GASTRIC FLUID ANALYSIS
What is Gastric fluid?
• A colorless to grayish or yellowish watery fluid
w/ a low specific gravity secreted by the
surface epithelium, gastric cells and the
various glands of the gastric tract.
Formation
• Gastric acidity results from the secretion of
HCl by the parietal cells in the stomach
• The hormone gastrin stimulates the parietal
cells to produce HCl
• HCl converts pepsinogen to pepsin, which aids
in the digestion of protein
Composition
• Gastric fluid contains: HCl, pepsin, saliva,
mucous, acid neutralizing chemicals, as well as
secretions from the intestines, biliary tract and
pancreas
Indications
• Diagnosis of gastric diseases and assist in the
selection of therapy i.e. peptic ulcer
• It measures the amount of acid produced by a
patient w/ symptoms of peptic ulcer
• Diagnosis of Zollinger-Ellison syndrome
(adenoma of Islet of Langerhans) a condition
of gastric hypersecretion produced by a
gastrin secreting tumor of the pancreas
• Drug analysis
Specimen Collection
• The patient must be in a fasting state for 12
hours
• Contamination w/ saliva neutralizes the gastric
acidity therefore it should be prevented.
• Time specimen should be collected for the
purpose of comparison
Types of Gastric Juice Collection
Using an evacuated tubes:
1.) Levine tube – inserted in the nose (nasal
intubation)
2.) Rehfuss tube – inserted in the mouth ( oral
intubation)
Collection using Levin/Rehfuss tube
Composition
• H2O – varying amounts (99 %)
• HCl – secreted by the parietal cells w/c provide
acidity for the activation of pepsinogen
• Digestive enzyme
– pepsin – catalyzes the protein digestion to proteoses;
secreted by chief peptic cells
– lipase – fats ( no importance to digestion)
– rennin – milk (ability to coagulate caseinogen to milk)
– gastricsin – importance not yet known in gastric secretion
Composition
• Mineral acid – chiefly acid phosphates
• Mucus – found in moderate amts secreted by
GOBLET cells of stomach to prevent
autodigestion of stomach
• Electrolytes – main electrolytes present is H+;
also present are Na, Cl, P, Ca and Mg
• Particles of food – undigested and partly
digested
Main Types of Cells Responsible for
Gastric Juice Production
• 1.) chief or peptic cells – producing the
protein- splitting enzyme pepsin
• 2.) parietal or oxyntic cells – producing HCl
and intrinsic factor (erythropoietic factor)
absence of w/c leads to pernicious anemia
• 3.) goblet or mucous secreting cells –
producing mucus for the protection of the
mucosa and lubricates the food.
MACROSCOPIC EXAMINATION
Volume
• 30 – 60 ml
• Fasting sample – contains few ml to 50 ml w/
an average of 30 ml
Normal Color
• Colorless, yellowish or pale gray with varying
amounts of mucus and food particles
Abnormalities in Color
1.) brownish red or coffee color – presence of
large amount of blood.
2.) opaque gray – seen after a test meal
3.) yellow – presence of fresh bile
4.) greenish – presence of old bile
5.) red – presence of small amount of blood
Normal Odor
• Odorless or maybe slightly sour or faintly
pungent
Abnormalities in Odor
• fecal odor – seen in intestinal obstruction or
gastrocolic-fistula
• foul or putrid odor – seen in carcinomatous ulcer
• alcoholic odor – seen in alcoholic coma, or after
alcohol test meal
• ammoniacal odor – seen in case of uremia
• rancid odor – due to butyric (fatty acid) and lactic
acid (present in sour milk) indicating stenosis and
fermentation
pH or Reaction
• Normally acidic – pH 1.6 to 1.8
• High acidity – pH 1.4 or lower
• Low acidity – pH 2.0 or 2.8
Terms in Acidity
• Euchlorhydria – refers to normal secretion w/
a pH bet. 1.6 to 1.8
• Hyperchlorhydria – increase free HCl above
normal around 60 ml i.e. peptic ulcer
• Hypochlorhydria – decreased free HCl
– carcinoma of the stomach
– chronic gastritis
– gastric syphilis
Terms in Acidity
• Achlorhydria – absence of free HCl
– pernicious anemia
– pellagra
– advanced gastric cancer
Titratable Acidity
• Both the ionized and the unionized H+ are
measured simultaneously by titrating the
specimen with 0.1 N NaOH to pH 7.0 using
phenol red as indicator
• Phenol red will change from yellow to red in
pH 6.6-8.0
• Titration results are reported as mEq/L or
mmoL/L
Post-stimulation gastric acidity
• Gastric stimulants used: Pentagastrin,
Histamine, Histalog
• Specimens are collected at 15-minute
intervals for 1 hour or 2 hours when using
Histalog
Normal and Abnormal Gastric Analysis
Results
Basal Acid Maximum BAO/MAO
Output Acid
mEq/hr Output
mEq/hr
Normal 2.5 25 10%
Pernicious Anemia 0 0 0
Duodenal Ulcer 5.0 30 17%
Zollinger-Ellison 18.0 25 72
Syndrome
Example
Specific Gravity
• Varies from 1.001 – 1.010 w/ an average of
1.007
Chemical Examination
• Acid contents of gastric juice are of 2 types:
1.) Free HCl an acid w/ a pH less than 3.5
2.) Combined HCl or organic acid – an acid w/c
combines w/ proteins or protein-like subs to
form protein salts of HCl.
Test for Free HCl
• 1.) Topfer’s method
• 2.) Tubeless gastric Analysis –Diagnex Blue
• 3.) Boa’s method
• 4.) Gunzberg method
Microscopic Examination
Normal Structures
• yeast cell – small amounts
• epithelial cells
• bacteria – lesser amounts
• starch granules
• fat globules
Abnormal Structures
1.) fragments of tissues
2.) rbc
3.) yeast – large amounts
4.) pus cells
5.) muscle fibers
6.) large number of bacteria and maybe seen are:
– a.) Sarcinae
– B. Oppler-Boas bacilli
