X-ray contrast researches
X-ray contrast researches visualize all GIT from a pharynx to a rectum and are most effective in diagnosis of volume educations and anatomic changes (e.g., tumors, strictures). Simple contrast researches are based on filling of a gleam of body with radiopaque substance, visualizing topography and the X-ray contrast plane image of body. More detailed images turn out at a double contrast study at which a small amount of barium of high density covers a cover mucosal surface, and administration of gas inflates body, increasing contrast. Gas at a double contrast study at an irrigoskopiya is entered into procedure time whereas at other researches the GIT contains only natural gas. In all cases the patient turns for hypodispersion of gas and barium. Flyuoroskopiya it is possible to control advance of a contrast agent. For documentation it is possible to use roentgenograms or a video, but the video is especially informative at assessment of disturbances of motility (e.g., a cricopharingeal spasm, an achalasia).
The main contraindication to X-ray contrast researches is suspicion on perforation as free barium is a strong revellent concerning a mediastinum and a peritoneum; a water-soluble contrast agent is less irritating and can be used in case of suspicion on perforation. For elderly patients it is sometimes difficult to change position of a body for achievement of hypodispersion of gas and barium in an intestines gleam.
At a X-ray contrast research of upper parts of a GIT patients have to exclude meal after midnight. Patients to whom the irrigoskopiya is appointed a day before the research keep only to a liquid diet, accept orally laxative like Na phosphate and bisacodyl suppository in the evening in the afternoon. Also other laxative modes are effective.
Complications are rare. Perforation at an irrigoskopiya at patients with toxic megacolon can be observed. Obturation barium can be prevented by oral administration of liquid after the research and sometimes laxatives.
It is the best of all to carry out a research of upper parts of a GIT as the two-phase research beginning with a double contrast study of a gullet, a stomach and a duodenum with the subsequent simple contrast research, using low-density barium. Intravenous administration of 0,5 mg of the glucagon causing gastric hypotonia increases efficiency of a research.
The research of a small bowel is carried out with use of a flyuoroskopiya that provides more detailed assessment of a small intestine. Before a research the patient is orally given Metoclopramidum of 20 mg for acceleration of a passage of a contrast agent.
Enteroklizma (enema of a small bowel) allows to carry out more detailed visualization of a small bowel, but demands a duodenum intubation the flexible probe with a spherical tip. After administration of suspension of a baric suspension methyl cellulose which works as substance of a double contrast study that improves visualization of a mucous membrane of a small bowel is entered.
Irrigoskopiya can be carried out as a simple contrast research or a research with a double contrast study. The usual irrigoskopiya is used at potential obstruction, a divertuculosis, fistulas and megacolon. The double contrast study is preferable at diagnosis of tumors.