Questioning and examination of Questioning and examination of patientspatients

with with gastrointestinal tract disordersgastrointestinal tract disorders

Propedeutic of internal medicine

PhD, assistant Zozuliak N.V.

Analysis of publications in recent years clearly shows that the incidence of the digestive system diseases increases, especially in developed countries. These trends are due to several reasons. First and foremost is the impact of such pathogenic factors such as chronic stress, allergy , the impact of negative factors, environmental factors (health and safety characteristics of water, air , eating canned food), and the resultant change in the body's immune properties of modern man. It was found that chronic gastritis wasdiagnosed in 50 % of the adult population, duodenitis in 70-90 % of patients with gastroenterological diseases.

1 2

3

Аnathomy of the GITAnatomical features of the digestive tract

Topographic anathomy of the abdomenAnatomical landmarks stomach

Horizontal topograhic lines

l. costarum – connects the lower edges of costal arches

l. spinarum – connects the front upper iliac bones

еpigastrium

mesogastrium

hypogastrium

Parts of the anterior abdominal wall(by M.D. Strazhesko)

regio iliaca dex.

regio epi-

gastrica

regio hypochondrica

dex.

regio paraumbilicalis

regio abdominalis

dex.

regio supra-pubica

regio hypochondrica sin.

regio abdominalis sin.

regio iliaca sin.

Pain

syndrome of gastric dyspepsia (disorders of appetite, bad taste in the mouth, bad breath, belching, nausea, heartburn, vomiting)

syndrome of intestinal dyspepsia (disorders of stool - diarrhea or constipation, bloating, rumbling, increased gas emission (meteorism), tenesmus)

complaints related to liver disfunction (jaundice, skin itching, etc.)

hemorrhagic syndrome

Complains during digestive tract disorders

Features of the pain: location, in spread pain - location of maximum pain

sensation

Irradiation

Character (burning, squeezing, knife-like)

Duration

provocation of the pain (food intake, changes in diet, hunger, some body position, weight lifting, jumping in after bumpy ride) and after how many minutes?

determine whether there is or not a growing pain in a certain body position, what relieves the pain, describe other symptoms that precede the pain, occur during or after the pain (nausea, vomiting, flatulence, defecation)

Topography of the abdominal organs lesions • stomach (large curvature)  • spleen  • tail of the pancreas  • splenic angle of the colon  • the upper pole of the left kidney

right hepatic lobe  • gallbladder  • hepatic angle of the colon    transverse  • the upper pole of the right    kidney

liver (left lobe and small    part of the right lobe)  • stomach (body and pylorus)  • upper half of duodenum  • Pancreas  • aorta

descending colon  • part of the small intestine loops  • lower pole of the left kidney

• ascending colon • small intestine • lover pole of the left kidney

sigmoid colon  • loops of small intestine  • left ureter  • Left Ovary

* appendix  • iliac intestine  • cecum * The right ureter  • The right ovary

lower horizontal part of the duodenum  • transverse colon  • cecum and ileum  • right kidney (medial part)  • aorta

8

loops of small intestine  • bladder (upper half)  • part of the sigmoid colon  • uterus

7 9

6

32

5 4

1

Esophagus (acute inflammatory lesions of the mucous membrane, heartburns)

located along the course of the esophagus or behind the breastbone

irradiation to the shoulder, lower jaw, interscapular region

closely associated with the food intake

increases or decreases during swallowing

PAIN

Stomach: main reasons of the pain occurence

spasm strain disturbances in the motor function transition of the inflammation to the peritoneum

PAIN

Spastic contraction of the muscles of the stomach → periodic pain

Irritation of the nerves of the stomach → permanent pain Increased tone of the n. vagus - ↑ acidity of the stomach

juice. The pain occurs in different time period: early (30-40 min), late (1.5-2 h), night pain. Improvement after vomiting - release of acidic content.

Seasonality of pain - the occurence or exacerbation at autumn or spring.

Connection with food intake: Increased pain after taking spicy, salty food

Stomach pain irradiats to the back, shoulder, lower interscapular area, left hypochondrium.

Pain in the stomach

Stomach:Character of pain (feeling of tension,

overflow, heaviness, swelling, drilling, burning)

- Pulling pain - as a result of stretching. - Paroxysmal (colic) - spasm of the

pylorus. - During ulcer perforation is observed a

sharp pain (occurs suddenly, piercing the belly, “knife-like")

Pain

Stomach: More higher ulcer location is characterized by lesser time interval of pain occurrence after food intake

Ulcer of cardiac part of stomach and small curvature – pain occurs after 15-20 min;

Ulcer of the big curvature – pain occurs after 30-45 min; Ulcer of the antrum – after 1-1,5 hours; Ulcer of duodenum - 2 hours after food, often – in the

night.

Pain

Intestinal Pain differs from the stomach:

is independent from eating time There is connection with the act of defecation (increases before and

during defecation, decreasing after defecation)

Character Spastic pain - spasm - short-term Distensional pain - stretching – long-term

Location right iliac area - appendicitis, an inflammation of the cecum

(typhlitis) left iliac area - sigmoiditis, intestinal obstruction around the navel - enteritis. in the perineum - diseases of the rectum. irradiation depends on the part of the intestine

Pain

Pancreas

Head - the pain is localized in the epigastric region from the right Body - in the epigastric region from the left Tail - left upper quadrant The whole pancreas - encircling pain, upper abdominal pain

Features of the pain

intense, most pronounced in hemorrhagic pancreatitis, pancreatic edema

irradiating to the left half of the body - left upper quadrant, shoulder, arm, waist

due to stretching of the capsule, increased pressure in the duct, irritation of the parietal peritoneum that covers the pancreas

Pain

Печінка, жовчовивідні шляхи– ураження / розтягнення Гліссонової капсули – запалення жовчного міхура і жовчних протоків, а

також при їх розтягненні та спазміПатологічні процеси паренхіми можуть не даватибольових відчуттів

локалізується в правому підребер’ї, пов'язаний з вживанням їжі (жирної чи смаженої) та глибоким диханням.

особливо гострий біль при спазмі м’язів жовчного міхура, проток чи закупорці їх каменем (жовчна або печінкова коліка).

характер болю: колючий, ріжучий. іррадіює в ділянку правого плеча, праву лопатку, праву

половину шиї

БІЛЬLiver, Gallbladder

– Damage of the Glissons capsule – Inflammation of the gallbladder and bile ducts, and

during them distension or spasmN.B! Pathological processes in parenchyma do not cause

pain sensations

Features: Is localized in right hypochondrium, is connected with food intake в

(fat or fried food) and deep breathing. Especially acute pain occurs in case of gallbladder or it's ducts

spasm or stone formation (liver colic). Character of pain: piercing, knife-like. Irradiates to the right shoulder, right part of the neck

Pain

disorders of the swallowing act : can not to swallow or it is paintfull  disturbed promotion of the food in the pharynx and along the esophagus  discomfort feelings, associated with delayed food in the pharynx and esophagusOften patients should drink water after taking food.

Reasons:functional restriction - dysphagia occurs periodicallyorganic - increases gradually and progresses                    Paradoxical dysphagia – patient can eat solid food, and cannot - liquid food

Dysphagia

Burning sensation of the patients behind a sternum, in epigastric area.

Occurs due to the irritation of the esophagus by an acid stomach juice due to the reflux.

Heartburn (pyrosis)

discharge of air from the mouth, which was accumulated in the stomach (eructatio) or air with food (regurgitatio);

caused by contraction of the muscles of the stomach and simultaneous relaxation of the lower esophageal sphincter

The smell of rancid oil (due to oil and lactic acid ) due to the development of fermentation processes regurgitation with the smell of rotten eggs - gastritis with secretory  failure;Rotten, putrid belching before food intake - pyloric stenosis ; regurgitation with unbearable odor occurs in a case of fistula formation between the stomach and colon ;Acidic regurgitation is observed in increased acid formation in stomach Bitter taste may be associated with throwing bile into the stomach (duodeno-gastral reflux).

Belch (відрижка)

shows involvement in the pathological process of the phrenic nerve

Reflector hyper function (n. vagus )Salivatory glands due to the esophageal receptors irritation

Hiccup

Hypersalivation

reflex associated with n.vagus irritation

- Shows an unpleasant feeling of pressure in the epigastric region, general weakness, increased salivation and sweating, dizziness, decreased blood pressure, pale skin

- Often precedes vomiting, but can occur without it

- - Nausea often observed in diseases of the biliary tract

- Nausea can be caused by toxic drugs, toxins produced in the body in uremia, diabetes, burns

- - Reflex nausea may occur during stimulation of the tongue, throat, pharynx, trachea, vomiting center in the brain

Nausea

complex reflex due to excitation of the vomiting center, during which occures release of stomach contents through the esophagus, throat, mouth, sometimesnasal cavity

Reasons of the vomiting  central  haematogenic-toxic  visceral or reflectory

Vomiting which is not connected with the stomach diseases:  - is not associated with food intake  - is not preceded by nausea  - is repeated and do not brings relief  Reasons: medicines, infectious diseases, pregnancy, brain tumor

Vomiting, (emesis)

morning vomiting with a lot of mucus and saliva - chronic gastritis

a few minutes after eating - narrowing of the esophagus, ulcer of the stomach cardia

2-3 hours. after eating - chronic gastritis, peptic ulcer disease, gastric atony of muscles

stagnant vomiting, in vomit mass there is a residues of 1-2 days ago food – pylorus stenosis

a small amount of vomiting - stomach neurosis.

Acid vomiting mass - hypersecretionputrid smell - the disintegration of the tumorammonia smell - uremic gastritis, renal failureAlcohol odor - acute alcohol poisoningfecal vomiting - during intestinal obstruction

Vomiting (emesis)

Impurities in the vomiting mass, mucus (gastritis), bile (reflux from the duodenum to the stomach), pus (abscess), blood, worms.

Blood in vomiting mass

- Bloody vomiting (haematemesis, "coffee grounds") due to the formation of chloride hematin, which has a brown color and is formed by the interaction of hemoglobin with HCl- With hypo- and anacid blood is not changed in vomiting mass - Vomiting by the not changed blood due to the esophageal bleeding in a case of portal hypertension (cirrhosis)- An admixture of blood can be in the case of ingestion in cases of bleeding from the gums, nose

Vomiting (emesis)

Порушення апетиту

anorexia – loss of appetite due to decreased excitability of food center

loss of appetite can be selective - aversion to meat dishes - during gastric secretory function reducing

forced refusal of food: citofobia - refusal to eat food because of fear of pain (pancreatitis)

increased appetite bulimia (bulimia means: bus - buffalo, limos - hunger)

distortion of appetite, passion to chalk, graphite, coal – at anemia, pregnancy, hysteria . This condition is called pica or parorexia

Apetite disorders

desire to defecate, accompanied by sharp pain and spasms in the rectum, whicjh are completed by incomplete release of intestinal contents or without defecation.

During tenesmus occurs spastic contraction of the smooth muscle of the colon (rectum and sigmoid).

Tnesmus (teino - strain, stretch; tenesmus - unsuccessful desire to defecate; colica rectalis)

Meteorism is a medical condition in which excess gas accumulates in the gastrointestinal tract and causes abdominal distension

The digestive tract always contains a large amount of air and gases: an average amount is 900 cm3, under certain conditions, this number increases

Flatulence occurs in a case of:

- enhanced gas production in the intestine in the use of products that contain high amounts of fiber and starch (beans, cabbage, potatoes, black bread)

- excessive swallowing air (aerophagia)

- violating of the gas emission from intestine (atony, ileus)

- digestive disorders in the intestine due to insufficient enzyme production, violation of the intestinal microflora (dysbiosis)

- hysteria (psychogenic flatulence).

it is sounds in the stomach, they can be heard at a distance from the patient that occur during the passage of gas through relatively narrowed intestine.

Diagnostic value of grumbling is that it points on a combination of flatulence with difficulty of fecal passage through the intestines - spastic character.

Intestinal growl (borborigmus)

- the presence of bright red blood in the stool - ulcerative colitis, intestinal tumors, fissures, hemorrhoids (bleading from the lower part of intestines)

- Black stool - melena - bleeding from the stomach, upper parts of intestine

- The allocation of a large number of bright red blood - bleeding below the left colon flexure

Intestinal bleading

is rapid (more than 2 times per day) bowel movement with the release of liquid or soft excrements.

Diarrhea is a symptom of many diseases of internal organs:

  - intestinal infections (dysentery, cholera)  - inflammatory bowel disease (enteritis, colitis)  - other diseases of the digestive system (chronic pancreatitis, hepatitis and liver cirrhosis, disease of the biliary ways)  worms,  - poisoning by salts or heavy metals (mercury, lead and others.)  - endogenous intoxication (chronic renal failure)  - endocrine diseases (hyperthyroidism, insufficiency of adrenal glands)  - vitamins insufficienty,  - food allergies.

Diarrhea (diarrhoea)

The mechanism of diarrhea occurrence is complex and includes several pathogenetic parts:

- increasing osmolarity of intestinal content (for example, during taking laxatives)- increased secretion of water and electrolytes by epithelial cells of the small intestine (in case of cholera)- disturbance of digestion and absorption in the intestine (especially after extensive resection of the small intestine)- disorders of motor function of the intestine with the acceleration passage of intestinal contents- inflammatory changes of the intestinal mucosa

Diarrhea (diarrhoea)

There are such types of diarrhea- enteric - colitical

Enteral diarrhea have next features:

- lower frequency (not more than 4-5 times a day)- a significant volume of stool- is a manifestation of maldigestione syndrome (impaired digestion in the wall and cavity) and malabsorption (malabsorption) that occurs in various diseases of internal organs

Colical type of diarrhea is characterized by : - greater frequency (10 times or more per day)

- the release of a small amount of feces (often mixed with mucus and blood)- usually accompanied by cramping abdominal pain and tenesmus

Diarrhea (diarrhoea)

In a case of violating of the splitting and absorption of proteins occurs liquid stool dark color with alkaline reaction (due to the formation of ammonia) containing particles of undigested food with disgusting putrid smell, muscle fibers (creatorrhea) and connective tissue - putrefactive dyspepsia. In addition to intestinal methane also are formed hydrogen sulfide, indole, skatole and other products.

In a case of violating of the splitting and absorption of carbohydrates in combination with the activation of gut fermentation appear frothy mushy stool with acidic reaction, containing a significant amount of starch grains (amylorrhea) and iodinophilic microflora - fermentation dyspepsia. Stool is light yellow, defecation is not more than 5-6 times a day. Pain arise long before a bowel movement, are dull and not very intense, accompanied by rumbling. Flatulence is marked with a large amount of gas.

In a case of violating of the splitting and absorption of fats occurs their active excretion in the feces (steatorrhea) - fatty dyspepsia. Patients complain of bloating, rumbling, frequent liquid stools. Stool is usually light, with neutral or alkaline reaction.

Diarrhea (diarrhoea)

slowing of the intestinal emptying more than 2 days (in severe cases 5-7days). The water content in the stool decreases, it becomes harder, looks like "Sheep feces."

Constipation can be caused by various reasons:- alimentary - deficient fiber, liquid content in diet; fasting- so-called "conventional" constipation are associated with the weakening of the fefecation reflex - in a case of sedentary lifestyle, prolonged supine position, with the weakening of the abdominal muscles- neural – occurs in a case of spastic colon (or hyperkinetic or spastic constipation) or reducing of its motility (hypokinetic or atonic constipation)- proctogenic constipation - patients suffering from hemorrhoids- when taking certain medications (antacids)- endocrine diseases (myxedema)- constipation associated with organic diseases of the intestine, abnormal development (dolichosygma, megacolon), tumors of colon, diverticuls, intestinal obstruction due to adhesive process of the intestines (after surgery)

Obstipation (obstipatio)

Through history should be taking by common scheme, it is necessary to clarify:

- how disease began (acute, gradually);- the sequence in which complains appeared;- connection with food intake, the act of defecation;- tolerance of certain food products;- how patient nutrition affect the condition of the patient;- check the medical records – data of ultrasound (presence of stones in the gall bladder), previous endoscopic, radiologic studies;- Previous use of drugs (prolonged use of antibiotics can cause diarrhea and bloating, NSAIDs cause erosive lesions of the digestive tract, hormonal contraceptives cause biliary dyskinesia)- the nature of the treatment, its effectiveness.

case history

Doctor have to find out : regime and the nature of food intake use of a large number of fatty meat in combination with alcohol -

the risk of acute pancreatitis ; stress - important in the development of peptic ulcer ; Smoking - promotes diseases of stomach and duodenum ; hereditary factor ( cholelithiasis , peptic ulcer, hereditary

disease - congenital benign hyperbilirubinemia ); pay attention to surgery on abdominal organs, previous

diseases, helminths; contact with patients with jaundice in the last month or a history

of parenteral interventions over the last six months ; Occupation of the patient can also help in establishing the

diagnosis : the drivers are prone to diseases of the stomach and duodenum, is due to irregular eating and stressful nature of the work;

Professional intoxication ( lead, arsenic, mercury, gasoline vapors);

use of chemical and herbal poisons ( alcohol substitutes, mushrooms).

Anamnesis of the life

- pale skin indicates cancer, anemia (after bleeding, iron malabsorption or insufficient production of hematopoietic factors by gastric glands)- signs of itching- jaundice (icterus)

General view of the patient

Skin and mucous membrane

cahexia

Patients with gallbladder disease often have cholesterol deposits on the eyelids (xanthelasma) and skin (xanthoma).

At the review can also be noted the presence of: -Telangiectasia - spider navi - Hyperaemia of the tenar (palmar erythema or "liver palms“)-in men can be observed, gynecomastia (breast enlargement) These are all symptoms associated with hyperestrogenemia.

Skin and mucous membrane

gynecomastiaTelangiectasia

Palmar erythema

spider navi

Is performed in a vertical and horizontal position of the patient

Doctor should pay attention to:

condition of skindevelopment of subcutaneous veinsstate of the navelthe shape of the abdomensymmetrysize, presence and character of the rash on the skinthe presence of postoperative scarsvisible pulsations

Examination of the abdomen

-

Striae Scars

Ascitis Caput Medusae

caput Medusae

Gastric dyspepsia: nausea, vomiting, heartburn, regurgitation, distortion appetite.

Intestinal dyspepsia, flatulence, disorders stool (diarrhea, constipation).

Liver and biliary tract diseases are characterized by fatty indigestion (or soap) depends on fat digestion disorders. One of its causes is the rapid transition of food through the small intestine, lack of lipolytic pancreatic function, and violation of the flow of bile into the intestine.

Syndrome fermentation dyspepsia - indigestion in the colon. In the analysis, mushy stool, yellow color, with acidic reaction, a small amount of soaps and fatty acids; planty of starch, digested fiber and iodinophillic flora

Syndrome putrefactive dyspepsia - indigestion in the colon. In the fecal analysis, mushy stool with alkaline reaction and putrefactive smell; increased amount of fiber; increased ammonia content

Main syndromes

Malabsorption syndrome - clinical syndrome caused by malabsorption through the mucous membrane of the small intestine of one or more nutrients.

Maldigestion syndrome - clinical syndrome caused by indigestion of food particles required for absorption, which leads to malabsorption in the intestines through the intestinal wall

Main syndromes

jaundice syndrome

Hemorrhagic syndrome: bleeding gums, nosebleeds, skin hemorrhages.

Cholestatic syndrome: persistent have itching, jaundice, skin pigmentation, ksantelazms.

Intrahepatic cholestasis - lesions of hepatocytes.

Extrahepatic cholestasis, compression or inflammation of the liver ducts from inside by stone or from outside (tumor of the pancreas).

Hypersplenism syndrome, liver enlargement, anemia.

Portal hypertension – caput medusae

Main syndromes

INSTRUMENTAL METHODS OF gastrointestinal tract and kidneys

investigation

X-ray examination of the stomach Plain radiograph of the abdomen Іrrigoscopy Computer tomography

Gastric probing PH metryDuodenal probing

INSTRUMENTAL METHODS OF THE GASTROINTESTINAL TRACT ARE divided into:

Endoscopic:

EsophagogastroduodenoscopySigmoidoscopyFibrokolonoscopy

X- ray:

Probe methods: Sonographic:

Ultrasound of the abdomen

Fibroezophagogastroduodenoscopy

a review of the mucous membrane of the esophagus, stomach and duodenum using an endoscope, which is administered to the patient after anesthesia of the pharynx

Research of the mucosa membraine

Determination of pH Biopsy → morphological

study (diagnosis of the forms of chronic gastritis, gastric cancer)

Possibility of introducing drugs

Opportunity to stop the bleeding in the stomach or duodenum

Fibroezophagogastroduodenoscopy

OBJECTIVE:

- Fibrogastroduodenoscopy is performed at the morning on an empty stomach, emergency - at any time

- - At first anestesia of the throat and esophagus is performed by 3% solution of dicaine

- -The patient is placed on the left side- -Inserted into the mouth and injected sterile mouthpiece probe

- Before examining the patient for 2 hours should not eat, drink, smoke, and

- if biopsy was performed, patient can not eat that day a hot meal

Prepare patient for examination

Normal mucous membrane

Rectoromanoscopy (RRS)

With rectoromanoscop can be examined the colon mucosa to a depth of 30-35 cm from the anus.

Method of the endoscopic examination of the rectum and distal sigmoid, investigation of their inner surface with rectoromanoskop introduced through the anus.

Indications:- pain in the anus- discharge of blood, mucus or pus- violation of stool (constipation, diarrhea)- suspected cancer of rectum or sigmoid

Contraindications:No absolute contraindications.Relative contraindications are:  - cardiac decompensation  - severe general condition - narrowing of the rectum  - acute inflammation of the anus  - stenosing tumor of the anal canal

Rectoromanoscopy (RRS)

Preparing to RRS

An important condition for RSS is a thorough colon cleanse from the content. At the evening before investigation diet is prescribed - just tea is allowed . Investigation is performed on an empty stomach.- In the evening and 2 hours before investigation cleaning enemas are used.

Rectoromanoscopy (RRS)

Normal mucous membrane

РЕКТОРОМАНОСКОПІЯ (RRS)

RRS зазвичай виконується в колінно-ліктьовому положенні пацієнта. При виражених болях в області заднього проходу RRS проводять під місцевою або загальною анестезією.У анальний канал вводять ректоскоп і поступово просувають його вперед при подачі повітря для розправлення просвіту кишки.Після видалення обтуратора ректоскопа під контролем зору його проводять вгору до сигмоподібної кишки.При RRS можна провести біопсію для гістологічного дослідження. Показання до біопсії є: наявність поліпів, пухлини, виразок, інфільтратів.

Colonoscopy

   

  

 

   

     

Method of endoscopic investigation of colon

Colonoscopy is the most informative method of early diagnosis of benign and malignant tumors of the colon, ulcerative colitis, Crohn's disease allows to inspect 80-90% of the colon.It is possible also to perform various therapeutic manipulation - removal of benign tumors, stop the bleeding, extracting of the foreign bodies, recanalisation of bowel stenosisПоказання:підозра на пухлинузапальні захворюваннях товстої кишки (особливо неспецифічний виразковий коліт, хвороба Крона)кишкові кровотечікишкова непрохідністьнаявність сторонніх тіл

Протипоказання:гострі інфекційні хворобиперитонітпізні стадії серцевої та легеневої недостатностівиражені порушення згортання кровіважкі форми виразкового та ішемічного коліту

The success of the research depends on correct preparation for the procedure.At the evening before research should be performed two cleansing enemasIn the morning before study should be done the same two enemas3-4 days before investigation should be prescribed a diet, excluding from the diet fresh fruits and vegetables, brown bread, cabbage in any form

ColonoscopyPreparation

Colonoscopy

Normal mucous membrane

X-ray investigation of stomach

Indications:

- Dysphagia- Complaints: heartburn, belching, loss of appetite, abdominal pain, nausea, vomiting- stomach ulcers or tumors- weight loss- The presence of seals abdominal palpation- ascites- anemia of unknown ethiology

- the presence of occult blood in the stool

makes it possible to investigate the shape, size, position, mobility of stomach, ulcer, localization of tumors, relief of the stomach, damage or lack of folds, a symptom of "niche" (ulcers), "filling defect" in a case of tumors.

X-ray of stomach

Pefformed on an empty stomach2 - 3 daysbefore investigation should be removed from the patient's diet foods that cause flatulence (beans, cabbage, potatoes, black bread)Dinner before the test should be light, not later than 20:00.Immediately before the test patient drink 200 ml of a mixture of barium

Preparing

Normal

symptom of "niche“ULCER

CANCER

IrrigoscopyX-ray examination of rectum and colon, allows to determine the localization of the pathological process, the presence of diverticuls

and evaluate the functional capacity of the intestine.

Indications:

bloatingdiarrheaconstipation blood in the stoolweight loss

Preparing – cleaning enema, diet

Normal

Cancer

рН-metryThe method of gastric secretion determination

The clinical significance of pH metery: it is the best diagnostic method of functional disorders, acid-dependent diseases, in the digestive tract diseases, allowing in all cases, especially when combined pathologies develop an adequate treatment strategy and monitor the progress of treatment

рН Stomach

body

рН Antral part

hyperacidity < 1,6 < 2,1

Normoacidity 1,6-2,3 2,1-3,0

Hypoacidity > 2,3 > 5,9-6,0

рН-metry

Duodenal probingDuodenal probingResearch of duodenal content that is performed to investigate the bile to detect lesions of the biliary tract and gall bladder

The patient is siting with opened mouthThe probe is introduced that olive was at the root of the tongue, and we offer the patient to swallowWhen the probe, according to the marks, must be in the stomach, its position shoud be checked by aspirating of gastric content by syringe: muddy liquid with acid reaction. The liquid may be yellow in the case of throwing to the stomach contents of the duodenum, but the reaction should be acidicWhen the probe is in the stomach, the patient is placed on the right side that olive was mooved to pylorusThen the patient continues to swallow slowly probe till mark 70 cm, then expect the olive passage in the duodenum, which is due to 1-1,5 hours. If the olive is in the duodenum, the tube starts flowing with yellow liquid with alkaline reaction

Duodenal probingDuodenal probing

Phase duration volume characteristic

portion

І Choledochus 10-15 min. 15-20 ml Light yellow duodenal content “А”

ІІ Closed Oddi’s sphincter 2-3 min. - - -

ІІІ Bile excretion from bile duct 3-6 min. 3-5 ml Light yellow bile

ІV Bile excretion from gallbladder

20-30 min. 30-50 ml Dark brown bile “В”

V Bile excretion from liver duct

20-30 min. 10-30 ml Light yellow bile “С”

Duodenal probingDuodenal probing

Ultrasound Review subject: Liver, spleenPortal, spleen and splenic veingallbladderpancreasretroperitoneal lymph nodes kidneys

Ultrasound is performed on an empty stomach. For the patient with increased gas production is recommended for 2-3 days before the test use a diet, excluding from the diet raw vegetables, foods rich in fiber, milk, black bread, beans, sweets. It is advisable to take during this time enzymes and enterosorbents.

Preparing

Computer tomography

Excretory urography - one of the leading X-ray techniques to study the morphology and function of the kidneys and urinary tract. It is based on the physiological ability of the kidneys to capture from the blood iodinated organic compounds, excreting them with urine and contrast porous system of the kidneys, ureters and bladder.

Contrast is introduced i.v.

Ascending (retrograde) pyelography - a method that helps to clarify the status of renal pelvis system

Investigation is carried out on an empty stomach, after cleaning the bowel. In aseptic conditions, using a special cystoscope at first examine the bladder wall, than through the ureter in the renal pelvis is introduced the X-ray catheter. Than in the bowl slowly is injected 8-10 ml of 20-30% solution of sterile contrast agent.

Computer tomography