Phases of duodenal sounding. Indications for gastric cavity sounding and examination

Bad breath and morning bitterness in the mouth, plaque on the tongue, pressing pains and a feeling of heaviness in the upper abdomen - all these symptoms can indicate diseases of the biliary tract. There are many methods for diagnosing the digestive tract pathology, however, for making an accurate diagnosis, it is necessary to conduct laboratory analysis of bile and study the function of the gallbladder. For this, the classical method of duodenal sounding is used.

What is the study

Duodenal sounding (from “duodenum” - the duodenum) is a method for assessing the functional state of the biliary tract and gall bladder by introducing a probe (thin flexible tube) into the lumen of the duodenum.

Bile synthesis takes place in the liver, then, if at the moment there is no need for digestion, it enters the gall bladder. When there is fatty food in the stomach that requires bile acids to break down, the bubble contracts and the bile, passing through the bile duct, enters the duodenum.

The study involves taking several portions of samples that reflect the state of the various components of the biliary system.

For sounding it is necessary:

A probe (tube diameter 3-5 mm, length 1.5 meters), at the end of which an olive is placed.
Syringe with a volume of 10 or 20 ml.
Test tubes for individual servings of bile.

The duration of the procedure with the fence of 3 servings of bile is 1.5-2 hours. Then, a laboratory analysis of the selected samples is carried out for the presence of infectious pathogens, salts, and cholesterol crystals in them.

Varieties of method

There are various methods for collecting bile from the gallbladder:

Blind sounding (tubing). The method involves the introduction of choleretic drugs and emptying the gallbladder. It is carried out in the presence of symptoms of bile stasis and the risk of stones, confirmed by ultrasound (ultrasound).
Fractional duodenal sounding is a classic technique for taking 3 portions of bile at regular intervals using an inserted probe.
Chromatic sounding. A subspecies of the previous method with special staining of gallbladder bile. 12 hours before the study, the patient takes a contrast agent (methylene blue), which during the study stains a portion of bile from the bladder. This supplement allows you to accurately determine the quantity and diagnose the presence of obstruction to the exit of cystic bile.

In addition, depending on the purpose of the study, distinguish between diagnostic and therapeutic sounding. The latter is used to reduce the symptoms of stagnation of bile.

Indications for

Duodenal sounding is prescribed by patients, mainly of gastroenterological profile. The study is recommended in such conditions:

Acute and chronic cholecystitis (in remission).
Cholangitis (inflammation of the bile duct).
Infectious diseases: opisthorchiasis, giardiasis.
Cholelithiasis. Isolation from the lumen of the bile duct of the calculus is the only reliable sign of the disease.
Dysfunction of the biliary tract.

Important! A study in the presence of stones in the gallbladder is accompanied by a risk of complications. Therefore, the doctor must compare the likelihood of undesirable consequences and the diagnostic (or therapeutic) value of the procedure

Probing is also performed for persons with symptoms of liver disease and impaired outflow of bile: jaundice, bitterness in the mouth, heaviness in the right hypochondrium. Stagnation can be caused by a pancreatic tumor, stenosis (narrowing) of the openings of the biliary tract and many other pathologies.

Contraindications for duodenal sounding

The procedure involves the stimulation of secretion of bile and contractile activity of the biliary tract. Therefore, there are a number of conditions in which the study is prohibited or undesirable:

Acute cholecystitis.
Exacerbation of chronic cholecystitis.
Ultrasound confirmed presence of gallstones. After stimulation, the stone can come out and clog the bile ducts, which will cause an acute condition - hepatic colic.
Varicose veins of the esophagus. Passing the probe through the esophagus can damage the walls of the vessels and cause bleeding.
Pregnancy and the period of breastfeeding. The drugs used for the procedure can significantly reduce the pressure, which impairs the blood circulation of the fetus, and penetrates into breast milk.

In each individual case, the doctor himself assesses the risks and the feasibility of conducting the study.

How to prepare for the study

5-7 days before the procedure, it is necessary to stop taking choleretic drugs (Allohol, Holagol, Liv-52).

In order to obtain objective results, it is recommended not to take pronounced, antispasmodic drugs (No-shpa, Papaverine) and antibiotics.

2 days before the study, you should not eat foods that contribute to increased gas formation (cabbage, potatoes, flour and confectionery, legumes). The evening before the study, the last meal should be no later than 7 hours.

How is duodenal sounding performed?

The procedure is performed in the morning on an empty stomach in the treatment room of the hospital. The study takes place in several stages:

The patient is in an upright position, and the doctor measures the required length of the probe. It is equal to the distance from the corner of the mouth to the navel. The introduction of the probe begins with the placement of olive on the root of the tongue, then during the swallowing movements of the patient - the tube gradually drops to the first mark. The probe is in the stomach.
To facilitate the passage of the probe into the duodenum, the patient lies on his right side, placing a heating pad under it. The stomach aligns and the probe can pass through the pylorus. This is the part of the stomach that connects it with the duodenum.
At the time of passage of the tube into the intestine - through the lumen of the probe, a light golden transparent liquid begins to stand out. This portion A is a mixture of bile, pancreatic secretion and intestinal juice. The total volume should be up to 40 ml. The isolated material is sent to the first tube.
After that, a drug is injected into the intestine to stimulate the secretion of bile (magnesia sulfate, xylitol, sorbitol), the probe is pinched for 10 minutes.
After 10 minutes, a dark green cloudy liquid — cystic bile, portion B. — is collected through a probe into the tube. Its excretion lasts about 30 minutes. The total volume of 60 ml.
After 25-30 minutes, a bright yellow liquid begins to stand out from the probe - hepatic bile, portion C. For laboratory analysis, a sampling of 15-20 ml is performed.

Important! The swallowing of the probe is carried out along with swallowing saliva, which prevents it from entering the respiratory tract.
You need to swallow slowly, otherwise at the initial stages the probe may curl up in the stomach, and the procedure will need to be repeated

After collecting the third portion of bile, the probe is gradually removed. To prevent discomfort, rinse your mouth with water or glucose solution.

30 minutes after the study, you can eat, but on this day it is necessary to exclude fatty and fried foods from the diet.

Method advantage

Duodenal sounding, choledoch drainage (common bile duct) and ultrasound are used to collect bile and study the state of the biliary tract.

Comparative characteristics of these methods are presented in the table:

Criterion	Duodenal sounding	Drainage of the common bile duct	Ultrasound procedure
Methodology	Insertion of a small tube into the duodenal cavity with bile sampling	Open surgery with access to the biliary tract and the introduction of a drainage tube into their lumen	Study of the passage and reflection of ultrasonic waves through body structures
Invasiveness	Minimally invasive method	Surgical intervention	Non-invasive procedure
Need for anesthesia	Indicated local anesthesia	General anesthesia	Not necessary
Laboratory diagnosis of bile composition	Held. 3 samples of bile from different parts of the biliary tract	Only fresh liver bile is sampled	Not carried out
Duration of the procedure		1.5-2.5 hours

Analyzing the data, the best option for laboratory analysis of bile with minimal interference with the body is duodenal sounding.

Possible complications after duodenal sounding

The introduction of the probe and the use of magnesia sulfate during the procedure can lead to the development of undesirable consequences:

Significant salivation.
Bleeding caused by organ damage by the probe during swallowing.
Nausea and vomiting. For people who cannot suppress the feeling of nausea, anesthesia of the posterior pharyngeal wall with a spray is recommended before the procedure.
Diarrhea. Magnesium sulfate is considered to be a strong carrying agent, therefore, people with unstable digestion are recommended to use other drugs.
Dizziness and collapse resulting from a decrease in pressure caused by magnesia.

Doctor's advice. To avoid unpleasant consequences in the form of loss of consciousness, after the procedure you need to lie down for several minutes, and then slowly rise

How to decipher research results

The results are evaluated using laboratory diagnostics of the composition of bile and measuring the time intervals in which a certain portion of bile is secreted.

The standard methodology includes studies of 5 phases of bile excretion.

The first (choledochus). Normally, it lasts 10-15 minutes, during which up to 40 ml of light yellow transparent bile is secreted. The presence of blood in this portion may indicate cancer of the duodenum.
The second (closed sphincter of Oddi - a muscle that regulates the outflow of bile from the bile duct to the duodenum). Within 4-6 minutes, bile is not secreted. If this pause is extended, one should think about the inhibition of bile production.
Third (open sphincter of Oddi). From the common bile duct within 3-6 minutes, up to 6 ml of golden-colored bile is secreted (portion A). The lengthening of this phase or the appearance of pain indicates the presence of stones in the duct.
Fourth. A portion of B is allocated up to 60 ml of thick bile of dark green color. Duration up to 30 minutes. The release of more fluid (up to 120 ml) indicates cholecystotomy (increased tonus of the gallbladder).
Fifth. The phase of allocation of portion C (hepatic) of 15 ml of bright yellow bile in 10-15 minutes. If bile is pale yellow, a non-inflammatory liver lesion should be suspected.

The table shows the studied indicators of laboratory analysis of individual servings of bile and their indicators in normal and pathological conditions

	Cholecystitis	Giardiasis
The color is golden yellow. Transparency is complete. There is no protein. Epithelium 1-2 in sight. White blood cells 1-2 in the field of view. No salt crystals	Norm Option	The color is greenish. Transparency is incomplete. Epithelium 2-4 in sight. White blood cells 1-2 in the field of view. Slime is an insignificant amount. No salt crystals
The color is dark green. Transparency is complete. Protein up to 4.5 g / l. No epithelium White blood cells 2-3 in the field of view. Mucus is absent. Single salt crystals	The color is dark green. Protein is more than 5 g / l. Epithelium 2-3 in the field of view. White blood cells more than 10 in sight. A significant amount of mucus	Color greenish Transparency is a cloudy liquid. Epithelium - 1-2 in the field of view. A significant amount of mucus
The color is light yellow. Transparency is complete. Protein up to 2.5 g / l. The epithelium is absent. White blood cells 2-3 in the field of view. Mucus is absent. No salt crystals	Norm Option	The color is golden yellow. Transparency is complete. Epithelium 1-2 in sight. White blood cells 10-12 in the field of view. Slime is an insignificant amount. Giardia detected

Carrying out this study requires thorough knowledge and experience of a doctor. However, the results obtained during duodenal sounding can significantly affect the treatment of the disease.

The video shows the sounding procedure and the characteristics of the results.

The liver and gall bladder in the human body perform many functions, among which are direct participation in the digestion processes due to the production of special enzymes, the synthesis and accumulation of bile. Any violations in these organs, their structure, structure or work, immediately affect the well-being of a person, manifested by various symptoms like heartburn, stool disorders, weight loss, pain. In some cases, pathological processes in the liver or gall bladder cause the development of dangerous diseases - cirrhosis, gallstone disease, inflammation of the biliary tract. That is why, with the appearance of alarming symptoms in the abdominal cavity, do not delay with going to the doctor. In this case, one of the procedures that the doctor will prescribe to study the condition of the internal organs can be duodenal sounding.

What is duodenal sounding, why is it prescribed

Duodenal sounding is one of the methods of functional diagnostics in gastroenterology. With it, a physician is able to assess the condition of the duodenum and biliary 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 not 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 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 using duodenal sounding could confirm the presence of stones in the gallbladder and its ducts. Today, such a diagnosis does not require the mandatory appointment of sounding - it can be detected in the process of ultrasound examination. A specific procedure is carried out in order 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 about the anatomy and functioning of the liver and gall bladder

The liver together with the gallbladder form a special system - part of the digestive tract. In addition to food processing, the liver belongs to the immune system, in addition, it performs a protective function, partly 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 repeats the shape of the diaphragm. The lower edge is 1-2 centimeters below the arc of ribs, concave, as it is in contact with other internal organs.

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

The hepatic gate is located in the middle part of the inner surface of the organ - in this place the hepatic artery enters the liver, from which the portal vein and the hepatic duct exit, which removes bile from the liver.

Under the gates of the organ, the gallbladder “hid” - a small hollow organ that looks like a sac. It is adjacent to the outer edge of the liver and lies on the duodenum. The length of the organ is normal - 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 to neutralize the acidic environment of the food lump that comes out of the stomach, helps the absorption of cholesterol, calcium salts and fat-soluble vitamins.

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

The body 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, drugs, allergens.

The bile produced by the liver passes into the gall bladder, where it accumulates until the food enters the body, for the digestion of which it will be needed.

What types of procedures can be performed

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

blind sounding, when the patient does not have to swallow the probe - liquid is used for the procedure;
fractional or multimodal: in this case, the collection of the contents of the intestine is carried out with a certain interval, for example, every five minutes;
chromatic sensing implies that before the diagnosis, the patient is injected with a dye;
the minute procedure makes it possible to assess the condition and work of the sphincters.

Indications and contraindications: when it is necessary and in what cases it is impossible to conduct sounding

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

Indications for duodenal sounding are:

a feeling of bitterness in the oral cavity;
pain and discomfort in the right hypochondrium;
bile stasis diagnosed by ultrasound;
persistent nausea and bouts of vomiting;
discoloration of urine to yellow-brown or brown, discoloration of feces;
the need to establish a primary or confirm the existing diagnosis;
suspicion of an inflammatory process in the gallbladder;
diseases of the bile duct, liver.

The procedure is not performed if the patient has:

coronary insufficiency;
acute cholecystitis;
gastric and duodenal ulcer;
digestive tract cancer;
exacerbation of chronic cholecystitis;
varicose veins of the esophagus.

Sensing is also not recommended for pregnant and lactating women.

Features of preparation for diagnosis

The procedure of duodenal sounding can be carried out only strictly on an empty stomach, therefore, the patient should not be eaten 8-10 hours before it, and for 3-4 hours you should refrain from drinking fluid.

As part of the preparation of the patient, five days before the planned procedure, dietary restrictions in the diet are required. It is necessary to exclude from the menu:

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

Such a diet is introduced to reduce the level of gas formation in the intestine.

Preparation for the procedure also requires interruption of the following drugs during the same period:

choleretic (Barberin, Tsikvalon, Allohol, Flamin, Holosas and others);
antispasmodics like No-Shpa, Spazmalgon, Papaverin, Beshpan;
laxatives;
vasodilator;
enzyme-containing (Pancreatin, Creon, Festal).

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

The objectivity of the results directly depends on how carefully the patient will comply with all the requirements of preparation.

How is the study of the liver and gall bladder

The procedure implementation algorithm may include several diagnostic techniques:

classic duodenal sounding;
fractional sounding.

The first technique involves a three-stage study, and is considered somewhat outdated. During classical sounding, portions of bile are selected in three phases:

from the duodenum;
from the bile ducts and gall bladder;
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 his tongue out. The doctor performing the procedure puts a metal olive on the root of the patient’s tongue, which ends at one end of the probe. Next, the subject must carry out swallowing movements, and the doctor at this time advances the probe into the esophagus. The saliva secreted by the subject flows into a special tray that he holds in his hands.

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

According to the marks on the probe, the doctor understands how deep the probe enters, and when the olive reaches the stomach. The contents of the probe are pumped out with a syringe to check - if a turbid liquid enters the syringe, then the probe is located in the stomach.

To move the probe tube into the duodenum, the patient must be laid on the right side, putting a warm heating pad under it. The “on the side” position is required so that the saliva secreted does not enter the trachea.

A light yellow, slightly turbid fluid entering the cavity of the tube indicates that the probe has reached the duodenum. This moment is the beginning of stage A - the contents are collected from the duodenum for analysis. In its composition - bile, enzymes of the intestine and pancreas.

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

Stage B. After the first stage of fluid intake for analysis is completed, substances are introduced into the intestine that stimulate gastric secretion: sorbitol, oxygen, xylitol, or sulfate magnesia. The probe tube is pinched for several minutes. After 7-10 minutes, the clamp from the probe is removed, after which, if all the manipulations are done correctly, bubble contents enter the tube cavity - thick bile of a green-yellow hue. 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 hepatic bile enters it. For analysis, no more than 10-15 milliliters will be required. At the end of collecting the secret for analysis, the probe is slowly removed from the esophagus.

Fractional Duodenal Sounding Technique

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

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

At the third stage, the contents of the intrahepatic biliary tract begin to discharge within 3-4 minutes.

During the fourth phase, the gallbladder is emptied, its contents (thick brown or brown-yellow bile) are collected by the 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 content obtained: collection and examination of duodenal fluid

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

Liquid containers must be sent to the laboratory for research as soon as possible after collection, since the proteolytic enzymes of the pancreas tend to destroy leukocytes, in addition, cooling the liquid makes it difficult to detect lamblia in the duodenal contents: they stop moving when the temperature decreases.

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

Decryption of the analysis is carried out by a doctor-diagnostician with the appropriate qualifications. All results are recorded in the written opinion of the doctor.

If a large number of white blood cells is present in the collected fluid, this may indicate the presence of an inflammatory process. In this case, the diagnosticians carry out the analysis with the sowing of bile: 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 bile suggests that a pathological process is present in the stomach or duodenum.
The content of red blood cells indicates a possible microtrauma of the inner layer of organs, which could be caused by a probe.

Crystals of bilirubin and cholesterol are not normally found in duodenal contents, but if they are detected, then the colloidal properties of bile are impaired, and the patient may have a tendency to gallstone disease.

Blind sounding: features of the procedure

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

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

Half an hour after graduation, breakfast is allowed, while the food should be light. On this day, you must abandon fatty, spicy and fried foods.

What is chromatic sounding?

This type of sounding is used for the most accurate recognition of bile from the gallbladder. About 12 hours before the start of the study, usually in the evening before bedtime, and not earlier than 2 hours after the last meal, the patient needs to drink a capsule with 0.15 grams of methylene blue.

During sounding, the bile collected from the bladder turns blue-green. In this case, the doctor-diagnostician draws attention to the amount of bile secreted, and the time that elapses from the moment of administration of the irritating substance to the appearance of a portion of bile related to stage B.

Sounding in children: how is it carried out

All procedures using the probe are quite difficult for children to tolerate. The order and technique of conducting practically do not differ from the procedure in adults, with the exception of some indicators.

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

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

Duodenal sounding is an unpleasant procedure for the subject, moreover, it lasts, in some cases, for 40-50 minutes. Typically, the patient is conscious, but if the patient has no contraindications or is allergic to anesthesia, probing may occur under general anesthesia. Therefore, preparatory measures should include not only physiological medical measures, but also psychological preparation.

Duodenal Sounding Procedure - This is a type of study that is carried out for diagnostic and therapeutic purposes. As a result of the manipulation, the specialist receives the contents from the duodenum and gall bladder.

If we compare the benefits and harms of duodenal sounding, then the advantages of the technique are much greater. The procedure allows you to:

Find out how the bile secretion system functions in a particular patient.
Determine the composition of the gallbladder.
Detect the presence of functional impairment at an early stage.
All portions received are examined microscopically and bacteriologically (if necessary).

Duodenal sounding

Priority in the study is serving B.

When executed

Indications for duodenal sounding pathologies of the biliary system of an inflammatory nature are advocated. The procedure is useful and recommended in the presence of hepatic pathologies. With the help of this manipulation, it is possible to evaluate the work of the pancreas.

Symptoms to perform:

Bitterness in the oral cavity.
Soreness in the right side.
Gall bladder congestion.
High concentration of urine.
Nausea.

Features of the manipulation depend on the goal pursued.

Tactics

Duodenal sounding of the gallbladder today is performed in a fractional way, which has a huge many advantages.

In the course of the methodology a secret is retrieved every five minutes, which allows you to fix its volume.

Thus, the duodenal sounding method is used to diagnose various pathologies of the gallbladder and helps to determine the type of bile acid.

Features of preparation

The patient is asked to come to the procedure in the morning and on empty stomach. Previously, he needs to exclude heavy foods, dairy products, potato dishes, dark rye bread and other ingredients that can enhance gas formation from the diet.

A few days before the study is fully exclude the intake of choleretic drugs.

At the stage of preparation for the manipulation, a person should take the drug atropine and use a glass of warm water diluted with xylitol.

Procedure Steps

When performing the methodology, it is important to follow the phased steps. implies two options: the classical method and fractional.

Duodenal sounding

The fractional technique involves the observance of five phases:

At the first stage, a portion A is selected, consisting of contents and different types of juices.
Then, magnesium sulfate is introduced, after which the second phase begins.
At the third stage, the mass coming from the extrahepatic ducts comes out.
Highlighted in dark brown.
Taking a serving of C - secretion of a yellowish-golden hue.

Regardless of the methodology, a polymer probe with olive is always used at the end, where there is a gap for suctioning portions.

It is better to give preference to a double probe, because one of them performs a pumping function of the gastric contents.

Features of the manipulation

At the initial stage of the study the person should be upright. The following actions are performed:

The medical professional notes the distance from the navel to the mouth.
The patient sits on the couch, they give him a special container for saliva.
A person must loosen the belt and collar so that nothing interferes with the procedure.
The specialist will give a short briefing on breathing and swallowing olive.
When vomiting reflexes appear, the patient will have to firmly fix the probe with his teeth and concentrate on breathing.
An olive is placed on the root of the tongue, and the patient takes several swallowing actions.

Do not rush when swallowing the device, otherwise it may coagulate in the stomach.

If you need to confirm the location of the olive, the specialist looks at the color of the pumped mass.

A thin probe with a length of at least 1.5 m is used for the procedure

A syringe is also used to introduce oxygen into the probe. If at the same time the patient has rumbling in the abdomen, this indicates that the olive has reached the stomach. Otherwise, her location is the duodenum.

The patient lies on the right side and a warm heating pad is placed under his side.

What duodenal sounding shows will be judged by portion B, which has the most important diagnostic value.

The resulting secret is collected in special containers, which helps to measure its volume. To perform bacteriological culture, a little bile is collected in a separate tube.

When portion C is collected, the probe is carefully removed.

Features in children

Due to the fact that the procedure itself is considered quite complex and is a rather time-consuming process, duodenal sounding in children is characterized by a number of nuances:

The probe is introduced to infants approximately 25 cm.
Children from six months to 30 cm.
35 cm old baby
At the age of 2-6 years at 50 cm.
Senior at 55cm.

Magnesium sulfate is diluted in 0.5 ml of a 25% solution per kilogram of body weight. In all other respects, the technique and phasing of the steps are no different procedures for adults.

What results are considered normal

We examined all the subtleties and nuances of the study, and now we will understand what gives duodenal sounding.

The enzymatic level fluctuates. In assessing the exocrine pancreatic function, one should rely on the dynamics during the stage of secretion stimulation.

If a person has no functional and pathological disorders, then when performing the procedure, the level the content of bicarbonate and enzymes will decrease.

At the end of the first hour of manipulation, the concentration will again be restored, sometimes even exceeding the norm.

However, when evaluating the results, one should take into account the fact that about twenty percent of patients with normal indicators nevertheless have pathological functional disorders directly in the pancreas.

Duodenal sounding is not performed during pregnancy

You need to know about duodenal sounding, what is this research that it is not performed if there are the following contraindications:

Exacerbations of chronic cholecystitis.
Acute cholecystitis.
Relapses of any ailments of the digestive tract.
Varicose digestive system organs.
Circulatory problems.
Pregnancy.
Lactation period.

Contraindications of duodenal sounding apply to individuals who have gallstones. Stimulating the release of secretion can lead to clogging of the ducts.

With proper preparation, the procedure is well tolerated

Conclusion

So, we found out why duodenal sounding is needed.

With proper preparation, both physical and psychological, the procedure, in most cases, is well tolerated.

Moreover, it is not only diagnostic in nature, but also used for medicinal purposes to cleanse the gallbladder in case of congestion, and helps prevent the formation of stones.

Patients who underwent this manipulation leave positive feedback about duodenal sounding, and in the future they feel more confident when there is a need to go through it again.

In contact with

In order to have a complete picture of the state of the mucous membrane of one of the most difficult for the diagnosis of the digestive system organs, an informative examination such as gastric sounding is prescribed.

This examination is carried out on an outpatient basis by a gastroenterologist. A probe is inserted through the mouth or nose into the esophagus, it moves into the stomach. Using a specially developed algorithm, the doctor conducts diagnostic manipulations to study indicators such as:

the composition of gastric juice taken in several stages;
secretory function of the mucous membrane;
acidity level;
the presence or absence of food residues in the discharge of the mucosa;
the volume of fluid pumped out of the stomach.

The examination practically does not cause discomfort, despite the fact that it is carried out without anesthesia and anesthesia. The position of the probe in the patient’s stomach is monitored using an x-ray machine.

Insertion of the probe is possible through the nose.

The use of modern materials allows research using a very thin probe with a diameter of 0.4-0.5 cm. The minimum possible sizes will help to avoid gagging and do not create unpleasant sensations.

Modern medical equipment has further improved and simplified the sounding of the stomach. An exceptionally thin probe can now be equipped with a miniature video camera that transmits to the computer screen an image of the internal contents of the organ and the features of its structure. Based on the data obtained, the doctor will be able to confirm or refute the alleged diagnosis, differentiate it with similar pathologies, and in time to detect the onset of cancer of the mucous membrane and muscle wall of the organ.

Indications for the appointment of the procedure

Examination of the stomach according to this technique is carried out for various indications:

diagnosis of gastrointestinal diseases;
the need to feed or administer drugs directly to the stomach (premature babies, patients with pathologies and injuries of the esophagus, pharynx, oral cavity, as well as people who are unconscious);
flushing during intoxication of the body with chemicals or low-quality products.

Diseases for the diagnosis of which gastric tube is prescribed:

ulcerative lesions;
gastritis with high and low acidity;
reflux esophagitis.

The examination helps to identify the features of the course of the disease, changes in the tissues of the stomach, the appearance of neoplasms of any etiology, structural features of the mucous membrane. In case of toxic damage, probing with a special kind of probe will allow you to quickly remove poisons from the body, to prevent their harmful effects on organs and systems that ensure human activity.

How to prepare for sounding

Before examining the stomach, you need to try to normalize your mental state, talk with your doctor about the purpose of the sounding. The calmer the patient, the easier and more comfortable the procedure will be. Overexcitation can negatively affect the composition of gastric juice, strengthen the reflex, causing the urge to vomit.

On the eve of sounding, you can’t eat - at least 12 hours should pass from dinner or breakfast to the start of the examination. To obtain an objective picture of the composition of the gastric juice, it is advisable to neither drink nor smoke.

With these simple measures, preparation for the diagnosis of the stomach is completely exhausted. Special drug preparation is not necessary in advance. On the contrary, if the patient must follow the doctor’s prescription and take pills, he must inform the gastroenterologist who is conducting the probe. It is advisable to avoid the use of drugs that directly affect the functioning of the stomach: atropine, caffeine, antacids.

Preparation before the examination

The patient lies on the side of the couch, a tray for collecting saliva is placed next to him, the front part of the chest is covered with a napkin. This precaution is necessary so that salivation (salivation) does not interfere with normal breathing, as saliva spits, but does not swallow. First you need to remove the dentures, a special ring is installed in the mouth in order to exclude the possibility of clenching the jaws. To reduce sensitivity, an aerosol with an analgesic effect is sprayed into the oral cavity.

Diagnostic procedure

After all the preparatory measures have been taken, a probe is placed on the root of the subject's tongue, and the patient is offered to swallow. Tilting the head forward and deep breathing facilitate the passage of the probe through the esophagus. Processing the root of the tongue with novocaine removes excessive sensitivity and stops the gag reflex. After the probe reaches the desired depth, its outer part is fixed to prevent the tube from entering the duodenum.

Modern probes are very thin.

Sounding algorithm:

With a special pump or syringe, the contents of the stomach are removed.
Within 60 minutes, the basal secretion emitted by the mucous membrane on an empty stomach is pumped out. The interval between juices is 10 minutes; sampling takes place within 5 minutes.
The so-called "test breakfast" is introduced into the probe - a decoction of dried cabbage, meat broth or 5% alcohol.
After half an hour, a sample of the juice released in response to the stimulant is taken.

In the absence of contraindications, Insulin or Pentagastrin are used to stimulate secretion. Their use gives more pronounced results than broth or broth of cabbage. After 2-2.5 hours, the sensing procedure ends.

Assessment of the results of the study

Gastric juice fractions obtained as a result of sounding are sent to a laboratory study to diagnose possible pathologies of the stomach. The following indicators are taken into account:

Analysis of these data will allow the attending physician to compile a complete picture of the disease. If the indicators of a laboratory study of gastric secretion differ from those shown in the table, then you need to undergo treatment by a gastroenterologist.

Normal parameters of the parameters of the gastric juice of a healthy person

Complications and contraindications

Despite the safety of the procedure, there are categories of patients who should not be done without emergency.

Contraindications:

Bleeding of the gastric mucosa;
varicose veins of the esophagus;
pregnancy;
aortic aneurysm;
esophageal stenosis;
hypertension;
mental disorders;
the presence of diabetes mellitus or diseases of the heart and blood vessels.

The last contraindication in the list is due to the fact that drugs with contraindications in the form of diabetes and diseases of the heart and blood vessels are used to stimulate gastric secretion.

Recovery and sensations after sounding

A study conducted in compliance with all precautions does not require recovery. After removing the probe, the patient is left in the rest room, where he is monitored for an hour to exclude the possibility of injury to the esophagus or stomach. During the day, only light diet foods of room temperature with a minimum fiber content remain in the diet.

Incorrect sounding may result in bleeding due to mucosal injury or. In such emergency cases, the following measures are taken:

intravenous administration of calcium chloride;
intramuscular injection of Vikasol;
applying ice to the epigastric region;
blood transfusion.

Perforation of the walls of the stomach requires immediate surgical intervention.

It should be noted that such complications are extremely rare. In most cases, the sounding is carried out without any consequences for the subject, provides information for determining the treatment strategy.

\u003e Duodenal sounding

This information cannot be used for self-medication!
Be sure to consult with a specialist!

What is obtained using duodenal sounding?

A study in which the contents of the duodenum are obtained using a probe is called duodenal sounding. A duodenal probe is a rubber tube whose length is one and a half meters and a diameter of 5 mm. At its end there is a small metal olive with holes. There are 3 marks on the tube: at a distance of 40, 70 and 90 cm from the olive. The first corresponds to the distance from the teeth to the stomach, the second - from the teeth to the place where the stomach passes into the duodenum, the third - from the teeth to the place where the main ducts of the gallbladder and pancreas flow into the duodenum. The duodenal contents are usually called bile, although in fact, in addition to bile, it includes gastric, pancreatic and intestinal juices.

In what cases is this study indicated?

Duodenal sounding is now done quite rarely and only for special indications. He is usually prescribed by a gastroenterologist after an abdominal ultrasound. Symptoms in which the doctor may recommend a study are bitterness in the mouth, systematic pain in the right hypochondrium, nausea. Sometimes duodenal sounding is used for therapeutic purposes. For example, with stagnation of bile it is used to wash the bile ducts to prevent thickening of bile and the formation of stones.

How to prepare for the procedure?

On a duodenal sounding you need to come on an empty stomach. The last meal and liquid is allowed 10-12 hours before the procedure. To reduce gas formation in the intestine, two to three days before the study, milk, vegetables and fruits, brown bread, carbonated drinks should be excluded from the diet. On the day of sounding, you can not take medicine, smoke. If thirst is very worrying, you can drink a little water an hour before it.

How is duodenal sounding performed?

The patient in a sitting position swallows a duodenal probe. To make it easier, you need to breathe deeply. When the probe passes into the digestive tract to the first mark, it is advanced another 15 cm and the gastric contents are aspirated (aspirated) using a syringe. Then the patient swallows the probe to the second mark. After that, he lays on the couch on his right side. Under his right hypochondrium they put a heating pad, and under the pelvis - a roller so that the bile leaves well. Next to the couch on a low bench place a tripod with test tubes. They collect bile in a certain sequence. In the supine position, the subject continues to gradually (in 20-60 minutes) swallow the probe to the third mark. If bile is not well separated, then during the procedure, a bile secretion stimulator (magnesium sulfate, sorbitol, etc.) is injected into the probe using a syringe. Sounding lasts from 1 to 3 hours.

Contraindications for performing duodenal sounding

The procedure is contraindicated in acute cholecystitis and with an exacerbation of the chronic inflammatory process in the gall bladder, stomach ulcer or duodenal ulcer, gallstone disease, varicose veins of the esophagus. It is not carried out for people with serious heart diseases.

What do the sounding results show?

During the study, 3 portions of bile are obtained: portion A - bile from the lumen of the duodenum, B - from the gall bladder, C - from the hepatic ducts. By the color and amount of bile in each portion, you can determine how the different departments of the biliary tract work. Normally, portion A is golden yellow, B is olive or brown, C is light yellow. Then carry out a laboratory study of bile. Normally, it may contain single white blood cells and red blood cells, cholesterol crystals and calcium salts. Their presence in large quantities, as well as the presence of mucus, cells of the mucous membrane, bacteria or parasites, indicates a pathological process in the biliary tract.