Jun 06, 2018
The duodenal contents are taken by the nurse by of the duodenal sounding of .Picking time: 8-9 o'clock in the morning.
Patient preparation: all drugs containing pancreatic enzymes are canceled at least one day before the test( preferably 3 days).
Probing is performed on an empty stomach after a 14-hour fasting;it is allowed to drink a little water( a few sips), but no later than 2 hours before the study.
Position of the patient during duodenal sounding: the probe is inserted in the sitting position of the patient - he should breathe freely and make active swallowing movements. Usually, after 5-10 minutes, the first mark appears in the teeth, i.e.the olive reaches the stomach. The patient is placed on the right side and a roller is placed under it;he continues to slowly swallow the probe up to the second mark. Further movement of the probe through the gatekeeper is due to peristalsis of the stomach - this period usually lasts 1.5 hours. The free end of the probe descends into one of the test tubes located in a pedestal on a bench below the head of the patient.
While the olive is in the stomach, the gastric contents flow out of the probe - a turbid liquid of an acidic reaction. When the olive passes into the duodenum, a transparent yellow bile of an alkaline reaction begins to enter the tube. Bile is collected in separate small portions in a row of tubes( in each tube - for about 5 minutes).
Check the correct position of the probe can be a sample with air: a syringe injects a little air into the probe;when the probe is in the stomach, the patient feels air intake and rumbling;If the probe is in the duodenum, there are no sensations.
Bile is excreted dropwise, unevenly, the first portions are usually golden yellow, transparent, slightly viscous consistency. This bile comes from the bile duct and is designated as a portion of "A".
After 10-20 minutes after the onset of bile excretion, an irritant is injected, causing a contraction of the gallbladder. Some stimuli are injected through the probe, for example 30-50 ml of a 30% solution of magnesium sulfate, or olive oil, or egg yolks, 10% sorbitol solution. Other stimuli are administered parenterally. The best stimulus for the gallbladder is cholecystokinin, which is administered intravenously at a dose of 75 units( 1 ampoule).After 15-20 minutes, the secretion of a "cystic" bile of dark olive color is marked - portion "B", usually in the amount of 30-60 ml. If, after the introduction of the stimulus, the contraction of the gall bladder does not occur, the same stimulus is reintroduced. Duration of allocation of portion "B" - 10-15 minutes.
After emptying the gallbladder, a lighter and clearer hepatic bile is allocated - a portion of "C".After receiving 2-3 tubes of this dose, the probe is removed, after passing through it 20-30 ml of water or glucose solution to remove bile.
All the bile portions received are delivered to the CDL as quickly as possible. Analysis of bile should be carried out immediately after the preparation, as the cells can be destroyed by the action of enzymes.
When conducting duodenal probing, the children are injected at a shorter distance than the adult. This distance depends on age:
• newborn - up to 25 cm;
• for children up to 6 months - up to 30 cm;
• up to 1 year - up to 35 cm;
• up to 2-6 years -40-50 cm;
• up to 6-14 years - 45-55 cm.