Study of duodenal contents

At present, the method of multi-stage fractional sounding is used to evaluate the functional state of the bile ducts, which allows solving the problem of the presence of pathology in various departments of the biliary tract and, in particular, dyskinesia. A laboratory study of the resulting bile helps to clarify the nature of the pathological process. When multi-stage fractional sounding, the bile is collected into individual tubes every 5 or 10 minutes, the time of expiration of each bile portion is recorded, and the amount of bile is recorded. The results are reflected in the diagrams. To obtain a bile from the gallbladder (portion B) as a stimulant, a 33% solution of magnesium sulfate (50 ml) is usually used. Magnesium sulphate, like cholecystokinin, causes a reduction in the gallbladder.

The amount of bile and biliary phase

I phase - bile A - the contents of the duodenum before the introduction of the stimulus; Within 20-40 minutes 15-45 ml of bile are allocated. The decrease in the amount of bile secreted in the I phase indicates hypoxecretion, and the isolation of a lighter bile is observed with lesion of the hepatic parenchyma, impaired patency of the common bile duct. Hypoecretion in this phase is often observed with cholecystitis. Hyper secretion is possible after cholecystectomy, in the phase of incomplete remission of exacerbation of cholecystitis, with a dysfunctional gallbladder, with hemolytic jaundice.

Intermittent selection indicates a hypertonic sphincter of Oddi (duodenitis, angiocholite, stones, malignant neoplasm). Portion A may be absent in the midst of viral hepatitis.

II phase (sphincter of Oddi is closed) - the time of absence of bile from the moment of introduction of the stimulus to the appearance of bile A ₁ - 3-6 minutes.

The shortening of the II phase may be due to the hypotension of the Oddi sphincter or the increase in pressure in the common bile duct. Elongation of it may be due to hypertension of the sphincter of Oddi, stenosis of the duodenal papilla. The slowing of the passage of bile through the cystic duct, in particular in cholelithiasis, also causes the elongation of this phase.

III phase - bile A ₁ - the contents of the common bile duct; 3-5 ml of bile is released within 3-4 minutes. Lengthening of the III phase up to 5 min can be observed with atony of the gallbladder or its blockade of spastic or organic origin (stones in the gallbladder). The amount of bile fraction A ₁ decreases with severe lesions of the liver and increases with the expansion of the common bile duct.

IV phase - bile B - the contents of the gallbladder; 20-50 ml of bile are released within 20-30 min. Acceleration of the time of allocation of bile B testifies to hypermotor dyskinesia of the gallbladder while maintaining its normal volume. Prolonged bile secretion, intermittent excretion of it with an increased number is observed with hypomotor dyskinesia of the gallbladder. Reduction of the amount of bile extracted indicates a decrease in the volume of the gallbladder, in particular with cholelithiasis, sclerotic changes in the gallbladder.

The fraction of bile B is absent when:

• blockage of the cystic duct with stone or neoplasm;
• violation of the contractility of the gallbladder due to inflammatory changes;
• loss of gallbladder ability to concentrate bile due to inflammatory changes;
• the absence of the so-called "bubble" 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 dyskinesia of bile ducts.

V phase - "hepatic" bile, portion C - flows continuously while the probe is standing; Slow discharge is noted with lesion of the hepatic parenchyma.

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

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

[1], [2], [3], [4], [5], [6], [7], [8], [9],