Duodenal sensing, what is it? This is the manipulation used in order to study the contents of the duodenum. Thanks to this diagnostic method, it is possible to confirm or disprove the violation of the pancreas, gallbladder or liver. At the moment, duodenal probing is not so often used as before. This is due to the fact that at the present stage of the development of medicine there are more accurate instrumental and laboratory diagnostic techniques.

For several decades, many ways to quickly and comfortable confirmation of the diagnosis have been developed, so now duodenal probing is assigned only if there are special indications. To modify the procedure, and make it more informative, it was proposed to prevent the duodenal content of fractionally, i.e. portions every 5-10 minutes.

Grocery portions

Indications

For each diagnostic method, there must be their testimony and duodenal probing did not excel. This includes the presence of specific symptoms by the type of pain in the hypochondrium.

This area is a projection of the liver and gallbladder. Of course, when the first attacks of painful syndrome appear, the doctor suspects pathology in these bodies. Unpleasant feelings in the right hypochondrium can be felt in many diseases:

• Hepatitis;
• Cirrhosis of the liver;
• Liver abscess;
• Acute cholecystitis;
• Calculous cholecystitis;
• Aggravation of chronic cholecystitis;
• Bile colic;
• Cholangitis;
• Postcholecisto-ectomic syndrome;
• Echinococcosis;
• Hepatosis;
• Portal hypertension.

All these diseases can lead to painful sensations in the field of hypochondrium. Pathophysiology of this symptom is due to direct damage to the parenchyma or liver capsule, as well as the mucous membrane of the gallbladder or bile ducts. As a rule, a number of other symptoms are accompanied by a solid syndrome:

• Dyspepsia;
• Violation of digestion and suction of nutrients;
• Stool disorder;
• Nausea and vomiting;
• Changes in urine and feces;
• Jaggility and / or itching of skin;
• Palman erythema;
• Encephalopathy;
• Varicose veins of the esophagus;
• Hemorrhoids;
• Gastroofic bleeding;
• Ascites.

Opistorhoz

In the course of its livelihood of a cat, the fuelspox highlights the products of their livelihoods into the bloodstream, which are toxins for humans. From these substances in the body arises a number of additional pathological processes unrelated to the digestive system. From the side of the nervous system there is a breakdown, increased irritability, headaches. The immune system is characterized by an increase in lymph nodes and the development of allergic reactions.

The chronic form of the disease develops in endemic areas for which the high prevalence of this pathogen is characteristic. The list of these countries includes Ukraine, Kazakhstan, Uzbekistan, Russia and Southeast Asia. For people suffering from chronic opisthorchosis, the multiple damage to the digestive system is characteristic. With a detailed examination, such patients detected signs of gastritis, inflammation of the duodenum, duodenal and gastric ulcers. The severity of clinical manifestations is usually weak. Depending on the individual characteristics of the patient, the opistorhosis can be manifested in the form of cholangitis or as deficiency of digestive enzymes.

Preparation and technique for performing duodenal sensing on opistorhosis is not at all different from the standard recommendations.

Dyskinesia bile trapes

This pathological condition is characterized by improper operation of the muscular apparatus of biliary tract. Due to inadequate reduction, a violation of bile outflows occurs. Statistical studies show that women are more susceptible to this disease. A number of adverse factors can contribute to the development of diskinesia. Incorrect food is in the first place among the reasons that contribute to the incorrect outflow of bile. This category also includes other diseases of the digestive system (ulcerative ulcer of the stomach, pancreatitis, gastroduodenit, etc.), a hormonal balance failure and food allergic reactions.

It is customary to allocate two main types of diskinesium - hyper- and hypotonic. For hypertensive type, an increased muscular abbreviation is characteristic. At the same time, the muscular layer of the bottom of the bladder begins to actively shrink at the same time. Normally, during reception, the sphincter must be widely disclosed to give bile to go through bulls, but in the hyperkinetic type due to muscle disorganization it does not occur. At the same time, patients complain about the intense bouts of bile colic, which are cubized by the admission of spasmolitics.

In the hypokinetic type, the severity of the muscular abbreviation will be insufficient for pushing the bile, so it is stood in the bustling bubble. Painful sensations will be localized in the right hypochondrium. They have a slight intensity and carry a long, suitable character.

When a delayal sensing, a delay will be observed delaying

Preparatory stage

Preparation for duodenal probing is to comply with several simple recommendations. The study should be in the morning on an empty stomach, i.e. the studied should not take food for at least 12 hours. In two days, the sensing must be observed a special diet. It is required to refuse to eat vegetables, fruits, products with a high content of animal fats, as well as from all roasted, smoked meat products.

In the morning the patient is invited to the manipulation office, where it is conveniently located on the couch or in the chair with a back. It is extremely important before carrying out the procedure to remove dentures if available. The upper part of the body is covered with a towel, and for expectoration of saliva in hand give tray. It is recommended to use a probe having two holes - gastric and duodenal. This will allow to characterize gastric juice, and getting a cleaner, not having impurities, bile. 5 days before the procedure, it is recommended to cancel the reception of enzyme preparations. Otherwise, there is an increased risk of obtaining unreliable research data.

Technique for holding

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

Duodenal probe

In this olive there are holes through which, with the help of suction, the content will be taken. Three marks are applied to the probe:

• The first 45 cm is the distance from the cutters to the subcardial duty station;
• The second 70 cm - indicates the distance from the cutters to the pyloric sector of the stomach;
• The third 80 cm is the distance from the cutters to the duodenal pacifier.

All these "notches" are needed in order for the doctor to navigate the probe localization. The diameter of the probe is 3-5 mm, and the length is 150 cm. Depending on the anatomical features of the patient, its size, the physique, the age can be sealed. Olive size is 2 × 0.5 cm.

The procedure itself needs to be made on an empty stomach. The doctor is preparing a duodenal probe, pre-treating it to prevent transmission of infection. The doctor then puts the distal end of the probe to the root of the patient's tongue, and after that he pushes it with active movements along the digestive tract. To facilitate the passage of the rubber tube, the examined must be performed by active swallowing movements.

The notch of 45 cm indicates that the doctor reached the stomach cavity. To push the tube on the patient asking for the right side and at the same time put a hard roller under it.

Patient position facilitating probe

In this position, the patient must continue to perform swallowing movements for a long time (40-60 minutes). Only in this way, Oliva can pass through the pylorial department of the stomach. If you try to speed up the process, the probe will challenge and can not go through the gatekeeper. After the tube reaches a 75 cm mark, its proximal end is lowered into a special test tube used to fence duodenal content. A tripod with a capacity must be placed below the patient's level. For this purpose, a tripod is usually used to which a test tube is installed.

An indicator of the correct position of the probe is the flow of yellowish content, which is a mixture of pancreatic juice and bile. Make sure that the tube is located in the duodenum can be both in another way. To do this, you need to take a syringe, gain air into it and introduce into the probe. If it is localized in a duodenal space, nothing happens, and if it is in the stomach, a specific bubble sound will appear.

The information set in the text is not a guide to action. For more detailed information about its pathological condition, it is necessary to seek help from a specialist.

For a more accurate determination of the arrangement of the tube use the X-ray method of the study. Metal olive is very well distinguished against the background of the organs of the digestive tract, so it is not possible to establish its localization on the radiographic picture. Assessing X-ray data, a radiologist gives instructions for further tactics. The technique of performing duodenal sensing is quite simple, if it is well able to understand the anatomy and physiology of the digestive tract.

Phases sounding

The procedure itself was divided into several phases. This decision was made to facilitate the technique of implementing and developing a convenient phased algorithm.

The first phase is the fence of serving A. It consists of bile, pancreas and intestinal juice. If the gastric juice falls into the portion, then it starts to miserable. The duration of the phase is about 10-20 minutes.

After the fence of serving, cholecystokinetics are introduced to the patient:

• 25% magnesia;
• 40% glucose;
• Vegetable oil;
• Xylitis solution 40%;
• Pituitrine;
• Pepton solution is 10%.

After that, the second phase of duodenal probing occurs. In the second phase of the study, the Sphinteer Approved and the selection of bile is suspended. Its duration is about 4-6 minutes. After entering bile stimuli, it is necessary to close the probe for 15 minutes.

The third phase is the allocation of the contents of extrahepatic bile ducts. It has a golden yellow color.

Fourth phase. During it, you can visualize the presence of a dark yellow or olive discharge. This content is "bubble" bile. If there are stagnant phenomena in the bustle bubble, the dark green color will be separated, and with a weakened concentration function, the portion A and B will not be very different in color. In such cases, you can use a special dye (methylene blue), which in the dosage of 0.15 g, is given to the patient before conducting the study. Thanks to it, the bubble bile acquires the blue color, and divided portions from each other no longer represents difficulties. When obturation of the bile duct's lumen, the serving of the portion is not deleted. Such a situation is observed in calculous cholecystitis, or when cancer of the pancreas head. The volume of portions of B is about 30-60 ml.

Duodenal probing is the introduction of a probe to a duodenum, which is carried out both with diagnostic and therapeutic purposes.

The probe for duodenal probing is a rubber tube with a diameter of 3-5 mm and 1.5 m long; At the end, introduced into the stomach, the probe has a hollow metal olive size 2 cm, there are several holes on it. On the probe there are 3 labels: the first is 40-45 cm from the olive, the second - 70 cm and the third - 80 cm, the last label approximately corresponds to the distance from the front teeth to a large duodenal duct (Nipple Faterava). In addition to the probe, a clamp for probe is needed for a duodenal sensing procedure, a tripod with test tubes, a syringe on 20 ml, pituitrine, atropine and a 25% magnesium sulfate solution.

Before the procedure, the duodenal probe is boiled and cooled in boiled water. On the eve of the examination of the patient, 8 drops of a 0.1% atropine solution or a bit of warm water with 30 g of xylitol dissolved in it, after which it takes a light dinner, from which gas-generating products are excluded (black bread, milk, potatoes).

The study is carried out on an empty stomach. The probe mark the distance from the navel to the front teeth of the patient in the standing position, after that it is seated and give him a tray in his hands. Lubricate the olive probe glycerin, put it deeply for the root of the patient's tongue and offer it to make a swallowing movement, breathing deeply at the same time. After that, the patient slowly swallows the probe, and with the appearance of vomit movements, several deep breaths are performed. When the probe comes to the first label, you can be sure that Oliv is in the stomach.

The patient is placed on the right side, under which the roller is placed at the level of the lower edges, on top of the roller there are hot heating. After that, the patient continues to slowly pull out the probe. The probe passes into the twelfth intestine after 1-2 hours, with its stomach delay, it is possible to introduce a 1 ml of 0.1% atropine solution, 2 ml of a 2% papaverin solution and closed the closer with a probe for 10-15 minutes. When promoting the probe on the stomach, the syringe suck its contents, preventing falling into the duodenum.

As soon as the probe is in the intestine and advanced to the third mark, the syringe sucks the bile stitching out of the fauters. To stimulate it, the patient is given to drink 30-50 ml of a warm 25% magnesium solution of sulfate, intramuscularly can be introduced 2 ml of pituitrine or 0.5-1 mg of histamine.

Duodenal probing is not only a diagnostic, but also therapeutic procedure, since the washing of the biliary tract in the process of sensing reduces the stagnation of bile, thereby removing the risk of rock formation and inflammation.

However, despite such a positive therapeutic effect, duodenal sensing cannot be carried out often due to the fact that many people are hard and painfully tolerate the procedure for introducing a probe to the esophagus, during which they constantly have a vomiting for vomiting. Some patients are duodenal sensing in general contraindicated. These are patients who have recently gastrointestinal bleeding, having an extension of the veins of the esophagus, suffering from severe heart lesions and hypertensive disease in severe, curvature of the cervical spine.

Content

In case of diseases of the gastrointestinal tract, an analysis of the gastric juice may be needed. To do this, conduct special procedures. Sounding is an examination of the digestive system using a special probe. It is a thin tube with a diameter of 4 mm and a length of 1.5 m. The end of the probe is equipped with a metal nozzle with holes. Probing for diagnostic purposes may be subject to stomach, gallbladder.

Indications

Protecting the stomach or gastric bubble is carried out according to strict indications. These include:

Depending on the process of performing sensing, its destination is distinguished several types of procedure. The main are:

Preparation

The probing of the liver or stomach is a long procedure with unpleasant sensations. The doctor for holding the manipulation is required by the stool to which the patient will be sitting, a special capacity-basin, a thin sterile probe, a syringe or a pump for a hose, towel, sterile jars for analyzes. The patient is trained:

• during the day, the study refrains from smoking, drug intake;
• does not use products that increase the accumulation of gases and secretion of gastric juice;
• 14-16 hours before the study, nothing eats, drinks only clean water, except for the soda;
• there is a psychological state, it tries to avoid stress (otherwise the secretion of gastric juice increases);
• removes inserted dental structures if available.

Technique implementation

The duodenal probe for the sensing is a rubber tube with a special metal tip at the end in which there are holes for the collection of content using suction. On the probe there are three marks: 45 cm - the distance from the cutters to the subcardial dial of the stomach, 70 cm to the pyloric department and 80 cm to the duodenal papilla. The procedure is performed on an empty stomach that the contents of the digestive tract prevente the accuracy of the analyzes. Stages of holding:

1. The probe is processed by an antiseptic to eliminate the risk of infection. The patient's throat is processed by a local analgesic to reduce urges to nausea.
2. The doctor puts the distal end of the probe to the root of the tongue, actively pushes it along the digestive tract. The patient helps him performing active swallowing movements.
3. If you need to go further than 45 cm, the patient is put on the right side, put a hard roller under it. Lying, it continues to actively swallow for 40-60 minutes, because only so the tip will be held through the pylorial department. The procedure passes slowly, otherwise the probe folds and does not pass through the gatekeeper.
4. After reaching the tumble of 75 cm, the end of the probe is lowered into the test tube for the fence of duodenal content. Tripod with capacity is located below the patient level. Properly located probe provides a yellowish content of the mixture of pancreatic juice and bile through it. It also make sure that the tube hit the duodenum, can be introduced by air into the probe from the syringe. If it is localized in a duodenal department, then nothing happens if in the stomach - the doctor will hear a specific bubble sound.

To more accurately determine the arrangement of the tube, the X-ray method can be used. Sensing phases:

1. Selection of portions A - from bile, pancreas and intestinal juice. If the gastric juice hits, the liquid is mute. Phase duration 10-20 minutes.
2. After the phase fence, the patient is injected with cholecystokinetics (25% magnesia, vegetable oil, peptone solution of 10%, 40% glucose, 40% xylitis solution or pituitrine). The second phase occurs, in which the Sphinteer Approved closes, the selection of bile is suspended. The phase lasts 4-6 minutes. After entering the bile stimuli, the probe closes for 15 minutes.
3. The third phase is characterized by the allocation of the contents of extrahepatic bile ducts of golden yellow color. If the bustling bubble has bile closures, then the separated will be dark green. With a weakened concentration of bile, a portion A and in will not differ from each other. The volume of serving is 30-60 ml.
4. The fifth phase is a portion of serving C (light content of hepatic bile). Stage lasts 30 minutes.
5. It takes 5-10 minutes between each phase, then the patient receives a "trial breakfast" - light broth or enzymes for stimulating the performance of the gastric juice. This is done to determine the functionality of the stomach. After that, for an hour 7 times take the samples every 10-15 minutes. In the end of the probe is extracted.

Research is unparalleled for the patient. The process of swallowing the probe can cause urge to vomiting, while the tube in the digestive tract is constantly separated by saliva, which can provoke aspiration. To eliminate side actions, apply the pose on the side to saliva flow into the tray or on a diaper. After taking Magnesia, diarrhea may occur, xylitol or sorbitol - fermentation phenomena in the intestine. After the procedure, the patient lies at least an hour in the hospital, the staff controls its pressure and pulse indicators.

Features of the procedure for the child

Gastric sensing The child is carried out by a thinner probe with a diameter of 3-5 mm and a length of 1-1.5 m. The elastic tube is made from rubber, one of its end is rounded, there are two holes on the second (one for the introduction of a test breakfast and the content of content, the second - for Air supply). Before the procedure, the child needs to create a favorable psychological installation, the baby gives sleep and relax.

Manipulation is carried out in the morning on an empty stomach. The child is planted on the chair, covered with a loaf, introduce a sterilized probe for the root of the tongue. The baby makes breathing his nose and begins to swallow the tube. With each swallowing, the doctor slightly pushes the probe so that he reached the desired mark to the stomach from the teeth (20-25 cm for younger age, 35 cm - for preschoolers, 40-50 cm in schoolchildren). The probe cannot be pushed further due to the possible injury of the internal organs, the appearance of gastric bleeding or perforations.

After entering the probe, the syringe is inserted into it, take a bit of the gastric juice, the test breakfast is introduced and every 15 minutes for 2 hours you extract the contents of the stomach sent to the diagnosis. In most cases, sedative (sedative) means are given before diagnosing children. If an attempt to swallow the probe ends with a vomiting reflex, the tube is injected through the nose.

To have a complete idea of \u200b\u200bthe state of the mucous membrane of one of the most difficult to diagnose the organs of the digestive system, such an informative examination is appointed as probing a stomach.

This survey is carried out in an outpatient basis by a gastroenterologist. Through the mouth or through the nose in the esophagus, the probe is introduced, it is moving into the stomach. With the help of a specially developed algorithm, the doctor conducts diagnostic manipulations to study such indicators as:

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

The survey practically does not cause unpleasant sensations, despite the fact that it is carried out without anesthesia and anesthesia. The position of the probe in the patient's stomach is controlled using an X-ray apparatus.

The introduction of the probe is possible through the nose.

The use of modern materials allows you to conduct a study using a very thin probe with a diameter of 0.4-0.5 cm. The minimum possible dimensions will help avoid vomit urges and do not create unpleasant sensations.

Modern medical appliances even more improved and simplified the probing of the stomach. An exceptionally thin probe can now be equipped with a miniature video camera broadcasting an image of the internal content of the organ and the characteristics of its structure. Based on the data obtained, the doctor will be able to confirm or refute the alleged diagnosis, differentiate it with similar pathologies, to detect the beginning of the oncological lesion of the mucous membrane and the muscular wall of the organ.

Indications for the purpose of the procedure

The survey of the stomach for this technique is carried out according to various testimony:

• diagnostics of gastrointestinal diseases;
• the need for feeding or administration of drugs directly to the stomach (premature children, patients with pathologies and injuries of the esophagus, pharynx, oral cavity, as well as persons in an unconscious state);
• washer during body intoxication by chemicals or substandard products.

Diseases for the diagnosis of the stomach probing:

• ulcerative lesions;
• gastritis with increased and reduced acidity;
• reflux Ezophagitis.

The survey helps to identify the features of the course of the disease, changes in the tissues of the stomach, the emergence of neoplasms of any etiology, features of the structure of the mucous membrane. With toxic lesion, sensing with a special type of probe will allow you to quickly remove the poisons from the body to prevent their detrimental effect on organs and systems that ensure human life.

How to prepare for probing

Before the stomach examination, you must try to bring your mental state to normal, talk with the doctor about the purpose of the testing. The quiet will be the patient, the easier and more comfortable procedure will pass. The overjustion can negatively affect the composition of the gastric juice, strengthen the reflex, causing urge to vomiting.

On the eve of probing it is impossible to eat - from dinner or breakfast before the start of the survey should pass at least 12 hours. To obtain an objective painting of the composition of the gastric juice, it is desirable to drink anything or smoking.

These simple measures preparation for the diagnosis of the stomach is completely exhausted. Special medical preparation is not needed in advance. On the contrary, if the patient must do the appointments of the doctor and take pills, he must inform the gastroenterologist, conducting sensing. It is advisable to avoid the use of drugs directly affecting the work of the stomach: atropine, caffeine, antacids.

Preparation before conducting a survey

The patient falls on the couch on the side, near him put a tray for collecting saliva, the front of the chest is covered with a napkin. This precaution is needed so that sowing (salivation) does not interfere with normal breathing, as saliva is flattered, but not swallowed. It is first necessary to remove the dental prostheses, a special ring is installed in the mouth in order to eliminate the possibility of compressing the jaws. To reduce sensitivity to the oral cavity spray aerosol with an analgesic effect.

Methodology for the diagnostic procedure

After all preparatory measures, the probe is placed on the root of the language of the surveyed, they propose to swallow the patient. Tilt head forward and deep breathing facilitate the passage of the esophageal probe. The processing of the root of the novocaine language removes excessive sensitivity and stops a vomit reflex. After the probe reaches the required depth, its external part is fixed to prevent the tube from entering the 12-point intestine.

Modern probes are very thin.

Sounding algorithm:

1. The contents of the stomach are extracted with a special pump or syringe.
2. For 60 minutes, the basal secret of the secreted mucous membrane pumps. The interval between the fences of the juice is 10 minutes, the fence itself occurs within 5 minutes.
3. The so-called "trial breakfast" is introduced into the probe - decoction of dry cabbage, meat broth or 5% alcohol.
4. After half an hour, we take the sample of the juice highlighted in response to the stimulant.

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

Assessment of research results

The factions of the gastric juice obtained as a result of the testing are directed to a laboratory study to diagnose possible pathologies of the stomach. The following indicators are taken into account:

Analysis of this data will allow the doctor to make a complete picture of the disease. If the laboratory testing indicators of the gastric secretion differ from those shown in the table, it means that you need to undergo treatment with a gastroenterologist.

Normal indicators of the parameters of the gastric juice of a healthy person

Complications and contraindications

Despite the safety of the procedure, there are categories of patients who do not need to do without extreme need.

Contraindications:

• Bleeding of the gastric mucosa;
• varicose veins of the esophagus;
• pregnancy;
• aortic aneurysm;
• stenosis of the esophagus;
• hypertension;
• mental disorders;
• the presence of diabetes mellitus or heart disease and vessels.

The last contraindication in the listed list is due to the fact that drugs with contraindications in the form of diabetes and heart disease and vessels are used to stimulate gastric secretion.

Recovery and sensation after the sensing

A study conducted in compliance with all precautions does not require recovery. After the patient's probe is extracted, leave the resting room where it is observed for an hour to eliminate the likelihood of injury or stomach. During the day in the diet, only light dietary dishes of room temperature remain with a minimum content of fiber.

With incorrect sensing, bleeding is possible due to the injury of the mucous membrane or. In such emergency cases, the following measures are taken:

• intravenous administration of calcium chloride;
• intramuscular administration of vikasol;
• applying ice on the epigastric area;
• blood transfusion.

Perforation of the stomach walls require immediate surgery.

It should be noted that such complications are extremely rare. In most cases, sensing is carried out without any consequences for the surveyed, provides information to determine the treatment strategy.

Duodenal probing is a diagnostic procedure that is prescribed to study the contents of the duodenum - a mixture of bile with intestinal, gastric and pancutically juice. Such a study makes it possible to estimate the state of the biliary system, the secretory function of the pancreas and prescribe it with inflammation of the gallbladder, diseases of biliary ducts and liver, occurring with such symptoms: the stagnant sputum in the gallbladder, the feeling of bitterness in the mouth, nausea, pain in the right hypochondrium, Concentrated urine.

Conduct on an empty stomach, in the morning. Dinner on the eve should be easy, and potatoes are excluded, milk, black bread and other products that increase gas formation. 5 days before the testing should stop the intake of choleretic drugs (cycvalon, barberin, allohol, flamine, cholenism, Holys, Liv-52, Holyagol, Barbara salt, sulfate magnesia, sorbitol, xylitis), antispastic (but-shpa, Tifen, Bellalgin , Papaverin, Bishpan, Belloid, Belladonna), vasodilators, laxatives and such that improve digestion (Panzinorm, Abomin, Pancreatin, Festal, etc.).

In the preparation for duodenal sensing, the patient is given on the eve of 8 drops of atropine - 0.1% solution (the drug can also be introduced subcutaneously), give a drink warm water from 30g xylitol.

Duodenal testing technique

For research, two techniques are used: duodenal probing classical and fractional. The classic method is also called three-phase and consider somewhat obsolete, because Duodenal content is selected in total in three phases: from the intestine of duodenal, bile ducts, bubble and liver, thus obtaining bile duodenal, bubble and hepatic.

Fractional duodenal probing includes five phases and contents pump out every 5-10 minutes, which makes it possible to fix it with the dynamics and type of bile secretion:

• the first phase is distinguished by a portion A, which is selected when the probe enters the duodenum, before the introduction of cholecystokinetic agents. Duodenal content at this stage consists of bile, pancreatic, intestinal and partially gastric juice. Phase lasts about 20 minutes.
• The second phase - occurs after the administration of magnesium sulfate and stop the selection of bile from the sphincter spam appa. The second phase of fractional duodenal sensing is lasting 4-6 minutes.
• The third phase is the allocation of the contents of the extrahepatic biliary tract. Lasts 3-4 minutes.
• The fourth phase is to highlight a portion in: the empty of the gallbladder, the secretion of the bubble thick bile of brown or dark yellow.
• The fifth phase - begins after dark bubble bile ceased to stand out and again goes with a bile golden yellow color (portion C). Collect bile for half an hour.

For classical and fractional duodenal sensing, a rubber probe is used, at the end of which there is a plastic or metal olive with holes for sampling. It is preferable to use a double probe, because One of them pumps the contents of the stomach.

When preparing for duodenal sensing, the probe marks the distance from the front teeth of the patient to the navel (in the standing position) and put three labels that make it possible to understand where the probe is located. After that, the patient sit down, put him in the root of the olive language, lubricated by Glycerin, asking him to breathe deeply and make swallowing movements. When the first label is at the level of the cutters, it means that the probe was supposed to be in the stomach. The patient falls on the right side and continues to uplook the probe. It should be done until the second mark denoting the fact that Olive probe approached the gatekeeper and after the next disclosure, he will be able to get into the duodenum (the third mark on the probe rubber tube). It is usually happening in one or a half hours and a golden liquid starts from the probe - a portion A, which is collected in test tubes.

The portion is obtained in 20-30 minutes after serving A and it plays the greatest diagnostic value.

This technique of duodenal sensing makes it possible to determine the capacity of the gallbladder, the features of the bile separation, to detect organic and functional disorders of the bore. All bile sample probes obtained in the process are microscopic and bacteriological research.