Probing bile. Procedure for duodenal sounding of the gallbladder. What you need to conduct sounding at home

Probing of the gallbladder is a diagnostic either therapeutic method, in which a specialist can examine the state of the liver, organs gastrointestinal tract and gallbladder. AT outpatient settings it is carried out using a probe, and at home you can carry out the procedure more simple method. The essence of both methods is to stimulate the release of bile into the lumen of the duodenum. In the first case, the doctor can select it for analysis, at home it is carried out to prevent bile stasis and to improve digestion.

Indications and contraindications for the procedure

With pathologies of the liver and biliary tract, the patient manifests a characteristic complex of symptoms. Most feature is it acute or Blunt pain in the right hypochondrium, which may be present constantly or occur after a meal. I can also see various disorders indigestion (constipation or diarrhea), jaundice, skin rash and an increase in body temperature. For accurate diagnosis diseases, the doctor may prescribe a study of the composition of bile, which is collected from the duodenum using a probe.

Among the diseases that may be indications for duodenal sounding, the following can be distinguished:

cholecystitis, cholangitis;
inflammation of the liver, mucous membrane of the stomach or intestines;
cholelithiasis;
blockage of the bile ducts by helminths;
stasis of bile.

This procedure is carried out not only for diagnostic purposes, but also for the treatment of certain diseases. So, through the probe you can enter medications at helminthic infestations and inflammatory diseases. In addition, excess bile can be removed in this way if it accumulates in the gallbladder and does not exit into the intestinal lumen.

The probe is a long elastic tube with a tip (olive)

Probing of the gallbladder is not indicated for all patients. Before the procedure, the doctor collects anamnesis data and makes a complete examination.

Contraindications to duodenal sounding will be:

period of pregnancy;
age under 3 years;
asthma;
stomach ulcer;
intestinal bleeding shortly before the procedure;
high blood pressure;
signs of heart failure.

Preparation for duodenal sounding begins 5 days before the procedure. During this period, you must stop taking any medications that may affect the result of the examination. These include choleretic, laxative, vasodilators and antispasmodics. It is also not recommended to consume foods that can cause increased gas formation in the intestine. Probing is carried out on an empty stomach, eating is prohibited during the day.

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duodenal sounding

Duodenal sounding of the gallbladder is a procedure in which the condition internal organs examined with a probe. Depending on the technique of its implementation, several methods of sounding are distinguished:

fractional - used to collect 3 fractions of bile, especially informative if helminthic invasion is suspected;
blind probing - complete forced emptying of the gallbladder;
minute - registration of the output of 5 phases of bile, necessary for the diagnosis of dyskinesia of the biliary system;
chromatic - performed after staining the bile with a special dye to study its quantity.

This type of sounding is called duodenal because during the procedure the probe is placed in the lumen of the duodenum (duodenal) intestine. The technique is similar to gastric intubation, but the machine is placed deeper into the intestines.

Procedure technique

Duodenal sounding is a long process, in general it can take more than an hour. The probe is a long elastic tube, the tip of which is called an olive and can be metal or plastic. Before the examination, the doctor measures the distance from the patient's front teeth to his navel and makes several marks on the probe. Then you can start the procedure:

the olive is placed on the root of the tongue, and in sitting position the patient begins to swallow;
when the first mark is at the level of the front teeth (the probe has reached the stomach), it is necessary to lie on one side;
under the side of the patient is a heating pad, while you need to continue to make swallowing movements;
the second mark means that the probe is at the level of the entrance to the duodenum;
third mark and appearance yellow liquid will mean that the probe is in the intestinal lumen.

Portions of bile have a different shade and come out of them different departments hepatobiliary system

The duration of the procedure is individual, in some cases it can take up to 3 hours. After probing, you can eat after 30 minutes, but it should be light and dietary. Even during the day, it is better not to eat fatty and fried foods, that is, to follow the same diet that was prescribed to prepare for the procedure.

Bile study

At healthy person bile is liquid, transparent, has a yellow tint. Changes in at least one of these indicators indicate the presence of acute or chronic pathologies liver or bile ducts. In total, 3 portions of bile (A, B, C) are examined, which exit the lumen small intestine gradually.

Fraction A is transparent selection with an amber tint, which stand out within 20-40 minutes. The total volume of this phase can range from 15 to 45 ml. If the patient has signs of jaundice, and the first fraction of bile comes out colorless, this indicates a mechanical obstruction of the bile ducts.

After that, you need to get the next portion of bile (B). To do this, special drugs are injected through the probe that stimulate the activity of the gallbladder, and a clamp is placed on the hose itself. This portion of bile comes directly from the gallbladder and has greenish tint. Within 20-30 minutes, 20 to 50 ml of liquid should be collected. In the study of this portion, the following pathologies can be identified:

if bile does not come out - a violation of the contractile function of the gallbladder;
under the influence of drugs, bile is secreted for more than half an hour - the contractility of the bladder is reduced, in vivo insufficient;
changes in the color of bile - violations of the absorption function of the walls of the bladder;
the volume of bile exceeds 100 ml - expansion of the gallbladder, a decrease in the tone of its walls.

Portion C is hepatic bile. It has a bright yellow tint and is released within 20-30 minutes. If it comes out colorless or in insufficient quantity, this may indicate pathology from the liver.

It is also important to check the excreted secret for the presence of suspensions, the presence of helminth eggs and to check the ratio of cholesterol and bile acids. To do this, the liquid is examined under a microscope immediately after its collection. If necessary, carry out bacteriological examination bile in a test tube. This method will detect E. coli, pathogens of staphylococcus or typhoid fever.

Fractional sensing

If necessary, fractional probing can be done. Technically, this procedure does not differ from a standard duodenal study, but not 3, but 5 bile fractions are isolated here. Fractional sounding is more informative because it allows you to collect more accurate data.

The first 3 fractions make up portion A (at duodenal examination), the fourth fraction corresponds to portion C, and the fifth fraction corresponds to portion C.

The first fraction is 15–40 ml of light bile from the common hepatic duct. If it continues to be secreted after this time, the result indicates an increase in the level of secretion of this duct, and vice versa. After 30 minutes, 50 ml of magnesia sulfate is introduced into the probe and clamped with a special clamp.
The second fraction begins to stand out 2–6 minutes after the clamp is removed. If this does not happen, the symptom indicates a violation of the outflow of bile.
Within 2-3 minutes it should stand out a small amount of light yellow liquid, which is the residual volume of bile from the bile ducts.
The fourth fraction is cystic bile and corresponds to portion B.
The last fraction is portion C, which flows directly from the liver.

Further study of fractions occurs according to the same technology as with duodenal sounding. This method allows you to more fully analyze the state of the liver and biliary tract.

Blind probing is performed without additional tools at home

Carrying out the procedure at home

Probing the gallbladder at home is carried out blindly, that is, without the use of additional tools. Its main goal is to stimulate the release of bile into the lumen of the duodenum to cleanse the bladder and normalize digestion. Before the procedure, you must follow a diet for 3 days and limit the consumption of food of animal origin.

The simplest method of tubage (gall bladder cleansing) is using mineral sparkling water (Borjomi, Narzan or any other). It must be left open in the evening to go out carbon dioxide. Another option is a mixture of 500 ml of water with two tablespoons of sorbitol. In the morning, you need to act according to the following algorithm:

water is heated to 40 degrees and drunk in small sips in 5-7 minutes, while it is recommended to constantly walk;
then you need to lie on your right side, placing a warm heating pad under it, and remain in this position for an hour;
after that, you need to get up and drink a glass of warm water with lemon juice;
after another 15 minutes - a special breakfast to stimulate the outflow of bile.

It is recommended to have breakfast on the day of the procedure with a boiled egg and butter. It is advisable to use these products without bread and drink weak tea. After a while (usually 2-3 hours) diarrhea begins, but it quickly passes. This symptom indicates that gallbladder b cleared, and bile entered the cavity thin department intestines.

Probing of the gallbladder is called therapeutic, diagnostic or preventive actions that stimulate the release of bile into the lumen of the small intestine. Duodenal sounding is instrumental technique, which is carried out in a hospital to obtain and study bile. The blind method (tubage) can be carried out at home, but before starting the procedure, it is worth undergoing an examination and making sure that there are no contraindications.

P I have had stomach problems since childhood. I have heard about such a procedure with the intricate name "duodenal sounding" more than once, since it was performed on my mother. Every time you experience pain epigastric region, I was afraid that doctors would oblige to conduct this examination. But it bypassed me.

AT one "beautiful" day something happened to me that you wouldn't wish on your enemy. I sat all night in the toilet with a basin in my hands. By morning, there was nothing left in my stomach at all: my stomach stuck to my back, I couldn’t even swallow water, as it made me vomit, my blood pressure dropped to 80/60, my temperature rose to 38, attempts to get out of bed and generally move from my place caused excruciating pain throughout the body. But especially the stomach and liver area hurt. Feeling this area, I noticed some kind of compaction. My thoughts were very deplorable, about which I just did not think at that moment, and even about the most terrible. Still, I was inclined to believe that my dinner was to blame. I ate the day before oily fish, baked with onions and mayonnaise (even now this fish is in front of my eyes, but 5 years have passed).

At Trom called the doctor, who, seeing me green, gasped and urgently called an ambulance. I did not want to call an ambulance, because I was sure that they would take me to the infectious diseases hospital.

At they took me to the infectious diseases clinic, where they did not detain me for a long time, since I refused to go to the hospital. Prescribed medications strict diet and ordered to go to the infectious disease specialist at the local clinic.

To When I felt a little better, I went to an infectious disease specialist. The infectionist was a woman, very experienced doctor. After listening to everything that happened to me, she examined me: palpation of the abdomen. She also noticed a lump that was still present. And here she directs me to duodenal sounding of the gallbladder. It sounded like lightning from a clear sky. My very first reaction is - I won't go, I won't do it.

R Yesila first to do an ultrasound of the liver and gallbladder. Ultrasound showed stagnation of bile, the gallbladder contracted passively.

H After 3 days, I nevertheless persuaded myself: this is just temporary, I will find out what kind of seal it is, maybe it will pass, many do and live on, I can do it too and everything like that.

P I went to paid diagnostic center. I was first in line which was a big plus. The office turned out to be long, divided by screens of 2 beds. The doctor was a very nice woman who put a probe with a metal olive into my mouth and tried to push it further, but I resisted as best I could. Gagging began, hands reached out to pull the probe out of his mouth. And then the doctor turned from cute to brisk and shouted to me "Swallow!". I gathered myself and, realizing that I had nowhere to go, swallowed it safely. This was just the beginning. Now the most important thing is not to pull it back and suppress the urge to vomit, which pushed out the swallowed probe with all its might. She walked from one end of the office to the other and slowly swallowed.

To how to suppress the urge to vomit? No need to think about the probe. You need to breathe through your nose, evenly, without doing deep breaths and exhalations. It helps a lot.

To when the probe is swallowed to a certain mark, you lie on your right side and put a pillow in the gallbladder area (in my opinion this was a pillow made of sand, but maybe a heating pad, I can’t say for sure now, and there was not before). The probe will stick out of the right corner of the mouth, it cannot be squeezed with teeth, but must be held. The other end of the probe is placed in a test tube, where the liquid flows.

P Why did I say that being the first is good? After me, others began to come in, who also resisted. It was funny to listen to from the outside and it helped me take my mind off my probe. Laughing, of course, is also contraindicated, otherwise the probe starts to go back.

AND My fluid came out badly, bubbles, there were terrible spasms. Oliva in every possible way did not want to pass through the pylorus into the duodenum. By then it had been an hour. Things were going much better for my neighbor, the second test tube was already going. I started to worry, but I shouldn't have. Each of us has an individual organism: for someone this process goes faster, for someone it is slower. I belonged to the second type. My neighbor lay for 2.5 hours, and I for 3!!! The first one in and the last one out

P The last touch in the procedure was less pleasant. 0.5 l is poured into this probe, directly into the intestines. mineral water without gas, which washes the entire intestine, and the probe is removed. The main thing is to have time to run home! (or to the toilet).

R The results of the study are immediately reported. I had inflammation of the gallbladder (cholecystitis).

What to take with you for duodenal sounding?

Direction, passport, policy;
diaper;
Mineral water 0.5 l (at the time of registration they were told to bring Essentuki No. 4 mineral water);
Slippers.

What can not be done during the procedure?

Doubt your abilities
Speak,
Laugh,
Tighten your stomach
Look at others (God forbid to see someone's gagging).

What should be done during the procedure?

Think about the good
Forget about the probe
Breathe evenly through your nose.

What I learned during the procedure (the doctor turned out to be a very sociable woman who only cheered everyone up):

Conclusion:༰༰༰༰༰༰༰༰༰༰༰༰༰༰༰༰༰༰༰༰༰༰༰༰༰༰༰༰༰༰

Advise - do not advise this case doesn't make sense. If your doctor referred you to this study, then there is a reason for this and you should not refuse it. Many people do it, so you can do it too. This method of studying the liver and biliary tract is effective and allows you to detect diseases based on the analysis of bile.

Duodenal sounding, what is it? This is a manipulation used to study the contents of the duodenum. Thanks to this method diagnostics can confirm or refute a violation in the work of the gallbladder or liver. On the this moment duodenal sounding is not as commonly used as it used to be. This is related to the fact that present stage development of medicine, there are more accurate instrumental and laboratory diagnostic techniques.

Over the course of several decades, many ways have been developed to quickly and comfortably confirm the diagnosis, so now duodenal sounding is prescribed only if there is special indications. In order to modify the procedure and make it more informative, it was proposed to collect the duodenal contents fractionally, i.e. in portions every 5-10 minutes.

Portions of bile

Indications

For everybody diagnostic method should have their own indications and duodenal sounding was no exception. This may include the presence specific symptoms according to the type of pain in the hypochondrium.

This area is a projection of the liver and gallbladder. Of course, when the first attacks of pain syndrome appear, the doctor suspects pathology in these organs. can be felt in many diseases:

Hepatitis;
Cirrhosis of the liver;
hepatic abscess;
Aggravation chronic cholecystitis;
biliary colic;
Cholangitis;
Postcholecysto-ectomy syndrome;
Echinococcosis;
Hepatosis;
portal hypertension.

All of these diseases can lead to pain in the region of the hypochondrium. Pathophysiology given symptom due to direct damage to the parenchyma or capsule of the liver, as well as the mucous membrane of the gallbladder or bile ducts. As a rule, while pain syndrome accompanied by a number of other symptoms:

Dyspepsia;
Violation of digestion and absorption of nutrients;
stool disorder;
Nausea and vomiting;
Changes in the color of urine and feces;
Jaundice and / or itching of the skin;
Palmar erythema;
encephalopathy;
Varicose veins of the esophagus;
Gastroesophageal bleeding;
Ascites.

Opisthorchiasis

In the course of its life, the cat fluke secretes into circulatory system products of their vital activity, which are toxins for humans. From these substances in the body, a number of additional pathological processes unrelated to the digestive system. From the side nervous system there is sleep disturbance, irritability, headaches. The immune system characterized by an increase lymph nodes and development of allergic reactions.

The chronic form of the disease develops in endemic areas, which are characterized by a high prevalence this pathogen. The list of these countries includes Ukraine, Kazakhstan, Uzbekistan, Russia and Southeast Asia. For people suffering from chronic opisthorchiasis, multiple damage is common digestive system. A detailed examination of such patients reveals signs of gastritis, inflammation of the duodenum, duodenal and gastric ulcers. expressiveness clinical manifestations is usually weak. Depending on the individual features in a patient, opisthorchiasis can manifest itself as cholangitis or as a deficiency of digestive enzymes.

The preparation and technique for performing duodenal sounding for opisthorchiasis does not differ at all from standard recommendations.

Biliary dyskinesia

This pathological condition is characterized by improper functioning of the muscular apparatus of the biliary tract. Due to inadequate contraction, a violation of the outflow of bile occurs. Statistical studies show that women are more susceptible to this disease. The development of dyskinesia can contribute to a number of adverse factors. Improper nutrition is in the first place among the causes contributing to the improper outflow of bile. Other diseases of the digestive system can also be included in this category ( peptic ulcer stomach, gastroduodenitis, etc.), failure in hormonal balance and food allergic reactions.

It is customary to distinguish two main types of dyskinesia - hyper- and hypotonic. For hypertonic type characterized by increased muscle contraction. At the same time, the muscular layer of the bottom Bladder begins to actively decrease simultaneously with . Normally, during a meal, the sphincter should be wide open to allow bile to pass through the bile ducts, but in the hyperkinetic type, this does not happen due to muscle disorganization. At the same time, patients complain of intense attacks biliary colic, stopped by taking antispasmodics.

With the hypokinetic type, the severity of muscle contraction will be insufficient to push the bile, so it stagnates in the gallbladder. Painful sensations will be localized in the right hypochondrium. They are of low intensity and are of a long, aching nature.

When during duodenal sounding, there will be a delay in the release of portion B.

Preparatory stage

Preparation for duodenal sounding consists in observing several simple recommendations. The research should take place in morning time on an empty stomach, i.e. the subject should not eat for at least 12 hours. Two days before probing, it is necessary to observe special diet. It is required to stop eating vegetables, fruits, products with high content animal fats, as well as from all fried, smoked meat products.

In the morning, the patient is invited to the manipulation room, where he is comfortably placed on a couch or in a chair with a back. It is extremely important to remove dentures, if any, before the procedure. top the torsos are covered with a towel, and a tray is given into the hands to expectorate saliva. It is recommended to use a probe with two holes - gastric and duodenal. This will allow asperation gastric juice, and get a cleaner, free of impurities, bile. It is recommended to cancel the appointment 5 days before the procedure enzyme preparations. Otherwise, there is increased risk receiving inaccurate research data.

Technique

The duodenal probe is a rubber tube containing a special metal olive at the end.

duodenal probe

In this olive there are holes through which, with the help of suction, the contents will be taken. There are three markings on the probe:

The first 45 cm is the distance from the incisors to the subcardial part of the stomach;
The second 70 cm indicates the distance from the incisors to the pyloric section of the stomach;
The third 80 cm is the distance from the incisors to the duodenal papilla.

All these "notches" are necessary so that the doctor can navigate in the localization of the probe. The probe diameter is 3-5 mm and the length is 150 cm. Depending on anatomical features the patient, his size, physique, age, a probe can be selected. The size of the olive is 2 × 0.5 cm.

The procedure itself must be carried out on an empty stomach. The doctor prepares the duodenal tube, pre-processing it to prevent transmission of infection. Then the doctor puts the distal end of the probe on the root of the patient's tongue, and after that active movements pushes it through the digestive tract. To facilitate the passage of the rubber tube, the subject must perform active swallowing movements.

A notch of 45 cm indicates that the doctor has reached the stomach cavity. To advance the tube further, the patient is asked to lie on his right side and at the same time a hard roller is placed under it.

The position of the patient, facilitating the passage of the probe

In this position, the patient must continue to swallow for a long time (40-60 minutes). Only in this way will the olive be able to pass through the pyloric part of the stomach. If you try to speed up the process, then the probe will curl up and will not be able to pass through the gatekeeper. After the tube reaches a mark of 75 cm, its proximal end is lowered into a special tube used to collect duodenal contents. The stand with the container must be placed below the level of the patient. For this, a tripod is usually used, on which the test tube is placed.

An indicator of the correct position of the probe is the flow of yellowish contents through it, which is a mixture of pancreatic juice and bile. Make sure the tube is in the correct duodenum it is possible in another way. To do this, you need to take a syringe, draw air into it and insert it into the probe. If it is localized in the duodenal space, then nothing will happen, and if it is located in the stomach, then a specific bubbling sound will appear.

The information provided in the text is not a guide to action. For more detailed information about your pathological condition you need to seek help from a specialist.

For more exact definition tube locations use X-ray method research. Metallic olive stands out very well against the background of organs digestive tract, therefore, it is not difficult to establish its localization on an X-ray image. After evaluating the data x-ray examination, the radiologist gives instructions for further tactics. The technique for performing duodenal sounding is quite simple if you are well versed in the anatomy and physiology of the digestive tract.

Probing phases

The procedure itself was divided into several phases. This decision was made in order to facilitate the execution technique and develop a convenient step-by-step algorithm.

The first phase consists in taking portion A. It consists of bile, pancreas and intestinal juice. If the portion also gets gastric juice, then it begins to become cloudy. The duration of the phase is about 10-20 minutes.

After taking portion A, the patient is administered cholecystokinetics:

25% magnesium;
40% glucose;
Vegetable oil;
Xylitol solution 40%;
Pituitrin;
Peptone solution 10%.

After this, the second phase of duodenal sounding begins. In the second phase of the study, the sphincter of Oddi closes and bile flow stops. Its duration is about 4-6 minutes. After entering bile irritants, it is necessary to close the probe for 15 minutes.

In the third phase, the contents of the extrahepatic bile ducts are released. It has a golden yellow color.

Fourth phase. During it, you can visualize the presence of a dark yellow or olive discharge. This content is "bubbly" bile. In the presence of congestion in the gallbladder, the discharge will have a dark green color, and with a weakened concentration function, portions A and B will not differ dramatically in color. In such cases, a special dye (methylene blue) can be used, which is given to the patient at a dosage of 0.15 g before the study. Thanks to him, the gallbladder bile acquires a blue color, and it is no longer difficult to separate portions from each other. When obstructing the lumen of the bile duct, it is not possible to take portion B. Similar situation observed at calculous cholecystitis or cancer of the head of the pancreas. The volume of serving B is about 30-60 ml.

Even to to an ordinary person may require various diagnostic procedures. The most common general analyzes it is recommended to donate blood twice a year to everyone without exception, and more specific laboratory research carried out as directed by a doctor. So, with diseases of the liver and gallbladder, doctors often send patients for duodenal sounding of the gallbladder, let's analyze the algorithm for conducting this study, clarify what the technique should be for its implementation, what preparation is needed for such manipulation, and are there any contraindications to its implementation .

Duodenal sounding is a fairly popular diagnostic manipulation, in which the doctor examines the contents of the duodenum, which is a mixture of bile and digestive juices (intestinal, gastric and pancreatic). This study allows you to find out the state of the entire biliary system, as well as secretory functions pancreas. Most often, it is carried out with inflammatory lesions of the gallbladder, as well as with ailments of the bile ducts and liver.

Preparation for duodenal sounding

This study is carried out on an empty stomach, in the morning. The patient is allowed to have dinner in the evening (usually doctors advise making the last meal no later than 18.00): food should be light. Before duodenal sounding, you can not eat potatoes, Borodino black Rye bread, drink milk and consume other foods that can cause active increased gas formation in the intestine.

Five days before the study, it is necessary to abandon the consumption of choleretic drugs, represented by Tsikvalon, Barberin, Allochol, Flamin, Cholenism, Holosas, LIV-52. This group of medicines can also include cholagol, barbara salt, magnesium sulfate, sorbitol and xylitol. Also, five days before probing, it is necessary to exclude the use of antispasmodics: noshpa, bellalgin, tiphen, papaverine, bishpan, belloid, belladonna, etc. Vasodilators, laxatives and drugs to improve digestion, represented by panzinorm, abomin, are also prohibited at this time. pancreatin, festal, etc.

During preparation for duodenal sounding, the patient is given eight drops of atropine (0.1% solution) the day before, sometimes the drug is administered subcutaneously. In addition, use the usual warm water with thirty grams of xylitol.

How is duodenal sounding performed, algorithm, technique?

First of all, the need for this study is explained to the patient, and its sequence is told.

The patient is offered to go to the probing room, where he is seated comfortably on a chair with a back and his head is slightly tilted forward.
After that, a towel is placed on the patient's neck and chest. He needs to remove dentures (if any). In the hands of the patient give a tray for saliva.

Next, the health worker takes out a sterile probe from the bix and moistens its end with water. The specialist takes the probe right hand with an interval of ten to fifteen centimeters from the olive, and with his left hand supports its free end.

The health worker is located to the right of the patient and invites him to open his mouth. The olive is placed on the root of the tongue and the subject is asked to make a swallowing movement. During such a movement, the probe is advanced into the esophagus.

The specialist asks the patient to breathe deeply and diligently through the nose. The possibility of free and deep breathing confirms the fact that the probe is in the esophagus, also such breathing allows you to remove vomiting reflex arising from irritation of the area rear wall pharynx foreign body(probe).

The patient makes swallowing movements, and with each of them the probe is advanced deeper - up to the fourth mark, and then another ten to fifteen centimeters, which ensures the advancement of the probe inside the stomach.

Then the patient needs to swallow the probe exactly to the seventh mark. This manipulation is best done while walking slowly.

Next, the subject is laid on a trestle bed - on the left side. A small roller is placed under the pelvic area, and a warm heating pad is placed under the area of the right hypochondrium. This position of the body makes it easier to move the olive to the gatekeeper.

Lying down, the patient needs to swallow the probe to the ninth mark. So he gets into the duodenum.

The free end of this design is lowered into a jar, it is placed together with a rack with test tubes on a small (low) bench near the head of the subject.

After the separation of a yellow transparent liquid begins from the probe, its free end must be lowered into the first test tube (A). In twenty to thirty minutes, fifteen to forty milliliters of bile will come in - this is enough for research.

After a syringe, thirty to fifty milliliters of twenty-five percentage solution magnesium sulfate (heating it to forty-forty-two degrees). After that, a clamp is fixed on the probe (for five to ten minutes) or the free end is tied with a loose knot.

After five to ten minutes, the clamp is removed. The health worker lowers the free end of the probe into the jar, and after thick bile of a dark olive color begins to stand out from it, he places it inside test tube B. In about twenty to thirty minutes, fifty to sixty milliliters of bile is released.

After waiting for the separation of bright yellow bile from the probe, place its free end inside the jar.

After the flow of pure bright yellow hepatic bile begins, it begins to be collected in test tube C. The portion needed for the study has a volume of ten to twenty milliliters.

Having collected right amount bile, the patient is seated. The health worker removes the probe and gives the test water or antiseptic for rinsing oral cavity.

The specialist is interested in the patient's well-being, delivers him to the ward, puts him to bed and provides peace. The subject needs to lie down for some time, because magnesium sulfate can provoke a decrease in blood pressure.

The collection of bile by duodenal sounding can be considered complete. The patient must be left with breakfast, about which the guard nurse is warned in advance. Health workers monitor the well-being of the researcher and his blood pressure indicators. It must be remembered that magnesium sulfate has some laxative effect and can cause liquid stool.

For whom is duodenal sounding dangerous, what are its contraindications?

This research method is not practiced if the patient has acute cholecystitis, if an exacerbation of chronic cholecystitis and exacerbations of other ailments of the digestive tract has begun. Contraindications include varicose veins veins of the esophagus or stomach, as well as severe circulatory failure.

Duodenal sounding is not carried out if the patient has gallstones, since an active release of bile can provoke blockage of the ducts.
This study is contraindicated in women during childbearing and nursing mothers.

Folk recipes

Duodenal sounding is often performed in patients with various forms of cholecystitis. It is possible to cope with such ailments not only medicinal methods, but also with the help of traditional medicine. So great effect give birch leaves, medicinal properties which in this case can help you. Brew a couple of teaspoons of chopped raw materials with a glass of boiling water. Infuse the medicine under the lid for an hour, then strain. Drink the finished infusion in a third of a glass three times a day immediately before a meal.

You got acquainted with what and how duodenal sounding is performed, the execution technique is now clear to you. The feasibility of using traditional medicine for treatment different forms cholecystitis must be discussed with a doctor.

Probing of the gallbladder is a method of examining an organ using a probe. It is also called duodenal, because in the lower part of the duodenum there are 2 ducts: the gallbladder and the pancreas. When food enters there, then bile duct also enters for its digestion. For research, this same bile is called choleretic drugs and with the help of a probe they take it from there. This procedure can be performed both for diagnostic purposes and to alleviate the patient's condition.

How is the probing of the gallbladder performed?

There is also a probeless, or blind, way to separate bile. Consider the technique of carrying out both methods. Should be carried out special training to duodenal sounding of the gallbladder. The day before the start of the diagnosis, the patient is warned that food should not be taken after 18.00. Sounding is carried out in the morning on an empty stomach. The duodenal probe is a disposable sterile thin hose, at the end of which there is an olive. The nurse should have a tray, two heating pads, a towel, a syringe (20 ml), magnesium sulfate 25% and 3 sterile containers labeled A, B, C at the ready. There are markings on the probe that help health worker insert the probe into the duodenum using the correct length.

The patient is seated in a comfortable place so that he does not strain, and a towel is tied over his chest. The health worker teaches the patient in advance how to behave correctly when inserting the probe. A tray is given to drain saliva into the hands.

The most unpleasant procedure is the moment of swallowing the probe. The hose is carefully inserted into the mouth, the olive on the probe lubricates the throat for easy passage. The patient must breathe through the nose and make swallowing movements so that the hose enters the body more easily. The patient must breathe properly and deeply so that the urge to vomit is reduced. Having reached a depth of 14 cm, the liquid is withdrawn with a syringe. If cloudy contents come out, this will mean that the hose has reached the stomach.

The patient is placed on the right side and 2 warm heating pads are placed. When the probe is in the duodenum, the other end is lowered into the first test tube, marked A. Clean and clear liquid without any impurities. A mixture is formed immediately from 2 organs - the pancreas and the gallbladder. Usually, 15–40 ml of duodenal bile is sent for analysis.

After the first collection, a 25% solution of magnesia is injected into the intestine, after which, within 10 minutes, an active separation of bile from the gallbladder will begin. The liquid has a dark olive color. It is collected in a second tube labeled B. The bile should drain until the color changes to bright yellow. It should come out of the gallbladder from 50 to 60 ml.

The probe is carefully removed, the patient is given water to rinse the mouth and transferred from the treatment room to the department in which the patient will have to rest for about an hour. During this time, he will be under the control of doctors, his pulse and pressure will be measured.

Phases of duodenal sounding

So, the procedure goes through the main phases:

Receiving bile from the general stream. The stage takes 20 minutes. The liquid should not exceed 45 ml. With a larger volume we are talking about pathology.
The second stage is associated with the arrival of bile. It lasts a maximum of 6-10 minutes.
Then bile appears from the common ducts. This process takes up to 4 minutes.
The release of bile from the bladder lasts 20-30 minutes.

Evaluation of the results of the study

To begin with, evaluate appearance or the physical qualities of the intestinal contents. Pay attention to color, density and consistency. If a person is not sick, then the contents of all three test tubes should be transparent and slightly viscous. The normal specific gravity of mixed bile from the first tube and hepatic bile from the third is 1.008–1.012. And the bile from the gallbladder should be 1.026–1.032.

When a portion of bile becomes colorless as a result of obstruction of the biliary tract, this is a sign of jaundice.

Painful processes in the gallbladder are expressed total absence portion B, i.e. bile directly from the gallbladder. This can happen due to stagnation of bile and loss of contractility the organ itself. It can be cholelithiasis, cholecystitis, and dyskinesia that affects the bile ducts. Sometimes it happens that after the first attempt of probing and the introduction of magnesia, the necessary portion of bile is not released. Therefore, there is a need for a secondary introduction of the probe. Confirmation of the diagnosis will be the appearance of dark-colored bile in a large volume.

Expansion of the gallbladder can occur if 100 ml or more of bile enters tube B. Usually this phenomenon occurs as a result of stagnation.

When examining under a microscope, the sediment of all 3 containers is carefully examined. Normally, they should all be the same. When studying, they contain a meager amount of leukocytes, small epithelial cells, as well as a small amount of grains of cholesterol and sodium oxalate.

Slime and increased number leukocytes indicate inflammatory process. Depending on where it is found, one can judge the localization of inflammation.
At microbiological research for different pathogens, different pathogenic microorganisms such as Giardia, coli, staphylococcus, enterococcus, typhoid fever bacillus.

Who should not have duodenal sounding?

There are diseases in which it is risky to carry out this survey. It , acute cholecystitis, poor circulation and the presence of gallstones. When probing, a stone from the bladder can move and fall into bile duct. And this, in turn, will lead to jaundice. skin. Sounding is not carried out for people with exacerbation of gastritis, stomach ulcers and any other diseases of the digestive system. Before probing, an ultrasound of the internal organs should be done, after which a decision is made on the diagnosis.

With blind probing of the gallbladder, the gallbladder is emptied by the method of probeless tubage, which can be done at home.

Preparation is carried out as follows. Tubage without a probe is carried out early morning when there is no food or water in the stomach. It is at this time that the gallbladder is most active. You need to lie on your right side and bend your knees. The patient should take slow sips, within 30 minutes, to drink a cholagogue. To remove bile, you can use 2 cups of heated mineral water without gas. Can be brewed corn silk or drink a 25% magnesium water solution.

A heating pad is placed under the right side to stimulate the separation of bile. The whole process should take 2 hours. The fact that the procedure was carried out correctly will be indicated by a liquidish green stool. The cleansing process can be carried out 1 time in 7 days. The duration of therapy is 3 months.

When choosing mineral water for tubage, it is better to give preference to Borjomi, Kislovodskaya or Smirnovskaya. It is desirable to heat such water, but you can simply leave the bottle open overnight so that the gas evaporates.

Apply choleretic agents. You can mix 1 tbsp. l. olive oil with warm mineral water. Such natural remedies, like immortelle and stigmas of corn, you need to insist in a glass of boiling water. For such an amount of water, 15–20 g of the collection is enough. Sorbitol is dissolved in 200 mg of mineral water.

It is possible to combine 2 methods of tubage only on the condition that duodenal sounding will be carried out once a month, probeless tubage - 2 times a week. Tubage can be carried out for a long time, if the patient's condition requires it.

Tubage can also be carried out for the purpose of prevention to maintain the health of the body, if there are no contraindications for this. It can be successfully used in cholestasis. After the tubage, a person feels much better. He has no pain from the liver, the process of digestion of food improves and general state the patient is changing for the better.

Sounding helps in the case when an examination of the main ducts along which bile moves should be carried out. The purpose of the procedure is to empty the bile organ and prevent stagnation. With heaviness in the right hypochondrium and the appearance of bitterness in the mouth, it is possible to perform a liver and gallbladder tubage at home.