Preparation to radiological and to ultrasound examination of abdominal organs
Reliability and informational content of results of radiological, endoscopic and ultrasonic methods of a research of bodies of the alimentary system in no small measure depend on quality of training of patients to carrying out these researches. X-ray inspection of a stomach and duodenum allows to specify a form of these bodies, their position, a condition of a relief of a mucous membrane, a tone and a peristaltics and plays an important role in recognition of cankers of a stomach and duodenum, tumors and other diseases. Earlier before X-ray inspection of a stomach in all cases carrying out special preparation was considered necessary: a diet with an exception of the products promoting a meteorism, a cleansing enema the night before and in the morning in day of a research. Now the point of view is standard that patients with normal function of intestines do not demand any special preparation for X-ray inspection of a stomach. Only at sharply expressed meteorism and persistent locks the cleansing enema for 1,5 — 2 h prior to a research is recommended. In the presence in a stomach of a sick large amount of liquid, slime, the food remains (for example, at organic narrowing of output department of a stomach) it is necessary to wash out a stomach for 2 — 3 h prior to a research. As a contrast agent at X-ray inspection of a stomach and duodenum use a barium sulfate suspension which is prepared at the rate of 100 g of powder on 80 l of water. Apply to X-ray inspection of a gall bladder and biliary tract most often two main methods: the cholecystography (X-ray inspection of a gall bladder with preliminary oral administration of X-ray contrast agent) and a holegrafiya (X-ray inspection of bilious channels with intravenous administration of a contrast agent). Before carrying out the cholecystography and a holegrafiya the patient within three days has to keep to a diet for the prevention of a meteorism (an exception of crude cabbage, black bread, milk, etc.). Accumulations of gas in intestines, giving the roundish centers of an enlightenment at the radiological image, can be imposed on a shadow of a gall bladder, complicating the correct interpretation of the obtained data. Special obligatory cleansing enemas, as well as so-called "fat breakfasts" on the eve of the research (as it was recommended earlier), are not required now. Cleansing give an enema only at the expressed meteorism.
At the cholecystography of the patient on the eve of the research accepts X-ray contrast iodinated contrast agent (Cholevidum, йопагност, etc.) at the rate of 1 g on 20 kg of body weight of the patient, washing down it with sweet tea, usually on 0,5 g every 5 min. within half an hour. A contrast agent, getting into a liver, it is allocated with bile and collects in a gall bladder. At the same time the maximum concentration of drug in a gall bladder is observed in 15 — 17 h after reception; therefore if the cholecystography is appointed to 9 — 10 h morning, drug should be accepted the night before in 17 — 19 h. It is necessary to warn the patient about a possibility of emergence of nausea and a liquid chair after reception of the specified X-ray contrast agents. In the analysis of roentgenograms estimate intensity of a shadow of a gall bladder, its form, size, situation, existence or lack of deformation, concrements (stones), etc. For specification of motive function of a gall bladder the patient is given a so-called cholagogue breakfast (2 crude egg yolks or 20 g of sorbite in 100 — 150 ml of water) then in 30 — 45 min. (better serially, every 15 min.) do repeated pictures and define sokratitelny ability of a gall bladder. When carrying out a holegrafiya a contrast agent (Bilignostum, Bilitrastum, etc.) which is also allocated to cookies and contrasts zhelchy channels, enter intravenously. Taking into account a possibility of allergic reactions in the beginning intravenously enter a trial dose (1 — 2 ml) of 50% of solution of Bilignostum or Biligrafinum which is warmed up to body temperature. At absence in 5 — 10 min. allergic reactions (an itch, a fever) slowly administer the main part of the drug. More intensive filling of channels happens after additional introduction of sick 0,5 ml of 1% of solution of morphine. The subsequent pictures carry out in 20, 30—40 and 45 — 60 min. after administration of contrast agent. On roentgenograms estimate the sizes, contours, a gleam inside - and extrahepatic bilious channels, existence or lack in them of concrements, specify concentration and sokratitelny functions of a gall bladder. For more exact definition of a condition of the general bilious channel the intravenous holegrafiya is often supplemented with X-ray inspection of a duodenum (duode-nografiya). The cholecystography is not carried out at severe damages of a liver, hypersensitivity to iodine, and a holegrafiya, besides — at acute inflammatory diseases of the bilious channels proceeding with temperature increase (cholangitis), the expressed hyperfunction of a thyroid gland.
X-ray inspection of a large intestine (irrigoskopiya) is conducted by means of an opaque enema. Use of an irrigoskopiya allows to define a form, situation, a condition of a mucous membrane, a tone and a peristaltics of these or those departments of a large intestine and plays a large role in recognition of her various diseases — tumors, polyps, diverticulums, intestinal impassability. By preparation for an irrigoskopiya on the eve of the research the patient is given before a lunch 30 g of castor oil, give an enema cleansing in the evening, it is twice one better at an interval of 1 h. The patient has not supper. In the morning after a light breakfast two cleansing give enemas again. Unfortunately, sometimes before an irrigoskopiya forget to give castor oil therefore, despite 4 cleansing enemas, the patient is unprepared to a research as by means of enemas only lower parts of a large intestine are released. As a contrast agent use a barium sulfate suspension (at the rate of 400 g of powder on 1600 ml of water) who is the best of all for training in a blender. The suspension which is warmed up to body temperature is entered by means of an enema. Endoscopic methods of a research allow to examine by means of the special optical device (endoscope) a mucous membrane of a gullet, a stomach, a duodenum (ezofagogastroduodenoskopiya), a direct and sigmoid gut (rektoromanoskopiya), a large intestine (kolonoskopiya), abdominal organs (laparoscopy), to carry out in necessary cases a biopsy (to take a fabric piece) with the subsequent histologic research, to carry out medical manipulations (for example, an obkalyvaniye of ulcer defect medicines, radiation its helium - the neon laser, removal of small polyps, the concrements which are in the general bilious channel, etc.). Ezofagogastroduodenoskopiya does not demand special preparation. Planned gastroscopy is carried out in the morning, on an empty stomach; the emergency gastroscopy (for example, at gastric bleeding) is carried out at any time. In 30 min. prior to a research to the patient enter subcutaneously 1 ml of 0,1% of solution of atropine; just before a research carry out local anesthesia of a mucous membrane of a throat by Dicainum solution. After an ezofagogastroduodenoskopiya during 1 — 1,5 h the patient do not allow to eat food (to a complete recovery of normal swallowing). If the biopsy undertook, then food this day is given only to cold.
By preparation for a rektoromanoskopiya give an enema cleansing the night before and in the morning for 1,5 — 2 h prior to a research. The research is conducted without preliminary preparation at acute inflammatory diseases, for example dysentery, and also at considerable bleeding of a mucous membrane of a direct and sigmoid gut. Preparation for a kolonoskopiya is similar that at an ir-rigoskopiya. On the eve of the research in the afternoon the patient is given 30 — 50 ml of castor oil, in the evening and in the morning (for 2 h prior to a research) repeatedly give an enema cleansing. In need of carrying out the emergency kolonoskopiya (for example, at suspicion on impassability of a large intestine) preparation is limited to a siphon enema; through '/2 — 1 h after it carry out a kolonoskopiya. The ultrasonography (ekhografiya) which is widely applied to diagnosis of diseases of the digestive system is based that different environments of an organism have unequal acoustic properties and differently reflect the ultrasonic signals radiated by the device. It is possible to define situation, a form, the sizes, structure of various abdominal organs by an ekhografiya — a liver, a gall bladder, a pancreas, to reveal tumors, cysts, etc. The research is conducted, as a rule, on an empty stomach, preparation comes down usually to fight against a meteorism as accumulation of gases in loops of intestines complicates ultrasonic visualization of bodies. Except already mentioned restrictions in a diet, for elimination of a meteorism within 2 — 3 days before a research appoint reception of absorbent carbon or Carbolenum (on 0,5 — 1,0 g 3 — 4 times a day), and also (according to indications) — reception of fermental drugs, for example festal.