duodenal sounding

The liver and gallbladder in the human body perform many functions, including direct participation in the processes of digestion due to the production of special enzymes, the synthesis and accumulation of bile. Any violations in these organs, their structure, structure or work, immediately affect the state of health, manifesting itself in such symptoms as heartburn, stool disorders, weight loss, pain. In some cases, pathological processes in the liver or gallbladder become the first signs of the development of dangerous diseases – liver cirrhosis, cholelithiasis, inflammation of the biliary tract. That is why, with the appearance of alarming symptoms in the abdominal cavity, you should consult a doctor. In this case, one of the procedures that the doctor will prescribe to examine the condition of the internal organs can be duodenal sounding.

What is duodenal sounding, why is it prescribed

Duodenal sounding is one of the methods of functional diagnostics in gastroenterology, which allows the doctor to assess the condition of the duodenum and the composition of bile.

In the probing process, a special probe is used – a long elastic hollow tube with a specific tip. The diameter of the tube is no more than 5 millimeters, the length is 1,5 meters. The tip has the shape of a small olive 20 mm long, 5 mm wide, whose rounded shape and small size make it easier for the patient to swallow the probe.

Previously, the duodenal sounding procedure provided information about the presence of stones in the gallbladder and its ducts. To date, such a diagnosis does not require the mandatory appointment of probing – it can be detected in the process of ultrasound. A specific procedure is performed to obtain a sample of duodenal contents, as well as to assess the condition of the gallbladder, pylorus and sphincter of Oddi.

General characteristics of the anatomy and functioning of the liver and gallbladder

The liver and gallbladder are part of the digestive tract. In addition to participating in the digestion process, the liver is an organ of the immune system, in addition, it performs a protective function, partly the function of hematopoiesis, and most importantly, detoxification.

Anatomically, the liver is located in the abdominal cavity, it is formed by two parts – the left and right lobes. Most of the organ is located in the upper right part of the abdominal cavity. The left lobe partially passes into the left half of the abdominal cavity.

The liver is located under the diaphragm, its upper border is at chest level, it is convex and follows the shape of the diaphragm. The lower edge is 1-2 centimeters below the arc of the ribs, concave and in contact with other internal organs.

The right lobe of the liver is about 6 times larger than the left. The mass of the organ is from one and a half to two kilograms.

In the middle part of the inner surface of the organ there are hepatic gates – in this place the hepatic artery enters the liver, from there the portal vein and the hepatic duct exit, which removes bile from the liver.

Under the gates of the organ, the gallbladder “hid” – a small hollow organ from 12 to 18 cm long, which is adjacent to the outer edge of the liver and lies on the duodenum. The structure of the bladder is represented by the bottom, body and neck, which passes into the cystic duct.

The liver is responsible for the secretion of bile, which breaks down fats, enhances intestinal motility and the action of pancreatic and intestinal enzymes. Bile also helps to neutralize the acidic environment of the food bolus that comes out of the stomach, promotes the absorption of cholesterol, amino acids, calcium salts and fat-soluble vitamins.

The liver is involved in all metabolic processes of the body – in protein, fat, carbohydrate.

The body also carries out the synthesis of hormones, stimulation of the production of hormones by the adrenal glands, thyroid and pancreas.

In addition, the liver is a huge protective filter that neutralizes the effects of toxins, poisons, medicines, allergens.

The bile produced by the liver enters the gallbladder, where it accumulates until the food that has entered the body is digested.

What types of procedures can be performed

Duodenal sounding may differ depending on how it is carried out:

• blind probing, when the patient does not have to swallow the probe – the process of stimulating bile formation is used for the procedure;
• fractional or multi-stage: in this case, the collection of content is performed at a certain interval, for example, every five minutes;
• chromatic probing implies that a dye is injected into the patient before diagnosis;
• a minute procedure makes it possible to assess the state and work of the sphincters.

Indications and contraindications for probing

The procedure, due to its specificity and the discomfort that it causes to the subject, can be carried out only if there are indications for it – special symptoms or suspicion of a disease.

Indications for duodenal sounding are:

• feeling of bitterness in the oral cavity;
• pain and discomfort in the right hypochondrium;
• bile stasis diagnosed by ultrasound;
• persistent nausea and bouts of vomiting;
• change in the color of urine to yellow-brown or brown, discoloration of feces;
• the need to establish a primary or confirm an existing diagnosis;
• suspicion of an inflammatory process in the gallbladder;
• diseases of the bile ducts, liver.

The procedure is not performed if the patient has:

• coronary insufficiency;
• acute cholecystitis;
• stomach ulcer and duodenal ulcer;
• cancer of the digestive tract;
• exacerbation of chronic cholecystitis;
• varicose veins of the esophagus.

Probing is also not recommended for pregnant and lactating women.

Features of preparation for diagnostics

The duodenal sounding procedure can only be carried out strictly on an empty stomach, therefore, 8-10 hours before it, the patient should not eat, and 3-4 hours should refrain from drinking liquids.

As part of the preparation of the patient, five days before the planned procedure, the introduction of dietary restrictions in the diet is required. From the menu it is necessary to exclude:

• high-fiber fruits and vegetables, raw and cooked;
• bread, pastries;
• confectionery;
• milk and dairy products;
• beans;
• fatty meats and fish.

Such a diet is introduced to reduce the level of gas formation in the intestines.

Preparation for the procedure also requires interrupting the following groups of drugs during the same period:

• biliary;
• antispasmodics;
• laxatives;
• vasodilators;
• enzyme-containing.

On the eve of the study, the patient undergoes the necessary medical preparation, which is prescribed by a gastroenterologist or a doctor of functional diagnostics. Additionally, you can drink a glass of warm water with 30 grams of xylitol dissolved.

The objectivity of the results directly depends on how carefully the patient will comply with all the requirements of the preparation.

How is the study of the liver and gallbladder

The procedure implementation algorithm may include several diagnostic techniques:

• classic duodenal sounding;
• fractional sounding.

The first technique involves the implementation of a three-stage study, and is considered somewhat outdated. During classical probing, portions of bile are taken in three phases:

• from the duodenum;
• from the bile ducts and gallbladder;
• from the liver.

The technique consists of phases A, B and C.

Stage A. The patient is seated on a chair, he needs to tilt his head forward, open his mouth wide and stick out his tongue. The doctor performing the procedure puts a metal olive on the root of the patient’s tongue, which ends one end of the probe. Next, the subject must carry out swallowing movements, and the doctor at this time advances the probe into the esophagus. The saliva secreted by the subject flows into a special tray, which he holds in his hands.

To understand that the probe is in the esophagus, and not in the trachea, the doctor suggests that the patient make deep breathing movements. If the subject can breathe deeply and freely, then the probe is located correctly.

According to the marks on the probe, the doctor determines the depth of the probe advance, and when the olive reaches the stomach. The contents of the probe are pumped out with a syringe, if a cloudy liquid enters the syringe, then the probe is located in the stomach.

To move the probe tube into the duodenum, the patient must be placed on the right side, placing a warm heating pad under it. The position “on the side” is required so that the secreted saliva does not enter the trachea.

Light yellow, slightly cloudy liquid entering the cavity of the tube indicates that the probe has reached the duodenum. This moment is the beginning of stage A – the contents are collected from the duodenum for analysis. It contains bile, intestinal and pancreatic enzymes.

In about half an hour, from 15 to 40 milliliters of liquid is collected in a special container. If the probe is wrapped in the stomach, the contents cannot be collected. In this case, the probe tube is pulled out to the previous mark, after which it is carefully inserted again until it reaches the duodenum.

Stage B. After completion of the first stage of fluid intake for analysis, substances that enhance gastric secretions are introduced into the intestine: sorbitol, oxygen, xylitol or magnesium sulfate. For a few minutes, the probe tube is pinched. After 7-10 minutes, the clamp is removed from the probe, after which, if all the manipulations are done correctly, the bladder contents enter the cavity of the tube – thick bile of a green-yellow hue. In about half an hour, up to 60 milliliters of liquid is collected.

Stage C. Gradually, the color of the liquid in the tube becomes bright yellow, which means that hepatic bile enters it. For analysis, no more than 10-15 milliliters will be required. At the end of the collection of the secret, the probe is slowly removed from the esophagus.

Fractional duodenal sounding technique

In this case, duodenal contents are pumped out every 5-10 minutes. At the first stage, a portion of the liquid from the duodenum is collected – it contains bile, pancreatic and intestinal enzymes, and partially gastric juice. The stage lasts about 20 minutes.

At the second stage, a solution of magnesium sulfate is supplied to the intestine through a probe tube. The secretion of bile from the spasm of the sphincter of Oddi stops. This stage lasts 4-6 minutes.

At the third stage, the secretion of the contents of the intrahepatic biliary tract begins within 3-4 minutes.

During the fourth phase, the gallbladder is emptied, its contents (thick brown or brown-yellow bile) are collected by a probe.

At the end of the process of separation of thick dark contents, the fifth phase begins, when the liquid in the probe tube again acquires a golden yellow color. The collection lasts up to half an hour.

Technique for collecting and examining duodenal fluid

Each portion of the test substance is collected in a separate sterile tube, with strict observance of all the rules of sterility.

Containers with liquid are sent to the laboratory for research immediately after sampling, since proteolytic enzymes of the pancreas tend to destroy leukocytes, in addition, cooling the liquid makes it difficult to detect Giardia in the duodenal contents: when the temperature drops, they stop moving.

To prevent cooling, test tubes are lowered into a glass of warm water (39-40 degrees).

Duodenal sounding allows the patient to detect traces of parasite invasion, including opisthorchiasis, the presence of a bacterial infection, viral inflammatory processes, the presence of stones in the bile ducts, abnormalities in the sphincter or gallbladder walls, as well as pathological processes in the stomach and duodenum.

The interpretation of the analysis is carried out by a doctor of functional diagnostics and a written conclusion is provided.

If a large number of leukocytes is present in the collected fluid, this may indicate the presence of an inflammatory process. In this case, bile culture is performed when the sample is sown on special nutrient media. This method helps to identify Escherichia or Pseudomonas aeruginosa, and some other pathogens. The presence of epithelial cells in the samples indicates a pathological process in the stomach or duodenum. The presence of erythrocytes indicates a possible microtrauma of the inner layer of organs, which could be caused by a probe.

Normally, bilirubin and cholesterol crystals are not found in the duodenal contents, but if they are detected, then the colloidal properties of bile are impaired, and the patient may have a tendency to cholelithiasis.

Blind probing: features of the procedure

For the implementation of blind duodenal sounding, the patient does not need to swallow the probe. In this case, he will need drugs that stimulate the secretion of bile – for this purpose, a decoction of hawthorn, Borjomi or Essentuki mineral water, a solution of sorbitol or xylitol, Epsom salt or magnesium sulfate can be used.

The irritant is taken in the morning on an empty stomach, while it is necessary to lie down on the right side, placing a warm heating pad under it. The selected remedy must be drunk slowly, as a rule, up to one and a half liters of liquid is used. The legs should be bent at the knees and bent under you, then take a few deep breaths, inflating the stomach, and when exhaling, pulling it in. The duration of the procedure is from 40 minutes to two hours, and all this time it is necessary to lie in a relaxed state, ideally – to fall asleep.

Half an hour after the end of blind probing, it is allowed to have breakfast, and the food should be light. On this day, it is necessary to abandon fatty, spicy and fried foods.

What is chromatic sounding

This type of probing is used to characterize bile from the gallbladder. Approximately 12 hours before the start of the study, usually in the evening before bedtime, and not earlier than 2 hours after the last meal, the patient should drink a capsule with 0,15 grams of methylene blue.

During probing, the bile collected from the bladder turns blue-green. For diagnosis, such characteristics as the volume of bile released, and the time that elapses from the moment the irritant is administered until the appearance of a portion of bile related to stage B are used.

Probing in children: how is it carried out

All procedures using a probe are quite difficult for children to tolerate. The order and technique of carrying out practically do not differ from the procedure in adults, with the exception of some indicators.

In children, probing is performed using a probe of a smaller diameter. In newborns, the tube is inserted to a depth of about 25 centimeters. Children from 6 months – to a depth of 30 centimeters. For a one-year-old child, the probe is inserted to a depth of up to 35 centimeters, from 2 to 6 years old – by 40-50 centimeters, for older children – up to 55 centimeters.

The amount of magnesium sulfate administered is calculated as 0,5 milliliters of a 25% solution for each kilogram of body weight.

Duodenal sounding is an unpleasant procedure for the subject, moreover, it lasts, in some cases, for 40-50 minutes. Usually the patient is conscious, however, if the patient has no contraindications or allergies to anesthesia, probing can be performed under anesthesia. Therefore, preparatory measures should include not only physiological medical measures, but also psychological preparation.