home Audience 3 Duodenal intubation: purpose, pathological conditions and stages of implementation. The procedure for blind probing of the gallbladder and liver at home

Duodenal intubation: purpose, pathological conditions and stages of implementation. The procedure for blind probing of the gallbladder and liver at home

Probing of the gallbladder is a procedure that helps improve the process of bile secretion and eliminate its stagnation in the ducts. When performed regularly (every 3-6 months), it promotes weight loss. This procedure is popularly called “tubage”.

Indications for use

Probing is carried out only for people who have been diagnosed with Identified this pathology through the normal and gallbladder. As a rule, such patients complain of constant presence. People who are most susceptible to this are those who:

there is sand in the gallbladder;
is overweight.

Contraindications

Blind probing of the gallbladder is prohibited for the following indications:

Exacerbation of chronic diseases (bronchial asthma, cholecystitis, pancreatitis, etc.).
Presence of stones in the gall bladder. This procedure can provoke their movement along the bile ducts. In this case, the stones can simply get stuck, which in due course will lead to severe consequences, the solution of which will only be to carry out the operation.
Ulcerative colitis. With this disease this procedure leads to bleeding in the intestines.
Gastritis is also a disease in which probing of the gallbladder is contraindicated. In this case, this procedure provokes the appearance of a stomach ulcer.
It is not recommended to resort to sounding when a person is healthy and does not have any diseases except in the ducts. In this situation, the body itself copes with the task without any additional measures. The main condition is a mandatory breakfast, which provokes the excretion of the so-called “night” bile.

What does this procedure involve?

The main purpose of probing is to increase the activity of the gallbladder, which will help get rid of bile stagnation. The main assistants in this procedure are sorbitol and magnesium.

Probing the gallbladder requires careful preparation, which consists of following special diet 3 days before the procedure. It is based on eating light and plant-based foods that help unload the body.

Probing is performed in the morning on an empty stomach; the patient should not get out of bed. You need to drink about a glass of warm non-carbonated mineral water, to which 5 grams of sorbitol or magnesia are added. Then you need to lie on your side (right) and put a bottle filled with warm water or a heating pad.

It’s worth lying there for at least an hour. Then you need to drink warm water again, but with the addition of lemon. After 15 minutes you can eat a choleretic breakfast - a soft-boiled egg with a small piece butter. Eating bread is not encouraged.

How do you know that the procedure was successful?

If you have mild diarrhea within a few hours, then you can safely say that the probing was successful. Stagnant bile is released along with the feces.

The gallbladder is one of the organs of the gastrointestinal tract. It accumulates bile, which is necessary for complete digestion. Stagnation of bile entails dangerous consequences, such as failure of the food digestion process, biliary cirrhosis, inflammatory processes in the gallbladder, leading to cholecystitis. To eliminate pathology, there are a number of medicines, but you should not take them without a specialist’s prescription. In a hospital setting, the mechanism of bile secretion can be studied in more detail by duodenal intubation of the gallbladder, which involves inserting a probe into the duodenum through the patient’s mouth. Despite the effectiveness of the procedure, many patients find it difficult to tolerate the insertion of the tube, and in cases of recent bleeding in the gastrointestinal tract, dilation of the esophageal veins, severe heart disease, or spinal curvature this method contraindicated. To restore normal bile flow, blind probing gallbladder, which can be done independently at home.

Blind probing of the gallbladder is a douching performed to reduce the load on the liver and stimulate the gastrointestinal tract. Active tubage is used in combination with moderate physical activity. Passive probing is done at night so that bile can be naturally leave the body.

Procedures are carried out every 3-4 days. The course must include at least 3 sessions. It is recommended to repeat the preventive course after three months.

Abundant stool with a greenish tint indicates that the treatment was successful. If it is difficult to empty the intestines, an enema is prescribed.

Indications for the procedure:

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acalculous cholecystitis;
painful sensations in the right hypochondrium;
bitter taste in the mouth;
yellowing of the whites of the eyes and skin;
causeless fatigue;
regular consumption of alcoholic beverages;
tendency to overeat;
constipation, gas formation, heaviness after eating;
rehabilitation period after cholecystectomy;
dyskinesia of the bile ducts.

in the presence of acute infectious processes;
with cholelithiasis with formed stones;
if complaints of bile stagnation are not accompanied by deterioration in health.

Preparing for blind probing

A few days before cleansing, you need to stick to a diet, the bulk of the diet should be light plant food. Drinking should be plentiful - water, freshly squeezed juices. This is primarily necessary in order to prevent the formation of a fecal plug, which can prevent bile from leaving the body.

Tubage with sorbitol

This method of probing the gallbladder is considered the most accessible. It is carried out in the morning on an empty stomach. A tablespoon of sorbitol must be dissolved in 200 ml warm water and drink right away. After this, lie down, pressing a heating pad to your right side for two hours. Under the influence of heat, blood flow in the liver increases, the action of enzymes is activated, and bile is liquefied. As a rule, after the procedure is completed, there is a desire to go to the toilet. Toxic substances, coarse residues with toxins, as well as stagnant bile will be released along with feces. After this, patients are provided with mineral water with citrus fruits, boiled eggs and a small piece of butter.

Tubage with magnesia

Magnesia is known for its pronounced diuretic effect. The medicine is sold at the pharmacy in the form of ampoules or powder. To make a solution, combine a tablespoon of the product with 200 ml of water. If a person's body weight exceeds 70 kg, the dosage can be doubled. For children, the amount of product is calculated individually. The unpleasant taste remaining in the mouth after taking the medicine can be neutralized by eating a slice of lemon. After this, you need to lie on your right side, after placing a heating pad under it. Warming up lasts several hours; an hour after the procedure, you can drink herbal decoctions and mineral water. Cleansing the gallbladder at home is carried out in this way once a month.

Contraindications:

Cleansing with mineral water

Drinking water of medium mineralization “Borjomi”, “Essentuki”, “Jermuk”, “Arzni” normalizes acidity and starts the process of natural cleansing of the body. Bile is liquefied, bladder spasm is eliminated, and intestinal motility is improved. Drinks can be used as an independent means of healing and stimulation metabolic processes in the following way:

In the evening, take a bottle of mineral water, shake it thoroughly and release all the gas, and leave it open all night.
In the morning, pour 400 ml of mineral water and warm to 40 degrees.
Treatment is carried out on an empty stomach. After drinking a little water, you need to lie down on your right side, applying a warm heating pad to the right under your ribs.
After five minutes, stand up, inhale and exhale deeply several times, drink again and continue warming up. Deep breathing helps to “massage” the liver with the diaphragm.
The steps are repeated until the prepared portion of mineral water is drunk, but no more than one hour.

You can enhance the effect by adding active ingredient– magnesia or sorbitol. The procedure ends with heating the gallbladder area for several hours.

Tubage using herbal ingredients

There is a probing method that does not require warming up. For cooking medicinal infusion 40 grams of crushed rose hips are poured into 400 ml of boiling water and infused in a thermos overnight. In the morning, infusion with the addition of 2 tbsp. A spoonful of sorbitol is drunk on an empty stomach. After this, it is recommended to move.
Tubage using dandelion root, corn silk, St. John's wort, immortelle, and mint gives a good effect. A tablespoon of raw material is placed in a glass and filled with boiling water to the top. After an hour, the broth should be filtered and drunk. The procedure is completed by warming the right side with a heating pad.

Meal intake is acceptable 30 minutes after tubage and should be light, for example, porridge boiled in water, sweet tea with a piece white bread, a little butter and cheese. During the day, you need to drink enough liquid and avoid fatty, fried, smoked foods, marinades, chocolate, and coffee.
Whenever painful sensations the procedure must be stopped immediately. To find out the cause of the pain, you need to consult a specialist.

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Diseases of the biliary system and liver are often accompanied by stagnation of bile. Disturbances in its outflow provoke disruptions in the digestive and excretory processes, lead to functional disorders in the functioning of the liver and stomach. Clear gallbladder and ducts can be done using a procedure called blind probing. It is done quite simply, provided you follow all the recommendations.

a brief description of

Blind probing or tubage is a method of stimulating the outflow of bile by flushing the gallbladder and bile ducts. This is a gentle, economical way to cleanse the biliary tract, which can be done at home.

The procedure allows you to cleanse the liver and biliary system of toxins, waste, and removes excess bilirubin from the bloodstream. Restoring the normal flow of bile regulates the digestive process and normalizes the functioning of the liver and intestines.

Indications for testing

Disturbances in the outflow of bile throughout the gallbladder and bile ducts are called cholestasis. This pathology is observed both inside the liver and outside it (in the gallbladder and ducts). Indications for blind probing are cholestatic phenomena in diseases accompanied by such characteristic features, such as dyspeptic disorders, digestive and defecation disorders. These include:

Blind probing is also carried out to prevent bile stagnation and improve digestion. The procedure is recommended only after full examination according to the results of analyzes and instrumental studies(ultrasound, MRI).

The procedure can only be performed in consultation with the attending physician, after the diagnosis has been clarified and in the absence of contraindications.

Contraindications

There are several pathologies for which blind probing is prohibited. These are diseases such as:

Contraindications apply to patients with hyperkinetic dyskinesia, patients with cholelithiasis (stones in the gall bladder or ducts), if tumor processes. The procedure is not recommended for pregnant women, as well as during menstruation (plus 10-14 days before its onset).

Blind Probing Method

After agreement with your doctor, you can perform a cleansing choleretic treatment on one's own. The procedure for cleaning the gallbladder is carried out at home, following the rules of preparation and taking into account individual characteristics body.

Preparatory activities

Before blind probing, it is necessary to carry out some preparatory activities. They consist of the following stages:

Choleretic sounding is carried out using special means stimulating the flow of bile. You need to choose them based on the individual reaction of the body.

The table shows the means used for blind probing:

Means	Action	Contraindications
Mineral water	Stimulate the flow of bile Strengthens intestinal motility Eliminate spasms of the biliary tract	No
Magnesium sulfate (magnesium)		Pathologies of the gastrointestinal mucosa, Oy *
Sorbitol or xylitol		OU *
Rosehip berries		OU *
Olive oil		Pancreatitis, Ou *
Herbal choleretic mixture		OU *
Egg yolks		OU *
Honey		Diabetes mellitus, Oh*

Oy * (special conditions) - individual intolerance or allergic reaction on the substance.

Tubazh with mineral water

The most common method, suitable for almost all categories of patients. Medium carbonated natural mineral water (Narzan, Borjomi) with reduced salinity is recommended.

The blind probing technique is carried out in several stages:

Step 1. Excess is removed from mineral water carbon dioxide. To do this, you can open a bottle with mineral water 7-10 hours before the procedure.

Step 2. Tubage is carried out early in the morning, on an empty stomach. The total volume of liquid is 400 ml (2 cups). The water is heated to 36-40 0 C.

Step 3. Drink 3-4 sips of water, take a horizontal position, lie on your right side. A warm heating pad is applied to the area of the right hypochondrium for 5 minutes.

Step 4. After 5 minutes, you need to get up, take a few deep breaths and do a few active movements(tilts or turns of the body).

Step 5. Repeat the third and fourth steps until the water runs out.

The total duration of blind probing should not exceed 1 hour. As a result of the procedure, the urge to empty the bowel appears. The stool may have a soft consistency, the mass is colored dark green color. This indicates successful cleansing of the gallbladder and intensive bile outflow.

IMPORTANT! During the procedure, slight pain and discomfort may occur in the right hypochondrium, caused by the rapid outflow of bile.

Tubage with various means

In addition to mineral water, blind tubage is carried out with magnesium. The solution is prepared as follows: the powder is dissolved in warm boiled water with the addition of a slice of lemon. The required dose is calculated taking into account the patient’s weight, 10 g of the drug per 10 kg of weight. The finished solution retains its properties for 12 hours after preparation.

Food sweeteners such as xylitol and sorbitol are also used for blind probing. They can be used for tubing children or patients with diabetes mellitus. To prepare the solution 4 tbsp. l of the substance is diluted in 200 ml of warm water. Other means for the procedure are prepared as follows:

olive oil mixed with lemon juice, in a ratio of 1/1 (total amount - 1 glass);
raw yolks (3 pcs.) are ground with sugar, diluted in 250 ml of water;
3 tsp honey per 250 ml boiled water.

Probing is carried out in the same way as in the method with mineral water. After tubing (regardless of the method) is required light breakfast. What can you eat after the procedure? Light choleretic food is recommended. Breakfast can consist of 1 egg, mashed with a small amount of butter, and hot tea, green, black or herbal.

This method of stimulating the outflow of bile is used only in medical institution. It involves flushing the biliary tract using a probe. In this case, bile is pumped out without a heating pad, but with the use of other special equipment.

Duodenal intubation is carried out both to clean the biliary system and to collect biological material for analysis. Preparation for duodenal intubation is similar to preparation for blind tubing, but requires compliance with more stringent conditions:

duration plant based diet is at least 5 days;
5 days before the sounding, it is necessary to stop taking antispasmodics, vasodilators and laxatives, as well as drugs that stimulate bile secretion.

Dinner before the procedure cannot contain gas-forming products. It should be light and consist of one dish.

The method involves swallowing a special probe with an olive at the end. Before inserting the probe, the patient is given atropine to reduce salivation. The length of the rubber tube inserted into the esophagus is equal to the distance between the navel and the bite line in a standing position. The tube is inserted gradually, the patient helps the insertion by making a swallowing movement. The introduction is controlled by marks applied to the probe or using a special device.

Bile collection for analysis is carried out at different stages(fractions) of administration, therefore the procedure is called fractional probing.

Flushing with a probe begins at the moment when the tube is inserted into the duodenum through the duodenal papilla. To initiate intensive bile secretion, an irritating solution (xylitol, olive oil, pituitrin, magnesium sulfate or other secretion irritant) is injected into the tube. The drainage is left until the gallbladder is completely emptied. This is determined by the secretion of a transparent mixture of intrahepatic bile and intestinal juice. The tube is then removed.

The course of tubage treatment is 3 procedures with an interval of 3-4 days between them. To prevent bile stagnation, blind probing can be performed once a month. Before preventive procedures Consultation with a gastroenterologist is required.

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Technique

Diagnostic test takes into account the structure of all organs involved in the procedure, in accordance with their anatomical features. In the lumen duodenum There is a duodenal papilla, on the surface of which two ducts open: the common bile duct and the pancreatic duct.

So-called choleretic solutions are sent directly to the duodenum. The use of a double probe is considered quite convenient for the procedure, which delivers solutions inside the body and takes gland secretions for diagnosis.

Preparation for the procedure:

The procedure is performed in the morning and is performed on an empty stomach.
At home, the day before, patients should exclude legumes, garlic and other foods that cause strong gas formation.
5 days before the procedure, it is necessary to stop taking certain medications: choleretic, laxatives, antispasmodics, vasodilators.

Subcutaneous or oral administration of 8 drops of atropine in a 0.1% solution helps reduce unnecessary salivation during diagnosis.

The depth of insertion of the probe is determined by the person’s height. The probe is a completely safe plastic tube with thickened olives at the end. Typically, the distance from the line between the teeth to the navel is considered equivalent to the length of the probe immersed in the intestine. Three marks are applied to the probe for better orientation of the doctor.

The process of swallowing olives seems to be the most unpleasant and difficult for patients.

Diagnostic procedure:

Patients must be placed on their right side.
Experienced doctors know how to promote better swallowing and immersion of an unpleasant instrument.
Using progressive movements, they bring the probe to the duodenum, focusing on the marks of the probe tube.
If the probe is inserted correctly, after some time a golden liquid will begin to separate, which is immediately transferred to several test tubes for further examination.

In connection with such a stepwise examination, probing of the gallbladder is called fractional. A total of five fractions of the pumped bile or mixed secretion are collected, according to which the procedure is divided into phases.

Next, bile formation is stopped by introducing magnesium sulfate. This is how secretions from the pancreas and intestinal digestive glands are collected. Bile continues to be released from the bladder, since it has the ability to accumulate, it is also collected.

When the action of the bile-stopping drug ends, a new, fresh bladder secretion is produced, which is also collected for research. These and other collected samples are stored and transported to the laboratory for microscopic and bacteriological testing. This technologically difficult and sometimes unbearable procedure for patients is very informative and perfectly reflects the condition of almost all digestive glands.

Blind View Probing

Probing completely eliminates bile stagnation, but there are other beneficial effects on the body. The so-called blind implementation of this procedure every month for six months or more promotes the removal of waste and toxins, as well as weight loss. Probing of this type is also called tubage.

There are clear indications for the procedure that must be strictly followed:

Two components are used for tubage - sorbitol and magnesia.

Preparation and carrying out the procedure:

Before the procedure, patients receive special dietary food with mineral water from natural springs.
Patients spend about three days on plant-based and easily digestible foods.
Blind probing is performed in the morning on hungry patients who have not gotten out of bed.
Patients are given mineral water with 5 grams of magnesia and sorbitol.
Next, they are placed on right side and apply a warming element to the liver area.
It is necessary to lie down, if possible, for at least an hour, and then also drink a mixture of lemon and mineral water.
Next, patients are served a choleretic breakfast in the form of a boiled egg and a piece of butter.

At home, you can also carry out blind probing, but after consulting a doctor and identifying necessary indications to the procedure. IN alternative medicine There are two sensing methods: active and passive. Any traditional healing carries a risk of complications, especially at home, several more are added to the existing contraindications to sounding:

pregnancy, breastfeeding;
menstrual flow;
oncological diseases.

Ignoring previously described infectious diseases and these moments will cause irreparable consequences, despite the conviction traditional healers tubage is beneficial for absolutely everyone.

If the doctor allows probing at home, it is better to do it on the weekend. Before this, carry out unloading diet days with plenty of fruit juices and fiber-rich foods. Choleretic effect have mineral water, a decoction of rosehip and other herbs, and vegetable oil.

Passive tubage is based on mineral water and rosehip decoction. About half a liter of warm mineral water is drunk by the patient in the morning, after which it is necessary bed rest with a heating pad on the liver area for at least two hours.
The active method is based on bed rest replacement physical exercise. The use of mineral water alternates with active physical activity; the volume of mineral water should be up to three liters.

At home, an indicator of the success of the procedure will be abundant stool with a green tint. Naturally, this treatment will not be as effective as in a medical institution, but it is an effective form of cleansing the body and eliminating bile stagnation.

Probing of the liver bladder can be duodenal and blind, and can be performed in the hospital or at home. But only strict adherence The recommendations of the attending physician will make this procedure effective and painless.

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Definition, description, advantages of the procedure

Probing of the gallbladder has another name - tubage. The essence of the method is to artificially stimulate the flow of bile by introducing choleretic solutions. According to anatomy digestive organs, on the inner side of the wall from below in the duodenum there is a duodenal papilla connecting the main canal of the pancreas and the bile duct.

When food is digested, the contents of the gallbladder are discharged through this channel into the duodenum. In the absence of digestive process, the release of bile must be stimulated artificially, which will allow taking a sample of the contents for its study. To do this, special choleretic liquids are injected into the duodenum, and after a while samples are taken. The procedure is performed using a duodenal tube.

Along with analyzing the composition and quality of bile, the procedure allows you to improve the outflow of bile and eliminate congestion in the bile ducts. Duodenal sounding has the following advantages:

You need to prepare for the manipulation 5 days in advance. At this time you should stop taking:

choleretic drugs;
antispastic agents;
vasodilators;
laxatives;
compounds that improve digestion.

Before the procedure:

the last meal should be before 18:00;
For dinner you should not eat potatoes, cabbage, brown bread, drink milk or soda, that is, foods that cause advanced education gases in the intestines;
food should be light, not irritating;
you need to drink 8 drops of a 0.1% Atropine solution or inject it subcutaneously in the appropriate dosage instructions;
should drink warm solution 30 g xylitol.

Probing is carried out in the morning on an empty stomach. If you have an increased gag reflex, it is better to use local anesthesia.

Technique

There are two types of manipulations:

The classical method, in which three fractions are selected: from the duodenum, the gallbladder with ducts, and the liver. The method is outdated and uninformative.
The fractional method involves selecting five phases with pumping out the contents after 5-10 minutes. This allows us to record dynamic changes in composition and quality and determine the type of bile secretion.

The principle of fractional analysis consists of 5 stages:

The first stage is the collection of the first fraction (portion “A”) from the duodenum before the administration of choleretic cholecystokinetics. The duodenal composition contains bile with admixtures of pancreatic juice, fluid from the intestines and stomach. The duration of the phase is 20 minutes.
The second stage begins with the introduction of magnesium, which stops the release of bile from the large duodenal papilla. The duration of the stage is 6 minutes.
The third stage is characterized by taking a sample from biliary tract outside the liver. The duration of the stage is 4 minutes.
The fourth stage involves the collection of fraction “B”, when the bile is ejected by the bladder. At the same time, the secret is thick consistency and color ranges from dark yellow to brown.
The fifth stage involves taking portion “C”, when instead of dark liquid, a light golden-yellow liquid is released. Bile collection takes 30 minutes.

Both probing options are carried out with a rubber probe. An olive made of metal or plastic is attached to its end for sampling. A double probe is predominantly used, which simultaneously with sampling pumps out gastric contents.

To accurately guide and determine the location of the probe, three marks are made on it at the distance taken in a vertical position from the teeth to the navel.

Probing is carried out in a sitting position. The patient is placed on the root of the tongue with an olive in glycerin to improve gliding. The patient must do deep breath and start swallowing the probe. The device will enter the stomach when it reaches the first mark. At the next stage, the patient takes a horizontal position on the right side and continues to swallow the olive. The probe reaches the gastric sphincter at the second mark. At the third mark, the device is inserted into the duodenum.

The first portion of golden yellow color begins to come out of the probe after half an hour. Then the next portions gradually come out. All samples taken are sent for microscopic and bacteriological analysis.

Analysis of results

Bile analysis is performed in a laboratory.

During probing, the density, color, transparency, and nature of the sediment in the bile being studied are analyzed. The first three portions of bile healthy person They are distinguished by their viscousness and transparency. Any deviations from the norm indicate the development of pathology.

The normal composition of bile with a healthy bile-producing system:

cholesterol crystals with sodium oxalate;
low content of cellular epithelium with single leukocytes.

An increase in the level of leukocytes with a bile tinge in portion “B” indicates the onset of inflammation in the bladder. The same picture in portion “C” indicates pathology in the intrahepatic ducts. On this basis, cholangitis develops.

If bile is obtained within 30 minutes, the patency of the bile ducts can be judged. If portion “B” is received, then the concentration and contractile properties of the gallbladder are normal. If it is not possible to advance the olive of the probe into the duodenum within 2 hours, the procedure is stopped.

Contraindications

If they have one disease from the list presented, probing is excluded:

severe circulatory system failure;
exacerbated chronic or acute cholecystitis;
aggravated cholelithiasis;
exacerbation of duodenal and gastric ulcers;
cancerous tumors in the stomach with metastases in the esophagus;
severe shortness of breath of pulmonary and cardiac type;
varicose veins of the esophagus;
ischemia;
myocardial infarction.

A separate sounding method is chromatic examination of bile contents. In the evening before the procedure, at 20-21:00, the patient should take 0.15 g of methylene blue in a gelatin shell. At least 2 hours must pass since the last meal. Methylene passes through the blood to the liver, where it becomes discolored. The dye then enters the gallbladder, coloring its contents. When performing standard morning probing, blue bile is obtained.

Advantages of the method:

gives exact amounts of bile produced by the bladder;
high efficiency in diagnosing diseases of the biliary tract.

Features of the procedure in children

In children, the procedure is similar to extraction gastric juice, difficult to carry out. To do this, a 25% solution of magnesium is injected into the duodenum at the rate of 0.5 ml per 1 kg of body weight. The probing itself does not differ from the technique used in adults.

It should be taken into account that the probe is inserted at distances corresponding to the child’s age:

in newborns, the insertion depth is 25 cm;
in infants up to 6 months - 30 cm;
in babies under one year old - 35 cm;
for children 2-6 years old - 40-50 cm;
in patients over 6 years old - 50-55 cm.

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What is gallbladder probing?

This term refers to non-invasive manipulation, the purpose of which is to obtain bile. This procedure can be both diagnostic and therapeutic in nature, and is carried out both at home and in hospital.

There are several research methods:

chromatic;
factional;
minuted;
probeless.

This manipulation is used to obtain bile. The procedure is indicated for:

organ diseases digestive tract(pancreas, liver, gallbladder, duodenum);
suspected helminthic invasion of the biliary tract, for example, giardiasis.

Contraindicated in acute cholecystitis (including chronic exacerbations).

Preparation

In order for duodenal intubation to be effective, it is necessary to properly prepare for it. To do this you need:

A few days before the study, you must stop consuming foods that contribute to flatulence [brown bread, legumes, fiber (for example, cabbage), potatoes, milk, sweets, alcohol].
Within a day or several days, all drugs that stimulate the secretion of bile and pancreatic juice are discontinued.
Probing of the gallbladder is performed on an empty stomach, ideally at 8–9 am. The last meal on the eve of the study is allowed no later than six to eight o'clock in the evening.
If the research is not carried out in private clinic, and in government agency, it makes sense to take a clean towel with you.
Before starting the research, nurse or another health worker who will carry out the manipulation prepares the patient psychologically, telling him what will happen to him and in what sequence, and how to behave during and after the procedure.

Procedure

The duodenal tube is a rubber tube with a metal olive at the end that has holes. Before starting the procedure, it is necessary to determine to what depth it should be inserted. To do this, first measure two distances:

from the incisors to the auricle;
from the incisors to the navel.

On average, in an adult, the distance to the papilla of Vater (the entrance to the common bile duct) is 70–80 cm. Next, the patient sits on a chair or couch, covering his shoulders and chest with a clean towel. The probe, moistened with boiled or distilled water, is placed with the olive on the root of the tongue, after which it is swallowed. In parallel with deep breathing through the nose, swallowing movements are performed, during which the nurse gradually moves the probe to a certain mark.

After installing the probe, the patient, holding a warm heating pad in the right hypochondrium, slowly walks around the room for half an hour, continuing to insert the probe to the intended length. After this time, he lies on his back and the nurse administers 10 cm3 of air. If a push is felt in the right hypochondrium, it means that the probe is installed correctly and the study can begin. If not, the installation procedure is repeated. You can also check the correct placement of the probe using fluoroscopy.

The next step is to place the patient on the couch on the right side without a pillow, place a towel under the head, and place a hot heating pad (60 ̊ C) under the right hypochondrium.

Below the patient's level, on a special stand, a stand with test tubes, a tray and a syringe are placed. The outer end of the probe is lowered into the test tube. Three portions of bile are used for the study: A, B, C.

Portion A is the contents of the duodenum. It may contain impurities of gastric contents, so it has a light yellow color. The first portions may be cloudy. Isolation time - 20–30 minutes. Volume - 15–40 ml.

Portion B is bile from the gallbladder. Its secretion is stimulated either by introducing enteral irritants into the tube (magnesium sulfate, olive or corn oil, 40% xylitol or glucose solution, dark beer), or intramuscular injection hormonal drugs pituitrin, cholecystokinin. Bile is yellow-green in color, viscous, thick. Within 20–30 minutes, about 50–60 ml are released.

Portion C is a fresh portion of bile coming directly from the liver (bypassing the gallbladder). Normally it is light lemon in color, without impurities. The amount can vary from 10 to 30 ml.

After completing the study, the probe is washed with water or glucose and removed.

When bile stagnates in the gallbladder, a person suffers from pain in the right hypochondrium, he constantly feels nauseous, and there is a bitter taste in his stomach. oral cavity. These signs indicate that the liver tissue, bile ducts or bladder are affected by inflammation. To diagnose pathology and determine the severity, doctors prescribe a clinical examination called duodenal intubation. During the procedure, the quantitative and qualitative composition of bile is examined. Duodenal probing of the gallbladder provides an opportunity to analyze the secreting mechanism of the pancreas, which works in conjunction with the bile-forming system.

Definition, description, advantages of the procedure

Probing of the gallbladder has another name - tubage. The essence of the method is to artificially stimulate the flow of bile by introducing choleretic solutions. According to the anatomy of the digestive organs, on the inner side of the wall below in the duodenum there is a duodenal papilla connecting the main canal of the pancreas and the bile duct.

When food is digested, the contents of the gallbladder are discharged through this channel into the duodenum. In the absence of the digestive process, the release of bile must be stimulated artificially, which will allow a sample of the contents to be taken for its study. To do this, special choleretic liquids are injected into the duodenum, and after a while samples are taken. The procedure is performed using a duodenal tube.

You need to prepare for the manipulation 5 days in advance. At this time you should stop taking:

choleretic drugs;
antispastic agents;
vasodilators;
laxatives;
compounds that improve digestion.

Before the procedure:

the last meal should be before 18:00;
for dinner you should not eat potatoes, cabbage, brown bread, drink milk or soda, that is, foods that cause increased formation of gases in the intestines;
food should be light, not irritating;
you need to drink 8 drops of a 0.1% Atropine solution or inject it subcutaneously in the appropriate dosage instructions;
You should drink a warm solution of 30 g of xylitol.

Probing is carried out in the morning on an empty stomach. If the gag reflex is increased, it is better to use local anesthesia.

Technique

There are two types of manipulations:

The classical method, in which three fractions are selected: from the duodenum, the gallbladder with ducts, and the liver. The method is outdated and uninformative.
The fractional method involves selecting five phases with pumping out the contents after 5-10 minutes. This allows us to record dynamic changes in composition and quality and determine the type of bile secretion.

The principle of fractional analysis consists of 5 stages:

The first stage is the collection of the first fraction (portion “A”) from the duodenum before the administration of choleretic cholecystokinetics. The duodenal composition contains bile with admixtures of pancreatic juice, fluid from the intestines and stomach. The duration of the phase is 20 minutes.
The second stage begins with the introduction of magnesium, which stops the release of bile from the large duodenal papilla. The duration of the stage is 6 minutes.
The third stage is characterized by sampling from the bile ducts outside the liver. The duration of the stage is 4 minutes.
The fourth stage involves the collection of fraction “B”, when the bile is ejected by the bladder. In this case, the secretion has a thick consistency and color - from dark yellow to brown.
The fifth stage involves taking portion “C”, when instead of dark liquid, a light golden-yellow liquid is released. Bile collection takes 30 minutes.

To accurately guide and determine the location of the probe, three marks are made on it at the distance taken in a vertical position from the teeth to the navel.

Probing is carried out in a sitting position. The patient is placed on the root of the tongue with an olive in glycerin to improve gliding. The patient should take a deep breath and begin to swallow the probe. The device will enter the stomach when it reaches the first mark. At the next stage, the patient takes a horizontal position on the right side and continues to swallow the olive. The probe reaches the gastric sphincter at the second mark. At the third mark, the device is inserted into the duodenum.

Analysis of results

Bile analysis is performed in a laboratory.

During probing, the density, color, transparency, and nature of the sediment in the bile being studied are analyzed. The first three portions of bile in a healthy person are viscous and transparent. Any deviations from the norm indicate the development of pathology.

The normal composition of bile with a healthy bile-producing system:

cholesterol crystals with sodium oxalate;
low content of cellular epithelium with single leukocytes.

Gallbladder 08/14/2013

Dear readers, today on the blog we will talk about probing the gallbladder and tubing the gallbladder. These articles are all included in the “Gall Bladder” section, which is led by a doctor with extensive experience, Evgeniy Snegir, author of the site. Medicine for the soul I give the floor to Evgeniy.

Probing the gallbladder in medical language is called duodenal intubation. For diseases of the gallbladder, it can be performed both diagnostically and therapeutic purpose. Let's talk about this in more detail.

Duodenal intubation of the gallbladder

Why is sounding called duodenal? The whole point is that inner surface The descending part of the duodenum is the large duodenal papilla, on which the common bile duct (choledochus) and the main pancreatic duct open.

During digestion, all the bile that is stored in the gallbladder enters the common bile duct from the gallbladder into the duodenum. Outside of digestion, by introducing special choleretic solutions into the duodenum, it is possible to stimulate the flow of bile into the duodenum and take it from there for research. Thus, duodenal intubation is the acquisition of duodenal contents using a probe.

Technique of duodenal intubation

To perform the procedure, you need a sterile duodenal probe with an olive at the end, a syringe with a capacity of 20 ml, a soft roller, a warm heating pad, a towel, a tray, 50 ml of a warm 25% magnesium sulfate solution, three test tubes indicating portions A, B, C, a clean dry jar , boiled water. The probe has special markings to help position it correctly in the duodenum.

The night before, the patient is explained that the study is carried out in the morning, on an empty stomach. The last meal should be no later than 18 pm.

In the treatment room, the person is asked to sit in a comfortable chair with a backrest. A towel is placed on the patient's neck and chest. It is best for the person to hold the saliva tray during the examination.

The nurse takes out a sterile probe from a special container and lightly treats its tip with olive oil. Next comes the unpleasant, but required procedure– the probe should be swallowed. It is best to bend your head slightly (bring it towards your chest). Then the patient opens his mouth, the nurse inserts a probe into the oral cavity, placing the olive at the root of the tongue, and then synchronous actions occur. During the forward movements of the probe, the patient needs to carry out swallowing movements himself, while breathing deeply through his nose. Deep breathing helps reduce the gag reflex that occurs due to irritation with the probe back wall throats. In this way, the probe is inserted to the fourth mark and then further advanced 10-14 centimeters forward deep into the stomach, after which a syringe is attached to the probe and the piston is pulled back. If a cloudy liquid enters the syringe, this indicates that the probe is in the stomach.

The next stage is to slowly advance the probe to the seventh mark, after which the patient is placed on a trestle bed on his right side. It is best to place a soft cushion under the pelvis, and a warm heating pad under the right hypochondrium. A heavy olive is necessary for the successful advancement of the probe to the pylorus of the stomach; thanks to it, the probe is inserted to the 9th mark - this is how it enters the duodenum. Hurray, we are already there!

The free end of the probe is lowered into test tube “A”. Yellow light begins to flow from the probe clear liquid– this is the so-called duodenal bile (portion A). In fact, this fluid is a mixture of bile, pancreatic secretion and duodenal contents. As a rule, 15 to 40 ml of such a mixture is received in 20-30 minutes; this amount will be quite enough to send for analysis.

The next step is to inject 30-50 ml of 25% magnesium sulfate solution, preheated to 40-42 C, into the duodenum.

Now you need to clamp the probe for 5-10 minutes. At this time, magnesium sulfate will stimulate the flow of bile from the gallbladder into the duodenum. After 10 minutes, we remove the clamp and see that dark olive-colored bile has flowed through the probe - this is exactly cystic bile (portion B). We also collect it in a test tube with the letter “B”. Normally, 50-60 ml of bile should be released within 20-30 minutes. Next, we monitor the change in the color of the bile. As soon as the probe begins to separate pure bright yellow bile, lower the end of the probe into another test tube and draw another 10-20 ml, this is hepatic bile (portion C).

This is where classic duodenal intubation ends. The patient sits down. Slowly and carefully remove the probe, after which the patient is asked to rinse his mouth with water. The nurse is always interested in the patient’s well-being and thanks him for his cooperation and patience.

If the patient’s condition is satisfactory, the patient is then transferred from the treatment room to the department’s ward. During the first hour, the patient remains in bed, his blood pressure and pulse rate are measured.

How are the results of duodenal intubation assessed?

Firstly, determine physical properties duodenal contents: color, transparency, consistency. In a healthy person, all three portions should be transparent, the consistency should be viscous, this is especially true for portion B. The specific gravity of the contents in portions A and C normally ranges from 1.008 to 1.012, and in portion B from 1.026 to 1.032.

If a patient has jaundice, and his portion A is colorless, then this indicates the mechanical nature of jaundice - the lack of patency of the biliary tract.

The absence of portion B tells us about pathological processes in the gallbladder, when its concentration and contractile function is impaired. This is observed when cholelithiasis, chronic cholecystitis, pericholecystitis, or when the cystic duct is blocked by a stone.

If the bile of portion B is not colored normal dark brown color, then this indicates a decrease in the absorption capacity of the mucous membrane of the gallbladder, which is very typical for chronic cholecystitis.

There are situations when, after a single injection of magnesium sulfate into the probe, we do not receive the required portion B, or it begins to arrive only after the second injection, all this indicates biliary dyskinesia. The secretion of very dark bile in large quantities may also indicate a similar problem.

Note that if the volume of portion B is more than 100 ml, then this is a sign of distension of the gallbladder due to prolonged stagnation of bile.

Microscopic examination of bile sediment is especially important. It is believed that in a healthy person, the microscopic picture of sediment is almost the same in all three portions of duodenal contents. Normally, the sediment consists of single leukocytes, not large quantity epithelial cells, single cholesterol crystals and sodium oxalate crystals.

If a large number of leukocytes and mucus in the form of long twisted threads are found in the sediment, then this indicates an inflammatory process. If a large number of leukocytes, possibly stained with bile, and mucus are detected in portion B, it can be argued that there is an inflammatory process in the gallbladder itself. If a similar picture is present in portion C, then inflammatory process The intrahepatic bile ducts have already been affected (cholangitis has developed). If you find a large number of cholesterol crystals in portion B, you can think about the presence of gallstones.

Fractional duodenal intubation

A type of duodenal intubation is fractional duodenal intubation. The technique is similar to the method described above and consists of five phases.

Phase 1 – receiving a portion of bile from the common bile duct. The phase lasts about 20 minutes; transparent light yellow bile in a volume of 15-40 ml is obtained for examination. If bile is more than 45 ml, then this indicates hypersecretion or expansion of the common bile duct. If the amount of bile is less than 15 ml, then this may be a sign of hyposecretion or a decrease in the capacity of the common bile duct.

After 20 minutes from receiving bile, 30-50 ml of 25% magnesium sulfate solution, heated to 40-42 degrees, is injected into the probe, after which a clamp is applied to the probe.

Phase 2 - the clamp is removed, the end of the probe is lowered into the jar and the bile begins to flow. Normally, this interval should be 2–6 minutes; lengthening the phase indicates hypertonicity of the common bile duct or the presence of an obstruction in it.

Phase 3 - the time before the appearance of cystic bile, normally ranges from 2 to 4 minutes, 3-5 ml of light yellow bile is released, the remainder of the bile is from the common bile duct. Prolongation of this phase may indicate an increase in the tone of the sphincter of Oddi.

Thus, the bile obtained during the first and third phases constitutes portion A of classical duodenal intubation.

Phase 4 – recording the duration of gallbladder emptying and the volume of gallbladder bile. Normally, 30-70 ml of dark olive-colored bile is released in 30 minutes - portion B. It is believed that the rate of release of gallbladder bile should be 2-4 ml/min, if less, then this indicates hypomotor function of the gallbladder, and if more , then, accordingly, about hypermotor.

Phase 5 – obtaining liver bile (portion C). Normally, 15 to 30 ml of light yellow bile should be released within 20 minutes.

When is duodenal intubation contraindicated?

This method is contraindicated when acute cholecystitis, exacerbation of chronic cholecystitis, with varicose veins veins of the esophagus and stomach, with severe circulatory failure.

Gallbladder tubing

The insertion of a duodenal tube is also used for the tubage procedure. Gallbladder tubing is the stimulation of bile secretion in order to empty the bladder. The term itself comes from the French word tubage, which means “probe”.

Gallbladder tubing can be:

probe, when a probe is inserted into the duodenum according to the method described above;
tubeless or blind, if we take choleretic drugs for the purpose of bile secretion.

When is gallbladder tubing used?

Tubage can be used as one of the components complex therapy for biliary dyskinesia, cholestatic hepatitis, chronic acalculous cholecystitis, chronic pancreatitis and duodenitis.

Tubage of the gallbladder. Contraindications

Let us immediately note that this procedure is strictly contraindicated in the presence of gallstones: stimulation of bile secretion in this situation can lead to an exacerbation of the disease, the appearance of biliary colic, it is possible that stones from the gallbladder may enter the bile ducts with the development of obstructive jaundice.

In addition, this technique is contraindicated for all exacerbations chronic diseases gastrointestinal tract (pancreatitis, hepatitis, chronic acalculous cholecystitis, duodenitis, gastritis, in the presence of erosions or ulcers of the gastrointestinal tract). Probe tubing is also contraindicated in all conditions where duodenal intubation is not permitted (see above).

Therefore, treat your health with care. Very often, tubing in popular articles on the Internet is presented as an absolutely harmless procedure aimed at cleansing the body of toxins. However, as we have already understood, this is far from the case. Before performing tubage, be sure to perform an FGDS and consult a doctor. Be reasonable!

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Tubage of the gallbladder. Methodology

So, when all the examinations have been completed and the doctor’s permission has been received, you can begin the tubing procedure. First, we will discuss the method of performing probe tubing.

As with duodenal intubation, a probe is inserted into the duodenum. Three portions of bile are discharged. Next, either saline solution or mineral water, heated to a temperature of 35-45 degrees, is injected into the duodenal tube. Sometimes washing is carried out immediately after the passage of portion A. The volume of the washing solution is 250-500 ml. The procedure is performed once every five to seven days. The course of treatment lasts from one and a half to two months, then take a break for a month and repeat the course.

The method of performing probeless tubing is quite simple; it can be easily performed at home.

Probeless tubing is performed in the morning, on an empty stomach. At this time, according to human biorhythms, the greatest activity of the gallbladder is observed. The patient is placed on the couch on the right side, knees should be bent. Within thirty minutes, a person drinks a choleretic drug in small sips. Most often, two glasses of rosehip decoction, two glasses of corn silk, one glass of 25% magnesium sulfate, two glasses of mineral water heated to 40-45 degrees are used as a choleretic agent. A heating pad is placed on the area of the right hypochondrium - this is done to stimulate bile secretion. The duration of the procedure is one and a half to two hours. The appearance of stool with a greenish tint will tell us about the effectiveness of tubage. The stool may be liquid, you should not be afraid of this. The procedure is performed once a week, the course duration is three months.

We will answer your questions immediately.

What kind of mineral water can be used when performing tubage?

You can buy Borjomi, Smirnovskaya, Kislovodskaya. Mineral water should be still, so it is best to open a bottle of mineral water in the evening, leave it open overnight, and calmly carry out the procedure in the morning.

What else can be used as choleretic agents during tubage?

Yes, a lot. For example:

a mixture of mineral water and one spoon of olive oil;
infusion choleretic herbs. To prepare it, you need to take half a tablespoon of immortelle herb and half a tablespoon of corn silk, pour the resulting mixture with a glass of water, bring to a boil and leave for half an hour;
xylitol or sorbitol. Dilute one tablespoon of xylitol or sorbitol in a glass of warm mineral water.

Is it possible to combine probe and blind tubes?

Yes, it's possible. In this case, the probe tube is carried out once a month, and the probeless version - twice a week.

How long can tubing be performed for therapeutic purposes?

The duration of treatment can be very long; for example, with an atonic form of biliary dyskinesia, tubing can be carried out quite easily for several years.

Is it possible to perform gallbladder tubing to improve the health of the body?

In the absence of contraindications, it is quite possible. If there are signs of bile stagnation (cholestasis syndrome), gallbladder tubing is quite effective. Digestion improves, passes nagging pain in the right hypochondrium, overall health improves.

So, probing the gallbladder helps in the diagnosis and treatment of diseases of the biliary system. The tube is aimed at stimulating bile secretion in order to empty the gallbladder. The tubeless version of tubage can be used at home for the treatment and prevention of liver and gallbladder diseases.

Where is the gallbladder located? Photo of the gallbladder