The main methods of functional diagnostics of diseases in gastroenterology.
Fractional method of collection and study of gastric contents. The research can be characterized by its secretory, motor and evacuation functions.
Before the study is forbidden to eat, drink, smoke, take drugs, etc.. Studies begin with suction of gastric juice on an empty stomach. This is called basal secretion. In this phase of the study is difficult to say which was the amount of gastric juice in the stomach and has evolved in response to the stimulus (probe). Juice suck for 30 or 60 minutes, every 15 minutes. Number of fasting gastric juice normally up to 50 ml. It increases the number of ulcers, gastritis.
After the study of
basal secretion (60 min) administered to the patient through a tube secretion
stimulator (test breakfast) - a warm liquid in volume 300 ml. For enteral
stimulants are 5% alcohol solution, a solution of caffeine (
After 10 min 10 ml suck, and after 15 minutes - the entire contents of the stomach. Further extraction was carried out for hours, every 15 minutes. These four portions containing pure gastric juice, which is released in response to the stimulant. Please note that each piece is collected in a separate tube. The juice collected in response to enteral or parenteral stimulus for an hour, hour is the volume of gastric juice (hour stress glands). Normally when an intermittent aspiration (juice taken once in 15 minutes in an hour) 50-60 ml, with continuous aspiration (suction juice constantly and every 15 minutes poured into a test tube) - 1.5-2 times more. With continuous aspiration of gastric juice does not manage to fall into the duodenum, which explains the significant increase in its quantity. Hourly volume of gastric juice obtained in response to submaximal stimulation histaminnu, ranges from 100-140 ml for maximum stimulation - 180-200 ml.
In terms of gastric juice in 25 minutes after the test breakfast you can watch the speed of evacuation of his stomach (motor function). Normally this volume an average of 75 ml. With the rapid gastric emptying or at reduced secretion of gastric juice is reduced.
On examination of gastric juice obtained portions are paying attention to color, texture, presence of impurities, odor.
Color. Gastric juice is almost colorless. In the presence of impurities of bile - yellow (the contents of the duodenum into the stomach throw), free hydrochloric acid - green blood - from red to brown.
Mucus in the gastric contents is normally in small quantities. If it floats on the surface in the form of lumps, it indicates its origin from the mouth, nose and throat. A large amount of mucus in gastric juice is gastritis, ulcers and other lesions of the gastric mucosa.
Each portion of gastric juice determined free hydrochloric acid, total acidity, linked hydrochloric acid in portions with maximum acidity - of pepsin.
The acidity of gastric juice is one of the most important indicators of the functional state of the stomach, it is determined by titration of its 0.1 mmol \ l sodium in the presence of indicators (reflecting the concentration of acid secretion).
Total acidity - free and bound hydrochloric acid, organic acid, acid, phosphate salts. Bound hydrochloric acid - HCl nedysotsiyovana protein-hydrochloric molecules gastric juice. It is determined by titration of individual portions of gastric juice (5 ml) in the presence alizarynsulfonovokysloho sodium (yellow).
In the presence of juice of any free acid color changes to purple - is their neutralization. Subtracting the total acidity of milliliters of NaOH, spent the titration of Alizarin (multiplied by 20), we obtain the bound hydrochloric acid.
All figures are total acidity below 20 should be considered as hipoatsydni above 100 as giperatsidnom
Hipoatsydnyy condition. Partial absence of hydrochloric acid in the gastric contents may be sign of gastritis with decreased secretion. Complete absence (achlorhydria) may occur in chronic anatsidnyh gastritis, gastric tumors, certain intoxications.
Giperatsidnom condition - increase of hydrochloric acid in gastric juice. It occurs in chronic gastritis with increased secretion, gastric ulcer and duodenal ulcer.
Akhil - lack of hydrochloric acid and pepsin in gastric juice. It occurs in atrophic gastritis and malignant tumors, B12, foliyevodefitsytnyh anemia, diabetes, hipoavitaminozah, intoxications.
In gastric ulcer, malignant tumors, gastroduodenitis hemorrhagic anemia may occur (different degrees of expression), due to the explicit or implicit gastrointestinal bleeding (decreased number of red blood cells, hemoglobin). Please note that chronic iron deficiency anemia develops chronic atrophic gastritis. After resection of the stomach or hastroektomiyi occurs secondary B12-deficiency anemia. Patients with cancer often find except B12-deficiency anemia and hypoplastic anemia due to toxic lesions of the red bone marrow. When erythremia significantly increases the risk of ulcers.
The number of leukocytes and leukocytic formula in patients with diseases of the stomach often remain normal. Leukocytosis occurs when penetration and other complications of peptic ulcer. If there is a perforation, abscess, leukocytosis accompanied by a shift leukocyte formula. In malignant tumors of the stomach there is persistent leukocytosis, allergic lesions occurring against the backdrop of eosinophilia. Postrezektsiyni complications may lead to the occurrence of leukopenia.
Erythrocyte sedimentation rate (ESR) gastric ulcer, gastritis, gastroduodenitis may be in the normal or low. Increased ESR can develop for complications of peptic ulcer disease, malignant tumors.
In most cases, the changes do not show. If you use a large number of antacid (gastric ulcer, chronic gastritis with increased secretion) reaction of urine may be alkaline. In patients with malignant tumors during the development of severe intoxication is often hematuria, proteinuria, cylindruria.
Total fecal enables agents to detect various infectious diseases. In gastric Akhil becomes mushy stool (clearly visible white lumps of tissue, a large number of muscle fibers - kreatoreja), the reaction is often alkaline.
Fecal occult blood. Positive reaction fecal blood observed in patients with bleeding stomach ulcer, erosive gastro tumors and diverticula of the stomach, nosebleeds, bleeding gums, pharynx, esophagus, Crohn's disease, ulcerative colitis, etc..
Fecal occult blood plays an important role in the diagnosis of diseases of the gastrointestinal tract when it is right conduct and interpretation.
Macroscopic study. Determine the amount of feces, texture, color, shape, smell, presence visible to the eye remains undigested food, pathological impurities parasites.
The normal brown stool due stercobilin and mezobilifustsynom. Also, it depends on the nature of food: meat - dark brown, milk - light brown, yellow, beets - red, chocolate, coffee - dark brown; rhubarb - brownish-yellow, red, liver sausage, blood 'Janko - Black and more. When diarrhea and use of certain antibiotics - golden yellow, acute pancreatitis, biliary tract cancer, major duodenal papilla, viral hepatitis - discolored, dysbiosis - golden yellow, bleeding from the stomach, ingestion of iron, bismuth, carbol - tarry. The lower intestine is located in the hearth of bleeding is best viewed in stool red. Fresh blood on the surface occurs in lesions of the lower colon - polyps, hemorrhoids, fissures, rectal cancer and so on.
The smell of faeces bad, but not sharp. It occurs due to bacterial decomposition of protein food residues and formation of indole and skatole it. Therefore, it is more pronounced in the use of protein-rich meat. When using plant food odor is much weaker in children - almost absent. In patients with constipation stools nearly odorless, with diarrhea - a sharp. When fermenting dyspepsia sour smell of excrement due to impurities acid fermentation. Putrid, heavy smell of decay is characteristic of intestinal tumors.
The remains undigested food can be found in the feces of each healthy person. Normally not peretravlyayutsya in the gastrointestinal tract - seeds, grains fruits, scales, fur and so on. In the absence of teeth, severe deficiency of gastric and pancreatic digestion detected in the feces of visible lumps of undigested food (liyentoreya). In addition, stool can see a lot of fat - steatorrhea. Stool is light gray, brilliant.
From the pathological origin of non food additives can detect mucus, pus, blood, pieces of tumor, parasite eggs.
Mucus is a small amount of stool. The increase is a sign of his disease process. When inflammation of the colon, it lies on the surface of the stool in the form of white flakes or mixed with it. The above is a pathological process in the intestine, the smaller flakes of mucus and the better they are mixed with feces. In dysentery and nonspecific ulcerative colitis, mucus mixed with blood. Pus may appear in purulent peryproktyti, a breakthrough in bowel abscess of the abdominal cavity. In dysentery, tuberculosis, ulcerative colitis, colon cancer decomposition it is mixed with mucus and blood.
The blood from the upper gastrointestinal tract provides tarry stool color (powder). The lower intestine is located along the location of bleeding, more clearly visible red. Red blood covering the stool, is usually a sigmoid or rectum. Hemorrhoids drop of fresh blood appearing at the end of the act of defecation.
Particles of tumors in the stool can be seen in the decay of cancer in the area of the sigmoid or rectum. They are brownish-red color, thick consistency.
Concretions. You can see the bile, and fecal pancreatic stones. Detection of gallstones confirms the diagnosis of cholelithiasis.
Intestinal parasites. Visually, you can see the roundworm, whipworm, pinworm, segments of swine and bovine tapeworm, broad lentetsa.
Ascarids refer to the
round worms live in the small intestine. In appearance similar to earthworms,
ranging in length from 15 to
often in the cecum and appendix. Looks like a worm, pink, length of 3 to
Pinworms look like
thin white threads that are on the surface of the stool in length from 3 to
Segments of the bovine
tapeworm (Taenia saginata) is the length of 15-
Microscopic examination of feces. Conduct research to food debris, identifying elements of pathological secretions of the intestinal wall, parasites. Stool microscopy performed in wet native preparations immediately after the act of defecation. The study did not recommend spending while taking drugs bismuth, iron, laxatives. In normal stool under a microscope shows a lot of detritus - small food particles, cell decay germs that can not be recognized. From the digested protein is clearly visible muscle fibers, connective tissue.
Undigested muscle fibers have a transverse posmuhovanist. Their number is increasing dramatically (kreatoreja) with insufficient digestion of protein (enzyme pancreatic insufficiency, Akhil, hastroenterotomiya etc.). Normally you can find in the field of one or two fragments of muscle fibers. A large amount of undigested muscle fibers with marked transverse posmuhovanistyu shows the simultaneous failure of gastric (reduction of hydrochloric acid) and pancreatic digestion. The large number of connective tissue fibers show a decrease gastric acidity or complete lack thereof.
Since carbohydrate foods in stool microscopy can detect cellulose and starch grains. The undigested fat has diagnostic value. A large number of starch grains indicates the high acidity of gastric juice.
Fat in small quantities may occur in the feces of healthy humans. It has the form of fat droplets, crystals holchatyh fatty acids, short needles, soaps of fatty lumps. A large amount of fat in the stool is called steatorrhea and indicate disorders of intestinal digestion and absorption. Steatorrhea been in violation of the secretion of bile, pancreatic exocrine function and clogging of ductless, declining absorption of fat in the intestine. With a small number of lipases in the stool there is a large amount of neutral fat (steatorrhea), bile - fatty acids.
If the stool is mucus, then it can be found epithelial cells formennyh elements of blood, macrophages, tumor cells.
Leukocytes in normal feces are one or two in sight. A large number of neutrophilic shift detected by dysentery, tuberculosis, cancer, ulcerative colitis. Increasing the number of eosinophils is characteristic of amoebic dysentery, helminthiasis, ulcerative colitis. Remember that white blood cells in the stool are when they come from the lower intestine (in the upper sections are destroyed under the influence of digestive enzymes). Macrophages appear in the stool in inflammatory processes.
When bleeding from the lower colon in the stool reveal a large number of unmodified erythrocytes. If the source of bleeding is high, the latter are destroyed by digestive enzymes. In ulcerative processes distal colon of stool showing red blood cells, white blood cells and mucus.
In normal feces in small amounts are cylindrical cells of the intestinal epithelium. The increase in their numbers is a sign of colitis.
Charcot-Leyden crystals indicate the presence of worms in the intestine.
Cells of malignant tumors found in the stool, if the tumor is in the rectum.
Carry on the machine
that works in "real time". Explores an empty stomach in the morning.
First, find a keeper (conducting longitudinal glow in the epigastric region to
the right of the midline). Over or under the lower edge of the liver it can be
seen in cross-section (diameter 2-
pylorostenosis stomach is increased in size. Significant and irregular
thickening of the stomach wall (more than
Remember that this method is used as an auxiliary. It can not replace the X-ray or endoscopy, but their complements.
When ultrasound can examine and evaluate the stomach wall, its outer contour and its surrounding organs and structures of the abdominal cavity.
Gastroscopy - a way to view the inside of the stomach using an optical device - gastroscope.
This method of research is a major.
Indications for are:
1) the need to establish or further diagnosis of any primary disease of the stomach (gastritis, ulcer, tumor, etc.);
2) determine the nature of changes in the stomach caused by changes in diseases of neighboring organs (liver, gallbladder, pancreas);
3) detection of foreign bodies and so on.
Contraindications for are:
1) esophageal disease (scarring and narrowing of the tumor, diverticulitis) and surrounding organs (retrosternal goiter, aortic aneurysm, tumor of the esophagus, the large curvature of the spine);
2) expressed in cardiovascular and pulmonary disease;
3) The veins of the esophagus.
Routine gastroscopy spend the morning on an empty stomach, emergency - at any time. For 15-20 minutes before the test is administered subcutaneously 1 ml of 2% solution promedola and 0.5-1 ml of 0.1% solution of atropine. Anestezuyut pharynx and esophagus initial 3% solution dicain. The patient was placed on the left side - the body straightened, shoulders bred muscles relaxed. In his mouth insert a sterile mouthpiece and injected probe.
After examination of the patient within 1-2.5 hours should not drink, eat, smoke, or if biopsy is performed, you can not take the day hot meals.
In normal gastric
mucosa skladchatist more pronounced at low and high curvature, and the front
and rear walls. Mucosa from pale pink to red. Injection of air into the cavity
of the stomach folds are smoothed. Goalkeeper is shaped outlet and at
considerable inflating the stomach reaches a diameter of
Before gastroscopy need to x-ray the patient to rule out contraindications - narrowing of the esophagus, esophageal diverticulum, esophageal dilatation and more.
Complications - perforation of the esophagus and gastric bleeding after biopsy, disorders of the cardiovascular and respiratory systems and more. Compliance with the rules of gastroscopy with regard Indications and contraindications and proper preparation of patients allows this test is quite safe and prevent complications.
This allows determining the shape, size, position, mobility, relief of the gastric mucosa and its functional state, showing localization of ulcers and tumors.
Indications for this test include:
2) complaints of heartburn, spitting, loss of appetite, bloating, abdominal pain, nausea, vomiting;
3) enhanced intestinal noises;
4) to confirm the diagnosis of chronic gastritis, ulcers, tumors of the stomach, etc.;
5) unwarranted weight loss;
6) the presence of seals abdominal palpation;
7) enlargement of the liver or spleen;
9) anemia of unclear etiology;
10) the presence of occult blood in the stool.
Research (X-rays or
X-ray) is performed on an empty stomach. During the study, the patient drinks
barium sulfate 100-
Recently, the widely
used technique of double contrast stomach. Studies conducted on an empty stomach.
Before it inspected subcutaneously injected 1 ml of 0.1% solution of atropine.
Stomach stretch air (400-500 cm3) - mucous smoothed. It is covered with a thin
layer of contrast solution. This allows you to get an image of the inside of
the stomach. In contrast using the following mixture:
Spend approximate enlightenment and a series of X-rays of the stomach in different body positions (horizontal, vertical, on the side).
Very popular technique dvohfazovoho study (in the first phase of the survey do double contrast, in the second - a study in tight filling of the stomach).
To study the gastric motor function renthenokimohrafiyu prescribe or make multiple X-ray images at short intervals.
Great diagnostic importance is the contour of the stomach. The site is not filled with barium, is called the defect content. It indicates the presence of tumors. Sustainable overemphasizing shadows stomach called niche (indicates the presence of ulcers).
Motor-evacuation function of the stomach assess the nature and time of transfer of contrast material into the duodenum. Normally one hour is less than 1 \ 3 drink fluids.
In the case of lesions of the stomach may occur following radiological syndromes:
1) dislocation of the stomach (offset);
2) change in topography;
3) expansion or contraction of the stomach;
4) changing contours;
5) dysfunction (hypersecretion, impaired motor-evacuation function).
Using this method, you
can explore the lining of the rectum and distal sigmoid intestine to a depth of
In pathological processes mucous rectum and sigmoid intestine can be dark red, dull, with layers of mucus, blood, pus. This indicates inflammation in it. Sometimes you can see ulcers, polyps, and malignant tumors.
Using rektoromanoskopy can take a biopsy material for morphological study and confirm the diagnosis. Indications for biopsy include: the presence of polyps, limited epithelial hyperplasia, tumors, ulcers, infiltrates, etc..
Fibrokolonoskopiya - visual inspection of the inside of the colon.
Indications for are:
1) suspicion of any disease of the colon when clinical, laboratory and radiological data will not set SMS messages sent reliably diagnosed;
2) pre-cancerous disease of the colon;
3) study patients at the dispensary previously undergone surgery (colon tumor);
4) histological examination of colonic mucosa.
Fibrokolonoskopiya is a
technically challenging procedure. At the planned study is to prepare the
patient for several days. Assign bezshlakovu diet. The day before the test give
the patient to drink 30-
The main clinical syndromes in Gastroenterology
1. Anemic syndrome is mediated through the origin stage of gastritis syndrome (violation of the secretory function of the stomach) caused
influence of various harmful factors, and malabsorption of vitamin B12 and iron in the gut. For professional pathology of the gastrointestinal tract is not critical and significant clinical manifestations.
2. Astenovegetativnogo syndrome harakteryzu_yetsya weakness, fatigue, poru_shennyam sleep, loss of efficiency, the main
pain. Sposterihayutsya drops in blood pressure, tahi_ or bradycardia, hyperhidrosis, red dermographism, impaired neuroendocrine function.
This syndrome is characteristic of many urazhenorhaniv gastrointestinal tract.
3. Astenonevrotychnyy syndrome - a psycho-emotional lability, irritability, nervousness, hypochondria, isolation, apathy, depression, sudden weight loss. Poyavatsoho syndrome shows the progression of symptoms. Typical for chronic gastritis, but may also occur in other lesions of the gastrointestinal tract.
4. Pain - Pain is different intensities according to the localization and harakte_
py urazhennya.Pry esophagitis, burns pain felt along the length of the esophagus during swallowing with or without irradiation in the blade area. Acute poisoning with pesticides containing arsenic or mercury, there is pain in the throat and esophagus during swallowing to tlidysfahiyi. Dysphagia in the case of toxic lesions can be functional and organic in nature. Accompanied delay lumps of food in the esophagus, which leads to a feeling of fullness and pain. Abdominal pain that occurs during occupational diseases, has no pathognomonic features and is different origin. In occupational disease pain is not always clear characteristics that indicate a direct localization of the lesion. It is characteristic of acute poisoning by mercury, pesticides (fosfor_, rtut_, organochlorine, mysh'yakovmisnymy, carbamates, and nitro_ hlorpohidnymy phenol), the components of nitrogen fertilizer, chronic lead poisoning, manganese, arsenic, amino_ and nitro derivatives of benzene. With intense effects on the infrasound range of unpleasant sensations arise, among which are a pain in zhyvoti.Sylnyy abdominal pain that is caused by blockage of blood vessels swell gas embolism, occurs in the case of acute decompression sickness. Abdomen tense, painful at palpation. The most distinct characteristic of the painful symptoms of chronic lead poisoning
5. Vyrazkovo_nekrotychnyy syndrome with different localization of foci of necrosis and ulceration.
In marked degree of chronic benzene poisoning and chronic radiation sickness appear vyrazkovo_nekrotychni changes mucosa rotovoyiporozhnyny.Urazhennya bone structures of the mouth, teeth and jaws - most notable for prolonged exposure to flour, sugar dust (necrosis of teeth) and chronic poisoning by phosphorus (quite possible necrosis of the jaws ). In case of ingestion of concentrated solutions of acids and bases developing severe burns of the mucous membrane of the alimentary canal - mouth, esophagus and stomach. After formation of ulcers and signs of necrosis in areas of destruction, which leads to the formation of fibrotic scarring and stricture of the development and changes of the anatomical configuration of these areas.
6. Hemorrhagic syndrome may be made conditional lesions of different parts of the alimentary canal and have different origins. Ulcers processes in oral mucosa leading to bleeding gums. Nay_
clearly against gingivitis bleeding occurs in acute poisoning by mercury and rtutorganicheskie compounds. Bleeding gums are often accompanied by chronic benzene poisoning, fluoride and chronic radiation sickness.
The source of bleeding from the gastrointestinal tract is often the esophagus. Ingestion of concentrated solutions of acids and bases leads to burns, vyrazkovo_nekrotychnyh formation processes in the esophagus with hemorrhagic manifestations.
Bleeding from the esophagus can be one of the signs of liver failure. Hemorrhagic syndrome in this case may be made conditional portal hypertension and impaired production of factors
coagulation in the liver in chronic toxic hepatitis.
Clinical manifestations are different - from microhematuria to massive bleeding. In total there are bleeding gums, nose, shlunkovo_kyshkovi bleeding or bleeding from esophageal varices.
Laboratory signs: loss of and changes in functional properties of platelets, decrease in blood clotting factors (II, V, VII).
Prolonged exposure to fluorine leads to the development of hemorrhagic gastritis.
Hemorrhagic syndrome may be a manifestation of ulcer and erosive processes of different origin, as described in the presentation of material on vyrazkovo_nekrotych_
tion syndrome. Gastric bleeding characterized by vomiting, bloody masses (coffee grounds) and tarry stool.
Acute mercury poisoning bloody diarrhea occurs. Diarrhea in the form of rice grains with domishkamykrovi happens when shlunkovo_kyshkoviy form of acute poisoning with pesticides that contain arsenic.
7. Hipersekretornyy syndrome in occupational pathology can be decomposed into hypersalivation and increased gastric acidity (giperatsidnom
Many poisonings may be accompanied by hypersalivation, a mechanism whose origin is different and can not be directly associated with damage to the digestive system. Hypersalivation observed in acute (mercury, rtutorganicheskie and organophosphorus compounds, components of nitrogen fertilizers) and chronic (mercury, fluoride, manganese, benzene) poisoning.
Increased gastric acidity (giperatsidnom gastritis) cause fluoride, hydrofluoric acid, methyl methacrylate, phenol, formaldehyde, heavy and prolonged physical work, stay
terms of noise, weightlessness. Hypersecretion in chronic lead poisoning
usually occurs at a young age in the early stages of intoxication.
8. Hiposekretornyy syndrome (hipoatsydnyy gastritis) arises from prolonged exposure to mercury, manganese, amino_ and nitro derivatives of benzene or toluene. He
characteristic of chronic radiation disease and silicosis. High body temperature accompanied hiposekretsiyeyu, which is obviously due to the violation of water and salt metabolism. Long-term course of chronic lead intoxication reduces the secretory function of the stomach.
9. Dyspeptic syndrome is divided into stomach (feeling unpleasant taste in the mouth, fullness - the severity and discomfort nadche_
Zealous area after meals, heartburn, nausea, vomiting) and intestinal (stool instability - diarrhea or constipation, bloating, rumbling and transfusion in the abdomen) dyspepsia. In dyspeptic syndrome manifestations also include loss of appetite and weight loss, which may have different origins.
It is believed that most clearly dyspeptic manifestations occur in case of poisoning with mercury, arsenic, carbon disulfide, amino_ and nitro derivatives of benzene, nitrogen fertilizer components. From the physical factors affecting
dyspepsia characteristic of chronic radiation sickness. Complaints against diarrheal manifestations can be observed in the case of continuous operation under the influence of dust or vapors of zinc, chromium, picric acid, nitrogen oxides, antimony, copper sulphate, and the production of certain plastics and other materials. Dyspeptic manifestations often accompany poisoning with lead, selenium, cadmium, kaprolaktamom, chlorinated hydrocarbons, organic solvents, as well as other substances. Decreased appetite is characteristic of chronic poisoning by arsenic, manganese, carbon disulfide, and fosfor_
organochlorine compounds, nitrogen fertilizer components. In case of acute poisoning rtutorganicheskie compounds can reach anorexia. Anorexia
due to hypothalamic failure occurs in severe cases, the long-term effects of contact ultrasound. Diverse factors that influence appetite, determines the possibility of a wide range.
10. Inflammatory syndrome manifested as gingivitis, stomatitis, esophagitis, gastritis, duodenitis, enteritis, colitis with relevant clinical, objective, laboratory and instrumental find that
depend on the localization of pathological protsesu.Hinhivit occupational origin characterized by swelling, redness, and sometimes - ulceration. Observed in acute and chronic arsenic poisoning, severe lead poisoning, exposure to trichlorethylene, chronic radiation sickness, chronic fluoride intoxication. Generalization of inflammation in the oral cavity characterized by the development of stomatitis.
11. Intoksykatsiyno_zapalnyy syndrome is characterized by joining an infectious factor against changes caused by exposure to harmful working environment. In this case, the patient's condition worsens, the body temperature rises, there are inflammatory changes in the blood, increasing signs of in_
Evaluation of urinalysis. Urine includes macro-and microscopic, chemical and physical investigations.
Physical research: estimating the number, color, odor, foam, transparency, the reaction of urine specific gravity, the presence of urinary stones.
In the assessment of pathological changes in the importance attached to proteinuria (PU).
PU can be determined as a symptom of renal only after eliminating the so-called functional PU, which include orthostatic PU transition idiopathic PU PU PU voltage and feverish.
The urinary sediment. The main research method is the microscopic study of sediment native preparations. Elements will share urinary sediment for organic (cellular elements, cylinders, bacteria, fungi, parasites) or inorganic (salt). To the cell elements include the epithelial cells, erythrocytes, leukocytes and cylinders. By the inorganic components of the urinary sediment include crystals of various salts (Fig. 10, 11).
Fig. 10. Painting bladder urine sediment and 1 - renal hemorrhage (1 - erythrocytes, 2 - leukocytes), 2 - vaginitis (1 - vaginal epithelium, 2 - leukocytes), 3 - spermatorreya 4 - urine sediment at the tumor (1 - tumor cells 2 - epithelial cells), 5 - urine sediment in gonorrhea (indicated by arrows in gonococci leukocytes), 6 - urine sediment at echinococcosis kidney (1 - characteristic hooks 2 - chitinous sheath hydatid bladder 3 - WBCs) 7 - normal color incontinence, urine 8 with diabetes insipidus (light yellow), 9 - nasischennaya brown-clear urine in heart failure, 10 - muddy, dirty red urine is the type of "meat washings," 11 - dark brown urine, jaundice s colored foam at shaking off, 12 - uraturia (yellowish sediment), 13 - almost black urine in melanoma of the liver, 14 - cloudy urine with white sediment in phosphaturia.
Fig. 11. Changes in urinary sediment in health and certain types of pathology 1 - cellular elements (1 - a group of squamous cells with lower urinary tract, 2 - "tailed" cell, 3 - polygonal cells of renal epithelium, 4 - epiteliya kidney cells), 2 - the cylinders in the urinary sediment (1 - hyaline cylinders deposition salts leukocytes, erythrocytes, 2 - granular cylinder 3 - cylinder hyaline deposition of detritus and salts), 3 - urine sediment cylinders (1-grained cylinder 2 - hematic cylinder 3 - waxy cylinder 4 - cylinder epithelial), 4 - crystalline precipitate in urine: 1-amorphous urates, 2 - crystallization of uric acid, 3 - crystals of calcium acetate, 5 - trippelfosfatov crystals, 6 - urine sediment crystalline (1 - leucine 2 - tyrosine, 3 - cholesterol, 4 - calcium sulfate), 7 - urine sediment in jaundice (1 - bilirubin crystals, 2 - cylinders, painted bile pigments, 3 - renal epithelial cells stained with bile pigment), 8 - crystals of sulfonamides in urine (1 - streptotsida, 2 - sulfasalazine, 3 - sulfotiazola), 9 - urine sediment in hypercholesterolemia (1 - cholesterol crystals, 2 - cylinder with the imposition of fat).
Rating sample for Zimnitskaya. When analyzing the results of this trial evaluated the overall diuresis, day and night diuresis, variations in the relative density of urine in all portions. In a healthy person daily diuresis always prevails over the night (2-2,5:1) swings in the relative density ranges from 1.002 to 1.030.
Rating sample for NECHIPORENKO. The sample for the presence of NECHIPORENKO
prescribed in the urinary sediment of blood cells, as well as cylinders. This assay determines the
content of erythrocytes, leukocytes, and the cylinders in 1 ml (or
Evaluation of daily proteinuria. Rating Dobova PU - an important test for determining the degree of renal damage, in particular, the glomeruli. There is a direct link between virazhennostyu daily PU and deep structures of the nephron destruction.
The daily PU consider insignificant
if it does not exceed
The daily UE is determined by measuring the amount of
Ultrasonography. Ultrasound of the kidneys is to register with
the equipment signals that are reflected at the boundary of different organs
and tissues due to their different acoustic characteristics. Length of normal kidney is 7.5-
Fig. 12. Scans right kidney was normal.
Renal pelvis better contoured transverse scan,
normally its anterior-posterior size is 1-
Ultrasound diagnosis of renal vascular condition includes two methods: - Direct ultrasound scan that displays the structure and topographic anatomical data on vessels (ultrasound angiography) and indirect vascular ultrasound (Doppler, Fig. 13).
Fig. 13. Doppler
ultrasound of right kidney in chronic PN: defined decrease in the rate of blood
The scan allows viyavit tumors, cysts, kidney stones, including rentgenootritsatelnye stones, polycystic kidney disease, hydronephrosis, tuberculous cavities, deformation, thickening of the renal pelvis complex.
In polycystic kidney sonogram determine the increase of their size with clearly defined boundary, especially the upper and lower segments, and cysts detected in the form of multiple ehootritsatelnyh zones (Figure 14).
Fig. 14. Polycystic kidney disease (SPL).
Kidney stones are of the form ehopolozhitelnyh structures, often they are placed in a cup-pelvis system. On the sonogram stone characterized by the presence of acoustic shadow, which is caused by the complete absorption or reflection of ultrasonic waves from its dense structures (Fig.
Fig. 15. Staghorn kidney stone (ultrasound, shows an acoustic shadow (1)
In acute PN skannogramme to note the increase in kidney, thickening of the walls of a cup-junction complex (Fig. 16)
Fig 16. Acute left-sided PN against nefroptoza (U.S.)
chronic - the uneven contours of the kidneys, thickening and deformation of a cup-junction complex, changing the thickness of the cortical layers of the brain and kidney (Fig. 17).
Fig. 17. Chronic right
PN (ultrasound, at the same time Dopplerograms reduction in the rates
determined by the linear velocity of the blood flow to
Radiographic and radioisotope methods of investigation of kidney function.
Survey radiography of the urinary tract. This method is mandatory. In analyzing the survey Voiding pay attention to the shape, size, contours, slope angle, placement and density of the shadow of the kidney.
Average size of the kidneys are:
Right - 12,9 x
ig. 18. Average size of kidneys in males (a) and women (B)
The presence of the shadow of the kidney or ureter proektsii founded to give a diagnosis, "nephrolithiasis" (Figure 19).
Figure 19. Left - the left kidney stone, right-to-left ureteral stone (plain film)
The most common method of X-ray examination of the kidneys is urography. It is based on the ability of the kidneys to excrete the body X-ray contrast agents (Urografin, urotrast, verografin, yodlipol).
When interpreting Voiding pay attention to the intensity of the shadow kidneys, their size, shape, position, shapes, beginning videleniya contrast material in the cup-junction system, the density of the shadow of a contrast agent, and in the urinary tract - the presence of morphologic changes in muscle tone and sostyaonie Pasazh urine (Fig. 20).