FRACTIONAL FRACTIONAL GASTRIC GASTRIC

ANALYSIS USING ANALYSIS USING TEST MEALTEST MEAL

METHOD OF CARRYING OUT METHOD OF CARRYING OUT THE TESTTHE TEST

•Introduction of Ryle’s tube in stomach of a Introduction of Ryle’s tube in stomach of a fasting patient (overnight) fasting patient (overnight)

•Removal of residual gastric contents &its Removal of residual gastric contents &its analysis. analysis.

•Ingestion of test meal.Ingestion of test meal.

•Removal of 5to6ml gastric contents after Removal of 5to6ml gastric contents after meal. meal.

TEST MEALSTEST MEALS

• EWALD TEST MEALEWALD TEST MEAL• 2 pieces of toast (35g)2 pieces of toast (35g)

• 250 ml of light tea. 250 ml of light tea.

•OAT MEAL :-OAT MEAL :-• 2 tablespoonful of oat meal2 tablespoonful of oat meal

• 1 quart of boiling water 1 quart of boiling water

• RIEGEL MEAL:- RIEGEL MEAL:- • 200 ml of beef broth 200 ml of beef broth

• 150g boiled beef steep150g boiled beef steep

• 100 g Smashed potatoes.100 g Smashed potatoes.

COLLECTION OF SAMPLE: -COLLECTION OF SAMPLE: -

At intervals of exactly 15 minutes At intervals of exactly 15 minutes about 10 ml of gastric contents are about 10 ml of gastric contents are removed by means of syringe attached removed by means of syringe attached to the tube. to the tube.

GRAPHICAL REPRESENTATION OF NORMAL PERSON’S ACIDITY

DIFFERENT CONDITIONS DIFFERENT CONDITIONS

• Hyperchlorhydria Hyperchlorhydria

• HypochlorydriaHypochlorydria

• AchlorhydriaAchlorhydria

HyperchlorhydriaHyperchlorhydria

This occurs when the maximum free This occurs when the maximum free acidity exceeds 45 mEq/l, combined acidity exceeds 45 mEq/l, combined acid remains the same as in normal acid remains the same as in normal persons. persons.

CAUSES OF CAUSES OF HYPERCHLORHYDRIAHYPERCHLORHYDRIA

i.i. Duodenal ulcerDuodenal ulcer

ii.ii. Gastric ulcerGastric ulcer

iii.iii. Gastric carcinoma Gastric carcinoma

iv.iv. Jejenal & Gastro Jejunal ulcers.Jejenal & Gastro Jejunal ulcers.

v.v. Hyperirritablity Hyperirritablity

vi.vi. Chronic appendicities Chronic appendicities

vii.vii.Gastric neurosis Gastric neurosis

viii.viii.Chronic cholecystitisChronic cholecystitis

HYPOCHLORHYDRIA HYPOCHLORHYDRIA

Low acidities are found.Low acidities are found.

CAUSES Carcinoma of stomach

Pernicious Anaemia

ACHLORHYDRIAACHLORHYDRIA

• This term is used when there is noThis term is used when there is no secreation of HCl, but enzyme like pepsin secreation of HCl, but enzyme like pepsin is present. is present.

• Achlorhydria can be differentiated fromAchlorhydria can be differentiated from hypochlorhydira by stimulation test with hypochlorhydira by stimulation test with histamine. histamine.

• Histamine stimulation shows rise in free Histamine stimulation shows rise in free HCl in hypochlorhydria, but not in HCl in hypochlorhydria, but not in achlorhydria. achlorhydria.

CAUSES OF ACHLORHYDRIACAUSES OF ACHLORHYDRIA

• Carcinoma of stomachCarcinoma of stomach• Chronic gastritisChronic gastritis• Partial GastrectomyPartial Gastrectomy• Microcytic Hypochromic anaemiaMicrocytic Hypochromic anaemia

ANALYSIS OF GASTIC- JUICE ANALYSIS OF GASTIC- JUICE FREE & TOTAL ACIDITYFREE & TOTAL ACIDITY

• REGENTS REQUIRED:-REGENTS REQUIRED:-– Gastric JuiceGastric Juice– N/10 NaOHN/10 NaOH– Phenolphthalein Indicator Phenolphthalein Indicator – Topfers Rgt.Topfers Rgt.

CHEMICALS REQUIRED:-CHEMICALS REQUIRED:-

• Conc. HClConc. HCl

• Glacial Acetic AcidGlacial Acetic Acid

• Sodium HydroxideSodium Hydroxide

• PhenolphthaleinPhenolphthalein

• Topfers Rgt.Topfers Rgt.

• EthanolEthanol

• Methyl orangeMethyl orange

REQUIREMENTSREQUIREMENTS

1.1. Gastric JuiceGastric Juice - - 1000ml 1000ml

2.2. N/10 Sodium Hydroxide- 4 gms of NaOH in N/10 Sodium Hydroxide- 4 gms of NaOH in 1000ml D.W.1000ml D.W.

3.3. Topfers Regt. – pH 2.9-4.0Topfers Regt. – pH 2.9-4.04.4. Phenolphthalein – 1g in 95% ethanol Phenolphthalein – 1g in 95% ethanol

pH 8.3-10.0pH 8.3-10.05.5. Methyl orange – pH 2.9-4.6Methyl orange – pH 2.9-4.6

ANALYSIS OF ACIDITY:-ANALYSIS OF ACIDITY:-

The gastric juice is analyzed for free, The gastric juice is analyzed for free, total and combined acidity by using total and combined acidity by using titration method.titration method.

FIRST TITRATION:-FIRST TITRATION:-

• Take 5ml of gastric juiceTake 5ml of gastric juice

• Add 2-3 drops of topfers Regt. as Add 2-3 drops of topfers Regt. as indicator indicator

• Mix it Mix it

• Take 0.01N NaOH and titrate until a Take 0.01N NaOH and titrate until a light yellowish orange colour appear.light yellowish orange colour appear.

• Note the initial and final reading Note the initial and final reading

• This gives us free acidity This gives us free acidity

SECOND TITRATION:-SECOND TITRATION:-

• To the titrated solution add 2-3 drops To the titrated solution add 2-3 drops of phenolphthalein indicator and of phenolphthalein indicator and continue to continue to titrate with 0.01N NaOH until the titrate with 0.01N NaOH until the light pink colour appears.light pink colour appears.

• Note the total volume of NaOH added Note the total volume of NaOH added

• This gives the total acidityThis gives the total acidity

EXPRESSION OF EXPRESSION OF RESULTSRESULTS

Results has been expressed as 0.01N Results has been expressed as 0.01N HCl/ 100ml gastric contents HCl/ 100ml gastric contents

TEST FOR OCCULT TEST FOR OCCULT BLOODBLOOD

• Reagents required Reagents required – 1pinch of benzidine powder 1pinch of benzidine powder – 3-4 drops of G.A.A3-4 drops of G.A.A

– 0.5ml of H0.5ml of H22OO22

– MixMix

PROCEDUREPROCEDURE

TakeTake few ml of gastric juice and then few ml of gastric juice and then add few drops of above solution add few drops of above solution

RESULTRESULT

Blue colour shows occult bloodBlue colour shows occult blood

LACTIC ACIDLACTIC ACID

1ml of filtered gastric sample, 1-2 1ml of filtered gastric sample, 1-2 drops of 10g /dl FeCL3drops of 10g /dl FeCL3

RESULT RESULT

Yellow colour shows presence of Yellow colour shows presence of lactic acid lactic acid

STARCHSTARCH

Few drops of gastric sample + few Few drops of gastric sample + few drops of iodine drops of iodine

RESULT RESULT

Blue Colour Blue Colour

THANK YOU