Examination of duodenal contents

Currently, the method of multi-stage fractional probing is used to assess the functional state of the biliary tract, which allows us to resolve the issue of the presence of pathology in various parts of the biliary tract, including dyskinesia. Laboratory testing of the obtained bile helps to clarify the nature of the pathological process. With multi-stage fractional probing, bile is collected in separate test tubes every 5 or 10 minutes, the time of flow of each portion of bile and its amount are recorded. The results are reflected in diagrams. To obtain a portion of bile from the gallbladder (portion B), a 33% solution of magnesium sulfate (50 ml) is usually used as a stimulant. Magnesium sulfate, like cholecystokinin, causes contraction of the gallbladder.

The amount of bile and the phases of bile secretion

Phase I - bile A - the contents of the duodenum before the introduction of the irritant; 15-45 ml of bile is secreted within 20-40 minutes. A decrease in the amount of bile secreted in phase I indicates hyposecretion, and the secretion of lighter bile is observed with damage to the liver parenchyma, obstruction of the common bile duct. Hyposecretion in this phase is quite often observed in cholecystitis. Hypersecretion is possible after cholecystectomy, in the phase of incomplete remission of exacerbation of cholecystitis, with a non-functioning gallbladder, with hemolytic jaundice.

Intermittent discharge indicates hypertonicity of the sphincter of Oddi (duodenitis, angiocholitis, stones, malignant neoplasm). Portion A may be absent at the height of viral hepatitis.

Phase II (the sphincter of Oddi is closed) - the time of absence of bile from the moment of introduction of the irritant until the appearance of bile A ₁ - 3-6 min.

Shortening of phase II may be due to hypotension of the sphincter of Oddi or increased pressure in the common bile duct. Its lengthening may be associated with hypertonicity of the sphincter of Oddi, stenosis of the duodenal papilla. Slowing down the passage of bile through the cystic duct, in particular in cholelithiasis, also causes lengthening of this phase.

Phase III - bile A ₁ - the contents of the common bile duct; 3-5 ml of bile is secreted within 3-4 minutes. An extension of phase III to 5 minutes can be observed with atony of the gallbladder or its blockage of spastic or organic origin (gallstones). The amount of bile fraction A ₁ decreases with severe liver damage and increases with expansion of the common bile duct.

Phase IV - bile B - gallbladder contents; 20-50 ml of bile is secreted within 20-30 minutes. Acceleration of the time of bile secretion B indicates hypermotor dyskinesia of the gallbladder while maintaining its normal volume. Prolonged secretion of bile, intermittent secretion with an increased amount is observed with hypomotor dyskinesia of the gallbladder. A decrease in the amount of bile secreted indicates a decrease in the volume of the gallbladder, in particular with cholelithiasis, sclerotic changes in the gallbladder.

Bile fraction B is absent in:

• blockage of the cystic duct by a stone or neoplasm;
• disruption of the contractile ability of the gallbladder due to inflammatory changes;
• loss of the gallbladder's ability to concentrate bile due to inflammatory changes;
• the absence of the so-called "bladder" reflex, that is, the emptying of the gallbladder in response to the introduction of conventional stimulants, which is observed in 5% of healthy people, but can also be caused by biliary dyskinesia.

Phase V - "hepatic" bile, portion C - flows continuously while the probe is in place; slow flow is observed when the liver parenchyma is damaged.

A complete absence of all portions of bile during probing with the correct position of the probe olive in the duodenum may be a consequence of:

• compression of the common bile duct by a stone or neoplasm;
• cessation of bile excretion function in severe lesions of the liver parenchyma.

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