Podcast
Questions and Answers
What is considered a normal level of the non-invasive marker in stool for pancreatic function?
What is considered a normal level of the non-invasive marker in stool for pancreatic function?
The secretin/CCK test requires the patient to consume food before the procedure.
The secretin/CCK test requires the patient to consume food before the procedure.
False
What is the minimum bicarbonate concentration that healthy subjects typically exhibit during the secretin/CCK test?
What is the minimum bicarbonate concentration that healthy subjects typically exhibit during the secretin/CCK test?
75 mM
A level of the non-invasive marker below _____ in feces indicates exocrine pancreatic insufficiency.
A level of the non-invasive marker below _____ in feces indicates exocrine pancreatic insufficiency.
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Match the following tests or methods with their characteristics:
Match the following tests or methods with their characteristics:
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What is a common reason for measuring fasting plasma gastrin levels?
What is a common reason for measuring fasting plasma gastrin levels?
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Serum amylase levels are significantly elevated in cases of chronic pancreatitis.
Serum amylase levels are significantly elevated in cases of chronic pancreatitis.
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What bacterium is commonly associated with peptic ulcer disease?
What bacterium is commonly associated with peptic ulcer disease?
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The Urease (CLO) test has a sensitivity of ________ for detecting Helicobacter pylori.
The Urease (CLO) test has a sensitivity of ________ for detecting Helicobacter pylori.
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Match the following terms with their correct descriptions:
Match the following terms with their correct descriptions:
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Which procedure has a sensitivity of 98% for diagnosing conditions related to peptic ulcer disease?
Which procedure has a sensitivity of 98% for diagnosing conditions related to peptic ulcer disease?
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A false positive can occur with serology testing for H. pylori.
A false positive can occur with serology testing for H. pylori.
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What are two common causes of acute pancreatitis?
What are two common causes of acute pancreatitis?
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Which of the following symptoms is commonly associated with Coeliac disease?
Which of the following symptoms is commonly associated with Coeliac disease?
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IgA deficiency occurs in 1 in 200 patients with Coeliac disease.
IgA deficiency occurs in 1 in 200 patients with Coeliac disease.
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What type of antibodies should be measured to confirm Coeliac disease if a patient is IgA deficient?
What type of antibodies should be measured to confirm Coeliac disease if a patient is IgA deficient?
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Patients with lactase deficiency often experience abdominal cramps and ______.
Patients with lactase deficiency often experience abdominal cramps and ______.
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Match the following malabsorption tests with their related conditions:
Match the following malabsorption tests with their related conditions:
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In the 14C-triolein test, what is administered to the patient to evaluate fat malabsorption?
In the 14C-triolein test, what is administered to the patient to evaluate fat malabsorption?
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Cholestatic liver disease may cause a positive fat malabsorption test due to the absence of bile salts.
Cholestatic liver disease may cause a positive fat malabsorption test due to the absence of bile salts.
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What should be measured to assess mean cell characteristics in malabsorption syndromes?
What should be measured to assess mean cell characteristics in malabsorption syndromes?
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What is the primary cause of bile salt malabsorption?
What is the primary cause of bile salt malabsorption?
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The Faecal osmotic gap is calculated using the formula: 290 – 2 x ([faecal sodium] + [faecal potassium]).
The Faecal osmotic gap is calculated using the formula: 290 – 2 x ([faecal sodium] + [faecal potassium]).
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Name one test used to detect bacterial overgrowth.
Name one test used to detect bacterial overgrowth.
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Bile salts are normally absorbed in the __________.
Bile salts are normally absorbed in the __________.
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Match the following malabsorptive disorders with their corresponding symptoms:
Match the following malabsorptive disorders with their corresponding symptoms:
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Which of the following is a common symptom of fat malabsorption?
Which of the following is a common symptom of fat malabsorption?
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A serum 7 a-hydroxycholestenone test is invasive and requires a biopsy.
A serum 7 a-hydroxycholestenone test is invasive and requires a biopsy.
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The condition characterized by inadequate absorption of nutrients is known as __________.
The condition characterized by inadequate absorption of nutrients is known as __________.
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Study Notes
Gastrointestinal Tests
- Gastrointestinal (GI) tests investigate various functions including gastric, exocrine pancreatic, and conditions related to nutrient malabsorption and inflammatory bowel diseases.
- Biochemical function tests often need to be used with other procedures (e.g., biopsies, histology, endoscopy, CAT scans) to provide a full picture, especially in areas of the GI tract with limited access.
- Endoscopes use a flexible tube with a camera to view the inside of the GI tract. They have features to adjust lenses, control bending, and allow for suction and biopsy collection, as well as illumination.
Stomach
- Peptic ulcer disease is caused by Helicobacter pylori.
- Invasive stomach procedures include biopsy followed by: histology, urease test on biopsy (90-95% sensitivity), color change due to alkaline ammonia.
- Non-invasive procedures include: Serology (IgG against H. pylori) test, ELISA for stool antigens to help identify H. pylori . Also, Breath test using [14C] or [13C] urea to check for eradication and see if antibodies persist.
Urea Breath Test for H. pylori
- The urea breath test detects H. pylori by measuring the presence of 13/14CO2 produced in the stomach after ingestion of labeled urea.
Fasting Plasma Gastrin
- Gastrin is released by G cells in the gastric antrum in response to food ingestion and stimulates acid secretion.
- It is measured with immunoassays.
- The most frequent reason to test fasting plasma gastrin is to detect gastrinoma (a gastrin-secreting tumor).
- Patients with gastrinoma experience elevated basal fasting acid secretion, which can lead to peptic ulcer disease.
Acute Pancreatitis
- Acute pancreatitis is characterized by severe abdominal pain and inflammation of the pancreas.
- Common causes include excessive alcohol consumption and gallstones, but it can also have an unidentified cause (idiopathic).
- A serum amylase level more than 10 times the upper limit of normal strongly suggests acute pancreatitis.
- Amylase is a pancreatic enzyme which leaks into the bloodstream. Lower elevations may be due to other issues like a perforated duodenal ulcer, intestinal obstruction, or renal failure (since some amylase is excreted in urine).
Chronic Pancreatitis
- Chronic pancreatitis involves loss of pancreatic function, often related to chronic alcohol intake or autoimmune forms and cystic fibrosis.
- Serum amylase levels are often normal or low in chronic pancreatitis.
- Serum IgG4 levels above 135 mg/dl suggest type 1 autoimmune pancreatitis.
- Two types of biochemical tests are used to assess chronic pancreatitis:
- Non-invasive tests
- Invasive tests (not commonly used any more)
Chronic Pancreatitis - Non-invasive
- Pancreatic elastase 1 in stool (not degraded) is a key non-invasive marker.
- Low levels of pancreatic elastase 1 in stool can indicate exocrine pancreatic insufficiency.
- ELISA testing provides specificity and sensitivity greater than 90%.
- Values above 200 µg/g stool are considered normal.
- This test is unaffected by enzyme replacement therapy (e.g., pancreatin).
Chronic Pancreatitis - Invasive
- Secretin/CCK (cholecystokinin) stimulation tests are invasive.
- A radio-opaque tube is positioned to collect gastric and pancreatic secretions.
- Basal and stimulated collections (e.g., 2 x 10 minutes with secretin) are measured to evaluate secretion rates, electrolyte levels, and functional pancreatic output.
- This procedure is considered a "gold standard" for assessing pancreatic function and serves as a benchmark for evaluating newer tests.
Chronic Pancreatitis - Invasive (Non-Biochemical)
- Endoscopic ultrasonography is used for imaging and fine-needle aspiration for cytology.
- This method provides detailed images of the pancreas and allows for tissue sampling for pathologic assessment (in addition to non-biochemical tests).
Summary
- The GI tract has various organs with different functions.
- Many biochemical and non-biochemical markers are utilized to assess GI disorders.
- Acute and chronic pancreatitis have distinguishable biomarkers used to differentiate the two conditions.
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Description
This quiz covers essential gastrointestinal tests, including their functions and methodologies. It highlights the importance of both invasive and non-invasive procedures in diagnosing conditions related to the GI tract, such as peptic ulcer disease caused by Helicobacter pylori. Test your knowledge of the roles that various tests play in understanding gastrointestinal health.
