Examination for diseases of the gastrointestinal tract. Procedure for examining patients with diseases of the digestive system

In gastroenterological practice, there are a considerable number of different diseases, some of which can be very dangerous and lead to the development of severe complications. According to statistics, every second person on earth suffers from one or another pathology of the digestive system. That is why it is extremely important to conduct a timely examination of the gastrointestinal tract (GIT), which will allow the specialist to develop effective treatment tactics.

Today, there are quite a few modern diagnostic methods that make it possible to conduct a comprehensive study of all organs and parts of the gastrointestinal tract, identify the disease in the shortest possible time and with maximum reliability, clarify its stage, degree of prevalence and other features. Research methods used in gastroenterology can be divided into three groups:

physical;
laboratory;
instrumental.

Instrumental methods, in turn, can be divided into secretion studies, endoscopic and radiation studies. The appropriateness of prescribing a particular examination will be determined by the doctor while working with the patient.

Physical studies

The first stage of a gastroenterological examination is a consultation with a gastroenterologist or therapist, who must collect a history of the patient’s complaints and draw up a general clinical picture. The doctor conducts a more detailed examination using special methods: palpation, percussion, auscultation.

Palpation is a procedure in which the patient’s abdomen is felt without the use of any additional instruments. This method makes it possible to detect certain signs characteristic of certain diseases of the gastrointestinal tract, in particular, to identify the degree of tension in the peritoneal wall and painful areas. Palpation can be performed while the patient is standing or lying on the couch. In a standing position, palpation is performed in cases where it is necessary to examine organs located on the sides of the abdominal cavity.

Usually, simultaneously with palpation, percussion is performed - a study that allows one to determine the boundaries of the location of the organs of the gastrointestinal tract by tapping. In gastroenterological practice, this technique is used mainly for studying the spleen and liver.

Diagnosis using auscultation involves listening to the sounds made by the organs of the gastrointestinal tract. To do this, the doctor uses a special instrument - a stethoscope. During the procedure, symmetrical areas of the body are listened to, and the results obtained are then compared.

The diagnostic studies described above are only primary and do not allow a specialist to accurately diagnose a particular gastrointestinal disease. So, for example, practical physical methods do not allow a specialist to identify organic pathologies of the gastrointestinal tract when their mucous membrane is predominantly affected. This requires a more complete examination, the plan of which is drawn up individually for each patient and may include a number of different clinical, laboratory and instrumental methods.

Lab tests

Laboratory diagnostics plays a vital role in identifying many diseases of the gastrointestinal tract. At the discretion of the doctor, the patient may be prescribed blood tests to determine the following substances and enzymes:

bilirubin is a special substance formed after the breakdown of hemoglobin in red blood cells and is part of bile. The detection of direct bilirubin in the blood may indicate a number of gastrointestinal pathologies associated with impaired bile outflow, for example, obstructive or parenchymal jaundice;

transaminases: aspartate aminotransferase (AST) and alanine aminotransferase (ALT) - these enzymes function in almost all organs of the human body, especially in the liver and muscle tissue. Increased concentrations of AST and ALT are observed in various liver diseases, including chronic ones;

gamma-glutamyl transpeptidase (gamma-GT) is another enzyme, an elevated level of which indicates inflammation of the bile ducts, hepatitis or obstructive jaundice;

amylase - this enzyme is produced by the pancreas, and as part of its juice, amylase enters the intestines, where it promotes accelerated digestion of carbohydrates. If amylase levels in the blood are elevated, the patient most likely has some kind of pancreatic disease;

lipase is another enzyme produced by the pancreas, the level of which increases with pancreatitis and other pathologies of the digestive system.

In addition, a general stool analysis is required, which will allow the specialist to fully assess the functioning of the digestive system and detect signs of disorders and inflammation of various parts of the intestine. In addition, when examining stool, microorganisms that cause infectious diseases can be detected.

A more detailed examination of stool is called a coprogram. With its help, the digestive and enzymatic activity of the stomach is assessed, signs of inflammation are identified, microbial activity is also analyzed, and fungal mycelium can be detected.

If necessary, a bacteriological study can be prescribed, that is, a determination of the microbial composition. This will detect intestinal dysbiosis and infections. There are also special tests for identifying antigens of microbial pathogens, which make it possible to identify viral infectious diseases.

Another common laboratory test widely used in gastroenterology is the occult bleeding test. This analysis is based on the detection of hidden hemoglobin in stool.

If the patient is taking iron supplements or other medications, the attending physician must be informed about this, since medications can significantly distort test results. Before donating blood, you must adhere to a special diet for several days, excluding fatty foods, meat, green vegetables and tomatoes from your diet.

If necessary, laboratory diagnostics of the gastrointestinal tract can be supplemented with studies such as enzyme-linked immunosorbent assay (ELISA) of feces and blood plasma.

Instrumental techniques

The most important section of a comprehensive examination of patients with gastrointestinal pathologies is instrumental diagnostics. It includes endoscopic, x-ray, ultrasound, electrometric and other diagnostic techniques.

The appointment of a particular study in order to obtain the most common information occurs at the discretion of the attending physician, depending on the existing clinical picture. Each of the instrumental methods makes it possible to assess the structural and morphological features of the organ under study, as well as its function. Most of these studies require special preparation from the patient, since their information content and reliability will depend on it.

Assessment of gastric acid secretion

Since most inflammatory diseases of the digestive system are characterized by changes in stomach acidity. That is why, during a diagnostic examination, it may be indicated to assess the secretion of gastric acid, necessary for adequate digestion of food, using a special technique called pH-metry. Indications for its implementation are peptic ulcer of the duodenum and stomach, chronic duodenitis, gastritis and other pathologies of the gastrointestinal tract.

In gastroenterology, there are several types of pH measurements: short-term (intragastric), long-term (daily), endoscopic. Each of these methods involves inserting a pH probe through the mouth or nasal opening into the corresponding part of the digestive system for a certain period of time. The acidity level is measured at a specific point using built-in electrodes. With endoscopic pH-metry, the probe is inserted through a special instrumental channel of the endoscope.

Any type of pH measurement requires certain preparation. First, the patient should not smoke or eat food for at least twelve hours before the procedure. Secondly, several hours before the study, drinking any liquids is prohibited in order to avoid vomiting and aspiration. Additionally, you should consult your doctor about the medications you are taking.

Another common procedure used in gastroenterological practice for suspected gastritis, peptic ulcer and many other pathologies is duodenal intubation of the stomach. When studying the secretory function of the stomach using this method, all contents are first pumped out of the stomach, and then the basal secretion. After this, the patient is stimulated with secretion using special drugs or given a trial breakfast in the form of broth; after half an hour, a fifteen-minute secretion is collected, which is then studied in the laboratory. The procedure is performed under local anesthesia on an empty stomach.

Probing of the stomach is a procedure that has a number of contraindications. It cannot be performed in cases of severe pathologies of the cardiovascular system, gastric bleeding, or during pregnancy.

If the patient has contraindications to duodenal intubation of the stomach, secretion assessment is performed using a probeless method using the drug "Acidotest". The test is also carried out in the morning on an empty stomach. Analysis of the secretory function of the stomach is carried out by examining portions of urine after taking the drug.

Endoscopic techniques

Endoscopic examination of the organs of the gastrointestinal tract involves the introduction of special optical devices into its lumen. Today, this is the most technologically advanced procedure that allows you to get a complete picture of the condition and functioning of the large and small intestines, as well as perform a biopsy - obtain a sample of material for further histological examination.

Endoscopic methods for examining the gastrointestinal tract include the following diagnostic procedures:

As a rule, endoscopic methods for examining the gastrointestinal tract are not used if the patient is allergic to anesthetic drugs, as well as pathologies associated with blood clotting disorders. In addition, they all require special training, which the attending physician will discuss in detail.

Radiation techniques

As the name suggests, radiation methods for studying the gastrointestinal tract usually include those that involve the use of radiation. The following methods are most widely used in gastroenterology:

Fluoroscopy or radiography is the study of the abdominal organs by taking x-rays. Usually, before the procedure, the patient needs to consume barium porridge, which is opaque to X-ray radiation and makes it possible to clearly visualize almost all pathological changes; abdominal ultrasound examination of the gastrointestinal tract using ultrasound radiation. A type of ultrasound is the so-called Doppler ultrasound, which allows one to evaluate the speed of blood flow and movement of organ walls; scintigraphy is the study of the activity of the gastrointestinal tract using radioactive isotopes that the patient consumes with food. The process of its advancement is recorded using special equipment; computed tomography and magnetic resonance imaging, these studies are prescribed only if absolutely necessary, if tumor neoplasms, cholelithiasis and other pathological conditions are suspected.

Opportunities of modern gastroenterology

Today, many modern clinics offer their patients such a service as a comprehensive examination of the gastrointestinal tract, which can be completed both if you suspect a disease of any organ of the digestive system, and for preventive purposes. Comprehensive diagnostics involves the use of a combination of various techniques that allow one to assess the condition of the gastrointestinal tract and get the most complete picture of existing disorders.

Such an extended diagnosis may be necessary for those patients who suffer from a complex disease of unknown etiology, accompanied by metabolic disorders and other serious symptoms. The capabilities of modern gastroenterological clinics make it possible to conduct a comprehensive examination of patients using the latest generation medical equipment, with the help of which it is possible to obtain the most accurate research results in a short time. The list of tests and studies performed may vary depending on the specific diagnostic program.

The presence of symptoms such as:

smell from the mouth
stomach ache
heartburn
diarrhea
constipation
nausea, vomiting
belching
increased gas formation (flatulence)

If you have at least 2 of these symptoms, then this indicates a developing

gastritis or ulcer.

These diseases are dangerous due to the development of serious complications (penetration, gastric bleeding, etc.), many of which can lead to

outcome. Treatment needs to start now.

Read the article about how a woman got rid of these symptoms by defeating their main cause. Read the material...

Every sane person who is not indifferent to his health and the general condition of the body should periodically check his digestive organs from time to time.

How to undergo a complete examination of the digestive organs?

It is known that the digestive system begins with the oral strip, the pharynx, which passes into the esophagus. From the esophagus, food enters the stomach. The continuation of the stomach is the small and large intestine. In addition, the digestive system includes the glands of the stomach and small intestine, the presence of the pancreas, liver and gall bladder.

A complete examination of the digestive organs includes:

specialist appointment;

Ultrasound of the digestive organs;

collection of liver function samples;

blood test for total and direct bilirubin;

blood tests for AST and ALT;

analysis for alkaline phosphatase levels.

The reliability and information content of the results of X-ray, endoscopic and ultrasound methods of studying the organs of the digestive system largely depend on the quality of preparation of patients for these studies.

X-ray examination of the digestive organs

X-ray examination of the digestive organs. Patients with normal bowel function do not require any special preparation. For severe flatulence and persistent constipation, a cleansing enema is recommended 1.5–2 hours before the test. As a contrast agent for fluoroscopy, a suspension of barium sulfate is used, which is prepared at the rate of 100 g of powder per 80 ml of water.

For X-ray examination of the gallbladder and biliary tract, the following methods for studying the organs of the digestive system are used:

cholecystography
and cholegraphy (examination of the bile ducts).

Before cholecystography and cholegraphy, the patient must follow a diet for 3 days to prevent flatulence (raw cabbage, black bread, milk are excluded). A cleansing enema is given only in cases of severe flatulence. During cholecystography, on the eve of the study, the patient takes a radiopaque iodine-containing drug (cholevis, iodagnost, etc.) at the rate of 1 g per 20 kg of the patient’s body weight, washed down with sweet tea for half an hour. The maximum concentration of the drug in the gallbladder is observed 15–17 hours after administration, after which X-rays of the gallbladder are taken. When conducting cholegraphy, a contrast agent (Bilignoy, Bilitrast, etc.) is administered intravenously.

Cholecystography is not performed in case of severe liver damage, hypersensitivity to iodine, and cholegraphy is not performed in case of acute inflammatory diseases of the bile ducts that occur with an increase in temperature (cholangitis), severe hyperfunction of the thyroid gland. X-ray examination of the colon (irrigoscopy) is performed using a contrast enema.

In preparation for irrigoscopy on the eve of the examination, the patient is given 30 g of castor oil before lunch, and a cleansing enema is given in the evening and in the morning. A barium sulfate suspension heated to body temperature is used as a contrast agent; the suspension is administered using an enema.

Endoscopic examination of the digestive system

Endoscopic examination of the digestive organs allows using a special optical device (endoscope) to examine the mucous membrane of the esophagus, stomach, duodenum, rectum and sigmoid colon (sigmoidoscopy), colon (colonoscopy), and abdominal organs (laparoscopy).

During esophagogastroduodenoscopy, special preparation of patients is not required. Planned gastroscopy is carried out in the morning on an empty stomach, emergency - at any time of the day, 30 minutes before the study, the patient is injected subcutaneously with 1% atropine solution in ml; Immediately before the examination, local anesthesia of the pharyngeal mucosa is performed with Dipanin solution. Preparation for sigmoidoscopy includes giving a cleansing enema in the evening and in the morning. Preparation for colonoscopy is similar to that for irrigoscopy.

Ultrasound (echography) is widely used to diagnose diseases of the digestive system. Preparation for it usually comes down to fighting flatulence (diet, taking activated carbon 2-3 days before the test, taking enzyme preparations, for example Festal).

Stages of a complete examination of the digestive organs

If you don’t know where to start and how to undergo a full examination of the digestive organs, first of all, it is recommended that you visit a doctor who examines and diagnoses the digestive system. The survey includes the following processes:

probing;

fluoroscopy;

scanning tomography;

ultrasonic localization.

With the help of the above methods, it has become possible to conduct a comprehensive examination of all organs of the digestive system, using modern and new computer equipment.

If you have teeth damaged by caries, it is recommended to consult a doctor at a dental clinic and undergo oral sanitation. To some extent, caries is also considered the cause of the development of diseases of the gastrointestinal tract, since various microorganisms of unknown origin enter the body with food intake.

The esophagogastroscopy method is prescribed in cases where there is heaviness in the stomach after eating food, a sour taste in the mouth, nausea, coating on the tongue, as well as hunger pains. The essence of this method is to insert a tube with a monitor, with which it is possible to examine the gastric mucosa and, if necessary, take tissue tests or stop bleeding, which can also be diagnosed using a similar method.

To examine the digestive organs, ultrasound is most often used. With its help, you can examine the stomach and entire abdominal cavity of a person, obtaining accurate results. Diagnosis using ultrasound helps to identify disorders in the functioning of such digestive organs as

liver,
stomach,
check for pancreatic diseases,
and also check whether excrement is present or absent in the gallbladder.

Complete liver examination method

Laboratory diagnosis of diseases of the gastrointestinal tract will help to promptly identify pathology, clarify its stage and prescribe the necessary treatment.

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Timely detection of stomach diseases is an opportunity to reduce the risk of developing pathologies such as ulcers, oncology and others.

Find out more...

Laboratory diagnosis of diseases of the gastrointestinal tract requires special preparation for the procedures - the informativeness and reliability of the study depends on this.

Learn about preparing for the study

You can receive test results in person, by phone, by email or by courier.

Find out more...

The stomach is an organ of the gastrointestinal tract in which food is digested. In gastroenterological practice, a large number of different stomach diseases are identified. Some of them can be dangerous and lead to complications. This is why it is so important to carry out instrumental and laboratory examinations of the stomach prescribed by a specialist. They will allow you to timely identify the disease, clarify its stage with maximum certainty and prescribe effective treatment.

When should you get a stomach exam?

If any abnormalities in the gastrointestinal tract are detected, you should contact a gastroenterologist. It is this specialist who can recommend undergoing a stomach examination both to establish or clarify the diagnosis, and for preventive purposes. It is usually prescribed if the patient has the following symptoms:

pain behind the sternum or in the epigastric region;
increased gas formation;
bleeding from the colon;
pain, feeling of fullness or heaviness that appears in the stomach after eating;
frequent heartburn;
vomiting, in which there is an admixture of blood;
belching that has a sour taste;
frequent nausea or vomiting of food eaten the day before;
disturbance of digestive function or swallowing;
feeling of a foreign body in the esophagus;
changes in appetite (when the desire to eat decreases or is absent for a long time, as well as in cases where a person is constantly tormented by a feeling of hunger).

Indications for a medical examination of the stomach may include various diseases. Hardware diagnostic tools help identify the cause of the disease and find out how effective the treatment is. Various stomach examination procedures are carried out for:

the presence of polyps and other neoplasms on the gastric mucosa;
gastritis;
hernia;
peptic ulcer;
reflux disease;
oncological diseases;
inflammatory processes of any etiology in the pancreas, in the duodenum and stomach;
portal hypertensive gastropathy;
achalasia of the esophagus;
gallstone disease.

In order to clarify the diagnosis or monitor the treatment, the gastroenterologist prescribes various types of instrumental and laboratory tests.

Methods for diagnosing stomach pathologies

Statistics say that approximately 95% of the population, to one degree or another, needs regular monitoring by a gastroenterologist. But there is no need to be afraid of this. The current level of diagnosis of stomach diseases in Russia is high. Many clinics have high-tech equipment that allows diagnostics to be carried out with high accuracy, and qualified gastroenterologists who will explain what kind of stomach examination you need and where to start preparing for it.

Instrumental methods for examining the stomach

Hardware methods for examining the stomach are the main link in diagnosing diseases of the digestive system. They cannot replace each other. Each of these methods of examining the stomach is prescribed based on the existing clinical picture and makes it possible to assess the morphological and structural features of the digestive organ.

Modern instrumental methods for examining the stomach include:

Gastroscopy, or esophagogastroduodenoscopy (EGDS),- this is an examination of the stomach using a special flexible instrument, with a fiber-optic thread inside and a micro-lens at the end of the device - an endoscope. Endoscopy is prescribed before a planned operation, with significant weight loss and any symptoms of stomach or intestinal diseases (nausea, severe heartburn, pain, belching, feeling of heaviness in the stomach, etc.). Contraindications to its implementation are:

severe respiratory failure;
heart rhythm disturbances;
hypertensive crisis;
stroke;
hypertensive crisis;
mental disorders.

The doctor always tells all patients how to prepare for such a stomach examination, since the reliability and information content of the results depends on this. The patient should:

refuse food 10 hours before the test;
do not smoke or take medications in capsules or tablets before the procedure;
Remove your tie, glasses and dentures for the duration of the procedure.

Gastroscopy takes from 5 to 10 minutes. The patient is asked to lie on his left side. A mouthpiece is inserted into the mouth and an endoscope is inserted into the throat. The doctor asks you to make a swallowing movement and, controlling the endoscope, makes an examination.

Note!
Do not be afraid of pain during gastroscopy. When using new equipment and special anesthetics, discomfort is minimized.

No other types of stomach diagnostics will provide so much information for making a diagnosis and choosing a treatment method. Only endoscopy allows you to examine the internal surface of the organ in detail, make a digital video recording of the process and conduct the necessary additional studies (biopsy and determination of the acidity of gastric juice). The results of a gastroscopic examination with a detailed description of age-related or pathological changes seen during the examination are given to the patient on the same day. Often EGDS is prescribed together with colonoscopy, or fibrocolonoscopy (FCS), - a similar procedure, but intended to examine the intestines.

X-ray of the stomach is a visualization of an organ on the screen of X-ray equipment, used to study the condition of the mucous membranes and diagnose disorders in their functioning. Indications for its implementation are:

weight loss;
belching;
blood in stool;
heartburn;
swallowing disorder.

Attention!
Do not confuse fluoroscopy with radiography! Radiography involves the creation of X-ray images for subsequent study. Digital fluoroscopy is the most informative method of studying an organ in real time and in motion. The procedure is quick and does not require taking numerous pictures. In addition, the radiation exposure itself in fluoroscopic devices is hundreds of times lower.

Fluoroscopy of the stomach has contraindications. It is not recommended to carry out it in case of intestinal obstruction, a through violation of the stomach wall, pregnancy, and if the patient is allergic to drugs that contain barium.

Preparation for such a stomach examination is very simple. The patient needs to exclude legumes, milk, baked goods, fruits, vegetables from the diet for several days and refrain from eating the evening before the procedure.

Before fluoroscopy begins, the patient takes a contrast agent - a suspension with barium sulfate (approximately 0.250 ml). This substance envelops the gastric mucosa, blocks X-rays, providing a clear image of the organ on the screen. After this, the patient is asked to take different positions and photographs are taken. The procedure does not cause any discomfort.

It is important to know!
After the examination is completed, mild nausea may occur and the stool will be white for 2-3 days. Do not worry! This is how the body eliminates barium sulfate.

The results of fluoroscopy allow you to quickly and accurately diagnose various stomach diseases - gastritis, hernia, malignant tumors, gastric and duodenal ulcers.

Echography, or ultrasound examination of the stomach, - a method based on the ability of tissues to reflect sound waves with a frequency of more than 20 kHz. Such a study is prescribed extremely rarely and mainly for children. Why? Ultrasound of the stomach (specifically the stomach) is a low-informative procedure in comparison, for example, with gastroscopy. With echography, it is impossible to discern the entire pathology; it is impossible to simultaneously perform a biopsy and track the nature of the changes. But in view of the fact that other types of hardware examinations can cause discomfort for children, they start with an ultrasound of the stomach - solely to confirm the suspicions of the gastroenterologist. A final diagnosis cannot be made after this study. As a primary diagnosis, it is sometimes prescribed to adults who are fearful of other types of research.

An ultrasound of the stomach is recommended if you experience increased gas formation, pain in the stomach area, problems with digesting food, or suspicions of gastritis, ulcers, polyps or cancer.

When prescribing an ultrasound of the stomach, the doctor always specifies what kind of preparation is required during the examination, because the accuracy of the results depends on it. About 3 days in advance, patients should exclude fiber (fruits, vegetables), dairy products, legumes, carbonated drinks and pickles, and bread from the menu. The morning before the procedure you should not eat, drink or smoke. Usually this study is carried out (not always) as part of an ultrasound of all abdominal organs.

An ultrasound takes 7–15 minutes. The patient lies down on the couch and a special gel is applied to his stomach. The doctor moves the sensor over the skin and receives an image on the monitor. In some cases, after the examination on an empty stomach, the patient needs to drink 0.5 liters of water and go through the procedure again. Ultrasound does not cause any unpleasant sensations.

The results of the ultrasound are known immediately after completion of the examination. They suggest what is causing the discomfort as many factors are assessed:

the position and size of the organ in sections - normally they are “oval or rounded ring-shaped formations with an echo-negative rim and an echo-positive center”;
the outer serous membrane is normally “hyperechoic”;
the size of the muscular membrane is “20–25 mm, hypoechoic in nature”;
the size of the submucosal membrane is “up to 3 mm, medium echogenicity”;
muscular plate of the mucosa - “up to 1 mm, low hypoechogenicity”;
condition of the mucosa - “up to 1.5 mm in size, hyperechoic”;
wall thickness is normal “5 layers of the wall, varying in echogenicity, wall thickness - from 4–6 to 6–8 mm in the proximal sections”;
layers of the gastric wall - “uniform”;
peristalsis - “primary evacuation of a glass of water - 3 minutes, complete - 20 minutes”;
presence of inflammation - “absent”.

This is interesting!
Ultrasound is a method of diagnosing the stomach that does not have any harmful effects on the body. It is even used on newborns.

Laboratory diagnosis of stomach pathologies

These are studies of biological fluids of the body: gastric juice, blood, feces and urine. Without instrumental methods, they will not help make an accurate diagnosis. But they must be carried out with a complete examination of the stomach, otherwise it is impossible to determine secretory activity, bacterial composition of the intestine, activity of liver enzymes and other important indicators.

Study of gastric juice prescribed for chronic gastritis and stomach ulcers. This examination is also carried out for conditions such as functional achlorhydria and irritable stomach.

You need to prepare for the study - no later than 8 o'clock in the evening the night before, eat a light dinner, and on the morning of the procedure do not smoke, drink liquids, take medications or eat. Gastric juice is taken using a special probe, which is carefully inserted through the mouth and esophagus. After this, the probe is removed, the patient is given breakfast, and then another portion of gastric juice is taken. There is also a probeless method. It is based on the patient taking reagents, after which saliva and urine are examined for color changes.

The results of probing include a description of color, volume, smell, and determination of the acidity of gastric juice. They make it possible to assess the functional and morphological state of the gastric mucosa and are fundamental for determining the secretory function of the stomach. But the results of tubeless methods provide only indicative information without quantitative characteristics of gastric secretion.

Blood test. Not a single comprehensive examination when diagnosing or checking any stomach diseases can be done without it. Blood is taken for analysis in the morning on an empty stomach. The day before the procedure, you should not drink alcohol or fatty, high-calorie foods, and you should refrain from smoking. If the study requires taking, for example, a stimulation test involving the consumption of a protein mixture, it is necessary to make sure that the patient does not have a history of allergies to certain plant or animal proteins. If a gastroenterological patient is taking medications, it is necessary to find out whether it is possible to refuse them. If not, then at least 1 day before the test, you need to reduce the dosage. It is also possible that the drugs will not interfere with the test results. Blood is taken in compliance with all rules of asepsis and antisepsis.

Based on the results of the analysis, it is possible to assess the general condition of the body, morphological tissue damage, determine the functional characteristics of the organ, determine the stage of the inflammatory process and the effectiveness of therapy.

Today, special gastroenterological panels have been developed, including a set of tests with blood taken from a vein. The panel may include, for example, tests for the level and proportions of pepsinogens I and II, stimulated or basal gastrin-17, for the presence of antigens (IgG) to the bacterium Helicobacter pylori, which can lead to H. pylori-associated chronic gastritis. In addition, indications for such a study are usually the risk of peptic ulcer disease and various dyspeptic disorders.

It is known that during inflammation of the pancreas, the enzyme lipase (triacylglycerol acylhydrolase) enters the blood, so if lipase can be detected in the blood in a volume of more than 78 U/l, we can talk about acute or chronic pancreatitis or a perforated gastric ulcer.

To confirm or refute autoimmune pathologies of the stomach (chronic atrophic gastritis, pernicious anemia, etc.), blood serum is taken for antibodies (IgG, IgA, IgM) to the parietal cells of the stomach, as well as for antibodies (IgG) to the internal Castle factor and antibodies ( IgG) to Saccharomyces - baker's yeast Saccharomyces cerevisiae (ASCA).

Although perfect specific tumor markers for gastric cancer have not yet been discovered, it is known that the level of some antigens correlates with the stage of cancer. Such antigens especially include oncofetal carbohydrate antigens CA 72-4 and Ca 19-9. The latter is used to monitor pancreatic carcinoma together with carcinoembryonic antigen (CEA).

Urine examination. A general urine test is prescribed for diarrhea, vomiting, ascites (fluid accumulation in the abdominal cavity) and malignant neoplasms. It should be noted that with uncomplicated peptic ulcer, the results of urine analysis do not show any significant changes. The day before the procedure, you should not take diuretics or eat any foods that change the color of urine (carrots, beets, etc.). Only morning urine on an empty stomach is taken for analysis. Before this, hygiene procedures for the external genitalia should be carried out. Release a small amount of urine (the first 1-2 seconds) into the toilet, and collect the next 50 ml portion into a sterile container.

The results of the analysis indicate the physicochemical characteristics of urine (specific gravity, acidity, color, transparency) and check the urinary sediment for the presence of certain inclusions (protein, blood cells, glucose, hemoglobin, etc.).

Stool examination. Prescribed when any symptoms of diseases of the digestive system appear. For the results to be informative, the patient must exclude fish and meat products from the diet for 3 days before the procedure, and also not take medications containing iodine, iron and bromine. For analysis, a small amount of stool is taken immediately after sleep. It is sent for examination in a sterile container.

The results always indicate the presence of blood and mucus in the stool, evaluate its color, smell, consistency and other physical and chemical characteristics. Explicit and especially hidden bleeding is observed in peptic ulcers in 10–15% of cases. But most often bleeding is recorded with a duodenal ulcer. In acute blood loss, the stool is tarry.

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.

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.

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.

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.

From the book Health Pharmacy according to Bolotov author Gleb Pogozhev

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

From the book Treatment with plantain author Ekaterina Alekseevna Andreeva

Restoring the gastrointestinal tract The first step is to restore the gastrointestinal tract. Vegetable cakes. Juice is squeezed out of carrots, black radishes (the skins of radishes are not peeled) or white cabbage using a juicer. As soon as you receive the cakes, they

From the book Pharmacy in the Garden author Lyudmila Mikhailova

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From the book Rosehip, hawthorn, viburnum in cleansing and restoring the body author Alla Valerianovna Nesterova

Restoration of the gastrointestinal tract Oil cakes. The juice is squeezed out of potatoes or rowan using a juicer. As soon as you receive the cakes, you immediately need to roll them with your palms into small balls the size of a bean. Cake balls should not be stored in the refrigerator.

From the book Medical Research: A Guide author Mikhail Borisovich Ingerleib

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Restoration of the gastrointestinal tract Treatment begins with the restoration of the gastrointestinal tract. The juice is squeezed out of potatoes or rowan using a juicer. As soon as you receive the cakes, you immediately need to roll them with your palms into small balls the size of a bean. Store the balls from

From the author's book

Restoring the gastrointestinal tract The first step is to restore the gastrointestinal tract. Cake. The juice is squeezed out of potatoes or rowan using a juicer. As soon as you receive the cakes, you immediately need to roll them with your palms into small balls the size of

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Restoration of the gastrointestinal tract After relieving inflammation in the kidneys, it is necessary to restore the gastrointestinal tract. Cake. The juice is squeezed out of potatoes or rowan using a juicer. As soon as you receive the cakes, you immediately need to roll them with your palms into small

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Restoring the gastrointestinal tract Take parsley root cakes, and drink the resulting juice 2-3 tbsp. spoons 20–30 minutes after eating. A mixture of black radish and honey. Take 1 glass of honey per 1 kg of mass, ferment it for 2-3 days, eat this mass 1 tbsp. spoon in

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Gastrointestinal Disorders Gastrointestinal disorders are very common and can be associated with eating poor quality foods and many other factors. Stomach infection can be cured with an infusion prepared

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Contrast studies of the gastrointestinal tract The gastrointestinal tract (GIT) is often the object of X-ray examination with contrast. X-ray examination of the stomach, esophagus and small intestine is performed on an empty stomach, the patient

The gastrointestinal tract is a tube that bends throughout the body. It is even believed that the contents of the stomach and intestines are external to the body. At first glance, this is surprising: how can an internal organ turn out to be an external environment?

And yet, this is so, and this is precisely why the digestive system is seriously different from all other systems of the body.

Methods for studying the digestive organs

Examination of the gastrointestinal tract and gastrointestinal tract can be divided into three categories:

physical examination, that is, one that the doctor performs right in his office on his own;
laboratory methods;
instrumental research methods.

Physical research methods

For any complaint, the doctor first of all collects an anamnesis. Skillful questioning is very important; the history of the onset of the disease immediately directs the diagnosis along a certain path. After collecting anamnesis, an examination is carried out. The color and condition of the skin can tell the doctor a lot. Then the abdomen is palpated: superficial and deep. Palpation means feeling. The doctor determines the boundaries of the organs: liver, stomach, spleen and kidney. In this case, the pain and its severity are determined.

Percussion (tapping) determines the condition of the stomach and intestines. Characteristic symptoms help to practically make diagnoses such as appendicitis, cholecystitis, pancreatitis already at this stage. Typically, laboratory research methods are used only to confirm the diagnosis.

Laboratory research methods

The easiest way to test is blood: it can be easily taken from a finger or from a vein, and the analysis is very informative. Moreover, if the number of leukocytes, erythrocytes, and platelets is determined during a clinical analysis, and this way inflammation or anemia can be determined, then a biochemical analysis allows one to examine the state of the blood serum. Here are the biochemistry indicators that interest the doctor if various pathologies of the digestive organs are suspected:

bilirubin (direct and indirect),
amylase,
blood hemoglobin if bleeding is suspected.

Urine is the fastest test to collect and perform, so it is often collected in the emergency room. Several indicators in this analysis are markers of gastrointestinal diseases. For example, an increase in diastase in the urine indicates pancreatitis, urobilin indicates jaundice. In this case, stool analysis (coprogram) is very informative. It can be revealed

helminths (worms) and their eggs;
occult blood;
Giardia.

And also evaluate the quality of food digestion. To identify dysbiosis, stool is submitted for culture. The microflora of the large intestine is determined by cultures of bacteria grown on a nutrient medium.

Methods of instrumental examination of the gastrointestinal tract

The main goal of instrumental research is usually to visualize the organ of interest as much as possible. Almost all research methods are applicable to the gastrointestinal tract.

The method is based on recording reflected ultrasonic waves. For each organ, the frequencies at which they are better visible are specially selected. This is an excellent method for diagnosing diseases of the liver, gall bladder, and pancreas (). With pathological changes in organs, their echogenicity, that is, the ability to reflect ultrasonic waves, also changes. Hollow organs, such as the intestines and stomach, are less visible on ultrasound. They can only be seen by a very talented and experienced diagnostician. Preparation is sometimes required for an ultrasound, but it varies depending on which organ the ultrasound is being performed.

An X-ray of the esophagus, stomach, and intestines helps to identify defects in their walls (ulcers and polyps), determine how the intestines and stomach contract, and the condition of the sphincters. A plain x-ray may show free gas in the abdomen, indicating perforation of the stomach or intestines. There are radiographic signs of acute intestinal obstruction.

Contrast tests are also performed. The contrast is a substance that captures and delays X-rays - barium sulfate. The patient drinks the contrast, after which a series of images are taken at short intervals. The contrast agent passes through the esophagus and its walls can be examined if necessary, fills the stomach, is evacuated into the intestine through the sphincter, and passes through the duodenum. By observing these processes, the doctor receives a lot of information about the state of the digestive system. Previously, the study was used more often, but recently it has been almost completely replaced by endoscopy.

It is not possible to obtain a clear image of the colon through oral (oral) administration because the contrast is gradually diluted. But if barium lingers in some place, acute intestinal obstruction can be detected. If a clear image of the colon is needed, a barium enema is administered and an x-ray is taken. This type of research is called irigography.

Endoscopic examination

An endoscope is a device equipped with a small camera that is connected to a computer screen using a fiber optic system. People simply call this device a “tube”, and the procedure itself is called “swallow a tube”, but this study is actually called FGDS (fibrogastroduadenoscopy). This is the main method for diagnosing diseases of the upper gastrointestinal tract. Indeed, you have to swallow the pipe, although it is not as difficult as before. Nowadays the throat is usually irrigated with anesthetics, so it is now easier to overcome the reflexes. The camera allows you to literally look inside the stomach and examine its walls in detail. The doctor looks through the eye of the endoscope and examines all the walls of the stomach. A biopsy can be taken using an endoscope. Sometimes, using an endoscope, a catheter is inserted into the duct that comes from the gallbladder and pancreas and with its help, all these ducts are filled with radiopaque contrast. After this, an x-ray is taken and a clear image of all the bile ducts and pancreatic ducts is obtained. If an endoscope is inserted into the anus, the procedure is called fibrocolonoscopy. With its help you can examine the entire colon, which is about two meters in length. View intestinal microflora (). The examination is often painful, because for better visibility, air is introduced into the intestine, the tube is pulled and turned.

Sigmoidoscopy

A rigid tube is inserted into the rectum and the anal canal is examined: 2–4 cm from the anus. This place is best examined this way; it is not visualized during fibrocolonoscopy. Namely, this is where hemorrhoids and anal fissures are located. With this study, another 20 to 30 cm of the colon can be examined.

Laparoscopic examination

The study is performed in unclear diagnostic cases in emergency surgery. Blood or effusion, atypical appendicitis and other diseases can be seen in the abdominal cavity. A puncture is made in the anterior abdominal wall using a special needle. Carbon dioxide is pumped into the abdominal cavity, a tracar is passed through the same puncture and an endoscope is inserted. All internal organs can be viewed as the image from the camera is displayed on the screen. When preparing for this study, it is advisable to stop eating 12 hours in advance to reduce the urge to vomit. It is advisable not to take liquid either, as a last resort if necessary.

MRI, CT abdominal organs if a tumor, cholelithiasis, or pancreatitis is suspected. The study is quite expensive and therefore is used only if other diagnostic methods have exhausted themselves.

, gastroenterologist

After 30 years, the aging process begins in the body - metabolism slows down, the body does not easily tolerate strict diets or, conversely, overeating.

In our youth, we often take our health rather lightly and go to the doctor only when the disease has already made itself felt. It is not right. And the older you get, the more important it is to change this approach to your health. It is necessary to carefully monitor all body systems, including the gastrointestinal tract. Elena Igorevna Pozharitskaya, a gastroenterologist at the Semeynaya clinic network, spoke about how to properly examine the gastrointestinal tract after 30 years.

After 30 years, the aging process begins in the body - metabolism slows down, the body does not easily tolerate strict diets or, conversely, overeating. The risk of stomach diseases increases. And, as you know, a disease is easier to prevent than to cure. Therefore, after 30, it is important to undergo regular examinations of the gastrointestinal tract in order to promptly identify the risks of certain pathologies.

Gastrointestinal examinations

Here are 4 gastrointestinal examinations that need to be done after 30 years of age:

1. Ultrasound– the simplest, non-invasive, but still informative examination. Using ultrasound, you can evaluate the condition of the spleen, pancreas, gallbladder and liver. Ultrasound will help identify diseases such as liver cirrhosis, cholecystitis, the presence of gallstones, cysts, neoplasms, abnormalities in the structure of organs, internal injuries of the abdominal organs, as well as a number of certain chronic disorders.

The presence of gases in the stomach can interfere with the quality of the ultrasound examination, therefore, 1 day before the procedure, it is important to avoid foods that increase gas formation and cause bloating (legumes, bread, flour, sweets, raw vegetables and fruits containing fiber, sauerkraut, milk, carbonated drinks, alcohol). The last meal should be taken no later than 5-6 hours before the test. You can do an ultrasound as often as necessary for health reasons. For a routine inspection, it is enough to do it once a year.

2. Esophagogastroduodenoscopy- examination of the mucous membrane of the esophagus, stomach and duodenum using a gastroscope (it is inserted through the mouth), which is used if erosion or ulcer is suspected, and also often helps to clarify the presence of diseases of neighboring organs - the pancreas and gall bladder. The examination, like others, is carried out on an empty stomach; to facilitate insertion of the gastroscope, local anesthesia is used - irrigation of the mucous membrane with anesthetics.

- a method that allows you to measure acidity directly in the esophagus, stomach and duodenum, to diagnose the reflux of stomach contents into the esophagus (gastroesophageal reflux), as well as reflux from the duodenum into the stomach. If these conditions are prolonged, then this can lead to the development of inflammation of the esophagus, gastroesophageal reflux disease, and the reflux of bile into the stomach can lead to erosions and even ulcers.

4. Colonoscopy– examination of the rectum and colon using an endoscope. This procedure is invasive and is prescribed by a doctor when other diagnostic methods have been exhausted. During this study, the doctor can not only “live” see the condition of the colon mucosa, but also take a piece of tissue to confirm the diagnosis. It is enough to undergo once every 5 years after 50 years in the absence of risk factors. Colonoscopy after 30 years for healthy patients is recommended if there are clear indications, such as: cancer of the colon in first-degree relatives under the age of 40, hereditary polyposis of the colon. Inflammatory diseases of the colon, such as Crohn's disease and Ulcerative colitis, have a characteristic clinical picture and if a doctor suspects this pathology, to confirm the diagnosis, they initially use non-invasive diagnostic methods prescribed by the doctor; if the results of these methods are positive, a colonoscopy is performed to determine the extent of the lesion , morphological research. 72 hours before the procedure, it is necessary to exclude fatty foods, legumes, sweets, coffee, foods rich in fiber (fruits, vegetables), milk, and cereals from the diet. It is better to give preference to liquid foods and drink a lot. A light snack is possible 1.5 hours before the test.

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Vomit or stomach contents obtained through a thin or thick probe may be examined; in the second case, the contents of the stomach are distinguished, received on an empty stomach or pumped out after a certain period of time after the so-called test breakfast of various compositions.

Any conclusions based on the study of gastric contents released with vomiting movements can only be drawn if the patient experiences vomiting as a chronic, frequently recurring phenomenon.

1)QUANTITY. When examining vomit, first of all, their quantity is measured, since this in itself can give some diagnostic indications. So, for example, if their quantity is very large (more than 0.5 liters) or exceeds the volume of food and drink introduced during the last hours, then pathological dilatation of the stomach and food retention can be diagnosed.

2) COMPOSITION. More valuable information can be obtained by studying the vomit in detail and comparing it with the contents of the last meal; In this case, it is necessary to know how long after eating the vomiting occurred. If gastric contents expelled by vomiting more than 2 hours after tea with bread or more than 7 hours after a regular lunch or dinner still contain food residues, then delayed gastric emptying is evident. There is even more reason to talk about food retention in the stomach if it turns out that the vomit also contains remnants of what the patient ate during the previous meal, or, for example, if there are remnants of dinner in the morning vomit on an empty stomach. If vomiting produces mainly acidic fluid, then there is increased gastric secretion. Alcoholics often gag small amounts of mucous, alkaline or acidic gastric contents on an empty stomach.

3) COLOR. The color of the vomit, especially if it is released on an empty stomach in the morning, depends on whether there is backflow of the contents of the duodenum. The presence of bile and duodenal juice in itself does not provide any valuable diagnostic information; sometimes it indicates the strength of gag movements or incomplete closure of the pylorus. The color of daytime vomit and its entire appearance are determined mainly by the length of time the food remains in the stomach. The shorter this period of time, the less the food has changed. Dark brown or dark green, almost complete color mostly indicates the admixture of old food masses. The color of vomit changes especially sharply depending on blood impurities. With fresh gastric bleeding, the gastric contents are colored red, which, under the influence of the acidic reaction of the environment, gradually turns into brown, and with long-standing bleeding, into black-brown. With stomach cancer, blood is released in small quantities, but constantly: with such bleeding, the gastric contents look like brown-black coffee grounds; True, the same can sometimes be observed with small non-bleeding ulcers. Bloody vomiting is much more likely to be a symptom of an ulcer than of cancer; sometimes it occurs with uremia, as well as with poisoning, especially associated with a burn to the stomach wall. Small (hidden) bleedings are revealed under a microscope or by chemical reactions (see “Feces”).

4) CHARACTER. By the nature of food residues one can judge the digestive function of the stomach. If, for example, several hours after the patient has eaten meat, pieces of meat can be found in the vomit, then this indicates insufficient enzymatic activity of the stomach. After 2 - 3 hours, with normal gastric digestion, the bread turns into an almost homogeneous small mass. The reaction of vomit is mostly acidic, but this acidity is often caused not by the presence of hydrochloric acid in gastric juice, but by lactic acid fermentation. In the latter case, the smell of vomit is not sour, but sourish-rancid or alcoholic. With uremic vomiting, alkaline masses are often released, emitting an ammonia odor.

STOMACH CONTENTS RECEIVED

VIA PROBE.

GENERAL INSTRUCTIONS FOR EXTRACTION OF GASTRIC CONTENTS.

The stomach contents can be removed on an empty stomach or after a test breakfast. Retrieval of gastric contents on an empty stomach is of great clinical importance. This study allows us to judge the secretory and motor function of the stomach, which in the clinic of gastric diseases is sometimes more important than determining the acidity of gastric juice after a test breakfast. When examining on an empty stomach and after a test breakfast, you can use two types of gastric tubes: thick and thin.

The so-called thick probe is a thick-walled rubber tube that is not too soft and flexible; its thickness is usually 10 - 12 mm, clearance - at least 8 mm; Thicker probes cause discomfort to the patient, and thinner probes are difficult to insert due to their too softness; in addition, their lumen is easily clogged with poorly chewed lumps of bread.

The length of the probe is about 70 - 75 cm. At a distance of 40 cm from the end intended for insertion into the stomach, there is a mark on the rubber indicating which section of the probe needs to be inserted; this mark should be located near the teeth; For tall people, the probe is inserted slightly deeper. The end inserted into the stomach is usually blind, and there are holes (at least two) located slightly higher; their edges should be rounded, since a sharp edge can injure the gastric mucosa. The outer end of the probe is usually widened in a funnel shape, since a funnel is inserted into it to lavage the stomach.

The patient is seated on a chair with the upper half of the body and head slightly tilted forward. If the patient has an artificial jaw, it should be removed. A boiled, moist, warm, but not too hot probe is inserted into the pharynx and carefully pushed further; if the patient has a coughing attack, it is better to immediately pull out the probe and, after the attack has passed, try to insert the probe again; sometimes, if the probe does not pass, they ask the patient to close his mouth and make a swallowing movement, after which the probe is immediately pushed into the esophagus.

If the pharyngeal reflex is increased, lubricate the pharynx with a solution of novocaine. The patient is constantly reminded to breathe deeply through his nose, otherwise he will feel like he is suffocating and will tear the probe out with his hands; just in case, it is better to offer him to hold a basin in his hands to collect saliva flowing from the mouth and gastric contents. To study gastric contents in children, the same probe is used; to determine to what depth it should be inserted, measure the distance from the edge of the teeth to the epigastric region (along the midline) and make a mark y on the probe. When the probe is inserted to the mark, its outer part should hang down freely; the end is immersed in a graduated beaker. The contents of the stomach often flow out without any effort on the part of the patient, or he is asked to reproduce several vomiting movements; Sometimes the gastric tube is moved slightly back and forth to stimulate gastric movements. In this case, it is necessary to keep the probe at the patient’s mouth all the time, since it is sometimes pushed back by antiperistaltic movements.

In most cases, it is desirable to obtain data on the amount of gastric contents; therefore, they strive to extract as much of it as possible. For this purpose, the patient is tilted forward, pressure is applied to the epigastric region, an attempt is made to insert the probe a little further, etc. If it is not possible to obtain gastric contents at all, then the probe is removed and reintroduced; repeated administration often gives better results.

After pumping is completed, the probe is quickly pulled back out.

The thin probe used to obtain gastric contents is almost no different from the duodenal one, only the olive openings should be larger. Using a thin probe, the contents of the stomach are aspirated with a syringe. Both thick and thin probes have their advantages.

1)Advantages and disadvantages of thick and thin probes. Upo The usually consumed Boas-Ewald breakfast bread represents the most physiological irritant and gives a complete picture of the function of the gastric glands. The disadvantage of this method is that it uses a thick probe and the contents are removed simultaneously after a certain period of time. This method of obtaining gastric contents does not cover the entire period of the secretory process, which lasts for several hours. A thin probe, when extracting contents from the stomach every 15 minutes (fractionally) for a long time, makes it possible to judge the dynamics of gland function at a number of stages. However, it should be noted that trial liquid breakfasts designed to extract gastric contents with a thin tube not all f are physiological and, most importantly, with these breakfasts, firstly, the mental factor, which plays such an important role in the secretory function of the stomach, disappears, and secondly, the fact of chewing and the significance of food lumps is absent, which, according to Pavlov’s school, causes normal gastric digestion. Prof. N.S. Smirnov proposed combining a bread breakfast with pumping with a thin probe, provided that the olive was wrapped in gauze. In this form, the olive allows only liquid to pass through, leaving the dense parts of the breakfast aside. This method has been largely justified and has provided the author with a number of valuable data; but it has, however, the drawback that if after the Boas-Ewald breakfast, with the extraction of the latter with a thick probe, albeit simultaneously, we get an idea of the motor function of the stomach and the degree of chemicalization of bread particles, then with the Smirnov method this side of the study the stomach disappears.

E.G proposed an olive of a special design, which allows combining fractional study of stomach contents after a bread breakfast