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Gastric Funcn Test

This document discusses various tests used to analyze gastric function, including tests to measure gastric acid, pepsinogen, and intrinsic factor secretion. It describes methods to classify gastric function abnormalities, including analysis of gastric residue and stimulation tests using histamine, insulin, pentagastrin, and other substances. The tests are used to diagnose conditions like peptic ulcer, Zollinger-Ellison syndrome, pernicious anemia, gastric cancer, and to assess vagotomy completeness.

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Arshdeep Singh
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168 views18 pages

Gastric Funcn Test

This document discusses various tests used to analyze gastric function, including tests to measure gastric acid, pepsinogen, and intrinsic factor secretion. It describes methods to classify gastric function abnormalities, including analysis of gastric residue and stimulation tests using histamine, insulin, pentagastrin, and other substances. The tests are used to diagnose conditions like peptic ulcer, Zollinger-Ellison syndrome, pernicious anemia, gastric cancer, and to assess vagotomy completeness.

Uploaded by

Arshdeep Singh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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GASTRIC FUNCTION TEST

Gastric juice
HCL
PEPSINOGEN
INTRINSIC FACTOR
HCL SECRETION
 Lumen Co2 + H2O
Blood

CA

H2CO3

k+ k+
ATPase
H+ H++HCO3- HCO3-

Cl- Cl- Cl-


REGULATION
 NEURAL PHASE :VAGUS

 GASTRIC PHASE : GASTRIN

 INTESTINAL PHASE : GI HORMONES

 ALKALINE TIDE
CLASSIFICATION
 ANALYSIS OF GASTRIC RESIDUE
 DETERMINATION OF ENZYMES
 FRACTIONAL GASTRIC ANALYSIS
 STIMULATION TESTS
 TUBELESS GASTRIC ANALYSIS
INDICATIONS

 PEPTIC ULCER
 ZOLLINGER-ELLISON SYNDROME
 POST OPERATIVE
 COMPLETENESS OF VAGOTOMY
GASTRIC RESIDUE ANALYSIS
 CONTENT OF STOMACH AFTER 12h
FASTING
 NORMAL < 50 ml
 > 100 ml pyloric obstruction
peptic ulcer/ZES

 COLOURLESS, FLUID, SOUR


FREE ACIDITY
 ACIDITY DUE TO FREE HCL
 NORMAL = 10 – 30 mmol/L
 HYPERCHLOROHYDRIA

PEPTIC ULCER
True ACHLOROHYDRIA :
NO HCL SECRETION
PERNICIOUS ANAEMIA
CHRONIC GASTRITIS
CARCINOMA OF STOMACH
FALSE ACHLOROHYDRIA

 ABSENCE OF FREE HCL DUE TO


NEUTRALIZATION BY ALKALINE SUBSTANCES
 INJECTION OF HISTAMINE

HCL SECRETION
ACHYLIA GASTRICA
NO HCL/PEPSIN SECRETION
PERNICIOUS ANAEMIA
GASTRIC CARCINOMA
TOTAL ACIDITY
 ACIDITY DUE TO HCL AND ORGANIC ACIDS
(e.g. lactic acid)
 NORMAL=10- 40 mmol/L
 LACTIC ACID: GASTRIC CARCINOMA
PYLORIC STENOSIS
MUCUS :MALIGNANCY
BLOOD :TRAUMA
ULCER
PEPSINOGEN

I II
oxyntic glands cardiac/pyloric
glands
20-100µg/L 5-20µg/L
ZES GASTRIC ULCER
PEPTIC ULCER
FRACTIONAL GASTRIC ANALYSIS

TEST MEALS
EWALD MEAL (toast + tea)
RIEGEL MEAL (beef steep + boiled
potato)
Normal Response
Free Acid = 10 – 30 mmol/L
Total Acid = 10 – 40 mmol/L
HISTAMINE STIMULATION TEST
STANDARD HISTAMINE TEST
histamine =0.01mg/kg body wt
AUGMENTED HISTAMINE TEST
histamine =0.04mg/kg body wt
INDICATIONS
1) To differentiate true achlorohydria from
false achlorohydria
2) To asses the maximum possible acid
secretion
3) To show an inability to secrete acid
INTERPRETATION

 NORMAL = 10 – 30 mmol/L
 PEPTIC ULCER = >100 mmol/L
 PERNICIOUS ANAEMIA = 0

ALCOHOL STIMULATION TEST


7% ETHYL ALCOHOL (100 ml)
CAFFEINE STIMULATION TEST
Caffeine sodium benzoate (500 mg)
INSULIN STIMULATION TEST
(HOLLANDER’S TEST)

 INDICATIONS
TO asses the completeness of
vagotomy in patients with peptic ulcer

PRINCIPLE
Insulin(0.1u/kg) hypoglycemia
vagus

Acid secretion
PENTAGASTRIN STIMULATION TEST

 SYNTHETIC PEPTIDE
 6 µg/kg

 BASAL ACID OUTPUT (BAO)

acid output in mmol/hr in the basal


secretion (without stimulation)
MAXIMAL ACID OUTPUT (MAO)
sum of the acid output of the four 15-min
samples after the stimulation
PEAK ACID OUTPUT (PAO)

 Sum of the acid output of the 2


consecutive 15-min samples having the
highest acid content
 INTERPRETATION

normal peptic ulcer ZES


BAO 1–5 5 – 15 >20
MAO 10 – 40 15 - 50 >50
PAO 15 – 50 20 – 60 >60
TUBELESS GASTRIC ANALYSIS

 DIAGNEX BLUE TABLETS


(carbacrylic cation exchange resin
+ azure A)
HCL

Azure A is released and excreted in urine


ZOLLINGER ELLISON SYNDROME

 ISLET CELL TUMOR OF PANCREAS


 GASTRIN HYPERSECRETION
PEPTIC ULCER
DIARRHOEA

LAB DIAGNOSIS
Gastrin, BAO, MAO, PAO

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