Poisoning

Preparation and carrying out anorectal manometry

Using this procedure, the pressure of the muscles of the esophagus, their interaction during the pharynx is measured. With the defeat of the upper parts of the digestive system, the first symptoms may be completely different or different diseases may appear identical, therefore, using manometry, you can determine the final diagnosis.

The procedure makes it possible to evaluate each department of the organ: responsible for swallowing, the upper and lower parts of the esophageal sphincter, and the organ itself. With its help, it is possible to determine the plan of the operation and check after surgery.

How does a water-perfusion catheter?

Water-perfusion catheter has special thin tubes that open in specific places on the surface of the catheter (pores). They are connected to the sensor, which is located externally, and the water pump. Using a pump, water is introduced into the tubes at high speed. At the same time, a change in pressure occurs in the pores, information about which passes to the sensor, and from it is displayed on the monitor as a graphic image. Most often, the catheter has 4 or 8 tubes.

The manometry of the esophagus is needed by a patient who develops symptoms, which is most often associated with impaired functioning of the upper gastrointestinal tract. The indications for esophagomanometry include:

  • singlephagy
  • dyspepsia (pathology of the pharynx, sphincter, alahazia, diffuse spasms, etc.),
  • dysphagia
  • gastroesopheral reflux disease,
  • exclusion of problems with the esophagus, as the genesis of anorexia nervosa,
  • non-coronary chest pain.

The procedure should be carried out in patients who have to undergo anti-reflux surgery or if there is a suspicion that the malfunction of the organ is part of a systemic disease (for example, diabetes, scleroderma, etc.).

Contraindications

Esophageal manometer is prohibited if the patient has the following problems:

  • blood coagulation disorders
  • mental disorders of various genesis,
  • the presence of tumors in the esophagus,
  • suspected organ tumors
  • ulcerative organ disease
  • strictures
  • varicose veins of the esophagus,
  • diverticulum.

Training

Before conducting manometry of the esophagus, the patient must be prepared. It is forbidden to eat or drink any liquid on the day of the study. Doctors do not recommend using antispasmodics, analgesics or sedatives, and many other pharmaceutical preparations. Better not to drink coffee.

Before starting the examination, the mucous membrane is treated with a spray, which is anesthesia. A catheter is inserted when a person is sitting, after which he needs to lie on his left side. The duration of esophagus manometry is half an hour. The results of the procedure can be found in a few days.

Carrying out the procedure

A long thin tube is inserted through the nasal passage into the organ lumen. At the tip of the conductor there are cylinders-sensors, the volume of which is regulated by a doctor. From the change of volume, the pressure in the organ changes upward, which is fixed by the sensors. These data provide an opportunity to evaluate the muscles of the esophagus.

Manometry of the lower esophageal sphincter

First, the organ is assessed at rest, then during swallowing of a small volume of fluid (sedation, residual pressure, etc.) are evaluated. The pressure at rest is the highest. To assess the relaxation, the patient is injected with 5 ml of water. It is necessary to check the period of relaxation, residual effects, etc.

Research results

The results are recorded in such fragments: the distal and proximal sections, the middle third, and also at points 3, 8, 13, 18 centimeters higher from the lower esophageal sphincter. The speed in the proximal and distal regions should be 3.0 ± 0.6 cm / s and 3.5 ± 0.9 cm / s, respectively.

Duration (measured in seconds) in sections, above the esophageal sphincter:

The amplitude is measured in millimeters of a mercury column:

Deviation

Deviations that are detected during manometry do not always indicate violations of the gastrointestinal tract. They can cause other diseases. Incomplete relaxation of the upper esophageal sphincter may indicate neurological abnormality. This can occur due to stroke, polio, Parkinson's disease, etc.

In any case, the manometry of the esophagus makes it possible to carry out an adequate diagnosis and prescribe the correct treatment.

What allows to reveal anorectal manometry?

  • irritable bowel syndrome,
  • fecal incontinence,
  • diverticular disease
  • megakolon,
  • disruption of the anal sphincter,
  • Hirschsprung disease,
  • causes of constipation, pain in the intestine.

The procedure for anorectal manometry

  1. The patient changes into special clothes.
  2. The patient takes a position on the left side.
  3. Through the anal sphincter, a tube catheter is inserted into the rectum, which has a special balloon.
  4. The second end of the catheter is connected to an apparatus that measures pressure.
  5. The necessary measurements are taken, while the patient will need to reduce or relax the anal sphincter at the moment when asked by the doctor.
  6. Estimated pressure during muscle movements.

Electromyography

Additionally, during the study, electromyography can be done - an assessment of the electrical activity of the fibers of the anal sphincter. It involves bringing a small electrode to the anal sphincter area.

The patient must first completely relax the muscle ring and then squeeze it sharply. For some time he must imitate the movements made during defecation - to push. The device records electrical changes in the muscle fibers of the sphincter, so you can evaluate its activity directly during anorectal manometry. During the study, the synchronicity of myocyte contractions, coordination of contractions and muscle relaxation are assessed.

After the additional test, the compliance of its results with the manometry data is assessed. Reduced pressure in the rectum during normal contractile activity of the sphincter indicates muscle function dysfunction.

Spray Test

The second additional test is the examination of the expulsion of the canister of the catheter from the apparatus. It is filled with water and placed in the rectum. After that, the patient is asked to do contractile movements that push the device. The specialist determines the time during which the balloon comes out of the rectum. Increased duration of elimination can be considered a sign of dysfunction of muscle elements in the anorectal region.

When manometry is prescribed, the readings

Detection of diseases of the gastrointestinal track is a difficulty in accurate diagnosis. Modern medicine offers examination options. Esophageal manometry is a safe, accurate way to study the digestive organs.

The procedure measures the pressure inside the esophagus. The examination assesses in real time the motor function of the esophagus, helps to follow the work of contractions and muscle relaxation. If the patient has symptoms associated with stomach pains and diseases associated with the work of the gastrointestinal tract, a manometry examination is prescribed.

  • With gastroesophilic reflux disease,
  • If there are abnormalities in the development of the upper esophageal sphincter, pharynx,
  • Disruption of the process of swallowing, inability to take a sip (dysphagia),
  • To eliminate problems with the esophagus,
  • It is made with hypertonicity of the lower esophageal sphincter (the sphincter is a valve that separates the esophagus and the stomach),
  • If there is pain when swallowing (singularity),
  • To prepare for surgery,
  • Used for postoperative control of the recovery process,
  • To diagnose GERD (assistance in determining the position of the pH probe),
  • When chest pains of non-coronary origin, may occur during tumor processes in the digestive tract organs, hernias, diverticula of the lower esophagus,
  • With severity, stomach cramps, esophageal dyspepsia.

Manometry is anorectal or anal (colonic method). It is used to diagnose diseases of the colon, used in proctology. The method allows to obtain information about the tone of the anorectal muscle complex, the duodenum is examined.

The need and frequency of the procedure determined by the attending physician.

Preparations for the manometry

The survey method requires preparation. The attending physician, who prescribes the manometry, should conduct explanatory conversations with the patient, tell in detail how the research will take place, what rules need to be considered, how to prepare the body.

  • A few days before the examination, the esophagus is washed through a thick stomach tube.
  • The day before the study, limit the intake of spicy, fatty foods. It is recommended to eat light broths to reduce the load on the digestive tract. 12 hours before the procedure can not eat and drink.
  • If you are taking medications, the doctor should know about it.
  • On the day of the manometry can not eat painkillers, antispasmodic, sedatives, the procedure is carried out on an empty stomach.

How is manometry performed

Manometry (esophagotonography) is an instrumental diagnostic method for studying diseases of a different nature of the esophageal tube. In this way, it is possible to study in detail the motor-evacuation function of the alimentary canal, starting from the pharynx and ending with the lower sphincter. The examination is carried out on an outpatient basis. The procedure is performed by a gastroenterologist.

  1. The procedure is less traumatic, during the integrity of the tissues and mucous membranes are not disturbed. The patient with the introduction of the probe feels temporary discomfort. Before the procedure, it is obligatory to consult a doctor, preparatory measures.
  2. The patient is seated in a special chair, in a comfortable position. The doctor treats the mucous membranes with anesthetic drugs (before the examination, report any allergic reactions to the drugs).
  3. After a few minutes, a probe is inserted (there should be no pain, as anesthetics are used). The patient feels discomfort, emetic desires are possible. If the probe cannot be inserted through the mouth, it is inserted through the nose.
  4. The patient is placed on a couch (examination is carried out in a horizontal position). The doctor measures the required indicators. The duration of the procedure is 20-30 minutes.
  5. The sensors record and transmit to the monitor the data that the gastroenterologist records for subsequent processing.
  6. After studying the esophagus, getting all the data, the gastroenterologist gently removes the probe. Possible pain in the throat, nausea, in rare cases, arrhythmia, bronchospasm.
  7. After completing a medical examination, a person returns to normal life. There should be no restrictions in physical activity and nutrition.

The procedure should be carried out by a highly qualified doctor. The insertion of the probe is important to be done carefully, so as not to injure the mucous membrane and not to induce vomiting in the patient.

What manometry shows

The procedure is used to accurately diagnose disorders in the esophagus. With the help of sensors that are attached to the probe, a gastroenterologist can study the indicators:

  • Evaluated the condition of the body
  • How do the sections of the esophageal tube interact, while reducing one section of the other should relax,
  • The duration of contractions and relaxations of the upper and lower sphincter is analyzed.
  • Muscle pressure, esophageal,
  • The digestive tube is examined for contractile abilities of the muscles (for lack of functioning),
  • A simultaneous recording of the pressure of the muscles of the esophagus and the colon,
  • Changes in indicators after taking 5 ml of fluid are evaluated.

The antroduodenal method can be used to examine the upper sections of the GTC.

The result of manometry is obtained in the form of digital indicators and graphs. On the chart, a gastroenterologist notes the measurement of amplitude, the duration and speed of contractions, compares with normal indicators of motility. Using the data manometry can be based diagnosis.

High resolution manometry reveals impaired antroduodenal coordination. Data analysis may take several days, issued after the conclusion of the diagnosis. The decoding analysis is performed by a specialist gastroenterologist. Based on the diagnosis, the doctor prescribes the appropriate treatment and makes recommendations. It may be necessary to conduct a re-examination after a time in order to follow the dynamics of the disease, the recovery process.

NPS manometry

During the examination of the lower food sphincter (LES), the pressure at rest is measured, a reduction is estimated at the moment of swallowing a small volume of fluid (percentage relaxation, duration, residual pressure on the organ walls). Determines the location of the NPC and size. The parameters that the doctor evaluates during the examination:

  • The resting pressure of the pump station (at the end of the input-output, average) is the point of greatest pressure,
  • The duration of relaxation - an assessment is carried out after taking a small amount of fluid
  • Total length,
  • Location

Indications and preparation for the survey

Anorectal manometry is prescribed to patients as a postoperative control, especially after the operation according to the diagnosis of “Hirschsprung's disease”, as well as after operations of anus atresia. The intervention occurs if there is a lack of relaxation of the internal anal sphincter, impaired motility of the colon without a reason, fecal incontinence.

Manometry do to assess the results of honey. interventions, diagnostics of differential type of chronic intestinal pseudo-obstruction, with pain with localization in the lower abdomen, constipation of chronic type that are not amenable to medical treatment.

A few hours before the scheduled examination, the patient is given several enemas. It is important to eat nothing at least six hours before the procedure. Before manometry at least two hours you need to abandon any drugs. During the period of taking the medication, you should try to drink as little water as possible in the last 24 hours.

Algorithm of the procedure

There are a lot of reasons that can provoke chronic constipation. It is worth noting that according to statistics, twenty percent of constipation appear due to psychological problems of the patient.

The duration of the procedure can vary within three hours, it all depends on the complexity of the situation. Before proceeding to a manometry, the doctor or nurse will ask the patient a standard list of questions in order to avoid unpleasant complications after the procedure. The patient is moved to the couch in this position: on the left side, legs bent at the knees.

A sterile disposable catheter (flexible tube with a can at the end) is inserted into the rectum.On the other hand, the catheter tube is connected to the device, which is responsible for the pressure level. To determine the reflex activity of the rectum balloon is pumped. At the same time, the patient is asked to relax the sphincter as much as possible, then compress it and perform standard emptying movements.

In addition to this method, anorectal manometry implies other methods.

Electromyography of the anal sphincter is a diagnostic type method by which the electrical potential of the sphincter muscles is studied. The control of pulses is carried out by means of special electrodes, which are installed in the anal cavity of the patient. Electromyography demonstrates the degree of coordination of relaxation and contraction of the muscles of the pelvic floor and anus.

The test of the expulsion of the balloon from the rectum - this type of study allows you to determine the time period over which the rectum will push the balloon out. A special balloon is inserted into the patient's anus, after which the tube is filled with water. The patient moves to the bathroom and performs a bowel movement procedure. The time for “ejecting” the can is fully fixed. If the time interval is too long - this is a direct indicator of the presence of violations of the functionality of the intestine and the anorectal region.

Possible risks and contraindications

Anorectal manometry is essentially a harmless and completely safe procedure, as it has the minimum amount of risk. The procedure is painless with slight discomfort. Sometimes during the procedure, there may be bleeding or rupture of the intestinal wall - an extremely rare phenomenon. Also, complications can occur in the presence of an allergic reaction to latex.

In order to avoid possible side effects, the doctor prior to the procedure prescribes the patient to undergo a whole range of examinations and tests, including:

  • Ultrasound examination of the abdominal cavity and small pelvis,
  • blood test for the group, KLA and OAM,
  • blood test for sexually transmitted diseases,
  • allergy tests.

To date, there are no direct and acute contraindications for conducting anorectal manometry, as the procedure is safe, with a low level of discomfort and pain. With care it is necessary to carry out this procedure to patients with diabetes mellitus, with the presence of blood diseases, with the presence of sexually transmitted diseases. Also at risk are patients with impaired functionality of the central nervous system.

Before the procedure, they are required to give sedative drugs in order not to provoke panic attacks, etc.

Due to the fact that the procedure is as safe as possible, it does not have age restrictions, therefore, it can be prescribed both for small children (only if indicated) and for patients in deep old age (it is mandatory to have a cardiogram before the procedure).

The results of the diagnosis

Normally, for each person, the depth of the anal sphincter should be within three centimeters, the minimum sensitivity threshold within ten to fifteen milliliters. During the procedure, the doctor assesses the vector volume of the intestine, pressure in the rectum and the rectonal reflex.

If all indicators are normal, and the problem with the intestines exists, then other diagnostic methods are prescribed. If the pressure of the sphincters is very high - this is a possible cause of constipation, low, in turn, may be the cause of the incontinence of fecal masses. Abnormal manifestations of reflexes in the rectum also signal the presence of a problem. The presence of Hirschsprung's disease may be indicated by the inability of the intestines to relax. For any problems with the intestines, it is important to consult a doctor and not self-medicate.

Watch the video: Anorectal Manometry Test, Live Patient Demo & Training (January 2020).