Gastrointestinal Tests Overview
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Questions and Answers

What is considered a normal level of the non-invasive marker in stool for pancreatic function?

  • 100 - 200 µg/g stool
  • Under 100 µg/g stool
  • Below 75 mM concentration
  • 200 µg/g stool or higher (correct)

The secretin/CCK test requires the patient to consume food before the procedure.

False (B)

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.

<p>200 µg/g</p> Signup and view all the answers

Match the following tests or methods with their characteristics:

<p>ELISA = Non-invasive marker for pancreatic function Secretin/CCK test = Invasive test requiring collection of pancreatic secretions Endoscopic ultrasonography = Imaging method with fine needle aspiration capability Trypsin and amylase tests = Comparison of enzyme activities to local standards</p> Signup and view all the answers

What is a common reason for measuring fasting plasma gastrin levels?

<p>Gastrinoma (B)</p> Signup and view all the answers

Serum amylase levels are significantly elevated in cases of chronic pancreatitis.

<p>False (B)</p> Signup and view all the answers

What bacterium is commonly associated with peptic ulcer disease?

<p>Helicobacter pylori</p> Signup and view all the answers

The Urease (CLO) test has a sensitivity of ________ for detecting Helicobacter pylori.

<p>90-95%</p> Signup and view all the answers

Match the following terms with their correct descriptions:

<p>Fasting plasma gastrin = Measured for gastrinoma assessment Serum amylase = Indicates acute pancreatitis when elevated Pancreatic elastase 1 = Non-invasive test for pancreatic function ELISA = Detects stool antigens for H. pylori</p> Signup and view all the answers

Which procedure has a sensitivity of 98% for diagnosing conditions related to peptic ulcer disease?

<p>Histology following biopsy (B)</p> Signup and view all the answers

A false positive can occur with serology testing for H. pylori.

<p>True (A)</p> Signup and view all the answers

What are two common causes of acute pancreatitis?

<p>Excessive alcohol and gallstones</p> Signup and view all the answers

Which of the following symptoms is commonly associated with Coeliac disease?

<p>Diarrhoea (D)</p> Signup and view all the answers

IgA deficiency occurs in 1 in 200 patients with Coeliac disease.

<p>False (B)</p> Signup and view all the answers

What type of antibodies should be measured to confirm Coeliac disease if a patient is IgA deficient?

<p>IgG antibodies to tissue transglutaminase</p> Signup and view all the answers

Patients with lactase deficiency often experience abdominal cramps and ______.

<p>diarrhoea</p> Signup and view all the answers

Match the following malabsorption tests with their related conditions:

<p>14C-triolein test = Fat malabsorption Blood glucose response after lactose = Lactase deficiency Antibody tests = Coeliac disease Serum ferritin measurements = Iron deficiency</p> Signup and view all the answers

In the 14C-triolein test, what is administered to the patient to evaluate fat malabsorption?

<p>14C-triolein in a fat meal (D)</p> Signup and view all the answers

Cholestatic liver disease may cause a positive fat malabsorption test due to the absence of bile salts.

<p>True (A)</p> Signup and view all the answers

What should be measured to assess mean cell characteristics in malabsorption syndromes?

<p>Mean red cell volume and mean corpuscular hemoglobin</p> Signup and view all the answers

What is the primary cause of bile salt malabsorption?

<p>Ileum damage (B)</p> Signup and view all the answers

The Faecal osmotic gap is calculated using the formula: 290 – 2 x ([faecal sodium] + [faecal potassium]).

<p>True (A)</p> Signup and view all the answers

Name one test used to detect bacterial overgrowth.

<p>Breath H2 test</p> Signup and view all the answers

Bile salts are normally absorbed in the __________.

<p>ileum</p> Signup and view all the answers

Match the following malabsorptive disorders with their corresponding symptoms:

<p>Coeliac disease = Gluten intolerance Lactase deficiency = Lactose intolerance Fat malabsorption = Steatorrhea Bile salt malabsorption = Diarrhea</p> Signup and view all the answers

Which of the following is a common symptom of fat malabsorption?

<p>Steatorrhea (D)</p> Signup and view all the answers

A serum 7 a-hydroxycholestenone test is invasive and requires a biopsy.

<p>False (B)</p> Signup and view all the answers

The condition characterized by inadequate absorption of nutrients is known as __________.

<p>malabsorption</p> Signup and view all the answers

Flashcards

Fecal elastase test

A test that measures the level of elastase in stool. Low levels indicate exocrine pancreatic insufficiency.

Secretin/CCK test

A test that measures the response of the pancreas to secretin and cholecystokinin (CCK) hormones.

Endoscopic ultrasonography

This test involves examining the pancreas using ultrasound while a thin needle is inserted for biopsy.

Trypsin

An enzyme produced by the pancreas that helps break down proteins.

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Amylase

An enzyme produced by the pancreas that breaks down carbohydrates.

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Peptic ulcer disease

Caused by the bacterium Helicobacter pylori, peptic ulcer disease can be diagnosed through biopsy followed by histology or a urease test, or non-invasively by serology, ELISA for stool antigens or a breath test.

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Fasting plasma gastrin

A blood test measuring gastrin levels. This test is primarily used to detect gastrinomas (tumors that produce gastrin), leading to increased acid secretion and peptic ulcers.

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Acute pancreatitis

A condition characterized by severe abdominal pain and inflammation of the pancreas, often caused by alcohol abuse, gallstones, or unknown factors.

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Chronic pancreatitis

A chronic condition involving the gradual loss of pancreatic function, often due to alcohol abuse, autoimmune disorders, or cystic fibrosis.

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Pancreatic elastase 1 in stool test

A non-invasive test for chronic pancreatitis that measures the level of pancreatic elastase 1 in stool, which is not broken down in this condition.

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Urea breath test

A test used to detect Helicobacter pylori, where the patient ingests a special form of urea containing a radioactive isotope. The bacteria digest the urea, liberating a gas that can be detected in the breath.

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Type 1 autoimmune pancreatitis

A type of chronic pancreatitis characterized by elevated levels of IgG4, a type of antibody.

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Biopsy for Helicobacter pylori

An invasive procedure used to diagnose peptic ulcer disease. A biopsy sample is taken and examined under a microscope for the presence of Helicobacter pylori.

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Malabsorption

A condition where undigested food passes through the digestive tract, leading to issues with absorbing nutrients. Common examples include celiac disease, lactase deficiency, and fat malabsorption.

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Celiac disease

An autoimmune disorder triggered by gluten, a storage protein found in wheat, rye, and barley. It damages the small intestine's lining, leading to nutrient malabsorption.

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Lactase deficiency

A condition where the body doesn't produce enough lactase, the enzyme needed to break down lactose, the sugar in milk. Symptoms include cramps and diarrhea after consuming dairy products.

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Blood glucose response to lactose ingestion

A test to diagnose lactase deficiency. It measures the blood glucose level after consuming a lactose solution. A low rise in blood sugar suggests lactase deficiency.

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Breath hydrogen test

A test to diagnose lactase deficiency. It measures the amount of hydrogen gas in breath after consuming lactose. Higher hydrogen levels suggest lactase deficiency.

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Fat malabsorption

A condition where the body struggles to absorb fat properly. Causes include pancreatic problems, liver disease, and digestive disorders.

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14C-triolein test

A test to diagnose fat malabsorption. It measures the amount of radioactive carbon dioxide exhaled after consuming a meal containing a special type of fat.

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Cholestatic liver disease

A condition where the liver doesn't produce enough bile salts, crucial for fat digestion, leading to fat malabsorption.

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Bile salt malabsorption

A condition where bile salts aren't effectively absorbed in the ileum, leading to their accumulation in the colon and causing diarrhea.

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Whole body retention of selenium labelled homotaurocholic acid

A test measuring the retention of a radioactive bile salt in the body. This test is helpful in detecting malabsorption of bile salts.

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Serum 7 a-hydroxycholestenone test

A non-invasive test where a blood sample is analyzed for an intermediate product of bile acid synthesis. Increased levels suggest increased bile acid synthesis due to malabsorption.

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Breath H2 test for bacterial overgrowth

A test used to detect bacterial overgrowth in the small intestine. It involves drinking a lactose-containing beverage and measuring hydrogen levels in the breath.

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Malabsorptive disorders

A group of conditions characterized by impaired nutrient absorption from the small intestine, often leading to diarrhea, weight loss, and nutritional deficiencies.

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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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Gastrointestinal Tests PDF
Gastrointestinal Tests PDF

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.

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