GASTRIC DISEASES :
Most peptic ulcer associated with H. pylori infection
the organism is present in the mucosa and its protect
from stomach acidity by creation of more neutral
microenvironment through secretion of large
amount of urease enzyme.
ZOLLINGER –ELLISON DISEASE
Ectopic secretion of gastrin (gastinoma).
That is neoplasia of either pancreatic gastrin producing cell
or gastric gastrin producing cell.
secretion Increase gastrin production lead to chronic hyper
of gastric acid .
is one of many types of the larger family of megaloblastic
anemias. It is caused by loss of gastric parietal cells, which
are responsible, in part, for the secretion of intrinsic factor,
a protein essential for subsequent absorption of vitamin
B12 in the ileum.
Measurement of the amount of HCl
produced by the stomach without
exposure to visual, auditory or
One hour morning aspiration
Following a 12 hour overnight fast, the patient is
intubated under fluoroscopic guidance
B) Pentagastrin stimulation test
Pentagastrin is a synthetic pentapeptide containing
the four C-terminal amino acids of gastrin coupled
to alanine. It has biologic activity similar to gastrin,
stimulating HCl and pepsin secretion.
is injected subcutaneously (4 µg/kg).
Collect the second aspiration .
(mucosal peptic ulcer
A BASELINE BREATH SAMPLE IS REQUIRED BEFORE TAKING THE ISOTOPE-LABELED
Prepare the solution of isotope-labeled urea
Patient drinks the solution. The patient drink the solution using the
plastic straw provided.
Wait 15 minutes, then collect second breath sample in the bag
when acid Content reach the duodenum stimulate the
duodenal S cells to release secretin into the blood, which
signals the ductul cells of the small ducts of the pancreas to
secrete a large volume of bicarbonate-rich, clear, watery
Similarly, the postprandial increase in amino
acids and fatty acids in the duodenal fluid stimulate
the I cells of the duodenum to secrete cholecystokinin
(CCK, aka pancreozymin). CCK, in turn, signals the
acinar cells of the pancreas to release enzyme-rich
fluid into the pancreatic duct. This is so called( ecbolic
Acute pancreatitis is a sudden inflammation that
occurs over a short period of time. In the majority
of cases, acute pancreatitis is caused by
gallstones or heavy alcohol use
Is ultimately caused by auto digestion of
occurs most commonly after an episode of acute
pancreatitis and is the result of ongoing
inflammation of the pancreas.
In about 45% of people, chronic pancreatitis is
caused by prolonged alcohol use. Other causes
include gallstones, hereditary disorders of the
pancreas, cystic fibrosis
CYSTIC FIBROSIS :
Inherited autosomal recessive genetic Disorder
Cystic fibrosis (CF) occurs when the gene
responsible for manufacturing an chloride ion
channel becomes mutated, causing the gene to
work abnormally. This channel creates
mucus, digestive juices and sweat. When this gene
mutates it tells the body to produce thick, sticky
mucus which promotes sinus conditions.
SECRETIN AND CCK TEST :
The secretin / cholecystokin-pancreozymin test to
assess pancreatic exocrine function.
Overnight fasting patient
Collect the basal juice
Pancreatic secretion is stimulated by intravenously
administrated of secretin in a dose varying from 23UKg of body weight
After of 20min of secretin injection administrated of
CCK and after 1h collect the pancreatic juice
Then the PH ,volume ,HCO3 level and enzymes activity are
Decrease pancreatic fluid with increase enzyme activity is
associated with pancreatic obstruction
Low concentration of HCO3 with low enzyme is associated
by cystic fibrosis or chronic pancreatitis
OTHER PANCREATIC FUNCTION:
Xylose absorption test.
Fecal fat determination
Sweet test (cystic fibrosis)
MALDIGESTION / MALABSORPTION
Maldigestion describes the inability of an individual
to digest food in the gut .
malabsorption is the inability to absorb nutrients
which have been digested from food through the
Celiac disease is an immune reaction to eating
gluten, a protein found in wheat.that damages
the small intestine's lining and prevents
absorption of some nutrients (malabsorption).
XYLOSE ABSORPTION TEST
Xylose is pentose sugar is ordinarily not present in
the blood. Pentose sugars Are absorbed un
changed by small intestine .
The test is done by ingestion of 25g dose by fasting
adult half of ingested xylose lose by the action of
bacteria and anther half excreted unchanged in the
So before making the test must be sure the normal
function of kidney .
After ingestion collected one or more than one of
And collected the urine sample after 5h of ingestion
Then measured the xylose in the plasma and urine
sample by heating of protein free supernates of
urine and plasma to convert xylose to furfural with
is then react with p-bromoaniline to form a pink
product the absorbance measured in 250nm and
thiourea is add as an antioxidant to prevent the
information of interfering chromogene.
Normal ( ↑p ↑p)
Intestinal malabsorption (↓P ↓U)
Renal “retention” (renal failure) (nl or ↑P, ↓U)
FECAL FAT ANALYSIS
Fecal fat drivedfrom four source
Unabsorbed in gested lipid , lipid excreted to the intestine
from the bile,cell shed into the intedtine and metabolism of
The fecal fat dose not normally exceed that 7g in
Increse fecal fat can be caused by biliriiy obestruction ,
sever steatorrhea associated with pancreatic exocrine
insuffinency or disease of small intestine
Normal fecal lipid is comoped of about 60% fatty acid ,
30%sterole and carotenoid and 10% triglyceride with small
amount of cholestrol and phosphlipid .
Qulative screeing test for fecal fat
Screeing test for detection steatorrhea this test commonly
used fat soluble stain ( sudan 3, sudan5,oil redOand blue
nile)which dissolved in and colour the lipid droplets
Quantitative fecal fat analysis
Usually on 72-hour stool collection and may
increase to 5 day.
Gravimetric method for fecal fat analysis
The entire sample is emulsified with water and liquid
is acididified to convert all fatty acid soap to free
fatty acid followed by extraction of lipid into a
organic solvent and then evaporations of the
organic solvent and the lipid residue is weighted.
Lactose tolerances test