X-ray of the abdominal cavity is one of the most common methods for diagnosing diseases of the gastrointestinal tract. It is this examination method that is used primarily in a hospital when a patient is admitted with complaints of abdominal pain, flatulence, and stool disorders.
The essence of radiography
X-ray is one of the most ancient methods of visualization of internal organs. The essence of his work is the passage of x-rays through the internal organs. Since radiation easily passes through the intestinal tube and is weakly reflected from the intestinal wall, plain radiography of the abdominal organs is in many cases of little information.
However, the speed of obtaining the result, the low cost of this method, the absence of the need for high-tech equipment make X-rays quite common for the urgent diagnosis of diseases of internal organs. In addition, there are a number of radiological symptoms that cannot be seen using other examination methods. Namely, the presence of thesesymptoms is decisive in some pathologies.
How a normal X-ray should look can be seen in the figure below.
Types of radiography
There are two types of X-ray examination of the abdominal organs: contrast and plain abdominal radiography.
The introduction of contrast during the procedure significantly increases its informativeness and diagnostic value. The contrast for the intestines is a barium solution. The patient drinks a glass of this substance (100 ml of water per 80 g of barium), and then a series of images is taken for an hour. If the study is carried out to diagnose the pathology of the rectum, the solution is administered using an enema. It consists of 720 g of barium and 1 liter of 0.5% tannin solution. This contrast agent is not absorbed into the blood and is excreted along with feces.
The radiologist observes how barium passes through the intestines, how the loops of the intestinal tube are filled, after what time the barium is evacuated from different departments. This allows you to visualize both structural changes in the intestine and a violation of its motor function.
What does an x-ray show?
As noted above, plain X-ray is not very informative, but extremely common. Then what does a plain abdominal x-ray show?
- Presence of gas and fluid in the abdominal cavity.
- Presence of foreign bodies.
- Defects of the abdominal organs.
- Is there an obstaclethe movement of feces in the intestines.
- Is there internal bleeding.
Thus, when answering the question of what an abdominal radiography shows, it is worth saying that it only reflects the presence of some kind of pathology in the body. But to make an accurate diagnosis, it is often necessary to conduct an additional examination.
Indications for plain radiography
Despite the minimum dose of radiation during x-rays, there is still radiation exposure. Therefore, this diagnostic method is carried out only in the direction of a doctor. He, in turn, can write out a referral for an abdominal radiography, subject to the presence of such symptoms and conditions:
- acute abdomen syndrome - sharp pains in the abdomen;
- flatulence;
- abdominal injuries;
- diverticulitis - protrusion of the intestinal wall with inflammation.
Although x-rays are rarely the gold standard for diagnosing abdominal diseases, this is the method most often used first. Abdominal x-rays can be used to suspect the following conditions:
- acute intestinal obstruction;
- perforated stomach or intestinal ulcer;
- acute cholecystitis;
- acute pancreatitis;
- cholelithiasis and urolithiasis;
- abscesses (purulent cavities) of internal organs.
Preparation for exposure
Specific preparation for the reviewabdominal x-ray is not required. It is only recommended to empty the bladder before the examination.
But the preparation for an abdominal x-ray with barium takes place. To ensure the information content of the examination and avoid complications, a number of rules must be followed:
- do not eat solid food 12 hours before the examination;
- avoid eating raw vegetables, black bread, lactic acid products for a day, as they increase intestinal motility;
- an hour or two before the x-ray, bowel movements are performed with an enema or suppositories with a laxative;
- immediately before the examination, all metal objects must be removed.
Separately allocate a method of preparation for x-rays using the drug "Fortans". The sachet dissolves in one glass of water. The dosage prescribed by the doctor is drunk in the evening before the examination, one sachet every hour.
How x-rays are done
Plain radiography of the abdominal cavity is done in two projections: lying and standing. Most often, the first option is omitted and an x-ray is taken only while standing, this method is more informative. This way, intestinal obstruction is better visualized, as well as perforation, or perforation, of an ulcer.
More difficult is the contrast radiography. Here it is necessary to take a series of pictures after a certain time and observe how the barium solution moves through the intestines. This process of moving barium is called passage.
Location of barium depending onfrom time to time is:
- after 1 hour - contrast partly in the stomach, partly in the small intestine;
- after 3 hours - the contrast should completely leave the stomach and fill the small intestine;
- after 6 hours - contrast in the initial sections of the large intestine (caecum and ascending colon);
- after 9 hours - contrast in the transverse and descending colon;
- after 12 hours - contrast in the descending colon and sigmoid colon;
- after 24 hours - contrast in the rectum.
Contraindications for x-rays
Diagnostics using x-rays should be carried out only in the direction of the attending physician. After all, only a qualified specialist can comprehensively assess the patient's condition and find out if he has contraindications for abdominal radiography.
All contraindications can be divided into absolute (in which it is strictly forbidden to conduct research) and relative (it is allowed only in extreme cases, when the possible risk is less than the intended benefit).
The following are only the most basic conditions that are a contraindication to any x-ray diagnostics, not only the abdominal cavity:
- pregnancy, especially the first half, since during this period the formation of the child's organs occurs;
- a serious condition of the patient, in which it is impossible to transport him to the X-ray room;
- open pneumothorax - a pathology in which air from the environment enters the pleural cavity around the lungs;
- bleeding.
Contraindications for contrast radiography
X-ray with contrast is contraindicated in the following cases:
- severe liver and kidney failure;
- allergic to contrast components;
- diabetes mellitus in the stage of decompensation;
- active tuberculosis;
- Severe thyroid disease.
Also, the procedure cannot be performed on women during lactation.
Intestinal obstruction: X-ray signs
Among the pathologies of the intestinal tube, X-rays have received the greatest diagnostic value in acute intestinal obstruction. Rapid results and symptoms characteristic of obstruction enable the surgeon to make a diagnosis and perform immediate surgery.
In case of obstruction, a survey X-ray is performed in a vertical position. Characteristic is an increase in the airiness of the intestinal tube, which indicates an excessive accumulation of gas in the intestine.
The most academic symptom is the presence of fluid levels, the so-called Kloiberg cups. Moreover, the level of pathology can be determined by the shape and location of these bowls. If the bowls are high and narrow and are located on the periphery of the x-ray, we can talk about the presence of obstruction in the large intestine. Surgeons also use the term "low obstruction".
If Kloyberg bowls are low and wide, and also placed closer to the center, this indicatesabout small bowel obstruction, or high. Also characteristic is the expansion of the intestine to the place of the obstruction and the collapse of the intestine after.
When taking a contrast X-ray, you can see that the evacuation of barium is slow or absent.
In some cases, radiography can visualize the obstruction itself (tumor, torsion, adhesions).
Obstruction of the small and large intestine: differences
When diagnosing obstruction, it is important to distinguish in which part of the intestine the problem arose: in the thin or thick. In addition to the difference in the location and shape of the Kloiberg bowls, there are a number of other features.
If the bowls are not clear enough which department is involved in the pathological process, you can do a contrast radiography of the abdominal cavity. At the same time, swollen intestinal loops are perfectly visualized.
Signs of small bowel obstruction:
- bloated loops occupy mainly the center of the picture;
- they do not exceed 4-8 cm in size;
- characterized by the presence of transverse striation against the background of swollen loops;
- no specific concavities at the edges (gaustra).
Signs of large bowel obstruction:
- inflated loops of larger diameter;
- there are concavities - gaustras;
- characterized by the presence of arched folds (symptom of arches).
Thus, the value of abdominal radiography in the diagnosis of obstruction is extremely high. However, there are times when the x-ray picture is unclear. Then it is necessary to conduct other examination methods: ultrasound, computed tomography.
Perforated ulcer: X-ray signs
Perforated (perforated) ulcer is a rupture of the wall of the stomach or intestines, which is accompanied by severe, dagger pain.
When ruptured, air enters the abdominal cavity and rises up to the diaphragm. Since the liver is located on the right under the diaphragm, the accumulation of air is best seen between these two organs. It gathers there in the form of a thin arcuate strip. This phenomenon is called the sickle of air on abdominal x-rays.
This symptom is most characteristic of a perforated ulcer, but other signs can be determined on an x-ray:
- the presence of a gas bubble that shifts when the position of the body changes;
- displacement of the sickle of air under the sternum when the patient is turned on his side;
- if the gas is not detected in the first picture, the patient is allowed to drink carbonated water; the gas will escape through the resulting hole and will be visible on the x-ray;
- with an unclear diagnosis, contrasting is possible, but not with barium, but with gastrografin; the substance will come out through the hole in the hollow organ.
It can be concluded that radiography of the abdominal organs is a really effective method at the initial stages of diagnosing a number of pathologies of the abdominal organs. And if you suspect intestinal obstruction and perforated ulcer, his role is simply invaluable.
