Plain x-ray of the abdominal cavity. What can be seen on an abdominal x-ray

The date: 21.10.2019

Plain radiography abdominal cavity is a technique radiodiagnosis, which allows you to assess the state of organs in a given localization, to detect signs of pathologies and emergency conditions requiring medical intervention. A review study does not involve the use of a contrast agent, therefore it is a preliminary, “screening” diagnostic method.

Plain radiography is relatively informative method diagnosis and in most cases requires additional research(, contrast radiography).

In most cases, it plays the role of a study of the first level of diagnostics, giving general information about the patient's condition and allows you to quickly make a preliminary diagnosis. In addition, this technique is used as a screening for preventive examination a large number of people.

Preparation for the procedure

Nutrition

A few days before the study, you need to go to special diet. The patient should not strictly limit himself in nutrition, it is only necessary to slightly adjust the diet. It is recommended to limit the consumption of the following foods:

The diet is recommended to be simple meals- cereals on the water, soups, salads. It is important to stay hydrated and drink enough fluids every day. This will normalize peristalsis and prevent constipation and flatulence. In the presence of these symptoms, the information content of the study is significantly reduced, so dieting is an important component of preparation. However, if the patient is admitted to the hospital urgently with any acute condition, the study can be carried out without special training.

Cleansing enema

Before the procedure, it is advisable to do a cleansing enema (see cleansing or). Bowel emptying also increases the likelihood of a reliable test result. The enema is carried out in the usual manner, in the evening on the eve of the x-ray. It is advisable to repeat the cleansing in the morning immediately before going to the doctor.

Laxatives

Instead of an enema, patients can use.

Most effective drug from this group is, which is available in powder form in paper bags. One portion of the powder should be diluted in 1 liter of water. For a woman of average weight, it is necessary to prepare 3 liters of solution, for a man - about 4 liters. The patient should slowly drink the resulting liquid at a rate of 1 liter per hour. A significant water load allows you to clean the intestines and remove, which can interfere with x-rays.

The use of the Fortrans drug, the patient should without fail agree with your physician. The tool has a number of contraindications, it is not recommended to prescribe it to weakened and elderly patients. Increased water load is also undesirable for patients with pathologies. of cardio-vascular system or with kidney disease.

Immediate preparation for the study

Approximately 12 hours (from the evening of the previous day) it is recommended to stop eating solid food, as it can be visualized in the intestine and make diagnosis difficult. Immediately before the study, it is necessary to empty bladder. In the doctor's office, you must remove all jewelry and other metal objects, you do not need to undress.

Radiography of the abdominal organs- projection images internal organs(stomach, small and large intestines, gallbladder and biliary tract and etc.). When examining the abdominal cavity, survey and sighting shots in standard or supplementary projections. Plain radiography can detect free gas and fluid in the abdominal cavity, stones in gallbladder and urinary tract, tumors, signs of intestinal obstruction. Since hollow organs do not reflect X-rays, their examination is carried out after preliminary contrasting. Contrasting types of radiography include esophagography, gastrography, cholecystography, cholangiography, enterography, irrigography, etc. The cost varies depending on the type of examination, the need to use and the type of contrast agent.

Indications

In clinical practice, an overview and radiopaque examination of the abdominal organs is used in gastroenterology, abdominal surgery and urology. Plain radiography of the abdominal cavity is prescribed for acute pain in the abdomen and lumbar region, bloating, suspected intestinal obstruction(for malignant and benign tumors, inflammatory diseases etc.), diverticulitis, intussusception of the intestine, rupture of a hollow or parenchymal organ, cholecystitis, pancreatitis, cholelithiasis and urolithiasis.

Contrast radiography of the abdominal organs is performed after a survey image is taken, confirming the integrity of the hollow organs (to avoid barium reflux into the abdominal cavity). The indication for the study is the suspicion of the presence of a neoplasm, diverticulum or stenosis of a hollow organ. Based on the data of survey and contrast radiography, a treatment plan is drawn up, prescribe additional examinations(if necessary) or decide on a surgical intervention.

Contraindications

Contraindications for contrast radiography are hypersensitivity to a contrast agent, perforation of a hollow organ, acute diverticulitis, ulcerative colitis during an exacerbation, severe dehydration, intestinal obstruction (prevents the excretion of barium with feces), mixed and intestinal forms cystic fibrosis. Alternatively, ultrasound or MSCT of the abdominal organs, colonoscopy, laparoscopy and other studies may be prescribed. The decision on the need for radiography is made individually, taking into account the severity of the pathology and the risks associated with the study.

Training

Special preparation for the review study is not required. Before starting the procedure, you should empty your bladder. Before performing a contrast radiography, it is necessary to refrain from drinking for a day. rye bread, vegetables and dairy products and within 12 hours - from the use of solid food. Before irrigoscopy the night before and 1-1.5 hours before the procedure, the colon should be cleaned using an enema or laxative.

When researching upper divisions gastrointestinal tract a contrast agent is administered orally or through a probe, in the study of the lower intestine - with an enema. Survey radiography of the abdominal organs is performed in a standing position (in the supine position, gas and liquid will be distributed throughout the abdominal cavity, and their levels will not be visible), contrast radiography - in a standing or lying position, in several projections. The radiologist then describes the images and passes them along with the description to the attending physician. Sometimes the results are handed over to the patient (for example, when referring to a consultation at another clinic).

Interpretation of results

For acute intestinal obstruction plain radiograph"inverted bowls" (accumulations of gas above the liquid) are detected, a large number of gas and transverse striation. With ascites and bleeding in the abdominal cavity, a horizontal level of fluid is visible. Foreign bodies appear on the images as shadows. The color and saturation of the shadow depends on the density of the object: the greater the density, the lighter the shadow. Stones in the kidneys and gallbladder containing calcium salts are also light inclusions. Based on the X-ray of the abdominal cavity, the doctor can determine the size, shape and location foreign bodies and stones. By studying images using a contrast agent, one can draw a conclusion about the state of the intestinal mucosa, the presence of areas of narrowing and tumor-like formations, assess the length and severity of areas of narrowing, the contours of tumors and ulcers, etc.

Abdominal X-ray is a method of radiation diagnostics, which is widely used to study the state of internal organs. It is based on the ability of X-rays to pass through the dense tissues of the body. This allows you to evaluate morphological and functional changes in organs and tissues, to identify the presence of foreign bodies and tumors.

An abdominal x-ray does not replace other diagnostic methods, including clinical examination. It significantly supplements them with objective data, thereby helping to make a more accurate and faster diagnosis. X-ray diagnostics is carried out by 2 methods:

Radiography. This way x-ray examination allows you to observe changes in organs on X-ray images obtained on a photosensitive film.
X-ray. This technique gives an idea of the pathological processes through x-ray images obtained on a glowing screen.

Radiography

An abdominal x-ray is divided into 2 types: survey and contrast. The abdominal cavity is a space separated from the sides by the abdominal muscles, behind by the lower back, in front by the peritoneum, below by the ilium of the pelvis and above by the muscles of the diaphragm. It includes the following systems and organs:

bodies digestive system: stomach, intestines, esophagus, gallbladder, liver and pancreas;
bodies genitourinary system: bladder, kidneys, ureters, ovaries, testes, prostate, uterus and ovaries.

Plain radiography of the abdominal organs is a standard research method that does not require the presence of special contrast agents. This method makes it possible to determine:

distribution of fluid and gases in the abdominal cavity;
the presence of foreign bodies (conglomerates in the kidneys and gallbladder, accidentally swallowed objects);
the presence of internal bleeding;
existing internal damage.

Indications for examination

Plain radiography of the abdominal cavity is prescribed by a specialist if the patient has complaints of unbearable pain in the abdomen. This condition may indicate the following diseases:

pancreatitis;
cholecystitis;
various tumors;
intestinal obstruction;
nephrolithiasis;
diverticulitis;
hepatic and biliary colic;
the presence of stones in the kidneys and gallbladder;
inflammation in the abdominal cavity;
appendicitis;
polyps;
injury.

In case of rendering emergency care The patient is initially given a survey x-ray. It enables the physician to general idea about the state of the body in order to carry out further diagnostics and prescribe proper treatment. This method is especially appreciated in practical work emergency medicine due to the simplicity and speed of obtaining results.

Performing an abdominal x-ray

The procedure can be performed in a standing or lying position, depending on the condition of the patient. In addition, in some cases, an image in two projections is required. Most often, an x-ray is done only in a standing position, since in this position you can better understand the localization of some problems. You do not need to take off your clothes, but it is recommended to remove metal objects.

The patient is located near the X-ray machine, the specialist adjusts the position of the device in accordance with the height of the patient. At the time of the passage of the rays through the body, you can not move (this lasts no more than 2 minutes). The x-ray will be ready almost immediately, and the doctor will inform you about the results of the examination. The conclusion should be made by a qualified radiologist, and the final diagnosis is made by the clinician who referred the patient for the procedure. It is not recommended to take x-rays several times within a short period of time, since there is a certain radiation exposure.

No special preparation is required for emergency diagnostics. If the examination is planned, then the doctor advises to pre-cleanse the intestines from feces and accumulation of gases. This is necessary so that there are no extraneous shadows that make it difficult to process the results. For this purpose, a cleansing enema or Fortrans is prescribed on the eve of the procedure.

For patients suffering from excessive gas formation or who have a tendency to constipation, there are recommendations to switch to a 3-day diet before the study. At this time, you can not eat some products that contribute to the production of gases: raw vegetables and fruits, beans, milk, dark breads. It is advisable to include pasta, cereals and meat in the diet. On the day of the examination, only tea is allowed for breakfast. The diet should be accompanied by the intake of charcoal tablets.

Contrast x-ray

An overview picture is not always informative enough, since not very dense tissues and air cavities do not reflect X-rays, and the image is fuzzy. A contrast radiograph is used to detect the pathology of hollow formations and low-density structures.

Barium sulfate is used as a contrast agent. It is given to drink in the form of a flavored suspension or administered through a tube. The barium solution spreads into all cavities that are not visualized on plain X-ray. The contrast agent does not dissolve in water, transmits rays well, is not absorbed in the stomach and intestines and does not enter the bloodstream. The drug is excreted from the body with feces during the day.

In addition to barium sulfate, nitric oxide is sometimes used, as well as water-soluble contrast agents. This is allowed in cases where there is a suspicion of a violation of the integrity of internal organs. The ingress of barium sulfate into the abdominal cavity threatens with such complications as peritonitis. Also, contrast x-rays are not used for exacerbation ulcerative colitis, dehydration and existing bronchial asthma.

Contrast X-ray can be carried out in dynamics, tracking the movement of the solution through the cavity. The average duration of the procedure is 2 hours. This method indispensable in the examination of the genital organs, allowing you to determine the presence of tumors, foci of inflammation, lesions of the mucous membranes.

Fluoroscopy

A radiographic image gives an idea only of the structure of the organ under study. To evaluate functional state and dynamics (contractions, extensibility), the fluoroscopy method is used. In this case, the image is displayed on a special screen (fluorescent). It is a sheet of thick cardboard coated with a special composition. Increasingly, devices are used that are designed in such a way that the picture is visible on the monitor screen. It can be printed later.

The procedure takes about 10 minutes. It is painless and fast. It is possible to store images on electronic media. Unlike a radiograph, a three-dimensional image is produced, which makes it possible to more accurately determine the location of pathological processes.

It's worth knowing that this method has more high level radiation exposure and cannot be done frequently. In addition, this type of examination does not make it possible to reveal the fine details of pathological processes, and it happens that some disease states go unnoticed. In this regard, the method of fluoroscopy cannot be used as a preventive study.

Each person has faced the need for x-rays in their long life, this procedure can be associated not only with the diagnosis of various injuries, but also with the need to identify any diseases and other health problems. In this material, let's consider such a procedure as an x-ray of the abdomen, since such an examination is carried out quite often and requires some preparation as directed by the doctor.

Let us mention right away that radiography can be performed only in the presence of pain or other serious indications for this, since the body receives a certain amount of radiation during x-rays. If you have any disorders, such as butterflies in your stomach or other unpleasant feelings, you should immediately contact a specialist who will decide on the best diagnosis.

Types of abdominal x-rays

Specialists distinguish two types of radiography, namely: survey and contrast. The first type of this procedure is carried out almost always when dealing with complaints, it is characterized by a survey examination of the organs located in the chest, as well as in the abdominal cavity. This type of examination allows specialists to draw conclusions about the state of the organs of the gastrointestinal tract, primarily about the esophagus and stomach. It should be mentioned that the organs of the abdominal cavity have a rather loose structure, therefore, their shadows are not so pronounced on the pictures. For this reason, the overview version of the x-ray allows you to diagnose only serious changes in organs and tissues due to any diseases or traumatic injuries.

X-ray of the abdominal cavity.

Note! Plain radiography is considered an extremely cheap and fairly informative diagnostic method, so it is often performed almost immediately after visiting a doctor in order to clarify the diagnosis or select methods for further diagnosis. Among its advantages, one should also highlight the speed of implementation and low cost, and if you are undergoing treatment in public institution, then such an x-ray will most likely be free.

As you might guess, unfortunately, this method can not always give a complete picture of your illness. In such situations, specialists prescribe a barium contrast radiography or some other more detailed and informative examination, such as an MRI.

As mentioned earlier, the contrast agent used in the examination of the abdomen is most often barium, and it is its aqueous suspension that is used. In the overwhelming majority of situations, this contrast is simply drunk by the patient, after which he waits. certain time its penetration into the organs of the gastrointestinal tract, which need to be examined. In extremely rare situations, a contrast agent may be injected through a tube.

Note! Specialists use exactly barium, since it does not tend to dissolve in water or in any physiological fluids, while it has the property of absorbing X-rays, and this makes it possible to draw conclusions about the relief of mucous membranes.

X-ray of the abdomen with contrast agent.

During the procedure, while the contrast agent has not yet reached the desired part of the gastrointestinal tract, the specialist will monitor using transillumination, which is very important, as this allows you to study the functions of the esophagus, as well as the stomach and intestines, and if there are any either neoplasms, lesions or even obstruction the problem will be established with a high probability.

Indications for carrying out

As mentioned earlier, due to the radiation (radiation) from fluoroscopy, the procedure can in no case be carried out thoughtlessly, that is x-rays should be done only if it is necessary to detect any violation or serious problem. Here is a list of the main diseases for the detection of which such irradiation is carried out:

intestinal ischemia;
pancreatitis;
blockage of the intestine;
cholecystitis;
acute appendicitis;
urolithiasis disease;
malignant or benign tumors;
nephrolithiasis;
intussusception;
purulent accumulations and inflammatory processes;
various traumatic injuries relating to the abdominal organs;
hitting any foreign objects in the region of the abdominal organs.

Also, the procedure is often prescribed according to the complaints of patients, here are the main ones:

Availability pain or other kind of discomfort in the abdomen;
feeling of heaviness in the digestive organs;
bloating.

Important! Once again, we recall that the procedure can only be prescribed qualified specialists, in some situations it would be better to give preference to more modern and expensive methods, since an x-ray with barium will not carry enough information to prescribe competent therapy.

Contraindications

Irradiation is not the only reason for refusing to conduct an examination, since there are also contraindications, in the presence of which it is impossible to go for the procedure in any case.

To get more informative pictures, you need to properly prepare for the procedure.

We are talking about the following situations:

pregnancy;
transferring a biopsy;
small age;
lactation.

When using a contrast medium, the following contraindications must be considered:

individual intolerance to the components of the contrast;
such serious illness, as kidney failure, liver failure, heart failure, diabetes and many others.

Preparation for the examination

To obtain high-quality images, careful preparation for the examination is necessary. We will immediately mention that this applies only to those cases when X-ray with barium is meant, since the survey examination is most often done spontaneously.

During the procedure with contrast, it is necessary not to eat food 12 hours before the examination, and 3 days before the examination, it is necessary to stop eating foods that promote gas formation, namely: vegetables, fruits, foods, sweets, black bread. Most often, it is also necessary to clean the intestines, which is done with the help of a special enema, which is prescribed for the evening before the examination and two hours before it starts.

Despite the exposure, it is necessary to conduct such examinations, since it is informative, and the conduct itself does not cause any difficulties.

Internal organs under x-rays are not characterized by high information content. Parenchymal and air tissues do not reflect radiation, therefore, a clear picture is not visualized on radiographs. In order to reveal the pathology of hollow structures and formations of low density, their complete contrasting (injection of a contrast agent) is necessary.

What is an abdominal x-ray

Plain x-ray of the abdomen showing x-ray contrast gallstones, urinary tract, kidney and large intestine. With perforation (destruction of the intestinal wall), the study allows you to detect free gas under the right dome of the diaphragm and fluid levels in the lower part of the abdominal cavity, as well as the small pelvis. Plain radiography of the abdomen shows:

large tumors;
fecal masses;
intestinal obstruction (Cloiber bowls and arches).

The examination is not preventive and is not assigned to every patient. Abdominal x-rays are done for suspected intestinal obstruction, perforation of the intestinal wall, or for back pain.

What is the passage of barium through the intestines

The passage of barium through the intestines is performed if there is a suspicion of intestinal need, but before the procedure, perforation (destruction of the wall with the release of air) of the gastrointestinal tract with the help of FGDS should be excluded.

X-ray photo 6 hours after taking barium: Kloiber bowls are traced (marked with arrows) in acute intestinal obstruction

Attention! The passage with barium through the intestines in case of destruction of the intestinal wall is contraindicated. Barium sulfate is a water insoluble contrast. Its entry into the peritoneum will contribute to the development of peritonitis (inflammation of the peritoneum).

The technique involves oral (by mouth) application of a contrast agent and taking pictures after 1, 3, 6, 9, 12 and 24 hours. At these intervals, the contrast moves into different parts of the gastrointestinal tract:

After 1 hour - a contrast agent in the small intestine.
3 hours - barium accumulates in the transition area between the small and large intestines.
6 hours - the initial sections of the ascending colon.
9 hours - transverse and colon.
12 hours - descending colon and sigmoid colon.
24 hours - rectum.

The barium passage through the intestines shows:

narrowing of the lumen of the gastrointestinal tract;
difficulties of its advancement at the block;
intestinal obstruction;
small intestine fistulas.

Recall that an x-ray of the abdominal organs without a contrast agent is uninformative. But he shows great. emergency- acute intestinal obstruction, in which free gas is visible under the dome of the diaphragm (symptom of the "sickle"). If such signs are identified, urgent surgical intervention to identify the causes of perforation (perforation).

When is a Plain Abdominal X-ray with Contrast Taken?

Plain radiography of the abdominal organs is done with the following diseases:

pancreatitis - inflammation of the pancreas;
cholecystitis - inflammatory changes gallbladder;
abscess - purulent cavity;
urolithiasis, nephrolithiasis - stones in the kidneys and urinary tract;
invagination - twisting of the intestine around the axis;
blockage of the lumen by a tumor;
diverticulitis;
traumatic injuries;
abdominal pain.

In these diseases, a survey x-ray of the abdominal organs is first performed. This requires prior preparation. It involves a cleansing enema 2 hours before the procedure.

After performing an overview image and in the absence of x-ray signs of perforation of the intestinal wall, the organs are contrasted with barium orally.

Attention! In a contrast study of the abdominal cells and large intestine (irrigoscopy), the contrast is injected through the rectum.

Method of passage with barium through the gastrointestinal tract

Virtual endoscopy: spastic contractions of the large intestine in colitis

The passage technique is highly informative for research small intestine. This part of the abdominal cavity has many anatomical formations, bends, anatomical narrowing, tumors, areas of impaired motility and secretory activity.

To study all parts of the small intestine, it is necessary to perform targeted radiographs in 30-60 minutes. As a result, it is accompanied by a significant radiation load on the patient.

As barium advances in the abdominal cavity, it is possible to study the structure various departments. When the caecum is seen on the x-ray during the passage with barium, the study is stopped so as not to additionally irradiate the patient.

For pain in abdominal wall, as well as identifying symptoms of tension in the abdominal cavity, x-rays can be continued to examine the condition of the large intestine. True, it should be planned in advance in order to qualitatively clean the gastrointestinal tract ( Activated carbon, fortrans). A slag-free diet is prescribed 1-2 days before the procedure.

Preparing for a Contrast Abdominal X-Ray

How is the preparation for an abdominal radiography followed by contrasting:

For 2-3 days, you should give up dairy products, black bread, coffee, spicy, chocolate, alcohol and smoking.
You can use butter, white bread, pasta, fish.
On the day of the procedure, the stomach should be empty. To do this, refrain from eating, smoking, chewing gum.

To eliminate slag accumulations in the intestines, some doctors recommend the drug Fortrans. It can be purchased at a pharmacy. Before use, the sachet of the product is diluted with a liter of boiled water. Fortrans is applied in the evening with an interval of 1 hour until the dosage recommended by the doctor is over.

An x-ray of the internal organs is performed if there is a suspicion of dangerous states. If the doctor has prescribed a study, you should not refuse it. The passage with barium can save a life!

The use of a contrast agent for examination of the gastrointestinal tract and preparation for the examination require professional skills. To obtain high-quality images, it is necessary not only the ability to set the time for performing radiographs. It is important to properly prepare barium. This substance is diluted with water, but is not water soluble. Depending on the density of the suspension, an image is obtained on the radiograph. To explore small intestine, located near the Bauhinian valve (colonic junction), it is necessary to prepare a solution of low density.