Gastric Analysis

MAHATHIR ALPHA · 55問 · 2年前

通報

問題一覧

↳ Colorless to grayish/yellowish watery fluid ↳ About 99% water and 1% solid ↳With a low specific gravity

Gastric Juice

Gastric juice are secreted by:

1)Surface epithelium 2)Gastric cells 3) Various glands of the gastric tract.

What are the Major Constituents of Gastric juice?

Water, HCl

What are the Orgnanic Constituents of Gastric juice?

Pepsin, Rennin, Lipase, Gastrin

What are the 2 kinds of Mucin?

Soluble mucin, Glairy mucin

This type of mucin plays an important part in buffering the acid

Soluble mucin

This type of mucin is not concerned with the function of buffering the acid.

Glairy mucin

What are the Inorganic(electrolytes) constituents?

Sodium, Chlorides, Sulfates, Hydrogens, Potassium, Calcium phosphates, Bicarbonate, Phosphorus

➡ PURPOSES OF GASTRIC ANALYSIS: 1) Determines whether or not a patient can secrete any gastric juice. 2) Measures the amount of gastric acid. 3) Reveals the hypersecretory characteristic state of the Zollinger- Ellison syndrome. 4) Determines the completeness of vagetomy by the insulin test. 5) Determines numerous conditions that disturb fucntions of the stomach, duodenum, liver, pancreas, and the systematic conditions of anemia. 6) Helps the physician in the diagnosis of gastric diseases and assist in therapy and prognosis selection.

↳ Line by a loose, thick mucosa ↳ Platelike pattern of low ridges or folds ↳ Containing large number of cells

Stomach

What are the 3 main types of cells found in the stomach?

Chief or Peptic cells, Parietal or Oxyntic cells, Goblet mucous-secreting cells

This cell produces the protein-splitting enzyme pepsin

Chief or Peptic cells

This cell produces HCl and intrinsic factor (erythropoietc factor) of castle.

Parietal or Oxyntic cells

This cell functions for the protection of the mucosa of the stomach and lubricates the food.

Goblet mucous-secreting cells

It produces Lipase (fat-splitting enzyme)

Gastric glands

What are the sources of Gastric juice?

Stomach, Gastric glands, Rennin

It causes crudling of milk

Rennin

This hormone is found in the stomsch wall of the pyloric region.

Gastrin

What are the phases under the Digestive Period?

Cephalic phase, Gastric phase, Intestinal phase

•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.

Interdigestive period

What are the Gastric inhibitory hormones from intestinal mucosa?

Serotonin, Secretin, Enterogastrone

Chalone produced by antral mucosa on contract with HCl

Antral Inhibitory Hormone

↳ Found in gastric juice, particularly towards the end of gastric phase of digestion. ↳ Concentration is high in patients with achlorhydria.

Gastrone

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

Serotonin

It is from the mucosa of the duodenum and jejunum upon contact with gastric chyme - stimulates pancreatic secretion.

Secretin

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

Enterogastrone

What are the types of Evacutation tubes used in Gastric Analysis?

Ewald's tube, Rehfuss tube, Sawyer tube, Kaslow tube, Levin tube

This tube has a stylet

Jutte tube

This tube has mercury at the tip and with specific gravity of 13.6

Miller-abbot tube

Provides the pathways for secretary stimuli to the gastric mucosa.

Parasympathetic (vagus) pathway

Regulate gastric secretion indirectly due to their control over vasomotor mechanisms and blood flow to the mucosa.

Sympathetic pathways

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

Intestinal phase

The psychic or appetite secretion is produced by sight, thought, or taste of food. (15-20 minutes duration)

Cephalic phase

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

Complete method

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

Practical method

•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

•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

•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

•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

•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

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

Pepsin

•An enzyme produced in the stomach. •To curdle milk.

Rennin

Blood from the stomach

Hematemesis

Blood from the lung

Hemoptysis

Normal acidity

Euchlorhydria

High acidity

Hyperchlorhydria

Low acidity

Hypochlorhydria

Absence of acidity

Achlorhydria

Complete absence of HCl

Achylia

•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

Gastric juice in Fasting stomach

20-50 ml

Color of gastric juice

Colorless

Odor of Gastric juice

Odorless or slight sour

Result of Toffer's test

Pink color

Result of Conge Red Paper

Blue color

Specific gravity of gastric acid

1.001 to 1.010(1.007)

Gelatinous in nature and forms a white coagulum in presence of HCl

Visible mucus

It does not coagulate in the presence of HCl

Dissolved or Soluble mucus

1.6-1.9

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

Histamine Phosphate

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

Insulin

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

Caffeine

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

Ewald's test meal(break fast)

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

Riegel's test meal

•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

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

Heckmen's test meal

•Modification of Ewald's test meal. •The shredded wheat biscuit completely eliminates lactic acid.

Dock's test meal

•Gives higher acidity values than the Ewald's test. •Similar to the Riegel. •This and riegel meals could be removed in 3 to 4 hours after.

Fischer's test meal

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 or Lavine's test meal

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

Motor test meal

•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

•Simplier tha Salzer meal. •Examine for rice starch and particles of raisin. •The stasis meal is being supplanted by barium meal and fluoroscopic examination

Statis meal

Give out the diff types of 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) Salzer Motility Test Meal 10) Stasis Meal

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