General X-ray symptoms mainly expressed by a change in the pattern - the structure of the shadow picture abdominal cavity and is caused by the appearance of additional clearings and areas of shading, which can be reduced to the following symptoms.
1. Symptom of crescentic clearing or a symptom of the presence of free space under the right dome of the diaphragm. The mechanism of formation of this symptom is as follows. As is known, healthy person There is no free gas in the abdominal cavity. Due to perforation of the wall of any hollow organ: the stomach, duodenum, small or large intestine, most often due to an ulcerative process, gas from the lumen - the cavity of these organs rushes upward through the perforation, enters the free abdominal cavity and ends up under the right dome of the diaphragm when examining in vertical position sick.
Less common cause clusters free air in the abdominal cavity is uterine rupture, traumatic intestinal rupture, blowing fallopian tubes, peritonitis caused by gas-forming microbes. The accumulation of gas under the dome of the diaphragm due to artificial therapeutic and diagnostic pneumoperitoneum and after laparotomy does not present difficulties in interpretation - the anamnesis decides.
In other cases explanation The cause of this symptom requires some effort. In the vast majority of cases, this symptom is the result of a perforated ulcer of the stomach and duodenum.
In differential diagnostic terms the symptom of crescentic clearing, which arose due to perforation of a hollow organ, must be differentiated from interpositio colli - the penetration of the colon between the liver and the diaphragm. In this case, the accumulation of gas under the diaphragm will also be visible, but at the same time, shadow stripes - semilunar folds - will be revealed against the background of the gas accumulation.
2. Symptom of gas and liquid accumulation in the digestive tract or a symptom of “Kloiber cups”. The pathomorphological basis of this symptom, as the name implies, is abnormal - excessive accumulation of gas and liquid contents in the lumen of the intestine, especially the small one. Radiologically, the “Kloiber cup” is semicircular shape a gas bubble with a liquid level whose width is greater than the height of the gas bubble, if they are located in small intestine, and vice versa - the height of the gas bubble is greater than the width of the liquid level when the “bowl” is located in the large intestine.
Symptom of fluid accumulation and gas occurs in two varieties: typical “bowls” and “arches”. The “Kloiber cup” pattern is formed when a loop of intestine contains more fluid and a small amount of gas. “Arches” occur when, on the contrary, more gas accumulates in the intestinal loops than liquid, and on radiographs the gas is located in the upper part of the loop in the form of an arched clearing, under which horizontal levels of liquid are revealed.
Due to the change in quantity liquids and gas in the intestinal loops, “arches” can turn into “cups” and vice versa.
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1. b 2. b 3. d 4. c 5. b 6. c 7. c 8. a 9. d 10. c 11. c 12. c 13. b 14. b 15. d 16. a 17. d 18. c 19. a 20. b 21. b 22. c 23. c 24. c 25. a 26. c
"Acute abdomen" syndrome. Injuries and diseases of the rectum.
1. Free gas in the abdominal cavity is determined when
a) cholecystitis
c) appendicitis
2. Protective muscle tension typical for
a) acute peritonitis
b) edematous form of pancreatitis
c) intussusception
d) gastric bleeding
3. Sitkovsky’s symptom is observed when
a) acute cholecystitis
b) acute pancreatitis
d) renal colic
4. When stomach bleeding shown
a) X-ray of the stomach with barium
b) Ultrasound
c) emergency FGDS
d) emergency surgery
5. For "syndrome" acute abdomen" necessary
a) do a cleansing enema
b) administer an anesthetic
c) rinse the stomach
d) apply cold, urgently hospitalize the patient
6. Symptom characteristic of a reducible hernia
a) tense hernial protrusion
b) acute pain
V) positive symptom cough impulse
d) intestinal obstruction
7. Vomiting in acute pancreatitis
a) repeated, not bringing relief
b) one-time
c) repeated, bringing relief
d) absent
8. Cause of obstructive jaundice in cholecystitis
a) liver failure
b) blockage of the common bile duct by a stone
c) hemolysis of erythrocytes
d) metabolic disorder
9.Gastric perforation is characterized by
a) bloating
b) cramping pain
c) disappearance of liver dullness
d) retention of stool and gases
10. Girdle pain is observed when
a) pancreatitis
b) cholecystitis
c) spleen injury
d) perforated gastric ulcer
11. Reliable sign peritonitis
a) abdominal pain on palpation
b) non-passage of gases and feces
c) vomiting
d) symptoms of peritoneal irritation
12. Eventration is
a) inflammation of the peritoneum
b) intestinal strangulation in adhesions
c) exit of intestinal loops onto the anterior abdominal wall
d) discharge of intestinal contents from the wound
13. Syndrome characteristic of damage to the parenchymal organs of the abdominal cavity
a) acute peritonitis
b) dysfunction of the gastrointestinal tract
c) internal bleeding
d) acute respiratory failure
14. Peritonitis develops when damaged
a) kidney
b) intestines
c) anal canal
d) spleen
15. “Kloiber cups” on an x-ray are characteristic of
a) liver rupture
b) intestinal bleeding
c) intestinal obstruction
d) intestinal perforation
16. Used to stimulate the intestines in the postoperative period
a) 0.9% sodium chloride solution
b) oil enema
c) atropine
d) prozerin
17. Contraindications to surgery for acute appendicitis
a) old age
b) absent
c) hypertension
d) acute pneumonia
18. In case of acute peritonitis, surgery is performed
a) diagnostic
b) planned
c) urgent
d) emergency
19. Kocher's sign is observed in acute
a) appendicitis
b) cholecystitis
c) paraproctitis
d) pancreatitis
20.V general analysis blood in acute appendicitis
a) eosinophilia
b) anemia
c) leukocytosis
d) no changes
21. Nature and localization of pain in acute cholecystitis
d) “dagger” in the epigastrium
22. Symptom of acute cholecystitis
a) supply drop
b) Pasternatsky
c) Sitkovsky
d) Ortner
23. Treatment method for uncomplicated acute cholecystitis
a) surgical
b) conservative
c) physiotherapeutic
d) sanatorium-resort
24. A blood and urine test for amylase content is performed if there is a suspicion of
a) intestinal bleeding
b) acute proctitis
c) acute pancreatitis
d) acute peritonitis
25. Transportation of a patient with peritonitis is carried out
a) public transport
b) sitting
c) lying on a stretcher
c) lying on a shield
26. A “board-shaped” abdomen is observed when
a) liver damage
b) perforated gastric ulcer
c) gastric bleeding
d) acute appendicitis
27. In case of intestinal obstruction, stomach
a) not changed
b) board-shaped
c) asymmetrical, swollen
d) pulled in
28. Tactics of a paramedic for acute cholecystitis
a) cold on the stomach, hospitalization
b) a heating pad on the liver area
c) "blind probing"
G) choleretic agents on an outpatient basis
29. Tactics of a paramedic for a strangulated hernia
a) urgent hospitalization
b) a heating pad on the stomach
c) hernia reduction
d) cleansing enema
30. Nature and localization of pain in perforated gastric ulcer
a) constant, strong in the right iliac region
b) constant, sharp pains in the right hypochondrium
c) encircling, dull in nature
d) “dagger” in the epigastrium
31. Nature and localization of pain in acute appendicitis
a) permanent severe pain in the right iliac region
b) constant, sharp pain in the right hypochondrium
c) encircling, dull in nature
d) “dagger” in the epigastrium
32. Causes of anal fissures
a) proctitis
b) hemorrhoids
c) prolonged constipation
d) paraproctitis
33. The nature of pathological impurities in feces with hemorrhoids
a) blood mixed with feces
b) tarry stools
c) stool with mucus
d) blood is not mixed with feces
34. Hemorrhoids may become more complicated
a) thrombosis of hemorrhoids
b) inflammation of the skin around the anus
c) dermatitis
d) dyspepsia
35. Urgent Care for bleeding from hemorrhoids
a) cold on the anus area
b) cleansing enema
c) bandage with furatsilin ointment
d) gas outlet pipe
a) inflammation of the veins of the rectum
b) rectal prolapse
c) inflammation of the perirectal tissue
d) inflammation of the rectum
37. Symptoms of subcutaneous paraproctitis
a) tense blue-purple nodes in the anal area
b) cracks in the area of the posterior commissure
c) pain, swelling, redness of the skin around the anus
d) itching in the anal area
38. Cause of perirectal fistulas
a) non-radical treatment of acute paraproctitis
b) prolonged diarrhea
c) sedentary work
d) diet disorder
39. Tactics of the paramedic for prolapse of the rectal mucosa
a) administration of antispasmodics
b) lotions with a warm solution of furatsilin
c) repositioning of the rectal mucosa
d) administration of proserin
40. A reliable symptom of appendicitis
a) diffuse abdominal pain
b) nausea
c) bloating
d) Shchetkin-Blumberg symptom
41. Appendicitis is more common in children
a) neonatal period
b) up to 1 year
c) from 1 year to 3 years
d) after 3 years
42. In acute appendicitis, the patient is typically in a lying position
a) right side
b) left side
c) back, with the head end down
d) stomach
43. A disease most often complicated by peritonitis
a) acute intestinal obstruction
b) acute appendicitis
c) acute cholecystitis
d) acute pancreatitis
44. The main thing in the treatment of pancreatitis is the use
a) antibiotics
b) antispasmodics
c) painkillers
d) protease inhibitors
45. Endoscopic method for the diagnosis of rectal cancer
a) digital examination
b) irrigoscopy
c) Ultrasound
d) sigmoidoscopy
46. Cause of obstructive intestinal obstruction
a) fecal stones
b) intestinal spasm
c) strangulated hernia
d) intestinal paresis
47. A “sickle” of air during radiography of the abdominal cavity is characteristic of
a) intestinal obstruction
b) perforated ulcer
c) bleeding ulcer
d) pancreatitis
48. A complication of gastric ulcer is
a) intestinal obstruction
b) strangulated hernia
c) ascites
d) perforation
49. Obstructive jaundice is a complication
a) acute peritonitis
b) acute appendicitis
c) acute cholecystitis
d) acute gastritis
50. The main thing in the treatment of peritonitis is
a) antibiotic therapy
b) laparotomy
c) detoxification therapy
d) laparoscopy
51. The operation of opening the abdominal cavity is called
a) necrotomy
b) strumectomy
c) laparotomy
d) thoracotomy
52. Vomiting that does not bring relief is characteristic of
a) catarrhal appendicitis
b) chronic cholecystitis
c) acute pancreatitis
d) irreducible hernia
53. A tympanic sound during percussion of a hernial protrusion indicates the presence of a hernial sac.
a) oil seal
b) intestinal loops
c) bladder
d) ureter
54. Paramedic tactics for “acute abdomen”
a) administration of analgesics
b) gastric lavage
c) eating and drinking
d) applying cold to the abdominal area
55. Symptom of acute appendicitis
a) pain in the epigastrium with transition to the right iliac region
b) pasty stool
c) debilitating vomiting
d) significant intoxication
An X-ray of the stomach is performed with contrast enhancement. For these purposes, a person takes half a glass of barium sulfate solution (the dosage varies depending on the purposes of the study). A provocative test is preliminarily carried out to exclude allergic reactions for this water-insoluble contrast.
If not observed within 15 minutes skin rashes and other changes in the patient’s body, proceed to fluoroscopy. In case of allergies, the test is not performed.
To identify pathology in the stomach, there are certain pathological syndromes. When interpreting the radiographs, the radiologist describes them and forms an analytical conclusion based on a comparison of the detected pathological signs.
What can be determined on an x-ray of the stomach
A number of x-ray symptoms can be identified on an x-ray of the stomach:
- Serpa.
- Syringe.
- Flows.
- Filling defect.
- Kloiber bowls.
When using the double contrast technique (barium and air), it is possible to assess the state of the relief of the mucous membrane of the esophagus and stomach. Normally, the wall of these organs consists of protrusions and concavities. In the esophagus they are directed longitudinally from top to bottom, and in the stomach they have a tortuous course. In the presence of inflammatory diseases, cancer, ulcerative defects, the grooves change direction, decrease or increase (with Ménétrier's disease).
On normal contrast radiograph a change in the relief of the mucous membrane is not detected, since folds are not visible against the background of barium. Studying with air allows you to evenly distribute contrast particles in the grooves, which allows you to clearly trace their contours.
At pathological changes Additional shadows (contrast accumulation) and highlights also appear.
An X-ray of the stomach is informative when mastering gastrography tactics and using several examination methods simultaneously. Its quality significantly depends on the qualifications of the radiologist.
What does the “sickle” symptom on a gastrogram indicate?
The “sickle” symptom on the gastrogram appears when air accumulates in the upper part of the abdominal cavity. The cause of the pathology is a rupture of the intestinal wall with the release of free air during intestinal obstruction, ulcerative defects and necrotizing colitis (inflammation of the intestine with death of the epithelium).
Positioning the patient for abdominal radiography in lateral projection
How to identify the “sickle” symptom in an image:
- a strip of clearing under the right dome of the diaphragm with the patient in an upright position;
- clear upper contour of the liver;
- absence of additional shadows against the background of enlightenment
This symptom requires differential diagnosis with the insertion of the colon between the diaphragm and the liver (interpositio colli). This is quite easy to do. It is necessary to observe on the radiograph under the diaphragm the presence or absence of folds formed by intestinal constrictions.
Identifying a “sickle” in an image requires immediate surgical treatment to save a person's life. Otherwise, peritonitis (inflammation of the peritoneum) will develop and the person will die from painful shock.
X-ray symptom of “Kloiber cup”
X-ray of the stomach: Kloiber cups with colonic (the width of the horizontal liquid level is greater than the height of the cup) and small intestinal obstruction “Kloiber cups” appear on the gastrogram in the presence of intestinal obstruction (mechanical or spastic). At the interface between the intestinal contents and air, darkening with a horizontal level can be traced, which are clearly visible on the x-ray.
How to identify “Kloiber cups” in an image:
- rounded clearing in the projection of the intestine;
- liquid level with a width greater than the gas bubble (in the large intestine);
- detection of “bowls” or “arches” (2 types of X-ray symptoms of intestinal obstruction).
When the amount of air content in the intestines changes, the cups can turn into arches and vice versa.
What does a “filling defect” mean on a stomach image?
A “filling defect” in an image of the stomach means partial disappearance of the anatomical contour of the organ wall due to the growth of a pathological formation. Radiologists call this the “minus shadow plus tissue” symptom. The defect is formed due to the presence of additional tissue, which disrupts the normal x-ray anatomy of the organ structure.
How to detect a filling defect on a gastrogram:
- lack of physiological contour of the stomach wall;
- atypical relief of the mucous membrane;
- uneven, unclear, jagged contours.
By the location of the “filling defect” one can distinguish benign tumor from malignant. With the central location of the “plus tissue” and a slight change in the relief of the folds of the stomach, one can assume the benign nature of the formation.
At malignant tumors in the “filling defect” one can identify the symptom of a “niche” when organ tissue is destroyed. A “niche” for cancer is different from a peptic ulcer. It is wide, but not deep. A series of gastrographs show an increase in the crater mainly in width.
What does the “niche” symptom show?
X-ray photo: ulcerative symptom niches (indicated by an arrow) with a “pointing finger” on the opposite side due to contraction of the muscles of the greater curvature This symptom indicates destructive cancer or peptic ulcer. The ulcerative defect has a smooth, clear contour. Its width significantly exceeds the depth of the shadow. Sometimes radiologists describe this symptom as “a niche in a filling defect.” This description indicates that an infiltrative shaft has been formed around the ulcer, which leads to the appearance of “plus tissue” on the radiograph. It has no form large sizes and decreases over time.
A benign ulcer is localized on the lesser curvature of the stomach, and on the opposite side a spastic contraction of the greater curvature is detected.
How to detect cancer “niches” in an image (symptoms of “syringe” and “wraparound”):
- are localized in the stomach most often along the greater curvature;
- lead to deformation of the fundus or esophagus;
- the symptom of “syringe” and “flow around” is concentric compression of the stomach by a tumor with a decrease in its size on an x-ray.
How to identify an ulcer on a stomach image
The main radiological manifestation of an ulcer in the image is the “niche” symptom. It is a crater, the length of which is perpendicular to the wall of the organ.
With contrast gastrography, barium fills the “niche”, so it is clearly visible on the lateral image. On the anterior gastrogram the symptom can be traced in the form of an even round spot.
How to identify ulcers in a stomach image:
- oval and clear contours;
- swelling of the folds of the mucous membrane (“filling defect”);
- narrow and deep “niche”;
- infiltrative shaft due to inflammatory or sclerotic changes in the mucous membrane;
- the “pointing finger” symptom is an indentation on the opposite contour of the stomach due to muscle spasm.
How to detect early stage cancer on a stomach x-ray
The increasing number of patients with stomach cancer requires doctors to identify malignant tumors on early stages. When tumors are detected gastrointestinal tract Contrast radiographic studies play a leading role.
How to detect early stage cancer:
- Do not forget about studying the relief, since many tumors begin to grow in the submucosal layer.
- The absence of organ folding on an x-ray may be a sign malignant neoplasm. To detect pathology, double contrast is necessary.
- An increase in the distance between the diaphragm and the gas bubble can occur not only with the “sickle” symptom, but also with cancer of the subcardial part of the stomach.
- Carefully examine the gas bubble of the stomach in the image. Its shape changes when the organ is bent, which is often found in tumors of the cardiac region.
- An inflection (the “waterfall” symptom) often occurs with cancerous ulceration of the greater curvature.
To detect the above-described x-ray symptoms, it is important to conduct a polypositional examination of the patient and use different techniques. It is necessary to take pictures in a horizontal, vertical and lateral position of a person on an x-ray diagnostic table during fluoroscopy of the gastrointestinal tract. They will help identify additional signs pathologies that the doctor did not notice during X-ray examination.
For patients, we remind you that the effectiveness of diagnosing gastrointestinal pathology significantly depends on the quality of intestinal cleansing at the stage of preparation for the study. Follow the radiologist's recommendations carefully!
Detectable when X-ray examination abdominal organs - a narrow crescent-shaped strip of clearing between the liver and diaphragm; a sign of perforation of the stomach or intestines caused by the presence of gas in the abdominal cavity.
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