X-ray image of stomach
Then, thanks to tomography images on ultrasound, computed tomography, magnetic resonance will show a direct correlation between the stomach and neighboring organs.
Gastric X-ray technique
To examine the stomach on X-ray images, we give the patient a baryte drink in the amount of 250-300ml. Depending on the age of the patient and the medical condition of the stomach, this number will vary. To see the mucosa, we only need to give the patient 50-100ml to drink. We can also inflate to do double contrast with steam from 500 - 600ml O2 or air. With this method, many tumors and facial ulcers can be detected quite clearly. Then let the patient take pictures in many different positions: upright, supine, prone, anti-Trendelenburg to reveal all details of the stomach and lesions.
It should be noted that the image seen on routine radiographs is the image of the inside of the stomach, to evaluate the stomach wall and surrounding organs, it is necessary to supplement with tomographic methods such as ultrasound, computerized tomography. Nowadays, the trend of diagnosing gastric pathology is giving way to endoscopy.
Appearance: on radiographs, the stomach appearance is similar to that of normal anatomy.
In the upright position, the stomach is J-shaped for a normal person. The airbag section is at the top and has a horizontal baryte level.
Lying supine, the stomach image is the same as on complete anatomy.
Lying on the stomach, it is again as a shoe.
Tone: is the tension of the muscle at rest, when contraction increases this tone (muscle tension), the tone is mainly influenced by the X cord. When the:
In a normal tone, the stomach is in the shape of a J.
Short gastric hypertonicity with bull horn shape.
The decreased tone of the long stomach hanging down to the sock shape.
Loss of gastric tone dilated pelvic floor.
Shape and tone are not solely influenced by the site of the wall, but also by:
The patient's body: obese stomach is pushed up, the antrum is pulled back. The same can happen in pregnant women.
The stiffness of the abdominal wall affects the relationship of the organs in the abdomen, the flabby abdominal wall reduces this total tone.
Condition of nearby organs: liver, spleen, small intestine, large intestine.
The relationship of this part of the stomach, first, we must firmly grasp the anatomy. Then, thanks to tomography images on ultrasound, computed tomography, magnetic resonance will show a direct correlation between the stomach and neighboring organs.
Peristalsis of the stomach:
That is, the contraction of the gastric wall muscles manifests as waves that start at the great curvature and then the small curvature. The wave starts in the middle of the great curvature, is usually shallow, and then deepens, the deepest is in the prepyloric cave, sometimes 2 waves on the 2 banks are close to each other, forming a duodenal pseudobulb. Usually, 2-3 waves go together and are about 1/10gy apart.
The stomach moves according to breathing, movement of the abdominal wall, the pressure outside the abdominal wall.
Normally, after 2 hours after eating, the stomach has eliminated all barite. This time also varies depending on the substance eaten or drunk and depends on the temperature of the food. Use this property to accelerate the excretion of the drug: cold.
Mucosal changes depending on the region (as seen on routine radiographs or on endoscopic images):
In a gastric aneurysm, the mucosa is irregular, rough, and short, with sinuses.
In the cardia, it passes along the small curvature of the smooth mucosa parallel to the pylorus, sometimes with some mucosa crossing the greater curvature in the antrum.
On the two sides, the larger mucosa is arranged parallel to each other in the body of the antrum with diagonal folds.
In the great curvature, the mucosa is rough, and the folds run perpendicular to this border, forming a serrated appearance.
In the pylorus, the mucosa is less and parallel to the duodenum.
The mucosa does not change with peristalsis, but changes with tone: when increased, the mucosa is flat and unclear; when reducing clear mucosa, deep folds.
Symptoms of Stomach Disease
A diaphragmatic hernia is a part of the stomach that protrudes from the abdomen into the chest.
Left diaphragmatic paralysis: paradoxical gastric motility.
Gastric volvulus (rare).
Tumors do push.
Ascites, pregnant women.
Change body shape:
Lengthening the vertical axis (normally the length of the stomach is 23cm, the base is above the iliac crest) causing prolapse over the iliac crest is called gastric prolapse.
Widely dilated when the stricture cannot be discharged.
Stomach atrophy called Squirrheux (Linite gastrique) stomach
Change at the shore:
Called defect shape: here the organizations are in the normal wall (called push shape), if the organization is in the abnormal wall, it is called pedunculated defect or not.
Depending on whether the stomach wall is damaged or not, we have:
The defect is compressed by external tumors: the pancreas, liver, spleen, and intestines are distended, these defects will change when changing position, the edges are soft, called nébuleux.
Defects of benign tumors: with regularly rounded margins, quite often on many different films: polyps, myoma, schwannoma, tricobézoat.
Stomach cancer lacunae: regular malformation with hard, rough margins that did not change on all films.
Small serrated defect: seen in gastritis, small ulcer, inflammation around the stomach.
Pseudoaneurysms: those are non-existent defects that often disappear when pressed, usually inside the stomach: food, fake drug deposits.
Contraction shape: depending on the degree, there are many types.
Shallow: 2 - 3cm measuring peristaltic wave changes frequently.
Deep stretch: > 3cm (regularly fixed) may be due to pressure of the splenic flexure of the colon, pressing on the aneurysm will disappear.
Further deepening (> 5cm): divides the stomach into two pouches:
Muscle tension due to contraction of gastric sphincter fibers is only visible in the greater curvature because the longitudinal bundle is weaker here than in the minor curvature. This stretch is often accompanied by a small curvature ulcer, which is quite often present and disappears only with atropine injection.
Physical protrusion: due to fibrous shrinkage of the ulcer at the small curvature or K infiltration, a tubular defect occurs. This stretch does not go away but develops further with the injection of atropine.
Convexity or diverticulum: This is a collection of drugs, caused by damage or malformation of the stomach wall:
Fixed, permanent convex shape: due to the damage penetrated deep into the stomach wall, creating an ulcer.
Fixed convex shape but variable in size: Gastric diverticulum is most commonly found in the upper part of the stomach, esophagus, and most typically with a stalk.
Common stomach diseases
Stomach ulcers :
Typical Haudek ulcer: The ulcer is caused by local destruction of the gastric mucosa, creating a defect. When taking an X-ray, the drug will get into that ulcer. On the straight film taken at the edge, we see a convex image outside the stomach wall, taken at the surface, we can see the drug deposition. Depending on the size of the shallow depth, we see many images: pink spikes, strawberry or half-globes, mushrooms, fingers, lances, giant ulcers.
The location of the ulcer: most often found in the small curvature; less than in the back of the stomach, which can be detected by compression, mucosal or side scans. Ulcers just below the cardia and anteriorly are rarer.
Ulcers in the prepyloric region and of the pyloric canal are usually very small, with surrounding edema in the form of pink spikes.
Ulcers in the great curvature are rarely seen with a concave shape in the great curvature and the ulcer is often protruding in the center of that line, the ulcer is often irregular but always malignant.
Ulcers may also perforate an adjacent organ: spleen, pancreas, liver, colon.
According to Gutmann, both vertical ulcers are benign, and transverse ulcers can be potentially malignant, so gastrectomy is needed when ulcers are present.
Of course, endoscopic biopsy for a more definitive diagnosis.
Ulcus wall ulcers often have edematous protrusions on the face, in addition, long-term ulcers may have convergent mucosal marks, thickened folds, and may contract.
Figure: Comparison of macroscopic and radiographic images of gastric ulcer.
(a. gross picture; b. overall picture; c. radiographic image).
Indirect imaging has only a secondary value, without ulceration, it is impossible to conclude whether or not an ulcer is present.
Partial loss of peristalsis, or rectitude segmentation, of the minor curvature. This is a sign that precedes ulceration, due to a decrease in wall softness, followed by limited mucosal edema. The radiograph shows that the peristaltic wave does not pass through this area normally. Loss of peristalsis is a very faithful indirect symptom, but difficult to detect. It is necessary to compare many films, take many times, even take multiple photos (polygraphic) to detect it.
Indentation in the great curvature due to constriction of the annular bundle in the area of the ulcer. Always found on the opposite bank i.e. the large curvature called the index finger.
Increased peristalsis: to overcome the spasm in the pylorus (due to inflammation) the stomach muscles must increase peristalsis to make the waves deeper, more rhythmic. At first, this attempt was also effective in gastric emptying. As the stomach wall becomes tired, the muscles contract weakly, leading to:
The most delayed gastric emptying are ulcers near the pylorus:
The stomach still has a lot of secretions, showing a layer of pale contrast fluid near the air sac, that is secretion.
Pain when pressed, this symptom is of little importance. If the ulcer in the pylorus, there are additional symptoms but only relative.
The angle of the pyloric canal.
Prolonging the pyloric canal.
Deviation of the pyloroduodenal canal axis, asymmetry through the pyloric canal of the duodenal wall
Benign ulcers and malignant ulcers:
Ulcers with pseudo-drug deposits especially in the upper part of the minor curvature.
Treitz angle, diverticulum: lost on compression, not fixed.
Complications of stomach ulcers:
The stomach has two pouches.
Perforated gastric ulcer with hard infection.
Shrinkage at a small curvature gives the shape of a snail's stomach.
Pyloric stenosis: perineal stomach with snowfall
Mainly adenocarcinoma, this is the most common type K.
In the early stage, it is only localized in the mucosa and does not penetrate deeply into the mucosal muscle layer, this stage is very discreet and difficult to see.
In the advanced stage, there is an invasion into the muscular layers inside the stomach wall, and at the same time invades the gastric lumen with the following symptoms:
Hard infection: we can see the loss of peristaltic waves on a segment or segments of the curvature.
Wart form: corresponds to the shape of the jagged edges
Ulcers: are convex shapes, with hard infected legs, jagged bottom, lens-shaped.
Figure: Types and locations of gastric cancer.
1 and 2: Limited hardening.
3: Gastric atrophy in full-blown gastric cancer (Linite gastrique).
4: Ulcerative carcinoma at a small curvature angle.
5: Cancer in the gastric aneurysm.
6: Cancer of ring-shaped warts in the body of the stomach.
7: Cancer of antrum causing “apple-core” narrowing.
8: pyloric stenosis, gastric dilatation.
9: Ulcerative carcinoma causes shrinkage at a small curvature angle.
10: Hard surface carcinoma causes widening of the small curvature angle.