The document outlines various tests for assessing pancreatic and intestinal functions, detailing the exocrine and endocrine roles of the pancreas, along with specific pancreatic enzyme levels and their implications in conditions like acute pancreatitis. It also discusses the function and testing of the small intestine, the diagnostic relevance of various tests for malabsorption and intestinal diseases, and the role of tumor markers in conditions like pancreatic carcinoma and carcinoid syndrome. The document serves as a comprehensive guide for understanding both pancreatic and intestinal function tests in clinical practice.

1. TESTS FOR PANCREATIC AND
INTESTINAL FUNCTIONS
Dr.S.Sethupathy,M.D,Ph.D.,
Professor of Biochemistry,
Rajah Muthiah Medical college,
Annamalai university

2. PANCREATIC FUNCTION TESTS
 Pancreas performs both exocrine and endocrine
functions.
 Exocrine pancreas secretes about 1000-2500 ml of
juice in 24 hrs.
 The pancreatic juice is alkaline and contains
bicarbonate and enzymes.
 Secretin from duodenum induces the secretion of
juice with high bicarbonate.
 Cholecystokinin (CCK) produces enzyme rich
pancreatic secretion.
 Gastrin from stomach stimulates CCK production.

9. PANCREATIC ENZYMES
 The enzymes present in pancreatic juice are amylase, lipase,
trypsin, chymotrypsin carboxypeptidase and elastase as their
zymogens.
 Serum amylase
 The serum amylase contains the pancreatic(P) and
salivary(S)isoenzymes.
 They can be differentiated by S-isoenzyme inhibitor.
 Normal serum amylase level is 50-120 units.
 In case of acute pancreatitis, the level rises within 5 hours and
reaches a peak in 12 hours.
 Within 2-4 days, serum amylase may become normal but
urinary amylase level increases.

10.  Clearance ratio = (urinary amylase level /
Sr. amylase level) x ( Sr. creatinine / urine
creatinine) x 100
 The normal clearance ratio is 1-4.4% but
in patients with acute pancreatitis the ratio
varies from 7-15%.
 Mild elevation of serum amylase is seen in
cholecystitis, peptic ulcer, diseases of
mesentery, intestinal obstruction and
chronic pancreatitis.

11. MACROAMYLASEMIA

13. SERUM LIPASE
 Its level is highly elevated in acute
pancreatitis and persists for 7-14 days.


14. SECRETIN CHOLECYSTOKININ TEST
 Secretin is commonly used as a gastrin provocative test.
 Secretin causes increased secretion of gastrin from
gastrinomas.
 There will be no response to secretin when high gastrin
levels are due to other causes.
 After secretin and cholecystokinin administration,
duodenal contents are aspirated for 80 min at 10 min
intervals.
 Duodenal content is analyzed for bicarbonate content,
amylase activity.
 In pancreatic carcinoma and chronic pancreatitis
,bicarbonate and amylase are decreased.


18. SWEAT ELECTROLYTES
 In pancreatic fibrocystic diseases, sweat
sodium chloride is increased.
 Sweat chloride more than 60 nmol/L on
two separate occasions is diagnostic of
cystic fibrosis


19. CYSTIC FIBROSIS- MUCOUS BLOCKS

22. PANCREAS – TUMOUR MARKERS
Carcinoembryonicantigen(CEA)
α-fetoprotein
Pancreatic oncofetal antigen.
Leucine amino peptidase is usually
elevated in pancreatic carcinoma.

23. SMALL INTESTINAL FUNCTION TESTS
 Functions
 Small intestine secretes regulatory molecules
and enzymes for digestion of carbohydrates
lipids and proteins.
 The regulatory molecules are secretin,
cholecystokinin,vasoactive intestinal
polypeptide.
 Secretin and cholecystokinin stimulate
pancreatic secretion.
 Secretin also stimulates gall bladder and
gastric secretion.


25. INTESTINAL ENZYMES
 Disaccharidases of intestinal mucosal brush border
 Dipeptidases
 Tripeptidases in mucosal cell
 Intestinal lipase in the mucosal cell.
 Absorption
 Fats, proteins, carbohydrates are absorbed in the
proximal jejunum.
 Vitamin B12, bile acids are absorbed in the terminal
ileum.
 Water and electrolytes are also absorbed by small
intestine.


26. SMALL INTESTINAL FUNCTION TESTS
 Used to diagnose malabsorption
 To diagnose specific intestinal diseases

27. FECAL FAT ESTIMATION
 A collection period of three days
 An average intake of 90 gm fat daily
 Fecal fat is normally less than 7 gm / 24 hours.
 When the feces contain split fatty acids, it
indicates normal pancreatic function but
defective absorption.
 If the excreted fat is neutral fat, it is due to
defective digestion and in favor of pancreatic
disease.


35. TRIACYLGLYCEROL BREATH TEST
 14C- labeled triacylglycerol is given orally
and breath CO2 with label is analyzed.
 The amountof labeled CO2 is measure of fat
digestion and absorption.
 In steatorrhoea, labeled CO2 is decreased in
breath.
 This test is not reliable in diabetes mellitus
and respiratory disease.


38. LACTOSE TOLERANCE TEST
 50 gm lactose is given orally and increase in
blood glucose level is evaluated.
 The lactose tolerance test requires an individual
to drink a liquid that contains lactose.
 Several blood samples are taken over a two
hour period
 The blood test is considered abnormal if
glucose level rises less than 20 mg/dL (1.1
mmol/L) within 2 hours of drinking
the lactose solution.

39. LACTOSE BREATH TEST
 14C labeled lactose is given orally and
breath 14C labeled CO2 is estimated.
 In lactose intolerance labeled CO2 will be
low.


41. AMINO ACIDS ABSORPTION
 Specific disorders of amino acid transport
affect both proximal jejunum and proximal
renal tubules.
 Eg.Cystinuria, Hartnup disease.
 Diagnosed by chromatography of amino
acids in urine samples.

42. TESTS FOR GUT PERMEABILITY
 Normally lactulose is not absorbed by intestinal
mucosal cell whereas rhammose is well
absorbed.
 In case of Celiac disease and Crohn’s disease,
there will be increased absorption of lactulose
and decreased absorption of rhammose.
 Alcohol also alters gut permeability and
increases the absorption of endotoxin leading to
liver injury.

43. TESTS FOR ABSORPTIONS DEFECTS
 51cr EDTA
 51 Cr EDTA is given orally
 It is increased excretion in urine indicates
altered gut permeability.
 It is not to be done in renal failure

 Test for protein loss
 51 Cr- albumin excretion is increased in protein
losing enteropathy.


44. TESTS FOR BACTERIAL GROWTH
 By intubation intestinal samples collected are
analyzed for bacterial contamination.
 It is an invasive procedure.
 Indican is derived from tryptophan by bacterial
overgrowth.
 It results in increased excretion of indican in urine.
 14C- Xylose breath test
 Xylose is metabolized by bacteria and labeled CO2 is
released in breath.


46.  14C-glycocholatebreath test
Glycocholate is deconjugated by bacteria and labeled
CO2 appears in breath.
 In bacterial overgrowth, there will be increase in
labeled CO2 in breath.
 Schilling’s test
 Pernicious anemia.
 Initially body B12 stores are replenished by B12
injection.
 Then radio labeled B12 is given orally and the
excretion of labeled B12 indicates the presence of
intrinsic factor.
 If labeled B12 and intrinsic factor are given orally and
labeled B12 is not excreted, it indicates intestinal
disease.

47.  Detection of antibodies
 Antibodies of a gliadin detected in
plasma in Celiac disease.
 Tropical sprue is characterized by
villous atrophy and malabsorption.
 It may be due to bacterial infection and
respond to broad spectrum antibiotics.
 Antibodies to gliadin are not present.

48. CARCINOID SYNDROME
 Increased excretion of 5-hydroxy indole acetic acid
(5-HIAA).
 Normal excretion of HIAA is less than 7 mg/day
 Carcinoid syndrome is caused by tumor of
Argentaffin cells from small intestine
 It produces large amount of serotonin and the
metabolites of it, 5- HIAA.
 Tumor markers
 Serum CA 125 and carcino embryonic antigen
(CEA) are increased in colon cancer.



50. Thank you