Indices of gastric contents in diseases
The amount of gastric contents may increase with peptic ulcer and hyperacid gastritis;reflex increase can be observed during attacks of acute appendicitis, acute cholecystitis. A decrease in the amount of gastric juice is observed with accelerated gastric emptying and with a decrease in secretion.
Mucus in significant quantities is found in gastritis and peptic ulcer, and with leukocytes or their nuclei, cells of the cylindrical epithelium, deposits of hydrochloric acid hematin - with organic lesions of the mucosa, gastritis, peptic ulcer, polyposis, cancer.
An increase in the concentration of pepsin in gastric juice is characteristic of peptic ulcer of the stomach and duodenum, hyperthyroidism, diabetes mellitus. Decrease or total absence of pepsin in gastric juice is detected with atrophic gastritis, pernicious anemia, hyperthyroidism, Addison's disease, intoxications.
The concentration of free hydrochloric acid decreases with hypoacid gastritis. Complete absence of free hydrochloric acid( achlorhydria) is revealed in chronic anatide gastritis, neoplasms of the stomach, intoxications, infectious diseases. In the absence of free hydrochloric acid, it is desirable to determine the presence and amount of bound hydrochloric acid to determine the degree of achlorhydria. In the absence of free, but the presence of bound hydrochloric acid, ascertain the relative achlorhydria;in the absence of both, absolute achlorhydria. The absence of hydrochloric acid and pepsin in the stomach contents is called achilia. Achilia is possible with chronic atrophic gastritis, malignant neoplasms, Addiso-on-Birmer's anemia, infectious diseases, intoxications, diabetes, hypovitaminosis( rarely).
An increase in the concentration of free hydrochloric acid is revealed in chronic hyperacid gastritis, peptic ulcer of the stomach and duodenum.
The amount of bound hydrochloric acid increases with the increase in the stomach amount of substrates to bind it( food, pus, mucus, blood, tissue decay), that is, with stagnant phenomena, inflammation, tumors, etc.
Changes in microscopic examination. When microscopic examination of gastric contents in it distinguish elements of stagnation, elements of inflammation and elements of atypia.
Stagnant gastric juice in which lactic acid is formed( the result of the vital activity of lactic acid ferment rods or the product of the metabolism of a cancerous tumor) is accompanied by the appearance of plant fiber( undigested and digestible), fat, sarcin, yeast, epithelium, leukocytes, erythrocytes. Lactic acid fermentation sticks usually appear in the absence of free hydrochloric acid. The increase in the number of goblet cells, especially in the zone of gastrointestinal anastomosis, is a sign of gastritis. The pronounced atypia of epithelial cells( proliferation with pronounced atypia) is characteristic for the initial stage of malignant growth. In the diagnosis of adenocarcinoma, polymorphism of nuclei, nuclear atypia is important, which is also revealed in solid cancer, colloid cancer, malodifferentiated or undifferentiated stomach cancer.