Home Children's dentistry Duodenography - X-ray features of the gallbladder and duodenum. Duodenum (Duodenography) Relaxation duodenography

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Duodenography - X-ray features of the gallbladder and duodenum. Duodenum (Duodenography) Relaxation duodenography

The duodenum is one of the organs accessible to x-ray examination, therefore many diseases of this organ can be detected during a routine x-ray contrast examination.

What does this research reveal?

Since the topographic-anatomical relationship of the duodenum with the biliary system (biliary tract) is particularly close, using this procedure it is also possible to identify pathologies developing in the structures:

big duodenal papilla;
pancreas;
terminal section of the common bile duct;
gallbladder.

However, during the traditional x-ray examination Gastrointestinal tract using barium suspension, the area of the major duodenal papilla, containing the final sections of the pancreatic and common bile ducts opening into it, does not fall into the field of view of the specialist performing the procedure.

This type of study also does not reveal changes in the duodenum caused by pressure on its walls exerted from the outside, gallbladder or an enlarged head of the pancreas.

The above-mentioned difficulties that make it difficult to study individual characteristics duodenum, are explained by the too rapid passage of a radiopaque substance through it.

A real breakthrough in radiology in 1955 was made by the Argentine surgeon Liotta, who proposed combining the supply (through a probe) of a barium suspension into the duodenum with simultaneous hypotension of this organ, caused by the administration of anticholinergic (the so-called substances that interfere with the conduction of nerve impulses) drugs.

This procedure is called an X-ray examination of the duodenum under conditions of artificial hypotension (relaxation) or hypotonic (relaxation) duodenography.

With the help of relaxation duodenography, radiologists can:

Check availability tumor process in the structures of the papilla of Vater and the head of the pancreas, thereby confirming the mechanical etiology of the developed jaundice.
Diagnose the presence of bilioduodenal.
To draw a conclusion about the work of bilioduodenal anastomoses formed in patients who underwent surgery for biliary tract. Thanks to discovery pathological processes, occurring in the tissues and lumen of the hepatobile duct, doctors are able to establish the causes of relapses of suffering.
Reveal chronic pancreatitis.

Indications

The relaxation duodenography procedure is used if:

clinical suspicion of any disease of the duodenum;
anemia ( pathological condition, characterized by a significant decrease in the number of red blood cells and the level of hemoglobin in the blood) of unknown etiology;
pathologies of the pancreas, liver and diaphragm;
disorders of the motor-evacuation function of the gastrointestinal tract;
suspicions of (occurring in infiltrative form) that arose during endoscopic examination;
from gastrointestinal tract reflected in the anamnesis;
jaundice of unknown origin;
suspicions about .

Duodenography also allows for dynamic monitoring of patients suffering from organic diseases duodenum.

Contraindications

The procedure is absolutely contraindicated:

patients in serious condition;
at gastrointestinal bleeding, which opened shortly before the scheduled study;
in the presence of severe vomiting.

Preparation

When consulting the patient on the eve of the scheduled procedure, the attending physician must explain to him:

Purpose of the study.
Where and by whom it will be held.
The sequence and essence of the upcoming medical manipulations. The patient must be aware that during the study, a radiopaque substance (barium sulfate solution) and a certain amount of air will be introduced into his body through a special catheter.
That the introduction of air into the lumen of the intestine under study may be accompanied by the occurrence of painful sensations. In this case, for cupping pain syndrome the patient will have to breathe slowly and deeply through the mouth, since such breathing will promote maximum relaxation of the muscles of the anterior abdominal wall.
The likelihood of side effects due to the administration of an anticholinergic drug or glucagon. Exposure to an anticholinergic drug may cause severe thirst, dry mouth, temporary visual impairment, tachycardia and urinary retention. Glucagon can cause nausea, vomiting, flushing (redness) of the face and skin rash(like urticaria).
Necessity:

the presence of any acquaintances or relatives who, after the end of the procedure, could accompany the patient home;
refrain from eating any food during the night hours preceding the scheduled study (a light dinner should take place before 19:00);
bowel movements before the procedure;
complete abstinence from drinking liquids, food and smoking on the day of the study (otherwise the procedure will give biased results).

Before undergoing duodenography, the patient may be prescribed a preliminary examination, including:

careful collection of medical history (information about any operations ever undergone is of particular value);
consultation with specialized specialists (primarily oncologist and gastroenterologist);
performing esophagogastroduodenoscopy;
taking tests: blood (general, biochemical and tumor markers) and urine (general).

How is duodenography performed?

Before performing the procedure, the patient will be asked to remove metal hair clips and hairpins from his hair, dentures from his mouth, and remove jewelry, glasses and clothing with decorative metal elements.

The duodenography procedure can be carried out in two versions: with and without the use of a duodenal probe. The first version of the study is carried out as follows:

Having sat the patient down and monitoring the actions using the X-ray machine monitor, a thin probe with a metal olive at the end is inserted into his stomach through one of the nasal passages (in some clinics they prefer not to use an olive, believing that without it it is easier for the probe to pass through the pylorus).
With the patient lying on his back and continuing to act under the control of the translucent screen, the probe is advanced into the vertical (descending) branch of the duodenum.
To relax the intestine under study, anticholinergic drugs are used to help reduce its motor activity: the patient is injected intravenously with 1-2 ml of a 0.1% atropine solution or intramuscularly with 3-5 ml of a 0.1% solution of metacin (the dosage is calculated taking into account body weight).
Twenty minutes later, the mucous membranes of the duodenum are irrigated with a 2% solution of novocaine (10-15 ml is required).
After ten minutes, the patient is placed on the X-ray table and, using a Janet syringe under slight pressure, using a probe, a liquid barium suspension (250-300 ml) at room temperature is injected into the duodenum. The introduction of a suspension helps to achieve tight and uniform filling of the intestine under study along its entire length, which persists for a long time.
During the examination, the patient is placed on his back, stomach, left and right side, taking a series of radiographs. The film used, which has parameters of 24x30 cm, allows you to capture not only the examined intestine, but also the organs located next to it.
After examining the condition of the walls of the duodenum, air is blown through the duodenal tube (300-350 cm 3). Thanks to this manipulation, the contrast mass moves into the lumen of the jejunum, and the radiologist takes another series of radiographic images that help to get an idea of the pneumorelief of the organ under study, which helps identify existing pathological changes in the structures of the intestinal walls.
After completing the study, carefully remove the probe. Relaxation of the duodenum, artificially created with the help of novocaine and metacin, persists for thirty to forty minutes, after which its motor function is restored in full.

To prevent the possibility of unwanted side effects, the radiologist is obliged to monitor the condition of his patient during the examination.

If anticholinergic drugs were used to relax the test bowel, medical staff must ensure that the patient urinates during the first hours after the procedure.

Outpatients who come to the clinic without an accompanying person should, if possible, spend at least two hours in emergency room: until their vision is fully restored.

A patient who has undergone duodenography receives a recommendation to drink as much fluid as possible (of course, provided there are no contraindications), which will help accelerate the removal of barium from the body. Some patients will require laxatives after duodenography.

Before the patient leaves the X-ray room, the doctor must warn him about the likelihood of developing flatulence and belching air, as well as the inevitable release of discolored feces, the consistency of which will resemble lime for 24-72 hours.

The patient is advised to pay attention to the consistency and color of his stool. If after this period its character does not change (this indicates that barium continues to remain in the intestines), the patient must definitely inform his doctor about this.

Duodenal hypotension can be created without the use of a probe: it is enough to take one or two Aeron tablets and place them under the tongue.

In some cases, aeron may be added to water solution barium sulfate. It has been established that sufficient atony of the duodenum occurs within fifteen to twenty minutes after taking the above drug.

The probeless version of duodenography, of course, is much easier to tolerate by patients, but the relaxation of the examined intestine, achieved with the help of a probe, is more stable and consistent.

In addition, it allows you to regulate the rate of introduction of the radiopaque substance and its volume, as well as the possibility of pumping air into the intestinal lumen, which gives greater expressiveness to the X-ray picture.

Decoding norms and deviations

The normal indicator on the resulting radiograph is considered to be:

V-shaped or U-shaped shape of the intestine under study, due to the action of anticholinergic drugs that contribute to the temporary shutdown of its motor activity;
uniformity and smoothness of the mucous membranes of the hypotonic duodenum, the walls of which were stretched due to the introduction of air and barium sulfate solution;
the presence of jagged outlines of folds of the mucous membrane, located circularly;
the smoothness of the contours of the intestinal walls surrounding the head of the pancreas, which has no signs of pathological changes;
increase in the diameter of the duodenum to 50-60 mm;
the presence of uniform transverse keyboard striations formed by clearing of the folds of the mucous membrane.

The major duodenal papilla is detected in only 30% of patients.

Deviations from the norm on an x-ray may include:

Irregular outlines of the walls of the examined intestine, distorted by the presence of nodules and protrusions. This radiological sign may indicate the presence of chronic pancreatitis, a tumor of the head of the pancreas or the hepatopancreatic ampulla.
A number of signs indicating the likelihood of pancreatic diseases:
- unfolding of the intestinal loop;
- the presence of depressions on the medial contour of the descending part of the intestine being examined;
- double-circuitry of the intestinal walls (referred to as the “backstage symptom”);
- specific deformation of internal contours (the so-called “inverted Frostberg triple” symptom);
- the presence of pancreatic and bile reflux;
- an increase in the shadow of the major duodenal papilla, due to the presence of edema or tumor.

To be sure preliminary diagnosis it is necessary to carry out a number of additional diagnostic procedures And laboratory research, For example:

endoscopic retrograde cholangiopancreatography (ERCP);
computed tomography (CT) or ultrasound examination(ultrasound) of the pancreas;
an analysis aimed at determining amylase activity in urine and blood serum.

Precautionary measures

Several decades of practical use have proven that the relaxation duodenography procedure does not cause complications, and precautions may be required due to the presence of certain diseases.

The administration of anticholinergic (cholinolytic) drugs is contraindicated in patients with glaucoma and severe diseases of the heart muscle.
The use of glucagon is absolutely contraindicated in patients with insufficiently compensated diabetes mellitus, and in relation to patients suffering from type I diabetes mellitus, it should be used with great caution.
The relaxation duodenography procedure is absolutely contraindicated for stenoses of the upper gastrointestinal tract, provoked either by a large and voluminous neoplasm, or by the presence of an ulcer.

The relaxation duodenography procedure can provoke the development of gastroesophageal reflux in elderly patients and in patients suffering from severe pathologies.

If you ignore the ban on eating food several hours before the scheduled procedure, the results of the study may be unreliable.

Relaxation duodenography is an X-ray examination of the duodenum after the introduction of a solution of barium sulfate and air through a catheter. Indications for the study are symptoms of dysfunction of the duodenum and pancreas, for example constant pain in the epigastrium. The catheter is inserted intranasally and installed in the duodenum. In order to ensure intestinal atony, glucagon is administered intravenously or propantheline bromide (or another anticholinergic drug) is administered intramuscularly. The introduction of barium and air causes stretching of the atonic intestinal wall and smoothing of deep circular folds; made against this background x-rays provide an opportunity to evaluate anatomical features organ. The method allows you to quickly visualize even small damage to the duodenum and tumors of the head of the pancreas adjacent to the duodenal wall, however, to clarify the diagnosis, it is necessary to additional research.

Target

Identify small changes in the duodenum located below the bulb, as well as tumors of the head of the pancreas and tumors of the hepatopancreatic ampulla.
Confirm the diagnosis of chronic pancreatitis.

Preparation

It should be explained to the patient that the study allows one to evaluate the condition of the duodenum and pancreas after the administration of a solution of barium sulfate and air.
The patient should refrain from eating after midnight the night before the test.
The essence of the study should be explained to the patient and who will conduct it and where.
The patient should be warned that for the study, a catheter will be inserted through the nose into the duodenum, and barium and air will be introduced through the catheter into the duodenum.
The patient is warned about the possibility of pain as air enters the intestine. In this case, he is advised to breathe deeply and slowly through his mouth to facilitate relaxation of the abdominal muscles.
If administration of glucagon or an anticholinergic drug is expected during the study, possible side effects(glucagon can cause nausea, vomiting, urticaria and facial flushing, and anticholinergic drugs can cause dry mouth, thirst, tachycardia, urinary retention and blurred vision). When conducting research on outpatients, it is necessary that they are accompanied home by a relative or friend.
Before starting the study, the patient is asked to remove dentures from his mouth, remove hairpins or combs from his hair, and also remove glasses, jewelry, and clothing with metal parts.
Before the test, the patient must have a bowel movement.

Procedure and aftercare

The patient sits, the probe is inserted into the stomach through the nasal passage. The patient is placed on his back and, under fluoroscopic control, the probe is advanced into the duodenum.
Glucagon is injected intravenously, which causes rapid (in about 20 minutes) development of duodenal atony; instead of glucagon is allowed intramuscular injection anticholinergic drug.
A barium sulfate solution is injected through a probe, after which images of the duodenum are taken.
Some of the barium is evacuated, air is pumped through the probe, and additional images are taken.
The probe is removed.
After completing the study, the patient is recommended to drink plenty of fluids (if there are no contraindications) to accelerate the removal of barium.
During the study, it is necessary to carefully monitor the patient's condition due to the possibility of adverse reactions. When using anticholinergic drugs, it is necessary to ensure that the patient urinates in the first few hours after the study. For outpatient patients, if no one is accompanying them, it is advisable to spend about 2 hours in the waiting room until full recovery vision.
If necessary, laxatives are prescribed.
The patient should be warned about the possibility of belching air or flatulence, and that within 24-72 hours he will have discolored stool, resembling the consistency of lime. The patient is advised to drink plenty of fluids to speed up the removal of barium.
After each bowel movement, you should pay attention to the nature of the stool and notify the doctor if barium is not released from the intestines within 2-3 days.

Precautionary measures

The use of anticholinergic drugs is contraindicated in serious illnesses heart and glaucoma.
A contraindication to the use of glucagon is insufficiently compensated diabetes mellitus; glucagon should be used with caution in patients with type I diabetes mellitus.
Relaxation duodenography is contraindicated for stenosis of the upper gastrointestinal tract, especially caused by an ulcer or large space-occupying lesion.
The likelihood of gastroesophageal reflux in elderly people or those suffering from severe illness should be taken into account.
Relaxation duodenography is contraindicated during pregnancy due to its teratogenic effect.

Normal picture

After stretching the atonic intestinal wall by introducing barium and air, the mucous membrane should look smooth and uniform. The smooth contour of the wall of the duodenum bends around the unchanged head of the pancreas.

Deviation from the norm

Irregular outlines of the wall of the duodenum, the presence of protrusions and nodes on it are a sign of pathology (tumor of the hepatopancreatic ampulla or head of the pancreas, chronic pancreatitis). Clarification of the diagnosis requires additional studies, such as endoscopic retrograde cholangiopancreatography, determination of amylase activity in blood serum and urine, ultrasound or CT scan of the pancreas.

Factors influencing the result of the study

Failure to comply with the food ban may adversely affect the quality of the study.

B.H. Titova

"Relaxation (hypotonic) duodenography" and others

There are two types of duodenography - with a probe and without a probe. The study is carried out on an empty stomach. Under screen control, a duodenal tube is inserted into the patient into the descending part of the duodenum. 20 minutes before the X-ray examination, the drug metacin (2-4 ml of 0.1% solution) is administered intramuscularly, causing intestinal hypotension.

10 minutes after the injection, an additional 10-20 ml of a 2% novocaine solution is injected through a probe to anesthetize the duodenal mucosa. X-ray examination begins by introducing, under low pressure, through a probe an ordinary suspension of barium sulfate heated to 38 °C.

Pictures are taken in various projections in horizontal position sick. The relief of the intestinal mucosa is studied after suctioning the contrast mass with a syringe through a probe and introducing air into the intestine. Subsequently, this method of duodenography in a state of artificial hypotension of the duodenum1 was slightly modified: to obtain hypotension, 10 ml of a 10% solution of gluconate or calcium chloride and 1 ml of a 0.1% solution of atropine are administered intravenously.

In this case, anesthesia of the duodenal mucosa is not used, and the barium sulfate suspension is not specially heated. 10 minutes after intravenous injection A 10% solution of calcium chloride and a 0.1% solution of atropine is injected through a probe with a Janet syringe into the duodenum and 350-450 ml of a regular contrast mass at room temperature is injected into the duodenum.

The patient is in a horizontal position on his back during this procedure. Images are taken under screen control with the patient in the supine, abdominal, and oblique projections.

The relief of the mucous membrane is studied without additional suction of barium sulfate from the intestine, but with the obligatory introduction of 400-500 ml of air into it. Duodenography without a probe is usually used in the presence of pronounced functional changes that make tight filling difficult. Pharmacological drugs administered subcutaneously (1 ml of 0.1% atropine sulfate solution or 4-6 ml of 0.1% metacin solution) or intravenously (1 ml of 0.1% atropine sulfate solution). Then the patient drinks a portion of the contrast suspension, and the intestine is examined in different positions. Intestinal hypotension occurs after subcutaneous administration of the drug after 20-25 minutes, and after intravenous administration - after 7-10 minutes.

Recently, instead of atropine and metacin, Aeron (1-2 tablets under the tongue) has become widely used.

"Medical X-ray technology"
A.N. Kishkovsky, L.A. Tyutin

See what “Relaxation duodenography” is in other dictionaries:

- (syn. D. hypotonic) D., carried out under conditions of artificial intestinal hypotension caused by the use of anticholinergic drugs ... Large medical dictionary

See Relaxation duodenography... Large medical dictionary

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