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X-ray of the stomach and duodenum
Last reviewed: 18.10.2021
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Radiation and endoscopy studies form the basis of a comprehensive diagnosis of stomach diseases. Radiological methods are of primary importance among ray methods. The plan for X-ray examination of the stomach and duodenum depends on the history and clinical picture of the disease.
In conditions of emergency diagnosis, i.e. In acute conditions, the patient is given a radiograph of the organs of the thoracic and abdominal cavities in the vertical and horizontal positions. Artificial contrasting of the digestive canal is performed only on special indications.
Preparation for X-ray of the stomach and duodenum
Verification studies of the stomach during clinical examination are performed on special X-ray diagnostic devices - gastrofluorographs - under the control of X-ray television inspection. The study is performed on an empty stomach. For 20-30 minutes before the patient puts under the tongue 2-3 tablets of an aeron for the relaxation of the stomach. As a contrast agent, a specially prepared highly concentrated suspension of barium sulphate is used, and for stretching the stomach a fanulent blowing agent is used. X-ray photography is performed in several standard projections with vertical and horizontal patient positions. The resulting images are called "gastrofluorogrammy." The size of them, unlike conventional radiography, is small - 10x10 or 11x11 cm, the number is 8-12. If the images show pathological changes, the patient, as a rule, is directed to fibrogastroscopy. Carrying out mass X-ray examinations is justified in those geophysical regions where the incidence of gastric cancer is high.
Preparation for X-ray of the stomach and duodenum
Normal stomach and duodenum
Before receiving contrast mass in the stomach, there is a small amount of air. With the vertical position of the body, the gas bubble is located in the region of the arch. The rest of the stomach is a roller with thick and maximally close walls.
The contrast mass swallowed by the patient, with the vertical position of the body, gradually passes from the esophagus into the stomach and descends from the cardial opening into the body, the sinus and the antral compartment. After the first small sips of barium, the folds of the mucous membrane of the stomach appear - a relief appears on the inner surface of the organ. This folded relief is unstable and reflects the physiological state of the stomach.
Normal X-ray anatomy of the stomach and duodenum
Diseases of the stomach and duodenum
Indications for radiation examination of the stomach are very wide due to the large prevalence of "gastric" complaints (dyspeptic phenomena, abdominal pain, lack of appetite, etc.). X-ray examination is carried out with suspicion of peptic ulcer, tumor, in patients with achilles and anemia, as well as with polyps of the stomach, which for some reason are not removed.
Chronic gastritis. In the recognition of gastritis the main role is assigned to the clinical examination of the patient in combination with endoscopy and gastrobiopsy. Only by histological examination of a piece of the gastric mucosa can the form and prevalence of the process and the depth of the lesion be established. However, with atrophic gastritis, an X-ray examination of efficacy and reliability is equivalent to fibrogastroscopy and second only to microscopy of the biopsy specimen.
Stomach ulcer and duodenal ulcer. Radiography plays an important role in the recognition of ulcers and its complications.
When X-ray examination of patients with peptic ulcer of the stomach and duodenum before the radiologist, there are three main tasks. The first is the evaluation of the morphological state of the stomach and duodenum, primarily the detection of a ulcerative defect and the determination of its position, shape, size, shape, and the state of the surrounding mucosa. The second task is to study the function of the stomach and duodenum: the detection of indirect signs of peptic ulcer, the establishment of the stage of the disease (exacerbation, remission) and evaluation of the effectiveness of conservative therapy. The third task is to recognize the complications of peptic ulcer.
Stomach cancer. Initially, the tumor is an islet of cancerous tissue in the mucosa, but in the future, different ways of tumor growth, which predetermine the radiographic signs of small cancer, are possible. If necrosis and ulceration of the tumor prevail, then its central part falls in comparison with the surrounding mucosa - the so-called advanced cancer. In this case, when double contrasting, a niche of irregular shape with uneven contours is defined around which there are no areolas. The folds of the mucous membrane converge to ulceration, slightly widening in front of the niche and losing its outlines here.
Benign tumors of the stomach. X-ray picture depends on the type of tumor, the stage of its development and the nature of growth. Benign tumors of epithelial nature (papillomas, adenomas, villous polyps) come from the mucous membrane and go into the lumen of the stomach. Initially, among the areolas, an unstructured, rounded portion is found, which can be seen only when the stomach is double-contrasted. Then determine the local extension of one of the folds. It gradually increases, taking the form of a rounded or slightly oblong defect. The folds of the mucous membrane bypass this defect and are not infiltrated.
Postoperative diseases of the stomach. X-ray examination is necessary for timely detection of early postoperative complications - pneumonia, pleurisy, atelectasis, abscesses in the abdominal cavity, including subdiaphragmatic abscesses. Gas-containing abscesses are comparatively easy to recognize: in the pictures and during the examination it is possible to detect a cavity containing gas and liquid. If there is no gas, a subdiaphragmatic abscess can be suspected for a number of indirect symptoms. It causes a high position and immobilization of the corresponding half of the diaphragm, its thickening, uneven outlines. There is a "sympathetic" effusion in the costal-diaphragmatic sinus and foci of infiltration in the base of the lung. In the diagnosis of subdiaphragmatic abscesses, sonography and computed tomography are successfully used, since pus accumulations clearly appear in these studies. Inflammatory infiltrate in the abdominal cavity gives an echo-inhomogeneous image: there are no areas that are free from echoes. Abscess is characterized by the presence of a zone devoid of such signals, but around it a denser rim appears - a mapping of the infiltrative shaft and the pyogenic shell.