gastric exammination
DESCRIPTION
Radiology of the GITTRANSCRIPT
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The radiological
methods of the
gastrointestinal system
examination
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The main methods of
examination
- Roentgenoscopy (fluoroscopy)
- Roentgenography
- Fluorography
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The additional methods
- Roentgen polygraphy
- Roentgen kymography
- Tomography
- Roentgenoscopy with primary
magnification
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The special contrast methods
- Double contrasting
- Pneumoparietography of the stomach
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The roentgen anatomy and
examination of esophagus
- Width – from 1,5-2 см to 2 см;
- Length – 25-26 см;
- The parts of esophagus:
А) cervical;
Б) thoracic;
В) abdominal.
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- Three physiologic narrowings:
А) at the level of cricoid cartilage;
Б) at the level of aortic arc;
В) at the level of cardia.
- The folds of mucosa – 2-3 см, parallel,
longitudinal;
- The velocity of contrast movement
is 4-6 sec.
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folds
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peristalsis
narrowing (arc)
cardia
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The roentgen anatomy and
examination of the stomach
1. The survey roentgenoscopy.
2. The first stage of examination – the
patient drinks 1-2 swallows of contrast
(we can evaluate the folds of mucosa of
the stomach).
3. The second stage of examination –
tight filling. We can determine the
shape, size and position of stomach.
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4. The stomach peristalsis:
- Superficial;
- Medium depth;
- Deep;
- Segmental;
- The velocity of peristaltic wave is 21 sec.
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trendelenburg
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Double contrasting
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parietography
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5. Parts of the stomach:
- Fundus;
- Cardiac part;
- Body;
- Sinus (or angle);
- Antrum;
- Pyloric part;
- Minor and major curvature.
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The roentgen anatomy and
examination of duodenum and
small intestine
1. The duodenum comes after stomach
and it has three parts:
- Superior (bulb of triangular shape);
- Descending (covers the head of
pancreas);
- Inferior.
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2. Small intestine:
- duodenum;
- jejunum;
- ileum;
- Kerckring's folds of the mucosal layer.
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N
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The roentgen anatomy and
examination of large intestine
1. The methods of examination:
- Per os;
- Irrigoscopy – contrast enema.
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2. Roentgen anatomy and parts of the
large intestine:
- Caecum;
- C. ascendens;
- C. transversum;
- C. descendens;
- C. sygmoideum;
- Rectum.
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3. Irrigoscopy:
- The first stage of examination – tight filling of the bowel.
А) shape;
Б) size;
В) localization.
- The second stage of examination– the evaluation of the mucosa folds (after depletion of patient);
- The third stage of examination– double contrasting (inflation of large intestine with barium sulfate by Bobrov device). The elasticity of the walls is determined.
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N
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The pathology of the
gastrointestinal tract
1. Esophagus:
- Esophageal diverticuli:
А) pulsational;
Б) tractional;
В) functional.
- Achalasia of esophagus;
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Balon dilatation
Achalasia beforeafter
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- Cancer of esophagus:
А) scirrhous;
Б) bowl-shaped (saucer-shaped);
В) medullar shape.
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The symptoms of cancer:
- Stenosis of esophagus;
- Filling defect;
- Irregular borders;
- The delay of contrast media above the
level of stenosis;
- Deformation and absence of the folds;
- The absence of peristalsis at the level of
defect.
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cr
cr
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- Burn of esophagus:
The first examination is possible after 2-3 weeks.
Symptoms:
• Circular stenosis;
• Flat contours;
• Deformation – cone-, funnel-, ampullar.
- Foreign substances
Method by Ivanova-Podobed.
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burn
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2. Stomach:
- Gastritis:
А) acute;
Б) chronic;
В) chronic hyperthrophic gastritis;
Г) rigid antral gastritis.
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- The ulcer of stomach and duodenum:
Symptoms:
• “niche”;
• inflammative elevation of mucosa;
• folds convergention;
• the symptom of “pointing finger”.
Complications:
• hemorrhage;
• perforation;
• penetration;
• malignisation (transformation into cancer).
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Acute ulcer
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Chronic ulcer
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ulcus
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ulcus
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ulcus
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- Cancer of stomach:
• polypous;
• bowl-shape;
• ulcerative cancer;
• diffuse;
• cancerous ulcer;
• cancer from polyp.
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Symptoms:
• filling defect;
• the absence of the folds of mucosa;
• the absence of peristalsis at the defect
localization;
• stenosis of the lumen.
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cr
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cr
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polyposis
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Malignant polyps of stomach
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3. Large intestine:
- Inflammations:
А) colitis;
Б) chronic colitis;
В) chronic spastic colitis;
Г) unspecific ulcerative colitis.
Symptoms:
• spasm of intestine;
• smoothness of haustrum;
• smoothness of the folds of mucosa.
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colitis
artefact
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n
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- Cancer of the large intestine
Symptoms:
• filling defect;
• irregular contours;
• circular stenosis;
• the absence of the folds of mucosa;
• evacuation disorders.
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Cr sygm
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The roentgenologic picture of
the acute abdomen
1. Bowel obstruction.
- high;
- low.
Symptoms:
- Kloyber cups(at the background of
swallen bowel there is the presence of
horisontal level of fluid).
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B. obstruction
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2. Perforate ulcer.
- Symptom of sickle (the presence of air
under the right cupola of the diaphragm).