Duodenal intubation - a diagnostic procedure that is prescribed for the study of the contents of the duodenum - a mixture of bile to the intestinal, stomach and pankteraticheskim juice. This study provides an opportunity to assess the state of the biliary system, the secretory function of the pancreas and assign it with the inflammation of the gallbladder, bile ducts and diseases of the liver, occurring with such symptoms: stagnant mucus in the gallbladder, a feeling of bitterness in the mouth, nausea, pain in the right upper quadrant, concentrated urine.
Preparing for duodenal intubation
Diagnose an empty stomach in the morning. Dinner on the eve should be easy, to the exclusion of potatoes, milk, black bread and other foods that increase flatulence. For 5 days prior to the sensing to stop taking drugs choleretic (tsikvalon, Barberini, allohol, Flamini holenizm, holosas, Liv-52 Holagol salt Barbara, magnesium sulfate, sorbitol, xylitol), antispastic (no-spa, Tifen, bellalgin , papaverine, bishpan, Belloidum, belladonna), vasodilators, laxatives are those that improve digestion (panzinorm, abomin, pancreatin, Festal, etc..).
In preparation for duodenal intubation give the patient the day before 8 drops of atropine - 0, 1% solution (you can also enter the drug subcutaneously), allow to drink warm water with 30g of xylitol.
Technique duodenal intubation
To conduct the study using two techniques: classical duodenal intubation and fractional. The classical method is also called the three-phase and considered somewhat dated since duodenal contents taken just three phases of the intestine duodenum, bile duct, bladder, and liver, thus obtaining, duodenal bile, hepatic and cystic.
The fractional duodenal intubation comprises five phases and the contents pumped out every 5-10 minutes, allowing it to capture the dynamics and type of secretion of bile:
- The first phase - is allocated a portion of A, which is taken when the probe enters the duodenum, before the introduction of holetsistokineticheskih funds. Duodenal content at this stage consists of bile, pancreatic, gastrointestinal and partially gastric juice. The phase lasts about 20 minutes.
- The second phase - comes after administration of magnesium sulfate and cessation of bile flow from the spasm of the sphincter of Oddi. Lasts second phase fractional duodenal intubation 4-6 minutes.
- The third phase - the allocation of the contents of the extrahepatic biliary tract. It lasts for 3-4 minutes.
- The fourth phase - the allocation of servings: emptying of the gallbladder, bile secretion of cystic thick brown or dark yellow.
- Fifth phase - begins after dark gallbladder bile ceased to stand again is golden yellow bile (portion C). Bile was collected over an hour.
For the classical and fractional duodenal intubation using a rubber tube, which in the end is a plastic or metal olive tree with holes for sampling. It is preferable to use a double probe, as one evacuates the contents of the stomach.
In preparation for duodenal intubation on the probe mark the distance from the front teeth of the patient to the navel (standing) and put three marks, which give an opportunity to understand where the probe. After that, the patient is seated, put his tongue root of the olive tree, smeared with glycerine, asking him to breathe deeply and make swallowing movements. When the level of the incisors will be the first label, then the probe allegedly hit the stomach. The patient lies on his right side and continues to swallow the probe. Doing it relies to a second label, indicating that the probe olive went to the doorkeeper, and after yet another of his disclosure, he can get into the duodenum (the third mark on the rubber tube of the probe). This happens usually in one or one and a half hours, and from the probe starts flowing golden liquid - A portion of which was collected in a test tube.
Portion B was obtained in 20-30 minutes after the portions A and plays the greatest diagnostic value.
This technique duodenal sensing enables us to determine the capacity of the gallbladder, bile particular department, detect organic and functional disorders of bile secretion. All received during sensing bile samples subjected to microscopic and bacteriological examination.