Abdominal x-ray 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 enters with complaints of abdominal pain, flatulence, and stool disturbance.
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 the radiation easily passes through the intestinal tube and is weakly reflected from the intestinal wall, survey radiography of the abdominal organs is in many cases uninformative.
However, the speed of obtaining the result, the cheapness of this method, the lack of the need for high-tech equipment make x-rays common enough for emergency diagnosis of diseases of internal organs. In addition, there are a number of radiological symptoms that cannot be seen with other examination methods. Namely, the presence of these symptoms is crucial in some pathologies.
How the x-ray should look normal, can be seen in the figure below.
Types of X-ray
Examination of the abdominal organs using x-rays is of two types: contrast and panoramic radiography of the abdominal cavity.
The introduction of contrast during the procedure significantly increases its information content and diagnostic value. The contrast to the intestines is a solution of barium. The patient drinks a glass of this substance (100 ml of water per 80 g of barium), and then a series of pictures is taken within an hour. If the study is carried out to diagnose rectal pathology, the solution is injected with an enema. It consists of 720 g of barium and 1 liter of a 0.5% tannin solution. This contrast medium is not absorbed into the bloodstream and excreted along with feces.
The radiologist observes how barium passes through the intestines, how the loops of the intestinal tube fill up, after what time 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 x-ray show?
As noted above, a review x-ray is not very informative, but extremely common. Then what does an abdominal x-ray show?
- The presence of gas and fluid in the abdominal cavity.
- The presence of foreign bodies.
- Defects in the abdominal cavity.
- Is there an obstruction to the movement of feces in the intestine.
- Is there any internal bleeding.
Thus, when answering the question of what the abdominal x-ray 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, most often you have to conduct an additional examination.
Indications for survey radiography
Despite the minimum dose during x-rays, radiation exposure still exists. Therefore, this diagnostic method is carried out only in the direction of a doctor. He, in turn, can write out a direction for a survey radiography of the abdominal cavity, subject to the presence of such symptoms and conditions:
- acute abdominal syndrome - sharp abdominal pain;
- flatulence;
- abdominal injuries;
- diverticulitis - protrusion of the intestinal wall with its inflammation.
Although x-rays are rarely the gold standard for diagnosing abdominal diseases, this method is most often used in the first place. Using radiography of the abdominal organs, you can suspect the presence of such diseases:
- acute bowel obstruction;
- perforated stomach or intestinal ulcer;
- acute cholecystitis;
- acute pancreatitis;
- gallstone and urolithiasis;
- abscesses (purulent cavities) of internal organs.
X-ray preparation
Specific preparation for a survey radiography of the abdominal cavity is not required. It is only recommended to empty the bladder before the examination.
But preparation for radiography of the abdominal cavity with barium takes place. To ensure the information content of the examination and to avoid complications, you need to adhere to a number of rules:
- do not eat solid food 12 hours before the examination;
- avoid eating raw vegetables, black bread, lactic acid products per day, as they increase intestinal motility;
- an hour or two before the x-ray is carried out bowel movements with an enema or candle with a laxative;
- immediately before the examination you need to remove all metal objects.
Separately, the method of preparation for x-ray using the drug "Fortans" is isolated. The bag dissolves in one glass of water. The dosage prescribed by the doctor is drunk in the evening before the examination, in a sachet every hour.
How is x-ray
Survey radiography of the abdominal cavity is done in two projections: lying and standing. Most often, the first option is omitted and X-rays are made only while standing, this method is more informative. This is better visualized bowel obstruction, as well as perforation, or perforation, ulcers.
More difficult is the conduct of contrast radiography. Here you need 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 a passage.
The location of barium depending on time is as follows:
- after 1 hour - the contrast is 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 (blind 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 to x-ray
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 to abdominal radiography.
All contraindications can be divided into absolute (in which it is strictly forbidden to conduct a study) and relative (it is allowed only in extreme cases, when the possible risk is less than the intended benefit).
Below are listed only the most basic conditions that are a contraindication to any X-ray diagnosis, not just the abdominal cavity:
- pregnancy, especially the first half, since during this period the formation of the child’s organs occurs;
- serious condition of the patient, in which its transportation to the X-ray room is impossible;
- open pneumothorax - a pathology in which air from the environment enters the pleural cavity located around the lungs;
- bleeding.
Contraindications to contrast radiography
Radiography using contrast is contraindicated in the following cases:
- severe hepatic and renal failure;
- allergic to contrast components;
- decompensated diabetes mellitus;
- active tuberculosis;
- severe thyroid disease.
Also, the procedure can not be performed for women during lactation.
Bowel obstruction: X-ray signs
Among the pathologies of the intestinal tube, the greatest diagnostic value was obtained by x-ray in acute intestinal obstruction. The fast results and the presence of symptoms characteristic of obstruction enable the surgeon to establish a diagnosis and carry out immediate surgery.
In case of obstruction, a panoramic radiography is performed in an upright 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 bowls. Moreover, the shape and location of these bowls can determine the level of pathology. If the bowls are tall and narrow and are located on the periphery of the x-ray photograph, we can talk about the presence of obstruction in the large intestine. Surgeons also use the term "low obstruction".
If Kloyberg's bowls are low and wide, and also placed closer to the center, this indicates small bowel obstruction, or high. Also, the expansion of the intestine to the place of the presence of an obstacle and the subsidence of the intestine after.
When conducting contrast radiography, you can notice that the evacuation of barium is slowed down or absent altogether.
In some cases, radiography allows you to visualize the obstruction itself (tumor, intestinal torsion, adhesions).
Small and large bowel obstruction: 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 differences in the location and shape of the Kloiberberg bowls, there are a number of other signs.
If the bowls are not clear enough which department is involved in the pathological process, a contrast radiography of the abdominal cavity can be done. In this case, inflated loops of the intestine are perfectly visualized.
Signs of small bowel obstruction:
- bloated loops occupy mainly the center of the picture;
- they do not exceed 4-8 cm;
- the presence of transverse striation against the background of swollen loops;
- there are no specific concavities at the edges (gaustres).
Signs of bowel obstruction:
- swollen loops of larger diameter;
- there are concavities - haustra;
- the presence of arched folds (a symptom of arches) is characteristic.
Thus, the value of abdominal radiography in the diagnosis of obstruction is extremely high. However, there are times when the radiological picture is unclear. Then it is necessary to conduct other examination methods: ultrasound, computed tomography.
Perforated ulcer: X-ray signs
A perforated (perforated) ulcer is a rupture of the wall of the stomach or intestine, which is accompanied by severe, dagger pain.
At break, the air goes into the abdominal cavity and rises up to the diaphragm. Since the liver is located under the diaphragm on the right, the accumulation of air is best seen between these two organs. It gathers there in the form of a thin arched strip. This phenomenon is called air sickle during abdominal radiography.
This symptom is most characteristic of perforation of the ulcer, however, other signs can be determined on x-ray:
- the presence of a gas bubble, which shifts when the body position changes;
- displacement of a sickle of air under the sternum when the patient turns on his side;
- if gas is not detected in the first image, the patient is given a drink of sparkling water; gas will escape through the hole formed 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 escape through an opening in the hollow organ.
It can be concluded that abdominal x-ray is a really effective method in the initial stages of the diagnosis of a number of abdominal pathologies. And with suspected intestinal obstruction and perforated ulcer, its role is simply invaluable.