Gastric and

Duodenal Contents
Examination
Prepared by: Eliazel G. Ocfemia
Gastric fluid
Colorless to grayish or yellowish watery fluid
Also called as gastric acid/juice
Has low specific gravity
Secreted by: Surface epithelium
Gastric cells
Various glands of gastric tract
Clinical Significance
Determine if patient can secrete
gastric acid
Differential diagnosis of gastric from
duodenal ulcers
Diagnosis of gastric diseases
Assist in the selection of therapy (peptic)
Clinical Significance
Measures the amount of acid produced
Patient with symptoms of peptic ulcer

Diagnosis of Zollinger – Ellison syndrome

Adenoma of Islet of Langerhans
Clinical Significance
Assess completeness of surgical vagotomy

Determine of proper surgical procedure

Peptic ulcer treatment
 Gastric Acid Secretion

1 ST 2 ND 3RD

Cephalic phase Gastric phase Interstitial

phase
 Cephalic Phase

Sight
Taste
1ST Smell
Thought of Food
 Gastric Phase

2ND

Entry of food into stomach

Interstitial Phase

Hormones produced
by small intestine 3
RD
3 Cell Types

Chief or Peptic Cells

Producing the protein – splitting
enzyme pepsin

Gastric fluid
3 Cell Types

Parietal or Oxyntic Cells

Producing HCL and intrinsic factor
Stimulated by gastrin

Gastric fluid
3 Cell
Types
Goblet or Mucous Secreting Cells
Producing mucus for the protection
of mucosa Lubricates the food

Gastric fluid
Gastric Juice Composition
1. Hydrochloric
acid
Secreted by parietal cells
Converts pepsinogen to pepsin
Hydrolyzed polypeptides and
disaccharides only
Gastric Juice Composition

2. Intrinsic factor
Produce by parietal cells
Required for vit B12 absorption
Absent in pernicious anemia
Gastric Juice Composition

3. Mucus
Secreted by parietal cells
Converts pepsinogen to pepsin
Hydrolyzed polypeptides and
disaccharides only
 Gastric Juice Composition

4. Electrolytes
NaCl and trace mineral zinc
essential for the production of Hcl
All electrolytes are present
 Digestive
PEPSI
enzymes
N
Major digestive enzyme,
Initiates digestion of protein
Catalyzing proteolysis at pH 1.6-3.6
Proteolytic enzyme secreted by chief cells
 Inactive precursor, pepsinogen.
Endopeptidase and active at acid pH
 Digestive
Gastric
enzymes
Lipase
GastriDigestion of dietary fats
n
Aids in gastric motility
 Digestive
Renin
enzymes
(Chymosin)
Proteolytic enzyme
related to pepsin
Secreted by parietal cells
Role in digestion is to
coagulate milk
 None
Lactate – digestive(LDH),
Dehydrogenase
Aspartate Aminotransferase
Enzymes:
(AST),
Alanine Aminotransferase (ALT)
and
Ribonuclease
Analysis
 Involves quantification of gastric acid
-Gastric acid produced by stomach

 Collected by inserting nasogastric tube

into stomach
- Aspirating the contents for analysis
Patient Preparation
 Patient must be in fasting state
12-15 hours without medication (24hrs)

 Should be resting and relaxed

 Timed specimen should be collected
For purpose of comparison
Specimen Collection Methods
During collection:
 Don’t swallow excessive amount of saliva

Tubeless or Diagnex Blue Method

o Orally administered ion – exchange resin
Detects the presence of H+ in gastric fluid
Tubeless or Diagnex Blue
Method
o Presence of free gastric acid
Azure A is released from its resin
Binding in exchange for H+
o Azure A is rapidly reabsorbed from intestine
 Travels into blood, kidney –excreted –urine

Specimen Collection
 Tube or Intubation Methods
2 Types of Gastric Juice
Collection:
Levin tube
o Single lumen tube used for stomach decompressing
o for washing stomach free of toxic substances
o Can be used to administer meds/feeding
 Tube or Intubation Methods
2 Types of Gastric Juice
Collection:

Rehfuss tube
o Flexible tube, Calibrated with syringe
o Used for withdrawing gastric juice from stomach
o Small oral tube with metal “oral tip”
o Used for gastric juice analysis / emptying stomach
 Other Tube Methods
Levin
Gastric collection, rubber, smallest diameter
Inserted through the nose

Kaslow
Gastric collection
 Other Tube Methods

Ewald’s or
Miller BOA’s
Abbot For washing and emptying stomach
Has mercury tip (poisoning cases)
 Contraindication of Gastric Analysis

Pyloric stenosis 0 Esophageal 0 Severe

2 malignancy 4 hemorrhage

0
Heart ailments: arrythmias, 0 Esophageal varices or
0
1 heart failure 3 5
stricture
PROCEDURES:
Basal Gastric
o Measures fasting
secretion
o 1 hour collection:
 Four 15-min. fasting specimen
o Normal values of volume and acidity
Based on total 1hour specimen
 Basal Gastric
secretion
• BASAL ACID OUTPUT (BOA)
A period of total gastric secretion
0-6 mEq/hr
 Major diagnostic value:
• Markedly elevated acidity
Indicative of Zollinger Ellison Syndrome
PROCEDURES
Maximal gastric secretion
o Stimulation of fluid formation through stimulant

o MAXIMAL ACID OUTPUT (MAO)

Total acid secreted in hour after stimulation
NV: 5-40 mEq/hr

PROCEDURES
 Maximal gastric
• Gastric stimulants
secretion
oHistamine:
unpleasant to blood vessels, smooth muscles

oHistalogs:
Histamine isomer
Preferential effect on gastric acid secretion
Maximal production of gastric secretion activity

PROCEDURES
Maximal gastric secretion
• Gastric
stimulants
o Pentagastrin:
 stimulant of choice
 produce more rapid response than histalogs
 doesn’t cause discomfort to patient

PROCEDURES
 Test Meals
Ewald Test
Bread and tea routinely used
Meal

Boas Oatmeal for lactic acid

Beef steak and Recommended for detection

Reigel mashed potato of Achylia and Hypoactivity

Maximal Gastric Secretion

 Reigel
Absence of Lower than
gastric juice normal degree
of acidity

Achyli Hypoacidit
a y
Test Meals
 Macroscopic
Examination
Volume:
30-60ml
Fasting sample: few- 50 ml (average: 30ml)

Color
:
Colorless, yellowish or pale
Varying amount of mucus and
food particles
Macroscopic examination
Abnormalities in
Brownish red/Color
coffee color
Presence of large amount of blood
Opaque gray – seen after a test meal
Yellow – presence of fresh bite
Greenish – presence of old bite
Red – presence of small amount of blood
Macroscopic Examination

Od
orOdorless/ slightly sour/ faintly pungent
Abnormalities in
odor
Fecal odor
Intestinal obstruction/ gastrocolic – fistula
Foul/putrid – carcinomatous ulcer
 Macroscopic Examination

Abnormalities in
odor
Alcoholic – alcoholic coma/ after alcohol
test meal
Ammoniacal – case of uremia
Rancid – due to butyric and lactic acid
Indicating stenosis and fermentation
Chemical Examination
pH Reaction
Normally acidic : pH 1.6 – 1.8
High acidity : pH 1.4 – or lower
Low acidity : pH 2.0 or 2.8
Euchlorhydri
aNormal secretion with pH between 1.6 – 1.8
Hyperchlorhydria – increase free HCL
Above normal around 60ml (peptic ulcer)

Hypochlorhydria – decrease free HCL

 Carcinoma of stomach
 Chronic gastritis
 Gastric syphilis

Chemical Examination
Achlorhydria – absence of free HCL
Pernicious anemia
Pellagra
Advanced gastric cancer

Chemical Examination
Specific
gravity:
Varies from 1.001 – 1.010
with an average of 1.007

Chemical Examination
 Acid Contents of Gastric
Juice
2 Types:
1)Free HCL an acid, pH less than 3.5
2)Combine d HCL/ organic acid
˪ Acid combined with proteins
˪ Form protein salts HCL

Chemical Examination
Test for free HCL
1) Topfer’s method
2) Tubeless gastric analysis – Diagnex Blue
3) Boa’s method
4) Gunzberg method

Chemical Examination
Patient Preparation
Normal Structures:
1) Yeast cells – small amounts
2) Epithelial cells
3) Starch granules
4) Bacterial – lesser amounts
5) Fat globules
Pathologic structures
1)Fragments of tissue
2) Rbc
3) Yeast – large
amounts
4) Pus cells
Pathologic structures
6)Muscle fibers
7)Large number of
bacteria :
Sarcinae
Oppler – Boas bacilli
 Gastric and
Duodenal Contents
Examination
Prepared by: Eliazel G. Ocfemia