Examination of the small intestine with barium
X-ray methods of examination for adhesions
X-ray methods are widely used in the diagnosis of adhesions. especially adhesive intestinal obstruction. The examination should begin with a polypositional survey of chest and abdominal chest radiography according to the procedure recommended by M.K. Shcherbatenko et al. (1977), E.A. Beresneva et al. (1997). When radiographing the chest, indirect signs are identified, indicating the OKH, namely the height standing diaphragm domes, their mobility, the presence of discoid atelectasis in the lungs, the detection of pleural effusion. With an overview of the radiography of the abdominal cavity for adhesions with PSC phenomena, pneumonia of the small intestine is detected, dilatation of the loops thin or large intestine, the presence of the symptom of an "isolated loop Clauberg's bowls, intestinal arches with edged folds of Kerkring, horizontal levels of fluid in the loops of the intestine, a symptom of the movement of fluid from one loop of the small intestine to another and the presence of free fluid in the abdominal cavity. Free gas in the abdominal cavity is revealed by perforation of the hollow organ. An overview radiograph of the thoracic and abdominal cavity should be performed by all patients in order to exclude the phenomena of obstruction, which requires urgent surgical operations.
In the absence of clinical and radiologic signs of OKH, we conducted a routine examination to identify the location of adhesions. The examination was started with X-rays of the stomach and duodenum. For this, the patient once received inward 100 grams of barium sulfate, dissolved in 100 ml of water. For a more even filling of the small intestine with contrast, after 30-60 minutes a similar dose of barium sulfate was given.
In the presence of perivistserita in the area of the outlet of the stomach or duodenum, their deformation with a compressed lumen arises, which causes a persistent violation of evacuation from the stomach. The main cause of perivistseritis in the bulb of the duodenum is peptic ulcer disease of this localization or surgical interventions for ulcer complications. The second most frequent zone of perivistercite is the area of the duodenal-junction transition, connected either with anatomical features of the structure of this zone, or with the inflammatory process in the lymph nodes Treetz's ligament.
The next stage of the study of the stomach and duodenum is the passage of barium in the small intestine. We examined the proximal parts of the jejunum after receiving the first dose of barium suspension. After taking a second dose of contrast for 2-3 hours, the study observed the movement of the contrast medium the middle parts of the small intestine, and for 4-8 hours examined the distal parts of the small intestine and the right half of the colon guts. In cases of delayed passage of the barium through the intestine, the study was conducted within 24 hours of its onset. Direct signs that determine the shape, size, appearance, location of adhesions, with radiopaque methods were not obtained. However, we paid attention to the presence of 6% of the examined indirect signs of the peritoneal adhesion process: the deformation of the intestinal loops, fixing them to abdominal wall or postoperative scar, other organs, conglomerates of the small intestine loops with uneven speed of evacuation of contrast, narrowing of the segments of the small intestine, widening and thickening of the intestinal wall above the adhesions, the formation of false diverticula in the small intestine due to its traction spikes. Most often, a combination of several radiographic signs of the adhesive process was found.
Irrigoscopy we used when examining 26 patients to identify the adhesive process in the large intestine. Adhesions of the large intestine are often formed against a background of chronic inflammatory diseases of the colon. Patients with ulcerative colitis and Crohn's disease were not included in our group. The examination was conducted in 4 main stages after thorough cleaning of the intestine with the help of saline laxatives and enemas. The first stage was survey radiography of the abdominal cavity, the second - a tight filling with contrast of the colon, the third - the phase of emptying and the fourth - the phase of double contrasting due to the residues of the solution of barium and air introduced into the thick gut. In 3 patients with irrigoscopy, the phenomena of perivistseritis were detected against congenital anomalies, megadolioschigms, megacolons and abnormal motility of the colon. In 5 patients, symptoms of irritable bowel syndrome, clinically manifested by enterocolitis, were found. One patient was diagnosed with ileotransversoanastomosis, which had been applied earlier in connection with the adhesive conglomerate in the small intestine. Thus, in the course of irrigoscopy, 9 out of 26 examined patients showed pathology.
Radioisotope method of GIT research
X-ray examination of the motor-evacuation function of the gastrointestinal tract was supplemented with a radioisotope scanning after taking regular food with radioactive isotopes that are not absorbed into the digestive tract: iodine 131 and Tc y 48 patients. By the passage time of the radioactive food lump, the degree of severity of evacuation disturbances in various sections of the intestinal tube was judged. The rate of evacuation of the isotope along the gastrointestinal tract was assessed, and also the boundaries of the isotope in the intestinal sections were determined, where its delay was observed.
Radioisotope scanning has a number of advantages over X-ray research and gives a correct idea of the magnitude and position of the stomach, small and large intestine, reflects the process of gastric emptying and the transition of food into the duodenum, thin and thick gut. Scanning was carried out on a RDA-107 apparatus of Toshiba by a universal scanner.
How to check the small intestine
The small intestine consists of the duodenum, jejunum and ileum, which are located between the stomach and the large intestine. The gastroenterologist will listen to your complaints and give directions to radiography. Before conducting an X-ray examination, you must follow the diet for two weeks, eat liquid mashed porridges on the water. For 36 hours before a direct examination, completely refrain from food. make an enema. All these activities are aimed at the maximum release of food from the gastrointestinal tract.
Before the radiography you will be given a barium mixture. After 3-4 hours will be screened. Barium does not miss X-rays, which helps to detect violations of the small intestine. With the help of the examination it is possible to detect intestinal obstruction, enteritis, dyskinesia.
If you are assigned an endoscopic examination, then with the help of an endoscope you will enter into the intestine a video cassette that will transmit to the monitor an examination of the examination of the mucous membranes of the small intestine. The examination is very informative, but not in all clinics due to the lack of necessary equipment.
Ultrasound will help the doctor determine the location of all internal organs, see foreign inclusions. Unfortunately, this method does not always give accurate results. especially if the patient is too obese.
When carrying out the irrigoscopy, you will be given an X-ray contrast substance with an enema. The examination is assigned to diagnose duodenal diseases.
When fibroscopy, the doctor will take the material for histological examination. The examination is appointed in case of emergency.
On the basis of a comprehensive survey, you will be diagnosed and prescribed treatment.
How to check the small intestine -print version
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Sources: http://surgeryzone.net/info/info-hirurgia/rentgenologicheskie-metody-obsledovaniya-pri-spaechnoj-bolezni.html, http://www.justlady.ru/articles-151187-kak-proverit-tonkiy-kishechnik
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