Fractional intubation of the stomach. Duodenal sounding

In order to understand what duodenal intubation is, it is necessary to understand the specifics of the method. This is a medical procedure, which is a diagnostic procedure aimed at examining the biliary tract and liver. In some cases, the procedure is necessary to empty the gallbladder.

Thanks to the study of duodenal contents, data is obtained on the exocrine functioning of the pancreas, biliary tract, gallbladder.

For reference! Bile analysis is carried out using a special probe, which is a rubber tube up to 1.5 meters long. At the end of the part that is inserted into the body, there is a metal part with holes.

The procedure helps to identify inflammatory processes (for example, with the development of biliary pancreatitis against the background cholelithiasis). Indications for duodenal intubation include:

There are several types of analysis for the study of duodenal contents:

• tubage, which is called blind probing and is indicated for stagnation of bile (the main advantage of the method is the absence of a probe for the procedure);
• fractional duodenal intubation, characterized by the presence of 5 stages of material collection, the interval between which is 5 minutes;
• chromatic sounding of the gallbladder, before which the bile is stained;
• classic type, including taking 3 servings;
• gastroduodenal type, for which a 2-channel probe is used: for the intestines and duodenum.

Be sure to identify contraindications before performing duodenal intubation. Manipulation is excluded in case of the following ailments:

• acute course of gastrointestinal diseases;
• identifying kidney stones;
• the occurrence of such pathology as cholecystitis in the acute phase;
• pregnancy;
• breastfeeding;
• asthma;
• high blood pressure;
• dilated veins of the esophagus.

Specifics of the procedure

Before performing duodenal intubation, it is useful to know the technique. This will allow you to tune in to the study and make it easier to endure.

Manipulation (as well as preparation for gastric probing) includes the following steps:

1. The patient is seated on a chair. The head should be tilted towards the chest, oral cavity open wide. A metal olive is placed on the root of the tongue, which ends one part of the probe.
2. Carrying out swallowing movements. With the help of such actions, the olive passes into the esophagus. The patient takes a few swallows and the specialist advances the tube.
3. Examination correct location olives. To do this, a person is checked to see how free he is. deep breathing. This will reveal that the probe has not entered the trachea.
4. Checking the location of the olive in the stomach. A syringe is used for this. When turbid liquid arrives, a conclusion is made about the correct placement of the probe (when examining gastric juices, the tube is not advanced further).
5. Promotion to the 12th duodenum. At this stage, the patient should lie on his right side. A warm heating pad is placed under it. A special cushion is placed under the hips. The lateral position during the examination is necessary so that the saliva that is formed during the procedure does not enter the tracheal area.

If during duodenal intubation the manipulation algorithm is followed, then after part of the probe enters the duodenum, golden liquid begins to flow from the tube. In the initial portion (A) there is a mixture digestive enzymes pancreas, intestines and bile. In 30 minutes you can collect liquid in an amount of 15 to 40 ml.

If there is no liquid, this may indicate that the probe has collapsed. A test is carried out during which air is pumped in using a syringe. If there is bubbling, check that the device is in the stomach. To position it correctly, the tube is pulled out to the previous mark. This is followed by re-swallowing.

After the first portion has been collected, a secretory process irritant is introduced into the intestine, and the tube is clamped for 10 minutes. After the time has passed, dark green bile should flow into the probe. This is portion B, which is collected within 30 minutes. During this time, approximately 60 ml of liquid should arrive.

After the color change, the next portion is collected - C. Its contents include liver bile with a bright yellow tint. The third portion is taken in an amount of 10-20 ml. After this, the tube is removed. The bitter taste will help remove the glucose solution.

The procedure for conducting blind probing is somewhat different. A probe is not required for the manipulation. The essence of the procedure is as follows:

1. Take a bile secretion stimulant on an empty stomach (prescribed by a doctor).
2. Lie on your right side, bend your limbs, placing a heating pad in the hypochondrium area.
3. Take several breaths (deeply) with the stomach inflating and retracting as you exhale.

The procedure time is from 40 minutes to 1 hour. About 30 minutes after the manipulation you need to eat. Meals include light foods. Throughout the day, exclude fried, highly salted, and fatty foods from the diet.

Rules for preparing for manipulation

Examination of duodenal contents is an important diagnostic procedure. In order for the information obtained during the analysis to be reliable, it is necessary to know the characteristics of behavior before manipulation. Preparing the patient for duodenal intubation includes performing certain rules. These include:

1. Carrying out on an empty stomach. From the moment you wake up until the manipulation, you should not eat.
2. Refusal from a “heavy” menu a few days before probing. The exclusion list also includes those products that cause increased gas formation.
3. Disclaimer choleretic drugs 7 days before the study.
4. Prohibition on the use of laxatives, vasodilators and drugs that have a targeted antispastic effect.
5. Avoiding the use of drugs that enhance functioning digestive tract.
6. Use of atropine (0.1% solution) on the eve of manipulation. The patient can take the medicine in one of the following ways: orally (8 drops dissolved in warm water) or by subcutaneous injection.

Direct preparation

Particular importance during diagnosis is given to the diet before duodenal intubation. The evening meal should be as early as possible (no later than 6 hours) using light dishes. The list of prohibited foods and dishes includes:

• dairy products;
• potato dishes;
• black bread;
• foods that contribute to increased formation of gases in the intestines.

You can eat porridge, low-fat soups, chicken or fish. As an example of preparation for duodenal intubation, the following menu can be given:

1. For breakfast: porridge, milk sausages, boiled egg, tea without sugar.
2. At lunchtime: soup with low-fat meat broth, slightly dry bread, chicken (it can be replaced with fish).
3. In the evening: tea without sugar, crackers without spices.

Important! On the day when duodenitis is removed, exclude food, liquids and smoking. You are allowed to drink a little water earlier than two hours before the procedure.

Obtaining research results

The diagnostic results are interpreted by a gastroenterologist. When drawing up a conclusion important It has:

• time of each probing stage;
• quantity and characteristics the resulting discharge (normally it is transparent, without mucus impurities - it is not a large number of acceptable in portion A);
• microbiological data from examination of duodenitis.

The diagnosis of infection can be confirmed by changes in the level of bilirubin, cholesterol, bile acids. To confirm helminthiasis, the medical procedure is repeated after a week. This will avoid a false negative result.

When prescribing an examination, the attending physician should tell you what duodenal intubation shows and how to prepare for diagnosis correctly. It is important to follow the recommendations of a specialist. Meals must include only approved foods. If the preparation rules are not followed, the research results will be unreliable. The patient's behavior also plays a big role. In order to avoid misunderstandings, you can preview the thematic video.

Duodenal sounding- insertion of a probe into the duodenum, which is carried out both for diagnostic and therapeutic purpose.

The probe for duodenal intubation is a rubber tube with a diameter of 3-5 mm and a length of 1.5 m; at the end inserted into the stomach, the probe has a hollow metal olive 2 cm in size, with several holes located on it. There are 3 marks on the probe: the first at a distance of 40-45 cm from the olive, the second - 70 cm and the third - 80 cm, the last mark approximately corresponds to the distance from the front teeth to the large papilla of the duodenum (papilla of Vater). In addition to the probe, the duodenal intubation procedure requires a probe clamp, a stand with test tubes, a 20 ml syringe, pituitrin, atropine and a 25% solution of magnesium sulfate.

Before the procedure, the duodenal tube is boiled and cooled in boiled water. On the eve of the study, the patient drinks 8 drops of a 0.1% atropine solution or a little warm water with 30 g of xylitol dissolved in it, after which it takes light dinner, from which gas-forming products (brown bread, milk, potatoes) are excluded.

The study is carried out on an empty stomach. The distance from the navel to the patient’s front teeth in a standing position is marked on the probe, after which he is seated and a tray is given to him. Lubricate the olive of the probe with glycerin, place it deep behind the root of the patient’s tongue and invite him to swallow, while breathing deeply. After this, the patient slowly swallows the probe, and when gagging appears, he makes several deep breaths. When the probe reaches the first mark, you can be sure that the olive is in the stomach.

The patient is placed on his right side, under which a cushion is placed at the level of the lower ribs, and a hot heating pad is placed on top of the cushion. After this, the patient continues to slowly swallow the probe. The probe passes into the duodenum after 1-2 hours; if it is retained in the stomach, the patient can be injected subcutaneously with 1 ml of a 0.1% atropine solution, 2 ml of a 2% papaverine solution and close the probe with a clamp for 10-15 minutes. As the probe moves through the stomach, its contents are sucked out with a syringe, preventing it from entering the duodenum.

As soon as the probe is in the intestine and advances to the third mark, the bile released from the nipple of Vater is sucked out with a syringe. To stimulate its secretion, the patient is given 30-50 ml of a warm 25% solution of magnesium sulfate to drink; 2 ml of pituitrin or 0.5-1 mg of histamine can be administered intramuscularly.

Duodenal intubation is not only diagnostic, but also medical procedure, since washing the bile ducts during probing reduces bile stagnation, thereby eliminating the risk of stone formation and inflammation.

However, despite such positive therapeutic effect, duodenal intubation cannot be performed frequently due to the fact that many people have a difficult and painful experience with the procedure of inserting a probe into the esophagus, during which they constantly experience the urge to vomit. For some patients, duodenal intubation is generally contraindicated. These are patients who have recently had gastrointestinal bleeding having dilated veins of the esophagus, suffering from severe heart damage and hypertension in severe form, with curvatures cervicothoracic region spine.

Classical and fractional duodenal intubation are procedures in which bile secretions are taken from the patient for analysis using a probe. Proper collection of fluids helps to identify pathologies and detect helminthiasis inside the gallbladder and liver with an accuracy of 90%. The probing procedure for the patient involves a number of uncomfortable sensations, so you need to strictly follow the doctor’s instructions.

What is duodenal intubation

The duodenal sounding procedure is a diagnostic method that is used to examine the liver and biliary tract. For medicinal purposes, a medical measure is used to remove the contents of the gallbladder. Carrying out such diagnostic manipulation becomes possible thanks to special equipment - a duodenal tube, which appearance is a tube made of flexible material 150 cm long and 3-5 mm in diameter. At the tip of the device there is a metal olive with holes on the surface.

A duodenal tube can enter the body through the digestive system, so the tube and other parts must be absolutely sterile. Using the device, doctors select required amount bile, gastric, intestinal and pancreatic juice from the duodenum. Duodenal method diagnostics is required if it is necessary to obtain information about the activity of the pancreas, the condition of the liver, biliary tract and gallbladder capacity.

Indications for duodenal intubation

The main indications for probing the liver and gallbladder are the following symptoms:

Very important proper preparation patient for duodenal intubation. The process is a set of measures consisting of the following actions:

• withdrawal of choleretic, laxatives, antispasmodics and enzymes medicines 5 days before the expected sounding;
• a diet that you need to start following 2-3 days before the study;
• refusal to eat 12 hours before the procedure - probing is carried out on an empty stomach;
• bowel cleansing in the evening before duodenal examination.

Diet before probing

Preparation for duodenal intubation involves following a diet. Dietary restrictions are not strict - on the eve of the study, the patient is allowed to eat his usual food. Experts recommend limiting the consumption of large amounts of foods that stimulate the biliary system. You should eat less fatty and fried foods, vegetable oil, dishes that include eggs, soups based on rich fish and meat broths, sour cream, cream, sweets.

It is not recommended to drink strong tea, coffee, carbonated drinks, or alcohol. Fruits, vegetables and berries have a strong stimulating effect on the gallbladder. When consuming these products, the secretory function organ. You should not combine vegetables with vegetable oils. Such a union provokes bile secretion. The diet must be followed by the patient for 2-3 days before duodenal examination.

Execution technique

Duodenal examination using a probe can be carried out in two versions: classical and fractional. The first technique, consisting of three phases, is practically not used because it is considered obsolete. As a result of the procedure, the specialist receives three types of bile for study: duodenal, hepatic, and cystic. These fluids are taken from the duodenum, bile ducts and bladder, and liver.

The fractional technique of duodenal intubation consists of 5 phases of pumping out bile secretion, which change every 5-10 minutes:

• The first phase is the release of portion A. Liquid is taken at the stage of the probe entering the duodenum before the use of cholecystokinetic agents. The duration of the probing phase is 20 minutes, during which the duodenal contents, consisting of pancreatic, gastric and intestinal juices, and bile, are pumped out.
• At the second stage duodenal examination the specialist introduces magnesium sulfate, the secretion of bile from the spasm of the sphincter of Oddi stops. The duration of this phase varies between 4-6 minutes.
• The third stage of probing is characterized by sampling the contents of the extrahepatic bile ducts and lasts 3-4 minutes.
• The fourth phase of the duodenal examination consists of isolating portion B: the contents of the gallbladder, the secretion of thick bile of a dark yellow or brown hue.
• At the final stage of probing, specialists begin to pump out bile, which has a golden hue. The process takes about half an hour.

Algorithm

Duodenal examination by probing involves a sequential algorithm:

1. The patient must take sitting position straightening your back. The specialist places the tip of the probe, on which the olive is located, into the oral cavity of the person being examined - it must be swallowed.
2. The umbrella then begins to sink deeper through slow swallowing.
3. When the hose for duodenal examination drops inward by 40 cm, it is necessary to advance it another 12 cm. At this stage, a syringe is attached to the device, which helps to collect gastric juice.
4. Next action the rubber tube for probing must be swallowed to the 70 cm mark.
5. When the duodenal tube is immersed to this depth, the patient should lie on the right side. In this case, the specialist places a pillow under the pelvis of the person undergoing probing, and a warm heating pad is placed under the ribs.
6. The outer free end of the duodenal hose is lowered into a test tube on a stand designed to collect secretions.
7. Immersion of the probe continues until the 90 cm mark. From 20 to 60 minutes are allotted for this stage of duodenal sounding.
8. After the olive enters the duodenum, the tube is filled with duodenal fluid yellow color;
9. When all phases of the procedure have completed, the probing hose is removed with gentle movements.

How to swallow a tube correctly

Probing of the liver and gall the bubble will pass successful if the patient can swallow the tube correctly. The doctor must carefully move the device through the esophagus and stomach to the required marks that are on the hose. Sudden swallowing can cause the probe to curl up, requiring repeated immersion, so the process must be carried out progressively. When immersing the tube inside digestive system The patient should breathe through the nose to relieve discomfort.

Patient's feelings

Duodenal examination is an unpleasant process for the patient. Swallowing the tube may cause nausea and aspiration due to salivation. Therefore, it is necessary to use a position lying on your side - saliva will flow into a special tray or onto a diaper. The patient's condition may worsen when drugs are administered - diarrhea or a feeling of fermentation in the intestines occurs. An unpleasant symptom often becomes a fall blood pressure and changes in heart rate.

Complications during the procedure

The occurrence of complications during probing can be caused by insufficient qualifications of the doctor and an unforeseen reaction of the patient. Experts identify the following possible Negative consequences:

• intense salivation;
• education internal bleeding;
• injuries of the larynx, esophagus and other organs;
• constant vomiting;
• fainting and collapse are rarely possible.

Analysis results and interpretation

Only a competent doctor can evaluate the results of a duodenal examination. In this case, the specialist must take into account the following indicators:

• duration of each phase;
• quantity and characteristics of discharge;
• microbiological indicators of liquids, which take into account the normal ranges of concentration of leukocytes, cholesterol, bilirubin, bile acids, protein, pH in duodenal samples.

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 decipher the analysis results.

What is duodenal intubation

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

The manipulation is carried out using special equipment - a duodenal probe. 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– prescribed for therapeutic purposes and performed to remove 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 analysis 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, 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's consider the technique of performing fractional sounding, since it is this option diagnostics 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, 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;
• V supine position The probe continues to gradually immerse 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, active release of duodenal contents occurs. 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 earlier again, this indicates sphincter hypotension, and if the spasm continues longer, then it indicates increased tone.
3. Third phase– the sphincter spasm goes away 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 color, 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 options. The doctor determines the exact insertion depth individually.

It is important to know that throughout the entire procedure there is increased secretion 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

Proper preparation is required before undergoing the procedure. 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 research and examination 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 get objective results, diagnostic procedure should be repeated at intervals of 5–7 days. This is caused by 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 normal indicators 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. At correct implementation the effectiveness of this complex diagnostic method is 90%. This procedure used to clarify many diagnoses associated with impaired functioning gastrointestinal tract. With its help, it is often possible to determine the presence of helminthiases that cannot be detected by other laboratory methods.

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 various symptoms such as heartburn, bowel disorders, weight loss, pain. In some cases, pathological processes in the liver or gall bladder cause the development dangerous diseases– liver cirrhosis, cholelithiasis, inflammation of the biliary tract. That is why, when anxiety symptoms in area abdominal cavity Don’t delay going to the doctor. In this case, one of the procedures that the doctor will prescribe to study the condition internal organs, may become duodenal intubation.

What is duodenal intubation and why is it prescribed?

Duodenal intubation is one of the ways 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. Her round 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 necessarily require probing - it can be identified in the process 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, forms a special system - part of the digestive tract. In addition to processing food, the liver also belongs to immune system, in addition, 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 left half 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 inner surface organ, the hepatic gate is located - this is where the liver enters hepatic artery, the portal vein and the hepatic duct emerge from there, 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 acidic environment The bolus of food that comes out of the stomach 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, medicines, allergens.

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 intubation 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 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 diagnostics

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 sensing.

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 subject must perform swallowing movements, and at this time 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 suggests the patient 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 intrahepatic contents begins biliary tract 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 a gas burner before and after collecting bile.

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 a large number of white blood cells are present in the collected fluid, this may indicate the presence of 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 in the stomach or duodenum present pathological process.
The content of red blood cells indicates possible microtrauma to the inner layer of organs, which could be caused by the probe.

Bilirubin and cholesterol crystals are not normally found in the duodenal contents, but if they are detected, it means that they are damaged colloidal properties bile, and the patient may have a tendency to gallstone disease.

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. The 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 procedure lasts 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, the bile collected from the bladder turns out to be blue-green. 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. One year old child the probe is inserted to a depth of up to 35 centimeters, from 2 to 6 years - 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 person being examined; 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. Therefore, preparatory measures should include not only physiological medical events, but also psychological preparation.