RU2234250C1 - Method for testing the state of patient's pancreas and spleen - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: before testing the patient one should introduce intraintestinally contrast substance - 0.5%-tea infusion at 500-600 ml. Then patient should take perorally 200.0 ml carbonate mineral water. Then comes computer-tomographic trial in the following sequence: the first picture is a survey one where general state of pancreas and spleen is evaluated to detect pathological focus. Then comes series of pictures in horizontal plane at the level of detected alterations (tomograph's pace is 0.5-1 cm). The state of wall should be evaluated: shape, size, structure interactions with surrounding organs and tissues and at pronounced edema, increased sizes, illegible contours and the state of parapancreatic fiber at roentgenological pictures it is possible to conclude upon the state of patient's pancreas and spleen. The method provides higher information nature of the trial conducted and prevents the development of complications.

EFFECT: higher accuracy of evaluation.

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Description

The invention relates to medicine, namely to surgery, gastroenterology and radiology and can be used to assess the condition of the pancreas and spleen.

Computed tomography (KT) is the most optimal x-ray method that allows you to get a clear detailed image of the pancreas and spleen, to evaluate their shape, size of structure, relationship with surrounding tissues and organs.

The prototype is a method that consists in the following: CT examination begins with a scan of the upper abdomen without the introduction of a contrast medium, while sections with a step of 5-10 mm are studied throughout the entire area from the dome of the diaphragm to the wings of the ilium.

To better distinguish between the pancreas and spleen from the adjacent sections of the gastrointestinal tract, the patient is given 1 ml of a 76% solution of verographin diluted in 200 ml of water 10-15 minutes before the study. In addition, in asthenics, due to the absence of parapancreatic fatty layers, the back contour of the pancreas can poorly differentiate from the adjacent vascular structures, which does not allow reliable orientation with respect to the true boundaries of the organ. In these cases, for a clear distinction, one must resort to intravenous contrast enhancement (General Guide to Radiology. Edited by Holger Pettersson VD // Medical Imaging Series, NICER Institute, PA “Spas”, 1996, pp. 1-67-1069).

Unfortunately, differential diagnosis of chronic pancreatitis and tumors of the spleen and pancreas is especially difficult. In general, tumors with a diameter of up to 2-3 cm cannot be detected either by visual or by densiometric analysis. And the accuracy of the diagnosis of cancer of the head of the pancreas reaches 84% (Todua F.I., Fedorov V.D., Kuzin M.I. Computed tomography of the abdominal organs (Atlas). M., Medicine, 1991. - p.19-22 ) It is known that the use of iodine-containing drugs is often accompanied by the development of allergic reactions and a tip that reduces image quality, since the contrast with intravenous amplification gives a value from +50 to +70 Hounsfield units. Which is significantly greater in density than calculi in the gallbladder or common bile duct.

The technical result is to increase the accuracy of the assessment of diseases of the pancreas and spleen due to the information content of the study, the prevention of complications.

The specified technical result is achieved by the fact that a 0.5% infusion of tea in an amount of 500-600 ml is administered intradermally as a radiopaque substance to the patient, and before the CT examination, the patient is prescribed to take 200 ml of carbonated mineral water inside, after which a series consecutive sections of the pancreas and spleen in the horizontal plane with a step of the tomograph of 0.5-1 cm.

The authors in the medical and patent literature did not find information on the use of these distinguishing features for assessing the state of the pancreas and spleen. Thus, the claimed invention meets the criterion of "novelty."

The proposed method is as follows: a day before the study, the patient takes only broth, tea with cracker. Before the study, the patient is prescribed a contrast enema (that is, administered intradermally) with a contrast agent - 0.5% tea infusion in an amount of 500-600 ml. And immediately before the study, the patient is given orally 200.0 ml of sparkling mineral water. Next, a CT scan is performed using the 3rd generation apparatus “Somatron CR, Somatron ARC”, in the following sequence: the first picture is a survey, in which the general condition of the pancreas of the spleen is assessed, a pathological focus is detected. Then carry out a series of images in a horizontal plane at the level of the detected changes (step of the tomograph 0.5-1 cm). The state of the wall is assessed: the shape, size, structure, relationships with surrounding organs and tissues, and the state of the pancreas and spleen are judged by the presence of pronounced puffiness, increase in size, blurred contours, and state of parapancreatic fiber on x-ray photographs. The method allows to determine the degree of spread of the pathological process.

When pathological changes are detected, sections are reconstructed.

Our studies have found that contrasting the colon with tea allows us to differentiate it from other anatomical structures, visualize the tail of the pancreas and spleen, and in some situations the head of the pancreas. And ingestion of carbonated mineral water by inflating the stomach with the gas contained in the mineral water, raising it and moving it to the anterior abdominal wall better contrasts the body and tail of the pancreas and spleen. Thus, the claimed invention meets the criterion of "inventive step".

The proposed method is illustrated by the following examples.

Example 1. Patient A., born in 1952, was admitted to the hospital with complaints of abdominal pain, nausea, weight loss. Ultrasound tomography revealed signs of chronic hepatitis. A week before admission to the clinic, computed tomography of the pancreas was performed with intravenous amplification in another clinic with the same diagnosis. Given the above arguments, the patient was assigned to computed tomography with contrasting of the stomach and colon.

In a series of successive images, it was revealed (Fig. 1): the liver - the contours are even, the density of the parenchyma is heterogeneous due to the expansion of intrahepatic passages. The right lobe protrudes from the edge of the costal arch by about 2 cm. The gall bladder is small in size with a thickened densified wall. Spleen - the position is correct, the contours are uneven, density = 37 U.N. adjacent to the left hypochondrium, connected to the intercostal spaces. The pancreas is the correct position, the sizes are not enlarged, the contours are fuzzy, the density of the parenchyma is heterogeneous, cysts and focal formations are not detected. Kidneys - the position is correct, the parenchymal layer is thickened.

Final diagnosis: chronic inductive pancreatitis.

Thus, the study allowed us to establish the correct diagnosis in the patient and prescribe adequate treatment. There were no complications during the manipulation.

Example 2. Patient N., 36 years old, was admitted to the hospital with complaints of pain in the left hypochondrium, weakness. An ultrasound scan revealed an enlarged spleen. In order to clarify the diagnosis, computed tomography with intraintestinal enhancement was prescribed: the liver - the contours are even, the right lobe protrudes 2.5 cm from the edge of the costal arch. The density of the parenchyma is heterogeneous due to the expanded intrahepatic passages. In the right lobe of the liver in the projection of the gallbladder, a site of heterogeneous density of 18-57 units of X is determined. Spleen - the position is correct, the contours are uneven, density = 43 units N. heterogeneous consistency, scalloped edges. The right kidney is omitted, the parenchymal layer is thickened. (figure 2).

Diagnosis: chronic biliary hepatosis, liver hemangioma is not excluded.

Thus, the proposed method made it possible to clarify the diagnosis and treatment tactics.

The proposed method was examined 8 patients. In all cases, the information content of the examination was high, the correct diagnosis was made, no complications were identified.

The proposed method is easily reproducible in a hospital environment and when used, the specified technical result is achieved. Thus, the claimed invention meets the criterion of "industrial applicability".

Claims (1)

A method for studying the state of the pancreas and spleen by X-ray tomography, characterized in that 0.5% tea infusion in the amount of 500-600 ml is administered intracutaneously as a contrast agent, then carbonated mineral water in the amount of 200.0 ml is orally administered, after which they conduct a series of successive sections of the pancreas and spleen in the horizontal plane with a tomograph pitch of 0.5-1 cm and determine the swelling, size, clarity of the contours, and sosten on radiological images yanie parapancreatic fiber, which are judged on the location, nature and stage of the pathological process in the pancreas and spleen.

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