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Cholecystography and cholangiography





Before cholecystography it is necessary to: a) before examinationinform the kitchen facility of the necessity for special nutrition; b) 14-15 h prior to examinationgive the patient radiopaque substance; c) at 10 p.m. and 7 a.m. cleansing enema; d) 14-15 h fromtaking of radiopaque substance the patient is given 2 raw eggs and sentto X-ray department.

The cholecystography allows not only to determine the presence of stones in gallbladder, but also their position, ability to move, and after two egg yolks –the degree of contraction and emptying of gallbladder. Cholangiography is done to examine of biliary ducts. For this type of examination instead of Bilitrastum30-40 ml of 20% Bilignostum or Biligrafinumwater solution is injected intravenously.

Cholangiography allows to detect pathological changes in common biliary, cystic and hepatic ducts. Cholecysto- and cholangiographyare contraindicated, besides cases of iodine drugs intolerance, indecompensatedcardiac diseases, other cardiac diseases accompanied by circulatory insufficiency, expressed atherosclerosis, II-III stagehypertensia, diabetes mellitusin severe form, hepatic cirrhosis, etc.

Gastroduodenoscopy

The basic indications for diagnostic gastroscopy are practically all gastric diseases, especially in suspicion of malignant neoplasm, differential diagnostics of functional and organic lesions of mucosa.

Contraindications to gastroscopy are esophageal stenoses, expressed cardiac and cardio-pulmonary insufficiency, aortic aneurysm, myocardial infarction, stroke, mental diseases, expressed deformation of spinal column, substernalgoiter, esophageal varicose veins dilatation.

Relative contraindications includecardiospasm, expressed diverticula of esophagus, inflammatory diseases of upper respiratory tracts, stenocardia, hypertensia, obesity. In cases when flexible gastroduodenoscopes are used complications are extremely seldom. Preparation of the patient for endoscopyis the same as foresophagoscopy.

Introduction of gastroduodenoscope is done more often in position when the patient is lying on his left side on a special table. The patient also throws back his heada little, bends his right knee,his left wrist should be on the right shoulder, and right wrist - on the right hip.

For safety and proper functioning of the device it is very important to steriliseit the right way. In case of gas sterilisation after preliminary washing offthe gastric contents the device is processed withethylene oxide and methyl bromide at 40°Сfor 4 h. For cold liquid sterilisation 6% solution of hydrogen peroxide (З1/2h), peracetic, performic acid (11/2 h) are used. After cleaning and sterilisation endoscopes are put intoa special cupboard designed for their storage.

Colonoscopy

Colonoscopy allows to detectpathological changes of large intestine mucosa, swelling, atrophy, intensification of vascular pattern, hyperemia, punctate hemorrhages, erosions, ulcers. By means of colonoscopy it is possible to detect small polyps (up to 0,2cm in diameter), initial stagesof cancer, inflammatory reaction of lymphoid tissue in the form of swollen follicles and pseudopolyps.

Colonoscopies aredone after thorough cleansing of intestine. 3-4 days prior to examination slagless diet is prescribed. The day before examination the patients after dinner (3 p.m.) take 30-50 grcastoric or olive oil, and in the evening a cleansing enema is done. Before sleep patients take sedative drugs. In the morning, 2 h prior to examination, a cleansing enema is doneonce again. On the day of examination patientsdo not eat breakfast. Premedication is reduced to intramuscular introduction of 0,1% atropin sulfatesolution or 0,2% platyphyllinhydrotartratesolution 1 ml in combination with promedol (1 ml) or 50% analgin solution (2 ml) 30 minutes before the examination.

The colonoscopy is advised in large intestine chronic diseases, suspicion of polyps and cancer, in intestinal bleedings of obscure origin, contradictions betweenthe results of clinical and radiological examination of large intestine, doubtfulresults of radiological examination.

Colonoscopy is absolutely contraindicated in cases ofcardiac insufficiency of II-III degree, myocardial infarction, acute thrombosis of cerebral vessels, coma, shock, hemophilia, acute diseases of abdominal organs with manifestations of peritonitis that demand surgical intervention.

Colonoscopy is relatively contraindicated in expressed strictures of rectum, acute inflammatory and purulent lesions of anorectalregion, psychoses, non-vividly expressed cardiovascular insufficiency.

 

Date: 2016-07-18; view: 271; Нарушение авторских прав; Помощь в написании работы --> СЮДА...



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