Contrast studies of the gastrointestinal tract. How to check the stomach and intestines: features of the most informative research methods Methods for examining the digestive tract

Colonoscopy or bowel MRI? This question is asked by every patient who has had to undergo an examination, perhaps the most inconvenient place. As sad as it is to realize, colonoscopy is one of the most effective methods. However, MRI has its own indications. What is better - MRI or colonoscopy - we will tell in this article.

The simplest methods for examining the gastrointestinal tract of a patient

There are many different methods for examining the stomach and intestines, the results of which can be used to diagnose or refute it.

The simplest methods can be carried out by a specialist during the first treatment of the patient with complaints. More complex are those that require additional equipment or a more qualified doctor.

In order for the diagnosis to be accurate, it will be necessary to pass some of the most important and significant tests, they will be prescribed by the doctor after the initial examination.

Palpation

Palpation is a procedure during which an experienced doctor can, with the help of a simple examination and palpation, without the use of an additional medical instrument, make an accurate diagnosis. What is the patient doing at this time? The patient will have to stand or lie down, as required by the doctor. The room should be warm, the doctor will feel the body with warm hands, this procedure is completely painless and does not pose any danger, there are no contraindications for its implementation.

Auscultation

Unlike palpation, for this procedure, the specialist will need an additional medical instrument - this is a stethophonendoscope. This procedure is also very simple and painless. The specialist simply listens to how the patient's internal organs work. Noise distorts the picture. There are also no contraindications for this procedure. It will take only a few minutes and will allow you to talk about pathologies in the work of the gastrointestinal tract, which will greatly help in making the final diagnosis.

Percussion

This is an additional method of initial research, which is often carried out during palpation. This procedure will help determine the boundaries of the location of the internal organs of the patient.

sounding

The doctor can get more information with the help of additional equipment or other tools. So, very useful information can be obtained using such a diagnostic method as probing. The procedure is not very pleasant, but very important and meaningful. It consists in the following: the doctor, using a probe, gains access to the digestive system from the inside. He will definitely take a sample of gastric juice for research. The entire procedure takes several hours. There are no contraindications for its implementation, but there are some recommendations that it makes sense to use before probing.

Within two or three days before the study, it is recommended to eat food that does not lead to increased gas formation. You can not eat fresh fruits and vegetables, drink water with gas. Do not eat for 12 hours before the procedure.

With the help of probing, it is possible to conduct a study of the stomach, or rather gastric juice, to check the acidity index.

Instrumental methods for examining the gastrointestinal tract

There are also known methods of studying the stomach, with which you can get more detailed and accurate information about the general condition of the digestive system of the patient. These include ultrasound, x-ray, examination with an endoscope, sigmoidoscopy, laparoscopic examination and MRI and CT. All these are instrumental methods for examining the gastrointestinal tract, which will allow a more thorough examination of the organ of the patient's gastrointestinal tract of interest to the doctor.

x-ray

This is a very important and simple procedure that has contraindications. It can not be carried out by pregnant women, and nursing mothers only on the recommendation of a doctor. X-ray examination of the stomach allows you to determine some defects in the internal organs of the digestive system. There are a variety of radiological methods for the study of the gastrointestinal tract and diagnostics.

Examination with a special tube

Endoscopic methods for examining the gastrointestinal tract are of different types. It all depends on which organ of the digestive system is examined. In order to conduct an examination of the intestine, a tube is inserted into the anus.

An endoscope is a tube that has a camera. In real time, it is quite possible to look inside a person and look at the walls of internal organs and determine whether there are defects or other pathologies or not.

Gastrointestinal diseases are one of the most common problems of a modern person who lives most of the time on constant snacks, business lunches and late dinners. According to statistics, almost every second modern person suffers from diseases of the gastrointestinal tract, but most of these ailments remain unidentified due to simple unwillingness to visit a specialist. Today, there are many opportunities for diagnosing diseases of the gastrointestinal tract, which allow you to identify the problem with high accuracy and in a short time and determine ways to solve it.

Physical examination methods

Of course, the first step towards establishing a diagnosis is a consultation with a specialist. It is necessary to answer in detail all the questions of a gastroenterologist or a therapist who, according to your complaints, will be able to compile a general picture of the disease. Next, the specialist proceeds to a more detailed examination, which includes methods such as palpation, auscultation, percussion. Below we will look at some of these methods of examination in more detail:

Palpation is a special technology of probing the patient's abdomen, performed by the doctor's fingers without the use of additional instruments. Scientists have long identified features characteristic of gastrointestinal diseases that can be detected by palpation. So, for example, with the help of palpation, a specialist can determine the foci of localization of pain, the degree of tension in the abdominal wall and other changes in the gastrointestinal tract. Palpation is performed in a warm room, while the patient can be in both vertical and horizontal positions. It is most convenient to carry out such a diagnostic method when the patient is in the supine position and the abdominal muscles are relaxed. To do this, the couch should be soft, and a small pillow should lie under the head of the person being examined. It is important that the room is warm, the hands of a specialist should also be pre-warmed. If it is necessary to diagnose diseases of the gastrointestinal tract located in the lateral parts of the abdominal cavity, then it is better to palpate in a standing position. Auscultation is a diagnostic method in which a specialist listens to sounds emanating from the digestive tract using a stethophonendoscope. In some cases, auscultation can also be carried out by applying the ear to the patient's abdomen. In the room where auscultation is carried out, silence should be observed, and listening is carried out on symmetrical parts of the body for subsequent comparison of the results. In this case, pressure on the patient's abdomen should be avoided. Percussion is a method of studying the organs of the gastrointestinal tract, which is carried out in order to determine the boundaries of their location. As a rule, percussion is performed simultaneously with palpation for the most accurate diagnosis. Percussion is used primarily to examine the liver and spleen.

More often, these methods of diagnosing diseases of the gastrointestinal tract are of a primary nature and allow only approximately determining the condition of a person. For a more accurate diagnosis, the specialist prescribes a series of clinical and laboratory tests. It is necessary to pass a general and biochemical blood test, as well as a general urine test.

Other technologies for diagnosing diseases of the digestive system: probing

As a rule, the above diagnostic methods can reveal only an approximate picture of the disease. If the specialist wants to get more accurate information for the diagnosis, he will refer you to additional examinations, which are carried out using special tools and equipment. The simplest and most common method for examining the gastrointestinal tract is probing. The main purpose of probing is to access gastric juice, which reflects all the necessary indicators of the state of the gastrointestinal tract. Violation of the content of hydrochloric acid in gastric juice causes malfunctions in digestion and becomes the cause of certain diseases. Sounding is the only way to investigate the balance of acidity in the stomach. In addition, it may be relevant in situations where it is necessary to diagnose certain diseases of the duodenum and even flush the stomach in case of poisoning.

Endotracheal and nasogastric sounding

The probing procedure consists in introducing a special probe through the esophagus to the stomach. In preparation for this method of examination of the gastrointestinal tract, the patient should avoid eating vegetables, fruits, carbonated drinks, milk and black bread in his diet for two to three days. During this period, it is recommended to take activated charcoal in order to reduce gas formation. The procedure itself is carried out ten to twelve hours after the last meal, on an empty stomach. Probing lasts an average of no more than two hours and does not entail any consequences for the gastrointestinal tract.

Endoscopy and features of its implementation

Endoscopy is another method of examining the gastrointestinal tract, which consists in the introduction of optical instruments into the lumen of the gastrointestinal tract. As a rule, endoscopy is the most effective technology for diagnosing diseases of the small or large intestine. During endoscopy, a special tube with a camera is inserted into the intestinal lumen, which allows you to get a picture of the state of the intestine from the inside. Endoscopy also allows you to extract material (biopsy) for further research and even some treatment. For the first time, this method of diagnosing diseases of the gastrointestinal tract began to be used back in the 19th century, and with the advent of a flexible gastroscope with an optical system, it began to be used more actively. Indications for endoscopy include suspicion of cancerous tumors, colitis, and some other diseases. Endoscopy allows you to see polyps and check the condition of the graft during intestinal transplantation. Endoscopy should not be performed if there is an allergic reaction to anesthesia drugs, blood clotting disorders in order to avoid dangerous consequences. In preparation for endoscopy, only liquids should be taken for 24 hours and laxatives. This method of studying the gastrointestinal tract practically does not cause complications, but it requires an exceptionally professional approach and accuracy.

Fast and efficient: sigmoidoscopy

The range of methods for diagnosing diseases of the gastrointestinal tract is constantly updated with new technologies, one of which is sigmoidoscopy. This method allows you to examine the rectal mucosa using a special optical instrument. The sigmoidoscope, which is inserted through the anus, is a rigid metal tube with a small camera at the end. Using a proctoscope, a specialist can assess the condition of the intestine at a distance of 20-25 cm from the anus.

Sigmoidoscopy is performed within a few minutes and does not require the use of anesthesia. In the case of professional performance, such diagnostics do not cause pain in the patient, however, if young children are examined, anesthetics may be used. Sigmoidoscopy is used in cases where the patient experiences pain in the rectum, with purulent and mucous secretions and bleeding. These conditions can act as symptoms of diseases such as hemorrhoids, polyps, malignant tumors, so timely diagnosis in such cases is of particular importance. There are practically no complications after this research method, preparation for the procedure is limited to brief recommendations. On the eve of sigmoidoscopy, it is necessary to cleanse the intestines with an enema and avoid heavy foods in the diet.

Rectosigmocolonoscopy and ERCP

Additional methods for diagnosing diseases of the digestive system are also rectosigmocolonoscopy and. The first procedure is used when a more thorough examination of the intestine is necessary, when conventional endoscopy and sigmoidoscopy are not enough. It is carried out using a flexible tube with a camera that photographs the condition of the intestinal mucosa and takes material for analysis. The procedure is absolutely painless, however, before it is carried out, the patient must follow a special diet for several days and thoroughly cleanse the intestines the day before.

Endoscopic retrograde cholangiopancreatography

ERCP, in turn, is aimed at examining the bile ducts and includes both endoscopic and radiological methods. With the help of an endoscope, a contrast fluid is injected into the bile ducts, which allows you to subsequently see and evaluate their condition in the picture. Before the ERCP, the patient should not eat to get a good x-ray. Among the rare complications of ERCP, only pancreatitis can be called, however, the professional performance of this procedure excludes the possibility of such a complication.

One way or another, today there is a wide variety of methods for diagnosing diseases of the digestive system, which allow you to accurately determine the problem and prescribe effective treatment. Modern technologies make these techniques painless for the patient and indispensable for the specialist.

Contrast studies of the gastrointestinal tract

The gastrointestinal tract (GIT) is often the object of X-ray examination with contrast. X-ray examination of the stomach, esophagus and small intestine is performed on an empty stomach, the patient is forbidden to drink and smoke on the day of the examination. 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 contrasting, it is necessary that the contrast agent has a high degree of dispersion and concentration of barium sulfate particles with 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 only with barium is justified in elderly and debilitated patients, in the postoperative period and for special purposes - for example, in the study of motility of the gastrointestinal 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 of various pathologies of the digestive tract can be grouped into ten main 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 can 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 obstruction of the intestine, 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 can be detected after blowing the 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 alimentary canal

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

Suspicion of cardiac insufficiency or esophageal achalasia,

Suspected hiatal hernia.

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 include pregnancy, ongoing gastric (esophageal) bleeding; 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 water, cabbage, etc. The diet should 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

Examination of the duodenum

The essence of the method: relaxation duodenography- contrast radiography of the duodenum in its relaxed state, artificially induced by drugs. 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 whose 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 the large intestine is tightly filled 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 contrasting reveals intraluminal tumors, ulcerative defects, inflammatory changes in the mucosa.

Indications for research:

Abscess of the abdominal cavity;

Anal itching;

Anococcygeal 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, suspected 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 of the biliary tract by intravenous administration of hepatotropic radiopaque drugs 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 the vertical position of the 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 the vertical and horizontal positions of the subject. 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 severe impairment of the liver, kidneys, cardiovascular 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