GASTRIC
FUNCTION TESTS
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DR . SUDHANSHU SHEKHARASSOCIATE PROFESSOR
DEPT. OF BIOCHEMISTRY
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Indications of gastric function tests1. Diagnosis of gastric ulcer
2. In chronic duodenal ulcer
3. Evaluate pernicious anemia in adult
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4. Presumptive diagnosis of Zollinger ? Ellisonsyndrome
5. Determination of completeness of surgical
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vagotomy
CLASSIFICATION
1.Examination of resting contents in resting juice
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(GASTRIC RESIDUM )
2.Fractional test meal
3.Examination of contents after stimulation
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a) Alcohol stimulationb) Caffeine stimulation
c) Histamine stimulation
d) Augmented histamine test
e) Insulin stimulation test
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f) Pentagastrin test4.Tubeless gastric analysis
5. Endoscopy
Collection of sample
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Collection of contents of stomach? After overnight fast
? After test meal
Types of stomach tubes
Rehfuss tube
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Ryles tubeMarkings on tube
Single ring reaches lips ----Tip reaches cardiac end
Double ring reaches lips--- Tube in body of stomach
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Examination of resting contents1.Volume
Normal ----20 ? 50 ml
Abnormal -----greater than 100 ? 120 ml
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Hypersecretion of gastric juiceI. Retention of gastric contents due to delayed
emptying
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II. Due to regurgitation of duodenal contents2. Consistency
Normal -----fluid
Abnormal ----food residues ( Ca stomach)
.
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3.Colour
Normal -----clear or colourless
Abnormal ------
slightly yellow /green -- regurgitation of bile
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red brown--- due to presence of blood4.Bile
Intestinal obstruction
Ileal stasis
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.5.Blood
In trace amount ? may be due to trauma during
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Ryles tube passageIncreased amount ?
Gastric carcinoma
Erosive gastritis
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Bleeding peptic ulcer6. Mucus
Normal --- small amount
Increased mucus ----gastritis and gastric
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carcinoma.
7. Organic acids
Absence of HCl ------micro organisms thrive and
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ferment food residues to produce organic acids,
lactic acid and butyric acid
8. Pepsin
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Absence ---Achylia GastricaIncresed --- Z E syndrome
duodenal ulcer
gastritis
Decresed --- chief cell mass
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atrophic gastritisgastric carcinoma
9. FREE AND TOTAL ACIDITY
Free acidity (0 ? 30 mEq/L)
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measures only HClit is measured by titration with N/10 NaOH using
Topfer's reagent as indicator
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Combined acidity ( FA-TA)include Protein hydrochlorides, acid phosphates, and
organic acids like lactic acid and other organic acids
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Total Acidity (10 ? 40 mEq/L)sum total of free and combined study.
it is measured by titration with NaOH by
phenophthalein indicator
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Fractional gastric analysis/fractionaltest meal
Introduction of ryles tube in stomach of fasting
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patient Removal of residual gastric contents and its
analysis
Ingestion of test meal
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(Ewald meal: toast, with water or tea Fractional testmeal of Rehffus: Pint of oat meal gruel)
Analysis of samples
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Hyperacidity/.
Max free acidity
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Duodenal ulcer
hyperchlorhydria
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exceeds 45 mEq/LGastric ulcer
Gastric carcinoma
Hyperirritability
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Hypoacidity
Free acid below the
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Pernicious anemianormal range
Achlorhydria
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No secretion of HCl
Carcinoma stomach
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but enzyme pepsin isPartial gastrectomy
present
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Pernicious anemia
Hyperthyroidism
myxedema
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Achylia gastrica ? both enzymes and acids are absent indicatingcomplete absence of gastric secretions
Advanced gastric cancer
Typically seen in pernicious anemia and subacute combined
degeneration of spinal cord
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Stimulation tests ?1. Alcohol stimulation test
Overnight fast, Ryles tube passed ? resting
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contents removed for analysis
100 ml of 7% ethyl alcohol is administered
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Samples removed after every 15 mins and analysed
for free and total acidity, presence of bile, blood
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and mucus2. Caffeine stimulation Test
caffeine sodium benzoate (500 mg in 200 ml water) given
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orally3. Histamine stimulation test
Powerful stimulant for HCl in normal stomach
Acts on receptors of oxyntic cells, increasing cAMP,
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which causes secretion of increased volume of high
acidic gastric juice with low pepsin content
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Best to differentiate between true achlorhydria fromfalse achlohydria
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.Augmented histamine test
? Normal persons ---Upto 10 mEq/hr acid is
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present in pre histamine specimen ,with 10 -25 mEq in post histamine
specimens
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Pernicious anemia ----No free HCl secreted
Duodenal ulcer ----- > 100 meq
4. Insulin stimulation test (Hollander's test)
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Potent stimulus for gastric acid secretion ?hypoglycemia
Indication :
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To check the effectiveness of vagotomy in patientswith duodenal ulcer
Stimulus ? 0.1-0.2U/kg body weight of soluble
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insulin iv
After successful vagotomy , since there is no response
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to insulin, gastric acidity remains at a low level of 15-20 meq/L before as well as after insulin
administration.
5.Pentagastrin stimulation test
? Pentagastrin is a synthetic peptide.
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? It stimulates the gastric secretion in a mannersimilar to the natural gastrin.
? The stomach contents are aspirated by Ryle's
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tube in a fasting condition.
? This is referred to as residual juice.
? The gastric juice elaborated for the next one
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hour is collected and pooled which represents
the basal secretion.
.
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? Pentagastrin (6 micg/kg body wt given sc) isnow given to stimulate gastric secretion.
? The gastric juice is collected at 15 minute
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intervals for one hour.
? This represents the maximum secretion.
? Each sample of the gastric secretion collected
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is measured for acidity by titrating the samples
with N/10 NaOH to pH 7.4.
? The end point may be detected by an indicator
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(phenol red) or a pH meter
.
Basal acid output (BAO) refers to the acid
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output (millimol per hour) under the basal
conditions i.e. basal secretion.
Maximal acid output (MAO) represents the
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acid output (millimol per hour) after the
gastric stimulation by pentagastrin i.e.
maximum secretion.
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? In normal individuals,BAO is 1- 2.5 mmol/hr
MAO is 20-40 mmol/hr.
Condition
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.Basal secretion
Maximal scretion
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Normal
1 ? 2.5 mEq/hr
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20 ? 40 mEq/hrDuodenal ulcer
Moderately raised
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Above 40 mEq/hr
Zollinger Ellinsons Highly raised
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Highly raisedSyndrome
Gastric cancer
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True achlorhydria
Pernicious anemia
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True achlorhydriaTubeless gastric analysis
? The tubeless gastric analysis involves
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administration of a cation exchange resintagged with a dye Azure A is given orally.
HCl secreted by stomach displaces the dye
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Absorbed in intestineExcreted in Urine
The amount of dye excreted in urine is
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proportional to acid output.Helicobacter Pylori Detection
? H.pylori infection is playing a role in acid peptic disease.
? The bacteria releases Urease enzyme
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Tests for H.Pylori
1. Rapid urease test in gastric biopsy
2. Serological tests ? anti H.Pylori antibody ,less reliable
3.
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13 C, 14 C- Urea breath CO2 test
4. Stool antigen for H.Pylori
5. Histological examination and culture of gastric biopsy
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sample.
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ENDOSCOPYImportance
Limited but specific uses in certain conditions
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Perinicious anaemiaZES
Peptic ulcer
Now endoscopy plays a major role
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Biopsy can be taken