Study of bile / Chapter 8 of section I of the book. Ishmanov M.Yu., Sertakova A.V., Solovyov A.M., Fedyashina N.A., Shcherbakova E.V. 250 health indicators. Directory. From “Scientific Book”, 2013.

Contraindications

Conditions in which this manipulation cannot be performed include:

• varicose veins of the esophagus
• obstruction of the esophagus (narrowing, diverticula)
• exacerbation of gastritis, gastric ulcer and duodenal ulcer
• stomach/intestinal bleeding and conditions after it
• oncological diseases of the gastrointestinal tract
• cholelithiasis (presence of movable stones in the gallbladder), surgery to remove the gallbladder
• chronic cholecystitis and/or pancreatitis in the acute stage
• aortic aneurysm
• cardiovascular failure
• decompensated diabetes mellitus
• asthma attack
• pathologies of the oropharynx, accompanied by impaired swallowing
• general serious condition of the patient
• pregnancy and breastfeeding period.

General characteristics of the anatomy and functioning of the liver and gallbladder

The liver and gallbladder form part of the digestive tract. In addition to participating in the digestion process, the liver is an organ of the immune system; in addition, it performs a protective function, partly the function of hematopoiesis, and most importantly, detoxification.

Anatomically, the liver is located in the abdominal cavity, it is formed by two parts - the left and right lobes. Most of the organ is located in the upper right part of the abdominal cavity. The left lobe partially passes into the left half of the abdominal cavity.

The liver is located under the diaphragm, its upper border is at chest level, it is convex and follows the shape of the diaphragm. The lower edge is 1-2 centimeters below the arch of the ribs, concave and in contact with other internal organs.

The right lobe of the liver is approximately 6 times larger than the left. The mass of the organ ranges from one and a half to two kilograms.

In the middle part of the internal surface of the organ, the hepatic gate is located - at this place the hepatic artery enters the liver, from there exit the portal vein and the hepatic duct, which removes bile from the liver.

The gallbladder is “hidden” under the gate of the organ - a small hollow organ 12 to 18 cm long, which is adjacent to the outer edge of the liver and lies on the duodenum. The structure of the bladder is represented by the bottom, body and neck, which passes into the cystic duct.

The liver is responsible for the secretion of bile, which breaks down fats, enhances intestinal motility and the action of pancreatic and intestinal enzymes. Bile also helps neutralize the acidic environment of the food bolus that leaves the stomach, promotes the absorption of cholesterol, amino acids, calcium salts and fat-soluble vitamins.

The liver is involved in all metabolic processes in the body - protein, fat, carbohydrates.

The organ also synthesizes hormones and stimulates the production of hormones by the adrenal glands, thyroid and pancreas.

In addition, the liver is a huge protective filter that neutralizes the effects of toxins, poisons, medications, and allergens.

Bile produced by the liver enters the gallbladder, where it accumulates until the food entering the body is digested.

Necessary preliminary studies

The duodenal intubation procedure, like any invasive, i.e. penetrating into the body, study is a serious procedure that requires the so-called tolerance to minimize possible complications. The task of the specialists of the EXPERT Clinic is to responsibly approach the issue of examination and the safety of its implementation.

Therefore, duodenal intubation is performed in patients only if:

1. referrals from a specialist who clearly assesses the validity of the procedure and the competence of its implementation for a specific patient
2. preliminary ultrasound of the gallbladder, which will assess the condition of the gallbladder and its contents. If there are stones or inflammation of the wall, the procedure can be extremely dangerous. Shelf life: 1 month.
3. FGDS, which is carried out to assess the condition of the mucous membrane of the stomach and duodenum, because the presence of inflammation, ulcers, or anatomical features may be a contraindication or impossibility of the procedure. Shelf life: 1 month.
4. An ECG, which will allow you to assess the presence or absence of risks of cardiovascular complications during the probing process, because The procedure lasts several hours with possible fluctuations in blood pressure, in particular. Shelf life: 1 month.

Classification

The most common cases in the diagnosis of gallbladder diseases are acute and chronic cholecystitis, bile duct dyskinesia, and cholelithiasis.

Cholecystitis

Based on the severity of symptoms and the course of the disease, acute and chronic forms of cholecystitis are distinguished.

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No special preparation is required for MRI of the head, spine, musculoskeletal system, soft tissues and male external genitalia.

• On the same day, an MRI is performed with contrast in only one area.
• The collection of biomaterial for research is performed before MRI.

Preparation for the procedure

Duodenal intubation is performed in the morning strictly on an empty stomach. Two hours before the procedure, it is permissible to take a few sips of plain water. Immediately before the procedure, you should not drink, smoke, or take medications. The oral cavity must be rinsed, the nasal passages cleaned, and dentures removed (if any).

Dinner on the eve of the procedure should be no later than 18.00. Products that cause gas formation are prohibited. This:

• fermented milk products
• black bread
• fresh vegetables and fruits
• legumes
• potato
• carbonated drinks, etc.

Taking medications is possible only with the permission of a doctor.

5 days before probing, you must stop taking medications:

• choleretic (allochol, cholenzym, liv-52, holosas, etc.)
• digestive enzymes (pancreatin, festal, panzinorm, etc.).

Organs of the abdominal cavity, retroperitoneal space

Liver, gallbladder, bile ducts (cholangiography), pancreas, spleen, kidneys, adrenal glands, retroperitoneal lymph nodes

The procedure is carried out strictly on an empty stomach (at least 8 hours after eating). The day before, it is necessary to exclude flour products, legumes, vegetables, fruits, whole milk, fermented milk products, fatty fish and meats, mayonnaise-based sauces, carbonated drinks, alcohol, candies, and chewing gum.

You can eat: boiled lean beef, chicken, horse meat, turkey, rabbit, baked, steamed or boiled low-fat fish, one hard-boiled chicken egg, water porridge (barley, buckwheat, oatmeal), low-fat hard cheese.

In case of increased gas formation, it is necessary to do a cleansing enema (1.5 liters of water at room temperature) within 6–8 hours and, if there are no contraindications, take enterosorbent: 1 tablet of activated carbon (500 mg) for every 10 kg of body weight.

• After gastroscopy, colonoscopy or endoscopic therapeutic and diagnostic studies, at least 2 days must pass.
• After an X-ray examination of the gastrointestinal tract with a barium suspension, at least 7 days should pass.

Methodology

Duodenal intubation is carried out with a disposable sterile probe, much smaller in diameter and more flexible than the probe for FGDS. Initial position of the patient: sitting with the chin pressed to the chest and the mouth wide open.

1. The end of the probe (olive) is placed on the root of the tongue and, at the moment of swallowing, is advanced into the esophagus and further into the stomach (it is recommended to breathe deeply).
2. Then the patient is placed on the couch on his right side, placing a small cushion.
3. The patient is asked to make a swallowing movement, while simultaneously advancing the probe into the duodenum. The accuracy of the actions performed is confirmed by the flow of golden-yellow liquid into the probe. So, within about half an hour, the first portion of duodenal contents of 15-40 ml is collected - portion “A”.
4. Then a substance that enhances secretion (xylitol, sorbitol, magnesium sulfate) is introduced into the lumen of the duodenum, and the lumen of the probe is clamped with a clamp. After 5-10 minutes, the instrument is removed, and dark green bile begins to flow into the probe. Portion “B” with a volume of about 60 ml is collected within 20-30 minutes.
5. When there is a noticeable change in the color of the liquid to bright yellow, they begin collecting portions “C” with a volume of 10-20 ml.

Upon completion of the collection of all types of portions (A, B and C), the patient is placed in a sitting position and the probe is carefully removed. If a bitter taste is felt in the mouth, the patient is offered to rinse with antiseptics or glucose solution.

Recommendations after the procedure

Eating is allowed 30-40 minutes after probing (light breakfast). Throughout the day, you must follow a diet with the exception of heavy foods - fatty, fried, spicy foods.

After the procedure, the patient’s blood pressure and pulse may destabilize, so it is advisable for him to remain in the ward or in the clinic lobby for an hour under the supervision of medical workers. It is also possible for the body to develop a response to the administration of magnesium sulfate in the form of diarrhea (loose stools).

Mammary gland

The study is carried out from the first “dry” to the 10th day of the menstrual cycle. MRI of the mammary glands is always performed with contrast (except for determining the viability of implants).

Breastfeeding is prohibited for 24 hours after the MRI. If you are breastfeeding, you must express milk before the test.

Duodenal sounding using expert-class equipment

Results of duodenal sounding

Duodenal sounding is a very informative diagnostic method for specialists.

• Studying the dynamics of bile secretion allows us to assess the functional state of the gastrointestinal tract. For example, acceleration or deceleration of the intake of portion “B” is usually observed with functional disorders of the gallbladder (dyskinesia), the release of bile more than 60 ml indicates congestion, and its complete absence indicates a possible obstacle to the outflow of bile (stone, tumor, inflammatory infiltrate , scar deformity, etc.).
• Laboratory analysis makes it possible to determine the presence of cholelithiasis, helminthic infestations, bacterial infections, as well as assess the exocrine function of the pancreas, the consistency of the sphincters and muscles of the gallbladder.
• In addition, duodenal intubation allows the administration of medications bypassing the stomach, which can be very important for some gastrointestinal pathologies. Also, the method of probing is used to introduce nutritional mixtures in the process of caring for “severe” patients.
• The results of this examination are decisive in the process of making a diagnosis and developing a conservative treatment regimen and very often allow patients to avoid serious surgery.

ECG in "Hemotest"

You receive the ECG results without decoding immediately. The ECG result with interpretation can be obtained in one of the convenient ways the next day: in any laboratory department and on-line (through your personal account).

No prior registration or special preparation for the study is required.

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• Delivery date: tomorrow

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Active ingredients

Milk thistle fruit extract

pharmachologic effect

Milk thistle (milk thistle) oil is a liver protector. Milk thistle is a vigorous plant with large purple-red inflorescences from the Asteraceae family. It is distinguished from other “relatives” by the “marble” pattern on the leaves, similar to drops of milk falling on them. Milk thistle (milk thistle) has been used for thousands of years to heal the liver. It contains the natural substance silymarin - a mixture of glycosides (silybin, silydianin, silychristin), which, first of all, helps the liver perform a detoxification function, including by increasing the level of antioxidant protection. The oil is rich in fat-soluble vitamins A, D, E, F, and is especially rich in vitamin E, the main antioxidant among vitamins. It is actively involved in neutralizing free radicals, which “break” many enzymatic reactions, causing irreparable harm to the body. Good results are shown by the use of milk thistle oil to restore the body in cases of alcohol poisoning, intestinal diseases and stomach ulcers.

Milk thistle oil is indispensable:

- in the process of weaning off alcohol and drugs;

- to eliminate side effects when taking medications that affect the liver;

— after completing a course of chemotherapy or radiation therapy;

— in the process of recovery after treatment of liver diseases;

- in homeopathy for diseases of the liver, gall bladder, spleen.

Milk thistle oil has a pronounced healing, analgesic, and choleretic effect.

Indications for use

Recommended as a biologically active food supplement - an additional source of polyunsaturated fatty acids (PUFAs).

• Gallbladder dyskinesia
• Cholelithiasis
• Cholangitis
• Cholesterosis
• Chronic cholecystitis

The gallbladder serves as a reservoir for bile produced by the liver. Her work is related to enzymatic reactions: participation in the emulsification of fats, weakening the effect of pepsin. Bile stimulates secretory activity and motility of the small intestine, and activates mucus production.

The gallbladder and ducts form the biliary system. Disorders of the functions of the biliary system are caused by a sedentary lifestyle, excess weight, an abundance of fried and fatty foods in the diet, hereditary factors, and specific anatomy (bends, adhesions of the gallbladder).