gastric fluid analysis

1. GASTRIC FLUID ANALYSIS Gastric Juice A colorless to grayish or yellowish watery fluid w/ a low specific gravity secreted by the surface epithelium, gastric cells and the various glands of the gastric tract. Importance of Detection Diagnosis of gastric diseases and assist in the selection of therapy i.e. peptic ulcer It measures the amount of acid produced by a patient w/ symptoms of peptic ulcer Diagnosis of Zollinger -Ellison syndrome (adenoma of Islet of Langerhans) a condition of gastric hypersecretion produced by a gastrin secreting tumor of the pancreas

2. Collection of the Specimen The patient must be in a fasting state for 12 hours Contamination w/ saliva neutralizes the gastric acidity therefore it should be prevented. Time specimen should be collected for the purpose of comparison 2 Types of Gastric Juice Collection Using an evacuated tubes: 1.) Levine tube – inserted in the nose (nasal intubation) 2.) Rehfuss tube – inserted in the mouth ( oral intubation)

3. Composition 1.) H 2 O – varying amounts (99 %) 2.) HCl – secreted by the parietal cells w/c provide acidity for the activation of pepsinogen 3.) Digestive enzyme pepsin – catalyzes the protein digestion to proteoses ; secreted by chief peptic cells lipase – fats ( no importance to di gestion ) rennin – milk (ability to coagulate caseinogen to milk) gastricsin – importance of this enzyme is not yet known in gastric secretion 4.) Mineral acid – chiefly acid phosphates 5.) Mucus – fd in moderate amts secreted by GOBLET cells of stomach to prevent autodigestion of stomach

4. Composition 6.) Electrolytes – main electrolytes present is H + ; also present are Na, Cl , P, Ca and Mg 7.) Particles of food – undigested and partly digested 3 Main Types of Cells Responsible for Gastric Juice Production 1.) chief or peptic cells – producing the protein- splitting enzyme pepsin 2.) parietal or oxyutic cells – producing HCl and intrinsic factor ( erythropoietic factor) absence of w/c leads to pernicious anemia 3.) goblet or mucous secreting cells – producing mucus for the protection of the mucosa and lubricates the food.

5. Macroscopic Examination Volume: 30 – 60 ml Fasting sample – contains few ml to 50 ml w/ an average of 30 ml Color : Colorless , yellowish or pale gray w/ varying amounts of mucus and food particles Abnormalities in Color : 1.) brownish red or coffee color – presence of large amount of blood. 2.) opaque gray – seen after a test meal 3.) yellow – presence of fresh bile

6. Abnormalities in Color : 4.) greenish – presence of old bile 5.) red – presence of small amount of blood Odor : Odorless or maybe slightly sour or faintly pungent Abnormalities in Odor : 1.) fecal odor – seen in intestinal obstruction or gastrocolic -fistula 2.) foul or putrid odor – seen in carcinomatous ulcer 3.) alcoholic odor – seen in alcoholic coma, or after alcohol test meal 4.) ammoniacal odor – seen in case of uremia 5.) rancid odor – due to butyric (fatty acid) and lactic acid (present in sour milk) indicating stenosis and fermentation

7. pH or Reaction: Normally acidic – pH 1.6 to 1.8 High acidity – pH 1.4 or lower Low acidity – pH 2.0 or 2.8 Euchlorhydria – refers to normal secretion w/ a pH bet. 1.6 to 1.8 Hyperchorhydria – increase free HCl above normal around 60 ml i.e. peptic ulcer Hypochlorhydria – decreased free HCl i.e. 1.) carcinoma of the stomach 2.) chronic gastritis 3.) gastric syphilis Achlorhydria – absence of free HCl i.e. 1.) pernicious anemia 2.) pellagra 3.) advanced gastric cancer

8. Specific Gravity Varies from 1.001 – 1.010 w/ an average of 1.007 CHEMICAL EXAMINATION Acid contents of gastric juice are of 2 types: 1.) Free HCl an acid w/ a pH less than 3.5 2.) Combined HCl or organic acid – an acid w/c combines w/ proteins or protein-like subs to form protein salts of HCl . Test for Free HCl 1.) Topfer’s method 2.) Tubeless gastric Analysis – Diagnex Blue 3.) Boa’s method 4.) Gunzberg method

9. MICROSCOPIC EXAMINATION Normal Structures 1.) yeast cell – small amounts 2.) epithelial cells 4.) bacteria – lesser amounts 3.) starch granules 5.) fat globules Pathologic Structures 1.) fragments of tissues 2.) rbc 3.) yeast – large amounts 4.) pus cells 5.) muscle fibers 6.) large number of bacteria and maybe seen are: a.) Sarcinae b.) Oppler -Boas bacilli

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