Gastritis

Radiological examination of the stomach may be important to determine the condition of the relief of the mucous membrane of his gastritis.
Acute and aggravated chronic processes are accompanied by a more severe types of strain relief mucosa due to the fact that in such cases by the increase of hydrodynamic balance submucosal layer. Resistance mucosal changes can't be completely installed at one time held by chest x-ray. There are also frequent monitoring when in 3-4 days after the first test, which revealed a seemingly resistant strain relief, had been considerable shifts in the direction of normalization of the relief of the mucosa. Functional deformations of the mucous membrane potential, in particular, changing diet or under the influence of certain drugs. Often we meet with "flying" by edema of the mucous characterizing the influence of some acute stimulus. Strain relief is called, therefore, not only pathological changes, but also functional disorders and, first of all, swelling and oedema of the mucous noninflammatory nature. Of great importance for assessment of the relief of the mucous membrane in such cases have pharmacological effects, leading to the regulation of hydrodynamic balance submucosal layer (Fig. 82) remove or reduce the swelling of the mucous membrane.
Radiographically chronic hypertrophic gastritis is represented in the form of swelling folds from increasing their width without changing course up significant swelling with severe strain relief. However, for such radiographically detected changes score them as the "hypertrophic" gastritis significantly narrows ideas about the nature of the pathological process, limiting the possibilities of revealing functional layers and features of the other anatomic and clinical signs of disease. Thus, hypertrophic component, even when available, may be obscured by other elements of an inflammation.

Fig. 82. Variability of relief mucosa of the stomach (x-ray).
and strain relief swelling of mucous membrane; b - the same observation in 10 days after decongestant therapy is the normal relief mucosa.

Special place acute gastritis (burns, poisoning). In cases of acute gastritis there are also significant high artificial swelling due to hyperemia and lymphostasis in the submucosal layer. Such deformation changes are so pronounced that at high degrees of inflammatory edema on the screen or radiographs can be observed separate filling defects, between which only defines a little shapeless areas of subsidence barium, creating a mixed view of the changed relief mucosa.
In those cases, when acute or chronic aggravated gastritis breeds in a limited area, there are phenomena on the part of the lining of the stomach. This affects, either in the form of rectification of wrinkles, losing its softness and elasticity palpation or increased their sinuosity. Such irritative phenomena provide an opportunity to consider the nature of the reaction of the mucous membrane with gastritis, established on the basis of clinical data and gastrobiopsy. In addition to the above deformation changes are observed and radiographic manifestations of gastritis in grained pattern while maintaining almost the usual form of folds (nodularia-hyperplastic type) in separate tabs, resembling a wart, or in the form of protrusions - Islands in the background smoothed mucosa (polypous type).
In recent years, subjected to review the question of hypertrophic gastritis, the diagnosis is based on radiology and endoscopy data. According to the materials produced aspiration biopsy (Centners, Masevich, 1967, and others) in most cases radiographically and endoscopy established diagnosis of hypertrophic gastritis or not confirmed or marked easy exudative-infiltrative inflammation. At the same time, for certain special forms of gastritis x-ray diagnostics retains its main value. These forms, in particular, the so-called disease menetrie, which results in excessively developed mucous membrane, leading to the emergence of many opinions about the essence of it. In the basis of this form of relief mucosa lies glandular hyperplasia it possibly linked to inflammatory changes that gave occasion to call the disease, menetrie giant hypertrophic gastritis (C. M RISS, 1966). Radiographically the disease is large strain folds, reaching enormous size (Fig. 83). Usually these giant folds are located closer to the greater curvature and very rarely found near the lesser curvature of the stomach. One of the radiological features characterize the changes of relief mucous when illness of menetrie, is to localize them in the vast majority of observations mainly in the body of the stomach from a very rare spread below him. Thickened and deformed folds are connected by a large number of connecting winding walkways, so that there is atypical krupnooptovye relief. The greater curvature occurs rough aliasing. These folds are closely adhering to one another, you can create a picture of filling defect, sometimes simulating the tumor. The differential diagnosis of great importance should be attached to functional characteristics (hypersecretion of mucus, loss of peristalsis, rigidity mucous)that are not under the excessive mucous (Yu. N. Sokolov, and P. C. Vlasov, 1968).

Fig. 83. Excessive wrinkling of the gastric mucosa with the disease, menetrie (x-ray).


Thus, for purely radiological signs not with sufficient reliability to speak out in favor of hypertrophic gastritis based on the thick folds and strain relief. These symptoms can be set only in combination with data obtained with careful clinical analysis using available modern methods of research, especially aspiration biopsy.
Atrophic forms appear as thick folds to partial or complete disappearance that creates the picture of the subtle relief either expressed its smoothness. However, atrophic States do not always respond well to x-ray detection. According to the data of aspiration biopsy, often with radiographic manifestations rough terrain found morphological features of atrophic gastritis (Centners, Masevich, 1967).
Thus, gastrobiopsy and x-ray studies show that these two methods do not always coincide, and therefore is necessary to carefully assess the state of the relief of the mucous membrane, based in the analysis of x-ray data on clinical and x-ray mapping. It is especially important that strain relief mucosa may depend not only on the true inflammatory process, but the reflex influences and related changes that may occur in diseases of the pancreas, bile ducts, small and large intestines, endocrinopathy, vitamin deficiency, and so on
In a tight filling the stomach of patients with gastritis possible to observe a number of functional changes of the peristalsis, tone and evacuation, as well as secretion, which is recognized by the amount of liquid, increasing in their number during the study. Registration of functional characteristics allows each case to have the judgment of the characteristics of the disease when conducting follow-up research.
Between anatomical changes of the mucous membrane, radiographically detected in gastritis, and character secretion and acidity no strict logical dependencies. In particular, in many cases the so-called hyperplastic changes are observed low levels of acidity and secretion that may be associated with swelling of the mucous membrane that affect the state of the excretory ducts glandular apparatus of the mucosa. This state secretion may depend on atrophic state mucosa that may exist not only in painting smooth relief mucosa, but with significantly expressed swelling and deformation of the folds of mucous membrane of the stomach.
It is appropriate to say that, in addition to a number of reasons noninflammatory nature, which has already been mentioned above, you may experience swelling of the mucous membrane with a significant strain relief and on the basis of allergic conditions. In such cases should be taken to eliminate such changes. As with any other reasons, as a factor pharmacological effects can be recommended proposed S. Century Gurvich and modified by us influence on the mucous membrane through the use of antineoplastic preparation in the form of a mixture consisting of a solution of piramidon and adrenaline in the following recipe: pyramidonum 1,0, water 300,0, epinephrine 1 : 1000-20 drops. This mixture if necessary, appoint to receive for one's throat every hour during 7-8 days before x-ray studies. The use of the mixture leads to reduce inflammation of the gastric mucosa associated with inflammatory changes of the functional disorders to extinction with normalization picture of relief mucosa (see Fig. 82). Naturally, the absence of reaction of the mucous membrane on the impact of this mixture should be considered a factor, indicating the presence of persistent violations of relief, often associated with tumor infiltration.
A special form represents chronic gastritis, accompanied sclerotic seal and thickening of the walls of the antrum. A. N. Red and Y. N. Sokolov (1947) called this form of "rigid antral gastritis". The disease has a specific clinical and radiological picture. Radiographically detected thickening folds of mucous membrane with the reorganization of the relief. Antral section steadfastly narrower and shorter. The greater curvature is determined Jaggy and indrawing from spasm or perigastric. In the parenchymal changes, accompanied by thickening of the muscle layer and mucous membrane, the output part takes the form of rigid pipes, walls of which are devoid of visible peristalsis. In the differential diagnosis regarding the question about the possibility of a cancerous lesion antrum. To clarify the diagnosis is aided by the use of pharmacological effects, stimulating peristalsis. Particularly effective is the use of injections of morphine (Porcher, 1946; A. N. Red and Y. N. Sokolov, 1947; E. M. Kogan, 1958) and prozerina (C. A. Fanarjyan, 1959). Under the influence of such factors in the rigid antral gastritis changed shape antrum and appears peristalsis (Fig. 84). This disease requires special watchfulness, as may sometimes encounter insurmountable difficulties in their differential diagnosis.
In some cases antral gastritis simulates excess mucous membrane of the antral, Last may fall in the onion duodenum. This phenomenon is known from 1941 (Schinz, etc., 1952), however, only in recent years it has become a well recognized. The essence of these changes is that, due to excessive mobility part of the mucous membrane of the stomach moves through the pylorus and at the base of the bulb creates an original Polytechnicheskaya the filling defects, causing deformation of the bulb (Fig. 85).

Fig. 84. Rigid antral gastritis (x-ray).
and the narrowing of the antrum; b - the same observation after injection of morphine - form antral has changed.
Fig. 85. Loss (a, b), the excess of the antral mucosa in the onion duodenum (x-ray).

During fluoroscopy or serial aligned pictures you can see the link filling defects, located in the duodenal bulb, with pleats preprocessor Department of the stomach. Quite often during fluoroscopy can "set" mucosa, and then the bulb duodenal ulcer appears to be unchanged. Occurring sometimes in the bulb polypous education readily distinguishable from the drop mucosa, as they have a rounded shape and distinct.
When considering the x-ray detection gastritis attention of the radiologist should be mobilized not only on account rentgenokhirurgicheskikh changes, but also on those functional changes relief of gastric mucosa and in General that enriched understanding of the reactivity of the body in this disease and in the border States.