Duodenal probing of the gallbladder. Blind probing of the gallbladder. In what cases the procedure is not carried out

The cleansing of the gallbladder, which for one reason or another is in hypotonicity, is carried out according to the testimony of a doctor, since this procedure can be prescribed only after excluding all possible contraindications and selection of one method or another. To perform the cleaning procedure, they are used as non-invasive methods in the form special exercises and reception choleretic agents chemical or natural origin, and invasive methods performed using a probe.

In this article, we will introduce you to different ways cleaning of the gallbladder and its ducts, indications and contraindications to them, methods of performing and monitoring the effectiveness of the procedure performed. This information will help you avoid making mistakes that, when self-assigning these procedures, can lead to such severe complications how obstructive jaundice, peritonitis, etc.

What is tyubazh and blind tyubazh?

Doctors call the methods of cleansing the gallbladder such terms as “tubage” or “blind tubage”. Translated from French this is unfamiliar ordinary people the word means such procedures as "insertion of a probe", "intubation" or "insertion of a tube" into the lumen of an organ.

Varieties of tubage

Tyubazh implies the implementation of medical procedure, which is accompanied by the introduction of a duodenal probe and medicines into the lumen duodenum, i.e. duodenal sounding.
Blind tubazh carried out with the help various means that promote the outflow of bile and reduce the muscle layer of the gallbladder: antispasmodic and choleretic drugs, a complex of special therapeutic exercises, heating pads. They are administered orally, applied topically and are not accompanied by the introduction of a probe into the digestive tract.

Each of these methods has its advantages and disadvantages, indications and contraindications. Blind tubage can be carried out at home after the doctor thoroughly familiarizes and teaches the patient the technique of its implementation and selects for him the method of this method of cleansing the gallbladder and ducts, which will not harm his health. And the usual tubage is performed only in a clinic or hospital.

Is it necessary to cleanse the gallbladder and its ducts as a preventive measure for healthy people?

This question is increasingly being asked by people who care about their health. AT last years recommendations on the need for regular “liver and gall cleansing” and advertising various ways on "cleansing the bile ducts and liver" are increasingly found in the media and on Internet resources. Many of these pseudo-recommendations can be not only inappropriate, but also dangerous for some people with various chronic diseases.

In this regard, many therapists, gastroenterologists and specialists in other areas of medicine have begun to hear more and more questions from their patients about the advisability of performing such procedures. And in some cases, the illiterate implementation of such "methods for cleansing the liver and bile" becomes the reason for calling the ambulance team and the need for an urgent surgical operation.

Most gastroenterologists do not recommend tubage in the absence of or suspected biliary tract disease. This is because in the absence of stagnation of bile, which leads to various other malfunctions in the functioning digestive organs, gallbladder and its ducts do not need additional "cleaning".

Tyubazh

Tubage, or duodenal sounding, for therapeutic and diagnostic purposes can be prescribed for various diseases gastrointestinal tract, which are accompanied by hypotension of the gallbladder and bile ducts. At its core, this procedure is the most effective for cleansing the gallbladder of bile that has stagnated in it, since it guarantees its almost complete excretion.

Indications

Indications for the appointment of this procedure may be such diseases and procedures:

biliary dyskinesia with cholecystitis, which is not accompanied;
chronic duodenitis;
chronic pancreatitis;
diagnostic microscopic or bacteriological examination bile.

Contraindications

Like every medical procedure, tubage may be contraindicated if the patient has various concomitant diseases:

narrowing of the esophagus;
acute cholecystitis;
exacerbation;
acute gastritis, duodenitis and other acute inflammatory processes digestive tract at the initial stage;
suffocation or with broncho-pulmonary pathologies;
coronary insufficiency;
esophageal carcinoma;
or duodenal ulcer during an exacerbation or with a tendency to develop gastrointestinal bleeding;
tendency to arterial hypertension in combination with the threat of stroke and other complications of vascular diseases;

How is the procedure performed?

Tubage can only be prescribed by a doctor after preliminary survey.

Before setting the date for performing the gallbladder and ducts tubage, the doctor must appoint a patient a number of diagnostic tests, which allow you to determine if the patient has possible contraindications to this procedure. Their number is determined after a thorough history of the patient and his examination.

The patient may be prescribed the following methods of examination:

clinical blood and urine tests;
Ultrasound of the liver, gallbladder and other abdominal organs;
Fibrogastroduodenoscopy, etc.

To prepare for the tubage procedure, it is recommended to follow a diet that prevents flatulence for 2-3 days and take belladonna or Atropine 1-2 times a day. Before going to bed, you need to apply a heating pad. On the evening before the procedure, the patient should cleansing enema or take a saline laxative.

The procedure is carried out in the morning. On the day of probing, the patient should not eat or drink water, because when the probe is inserted into the esophagus, he may vomit, and the vomit may enter the respiratory tract.

The duodenal sounding procedure can be performed in outpatient settings or in a hospital. It runs like this:

The patient is seated on a couch and asked to do a few deep breaths and exhalations.
The nurse performing the insertion of the probe explains to the patient how he should swallow the olive at the end of the probe.
The olive is placed on the root of the tongue, and the patient performs several slow swallowing movements.
Next, the nurse gently inserts the probe to the first mark and lays the patient on the couch on the right side, placing a roller and a heating pad under the right hypochondrium under the pelvis. After this, the pylorus opens between the stomach and duodenum. Sometimes with spasm of the pylorus, I suggest that the patient take a 2% solution of soda, which helps to eliminate spasms in the muscles of the stomach and duodenum, do light massage the upper half of the abdomen or perform an injection of a 0.1% solution of Atropine sulfate.
After opening the pylorus, the patient continues to perform slow swallowing movements and swallows the probe to the second mark.
The nurse sucks with a syringe attached to the other end of the probe, the contents and, by its nature, locates the olive. When the probe is inserted into the duodenum, a golden color is drawn into the syringe. clear liquid co alkaline reaction, which is determined using litmus paper.
The outer end of the probe is lowered into tube A and the contents of the duodenum are collected in it.
The patient is asked to lie on his back and a 33% solution of Magnesia (warmed up to 40-42 ° C) is injected into the probe, which can cause the so-called "bubble reflex", contraction of the gallbladder walls and contraction of the sphincter of the common bile duct. A clamp is applied to the probe for 5-10 minutes.
After that, the clamp is opened and the secreted portion of dark bile is collected in another test tube B.
Following this portion of dark bile, a golden liquid begins to be released into the test tube, which is collected in the next, third test tube C.
After the release of the golden liquid is complete, the probe is carefully removed.
The tubes with the obtained bile are sent to the laboratory, which performs quantitative, microscopic and bacteriological analysis all three portions.

Sometimes patients with bowel disease are advised to insert before removing the probe. medicinal substances into the duodenum. Your doctor may prescribe the following solutions:

After completion of the tubage procedure, the patient is measured arterial pressure, pulse. If the procedure was performed in a hospital, then it is delivered to the ward. He can have breakfast there. The medical staff continues to monitor the patient's well-being.

If the tubage was carried out on an outpatient basis, then the patient is allowed to go home only after his state of health is completely stabilized - after about 40-60 minutes - and they are told the date and time for a visit to the doctor and evaluation of the results of laboratory tests.

Tubage results

After the completion of the tubage procedure, most patients with gallbladder diseases experience a feeling of relief in the right hypochondrium. They note that their digestion normalizes and painful and unpleasant sensations in the gallbladder area disappear.

Therapeutic tubage can be performed as follows: a course of procedures is carried out for 1.5 months with an interval between them of 5-7 days. If necessary, after 3-4 weeks, the course of therapeutic probing is repeated.

Blind tubazh

Blind tubage, or probing, can be performed using various techniques. The most suitable and effective of them should be selected by a doctor who can be guided by the data of diagnostic studies.

With mineral water and heating pad

To perform this method of blind tubage, it is recommended to use an alkaline mineral water"Essentuki-17", "Borjomi". It is necessary to release gas from it, which can interfere effective cleansing gallbladder and warm to room temperature.

Drink a glass of mineral water every 20 minutes. In this way, it is necessary to take at least 1.5-2 liters.
Lie on your right side and put under right hypochondrium warm heating pad. Lie down for about 1.5-2 hours.

With Mineral Water and Xylitol

To perform this method of tubage, mineral water without gas and Xylitol or Magnesia dissolved in it are used (these drugs can be purchased at a pharmacy). Dissolve 1 teaspoon of one of these drugs in a glass of water.

Drink a glass of mineral water with Magnesia or Xylitol.
Lie on your right side and put a warm heating pad under your right hypochondrium. Lie down for about half an hour.
Drink the remaining 1.5-2 liters of mineral water.
Repeat the same procedure after 2 days.

With mineral water and raw egg yolks

To perform this method of tubage, Slavyanskaya mineral water without gas and raw egg yolks are used.

Drink 2 yolks.
Drink 0.5 liters of mineral water.
Lie on your right side and place a warm heating pad under the liver area.
Drink another 0.5 l of mineral water in small sips.
After the urge to defecate, go to the toilet. Usually they appear immediately after taking all the mineral water.

The course of blind tubages is usually designed for 25 days, i.e., it involves the implementation of 10 procedures. These days it is necessary to stay at home, because the procedures cause a laxative effect.

In addition to these simple recommendations should not be forgotten that for effective procedure cleaning the gallbladder and its ducts, the food taken should be sparing: not greasy, not spicy, not smoked, containing a sufficient amount of vitamins and minerals. On the days of blind tubage, it is recommended to follow a milk-vegetable diet and take enough liquids (water, choleretic teas or rosehip infusion).

Blind probing, otherwise called tyubazh ─ effective method cleaning the liver, bile ducts, gallbladder. The method promotes the evacuation of liver secretions, normalizes the functioning of organs, and is a prevention of the occurrence of cholelithiasis. Sounding in medical practice is used everywhere. The procedure is simple and can be done at home. True, there are a number of contraindications. In view of this, before carrying out tubage, approval from the attending physician should be obtained.

Blind probing of the gallbladder and liver is carried out as with therapeutic purpose as well as for prevention purposes. The procedure stimulates the evacuation of bile, eliminates its stagnation.

Indications for tubage are:

non-calculous (without stones in the bladder) cholecystitis, hepatitis, duodenitis;
prolonged constipation;
violation motor function bile ducts;
recovery after removal of the gallbladder;
obesity.

Blind probing is carried out strictly according to indications. Tubage is used only after diagnosing stagnation of bile. It is seen on ultrasound ultrasound examination). Additional confirmation ─ availability accompanying symptoms: pain and heaviness in the right side, constant nausea, unpleasant belching, disruption of the digestive system.

It is not necessary to carry out tubage in patients with a slight stagnation of bile. A choleretic breakfast will help to cope with the problem, which promotes the outflow of liver secretions after a night's sleep.

Cholagogues used in blind probing contribute to rapid evacuation excess bile, while removing various toxins, toxins, pathogens. After the procedure, the motility of the bladder improves, relief is felt under the right hypochondrium, the processes of digestion of food are normalized.

Despite the simplicity of the method, it should be performed with care so as not to harm health.

History of the development of blind sensing

Described by ancient doctors. Gallstone pathology, for example, was described at the turn of the era. Two thousand years ago, healers used herbal decoctions, natural bile of animals for treatment. By making observations and systematizing the data, the healers proposed ways to stimulate bile flow.

Blind probing of the liver and gallbladder has also been known since antiquity. In the recipes of Russian healers of the 9th-12th centuries, the method of tubage using olive oil and lemon juice. The last one took half a cup. Olive oil needed a glass. Liquids were drunk at night. The product was used 5 times a month. The recipe is relevant to this day, contributes to the dissolution of stones in the gallbladder.

Features of probing the gallbladder

Tubage of the gallbladder can be carried out by probe and probeless (blind) method. The probeless method is quite simple, which allows you to carry it out at home.

Blind probing at home is carried out using sorbitol, herbal decoctions, magnesia, mineral water. With the aim of correct execution procedure is required to follow the basic rules and steps.

Blind probing with magnesia can be too aggressive for the mucous membranes of the stomach and intestines. The solution is prepared by diluting two tablespoons of magnesium sulfate in a glass of water. The remedy is drunk in the morning on an empty stomach, then it takes a position on the left side, a heating pad is placed on the right.

Blind probing with sorbitol is a fairly commonly used method. A tablespoon of sweet alcohol dissolves in a glass of water. The remedy is drunk on an empty stomach in the morning. In the future, you should lie down and put a heating pad on your right side.

Purification with mineral water is carried out similarly to the previous methods. For the procedure, you can use any mineral water. It should be non-carbonated, and therefore it is recommended to leave the bottle open in the evening to allow gases to escape. Blind probing with mineral water most suitable for tubage, held for the first time.

Tubage is active and passive. In the first case, it is accompanied exercise, in the second it is required to take a lying position with a heating pad for several hours.

It should be remembered that blind probing is accompanied by subsequent indigestion in the form of diarrhea, the duration of which is determined by the degree of blockage of the bile duct and its ducts.

Of paramount importance is careful preparation before procedure:

a few days before the procedure, you must follow a diet based on the use of plant foods;
reduce the amount of portions consumed;
do not eat after 6 pm;
drink a large number of liquids and fresh juices.

The above measures will prevent the accumulation stool in the intestine. During cleansing, its contents will prevent the release of bile.

Tubage is aimed at cleansing the liver or gallbladder.

Tubage, aimed at cleansing the liver, is carried out in the evening. Do not eat 8 hours before the procedure. Three days before cleaning must be followed strict diet. A solution with magnesia and sorbitol is prepared in advance, horizontal position and a heating pad is placed on the liver area. First, the prepared solution is drunk, and during the probing, warm herbal decoctions are drunk. The first meal is allowed only the morning after the procedure.

Blind probing of the gallbladder at home is aimed at removing stagnant concentrated liver secretions. Warm when tyubage herbal decoction drinking throughout the day. In the evening, you should lie down and put a heating pad on your right side. The heating pad lasts for several hours, during this period it is forbidden to eat and drink.

Proper conduct Tubage allows you to get rid of toxins, toxins, reduce weight.

The phases of probing the gallbladder

Probing of the gallbladder is carried out in stages.

The procedure using sorbitol consists of the following steps:

Pre-prepared warm solution is drunk in the morning on an empty stomach in small sips.
A warm heating pad is prepared in advance. After drinking the solution, it is placed on the liver area, taking a lying position.
The duration of being in the supine position is at least an hour.
It is allowed to get up after the heating pad has cooled down. You should drink water with lemon juice, then have breakfast. The meal should consist of choleretic products, for example, soft-boiled eggs, butter, green tea with sugar.
After some time, there will be a desire to defecate - this normal reaction, indicates a correctly carried out tubage.

On the day of cleansing, you can not eat flour, dairy products, it is better to give preference to vegetables, fruits, teas.

A heating pad relieves spasm of the bile ducts and accelerates the process of outflow of hepatic secretions.

When probing with magnesia, the patient drinks a pre-prepared solution, then takes a position on the left side with a heating pad for two hours. After the patient gets up, does a few squats, bends. You can eat in an hour light breakfast from vegetables.

To carry out a tubage using mineral water, the following steps should be performed:

Mineral water is heated up to 40 degrees.
A heating pad is prepared in advance.
5 sips of water are drunk, after which the patient takes a horizontal position on the back or right side, putting a heating pad on the site of the projection of the liver. This position is maintained for 5 minutes.
Then the patient gets up and drinks mineral water, occupies the same position for 5 minutes.
The procedure is repeated every 5 minutes. Standing patient drinks a total of 500 milliliters of water.
After drinking the entire volume of the prepared liquid, you need to lie down for 20 minutes.

When any discomfort when conducting blind probing, you should immediately stop it and apply for medical care.

How long does the procedure take

Blind probing using magnesia will take 90 minutes. They are carried out lying down with a heating pad on their side. The solution is drunk in the morning on an empty stomach.

It takes an hour to carry out a tubage with sorbitol. The prepared solution is also drunk on an empty stomach. After 60 minutes, you need to lie on your side with a heating pad.

Duodenal sounding - special method study of the contents of the stomach, which consists of intestinal, gastric and pancreatic juices mixed with bile. The analysis of these compounds allows you to evaluate the work of the duodenum and gastrointestinal tract, as well as identify possible problems.

The concept of research and its purpose

The procedure is carried out using a special probe. This is a hollow rubber tube with a metal tip (olive) with numerous holes. It is through them that bile and gastric juice are taken.

The length of the hose is from 110 to 150 centimeters. Based individual features patient on the hose marks the location of the probe on gastric tract. Usually there are three of them: at the level of the cardial part of the stomach (40 - 45 centimeters), up to the first pylorus (65 - 70 centimeters) and up to the large duodenal nipple (about 80 centimeters).

Types of duodenal sounding:

Tubage. Reception in progress choleretic drugs and warming the area of the liver. This method is also known as blind probing. Used to empty the gallbladder.
Fractional sounding. The most advanced method. Divided into five phases during which the content is withdrawn different departments stomach.
Chromatic sounding. The main difference is the use of special indigo carmines administered intravenously to the patient before probing. This pigment will allow identification of gallbladder bile from choledochial and hepatic bile.
Minute examination. In this case, bile sampling is carried out every 5 to 10 minutes.

The chosen method of examination depends on individual indicators. Sometimes the procedure will need to be repeated after a while, for example, in case of insufficient production of enzymes.

Indications

The procedure is included in comprehensive examination. The results of the analysis have great importance to make a definitive diagnosis, but cannot be used as independent information.

In what cases is the procedure prescribed:

Inflammatory processes of the gallbladder.
Diseases of the biliary tract and liver.
Bitterness in the mouth and heartburn.
Constant or recurrent pain in the region of the right hypochondrium.
Concentrated composition of urine in previous tests.
Stagnation of sputum in the gallbladder.

Typically, test results are ready in a few days. The decoding will be carried out by a specialist, and the final treatment and possible additional examinations must be agreed with the attending physician.

Contraindications

The duodenal sounding procedure usually does not have serious contraindications. Despite some discomfort and pain, bile sampling is tolerated relatively easily and does not cause complications.

In some cases, there may be severe individual reaction therefore, the expediency of such a procedure is determined by a specialist on the basis of an examination and a personal interview of the patient.

In what cases the procedure is not carried out:

With localization of the gastrointestinal tract.
Hypertonic disease.
Deformity of the esophagus or spine.
Cardiovascular diseases.
Enlargement of the veins of the esophagus.
Severe condition of the patient.

To prevent this from happening, you must strictly follow the instructions medical workers and follow their recommendations. The procedure does not differ in pleasant sensations, but competent control can reduce discomfort to a minimum.

Preparing the patient for the procedure

In order for everything to be as successful as possible, the patient needs to prepare in advance before the examination. For this, it would be useful to consult the attending physician, as well as collect necessary information about the sampling algorithm.

What to do before the procedure:

At least five days before the examination, refuse to take enzyme preparations.
Cancel drugs that stimulate digestive activity, antispasmodics and vasodilators.
Do not take a laxative three days before the procedure.
The day before, the patient is given a solution of atropine to drink or injected subcutaneously.
Immediately before the procedure, the patient drinks a solution of xylitol.

Dieting is very important factor, because it is he who affects the evaluation of the results of the analyzes. You can not starve the day before the procedure, it is better to eat a light dinner.

So that food does not affect the results of the analysis, it is necessary to exclude heavy, fatty and gas generating products from the diet. These include brown bread, milk, potatoes, fatty meats, alcohol and carbonated drinks.

If the examination is scheduled for the morning, the dinner time should be no later than 18 pm.

Duodenal sounding technique for adults and children

Often this procedure is carried out in a fractional way. Before the session, the disposable probe must be boiled and cooled in boiled water. For ease of administration, it is not forbidden to use glycerin as a lubricant.

The entire procedure takes two to four hours, depending on the bile flow. When conducting fractional sounding, five phases are distinguished, during which a sample is taken from a certain part of the stomach, and a change in the position of the patient and additional stimulant drugs are also used.

Carrying out algorithm:

Portion "A" is constipated - the contents of the duodenal cavity. Total duration is 20 minutes.
The patient is given a dose of a cystokinetic that relaxes the sphincter of Oddi. The second phase lasts several minutes, during which bile sampling is not carried out.
Extravesical bile is secreted, which is easily identified by its golden color. The phase lasts only a few minutes, after which the patient changes position again.
Portion "B" is taken, which is formed directly in the gallbladder. The color of the liquid in this case will be dark and saturated.
After changing the color of the bile, portion "C" is collected, which has a lighter color. It is secreted from the intrahepatic ducts.

The bile sampling algorithm in children is no different except for the size of the probe. In addition, it is necessary to explain to the child all the stages of the procedure, if necessary, one of the parents may be present during the collection.

Usually it is prescribed for suspected infection with cholecystitis or.

Deciphering the results: norm and deviation

The contents taken must undergo bacteriological and microscopic examination. The duration of each phase is also recorded.

An increase in this period may indicate a spasm of smooth muscles, as well as an obstruction (stone or). An increase in the bile outflow phase can also indicate the presence of certain problems with the functioning of the digestive system.

Other indicators of the studied material:

After receiving negative results, it is necessary to undergo other types of examinations, for example, ultrasound. Despite the discomfort of the probing procedure, this method has not yet lost its relevance when taking samples for research.

When a person has stagnation of bile in the gallbladder, he feels pain in the right hypochondrium, nausea, bitterness in the mouth. Such symptoms indicate diseases of the liver, bile ducts, or inflammation of the gallbladder. In order to correctly determine the pathology that has arisen, doctors often prescribe a clinical diagnostic procedure for the patient - duodenal sounding of the gallbladder. In this case, a mixture of bile with gastric, pancreatic and intestinal juice, which are part of the contents of the duodenum. This procedure allows you to assess the state of the secretory function of the pancreas and the entire biliary system.

What does the term "duodenal" mean?

To answer this question, one must refer to anatomical structure internal organs. On the inner surface the lower part of the duodenum is the so-called duodenal papilla, which opens the pancreatic duct and common choledochus bile duct. During digestion, the bile in the gallbladder travels through the cholidochus into the duodenum. When the process of digestion is absent, the flow of bile into this body needs to be stimulated so that a sampling of the contents can be taken for research. For this purpose, special choleretic solutions are used, which are injected into the duodenum. The introduction of solutions and sampling is carried out using a double probe. Therefore, this procedure is called duodenal sounding.

Carrying out duodenal sounding

The procedure is carried out in the morning, on an empty stomach. The day before probing, it is necessary to exclude from the use of products that cause increased gas formation. Also, 5 days before the scheduled study, you will need to stop taking laxatives, vasodilators, antispastic and choleretic drugs. On the eve of the procedure, the patient is injected subcutaneously or given inside 8 drops of a 0.1% solution of atropine.

Duodenal sounding involves the introduction of a probe with a plastic or metal olive located at its end. Three marks are marked on the probe, measuring the distance from the patient's front teeth to the navel in a standing position. This is necessary so that the doctor is guided and knows where the probe is located.

The patient will then need to swallow the olive. For many people, this procedure is extremely unpleasant, but it is necessary. After swallowing the olive, the doctor advances the probe inward with translational movements, and the patient synchronously performs swallowing movements. The first mark, fixed at the level of the front teeth, means that the probe has entered the stomach. After this, the patient is placed on the right side and the swallowing of the probe continues. The second mark indicates the approach of the probe to the pylorus, and the third mark indicates the penetration of the probe into the duodenum. After a certain time, a golden liquid begins to come out of the probe, which is placed in different test tubes for research.

Procedure technique

Currently, duodenal sounding uses the so-called fractional technique, which consists of five phases of bile pumping.

The first phase involves sampling the contents of the duodenum - bile, gastric, pancreatic and intestinal juices. This procedure takes approximately 20 minutes.

Then it is necessary to stop the formation of bile in the spasm of the sphincter of Oddi. So the second phase clinical trial consists in the introduction of magnesium sulfate inside. This phase lasts about 5 minutes.

During the third phase, which lasts no more than 4 minutes, the contents of the extrahepatic bile ducts are taken.

After the cessation of the formation of bile in the sphincter of Oddi, brown thick cystic bile continues to stand out. The fourth phase is the taking of her sample (portion B).

When the bile returns to its characteristic golden yellow color, the fifth phase begins: it is collected for research within half an hour.

On this bile fence for laboratory research ends. All samples obtained are subjected to bacteriological and microscopic examination. Of course, duodenal sounding of the gallbladder unpleasant procedure, but it is necessary to come to terms with its implementation.

Probing of the gallbladder is a diagnostic either therapeutic method, in which a specialist can examine the state of the liver, organs of the gastrointestinal tract and gallbladder. On an outpatient basis, 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 become 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.

TEST: How is your liver?

Take this test and find out if you have liver problems.

duodenal sounding

Duodenal sounding of the gallbladder is a procedure in which the condition of the internal organs is examined using 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 amount.

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 different parts of the 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 - contractility bubble reduced, 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, a bacteriological study of bile in a test tube is also carried out. This method will detect coli, causative agents of staphylococcosis 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 is injected into the probe magnesium sulfate and clamp it 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 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 the gallbladder is cleared, and bile has 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.