GASTRIC FUNCTION TESTS

1. DR NILESH KATE
MBBS,MD
PROFESSOR
ESIC MEDICAL COLLEGE, GULBARGA.
DEPT. OF PHYSIOLOGY
GIT FUNCTION
TESTS

2. OBJECTIVES
 Gastric Function tests
 Liver Function tests
 Pancreas Function tests.
Thursday, May 6, 2021

3. Gastric Function Tests
 Used to establish the presence of
hyperchlorhydria (associated with peptic
ulcer) or
 achlorhydria (complete absence of acid
secretion) associated with pernicious
anaemia.
Thursday, May 6, 2021

4. It includes…
 Fractional test meal test.
 Histamine test
 Augmented histamine test.
 Pentagastrin test
 Insulin test
 Barium meal study
 Endoscopic examination and biopsy
Thursday, May 6, 2021

5. Fractional test meal test.
 Previously used commonly for analysis of
gastric juice.
 Presently, it is no more used because of its
relative insensitivity and inconvenience.
Thursday, May 6, 2021

6. Fractional test meal test.
After an overnight fast,
the gastric fluid present
in the stomach is
aspirated with the help of
the Ryles’ tube
Test meal -300 mL of
oat meal gruel or dry
toast and cup of tea or
wheat biscuits and 300
mL of water.
After 15 min, a sample
of gastric content (10
mL of fluid) is
aspirated.
The procedure is
repeated every 15 min
for 3 h.
A total of 13 samples
are collected in
separate
containers.
Analyzed for free acidity,
combined acidity (Fig.
7.3-19), starch and sugar,
bile, total chlorides,
blood lactic acid and
mucus.
Thursday, May 6, 2021

7. Histamine test
 More sensitive,
 First, the histamine is a powerful stimulator of
acid secretion and
 Secondly, due to histamine injection, acid level
increases very rapidly
 So there is no time for neutralization of acid
Thursday, May 6, 2021

8. Histamine test
Thursday, May 6, 2021
After
overnight fast,
in the
morning
stomach is
aspirated and
washed with
distilled water.
0.5 mg
histamine
is injected
subcutaneo
usly
The gastric
samples
are
aspirated
and
analysed

9. Augmented histamine test.
Performed with progressively increasing
dose of histamine in a stepwise manner
till a maximal secretory response is
obtained.
The maximal secretory response
correlates well with the total
number of the parietal cells in the
gastric mucosa.
Thursday, May 6, 2021

10. Pentagastrin test
Performed
to assess
the gastric
acid
status.
It is
performed
similar to the
histamine
test.
Except that in
this, instead of
histamine, 6 mg
of pentagastrin
(a synthetic
gastrin) is given
as subcutaneous
injection.
Thursday, May 6, 2021

11. Insulin test
 Principle - Hypoglycaemia (blood sugar
below 45 mg%) produces vagal stimulation
through hypothalamus and that vagal
stimulation causes secretion of acid from the
stomach.
Thursday, May 6, 2021

12. Test
 Seven units of insulin are given
intravenously and the gastric samples are
tested for the presence of free acid, as done
in histamine test.
Thursday, May 6, 2021

13. Interpretation.
 Acid secretion occurs after insulin injection
(positive test) only if vagus is intact.
 Therefore, insulin test performed after
vagotomy operation (for gastric ulcer)
 To know whether all the fibres of nerve
supplying stomach are cut or not.
 If vagotomy is done properly, insulin test is
negative
Thursday, May 6, 2021

14. Barium meal study
 Radiographic evaluation of the status of
mucosa and lumen of the upper intestinal
tract.
 Patient swallows a suspension of radiopaque
barium sulphate, while its passage through
the GIT is observed by radiograph on
fluorescent screen and films are taken to
provide a permanent record.
Thursday, May 6, 2021

15. Barium meal study
Thursday, May 6, 2021

16. Endoscopic examination and
biopsy
 Esophagus, gastric and duodenal mucosa can be
directly visualized by the endoscope.
 The endoscopes carry a channel through which
biopsy forceps or a brush can be introduced to
obtain specimen for histological and cytological
examination.
Thursday, May 6, 2021

17. LIVER FUNCTION TESTS
 Tests to assess Secretory functions of liver
 Tests to assess Metabolic functions of liver.
 Tests to assess Synthesis of function of liver.
 Tests to assess Detoxication function of liver.
 Tests to assess Hepatic cellular integrity.
 Miscellaneous tests
Thursday, May 6, 2021

18. TESTS TO ASSESS SECRETORY
FUNCTIONS OF LIVER
 Serum bilirubin –
 Total serum bilirubin – 0.3-1 mg/dl
 Conjugated bilirubin – 0.1-0.3 mg/dl
 Unconjugated bilirubin – 0.2-0.7 mg/dl
 Urine bilirubin & bile salts
 Urine urobilinogen > 4mg/dl
 Faecal stercobilinogen - > 20-25 mg/dl
 Faecal fat level - > 5-6 %
Thursday, May 6, 2021

19. TESTS TO ASSESS METABOLIC
FUNCTIONS OF LIVER.
 Galactose tolerance tests
 Blood glucose level < 70-90 mg/dl
 Blood & urine amino acid levels > 30-65
mg/dl
 Lipid Profile
 Increase – plasma NEFA & FFA & Ketone bodies
 Decrease – serum cholesterol, serum TG, Serum PL,
total lipids.
Thursday, May 6, 2021

20. TESTS TO ASSESS SYNTHESIS
OF FUNCTION OF LIVER.
 Estimation of plasma proteins –
Hypoalbuminemia & reversal of A:G ratio
 Serum liver enzymes level – raised
Transaminase & alkaline phosphatase
 Blood urea - < 20-40 mg/dl
 Blood ammonia - > 20-80 mg/dl
 Coagulation factors – II,V, VII, IX & X
decreases.
Thursday, May 6, 2021

21. TESTS TO ASSESS DETOXICATION
FUNCTION OF LIVER.
 Bromsulphthalein excretion test.
 Rate of removal of BSP from blood depends on
functional efficiency of liver & rate of hepatic blood
flow.
Thursday, May 6, 2021

22. TESTS TO ASSESS HEPATIC
CELLULAR INTEGRITY.
 USG – to detect
cirrhosis of liver, fatty
liver, abcesses, cysts,
tumours, gall stones &
dilatation of biliary
system.
 CT scan
Thursday, May 6, 2021

23. TESTS TO ASSESS HEPATIC
CELLULAR INTEGRITY.
 Radionucleotide imaging – Technetium (99mTc)
 Liver biopsy
 FNAC
 Cholecystography
 Other tests –
 Percutaneous choleangiography
 Portal venography
 Endoscopic retrograde cholagio pancraetiography
Thursday, May 6, 2021

24. PANCREATIC FUNCTION TESTS
 Analysis of pancreatic
juice
 Analysis of product of
digestion.
 Estimation of serum
amylase levels
Thursday, May 6, 2021

25. ANALYSIS OF PANCREATIC
JUICE
 Collection of pancreatic juice – Double
lumen Radiopaque tube (D Veiling tube)
inserted upto Ampulla of Vater
 Recently Fiberoptic catheter used for
aspiration.
Thursday, May 6, 2021

26. ANALYSIS OF PANCREATIC
JUICE
 Analysis of pancreatic juice collected after
direct stimulation of pancreas - Secretin test
– after overnight fasting duodenal & gastric
content aspirated then intravenous infusion
of secretin given & duodenal aspirate
measured.
Thursday, May 6, 2021

27. ANALYSIS OF PANCREATIC
JUICE
 Combined secretin & CCK test – after above
test CCK is given intravenously & whole
process repeated.
Thursday, May 6, 2021

28. ANALYSIS OF PRODUCT OF
DIGESTION.
 Faecal fat excretion test – subject on 100
gm of fats /day & stool tested for fats for 3-5
days.
Thursday, May 6, 2021

29. ANALYSIS OF PRODUCT OF
DIGESTION.
 Tripeptide hydrolysis test – subject given
synthetic peptide B2-T4- PABA & PABA
excretion measured.
Thursday, May 6, 2021

30. ESTIMATION OF SERUM
AMYLASE LEVELS
 To rule out acute pancreatitis in acute pain
in abdomen.
 In acute pancreatitis serum amylase level
raised more than normal level of 50-120
units/L.
Thursday, May 6, 2021

31. THANK YOU