Methods of examination of the gastrointestinal tract. How to check the stomach and what tests are needed for this How to check the stomach in adults

An examination of the intestines will be required if the following phenomena are of concern:

• persistent constipation or diarrhea;
• the presence of various impurities (blood, mucus and others) in the stool;
• sudden weight loss that is not due to obvious reasons (for example, a strict diet);
• various types of pain in the area anus or stomach;
• the presence of a foreign object in the intestine;
• bloating.

Diagnosis of the stomach is necessary if you suspect:

• gastritis, pancreatitis and peptic ulcer;
• internal bleeding;
• cholelithiasis;
• malignant tumors.

An examination is prescribed if nausea with bouts of vomiting, pain in the left side of the abdomen, belching, heartburn are often disturbed.

Existing Methods

For dysfunction of the digestive tract, the following diagnostic methods are used:

• external examination (physical examination);
• laboratory research;
• instrumental diagnostics;
• radiation examination.

The first two methods help to make a preliminary diagnosis. The latter confirm the assumptions and allow you to choose the optimal treatment.

Visual inspection

The physical examination involves assessing the condition of the skin and oral cavity, as well as superficial and deep palpation. If, as part of the last procedure, the patient experiences severe pain, then this symptom indicates deviations in the work of the gastrointestinal tract.

Additionally, during a physical examination, an examination of the area in the anus is carried out to detect cracks, neoplasms and hemorrhoids.

Laboratory research

In the laboratory, blood and stool tests are carried out. The first is used to detect the presence of foci of inflammation in the body. Analysis of fecal masses is prescribed for suspected helminthic invasion and other disorders. The latter are diagnosed through a coprogram. This method is used to assess changes in the color, texture and smell of stools, which may indicate dysfunction of the digestive system.

If necessary, an analysis is carried out for dysbacteriosis, characteristic of some pathologies of the gastrointestinal tract.

Instrumental diagnostics

To confirm the preliminary diagnosis is used:

1. Abdominal ultrasound. It is prescribed for pain in the abdomen. Ultrasound helps to assess the nature of the location and degree of filling of the stomach and intestines. Also, with the help of a diagnostic apparatus, tumors of a different nature are detected.
2. Sigmoidoscopy. The method helps to identify changes in the structure of the intestinal mucosa.
3. Colonoscopy. The procedure is similar to sigmoidoscopy. The difference lies in the fact that during a colonoscopy, tissue is taken for subsequent histological examination and (if necessary) tumors are removed.
4. Endoscopy. The method is similar to the previous ones, except that during this procedure the tube is inserted through the pharynx.
5. Laparoscopy. A minimally invasive operation that allows diagnosing ascites, neoplasms, the consequences of mechanical damage and other changes in the structure of the abdominal organs.

If there are appropriate opportunities, the examination of the stomach is carried out using a gastropanel, which provides for the intake of a special stimulant and a subsequent blood test. The method allows you to determine the rate of assimilation of soy or food proteins by the body.

In some cases, it is used capsule diagnostics, in which the patient needs to swallow two capsules with chambers. The procedure is similar to endoscopy.

Radiation examination

In case of detection of neoplasms or stones in the digestive tract, the following is used:

1. CT scan. Allows you to identify minor tumors and stones.
2. Irrigoscopy with barium. Provides comprehensive information about the state of organs.
3. Radiosotropic scan with contrast agent. Helps diagnose tumors and assess intestinal motility.

Many of the procedures described are painful and require the use of anesthetics. After the diagnosis of the gastrointestinal tract, complications rarely occur.

Heading materials

Preparation for an appointment with a proctologist is a series of activities aimed at cleansing all parts of the intestine. Restriction of food intake is shown, in some cases short fasting, cleansing enemas, taking laxatives. To determine the problem, the doctor must see the condition of the mucous membranes and epithelium of all parts of the intestine. Therefore, it is necessary to empty the digestive organ before a visit to a highly specialized specialist.

Recently, more and more patients of different ages are faced with diseases of the gastrointestinal tract. In order to make a competent diagnosis and prescribe a suitable treatment method, the proctologist needs to visually examine the walls of the colon, assess the condition of the tissues. This can only be done with a colonoscope.

FGDS under anesthesia allows you to reduce discomfort and discomfort during the procedure. Manipulation provides a normal mental state of the patient. The specialist in this case, when performing FGDS, is not distracted by the patient.

Or they are at risk, they often ask the question: how to check the stomach and intestines? There are a large number of diagnostic methods that are characterized by high efficiency and allow you to accurately determine the disease.

Doctors quite often prescribe a colonoscopy.

If a patient has pathological changes in the intestines or stomach, then he must undergo an instrumental examination without fail. Doctors in most cases recommend:

1. Magnetic resonance imaging;
2. PET scan;
3. Computed tomography;
4. Capsule endoscopy;

With the help of these methods, it is possible to examine the gastrointestinal tract, as well as to determine the presence of diseases. Some research methods require the use of anesthesia, as a person will not be able to endure the intervention. The choice of a particular research method directly depends on the characteristics of the development of the disease and the preliminary diagnosis.

Features of PET scanning and computed tomography

PET - scanning - as an effective diagnostics.

Computed tomography and PET scans are often used to examine the large and small intestines.

With the help of these research methods, visualization of the affected organs is carried out.

During the diagnosis, the doctor receives an image on a radiograph or computer monitor.

The equipment used for diagnostics visualizes the status internal organs through the use of methods such as magnetic field, ultraviolet waves, x-rays.

Thanks to the use of a computer, it is possible to obtain several multi-layered images of the stomach and intestines, which greatly simplifies the process of studying the state of these organs for the doctor.

With the help of this research method, an assessment is given not only to the internal, but also to the external contour. Before the scan, the patient is given a contrast agent. It can also be administered intravenously during the computed tomography.

During the diagnostic period, images are taken in a special camera. That is why if the patient has claustrophobia, he is not recommended to conduct a study. Also, diagnosis is not carried out with excessive obesity of the patient. Virtual colonoscopy is one of the types of computed tomography.

During the period of using this method, it is possible to obtain images that have a three-dimensional image. This diagnosis is quite informative in the presence of growths on the walls of the intestine, the size of which is more than one centimeter.

PET diagnostics is the use of radioactive sugar, which is used to obtain images of the large and small intestines. It is injected into the patient intravenously before the study.

For diagnostics, positron emission equipment is used, which is equipped with a special table for patient positioning. The duration of the study is on average half an hour.

If a patient has been previously diagnosed by a doctor or early oncology, then this method is not used to confirm the diagnosis. But, with its help, the level of anomalies of the inflamed intestinal wall, which was previously revealed by the tomogram, is checked.

In case of bowel cancer, using this method of research, the presence of metastases is checked lymphatic system and nearby organs. Thanks to the possibility of simultaneous use of computed tomography and a PET scanner, the doctor can compare the images and establish the diagnosis as accurately as possible.

To get a more complete picture, the doctor very often prescribes a surrender.

What is capsule endoscopy, the video will tell:

Performing ultrasound and MRI

Ultrasound is one of the diagnostic methods.

In order to check the intestines and stomach for development oncological diseases ultrasound is used.

It is used for fairly large tumors. If the patient has early or polyps in the organs of the gastrointestinal tract, then this method is not used for diagnosis.

In some cases ultrasound procedure used to determine the metastases of intestinal cancer in other organs.

If the patient is previously diagnosed with rectal cancer, then endorectal ultrasound is used to confirm this diagnosis. For this purpose, a special device is used, which is inserted into the patient through the rectum.

Endorectal ultrasound makes it possible to determine the prevalence of pathological foci and the presence of pathological processes in the rectum and neighboring organs.
Magnetic resonance imaging can be used to diagnose diseases of the stomach and intestines.

When it is carried out on a computer screen, images are obtained that display sections of the patient's body. This research method uses radio waves and strong magnets. During the period of examination, the human body absorbs energy, which is displayed by the picture. Thanks to the presence of a special program in the tomograph, the template is converted into an image.

Before the study, a drug is administered to a person, which includes gadolinium. The distribution of the substance throughout the patient's body is carried out in different ways, depending on the location of the disease.

This makes it possible to distinguish between healthy and diseased tissues of the stomach and intestines. Compared to computed tomography, magnetic resonance imaging transmits clearer images. If the patient has kidney failure this diagnostic method is not applicable. Capsule endoscopy is most commonly used to determine.

This research method is based on the use of a capsule that has a built-in wireless camera of the smallest possible dimensions. Thanks to this device, it is possible to obtain photographs of the stomach and intestines. The video tablet makes it possible to examine hard-to-reach areas. Unlike endoscopy, this method examines the small intestine.

Ultrasound, magnetic resonance imaging and capsule endoscopy are highly effective diagnostic methods that are characterized by a minimum number of contraindications.

Features of laparoscopy and endoscopy

A laparoscope is an instrument for performing laparoscopy.

If the diagnostic case is unclear, then laparoscopy is used.

With the help of this method of research, the depth of the lesion of the stomach is determined. This method can be used not only for diagnostics, but also for surgical interventions. With the help of laparoscopy, the determination of stomach cancer is carried out, as well as the degree of spread to neighboring organs.

During the study, a special instrument is used - a laparoscope. Initially, anesthesia is administered to the patient. After that, an incision is made, the dimensions of which reach from 0.5 to 1 centimeter.

Through it, a device is introduced, with the help of which carbon dioxide is pumped into the stomach. Due to this, the organ is enlarged, which allows you to get the most detailed picture. Next, the laparoscope is inserted into the resulting space.

Standard laparoscopy does not make it possible to determine the presence of metastases in. For this purpose, the use of laparoscopic ultrasonography is carried out, which makes it possible to examine the organs of the abdominal cavity. For this purpose, special laparoscopic sensors are used. With their help, the study of hard-to-reach areas is carried out.

Laparoscopy is practically the only diagnostic method by which metastases are determined before surgery. Endoscopy is performed using a special device - an endoscope.

It has a small camera that connects to the computer screen. Using this method, the upper parts of the digestive tract are examined. The endoscope tube during the study period must be swallowed by the patient.

Before this, the throat is irrigated with the use of anesthetics. This provides a simplification of the overcoming process. With the help of the camera during the study period, the walls of the stomach are examined. The doctor looks through the pictures taken by the camera in the eye of the endoscope.

This research method allows you to take a biopsy. In some cases, with the help of an endoscope, a catheter is inserted and all ducts are filled with radiopaque. This makes it possible to conduct x-rays of the gastrointestinal tract.

A variety of research methods can be used to determine the condition of the stomach and intestines. They should be chosen only by a doctor in accordance with the indications and individual characteristics of the patient.

In gastroenterological practice, there are a considerable number of different diseases, some of which can be very dangerous and lead to the development of severe complications.

According to statistics, every second person on earth suffers from one or another pathology of the digestive system. That is why it is extremely important to conduct a timely examination of the gastrointestinal tract (GIT), which will allow the specialist to develop an effective treatment strategy.

Today, there are quite a few modern diagnostic methods that allow for a comprehensive study of all organs and departments of the gastrointestinal tract, to identify the disease as soon as possible and with maximum reliability, to clarify its stage, prevalence and other features.

Research methods used in gastroenterology can be divided into three groups:

• physical;
• laboratory;
• instrumental.

Instrumental methods, in turn, can be divided into secretion studies, endoscopic and radiation studies.

The expediency of prescribing a particular examination will be determined by the doctor in the process of working with the patient.

Contraindications

Each of the methods of examining the stomach has its own contraindications, which should be clarified with a doctor. Physical, radiation and laboratory techniques have practically no contraindications - most of the prohibitions relate to endoscopic techniques, as they involve interference with the work of the stomach and intestines, and in some diseases can cause side effects.

Absolute contraindications to gastroscopy, EGD and other endoscopic techniques include:

• severe mental disorders;
• diseases of the cardiovascular system (heart failure, heart attack, atherosclerosis, aortic aneurysm);
• depletion of the body;
• serious disorders of the immune system;
• obesity;
• rachiocampsis;
• hematopoietic disorders;
• phlebeurysm;
• acute period peptic ulcer stomach.

Relative contraindications include: angina pectoris, exacerbations of chronic diseases of the gastrointestinal tract and upper respiratory tract, neurasthenia, swollen lymph nodes.

To find out in what ways it is better to conduct an examination of the stomach and intestines in a particular case, you need to show the doctor a medical card and, if necessary, undergo a comprehensive examination of the body.

Preparation for examination of the gastrointestinal tract

To get accurate results of the diagnosis of the gastrointestinal tract, you need to properly prepare for any examination. Preparation depends on the research method and most often consists of the following:

• diet, which must be observed for 2-3 days before the examination - you need to eat only easily digestible food, exclude foods, causing flatulence and bloating;
• taking drugs for bowel cleansing or enemas (need try to clear the digestive tract completely so that the doctor can examine the entire abdominal cavity);
• stop taking medications, especially those that affect digestion, thin the blood and contain iron (if this is not possible, it is necessary to report all medicines to the doctor);
• 1-2 days before the visit to the clinic, you need to abandon serious physical activity, use alcoholic beverages and smoking.

Most studies are performed on an outpatient basis, but in some cases, patients have to go to the hospital.

Adults usually do not require any additional medicines, but children are sometimes given general anesthesia (during gastroscopy and other endoscopic studies). When conducting a diagnosis, the patient needs to carefully listen to the doctor and follow all his instructions so that the procedure is as informative and painless as possible.

Is there an alternative to gastroscopy?

Gastroscopy is an unpleasant research method, and many patients are interested in the question: is it possible to do without it during a comprehensive examination of the gastrointestinal tract? The use of modern computer techniques (CT, MRI) allows you to minimize discomfort, but they do not always give an accurate result, and the procedure is quite expensive and is not offered in all medical institutions.

An alternative to invasive methods can be a capsule technique - endoscopy of the gastrointestinal tract using a capsule. Its essence is as follows: the patient swallows a capsule equipped with a miniature video camera, which takes one picture of the organ every second. It passes through the entire gastrointestinal tract, after which it leaves it naturally, and the doctor reviews the obtained images, identifies pathologies and makes a diagnosis. The capsule technique is considered the "gold standard" for the diagnosis of the digestive tract, but is used only in modern gastroenterological centers.

Some medical institutions use non-traditional methods for diagnosing diseases - for example, iridology. It is based on the theory that all pathological processes occurring in the body can be detected by examining the iris of the eye. The use of such diagnostic methods raises many questions among many specialists, therefore, it cannot be considered an informative technique.

You can do without the unpleasant procedure of probing the stomach and intestines, but if other diagnostic methods do not give a complete picture of the disease, it is better to agree to gastroscopy.

Physical research

The first stage of a gastroenterological examination is a consultation with a gastroenterologist or therapist, who must collect an anamnesis of the patient's complaints and compile an overall clinical picture. The doctor conducts a more detailed examination using special methods: palpation, percussion, auscultation.

Palpation is a procedure in which the patient's abdomen is felt without the use of any additional instruments. This method allows you to detect certain signs characteristic of some diseases of the gastrointestinal tract, in particular, to identify the degree of tension of the peritoneal wall and painful areas. Palpation can be performed while the patient is standing or lying on the couch. In a standing position, palpation is performed in cases where it is necessary to examine the organs located on the sides of the abdominal cavity.

Usually, simultaneously with palpation, percussion- a study that allows you to determine the boundaries of the location of the organs of the gastrointestinal tract by tapping. In gastroenterological practice, this technique is mainly used to study the spleen and liver.

Diagnosis by auscultation involves listening to the sounds that the organs of the gastrointestinal tract emit. To do this, the doctor uses a special tool - a stethophonendoscope. During the procedure, symmetrical parts of the body are listened to, and the results are then compared.

The above diagnostic studies are only primary and do not allow a specialist to accurately diagnose a particular gastrointestinal disease. So, for example, physical methods practically do not allow a specialist to identify organic pathologies of the organs of the gastrointestinal tract with a predominant lesion of their mucous membrane. This requires a more complete examination, the plan of which is drawn up individually for each patient and may include a number of different clinical, laboratory and instrumental methods.

Laboratory tests

Laboratory diagnostics plays an important role in the detection of many diseases of the gastrointestinal tract. At the discretion of the doctor, the patient may be assigned blood tests to determine the following substances and enzymes:

bilirubin- a special substance formed after the breakdown of erythrocyte hemoglobin and which is part of bile. The detection of direct bilirubin in the blood may indicate a number of pathologies of the gastrointestinal tract associated with a violation of the outflow of bile, for example, obstructive or parenchymal jaundice;

transaminases: aspartate aminotransferase (AST) and alanine aminotransferase (ALT) - these enzymes function in almost all organs of the human body, especially in the liver and muscle tissues. An increased concentration of AST and ALT is observed in various hepatic diseases, including chronic ones;

gamma-glutamyl transpeptidase (gamma-GT)- another enzyme, an elevated level of which indicates inflammation of the bile ducts, hepatitis or obstructive jaundice;

amylase- this enzyme is produced by the pancreas, and as part of its juice, amylase enters the intestine, where it contributes to the accelerated digestion of carbohydrates. If the level of amylase in the blood is elevated, most likely the patient has some kind of pancreatic disease;

lipase- another enzyme produced by the pancreas, the level of which increases with pancreatitis and other pathologies of the digestive system.

In addition, a general analysis of feces is mandatory, which will allow the specialist to assess the overall functioning of the digestive system, detect signs of disorders and inflammation of various parts of the intestine.

In addition, the study of feces can detect microorganisms that are the causative agents of infectious diseases.

A more detailed study of feces is called a coprogram. With its help, the digestive and enzymatic activity of the stomach is assessed, signs of inflammation are revealed, microbial activity is also analyzed, fungal mycelium can be detected.

Can be assigned if needed bacteriological examination, that is, the determination of the microbial composition. This will detect intestinal dysbacteriosis, infections. There are also special tests for the detection of antigens of microbial pathogens, making it possible to identify viral infectious diseases.

Another common laboratory test widely used in gastroenterology is the occult bleeding test. This analysis is based on the detection of latent hemoglobin in the feces.

If the patient is taking iron supplements or other medications, the attending physician must be informed about this, as medications can significantly distort the results of the tests. Before donating blood, you must follow a special diet for several days, excluding fatty foods, meat, green vegetables and tomatoes from the diet.

If necessary, laboratory diagnostics of the gastrointestinal tract can be supplemented by such studies as enzyme-linked immunosorbent assay (ELISA) of feces and blood plasma.

Instrumental techniques

The most important section of a comprehensive examination of patients with gastrointestinal pathologies is instrumental diagnostics. It includes endoscopic, radiological, ultrasound, electrometric and other diagnostic techniques.

The appointment of a study in order to obtain the most common information is at the discretion of the attending physician, depending on the available information. clinical picture. Each of the instrumental methods makes it possible to evaluate the structural and morphological features of the organ under study, as well as its function. Most of these studies require special preparation from the patient, since their information content and reliability will depend on it.

Assessment of gastric acid secretion

Since the majority inflammatory diseases digestive system are characterized by a change in the acidity of the stomach. That is why, during a diagnostic examination, an assessment of the secretion of gastric acid necessary for adequate digestion of food, using a special technique called pH-metry, can be shown. Indications for its implementation is peptic ulcer duodenum and stomach, chronic duodenitis, gastritis and other pathologies of the gastrointestinal tract.

There are several types of pH-metry in gastroenterology: short-term (intragastric), long-term (daily), endoscopic. Each of these methods involves the introduction of a pH-metric probe through the mouth or nasal opening into the corresponding section of the digestive system for a certain period. The level of acidity is measured at a specific point using built-in electrodes.

In endoscopic pH-metry, the probe is inserted through a special instrumental channel of the endoscope.

Any type of pH measurement requires some preparation. First, the patient should not smoke or eat at least twelve hours before the procedure. Secondly, a few hours before the study, the use of any liquids is prohibited, in order to avoid the occurrence of vomiting and aspiration. Additionally, you should consult with your doctor about the medications you are taking.

Another common procedure used in gastroenterological practice for suspected gastritis, peptic ulcer and many other pathologies is duodenal sounding of the stomach. When conducting a study of the secretory function of the stomach in this way, all contents are first pumped out of the stomach, and then the basal secret. After that, the patient is stimulated with secretion with the help of special preparations or is given a trial breakfast in the form of broth, after half an hour a fifteen-minute secretion is taken, which is then studied in the laboratory. The procedure is performed under local anesthesia on an empty stomach.

Gastric probing is a procedure that has a number of contraindications. It cannot be carried out in case of severe pathologies of the cardiovascular system, gastric bleeding, as well as during pregnancy.

If the patient has contraindications to duodenal sounding of the stomach, secretion is assessed by a tubeless method using the Acidotest preparation. The test is also carried out in the morning on an empty stomach. Analysis of the secretory function of the stomach is carried out by examining portions of urine after taking the drug.

Endoscopic techniques

Endoscopic examination of the organs of the gastrointestinal tract involves the introduction of special optical instruments into its lumen.

To date, this is the most technologically advanced procedure that allows you to get a complete picture of the condition and functioning of the large and small intestines, as well as to conduct a biopsy - to obtain a sample of material for further histological examination.

The endoscopic methods for examining the gastrointestinal tract include the following diagnostic procedures:

FGDS (fibrogastroduodenoscopy) is a whole complex of gastroenterological studies, which consists in examining the organs of the gastrointestinal Tartak using a probe. Depending on the diagnosed disease, the patient may be prescribed procedures such as gastroscopy (examination of the stomach), duodenoscopy (examination of the duodenum), esophagoscopy (examination of the esophagus); colonoscopy examination of the inner surface of the large intestine using a colonoscope inserted into the anus. Today, such an ultra-modern method as virtual colonoscopy is also used, in which you can get a clear image of the intestinal walls using computed tomography; sigmoidoscopy a high-tech method for examining the mucous membrane of the rectum using a special optical device - a sigmoidoscope. It is inserted through the anus for only a few minutes, and anesthesia is usually not required; ERCP (endoscopic retrograde cholangiopancreatography) is an additional diagnostic procedure aimed at examining the condition of the bile ducts, into which a contrast agent is injected using endoscopic equipment. After that, an x-ray is taken; Capsule endoscopy is the most advanced way to examine all parts of the gastrointestinal tract. The patient is required to swallow a small capsule equipped with a mini video camera, which will transmit images to a computer as it progresses, after which it will come out naturally.

This procedure allows to diagnose oncological tumors and other pathologies with high accuracy;

Diagnostic laparoscopy, this procedure is usually prescribed in cases where it is not possible to accurately determine the cause of the disease. When it is carried out, a puncture is performed in the anterior abdominal wall, through which carbon dioxide is first pumped, and then endoscopic equipment is introduced. Using this imaging method, you can detect bleeding, foci of inflammation and other pathologies, and, if necessary, immediately take therapeutic measures.

As a rule, endoscopic methods for examining the gastrointestinal tract are not used if the patient has an allergy to anesthetic drugs, as well as pathologies associated with impaired blood clotting. In addition, they all require special training, which will be discussed in detail by the attending physician.

Radiation techniques

As the name implies, it is customary to refer to radiation methods for examining the gastrointestinal tract those that involve the use of radiation. The most widely used in gastroenterology are the following methods:

Fluoroscopy or radiography study of the abdominal organs by performing x-rays. Usually, before the procedure, the patient needs to consume barium porridge, which is opaque to x-rays and makes it possible to visualize almost all pathological changes well; ultrasound examination of the abdominal cavity examination of the organs of the gastrointestinal tract using ultrasound radiation. A variety of ultrasound is the so-called dopplerometry, which allows you to assess the speed of blood flow and movement of the walls of organs; scintigraphy study of the activity of the gastrointestinal tract using radioactive isotopes that the patient consumes with food. The process of its progress is fixed with the help of special equipment; computer and magnetic resonance imaging, these studies are prescribed only when absolutely necessary, if you suspect tumor neoplasms, cholelithiasis and other pathological conditions.

Histological methods

Examination of the gastrointestinal tract sometimes requires a biopsy - this is an analysis of pieces of mucosal tissue (biopsy specimens) taken during endoscopic examination. A biopsy is performed to make an accurate diagnosis, determine the stage and characteristics of the pathological process in gastritis, peptic ulcer, gastric and intestinal neoplasms, and to evaluate the effectiveness of treatment. Biopsy specimens are processed in an appropriate way, after which they are examined under a microscope, which allows you to get a complete picture of the disease.

The disadvantage of the histological method is that it often causes side effects and bleeding.

Possibilities of modern gastroenterology

Today, many modern clinics offer their patients a service such as a comprehensive examination of the gastrointestinal tract, which can be done, both if you suspect a disease of any organ of the digestive system, or for preventive purposes. Comprehensive diagnostics involves the use of a combination of various methods that allow you to assess the state of the organs of the gastrointestinal tract, to get the most complete picture of the existing violations.

Such an extended diagnosis may be necessary for those patients who suffer from a complex disease of unknown etiology, accompanied by metabolic disorders and other serious symptoms. The capabilities of modern gastroenterological clinics allow for a comprehensive examination of patients using the latest generation of medical equipment, with which you can get the most accurate research results in a short time.

The list of analyzes and studies carried out may vary depending on the specific diagnostic program.

Pathology detected: is it necessary to double-check?

If pathologies of the gastrointestinal tract are detected after a comprehensive diagnosis, the patient is prescribed a course of treatment, but there are situations when patients do not agree with the diagnosis. If the examination was carried out in a free clinic using old equipment, it can indeed be erroneous. To prevent unpleasant consequences, you can undergo control diagnostics in a more modern medical institution.

Stages of a complete examination of the digestive organs and their cost

A complete examination of the gastrointestinal tract usually includes the following steps:

• consultations of specialists (therapist, gastroenterologist);
• blood tests: general, biochemical, liver tests, tests for infections, including hepatitis and Helicobacter pylori;
• Ultrasound of the abdominal cavity;
• gastroscopy.

The cost of the basic research program is about 20 thousand rubles, but may vary depending on additional procedures and the pricing policy of the medical institution.

Time to complete the full study

The time of complex diagnostics depends on the number of procedures that need to be completed - the basic program usually takes 1-2 days, but if additional studies are necessary, the period may be delayed.

After the age of 40, a complete examination of the gastrointestinal tract is recommended once a year, even in the absence of digestive problems. People at this age significantly increase the risk of developing serious diseases, including oncological processes, and with early diagnosis, the chances of a full recovery increase significantly.

How to check the gastrointestinal tract quickly, cheaply and informatively?

For a quick and informative check of the gastrointestinal tract, you need to find a good gastroenterological clinic with modern equipment.

Diagnostics can be done at any public medical institution, where some services are provided free of charge, but in this case, the time for completing all procedures will increase significantly.

conclusions

1. Comprehensive diagnosis of the gastrointestinal tract may include different procedures, depending on the primary diagnosis, age and well-being of the patient.
2. The key to obtaining accurate examination results is proper preparation, which begins a few days before the visit to the clinic.
3. Most diagnostic procedures are painless and safe, with the exception of endoscopic techniques, which are associated with certain discomfort and the risk of side effects.
4. To reduce the time required for a complete examination of the digestive system, reduce the likelihood of discomfort and misdiagnosis, you need to go to a good clinic with modern equipment.

A comprehensive study of the gastrointestinal tract is a guarantee of the health of the digestive system and a way to avoid serious health problems that can lead to digestive disorders.

Diagnostics should be carried out regularly even in the absence of symptoms of diseases for preventive purposes and carefully monitor the condition of the stomach and intestines.

Contrast studies of the gastrointestinal tract

The gastrointestinal tract (GIT) is often the object of X-ray examination with contrast. X-ray examination of the stomach, esophagus and small intestine performed on an empty stomach, the patient is forbidden to drink and smoke on the day of the study. In the case of severe flatulence (gas in the intestines), which interferes with the study in patients with colitis and constipation, more thorough preparation is necessary (see page 19).

The main contrast agent for the study of the gastrointestinal tract - aqueous suspension of barium sulfate. Barium sulfate is used in two main forms. The first form is a powder mixed with water before use. The second form is a ready-to-use suspension for special X-ray studies. In clinical practice, two levels of barium concentration are used: one for conventional contrasting, the second for double contrasting.

For routine examination of the gastrointestinal tract, an aqueous suspension of barium sulfate is used. It has the consistency of semi-thick sour cream and can be stored in a glass container in a cool place for 3-4 days.

To conduct a study with double contrast, it is necessary that the contrast medium has a high degree dispersion and concentration of particles of barium sulfate at a low viscosity of the suspension, as well as good adhesion to the gastrointestinal mucosa. To do this, various stabilizing additives are added to the barium suspension: gelatin, carboxymethylcellulose, flax seed mucus, starch, marshmallow root extract, polyvinyl alcohol, etc. Ready-to-use finely dispersed barium suspension of high concentration is produced in the form of ready-made preparations with various stabilizers, astringents, and flavoring agents. additives: barotrast, baroloid, barospers, micropak, mixobar, microtrust, novobarium, oratrast, skiabary, sulfobar, telebrix, hexabrix, chytrast and others.

NB! Barium preparations are contraindicated in case of suspected perforation of the gastrointestinal tract, since their entry into the abdominal cavity leads to severe peritonitis. In this case, water-soluble contrast agents are used.

Classical x-ray examination necessarily includes three stages:

Examination of the relief of the mucous membrane;

Study of the shape and contours of organs;

Assessment of tone and peristalsis, elasticity of the walls.

Now contrasting only with barium suspension is gradually giving way double counterstaining with barium suspension and air. Double contrasting is in most cases much more effective and is considered as standard method x-ray examination of the gastrointestinal tract. Inflating the studied section of the gastrointestinal tract with air contributes to the identification of wall rigidity and the uniform distribution of a small amount of barium suspension, which coats the mucous membrane with a thin layer. Contrasting only with barium is justified in elderly and debilitated patients, in the postoperative period and for special purposes - for example, in the study of motility of the gastrointestinal tract.

NB! With double contrasting, as a rule, drugs are used to relax the muscles of the gastrointestinal tract (atropine, aeron; paralyzing glucagon and buscopan). They are contraindicated in patients suffering from glaucoma and prostate adenoma with impaired urination.

X-ray symptoms of various pathologies of the digestive tract can be grouped into ten main syndromes.

1. Narrowing (deformity) of the esophagus, stomach, or intestines occurs in a large group of pathological processes. This syndrome can be caused by both pathological processes emanating from the wall of the esophagus, stomach or intestines, as well as diseases of adjacent organs, as well as some developmental anomalies (malformations). The narrowing of the lumen often occurs after surgical interventions on the esophagus, stomach and intestines. The cause of the narrowing of the lumen (spasm) of any part of the digestive canal can also be cortico-visceral and viscero-visceral disorders.

2. Lumen expansion(deformation) esophagus, stomach or intestines may be limited to a part of the organ (local) or capture the entire organ (diffuse) and reach varying degrees of severity. The expansion of the lumen of the body is often combined with a significant accumulation of contents in it, usually gas and liquid.

3. Filling defect may occur in any part of the digestive tract and may be due to various diseases organs or the presence of contents in their lumen.

4. barium depot(niche) often occurs in pathological processes accompanied by destruction of an organ (ulcer, tumor, actinomycosis, syphilis, tuberculosis, erosive gastritis, ulcerative colitis), local bulging of the wall (diverticulum) or its deformation (adjacent process, cicatricial changes, consequences of trauma or surgical interventions).

5. Change in the relief of the mucous membrane- a syndrome, the timely detection of which contributes to the early recognition of many diseases of the esophagus, stomach and intestines. A change in the relief of the mucous membrane can be manifested by thickening or thinning of the folds, excessive tortuosity or their straightening, immobility (rigidity), the appearance of additional growths on the folds, destruction (break), convergence (convergence) or divergence (divergence), as well as a complete absence ("bare plateau") folds. The most informative image of the mucosal relief is obtained in images under double contrasting conditions (barium and gas).

6. Violation of the elasticity of the wall and peristalsis usually due to inflammatory or neoplastic infiltration of the organ wall, a nearby process, or other causes. Often combined with a decrease in the lumen of the organ in the affected area or its diffuse expansion (atony, paresis), the presence of a pathological relief of the mucous membrane, a filling defect or barium depot (niche).

7. Violation of the position- displacement (pushing, pulling, pulling) of the esophagus, stomach or intestines may occur as a result of damage to the organ itself (scarring ulcer, fibroplastic form of cancer, gastritis, colitis) or be a consequence of pathology in adjacent organs (heart defects, tumors and cysts of the mediastinum, abdominal cavity and retroperitoneal space, aneurysm of the thoracic or abdominal aorta). Violation of the position of the esophagus, stomach or intestines can be observed with some anomalies and malformations of their development, as well as after surgical interventions on the organs of the chest and abdominal cavities.

8. Accumulation of gas and fluid in the intestines accompanied by the formation of single or multiple horizontal levels with gas bubbles above them - Cloiber bowls. This syndrome is found mainly in mechanical obstruction of the intestine, developing due to narrowing of the intestinal lumen due to tumors, cicatricial changes in the intestinal wall, volvulus, intussusception and other causes, as well as dynamic intestinal obstruction that occurs reflexively during various pathological processes in the abdominal cavity and retroperitoneal space (appendicitis, pancreatitis, peritonitis).

9. Free gas and/or fluid (blood) in the abdomen or retroperitoneum found in some diseases (gastric or duodenal ulcer, ulcerative colitis, acute appendicitis) and injuries (closed abdominal trauma, penetrating wound, foreign body), accompanied by a violation of the integrity of the wall of a hollow organ. Free gas in the abdominal cavity can be detected after blowing the fallopian tubes and surgical interventions (laparotomy).

10. Gas in the wall of a hollow organ can accumulate in the lymphatic crevices of the submucosal and serous membranes of the stomach, small or large intestine in the form of small thin-walled cysts (cystic pneumatosis), which are visible through the serous membrane.

Examination of the esophagus

The essence of the method: the method is simple, painless, but its informativeness and diagnostic value are several times inferior fibrogastroscopy- endoscopic examination of the esophagus and stomach. The most common indication for using the method is the fear and active unwillingness of the patient to undergo fibrogastroscopy in the presence of certain complaints. Then an X-ray contrast study is performed, but with the slightest doubt and suspicion of the presence of a pathology, endoscopy is performed.

Indications for research: the main indication for the study is a violation of swallowing (dysphagia), the detection of intrathoracic lymphadenopathies, tumors and cysts of the mediastinum. Besides:

Anomalies of the aortic arch and its branches,

Chest pain of unknown origin

Foreign body in throat and esophagus

mediastinal compression syndrome

Bleeding from the upper parts of the alimentary canal,

Determining the degree of heart enlargement, especially with mitral defects,

Suspicion of cardiac insufficiency or esophageal achalasia,

Suspected hiatal hernia.

Conducting research: The examination is carried out with the patient in a standing position. The patient is asked to drink

barium suspension, and then stand next to the x-ray machine; the doctor adjusts the position of the device depending on the height of the patient. Then the patient is asked not to move for several minutes and is told when the study is completed.

There are no contraindications to the study. There are no complications.

Preparation for the study: not required.

It should be carried out by a qualified radiologist, the final conclusion, based on all the data on the patient's condition, is made by the clinician who sent the patient for examination - a gastroenterologist, surgeon, oncologist, cardiologist.

Examination of the stomach and duodenum

The essence of the method: radiography of the stomach allows you to clarify the position, size, contours, relief of the walls, mobility, functional state of the stomach, to identify signs of various pathologies in the stomach and its localization (foreign bodies, ulcers, cancer, polyps, etc.).

Indications for research:

Abscess of the abdominal cavity;

Amyloidosis of the kidneys;

aspiration pneumonia;

Stomach ache;

Gastrinoma;

Gastritis is chronic;

Gastroesophageal reflux disease;

Hernia of the white line of the abdomen;

Hernia of the esophageal opening of the diaphragm;

dumping syndrome;

Benign tumors of the stomach;

Difficulty swallowing;

Foreign body of the stomach;

ovarian cystoma;

Nephroptosis;

Tumors of the liver;

Acute gastritis;

Belching, nausea, vomiting;

Polyps of the stomach;

portal hypertension;

Postoperative hernia;

Umbilical hernia;

Stomach cancer;

ovarian cancer;

Syndrome of "small signs";

Zollinger-Ellison syndrome;

Decrease in the level of hemoglobin in the blood (anemia);

Gastric ulcer.

Conducting research: the patient drinks a barium suspension, after which fluoroscopy, survey and targeted radiography are performed with a different position of the patient. Evaluation of the evacuation function of the stomach is carried out by dynamic radiography during the day. X-ray of the stomach with double contrast- a technique of contrast X-ray examination of the state of the stomach against the background of its filling with barium and gas. To perform a double contrast x-ray, the patient drinks a suspension of barium sulfate through a tube with perforated walls, which allows air to enter the stomach. After massaging the anterior abdominal wall, barium is evenly distributed over the mucosa, and the air straightens the folds of the stomach, allowing you to examine their relief in more detail.

Contraindications, consequences and complications: There are no absolute contraindications for radiography of the stomach. Relative contraindications include pregnancy, ongoing gastric (esophageal) bleeding; as well as such changes in the lumbosacral spine that will not allow the patient to spend the necessary time in the supine position on a hard surface.

Preparation for the study: , i.e. exclude or limit dairy products, sweets, muffins, soda water, cabbage, etc. The diet should contain lean meat, eggs, fish, a small amount of cereals on the water. With constipation and flatulence in the morning on the day of the study, a cleansing enema is placed, if necessary, the stomach is washed.

Deciphering the results of the study

Examination of the duodenum

The essence of the method: relaxation duodenography- contrast radiography of the duodenum in its relaxed state, artificially induced medicines. The technique is informative for the diagnosis of various pathological changes intestines, head of the pancreas, end sections of the bile duct.

Indications for research:

Gastrinoma;

Duodenitis;

Cancer of the small intestine;

Zollinger-Ellison syndrome;

Strictures of the bile ducts;

Peptic ulcer of the duodenum.

Conducting research: in order to reduce the tone of the intestine, an injection of an anticholinergic agent is performed, then a portion of warm barium suspension and air is introduced through an intranasal probe installed in the lumen of the duodenum. Radiographs are performed under conditions of single and double contrasting in frontal and oblique projections.

Preparation for the study: patients in whom the functions of the stomach and intestines are not impaired, no special preparation is required. The only condition that must be met is not to eat 6-8 hours before the procedure. Patients suffering from any pathology of the stomach and intestines, and the elderly, already 2-3 days before the procedure, it is recommended to start adhering to gas-reducing diet, i.e. exclude or limit dairy products, sweets, muffins, soda, cabbage, etc. The diet may contain lean meat, eggs, fish, a small amount of cereals on the water. With constipation and flatulence in the morning on the day of the study, a cleansing enema is placed, if necessary, the stomach is washed.

Deciphering the results of the study should be carried out by a qualified radiologist, the final conclusion based on all the data on the patient's condition is made by the clinician who sent the patient for examination - a gastroenterologist, surgeon, oncologist.

Examination of the small intestine

The essence of the method: X-ray fixation of the process of advancing the contrast through the small intestine. By radiography of the passage of barium through the small intestine

revealed diverticula, strictures, obturation, tumors, enteritis, ulceration, malabsorption and motility of the small intestine.

Indications for research:

Amyloidosis of the kidneys;

femoral hernia;

Crohn's disease;

Hernia of the white line of the abdomen;

dumping syndrome;

Benign tumors of the small intestine;

Malabsorption;

Interintestinal abscess;

Inguinal hernia;

Postoperative hernia;

Umbilical hernia;

Cancer of the small intestine;

celiac disease;

Enteritis;

Enterocolitis.

Conducting research: radiopaque examination of the small intestine is performed after ingestion of a solution of barium suspension. As the contrast advances through the small intestine, targeted radiographs are taken at intervals of 30–60 minutes. X-ray of the passage of barium through the small intestine is completed after contrasting all its departments and entering the barium into the caecum.

Preparation for the study: patients in whom the functions of the stomach and intestines are not impaired, no special preparation is required. The only condition that must be met is not to eat 6-8 hours before the procedure. Patients suffering from any pathology of the stomach and intestines, and the elderly, already 2-3 days before the procedure, it is recommended to start following a diet that reduces gas formation, i.e. exclude or limit dairy products, sweets, muffins, soda, cabbage, etc. d. Lean meat, eggs, fish, a small amount of cereals on the water may be present in the diet. With constipation and flatulence in the morning on the day of the study, a cleansing enema is placed, if necessary, the stomach is washed.

Deciphering the results of the study should be carried out by a qualified radiologist, the final conclusion based on all the data on the patient's condition is made by the clinician who sent the patient for examination - a gastroenterologist, surgeon, oncologist.

Examination of the large intestine

X-ray examination of the large intestine is performed by two (and one might say three) methods: x-ray of the passage (passage) of barium through the large intestine and irrigoscopy(regular and double contrast).

X-ray of the passage of barium through the large intestine The essence of the method: a technique of radiopaque examination, performed to assess the evacuation function of the large intestine and the anatomical relationship of its departments with neighboring organs. X-ray of the passage of barium through the large intestine is indicated for prolonged constipation, chronic colitis, diaphragmatic hernia (to determine the interest of the large intestine in them).

Indications for research:

Appendicitis;

Hirschsprung disease;

Crohn's disease;

Hernia of the white line of the abdomen;

diarrhea (diarrhea);

Intestinal obstruction;

Megacolon;

Interintestinal abscess;

Nonspecific ulcerative colitis;

Perianal dermatitis;

Postoperative hernia;

colon cancer;

Seronegative spondyloarthritis;

irritable bowel syndrome;

Chronic appendicitis.

Conducting research: the day before the upcoming study, the patient drinks a glass of a suspension of barium sulfate; X-ray examination of the large intestine is performed 24 hours after barium intake.

Preparation for the study: no special preparation is required.

Deciphering the results of the study should be carried out by a qualified radiologist, the final conclusion based on all the data on the patient's condition is made by the clinician who sent the patient for examination - a gastroenterologist, surgeon, oncologist.

Irrigoscopy

The essence of the method: unlike the passage of barium in the natural direction of movement of masses in the intestine, barium enema is performed by filling the large intestine with a contrast agent using an enema - in a retrograde direction. Irrigoscopy is performed in order to diagnose developmental anomalies, cicatricial narrowing, tumors of the large intestine, chronic colitis, fistulas, etc. After the large intestine is tightly filled with a barium suspension, the shape, location, length, extensibility, and elasticity of the intestine are studied using an enema. After bowel emptying from the contrast suspension, organic and functional changes in the colon wall are examined.

Modern medicine uses irrigoscopy with simple contrasting of the colon(using barium sulfate solution) and irrigoscopy with double contrast(using a suspension of barium and air). Tight single contrasting allows you to get an x-ray image of the contours of the colon; irrigoscopy with double contrasting reveals intraluminal tumors, ulcerative defects, inflammatory changes in the mucosa.

Indications for research:

Abscess of the abdominal cavity;

Anal itching;

Anococcygeal pain syndrome ( coccygodynia);

Appendicitis;

femoral hernia;

Hirschsprung disease;

Prolapse of the rectum;

Haemorrhoids;

Hernia of the white line of the abdomen;

diarrhea (diarrhea);

Benign tumors of the small intestine;

Benign tumors of the ovaries;

gastrointestinal bleeding;

ovarian cystoma;

Intestinal obstruction;

Megacolon;

Interintestinal abscess;

Acne lightning;

Nephroptosis;

Tumors of the liver;

Inguinal hernia;

Perianal dermatitis;

Polyps of the rectum;

Postoperative hernia;

Pseudomucinous ovarian cystoma;

anus cancer;

Liver cancer;

Cancer of the body of the uterus;

colon cancer;

Cancer of the small intestine;

Cervical cancer;

ovarian cancer;

Birth injury;

Sarcoma of the uterus;

Fistulas of the vagina;

Fistulas of the rectum;

Seronegative spondyloarthritis;

Irritable bowel syndrome (IBS);

Chronic appendicitis.

Conducting research: the patient is placed on an inclined table and a survey radiography of the abdominal cavity is performed. Then the intestines are filled with a barium solution (an aqueous suspension of barium sulfate heated to 33–35 ° C). In this case, the patient is warned about the possibility of a feeling of fullness, pressure, spasmodic pain or the urge to defecate and is asked to breathe slowly and deeply through the mouth. For better filling of the intestine in the process of irrigoscopy, a change in the inclination of the table and the position of the patient, pressure on the abdomen are made.

As the intestine expands, sighting radiographs are performed; after complete tight filling of the lumen of the colon - survey radiography of the abdominal cavity. The patient is then escorted to the toilet to have a natural bowel movement. After removing the barium suspension, a survey radiograph is again performed, which allows assessing the relief of the mucosa and the evacuation function of the colon.

A double-contrast barium enema can be performed immediately after a simple barium enema. In this case, a dosed filling of the intestine with air is performed.

Contraindications, consequences and complications: irrigoscopy is not performed during pregnancy, general severe somatic status, tachycardia, rapidly developing ulcerative colitis, suspected perforation of the intestinal wall. special care during barium enema is required in case of intestinal obstruction, diverticulitis, ulcerative colitis, liquid stool with an admixture of blood, cystic pneumatosis of the intestine.

NB! factors that can distort the results of irrigoscopy can be:

Poor bowel preparation

The presence of barium residues in the intestine after previous studies (radiography of the small intestine, stomach, esophagus),

Inability of the patient to retain barium in the intestines.

Preparation for the study: before irrigoscopy, a thorough bowel preparation is carried out, including a slag-free diet, cleansing enemas in the evening and in the morning until clear waters. Dinner on the eve of irrigoscopy is not allowed.

NB! With bleeding from the gastrointestinal tract or ulcerative colitis, enemas and laxatives before barium enema are not allowed.

Deciphering the results of the study should be carried out by a qualified radiologist, the final conclusion, based on all the data on the patient's condition, is made by the clinician who sent the patient for examination - a gastroenterologist, surgeon, proctologist, oncologist.

Examination of the liver (gall bladder and bile ducts), pancreas

Cholegraphy and cholecystography

The essence of the method: cholegraph? i- x-ray examination biliary tract through intravenous administration hepatotropic radiopaque preparations secreted by the liver with bile. Cholecystography- a technique for radiopaque examination of the state of the gallbladder, is performed to determine the position, size, shape, contours, structure and functional state of the gallbladder. Cholecystography is informative for detecting deformities, calculi, inflammation, cholesterol polyps, gallbladder tumors, etc.

Indications for research:

Biliary dyskinesia;

Cholelithiasis;

Calculous cholecystitis;

gallbladder cancer;

Chronic cholecystitis;

Chronic acalculous cholecystitis.

Conducting research: cholegraphy perform on an empty stomach. Previously, the patient is recommended to drink 2–3 glasses of warm water or tea, which reduces the reaction to the procedure, 1–2 ml of a radiopaque substance is administered intravenously ( allergic test), in the absence of a reaction after 4-5 minutes, the rest of its amount is poured in very slowly. Usually, a 50% solution of bilignost (20 ml) heated to body temperature, or similar means, is used. For children, drugs are administered at a dose of 0.1–0.3 g per 1 kg of body weight. Radiographs are taken 15–20, 30–40 and 50–60 minutes after injection at horizontal position patient. To study the function of the gallbladder, sighting pictures are taken in vertical position subject. If there is no image of the bile ducts in the pictures 20 minutes after the administration of the radiopaque substance, 0.5 ml of a 1% solution of pilocarpine hydrochloride is injected under the skin to cause a contraction of the sphincter of the common bile duct.

Before cholecystography produce an overview x-ray of the right half of the abdominal cavity. After translucence, several pictures of the gallbladder are taken in different projections with the vertical and horizontal positions of the subject. Then the patient is given the so-called " choleretic breakfast"(2 raw egg yolks or 20 grams of sorbitol in 100–150 ml of water), after which, after 30–45 minutes (preferably serially, every 15 minutes), repeated shots are taken and the contractility of the gallbladder is determined.

Contraindications, consequences and complications: cholegraphy and cholecystography are contraindicated in severe impairment of the liver, kidneys, cardiovascular system and hypersensitivity to iodine compounds. Side effects when using bilitrast, they are observed infrequently and are of a very moderate nature. They can be expressed in the form of a sensation of heat in the head, a metallic taste in the mouth, dizziness, nausea, and sometimes slight pain in the abdomen.

Preparation for the study: 12-15 hours before cholecystography, the patient takes bilitrast(an organic compound of iodine) or other contrast agent ( cholevid, yopagnost, telepak, bilimin etc.) at a dose of 1 g per 20 kg of body weight, washed down with water, fruit juice or sweet tea. Contrast agents (organic compounds of iodine) can be taken by the patient not only orally, but also administered intravenously, less often through a probe into the duodenum. The night before and 2 hours before the examination, the patient is cleansed with an enema.

Deciphering the results of the study should be carried out by a qualified radiologist, the final conclusion, based on all the data on the patient's condition, is made by the clinician who sent the patient for examination - a gastroenterologist, surgeon, oncologist, hepatologist.