Insertion of a gastric tube through the nose algorithm. Inserting a gastric tube through the mouth

14.07.2019 -

Insertion of a tube into the stomach through the mouth is usually poorly tolerated by conscious patients, so it is more often used in intubated patients.

Inserting a gastric tube through the mouth

The patient is conscious, behavior is adequate.

Equipment: gastric tube (the tube must be in the freezer for at least 1.5 hours before the procedure; in emergency situation the end of the probe is placed in a tray of ice to stiffen it); towel; napkins; petroleum jelly or glycerin; tray; gloves; waterproof apron - 2 pcs., gloves, Janet syringe, phonendoscope.

Note. In surgical practice, a probe is used that has a drainage outlet for fluid outflow.

I. Preparation for the procedure

Clarify with the patient the understanding of the course and purpose of the upcoming procedure (if the patient is conscious) and his consent to the procedure. If the patient is uninformed, clarify further tactics with a doctor.
Offer or help the patient to sit on a chair, closer to the back.

Note. If the patient cannot achieve a chair-sitting position, he or she can lie on his side without a pillow under his head.

Cover the patient's chest with a waterproof apron (diaper).
Determine the distance to which the probe should be inserted: from the lips to the earlobe and down the anterior abdominal wall so that the last hole of the probe is lower xiphoid process(make a mark on the probe if necessary).
Explain to the patient (if possible) that:
- when inserting a probe, nausea and vomiting are possible, which can be suppressed by breathing deeply through the nose;
- Do not squeeze the lumen of the probe with your teeth and pull it out.

II. Executing the procedure

Wash and dry your hands and put on gloves.
Pour glycerin over the blind end of the probe (above the tray).
Stand to the patient's right (if you are right-handed). Invite him to open his mouth and place the blind end of the probe generously lubricated with glycerin on the root of his tongue.

Note. If the patient behaves inappropriately (when inserting a tube for the purpose of gastric lavage), this procedure must be performed with an assistant: means of fixing the arms and legs should be used; the assistant fixes the head with his hand; Use a mouth opener to hold the patient's mouth open.

Ask the patient to swallow several times (if possible) while gently advancing the probe into the esophagus (if the patient is unable to swallow, the probe should be placed in the patient's mouth and slowly guided until the tip of the probe passes into the esophagus).
Advance the probe slowly and evenly. If you encounter resistance, stop and remove the probe. Repeat step 8.
Continue inserting the probe to the desired mark if the probe moves with little resistance.
Make sure the tube is positioned correctly in the stomach:
1. introduce about 20 ml of air into the stomach using a Janet syringe, while listening to the epigastric region using a phonendoscope: characteristic sounds should appear, or
2. the correct position of the probe is confirmed only by aspiration of a large volume of liquid with a Janet syringe.
Continue the procedure for which the probe was inserted. If the probe is inserted long time(for example, in the early postoperative period):
- fix the probe;
- flush it every four hours with isotonic sodium chloride solution (for a drainage probe, inject 15 ml of air every four hours through the outflow outlet).

III. Completing the procedure

Remove the probe from the stomach at the end of the procedure: wrap part of the probe near the patient’s mouth with a napkin and slowly pull it out with progressive movements.
Place the probe and napkin in a waterproof container.
Remove gloves. Wash the hands.

Probe manipulations

The student must know:

sensing targets digestive tract;

technique for inserting a gastric tube through the nose or mouth;

technique for inserting a thick gastric tube through the mouth;

indications and contraindications for gastric lavage;

methods of taking gastric contents to determine secretion;

purposes of duodenal intubation;

universal precautions when working with obtained samples;

methods of decontamination of probes, funnels, syringes.

The student must be able to:

insert a thin probe into the stomach through the nose and through the mouth;

insert a thick probe into the stomach;

rinse the stomach;

take wash water for testing;

Explain to the patient the progress of the upcoming study of gastric contents and the contents of the duodenum and gall bladder;

Questions for self-study :

purposes, indications, contraindications of probe procedures;

deontological support of probe procedures;

equipment for probe manipulations;

algorithm for fractional sensing using the Leporsky method;

algorithm of action of fractional probing with a parenteral stimulus;

algorithm of action of duodenal intubation;

algorithm for gastric lavage;

positive and negative sides application of methods for studying gastric contents using the Leporsky method and with a parenteral stimulus.

nurse tactics in case of a patient’s reaction to histamine administration;

tactics of the nurse in case of absence of one of the portions during duodenal intubation (two possible reasons this);

the use of probeless methods, their positive and negative aspects;

performing gastric lavage if the patient is unconscious;

vomiting and assistance with vomiting.

glossary

term

explanation

Atony

Weakening of tone, i.e. tension, excitability of tissues and organs

Hypokinesia

Insufficient movement

Intubation

Insertion of a special tube into the larynx

Cardia

The section of the stomach that comes after the esophagus

Regurgitation

Reverse current (liquids)

pH-metry

Determination of the pH of the contents of various parts of the stomach and duodenum.

Stenosis

Narrowing of the lumen

Subcardinal section

Part of the stomach belowardia

Theoretical part

Ethical and deontological support

Many patients do not tolerate the insertion of the probe. The reason for this is cough or gag reflexes, high sensitivity of the mucous membrane of the pharynx and esophagus. In most cases, poor tolerability of probe manipulations is caused by the patient’s negative psychological attitude towards the probing process; a “fear of examination” arises. To eliminate the “fear of research,” the patient should be explained the purpose of the study, its benefits, and speak politely, calmly, and kindly from the beginning to the end of the procedure.

Sample conversation content medical worker with the patient during insertion of the probe:

“We will now begin the procedure. Your well-being will largely depend on your behavior during probing. The first and basic rule is not to make sudden movements. Otherwise, nausea and cough may occur. You should relax and breathe slowly and deeply. Please open your mouth slightly and keep your hands on your knees. Breathe slowly and deeply. Take a deep breath and swallow the tip of the probe. If you have difficulty breathing through your nose, breathe through your mouth and gently advance the tube as you inhale. If you feel dizzy, breathe normally, shallowly, for a few minutes, then resume deep breathing. You swallow very well. It would be nice if other patients swallowed the tube just as easily.

Safety regulations

Attention !

If during any probe manipulation there is blood in the resulting material, stop probing and call a doctor!

If, when the probe is inserted, the patient begins to cough, choke, or his face becomes cyanotic, the probe should be immediately removed, since it has entered the larynx or trachea, and not the esophagus.

If the patient has an increased gag reflex, treat the root of the tongue with an aerosol 10% lidocaine solution.

Contraindications for all probe manipulations: gastric bleeding, varicose veins esophageal veins, tumors, bronchial asthma, severe cardiac pathology.

Probing of the digestive tract is carried out for both therapeutic and diagnostic purposes. With the help of intubation, you can obtain the contents of the stomach with its subsequent examination, and rinse the stomach. At acute dilatation(atony) of the stomach, especially in the early postoperative period, at high intestinal obstruction With the help of the inserted probe, the contents, including gases, are removed. With the help of a probe inserted into the stomach, one of the ways to artificially feed the patient becomes possible. Medicines can be administered through a probe inserted into the digestive tract.

Fractional intubation of the stomach with a parenteral stimulus

Algorithm for inserting a gastric tube through the mouth

Purpose: research gastric juice, gastric lavage .

Contraindications: contraindications for all probe manipulations: gastric bleeding, varicose veins of the esophagus, tumors, bronchial asthma, severe cardiac pathology.

Equipment : Sterile gastric probe - rubber tube with a diameter of 3 - 10 mm. with lateral oval holes at the blind (inner) end. There are three marks on the probe: 1) 50-55cm (distance from the incisors to the entrance to the stomach); 2) 60-65cm (distance from the incisors to the stomach cavity); 3) 70-75cm (distance from the incisors to the exit from the stomach). Gloves, towel, glycerin.

Explain to the patient the procedure and obtain consent.

Open the package with the sterile probe. Remove it using sterile tweezers and place it in a sterile tray. Take the probe from the tray into right hand closer to the blind (inner) end, and with the left - to support the free end.

Explain to the patient, if possible, that:

when inserting a probe, nausea and vomiting are possible, which can be suppressed by breathing deeply through the nose;
Do not squeeze the lumen of the probe with your teeth and pull it out.

Note : if the patient behaves inappropriately, this procedure must be performed with the help of an assistant: means of fixing the arms and legs should be used, the assistant fixes the head with his hand. A mouth opener is used to hold the patient's mouth.

Height - 100cm.
The distance from the earlobe to the tip of the nose and to the navel.
Up to 2 or 3 marks.

Moisten the inner end of the probe with boiled water or glycerin.

Stand to the patient's right (if you are right-handed)

Invite the patient to open his mouth.

Place the end of the probe on the root of the tongue and invite the patient to swallow, breathe deeply and slowly through the nose (preferably).

Inject slowly and evenly to the desired mark.

Algorithm for obtaining material for research

(fractional sensing)

Equipment :

Sterile gastric probe - rubber tube with a diameter of 3 - 10 mm. with lateral oval holes at the blind (inner) end. There are three marks on the probe: 1) - 50-55cm (distance from the incisors to the entrance to the stomach); 2) - 60-65cm (distance from the incisors to the stomach cavity); 3) - 70-75cm (distance from the incisors to the exit from the stomach).

department______________ ward No.____

Referral to a clinical laboratory

gastric juice obtained with a parenteral irritant (pentagastrin)

9 servings

Patient: Full name____________________

Date___________ Nurse's signature________

Glycerin is sterile.

Dishes: 9 clean jars or test tubes with labels.

Sterile syringe - 20.0 ml for extraction.

Sterile syringe - 2.0 ml for introducing the stimulus.

Irritant: histamine solution 0.1% or pentagastrin solution 0.025%.

Alcohol balls (alcohol - 70°).

Note: After each removal of gastric contents, the stomach must remain empty!

Fractional sounding using the Leporsky method

Purpose: study of gastric juice .

Contraindications : contraindications for all probe manipulations: gastric bleeding, tumors, bronchial asthma, severe cardiac pathology.

Equipment :

Thin sterile probe - rubber tube with a diameter of 3 - 5 mm. with lateral oval holes at the blind (inner) end. There are three marks on the probe: 1) - 50-55cm (distance from the incisors to the entrance to the stomach); 2) - 60-65cm (distance from the incisors to the stomach cavity); 3) - 70-75cm (distance from the incisors to the exit from the stomach).

Glycerin is sterile.

Dishes: 7 clean jars or test tubes with labels.

Sterile syringe - 20.0 ml or vacuum unit for extraction.

Gloves, towel, sterile tray, direction:

department________ ward No.___

Referral to the clinical laboratory of gastric juice obtained by the Leporsky method (cabbage broth)

1, 4, 5, 6 and 7 servings

Patient: Full name______________

Date of_____

Signaturem/s________

Enteral irritant - cabbage broth 200 ml, heated to 38°C.

Note : In addition to cabbage broth, enteral irritants can include: meat broth, caffeine solution, etc.

Algorithm for taking gastric juice using the Leporsky method

Explain to the patient the procedure for the procedure, warn in the evening that probing is done on an empty stomach, so that in the morning the patient does not eat, drink, or smoke anything(if probing is done in the office, then warn the patient not to forget to take a clean towel with him).

Correctly seat the patient: leaning on the back of the chair, tilting the head forward; if the patient is in bed, then a high Fowler position. If the patient cannot be placed in a sitting or reclining position, he can lie on his side without a pillow.

Wash your hands, put on gloves.

Place a towel on the patient's neck and chest, if available. removable dentures, remove them.

Insert a tube (see algorithm for inserting a gastric tube through the mouth).

Using a 20.0 ml syringe, extract the contents of the stomach on an empty stomach -first a portion

Using the barrel of a 20.0 ml syringe (using it as a funnel, attaching it to the outer end of the probe), inject 200 ml of cabbage broth, heated to 38 ° C.

After 10 minutes, remove 10 ml of gastric contents -second a portion.

After 15 minutes, remove all stomach contents -third portion, the stomach should remain empty.

For an hour, every 15 minutes, use a 20.0 ml syringe to extract 4 more portions of stomach contents -fourth, fifth, sixth And seventh portions.

Carefully remove the probe using a towel or large napkin and place it in the disinfectant solution.

Wipe the patient's mouth and help him get into a comfortable position.

Remove gloves, place them in a disinfectant solution, and wash your hands.

Send to laboratory1, 4, 5, 6 and 7 portions along with direction.

When you receive a response from the laboratory, immediately paste it into the patient’s chart.

Remember ! With any method, you need to extract the contents as completely and continuously as possible! If a significant amount of blood appears, stop extraction, call a doctor, show the contents and act according to his instructions.

additional information

Equipping probe procedures for each patient individually.

Fractional research using the Leporsky method is currently rarely used due to technical inconvenience and less reliable research results.

Fractional study using parenteral irritants:

parenteral irritants are physiological, but are stronger than enteral ones, are precisely dosed and when used, we obtain pure gastric juice. When histamine is administered, it is possible that side effects in the form of dizziness, feeling of heat, decreased A/D, nausea, difficulty breathing, etc. In case of these phenomena, you should urgently call a doctor and prepare one of the following for parenteral administration antihistamines: diphenhydramine, suprastin, pipolfen. Sometimes for warning purposes allergic reactions when using histamine, 30 minutes before its administration, inject a solution of diphenhydramine 1% - 1 ml subcutaneously.
during collapse and anaphylactic shock- see algorithms for help with collapse and anaphylactic shock. Pentagastrin side effects almost doesn't cause it. It is administered subcutaneously at a dose of 6 μg (0.006 mg) per 1 kg of patient weight.
The study is carried out in the morning on an empty stomach. The evening before the patient should not eat coarse, spicy food, and in the morning before the examination should not eat, drink, or smoke.
In some cases, to make it easier to insert the probe into the stomach, the probe is placed in the freezer 1.5 hours before the procedure.
After each removal of gastric contents, a clamp is applied to the outer end of the probe or it is bent and the patient holds the probe in his hand (if he is able), or tied it in a knot.
After use, the probes are disinfected by boiling in distilled water for 30 minutes from the moment of boiling at full immersion. Then they undergo pre-sterilization treatment, just like syringes (only they cannot be cleaned with brushes), and then hang-dried with the blind end up, individually packaged and sterilized by steam, gentle mode or 6% hydrogen peroxide (then they are not packaged).Order No. 345.

Can be disinfected in a 3% solution of samarovka for 1 hour.

Probes cannot be disinfected with chlorine-containing preparations, since the smell of chlorine from rubber is very difficult to remove.

All extracted portions of gastric contents are sent to the laboratory, where the quantity, color, consistency, smell, and the presence of impurities (bile, mucus, etc.) are determined. By titrating gastric juice with a 0.1 N sodium hydroxide solution, the free and total acidity in each portion is determined, and then the basal and stimulated production (output) of hydrochloric acid is calculated using the formula.

Unfortunately, in practice one often has to deal with erroneous results of fractional sounding. To avoid them, two circumstances must be taken into account. Firstly, after insertion into the stomach, the probe may take an incorrect position (collapse, be in upper section stomach, etc.). Therefore, if little gastric contents are obtained during suction, you need to inform your doctor. In this case, using x-ray examination You can check the position of the tube in the stomach. Secondly, the weak stimulants of gastric secretion that have been recommended so far (for example, cabbage broth, meat broth, caffeine, etc.) do not objectively reflect the state of gastric acid secretion. Histamine or (if there are contraindications) pentagastrin are used as a stimulant.

Probeless methods for studying gastric contents

Intracavity Ph -metry

One of modern methods studies of acid-forming and acid-neutralizing functions of the stomachis intracavitary Ph -metry - definition Phcontents of various parts of the stomach and duodenum by measuring the electromotive force generated by hydrogen ions. For this study, a specialPh-metric probe. Normal indicatorsPh usually 1.3 - 1.7.

In recent years, both in our country and abroad, this method of intracavitary (24-hour) continuous monitoringPhhas become widespread in specialized medical institutions. According to experts, the method is multi-purpose. Measurement phin the lumen of the stomach, esophagus or duodenum, carried out throughout the day, taking into account interdigestive and night secretion of acid - the most dangerous when peptic ulcer- places this method among the most informative, accurate, and physiologically based.

Radiotelemetry method

R hGastric contents are sometimes determined using special “pills” (radio capsules) equipped with a miniature radio sensor. After swallowing such a radio capsule, the sensor transmits information aboutPh, temperature and hydrostatic pressure in the lumen of the stomach and duodenum, which is recorded by the receiving device.

In the morning on an empty stomach, the patient swallows a radiocapsule attached to a thin silk thread or a probe to hold the capsule in the desired part of the digestive tract. Then a belt is put on the patient, in which a flexible antenna is pre-mounted for receiving signals from the radio capsule, and the tape drive mechanism is turned on.

The radiotelemetric research method is the most physiological in the study of secretory and motor functions stomach.

"Acidotest"

The use of ion exchange resins for studying gastric secretion is based on the ability of the resins to exchange ions in an acidic environment. This principle is used in the Acidotest method. The method is based on the detection in urine of a dye formed in the stomach when an ingested ion exchange resin (yellow dragees) reacts with free hydrochloric acid. Caffeine (white tablets) serves as an enteral irritant. The color intensity is determined using a standard (color scale) in the laboratory.

The day before and on the day of the examination, the patient should not take medications or consume foods that color the urine. The study begins in the morning on an empty stomach, no earlier than 8 hours after eating.

Despite the fact that the “Acidotest” technique is not a probe procedure, the authors consider it possible to give it in this chapter.

Patient training in the “Acidotest” technique

(when carried out on an outpatient basis)

Equipment: two containers for urine

Clarify the patient’s understanding of the progress and purpose of the upcoming study and obtain his consent.

Assess the patient's ability to learn.

Explain the “Acidotest” method:

in the morning on an empty stomach (9 hours after the last meal) the patient empties bladder(this portion is not collected);
After emptying your bladder, immediately take 2 caffeine tablets;
empty your bladder after 1 hour into a glass container (mark it with a label that says “Control portion”);
take 3 yellow tablets with a small amount of water;
empty your bladder after 1.5 hours into a second container (mark it with a label that says “Experimental portion”);
deliver to the laboratory the direction and containers with control and experimental portions of urine.

Ask the patient to repeat the “Acidotest” technique. Ensure that the training was effective. If necessary, provide written instructions.

Duodenal sounding

Probing of the duodenum is carried out to examine bile, which helps in the diagnosis of diseases of the biliary tract, gallbladder, pancreas and duodenum. Duodenal intubation is also used for therapeutic purposes (for example, to pump out bile with reduced motor function of the gallbladder).

Research is carried out using a special duodenal probe with a diameter of 4 - 5 mm and a length of up to 1.5 m, which has a metal olive with holes at the inner end. Such probes are rubber, but now probes are produced from polymer materials, their olive is a brass melt at the inner end. All duodenal tubes have marks every 10cm.

The resulting portions of duodenal contents are subjected to microscopic examination, which makes it possible to identify inflammation in gallbladder and biliary tract (leukocytes, epithelial cells), detect various bacteria and protozoa (for example, Giardia). In addition, you can detect: atypical cells, cholelithiasis (by the presence of sand in bile), determine a violation of the colloidal composition of bile ( a large number of cholesterol crystals), etc.

As a rule, when performing duodenal intubation, three portions are obtained:

"A" – contents of the duodenum, its composition - duodenal juice + pancreatic juice + bile;

"IN" – bladder bile;

"WITH" – bile from intrahepatic bile ducts.

In some cases, a fourth portion appears - “VS”, the so-called bladder reflex, which usually occurs in children with gallbladder hypokinesia, and in adult patients with cholelithiasis.

Remember ! Portion “BC” is portion “C” against the background of portion “B” .

Considering the important diagnostic value this portion, the sister performing duodenalprobing,you need to observe the color of the bile when receiving portions “B” and “C”. The “BC” portion should be collected in a separate tube and marked accordingly.

In some diseases, for example, when the bile duct is blocked by a stone, it is not possible to receive portion “B”.

Algorithm for duodenal intubation

(fractional method)

Target : diagnostic .

Equipment : sterile duodenal tube in a package, a stand with test tubes, a stimulator for gallbladder contraction (25 - 40 mm 33% magnesium sulfate solution, or 10% alcohol solution of sorbitol or chylecystokinin), 20.0 ml syringe for aspiration, syringe for injection (if chylecystokinin is used ), heating pad, cushion, gloves, towel, small bench.

Clarify the patient’s understanding of the process and purpose of the procedure, obtain his consent to the procedure(if probing is done in the office, then warn the patient not to forget to take a clean towel with him).

Wash your hands, put on gloves.

Invite the patient to sit on a chair or couch.

Place a towel on the patient's chest.

Open the package with the sterile probe, take the inner end of the probe in your right hand at a distance of 10 - 15 cm, hold the outer end with your left hand.

Determine the distance to which the patient should swallow the probe so that it is in the subcardinal part of the stomach (on average about 45 cm) and in the duodenum: the distance from the lips and down the anterior abdominal wall so that the olive is located 6 cm below the navel.

Invite the patient to open his mouth, place the olive on the root of the tongue, the patient swallows the olive, the nurse helps him swallow, carefully moving the probe deeper. The patient continues to swallow. With each swallowing movement, the probe will move into the stomach to the desired mark (4th or 5th). The patient can sit or walk while the tube is being swallowed.

Check the location of the probe by connecting a syringe to the outer end and aspirate the contents. If the syringe receives a cloudy liquid yellow color- olive is in the stomach; if not, pull the probe towards you and ask him to swallow the probe again.

9. If the probe is in the stomach, place the patient on the right side, placing a cushion or blanket under the pelvis, and a warm heating pad under the right hypochondrium. In this position, the patient continues to swallow the probe until the 7th - 8th mark. Duration of ingestion is from 40 to 60 minutes.

Note : A rack with test tubes is installed below the level of the couch. When the olive is in the duodenum, a golden-yellow liquid enters the test tube - duodenal contents - portion A . In 20 - 30 minutes, 15 - 40 ml of duodenal contents (2 - 3 tubes) are delivered. If the liquid does not enter the test tube, you need to check the location of the probe by injecting air into it with a syringe and listening to the epigastric region with a phonendoscope. If the probe is in the duodenum, then the insertion of the probe is not accompanied by any sounds; if the probe is still in the stomach, then when air is introduced, characteristic bubbling sounds are noted

10. When swallowing the probe to the 9th mark (80 - 85 cm), lower the outer end into the test tube.

11. After receiving the portion"A" , use a syringe to inject a gallbladder contraction stimulator (25 - 40 ml of 33% magnesium sulfate solution, or 10% alcohol solution sorbitol, or cholagogue hormonal nature, for example, cholecystokinin – 75 units. i/m). Move the probe to the next tube.

12. 10 - 15 minutes after the introduction of the stimulant, a portion will begin to flow into the test tube« IN" – bladder bile. Duration of receiving portion« IN" – in 20 - 30 minutes. – 30 - 60 ml of bile (4 - 6 tubes).

Note : for timely detection of portions " Sun" carefully observe the color of the portion « IN" . When liquid appears light color, move the probe to another tube, then, when liquid appears dark color– move the probe again. Mark portion "Sun" .

13. After receiving the portion« IN" move the probe to the next test tube to obtain a portion « WITH" – liver portion. Duration of receiving portion« WITH" – in 20 - 30 minutes - 15 - 20 ml (one - two test tubes).

14. Carefully remove the probe using a towel or napkin using slow progressive movements, while wiping it.

15. Immerse the probe in the disinfectant solution.

16. Wash your hands, remove gloves, place them in a disinfectant solution, wash and dry your hands.

17. Send all portions to the clinical and bacteriological laboratories with directions.

18. When receiving an answer from the laboratory, immediately paste it into the patient’s chart.

department_______ ward No.___

Referral to clinical

Laboratory

Patient name_______________

department_______ ward No.___

Referral to bacteriological

Laboratory

Bile - portions “A”, “B”, “C”.

Patient name_______________
date________ signature m/s_____

Bile delivered to the laboratory is examined:

determine physical properties(color!. transparency, quantity, specific gravity, reaction);

conduct a chemical study (study of the concentration function of the gallbladder, colloidal stability of bile (determination of protein, bilirubin, urobilin, bile acids, cholesterol));

Normal bile contains almost no cellular elements and sometimes contains a small amount of cholesterol.

In case of pathology, the contents appear leukocytesLeukocytes: White blood cells. In an adult healthy person 1 μl of blood contains 5-9 thousand L. The amount of L. can either increase (leukocytosis) or decrease (leukopenia). In an adult, leukocytes are formed mainly in bone marrow. Leukocytes have amoeboid movements and take part in immune reactions. Define leukocyte formula: quantitative relationship between individual forms of L., revealed by clinical analysis blood is essential in determining the disease. Depending on the structure and functions performed, L. are divided into granulocytes and agranulocytes: granulocytes make up 60% of all L. Their cytoplasm has a granular structure. Granulocytes are divided into three types: basophils (produce heparin, which prevents blood clotting), neutrophils (perform a phagocytic function, accumulating in areas of tissue damage or penetration of microbes into the body), eosinophils (participate in the neutralization and destruction of foreign proteins). Agranulocytes (non-granular leukocytes) are divided into lymphocytes and monocytes. Lymphocytes are formed in lymph nodes, tonsils, spleen and bone marrow. Various groups lymphocytes react differently to a foreign protein, producing either enzymes that destroy protein bodies (microbes, viruses) or specific antibodies that bind and neutralize the foreign protein. Monocytes have amoeboid movements and are characterized by high phagocytic activity, but under conditions other than neutrophils, appearing in the site of inflammation at the final stage and preparing this area for regeneration.» | mucus, epithelium - signs of inflammation; red blood cells, cholesterol crystals, bilirubin - signs cholelithiasis.

Portion A is obtained from the duodenum - the pathology in it confirms the pathology in portions B and C or the pathology of the stomach and duodenum.

Portion C - from intrahepatic bile ducts; disease - cholangitis.

If you cannot get portion B, you can think about the hypertensive form of biliary dyskinesia. If portion B is excessively abundant, one can think of a hypotonic form of dyskinesia.

If protozoa Giardia or helminths (opisthorchiasis) are detected, this is a possible etiology of the disease.

Gastric lavage

At acute poisoning large doses medicines taken orally, poor quality food, alcohol, mushrooms, etc., the stomach is lavaged through a thick or thin tube. (At the same time, experts in the field of toxicology consider gastric lavage with a thick probe to be an unsafe procedure).

Remember ! Gastric lavage for an unconscious patient in the absence of cough and laryngeal reflexes to prevent aspiration of fluid is carried out only after preliminary intubation of the trachea, which is performed by a doctor or paramedic.
If, when the probe is inserted, the patient begins to cough, choke, or his face becomes cyanotic, the probe should be immediately removed - it has entered the larynx or trachea.

Decontamination of probes is carried out in accordance with available regulatory documents. Each probe must be packaged in a separate bag. In the same bag, it is cooled in the freezer for 1.5 hours before insertion, which greatly facilitates the procedure for inserting the probe.

Algorithm for gastric lavage with a thick probe

Goal: cleanse the stomach of poisons and toxins.

Indications :

Contraindications:

Equipment : gastric lavage system (2 thick - up to 1 cm in diameter sterile gastric probes connected by a glass tube, the blind end of one probe is cut off), a glass funnel with a capacity of 1 - 1.5 liters, a towel, napkins, a sterile container for rinsing water (if you will need to send them to the laboratory), a container with water T° - 18° - 25° - 10 l, a mug, a container for draining wash water, gloves, 2 waterproof aprons, glycerin.

Note :

Disconnect the funnel and remove the probe using a towel or napkin. Place contaminated items in a waterproof container. Pour the rinsing water into the drain.

Remove gloves, wash hands.

Gastric lavage with a thin probe

Goal: cleanse the stomach of poisons and toxins .

Indications : acute poisoning with large doses of drugs taken orally, poor quality food, alcohol, mushrooms, etc.

Contraindications: organic narrowing of the esophagus, acute esophageal and gastric bleeding, severe chemical burns mucous membrane of the larynx, esophagus, stomach with strong acids and alkalis (several hours after poisoning), myocardial infarction, violation cerebral circulation, malignant tumors stomach, esophagus, pharynx.

Equipment : thin gastric tube, Janet syringe, towel, napkins, sterile container for washing waters (if you need to send them to the laboratory), container with water T° - 18° - 25° - 10 l, container for draining washing waters, gloves, 2 waterproof apron, glycerin.

Clarify the patient’s understanding of the course and purpose of the manipulation (if the patient is conscious) and obtain his consent.

Wear aprons for yourself and the patient.

Wash your hands at a hygienic level, put on gloves, treat your gloves with a glove antiseptic.

Insert the gastric tube to the established mark through the mouth or through the nose (see the algorithm for inserting the gastric tube through the mouth or through the nose).

Fill the Janet syringe with 0.5 liters of water, attach it to the probe and inject the water into the stomach.

Pull the piston towards yourself, aspirating (removing) the injected water from the stomach.

Note : if necessary, take washing water for examination (as prescribed by a doctor):

reintroduce this portion of liquid into the stomach;

if poisoning with cauterizing poisons is suspected, immediately take the first portion of rinsing water;

repeat steps 5 - 6 twice and pour the rinsing water into a sterile container and close the lid.

Note : If blood appears in the rinsing waters, immediately inform the doctor without removing the probe, show the rinsing waters to the doctor!

Repeat the introduction of water into the stomach and its aspiration until the rinsing water is clean (all 10 liters of water must be consumed).

Disconnect the Janet syringe and remove the probe using a towel or napkin. Place contaminated items in a waterproof container. Pour the rinsing water into the drain.

Remove aprons and place them in a waterproof container

Wash the patient, lay him comfortably on his side, and cover him.

Remove gloves, wash hands.

Write a direction and send the wash water to the laboratory.

Make a record of the manipulation and the patient’s reaction to it in medical card.

View on the website:

http://video.yandex.ru/users/nina-shelyakina/collections/?p=1 in the collectionPM 04 films No. 192, 193, 194 and repeat all the manipulations on the topic.

From the Internet

DUODENAL PROBING

In what cases is duodenal intubation indicated for a patient?
Duodenal intubation is carried out for diseases of the liver and biliary tract for both diagnostic and therapeutic purposes. At the same time, in duodenum or parenterally introduce various irritants that stimulate contractions of the gallbladder, relaxation of the sphincter of the common bile duct and the passage of bile from the biliary tract into the duodenum.
What substances are used as irritants introduced into the duodenum during duodenal intubation?
30-50 ml of warm 25% magnesium sulfate solution is used as irritants. 2 ml are administered parenterally. gastrocepin.
What is a duodenal intubation probe?
For duodenal intubation, use a sterile disposable probe with a diameter of 3 ml and a length of 1.5 m. At its end, inserted into the stomach, there is a hollow metal olive with a number of holes. There are 3 marks on the probe: at a distance of 40-45 cm from the olive, 70 cm and 80 cm from the olive. The last mark approximately corresponds to the distance from the front teeth to the major duodenal papilla (papilla of Vater).
How do you prepare for the probing procedure?
In addition to the probe, a clamp for the probe, a stand with test tubes, a syringe with a capacity of 20 ml, sterile test tubes for inoculation, a tray, and medications (25% magnesium sulfate solution) are prepared for the duodenal intubation procedure.
To prepare for the study, the patient is prescribed 2 tablets of no-shpa orally the night before. Dinner - light; gas-forming products (brown bread, milk, potatoes) are excluded.
How is the duodenal intubation procedure performed?
The study is carried out on an empty stomach. Mark on the probe the distance from the navel to the front teeth of the patient, who is in a standing position. After this, the patient is seated and a tray with a probe is given into his hands. An olive is placed deep behind the root of the patient’s tongue, inviting him to swallow and breathe deeply (the olive can be lubricated with glycerin beforehand). Subsequently, the patient slowly swallows the probe, and when gagging occurs, he clamps it with his lips and takes several deep breaths. When the probe reaches the first mark, the olive is presumably in the stomach. The patient is placed on the couch on the right side, under which a cushion of rolled up blanket or pillow is placed (at the level of the lower ribs and right hypochondrium). A hot heating pad wrapped in a towel is placed on top of the roller.
What is portion A during duodenal intubation?
If the olive enters the intestine, a golden-yellow transparent liquid begins to be released - portion A (a mixture of intestinal juice, pancreatic secretion and bile). The liquid flows freely from the outer end of the probe lowered into the test tube, or it is aspirated with a syringe. A test tube with the most transparent contents is selected for analysis.
How is portion B collected during duodenal intubation?
One of the irritants is introduced through a probe (usually 40-50 ml of a warm 25% solution of magnesium sulfate). The probe is closed with a clamp (or tied in a knot) for 5-10 minutes, then opened, the outer end is lowered into a test tube and concentrated dark olive bladder bile is collected (second portion - B). If this does not happen, you can repeat the administration of magnesium sulfate after 15-20 minutes.
How is portion C collected during duodenal intubation?
After the gallbladder is completely emptied, golden-yellow (lighter than portion A), transparent, without impurities, portion C begins to flow into the test tubes - a mixture of bile from intrahepatic biliary tract and duodenal juices. After receiving this portion, the probe is removed.
How is material collected for bacteriological research?
For bacteriological examination, part of the bile from each portion is collected in sterile tubes. Before and after filling the tubes with bile, their edges are held over the flame of the burner and all other rules of sterility are observed.
The resulting portions of duodenal contents should be delivered to the laboratory as quickly as possible, since the proteolytic enzyme of the pancreas destroys leukocytes. Giardia is difficult to detect in cooled duodenal contents because they stop moving. To prevent cooling, the test tubes are placed in a glass with hot water(39-40 °C).
How is the assessment carried out? functional state biliary system based on duodenal intubation data?
The receipt of bile indicates the patency of the bile ducts, and portions B indicate the preservation of the concentration and contractile function of the gallbladder. If within 2 hours it is not possible to advance the olive of the probe into the duodenum, the study is stopped.
What is chromatic duodenal sounding?
For more accurate recognition of cystic bile, chromatic duodenal sounding is used. To do this, the night before, approximately 12 hours before the test (at 21.00-22.00, but not earlier than 2 hours after a meal), give the test subject 0.15 g of methylene blue in a gelatin capsule.
In the morning, when the bladder is probed, the bile turns out to be blue-green. The time elapsed from the moment of introduction of the stimulus until the appearance of portion B and the volume of bile are determined.
What are the features of duodenal intubation in children?
In children, duodenal intubation is as difficult as extracting gastric juice. An olive probe is inserted into newborns to a depth of approximately 25 cm, children 6 months old - 30 cm, 1 year old - 35 cm, 2-6 years old - 40-50 cm, older children - 45-55 cm. Magnesium sulfate is injected into duodenum at the rate of 0.5 ml of 25% solution per 1 kg of body weight. Otherwise, the procedure and probing technique are the same as for adults.

№	Action algorithm	Raw score	Score received
	Equipment
1.	Sterile gastric tube
2.	Gloves
3.	Towel
4.	Glycerol.
	Preparation for the procedure
1.*	1. Explain to the patient the procedure, warn in the evening that probing is done on an empty stomach, so that in the morning the patient does not eat, drink, or smoke anything
2.	2. Sit the patient correctly: leaning on the back of the chair, tilting the head forward; if the patient is in bed, then a high Fowler position. If the patient cannot be placed in a sitting or reclining position, he can lie on his side without a pillow
3.
4.*	3. Place a towel on the patient’s neck and chest; if there are removable dentures, remove them
5.	4. Check the packaging with the sterile probe for expiration date and tightness
6.	5. Open the package with the sterile probe. Take it out and put it in a sterile tray
7.	6. Take the probe from the tray in your right hand closer to the blind (inner) end, and support the free end with your left hand
8.	7. Explain to the patient, if possible, that: · when inserting a probe, nausea and vomiting are possible, which can be suppressed by breathing deeply through the nose; · Do not squeeze the lumen of the probe with your teeth and pull it out. Note: if the patient behaves inappropriately, this procedure must be performed with the help of an assistant: means of fixing the arms and legs should be used, the assistant fixes the head with his hand. A mouth opener is used to hold the patient's mouth
9.*	Determine the depth of insertion of the probe Height – 100 cm Distance from the earlobe to the tip of the nose and to the navel Up to 2 – 3 marks (50 – 55 cm, 60 – 65 cm)
10.*	8. Moisten the inner end of the probe with boiled water or treat it with glycerin
	Performing a manipulation
11.	9. Stand to the patient’s right (if you are “right-handed”)
12.	10. Invite the patient to open his mouth
13.	11. Place the end of the probe on the root of the tongue and invite the patient to swallow, breathe deeply and slowly through the nose (preferably)
14.	12. Inject slowly and evenly to the desired mark
15.	13. Place a plug or sterile napkin on the outer end of the probe
	Completing the procedure
16.	Wipe the patient's mouth and help him get into a comfortable position
17.	Remove gloves, place them in disinfectant solution, wash hands
18.	Note in the medical record about the performed manipulation
	Total points:

Date _________________ Teacher’s signature ____________________________

Student signature ___________________________________

Teacher Comments ___________________________________________________ ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Score Sheet

Gastric lavage with a thick probe

Student _____________________________________________________

Group _________________________ brigade _________________________

№	Action algorithm	Raw score	Score received
	Equipment
1.	System for gastric lavage (2 thick - up to 1 cm in diameter sterile gastric probes connected by a glass tube, the blind end of one probe is cut off)
2.	Glass funnel with a capacity of 1 - 1.5 liters
3.	Towel
4.	Napkins
5.	Sterile container for rinsing water (if you need to send it to the laboratory)
6.
7.
8.	Gloves
9.	Mug
10.	2 waterproof aprons
11.	Glycerol
	Preparation for the procedure
1.
2.	Place the patient in a chair
3.	Wear aprons for yourself and the patient
4.	Wash hands to hygienic level, put on gloves, treat gloves with antiseptic for gloves
5.	Place a container for rinsing water between the legs or on the patient’s knees.
6.	Open the package with the gastric lavage system
	Performing a manipulation
7.	Insert the tube to the set mark (see algorithm for inserting a gastric tube through the mouth)
8.	Attach a funnel to the probe, lower it to the level of the stomach, pour 1 liter of water into it
9.*	Slowly lift the funnel up to a distance of up to one meter from the floor. As soon as the water reaches the mouth of the funnel, slowly lower the funnel to the level of the patient’s knees, without allowing the water to spill out
10.*	In the event that it is necessary - take wash water for testing repeat step 9 twice and pour the rinsing water into the prepared sterile container
11.	If poisoning with cauterizing poisons is suspected, immediately take the first portion of rinsing water. Rinse the stomach, repeating steps. 8 and 9, but pour the wash water into a container for draining the wash water, do this until the wash water is clean (use all 10 liters) Note:
	Completing the procedure
12.	Disconnect the funnel and remove the probe using a towel or napkin.
13.
14.
15.*
16.	Remove gloves, wash hands
17.
18.
	Total points:

Appraisal control Assessment ___________________________________

Date _________________ Teacher’s signature _________________________

Student signature __________________________

Teacher's comments ________________________________________________ _____________________________________________________________________________________________________________________________________________________

* If this point is not fulfilled, the manipulation stops and the student receives an unsatisfactory grade!

Score Sheet

Gastric lavage with a thin probe

Student _____________________________________________________

Group _________________________ brigade _________________________

№	Action algorithm	Raw score	Score received
	Equipment
1.	Thin sterile gastric tube in the freezer
2.	Syringe Janet
3.	Towel
4.	Napkins
5.	Sterile container for rinsing water with a lid (if you need to send it to the laboratory)
6.	Capacity with clean water T° – 18° - 25° – 10l
7.	Container for draining wash water
8.	Gloves
9.	2 waterproof aprons
10.	Glycerol
11.	Absorbent diaper
	Preparation for the procedure
1.	Clarify the patient’s understanding of the course and purpose of the manipulation (if the patient is conscious) and obtain his consent
2.	Place the patient in a chair or in a high Fowler position
3.	Put aprons on yourself and the patient or place an absorbent diaper on the patient’s chest (if the patient is lying down)
4.	Wash hands to hygienic level, put on gloves, treat gloves with antiseptic for gloves
5.	Place a container for rinsing water nearby
6.	Remove the tube from the freezer, check the expiration date, tightness, open the package with a thin gastric tube
	Performing a manipulation
7.	Insert the gastric tube to the established mark through the mouth or through the nose (see algorithms for inserting the tube through the mouth and introducing the NGZ through the nose)
8.	Fill the Janet syringe with 0.5 liters of water, attach it to the probe and inject the water into the stomach
9.*	Pull the piston towards you, extracting the injected water (aspiration of rinsing water). Note: if necessary, take washing water for examination (as prescribed by a doctor): · reintroduce this portion of liquid into the stomach; · if poisoning with cauterizing poisons is suspected, immediately take the first portion of rinsing water; · repeat p.p. 8, 9 twice and pour the rinsing water into a sterile container for rinsing water Note: If blood appears in the rinsing waters, immediately inform the doctor without removing the probe, show the rinsing waters to the doctor!
10.*	Repeat the introduction of water into the stomach and its aspiration until the rinsing water is clean (all 10 liters of water must be consumed)
11.	Disconnect the Janet syringe and remove the probe using a towel or napkin
	Completing the procedure
12.	Place contaminated items in a waterproof container
13.	Pour rinsing water down the drain
14.	Wash the patient, lay him comfortably on his side, cover him
15.	Remove gloves, wash hands
16.	Write a direction and send the wash water to the laboratory
17.	Make a record of the manipulation and the patient’s reaction to it in the medical record
	Total points:

Appraisal control Assessment _______________________________

Date _________________ Teacher’s signature __________________________

Student signature ___________________________

Preparation for the procedure:
Introduce yourself to the patient and explain the course of the upcoming procedure (if he is conscious). Make sure the patient has informed consent for the upcoming procedure.
Patient position sitting on a chair:
- Place the patient in a chair with a backrest.
- Measure blood pressure, count pulse. Check patency respiratory tract(ask the patient to breathe alternately through the right and left nostrils).
- Treat your hands hygienically, dry them, put on gloves and an apron.
- Put an apron on the patient and give them a towel.
- Place the basin at his feet, lower the end of the apron into the basin.
Patient position lying on left side:

3.1. Clean your hands in a hygienic manner, dry them, put on gloves,

3.3.Place an oilcloth under the patient’s head.

3.4. Place the basin at the head end of the couch, lower the end of the oilcloth into the basin.

3.5. Put an apron on the patient and give them a towel.

When inserting a gastric tube through the mouth: Use a thread to measure the distance from the navel to the incisors plus the width of the patient’s palm.
Transfer the mark to the probe, starting from the rounded end.
Take the probe in your right hand like a “writing pen” at a distance of 10 cm from the rounded end.
Moisten the blind end of the probe with dicaine.

Performing the procedure:

Stand to the side of the patient.
Invite the patient to open his mouth and tilt his head back slightly.
Place the probe on the root of the tongue, ask the patient to make swallowing movements simultaneously with the advancement of the probe.
Tilt the patient's head forward and down, ask the patient to breathe deeply through the nose.
Slowly advance the probe following the swallowing movements to the mark.
Make sure that the probe in the stomach has an “air gap”: attach a syringe to the probe and introduce air. Using a phonendoscope, listen for gurgling sounds. During insertion of the probe, monitor the patient's condition (absence of cough and cyanosis).

1.7. Advance the probe another 7-10 cm into the stomach.

Inserting the probe through the nose:

2.1.Measure the distance with a silk thread from the tip of the nose to the earlobe and from the earlobe to the xiphoid process of the sternum, put 2 marks on the probe.

2.2. Stand at the patient's head.

2.3. Moisten the blind end of the probe with dicaine.

2.4. Insert the blind end of the probe into the lower nasal passage, slowly advancing it.

at the “first mark” depth. Ask the patient to make swallowing movements simultaneously with the advancement of the probe.

2.5. Tilt the patient's head forward and down.

2.6. Slowly advance the probe following the swallowing movements to the second mark, while the patient should breathe deeply through the mouth.

2.7. Make sure that the probe in the stomach has an “air gap”: attach a syringe to the probe and introduce air. Using a phonendoscope, listen for gurgling sounds. During insertion of the probe, monitor the patient's condition (absence of cough and cyanosis).

2.8. Advance the probe another 7-10 cm into the stomach.

Completing the procedure:
1. Secure the gastric tube with a bandage or fixing tape.
2. Attach the evacuation bag to the probe.
3. Tie the evacuation bag with a bandage to the side wall of the bed.
4. Allow the patient to catch his breath, lay him down, cover him warmly, and monitor the patient’s condition.
5. Remove gloves, place the apron in a container with a disinfectant solution, treat hands hygienically, and dry.

Mark the completion of the procedure on the appointment sheet.

Gastric intubation is used as an extremely effective method to determine diseases of the gastrointestinal tract. The procedure allows you to obtain accurate results. The examination is prescribed in the following cases:

when symptoms of peptic ulcer occur;
if gastritis is suspected;
when symptoms of reflux disease occur;
to identify other pathologies of the digestive system.

The gastric intubation technique is used when it is necessary to rinse the stomach in case of acute intoxication, which helps quickly remove toxins and prevent damage to the body. The technique allows artificial feeding of patients who are in a coma or have serious damage to the digestive organs.

Today, various methods have been developed to study the secretory function of the stomach. Each method has advantages and disadvantages. The probing method with further chemical, macroscopic study of the secretion is considered well-known and widespread in the world. Based on the obtained tests, the digestive ability of gastric secretions and the motor function of the stomach are assessed.

Simultaneous sensing

To perform this type of examination, use fat look probe - a tube made of rubber material, 80-100 cm in length, approximately 10 mm in diameter. Now the method is practically not used as a diagnostic method, as it is considered uninformative. This type of sounding is carried out in medicinal purposes. For example, for gastric lavage.

Multi-instant sensing

Multi-moment, or fractional, sounding is performed using a thin probe with a diameter of 4 mm and a length of 100-150 cm. A syringe attached to the tube periodically sucks in the contents of the stomach. With the type of examination described, the gag reflex, as a rule, does not occur. Fractional studies can be extremely informative and provide a comprehensive picture of gastric secretion.

The research algorithm involves 3 stages:

Lean stage. Gastric juice is extracted after insertion of the tube.
Basal stage. The liquid is sucked out over an hour.
Stimulating stage. Stimulating drugs and products are administered. After 15 minutes, the gastric contents are suctioned.

Equipment

For the procedure you will need:

a chair or couch to accommodate the patient;
clean towel or napkin;
medical probe;
syringe, vacuum suction for attachment to the hose;
medical tray or basin;
test tubes for collecting tests;
products, drugs that stimulate the production of gastric secretions.

Who is the examination contraindicated for?

Despite its prevalence, effectiveness and safety, this type of diagnosis has a wide range of contraindications:

pathologies of the vascular system;
pulmonary pathology, serious illnesses kidney;
coronary heart disease;
aggravated stage of atherosclerosis;
arterial hypertension;
arterial hypotension;
aortic aneurysm;
nasopharyngeal disease;
aggravated stage of diabetes mellitus;
allergic reactions to gastric secretion stimulants;
improper nasal breathing;
increased manifestation of cough;
a woman carrying a child;
mental disorders;
varicose veins of the esophagus;
stomach bleeding.

Stages of preparation for the examination

Preparation for gastric intubation begins a couple of days before the study.

Before the procedure, it is important to unload gastrointestinal tract, eating is prohibited. The last meal is taken 13-16 hours before the examination. You are allowed to drink clean water.
Two days before probing, you should avoid foods that stimulate secretory function stomach, increasing the accumulation of gases.
During the day before the examination, do not drink alcoholic or caffeine-containing drinks, do not smoke, or take medications internally.
It is recommended to remove dentures before starting the examination.
It is advisable to avoid stressful situations and excitement. Excessive tension can increase the production of gastric secretions and cause a gag reflex during the examination. In this case, the results will be incorrect, which will prevent an accurate diagnosis.

In the treatment room, the patient is prepared for examination as follows:

Detailed description of the research technique

The probing technique consists of stages:

The gastric intubation method, as a rule, does not provoke side effects. Most people examined easily tolerate the procedure without subsequently feeling any discomfort. In rare cases, mild malaise and indigestion may occur during the day. On this day, doctors recommend not to overload the stomach and avoid heavy foods. For lunch it is better to drink sweet tea with crackers. In the evening, when you feel better, you can have a light dinner.

New technologies make it possible to carry out probing in a more comfortable mode than before. Don't put off getting tested because you're afraid discomfort. The described type of diagnosis helps to identify the disease in different stages. Pain in the stomach may be a sign of the development of the disease. A correct diagnosis will allow you to receive timely help.

Before undergoing the examination, you can consult with a gastroenterologist to learn more about the procedure and make sure whether there is a serious contraindication.

Processing of survey results

The results are assessed in the laboratory. After the procedure, test tubes with portions of gastric secretions are labeled and given for study.

To correctly determine the diagnosis, the following parameters are considered significant: amount of content, consistency, color.

If the juice has a runny consistency and no color, this indicates normal functioning of the stomach.
Abundant fluid secretion indicates hypersecretion of the stomach, a shift in acidity levels in one direction or another.
At reduced level hydrochloric acid, the liquid acquires the smell of acetic or butyric acid.
A yellowish-green tint of the secretion indicates the presence of bile, brownish-red inclusions indicate the presence of blood.
Abundant blood in the liquid indicates possible bleeding in the stomach.
Viscous and thick liquid may indicate a leak. inflammatory processes, about the presence of gastritis or peptic ulcer.
The putrid odor of the liquid may indicate the presence of cancerous tumor. If the stomach is healthy, the liquid has no odor or has a sour odor.
Researched chemical composition secret.

Based on the diagnosis, appropriate treatment is prescribed.

Thus, probing allows you to study the physical and chemical parameters of gastric juice and obtain a reliable result.