Scribd
Upload
5K views15 pages

Gastric Function Tests

This document discusses tests of gastric and pancreatic function. It outlines the main components of gastric secretion and how gastric secretion is stimulated by the vagus nerve, gastrin, and histamine. It also discusses hypersecretion and hyposecretion of gastric juice and conditions that can cause them. For pancreatic function, it describes the endocrine and exocrine secretions and enzymes. It then summarizes some tests of exocrine pancreatic function, including plasma enzyme measurements, duodenal aspiration tests, and tubeless tests like the PABA test and pancreolauryl test.

Uploaded by

Mustafa Khandgawi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
5K views15 pages

Gastric Function Tests

This document discusses tests of gastric and pancreatic function. It outlines the main components of gastric secretion and how gastric secretion is stimulated by the vagus nerve, gastrin, and histamine. It also discusses hypersecretion and hyposecretion of gastric juice and conditions that can cause them. For pancreatic function, it describes the endocrine and exocrine secretions and enzymes. It then summarizes some tests of exocrine pancreatic function, including plasma enzyme measurements, duodenal aspiration tests, and tubeless tests like the PABA test and pancreolauryl test.

Uploaded by

Mustafa Khandgawi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 15

Gastric function tests

Introduction
The main components of gastric secretion are:(1)Hydrochloric acid.
(2)Pepsin.
(3)Intrinsic factor.
All important for normal digestion & absorption.
Gastric secretion may be stimulated by:-

(1)The vagus nerve


Which , in turn , responds to stimuli from the cerebral cortex
, normally resulting from the sight , smell and taste of food.
Hypoglycaemia can stimulate gastric secretion and so can be
used to assess the completeness of a vagotomy.

(2)Gastrin
Is carried by the blood stream to the parietal cells of the
stomach ; its action is mediated by histamine.
Gastin is inhibited , by negative feedback , by acid in the
pylorus.
Calcium also stimulates gastrin secretion and this may
explain the relatively high incidence of peptic ulceration in
patients with chronic hypercalcaemia.

(3)Histamine
Only stimulates gastric secretion after binding to specific
cell-surface receptors of which there are at least two types:(1)Those for which antihistamines compete with histamine
(H1 receptors). These are found on smooth muscle cells.
(2)Those on which antihistamines have no effect. These
H receptors are found on gastric parietal cells.

Hypersecretion of gastric juice


May cause duodenal ulceration.
However , there is overlap between the amount of acid
secreted in normal subjects and in those with duodenal
ulceration.
Estimation of gastric acidity is of very limited diagnostic
vaule.
In the very rare Zollinger-Ellison syndrome , acid secretion
is very high due to excessive gastrin production usually by a
pancreatic tumour.

Hyposecretion of gastric juice


Occurs most commonly in associated with pernicious
anaemia , due to the formation of antibodies to the parietal
cells of the gastric mucose.

Extensive carcinoma of the stomach and chronic gastritis


may also cause gastric hyposecretion.
Plasma gastrin concentrations are causes loss of negative
feedback inhibition.

Tests of gastric function


Tests of gastric function involving measurement of acid
secretion have largely been superseded by endoscopic
examination of the stomach and duodenum and by
histological examination of the biopsy material obtained.

Stimulation of gastric secretion


With the measurement of gastric acidity , may be used to test
the completeness of section of the vagus nerve in patients
who remain symptomatic after surgery for duodenal
ulceration.
The stimulus is stress due to insulin-induced
hypoglycaemia(compare the use if insulin to stimulate
cortisol secretion).

If vagotomy is complete , symptomatic hypoglycaemia with


a plasma glucose concnetration below 2.5mmol/l (45mg/dl)
should produce no increase in acid secretion.

Pancreatic function

Introduction
Pancreatic secretions can be divided into endocrine and
exocrine compontents.
The endocrine function which controls the plasma glucose
concnetration.
Exocrine secretion are made up of two components:(1)Alkaline pancreatic fluid.
(2)Digestive enzymes.
The alkaline fluid is primarily responsible for neutralizing
gastric acid secretions , thus providing an optimal
environment for duodenal digestive enzyme activity.
These enzymes include the proteases , trypsin and
chymotrypsin , and amylase and lipase.

Some of the proteases are secreted as precursors and are


converted to the active form within the intestinal lumen.
Gut peptides , released from the duodenum in response to a
rise in the hydrogen ion concentration or to the presence of
food , control pancreatic secretion.
They include:-(1)Secretin which stimulates the release of a
high volume of alkaline fluid.
(2)Cholecytokinin which stimulates the release of a fluid rich
in enzymes.

Tests of exocrine pancreatic function


Plamsa enzyme
Measurements are of limited value in assessing exocrine
function.
Such measurements include:-

Plasma trypsin concnetrations


Used to screen for cystic fibrosis during the first six weeks
of life when full pancreatic function should be established.
Blockage of pancreatic ductless by sticky mucus secretion
causes high plasma trypsin concentrations.
After about six weeks plasma concentration s may fall as
pancreatic insufficiency develops ; normal levels do not
exclude the diagnosis.

Plasma amylase activity


This enzyme consists of two forms , of salivary gland and
pancreatic origin respectively.
Because salivary isoenzyme is the principle form in plasma ,
total enzyme activity is not significantly lowered when the
pancreatic secretory cell mass is reduced by chronic
pancreatic disease.
However ,in acute pancreatitis total plasma amylase activity
is usually significantly increased due to release from damage
cells.

Duodenal enzymes
Measurement of pancreatic enzymes and the
bicarbonate concentration in duodenal aspirates
before and after stimulation with cholecytokinin and
secretin is not very suitable for routine use because
of the difficulty in positioning the duodenal tube and
in quantitative sampling of the secretions.
Tubeless tests have been developed that avoid the
need for intubation and that overcome the difficulties
of sample collection.

PABA test
A synthetic peptide , labelled with p-aminobenzoic
acid (PABA) , is taken orally.
After PABA has been split from the peptide by
chymotrypsin , it is absorbed and excreted in the
urine.
Urinary excretion of PABA is significantly reduced
in chronic pancreatitis.
Abnormal results may occur if there is renal
glomerular dysfunction , liver disease , or
malabsorption even in the presence of normal
pancreatic function.

The effect of these conditions is assessed by


repeating the test with unconjugated PABA , which
eliminates the need for digestion before absorption.
This test is rarely necessary and is only performed in
special centres.
The pancreolauryl test
A similar , but technically simpler , test uses
fluorescein dilaurate.
Fluorescein is released and absorbed and the amount
excreted in a timed urine sample is measured.

You might also like