perform a double contrast x-ray, the patient drinks a suspension of barium sulfate through a tube with perforated walls, which allows air to enter the stomach. After massaging the anterior abdominal wall, barium is evenly distributed over the mucosa, and the air straightens the folds of the stomach, allowing you to examine their relief in more detail.

Contraindications, consequences and complications: There are no absolute contraindications for radiography of the stomach. Relative contraindications pregnancy, ongoing stomach (esophageal) bleeding can be considered; as well as such changes in the lumbosacral spine that will not allow the patient to spend the necessary time in the supine position on a hard surface.

Preparation for the study: , i.e. exclude or limit dairy products, sweets, muffins, soda, cabbage, etc. The diet should contain lean meat, eggs, fish, a small amount of porridge on the water. With constipation and flatulence in the morning on the day of the study, a cleansing enema is placed, if necessary, the stomach is washed.

Deciphering the results of the study

Examination of the duodenum

The essence of the method: relaxation duodenography- contrast radiography of the duodenum in its relaxed state, artificially induced medicines. The technique is informative for diagnosing various pathological changes in the intestine, head of the pancreas, and the final sections of the bile duct.

Indications for research:

Gastrinoma;

Duodenitis;

Cancer of the small intestine;

Zollinger-Ellison syndrome;

Strictures of the bile ducts;

Peptic ulcer of the duodenum.

Conducting research: in order to reduce the tone of the intestine, an injection of an anticholinergic agent is performed, then a portion of warm barium suspension and air is introduced through an intranasal probe installed in the lumen of the duodenum. Radiographs are performed under conditions of single and double contrasting in frontal and oblique projections.

Preparation for the study: patients in whom the functions of the stomach and intestines are not impaired, no special preparation is required. The only condition that must be met is not to eat 6-8 hours before the procedure. Patients suffering from any pathology of the stomach and intestines, and the elderly, already 2-3 days before the procedure, it is recommended to start adhering to gas-reducing diet, i.e. exclude or limit dairy products, sweets, muffins, soda, cabbage, etc. The diet may contain lean meat, eggs, fish, a small amount of cereals on the water. With constipation and flatulence in the morning on the day of the study, a cleansing enema is placed, if necessary, the stomach is washed.

Deciphering the results of the study should be carried out by a qualified radiologist, the final conclusion based on all the data on the patient's condition is made by the clinician who sent the patient for examination - a gastroenterologist, surgeon, oncologist.

Examination of the small intestine

The essence of the method: X-ray fixation of the process of advancing the contrast through the small intestine. By radiography of the passage of barium through the small intestine

revealed diverticula, strictures, obturation, tumors, enteritis, ulceration, malabsorption and motility of the small intestine.

Indications for research:

Amyloidosis of the kidneys;

femoral hernia;

Crohn's disease;

Hernia of the white line of the abdomen;

dumping syndrome;

Benign tumors of the small intestine;

Malabsorption;

Interintestinal abscess;

Inguinal hernia;

Postoperative hernia;

Umbilical hernia;

Cancer of the small intestine;

celiac disease;

Enteritis;

Enterocolitis.

Conducting research: radiopaque examination of the small intestine is performed after ingestion of a solution of barium suspension. As the contrast advances through the small intestine, targeted radiographs are taken at intervals of 30–60 minutes. X-ray of the passage of barium through the small intestine is completed after contrasting all its departments and entering the barium into the caecum.

Preparation for the study: patients in whom the functions of the stomach and intestines are not impaired, no special preparation is required. The only condition that must be met is not to eat 6-8 hours before the procedure. Patients suffering from any pathology of the stomach and intestines, and the elderly, already 2-3 days before the procedure, it is recommended to start following a diet that reduces gas formation, i.e. exclude or limit dairy products, sweets, muffins, soda, cabbage, etc. d. Lean meat, eggs, fish, a small amount of cereals on the water may be present in the diet. With constipation and flatulence in the morning on the day of the study, a cleansing enema is placed, if necessary, the stomach is washed.

Deciphering the results of the study should be carried out by a qualified radiologist, the final conclusion based on all the data on the patient's condition is made by the clinician who sent the patient for examination - a gastroenterologist, surgeon, oncologist.

Examination of the large intestine

X-ray examination of the large intestine is performed by two (and one might say three) methods: x-ray of the passage (passage) of barium through the large intestine and irrigoscopy(regular and double contrast).

X-ray of the passage of barium through the large intestine The essence of the method: a technique of radiopaque examination, performed to assess the evacuation function of the large intestine and the anatomical relationship of its departments with neighboring organs. X-ray of the passage of barium through the large intestine is indicated for prolonged constipation, chronic colitis, diaphragmatic hernia (to determine the interest of the large intestine in them).

Indications for research:

Appendicitis;

Hirschsprung disease;

Crohn's disease;

Hernia of the white line of the abdomen;

diarrhea (diarrhea);

Intestinal obstruction;

Megacolon;

Interintestinal abscess;

Nonspecific ulcerative colitis;

Perianal dermatitis;

Postoperative hernia;

colon cancer;

Seronegative spondyloarthritis;

irritable bowel syndrome;

Chronic appendicitis.

Conducting research: the day before the upcoming study, the patient drinks a glass of a suspension of barium sulfate; X-ray examination of the large intestine is performed 24 hours after barium intake.

Preparation for the study: no special preparation is required.

Deciphering the results of the study should be carried out by a qualified radiologist, the final conclusion based on all the data on the patient's condition is made by the clinician who sent the patient for examination - a gastroenterologist, surgeon, oncologist.

Irrigoscopy

The essence of the method: unlike the passage of barium in the natural direction of movement of masses in the intestine, barium enema is performed by filling the large intestine with a contrast agent using an enema - in a retrograde direction. Irrigoscopy is performed to diagnose developmental anomalies, cicatricial narrowing, tumors of the large intestine, chronic colitis, fistulas, etc. After tight filling of the large intestine with a barium suspension, using an enema, the shape, location, length, extensibility, and elasticity of the intestine are studied. After bowel emptying from the contrast suspension, organic and functional changes in the colon wall are examined.

Modern medicine uses irrigoscopy with simple contrasting of the colon(using barium sulfate solution) and irrigoscopy with double contrast(using a suspension of barium and air). Tight single contrasting allows you to get an x-ray image of the contours of the colon; irrigoscopy with double contrast reveals intraluminal tumors, ulcerative defects, inflammatory changes in the mucosa.

Indications for research:

Abscess of the abdominal cavity;

Anal itching;

Anokopchikovy pain syndrome (coccygodynia);

Appendicitis;

femoral hernia;

Hirschsprung disease;

Prolapse of the rectum;

Haemorrhoids;

Hernia of the white line of the abdomen;

diarrhea (diarrhea);

Benign tumors of the small intestine;

Benign tumors of the ovaries;

gastrointestinal bleeding;

ovarian cystoma;

Intestinal obstruction;

Megacolon;

Interintestinal abscess;

Acne lightning;

Nephroptosis;

Tumors of the liver;

Inguinal hernia;

Perianal dermatitis;

Polyps of the rectum;

Postoperative hernia;

Pseudomucinous ovarian cystoma;

anus cancer;

Liver cancer;

Cancer of the body of the uterus;

colon cancer;

Cancer of the small intestine;

Cervical cancer;

ovarian cancer;

Birth injury;

Sarcoma of the uterus;

Fistulas of the vagina;

Fistulas of the rectum;

Seronegative spondyloarthritis;

Irritable bowel syndrome (IBS);

Chronic appendicitis.

Conducting research: the patient is placed on an inclined table and a survey radiography of the abdominal cavity is performed. Then the intestines are filled with a barium solution (an aqueous suspension of barium sulfate heated to 33–35 ° C). In this case, the patient is warned about the possibility of a feeling of fullness, pressure, spasmodic pain or the urge to defecate and is asked to breathe slowly and deeply through the mouth. For better filling of the intestine in the process of irrigoscopy, a change in the inclination of the table and the position of the patient, pressure on the abdomen are made.

As the intestine expands, sighting radiographs are performed; after complete tight filling of the lumen of the colon - survey radiography of the abdominal cavity. The patient is then escorted to the toilet to have a natural bowel movement. After removing the barium suspension, a survey radiograph is again performed, which allows assessing the relief of the mucosa and the evacuation function of the colon.

A double-contrast barium enema can be performed immediately after a simple barium enema. In this case, a dosed filling of the intestine with air is performed.

Contraindications, consequences and complications: irrigoscopy is not performed during pregnancy, general severe somatic status, tachycardia, rapidly developing ulcerative colitis, suspicion of perforation of the intestinal wall. special care when conducting irrigoscopy, it is required in case of intestinal obstruction, diverticulitis, ulcerative colitis, loose stools mixed with blood, cystic pneumatosis of the intestine.

NB! factors that can distort the results of irrigoscopy can be:

Poor bowel preparation

The presence of barium residues in the intestine after previous studies (radiography of the small intestine, stomach, esophagus),

Inability of the patient to retain barium in the intestines.

Preparation for the study: before irrigoscopy, a thorough bowel preparation is carried out, including a slag-free diet, cleansing enemas in the evening and in the morning until clear waters. Dinner on the eve of irrigoscopy is not allowed.

NB! With bleeding from the gastrointestinal tract or ulcerative colitis, enemas and laxatives before barium enema are not allowed.

Deciphering the results of the study should be carried out by a qualified radiologist, the final conclusion, based on all the data on the patient's condition, is made by the clinician who sent the patient for examination - a gastroenterologist, surgeon, proctologist, oncologist.

Examination of the liver (gall bladder and bile ducts), pancreas

Cholegraphy and cholecystography

The essence of the method: cholegraph? i- x-ray examination biliary tract through intravenous administration hepatotropic radiopaque preparations secreted by the liver with bile. Cholecystography- a technique for radiopaque examination of the state of the gallbladder, is performed to determine the position, size, shape, contours, structure and functional state of the gallbladder. Cholecystography is informative for detecting deformities, calculi, inflammation, cholesterol polyps, gallbladder tumors, etc.

Indications for research:

Biliary dyskinesia;

Cholelithiasis;

Calculous cholecystitis;

gallbladder cancer;

Chronic cholecystitis;

Chronic acalculous cholecystitis.

Conducting research: cholegraphy perform on an empty stomach. Previously, the patient is recommended to drink 2–3 glasses of warm water or tea, which reduces the reaction to the procedure, 1–2 ml of a radiopaque substance is administered intravenously ( allergic test), in the absence of a reaction after 4-5 minutes, the rest of its amount is poured in very slowly. Usually, a 50% solution of bilignost (20 ml) heated to body temperature, or similar means, is used. For children, drugs are administered at a dose of 0.1–0.3 g per 1 kg of body weight. Radiographs are taken 15–20, 30–40 and 50–60 minutes after injection with the patient in a horizontal position. To study the function of the gallbladder, sighting pictures are taken in vertical position subject. If there is no image of the bile ducts in the pictures 20 minutes after the administration of the radiopaque substance, 0.5 ml of a 1% solution of pilocarpine hydrochloride is injected under the skin to cause a contraction of the sphincter of the common bile duct.

Before cholecystography produce an overview x-ray of the right half of the abdominal cavity. After translucence, several pictures of the gallbladder are taken in different projections with vertical and horizontal positions researched. Then the patient is given the so-called " choleretic breakfast"(2 raw egg yolks or 20 grams of sorbitol in 100–150 ml of water), after which, after 30–45 minutes (preferably serially, every 15 minutes), repeated shots are taken and the contractility of the gallbladder is determined.

Contraindications, consequences and complications: cholegraphy and cholecystography are contraindicated in case of a serious violation of the function of the liver, kidneys, of cardio-vascular system and hypersensitivity to iodine compounds. Side effects when using bilitrast, they are observed infrequently and are of a very moderate nature. They can be expressed in the form of a sensation of heat in the head, a metallic taste in the mouth, dizziness, nausea, and sometimes slight pain in the abdomen.

Preparation for the study: 12-15 hours before cholecystography, the patient takes bilitrast(an organic compound of iodine) or other contrast agent ( cholevid, yopagnost, telepak, bilimin etc.) at a dose of 1 g per 20 kg of body weight, washed down with water, fruit juice or sweet tea. Contrast agents (organic compounds of iodine) can be taken by the patient not only orally, but also administered intravenously, less often through a probe into the duodenum. The night before and 2 hours before the examination, the patient is cleansed with an enema.

Deciphering the results of the study should be carried out by a qualified radiologist, the final conclusion, based on all the data on the patient's condition, is made by the clinician who sent the patient for examination - a gastroenterologist, surgeon, oncologist, hepatologist.

Restoration of the gastrointestinal tract Before eating, you must take (without chewing!) In the form of balls vegetable cakes of carrots, cabbage, radish. At the same time, they cannot be chewed so that they are not saturated with saliva enzymes. Reception of cakes continues until