Examination of gastric contents

Clinical study of gastric contents

Gastric juice - secret glands located in the mucous membrane of the stomach; he participates in a complex process of digestion and secreted 5-10 minutes after eating. Out of digestion, gastric juice is not secreted. The study of gastric juice is important for assessing the functional state of the stomach. It includes the study of physical and chemical properties and microscopic research. The main method of functional investigation of gastric secretion is fractional sounding with the use of a stimulant of gastric secretion (test breakfast). The essence of the method is that after the introduction of the probe into the stomach, extract the entire contents of the stomach - a portion on an empty stomach; In the future, 4 portions of gastric juice are collected in a separate dish every 15 minutes. Irritant in this case is a probe introduced into the stomach (the first phase of secretion or basal secretion); then a food stimulus (cabbage juice or meat broth, "alcoholic" or "caffeine" breakfast) is introduced into the stomach through the probe. 10 minutes after the introduction of the food stimulus, 10 ml of gastric contents are removed, and after 15 minutes all the contents of the stomach are removed - the remainder of the test lunch. Later, within an hour, every 15 minutes, all the gastric contents (the second phase of secretion or stimulated secretion) are taken out into separate cups.

Gastric contents

Colour. Normally gastric juice is yellowish white. The admixture of blood gives the gastric juice various shades of red: with fresh bleeding - scarlet, if the blood was in the stomach for a long time - brown. Bile gives the gastric juice a green color, as bilirubin of bile passes into biliverdin. At an achitis biliverdin is not formed and gastric juice with an admixture of bile has a yellow tint.

Smell. Normally, gastric juice has no smell. The putrefactive odor appears when hypoecretion or lack of hydrochloric acid, stagnation and fermentation of the contents of the stomach, stenosis, decay of the tumor, decay of proteins. In the absence of hydrochloric acid, there can be a smell of organic acids - acetic, lactic, oil.

The amount of gastric juice. Determine the amount of fasting contents, the volume of basal secretion, the volume of gastric contents extracted 25 minutes after the test breakfast (balance) and the hourly secretion voltage. The hourly voltage is the volume of gastric juice allocated per hour. For example, the hourly voltage of the I phase of secretion is the sum of volumes 2, 3, 4 and 5 portions after the introduction of the probe (without a test meal). The sum of the volumes of 8-, 9-, 10- and 11-th portions or 3-, 4-, 5-, and 6-th portions after the introduction of a test breakfast is considered the hourly tension of the second phase of secretion.

Acidity. To judge about the acid-forming function of the stomach determine a number of indicators.

• Total acidity is the sum of all acidic products contained in the gastric juice: free and bound hydrochloric acid, organic acids, acid phosphates and sulfates.
• Bound hydrochloric acid - undissociated hydrochloric acid of protein-hydrochloric acid complexes in gastric juice; with gastritis, bleeding ulcer, tumor decay, the amount of proteins in the stomach increases, and the content of bound hydrochloric acid may increase.
• Free hydrochloric acid - dissociated into H ⁺ and CL ^- ions .
• The debit of hydrochloric acid is the absolute amount of hydrochloric acid released within a certain time.
• Acidic residue - all acidic components of gastric juice, in addition to hydrochloric acid, that is, acid salts and organic acids.

Reference indices of gastric secretion

Gastric secretion	Acidity, titration units		Debit HCl, mmol / h	The rate of free HCl, mmol / h	Gastric contents, ml
	Total HCl	Free HCl
On an empty stomach	Up to 40	Up to 20	Up to 2	Up to 1	Up to 50
Basal Stimulation (Phase I)	40-60	20-40	1.5-5.5	1-4	The hourly secretion voltage is 50-100
Stimulation by Leporskiy (Phase II)	40-60	20-40	1.5-6	1-4.5	The remainder is up to 75. The hourly secretion voltage is 50-110

Concentration of pepsin. The reference values of the concentration of pepsin, determined by Tugolukov's method, are: on an empty stomach 0-21 g / l, after test cabbage breakfast - 20-40 g / l. Pepsin concentration is an important indicator in the diagnosis of Achilles - a condition in which gastric acid lacks hydrochloric acid and pepsin. Achilia can be detected with Addison-Birmer anemia, which is not characteristic of other forms of vitamin B _12- deficiency anemia. Achilia, accompanying a special form of gastritis - a rigorous gastritis, requires additional studies for the exclusion of stomach cancer.

In clinical practice, unstimulated (basal) and stimulated gastric secretion are studied. As stimulants are used enteral (cabbage broth, meat broth, alcoholic breakfast) and parenteral (gastrin and its synthetic analogues, for example, pentagastrin, histamine) stimulants.

The indices of histamine-stimulated gastric secretion

Histamine is one of the strongest stimulators of gastric secretion, causing sub-maximal and maximum histamine secretion, depending on the dose. A direct relationship between the mass of functioning lining cells and the rate of hydrochloric acid was noted after maximum histamine stimulation. The decrease in the number of functioning lining cells is reflected, respectively, on the volume of acid secretion. Histamine is used to differentiate organic achlorhydria, which depends on atrophic changes in the gastric mucosa, and functional, associated with inhibition of gastric secretion.

Reference values (norm) of the main indicators of basal, submaximal and maximal gastric secretion with histamine stimulation

Main factors		Gastric secretion
Gastric secretion	Basal	Submaximal	The maximum
The volume of gastric juice, ml / h	50-100	100-140	180-120
Total acidity, titration units	40-60	80-100	100-120
Free HCL, titration units	20-40	65-85	90-110
Acidic production (HCL rate), mmol / h	1.5-5.5	8-14	18-26
Pepsin by Tugolukov:
Concentration, mg%	20-40	50-65	50-75
Flow rate, mg / h	10-40	50-90	90-160

If hydrochloric acid is detected in the gastric juice with histamine stimulation, hydrochloride, detected earlier by probing without histamine, is regarded as functional. With organic achlorhydria, free hydrochloric acid does not appear after the administration of histamine. Organic chlorhydria is accompanied by Addison-Birmer anemia, atrophic gastritis and stomach cancer. Functional achlorhydria is possible in many pathological processes, accompanied by suppression of gastric secretion, in some cases can be a reaction to self-probing.

A simple and double histamine test (subcutaneous administration of a solution of histamine hydrochloride at a dose of 0.08 ml / kg) refers to the methods of submaximal stimulation of gastric secretion. At the maximum histamine test of Kay, a solution of histamine dihydrochloride is subcutaneously administered at a rate of 0.024 mg / kg. 30 minutes before the administration of histamine 2 ml of a 2% solution of chloropyramine are injected to prevent the toxic effect of histamine.

Microscopic examination. Microscopically examine the portion of gastric juice obtained on an empty stomach: Normally find the nucleus of leukocytes and a small number of epithelial cells. A large number of intact leukocytes and epithelial cells are characteristic of achlorhydria. Single red blood cells can appear in the gastric juice as a result of a trauma of the gastric mucosa with a probe. A significant number of erythrocytes can be found in peptic ulcer of stomach, ulcerated stomach cancer.

[1], [2], [3], [4],