X-ray examination of the stomach

The form and position of the stomach. X-ray image of the stomach is essentially different from the usual anatomical picture (Fig. 79). This is primarily due to the fact that "live" the stomach is affected tone, conditions of hydrodynamic influence on the walls and constitutional features. There are two main types of the form of the stomach: 1) the stomach in the form of hook and 2) in the form of a horn. However, the sharp differentiation of these forms characteristic vertical position of a body in question. The form of the stomach, of course, depends on the tone of his muscles, the degree of filling, the state of intra-abdominal pressure and other factors.

Fig. 79. Normal gastric (x-ray).

Accordingly x-ray views on the form and position of the stomach nomenclature of its departments is different from anatomical. The most common signs of stomach are gastric bubble, the descending part of body, ascending Department and privatemovie or antrum.
Often the result of accumulation of gases in the intestines may develop so-called cascade stomach, representing a strangled from back and shifted slightly upward to two labels. When receiving contrast mist fills first the top division, and then contrast weight narrow band joins in caudal pole, giving the image of a cascading waterfall. Cascade form, due to the influence of the gas accumulations can be eliminated, if we put the analyzed on the left side.
Smexiest stomachdefined for the screen represents one of the important factors considered in the study. Normally, the stomach has good mobility from the greater curvature. Smexiest less pronounced in privratnika part and on the part of the lesser curvature, especially palpation in a vertical position investigated.
Violation of smaduamei largely determined by the presence of growths and is limited and widespread. Violation of smaduamei may depend on adjacent to the stomach or from the tumor or from increasing neighboring organs, so that the mobility of the stomach is difficult or impossible.
The tone stomach depends on contractile ability of his muscles and control apparatus. Various reflex points, pain, mental state, and so on, can also influence the tone.
In the stomach with a normal tone contrast weight slowly descends to the caudal pole, gradually reaching the gatekeeper. Filling hypertensive stomach is even slower; contrast weight, getting it, stress spreads wall stroking at the same time in the beginning of filling wedge picture of the cast. If hypotension stomach has a very weak resistance, and contrast weight quickly falls down. Bag stomach quickly and significantly stretched. When dramatically hypotension stomach the whole mass is accumulated at the bottom, and there is a lateral extension of gastric pouch with horizontal upper level, put food on line gatekeeper. The lower wall of the stomach is drawn, resulting in the body turns interception in the form of a narrow waist. Air bubble code becomes elongated pear shape.
Low position of the stomach if hypotension should not be mixed with the true dropped his so - called bathygastry. Bathygastry refers to constitutional changes; characteristic is the lengthening of the entire stomach and lower than normal, the position of the lower pole of the lesser curvature and gatekeeper. The gatekeeper is below Grebeshkova line. Motility of the stomach when bathygastry usually expressed very well. Tone and peristalsis may remain unchanged. Evacuation is mostly not slowing down.
The motility of the stomach. Under physiological conditions, the motility of the stomach was immediately available for study in humans only with the help of x-ray method. A huge favor for understanding the mechanism of peristalsis brought rentgenonegativee and videomania entry x-ray images, which can be frame-by-frame analysis of peristaltic variability of the stomach (Yu N.sokolov and P. C. Vlasov, 1968) and get an objective view about its characteristics.
Substantial assistance in a wide x-ray practice could have a method of printing. This method is the fact that on one film with the detainee breath is three pictures in a row after 10-12-second intervals. On the PolyGram picture turns crossing paths stomach, at points which can be explored amplitude motility of the stomach and frequency alternating waves (Fig. 80). Based on the mapping of the amplitude and frequency of alternating waves can be generated descriptive term peristalsis.

Fig. 80. The PolyGram stomach. Explanation in the text.


Normal peristalsis is characterized by waves of medium depth, giving the greater curvature 1-2 long, well expressed, not fast moving stazeni with good ottnoreply antrum. This so-called "peaceful" type.
When the waves of small amplitude and rare them alternating turns out "weak" character peristalsis with surface waves. Such nature of peristalsis if hypotension occurs and decompensated muscles of the stomach.
Deep wave with frequent alternation indicate peristalsis "excited" type. This peristalsis usually occurs when undisturbed functions gatekeeper.
Impaired function gatekeeper, due to the long periods snapping his or organic changes (scar process, tumor, compression), calls "busy", stenotic type peristalsis. In these cases peristalsis has expressed categorizes nature, waves alternate rarely, their depth (with compensated muscle) is great. From gatekeeper can go waves in the opposite direction, indicating antiperistaltic activity, which is also a sign of a stenotic process.
Now resort to the pharmacological effects for excitation or inhibition peristaltic activity in terms of functional diagnostics. For excitation of peristalsis in sluggish its type or if you think its no use to the effects of morphine (E. M. Kogan, 1958; Porcher, 1959), proserin (C. A. Fanarjyan, 1961, 1964). Stimulate peristalsis of the stomach can be achieved frequent forced breath. For braking excitations peristalsis can be used ganglioblokirtee substances (I. A. Lermontov, 1964).
The process flow and changeability of nature peristalsis are important not only in terms of functional diagnostics, but also the possibility of early detection of the tumor changes stomach.
Power, rhythm and tempo peristalsis evidence of the qualitative characteristics of muscle arrays stomach, and they largely depend on interoceptive effects. These musculoskeletal manifestations of available analysis of reactivity of the stomach with the already established a certain diagnosis. The possibility of accounting for the effect of the treatment factors and their effectiveness control that adequately promotes clinical understanding of the current functional and organic changes of the stomach.
The game gatekeeper. When completely empty stomach gatekeeper is open. The first SIP barium suspension quickly passes into the duodenum, then the gatekeeper is closed. Coming then rhythmic game gatekeeper further regulates the flow of gastric contents into the duodenum.
The secretion of the stomach may be detected in the presence of liquid on an empty stomach before the injection of contrast mist. In pathological cases, the presence of abundant secretion fasting represents a common occurrence, and if, before contrasting studies have not taken pumping gastric content, there are great difficulties to define small forms, but the important but the value of pathological changes.
The relief of the mucous. Currently, it is difficult to imagine a substantiated clinical diagnosis of any disease of the stomach without radiological characteristics of the relief of the mucosa. In this respect, x-ray examination enriches the clinic possibility of functional-anatomical mapping data objective clinical studies with laboratory and instrumental data, especially with the results and sleep Russia gastrobiopsy.
Healthy mucous membrane of the stomach has a continuous variation of the form of folds, while at pathological conditions this variability or violated, or disappears. To establish or denial functional deformations of the gastric mucosa is necessary to make instant sighting pictures of the same sections of the stomach every 5-8 minutes, and only after comparing such series is possible to Express an opinion on the resistance of the strain relief mucosa.
X-ray picture of the relief of the mucous membrane caused by the formation of the shadow effect of the subsidence due barium from a liquid suspension in the furrows between the folds (Fig. 81).

Fig. 81. Normal stomach. The relief of the mucous (x-ray).

In the field of the body of the stomach pleats form a net figure. From here, start longitudinal folds, with a vertical direction and running through the body of the stomach to the sine of several parallel strips. Along the lesser curvature run 2-4 folds, which create a kind of "track" Aschoff-Waldeyer. Longitudinally running along the body folds part bent y gastric corner and disappear on the lesser curvature, and part of, coiling, go to the bag stomach, leaning in its course towards greater curvature. Here, a triangle is formed, which in a lateral direction is separated by fold, called the edge. The fold is as if separates the body of the stomach from the antrum. The greater curvature forms a distinct aliasing caused mostly obliquely placed and tangentially going folds. X-ray picture of the relief mucous represents the sum of the layers of the folds in the front and back walls.
X-ray picture of the stomach is extremely enriched by the study of the relief of the mucous. However, it would be erroneous to consider that the clarification of morphological features from the study of the relief of the mucous decides clinical diagnostics of diseases of the stomach. It must be emphasized that the study can be considered correct only if used all the possibilities of its implementation, i.e., which makes the study of the relief mucosa, and tight filling, without which there can be a complete analysis of any state of the stomach.