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Gastric function test ppt


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Gastric function test ppt

  1. 1. Dr. Vijay Marakala, Senior Lecturer BIOCHEMISTRY IMS, MSU. MBBS, MD.
  2. 2. Introduction Indications Classification
  3. 3. • Chemical examination of gastric contents has limited but specific value in diagnosis & assessment of disorders of upper GIT
  4. 4. • Normal fasting gastric juice per day is about 1L • Stomach of a person taking a normal diet secretes 2L-3L of gastric juice per day
  5. 5. During resting period During digestion after meals After stimulation
  6. 6. HCl • secreted by PARIETAL CELLS Pepsinogen Intrinsic factor • Secreted by CHIEF CELLS • Required for absorption of Vitamin B12 Alkaline mucous • Which coats the gastric walls act as lubricant
  7. 7. I N D I C A T I O N S To diagnose Gastric Ulcers To exclude the diagnosis of Pernicious anaemia & Peptic ulcer For presumptive diagnosis of Zollinger Ellison Syndrome To determine the completeness of Surgical Vagotomy.
  8. 8. Analysis of Resting contents Gastric Residuum Fractional Test Meal Analysis Fractional gastric analysis using a test ‘meal’ Analysis after Stimulation Stimulation by Alcohol or Caffeine or Histamine or Insulin or Pentagastrin Tubeless Gastric Analysis Used as screening test
  9. 9. Volume Consistency Colour Bile Blood Mucus Pepsin Free acidity Total acidity Organic acid
  10. 10. NORMAL ABNORMAL CAUSES Volume 20-50mL >100-120mL • Hypersecretion of Gastric juice • Retention due to delayed emptying • Regurgitation of duodenal contents Consistency - Fluid Food residues • Carcinoma of stomach Colour – clearcolourless or slightly yellowish or green Dark red or brown* Due to blood • Bleeding Gastric ulcer • Carcinoma of stomach Bile – occasionally Increased amount • Intestinal Obstruction and ileal stasis. Mucus - small amount Increased amount • Gastritis and carcinoma of stomach
  11. 11. NORMAL ABNORMAL CAUSES Organic acid Lactic acid , butyric acid present in large amount • Hypochlorhydria, achlorhydria and Ca stomach Free acidity-measures only HCl. 0-30mEq/L >50mEq/L • Hyperacidity Total acidity – includes HCl and other organic acids. Normal 10-40mEq/L Pepsin Decreased levels Increased levels • Atrophic gastritis, Ca stomach • Zollinger-Ellison syndrome
  12. 12. Procedure • After removing residual contents, meal is given. With intervals of 15 minutes contents of stomach are removed ,strained & analysed Normal response • Free acid rises steadily from 15 min – ½ hr/45 min, and decreases
  13. 13. Hyperchlorhydria Hypochlorhydria • Free acid >50mEq/L • Duodenal ulcer • Gastric ulcer • Gastric cell hyperplasia • Zollinger Ellison Syndrome • Ca of stomach • Atonic dyspepsia Achlorhydria • No HCl but pepsin is present • Seen in Ca stomach, chronic gastritis Achylia gastrica • Both HCl and pepsin are absent • Later stage of Ca stomach • Chronic gastritis • Pernicious anaemia
  14. 14. The residual contents removed after 7%100ml ethyl alcohol is given overnight fasting ALCOHOL STIMULATION Samples are taken every 15 min Analysed for free, total acidity, pepsin, blood, bile and mucus
  15. 15. CAFFEINE STIMULATION TEST Stimulus is caffeine sodium benzoate -500 mg in 200 ml water given orally
  16. 16. Histamine stimulation test Powerful stimulant for HCl in normal stomach Acts on receptors of oxyntic cells Best to differentiate between true achlorhydria from false achlohydria
  17. 17. Standard Histamine test Augmented histamine test (Kay’s test)
  18. 18. STANDARD HISTAMINE TEST Histamine is given Absence of HC subcutaneously indicates “achylia 0.01mg/kg body gastrica (true weight achlorhydria) Increase in HCl indicates Duodenal Ulcer
  19. 19. PROCEDURE • Procedure: After overnight fast, residual contents are analysed and contents are collected every 20 min for an hr. • Halfway through this period 4ml of mepyramine maleate (anthisan), given IM, to block H1 receptors. • At the end of hr histamine acid phosphate,0.04mg / kg bwt, SC given and contents removed every 15 min for 1 hr.
  20. 20. Normal response • Upto 10 mEq/hr acid is present in pre histamine specimens • with 10 -25 mEq in post histamine specimens In pernicious anaemia • No free HCl secreted In duodenal ulcer • > 100 meq
  21. 21. Hypoglycemia is Potent stimulus for gastric acid secretion Indication:To check the effectiveness of vagotomy in patients with duodenal ulcer Stimulus – 15 unit of soluble insulin iv
  22. 22. I. Before vagotomy II. After successful vagotomy, there is no response and acid level is very low.
  23. 23. Synthetic peptide It is a potent stimulator Measure of Total Parietal Mass Dose— 6 microgram/kg bwt, SC
  24. 24. After emptying the stomach of resting contents.. Inject pentagastrin 6g/μKg bwt, SC Collect gastric juice secreted for next 1 hr to have BASAL SECRETION. Analyse All the specimens collect 4 samples with 15 min intervals
  25. 25. • Basal secretion rate1-2.5mEq/hr • After pentagastrin stimulus, it is 2040mEq/hr Normal • 15-83mEq/hr • Mean 43 • >40 indicates duodenal ulcer In Duodenal ulcer • Basal secretion is > 10 mEq / hr in ZollingerEllison syndrome
  26. 26. It avoids discomfort of naso gastric tube Used only as a screening test. Fasting secretion is stimulated by histalogue , after 1 hr dye bound resin “Diagnex Blue” with “ Azure A” is given orally.
  27. 27. In the presence of HCl resin releases dye,which is absorbed & later excreted in urine The quantity of dye in urine provides indication of presence /absence of HCl. It is not reliable in pts with renal diseases, urinary retention,malabsorption,pyloric obstruction etc.
  28. 28. Reference Thank you