1) The document discusses gastric content examination, which involves analyzing the contents of the stomach through a nasogastric tube. 2) Key components of gastric juice that are examined include volume, pH, presence of blood, bile, mucus, and pepsin levels. Abnormal results can indicate conditions like ulcers, cancer, or pernicious anemia. 3) Gastric analysis is performed through tube insertion and aspiration of gastric contents, which are then examined visually, through pH testing, and chemical analysis of acidity levels. The results are used to diagnose disorders of the upper gastrointestinal tract.

1. GASTRIC CONTENTS
EXAMINATION
SUNIL KUMAR.P
DEPARTMENT OF CLINICAL PATHOLOGY
ST.JOHN’S MEDICAL COLLGE
BANGALORE
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2. Contents ………..
• Introduction
• Composition
• Gastric fluid secretion
• Indications & Contraindications
• Collection
• Analysis
• Disadvantages of GA
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3. Gastric Juice
• 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.
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4. GASTRIC ACID SECRETION
• There are three phases of gastric acid
secretions :
• 1.Cephalic phase : Caused by Sight, smell,
taste, or thought of food
• 2.gastric Phase : Caused by entry of food into
stomach….Increased pH caused by food
• 3.Interstital phase : hormones produced by
small intestine.
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5. Function of Gastric Secretion
• The gastric chief cells of the stomach secrete
enzymes for protein breakdown (inactive
pepsinogen, and in infancy rennin).
Hydrochloric acid activates pepsinogen into
the enzyme pepsin, which then helps
digestion by breaking the bonds linking amino
acids, a process known as proteolysis.
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6. INTRODUCTION
• Gastric analysis involves quantification of
gastric acid produced by the stomach.
• It is usually collected by inserting a nasogastric
tube into the stomach and aspirating the
contents for analysis.
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7. • Chemical examination
of gastric contents has
limited but specific
value in diagnosis &
assessmentof disorders
of upper GIT
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8. • Normal fasting gastric
juice per day is about 1L
• Stomach of aperson
taking anormal diet
secretes 2L-3Lof
gastric juice per day
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9. During resting
period
During digestion
after meals
After
stimulation
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10. HCl
• secretedby
PARIETAL
CELLS
Pepsinogen
• Secreted by
CHIEFCELLS
Intrinsic factor
• Requiredfor
absorption
of Vitamin
B12
Alkaline
mucous
• Whichcoats
the gastric
walls act as
lubricant
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11. I
N
D
I
C
A
T
I
O
N
S
Todiagnose GastricUlcers
Toexclude the diagnosis of
Pernicious anaemia & Peptic ulcer
For presumptive diagnosis of Zollinger
Ellison
Syndrome
Todetermine the completeness of
SurgicalVagotomy.
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12. Indications of Gastric Analysis
• 1.Recurrent peptic ulcer disease ( gastrin-
produced tumour etc)
• 2.To diagnose pernicious anaemia
• 3.Help to differentiate b/w benign ulcer and
malignant ulcer
• (benign usually associated with increased acid
secretion)
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13. Contra indications of GA
• 1. Oesophageal varices or stricture
• 2.Esophageal malignancy
• 3. Severe hemorrhage
• 4.Heart ailments : arrhythmias, heart failure
• 5.pyloric stenosis
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14. 4/18/2018 14SUNIL KUMAR.P

15. NASOGASTRIC TUBE INSERTION
• Requirements :
• 1. Fine bore nasogastric feeding tube with
radio-opaque line and guide wire.
• 2.pH indicator paper
• 3.Non sterile gloves
• 4.Clinically cleaner receiver
• 5.Tissues
• 6.Fixative tape
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16. METHOD OF NASOGASTRIC TUBE
INSERTION ( PROCEDURE)
• 1. The procedure should be explained to the patient
beforehand.
• 2.The patient should ideally be sitting in an upright
position with slight flexion of head.
• 3.If unable to sit the patient may be allowed to lie on
any side.
• 4.wear gloves after cleaning the hands
• 5.The distance of the tube to be inserted is measure by
measuring distance from the patients bridge of the
nose to the ear lobe and adding the distance from the
bridge of the nose to xiphisterneum
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17. • 6.the tip of the tube needs a little lubrication
before inserting into nose.(sterile water or saline)
• 7.The tube is advanced slowly into the nostril
pointing horizontally towards the floor of the
nasal cavity.
• 8.Once the Pt. Feels tube in his nasopharynx , he
is instructed to perform swallowing action.
• 9.As he swallows the tube is gently pushed
forward.
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18. • 10.When the limiting mark on the tube is
reached, stop advancing the tube.
• 11.Lightly tape the tube to the cheek.
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19. Analysisof
Resting contents Gastric Residuum
Fractional gastric analysis using atest ‘meal’
FractionalTest
MealAnalysis
Stimulation byAlcohol or Caffeine or Histamine
or Insulin orPentagastrin
Analysisafter
Stimulation
Usedasscreening test
TubelessGastric
Analysis
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20. Volume Consistency Colour Bile
Blood Mucus Pepsin Freeacidity
Total acidity
Organic
acid
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21. Macroscopic Examination
Volume:
 30 – 60 ml
 Fasting sample – contains few ml to 50 ml w/ an
average of 30 ml
Color:
 Colorless, yellowish or pale gray w/ 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 bile4/18/2018 21SUNIL KUMAR.P

22. Abnormalities in Color:
 4.) greenish – presence of old bile
 5.) red – presence of small amount of blood
Odor:
 Odorless or maybe slightly sour or faintly pungent
Abnormalities in Odor:
 1.) fecal odor – seen in intestinal obstruction or
gastrocolic-fistula
 2.) foul or putrid odor – seen in carcinomatous ulcer
 3.) alcoholic odor – seen in alcoholic coma, or after alcohol
test meal
 4.) ammoniacal odor – seen in case of uremia
 5.) rancid odor – due to butyric (fatty acid) and lactic acid
(present in sour milk) indicating stenosis
and fermentation4/18/2018 22SUNIL KUMAR.P

23. 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
 Euchlorhydria – refers to normal secretion w/ a
pH bet. 1.6 to 1.8
 Hyperchorhydria – increase free HCl above
normal around 60 ml i.e. peptic ulcer
 Hypochlorhydria – decreased free HCl
i.e. 1.) carcinoma of the stomach
2.) chronic gastritis 3.) gastric syphilis
 Achlorhydria – absence of free HCl
i.e. 1.) pernicious anemia
2.) pellagra
3.) advanced gastric cancer4/18/2018 23SUNIL KUMAR.P

24. 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 method4/18/2018 24SUNIL KUMAR.P

25. MICROSCOPIC EXAMINATION
Normal Structures
1.) yeast cell – small amounts
2.) epithelial cells
3.) starch granules
4.) bacteria – lesser amounts
5.) fat globules
Pathologic 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.) Sarcinae4/18/2018 25SUNIL KUMAR.P

26. NORMAL ABNORMAL CAUSES
Volume 20-
50mL
>100-120mL • Hypersecretionof Gastricjuice
• Retention due to delayedemptying
• Regurgitation of duodenalcontents
Consistency- Fluid Foodresidues • Carcinomaof stomach
Colour–clear- colourless
orslightly yellowish or
green
Darkredor
brown*
Dueto blood
• BleedingGastriculcer
• Carcinomaof stomach
Bile –occasionally Increasedamount • Intestinal Obstruction andilealstasis.
Mucus- smallamount Increasedamount • Gastritis andcarcinomaof stomach
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27. NORMAL ABNORMAL CAUSES
Organic acid Lactic acid , butyric acid
present in largeamount
• Hypochlorhydria,
achlorhydria and Castomach
Freeacidity-measures
only HCl.0-30mEq/L
>50mEq/L • Hyperacidity
Total acidity – includes HCland other organic acids. Normal 10-40mEq/L
Pepsin Decreased levels
Increased levels
• Atrophic gastritis, Ca
stomach
• Zollinger-Ellison syndrome
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28. 4/18/2018 28SUNIL KUMAR.P

29. Procedure
• After removing residual contents, meal is given. Withintervals of
15 minutes contents of stomach are removed ,strained &
analysed
Normal response
• Freeacid rises steadily from 15 min – ½hr/45 min,and
decreases
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30. Hyperchlorhydria
• Freeacid
>50mEq/L
• Duodenal ulcer
• Gastric ulcer
• Gastric cell
hyperplasia
• Zollinger Ellison
Syndrome
Hypochlorhydria
• Caof stomach
• Atonic
dyspepsia
Achlorhydria
• No HClbut
pepsin is
present
• Seenin Ca
stomach,
chronic gastritis
Achylia gastrica
• Both HCland
pepsin are
absent
• Later stageof
Castomach
• Chronic
gastritis
• Pernicious
anaemia
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31. Disadvantages of Gastric analysis
• 1.Unpleasent experience for the patient
• 2.None of the tests are confirmatory
Endoscopy offers more advantages over this
method.
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32. Method
• Acid secretions in the stomach is measured at
basal levels and then repeated after
stimulation with drugs .
• Acidity is estimated by the titration method
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33. Duodenal Content examination
• Sampling of duodenal contents is reliable
means of recovery of strongyloides larvae and
any other small intestinal parasites.
• Specimens can be obtained endoscopic ally by
intubation or by the use of enteric capsule or
string test (Enterotest).
• With the advent of antigen detection tests
these testing's have largely been replaced for
gardia and Cryptosporidium,
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34. THANKS
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