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gastric juice analysis Flashcards

1
Q

colorless to grayish or yellowish watery fluid with a low specific gravity

A

gastric juice

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2
Q

gastric juice is about 99% of ___ and 1% _____

A

99% water and 1% solid

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3
Q

major constituents of gastric juice

A

water, hcl and other inorganic constituents

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4
Q

inorganic constituents of gastric juice

A

sodium, potassium, chlorides, calcium phosphates, sulfates, bicarbonate, hydrogen and phosphorous.

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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.

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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.
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7
Q

how many gastric juice is secreted per day

A

approx. 2-3 L/day

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8
Q

gastric juice pH

A

1.0-2.0

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9
Q

gastric juice H2O

A

97-99%

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10
Q

gastric juice free Hcl

A

up to 0.5%

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11
Q

producing the protein-splitting enzyme pesin

A

chief or peptic cells

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12
Q

producing HCl and intrinsic factor of Castle

A

parietal or oxyntic cells

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13
Q

_______ products mucous for the protection of the mucosa of the stomach and lubricates the food.

A

goblet mucous-secreting cells

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14
Q

_____ produces lipase and remain in addition to the substances

A

gastric glands

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15
Q

fat-splitting enzyme which is active in alkaline medium and inactive in acid medium

A

lipase

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16
Q

an enzyme that causes curdling of milk

A

rennin

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17
Q

gastric secretion is initiated by ____ or ____ mechanisms

A

nervous or reflex

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18
Q

gastric secretion is regulated by both ___ and ___ mechanisms

A

neural and humoral mechanisms

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19
Q

the gastric mucosa is innervated by both division of the _____ system

A

autonomic nervous system

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20
Q

parasympathetic (vagus) innervation prvides pathways for _____ to the _____

A

secretory stimuli to the gastric mucosa

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21
Q

___ regulate gastric secretion indirectly due to their control over vasomotor mechanisms and blood flow to the mucosa

A

sympathetic pathway

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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

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23
Q

digestive period includes 3 phases

A

cephalic phase
gastric phase
intestinal phase

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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)

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25
Q

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.

A

Gastric Phase

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26
Q
  • 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
A

gastrin

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27
Q

Products of digestion present in the intestine starts humoral mechanism which is not clearly understood.

A

Intestinal Phase

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28
Q

other stimuli in gastric secretion

A

drugs
emotional states

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29
Q

Drugs stimulate gastric secretion

A

Histamine, Beta alamine, Pilocarpine, Salicylates, Caffeine, Cinchophen, Aminophylline, Adrenal corticosteroids, Insulin, & Alcohol

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30
Q

Drugs inhibits gastric secretion

A

Atrophine and Adrenalin

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31
Q

May increase or decrease secretion, such as anger and resentment.

A

Emotional States

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32
Q

mechanisms of gastric juice inhibition

A

psychic or neural
antral inhibitory hormone
gastrone
serotonin
secretin
enterogastrone

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33
Q

 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.

A

Psychic or Neural

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34
Q

Chalone produced by antral mucosa on contract with HCl.

A

Antral Inhibitory Hormone

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35
Q

Found in gastric juice, particularly towards the end of gastric phase of digestion.

A

Gastrone

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36
Q

Concentration is high in patients with achlorhydria.

A

Gastrone

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37
Q

Produced by the antral mucosa, duodenal, and jejunal mucosa.

A

serotonin

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38
Q

from the mucosa of the duodenum and jejunum upon contact with gastric chyme.

A

secretin

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39
Q

stimulates pancreatic secretion.

A

gastric chyme

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40
Q

from the duodenal and jejunal mucosa on
contact with split or non-split fats.

A

Enterogastrone

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41
Q

Before the collection, the patient must be fasting for _____ or more by means of a rubber tubing known as _____.

A

12 hours ; Evacuation tube

42
Q

METHODS OD WITHDRAWING GASTRIC CONTENTS

A

complete method
practical method

43
Q

 The stomach contents are removed completely at one time.
 All the contents are evacuated until stomach is empty.

A

complete method

44
Q

The stomach contents are removed with time interval little by little until the stomach is empty.

A

practical method

45
Q

TYPES OF EVACUATION TUBES

A

1) EWALD’S TUBE
2) REHFUSS TUBE
3) SAWYER TUBE
4) KASLOW TUBE
5) LEVIN TUBE

46
Q

 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.

A

EWALD’S TUBE

47
Q

 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.

A

REHFUSS TUBE

48
Q

 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.

A

SAWYER TUBE

49
Q

 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.

A

KASLOW TUBE

50
Q

 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.

A

LEVIN TUBE

51
Q

Other kinds of tubes which may be used

A
  1. Lyn tube
  2. Einborn tube
  3. Jutte tube
  4. Miller-Abbot tube
52
Q

other/uncommon tube that has a stylet

A

Jutte Tube

53
Q

other/uncommon tube that has mercury at the tip and with specific gravity of 13.6

A

Miller-Abbot tube

54
Q

different test meals

A

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
Q

TEST MEALS
 Commonly used at present for routine gastric juice examination.
 It is not advisable if lactic acid is to be detected.

A

Ewald’s Test Meal (Breakfast)

56
Q

 Used to detect hypoacidity or achylia.
 Consists of mashed potatoes, beef broth
& boiled beef steak.

A

Riegel’s Test Meal

57
Q

 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.

A

Boa’s Test Meal

58
Q

Easier to swallow or may be introduced through the evacuation tube itself.

A

Heckman’s Test Meal

59
Q

 Modification of Ewald’s test meal.
 The shredded wheat biscuit completely
eliminates lactic acid.

A

Dock’s Test Meal

60
Q

 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.

A

Fischer’s Test Meal

61
Q

 Helps in detecting the regurgitation of alkaline material from the duodenum into the stomach, by the changes of blue color to a greenish hue.

A

Alcohol Test Meal (Lavine’s Test Meal)

62
Q

Consists of either spinach or raisins + 400 cc of water.

A

Motor Test Meal

63
Q

 Give an Ewald’s meal 4 hours later.
 The presence of meat fibers and other
material from the first meal indicate
deficient gastric activity.

A

Salzer Motility Test Meal

64
Q

 Simplier than Salzer meal.
 Examine for rice starch and particles of
raisin.
 This meal is being supplanted by
barium meal and fluoroscopic examination.

A

Stasis Meal

65
Q

 Used for the detection of pernicious anemia where true
achloridia is so significant.
 Lacrimation and headache are some of the side effects.

A

Histamine Phosphate Test

66
Q

This is injected intraveneously in doses of 1 regular unit per kg. body weight and 10 ml is aspirated every 15 minutes.

A

Insulin Test

67
Q

200 – 250 mg of caffeine sodium benzoate with a glass of water.

A

Caffeine Test

68
Q

amount of gastric juice (physical exam)

A

Fasting stomach yield’s 20 – 50 ml of gastric juice.

69
Q

gastric juice color (physical exam)

70
Q

gastric juice odor (physical exam)

A

odorless or slightly sour

71
Q

gastric juice acidity (physical exam)

A

1.6 to 1.9

72
Q

Add 2 drops of Toffer reagent. Free acid will produce a Pink color.

A

Toffer’s Test

73
Q

Presence of free hydrochloric acid turns the color to blue.

A

Conge Red Paper

74
Q

SG of gastric juice (physical exam)

A

low from 1.001 to 1.010 (1.007)

75
Q

gastric juice consistency (physical exam(

A

watery and clear

76
Q

gelatinous in nature and forms a white coagulum in the presence of HCl.

A

visible mucus

77
Q

does not coagulate in the presence of HCl.

A

Dissolved or Soluble mucus

78
Q

sediments in gastric juice (p.e)

A

normally none

79
Q

This includes Free HCl and the combined acids.

A

total acidity

80
Q

The combined acid is composed of _____

A

combine HCl
acid salts
organic salts such as (lactic acid, butyric acid, and amino acid),
and acid phosphatase.

81
Q

 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.

A

FREE HYDROCHLORIC ACID

82
Q

This is includes free HCl in the Free State, organic acids and acid salts, but not include the combined HCl.

A

FREE ACIDITY

83
Q

normal acidity

A

Euchlorhydria

84
Q

high/increased acidity

A

Hyperchlorhydria

85
Q

Hyperchlorhydria is associated with

A

cholecystitis, peptic ulcer, etc.

86
Q

low/decreased acidity

A

Hypochlorhydria

87
Q

Hypochlorhydria is associated with

A

carcinoma of stomach, syphilis of stomach,
etc.

88
Q

absence of acidity

A

Achlorhydria

89
Q

Achlorhydria is associated with

A

pernicious anemia, sprue, pellagra, lateral
schlarosis, exopthalmia goiter, etc.

90
Q

complete absence of HCl

A

achylia / achylia gastrica

91
Q

achylia / achylia gastrica is associated with

A

chronic atrophic gastritis, hypochronic micrositic
anemia, etc.

92
Q

value is obtained by subtracting free acidity from total acidity (total acidity – free acidity)

A

Combined HCl

93
Q

value obtained by subtracting the value
of free HCl from that of free acidity (free acidity – free HCl)

A

Organic acid & Acid salts

94
Q

 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.

A

Lactic Acid

95
Q

Normally no Blood.
Small amount may be found due to trauma in passing the evacuation tube.

A

Occult Blood

96
Q

term for blood from the stomach

A

Hematemesis

97
Q

term for blood from the lung

A

Hemoptysis

98
Q

Small amount of bile is ___

99
Q

large amount of bile

A

yellow color

100
Q

old bile

A

green and turbid appearance

101
Q

An enzyme produced by the chief cells of the stomach and activated by HCl to act on proteins.

A

PEPSIN (PEPSINOGEN)

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