Gastric secretions

and
Duodenal content

The mucous membrane of the

stomach has tubular gastric glands
that secrete:
1. Hydrochloric acid
-From the Parietal cells.
-Needed to convert pepsinogen to
pepsin.
-Hydrolyze polypeptides and
disaccharides directly.
2. Mucus
-From the Goblet cells and the
mucous glands.
-Complex mixture of mucoproteins
and mucopolysaccharides.

3. Intrinsic Factor
-From the Parietal cells .
-Is required for vitamin B12
absorption.
4. Electrolytes
-Gastric secretions contains
all electrolytes found in
other body fluids on a
combined osmolar
concentration equal to or
slightly greater than plasma.

5. Digestive Enzymes
*Pepsin- Major digestive enzyme of
gastric secretion
-Secreted by Chief cells /Peptic cells
as 2 proenzymes..
Catalyzes degradation of proteins to
proteases and peptones.
*Gastric Lipase- digestion of dietary
fats
*Renin(chymosin)- secreted by chief
cell
*Gastricsin (Pepsinogen C)
6. Non Digestive Enzymes
-LDH, aspartate amino transferase,
isocitric dehydrogenase, alkaline
phosphatase

Secretions of the Small Intestine

-Other specialized mucous-secreting glands
(Brunners glands) that secretes a thick,
alkaline mucus in response to certain stimuli
*Enzymes in the membrane of microvilli:
-Peptidase- breaks down peptide into amino
acid
-Sucrase, maltase, lactase- breaks down
disaccharide into monsaccharide
-Lipase- breakdown fats into amino acid and
glycerol

-Somatostatin-hormone that inhibits

gastric secretion by stomach
-Cholecystokinin- hormone that
inhibits gastric glands, stimulates
pancreas to release in pancreatic
juices and stimulates gallbladder to
release bile.
-Secretin- Stimulates pancreas to
release bicarbonate ions in pancreatic
juice

Examination of Gastric Contents

-To determine if the patient can secrete gastric acid

-To measure the amount of acid produce by patients with
symptoms of peptic ulcer
-To support a hypersecretory state characteristic of ZollingerEllison syndrome
-To determine the completeness of vagotomy
-To aid in the differential diagnosis of gastric ulcer for duodenal
ulcer
-To evaluate the possibility of Hperchlorhydria or
Hypochlorhydric state.

For detection:
-Direct examination of lesion by endoscopy
-Improved radiologic technique- air contrast
-.pH sensitive electrode that will transmit pH
readings when passed into the stomach
-Measurement of serum gastrin levels
-Cytologic exam of gastric content for malignant
cells
-Immunologic testing of serum for the presence of
anti-intrinsic factor and anti-parietal cell antibodies
seen in pernicious anemia

Specimen Collection

-Nasal or Oral intubation(Levin tube is passed

thru the nose or a Rehfuss or similar tube is
passed thru the mouth) performed fasting state.
-Acidity testing is routinely performed on 15
min. interval specimens. Aspirate place in time
labeled containers that represent each 15 min of
the time required collection period and not as a
single specimen.

2. Volume
-Measured in ml. and is used with titrable acidity to determine
total acid output. Volume should increase following gastric
stimulation.
3. pH
-a ph meter used and correlation with the titrable acidity
activity values
Anacidity-Failure to produce Ph less than 6.0 following gastric
stimulation.
4. TITRABLE ACIDITY
-currently the measurement of overall H+ concentration s the
recommended procedure
-Both ionized and unionized hydrogen are measured
simultaneously by titrating the specimen 0.1 N NaOH to PH 7.0
-using indicator phenol red, which changes from yellow to red
in the ph range of 6.6 to 8.0

-report titration is milliequivalent or millimoles

per liter.
ACTUAL ACID OUTPUT
Specimen volume in liters x Titrable acidity

BASAL GASTRIC ACIDITY

POST STIMULATION
GASTRIC ACIDITY
It utilizes the principle of
introducing a gastric stimulant
into the patient.
PENTAGASTRIN

MICROSCOPIC EXAMINATION
OF GASTRIC CONTENTS

Helicobacter pylori

Gardia lamblia or cysts.

Strongyloides

Ascaris and Hookworm