GASTRIC FLUID ANALYSIS
GASTRIC PHYSIOLOGY
¡ Presence of food and fluid in the stomach and stimulation by
the vagus nerve promotes the G CELLS of the stomach to
produce GASTRIN
¡ Gastrin stimulates the PARIETAL CELLS to produce HCl
(Hydrochloric Acid)
¡ INTRINSIC FACTOR – necessary for intestinal
absorption of vitamin B12
¡ HCL converts PEPSINOGEN (produced by chief cells) to
PEPSIN
¡ Pepsin catalyzes protein digestion
GASTRIC JUICE COMPOSITION
¡ HCl – secreted by the parietal cells of the stomach and
activates pepsinogen
¡ Electrolytes
¡ MUCUS – acts as a barrier to protect gastric mucosa from
acid autodigestion
¡ Digestive and non-digestive enzymes
¡ Pepsin – major digestive enzyme catalysing proteolysis at
pH 1.6 to 3.6
¡ Gastrin
¡ Gastric lipase – important in digestion of fat especially
when pancreatic function is not well developed
¡ Renin
¡ LDH, AST, ALT and ribonuclease
NORMAL GASTRIC FLUID
¡ Appearance: translucent, pale gray, and slightly
viscous
¡ Volume: 50 – 75ml
¡ Odor: odourless, faintly pungent
¡ pH: 1.6 to 1.9
VARIATIONS
¡ Color:
¡ Yellow to green – bile which is regurgitated in the
normal stomach
¡ Red – blood from trauma during intubation
¡ Coffee ground – old blood
¡ Volume:
¡ Fasting state: 20 to 50ml
¡ After a test meal: 20 to 80ml
¡ Chemical stimulant: 45 to 150ml
IMPORTANT TERMS
¡ EUCHLORHYDRIA - normal gastric acidity
¡ HYPOCHLORHYDRIA – decreased acidity, failure
of pH to fall below 3.5, but can decrease to 1.0 pH after
stimulation
¡ ACHLORHYDRIA – absence of acidity, failure to fall
of pH to fall below 3.5 even with gastric stimulation
¡ ACHYLIA – absence of all acids
GASTRIC FLUID ANALYSIS
¡ Important in pernicious anemia, peptic ulcer,
Zollinger-Ellison Disease
¡ Zollinger-Ellison Disease – increased gastrin level;
gastric acid hypersecretion; adenoma of the Islets of
Langerhans
PROCEDURE / COLLECTION –
GASTRIC FLUID ANALYSIS
¡ Done by physician or well-trained personel
¡ Collect gastric juice for 1 hour in the unstimulated
fasting state
¡ Patient should not swallow excessive saliva during
collection
PROCEDURE / COLLECTION –
GASTRIC FLUID ANALYSIS
¡ Basal Gastric Secretion – measures fasting levels of gastric
production
¡ A tube is placed in the stomach for fluid collection to measure
the amount of secretion during the 12-15 hour fasting state
¡ Four 15 (or 30) minute specimens are collected, and the Volume,
pH, and titratable acidity are recorded and the total gastric
secretion during this period is termed BASAL ACID
OUTPUT (BAO)
¡ BAO – is usually 4-5mEq/hr
COLLECTION (TUBE OR
INTUBATION METHOD)
¡ LEVIN
¡ Most commonly used; smallest evacuation tube
¡ Propelled through mouth or nostrils
¡ BOA’S / EWALD’S
¡ Ideal for emptying or washing the stomach; for cases of
poisoning
¡ Flask is present at the tip
¡ REHFUSS
¡ Metallic tip; propelled in the mouth
COLLECTION (TUBE OR
INTUBATION METHOD)
¡ MILLER-ABBOT
¡ Mercurial tip is chilled; used for people who are easy to
vomit
¡ SAWYER
¡ Longest evacuation tube
¡ KASLOW
¡ Softest evacuation tube
¡ JUTTE
¡ Stylet tip
GASTRIC STIMULANTS
¡ PENTAGASTRIN - synthetic analog of gastrin and MOST
PREFERRED
¡ HISTAMINE – has unpleasant systemic effects on blood
vessels and smooth muscles
¡ HISTALOG (Betazole) – histamine isomer with
preferential effect on gastric acid secretion
¡ Caffeine
¡ Pilocarpine and acetylcholine
¡ Alcohols
TEST MEALS
¡ EWALD’S MEAL - bread and tea or water
¡ DOCK’S - modification of ewalds (biscuit instead of bread)
¡ BOA’S – oat meal; for lactic acid determination
¡ RIEGEL - beef steak and mashed potato; ideal for
determining hypoacidity and achylia
¡ LAVINE’S – “alcohol test meal”; uses ethyl alcohol and
methylene blue which detects regurgitation of alkaline
material from duodenum in stomach by the change of blue
to greenish blue
TUBELESS OR DIAGNEX BLUE
METHOD
¡ Specimen: urine
¡ Principle:
¡ Azure A (azure blue) is given by mouth
¡ The presence of azure blue in urine indicates the
presence of free HCl in the stomach
¡ Azure A is rapidly reabsorbed from the intestines and
travels into the blood, to the kidneys and excreted in the
urine
GASTRIC FLUID ANALYSIS
¡ Introduction of the stimulant is followed by another hour of
collection
¡ Total acid secreted in the hour after stimulation is
MAXIMAL ACID OUTPUT (MAO)
¡ Ratio BAO/MAO (0.3-0.6 ratio)
BAO MAO
Normal 2.5 10
Pernicious Anemia 0 0
Gastric Carcinoma 1.0 25
Duodenal Ulcer 5.0 17
Z-E Syndrome 18.0 72
MICROSCOPIC ANALYSIS
¡ PUS CELLS/WBC – stomach abscess, chronic
gastritis, gastric cancer
¡ RBC – ulcer or trauma
¡ YEAST CELLS - fermentation in the stomach
because large amounts of foods have been retained
¡ Bacteria
¡ Food residues
¡ parasites
QUALITATIVE TEST FOR FREE HCL
Dimethylaminoazobenzol (+) cherry red
Gunzberg Reagent: Phloroglucin,
Vanicllin, Alcohol = (+)
purple red color
Boas Reagent: Resorcinol, Cane
Sugar, Alcohol =(+) Rose
red color
TESTS FOR LACTIC ACID
TEST REAGENTS ENDPOINT
Modified FeCl3 + phenol Yellow
Uffelmann’s
Strauss FeCl3 + ether Yellow
Kelling’s FeCl3 yellow
