Gastric,
Pancreatic exocrine & 
Liver function tests


Introduction to Gastric,Pancreatic exocrine & Liver function tests

  • The stomach is a major organ of digestion and performs the following functions:
  • Stomach is a reservoir of ingested food.
  • It has a great churning ability which promotes digestion.
  • Stomach elaborates hydrochloric acid (HCl) and proteases which are responsible for the initiation of digestive process.
  • The products obtained in the stomach stimulate the release of pancreatic juice and bile

GASTRIC FUNCTION TESTS

  • There are several tests for gastric function evaluation; some of the important ones are listed below:
  • Fractional Test Meal: This is rather old and not used these days. Fractional test meal (FTM) involves the collection of stomach contents by Ryle’s tube in fasting. This is followed by a gastric stimulation, giving a test meal (rice, black coffee etc.) The stomach contents are aspirated by Ryle’s tube at different time periods (usually every 15 min for 2 hrs.) The samples are analyzed for free and total acidity in the laboratory. The results are normally represented by a graph.

PENTAGASTRIN STIMULATION TEST

  • Pentagastrin is a synthetic peptide which stimulates the gastric secretion in a manner similar to the natural gastrin. The test procedure adapted is as follows:
  • The stomach contents are aspirated by Ryle’s tube in a fasting condition. This is referred to as residual juice. The gastric juice elaborated for the next one hour is collected and pooled which represents the basal secretion. Pentagastrin is now given to stimulate gastric secretion. The gastric juice is collected at 15 minute intervals for one hour. This represents the maximum secretion. Each sample of the gastric secretion collected is measured for acidity.

OTHER TESTS:

  • Augment Histamine Test Meal
  • Insulin Test Meal
  • Tubeless Gastric Analysis

Pancreatic exocrine function tests

  • The pancreas is evaluated through several tests. These include the secretin pancreatic function test, fecal elastase test, computed tomography (CT) scan with contrast dye, an abdominal ultrasound, an endoscopic retrograde cholangiopancreatography (ERCP), an endoscopic ultrasound, and a magnetic resonance cholangiopancreatography.

Secretin pancreatic function test

  • The secretin pancreatic function test measures the ability of the pancreas to respond to the hormone secretin.
  • The small intestine produces secretin in the presence of partially digested food.
  • Normally, secretin stimulates the pancreas to secrete a fluid with a high concentration of bicarbonate.
  • This fluid neutralizes stomach acid and is necessary to allow a number of enzymes to function in the breakdown and absorption of food.
  • People with diseases involving the pancreas (e.g., chronic pancreatitis, might have abnormal pancreatic function.
  • In performing a secretin pancreatic function test, a healthcare professional places a tube down the throat, into the stomach, then into the duodenum (upper section of small intestine).
  • Secretin is inserted and the contents of the duodenal secretions are aspirated (removed with suction) for about an hour and analyzed.

Fecal elastase test

  • The fecal elastase test measures elastase, an enzyme found in fluids produced by the pancreas.
  • Elastase digests and degrades various kinds of proteins.
  • During this test, a patient’s stool sample is analyzed for the presence of elastase.

Computed tomography (CT) scan with contrast dye

  • This scan can help rule out other causes of abdominal pain and can also determine whether there is inflammation (swelling), scarring, or fluid collections in or around the pancreas.

Abdominal ultrasound

  • An abdominal ultrasound can detect gallstones and fluid from inflammation in the abdomen (ascites).
  • It also can show an enlarged common bile duct, an abscess, or a pseudocyst.

Endoscopic retrograde cholangiopancreatography (ERCP)

  • During an ERCP, a healthcare professional places a tube down the throat, into the stomach, then into the small intestine.
  • A small catheter is passed into the pancreas and bile ducts, and dye is injected to help the doctor see the structure of the common bile duct, other bile ducts, and the pancreatic duct on an X-ray.

LIVER FUNCTION TESTS

  • Liver function tests (LFTs or LFs), also referred to as a hepatic panel, are groups of blood tests that provide information about the state of a patient’s liver.
  • The liver function tests (LFTs) are the investigations to assess the capacity of the liver to carry any of the functions it performs.
  • Thus, LFTs help in:
  • Assessing the extent of functional damage to the liver,
  • Diagnosing the cause of hepatic insufficiency and
  • Assessing the progress/regress of the disease.

I. Tests to assess secretory functions of liver

  • 1. Serum bilirubin. The normal values are:
  • Total serum bilirubin: 0.3–1.0 mg/dL,
  • Conjugated bilirubin: 0.1–0.3 mg/dL and
  • Unconjugated bilirubin: 0.2–0.7 mg/dL.

Van den Bergh test is specific to identify the increase in

  • Serum bilirubin (above reference level). For procedure, the results of test are interpreted as:
  • Normal serum: Negative reaction,
  • Haemolytic jaundice: Indirect positive reaction,
  • Obstructive jaundice: Direct positive reaction and
  • Hepatic jaundice: Biphasic reaction.

2. Urine bilirubin and bile salts.

  • Normally, urine does not contain bilirubin and bile salts. In liver insufficiency, when the serum bilirubin levels increase above 2 mg/dL the bilirubin is excreted in the urine (bilirubinuria).

3. Urine urobilinogen.

  • In normal individuals with urine flow of about 1 mL/min, less than 4 mg of urobilinogen is excreted in the urine.
  • In liver insufficiency, initially thereoccurs mild increase in the daily excretion of urine urobilinogen.
  • However, in later stages urobilinogen is absent in the urine. This occurs because of the fact that the swollen liver cells block bile canaliculi and prevent excretion of the conjugated bilirubin in the bile.

4. Faecal stercobilinogen

  • Normal levels 20–25 mg/dL.
  • Increased initially in liver insufficiency producing dark brown stools.
  • Decreased in later stages of liver insufficiency producing pale coloured stool.

5. Faecal fat levels

  • Normally 5–6% of total fat intake per day in excreted in the faeces.
  • In liver insufficiency, fat excretion in faeces increases up to 40–50% of total intake (steatorrhoea). 
  • This is because of the fact that due to deficiency of bile salts emulsification and absorption of fat is inadequate in the intestine.

II. Tests to assess metabolic functions of liver

  • 1. Galactose tolerance test.
  • 2. Blood glucose level.
  • 3. Blood and urine amino acids levels.

III. Tests to assess synthesis functions of liver

  • 1. Estimation of plasma proteins
  • Albumin. Liver cell damage causes hypoalbuminaemia (normal 6.4–8.3 g/dL).
  • Globulins. Hyperglobulinaemia is usually associated with hypoalbuminaemia.
  • A:G ratio. In liver disorder, there occurs reversal of A:G ratio (normal 1.7:1).

2. Serum levels of liver enzymes

  • Transaminases. The activity of transaminase like SGPT and SGOT increases in the hepatic insufficiency. 
  • Serum SGPT levels are increased by 10–1000 times in an acute phase (normal value < 40 IU%).
  • Alkaline phosphatase. Alkaline phosphatase is not a liver specific enzyme, but secreted into the bile.
  • In obstructive jaundice, its level is markedly increased (< 30 KA units).

V. Tests to assess hepatic cellular integrity

  • 1. Ultrasonography is done to detect diffuse disease of parenchyma of the liver (cirrhosis liver, fatty liver), abscess, cysts, tumours, gall stones and dilatation of biliary system proximal to site of obstruction.

2. Computed tomography (CT)

  • CT scan has the same diagnostic significance as the ultrasonography except that it can also detect even smaller lesions.

3. Radionucleotide imaging

  • Technetium (99mTc) is a sulphur colloid, which is easily taken up by the liver cells, monocyte macrophage system (Kupffer’s cells) and emits γ-rays.
  • Gamma camera picks up these rays and is used to find out the size of the liver and the lesions of the liver (such as filling defect, diffuse liver disease and portal hypertension).

4. Liver biopsy

  • This is performed by a special needle passed through intercostal space under local anaesthesia to obtain tissue for histopathological examination.

5. Fine needle aspiration.

  • Very fine needle is usually guided by an ultrasound and material is aspirated for cytological, histopathological and bacteriological examination.

Other Physiology Notes

Taste Perception

Physiology of hearing

Functional anatomy of respiratory tract

. Visual and Auditory evoked potentials

Structure and function of Gastrointestinal tract

Microcirculation And Lymphatic System

Microanatomy of Salivary Gland

Transport of respiratory gases (Haemoglobin)

Physiology of Shock

Digestion and absorption in GIT

Enteric Nervous System (Gut Brain Axis)

URINE FORMATION

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