GASTRIC FUNCTION

TEST
GROUP 1:
• Umme Habiba.
• Rida Naveed.
• Ali Asghar.
• Sumbal Tahir
• Khadija Javed.
• Umar Ali.
• Hannan Shami.
POINTS OF CONCERN:
• Introduction.
• Anatomy of Stomach.
• Functions of stomach.
• Indications of gastric function test.
• Gastric glands.
• Regulation of gastric juice.
• Analysis of resting content.
• Gastric function tests.
• Other tests.
• Tests for Malabsorption.
INTRODUCTION:
• Stomach is an elastic muscular bag.
• Stomach is situated below the diaphragm on left side of abdominal
cavity.
• It is typically J-shaped when empty.
ANATOMY OF STOMACH:
 PARTS:
• First part of stomach where oesophagus empties its contents into
stomach is called cardiac region.
• At the junction between esophagus and the stomach, there is a
special ring of muscles called cardiac sphincter. It is also called as
lower oesophageal sphincter (LES). When the sphincter muscle
contract,the entrance to the stomach closes and prevents backward
movement of food. It opens when a wave of peristalsis coming down
the esophagus reaches it.
• Point where stomach joins duodenum is called pyloric sphincter.
Stomach empties into the duodenum through the relaxed pyloric
sphincter.
LAYERS:
1. Serosa OR Adventitia (Outer layer).
2. Muscularis externa (Middle layer).
3. Mucosa (Inner layer).
 FUNCTIONS OF STOMACH:
1. Food Storage
• It stores food from meals for some time, discountinous feeding possible.
2. Digestion of Food
• It partly digests protein food.
• Stomach shows both chemical and mechanical digestion.Mechanical
digestion is carried out by middle muscular layer and is called churning.
While chemical digestion is carried out by gastric glands.
• Muscular walls thoroughly mix up the food with gastric juice.
• End result of the digestion in stomach is formation of semi-fluid mass called
chyme.
3. Absorption
• Some absorption also occurs at stomach.
4. Defense/ Immunity
• Mucous membrane and HCL act as barriers against germs.
 INDICATIONS OF GASTRIC
FUNCTION TESTS:
1. To diagnose Gastric
Ulcers.
2. To exclude the
diagnosis of
Pernicious Anemia.

(Pernicious Anemia is defined as a type of vitamin B12

deficiency that results from impaired uptake of vitamin B-
12 due to the lack of a substance known as intrinsic
factor (IF) produced by the stomach lining.)
 3. For presumptive diagnosis of
Zollinger Ellison Syndrome.

(Zollinger Ellison Syndrome is a

condition in which a gastrin-
secreting tumour or hyperplasia
of the islet cells in the pancreas
causes overproduction of gastric
acid, resulting in recurrent
peptic ulcers.)
4. To determine the completeness
of surgical Vagotomy.

(Vagotomy is surgical ligation of

the vagus nerve to decrease the
secretion of gasttic acid.
GASTRIC GLANDS:
Types:
1. Cardiac gland.
2. Fundic gland.
3. Pyloric gland.
1. CARDIAC GLAND:
• The cardiac glands are found in the cardia of the stomach which is the
part nearest to the heart, enclosing the opening where the esophagus
joins to the stomach. Only cardiac glands are found here and they
primarily secrete mucus.They are fewer in number than the other
gastric glands and are more shallowly positioned in the mucosa.
Functions:
• Thick secretions.
• Cover inside of stomach.
• Protect stomach wall.
2. FUNDIC GLAND:
• The fundic glands (or oxyntic glands), are found in the fundus and body of the
stomach. They are simple almost straight tubes, two or more of which open into a
single duct. Oxyntic means acid-secreting and they secrete hydrochloric acid (HCl)
and intrinsic factor.
Functions:
• Maintains pH from 2-3.
• Provide acidic medium for enzymes.
• Softens food and kills microorganisms.
• Converts inactive pepsinogen into pepsin.
• Inactivates salivary amylase.
• Low pH denatures many proteins.
How HCl produce?
3. PYLORIC GLAND:
• The pyloric glands are located in the antrum of the pylorus. They secrete
gastrin produced by their G cells.
• The enterochromaffin-like cells store and release histamine when the pH of
the stomach becomes too high. The release of histamine is stimulated by the
secretion of gastrin from the G cells.Histamine promotes the production and
release of HCL from the parietal cells to the blood and protons to the stomach
lumen. When the stomach pH decreases(becomes more acidic), the ECLs stop
releasing histamine.
• The G cells are mostly found in pyloric glands in the antrum of the pylorus;
some are found in the duodenum and other tissues. The G cells secrete
gastrin. The gastric pits of these glands are much deeper than the others and
here the gastrin is secreted into the bloodstream not the lumen.
ENDOCRINE GLANDS:
• Produces hormones:
1 Gastrin:
Gastrin is a peptide hormone primarily responsible for enhancing gastric
mucosal growth, gastric motility, and secretion of hydrochloric acid (HCl) into
the stomach. It is present in the G cells of the gastric antrum and duodenum.
2. Secretin:
Secretin has 3 main functions: regulation of gastric acid, regulation of
pancreatic bicarbonate, and osmoregulation.
The major physiological actions of secretin are stimulation of pancreatic fluid
and bicarbonate secretion.
GASTRIC JUICE:
• "A thin watery acid digestive fluid secreted by the glands in the mucous
membrane of the stomach and containing 0.2 to 0.4 percent free hydrochloric
acid and several enzymes (as pepsin)“
Components:
Gastric juice is a variable mixture of :
• Water.
• Hydrochloric acid.
• Electrolytes (sodium, potassium calcium phosphate sulfate bicarbonate).
• Organic substances (mucus, pepsins, and protein)
This juice is highly acidic because of its hydrochloric acid content, and it is rich in
enzymes.
REGULATION OF GASTRIC JUICE:
• The nervous system, and endocrine system collaborate in the
digestive system to control gastric secretions, and motility associated
with food.
• Gastric activity involved in digestion is divided into three stages
known as:
1. Cephalic phase 2. Gastric phase 3. Intestinal phase.
• These phases can occur simultaneously.
• A fourth phase of acid secretion is known as the basal state which
occurs in the times between meals (interdigestive phase)
• Acid secretion is lowest in the morning before awakening and highest at night...
• The three stimulants of gastric acid secretion likely to have physiological roles in
regulation of secretion are:
• Acetylcholine.
• Gastrin.
• Histamine
• Regulation: Gastrin acts on parietal cells directly and indirectly too, by stimulating
the release of histamine. The release of histamine is the most important positive
regulation mechanism of the secretion of gastric acid in the stomach. Its release is
stimulated by gastrin and acetylcholine and inhibited by somatostatin
ANALYSIS OF RESTING
CONTENT:
Volume:
• Normal : 0-400 ml
Colour:
• Normal : colourless to grey
• Infection or trauma : red
• In case of bile : yellow to green
Consistency:
• Physiological findings show fluid consistency which may be slightly
viscous from mucus.
Bile:
• Bile is a digestive fluid made by
the liver, stored in the gallbladder,
and discharged into duodenum
after food is ingested to aid in the
digestion of fat. ... The presence
of small amounts of bile in the
stomach is relatively common
and usually asymptomatic, but
excessive refluxed bile causes
irritation and inflammation.
Mucus:
• Gastric mucus is a gel-mucous barrier secreted by epithelial cells and
glandular cells in the stomach wall. It acts as part of a barrier that
protects the stomach wall from the acid and digestive enzymes within
the stomach.
Normal value of gastric juice:
• The normal volume of the stomach fluid produced per day is between
20 to 100 mL.
GASTRIC FUNCTION TESTS:
1. Fractional Test Meal.
2. Histamine Test Meal.
3. Augmented Histamine Test.
4. Alcohol Test.
5. Pantagastrin Test.
6. Insulin Test Meal.
FRACTIONAL TEST MEAL:
• A method of examining the secretion of gastric juices
• The stomach contents are sampled at intervals via a stomach tube after a test meal of
gruel.
• It is usual to test for total and free acidity, and in addition peptic activity may be
measured.
• This is rather old and not used these days.
• Fractional test meal (FTM) involves the collection of stomach contents by Ryle’s tube
in fasting.
• This is followed by a gastric stimulation, giving a test meal (rice, black coffee etc.)
• The stomach contents are aspirated by Ryle’s tube at different time periods (usually
every 15 min for 2 hrs.) The samples are analyzed for free and total acidity in the
laboratory.
• The results are normally represented by a graph.
HISTAMINE TEST MEAL:
• Powerful stimulant For HCl in normal stomach.
• Acts on receptors of oxyntic cells, increasing cAMP, which causes
secretion of increased volume of high acidic gastric juice with low
pepsin content.
• Best to differentiate between true alchlohydria from false
achlorhydria.
AUGMENTED HISTAMINE TEST:
• Histamine is a powerful stimulant of gastric secretion.
• The basal gastric secretion is collected for one hour. Histamine is
administered subcutaneously and the gastric contents are aspirated
for the next one hour at 15 minute intervals.
• The acid content is measured in all these samples.
ALCOHOL TEST:
PANTAGASTRIN TEST:
• A test of the acid production by the stomach.
• An injection of a synthetic pentapeptide substance, pentagastrin is
given, and an hour later the fasting stomach contents are withdrawn
through a nasogastric tube.
INSULIN TEST:
• Hypoglycemia produced by insulin is a potent stimulus of gastric acid
secretion.
Indications:
• To see the effectiveness of vagotomy in pts with duodenal ulcer.
OTHER TEST:
1. Serum gastrin :
• The gastrin test is primarily used to help detect excess production of
gastrin and gastric acid.
• It is used to help diagnose gastrin-producing tumors called
gastrinomas, Zollinger-Ellison (ZE) syndrome, and hyperplasia of G-
cells.
2. OCCULT BLOOD TEST:

• A test for fecal occult blood looks for blood in your poop, or feces.
• It can be a sign of a problem in your digestive system, such as a
growth, or polyp, or cancer in the colon or rectum.
Cause of blood in fecal:
• Growths or polyps of the colon
• Hemorrhoids (swollen blood vessels near the anus and lower rectum
that can rupture, causing bleeding)
• Anal fissures (splits or cracks in the lining of the anal opening)
• Intestinal infections that cause inflammation.
TESTS FOR MALABSORPTION:
1. Schilling test:
• It is a B12 deficiency test.
• It can determines the patient has a B12 deficiency, intrinsic factor
deficiency and malabsorption problem.
• Two orally administered dose of radioactive B12.
• First test dose is B12 alone.
• Second test dose is B12 with intrinsic factor.
Result:
2. D- XYLOSE ABSORPTION:
• D- xylose absorption test measures the level of D-xylose, a type of
sugar, in a blood or urine sample.
Why this test is done?
• Check to see if malabsorption syndrome is causing symptoms, such as
chronic diarrhea, weight loss and weakness.
• A person with malabsorption syndrome is unable to absorb nutrients,
vitamins and minerals from the intestinal tract into the bloodstream.
• 24 hr prior: Avoid eating fruits, jams, jellies and pastries (high pantose
sugar foods)
• Do not eat/ drink anything except plain water for prior8 hours (4 hours
for children)
• Give 25g oral dose of D-xylose solution drink.
• Collect blood sample after 2 hours and 5 hours (in adults). For children:
1 hour after drink.
• Collect all of urine sample in 5 hours.
• Blood level peak in 2 hours and completely eliminated in urine by 5
hours.
FECAL FAT TEST:
• This is a semi quantative test.
• Used to detected the malabsorption and maldigestion with chronic
diarrhea and unexpected weight loss.
• It is a minimal inexpensive test which can be perform in small labs.
• In this test we can estimate the amount of digested or amount of
undigested fat.
Materials required to do this
test:
• Acitic acid solution.
• Afical sample.
• Glass slides.
• Microscope.
• Sudan 3 solution of stain.
• Tip with pipette.
False positive results:
• This test produced false positive results.