X-ray examination

Preparation of the patient to the study. In a patient with normal intestinal function research can be carried out on an empty stomach. Patients who have clinically defined bloating, delay chairs and other signs of dysfunction of the colon, it is necessary to recommend a cleansing enema in the evening and morning for 1 to 1.5 hours to fluoroscopy. When expressed constipation is advisable to prepare the patient carefully for 5 to 7 days, appointing inside antispasmodics (papaverine, platifillin, no-Spa and other) or broth chamomile (on a half-glass 3 times a day)and 20 - 24 h before the study 30-40 g of castor oil (but not salt laxatives). On the eve in the evening and in the morning you should also clean the intestines normally.
X-ray examination, usually begin with a study of the chest to detect or exclude changes in the lungs and mediastinum, due to the tumor process. Sometimes when cancer of the upper section of the stomach is the blockade of the lymphatics or the immediate invasion of tumor is often left thickening costal and diaphragmatic pleura, the occurrence of pleural effusion and compacting of the lower lobe of the left lung. Then make a sightseeing x-ray examination of abdominal cavity organs in the vertical position of the patient. In this case roughly estimate the size and position of large abdominal cavity organs (liver, spleen, kidneys)are excluded pathological inclusion in these bodies (concrements, calcification and horizontal levels of liquid in the intestines).
Study the shape and dimensions of the gas bubble stomach, registering on images of its displacement and deformation, and additional soft-tissue swelling at the background of the bladder, due to tumor sites. The increase of the distance between the aperture and the body of the stomach should be noted as a possible sign of cancer of the body of the stomach. However, it is known that such x-ray picture may be a result of deformation of the rear Department of the diaphragm, an enlarged spleen, ascites and other pathological changes and, therefore, needs to be clarified in the process of further contrasting stomach, and sometimes even in the conditions of pneumoperitoneum.
Conventional contrast examination of the stomach includes the study of the esophagus and main indicators of the state of the stomach: 1) relief of the mucous membrane; 2) the position, shape and smaduamei authority; 3) motor-evacuation function. Along with this condition all departments of the duodenum.
The study of the esophagus is a necessary moment in the study of any patient with suspected cancer of the stomach as the abdominal esophagus is usually involved in the disease process, especially in cancer of the upper localization. Often the main part of gastric tumors remains subtle, difficult to detect, while the signs of defeat of the esophagus appear most clearly. In addition, the study of the esophagus allows sometimes be detected in patients with suspected tumor gastric other pathological changes, give a similar clinical symptoms (hiatal hernia with relaxataion, the squeeze of the esophagus anomaline vessel, aortic aneurysm, enlarged left atrium, tumors of the mediastinum and so on).
The study of the relief of gastric mucosa is done by dosed compression of the anterior abdominal wall after taking 2-3 SIPS suspension of barium sulfate. Change the relief of the inner surface of the stomach (thickening folds, their rigidity, convergence, open circuit in a certain area, bumpy surface) is an important indicator of the pathological process and therefore must be recorded on a series of x-rays. The study of the shape and position of the stomach, the nature of the circuits it is achieved with a massive population. For the full unfolding of the walls of the stomach is usually required 200-400 ml suspension of barium sulfate. A malignant tumor, as we know, sooner cause loss of elasticity of gastric wall and rigidity of a certain portion unable to deal equally with neighboring departments, inevitably leads to deformation of authority and violation of the correctness of its contours. Therefore, the analysis of elasticity of the stomach and the nature of its contours with a massive filling is of paramount importance in the diagnosis of malignant tumors and, in particular, small endofitno growing tumors.
For timely detection of pathological changes of the plot gastric wall, evaluation of extent and morphological characteristics of the tumor must poleposition study that involves x-rays of the stomach in direct and lateral projections, not only in vertical and horizontal position of the patient. Along with this, depending on localization of the revealed changes, additionally produce sighting x-rays in an optimal way for the stomach of the projections. During research it is important to choose such provisions, which allow first massively contrast affected area barium suspension, and then contained in the stomach air, i.e. to get a picture of the inside surface on the background gas ("newmerella").
If the quantity of gas in the stomach is not enough, it is advisable to use the classical method of double contrast study, resorting to additional introduction of air with the help of gastric probe, through the reception of "sparkling mixes". After massive fill the stomach suspension of barium sulfate patient give consistently drink 1 g of citric acid and 2-3 g of baking soda dissolved in 15-20 ml of water.