Colitis

X-ray detection colitis is carried out by applying research after receiving contrast agents inside and administration of contrast enema.
Of particular importance in the x-ray diagnosis of colitis have abnormalities motor function, which may change due to the acceleration and deceleration time emptying of the colon as a whole and on separate sites. When segmental colitis observed gaps fecal post and the uneven nature of its promotion. Breaks fecal post can be caused not only violations of its formation and spasms, but also the fact that when colitis often have excess education gas emissions are unevenly distributed in the course of the contrasting intestine. This may be accompanied unevenly weak contrast enhancement, which is associated with the presence of a small amount of liquid contrast Kala. In such cases, the marbling and linearity of the picture with no Australi. In some cases, on the background of marbling are sporadic formless contrast spots, which to some extent reflect the presence of ulcerative changes.
With the introduction of a contrast enema, in cases of severe colitis contrast suspension quickly fills the colon, and are often marked suzinoti its clearance and lack of Australia.
Unmodified departments ulcer at that normally deal with the preservation gastrolnyj of segmentatsii that weaker pronounced than when filling the colon by receiving barium suspension inside. However, in the health departments of Australia may be pronounced, reflecting irritation these areas due to the presence of inflammatory changes in the neighborhood. When detecting the contours of filling contrast enema colon
the serration there are grounds for assumptions about the presence of ulcerative changes.
For diagnosis of colitis above features are certainly pathognomonic. Their value lies in the fact that with appropriate clinical and microscopic data they describe the background of functional disorders of the large intestine.
In the diagnosis of colitis great importance is the study of the relief of the mucosa of the colon. In the presence of inflammatory process folds thicken and the relief is subject to various deformations due to the swelling, but on the soil of hyperplastic and atrophic changes, and in cases of acute and worsening of chronic colitis - and swelling of the mucous.
After the painting relief mucous depending on the severity of inflammatory changes there are three stages colitis (Knothe, 1932). The first stage includes changes accompanied by a sharp inflammatory oedema of the mucous membrane. Along with nabukalu often there is a "Israeli" mucosa recesses of the wrong form that can match the ulcerations. Instead of the usual folds visible uneven tabs, streamlined small amount of barium. On the radiograph this is manifested in the form of complete disappearance of the usual pattern on the affected area. In some places are formed pincushion swelling of the mucous acting in the intestinal lumen. Between them are formed irregular shape depot contrast suspension characterizing ulcerative changes (Fig. 114).

Fig. 114. Colitis I (x-ray).
Sharply marked swelling of the mucosa of the colon.

The second stage corresponds to a quieter, but chronic inflammatory process. At this stage there resistant strain changes in the form of large and finely tuberous swelling, giving the picture of the islets of prosvetlenie and form a "cell" figure. Radiographic manifestations typical of the second stage, could experience a long period calculated in years, often with good subjective condition of the patient. In the period of exacerbation at the picture, typical for the second stage, naprashivaetsa relief changes that occur at the first stage (Fig. 115).

Fig. 115. Colitis II (x-ray).
Strain relief of the mucosa of the large intestine (exacerbation of chronic dysentery).

The third stage appears as nodularia-hyperplastic processes, usually indicating good turning. On radiographs are defined small enlightenment, indicating the presence of a large number of hyperplastic nodules mucosa. This absence of swelling of the mucous and other relief, which is a measure of the decay of the inflammatory process, with a trend towards approximation to normal mucosa.
Each of these stages indicates a functional and anatomical phase of illness that resolves radiographically to judge the degree of severity of the process at occurrence of diseases, exacerbations of chronic suffering on remission and anatomical localization of the relevant changes.
Atrophic condition of the mucosa of the large intestine characterized by the smoothness of the folds, and the terrain becomes a "gentle" with deformative changes (Fig. 116). Atrophic the mucous observed mainly in chronic dysentery.

Fig. 116. Atrophic the state of the mucosa of the large intestine in chronic dysentery (x-ray).

When the mucous colitis unaffected or maloznakomyh segments of the intestine always respond with heightened anxiety - irritatie. During treatment irritative changes begin to disappear first.
X-ray plays a very important role in the diagnosis of ulcerative colitis.
In milder forms of ulcerative colitis x-ray picture is very poor and can be characterized by some thickening of the folds of mucous and functional disorders spasms and accelerated motor on separate sections of the colon that occurs when a vulgar colitis. This very small manifestations of ulcerative colitis are devoid of any distinctive features.
Expressed forms are characterized by the fact that when filling bowel contrast enema define the rigidity of the walls, accompanied by the absence of Australia, the irregularities and the graininess of the contours. Barium suspension draws inhomogeneous picture due to the presence pseudopolyps formations. In some cases, the intestine is narrowed and shortened. In the study mucous after administration of contrast enema detected strain relief consisting of the unevenly thick and swollen folds, alternating with separate thinned longitudinal folds. In places where pseudopolyps units the terrain is grainy-loop wale (Fig. 117). Particularly well these changes are detected by double contrast study Fisher. The extent of destruction, determined radiographically, respectively characterizes the severity of the clinical course of the disease.

Fig. 117. Ulcerative colitis (x-ray).
"Marble" strain relief mucous descending part of the colon. No Australi in the areas filled with contrasting suspension.
Fig. 118. Tuberculosis ileocecal region, corsiva deformation of the distal ileum and the blind gut. Radiograph.

From other inflammatory diseases of the large intestine is of interest tuberculous lesions, mostly blind gut, rather ileocecal region (Fig. 118). This is manifested in the form of functional changes and a kind of filling defect with the formation of the picture functional-morphological lesions, known as the symptom Shtirlina. This symptom is considered classic for ileocecal tuberculosis and observed when expressed signs of defeat. It is found in the study of the gastrointestinal tract by receiving oral suspensions of barium sulphate, and also the introduction of a contrast enema.
In the study of contrast enema noted the lack of severity of the contours of Austr and decreased elasticity of the walls, find best when combined study by introducing air into the colon after partial emptying her from contrast enema.
Oral administration of contrast medium is determined by the gap fecal post, due to the limited increase
motor functions blind and proximal ascending part of the colon.
Reviewsmore symptom Shtirlina not mean the absence of tuberculosis, while its uniqueness in most cases corresponds to the presence of tuberculosis, but he certainly is not pathognomonic for tuberculosis. Be aware that symptom Shtirlina can be and other diseases neoplastic and inflammatory diseases (cancer, nonspecific granuloma, syphilis, actinomycosis).
In addition symptom Shtirlina, in ileocekalnom tuberculosis is observed shortening and decrease the clearance of blind and ascending colon, and Australia segmentation disappears. In addition, you may meet the jagged outline of these departments, which can be explained ulcerative changes. These changes can only be made by double contrast study Fisher, if they are krajobrazowe. You must specify that in the picture changes when TB has much in common with ulcerative colitis and distinguish them only on the basis of x-ray data is not always possible. However, in contrast to non-specific colitis, which captures large sections of the colon and without sharp boundary goes to the normal structures, tuberculosis marked segmental lesion with the change affected and unaffected areas.