SOUNDING OF THE STOMACH (fr. sonder to find out, investigate) — introduction of the probe to a stomach with the diagnostic and medical purpose. Extraction of gastric contents by means of the soft probe is entered into practice in the 70th 19 century by Evald (Page A. Ewald).
3. for the purpose of receiving its contents with the subsequent research for detection of diseases of a stomach and control of a condition of its secretory function in the course of treatment is diagnostic manipulation and it is made along with rentgenol, a research and gastroscopy (see). Constant extraction of contents of a stomach with the therapeutic purpose is shown at intestinal impassability (see. Impassability of intestines ), peritonitis (see), an acute gastrectasia (see. Stomach ), etc. Via the probe make a gastric lavage from diagnostic and to lay down. the purpose at poisonings, acute gastritis and a pyloric stenosis, administration of nutrients — at unconsciousness, burns and some mental diseases (so-called forced food).
Contraindication to 3. with the diagnostic purpose serious heart diseases, sharply expressed atherosclerosis, an aortic aneurysm, a serious illness of a respiratory organs, diseases of a nasopharynx and a gullet with difficulty of swallowing, sharp exhaustion of the patient, pregnancy, acute inflammatory process in an abdominal cavity, a myocardial infarction, an acute disorder of cerebral circulation are.
There are different types of gastric tubes: usual aspiration (thin and thick), pH-probes and endoradiosondes.
Usual aspiration gastric tubes — elastic rubber or plastic tubes with the rounded-off ends 1000 mm long. Near the rounded-off end entered into a stomach two oval openings are located. Outer diameter of probes is from 5 to 13 mm; probes to dia. 5 — 9 mm carry to thin, to dia. 10 — 13 mm — to thick. Stylets often have a metal olive on the end. For receiving rinsing waters of a stomach for the end of the probe place an abrasive cylinder.
rn-Zond, applied to an intragastric rn-metriya (see. Stomach, methods of a research ), represents the thin rubber probe with a metal olive on the distal end; in an olive electrodes are built in. The wires put in its thickness, the probe is connected to the chart recorder — anidomekhanografy (AMG-63) of Linar. Exist one - and multichannel pH-probes; in multichannel sensors are located in various departments of the probe.
Endoradiosondes (see. Endoradiozondirovaniye ) are a part of the installation applied to a radio telemetric research and represent the tiny radio transmitter connected to the reception and analytical device.
A technique of sounding of a stomach
Diagnostic sounding is made on an empty stomach or after a trial breakfast (see. Breakfast trial ). Since evening on the eve of the patient shall not eat, drink, smoke.) Removable dentures before manipulation need to be removed. 3. carry out in position of the patient sitting (his head is a little inclined forward), in case of heavy or unconsciousness of the patient — lying. In extremely exceptional cases at sharply expressed emetic reflex it is necessary to resort to anesthesia of a mucous membrane of a pharynx and throat, to-ruyu grease with solution of Dicainum, novocaine, etc.
Being on the right side from the patient, the right hand enter the warmed wet thick probe on a back wall of a pharynx. At the time of approach of the end of the probe to the level of an epiglottis to the patient suggest to make the deglutitory movement: the probe passes in an upper part of a gullet. The quiet rhythmical movements without violence the probe is pushed through a gullet in a stomach; at this moment of the patient deeply breathes a nose. During the carrying out the probe on 40 — 45 cm from the level of teeth it usually reaches a stomach. For determination of necessary depth of introduction of the probe it is possible to use also the figure equal to growth of the patient in centimeters, minus 100 — 105 cm. During the carrying out the probe in unconsciousness of the patient or in case of impossibility of performance of deglutitory movements by it the probe can get into a throat, goose breathing, cyanosis, a fidgets of the patient are signs of what. In this case it is necessary to take immediately the probe and to try to enter it again.
After entry of the probe into a stomach its contents begin to arrive via the probe. If it does not occur, it is necessary to wash out the probe and to force the patient to natuzhitsya slightly or movements of the probe to cause gaggings.
At extraction of the probe the spasm of muscles of a throat and gullet eliminated by introduction to the probe of a small amount of warm water is sometimes observed.
The stylet is entered the same as thick, but as it elastic, the patient shall swallow it. The seriously ill patient the stylet is quite often entered in a prone position, in Nov. Introduction of the probe takes several minutes and is easily transferred by the patient. Small impurity is fresher than blood to a gastric juice, unsharply expressed reaction to introduction of the parenteral activator of gastric secretion does not interfere with continuation of manipulation. The considerable and especially increasing impurity of blood — the basis for the termination of the procedure. The heavy reactions forcing to interrupt sounding arise seldom.
3. carry out by in one step thick probe or methods of multimoment (fractional) sounding, using a stylet.
Use way of single-step sounding only if there is no opportunity to apply more perfect methods; it supplies with the indicative information about sokootdelitelny and partly motor evakuatornoy functions of a stomach. In 45 or 60 min. after a trial breakfast enter the thick probe and completely take all gastric contents. If the gastric juice does not manage to be received, it is necessary fractional 3., since repetition of manipulations is inexpedient.
The thin gastric tube is entered on an empty stomach and pump out all contents of a stomach. Then enter an irritant (a trial breakfast, an injection of a histamine, insulin and gastrin). In 10 min. pump out 10 ml and in 15 min. — all contents of a stomach. Further within an hour pump out 4 portions at an interval of 15 min. It is desirable to pump out contents each 5 min., changing portion glasses every 25 min. Even more precisely results are achieved at constant suction of gastric contents.
Extraction of contents of a stomach is carried out by means of the stylet entered in Nov. This manipulation can be carried out periodically by the syringe attached to the probe, continuous pumping out with use of any suction is made less often.
Use preferential thick probe to a gastric lavage, the glass funnel joins the oral end to-rogo. As wash liquid use boiled water, isotonic solution of sodium chloride, solution of sodium bicarbonate, etc. The first portion of rinsing waters is subjected to a laboratory research. The gastric lavage is made also in the diagnostic purposes for the subsequent tsitol., bacterial, and toksikol, researches of rinsing waters.
For introduction to a stomach of nutritious mixes and proteinaceous drugs use thin (to dia. 2 — 3 mm) the polyvinyl chloride probes entered in Nov. At some patients them leave in a stomach for a period of 1 up to 4 months
the Research of gastric contents
the Research of gastric contents includes definition it physical. properties, chemical and microscopic examination.
The quantity of gastric contents is measured in the portions received on an empty stomach at a research of basal secretion and after a trial breakfast; on an empty stomach it fluctuates from 0 to 70 ml an hour, after use of irritants of gastric secretion — 50 — 110 ml (a food irritant) and 180 — 220 ml at stimulation by a histamine.
The smell at normal gastric contents is absent or slightly sourish. The putrefactive smell appears during the rotting of food proteins (e.g., at a pyloric stenosis), and also at disintegration of a cancer tumor.
Normal gastric contents are colourless. Impurity of bile paints it in yellow color in the absence of free salt to - you or in green — at its existence. Availability of blood changes coloring of gastric contents from red to brown. At gastritis and other diseases of a stomach slime is found in significant amounts.
The chemical research of contents of a stomach allows to judge acid-forming, zymoplastic and secretory its functions (see. Gastric juice ).
For microscopic examination choose the slime and various educations differing in color and a form from the general background. This material is washed fiziol, solution, placed on a slide plate and covered cover. From each studied portion prepare not less than three drugs; native, with solution of Lugol and Sudan III. In case of need studying of cellular structure dry up drugs and paint across Romanovsky.
Idiosyncrasy of gastric contents of healthy people — absence in it patol, impurity and the remains of the food eaten the day before. At disturbance, evakuatorny function of a stomach microscopic examination finds the digested cellulose in the form of the roundish cells with a thin cover containing starch; muscle fibers — yellowish cylindrical educations with cross striation; fat in the form of round drops of various size and in the form of needles fat to - t; barmy fungi — the oval, refracting light educations by the size there is slightly less erythrocyte, attendees are also normal, but in insignificant quantity; the sartsina having an appearance of the tied-up bales which find at stagnation in a stomach with existence free salt to - you.
Detection in gastric contents of slime with leukocytes and their kernels, cells of a cylindrical epithelium, deposits of muriatic hematin can indicate organic lesion of a mucous membrane of a stomach — gastritis, ulcer process, polyposes, cancer, etc. In the presence of a tumor of a stomach of its cell can be found in gastric contents. See also Stomach, methods of a research .
Bibliography: Linar E. Yu. Kislotoobrazovatelnaya function of a stomach is normal also of pathology» Riga, 1968; Fishzon-Ryss Yu. I. Modern methods of a research of gastric secretion, page 28, L., 1972.
A. I. Hazanov.