X-ray of the abdominal cavity preparation for the study. What can be seen on an abdominal x-ray. What is the difference between plain abdominal x-ray and individual organ x-ray?
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What does an abdominal x-ray show?
Abdominal x-ray is a study with a long history of application. Its versatility lies in the fact that with just one picture you can get certain information about the state of all abdominal organs at once. Although the data obtained through the survey x-ray, is not enough to establish an accurate diagnosis, with its help an experienced doctor can prescribe at the earliest possible time the right treatment. Plain x-rays can save time that would be required for other, more accurate diagnostic procedures.An abdominal x-ray is used to examine the following organs:
- small and large intestine;
- gallbladder and bile ducts;
- spleen;
Stomach on abdominal x-ray
The stomach is mostly located on the left side of middle line. It has the shape of a hook or horn with medium filling. The shape of the stomach varies widely depending on its fullness and the state of motor function. Its volume in an adult is 1.5 - 3 liters. The stomach is successfully examined using x-ray methods. However, this requires its filling with a contrast agent. On an x-ray, you can detect the structure of the inner wall of the stomach and its division into sections.In the stomach on an x-ray, the following departments are distinguished:
- cardiac part ( located near the esophagus);
- vault ( transitional part);
- body ( main part of the stomach);
- pyloric section ( pylorus, located near the duodenum).
Each section of the stomach is characterized by some features of the folds of the mucous membrane. So, the folds of the arch have the greatest thickness ( up to 2 centimeters), and the smaller one - at the gatekeeper ( up to 5 mm). In the body of the stomach, the folds are about 1 centimeter thick. Visualization of the gastric folds may be obstructed by the enveloping of the gastric mucosa with protective mucus, fluid, or food accumulations.
With the help of x-rays, you can study the motor-evacuation function of the stomach. It is regulated by complex nerve reflex mechanisms. Under the influence of peristaltic waves, the contents of the stomach move to the pylorus, but its excretion into the duodenum depends on the opening of the pylorus. Usually after 30 - 40 minutes, half of the contrast mass leaves the stomach. After 1 - 3 hours, the stomach is almost completely cleared of it. To monitor this process, a series of x-rays are taken at large intervals.
X-ray anatomy of the small intestine
The small intestine is the longest section of the gastrointestinal intestinal tract. Its initial section, the duodenum, is of the greatest importance, since digestive enzymes enter it and food is digested here. The intake of food into the duodenum reflexively depends on its fullness and acidity level. On x-ray, the internal contour is highlighted using a contrast suspension. small intestine, its folds and lumen width.The small intestine is divided into the following sections:
- Duodenum. At the beginning of the duodenum ( the so-called bulb) no folds are visible, so it should be smooth on a normal X-ray. Further oblique, transverse, longitudinal folds appear about 3 mm high. On X-ray, the wall of the duodenum has a mottled appearance. It is explained by the penetration of barium suspension into the spaces between the folds.
- Jejunum. It is the longest section of the small intestine. A characteristic anatomical feature is the transverse folds located in the jejunum especially densely. However, due to the small height of the folds, they are almost invisible on x-rays.
- Ileum. Has the smallest gap. The folds in the ileum are larger than in the jejunum, so its serration resembles the duodenum. The ileum opens into the lateral part of the large intestine.
X-ray picture of the large intestine is normal
The large intestine is examined on x-ray using irrigoscopy - rectal injection of a barium suspension. The procedure is quite unpleasant, but it allows you to reliably detect inflammatory and tumor diseases of the large intestine. With tight filling of the large intestine with barium, the spindle-shaped relief of the large intestine is clearly visible - the so-called haustra ( folds), composed of muscular and submucosal layers. Conventionally, the large intestine is divided into sections that have similar anatomical features.The large intestine consists of the following sections:
- Cecum. The initial section of the large intestine. It has a length of 20 mm and a diameter of 15 mm. Gaustrae of the caecum are large, but rare. The cecum is separated from the small intestine by the so-called ileocecal valve, which regulates the passage of food into the large intestine.
- Ascending gut. It has a slightly smaller diameter than the caecum. The length of the ascending intestine is 60 mm, it is directed upwards, which explains its name.
- Transverse colon. Passes from right to left in the retroperitoneal space, has a length of 50 centimeters.
- Descending colon. It runs parallel to the ascending colon, differs in less pronounced haustra and the vertical orientation of the mucosal folds. Has a length of 70 mm.
- Sigmoid colon. It has different shape and dimensions, wide lumen ( up to 30 mm).
- Rectum. It is the terminal part of the large intestine and gastrointestinal tract.
Liver on abdominal x-ray is normal
The liver is located in the upper right part of the abdominal cavity, for the most part covered by costal arches. The liver is a parenchymal organ. This means that it is entirely functional tissue and has no cavities. The liver is made up of hepatocytes ( special structure cells) grouped into segments. The liver is divided into two lobes ( right and left) and consists of 8 segments. Unfortunately, it is impossible to distinguish between these structures using x-rays. Normal sizes liver are 9 - 11 cm in the midclavicular line and 8 - 9 cm in the midline.On x-ray, the liver has the appearance of a uniform triangular shadow, which stands out well against the background of other organs of the abdominal cavity. Upper outline liver coincides with the contour of the diaphragm. The external contour of the liver stands out against the background of fatty tissue and muscles of the anterior abdominal wall. The lower contour of the liver corresponds to its anterior edge on palpation, approximately parallel to the costal arch. Conventional x-rays cannot show the intrahepatic ducts or hilar vessels. Therefore, the possibilities of X-ray in the study of the liver are limited and inferior to such techniques as ultrasound ( ultrasound) or magnetic resonance imaging ( MRI) .
Gallbladder and bile ducts on abdominal x-ray
The gallbladder and bile ducts are not visible on a plain x-ray of the abdomen. An indirect sign of the gallbladder is a recess in the lower contour of the liver. A prerequisite for studying the biliary tract on x-rays is the use of contrast agents. When applied, their lumen is completely stained, allowing you to see their anatomical structure.With a contrast x-ray of the gallbladder, it is defined as an oval formation 6-10 cm long, 2-4 cm in diameter. Normally, it is filled with a contrast agent evenly, the contour of its inner walls is even and smooth. The volume of the gallbladder is 30 - 70 cubic centimeters. In response to eating muscular wall shrinks, while the organ is reduced by half.
The bile ducts begin inside the liver. The left and right hepatic ducts depart from the lobes of the liver, which are combined into a common hepatic duct. After joining cystic duct the common bile duct is formed, which flows into the duodenum. Regardless of the way the contrast agent enters the bile ducts, they normally look the same on x-rays. Thanks to high density X-rays of the bile ducts turn bright white with a contrast agent.
The basis of a normal biliary tree is the uniformity of its lumen, the absence of expansion or narrowing. If the contrast agent does not penetrate into certain areas of it, this indicates a mechanical reason for the closure of the lumen of the bile ducts. The diameter of the common hepatic duct on x-rays normally does not exceed 5 mm, and the common bile duct is 10 mm. The common bile duct has a length of 5 to 10 centimeters, and when it flows into the duodenum, it forms a physiological expansion - an ampulla.
X-ray anatomy of the pancreas
The pancreas is an important organ of the digestive system. It secretes enzymes that allow the digestion of proteins and carbohydrates. The pancreas is located in the retroperitoneal space, conditionally located between the right kidney and the spleen. The pancreas consists of a head, body and tail. The main pancreatic duct passes through the entire thickness of the pancreas, which opens into the wall of the duodenum.The pancreas is normally not visible on X-ray. This is due to the fact that its tissue completely transmits x-rays. On the contrary, only with certain diseases and changes in the pancreatic tissue, it becomes visible on x-rays. This happens when stones or calcifications are included in it ( deposition of calcium salts). In this regard, X-ray examination of the pancreas is rarely performed, in contrast to the ultrasound examination of this organ.
When performing endoscopic retrograde cholangiopancreatography ( ERCP) a radiopaque substance is injected into the main pancreatic duct. This study allows you to see the lumen and walls of the duct. Normally, the diameter of the main pancreatic duct is 1 mm ( in the tail area) up to 3 mm ( in the area of the head). Normally, its walls are smooth and do not have expansion or protrusion.
Anatomy of the kidneys. Kidneys on abdominal x-ray
The kidney is the main organ of the urinary system. In the kidney, blood is filtered, it is cleansed of excess water, salts and metabolic products. The kidneys are bean-shaped and about 120 mm long. They are located in the retroperitoneal space, however, in terms of their level of location, they correspond to the upper floor of the abdominal cavity. The renal tissue is divided into medulla and cortex, but this boundary can only be traced on x-rays using contrast techniques.On a plain radiograph of the abdominal area, the kidneys are defined as two bean-shaped shadows in the area of the transition of the thoracic spine to the lumbar. Part of the kidneys is covered by the lower ribs. Left kidney located slightly above the right. It is not possible to determine the features of the internal structure of the kidneys with this research method. Due to the anatomical features and insufficient contrast of the equipment, the kidneys may not be visible on the plain x-ray. However, in any case, it can be used to detect stones or foreign bodies.
The shadow of the kidneys with excretory urography is more contrasting. The main advantage of this method is the display of the pelvicalyceal system. Three cups can usually be found ( top, middle and bottom), which flow into one larger pelvis. The size and shape of the cups and pelvis may vary. The ureters look like a shadow in the form of a narrow strip.
Normally, on excretory urography, following characteristics Images:
- clear contours of the pyelocaliceal system, ureters, bladder;
- uniform and symmetrical release of the contrast agent;
- The pelvicalyceal system of the kidneys has no bulges, the diameter of the cups is not more than 5 mm, and the pelvis is not more than 20 mm.
What diseases can be detected with an abdominal x-ray?
X-ray examination has a very long history of use. Today there is a large number of x-ray techniques adapted to specific organs. Each technique has its own set of indications. By combining all the options for X-ray examination together, you can significantly expand the list of indications. Thus, with the help of X-ray methods it is possible to diagnose almost any diseases of the abdominal organs. However, at the same time, an abdominal X-ray is not universal, and this is its main drawback. Diseases of the stomach on x-ray of the abdominal cavity. Chronic gastritis. peptic ulcer
Radiation examination of the stomach is often shown to be carried out. This is due to the fact that due to the malnutrition of a modern person, the stomach and digestive tract as a whole suffer to a large extent.With the appearance of pain in the abdomen, heartburn, malnutrition, a diagnosis of peptic ulcer, chronic gastritis is assumed. For their diagnosis, it is necessary to conduct an x-ray using a barium suspension.
For chronic gastritis, in most cases, an increase in folds is characteristic, their acquisition of sizes of 3–5 mm, limited by deep grooves. Gastric fields ( accumulation of folds) because of this become clearly distinguishable. At the same time, functional disorders of the stomach are also detected. With an exacerbation of chronic gastritis, the stomach is reduced in size due to tonic contraction, its peristalsis is enhanced. Abdominal pain is due to muscle spasms. With the help of x-rays, several variants of chronic gastritis can be distinguished.
On x-ray, the following variants of chronic gastritis are distinguished:
- Warty ( polyposis) gastritis. On x-ray, thickening of the mucosal folds in the form of polyps is determined. This variant of chronic gastritis is most common. Enlargement of mucosal folds ( hypertrophy) is a protective response to inflammation or stimuli.
- atrophic gastritis. X-ray shows thinning of the gastric mucosa. The wall of the stomach has a reduced tone, it contains a small amount of fluid.
- Sclerosing ( rigid) gastritis. With this disease, the output section of the stomach is affected. The mucosa thickens unevenly here, acquires a jagged contour on the x-ray, at the same time, the outlet section of the stomach decreases in diameter and becomes immobile.
Signs of an ulcer on an abdominal x-ray are:
- Niche symptom. It is a contrast depression in the wall of the stomach. The recess has smooth edges and a rounded shape. It is surrounded by a raised shaft, to which the folds of the mucous membrane converge concentrically.
- Deformation of the stomach wall. With a long ulcerative process in the gastric mucosa, scarring occurs - the replacement of epithelial tissue with connective tissue. It tightens the edges of the ulcer, because of which the stomach is deformed and takes on an irregular shape.
- Violation of the tonic and motor function of the stomach. They are observed mainly locally, in the area of the ulcer. At the same time, at the site of the ulcer, there is a reduced tone of the stomach wall, as well as a slowdown or complete absence of peristaltic waves.
Free gas on abdominal x-ray
The cause of the appearance of gas in the abdominal cavity is a violation of the integrity of the wall of a hollow organ. X-ray examination plays an important role in the diagnosis of complications of gastric ulcer and duodenal ulcer. One of the most formidable complications of peptic ulcer is a rupture of the stomach wall. This condition requires urgent medical care. When the ulcer perforates into the abdominal cavity, free gas is found in it.If a perforation of the ulcer is suspected, an X-ray examination is performed in the position in which the patient was taken to the X-ray room. The gas enters the abdominal cavity through an opening in the wall of the stomach. On radiographs, it forms a clearly visible enlightenment. Gas occupies the uppermost sections in the abdominal cavity, while it changes its location depending on the person's posture. It can be located under the diaphragm, under the anterior abdominal wall, in the lateral sections of the abdominal cavity. Therefore, when perforating the abdominal cavity, the gas is called free.
On penetration ( penetration of the ulcer into neighboring organs) certain radiological signs. ulcer defect ( niche) It has big sizes (a few centimeters). The ulcer is fixed; it does not move with palpation of the stomach or changes in body position. Treatment of ulcer penetration requires surgery, during which ulcer defect sutured.
Fluid on abdominal x-ray
Free fluid in the abdominal cavity, like gas, appears only as a result of pathological processes. However, fluid can appear in the abdominal cavity as a result of several reasons. It is very important to establish the exact cause through a thorough examination, since the quality of medical care depends on this. If a free fluid in the abdominal cavity is detected on an x-ray, it is necessary, first of all, to eliminate the cause of its appearance. Only after that, the fluid is removed from the abdominal cavity with the help of puncture and drainage.Free fluid in the abdominal cavity appears for the following reasons:
- Abdominal trauma. With trauma to various organs, intra-abdominal bleeding occurs. At the same time, the state of a person does not change until a certain point. After the loss of a quarter of the circulating blood, blood pressure drops sharply and cerebral circulation decreases.
- Ascites. It is the exit of fluid into the abdominal cavity through the wall of the veins as a result of stagnation of blood flow. Ascites is observed in heart failure and liver failure, kidney disease. With cirrhosis of the liver, there is also an expansion of the veins of the anterior abdominal wall, resembling the "head of a jellyfish." Ascites fluid is usually sterile and free of bacteria.
- Perforation of hollow organs. With a rupture of the gallbladder, peptic ulcer of the stomach or duodenum, their contents can enter the free abdominal cavity. In this case, acute pain occurs, caused not only by a rupture of the wall of a hollow organ, but also by irritation of the peritoneum.
- Peritonitis. It is an inflammation of the peritoneum as a result of bile, blood, pus, infection of ascitic fluid entering the abdominal cavity. Peritonitis is a complication of various purulent diseases such as appendicitis. Peritonitis requires surgical treatment, as it threatens with a rapid death due to the multiplication of pathogenic microorganisms.
Acute mechanical intestinal obstruction on abdominal x-ray
Usually, bowel diseases on x-rays are diagnosed only with the use of contrast agents. However, if intestinal obstruction is suspected, a regular x-ray is taken, without their use. The fact is that additional injection of a contrast agent into the gastrointestinal tract can aggravate the situation. With acute intestinal obstruction there is paroxysmal pain, severe bloating and vomiting. Acute intestinal obstruction is an emergency.In acute intestinal obstruction, x-rays reveal swelling of the intestinal loops above the site of blockage and bowel prolapse below this area. A sign of mechanical obstruction on x-rays are the so-called Kloiber cups. They represent fluid levels in loops located above the intestinal blockage. Kloyber's bowls are found within an hour after the onset of intestinal obstruction. The rapid progression of this condition can lead to death.
Among the diseases of the intestines, the following pathologies are most common:
- Crohn's disease and others.
Crohn's disease is an inflammatory bowel disease of an immunological nature. Crohn's disease is manifested by the same symptoms as enterocolitis - abdominal pain, prolonged diarrhea ( diarrhea), loss of appetite, weakness. With this disease, any part of the intestine can be affected, but the initial section of the large intestine and the final sections of the small intestine are more often affected.
The main sign of Crohn's disease on x-ray is the narrowing of the intestinal loops with the formation of cicatricial constrictions. This area looks like a narrow uneven channel ( "cord symptom"). The folds of the mucosa disappear, cracks and slit-like ulcers appear between them. The contrast medium penetrates into these gaps. When viewed, such a wall resembles the appearance of a "cobblestone pavement". A complication of Crohn's disease is the appearance of abscesses. They are drained under the control of an ultrasonic sensor.
Appendicitis on abdominal x-ray
Appendicitis is an acute inflammation of the appendix located at the beginning of the large intestine. It is known that appendicitis is manifested by pain in the right lower section belly. Its diagnosis is usually not difficult, but in unclear cases resort to methods of radiation diagnosis. More often, they begin with the use of ultrasound and, if necessary, an x-ray of the abdominal cavity is performed.On X-ray, acute appendicitis leads to a thickening of the colon, the appearance of gas and liquid in it. The accumulation of gas looks like enlightenment against the background of the wall of the large intestine. The folds of the mucous membrane are thickened and rigid, their mobility is reduced. In the appendix there may be stones that have a light shade on the x-ray. An abscess at the site of the appendix looks like a darkening and depression on the wall of the caecum. When the appendix ruptures, there may be small amounts of gas or liquid in the abdomen.
Diagnosis of liver disease using an abdominal x-ray
Liver diseases are the subject of study by doctors of various specialties. For a correct diagnosis, in addition to a clinical examination, a blood test and radiation diagnostic data are also required. Diseases of parenchymal organs with the help of x-rays are usually diagnosed only at a late stage. A more accurate test for diagnosing liver disease is ultrasound procedure.An abdominal x-ray can reveal diffuse or local changes in the liver. Unfortunately, they are not specific, that is, it is impossible to establish an accurate diagnosis with certainty. With hepatitis, an x-ray shows an increase in the size of the liver and a slight heterogeneity of the parenchyma of the organ. With fatty liver a large number of fatty inclusions in the liver cells) the liver on x-ray is characterized by low density.
Much more pronounced are the changes in cirrhosis of the liver. Cirrhosis is the end state of the liver, which is caused by various chronic diseases. Cirrhosis is manifested by scarring of the organ and functional insufficiency. On x-ray, there is a decrease in the size of the liver, deformation of its lobes, jagged contour. In the liver tissue, heterogeneity is even more pronounced than in hepatitis. Along with this, the spleen is enlarged. In the abdominal cavity, free fluid can be detected - a sign of ascites.
Among the focal changes in the liver on x-rays, there are:
- cysts ( cavities filled with fluid);
- abscesses ( accumulations of pus);
- tumors ( collections of cells atypical for the liver).
Diseases of the gallbladder and biliary tract. Gallstone disease on abdominal x-ray
Biliary tract disease occurs in a very large percentage of the population ( about 10%). Only in rare cases do they necessitate surgical treatment. But, unfortunately, these diseases are forced to limit the diet, primarily by excluding fatty foods and alcohol. The first method for diagnosing the biliary tract is ultrasound ( ultrasound). In cases where ultrasound is ineffective, special X-ray methods of examination with the use of contrast are used.The most common diseases of the gallbladder and biliary tract are the following diseases:
- acute and chronic cholecystitis;
- gallbladder damage;
- tumors.
One of the main symptoms of biliary tract lesions is skin jaundice. This symptom can become a complication of gallstone disease. Obstructive jaundice is the closure of the lumen of the bile ducts by various formations located inside or outside them. With obstructive jaundice, the use of cholangiography and cholegraphy is a valuable way to determine the cause of its occurrence.
Indirect signs of acute pancreatitis on a plain radiograph of the abdominal cavity are:
- focal enlightenment in the area of the pancreas, corresponding to gas bubbles;
- symptom of "cut off colon» ( swelling of the transverse colon before the beginning of the descending colon);
- enlargement of the pancreas.
Ultrasound, magnetic resonance imaging and computed tomography are considered the best methods for diagnosing diseases of the pancreas. With these methods, more close attention the internal structure of an organ that cannot be examined using a conventional x-ray of the abdominal cavity.
Kidney disease on abdominal x-ray
Kidney diseases are very diverse. To diagnose them, doctors use various methods diagnostics, each of which serves a specific purpose. For example, angiography is required for vascular diseases of the kidneys, excretory urography is required for chronic pyelonephritis, and an abdominal x-ray may be sufficient to detect kidney stones. In controversial cases, you can use a computer or magnetic resonance imaging.The most acute condition requiring an abdominal x-ray is renal colic. During renal colic, there is a sharp pain in the lower back and difficulty urinating. Renal colic is a complication of urolithiasis and is caused by the closure urinary tract stone. In the vast majority of cases, kidney stones are composed of calcium and phosphate, which makes them visible on x-rays. On the survey x-ray, you can establish its presence or absence. With the help of excretory urography, the exact position of the stone in relation to the ureters or pelvicalyceal system can be determined.
At urolithiasis using X-ray methods, the following signs are revealed:
- presence of kidney stones contrast shading);
- expansion of the pelvicalyceal system;
- a sign of a “large white kidney” is an increase in the size of the kidneys and an increase in its contrast on a plain radiograph.
Sometimes an x-ray can detect a decrease in the size of the kidneys ( less than 10 centimeters long). Such a sign is considered an unfavorable change. Kidneys shrink with prolonged flow chronic diseases (glomerulonephritis or pyelonephritis). This condition is called nephrosclerosis. Together with a decrease in size, the kidney becomes less functional, which threatens to increase pressure and intoxicate the body with its own metabolic products.
Almost any disease renal vessels can be detected by angiography. On an x-ray with good image quality, they are defined by narrowing or dilatation of the renal vessels at various levels. Changes in the renal artery are called vasorenal vascular pathology. In chronic glomerulonephritis or pyelonephritis, the vessels inside the kidneys are affected. This form is called parenchymal. The basis for angiography is the inexplicable high blood pressure (the lower value is greater than 110 mm Hg. Art.).
With the help of angiography, the following diseases of the kidneys and renal vessels can be determined:
- atherosclerosis, thrombosis of the renal arteries;
- chronic glomerulonephritis and pyelonephritis;
- renal arterial hypertension;
- congenital malformations of the vessels of the kidneys;
- kidney tumors ( especially malignant).
Where can I get an x-ray of the abdomen?
Plain x-rays of the abdomen can be taken at any medical institution which has an x-ray room. It can be either a public or a private medical and diagnostic center. However, for more complex X-ray techniques ( such as cholecystography, urography) requires specialized medical personnel. They are usually carried out in medical centers of the appropriate profile. Book an abdominal x-ray.
To make an appointment with a doctor or diagnostics, you just need to call a single phone number
+7 495 488-20-52 in Moscow
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The operator will listen to you and redirect the call to the right clinic, or take an order for an appointment with the specialist you need.
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It is generally accepted that such a diagnostic method as radiography is used primarily for the purpose of examining hard tissues. Indeed, the most common indication for the appointment of this procedure are injuries, fractures, dislocations. But quite often, patients are prescribed. What does this research method show, how to properly prepare and does it have serious contraindications?
Why do x-rays
This instrumental procedure belongs to the methods of radiation diagnostics, which is in demand in modern medicine. The principle of X-ray examination is to study the state internal organs and tissues by passing X-rays through them. According to the results of the diagnostics, doctors can evaluate morphological and functional changes inside the body, detect foreign bodies and neoplasms.
Briefly about the history of radiography
The technique owes its name to the inventor who managed to project gamma radiation onto paper. Later they began to use a special film, on which the image was clearer. This non-invasive examination is one of the oldest methods in the history of medical diagnostics.
What does an abdominal x-ray show? The radiation, passing through the internal organs and tissues, displays a picture in the form of light and shade. In places where the image turns out to be pale, a conclusion is made about a denser structure. Today, radiographic images are stored on digital or matrix media, which allows you to display the image on a computer monitor or print a picture for detailed study.
Usually, an x-ray of the abdominal organs is done without the use of a contrast agent. This type of research is called review. If it does not allow an objective assessment of the condition of the patient's internal organs, they resort to repeated radiography, but with the use of barium sulphate.
Study with contrast
Chemical compound, which allows you to get a clearer picture of the examination, give the patient a drink immediately before the start diagnostic procedure. An aqueous suspension of barium can be introduced through a probe if the subject is not able to take it on his own.
What does a barium abdominal x-ray show? This element practically does not dissolve in water and biological fluids of the body, but at the same time it has the property of powerful absorption of gamma radiation, thanks to which the doctor will be able to draw conclusions about the relief of the mucous membranes of the internal organs.
Specialists carefully observe how the contrast agent moves along digestive system patient. The areas where the barium mass accumulates glow and are easily visualized, which allows the radiologist to study the functionality of the esophagus, stomach, intestines, detect tumors, obstructions or damage.
Overview diagnostics
This method of radiographic examination is intended to study the state of the organs of the gastrointestinal tract and systems adjacent to the esophagus. Plain x-ray of the abdominal cavity is most often prescribed for children with suspected presence of foreign objects in the stomach. As a rule, it is recommended to carry out it in combination with other instrumental and laboratory procedures for making an accurate diagnosis.
Since the abdominal organs have a loose structure, the shadow in the picture is less pronounced than that of the bones. Compared to a contrast study, a plain x-ray is less informative and only detects a tenth of what a barium abdominal x-ray shows. At the same time, this type of study is quite enough to determine an organ injury in a patient or detect a foreign body in the cavity in a few minutes and without prior preparation.
What is the difference between fluoroscopy and radiography
X-ray, as an instrumental research procedure, cannot replace other diagnostic methods, but supplements them with objective information, and, therefore, contributes to the rapid and accurate determination of the disease. Today, doctors equally often resort to the use of both diagnostic methods. What is the difference?
- Radiography makes it possible to see changes in organs on images displayed on a photosensitive film.
- Fluoroscopy is a type of diagnosis that is carried out in real time. The picture is displayed on the screen.
What does an abdominal x-ray show?
From the course of school anatomy, it is known that the abdominal cavity is a space delimited on the sides by the muscles of the press, by the lumbar muscles in the back, and in front by the peritoneum. The iliac pelvic bones are located in the lower part of the abdominal cavity, and the diaphragm is located on top. This part of the body contains the digestive and genitourinary system. The first includes the stomach, esophagus, large and small intestines, liver, pancreas and gallbladder, the second - the internal genital organs, bladder, kidneys, etc.
Knowing what an abdominal x-ray shows, you can see a real picture of the functionality of internal organs, including determining:
- whether gases and liquids are distributed normally;
- whether there are accidentally swallowed objects, kidney stones, gall bladder in the gastrointestinal tract;
- Is there any internal bleeding?
- no organ damage.
Who needs an x-ray
This type diagnosis is appointed by a specialist, as a rule, in one case - if the patient has complaints about severe pain in a stomach. This syndrome may indicate the presence of pathologies such as:
- sharp and chronic pancreatitis;
- inflammation of the gallbladder and cholelithiasis;
- malignant and benign formations;
- intestinal obstruction;
- pyelonephritis and glomerulonephritis;
- intestinal diverticulitis;
- inflammation of appendicitis;
- serious injury, internal bleeding.
Patients admitted to the hospital emergency department for acute pain are first given a plain x-ray of the abdomen. What does this type of diagnostics show and how informative is it? Plain radiography is usually enough to get a picture in a matter of minutes. general idea about the patient's condition and draw up a plan for further action.
How is the procedure itself
The study can be carried out in any position convenient for the patient. In some cases, an image of the abdominal organs in several projections is required, so the pictures can be taken standing and lying down. You don't have to take off your clothes before taking an x-ray of the abdomen, but you should definitely remove any metal objects in the X-ray field.
The patient is placed close to the patient, and the specialist sets the optimal position of the device according to the growth of the subject. During the procedure, you can not move. Otherwise, the picture of the examination will be blurry and you will have to undergo the examination again.
The picture and description of the x-ray of the abdominal cavity are given to the patient immediately after the procedure. The conclusion is made by the radiologist, and the diagnosis is made by the specialist who issued the referral for this procedure. In order to avoid receiving increased radiation exposure, it is not recommended to undergo x-rays more than once every six months.
Preparation methods
The patient who needs urgent diagnosis does not undergo any specific training. If the examination was planned in advance, you will have to take time to cleanse the intestinal tract. On the eve of the study, the patient needs to give an enema or take a laxative "Fortrans". Knowing what an abdominal x-ray shows in adults and how it displays the examination picture, it is important to prevent extraneous shadows that will introduce errors in the conclusion.
If the patient is suffering severe flatulence or has a tendency to constipation, within three days before the scheduled date of the study, he needs to take a light diet menu. For this period, it is desirable to completely exclude products that promote gas formation:
- legumes;
- dairy;
- Rye bread.
Preparing for an abdominal x-ray also means avoiding pasta and meat. Do not eat on the day of the examination. During the diet, it is desirable to take sorbents that will help the body cleanse itself faster and more efficiently.
What can be seen in the pictures
As for the description of the images, it is worth noting right away that the initial results must be evaluated by a radiologist. If a patient is admitted to the emergency room after injury or exposure to other factors, first of all, doctors should rule out the possibility of internal bleeding, rupture of a hollow organ, which may be indicated by the presence of gases in atypical places. Hemorrhage is usually indicated by the presence of free fluid in the lower abdomen. At healthy person it shouldn't be there.
In addition, x-rays can help diagnose:
- pneumoperitoneum (abnormal gas filling of the abdominal cavity);
- the presence of stones in the gallbladder, bladder(stones are extremely rarely displayed on the projection, which, according to experts, depends on the location of the formations, their size, shape);
- intestinal obstruction (in this case, individual fragments of the intestine will resemble large expanded bowls, which contain a lot of gas and liquids);
- (this diagnosis put by doctors with significant restrictions in the mobility of the diaphragmatic dome and with the appearance of an effusion at the site of localization of the right pleural cavity);
- neoplasms, various foreign bodies that enter the body through the esophagus.
Some products, in particular those often swallowed by children, do not reflect X-rays, and therefore it is not always possible to see them in the picture. If pancreatitis is suspected, x-rays are recommended. abdominal organs.
Compared to plain radiography, contrast is considered more informative, as it allows you to detect even subtle nuances, for example, the degree of patency in any part of the gastrointestinal tract. With the help of barium mass, it is much easier to analyze the state of the mucous membrane of internal organs, to confirm or exclude the presence of tumors. An x-ray is able to detect a neoplasm in the abdominal cavity only when it already compresses the walls of neighboring organs.
Where to get an x-ray of the abdomen
This study is carried out in the direction of the attending physician. An x-ray can be prescribed by any of the narrowly specialized specialists - a therapist, gastroenterologist, urologist, nephrologist, endocrinologist. The cost of the procedure may vary slightly in different medical institutions, depending on the form of ownership, the technical capabilities of the equipment available, and the qualifications of the radiologist. You can make an x-ray both in a paid clinic and in a budget one. The main thing is that a qualified radiologist draws up a detailed and reliable conclusion. The cost of diagnostics usually includes the decoding of the image.
Internal organs under x-rays are not characterized by high information content. Parenchymal and air tissues do not reflect radiation, therefore, a clear picture is not visualized on radiographs. In order to reveal the pathology of hollow structures and formations of low density, their complete contrasting (injection of a contrast agent) is necessary.
What is an abdominal x-ray
Plain abdominal x-ray shows x-ray contrast stones of the gallbladder, urinary tract, kidneys, and large intestine. With perforation (destruction of the intestinal wall), the study allows you to detect free gas under the right dome of the diaphragm and fluid levels in the lower part of the abdominal cavity, as well as the small pelvis. Plain radiography of the abdomen shows:
- large tumors;
- fecal masses;
- intestinal obstruction (Cloiber bowls and arches).
The examination is not preventive and is not assigned to every patient. Abdominal x-rays are done for suspected intestinal obstruction, perforation of the intestinal wall, or for back pain.
What is the passage of barium through the intestines
The passage of barium through the intestines is performed if there is a suspicion of intestinal need, but before the procedure, perforation (destruction of the wall with the release of air) of the gastrointestinal tract with the help of FGDS should be excluded.
X-ray photo 6 hours after taking barium: Kloiber bowls are traced (marked with arrows) in acute intestinal obstruction
Attention! The passage with barium through the intestines in case of destruction of the intestinal wall is contraindicated. Barium sulfate is a water insoluble contrast. Its entry into the peritoneum will contribute to the development of peritonitis (inflammation of the peritoneum).
The technique involves oral (through the mouth) application of a contrast agent and taking pictures after 1, 3, 6, 9, 12 and 24 hours. At these intervals, the contrast moves into different parts of the gastrointestinal tract:
- After 1 hour - a contrast agent in the small intestine.
- 3 hours - barium accumulates in the transition area between the small and large intestines.
- 6 hours - the initial sections of the ascending colon.
- 9 hours - transverse and colon.
- 12 hours - descending colon and sigmoid colon.
- 24 hours - rectum.
The barium passage through the intestines shows:
- narrowing of the lumen of the gastrointestinal tract;
- difficulties of its advancement at the block;
- intestinal obstruction;
- small intestine fistulas.
Recall that an x-ray of the abdominal organs without a contrast agent is uninformative. But it perfectly shows an urgent condition - acute intestinal obstruction, in which free gas is visible under the dome of the diaphragm (the "sickle" symptom). If such signs are identified, urgent surgical intervention is necessary to identify the causes of perforation (perforation).
When is a Plain Abdominal X-ray with Contrast Taken?
Plain radiography of the abdominal organs is done with the following diseases:
- pancreatitis - inflammation of the pancreas;
- cholecystitis - inflammatory changes in the gallbladder;
- abscess - purulent cavity;
- urolithiasis, nephrolithiasis - stones in the kidneys and urinary tract;
- invagination - twisting of the intestine around the axis;
- blockage of the lumen by a tumor;
- diverticulitis;
- traumatic injuries;
- abdominal pain.
In these diseases, a survey x-ray of the abdominal organs is first performed. This requires prior preparation. It involves a cleansing enema 2 hours before the procedure.
After performing an overview image and in the absence of x-ray signs of perforation of the intestinal wall, the organs are contrasted with barium orally.
Attention! In a contrast study of the abdominal cells and large intestine (irrigoscopy), the contrast is injected through the rectum.
Method of passage with barium through the gastrointestinal tract
Virtual endoscopy: spastic contractions of the large intestine in colitis The passage technique is highly informative for the study of the small intestine. This part of the abdominal cavity has many anatomical formations, bends, anatomical narrowing, tumors, areas of impaired motility and secretory activity.
To study all parts of the small intestine, it is necessary to perform targeted radiographs in 30-60 minutes. As a result, it is accompanied by a significant radiation load on the patient.
As barium advances in the abdominal cavity, the structure of various departments can be studied. When the caecum is seen on the x-ray during the passage with barium, the study is stopped so as not to additionally irradiate the patient.
For pain in the abdominal wall, as well as identifying symptoms of tension in the abdominal cavity, x-rays can be continued to examine the condition of the large intestine. True, it should be planned in advance in order to qualitatively clean the gastrointestinal tract ( Activated carbon, fortrans). A slag-free diet is prescribed 1-2 days before the procedure.
Preparing for a Contrast Abdominal X-Ray
How is the preparation for an abdominal radiography followed by contrasting:
- For 2-3 days, you should give up dairy products, black bread, coffee, spicy, chocolate, alcohol and smoking.
- You can use butter, White bread, pasta, fish.
- On the day of the procedure, the stomach should be empty. To do this, refrain from eating, smoking, chewing gum.
To eliminate slag accumulations in the intestines, some doctors recommend the drug Fortrans. It can be purchased at a pharmacy. Before use, the sachet of the product is diluted with a liter boiled water. Fortrans is applied in the evening with an interval of 1 hour until the dosage recommended by the doctor is over.
An x-ray of the internal organs is performed if a dangerous condition is suspected. If the doctor has prescribed a study, you should not refuse it. The passage with barium can save a life!
The use of a contrast agent for examination of the gastrointestinal tract and preparation for the examination require professional skills. To obtain high-quality images, it is necessary not only the ability to set the time for performing radiographs. It is important to properly prepare barium. This substance is diluted with water, but is not water soluble. Depending on the density of the suspension, an image is obtained on the radiograph. To examine the small intestine, located near the Bauhinian valve (small-colonic junction), it is necessary to prepare a low-density solution.
Each person has faced the need for x-rays in their long life, this procedure can be associated not only with the diagnosis of various injuries, but also with the need to identify any diseases and other health problems. In this material, let's consider such a procedure as an x-ray of the abdomen, since such an examination is carried out quite often and requires some preparation as directed by the doctor.
Let us mention right away that radiography can be performed only if there is pain or other serious indications for this, since the body receives a certain amount of radiation during x-rays. If you have any disorders, such as butterflies in your stomach or other unpleasant feelings, you should immediately contact a specialist who will decide on the best diagnosis.
Types of abdominal x-rays
Specialists distinguish two types of radiography, namely: survey and contrast. The first type of this procedure is carried out almost always when dealing with complaints, it is characterized by a survey examination of the organs located in the chest, as well as in the abdominal cavity. This type of examination allows specialists to draw conclusions about the state of the organs of the gastrointestinal tract, primarily about the esophagus and stomach. It should be mentioned that the organs of the abdominal cavity have a rather loose structure, therefore, their shadows are not so pronounced on the pictures. For this reason, the overview version of the x-ray allows you to diagnose only serious changes in organs and tissues due to any diseases or traumatic injuries.
X-ray of the abdominal cavity.
Note! Plain radiography is considered an extremely cheap and fairly informative diagnostic method, so it is often performed almost immediately after visiting a doctor in order to clarify the diagnosis or select methods for further diagnosis. Among its advantages, one should also highlight the speed of implementation and low cost, and if you are undergoing treatment in a public institution, then such an x-ray will most likely be free.
As you might guess, unfortunately, this method can not always give a complete picture of your illness. In such situations, specialists prescribe a barium contrast radiography or some other more detailed and informative examination, such as an MRI.
As mentioned earlier, the contrast agent used in the examination of the abdomen is most often barium, and it is its aqueous suspension that is used. In the overwhelming majority of situations, this contrast is simply drunk by the patient, after which a certain time is expected for its penetration into the organs of the gastrointestinal tract, which need to be examined. In extremely rare situations, a contrast agent may be injected through a tube.
Note! Specialists use exactly barium, since it does not tend to dissolve in water or in any physiological fluids, while it has the property of absorbing X-rays, and this makes it possible to draw conclusions about the relief of mucous membranes.
X-ray of the abdomen with contrast agent.
During the procedure, while the contrast agent has not yet reached the desired part of the gastrointestinal tract, the specialist will monitor using transillumination, which is very important, as this allows you to study the functions of the esophagus, as well as the stomach and intestines, and if there are any either neoplasms, lesions or even obstruction the problem will be established with a high probability.
Indications for carrying out
As mentioned earlier, due to the radiation (radiation) from fluoroscopy, the procedure can in no case be carried out thoughtlessly, that is, X-rays can only be taken if any violation or abnormality is to be detected. serious problem. Here is a list of the main diseases for the detection of which such irradiation is carried out:
- intestinal ischemia;
- pancreatitis;
- blockage of the intestine;
- cholecystitis;
- acute appendicitis;
- urolithiasis disease;
- malignant or benign tumors;
- nephrolithiasis;
- intussusception;
- purulent accumulations and inflammatory processes;
- various traumatic injuries related to the abdominal organs;
- ingress of any foreign objects in the abdominal cavity.
Also, the procedure is often prescribed according to the complaints of patients, here are the main ones:
- Availability pain or other kind of discomfort in the abdomen;
- feeling of heaviness in the digestive organs;
- bloating.
Important! Let us remind you once again that the procedure can only be prescribed by qualified specialists, in some situations it would be better to give preference to more modern and expensive methods, since an x-ray with barium will not carry enough information to prescribe competent therapy.
Contraindications
Irradiation is not the only reason for refusing to conduct an examination, since there are also contraindications, in the presence of which it is impossible to go for the procedure in any case.
To get more informative pictures, you need to properly prepare for the procedure.
We are talking about the following situations:
- pregnancy;
- transferring a biopsy;
- small age;
- lactation.
When using a contrast medium, the following contraindications must be considered:
- individual intolerance to the components of the contrast;
- such serious illness like kidney failure, liver failure, heart failure, diabetes and many others.
Preparation for the examination
To obtain high-quality images, careful preparation for the examination is necessary. We will immediately mention that this applies only to those cases when X-ray with barium is meant, since the survey examination is most often done spontaneously.
During the procedure with contrast, it is necessary not to eat food 12 hours before the examination, and 3 days before the examination, it is necessary to stop eating foods that promote gas formation, namely: vegetables, fruits, foods, sweets, black bread. Most often, it is also necessary to clean the intestines, which is done with the help of a special enema, which is prescribed for the evening before the examination and two hours before it starts.
Despite the exposure, it is necessary to conduct such examinations, since it is informative, and the conduct itself does not cause any difficulties.
Examination of the abdominal organs using X-ray radiation is one of the most informative and popular research methods so far, despite the advent of ultrasound, CT and MRI. The advantages of this method are speed, low cost and relatively low radiation exposure.
Plain radiograph of the ABP
Plain radiography of the abdominal cavity is 150 times safer for humans than, for example, fluoroscopy of the stomach. Therefore, it is this research technique that is used in almost every hospital where there is a gastroenterological department, and even abdominal surgeons cannot imagine a case history without several panoramic radiographs of the abdominal cavity organs, performed in dynamics.
Relevance and effectiveness of the methodology
Special requirements are imposed on the qualifications of a radiologist precisely when conducting, interpreting and second reading an overview x-ray of the abdomen. It is much more difficult to make a diagnosis by this type of study than, for example, in the study of the skeleton, where the shadows from the bones are interpreted unambiguously. After all, a competent radiologist should be able to:
- to distinguish between the norm and the pathology, which is much more difficult, even if the object is defined;
- identify radiological symptoms by analyzing all kinds of characteristics of the shadows of organs, such as their position, number, shape, size, intensity, contours; it is important to be able to determine the displacement of the shadow, which can be shown by fluoroscopy;
- determine the leading x-ray syndrome, which allows you to make a diagnosis “immediately”, if any;
- make an assumption about the nature of this process.
It is very difficult to do this when performing an x-ray of the abdominal cavity, and the study will be effective only if the radiologist is highly qualified.
How to distinguish between norm and pathology?
Plain radiography of the abdominal cavity - the absence of a gas bubble of the stomach
Indeed, it is precisely in such a study as radiography of the abdominal organs that it is necessary not only to examine a large number of shadows of hollow organs (stomach, intestines) layered on top of each other, from hollow organs containing liquid, from gas bubbles. Other than that, what does this study show?
Plain x-ray allows you to see the liver and pancreas, the organs lying retroperitoneally - the kidneys and adrenal glands. Shadows are guessed from large vessels, especially if they contain calcifications, and also a shadow from the spine is located along the midline. And only a professional can understand this picture, therefore, it is especially important to observe the strict principle of diagnostic algorithms during this examination.
Indications for research
The scope of indications is extremely wide. These are dynamic disturbances in the passage of barium suspension, the diagnosis of intestinal obstruction, malignant neoplasms of the stomach and intestines, cicatricial stenosis of the esophagus in its burns. In case of gastric cancer, this type of study can even, with a high probability, establish a preliminary type of tumor (plaque-shaped, mushroom-shaped, polyposis, diffuse and other types of cancer).
X-ray of the abdominal cavity with intestinal obstruction
The study is carried out in emergency surgery to study the pathological relief of the mucous membrane (for example, in Menetrier's disease), as well as in the syndrome of stenosis of the alimentary canal throughout its entire length. A study helps to determine the level of damage with a foreign body of the esophagus and stomach.
An X-ray method for examining the abdominal cavity is also used in the dynamic diagnosis of gastric ulcer and duodenal ulcer, with gastroesophageal reflux, cardiospasm and other diseases.
The radiographic method of research helps to determine changes in the mucous membrane in gastritis, nonspecific ulcerative colitis, cancer of the large and small intestine, hemangiomas.
The cheapness and speed of the method make it possible to use it as a screening, before prescribing, for example, an MRI.
Contraindications
There are practically no contraindications to the study, except for the first trimester of pregnancy, as well as ongoing esophageal or gastric bleeding.
Even in an extremely difficult position, the patient can be put for a second to determine the horizontal levels of fluid in the swollen and paretic loops of the intestine, these are the so-called "Cloiber bowls", a pathognomonic symptom of intestinal obstruction.
Horizontal liquid levels with gas bubbles above them - Cloiber bowls
Preparation and methodology
There are several research methods. So, in the study of the organs of the digestive canal, the preparation consists in the introduction of a barium suspension, which can be given orally or retrograde, by filling the large intestine with a barium suspension during irrigoscopy.
When administered orally (through the mouth), barium sulfate is administered to the patient on an empty stomach. It is known that after 9-10 hours barium moves to the ascending colon, and a day later - to the rectum.
In turn, before irrigoscopy, the patient is asked to follow a slag-free diet for 2-3 days, on the eve he is given castor oil and a cleansing enema is performed.
Doctors, depending on the need, prescribe a series of images. Plain radiographic examination of the abdominal organs can be performed without the introduction of barium contrast.
Currently, for the study of lesions of the liver and pancreas, such a study as an X-ray of the abdominal organs is almost never used, since there are MRI, CT and ultrasound techniques.
Previously, radioisotope scintigraphy was used for this, but at present it is almost not performed.
Of the methods of preparing the patient, perhaps, the appointment of a fat-soluble contrast agent in the evening was left, so that it would be absorbed into the bile and contrast the bladder during cholecystography.
Problems in decoding and interpretation
We will not describe in detail all the radiographic symptoms and syndromes of lesions of the intestines, stomach and esophagus. It is known that catalogs of algorithms for lesions of the digestive organs in radiology in coloproctology, abdominal surgery and diseases of other organs, there are tens and hundreds of volumes.
We give only those basic, typical data that form the basis for the formulation of a visual diagnosis. So, for example, when studying diseases of the digestive canal, that is, a tube through which a barium suspension passes, you can get a number of syndromes:
- The phenomenon of organ dislocation. For example, the displacement of the stomach by a diaphragmatic hernia, or by a tumor, an aortic aneurysm will be manifested by its displacement.
- When a change in the relief of the mucous membrane is detected, a conclusion can be made about the local or general nature of the process, and then, as a clarifying diagnostic method perform a procedure such as EFGDS (esophagogastroduodenoscopy), or colonoscopy.
FGDS
- When a dynamic dysfunction of the alimentary canal is detected, the rate of progress of the contrast suspension on a series of radiographs is assessed, either acceleration or deceleration of the passage of barium is taken as a basis. Dynamic dysfunction is exhibited only in the unconditional absence of organic damage, or "suspicious" shadows.
In conclusion, it can be said that an examination such as X-ray (survey) of the abdominal cavity can, in some cases, make energy-intensive and expensive studies such as computed tomography and magnetic resonance imaging unnecessary, and immediately begin to treat the patient.