Contents
The small intestine is one of the sections of the digestive tract. It is in this part of the intestine that a significant amount of the processes of processing the food that has entered the body, absorption and assimilation of useful nutrients from it takes place. The small intestine, like other systems in the human body, is prone to various diseases. Some of them have specific manifestations, while the symptoms of others can relate to a dozen more diseases, so the doctor has a lot of diagnostic techniques in his arsenal, among which is X-ray of the small intestine, carried out with contrast.
Small intestine: structure and functions
Anatomically, this section of the intestine is located between the stomach and the large intestine, and together with the large intestine makes up the entire intestine. The name “small intestine” is due to the peculiarities of its structure – it has thinner walls and a narrower lumen than the large intestine.
The small intestine, in the aggregate of all its departments, is the longest tubular organ of the digestive tract – in the body of a living person, its length is 4-5 meters, after death, the walls, muscles and ligaments relax, and the total length of the small intestine can reach 7 meters.
The beginning of the small intestine is the pylorus, followed by the duodenum, about 25-30 centimeters long, followed by the jejunum and ileum, which make up 2/5 and 3/5, respectively, of the total length of this section of the intestine. The small intestine ends at the ileo-caecal opening – at this point it passes into the large intestine.
Along the entire length of the small intestine, its lumen tends to narrow from 4-6 to 2,5 centimeters.
The main function of the organ is to convert the beneficial substances contained in the absorbed food into soluble compounds so that they can subsequently be absorbed by the intestinal walls. Processing occurs under the action of pancreatic enzymes and intestinal juice, as well as bile.
As a result, proteins, fats and carbohydrates are broken down into amino acids, fatty acids and monosaccharides, respectively.
Further, these substances, together with water and salts, enter the blood and lymphatic vessels, through which, with the flow of blood and lymph, they are carried to all tissues and organs in the human body. In addition, the small intestine is also involved in the hormonal regulation of the body.
Its specific cells – neuroendocrine – produce various hormones, including: serotonin, gastrin, histamine, secretin, cholecystokinin.
Throughout the length of the walls of the small intestine have the same structure. They form four layers:
- mucous membrane;
- submucosal base;
- muscle layer;
- outer serous membrane.
What is radiography used for?
Specific intestinal diseases that most often affect this section include:
- enteritis, including enterocolitis, gastroenteritis, gastroenterocolitis;
- intestinal enzymopathies: disaccharidase deficiency, celiac disease;
- Will’s disease;
- diverticulosis;
- Crohn’s disease.
Enteritis
Enteritis is the inflammation of the mucous membranes in the small intestine. Such a pathology rarely has an isolated character, and is mainly localized simultaneously in the large and small intestines (enterocolitis), in the stomach and small intestines (gastroenteritis), or throughout gastrointestinal tract at the same time (gastroenterocolitis).
Enteritis can be caused by various factors – infectious and parasitic lesions, exposure to ionizing radiation and poisons.
Also, the disease can be caused by medication, diseases of nearby organs, such as pancreatitis, hepatitis, cirrhosis, gastritis, and even skin diseases. Enteritis can occur in acute or chronic form.
Intestinal enzymopathies
Intestinal enzymopathies are general changes in the activity of enzymes responsible for digestion. These diseases are mostly hereditary. Due to changes in the enzymeativNoy activity occurs violations of biochemical reactions, entailing metabolic diseases.
There are also acquired enzymopathies that appear after severe diseases with a chronic course, for example, as a result of dysentery.
Will’s disease
Will’s disease is also called intestinal lipodystrophy. This pathology is chronic, and is characterized by a violation of the process of absorption and assimilation of lipids from the contents of the intestine. The reasons for the appearance of this deviation have not yet been clarified by scientists.
Diverticulosis
Under this name lies a disease of the intestinal walls. They form sprains – the so-called blind pockets, protruding towards the abdominal cavity. Diverticula often appear in the jejunum, less often in the ileum, can be single or multiple. The simple course of the pathology does not cause significant problems to a person, except for periodic constipation and a feeling of bloating. However, 6-10% of patients develop complications in the form of bleeding, intestinal obstruction, or perforation of the intestinal wall, less often – cystic pneumatosis.
Crohn’s disease
Pathology is an inflammatory process that covers the entire digestive tract, including the small intestine. Its characteristic feature is a chronic course – inflammation lasts more than six months, and is permanent. Inflammation affects not only the inner mucosa, but also the submucosal layer, and can even cover the muscle tissue in the intestinal wall.
To determine these and other diseases of the small intestine, to correctly establish the diagnosis, to identify the presence or absence of indications for the operation, X-ray of the small intestine with contrast can be used.
Due to the fact that the organ has a hollow structure, its x-ray is carried out with the preliminary introduction of a special contrast agent with barium.
What does this diagnostic method show? The distribution of matter and air in the intestine makes it possible to identify the shape and structure of the small intestine in the pictures, to detect foci of inflammation, tumors, polyps, malignant neoplasms on the radiograph. The injected substance envelops the walls of the intestine, giving a clear and plastic picture of the inner layer of the intestines.
The contrast agent also helps to display:
- possible ulcerative lesion;
- cancer of the intestinal walls;
- fistulas;
- scarring;
- pathological narrowing and expansion of the lumen;
- the degree of extensibility, mobility and elasticity of the intestinal walls;
- mucosal relief;
- characteristics of the motor function of the small intestine.
Indications and contraindications
The referral to the procedure is issued to the patient by a general practitioner, oncologist or gastroenterologist. The patient usually comes to these specialists with characteristic symptoms: vomiting with blood content, blood in the stool, diarrhea or constipation, causeless weight loss; difficulty swallowing, persistent heartburn, persistent pain in the epigastric region.
Indications that are grounds for prescribing an x-ray: suspicion of enteritis, impaired muscle motility, malabsorption syndrome, narrowing and obstruction of the small intestine, chronic colitis, suspected peptic ulcer and cancer, diaphragmatic hernia, ulcerative colitis.
The procedure also has relative and general contraindications. For example, obstruction of the small intestine requires special care and responsibility on the part of the physician prescribing the procedure and the radiologist who performs it. The problem is that the contrast agent can increase the obstruction, so such a violation in some cases may not be an indication, but a ban on x-rays.
Absolute contraindications to the procedure:
- allergy or individual intolerance to contrast;
- rapidly developing ulcerative colitis;
- the period immediately after taking intestinal tissue for a biopsy – until the walls heal;
- toxic megacolon;
- suspicion of perforating lesions of the walls;
- the general serious condition of the patient, for example, if he is connected to a life support device;
- tachycardia;
- heart, kidney and liver failure;
- intense and severe pain in the abdomen.
How to prepare for the diagnostic procedure
The quality of the preparation, first of all, depends on the information content of the radiography of the small intestine, and the objectivity of the results obtained. Its whole essence comes down to cleansing the intestines from accumulations of gas and feces, since they are displayed on the pictures with additional contours and darkened areas, in addition, they interfere with the normal distribution of the contrast agent along the walls and cavity.
Before the diagnosis, the intake of drugs that slow down intestinal motility is canceled.
Two days before the appointed date, it is necessary to remove from the diet foods that enhance the process of gas formation in the intestines:
- Rye bread;
- dairy and dairy products;
- raw vegetables;
- carbonated drinks and alcohol;
- beans;
- fatty and fried foods.
On the days of preparation, you must drink at least two liters of fluid per day. The day before X-ray with barium, you should refuse solid food – you can use weak meat and fish broths, clear non-concentrated juices and compotes, herbal and green tea. After each meal, you need to take 3-4 tablets of activated charcoal. 12 hours before the procedure, the intake of any food and liquid is completely excluded.
Cleansing measures immediately before the X-ray begin in the evening. The patient needs to do one or two water enemas containing castor oil or magnesium sulfate – the subject determines how many times the enema will be given, focusing on the degree of transparency of the emerging fluid. In the morning before the procedure, a procedure with a water enema is performed.
Laxatives can also be used – in this case, it is better to take them in the evening.
Preparatory measures include the establishment of the absence of contraindications. The doctor clarifies the patient’s presence of allergic reactions, chronic diseases. Be sure to inform the doctor about all the drugs taken, women – about the presence of pregnancy.
procedure with contrast
To obtain high-quality images, it is recommended to remove all accessories and jewelry made of metal before the examination.
A contrast preparation containing barium can be introduced into the body of the subject in two ways. In the first case, a few hours before it starts, the patient drinks 500 milliliters of a weighed solution of barium sulfate. After a quarter of an hour, the liquid approaches the small intestine, and for the remaining time it is distributed throughout it.
The second option involves the rectal route of the contrast. For this purpose, a Bobrov container with a volume of one liter is used. It is filled with an aqueous solution of barium. The patient is located on a movable couch, lying on his back.
To ensure complete immobility, the subject can be fixed with special rollers.
Air is slowly supplied through the tube into the jar of Bobrov’s container. Another tube, using a special nozzle, is gently inserted through the anus into the rectum. Through this tube, a contrast fluid is supplied under slight pressure to the intestines. During the injection process, the patient is periodically turned from one side to the other so that the drug spreads along the walls of the digestive tract, enveloping them.
To improve the quality of images, the double contrast method can be used. In this case, after the first portion of the liquid contrast enters the small intestine, which spreads along its walls, air or gas slowly begins to enter it.
Having introduced the required amount of liquid or gas into the organ, the doctor takes a series of shots with varying degrees of fullness of the intestine. The total duration of the procedure can be 30-40 minutes. It, despite its painlessness, is quite unpleasant for the patient, therefore, before it starts, the doctor or X-ray technician advises him on how to properly respond to discomfort and how to breathe correctly in the process.
Modern x-ray machines allow not only to capture the image in the pictures, but also to display it on the monitor so that the doctor can assess the condition of the intestine in real time. In this case, the doctor, focusing on the passage of barium, studies intestinal motility and the condition of the mucous membrane. Areas with a pronounced lesion are fixed on x-ray images, while the movable couch allows you to take pictures in different projections.
Weak fullness makes it possible to study the relief of the inner lining of the small intestine, as well as the state of its folds. Tight filling allows you to evaluate the size, contours, location and degree of displacement of the organ. When the passage of contrast reaches the caecum, the examination is completed.
What happens after the diagnostic process
Usually, no complications and problems appear after X-ray of the small intestine with contrast, so the doctor allows the patient to return to a normal lifestyle and diet. In some cases, for example, if perforation of the intestinal wall occurs, the subject may be hospitalized in a hospital.
Normally, the contrast agent is excreted from the body along with feces within 2-3 days.
After analyzing the image on the monitor, and the picture recorded on the pictures, the results are interpreted by the radiologist. Most often, it will take him no more than an hour to draw up a conclusion, but in difficult cases, the doctor deciphers the results for a longer time, and may even involve related specialists.
After that, the images, together with the conclusion of the diagnostician, are issued to the patient. They must be transferred to the attending physician who referred the patient for examination – then he will be guided by these data, establishing the final diagnosis, developing treatment tactics, including deciding whether it is necessary to perform surgery in the small intestine.
The small intestine is the part of the digestive tract, which bears the main burden of processing food and sucking out nutrients from it: fats, proteins, carbohydrates. It is in the small intestine that these substances break down into fatty acids, amino acids and monosaccharides, after which they enter the vascular system, and then into all tissues and organs of the human body.
In order to assess the state of the small intestine, its motility, the health of its walls, the presence of narrowing or expansion, pathologies, tumors, inflammatory processes and various diseases, the attending physician prescribes special diagnostic measures to the patient, one of which is an X-ray of the small intestine.
The procedure is carried out using a contrast agent containing barium, or with filling the intestine with gas – only in this way it is possible to most accurately visualize a hollow organ related to the digestive tract on an x-ray.