Beruflich Dokumente
Kultur Dokumente
Glucagon
Glycogenolysis
Gluconeogenesis
Glucose
Glucose
Beta
Cells
Delta
Cells
Preinsulin
Insulin
Gastrin
Glucose uptake
Glucose
Digestion
Gastric acid
Enzymes
and
proteolytic
enzymes
precursors
Trypsin
-Amylase
Cholesterol
esterase
Phospholipase A
Lipase
Digestive
Stimulation
Protein
Starch
Cholesterol
esters
Phospholipids
Triglycerides
Gastric disorders
Macro amylassemia
Acute pancreatitis
Chronic pancreatitis
Cystic fibrosis
Intestinal disorders
Chronic diarrhea
HIV-related diarrhea
Nosocomial diarrhea
Gastric Disorders
Peptic Acid Disorders
Associated conditions:
Gastric ulcers
Non ulcer dyspepsia
Gastric carcinoma
Pancreatic Disorders
Macroamylasemia
Pancreatic
hyperamylasemia
Salivary
hyperamylasemia
Macroamylasemia
type 1
Macroamylasemia
type 2
Macroamylasemia
SERUM
AMACROAMYLASE
Alpha
Cells
Hypersecretory states
(in the absence of H. pylori and the use
NSAIDS)
Zollinger-Ellison syndrome
Cam:Ccr
Principle:
End results:
URINARY
AMYLASE
process
H. pylori test
Ability of organism to produce urease
SERUM
AMYLASE
SERUM
LIPASE
/N
/N
/N
Very
/N
N - Normal
M - Moderate
T - Trace
Cam:Ccr = amylase clearance:creatinine clearance ratio =
(urinary amylase/serum amylase) X (serum creatinine/urinary
creatinine)
Acute Pancreatitis
Serum Amylase
Universal laboratory test
Disease pattern
Serum amylase level appear first
Serum Lipase
Disease pattern
Rises 4-8 hours after the onset of
Lipase/amylase
Hematocrit
Chronic Pancreatitis
Cystic Fibrosis
Pancreas
Salivary glands
Peritracheal glands
Peribronchial glands
Peribronciolar glands
Sweat glands
Bileducts
Sweat testing
Demonstration of increased
Chronic diarrhea
Nosocomial diarrhea
Testing for Malabsorption and Cystic Fibrosis
Testing for Malabsorption
Tripeptide
Decreased para-aminobenzoic acid
Hydrolysis Test
results suggest pancreatic insufficiency
Fecal Fat
Values 5-10g% suggest malabsorption
Values > 10 g% suggest maldigestion
14C-Triolein
Decreased 14CO2 in expired air suggsts
Breath
fat malabsorption
D-Xylose
Values below reference ranges suggest
Absorption
little to no absorption capacity of the
proximal small bowel mucosa
Vitamin B12
Patients who excrete < 7% are
Malabsorption
suspected to have pernicious anemia
-Carotine
Decreased levels are seen in patients
with malabsorption and/or malnutrition
Testing for Cystic Fibrosis
Sweat Chloride
Increased levels are diagnostic of cystic
fibrosis
FECALYSIS
Collection of Feces
Examination of feces
Macroscopic examination
Microscopic examination
Collection of Feces
Adult Collection
24-hour stool collection
Method:
A.
Ingestion of dye (0.3 g) at the beginning and
charcoal at the end of collecting period
B.
Use of inert, non absorbable stool markers
End: charcoal (1 g)
Pediatric collection
Method:
Use of a thick-walled glass tube, which is
Obstructive jaundice
Diarrhea
Malabsorption
Rectosigmoidal obstruction
Dysentery
Ulcerative colitis
GIT bleeding
Macroscopic characteristics
Quantity
Form
Abnormal Forms
Diarrheal (watery)
Diarrhea
Inflammatory/Exudative
Crohns disease
Ulcerative colitis
Infectious
Salmonella
Shigella
Campylobacter
Eteroinvasive E. coli
Yersinia enterocolitica
HIV enteropathy
Secretory
Enteric infection
Salmonella
Shigella
Enterotoxigenic E. coli
V. cholera
Staphylococci
Clostridia
Protozoan
Rotavirus
Hormone mediated
rainwater@mymelody.com || 1st semester, AY 2011-2012
Osmotic
Non-absorbed substances retain water in
the GI tract lumen
Maldigestion- Incomplete breakdown of
Lactase, isomaltase-sucrase,and
trehalase enzymes
Others: Biliary obstruction, resection of
imbalance
Self- induced
Surreptitious laxative abuse associated with
psychiatric disorders
Color
Consistency
Formed
Watery stool
Mucoidal
Constipation:
Carcinoma
Bloody stool:
Red color stool
Biliverdin
Ingestion of spinach or green vegetables or
Mucus
Recognizable mucus in stool is abnormal
spastic constipation
mucous colitis
ulcerative colitis
bacillary dysentery
ulcerating diverticulitis
intestinal TB
Microscopic Examination
Pus
Fat
Method
Sudan III
Sudan IV
Oil Red O stains
Procedure
Neutral fat + soaps
Fatty acids
(stains strongly with Sudan III)
Indication
High specificity
High PPV
High NPV
Meat Fiber
Method
3 mins
Stool + 10% alcohol soln of eosin
Rectangular fibers
with striations
Leukocytes
Nuclear staining
(Leucocytes)
Fecal Blood
Causes
Carcinoid tumors
Neuroendocrine neoplasms of entrerochromaffin
Principle:
cpds.
HemoQuant
Carcinoid syndrome
Symptoms:
Skin flushing
Abdominal cramps
Nausea
Vomiting
Diarrhea
Hypotension
Bronchoconstriction
Cyanosis
Serotonin
tryptophan hydroxylase
Tryptophan
5-HTP
Dopa decarboxylase
Monoamine oxidase
5-HT
Aldehyde
dehydrogenase
5-HIAA
5-HTP (5-hydroxytryptophan)
5-HT (5-hydroxytryptamine [serotonin])
5-HIAA (5-hydroxyindoleacetic acid) metabolite from 24-hour
urine
Colorimetry
Fluorometry
Gas chromatography
Radioimmunoassay
bananas
pineapple
hickory nuts
plantains kiwi fruit
pecans
tomatoes walnuts
avocados
eggplant
B. Drugs
Acetaminophen
Guanifenesin
False positive decrease:
A. Drugs
Reserpine
Salicylates
L-dopa
Method: HPLC
Ref. interval:
Definition:
Result from impaired digestion or
Chronic pancreatitis
Creatorrhea
Undigested meat fibers in the feces
Steatorrhea
An increase in fat - largely triglyceride
(>5 grams of lipids (FA) in feces/24hrs)
Hepatic Maldigestion
Fat emulsificaton
Cause
Results
Hepatic steatorrhea
Pancreatic steatorrhea
Enteric Malabsorption
Diverticulosis
Lymphoma
Amyloidosis
Inflammation following radiation
Glossitis
Anemia
Edema
Ascites
Osteomalacia
Single foodstuff or vitamin or small group of
substances deficiency:
taken orally)
Lactulose-mannitol test
Sucrase-isomaltase deficiency
Lactase deficiency
Primary alactasia
Primary trehalase deficiency
Tropical sprue
methotrexate)
Problem: Diarrhea
Laboratory tests
Glucose oxidase
Galactose oxidase
Chromatography
OGTT (flat curve)
Protein-Losing Enteropathy
Causes:
Mntriers disease
Gastric cancer
Chronic gastritis
Benign or malignant tumors
Crohns disease
Celiac disease
Tropical sprue
Ulcerative colitis
Intestinal lymphatic obstruction
Graft-vs.-host disease of the intestine
Whipples disease (bacterial overgrowth)
Infectious enteritis