Comprehensive examination of the gastrointestinal tract. Gastrointestinal tract methods and features of direct examination of patients with diseases of the gastrointestinal tract Experimental and clinical methods for studying the gastrointestinal tract

State budgetary educational institution

higher professional education

"Omsk State Medical Academy"

Ministry of Health of the Russian Federation

Department of Propaedeutics of Internal Diseases

Laboratory and instrumental methods for diagnosing diseases of the gastrointestinal tract

S.S. Bunova, L.B. Rybkina, E.V. Usacheva

Study guide for students

UDC 616.34-07(075.8)
BBK 54.13-4ya73

This textbook presents laboratory and instrumental methods for diagnosing diseases of the gastrointestinal tract and outlines their diagnostic capabilities. The material is presented in a simple accessible form. The textbook contains 39 pictures, 3 tables, which will facilitate the assimilation of the material when working independently. The proposed textbook complements the textbook on propaedeutics of internal diseases. The presented test tasks are intended to consolidate the assimilation of the presented material.

This manual is intended for students studying in the following specialties: 060101 – General Medicine, 060103 – Pediatrics, 060105 – Medical and preventive medicine.

Preface
List of abbreviations

Chapter 2. Data from instrumental research methods for gastrointestinal diseases
1. Endoscopic research methods
1.1. Fibroesophagogastroduodenoscopy
1.2. Sigmoidoscopy
1.3. Colonoscopy
1.4. Enteroscopy
1.5. Capsule endoscopy
1.6. Chromoscopy (chromoendoscopy)
1.7. Diagnostic laparoscopy
2. X-ray research methods
2.1. Fluoroscopy (x-ray) of the esophagus and stomach
2.2. Computed tomography and multislice computed tomography of the abdominal organs
2.3. Survey radiography of the abdominal organs and study of the passage of barium through the intestines
2.4. Irrigoscopy
3. Ultrasound research methods
3.1. Ultrasound of the stomach
3.2. Ultrasound of the intestines (endorectal ultrasonography)
4. Functional diagnostic methods

4.2. Study of gastric secretion - aspiration-titration method (fractional study of gastric secretion using a thin probe)

Test tasks for self-study
Bibliography

Preface

Diseases of the gastrointestinal tract occupy one of the first places in the structure of morbidity, especially among young people of working age; the number of patients with pathologies of the digestive organs continues to increase. This is due to many factors: the prevalence of Helicobacter pylori infection in Russia, smoking, alcohol consumption, stress factors, the use of non-steroidal anti-inflammatory drugs, antibacterial and hormonal drugs, cytostatics, etc. Laboratory and instrumental research methods are an extremely important point in the diagnosis of gastrointestinal diseases tract, since they often occur latently, without obvious clinical signs. In addition, laboratory and instrumental methods for diseases of the esophagus, stomach and intestines are the main methods for monitoring the dynamics of the disease, monitoring the effectiveness of treatment and prognosis.

This textbook presents the diagnostic capabilities of laboratory and instrumental methods for diagnosing diseases of the esophagus, stomach and intestines, including general clinical and special laboratory research methods, endoscopic, radiological, ultrasound methods and methods of functional diagnostics.

Along with traditional studies that have become firmly established in practice, new modern methods for diagnosing diseases of the gastrointestinal tract were considered: quantitative determination of transferrin and hemoglobin in feces, determination of a marker of inflammation of the intestinal mucosa - fecal calprotectin, blood serum testing using the "GastroPanel", method diagnosing stomach cancer using a tumor marker in blood serum, modern methods for diagnosing Helicobacter pylori infection, capsule endoscopy, computed tomography and multislice computed tomography of the abdominal organs, ultrasound examination of the stomach and intestines (endorectal ultrasonography) and many others.

Currently, the potential of laboratory services has significantly increased as a result of the introduction of new laboratory technologies: polymerase chain reaction, immunochemical and enzyme immunoassays, which have taken a strong place on the diagnostic platform and allow screening, monitoring of certain pathologies and solving complex clinical problems.

Coprological research has not yet lost its importance in assessing the digestive capacity of the digestive system organs, for the selection of adequate enzyme replacement therapy. This method is easy to perform, does not require large material costs or special laboratory equipment, and is available in every medical institution. In addition, this manual describes in detail the main scatological syndromes.

For a better understanding of the diagnostic capabilities of laboratory and instrumental research methods and interpretation of the results obtained, the textbook presents 39 figures and 3 tables. The final part of the manual contains test tasks for self-preparation.

List of abbreviations

Chapter 1. Data from laboratory research methods for diseases

1. Screening research methods

1.1. General blood analysis

1.2. General urine analysis

1.3. Blood chemistry

1.4. Examination of stool for worm eggs and protozoan cysts:

2. Special research methods

2.1. Stool research methods

2.1.1. Coprological research (coprogram)

Scatological syndromes

Chewing deficiency syndrome

Mastication deficiency syndrome reveals insufficiency in the act of chewing food (detection of food particles in the stool, visible to the naked eye).

Causes of chewing deficiency syndrome:

• missing molars
• multiple dental caries with their destruction

Digestive insufficiency syndrome in the stomach (gastrogenic scatological syndrome)

Gastrogenic coprological syndrome develops as a result of impaired formation of hydrochloric acid and pepsinogen in the coolant.

Causes of gastrogenic scatological syndrome:

• atrophic gastritis
• stomach cancer
• conditions after gastrectomy
• erosions in the stomach
• stomach ulcer
• Zollinger-Ellison syndrome

The presence of digestible fiber in feces is an indicator of a decrease in the amount of free HCl and impaired gastric digestion. During normal gastric digestion, digestible fiber is macerated (softened) by free HCl of gastric juice and becomes accessible to pancreatic and intestinal enzymes and is not found in feces.

Pancreatic digestive insufficiency syndrome (pancreatogenic scatological syndrome)

A true indicator of pancreatic digestive insufficiency is the appearance of neutral fat in the stool (steatorrhea), since lipases do not hydrolyze fats.

There are muscle fibers without striations (creatorrea), the presence of starch is possible, and polyfecal matter is characteristic; soft, ointment-like consistency; unformed feces; color gray; pungent, fetid odor, the reaction to stercobilin is positive.

Causes of pancreatogenic scatological syndrome:

• chronic pancreatitis with exocrine insufficiency
• pancreas cancer
• conditions after pancreatectomy
• cystic fibrosis with exocrine pancreatic insufficiency

Bile deficiency syndrome (hypo- or acholia) or hepatogenic scatological syndrome

Hepatogenic coprological syndrome develops due to the lack of bile ( acholia) or its insufficient supply ( hypocholia) in the KDP. As a result, bile acids that participate in the emulsification of fats and activate lipase do not enter the intestine, which is accompanied by impaired absorption of fatty acids in the small intestine. At the same time, intestinal motility, stimulated by bile, and its bactericidal effect are also reduced.

The surface of the stool becomes matte, granular due to the increased content of fat droplets, the consistency is ointment-like, grayish-white in color, the reaction to stercobilin is negative.

Microscopic examination reveals a large amount of fatty acids and their salts (soaps) - products of incomplete breakdown.

Causes of hepatogenic scatological syndrome:

• diseases of the gallbladder (gallstones, obstruction of the common bile duct with a stone (choledocholithiasis), compression of the common bile duct and bile duct by a tumor of the head of the pancreas, severe strictures, stenosis of the common bile duct)
• liver diseases (acute and chronic hepatitis, liver cirrhosis, liver cancer)

Syndrome of indigestion in the small intestine (enteral scatological syndrome)

Enteral coprological syndrome develops under the influence of two factors:

• insufficiency of enzymatic activity of small intestinal secretions
• decreased absorption of end products of hydrolysis of nutrients

• mastication insufficiency syndrome gastric digestion insufficiency
• insufficiency of separation or entry of bile into the duodenum
• helminthic infestations of the small intestine and gallbladder
• inflammatory diseases of the small intestine (enteritis of various etiologies), ulcerative lesions of the small intestine
• endocrine diseases that cause increased intestinal motility (thyrotoxicosis)
• diseases of the mesenteric glands (tuberculosis, lymphogranulomatosis, syphilis, lymphosarcoma)
• Crohn's disease affecting the small intestine
• disaccharidase deficiency, gluten enteropathy (celiac disease)

Colon indigestion syndrome

Causes of indigestion syndrome in the colon:

• violation of the evacuation function of the colon - constipation, spastic dyskinesia of the colon
• inflammatory bowel diseases (ulcerative colitis, Crohn's disease)
• insufficiency of digestion in the large intestine, such as fermentative and putrefactive dyspepsia
• massive intestinal damage by helminths, protozoa

A sign of colitis will be the appearance of mucus with leukocytes and columnar epithelium. With inflammation of the distal colon (ulcerative colitis), a decrease in the amount of feces is observed, the consistency is liquid, the feces are unformed, pathological impurities are present: mucus, pus, blood; sharply positive reaction to blood and Vishnyakov-Triboulet reaction; a large number of columnar epithelium, leukocytes and erythrocytes.

Insufficiency of digestion in the large intestine according to the type of fermentative and putrefactive dyspepsia:

• Fermentative dyspepsia(dysbiosis, bacterial overgrowth syndrome in the colon) occurs due to impaired digestion of carbohydrates and is accompanied by an increase in the amount of iodophilic flora. Fermentation processes occur with an acidic pH environment (4.5-6.0). The stool is copious, liquid, foamy with a sour odor. Mucus mixed with feces. In addition, fermentative dyspepsia is characterized by the presence of large amounts of digestible fiber and starch in the feces.
• Putrid dyspepsia more common in people suffering from gastritis with secretory insufficiency (due to the lack of free hydrochloric acid, food is not properly processed in the stomach). The digestion of proteins is disrupted, their decomposition occurs, and the resulting products irritate the intestinal mucosa and increase the secretion of fluid and mucus. Mucus is a good breeding ground for microbial flora. In putrefactive processes, feces have a liquid consistency, dark brown color, an alkaline reaction with a sharp, putrid odor and a large number of muscle fibers under microscopy.

2.1.2. Bacteriological examination of stool

• quantitative assessment of microflora (bifido- and lactic acid bacteria, clostridia, opportunistic and pathogenic microflora, fungi) with determination of sensitivity to antibiotics and phages
• identification of pathogens of intestinal infections (Shigella, Salmonella, Proteus, Pseudomonas, Yersinia enterocolitica, Campylobacter jejuni, E.coli, Candida, rotaviruses, adenoviruses)

2.1.3. Markers of damage to the intestinal mucosa:

A. examination of feces for occult blood (Gregersen reaction)
B. determination of transferrin (Tf) and hemoglobin (Hb) in feces

A. Examination of feces for occult blood (Gregersen reaction):

Hidden blood is blood that does not change the color of stool and is not detectable macroscopically or microscopically. The Gregersen reaction for detecting occult blood is based on the property of blood pigment to accelerate oxidative processes (chemical study).

A positive fecal occult blood reaction can occur when:

• erosive and ulcerative lesions of the gastrointestinal tract
• tumors of the stomach and intestines in the decay stage
• infestations by helminths that injure the intestinal wall
• rupture of varicose veins of the esophagus, cardia of the stomach, rectum (liver cirrhosis)
• blood entering the digestive tract from the mouth and larynx
• impurities in the stool of blood from hemorrhoids and anal fissures

B. Determination of transferrin (Tf) and hemoglobin (Hb) in feces(quantitative method (iFOB)) - identification of lesions of the intestinal mucosa. This test is much more sensitive than the fecal occult blood test. Transferrin persists for a longer time than hemoglobin in feces. An increase in transferrin levels indicates damage to the upper intestine, and hemoglobin indicates damage to the lower intestines. If both indicators are high, then this indicates the extent of the damage: the higher the indicator, the greater the depth or affected area.

These tests are of great importance in the diagnosis of colorectal cancer, as they can detect cancer both in the early stages (I and II) and in later stages (III and IV).

Indications for the determination of transferrin (Tf) and hemoglobin (Hb) in feces:

• bowel cancer and suspicion of it
• screening for colorectal cancer - as a preventive examination for people over 40 years of age (once a year)
• monitoring the condition of the intestine after surgery (especially in the presence of a tumor process)
• intestinal polyps and suspicion of their presence
• chronic colitis, including ulcerative colitis
• Crohn's disease and suspicion of it
• examination of first- and second-degree family members who have been diagnosed with cancer or intestinal polyposis

2.1.4. Determination of a marker of inflammation of the intestinal mucosa - fecal calprotectin

Calprotectin is a calcium-binding protein secreted by neutrophils and monocytes. Calprotectin is a marker of leukocyte activity and inflammation in the intestine.

Indications for the determination of calprotectin in feces:

• detection of acute inflammatory processes in the intestines
• monitoring of inflammation activity during treatment for inflammatory bowel diseases (Crohn's disease, ulcerative colitis)
• differential diagnosis of organic intestinal diseases from functionally caused ones (for example, irritable bowel syndrome)

2.2. Blood serum examination using GastroPanel

"GastroPanel" is a set of specific laboratory tests that can detect the presence of coolant atrophy, assess the risk of developing stomach cancer and peptic ulcers, and determine HP infection. This panel includes:

• gastrin-17 (G-17)
• pepsinogen-I (PGI)
• pepsinogen-II (PGII)
• specific antibodies - immunoglobulins class G (IgG) to Helicobacter pylori

Intragastric pH measurements are presented in Table 2.

Table 2. Intragastric pH-metry indicators

The technique includes two stages:

1. Study of basal secretion
2. Stimulated secretion assay

Study of stimulated secretion: parenteral stimulants of gastric secretion (histamine or pentagastrin - a synthetic analogue of gastrin) are currently used. So, after studying secretion in the basal phase, the patient is injected subcutaneously with histamine (0.01 mg/kg of the patient’s body weight - submaximal stimulation of the parietal cells of the coolant fluid or 0.04 mg/kg of the patient’s body weight - maximum stimulation of the parietal cells of the coolant fluid) or pentagastrin (6 mg /kg of patient's body weight). Gastric juice is then collected every 15 minutes. The resulting 4 servings within an hour constitute the volume of juice in the second phase of secretion - the phase of stimulated secretion.

Physical properties of gastric juice: normal gastric juice is almost colorless and odorless. Its yellowish or greenish color usually indicates an admixture of bile (duodenogastric reflux), and a reddish or brownish color indicates an admixture of blood (bleeding). The appearance of an unpleasant putrefactive odor indicates a significant disruption of gastric evacuation (pyloric stenosis) and the resulting putrefactive breakdown of proteins. Normal gastric juice contains only a small amount of mucus. An increase in mucus impurities indicates inflammation of the coolant, and the appearance of food residues in the resulting portions indicates serious disturbances in gastric evacuation (pyloric stenosis).

Normal gastric secretion indicators are presented in Table 3.

Table 3. Indicators of gastric secretion are normal

1. Clock voltage change:

• an increase in the amount of gastric juice indicates hypersecretion (erosive antral gastritis, ulcer of the antrum or duodenum, Zollinger-Ellison syndrome) or a violation of the evacuation of food from the stomach (pyloric stenosis)
• a decrease in the amount of gastric juice indicates hyposecretion (atrophic pangastritis, stomach cancer) or accelerated evacuation of food from the stomach (motor diarrhea)

• normoacid state (normoaciditas)
• hyperacidity (hyperaciditas) - ulcer of the antrum or duodenum, Zollinger-Ellison syndrome
• hypoacid condition (hypoaciditas) - atrophic pangastritis, stomach cancer
• anacid state (anaciditas), or complete absence of free HCl after maximum stimulation with pentagastrin or histamine.

Disadvantages of the aspiration-titration method that limit its use in practice:

• removal of gastric juice disrupts the normal working conditions of the stomach; it is of little physiological value
• Some of the stomach contents are inevitably removed through the pylorus
• secretion and acidity indicators do not correspond to actual ones (as a rule, they are underestimated)
• the secretory function of the stomach increases, since the probe itself is an irritant of the gastric glands
• the aspiration method provokes the occurrence of duodenogastric reflux
• it is impossible to determine night secretion and the circadian rhythm of secretion
• it is impossible to assess acid formation after eating

• varicose veins of the esophagus and stomach
• burns, diverticula, strictures, stenosis of the esophagus
• bleeding from the upper gastrointestinal tract (esophagus, stomach, duodenum)
• aortic aneurysm
• heart defects, cardiac arrhythmias, arterial hypertension, severe forms of coronary insufficiency

Test tasks for self-study

1. Special laboratory tests for gastrointestinal diseases

1. scatological research
2. general blood analysis
3. blood serum examination using GastroPanel
4. bacteriological examination of stool
5. general urine analysis

1. neutrophilic leukocytosis
2. thrombocytosis
3. anemia
4. erythrocytosis
5. acceleration of ESR

1. gastric ulcer complicated by bleeding
2. condition after gastric resection
3. chronic duodenitis
4. cancer of the cecum in the decay stage
5. opisthorchiasis

1. hypoproteinemia
2. hyperproteinemia
3. hyperlipidemia
4. hypolipidemia
5. hypokalemia

1. positive reaction to stercobilin
2. positive reaction to bilirubin
3. positive Vishnyakov-Triboulet reaction (for soluble protein)
4. microscopy shows a small amount of neutral fat
5. microscopy shows a small amount of digested muscle fibers

1. acholic feces
2. "tarry" stool
3. Gregersen's strongly positive reaction
4. anemia
5. polyfecal

1. muscle fibers
2. stool color
3. reaction to stercobilin
4. stool consistency
5. reaction to bilirubin

1. reaction to stercobilin
2. connective tissue
3. shape of stool
4. reaction to bilirubin
5. Gregersen reaction

1. amount of stool
2. neutral fat
3. vegetable fiber (digestible)
4. leukocytes
5. red blood cells

1. ahilia
2. appendectomy
3. hyperchlorhydria
4. exocrine pancreatic insufficiency
5. normal coprogram

1. cholidocolithiasis
2. stomach tumor
3. tumor of the head of the pancreas
4. cirrhosis of the liver
5. atrophic gastritis

1. Gregersen reaction
2. transferrin in feces
3. reaction to bilirubin
4. hemoglobin in stool
5. reaction to stercobilin

1. morphological study of biopsy samples of the gastric mucosa
2. X-ray
3. urease breath test with 13C-urea
4. rapid urease test
5. bacteriological

1. fibroesophagogastroduodenoscopy
2. irrigoscopy
3. colonoscopy
4. fluoroscopy of the stomach
5. sigmoidoscopy

1. irrigoscopy
2. sigmoidoscopy
3. enteroscopy
4. computed tomography of the abdominal organs
5. fluoroscopy of the stomach

1. short-term
2. aspiration
3. endoscopic
4. X-ray
5. daily allowance

1. gastrin-17
2. hourly voltage
3. determination of IgG antibodies to Helicobacter pylori
4. flow-hour of free HCl
5. pepsinogen-I

Answers to test tasks

1. Vasilenko V.Kh., Grebenev A.L., Golochevskaya V.S., Pletneva N.G., Sheptulin A.A. Propaedeutics of internal diseases / Ed. A.L. Grebeneva. Textbook. – 5th edition, revised and expanded. - M.: Medicine, 2001 – 592 p.
2. Molostova V.V., Denisova I.A., Yurgel V.V. Scatological research in health and pathology: educational and methodological manual / Ed. Z.Sh. Golevtsova. – Omsk: Publishing House Omsk State Medical Academy, 2008. – 56 p.
3. Molostova V.V., Golevtsova Z.Sh. Methods for studying the acid-forming function of the stomach: educational manual. Supplemented and revised. – Omsk: Publishing House Om-GMA, 2009. – 37 p.
4. Aruin L.I., Kononov A.V., Mozgovoy S.I. International classification of chronic gastritis: what should be accepted and what is in doubt // Pathology Archives. – 2009. – Volume 71 – No. 4 – P. 11–18.
5. Roytberg G.E., Strutynsky A.V. Internal illnesses. Laboratory and instrumental diagnostics: textbook. – Moscow: Publishing house MEDpress-inform, 2013. – 816 p.
6. Electronic library of Omsk State Medical Academy. Access mode: weblib.omsk-osma.ru/.
7. Electronic library system "KnigaFond". Access mode: htwww. knigafund.ru
8. Electronic library system of the 1st Moscow State Medical University named after. I.M. Sechenov. Access mode: www. scsml.rssi.ru
9. Scientific electronic library (eLibrary). Access mode: http://elibrary.ru
10. Journal of Consilium Medicum. Access mode: www. consilium-medicum.com

To identify gastrointestinal pathologies in modern medicine, various research methods are used. The latest equipment helps to obtain valuable information about human health; in many cases, diagnosis does not cause discomfort. An anomaly can be detected even in situations where there are no complaints or external signs of illness.

Indications for examination of the gastrointestinal tract

Examination of the gastrointestinal tract is the most important step in making a correct diagnosis, since pathologies are common in people of all ages and can lead to serious consequences. Indications for intestinal examination are:

A stomach check is prescribed in the following cases:

• internal bleeding;
• gastritis (acute or chronic);
• pancreatitis;
• malignant formations;
• gallstones;
• stomach or duodenal ulcers;
• pain of unknown etiology;
• nausea, dry or bitter mouth;
• belching and heartburn;
• pronounced narrowing of the upper part of the stomach or its underdevelopment.

Often the entire gastrointestinal tract is examined. This allows you to determine the coherence of the organs or deviations in functioning.

Methods for diagnosing diseases of the gastrointestinal tract

Thanks to modern techniques, defect detection is now possible with minimal error. Standard tests are offered in any clinic, but many consider the procedures difficult to access, which is why they seek help when the pathology is at a late stage of development. Often one diagnostic method is sufficient; in complex cases they are combined. How to examine internal organs?

Physical approach

External non-invasive procedures are called physical techniques. These include palpation, percussion, visual inspection and auscultation. When examining a person, the doctor notes the following factors:

• dullness and roughness of the skin;
• pallor of the integument and deterioration of its elasticity;
• smoothness of the tongue or the presence of a white/brown coating on it.

If a person does not have problems with the gastrointestinal tract, these symptoms are unusual for him. The examination allows you to make a preliminary diagnosis. If one of the signs is detected, the doctor performs superficial or deep palpation. The specialist presses on the stomach, moving upward from the groin area. In a healthy person, the muscles do not tense too much and there is no pain. Deep palpation is carried out in the area of ​​discomfort.

A rectal examination is necessary to examine the anus and determine its functionality. The procedure is performed by a proctologist, assessing the presence of fissures, hemorrhoids, and polyps.

Analyzes and laboratory tests

Diagnostics in the laboratory is a necessary measure for all diseases. To check the stomach and intestines, a specialist prescribes tests:

• general blood test (performed in the morning, on an empty stomach);
• examination of stool for the presence of protozoa;
• examination of stool for worm eggs;
• microflora analysis (for dysbacteriosis);
• coprogram (comprehensive check of stool for changes in color, smell, shape, presence of various inclusions).

Instrumental methods

To examine the stomach and intestines, various instruments are often used that can show part of the organ or completely visualize parts of the gastrointestinal tract. How can you check your stomach and intestines? The following methods are relevant for the examination:

Radiation diagnostics

Patients may be offered non-invasive radiation examinations to help make a diagnosis. These include the following methods:

Possible complications after procedures

Most examinations are completely harmless, but some are quite unpleasant and painful, such as endoscopy and colonoscopy. For this reason, rectal tube insertion is performed under local anesthesia or sedation. The risk of complications is small, but it is there.

The consequences of different types of diagnostics are presented in the table.

Or they are at risk, very often they ask the question: how to check the stomach and intestines? There are a large number of diagnostic methods that are highly effective and allow you to accurately determine the disease.

Doctors quite often prescribe a colonoscopy.

If a patient experiences pathological changes in the intestines or stomach, then he must undergo an instrumental examination. Doctors in most cases recommend:

1. Magnetic resonance imaging;
2. PET scan;
3. Computed tomography;
4. Capsule endoscopy;

Using these methods, it is possible to examine the gastrointestinal tract, as well as determine the presence of diseases. Some research methods require the use of anesthesia, since the person will not be able to tolerate the intervention. The choice of a particular research method directly depends on the characteristics of the development of the disease and the preliminary diagnosis.

Features of PET scanning and computed tomography

PET scanning as an effective diagnosis.

Computed tomography and PET scans are often used to examine the large and small intestines.

Using these research methods, the affected organs are visualized.

During the diagnosis, the doctor receives an image on an x-ray or computer monitor.

Equipment used for diagnostics visualizes the condition of internal organs using methods such as magnetic fields, ultraviolet waves, and X-rays.

Thanks to the use of computer imaging, it is possible to obtain several multilayer images of the stomach and intestines, which greatly simplifies the process of studying the condition of these organs for the doctor.

Using this research method, not only the internal, but also the external contour is assessed. Before the scan, the patient receives a contrast agent. The drug can also be administered intravenously during a computed tomography scan.

During the diagnostic period, images are taken in a special camera. That is why, if a patient has claustrophobia, testing is not recommended. Also, diagnosis is not carried out if the patient is excessively obese. Virtual colonoscopy is one of the types of computed tomography.

When using this method, it is possible to obtain images that have a three-dimensional image. This diagnosis is quite informative in the presence of growths on the intestinal walls, the size of which is more than one centimeter.

PET diagnostics involves the use of radioactive sugar, which produces images of the large and small intestines. It is infused into the patient intravenously before the study.

To carry out diagnostics, positron emission equipment is used, which is equipped with a special table for positioning the patient. The duration of the study is on average half an hour.

If the doctor has previously diagnosed the patient with early oncology, then this method is not used to confirm the diagnosis. But, with its help, the level of abnormalities in the inflamed intestinal wall, which was previously identified by a tomogram, is checked.

In case of intestinal cancer, using this research method, the presence of metastases in the lymphatic system and nearby organs is checked. Thanks to the possibility of simultaneous use of computed tomography and a PET scanner, the doctor can compare the images and make the diagnosis as accurately as possible.

To get a more complete picture, the doctor very often prescribes a test.

This video will tell you what capsule endoscopy is:

Carrying out ultrasound and MRI

Ultrasound is one of the diagnostic methods.

To check the intestines and stomach for the development of cancer, ultrasound is used.

It is used for fairly large tumors. If the patient has early or polyps in the gastrointestinal tract, then this method is not used for diagnosis.

In some cases, ultrasound is used to determine metastases of intestinal cancer in other organs.

If a patient is preliminarily diagnosed with rectal cancer, then endorectal ultrasound is used to confirm this diagnosis. For this purpose, a special device is used, which is inserted into the patient through the rectum.

Endorectal ultrasound makes it possible to determine the extent of pathological foci and the presence of pathological processes in the rectum and neighboring organs.
Magnetic resonance imaging can be used to diagnose diseases of the stomach and intestines.

When it is carried out, images are obtained on the computer screen that display sections of the patient’s body. This research method uses radio waves and strong magnets. During the examination, the human body absorbs the energy that the image displays. Thanks to the presence of a special program in the tomograph, the template is converted into an image.

Before the test, a person is given a drug that contains gadolinium. The distribution of the substance throughout the patient’s body occurs in different ways, depending on the location of the disease.

This makes it possible to distinguish between healthy and diseased tissues of the stomach and intestines. Compared to computed tomography, magnetic resonance imaging provides clearer images. If the patient has renal failure, this diagnostic method is not used. To determine this, capsule endoscopy is most often used.

This research method is based on the use of a capsule that has a built-in wireless camera of the smallest possible size. Thanks to this device, it is possible to obtain photographs of the stomach and intestines. The video tablet makes it possible to examine hard-to-reach areas. Unlike endoscopy, this method examines the small intestine.

Ultrasound, magnetic resonance imaging and capsule endoscopy are highly effective diagnostic methods that are characterized by a minimum number of contraindications.

Features of laparoscopy and endoscopy

Laparoscope is a tool for performing laparoscopy.

If the diagnostic case is unclear, then laparoscopy is used.

Using this research method, the depth of damage to the stomach is determined. This method can be used for not only diagnostics, but also surgical interventions. Using laparoscopy, gastric cancer is determined, as well as the extent of spread to neighboring organs.

During the examination, a special instrument is used - a laparoscope. Initially, the patient is given anesthesia. After this, an incision is made, the dimensions of which range from 0.5 to 1 centimeter.

Through it, a device is inserted, with the help of which carbon dioxide is pumped into the stomach. Thanks to this, the organ is enlarged, which allows you to get the most detailed picture. Next, a laparoscope is inserted into the resulting space.

Standard laparoscopy does not make it possible to determine the presence of metastases in. For this purpose, laparoscopic ultrasonography is used, which makes it possible to examine the abdominal organs. For this purpose, special laparoscopic sensors are used. With their help, hard-to-reach areas are explored.

Laparoscopy is practically the only diagnostic method that can be used to determine metastases before surgery. Endoscopy is performed using a special device - an endoscope.

It has a small camera that connects to a computer screen. Using this method, the upper parts of the digestive tract are examined. The endoscope tube must be swallowed by the patient during the examination.

Before this, the throat is irrigated using anesthetics. This makes the coping process easier. During the study, the walls of the stomach are examined using a camera. The doctor views the captured images with a camera in the endocope eye.

This research method allows you to take a biopsy. In some cases, using an endoscope, a catheter is inserted and all ducts are filled with radiopaque contrast. This makes it possible to take an X-ray of the gastrointestinal tract.

A variety of research methods can be used to determine the condition of the stomach and intestines. They should only be selected by a doctor in accordance with the indications and individual characteristics of the patient.

Patient complaints:

1. Appetite disturbance (increase, decrease, absence - anorexia),

2. Perversion of taste (addiction to inedible substances, aversion to certain foods).

3. Belching (with air, odorless or odorless gas, food, sour, bitter).

4. Heartburn (frequency, intensity).

5. Nausea.

6. Vomiting (in the morning on an empty stomach, after eating, brings relief or without effect).

7. Pain in the abdominal area (localization, intensity, character, localization, connection with food intake, stool, gas, frequency, irradiation).

8. Flatulence.

9. Diarrhea (character, color, smell, presence of mucus, blood, pus).

10. Constipation (duration, shape, color of stool).

11. Skin itching.

12. Losing body weight.

History of the disease:

1. Onset of the disease, probable causes of its occurrence.

2. Development (frequency of exacerbations, variability of symptoms).

3. Treatment provided (frequency of hospitalizations, duration, effectiveness, medications used - constantly, periodically).

Life story:

1. Past diseases (presence of viral hepatitis, jaundice).

2. Nature of nutrition (irregular, dry food, monotonous, rough food, abuse of spicy seasonings).

3. Heredity (presence of peptic ulcer or cholelithiasis in blood relatives).

4. Bad habits.

5. Family and living conditions

6. Allergies (food, drug, household, presence of allergic diseases).

7. Long-term use of hormones, non-steroidal anti-inflammatory drugs, anti-tuberculosis drugs.

Physical examination:

1. Inspection: yellowness of the sclera, skin, scratch marks, decreased skin and tissue turgor, spider veins, swelling in the legs; changes in the tongue (plaque, atrophy of the papillae, dryness, discoloration), oral mucosa, teeth; examination of the abdomen (participation in the act of breathing, shape, size, symmetry of both halves, the presence of hernial protrusions, expansion of the venous network).

2. Palpation (tension, local pain (in the gall bladder, navel, sigmoid colon, epigastric region) or throughout the abdomen, liver - enlarged, painful, not palpable, spleen - palpable, not palpable, Kehr, Shchetkin-Blumberg symptoms) .

3. Percussion (Ortner's symptom).

Laboratory research methods:

1. Clinical analysis of blood and urine.

2. Biochemical blood test: protein and its fractions, prothrombin, fibrinogen, bilirubin, cholesterol, alkaline phosphatase, transaminases, amylase, lipase, trypsin inhibitor.

3. Urine analysis for diastase, bile pigments.

4. Fecal analysis (macro- and microscopic examination, bacteriological, for occult blood, for helminth eggs).

5. Serological blood tests.

6. Duodenal sounding.

7. Fractional study of gastric juice.

Instrumental research methods:

1. Stomach and duodenum: fluoroscopy, gastroduodenoscopy.

2. Intestines: irrigoscopy, sigmoidoscopy, colonoscopy.

3. Liver, biliary tract and pancreas6 Ultrasound, cholecystography, computed tomography, scanning, liver puncture biopsy, laparoscopy.

Stage II. Identifying patient problems.

In diseases of the digestive system, the most common problems of patients (real or real) are:

· loss of appetite;

· abdominal pain of various localization (specify);

· nausea;

· burping;

· heartburn;

· bloating;

· skin itching, etc.

In addition to the patient’s real, already existing problems, it is necessary to identify potential problems, that is, complications that may arise in the patient due to insufficient care and treatment, and unfavorable development of the disease. For diseases of the stomach and duodenum, these may be:

Ø transition of an acute disease to a chronic one;

Ø perforation of the ulcer;

Ø penetration of the ulcer;

Ø gastrointestinal bleeding;

Ø development of pyloric stenosis;

Ø development of stomach cancer, etc.

Possible problems with intestinal diseases:

Ø intestinal bleeding;

Ø development of intestinal cancer:

Ø dysbacteriosis;

Ø hypovitaminosis.

For diseases of the liver, biliary tract and pancreas:

Ø development of liver failure;

Ø development of liver cancer;

Ø development of diabetes mellitus;

Ø development of hepatic colic, etc.

In addition to physiological problems, the patient may have psychological ones, for example:

Lack of knowledge about your disease;

Feeling of false shame during special intestinal examinations;

Ignorance of the principles of therapeutic nutrition for your illness;

Lack of understanding of the need to give up bad habits;

Lack of understanding of the need for systematic treatment and visiting a doctor, etc. .

After identifying problems, the nurse determines nursing diagnosis, For example:

Increased gas formation (flatulence) due to intestinal digestion disorders;

Pain in the epigastric region after eating due to the formation of ulcers in the stomach;

Loss of appetite due to liver disease;

Heartburn due to chronic inflammation of the gastric mucosa;

Skin itching caused by liver failure;

Diarrhea due to inflammatory disease of the small intestine, etc.

Stage III. Planning nursing care and care.

The nurse sets priorities, forms short- and long-term goals, makes nursing choices (independent, interdependent and dependent), develops a plan of care and determines the expected outcome.

Independent nursing interventions for diseases of the digestive system may include:

Monitoring blood pressure, pulse, body weight, daily diuresis and stool;

Skin and mucous membrane care;

Timely change of bed and underwear;

Control over the transfer of food to the patient;

Creating a comfortable position in bed;

Training the patient and his family members to determine blood pressure, pulse rate, and provide first aid in emergency conditions;

Conversations about taking medications correctly, following a diet, and eliminating bad habits;

Feeding in bed;

Providing care items;

Providing emergency care for an attack of hepatic colic, gastric bleeding.

Interdependent nursing interventions:

Serving a heating pad and ice pack;

Preparing the patient and collecting biological material for laboratory tests;

Preparing the patient and accompanying him for instrumental types of examination;

Assist the doctor during abdominal puncture.

Dependent Nursing Interventions:

Timely and correct administration of medications prescribed by a doctor.

Stage IV. Implementation of the nursing intervention plan.

When implementing a nursing intervention plan, it is necessary to coordinate the actions of the nurse with the actions of other health care workers, the patient and his relatives, according to their plans and capabilities. The action coordinator is the nurse.

V stage. Evaluating the effectiveness of nursing interventions.

Efficiency assessment is carried out:

Ø by the patient (the patient’s reaction to nursing intervention);

Ø as a nurse (achieving the goal);

Ø by regulatory authorities (correctness of the nursing diagnosis, determination of goals and drawing up a plan for nursing interventions, compliance of the performed manipulations with the standards of nursing care).

Evaluating the effectiveness of the results allows you to:

§determine the quality of care;

§identify the patient’s response to nursing intervention;

§find new problems for the patient, identify the need for additional help.

Contrast studies of the gastrointestinal tract

The gastrointestinal tract (GIT) is often the object of contrast-enhanced X-ray examination. X-ray examination of the stomach, esophagus and small intestine is carried out on an empty stomach, the patient is prohibited from drinking and smoking 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 examining the gastrointestinal tract is 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 contrast, the second for double contrast.

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 double contrast study, it is necessary that the contrast agent has a high degree of dispersion and concentration of barium sulfate particles with a low suspension viscosity, 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 mucilage, starch, marshmallow root extract, polyvinyl alcohol, etc. Ready-to-use, finely dispersed barium suspension of high concentration is produced in the form of finished preparations with various stabilizers, astringents, flavorings additives: barotrast, baroloid, barospers, micropack, mixobar, microtrust, novobarium, oratrast, skiabarium, sulfobar, telebrix, hexabrix, hitrast and others.

NB! Barium preparations are contraindicated in cases 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.

A classic X-ray examination necessarily includes three stages:

Study 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 to double contrasting with barium suspension and air. Double contrast is in most cases much more effective and is considered as a standard method for X-ray examination of the gastrointestinal tract. Inflating the examined part of the gastrointestinal tract with air helps to identify wall rigidity and 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, when studying the motility of the gastrointestinal tract.

NB! With double contrast, as a rule, drugs are used to relax the muscles of the gastrointestinal tract (atropine, aeron; glucagon and buscopan, which paralyze motility). They are contraindicated for patients suffering from glaucoma and prostate adenoma with urination problems.

X-ray symptoms of various pathologies of the digestive tract can be grouped into ten main syndromes.

1. Narrowing of the lumen (deformation) 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, and diseases of adjacent organs, as well as some developmental anomalies (malformations). Narrowing of the lumen often occurs after surgical interventions on the esophagus, stomach and intestines. The cause of narrowing of the lumen (spasm) of any part of the digestive canal can also be cortico-visceral and visceral-visceral disorders.

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

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

4. Barium depot(niche) often occurs in pathological processes accompanied by organ destruction (ulcer, tumor, actinomycosis, syphilis, tuberculosis, erosive gastritis, ulcerative colitis), local bulging of the wall (diverticulum) or its deformation (related process, scar changes, consequences of injury or surgery interventions).

5. Changes 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. Changes in the relief of the mucous membrane can be manifested by thickening or thinning of folds, excessive tortuosity or straightening, immobility (rigidity), the appearance of additional growths on the folds, destruction (breakage), convergence (convergence) or divergence (divergence), as well as complete absence (“bare plateau") folds. The most informative image of the relief of the mucous membrane is obtained on images under double contrast conditions (barium and gas).

6. Impaired wall elasticity and peristalsis usually caused by inflammatory or tumor infiltration of the organ wall, a nearby process or other reasons. It is often combined with a decrease in the lumen of the organ in the affected area or its diffuse expansion (atony, paresis), the presence of pathological relief of the mucous membrane, a filling defect or barium depot (niche).

7. Violation of position- displacement (pushing, pulling, tugging) 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 certain anomalies and malformations, as well as after surgical interventions on the organs of the thoracic 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 - Kloiber bowls. This syndrome is detected mainly when mechanical intestinal obstruction, developing as a result of narrowing of the intestinal lumen due to tumors, cicatricial changes in the intestinal wall, volvulus, intussusception and other reasons, as well as dynamic intestinal obstruction, which 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 abdominal cavity or retroperitoneum is detected in certain 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 out the fallopian tubes and surgical interventions (laparotomy).

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

Esophageal examination

The essence of the method: the method is simple, painless, but its information content 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 patient’s fear and active reluctance to undergo fibrogastroscopy if there are certain complaints. Then an X-ray contrast study is performed, but if there is the slightest doubt or suspicion of pathology, endoscopy is performed.

Indications for the study: The main indication for the study is swallowing disorders (dysphagia), detection of hilar lymphadenopathy, tumors and mediastinal cysts. Besides:

Anomalies of the aortic arch and its branches,

Chest pain of unknown origin,

Foreign body in the pharynx and esophagus,

Mediastinal compression syndrome,

Bleeding from the upper alimentary canal,

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

Suspicion of cardia failure or esophageal achalasia,

Suspected hiatal hernia.

Conducting research: The examination is carried out with the patient standing. 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 patient’s height. Next, the patient is asked not to move for a few minutes and told when the study is completed.

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

Preparing for the study: not required.

It must be carried out by a qualified radiologist, the final conclusion based on all data on the patient’s condition is made by the clinician who referred the patient for the study - a gastroenterologist, surgeon, oncologist, cardiologist.

Examination of the stomach and duodenum

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

Indications for the study:

Abdominal abscess;

Kidney amyloidosis;

Aspiration pneumonia;

Stomach ache;

Gastrinoma;

Gastritis is chronic;

Gastroesophageal reflux disease;

Hernia of the white line of the abdomen;

Hiatal hernia;

Dumping syndrome;

Benign stomach tumors;

Difficulty swallowing;

Foreign body of the stomach;

Ovarian cystoma;

Nephroptosis;

Liver tumors;

Acute gastritis;

Belching, nausea, vomiting;

Stomach polyps;

Portal hypertension;

Postoperative hernia;

Umbilical hernia;

Stomach cancer;

Ovarian cancer;

“Small signs” syndrome;

Zollinger-Ellison syndrome;

Decreased blood hemoglobin level (anemia);

Stomach ulcer.

Conducting research: the patient drinks a barium suspension, after which fluoroscopy, survey and targeted radiography are performed in different positions of the patient. The evacuation function of the stomach is assessed by dynamic radiography during the day. X-ray of the stomach with double contrast- a technique for contrast X-ray examination of the condition of the stomach against the background of its filling with barium and gas. To perform a double-contrast x-ray, the patient drinks a barium sulfate slurry through a tube with perforated walls, which allows air to enter the stomach. After massaging the anterior abdominal wall, barium is evenly distributed throughout the mucous membrane, and air straightens the folds of the stomach, allowing a more detailed examination of their relief.

Contraindications, consequences and complications: There are no absolute contraindications for X-rays 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 lying on his back on a hard surface.

Preparing for the study: , i.e., exclude or limit dairy products, sweets, baked goods, carbonated water, cabbage, etc. The diet should contain lean meat, eggs, fish, and a small amount of water-based cereals. For constipation and flatulence, a cleansing enema is given in the morning on the day of the study, and if necessary, the stomach is washed.

Decoding the research results

Duodenal examination

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 final sections of the bile duct.

Indications for the study:

Gastrinoma;

Duodenitis;

Small intestine cancer;

Zollinger-Ellison syndrome;

Bile duct strictures;

Duodenal ulcer.

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

Preparing for the study: patients whose stomach and intestinal functions are not impaired do not require any special preparation. 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 elderly people are recommended to begin to adhere to Diet to reduce gas, i.e., exclude or limit dairy products, sweets, baked goods, carbonated water, cabbage, etc. The diet may contain lean meat, eggs, fish, and a small amount of water-based cereals. For constipation and flatulence, a cleansing enema is given in the morning on the day of the study, and if necessary, the stomach is washed.

Decoding the research results should be carried out by a qualified radiologist, the final conclusion based on all data on the patient’s condition is made by the clinician who referred the patient for the study - a gastroenterologist, surgeon, oncologist.

Small intestine examination

The essence of the method: X-ray recording of the progress of contrast through the small intestine. By radiography of the passage of barium through the small intestine

Diverticula, strictures, obstructions, tumors, enteritis, ulcerations, disturbances of absorption and motility of the small intestine are detected.

Indications for the study:

Kidney amyloidosis;

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;

Small intestine cancer;

Celiac disease;

Enteritis;

Enterocolitis.

Conducting research: X-ray contrast examination of the small intestine is carried out after ingestion of a barium suspension solution. As the contrast moves through the small intestine, targeted radiographs are taken at intervals of 30–60 minutes. Radiography of the passage of barium through the small intestine is completed after contrasting all its sections and entering the barium into the cecum.

Preparing for the study: patients whose stomach and intestinal functions are not impaired do not require any special preparation. 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 older people, 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, baked goods, sparkling water, cabbage, etc. etc. The diet may include lean meat, eggs, fish, and a small amount of water-based cereals. For constipation and flatulence, a cleansing enema is given in the morning on the day of the study, and if necessary, the stomach is washed.

Decoding the research results should be carried out by a qualified radiologist, the final conclusion based on all data on the patient’s condition is made by the clinician who referred the patient for the study - a gastroenterologist, surgeon, oncologist.

Colon examination

X-ray examination of the large intestine is performed by two (or 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 barium passage through the large intestine The essence of the method: a radiocontrast study technique performed to assess the evacuation function of the large intestine and the anatomical relationships of its parts 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 whether the colon is interested in them).

Indications for the study:

Appendicitis;

Hirschsprung's 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 test, the patient drinks a glass of barium sulfate suspension; An x-ray examination of the large intestine is performed 24 hours after barium ingestion.

Preparing for the study: no special preparation is required.

Decoding the research results should be carried out by a qualified radiologist, the final conclusion based on all data on the patient’s condition is made by the clinician who referred the patient for the study - 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, irrigoscopy 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 narrowings, tumors of the large intestine, chronic colitis, fistulas, etc. After tightly filling the large intestine with a barium suspension, the shape, location, length, distensibility, and elasticity of the intestine are studied using an enema. After bowel movement from the contrast suspension, organic and functional changes in the wall of the colon are examined.

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

Indications for the study:

Abdominal abscess;

Anal itching;

Anococcygeus pain syndrome ( coccydynia);

Appendicitis;

Femoral hernia;

Hirschsprung's disease;

Rectal prolapse;

Haemorrhoids;

Hernia of the white line of the abdomen;

Diarrhea (diarrhea);

Benign tumors of the small intestine;

Benign ovarian tumors;

Gastrointestinal bleeding;

Ovarian cystoma;

Intestinal obstruction;

Megacolon;

Interintestinal abscess;

Lightning acne;

Nephroptosis;

Liver tumors;

Inguinal hernia;

Perianal dermatitis;

Rectal polyps;

Postoperative hernia;

Pseudomucinous ovarian cystoma;

Anal cancer;

Liver cancer;

Cancer of the uterus;

Colon cancer;

Small intestine cancer;

Cervical cancer;

Ovarian cancer;

Birth injury;

Uterine sarcoma;

Vaginal fistulas;

Rectal fistulas;

Seronegative spondyloarthritis;

Irritable bowel syndrome (IBS);

Chronic appendicitis.

Conducting research: The patient is placed on an inclined table and a plain 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, spastic pain or the urge to defecate and is asked to breathe slowly and deeply through the mouth. To better fill the intestine, during irrigoscopy the tilt of the table and the position of the patient are changed, and pressure on the abdomen is made.

As the intestine straightens, targeted radiographs are taken; after complete tight filling of the lumen of the colon - a survey radiography of the abdominal cavity. The patient is then escorted to the toilet to have a bowel movement naturally. After removal of the barium suspension, a survey X-ray is again performed to assess the relief of the mucosa and the evacuation function of the colon.

Double-contrast barium enema can be performed immediately after simple barium enema. In this case, the intestine is dosed with air.

Contraindications, consequences and complications: irrigoscopy is not performed during pregnancy, general severe somatic status, tachycardia, rapidly developing ulcerative colitis, or suspected perforation of the intestinal wall. Extra Caution when performing irrigoscopy it is required in case of intestinal obstruction, diverticulitis, ulcerative colitis, loose stool mixed with blood, cystic pneumatosis intestinalis.

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

Poor bowel preparation

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

The patient's inability to retain barium in the intestines.

Preparing 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 the waters are clear. Dinner on the eve of irrigoscopy is not allowed.

NB! In case of bleeding from the gastrointestinal tract or ulcerative colitis, administering enemas and taking laxatives before irrigoscopy are not allowed.

Decoding the research results should be carried out by a qualified radiologist, the final conclusion based on all data on the patient’s condition is made by the clinician who referred the patient for the study - a gastroenterologist, surgeon, proctologist, oncologist.

Examination of the liver (gallbladder and bile ducts), pancreas

Cholegraphy and cholecystography

The essence of the method: Holegraph?I- X-ray examination of the biliary tract by intravenous administration of hepatotropic radiopaque agents secreted by the liver with bile. Cholecystography- a technique for X-ray contrast examination of the condition of the gallbladder, performed to determine the position, size, shape, contours, structure and functional state of the gallbladder. Cholecystography is informative for identifying deformities, stones, inflammation, cholesterol polyps, gall bladder tumors, etc.

Indications for the study:

Biliary dyskinesia;

Cholelithiasis;

Calculous cholecystitis;

Gallbladder cancer;

Chronic cholecystitis;

Chronic acalculous cholecystitis.

Conducting research: cholegraphy performed on an empty stomach. Beforehand, the patient is recommended to drink 2–3 glasses of warm water or tea, which reduces the reaction to the procedure, and 1–2 ml of a radiopaque substance is administered intravenously ( allergy test), if there is no reaction after 4–5 minutes, pour in the remaining amount very slowly. Typically, a 50% solution of bilignost (20 ml) warmed to body temperature, or similar products, is used. For children, the 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, targeted photographs are taken with the subject in a vertical position. If the images do not show the bile ducts 20 minutes after the administration of the radiocontrast agent, 0.5 ml of a 1% solution of pilocarpine hydrochloride is injected under the skin to cause contraction of the sphincter of the common bile duct.

Before cholecystography A survey x-ray of the right half of the abdominal cavity is taken. After x-raying, several photographs of the gallbladder are taken in different projections with the subject being examined in vertical and horizontal positions. 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), repeat images are taken and the contractility of the gallbladder is determined.

Contraindications, consequences and complications: cholegraphy and cholecystography are contraindicated in case of serious dysfunction 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 feeling of heat in the head, a metallic taste in the mouth, dizziness, nausea, and sometimes slight pain in the abdomen.

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

Decoding the research results should be carried out by a qualified radiologist, the final conclusion based on all data on the patient’s condition is made by the clinician who referred the patient for the study - a gastroenterologist, surgeon, oncologist, hepatologist.

Restoring the gastrointestinal tract Before eating, you must take (without chewing!) vegetable cakes of carrots, cabbage, and radishes in the form of balls. However, they should not be chewed so that they do not become saturated with salivary enzymes. Reception of cakes continues until