Duodenal sounding: evaluation of results

(According to Nazarenko GI, Kishkun AA Clinical evaluation of the results of laboratory studies. -M.: Medicine.-2000.-P.100-102)

Duodenal sounding is used to study the condition of the duodenum (duodenum) and the bile excretory system. In this laboratory study, a special probe is inserted into the 12-colon through the mouth with an olive on the end, bile is extracted from the probe, which is collected into tubes in a certain sequence. The study is performed only on an empty stomach in specialized offices of polyclinics or hospitals, diagnostic centers. More often in the analysis of bile, obtained by sounding, describe three portions of bile - A, B and C. In some laboratories, multi-stage fractional sounding is carried out with the collection of bile in separate test tubes every 5-10 minutes. To obtain a portion of bile from the gallbladder (portion B), a magnesium sulfate solution, sorbitol or other agents is used as the stimulant.

Physical and chemical properties of bile

The color of the bile is normal: portion A (from the duodenum) is golden yellow, amber. Portion B (from the gallbladder) - rich yellow, dark olive, brown. Portion C ("liver") - light yellow.

Color change occurs with inflammatory processes in the 12 duodenal ulcer, violation of cholic outflow due to dyskinesias or bends of the bladder, stones, tumors, enlargement of the head of the pancreas, etc.

Transparency. Normally, all bile portions are transparent. A small turbidity in the first minutes of sounding is associated with an admixture of hydrochloric acid and does not indicate an inflammatory process.

Reaction (pH ). Normally, Serving A has a neutral or basic reaction; Portions B and C are basic (alkaline).

Density . Portion A - 1002-1016 (sometimes they write 1.002-1.016). Portion B - 1016-1032. Portion C - 1007-1011. Density changes may indicate a thickening of bile, cholelithiasis, impaired liver function.

Bile acids . In a healthy person, the content of bile acids in portion A is 17.4-52.0 mmol / l, in portion B - 57.2-184.6 mmol / l, in portion C - 13.0-57.2 mmol / l .

Cholesterol. The norm in portion A is 1.3-2.8 mmol / l, in B - 5.2-15.6 mmol / l, in C - 1.1-3.1 mmol / l.

Bilirubin ( according to the method of Jendrashek, mmol / l): in A - 0,17-0,34, in B 6-8, in C - 0,17-0,34.

Microscopic examination of bile

Normal bile contains no mucosal cells. Sometimes there is a small amount of crystals of cholesterol and calcium bilirubinate.

Slime in the form of small flakes testifies to signs of inflammation.

Erythrocytes are of great diagnostic value, since they can be associated with traumatization of the mucous membrane during passage of the probe.

Leukocytes . Increased their content allows you to clearly identify the localization of the inflammatory process, depending on which portion of bile they prevail.

Epithelium (cells of the mucous membrane). Elevated epithelium content of a certain type also indicates the location of the lesion.

Cholesterol crystals . Are present at disturbance of colloidal properties of bile and propensity to stone formation.

Sterility . Normal bile is sterile. With parasitic disease in bile, there are vegetative forms of lamblia, eggs of helminths.