Gastrointestinal function dynamic test

Gastrointestinal dysfunction includes gastric motility test, intestinal transit time measurement and pressure measurement, rectal-anal motor function measurement, electrogastrogram (EGG), biliary motor function test, gastric filling and emptying function test, small intestine Filling and emptying function check, eight tests of acid reflux test, mainly to check gastrointestinal function. Check the previous day's dinner for food, then fast, and forbidden water within 4 hours before the check. Basic Information Specialist classification: Digestive examination classification: ultrasound Applicable gender: whether men and women apply fasting: fasting Tips: Check the previous day's dinner for food, then fast, and check the water for 4 hours before the check. Normal value 1. Intestinal Determination of food through the intestinal tract is normal and the pressure in the small intestine is normal and stable. 2. Determination of gastric motor function One hour after the meal, there was no or a small amount of indigestible markers in the stomach. The frequency of gastric antrum contraction after meal is >50 hours, and the average amplitude is >30mmHg/2 hours, which often indicates a decrease in gastric motility. 3. In the normal situation of the electrogastrogram, the main power ratio of the stomach after meals and before meals is greater than 1. The main frequency of normal gastric electricity is 2 to 4 weeks/minute, and should be more than 75% after meals. 4. Intravenous cholecystokinin (CCK) measures the emptying index of the gallbladder, up to 70%. 5. In the acid reflux test, the pH value in the stomach is 1 to 4, and the pH in the esophage in the high pressure area is 5 to 7. The rectal-anal motor function was determined by the initial rectal sensory value of 87.3 ml (P<0.05), rectal defecation value of 128.4 ml (P<0.05), and rectal pain value of 206.1 ml (P<0.05). Clinical significance Abnormal result 1. The intestinal tract is measured by practice and pressure to measure the passage of food through the intestine for a long or short period of time, and the pressure in the small intestine is large, which is irritable bowel syndrome. 2. Determination of gastric motor function After one hour of eating, most of the indigestible markers remained in the stomach, especially after a small test meal, indicating that the patient may lack the digestive phase contraction or contraction. Postprandial gastric sinus contraction frequency <50 hours, average amplitude <30mmHg/2 hours, often indicates a decrease in gastric motility. 3. In the electrogastrogram, the main power ratio of the stomach power after meals and before meals is less than 1. 4. Intravenous cholecystokinin (CCK) measures the emptying index of the gallbladder, <40% can be considered biliary dysfunction. 5. In the acid reflux test, pH<4 lasted for more than 5 minutes, which was positive for gastroesophageal reflux disease. 6. The gastrointestinal tract is slow or stagnant, and the filling time is long. Need to check the crowd: irritable bowel syndrome, gastroesophageal reflux disease, gastroparesis, biliary dysfunction, gastrointestinal dysfunction. Precautions Taboo before inspection: 1. Check the previous day's dinner for food, then fast, and forbidden water within 4 hours before the check. 2. Call for anticholinergic drugs, calcium channel blockers, nitroglycerin sedatives and psychotropic drugs for 48 hours before the test. 3. Sign the consent form (if the hospital has this requirement). 4. The patient pays attention to the interference of electrodes and other radio waves (mobile phones, etc.). Taboo when checking: 1. Gastrointestinal ultrasonography should be arranged in the morning, pay attention to the gastrointestinal ultrasound examination before X-ray barium angiography to avoid the effect of tincture on ultrasound examination. If the sputum angiography has been performed, the ultrasound should be checked after the sputum is completely discharged. 2. If the lactulose is taken on an empty stomach, the digestive interval is different for different patients, resulting in heterogeneity of the mouth-blind passage time, so the lactulose should be taken at the same time as the test meal. The ingredients of the test meal should have a defined diet similar to that of a regular meal. 3 intubation should pay attention to moderate. 4. The patient maintains a comfortable position during the operation and reduces the error caused by the movement. Avoid talking or moving your position during the inspection. Inspection process 1. Intestinal passage time measurement and pressure measurement (1) Intestinal transit time check: 1 Hydrogen breath test method: The principle is that sugars that cannot be absorbed in the small intestine, such as lactulose, are explained by bacterial fermentation in the colon, and hydrogen is exhaled through the lungs. Therefore, exhaled hydrogen is collected after oral administration of lactulose for a certain period of time (10-15 minutes). Determination of exhaled hydrogen concentration by gas sensitive chromatograph According to the change of exhaled gas and hydrogen concentration, the mouth-blind passage time is the peak when the respiratory hydrogen concentration is higher than 50% of the base value or higher than 4 to 10 ppm. Fructose until the peak time. 2 radionuclide scanning method: A. Small intestine transit time measurement: usually after 99mTC labeled test meal, count under gamma camera (nuclear scan of anterior and posterior position to correct the error), if one of the two radionuclides is used for gastric emptying One is used to measure the mouth-blind passage time, thereby estimating the passage time of the small intestine. B. Determination of colon transit time: The radioactive labeling liquid is filled into the cecum or the radionuclide capsules orally dislocated in the cecum, disintegrating to measure the filling of the colon and the passage time of each segment. (2) Pressure measurement: Intestinal pressure measurement: a pressure manifold or a catheter with a miniature pressure sensor is inserted into the duodenum through the stomach until the upper part of the jejunum (the guide wire can be inserted through the endoscope under the X-ray), and the intestinal digestive interval can be measured. Dynamic activity during the digestive period (shrinkage contraction amplitude and dynamic index). 2. The main methods for measuring gastric motility are gastric emptying, gastric pressure measurement, and gastric tension measurement. 1. Gastric emptying test Nuclide method: Tc labeled solid test meal, electrogastrogram method with Fe304 labeled solid test meal, using a camera count or weak magnetic measuring instrument to detect changes in gastric magnetic field at different times after meal, determination The amount of markers in the stomach. 2. Determination of gastric pressure: Inserting a pressure manifold or a catheter with a miniature pressure sensor into the stomach. In fact, many studies have inserted the catheter into the duodenum to simultaneously measure the pressure changes in the stomach and duodenum. The tube needs to be positioned under fluoroscopy, and sometimes the endoscope is placed on the guide wire and the intubation pressure measurement time should be determined according to requirements. Generally, the empty stomach pressure is measured for 3 hours, and the test meal is 2 hours later. If the portable pressure monitoring system is applied, the recording time can be up to 24 hours. 3. Determination of gastric tension: a balloon is placed at the proximal end of the gastric cavity, and is connected to the electronically regulated pump. When the stomach is slack, the electric pump pumps the gas, and when the contraction, the gas is sucked out, so that the constant low pressure level is always maintained in the airbag. The slow contraction and relaxation of the upper part of the stomach were measured, and the change in the volume of the balloon at different levels of the internal pressure of the balloon was also observed. 3. Electrogastrogram measurement: shave the body hair placed on the electrode part; clean the skin with a friction agent; place the conductive paste in the center of the electrode, let it dry for 1 minute; wipe off the excess conductive paste outside the electrode; place the detection electrode along the axis of the gastric antrum. One electrode is placed on the midline of the abdomen, the midpoint of the xiphoid is connected to the umbilical line, and the other detection electrode is placed at a 45° angle of 5 cm to the upper left. The reference electrode is placed at the same level of the right abdomen and the center electrode 10 to 15 cm; the impedance of the detection electrode is checked with an ohmmeter, and the impedance is less than 5 K for EGG inspection. Otherwise, the skin should be re-prepared or replaced with a new electrode; first check on an empty stomach for 30 to 60 minutes; give the patient a standard meal (eg egg sandwich plus 200 ml water). Marked after meals and before meals. Some devices have a note button for marking; after the meal, check for 60 to 90 minutes; after the surgery, remove the detection electrode. Four rectal-anal motor function tests: Anorectal manometry was performed with an electronic air pump and a fluid perfusion gastrointestinal pressure monitoring system. First record the anal internal sphincter resting pressure and the internal sphincter maximum systolic pressure sensory function test with increasing pressure phase expansion, inflating into the balloon, the inflation rate is 38ML / s, each pressure increase 5mmHg, the instrument automatically records the gas injection capacity, The time between the two insufflation intervals was reported. The subjects reported the sensation through the sensory language score table to observe the initial rectal sensation of the rectum, rectal defecation and rectal pain, and then calculate the rectal compliance. At the same time, the rectum was able to lead out the rectum during the insufflation. The anal inhibition reflects the minimum volume above the internal sphincter pressure drop, ie the minimum inhibition capacity. 5. Determination of biliary motility function: 1. After the patient has a fat meal, observe the change of the volume of the gallbladder with b-ultrasound, 2. The emptying index of the gallbladder was measured by intravenous injection of cholecystokinin (CCK). 6. Acid reflux test: Inject 0.1 mol/L HCL 150-300 ml into the stomach and slowly pull the electrode. The electrode was placed 5 cm above the lower esophageal high pressure zone. The pH values ​​at different points of 5, 10 and 15 cm were measured. At the same time with the Valsala technique (the glottis is closed for exhalation to increase the intrathoracic pressure) and Muller's technique 9 after exhaling, close the sound and inhale, increase the intrathoracic negative pressure and change the position, induce gastroesophageal reflux, and measure the pH value. . Not suitable for the crowd Patients who are sensitive to radionuclides. Adverse reactions and risks No complications.