General X-ray of the abdominal cavity. Examination of the abdominal area using x-rays

What diseases can be detected using an abdominal x-ray?

Where can I get an abdominal x-ray?

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X-ray examination. What is an abdominal x-ray?

X-ray examination ( x-ray) is perhaps the most famous diagnostic method. X-rays were discovered back in 1895, and in 1901 the Nobel Prize was awarded to their discoverer Wilhelm Conrad Roentgen for the use of X-rays in medicine. Most people are familiar with x-rays, since this method is performed for almost any limb injuries, fractures, and lung diseases. However, few people know that x-rays are also an effective diagnostic method for the abdominal organs.

X-rays using contrast agents are not performed on women during pregnancy. The fact is that the contrast agent has a high risk of causing developmental abnormalities in the child. The accumulation of contrast agent in fetal tissues can have an adverse effect on their development.

Abdominal X-ray for children and pregnant women

X-ray examination for women is absolutely contraindicated during the first trimester of pregnancy. This is the period when the formation of all fetal organs occurs. During the remainder of pregnancy, the cells increase in number and begin to function. If possible, X-rays should not be performed at all during pregnancy. During breastfeeding, X-ray examination of the mother is not contraindicated. X-rays do not affect the composition of breast milk.

For children, X-ray examination of the abdominal cavity is not recommended. This is due to the fact that the child’s body is in a state of growth and, accordingly, is more susceptible to ionizing radiation. This is also due to the fact that X-rays of the abdominal cavity usually require a higher dose of radiation than, for example, X-rays of the extremities. After reaching 18 years of age, abdominal x-rays can be performed without restrictions.

Techniques for performing abdominal x-rays. Preparing for different types of abdominal x-rays

The abdominal cavity is an anatomically important area containing a large number of vital organs. Currently, there are a variety of methods for studying them. X-ray examination is only one of the branches of radiation diagnostics, and special areas can also be distinguished in it.

Most abdominal x-ray examinations involve the use of contrast agents. This is due to the fact that soft tissues on x-rays do not have sufficient contrast and partially merge into the general background. Depending on the method of administration and the composition of the contrast agent, unique data on the condition of the abdominal organs can be obtained.

The following methods of X-ray examination of the abdominal cavity are distinguished:

plain X-ray of the abdominal cavity;
X-ray of the gastrointestinal tract with barium contrast;
cholegraphy;
endoscopic retrograde cholecystopancreatography ( ERCP);
angiography;
excretory urography and others.

Where is an abdominal x-ray performed? What is used during its execution?

An X-ray of the abdomen is a fairly common procedure, although it is not performed as often as X-rays of the bones or lungs. An abdominal x-ray is performed in a regular x-ray room. Such offices can be found in every clinic or diagnostic center. X-ray rooms have special anti-radiation protection, which is aimed at reducing the harmful effects of x-rays. The main equipment of the X-ray room is the X-ray unit. The X-ray machine is a high-tech device. It is used repeatedly to examine patients, so the X-ray machine must meet certain safety parameters. Modern X-ray installations are characterized by a low level of X-ray power and, at the same time, good image quality.

The X-ray installation consists of the following elements:

power supply and transformer;
x-ray table;
tripod;
x-ray emitter ( a tube);
focusing device;
X-ray receiver ( sensor or film cassette);
software package for image management and processing.

A survey x-ray of the abdominal cavity is performed by a radiologist. However, when contrast techniques are used for research, doctors of other specialties, for example, surgeons, are sometimes required. To perform contrast techniques in the X-ray room, special equipment must be prepared.

During special x-ray techniques, the following substances and equipment can be used:

contrast agents of various chemical compositions;
catheters;
surgical needles, syringes;
scalpels;
endoscopes;
tubes and drains;
dressings;
devices ( for example, Bobrov’s apparatus for irrigoscopy) and other equipment.

The variety of techniques for x-ray examination of the abdominal cavity should not confuse the patient. X-rays should only be performed for certain indications, as X-rays are not completely safe. Indications for x-ray examination are determined by the attending physician. Before undergoing any type of abdominal x-ray, you should find out from your attending physician the specifics of the x-ray examination in order to be fully prepared for it.

How is a plain abdominal x-ray obtained?

Radiography is a method of x-ray examination that produces a static image of certain organs. An abdominal x-ray is a survey because it shows all the organs of an entire anatomical region. A survey X-ray of the abdominal cavity serves as the first study, thanks to which most diagnoses are eliminated and a plan for further research is drawn up.

An abdominal x-ray is taken in a standing position in an x-ray room. Before performing it, you need to undress to the waist and remove all metal objects. They interfere with the X-ray image. An X-ray of the abdominal cavity is performed only in a direct projection. Next, the patient stands close to the X-ray screen, which contains electronic sensors or X-ray film. The X-ray emitter is installed at the same level as the patient’s abdomen, horizontally to the floor, at a distance of 1.5 to 2 meters. The doctor controls the X-ray unit remotely from a special room into which harmful radiation does not penetrate. The operation of the X-ray unit lasts a few seconds, after which the patient can get dressed, and the doctor begins to study the image.

For the patient, a plain X-ray of the abdominal cavity is absolutely painless. If the patient cannot maintain an upright position, he is x-rayed in a horizontal position, lying on the x-ray table. If necessary, after a survey x-ray, special techniques are performed using contrast agents. To clarify the indications for them, doctors use data from a plain X-ray of the abdominal cavity.

Method of performing an X-ray of the stomach and small intestine with barium

Contrast X-ray techniques involve taking pictures of the gastrointestinal tract after they are filled with a contrast agent. X-rays using a contrast agent take a long time. This is due to the fact that it takes a certain time for the contrast agent to pass through the gastrointestinal tract. Barium suspension is used as a contrast agent. It has a white color, dense consistency and a taste similar to lime. Before starting the study, the patient must undress to the waist.

X-ray of the stomach and intestines with barium includes the following steps:

fixing the patient to the table in a horizontal position;
transfer the patient to a vertical position;
taking several chest pictures ( for examination of the esophagus) and abdominal cavity;
taking about 600 ml of barium suspension in small sips;
massage ( light pressure) on the upper abdomen for better filling of the stomach;
taking photographs of the chest and abdomen at short intervals ( up to 30 minutes) and in different positions.

Sometimes, for x-ray examination, a double contrast technique with barium suspension and gas is used. After the patient drinks the barium suspension, he is additionally given a special powder. As a result of chemical reactions, it leads to gas formation, an increase in the volume of the stomach, and smoothing of folds.

Pictures are taken in direct and lateral projection, both standing and lying down. The time between doing them can be filled with discussion or reading a book. However, the patient must remain motionless all this time, being fixed to the examination table. After the procedure is completed, you can eat and prepare for other studies, for example, irrigoscopy.

Preparing for a barium x-ray of the gastrointestinal tract

X-ray of the gastrointestinal tract with barium is a complex procedure, so proper preparation is extremely important. It consists of following nutritional rules, which reduce the formation of gases in the intestines. In addition, the patient must be aware of the basic actions of the physician during this lengthy study.

Two to three days before the test you should switch to a slag-free diet. The last meal before an abdominal x-ray should be 10–12 hours before. It is also prohibited to smoke or drink alcohol during this time. During this period, you cannot take drugs that regulate the activity of the gastrointestinal tract to ensure the objectivity of the study. It is better to come to the X-ray room without jewelry or metal objects. You should take a book with you to fill the waiting time between scans, as well as food so you don't go hungry after the exam.

The patient should be aware that this study may take 2 hours or more, since images are taken at 30-minute intervals. The images are taken in different positions, most of the time the patient's position will be fixed on the table. Sometimes the doctor will press on the abdomen to better distribute the barium suspension. After the study, the contrast agent will leave the gastrointestinal tract for about 3 days, discoloring the stool. The contrast agent may cause unpleasant symptoms such as flatulence, constipation, and bloating. If they appear, you should immediately consult a doctor.

What should be the diet before an abdominal x-ray?

The diet before an abdominal x-ray is aimed at reducing the formation of gases in the stomach. This will ensure good filling of the stomach and intestines with the contrast barium mass. A diet that reduces gas formation is used before most abdominal examination techniques. The exact list of products, as well as the need to comply with it, should be clarified with your doctor or radiologist.

The diet before an abdominal x-ray excludes the following foods:

flour products ( bread, buns, pastry);

Preparation for irrigoscopy has its own characteristics. Feces interfere with this examination, so it is necessary to cleanse the intestines in advance using laxatives or an enema. Following a slag-free three-day diet also plays a certain role. On the day of the examination and 12 hours before the examination, you cannot eat food, you are only allowed to drink water ( up to 1 liter). The radiologist should explain the preparation plan for irrigoscopy.

The technique of irrigoscopy consists of the following steps:

in the X-ray room, the patient undresses and lies down on the table to take pictures;
Several survey images of the abdominal cavity are taken;
the patient takes a position on his side, puts his hands behind his back and draws his knees to his chest;
in this position, the X-ray contrast agent is administered rectally through a small diameter tube;
barium is injected slowly, and X-rays are taken as the colon fills;
After the procedure is completed, the patient is escorted to the toilet.

Method for studying the biliary tract using x-rays

The following methods of X-ray diagnostics of the biliary tract using a contrast agent are distinguished:

Cholecystography. This is a study of the gallbladder. The day before the study, the patient takes an iodine-containing contrast agent. During the night, it enters the bile, which collects in the gallbladder. In this case, the patient should not eat food all the time before the study. The bile ducts are poorly visible during this study. The main application of cholecystography is to identify gallstones.
Holegraphy. With this method, a contrast agent is injected intravenously, which allows you to see both the gallbladder and ducts. 5 - 7 minutes after injection into the blood, the contrast agent begins to fill the bile ducts. The filling of the bile ducts is monitored using a series of x-rays. Using cholegraphy, liver function and the ability of hepatocytes ( liver cells) remove contrast agent from the blood.
Percutaneous cholangiography. With this method, the contrast agent is injected directly into the bile ducts using a special needle that pierces the skin and liver. The condition of the lumen of the biliary tract is determined using x-rays.
Endoscopic retrograde cholangiopancreatography ( ERCP). The contrast agent is injected directly into the bile ducts at their junction with the duodenum, under the control of the intraintestinal fiber chamber. The contrast agent moves in the direction opposite to the bile flow, which is why the technique is called retrograde. Using this method, the contrast agent penetrates into the pancreatic duct. After the contrast agent is injected, several x-rays of the abdominal cavity are taken.

Technique for examining the urinary tract using x-rays. Excretory urography

A survey x-ray of the kidneys has some peculiarities. The patient lies on the X-ray table on his back, placing his hands behind his head. The X-ray emitter is positioned so that it covers the entire abdominal cavity, including the pelvis. To avoid radiation exposure, the external genitalia are protected with a special shield. During the procedure, a single x-ray is taken. It in itself provides valuable information and allows you to draw up a plan for subsequent research. If necessary, x-ray examination of the kidneys is supplemented with the use of contrast agents.

There are various methods of x-ray examination of the kidneys:

plain radiograph of the kidneys;
excretory urography;
retrograde pyelography;
angiography of the kidneys.

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Retrograde pyelography is less commonly used. With this method, only the upper urinary tract is examined ( ureter, pelvis and renal calyces), using the injection of a contrast agent directly into the ureter. This method is more difficult for the doctor and unpleasant for the patient. It is used in cases where excretory urography was not informative enough ( for example, in renal failure

X-ray of the abdominal cavity. X-ray picture of healthy abdominal organs. X-ray methods in the diagnosis of diseases of the abdominal organs

An X-ray of the abdominal cavity is performed to diagnose many pathologies. The study helps to identify stones in the kidneys, urinary or gall bladder, confirm peritonitis, intestinal obstruction, and the formation of abscesses. Diagnosis of intestinal and renal pathologies often requires the administration of contrast.

A routine examination requires special preparation; emergency x-rays are carried out only when indicated.

How to prepare for research

The intestine is an organ that occupies almost 80% of the image of the abdominal cavity. In case of flatulence, the study is not very informative, since the abundance of gases in the cavity of the intestinal tube interferes with the visualization of pathological changes in the kidneys and bladder.

For routine radiography, preparation in the form of a diet is required. Diet therapy is prescribed 2-3 days before the proposed study. Products that increase gas formation are prohibited: legumes, cabbage, brown bread, dairy products, alcohol.

If a contrast study of the digestive organs is required, then preparation is more essential. The last meal before the examination is 15-16 hours. The patient also needs to empty the intestines. This is achieved with the help of laxative medications or by performing an enema on the eve of diagnosis.

Methodology of the procedure

How is radiography done? The procedure is carried out in a specially designated diagnostic room - an X-ray room, where the X-ray machine is located. The examination takes place in a standing position; X-rays are taken in a lying position only if the patient’s condition is serious and it is impossible to rise.

The patient removes metal objects: pendants, chains, belts, watches. It is not necessary to remove clothing, which is important for emergency diagnostics, as it saves time. The laboratory technician or radiologist adjusts the screen according to the patient’s height. Then the patient is required to stand or lie motionless for no more than two minutes, during which time the X-rays pass through the anatomical structures of the abdomen and are reflected on the X-ray film.

For oral barium contrast studies, an accurate chronology of when the contrast was administered is required. Depending on which organ needs to be examined, diagnostics are carried out at a certain time.

Indications for the study

Indications for X-rays of the abdominal organs:

blunt abdominal trauma;
penetrating abdominal wound;
suspicion of the formation of an abscess in the abdominal cavity;
perforation of a hollow organ;
intra-abdominal bleeding;
intestinal obstruction;
kidney stones, bladder stones;
pyelonephritis;
gallstones;
foreign body in the cavity of the intestinal tube;
volumetric formations in the abdominal cavity;
defects in the internal mucous membrane of the stomach, intestines (contrast studies reveal ulcers, erosions, polyps, and so on).

When is the procedure contraindicated?

Since X-rays are ionizing and can cause mutations in actively dividing cells, the examination is contraindicated in pregnant women. This is due to pathological effects on the fetus.

For children, it is performed only according to strict indications and with caution. Diagnosis is often not recommended. Nursing mothers need to temporarily stop breastfeeding after an X-ray examination of the abdominal cavity. The child is transferred to artificial formula, and the mother expresses 2-3 times. Then you can resume feeding.

Types of diagnostics

There are several types of devices. To obtain a general image of the abdominal organs, radiography is used; for contrast studies, fluoroscopy is preferable.

Radiography

A static study that takes a single image. Diagnostics captures a brief moment during which the rays pass through the patient's body.

The examination is minimally invasive. Taking into account the diagnostics carried out using modern digital equipment, a significant reduction in the radiation dose has been achieved. The result is obtained within 5 minutes, so radiography is used as an express method.

X-ray

Diagnostics that help evaluate the anatomical structure of the abdominal organs and functionality. This occurs due to the fact that X-rays pass through the patient’s body continuously throughout the examination, the result is reflected on the fluoroscope screen in real time.

It is especially effective when contrasted with barium, as it helps to trace the peristaltic wave and assess the motility of the gastrointestinal tract. If necessary, the necessary points are recorded for further in-depth research. Some surgical interventions are performed under the control of a fluoroscope.

The disadvantage of diagnosis is the increase in radiation dose.

Contrast X-ray

To clarify pathological changes in the intestinal wall, an X-ray examination using barium is performed. The solution is drunk before diagnosis, then, using fluoroscopy or a regular X-ray machine, the examination itself is carried out over time.

Barium delays the rays and is visualized as a darkening in the image. Passing through the gastrointestinal tube, it envelops the walls, allowing you to see filling defects: “plus” (oncological pathology, polyps) or “minus” (erosions, ulcers) tissue. A contrast study will reveal abnormalities in intestinal development: additional loops (dolichosigma, dolichocolon), megacolon, Hirschsprung's disease.

What do you see in the photographs?

The following X-ray images of the abdominal organs clearly show:

Price

The study is not expensive in comparison with tomographic techniques (CT, MRI). Prices vary depending on the organ being examined and the need for a contrast agent.

Survey radiography costs on average about 350 rubles. A contrast study will not cost more than 1000 rubles.

Radiography is a relatively cheap diagnostic method that helps to conduct rapid diagnostics and clarify the nature of pathological changes during a routine examination. Thanks to modern digital devices, it has been possible to reduce radiation exposure to a minimum.

Video

X-ray of the abdominal organs- projection images of internal organs (stomach, small and large intestines, gall bladder and bile ducts, etc.). When examining the abdominal cavity, survey and targeted images in standard or additional projections are used. Plain radiography can detect free gas and fluid in the abdominal cavity, stones in the gall bladder and urinary tract, tumors, and signs of intestinal obstruction. Since hollow organs do not reflect X-rays, their examination is carried out after preliminary contrast. Contrast types of radiography include esophagography, gastrography, cholecystography, cholangiography, enterography, irrigography, etc. The cost varies depending on the type of study, the need for use and the type of contrast agent.

Indications

In clinical practice, survey and X-ray contrast examination of the abdominal organs is used in gastroenterology, abdominal surgery and urology. Plain radiography of the abdominal cavity is prescribed for acute pain in the abdomen and lumbar region, bloating, suspected intestinal obstruction (for malignant and benign tumors, inflammatory diseases, etc.), diverticulitis, intussusception, rupture of a hollow or parenchymal organ, cholecystitis, pancreatitis, cholelithiasis and urolithiasis.

Contrast radiography of the abdominal organs is carried out after taking a survey image confirming the integrity of the hollow organs (to avoid barium reflux into the abdominal cavity). Indications for the study are suspicion of the presence of a neoplasm, diverticulum or stenosis of a hollow organ. Based on the data from plain and contrast radiography, a treatment plan is drawn up, additional examinations are prescribed (if necessary) or a decision is made to perform surgical intervention.

Contraindications

Contraindications to contrast radiography are increased sensitivity to the contrast agent, perforation of a hollow organ, acute diverticulitis, ulcerative colitis during an exacerbation, severe dehydration, intestinal obstruction (prevents the excretion of barium with feces), mixed and intestinal forms of cystic fibrosis. Alternatively, ultrasound or MSCT of the abdominal organs, colonoscopy, laparoscopy and other studies may be prescribed. The decision on the need for radiography is made individually, taking into account the severity of the pathology and the risks associated with the study.

Preparation

No special preparation is required for the survey study. Before starting the procedure, you should empty your bladder. Before contrast radiography, it is necessary to refrain from eating rye bread, vegetables and dairy products for 24 hours and from eating solid food for 12 hours. Before irrigoscopy the night before and 1-1.5 hours before the procedure, you should cleanse the large intestine using an enema or laxative.

When examining the upper gastrointestinal tract, the contrast agent is administered orally or through a probe; when examining the lower intestines, it is administered using an enema. A survey radiography of the abdominal organs is performed in a standing position (in a lying position, gas and liquid will be distributed throughout the abdominal cavity, and their levels will not be visible), contrast radiography is performed in a standing or lying position, in several projections. The radiologist then describes the images and passes them along with the description to the attending physician. Sometimes the results are given to the patient (for example, when referred for a consultation to another clinic).

Interpretation of results

In case of acute intestinal obstruction, a plain radiograph reveals “inverted cups” (accumulations of gas above the liquid), a large amount of gas and transverse striations. With ascites and bleeding in the abdominal cavity, a horizontal level of fluid is visible. Foreign bodies appear as shadows on images. The color and saturation of the shadow depend on the density of the object: the higher the density, the lighter the shadow. Kidney and gallstones containing calcium salts are also light-colored inclusions. Based on abdominal x-ray data, the doctor can determine the size, shape and location of foreign bodies and stones. By studying images using a contrast agent, one can draw a conclusion about the condition of the intestinal mucosa, the presence of areas of narrowing and tumor-like formations, assess the extent and severity of areas of narrowing, the contours of tumors and ulcers, etc.

A diagnostic method such as radiography has been used in medicine for quite some time. Today, thanks to improvements in the quality of equipment, the speed of image acquisition, and the absence of the process of developing images, this diagnostic method has become effective, accurate and relatively safe.

Concept and types

The method is named after its inventor (Wilhelm Roentgen) and the Greek. gráphō – food. It refers to non-invasive medical research, and is based on the projection of X-rays onto paper or special film.

The rays, passing through the anatomical structures of the body, give an image in the form of light and shadow, weakened in those places where the structure of the organ is more dense.

In modern (digital) devices, the resulting image can be recorded on a cassette with a special film or on the matrix of an electronic device. Subsequently, the film can be printed, or the image is stored in a database and displayed on the monitor if necessary.

Before proceeding with a detailed examination, a survey fluoroscopy of the abdominal and thoracic organs is performed. If survey fluoroscopy cannot provide a complete picture of the examination, then they resort to a contrast procedure using barium mass.

Contrast radiography

During X-ray examination of the gastrointestinal tract, an aqueous suspension of barium is used as a contrast agent. The solution is drunk by the patient or, in some situations, administered through a tube.

Barium is almost insoluble in water and physiological fluids, but has the ability to absorb X-rays, which makes it possible to judge the relief of the mucous membrane

While the barium mass moves through the digestive organs, its progress is monitored using transillumination. In this case, the radiologist examines the function of the intestine and identifies the presence of tumors, obstruction or damage.

Overview

Survey radiography allows one to judge the condition of the organs adjacent to the esophagus, stomach, and other organs of the gastrointestinal tract.

The abdominal organs have a less dense structure, so the shadow in the image is less pronounced than that of the bones. But a survey examination allows you to see the presence of foreign objects or changes in any organ due to injury or illness.

This examination is prescribed in conjunction with other studies to clarify the diagnosis. It takes a few minutes and is quite affordable.

Indications

Diseases that require such diagnostics:

cholecystitis;
pancreatitis;
soft tissue damage;
abscesses.

This method is used when the patient complains of:

pain, discomfort in the abdomen;
bloating;
heaviness in the digestive system.

With the help of x-ray examination, peristalsis and tone of the organ, changes in the relief of the mucous membrane are clarified. The method also allows you to determine the level of fluid in hollow organs.

Contraindications

There are practically no contraindications to the study. The disadvantages of this method include:

exposure to ionizing radiation on the patient;
difficult assessment of organ functions;

When examining soft tissues with little distinguishable density, there is insufficient information content without the use of contrast agents.

Preparation

The examination requires the absence of gases and food, liquid, and mucus in the hollow organs.

Before the procedure, the following preparation is carried out:

When examining the liver and gallbladder, radiopaque agents (Iopagnost, Holevid) are used, which accumulate in the gallbladder and liver. To study the contractility of the gallbladder, choleretic agents can be used.
On the eve of the examination of the duodenum and stomach, for constipation and severe flatulence, do a cleansing enema and drink 30 g of castor oil.
On the day of the procedure, if there is severe flatulence, a cleansing enema is also given 2 hours before fluoroscopy. And also if there is a large amount of mucus, liquid, or food debris in the stomach, rinsing is carried out 3 hours before the test.

It is better to conduct the study on an empty stomach, having eaten a light dinner the day before. Patients with normal bowel function do not require special preparation in the form of enemas or diets.

How is an abdominal x-ray done?

It is advisable to carry out a diagnostic study in different projections, since the photograph is a flat image of a three-dimensional organ, and you need to look at all the walls. Therefore, the study is carried out in different body positions.

During a procedure using barium, with the patient in a horizontal position, the movement of the contrast mass slows down, which allows it to fill the hollow organ and take the necessary pictures:

after 1 hour– the contrast mass reaches the small intestine;
3 hours– accumulates in the transition between the small intestine and the large intestine;
6 hours– reaches the initial parts of the colon;
9 – colon and transverse intestine;
12 – sigmoid colon;
24 – large intestine.

Price

The X-ray procedure is relatively inexpensive and varies depending on the type of examination:

plain radiography – from 350 rubles;
X-ray of the stomach – from 750 rubles;
radiography with barium of the large intestine - from 600 rubles;
small intestine – from 950 rubles;
examination of the esophagus – from 500 rubles;
cholangiopancreatography (examination of the liver and biliary tract) – from 1,500 rubles;
irrigoscopy – from 1000 rub.

It is simply impossible to imagine modern medicine without such a simple and at the same time important branch as radiology diagnostics. Radiation diagnostic methods include: X-ray, radionuclide, ultrasound, magnetic resonance imaging, thermography, interventional radiology. Each method has its own advantages and disadvantages and is used to diagnose various diseases, either independently or in combination with others.

The ancestor of all radiation diagnostic methods can safely be called radiography. Radiography is a method of x-ray examination during which an object of interest is visualized on a solid medium under the influence of x-rays passing through human tissues of varying densities and structures.

For almost a hundred years, X-ray images were obtained exclusively on special X-ray films. At the moment, digital visualization methods have become increasingly widespread. Using computer technology, they allow you to process, save and instantly transmit high-quality X-ray images to specialists anywhere in the world.

Modern radiography is widely used to examine the musculoskeletal, respiratory, reproductive systems and even the abdominal organs.

What is an X-ray examination of the abdominal cavity and its types?

An X-ray examination of the abdominal cavity is a projection of the internal organs, based on the ability of the organs of the human body to reflect X-ray radiation differently. That is, X-rays passing from the beam gun of an X-ray machine to a special X-ray film encounter an obstacle in the form of a human body. They are reflected differently from different organs and structures and therefore reach the film cassette with varying degrees of power, which is what we see in the picture.

How X-rays work

Unfortunately, parenchymal organs do not have the same reflective ability as, for example, bone tissue, so their visualization is much lower. To enhance the image of the organs of interest, special contrast agents are introduced to “illuminate” the person from the inside. On this basis, radiography of the abdominal cavity is divided into survey (without the use of contrast agents) and contrast (with their use).

Contrast radiography of the abdominal cavity

Contrast radiography is actively used to detect pathological narrowings and dilations, ulcerations, perforations and tumors of the hollow organs of the digestive tract. For this, barium sulfate powder is used, which is insoluble in water and human body fluids and at the same time is capable of absorbing X-rays.

A barium suspension is taken orally before the study, after which, after certain time intervals, a series of images is taken to visualize the relevant organs and structures. Also, air or nitric oxide is sometimes used as a contrast, which enhances the contrast of organs during radiography.

Plain X-ray examination of the abdominal cavity

Plain radiography of the abdominal cavity is a cheap, simple, fast and reliable method for diagnosing a number of surgical diseases. The method allows you to display the condition of the main organs and structures of the abdominal cavity, but it is indicative.

This means that survey radiography can reveal predominantly nonspecific changes in the body, that is, find gross disturbances characteristic of a number of pathologies, and indicate in which organ the problem should be looked for.

To establish a more accurate diagnosis, doctors use other methods. For example, a survey X-ray of the abdominal organs reveals a dense formation in the projection of the left kidney, and to clarify whether it is calcification or a stone, an ultrasound examination is performed. The advantage of the method is the breadth of area coverage and the ability to be used everywhere.

Indications

Most often, plain radiography of the abdominal cavity is performed to diagnose emergency surgical pathology. Usually these are penetrating abdominal wounds, intra-abdominal bleeding, intestinal obstruction, and abscess formation.

The method is effective for identifying dense structures - kidney stones, gallstones, and bladder stones. In some cases, it is possible to determine the occurrence of tumor processes.

Preparation

Preparation for plain radiography is often not required at all. In some cases, it is recommended to empty your bladder before the procedure. In addition, you need to remove all metal items (belts, chains, metal fasteners) that may cause interference.

Preparing for a contrast examination is a little more complicated. Before contrast radiography, a special diet is required, excluding foods that increase gas formation in the intestines - cabbage, legumes, black bread.

12 hours before the test, solid food intake is stopped, and a cleansing enema is performed 1-2 hours before the test. In addition, on the day of the examination it is recommended to refrain from smoking and chewing gum.

Carrying out radiography

An X-ray of the abdominal cavity is performed in a standing or lying position (and sometimes in both positions sequentially) on a special couch. The patient is dressed, but all metal objects have been removed. The radiologist adjusts the position of the screen to take a targeted image. The examination takes from one to several minutes, which the subject must remain motionless.

To perform a contrast study, before the procedure begins, the patient drinks an aqueous suspension of barium sulfate, after which a series of images are taken depending on the organ of interest:

After 1 hour, barium enters the small intestine.
After 3 hours, the transition from the small intestine to the large intestine begins.
After 6 hours it enters the colon.
After 9 hours it passes through the transverse colon.
After 12 hours it passes into the sigmoid colon.
After 24 hours it goes through the rectum.

Detected pathologies and their radiographic signs

The results of the radiographs are assessed by a radiologist. When assessing the results of radiography, first of all, the presence of gas in the free abdominal cavity is determined, which is a sign of rupture of a hollow organ.

When the patient is in an upright position, the gas is located highest in the abdominal cavity and can move with changes in body position. The favorite place for gas bubbles to accumulate is under the diaphragm dome. A large amount of gas can displace internal organs, especially intestinal loops. Pneumoperitonium can be detected by placing the patient on his left side. In this case, gas collects in a pocket between the liver and the anterior abdominal wall, which is clearly visible on the x-ray.

Free fluid in the abdominal cavity indicates the presence of bleeding due to injury, tumor or destructive processes. Unlike air, under the influence of gravity, liquid flows down and accumulates in the pockets and spaces of the abdominal cavity. Free fluid must be looked for in the space between the colon and the anterior abdominal wall, which is visualized on lateral x-rays as a high-intensity ribbon-like formation.

Stones are not always visible on abdominal images. An important condition for their visualization is the presence of calcium salts in the composition of the stone. The radiologist indicates their shape, size and relationship with the abdominal organs.

Intestinal obstruction has its own special radiological sign - Kloiber cups. They are sections of the intestine that are partially filled with liquid and partially filled with gas. They look like inverted bowls with two-layer contents, which are fixed in a horizontal position of the patient.

The predominance of the vertical size of the “cups” indicates a pathology of the large intestine, but if the horizontal size is increased, this is a sign of small intestinal obstruction. Kloiber's bowls indicate the neglect of the process.

An X-ray of the abdominal organs can reveal a liver abscess. Its signs are as follows: limited mobility of the right dome of the diaphragm; effusion is often detected in the right pleural cavity. The mature abscess itself looks like a round formation, half filled with liquid and half with gas.

Plain radiography is not a specific method for identifying neoplasms of the abdominal organs, but in some cases it can detect tumors ranging in size from several centimeters.

X-rays are often used to detect foreign bodies in the gastrointestinal tract, especially in children, who often like to swallow needles, coins, and small toys. However, it should be remembered that not all swallowed objects will be reflected by X-rays. For example, glass that has entered the gastrointestinal tract is almost impossible to detect.

Contrast radiography allows you to assess the patency and degree of narrowing of parts of the gastrointestinal tract, assess the condition of the walls, in certain situations, identify neoplasms compressing the walls of the stomach and intestines.

Further actions

The radiologist draws up a conclusion based on the obtained radiograph. The attending physician is familiarized with the results of the examination. Based on them, taking into account the history, examination and laboratory data, he makes a diagnosis and plans further tactics - conservative, surgical treatment, or continuing the examination with other methods if there is insufficient information content.

Conclusion

As practice shows, abdominal x-ray is an important addition when examining patients with acute surgical pathology, and not using it would be a serious mistake. However, despite the simplicity, speed of obtaining results and the availability of plain radiography of the abdominal cavity, the method also has a number of disadvantages.

Due to radiation exposure, it is extremely undesirable for children, pregnant women, and patients with diseases of the hematopoietic system. A contrast study is not performed if perforation of the stomach or intestines, intestinal obstruction, vomiting, or bronchial asthma is suspected. In such situations, ultrasound examination is a reasonable substitute.