Duodenal intubation

duodenal probeDuodenal intubation - getting duodenal content, using a probe. Duodenal probe (Fig) is a soft, thin rubber tube length is 140 to 150 centimetres, at the end of which is attached metal Oliva, equipped with many holes. On the probe are three tags: first - at the distance of 45 cm from the olive tree (the distance from the cutters to the cardiac portion of the stomach), second - 70 cm (cutters to the janitor), the third - 80 cm [from incisors before the big nipple duodenum (Vater's papilla)]. Before the introduction of the probe should be boiled and enter wet.
Sounding is conducted on an empty stomach. Sitting patient put the olive tree to the root of the tongue and offer her to swallow recommending this to breathe deeply. After the first label will be on the level of cutters, studied placed on the right side on the edge of the bed or couch. Collapsed as a cushion cushion placed under the waist to the belly was higher than the head and legs. This situation facilitates the further passage of the probe through the gatekeeper to the duodenum. Next to the bed on a low rack (below beds) placed a tripod with a clean dry tubes for collecting duodenal contents. Lying on his right side, the patient continues to swallow the probe, and to do it very slowly, gradually, as otherwise the probe can curl up in the stomach. If Oliva true, by the time the second label will be on the level of cutters, Oliva must be the gatekeeper. One of the regular erections gatekeeper allows Oliva go into the duodenum. It is usually 45-60 minutes, in rare cases 15-20 minutes making Sure Oliva passed into the duodenum, offer the patient swallow the probe to the last stop. The location of olives is determined by the nature resulting from the probe liquid: duodenal contents completely transparent, has a Golden color, viscous consistency and alkaline reaction (when applied to the liquid on the blue litmus paper it is not red, but the red litmus test turns blue); gastric same content network dregs, and has an acidic reaction (blue litmus paper when applied to the drop content blushes). The most reliable is the way to check the location of olive fluoroscopy.
If you can not long to learn the duodenal contents, we must assume that the probe wrapped herself in the stomach. In such cases, the probe pull up to the first label and again offer slowly him to swallow. If in the future Oliva not penetrate into the duodenum, we have to assume spasm or stenoses privratnika. To relieve spasm use an injection of 1 ml of 0.1% solution of atropine. If spasm due to the high acidity of gastric juice, by imposing probe 1/4-1/5 Cup 2% solution of sodium bicarbonate (1 teaspoon on 1 glass). In cases of organic obstruction gatekeeper penetration probe into the duodenum is impossible. If within 3 hours the olive tree goes into the duodenum despite all the above-mentioned activities, it is necessary to remove the probe and to re-introduce it in 1-2 days.

Portions of bile a, b and C. the Left in the corner of the diagram biliary tract, which are used to produce the relevant portions of bile

Received duodenal content consists of bile, intestinal and pancreatic juice. It is accepted to name portion A. To receive the content of the gallbladder raise the free end of the probe is put on him a syringe without piston above the level of the duodenum, poured through him 50 ml 25% solution heated to a temperature 37C magnesium sulfate. After 5 to 10 minutes it starts to separate dark brown or olive thick liquid - serving Century the Emergence of a portion In the conditioned reflex contraction of the gallbladder with a simultaneous relaxation of the sphincter of Oddi in touch magnesium sulfate from the mucosa of the duodenum - the so-called cystic reflex. Instead of magnesium sulfate can be applied at 100 ml heated to the temperature 37C olive or sunflower oil, 30 ml of 10% solution peptone, 1-2 ml of pituitrin subcutaneously. After 15-20 minutes, and sometimes earlier, bile, which is the portion In, stops and starts to separate transparent Golden-yellow liquid - portion From the originating from intrahepatic bile ducts (Fig. 29). Upon receipt of the probe is removed.
The results of duodenal sounding are of great diagnostic value. If jaundiced portion And colorless, this indicates mechanical jaundice. No portion In the observed pathological processes in the gall bladder, accompanied by violation of concentration and its contractile function (cholelithiasis, chronic cholecystitis, pericholecystic, corking stone cystic duct). In some cases, bile portions although somewhat darker portions of A, however, does not have a normal dark brown. This indicates a decrease absorption capacity of the mucous membrane of the gallbladder (chronic cholecystitis). For dyskinesia of the gall bladder is characterized by volatility "cystic reflex" or retrieve it after re-introduction of the stimulus and the allocation of very dark, almost black bile, often in large quantities. In the study of duodenal contents determine its physical properties (color, transparency, consistency). OK all 3 servings transparent. The viscous consistency, especially in portions Century the Share content in portions a and C are usually ranges from 1,008 to 1,012, servings from 1,026 to 1,032. The normal number of servings is 50-60 ml If it is greater than 100 ml should be suspected stretching gallbladder in prolonged stagnation of bile. The admixture of a large number of leukocytes and mucus makes Muti. Chemical research (definition content of bilirubin, urobilin, bile acids, cholesterol) practical does not matter.

The most important microscopic examination, which, if separate getting three servings allows to localize painful process. Normal microscopic picture of sediment almost the same for all portions of duodenal contents. Sediment consists of single leukocytes, meager number of cells of the epithelium, separate cholesterol crystals and crystals of sodium. In inflammatory processes in the sediment can find a large number of leukocytes and a lot of mucus in the form of a long twisted yarns. A large number of leukocytes, sometimes painted with jelchew (imbibery bile), and mucus in the portion indicates inflammation in the gallbladder, in portions With - intrahepatic bile passages (holangit); a large amount of cholesterol crystals in serving on the presence of stones in the gallbladder. Important discovery in the duodenal contents of parasites - lamblia. The largest they have several more of cells and are easily recognized by vivid movements. To detect them it is necessary to investigate the sediment immediately after receipt of duodenal contents and pre-heat the test tube with the content in warm water. In addition, in the duodenal contents can be detected eggs cat (Siberian) Fluke or liver Fluke. For bacteriological research bile take in a sterile tube, not touching her top, and after being burned edges of the tube close it burnt cork. In diseases of the bile ducts of the most frequently distinguish E. coli, Staphylococcus, Streptococcus, Enterococcus, bruchkomitsky wand. Duodenal intubation is one of the methods of treatment of diseases of the gallbladder and biliary tract (see Cholecystitis, Cholelithiasis).
Duodenal probe used for the introduction of antibiotics in inflammation of the biliary tract and drug administration with the aim of deworming. Duodenal intubation is contraindicated in acute cholecystitis, chronic cholecystitis and cholelithiasis, proceeding with a high fever and leukocytosis, varicose veins of the esophagus and stomach, patients with coronary insufficiency.