Duodenal intubation allows you to determine the current state of the liver and biliary tract. You can undergo the procedure in a clinic, hospital, diagnostic center, and a qualified doctor should interpret the test results.

What is duodenal intubation

– a diagnostic method with which the biliary tract and liver are examined. Sometimes it is used for medicinal purposes for bowel movements gallbladder.

Manipulation is carried out using special equipment– duodenal tube. It is made in the form of an elastic rubber tube. Its length reaches 1.5 m, and its diameter is 3–5 mm. At the end of the tube, which is inserted into the body, there is a metal olive, the surface of which is covered with holes. This device, which must be completely sterile, collects duodenal contents from the duodenum, consisting of bile, as well as a mixture of juices secreted by the stomach, intestines, and pancreas.

Such diagnostics are prescribed to obtain information about the exocrine activity of the pancreas, as well as the biliary tract and gallbladder capacity.

The main indications for the procedure are frequent nausea, pain in the hypochondrium with right side, congestion in the gallbladder, suspicion of helminthiasis, bitterness in the mouth.

Carrying out duodenal sounding

Types of duodenal intubation:

1. Blind probing or tubing– appointed from therapeutic purpose and is performed to drain excessive accumulation of bile from the gallbladder. This allows you to avoid stagnant processes.
2. Multi-moment or fractional probing– collection of duodenal secretions is carried out at intervals of 5 minutes. The procedure involves 5 phases. This is followed by an analysis of the collected material. This is the most modern and frequently used option for the procedure.
3. Chromatic sensing– before it is carried out, the gallbladder bile is stained, after selection it is examined. For this purpose, in the evening before the procedure, the patient drinks a capsule containing methylene blue dye. If there is no colored bile in the material selected during the analysis, duct obstruction is diagnosed.
4. Three-phase or classic version sounding– provides for the collection of 3 portions of bile: A, B and C.
5. Gastroduodenal sounding– to carry it out, a 2-channel probe is used, which simultaneously probes the stomach and duodenum.

To get an accurate result, it is important to properly prepare for the procedure and carry it out correctly. If the examination rules are not followed, the results may be biased.

There are a number of contraindications to the procedure:

• acute form of diseases of the digestive tract;
• the presence of kidney stones;
• acute cholecystitis;
• pregnancy;
• lactation;
• asthma;
• hypertension;
• dilation of the veins of the esophagus.

Duodenal intubation is contraindicated during pregnancy

Algorithm for performing the examination

Let us consider the technique of performing fractional sounding, since this particular diagnostic option provides the opportunity to obtain the most accurate results. The procedure is carried out only on an empty stomach in the morning.

Sequential research algorithm:

• the patient sits down, the end of the probe with the olive is placed in his mouth, and he must swallow it;
• after this, its slow swallowing begins;
• when the hose reaches 40 cm, it is swallowed for about another 12 cm, and then a syringe is connected to it to take away the incoming gastric juice;
• then the hose is immersed to the 70 cm mark;
• when the probe is immersed to the indicated mark, the patient should lie on his right side, while a warm heating pad is placed under his rib, and it is advisable to place a pillow under the pelvis;
• a stand with test tubes for collecting secretions is placed at the head of the head; the outer end of the hose is lowered into them;
• in a supine position, the gradual immersion of the probe continues until the 90 cm mark is reached, this process takes 20–60 minutes;
• when the olive of the probe enters the duodenum, the test tube is filled with yellow duodenal secretion;
• After passing through all 5 probing phases, the hose is carefully removed.

Duodenal sounding can take up to 2 hours

The duration of the procedure is on average 1.5–2 hours.

Probing phases:

1. First phase– within 10–20 there is an active release of duodenal contents. It is labeled as portion “A”, consisting of a mixture of bile secretions, gastric, intestinal and pancreatic juice. This portion has practically no significance for diagnosis. This phase continues from the moment the probe penetrates the duodenum until the introduction of the cholecystokinetic substance. It can be played by 75 units. cholecystokinin administered intravenously, or 30-0 ml of magnesium sulfate solution 33%, which is infused through a tube.
2. Second phase– under the influence of a cholecystokinetic substance, a spasm of the sphincter of Oddi occurs, and bile completely ceases to be secreted. The normal duration of this phase is 4–6 minutes. If bile begins to be released again earlier, this indicates sphincter hypotension, and if the spasm continues longer, then this indicates increased tone.
3. Third phase– the sphincter spasm passes and within 3–4 minutes juice is released from the extrahepatic bile ducts. It has a yellow-golden color and is labeled as portion “A” or “A1”.
4. Fourth phase– at this stage, the gallbladder is emptied and portion “B” begins to be released. This is vesicular bile, it is dark yellow, closer to brown, and thick. It contains bilirubin, cholesterol and bile acids.

This process occurs due to contraction of the gallbladder, provoked by the introduction of a cholecystokinetic agent against the background of relaxation of the sphincters of the gallbladder and Oddi. The normal period for continuing the phase is 20–30 minutes. During this time, 20–30 ml of thick secretions should enter the test tube.

If 30 minutes after the cholecystokinetic substance was administered, the secretion of dark bile does not begin, an antispasmodic is administered. This can be a subcutaneous injection of 0.5 ml of atropine 0.1% solution or 30 ml of novocaine 20% solution directly through a probe. When this does not help, cholecystokinin is reintroduced.

If this does not provoke a bladder reflex, we can assume blockage of the ducts. Obstruction of the ducts can be caused by stones, tumors or helminths.

1. Fifth phase– the final stage, which lasts 30 minutes. During this period, light yellow-golden bile begins to be released again. This is portion "C". It is collected in a test tube, maintaining an interval of 10 minutes.

Duodenal intubation is an unpleasant procedure. It is accompanied by vomiting. In some people they are so strong that muscle spasm makes it impossible to diagnose.

This procedure is especially difficult for children. To do it, the child needs to be prepared not only physiologically, but also mentally. The depth of insertion of the probe depends on the age of the child. For newborns it is inserted to 25 cm, from 6 months - to 30 cm. For babies who have reached the age of one year, the hose is inserted to 35 cm, from 2 to 6 years the depth increases to 40-50 cm. After 6 years - from 45 cm. These are approximate parameters. The doctor determines the exact depth of insertion individually.

It is important to know that throughout the entire procedure there is an increased secretion of saliva. It should not be swallowed.

You can watch the video to see how duodenal analysis is performed. The price of the procedure is from 950 rubles.

Preparation for duodenal intubation

Before undergoing the procedure, you will need proper preparation. At least 5 days before the scheduled test, you must completely stop taking enzyme and choleretic medications, antispasmodics, laxatives, and vasodilators.

It is also important to start following a diet 5-7 days before the procedure. It is necessary to exclude legumes, dairy and fatty foods, and fried foods from the diet.

Immediately on the day of the procedure, you should avoid physical and emotional stress. They may negatively affect the objectivity of the analysis.

Before performing the procedure, you must follow a special diet

To confirm or refute the diagnosis of helminthiasis, duodenal secretions are subjected to bacteriological examination and study under a microscope. To do this, part of the secretions is collected into sterile tubes. Their edges are pre-treated with fire. The material must be delivered to the laboratory within a few hours.

To obtain objective results, the diagnostic procedure should be repeated at intervals of 5–7 days. This is due to the fact that if the helminths did not lay eggs on the day the material was collected for analysis, a false negative result can be obtained.

For objective results, probing must be repeated after a few days.

Analysis results and interpretation

A competent doctor should interpret test results.

It takes into account:

• time of occurrence of each phase;
• volume and characteristics of duodenal secretions;
• microbiological indicators of duodenal secretions (their norms are presented in the table).

Table of normal indicators of duodenal secretions

All portions of discharge should be transparent and free of mucus. A small amount of it is permissible only in portion “A”.

A gastroenterologist will be able to correctly decipher the results of a duodenal examination. When carried out correctly, the effectiveness of this complex diagnostic method is 90%. This procedure is used to clarify many diagnoses associated with dysfunction of the gastrointestinal tract. With its help, it is often possible to determine the presence of helminthiases that cannot be detected by other laboratory methods.

Everyone knows the phrase “probing the stomach.” It definitely causes unpleasant emotions, and sometimes even panic. But is gastric probing really that scary? What is it used for? Are there any contraindications? How does the procedure itself proceed? Let's try to deal with these questions in order.

Gastric probing is one of the safest and most informative medical procedures aimed at studying inner surface and digestive secretions of the stomach. For this purpose, a thin rubber probe is inserted through the oral or nasal cavity into the stomach.

Who is prescribed

Probing of the stomach is prescribed:

1. Patients with abdominal pain of unknown etiology.
2. For digestive disorders: heartburn, indigestion, bloating, nausea, colic, to establish the level of stomach acidity.
3. If gastritis is suspected.
4. If an ulcer is suspected.
5. For gastric lavage and rapid removal of its contents in case of poisoning with food, drinks or medications.
6. For feeding people in an unconscious state, coma.
7. If you suspect neoplasms and tumors in the stomach.

To dispel anxiety and fear of the unknown, before starting the probing procedure, it would be good to talk with the doctor and medical personnel who will carry out the manipulation. This will help to get a complete picture of how everything will go, and the patient will understand what is happening. The psychological attitude plays important role in preparation for sounding. Calm patients tolerate the procedure much easier.

Types of gastric intubation

There are 2 main types of sounding:

1. One-step. It is carried out with a thick (up to 13 mm in diameter) rubber tube. The gastric contents are pumped out only once. This type of research is no longer used as it is outdated and does not provide a detailed picture of the condition of the organ. The fairly thick tube caused severe discomfort and a pronounced gag reflex in patients.
2. Fractional probing is more gentle and effective. It is carried out with a thin probe (up to 5 mm) in several stages. Duration 2-3 hours. This procedure gives a complete picture of the condition and functioning of the stomach.

Required Equipment

For the procedure you will need:

• couch or chair;
• basin;
• thin sterile probe;
• syringe or hose pump;
• towel;
• trial breakfast or other gastric secretion stimulants;
• several labeled sterile test tubes.

How is the procedure performed?

The probing technique is as follows:

1. Routine probing of the stomach is carried out in the morning. The patient is invited to the treatment room.
2. The patient sits on a chair with a back or lies on his side on the couch.
3. A towel is placed on the patient's chest and shoulders, as saliva may leak. Some patients experience vomiting.
4. A tray is given to the hand or placed nearby to collect saliva (it must not be swallowed, but spat out).
5. The pharynx is treated with a weak local analgesic to reduce sensitivity and pain threshold.
6. The rounded end of a sterile probe is placed on the root of the tongue (it may have holes or a miniature camera, depending on the purpose of the study). Then the doctor invites the patient to swallow, and he quickly moves the probe inside.
7. Then the patient's nasal breathing is checked. He should breathe calmly through his nose.
8. With each swallowing movement, the tube is moved deeper until the desired mark is reached. The depth is calculated using a special formula: human height minus 100 cm.
9. Attach the hose to the patient’s clothing to secure it.
10. At the next stage, a pump is put on the outer end of the probe or a syringe is attached and the entire contents of the stomach are aspirated.
11. The basal (hungry) gastric secretion is pumped out in several stages, each of which lasts 5 minutes. Between them there are pauses of 10 minutes.
12. Using a probe, a heated “test breakfast” (dried cabbage extract or broth) or special enzymes that stimulate the production of gastric juice (Insulin, Histamine or Pentagastrin) are injected into the stomach. These products and preparations act as a “breakfast” and help to get a complete picture of the functioning of the stomach after eating.
13. After 10 minutes, a sample of gastric juice is taken again.
14. After another 15 minutes, another portion of the stomach contents is taken.
15. So within an hour they take gastric juice 7 times.
16. The probe is removed, the patient is allowed to rinse his mouth and rest.

All portions of the secret are numbered, signed and sent to the laboratory for study.

How to prepare for the procedure

For probing, there are strict recommendations that should be followed so that the results are informative and the procedure itself is as comfortable as possible. Patient preparation:

• it is necessary to refrain from eating 12-15 hours before the procedure in order to relieve the gastrointestinal tract;
• in the morning the day before, neither eat nor drink anything;
• no smoking;
• do not take any medications.

Contraindications for probing

Despite the fact that this procedure is common throughout the world and is considered safe, there are categories of patients for whom it is contraindicated:

1. Heart failure.
2. Hypertension.
3. Kidney failure.
4. Severe forms of diabetes.
5. Allergy to drugs that stimulate secretion.
6. Severe hypotension.
7. Some mental illnesses.
8. Impaired nasal breathing.
9. The patient has a severe cough.
10. Pregnancy.
11. Varicose veins of the esophagus.
12. Stomach bleeding.

Evaluation of test results

Signed beakers with analyzes are sent to the laboratory. To make a diagnosis, such indicators as color, quantity, and nature of the secretion are important. The doctor will pay attention to the following points:

1. The liquid should be colorless, moderately fluid, and not contain inclusions of a different color.
2. Abundant secretion indicates hyperfunction of gastric juice and a shift in acidity in one direction or another.
3. Yellowish – green indicates the presence of bile from the intestines. Reddish-brown spots indicate the presence of blood.
4. In a healthy stomach, gastric juice has no odor or is sour. The smell of rot may indicate the development of a cancerous tumor.
5. Besides physical indicators, is researched and chemical composition liquids.

Depending on the test results, the necessary treatment is prescribed.

Typically, gastric intubation does not cause any symptoms in patients. side effects. During the day, you may experience slight malaise and stomach upset. This condition does not require special treatment. Doctors advise not to overeat or burden your stomach on this day. At first, crackers and tea with sugar are recommended; in the evening, when the condition improves, you can eat a light dinner. Many patients tolerate the procedure well and immediately after it go to work and do their daily activities.

There is no need to be afraid of the gastric intubation procedure. Nowadays, probing is much more painless and comfortable than it was several decades ago. The main thing is to remember that it will help make an accurate diagnosis, therefore, restore lost health, and maybe save a life.

To make the correct diagnosis for gastrointestinal lesions and prescribe effective treatment, some research is needed. One of them is gastric probing. It is important to know under what circumstances the procedure is needed, how it is performed and when it is contraindicated.

Probing of the stomach is a very important diagnostic procedure

In gastroenterology, gastric probing and lavage are very important procedures, without which it is impossible to determine what disease a person is facing. Let's consider under what circumstances a study is ordered:

• To determine what disease has affected a person and prescribe effective treatment therapy.
• If you need to feed the patient or administer a medication directly into the stomach. This is necessary for premature babies, if the patient has pathologies or injuries associated with the esophagus, pharynx, oral cavity, as well as people in a coma.
• When to rinse the stomach during intoxication caused by chemicals or poor quality food.

Probing may be required in case of drug overdose and intoxication

Gastric and duodenal intubation allows the doctor to determine the characteristics of the development of the disease, whether the gastric tissue has changed, and also check for the presence of tumors.

In case of poisoning using a probe special type possible in short terms remove toxic substances from the body, so that they do not disrupt the functioning of vital internal organs.

Types of sensing

In medicine, there are two main methods of gastric intubation. Simultaneous probing of the stomach through the mouth is carried out with a thick gastric tube. This device looks like a rubber tube, about 100 cm long, and its diameter is up to 13 mm. The study got its name from the one-time pumping of stomach contents. This method has long been outdated and is practically not used due to the fact that it does not give a complete picture of the state of the organ. Due to the large size of the device, the patient feels uncomfortable and gags.

A special device is used for probing

Fractional research is carried out with a thin device in the form of a tourniquet, 100–150 cm long, its diameter is only 2 mm, the end of the tube is rounded, there are two holes and marks on it. The other edge of the device is equipped with a syringe, which is used to pump out gastric contents. There is no gagging during the procedure, so the doctor has the opportunity to conduct the study for an unlimited amount of time. Probing by the fractional method is carried out in 3 stages:

• Empty gastric juice. Once the tube is inserted, the contents of the stomach are removed.
• Basal gastric juice. The secretion is sucked out for 1 hour.
• Stimulated gastric juice after administration of a stimulant. The duration of secretion is about 2 more hours with suction of the stomach contents at intervals of 15 minutes.

The examination does not cause discomfort and can last quite a long time.

What is needed for research

Gastric lavage and probing are very important procedures that take a long time. To perform the procedure, doctors use:

• a stool for positioning the patient;
• a special container in the form of a basin;
• a thin sterile probe;
• a syringe or pump that fits onto the hose;
• towel;
• several labeled sterile test jars.

All of the above items must be prepared before the procedure begins, as they should always be on hand by the specialist conducting the study.

Each endoscope has a syringe or pump to control the manipulation of the device

Preparation for gastric intubation

Preparing the patient for gastric intubation plays a very important role, since without this process the results of the study may be false. These measures do not require any special effort; they are aimed at ensuring that the stomach is completely emptied before the procedure for a clear and clear picture of the examination through the probe:

• During the day before the study, you should refrain from smoking and taking medicines;
• do not eat foods that increase the secretion of gastric juice and the accumulation of gases;
• 14–16 hours before the procedure begins, do not eat anything, you are only allowed to drink clean water in unlimited quantities;

You should not drink soda before the procedure.

• establish your psychological state, do not be exposed to stress, otherwise the secretion of gastric juice will increase and the test results will be incorrect, which will prevent the disease from being correctly diagnosed;
• Immediately before the examination begins, the inserted dental structures should be removed.

How is the procedure performed?

The methods of duodenal and gastric intubation are very similar, so let’s look at how the study is carried out:

• the patient sits on a chair with a back, or sits on a couch, lying on his side;
• to avoid staining clothes with saliva or vomit, cover your shoulders and chest with a towel;
• a person is given a special container to spit saliva into;

Before probing, the throat is treated with an analgesic

• to reduce sensitivity and also eliminate pain, the pharynx is treated with a local analgesic;
• the edge of the probe is placed on the tongue as deeply as possible (there may be holes or a camera on it, depending on the purpose of the procedure), then the patient swallows, and the doctor carefully pushes the tube inside;
• the rhythm of nasal breathing is checked, it should be calm;
• With each swallowing movement, the device is pushed deeper and deeper until it reaches the desired mark. The required depth is determined according to the following scheme: 100 cm is subtracted from the person’s height. After that, the probe is attached to the patient’s clothing for fixation;

The patient is given a small tube to swallow

• then a pump or syringe is put on the opposite edge of the device and all its contents are pumped out of the stomach;
• the basal gastric secretion is sucked out in several stages, the duration of which is no more than 5 minutes, with breaks between them of 10 minutes;
• Next, the patient is given a so-called “test breakfast” in the form of a light broth or special enzymes that stimulate the productivity of gastric juice (thanks to this, the doctor determines how the stomach functions when food enters it);
• then over the course of an hour, samples of gastric juice are taken 7 times every 10 - 15 minutes;
• when gastric intubation has come to an end, the device is removed.

The doctor then takes samples of gastric juice

Possible contraindications

Despite the fact that the gastric intubation technique is very effective in determining the diagnosis and is completely safe, such a study still has its contraindications:

• when bleeding has formed in the gastric mucosa;
• at varicose veins esophageal veins;
• if a woman is carrying a baby;
• with stenosis of the esophagus;
• if there are mental disorders;
• at diabetes mellitus or heart disease.

Evaluation of results

After gastric intubation has come to an end, test tubes filled with tests that have been previously signed are handed over to the laboratory for testing. To determine the correct diagnosis, the color, volume and nature of the secretion obtained is taken into account:

• It is considered normal if the secretion has a transparent appearance and moderate ductility.

The resulting secretion is sent to the laboratory for analysis.

• If the amount of secretion is more than the prescribed norm and with the presence of undigested food residues, then this indicates that the person has elevated level gastric juice with clearly impaired acidity is released.

Other laboratory tests are needed to determine the exact acidity level.

• When the secretion is not transparent, but has some shade, this means that the patient has health problems. A green or yellow tint indicates the presence of bile in the stomach, which comes there from the duodenum. Red and brown tints indicate that blood is present in the organ.
• If the gastric juice is too viscous, then the person is faced with gastritis or peptic ulcer.

If the mucus is thick, the patient most likely has gastritis

Gastric intubation causes almost no side effects in anyone. During the day you may feel slightly unwell and have an upset stomach. There is no need to treat such phenomena; the condition will improve on its own. To avoid stress on the stomach, it is recommended not to eat too much during the day after the examination. It is best to have lunch with crackers and sweet tea; in the evening, when the condition returns to normal, you are allowed to have a full dinner.

There is no need to be afraid of gastric probing and put it off. Thanks to the latest technologies At the moment, the procedure is much more comfortable and painless compared to what it was before. The main thing is to realize that probing allows the doctor to determine the correct diagnosis and prescribe competent treatment therapy, thanks to which health will be restored or even a life will be saved.

How is gastric intubation performed? They will tell you about this in the video:

Liver and gallbladder in human body perform many functions, including direct participation in digestion processes through the production of special enzymes, synthesis and accumulation of bile. Any disturbances in these organs, their structure, structure or work, immediately affect a person’s well-being, manifesting itself in various symptoms such as heartburn, bowel disorders, weight loss, and pain. In some cases, pathological processes in the liver or gall bladder cause the development dangerous diseases– cirrhosis of the liver, cholelithiasis, inflammation of the biliary tract. That is why, when alarming symptoms appear in the area abdominal cavity Don’t delay going to the doctor. In this case, one of the procedures that the doctor will prescribe to examine the condition of the internal organs may be duodenal intubation.

What is duodenal intubation and why is it prescribed?

Duodenal intubation is one of the methods of functional diagnostics in gastroenterology. With its help, the physician is able to assess the condition of the duodenum and bile contents.

In the process, the doctor uses a special probe - a long elastic hollow tube, at the end of which there is a hollow metal olive. The diameter of the tube is no more than 5 millimeters, its length is 1.5 meters. The olive has the shape of a small olive, 20 millimeters long and 5 millimeters wide. Its rounded shape and small size should make it easier for the patient to swallow the probe.

What can the procedure show? Ten to fifteen years ago, only with the help of duodenal intubation it was possible to confirm the presence of stones in the gallbladder and its ducts. Today, such a diagnosis does not require probing; it can be detected during ultrasound examination. A specific procedure is performed to obtain a sample of duodenal contents from the duodenum, as well as to assess the condition of the gallbladder, pylorus and sphincter of Oddi.

General concepts of the anatomy and function of the liver and gallbladder

The liver together with the gallbladder form special system- part of the digestive tract. In addition to processing food, the liver is also involved in the immune system; in addition, it carries out protective function, partially – the function of hematopoiesis.

Anatomically, the liver is located in the abdominal cavity, it is formed by two parts - the left and right lobes. Most of it is located in the upper right part of the peritoneum. The left lobe partially passes into the left half of the abdominal cavity.

The location of the liver is under the diaphragm. The upper border of the organ is located at chest level, it is convex and follows the shape of the diaphragm. The lower edge is 1-2 centimeters below the arch of the ribs, concave in appearance, as it comes into contact with other internal organs.

The right lobe of the liver is approximately 6 times larger than the left. The mass of the organ ranges from one and a half to two kilograms.

In the middle part of the internal surface of the organ, the hepatic hilum is located - at this point the hepatic artery enters the liver, from there exit the portal vein and the hepatic duct, which removes bile from the liver.

The gallbladder is “hidden” under the gate of the organ - a small hollow organ similar to a sac. It is adjacent to the outer edge of the liver and lies on the duodenum. The normal length of the organ is from 12 to 18 centimeters. The structure of the bladder is represented by the bottom, body and neck, which passes into the cystic duct.

The liver is responsible for the secretion of bile, a fluid that breaks down fats, enhances intestinal motility and the action of pancreatic and intestinal enzymes. Bile also helps neutralize the acidic environment of the bolus of food that leaves the stomach, and helps absorb cholesterol, calcium salts and fat-soluble vitamins.

The liver is involved in all metabolic processes in the body - protein, fat, carbohydrates.

The organ also produces hormones, stimulates the production of hormones by the adrenal glands, thyroid and pancreas.

In addition, the liver is a huge protective filter that neutralizes the effects of toxins, poisons, medications, and allergens.

The bile produced by the liver passes into the gallbladder, where it accumulates until the food that it is needed for digestion enters the body.

What types of procedures can be performed

Duodenal sounding may differ depending on how it is performed. Doctors highlight:

• blind probing, when the patient does not have to swallow the probe - liquid is used for the procedure;
• fractional or multi-stage: in this case, collection of intestinal contents is carried out at a certain interval, for example, every five minutes;
• chromatic sounding implies that before diagnosis, a dye is injected into the patient;
• a minute-long procedure makes it possible to assess the condition and functioning of the sphincters.

Indications and contraindications: when is it necessary and in what cases should probing not be performed?

The procedure, due to its specificity and the discomfort it causes to the subject, can be performed only if there are indications for it - special symptoms or suspicion of certain diseases.

Indications for duodenal intubation are:

• feeling of bitterness in the mouth;
• pain and discomfort in the right hypochondrium;
• bile stasis diagnosed based on ultrasound results;
• constant nausea and bouts of vomiting;
• change in urine color to yellow-brown or brown, discoloration of feces;
• the need to establish a primary or confirm an existing diagnosis;
• suspicion of an inflammatory process in the gallbladder;
• diseases of the bile ducts and liver.

The procedure is not performed if the patient has:

• coronary insufficiency;
• acute cholecystitis;
• stomach and duodenal ulcers;
• cancer of the digestive tract;
• exacerbation of chronic cholecystitis;
• varicose veins of the esophagus.

Probing is also not recommended for pregnant and lactating women.

Features of preparation for diagnosis

The duodenal intubation procedure can only be carried out strictly on an empty stomach, so the patient should not eat 8-10 hours before it, and should refrain from drinking liquid 3-4 hours before.

As part of patient preparation, dietary restrictions are required five days before the scheduled procedure. The following must be excluded from the menu:

• high-content fruits and vegetables, raw and cooked;
• bread, pastries;
• confectionery;
• and dairy products;
• legumes;
• fatty meats and fish.

This diet is introduced to reduce the level of gas formation in the intestines.

Preparation for the procedure also requires stopping the use of the following medications during the same period:

• choleretic (Barberin, Tsikvalon, Allochol, Flamin, Holosas and others);
• antispasmodics like No-Shpa, Spazmalgon, Papaverine, Beshpan;
• laxatives;
• vasodilators;
• enzyme-containing (Pancreatin, Creon, Festal).

On the eve of the study, the patient must take 8 drops of Atropine in a 0.1% solution. The substance can also be administered subcutaneously. In addition, you can drink a warm glass with 30 grams of xylitol dissolved.

The objectivity of the results obtained directly depends on how carefully the patient follows all the preparation requirements.

How is the liver and gallbladder examined?

The procedure algorithm may include several diagnostic techniques:

• classic duodenal intubation;
• fractional sounding.

The first method involves performing a three-stage study, and is considered somewhat outdated. During classical intubation, portions of bile are collected in three phases:

• from the duodenum;
• from the bile ducts and gallbladder;
• from the liver.

The technique consists of phases A, B and C.

Stage A. The patient is seated on a chair, he needs to tilt his head forward, open his mouth wide and stick out his tongue. The doctor performing the procedure places a metal olive on the root of the patient's tongue, with which one end of the probe ends. Next, the patient must swallow, while the doctor advances the probe into the esophagus. The saliva released by the subject flows into a special tray, which he holds in his hands.

To understand that the probe is in the esophagus and not in the trachea, the doctor asks the patient to make deep breathing movements. If the subject can breathe deeply and freely, then the probe is positioned correctly.

Based on the marks on the probe, the doctor understands how deep the probe goes and when the olive reaches the stomach. The contents of the probe are pumped out with a syringe to check - if a cloudy liquid enters the syringe, it means that the probe is located in the stomach.

To move the probe tube into the duodenum, the patient must be placed on his right side, placing a warm heating pad under him. The “sideways” position is required to prevent saliva from entering the trachea.

Light yellow, slightly cloudy liquid entering the cavity of the tube indicates that the probe has reached the duodenum. This moment is the beginning of stage A - contents are collected from the duodenum for analysis. It contains bile, intestinal and pancreatic enzymes.

In about half an hour, from 15 to 40 milliliters of liquid is collected in a special container. If the tube is wrapped in the stomach, the contents cannot be collected. In this case, the probe tube is pulled out to the previous mark, after which it is carefully inserted again until it reaches the duodenum.

Stage B. After the first stage of collecting fluid for analysis is completed, substances that promote irritation of gastric secretion are introduced into the intestine: sorbitol, oxygen, xylitol or magnesium sulfate. The probe tube is pinched for a few minutes. After 7-10 minutes, the clamp is removed from the probe, after which, if all manipulations are done correctly, vesicular contents enter the cavity of the tube - thick green-yellow bile. In about half an hour, it is possible to collect up to 60 milliliters of liquid.

Stage C. Gradually, the color of the liquid in the tube becomes bright yellow, which means that liver bile is entering it. For analysis you will need no more than 10-15 milliliters. At the end of collecting secretions for analysis, the probe is slowly removed from the esophagus.

Technique for fractional duodenal intubation

In this case, duodenal contents are pumped out every 5-10 minutes. At the first stage, a portion of fluid is collected from the duodenum - it contains bile, pancreatic and intestinal enzymes, and partly gastric juice. The stage lasts about 20 minutes.

At the second stage, a solution of magnesium sulfate is supplied into the intestine through a probe tube. The secretion of bile from the spasm of the sphincter of Oddi stops. This stage lasts 4-6 minutes.

At the third stage, the release of the contents of the intrahepatic bile ducts begins within 3-4 minutes.

During the fourth phase, the gallbladder is emptied and its contents (thick brown or brown-yellow bile) are collected with a probe.

At the end of the process of separating the thick dark contents, the fifth phase begins, when the liquid in the probe tube again acquires a golden yellow color. The collection lasts up to half an hour.

What happens to the resulting contents: collection and examination of duodenal fluid

Each portion of the test substance is sent into a separate sterile test tube, with strict adherence to all sterility rules, including burning the edges of the test tubes on gas burner before and after bile collection.

Containers with liquid must be sent to the laboratory for examination as soon as possible after collection, since proteolytic enzymes of the pancreas tend to destroy leukocytes, in addition, cooling the liquid makes it difficult to detect Giardia in the duodenal contents: when the temperature drops, they stop moving.

To prevent cooling, the test tubes are lowered into a glass of water, which has a temperature of 39-40 degrees Celsius.

The analysis is interpreted by a diagnostician with the appropriate qualifications. All results are recorded in a written doctor’s report.

If the collected liquid contains large number leukocytes, this may indicate the presence of an inflammatory process. In this case, diagnosticians conduct an analysis with bile culture: the substance is sown on special nutrient media. This method helps to identify Escherichia coli or Pseudomonas aeruginosa, and some other pathogens.
The presence of epithelial cells in the bile indicates that a pathological process is present in the stomach or duodenum.
The content of red blood cells indicates possible microtrauma to the inner layer of organs, which could be caused by the probe.

Crystals of bilirubin and cholesterol are not normally found in the duodenal contents, but if they are detected, it means that the colloidal properties of bile are impaired, and the patient may be prone to cholelithiasis.

Blind probing: features of the procedure

To perform blind duodenal intubation, the patient does not need to swallow the probe. In this case, he will need to purchase a liquid that stimulates the secretion of bile - hawthorn decoction can be used for this purpose, mineral water Borjomi or Essentuki, sorbitol or xylitol solution, Epsom salt or magnesium sulfate.

The irritant is taken in the morning on an empty stomach. A person needs to lie down on his right side, placing a warm heating pad under him, and drink the chosen remedy slowly. Usually up to one and a half liters of liquid is used. Legs must be bent at the knees and tucked under you. Next, you need to take several deep breaths, inflating your stomach, and when exhaling, drawing it in. The duration of the procedure is from 40 minutes to two hours. All this time you need to lie in a relaxed state, ideally fall asleep.

Half an hour after finishing, you are allowed to have breakfast, and the food should be light. On this day you need to give up fatty, spicy and fried foods.

What is chromatic sensing?

This type of probing is used for the most accurate recognition of bile from the gallbladder. Approximately 12 hours before the start of the study, usually in the evening before bed, and no earlier than 2 hours after the last meal, the patient needs to drink a capsule with 0.15 grams of methylene blue.

During probing, bile collected from the bladder turns out to be colored blue-green color. In this case, the diagnostician pays attention to the volume of bile released, and the time that passes from the moment of administration of the irritating substance until the appearance of a portion of bile belonging to stage B.

Probing in children: how it is done

All procedures using a probe are quite difficult for children to tolerate. The procedure and technique are practically no different from the procedure in adults, with the exception of some indicators.

In children, probing is performed using a probe of a smaller diameter. For newborn babies, the tube is inserted to a depth of approximately 25 centimeters. Children 6 months old - to a depth of 30 centimeters. For a one-year-old child, the probe is inserted to a depth of up to 35 centimeters, from 2 to 6 years old - to 40-50 centimeters, for older children - up to 55 centimeters.

The amount of magnesium sulfate introduced into the intestine is calculated at 0.5 milliliters of a 25 percent solution per kilogram of body weight.

Duodenal intubation is an unpleasant procedure for the subject; moreover, it lasts, in some cases, 40-50 minutes. Usually the patient is conscious, but if the patient has no contraindications or allergies to anesthesia, probing can occur under anesthesia. That's why preparatory activities should include not only physiological medical measures, but also psychological preparation.

Duodenal contents are a mixture of bile with pancreatic, gastric and intestinal juices. The study of duodenal contents allows us to judge the state of the biliary system, as well as the exocrine function of the pancreas. Depending on the specific purposes used various techniques duodenal sounding.

Assessment of the state of the biliary system

Currently, the method of fractional duodenal intubation is used, which has significant advantages over the classical (three-phase) method, which was widespread in the past. During fractional intubation, duodenal contents are removed every 5-10 minutes. This allows you to graphically record its amount over time and diagnose one or another type of bile secretion.

Why is it important to do duodenal intubation?

Fractional duodenal sounding makes it possible to indirectly determine important features bile secretion, gallbladder capacity, the presence of functional and organic disorders of bile secretion. In addition, all three portions of bile (A, B, C) are subjected to microscopic and, if necessary, bacteriological examination.

The greatest diagnostic value is the study of gallbladder bile (portion B).

For what symptoms is duodenal intubation performed?

• pain in the right hypochondrium
• stagnation of mucus in the gallbladder
• bitterness in the mouth
• nausea
• concentrated urine

For what diseases is duodenal intubation performed?

• gallbladder inflammation
• diseases of the liver and biliary tract

To check/improve the performance of which organs should Duodenal sounding be done?

The study of exocrine pancreatic function includes:

• determination of enzymes in blood and urine;
• determination of basal and stimulated secretion of bicarbonates and enzymes in duodenal contents;
• examination of feces for the content of fat, nitrogen, muscle fibers, etc.

Determination of pancreatic enzymes and bicarbonates in duodenal contents is indicated for chronic diseases of the pancreas or the appearance of symptoms characteristic of insufficiency of its exocrine function (chronic diarrhea, steatorrhea, etc.).

How is the Duodenal Sounding procedure performed?

Duodenal sounding is carried out using a thin rubber probe with a metal or plastic olive at the end. It is more preferable to use a double probe, one of which serves to pump out gastric contents.

The study is carried out in the morning on an empty stomach. With the patient sitting, a duodenal tube is inserted (the same as a thin gastric tube). When the “40 cm” mark is at the teeth, the probe is advanced another 10-15 cm, a syringe is connected to it and the gastric contents are aspirated. After this, the patient swallows the probe up to the “70 cm” mark.

Next, the study continues with the patient positioned on the right side; a soft cushion or pillow is placed under the pelvis (in this position, the passage of the probe to the pylorus and into the duodenum is facilitated), and a warm heating pad is placed under the right hypochondrium. The outer end of the probe is lowered into the test tube, and the rack with test tubes is placed on a low bench at the head. In this position, the patient gradually (within 20-60 minutes) swallows the probe to the 90 cm mark. As soon as the olive passes from the stomach to the duodenum, a yellow liquid begins to flow into the test tube - duodenal contents, colored with bile.

There are five phases of fractional duodenal intubation.

First phase- release of duodenal contents (portion A) from the moment the probe enters the duodenum until the introduction of one of the cholecystokinetic agents. This portion of duodenal contents is a mixture of bile. pancreatic, intestinal and, partially, gastric juices and does not have much diagnostic value. Bile from portion A is collected within 10-20 minutes.

Second phase- this is the phase of complete cessation of bile secretion due to spasm of the sphincter of Oddi, which occurs as a result of the administration of a cholecystokinetic agent (30-50 ml of a warm 33% solution of magnesium sulfate through a probe or 75 units of cholecystokinin intravenously). Normally, the duration of the second phase does not exceed 4-6 minutes; its lengthening indicates an increase in the tone of the sphincter of Oddi, and its shortening indicates its hypotension.

Third phase- this is the release of golden-yellow contents of the extrahepatic bile ducts, which lasts 3-4 minutes. The bile released during this process also belongs to portion A (A1).

Fourth phase- emptying of the gallbladder and secretion of thick cystic bile of dark yellow or brown(portion B).

This portion of bile is released as a result of contraction of the gallbladder, which occurs under the influence of a cholecystokinetic agent, and the simultaneous relaxation of the sphincter of Oddi and the sphincter of the gallbladder. Portion B is 4-5 times more concentrated than liver bile and contains a significant amount of bile acids, cholesterol, and bilirubin. The secretion of gallbladder bile (normally about 30-60 ml) lasts 20-30 minutes.

If the bladder reflex is absent within 20-30 minutes after the administration of magnesium sulfate, which in some cases can be observed even in healthy people, it is necessary to administer antispasmodics (through a probe of 30 ml of a 20% novocaine solution or subcutaneously 0.5 ml of a 0.1% atropine solution ), and if there is no effect, repeat the administration of cholecystokinin.

Important: If, after the administration of novocaine or atropine, dark cystic bile begins to be released, this indicates a sphincter spasm; the absence of a cystic reflex even after the administration of antispasmodics and cholecystokinin (repeatedly) suggests the presence of an organic obstruction (blockage of the cystic duct with a stone) or a non-functioning gallbladder (wrinkling, gallbladder cancer, etc.).

Fifth phase- after the cessation of secretion of dark gallbladder bile, golden-yellow bile begins to be secreted through the probe again (portion C). It is also collected in test tubes for 30 minutes at 10-minute intervals.

How to prepare for Duodenal sounding?

The study is carried out in the morning on an empty stomach. To obtain adequate results, you must stop taking enzyme preparations 5 days before the test. It is better to use a double probe that has an opening at the level of the stomach and duodenum. Continuous aspiration during examination of gastric contents is necessary to obtain purer pancreatic juice. After inserting the probe, it is advisable to check its position radiographically.