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Gastointestinal tract tests


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Gastointestinal tract tests

  1. 1. Biochemical tests of gastrointestinal tract.
  3. 3. GASTRIC DISEASES : Peptic ulcer 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.
  4. 4. 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 . Pernicious anemia: 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.
  6. 6. PENTAGASTRIN TEST Measurement of the amount of HCl produced by the stomach without exposure to visual, auditory or olfactory stimuli.
  7. 7. A. BASAL GASTRIC SECRETION One hour morning aspiration Following a 12 hour overnight fast, the patient is intubated under fluoroscopic guidance Basal juice
  8. 8. 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 . Maximum secrotary
  9. 9. INTERPRETATION : basal MS Low HCL low HCL Low HCL high HCL high HCL high HCL (pernicious anemia) (mucosal peptic ulcer (ZE  
  11. 11. A BASELINE BREATH SAMPLE IS REQUIRED BEFORE TAKING THE ISOTOPE-LABELED UREA 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
  13. 13. 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 fluid called (hydraulic secretion). 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 Secretion).
  14. 14. ACUTE PANCREATITIS 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 pancreases
  15. 15. Chronic pancreatitis: 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
  16. 16. 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.
  17. 17. SECRETIN AND CCK TEST : The secretin / cholecystokin-pancreozymin test to assess pancreatic exocrine function. Method 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
  18. 18. Then the PH ,volume ,HCO3 level and enzymes activity are determined . 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
  19. 19. OTHER PANCREATIC FUNCTION: Xylose absorption test. Fecal fat determination Serum amylase Sweet test (cystic fibrosis)
  21. 21. 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 gut . 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).
  22. 22. 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 urine . So before making the test must be sure the normal function of kidney .
  23. 23. After ingestion collected one or more than one of blood samples(30m,1h.2h) 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.
  24. 24. Interpretion Normal ( ↑p ↑p) Intestinal malabsorption (↓P ↓U)  Renal “retention” (renal failure) (nl or ↑P, ↓U) 
  25. 25. 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 intestinal bacteria. The fecal fat dose not normally exceed that 7g in  24hperiod Increse fecal fat can be caused by biliriiy obestruction ,  sever steatorrhea associated with pancreatic exocrine insuffinency or disease of small intestine
  26. 26. 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
  27. 27. 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.
  28. 28. OTHER TEST Lactose tolerances test Serum caotenoid
  29. 29. Thank you Directed by Sara abdel mahmoud omer