gastric juice analysis Flashcards
1
Q
colorless to grayish or yellowish watery fluid with a low specific gravity
A
gastric juice
2
Q
gastric juice is about 99% of ___ and 1% _____
A
99% water and 1% solid
3
Q
major constituents of gastric juice
A
water, hcl and other inorganic constituents
4
Q
inorganic constituents of gastric juice
A
sodium, potassium, chlorides, calcium phosphates, sulfates, bicarbonate, hydrogen and phosphorous.
5
Q
major organic constituents of gastric juice
A
enzymes (pepsin, lipase, rennin, and gastrin)
mucin (soluble mucin and glairy mucin)
acids (combined acid)
erythropoietic factor
and blood group substances.
6
Q
significance of gastric juice analysis
A
- determines whether or not a patient can secrete any gastric juice.
- measures the amount of gastric acid that can be secreted by a patient with symptoms of peptic ulcer.
- reveals the hypersecretory characteristic state of the Zollinger-Ellison syndrome
- determines the completeness of vagotomy by the insulin test
- determines numerous conditions that disturb functions of the stomach, duodenum, liver, pancreas and the systematic condition of anemia.
- helps the physician in the diagnosis of gastric disease and assist him in the selection of its therapy and prognosis.
7
Q
how many gastric juice is secreted per day
A
approx. 2-3 L/day
8
Q
gastric juice pH
A
1.0-2.0
9
Q
gastric juice H2O
A
97-99%
10
Q
gastric juice free Hcl
A
up to 0.5%
11
Q
producing the protein-splitting enzyme pesin
A
chief or peptic cells
12
Q
producing HCl and intrinsic factor of Castle
A
parietal or oxyntic cells
13
Q
_______ products mucous for the protection of the mucosa of the stomach and lubricates the food.
A
goblet mucous-secreting cells
14
Q
_____ produces lipase and remain in addition to the substances
A
gastric glands
15
Q
fat-splitting enzyme which is active in alkaline medium and inactive in acid medium
A
lipase
16
Q
an enzyme that causes curdling of milk
A
rennin
17
Q
gastric secretion is initiated by ____ or ____ mechanisms
A
nervous or reflex
18
Q
gastric secretion is regulated by both ___ and ___ mechanisms
A
neural and humoral mechanisms
19
Q
the gastric mucosa is innervated by both division of the _____ system
A
autonomic nervous system
20
Q
parasympathetic (vagus) innervation prvides pathways for _____ to the _____
A
secretory stimuli to the gastric mucosa
21
Q
___ regulate gastric secretion indirectly due to their control over vasomotor mechanisms and blood flow to the mucosa
A
sympathetic pathway
22
Q
Basal period. Both the stomach and intestine are empty.
No stimulants are present or sights of food are absent.
Gastric juice secretion occurs in an intermittent manner.
Measured by continuous overnight aspiration of the stomach
contents or during a 1 to 2 hours fasting period in the morning.
A
Interdigestive Period
23
Q
digestive period includes 3 phases
A
cephalic phase
gastric phase
intestinal phase
24
Q
The psychic or appetite secretion is produced by sight, thought, or taste of food. (15 – 20 minutes duration)
A
Cephalic Phase (neural or psychic)
25
mechanical distention of the pyloric antrum and contact of the antral mucosa with chemical substance derived from partial hydrolysis of proteins may liberate the hormone - gastrin.
Gastric Phase
26
- circulates in the blood stream and acts directly on the parietal cells stimulating production of hydrochloric acid
- found in the stomach wall of the pyloric region
gastrin
27
Products of digestion present in the intestine starts humoral mechanism which is not clearly understood.
Intestinal Phase
28
other stimuli in gastric secretion
drugs
emotional states
29
Drugs stimulate gastric secretion
Histamine, Beta alamine, Pilocarpine, Salicylates, Caffeine, Cinchophen, Aminophylline, Adrenal corticosteroids, Insulin, & Alcohol
30
Drugs inhibits gastric secretion
Atrophine and Adrenalin
31
May increase or decrease secretion, such as anger and resentment.
Emotional States
32
mechanisms of gastric juice inhibition
psychic or neural
antral inhibitory hormone
gastrone
serotonin
secretin
enterogastrone
33
Emotions: fear, unpleasant memories or associations, disagreeable odor or taste may depress gastric secretion.
Epinephrine and sympathetic nerve stimuli reduce acid secretion, by blanching the gastric mucosa.
Psychic or Neural
34
Chalone produced by antral mucosa on contract with HCl.
Antral Inhibitory Hormone
35
Found in gastric juice, particularly towards the end of gastric phase of digestion.
Gastrone
36
Concentration is high in patients with achlorhydria.
Gastrone
37
Produced by the antral mucosa, duodenal, and jejunal mucosa.
serotonin
38
from the mucosa of the duodenum and jejunum upon contact with gastric chyme.
secretin
39
stimulates pancreatic secretion.
gastric chyme
40
from the duodenal and jejunal mucosa on
contact with split or non-split fats.
Enterogastrone
41
Before the collection, the patient must be fasting for _____ or more by means of a rubber tubing known as _____.
12 hours ; Evacuation tube
42
METHODS OD WITHDRAWING GASTRIC CONTENTS
complete method
practical method
43
The stomach contents are removed completely at one time.
All the contents are evacuated until stomach is empty.
complete method
44
The stomach contents are removed with time interval little by little until the stomach is empty.
practical method
45
TYPES OF EVACUATION TUBES
1) EWALD’S TUBE
2) REHFUSS TUBE
3) SAWYER TUBE
4) KASLOW TUBE
5) LEVIN TUBE
46
Moderately hard but flexible rubber tube. (About 12 mm)
Useful for emptying and washing the stomach in case of
poisoning.
Best used for short duration of evacuation and inexperienced
patients.
EWALD’S TUBE
47
Soft rubber. (About 3 to 4 mm)
Swallowed by aid of gravity
3 markings: 17, 23, & 30 inches length (to indicate that the tip
has reached the stomach as soon as this point has been
swallowed).
Catheter-like with gold or silver metal at the tip.
REHFUSS TUBE
48
Moderately soft rubber. (3- 4mm in diameter & 86cm in length)
3 markings: 49, 65, & 81 cm length.
It is introduced through the mouth by propulsion.
Usually connected to a syringe for aspiration of gastric content.
SAWYER TUBE
49
Moderately soft rubber. (3-4mm in diameter & 56 inch’s length)
3 markings: 18, 26, & 30 inches length.
Introduction is also by propulsion and gastric contents are collected by a syringe attached with it.
KASLOW TUBE
50
Made of soft rubber and has plain catheter tip with several openings.
It is swallowed or passed through the nostril (often through the nostril when tube is to remain in the stomach for a period of time).
Has a smaller diameter than others.
Marked at 22 to 24 inches length with a tape.
It is inserted in the nose after application of 1% cocaine hydrochloride and the tube lubricated with mineral oil or a few drops of glycerine.
LEVIN TUBE
51
Other kinds of tubes which may be used
1. Lyn tube
2. Einborn tube
3. Jutte tube
4. Miller-Abbot tube
52
other/uncommon tube that has a stylet
Jutte Tube
53
other/uncommon tube that has mercury at the tip and with specific gravity of 13.6
Miller-Abbot tube
54
different test meals
1.Ewald’s Test Meal (Breakfast)
2.Riegel’s Test Meal
3.Boa’s Test Meal
4.Heckman's Test Meal
5.Dock's Test Meal
6.Fischer's Test Meal
7.Alcohol Test Meal (Lavine's Test Meal)
8.Motor Test Meal
9.Saizer Motility Test
10.Stasis Meal
55
TEST MEALS
Commonly used at present for routine gastric juice examination.
It is not advisable if lactic acid is to be detected.
Ewald’s Test Meal (Breakfast)
56
Used to detect hypoacidity or achylia.
Consists of mashed potatoes, beef broth
& boiled beef steak.
Riegel’s Test Meal
57
This is ideal if one would like to detect the presence of lactic acid in the gastric juice.
The stomach should always be washed
with water the evening before this meal is used.
Boa’s Test Meal
58
Easier to swallow or may be introduced through the evacuation tube itself.
Heckman’s Test Meal
59
Modification of Ewald’s test meal.
The shredded wheat biscuit completely
eliminates lactic acid.
Dock’s Test Meal
60
Gives higher acidity values than the Ewald’s test.
Similar to the Riegel.
The fisher and riegel meals could be
removed in 3 to 4 hours after.
Fischer’s Test Meal
61
Helps in detecting the regurgitation of alkaline material from the duodenum into the stomach, by the changes of blue color to a greenish hue.
Alcohol Test Meal (Lavine’s Test Meal)
62
Consists of either spinach or raisins + 400 cc of water.
Motor Test Meal
63
Give an Ewald’s meal 4 hours later.
The presence of meat fibers and other
material from the first meal indicate
deficient gastric activity.
Salzer Motility Test Meal
64
Simplier than Salzer meal.
Examine for rice starch and particles of
raisin.
This meal is being supplanted by
barium meal and fluoroscopic examination.
Stasis Meal
65
Used for the detection of pernicious anemia where true
achloridia is so significant.
Lacrimation and headache are some of the side effects.
Histamine Phosphate Test
66
This is injected intraveneously in doses of 1 regular unit per kg. body weight and 10 ml is aspirated every 15 minutes.
Insulin Test
67
200 – 250 mg of caffeine sodium benzoate with a glass of water.
Caffeine Test
68
amount of gastric juice (physical exam)
Fasting stomach yield’s 20 – 50 ml of gastric juice.
69
gastric juice color (physical exam)
colorless
70
gastric juice odor (physical exam)
odorless or slightly sour
71
gastric juice acidity (physical exam)
1.6 to 1.9
72
Add 2 drops of Toffer reagent. Free acid will produce a Pink color.
Toffer's Test
73
Presence of free hydrochloric acid turns the color to blue.
Conge Red Paper
74
SG of gastric juice (physical exam)
low from 1.001 to 1.010 (1.007)
75
gastric juice consistency (physical exam(
watery and clear
76
gelatinous in nature and forms a white coagulum in the presence of HCl.
visible mucus
77
does not coagulate in the presence of HCl.
Dissolved or Soluble mucus
78
sediments in gastric juice (p.e)
normally none
79
This includes Free HCl and the combined acids.
total acidity
80
The combined acid is composed of _____
combine HCl
acid salts
organic salts such as (lactic acid, butyric acid, and amino acid),
and acid phosphatase.
81
Normally found in gastric contents in these values: 0.1 – 0.2% or 25 – 50 degrees or 20 – 40 mEq/L.
This is HCl not combined with proteins.
FREE HYDROCHLORIC ACID
82
This is includes free HCl in the Free State, organic acids and acid salts, but not include the combined HCl.
FREE ACIDITY
83
normal acidity
Euchlorhydria
84
high/increased acidity
Hyperchlorhydria
85
Hyperchlorhydria is associated with
cholecystitis, peptic ulcer, etc.
86
low/decreased acidity
Hypochlorhydria
87
Hypochlorhydria is associated with
carcinoma of stomach, syphilis of stomach,
etc.
88
absence of acidity
Achlorhydria
89
Achlorhydria is associated with
pernicious anemia, sprue, pellagra, lateral
schlarosis, exopthalmia goiter, etc.
90
complete absence of HCl
achylia / achylia gastrica
91
achylia / achylia gastrica is associated with
chronic atrophic gastritis, hypochronic micrositic
anemia, etc.
92
value is obtained by subtracting free acidity from total acidity (total acidity – free acidity)
Combined HCl
93
value obtained by subtracting the value
of free HCl from that of free acidity (free acidity – free HCl)
Organic acid & Acid salts
94
Not normally found in gastric juice.
It may be present after ingesting certain foods such as sour milk
or food prepared with it.
Common in advanced carcinoma of the stomach.
Lactic Acid
95
Normally no Blood.
Small amount may be found due to trauma in passing the evacuation tube.
Occult Blood
96
term for blood from the stomach
Hematemesis
97
term for blood from the lung
Hemoptysis
98
Small amount of bile is ___
normal
99
large amount of bile
yellow color
100
old bile
green and turbid appearance
101
An enzyme produced by the chief cells of the stomach and activated by HCl to act on proteins.
PEPSIN (PEPSINOGEN)
