Duodenal sounding is a procedure for inserting a probe, for the purpose of diagnosis and treatment, into the duodenum. For research, it is necessary to take the contents of the duodenum, bile and pancreatic juice produced by the pancreas. Sometimes the procedure is used for therapeutic purposes to remove secretions from the organ in case of sluggish inflammation of the gallbladder or for washing and administering drugs in the treatment of pancreatitis and peptic ulcer.
What is the study?
The method of studying duodenal contents has almost a century of history and is often used in gastroenterology to make a diagnosis. The composition of the duodenal fluid obtained with a probe consists of the secret of the intestine itself and the pancreas, bile and gastric juice. This method is used to determine the state of the gallbladder and biliary tract. It is used for suspected parasites in the liver and duodenum, for cirrhosis and viral infections.hepatitis, gallstone disease. For research, several portions of samples are taken, reflecting the state of the biliary system. Manipulation requires:
- Probe with an elastic rubber tube with a diameter of three to five millimeters and a length of one and a half meters, the end of which is equipped with a metal or plastic olive with holes. There are three marks on the probe: the first is at a distance of 0.45 m from the olive, the second is 0.7 m and the third is 0.8 m.
- Syringe with volume of 10 or 20 ml.
- Tubes for collecting individual portions of bile.
It takes one and a half to two hours to collect three portions of the contents of the duodenum. After that, a study of the duodenal contents is carried out in the laboratory.
Indications for diagnostics
The procedure for taking material for research has its own characteristics and gives a certain discomfort to the individual, therefore, it is carried out only with unusual symptoms and suspicions of certain diseases. These include:
- constant feeling of bitterness in the mouth;
- pain and discomfort in the right hypochondrium;
- stable nausea and vomiting;
- Discoloration of feces and urine color change to brown or yellow-brown;
- bile stasis detected by ultrasound;
- confirmation of existing diagnosis;
- diseases of the bile ducts and liver;
- suspicion of inflammation in the gallbladder;
- gallstone disease.
Taking material for the study of duodenal contents in the presence of gallstones has a risk of complications, therefore, when prescribing the procedure, the doctor must evaluate the benefits and harms for the patient.
Contraindications for duodenal sounding
Manipulation is accompanied by increased secretion of bile and increases the number of contractions of the biliary tract, so the study is undesirable when:
- Exacerbation of chronic or acute cholecystitis.
- Varicose disease of the esophagus - possible damage to the walls of the vessels with a probe and the occurrence of bleeding.
- The presence of stones in the gallbladder - the movement of the stone may begin, which will clog the bile duct.
- During pregnancy and breastfeeding - the use of drugs during the procedure for examining duodenal contents leads to a decrease in blood pressure, which contributes to a deterioration in the blood supply to the fetus, in addition, drugs penetrate into breast milk.
- Cancer of the digestive tract.
Before prescribing the procedure, the doctor evaluates the feasibility of its implementation.
Types of manipulations for duodenal sounding
Methods of collecting duodenal fluid can be of several types. There are the following types of probing:
- Blind - carried out without the use of a probe. The patient is given choleretic agents to cleanse the gallbladder. This method is used for stagnation of bile and riskoccurrence of stones.
- Fractional - a classic method for obtaining duodenal contents, consisting of taking three portions of bile with a probe at set intervals.
- Chromatic - a special staining of gallbladder bile is used to accurately determine its amount. To do this, the individual takes a contrast agent 12 hours before the procedure.
In addition, duodenal sounding is also used for therapeutic purposes.
How to prepare for the study? Doctor's advice
Duodenal sounding is performed on an empty stomach. 8-10 hours before the procedure, the patient should not eat, and 3-4 hours - liquid. When preparing for the procedure for probe examination of duodenal contents, five days before it begins, the following products must be excluded from the menu:
- all bakery and confectionery products;
- vegetables and fruits with lots of fiber, in any form;
- milk and products made from it;
- fatty fish and meat;
- legumes.
Diet helps to reduce gas formation in the intestines. In addition, the patient must stop taking the following drugs:
- antispasmodics - Papaverine, Beshpan, Spazmalgon, No-shpa;
- choleretic - Holosas, Flamin, Allochol, Barberine;
- vasodilators;
- laxatives;
- containing enzymes - "Festal", "Pancreatin", "Creon".
Beforeconducting a study, it is recommended to take eight drops of a 0.1% solution of "Atropine" and drink a glass of warm water, dissolving 30 grams of xylitol in it. The objectivity of the results obtained depends on compliance with the preparatory measures.
Possible complications after the procedure
When inserting a probe and using medications to obtain material for the study of gastric and duodenal contents, adverse events may develop:
- Increased salivation.
- Bleeding that occurs as a result of damage to the mucosa, when the probe is quickly swallowed.
- Nausea and vomiting. For patients with hypersensitivity to the occurrence of an emetic reaction, it is advisable to anaesthetize the posterior pharyngeal wall using a special spray before the procedure.
- Diarrhea. "Magnesia sulfate", used during the manipulation, has a strong laxative effect. For patients with digestive problems, it is advisable to use other drugs.
- Dizziness occurs as a result of a decrease in blood pressure under the influence of Magnesium Sulphate.
Doctors recommend lying down for a few minutes after the procedure and then slowly getting up.
Method of duodenal sounding and examination of duodenal contents
For diagnosis, certain portions of bile are obtained from different localization sites and then microscopic and chemical analysis is carried out. The procedure for taking fluid takes place in several stages:
- The patient is insitting position. The probe is inserted into the open mouth, placing the olive near the root of the tongue. The individual makes swallowing movements, and the probe begins to move down the pharynx into the esophagus. When vomiting, it is advisable for the patient to breathe deeply through the nose. In rare cases, anesthesia is performed. The first mark on the probe means that it is in the stomach. A cloudy liquid will flow from the outer end of the rubber tube into the inserted syringe.
- To facilitate further passage of the probe when taking duodenal contents, the nurse performs the following manipulations: turns the patient on the right side, and places a soft roller under the pelvic area so that the probe, under the weight of the olive, goes to the pylorus - part of the stomach passing into the duodenum.
- After passing the 70 cm mark, the olive reaches the duodenum, and a clear golden yellow liquid begins to flow into the syringe. It is a mixture of bile, intestinal juice and pancreatic secretion and is called portion A, which is placed in the first tube in a volume of 40 ml.
- To stimulate the secretion of bile, "Sorbitol", "Xylitol" or "Magnesium sulfate" is injected into the intestine, a clamp is placed on the probe for 10 minutes.
- After a break, they begin to collect the second portion B, consisting of gallbladder bile. The process takes half an hour to collect 60 ml.
- After 30 minutes, hepatic bile begins to be released, which has a bright yellow color. Serving C is collected in the amount of 20 ml.
After the end of the sampling, the probe is carefully removed. After half an hour, the patienteat he althy food. Three collected portions of bile are sent to the laboratory for microscopic, chemical, and, if necessary, bacteriological examination.
What happens to the received content?
Each portion of the substance that requires research is collected in a separate sterile test tube, from which the edges are burned before and after bile sampling using a gas burner. The tubes are immediately sent to the laboratory for analysis. Delay in sending will violate the correctness of the results: leukocytes will be destroyed, it will be difficult to detect Giardia, because when the temperature drops, they stop moving. The interpretation of the analysis is carried out by a doctor who has the appropriate qualifications. Registration of studies of duodenal contents is carried out by a doctor in writing and is recorded in special documents. With the help of duodenal sounding, it is possible to detect the occurrence of viral and bacterial infections, the presence of stones in the bile ducts, pathologies in the functioning of the sphincter and walls of the gallbladder, various pathologies in the stomach and duodenum, traces of parasites. The patient with the resulting interpretation of the results is returned to the attending doctor for further therapy.
Physical properties of bile
As mentioned above, the study is carried out necessarily on an empty stomach and after preliminary preparation in diagnostic centers, specially equipped rooms in clinics or hospitals. Most often, when examining duodenal contents, decoding is done in three portions of bileA, B, and C. The physical properties of the examined content include:
Color. Normally, portion A, which is taken from the duodenum, is colored amber, golden yellow, B (from the gallbladder) - an intense yellow tint, C - the liver portion of a light yellowish color. Color modification is performed with inflammation of the duodenum, as a result of the formation of stones and tumors of various origins, as well as impaired bile flow
- Transparency. All portions of bile are normally transparent. Slight turbidity at the very beginning of probing occurs due to the admixture of hydrochloric acid and is not associated with an inflammatory process.
- Density. In portion A, the upper limit is 1016, B - 1032, C - 1011. Its increase indicates the occurrence of gallstone disease, thickening of bile and impaired liver function.
Description of microscopic examination of duodenal contents
Immediately after the release of the duodenal fluid, a microscopic examination is done, because the leukocytes are destroyed ten minutes after the material is taken, and other elements a little later. In the absence of the possibility of an immediate study, formalin is added to the bile, which adversely affects the results of processing.
The bile of each portion is distributed into Petri dishes and analyzed in turn on a black and white background. Mucus flakes are placed on a glass slide and examined under a microscope. Sometimes another method is used to study the duodenalcontent. For this, bile is subjected to centrifugation for 7-10 minutes. The resulting liquid is drained, and the precipitate is subjected to microscopic examination:
- Leukocytes. Normally, these elements are contained in a single quantity. Their increased number in bile indicates an inflammatory process in the bile secretion system. It must be taken into account that leukocytes can get into the test fluid from the oral cavity, stomach and respiratory organs.
- Epithelial cells. The presence in portions B and C of a large number of round epithelial cells indicates abnormal changes in the duodenum, and cylindrical - inflammation of the biliary tract.
- Calcium bilirubinate. Microscopic examination of the duodenal contents is found in the form of shapeless grains of black, brown, brown or yellow-golden color. Their high content indicates cholelithiasis.
- Cholesterol crystals are quadrangular plates, thin and colorless. Normally found in portion B in a small amount.
- Microliths are dark multifaceted or rounded formations, consisting of mucus, lime and cholesterol. They are detected with a predisposition to stone formation.
- Parasites - most often found in bile Giardia and helminth eggs that affect the liver and duodenum.
Chemical analysis
In the chemical study of duodenal contents, the presence of the following components is determined:
- Bilirubin (µmol/l). Its norm in bile: in portions A - 227, B - 657, C - 339. Increased rates in the first two servings confirm stagnation and thickening of bile. Reduced - signal a failure of the concentration function of the gallbladder. When modifying indicators in portion C, they judge violations of the liver associated with the release of bilirubin.
- Cholesterol (mmol/l). It is determined to establish an assessment of the colloidal stability of bile. In the study of duodenal contents, the upper limit of cholesterol is normally in portions A - 2.08, B - 10.04, C - 2.08. With cholecystitis and cholelithiasis, these figures increase.
- Bile acids. By the amount of their content in the duodenal fluid, the functional abilities of the liver, gallbladder and biliary tract are determined. The secret of the duodenum normally does not contain free bile acids.
- Proteins. Not present in normal bile. Their appearance indicates the occurrence of an inflammatory process.
It should be noted that the content of bile components may differ from those given above. It depends on how they are defined, of which there are several.
Bacteriological study
Bacteriological examination of the duodenal contents of the duodenum and gallbladder is carried out to detect microorganisms in each portion of bile. It can be difficult to determine the location of the inoculated microorganisms. It may include the intestines, oral cavity and biliary tract. When conducting secondary surveys and sowing the same microflora in the same portionbile is regarded in such a way that the microorganisms found were in the biliary tract. The norm is the complete sterility of all portions of bile.
Conclusion
The duodenal fluid of the duodenum includes intestinal juice, bile, pancreatic secretion, gastric juice, which enters the intestine through the pylorus, and a small amount of mucus. Under abnormal conditions, a significant amount of mucus, blood, pus, altered bile or digestive juice is added to this content.
Therefore, the study of bile and duodenal contents by physical, microscopic, chemical and bacteriological methods provides the necessary data on various lesions and functional activity of the pancreas, liver, biliary tract and duodenum.
