Examination of the stomach and duodenum

The examination of patients with diseases of the gastroduodenal region begins with questioning. Most often these patients complain of pain in the epigastric region, nausea, eructation, vomiting, changes in appetite. However, these complaints are quite often encountered in the pathology of other organs and therefore are of little specificity. The data of the physical examination of patients (examination, palpation of the abdomen) is usually not informative. In connection with this, additional methods of investigation, especially gastroduodenoscopy and X-ray examination, are of decisive importance in the diagnosis of diseases.

Resolve

Complaints. Abdominal pain due to the pathology of the stomach is usually localized in the epigastric region and can be either permanent or paroxysmal. The most characteristic paroxysmal pain associated with food intake, occurring soon after eating after a certain period of time or after eating. Patients may complain of an undefined painful feeling of pressure or tension in the epigastric region, associated with overflow of the stomach and its swelling. Pain associated with a stomach disease, arise as a result of violations of the motor function of this organ (with spasm or stretching smooth muscle fibers of its walls).

Heartburn is a burning sensation in the esophagus caused by the casting of gastric contents.

Nausea is an unpleasant sensation in the epigastric region. With diseases of the stomach is usually combined with pain.

Vomiting - paroxysmal discharge of stomach contents into the esophagus and further into the oral cavity as a result of contractions of the abdominal press, movements of the respiratory muscles with the closed gatekeeper, often combined with nausea, abdominal pain. In patients with stomach disease after vomiting, the pain usually subsides.

An eructation is a sudden release into the oral cavity of a small portion of the gastric contents due to the squeezing of the stomach between the diaphragm, the abdominal wall and swollen bowels or spasm of the pylorus.

Changing appetite - its decline is widespread. Lack of appetite - anorexia - a frequent symptom of stomach cancer.

Anamnesis of the disease. The onset of the disease can be acute (gastritis after a bias in the diet) and gradual. Often there are exacerbations and long periods of remission (with peptic ulcer). Progression of the disease is characteristic of stomach cancer. It is always important to clarify the relationship of stomach disease with medication, for example with non-steroidal anti-inflammatory drugs.

Physical methods of research

A general examination of the patient can reveal weight loss (up to fco cachexia), pallor of the skin, associated with anemia, white-lined tongue.

With superficial palpation of the abdomen, pain in the epigastric region and a slight tension of the abdominal muscles, usually associated with peptic ulcer or gastritis, are often found.

Deep gliding palpation only occasionally allows to probe small and large curvature and pyloric parts of the stomach and even less often - a stomach tumor. Percussion and auscultation of the stomach, as a rule, do not have a significant significance.

Additional research methods

X-ray examination. First of all, it is necessary to prepare the patient for the study. To this end, on the evening and morning on the day of the study, cleanse his bowels with enemas, with persistent constipation appoint laxatives. The test is performed on an empty stomach, in the upright position of the patient. As a contrast, sulfuric acid barium is used. The study begins with the definition of the relief of the gastric mucosa, the folds of which have great variations and often vary depending on the stage of the digestive process, becoming more distinct and distinct, then flattening. If their course breaks, assume the presence in this place of the pathological process. It is important to study the contours of the stomach. Steady protrusion of his shadow is designated as a niche, which serves as a typical sign of gastric ulcer. The lack of filling the contrast mass of the stomach area is called the filling defect and is an important symptom of the neoplasm.

Gastroduodenoscopy. With the use of fiber optics, gastroduodenoscopy was intensively developed and became the most effective and rapidly applied method. Simultaneous biopsy and morphological examination made this method the most effective diagnostic method. The main indication for gastroduodenoscopy is bleeding from the upper gastrointestinal tract and epigastric pain. The great importance of this method is also in the possibility of using local treatment with continuing bleeding. The advantage of gastroscopy is the possibility of detecting superficial changes in the mucous membranes that are not detectable by roentgenology. In the presence of gastric ulcers detected during X-ray examination, endoscopy is usually required for visual and histological exclusion of the affected tumor. With any suspicion of a stomach tumor, including those with symptoms such as weight loss, anemia, endoscopic examination is necessary.

Biopsy of the gastric mucosa and cytological examination. This method is used to exclude or confirm the presence of a tumor. In this case, the tissue for the study is taken in several (preferably 6-8) places, the accuracy of the diagnosis in this case reaches 80-90%. It should be noted that both false positive and false negative results are possible.

Examination of gastric juice. The study is carried out using a thin probe, the introduction of which requires the active help of the subject. A portion of gastric contents is obtained on an empty stomach and then every 15 minutes after the introduction of the stimulus. The acidity of the gastric contents can be determined by titrating it with 0.1 mmol / L NaOH solution in the presence of dimethylaminoazobenzene and phenolphthalein (or phenol red) indicators to pH 7.0 while neutralizing the acidic content with alkali.

Basal secretion of acid is the total amount of hydrochloric acid secreted in the stomach in four 15-minute intervals and expressed in mmol / h. This index varies in the norm from 0 to 12 mmol / h, an average of 2-3 mmol / h.

Study of stimulated secretion of hydrochloric acid. The strongest irritants of gastric secretion are histamine and pentagastrin. Since the latter has less side effect, it is being used now more often. To determine basal secretion of acid, pentagastrin or histamine is injected subcutaneously and gastric contents are collected for four 15-minute periods. As a result, the maximum secretion of the acid is determined, which is the sum of the maximum consecutive values of secretion in 15 minutes of collection of gastric juice.

Basal and maximum secretion of acid is higher in patients with ulcer in the duodenum, with the location of the ulcer in the stomach, acid secretion in patients is less than in healthy ones. Benign ulcer of the stomach rarely occurs in patients with achlorhydria.

Research of gastrin in blood serum. Determination of gastrin content in the serum is carried out by radioimmunoassay and can be of diagnostic value in diseases of the gastroduodenal zone. The normal values of this index on an empty stomach are 100-200 ng / l. An increase in gastrin content of more than 600 ng / l (pronounced hypergastrinemia) is observed in the syndrome of Zollinger-Ellison and pernicious anemia.

[1], [2], [3], [4], [5]