Perform duodenal intubation with analysis and interpretation in Moscow

The stomach is one of the most important organs of the human digestive system, digesting food.
His diseases are very diverse in their course and clinical manifestations. One of the most characteristic symptoms is a change in the secretion and parameters of gastric juice formed by the cells of the mucous membrane. To determine the type of secretion and acidity of digestive juices, the method of probing the stomach is used. Read on to find out what it is, how it is carried out and what information it provides to the doctor to make a diagnosis.

How is the duodenal intubation procedure performed?

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Duodenal intubation is necessary in order to determine the composition of the contents of the duodenum. Through probing, they determine how well the patient’s biliary system works and the presence of parasites in the liver. You will learn about the features of this procedure, as well as the process of preparing for it, from this article.

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What is duodenal intubation?

Duodenal intubation is a procedure prescribed to examine the biliary system. The procedure can be used not only for diagnostic purposes: sometimes it is performed to empty the gallbladder if it is impossible to do this naturally due to some pathological processes.

To carry out the manipulation, a special duodenal probe is used, which is a thin tube whose length is about 1.5 m and diameter is 4 mm. At the end of the tube there is a metal nozzle with many holes.

Indications for the procedure

Most often, the main indication for duodenal intubation is chronic pain in the hypochondrium, which indicates the presence of pathologies of the gallbladder and liver.

Pain in this area may indicate the following pathologies:

hepatitis;
cirrhosis of the liver;
liver abscess;
cholecystitis;
echinococcosis and other parasitic diseases.

Duodenal intubation for parasites allows one to obtain fairly accurate results, so it is prescribed quite often.

Typically, a study is prescribed if the patient has other symptoms, among which special mention should be made:

digestive disorders;
nausea and vomiting;
diarrhea or constipation;
changes in the color of stool;
the skin acquires a yellowish tint;
intestinal bleeding is observed. Usually, you can notice traces of blood in the stool or darkening of the stool, which becomes almost black;
ascites (accumulation of fluid in the abdominal cavity).

Preparing for probing

Duodenal intubation is a procedure that requires careful preparation.

The patient must follow the following rules:

Do not eat food 12 hours before the procedure. Typically, probing is carried out in the morning; you should not have breakfast on this day.
It is important to follow a special diet 48 hours before the procedure. In particular, the patient is prohibited from eating fruits and vegetables, fatty and meat foods, as well as canned and smoked foods. The diet should exclude hard-to-digest foods that can affect the functioning of the pancreas gall bladder. You can eat light soups, porridges, stewed and boiled dishes.
Five days before probing, it is prohibited to take drugs with choleretic properties.

Proper preparation for the study is very important, otherwise the results may be inaccurate. Typically, a nurse or doctor explains to the patient how to behave on the eve of probing.

Immediately before the procedure, the patient is given an atropine solution, which is usually injected subcutaneously, and is also asked to drink a warm solution of xylitol in water.

Execution technique

Two methods of probing are possible: classical and fractional. The classical technique is rarely practiced these days, since the process involves removing the intestinal contents in three stages.

Fractional sounding is carried out in five phases, and the contents of the duodenum are pumped out several times at short time intervals, which makes it possible to monitor the functioning of the bile ducts and endocrine glands over time.

For functional probing, the procedure algorithm is as follows:

Isolation of portion A, taken from the duodenum before the administration of drugs for the secretion of bile.
In the second stage, intestinal contents are collected after administering magnesium sulfate to the patient to check the activity of the endocrine glands.
At the third stage, secretions from the extrahepatic biliary tract are collected.
The fourth stage is the collection of portion B after emptying the gallbladder. At this stage, thick bile is secreted, which has a dark brown tint.
The final phase begins after dark bile with a thick consistency ceases to be secreted and light yellow bile begins to appear.

How is the research conducted?

Probing is carried out as follows:

The patient takes a sitting position, after which he swallows the end of the probe on which the metal olive is located.
The patient swallows the probe to a length of about 52 centimeters.
A syringe is attached to the probe, with the help of which gastric juice is taken.
The hose is swallowed up to a length of 70 centimeters.
The patient is placed on his left side. In this case, a heating pad filled with warm water should be located under his ribs. For the patient's comfort, a small pillow is placed under his pelvis. The patient's position most convenient for the study can be seen in the photo below.
A stand with test tubes in which the secretions are collected is installed near the head.
The probe is immersed to a length of 90 cm.
After the procedure is completed, the probe is carefully removed.

Analysis results and interpretation

Only an experienced doctor should interpret the results of duodenal intubation. Therefore, before deciding where this procedure can be done, you should find out whether the specialist has a sufficient level of qualifications.

In this case, it is necessary to take into account:

the time each phase of the study took;
the amount of discharge, as well as their characteristics;
microbiological parameters of secretions.

After a thorough laboratory examination of the collected secretions, the indicators are compared with special tables, on the basis of which a conclusion is drawn about the patient’s health status.

Contraindications to the procedure and possible complications

Duodenal intubation should not be performed if patients have the following pathologies:

there are stones in the gall bladder. During the examination, bile production is stimulated, which can cause blockage of the biliary tract and jaundice;
diseases of the digestive system in the acute stage;
cholecystitis;
varicose veins of the esophagus;
breastfeeding and pregnancy.

Whether probing can be performed on a child depends on his age: children under three to five years of age do not usually undergo the procedure.

Complications after the procedure are extremely rare, but they are not excluded.

Execution technique

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

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

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

Algorithm

Duodenal examination by probing involves a sequential algorithm:

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

Preparation for duodenal intubation for parasites

Duodenal examination of the internal contents of the stomach and duodenum - bile - has a certain significance for establishing an accurate diagnosis. Sounding, as this procedure is called, is carried out using a specialized rubber catheter, or probe. With its help, bile is extracted - liver and bladder, and juices - intestinal, pancreatic and gastric - are extracted.

Thanks to sounding, it is possible to get a general picture of the condition of the biliary tract and the quality of the biliary process. In addition, it is possible to determine the presence of parasites in the gastrointestinal tract.

The juices secreted by the alimentary tract are a secretion contained in parts of the duodenum:

bile coming from the bile ducts;
pancreatic secretion located in the intestine after passing through the Wirsung duct;
intestinal juice produced by mucous membranes;
gastric contents entering the duodenum from the pylorus.

Probing of gastric secretions provides valuable information about the functioning of the pancreas and the presence of gastroenterological diseases.

Today, duodenal intubation is prescribed extremely rarely. It is carried out only when absolutely necessary, or due to special indications. This may be a suspicion of the presence of giardia cholecystitis caused by the protozoan Giardia, which is clearly visible in the test results.

The main indications indicating the need for probing are a number of scientific studies to determine some of the characteristics of the patient’s bile. By studying the duodenal contents, pH and lithogenicity index are determined, and biochemical studies are also carried out, says parasitologist, chief specialist of the Center for Parasitology of the Russian Federation, doctor of the highest category, Boris Vladimirovich Orlov.

Research methods

The method of duodenal examination, as discussed above, is based on the use of a special probe. The part that descends into the gastrointestinal tract is equipped with a metal tip that looks like a perforated olive.

The probe tube has special marks that control the level of its immersion into the esophagus. A probing catheter is inserted into the digestive tract of the patient sitting on a chair. As soon as the probe reaches the stomach during swallowing, as indicated by the corresponding mark, the patient is transferred to a position lying on the right side. This facilitates the further process of introducing the probe into the duodenum, from where the first portion for research, which is pale yellow in color, is taken.

Pancreatic juice, bile and duodenal secretion are components of the first portion of the secretion, thanks to probing.

After the cessation of bile secretion, according to the existing method, 50 milliliters of a warm magnesium solution is injected into the patient’s stomach through a catheter to stimulate the digestion process. Thanks to the stimulating factor, light bile is secreted in the bile and cystic ducts. Immediately after the cessation of separation of the portion secreted by the cystic duct, the secretion of golden-yellow hepatic bile begins. This is the second portion of secretion for duodenal examination.

The third and final portion for research includes the secretion of the gallbladder, which is secreted especially intensively. This is a viscous, concentrated liquid of dark green color, rapidly flowing out of the probe.

All three portions of probing are placed separately in test tubes and, upon completion of the procedure, must be immediately sent for laboratory analysis. Microscopic examination can show the presence of parasites, if any, in the patient's body.

Research results

Laboratory indicators of duodenal examination show:

Functionality of work performed by the gallbladder:

the ability to conduct concentration activity, which consists in the absorption of water molecules and thickening of bile;
the presence of contractile functions consisting in mixing and removing bile into the intestines.

Condition of Oddi pulp. This is a ring-shaped obturator sphincter, which is located at the back of the bile duct.
The functionality of the Lutkens sphincter, with the locking functions of the neck of the gallbladder.
Condition of the bile ducts.
Foci of the inflammatory process in the gastrointestinal tract.
The presence of pathogens in the bile ducts.
The presence of parasites – causative agents of infectious diseases in the gastrointestinal tract.

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In order to have a complete understanding of the condition of the mucous membrane of one of the most difficult organs of the digestive system to diagnose, an informative examination such as gastric probing is prescribed.

Execution technique

A duodenal probe for sounding is a rubber tube with a special metal tip at the end, which contains holes for collecting contents using suction. There are three marks on the probe: 45 cm – the distance from the incisors to the subcardial part of the stomach, 70 cm – to the pyloric part and 80 cm – to the duodenal papilla. The procedure is carried out on an empty stomach so that the contents of the digestive tract do not interfere with the accuracy of the tests. Stages of implementation:

The probe is treated with an antiseptic to eliminate the risk of infection. The patient's throat is treated with a local analgesic to reduce nausea.
The doctor places the distal end of the probe on the root of the tongue and actively pushes it along the digestive tract. The patient helps him by performing active swallowing movements.
If you need to go further than 45 cm, the patient is placed on his right side and a hard cushion is placed under him. Lying down, he continues to actively swallow for 40-60 minutes, because this is the only way the tip will pass through the pylorus. The procedure is slow, otherwise the probe curls up and does not pass through the pylorus.
After the tube reaches the 75 cm mark, the end of the probe is lowered into a test tube to collect duodenal contents. The stand with the container is located below the patient's level. A correctly positioned probe ensures that yellowish contents flow through it - a mixture of pancreatic juice and bile. You can also make sure that the tube has entered the duodenum by introducing air into the probe from a syringe. If it is localized in the duodenal region, then nothing will happen; if in the stomach, the doctor will hear a specific bubbling sound.

To more accurately determine the location of the tube, an x-ray method can be used. Probing phases:

Taking portion A - from bile, pancreatic and intestinal juice. When gastric juice enters, the liquid becomes cloudy. The duration of the phase is 10-20 minutes.
After taking phase A, the patient is administered cholecystokinetics (25% magnesia, vegetable oil, 10% peptone solution, 40% glucose, 40% xylitol solution or pituitrin). The second phase begins, in which the sphincter of Oddi closes and the secretion of bile stops. The phase lasts 4–6 minutes. After introducing bile irritants, the probe is closed for 15 minutes.
The third phase is characterized by the release of the contents of the extrahepatic bile ducts of a golden yellow color. If there is stagnation of bile in the gallbladder, the discharge will be dark green in color. With a weakened bile concentration, portions A and B will not differ from each other. The serving volume is 30-60 ml.
The fifth phase is the collection of portion C (the light contents of liver bile). The stage lasts 30 minutes.
5–10 minutes pass between each phase, then the patient receives a “test breakfast” - light broth or enzymes to stimulate the productivity of gastric juice. This is done to determine the functionality of the stomach. After this, samples are taken 7 times every 10–15 minutes over the course of an hour. Finally, the probe is removed.

The examination is not pleasant for the patient. The process of swallowing the probe can cause the urge to vomit; while the tube is in the digestive tract, saliva is constantly released, which can provoke aspiration. To avoid side effects, use a position on your side so that saliva flows into a tray or onto a diaper. After taking magnesium, diarrhea may occur, xylitol or sorbitol - fermentation phenomena in the intestines. After the procedure, the patient lies in the hospital for at least an hour, the staff monitors his blood pressure and pulse.

About the probing procedure

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

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

Examination methods

Today, various methods have been developed to study the secretory function of the stomach. Each method has advantages and disadvantages. The probing method with further chemical, macroscopic study of the secretion is considered well-known and widespread in the world. Based on the obtained tests, the digestive ability of gastric secretions and the motor function of the stomach are assessed.

Simultaneous sensing

To perform this type of examination, a thick type of probe is used - a tube made of rubber material, 80-100 cm in length, approximately 10 mm in diameter. Now the method is practically not used as a diagnostic method, as it is considered uninformative. This type of sounding is carried out for therapeutic purposes. For example, for gastric lavage.

Multi-instant sensing

Multi-moment, or fractional, sounding is performed using a thin probe with a diameter of 4 mm and a length of 100-150 cm. A syringe attached to the tube periodically sucks in the contents of the stomach. With the type of examination described, the gag reflex, as a rule, does not occur. Fractional studies can be extremely informative and provide a comprehensive picture of gastric secretion.

The research algorithm involves 3 stages:

Lean stage. Gastric juice is extracted after insertion of the tube.
Basal stage. The liquid is sucked out over an hour.
Stimulating stage. Stimulating drugs and products are administered. After 15 minutes, the gastric contents are suctioned.

Equipment

For the procedure you will need:

a chair or couch to accommodate the patient;
clean towel or napkin;
medical probe;
syringe, vacuum suction for attachment to the hose;
medical tray or basin;
test tubes for collecting tests;
products, drugs that stimulate the production of gastric secretions.

Indications for the procedure

Examination of the stomach using this method is carried out for various indications:

diagnosis of gastrointestinal diseases;
the need to feed or administer medications directly into the stomach (premature infants, patients with pathologies and injuries of the esophagus, pharynx, oral cavity, as well as unconscious persons);
washing in case of intoxication of the body with chemicals or low-quality products.

Diseases for the diagnosis of which gastric intubation is prescribed:

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

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

How to prepare for probing

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

On the eve of probing, you should not eat - at least 12 hours must pass from dinner or breakfast to the start of the examination. To obtain an objective picture of the composition of gastric juice, it is advisable not to drink or smoke anything.

With these simple measures, preparation for diagnosing the stomach is completely exhausted. There is no need to carry out special drug preparation in advance. On the contrary, if the patient must follow the doctor's orders and take pills, he must inform the gastroenterologist performing the intubation. It is advisable to avoid the use of drugs that directly affect the functioning of the stomach: atropine, caffeine, antacids.

Preparation before the examination

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

Methodology for carrying out a diagnostic procedure

After all preparatory measures have been carried out, a probe is placed on the root of the subject’s tongue and the patient is asked to swallow. Tilt of the head forward and deep breathing facilitate passage of the probe through the esophagus. Treatment of the root of the tongue with novocaine relieves excessive sensitivity and stops the gag reflex. After the probe reaches the required depth, its outer part is secured to prevent the tube from entering the duodenum.

Probing algorithm:

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

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

Evaluation of the study results

Fractions of gastric juice obtained as a result of intubation are sent for laboratory testing to diagnose possible gastric pathologies. The following indicators are taken into account:

Juice acidity;
The color should be transparent, a reddish tint of gastric secretion is an admixture of blood, yellow-green is a sign of bile reflux from the duodenum;
The volume of secreted juice - its increase indicates hypersecretion of the gastric mucosa;
Foreign inclusions - food particles indicate incomplete digestion of food;
Secretion viscosity – increased viscosity indicates gastritis.

Analysis of this data will allow the attending physician to draw up a complete picture of the disease. If the laboratory test results for gastric secretions differ from those shown in the table, then you need to undergo treatment from a gastroenterologist.

Normal parameters of gastric juice in a healthy person

Complications and contraindications

Despite the safety of the procedure, there are categories of patients who should not undergo it unless absolutely necessary.

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

The last contraindication in the above list is due to the fact that drugs with contraindications such as diabetes and heart and vascular diseases are used to stimulate gastric secretion.

Who is the examination contraindicated for?

Despite its prevalence, effectiveness and safety, this type of diagnosis has a wide range of contraindications:

pathologies of the vascular system;
pulmonary pathology, serious kidney disease;
coronary heart disease;
aggravated stage of atherosclerosis;
arterial hypertension;
arterial hypotension;
aortic aneurysm;
nasopharyngeal disease;
aggravated stage of diabetes mellitus;
allergic reactions to gastric secretion stimulants;
improper nasal breathing;
increased manifestation of cough;
a woman carrying a child;
mental disorders;
varicose veins of the esophagus;
esophageal diverticula;
stomach bleeding.

Recovery and sensations after probing

The study, carried out in compliance with all precautions, does not require restoration. After removing the tube, the patient is left in the rest room, where he is observed for an hour to exclude the possibility of injury to the esophagus or stomach. During the day, only light dietary meals at room temperature with minimal fiber content remain in the diet.

If probing is incorrect, bleeding due to injury to the mucous membrane or perforation of the stomach is possible. In such emergency cases, the following measures are taken:

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

Perforation of the stomach walls requires immediate surgical intervention.

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

Everyone knows the phrase “probing the stomach.” It definitely causes unpleasant emotions, and sometimes even panic. But is gastric probing really that scary? What is it used for? Are there any contraindications? How does the procedure itself proceed? Let's try to deal with these questions in order.

Probing of the stomach is one of the safest and most informative medical procedures aimed at studying the inner surface and digestive secretions of the stomach. For this purpose, a thin rubber probe is inserted through the oral or nasal cavity into the stomach.

Operating principle of the device, dimensions

A nasogastric tube, the placement algorithm of which is controlled by a doctor or nurse, is installed in the hospital. The procedure can be performed while the patient is asleep under anesthesia, but more often the device is installed while the person is conscious. In some cases, local anesthesia of the nostrils using lidocaine or an anesthetic spray is used.

Types of nasogastric tubes:

Levine catheter. A small diameter tube is used for oral administration of medications.
Dobhoff tube. A catheter with a small hole and a weight at the end, ensuring its insertion under the influence of gravity.
Double-tube catheter with large diameter and double lumen. With its help, suction is carried out in one lumen and ventilation in the other, preventing the mucous membrane from entering the catheter.

Probes are available in lengths from 38 to 120 cm. The smallest ones are intended for children; all catheters are made taking into account the anatomical characteristics of a person.

If drainage is required, a wide tube is used. Fine tubes (caliber less than 9) cause less discomfort and reduce the risk of rhinitis and esophageal erosion. PVC tubes can be used for up to two weeks, polyurethane and silicone tubes are not affected by stomach acid and can remain in the stomach for a long time.

PVC tubes. The cheapest option, the main disadvantage of which is their susceptibility to corrosion, which reduces their service life to 7 days.
Polyurethane. Usage period: up to 4 weeks. The probes are quite rigid and are not exposed to gastric juice.
Silicone. They tolerate sterilization well and have a long service life, but the use of guides is required when placing them on a patient.

Who is prescribed

Probing of the stomach is prescribed:

Patients with abdominal pain of unknown etiology.
For digestive disorders: heartburn, indigestion, bloating, nausea, colic, to establish the level of stomach acidity.
If you suspect gastritis.
If an ulcer is suspected.
For gastric lavage and rapid removal of its contents in case of poisoning with food, drinks or medications.
For feeding people in an unconscious state, coma.
If you suspect neoplasms and tumors in the stomach.

To dispel anxiety and fear of the unknown, before starting the probing procedure, it would be good to talk with the doctor and medical personnel who will perform the manipulation. This will help to get a complete picture of how everything will go, and the patient will understand what is happening. Psychological attitude plays an important role in preparing for probing. Calm patients tolerate the procedure much easier.

Types of gastric intubation

There are 2 main types of sounding:

One-step. It is carried out with a thick (up to 13 mm in diameter) rubber tube. The gastric contents are pumped out only once. This type of research is no longer used as it is outdated and does not provide a detailed picture of the condition of the organ. The fairly thick tube caused severe discomfort and a pronounced gag reflex in patients.
Fractional probing is more gentle and effective. It is carried out with a thin probe (up to 5 mm) in several stages. Duration 2-3 hours. This procedure gives a complete picture of the condition and functioning of the stomach.

Fractional sensing

It is practically no different from duodenal intubation, but is only a variation of it. The difference is that 5 fractions are obtained instead of 3. This type of study is more accurate and provides more information about the condition of the organ.

Consists of the following steps:

Bile from the liver ducts. An average of 30 ml is released. Prolonged outflow indicates increased secretion. After half an hour, magnesium is injected, squeezing with a special clamp.
The liquid begins to release 5 minutes after the solution begins to act and the clamp is removed. If there is no bile, this indicates a pathology of the gallbladder - blockage of the ducts.
After 2 minutes, the residual yellow liquid leaves the ducts.
At this stage, bile from the bladder is examined.
Fluid comes from the liver.

Fractions are studied equally, but it is better to give preference to fractional research, it will more fully reflect the cause of the organ disease.

How is the procedure performed?

The probing technique is as follows:

Routine probing of the stomach is carried out in the morning. The patient is invited to the treatment room.
The patient sits on a chair with a back or lies on his side on the couch.
A towel is placed on the patient's chest and shoulders, as saliva may leak. Some patients experience vomiting.
A tray is given to the hand or placed nearby to collect saliva (it must not be swallowed, but spat out).
The pharynx is treated with a weak local analgesic to reduce sensitivity and pain threshold.
The rounded end of a sterile probe (it may have holes or a miniature camera, depending on the purpose of the study) is placed on the root of the tongue. Then the doctor invites the patient to swallow, and he quickly moves the probe inside.
Then the patient's nasal breathing is checked. He should breathe calmly through his nose.
With each swallowing movement, the tube is moved deeper until the desired mark is reached. The depth is calculated using a special formula: human height minus 100 cm.
Attach the hose to the patient’s clothing to secure it.
At the next stage, a pump is put on the outer end of the probe or a syringe is attached and the entire contents of the stomach are aspirated.
The basal (hungry) gastric secretion is pumped out in several stages, each of which lasts 5 minutes. Between them there are pauses of 10 minutes.
Using a probe, a heated “test breakfast” (dried cabbage extract or broth) or special enzymes that stimulate the production of gastric juice (Insulin, Histamine or Pentagastrin) are injected into the stomach. These products and preparations act as a “breakfast” and help to get a complete picture of the functioning of the stomach after eating.
After 10 minutes, a sample of gastric juice is taken again.
After another 15 minutes, another portion of the stomach contents is taken.
So within an hour they take gastric juice 7 times.
The probe is removed, the patient is allowed to rinse his mouth and rest.

All portions of the secret are numbered, signed and sent to the laboratory for study.

Technique

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

Duodenal tube

This olive contains holes through which the contents will be drawn using suction. There are three marks 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 part 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 the location of the probe. The diameter of the probe is 3-5 mm and the length is 150 cm. Depending on the anatomical characteristics of the patient, his size, build, and 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-treating it to prevent transmission of infection. Then the doctor places the distal end of the probe on the root of the patient’s tongue, and then pushes it through the digestive tract with active movements. To facilitate the passage of the rubber tube, the patient 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 a hard cushion is placed under him.

Position of the patient that facilitates the passage of the probe

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

An indicator of the correct position of the probe is the flow of yellowish content through it, which is a mixture of pancreatic juice and bile. There is another way to make sure that the tube is located in the duodenum. 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, but if it is located in the stomach, then a specific bubbling sound will appear.

To more accurately determine the location of the tube, an x-ray examination method is used. The metallic olive stands out very well against the background of the digestive tract organs, so it is not difficult to establish its location on an x-ray image. Having assessed the X-ray data, the radiologist gives instructions for further tactics. The technique for performing duodenal intubation is quite simple if you have a good understanding of the anatomy and physiology of the digestive tract.

Contraindications for probing

Despite the fact that this procedure is common throughout the world and is considered safe, there are categories of patients for whom it is contraindicated:

Heart failure.
Hypertonic disease.
Kidney failure.
Severe forms of diabetes.
Allergy to drugs that stimulate secretion.
Severe hypotension.
Some mental illnesses.
Impaired nasal breathing.
The patient has a severe cough.
Pregnancy.
Varicose veins of the esophagus.
Stomach bleeding.

Contraindications

The drugs have a number of limitations:

Insulin and histamine are not used for liver and kidney failure, cardiovascular diseases, and diabetes.
Histamine is prohibited if there has been gastrointestinal bleeding within the last 2 weeks or if there is a pheochromocytoma.
Pentagastrin can cause hypotension and rhythm disturbances, so it is not administered for arrhythmias, a tendency to hypotension, or grade 2-3 circulatory failure.

A general contraindication is a history of an allergic reaction.

Evaluation of test results

Signed beakers with analyzes are sent to the laboratory. To make a diagnosis, such indicators as color, quantity, and nature of the secretion are important. The doctor will pay attention to the following points:

The liquid should be colorless, moderately fluid, and not contain inclusions of a different color.
Abundant secretion indicates hyperfunction of gastric juice and a shift in acidity in one direction or another.
A yellowish-green color indicates the presence of bile from the intestines. Reddish-brown spots indicate the presence of blood.
In a healthy stomach, gastric juice has no odor or is sour. The smell of rot may indicate the development of a cancerous tumor.
In addition to physical indicators, the chemical composition of liquids is also studied.

Depending on the test results, the necessary treatment is prescribed.

Recommendations

Typically, gastric intubation does not cause any side effects in patients. During the day, you may experience slight malaise and stomach upset. This condition does not require special treatment. Doctors advise not to overeat or burden your stomach on this day. At first, crackers and tea with sugar are recommended; in the evening, when the condition improves, you can eat a light dinner. Many patients tolerate the procedure well and immediately after it go to work and do their daily activities.

There is no need to be afraid of the gastric intubation procedure. Nowadays, probing is much more painless and comfortable than it was several decades ago. The main thing is to remember that it will help make an accurate diagnosis, therefore, restore lost health, and maybe save a life.