Minerals Evidence in Saliva, Gastric Juice Collection & More PDF

MINERALS EVIDENCE IN SALIVA KSCN (Potassium sulfocyanate) MATERIALS: test tube, FeCl3 (ferric chloride) 3%, HCl (hydrochloric acid) 10%, saliva PROCEDURE: take 3-4 ml of saliva in a test tube, add 1-2 drops of HC land 1-2 drops of FeCl3. A brick-red precipitate of ferric sulfocyanate appears. Th...

MINERALS EVIDENCE IN SALIVA KSCN (Potassium sulfocyanate) MATERIALS: test tube, FeCl3 (ferric chloride) 3%, HCl (hydrochloric acid) 10%, saliva PROCEDURE: take 3-4 ml of saliva in a test tube, add 1-2 drops of HC land 1-2 drops of FeCl3. A brick-red precipitate of ferric sulfocyanate appears. The SCN- ion is found in saliva in concentration of 0,01-0,03 mg%. It is an excretory product, resulted from proteic metabolism or fruit ingestion. This is an detoxification mechanism. The SCN- concentration increases in smokers saliva. KSCN in the saliva of non-smokers (left) compared to smokers (right). There is an increased concentration of KSCN in smokers that is identified by a stronger, darker color. GASTRIC JUICE COLLECTING In humans gastric aspiration using an Einthorn tube or endoscope is the most common method. GASTRIC JUICE SECRETION can be stimulated clinically using specifical stimulators: histamin, histalog ( a synthetic analogue), pentagastrin, insulin. The HCl secretion rate is usefull in gastric ulcer investigation. a. The maximal stimulatory test using Histamin was introduced by Kay in 1953; PROCEDURE: 24 h before the test, remove the antiacid and anticholinergic theraphy. In the morning of the test, pass the Einthorn tube through the esofagus into the stomach. Aspire the gastric stasis using 20 ml siringe and collect the basal secretion for 1 hour. Then inject an antihistaminic drug (which doesn’t influence the gastric secretion but prevents the possible adverse events of histamin), followed by the histamin phosphate administration, 0,04 mg /kg body weight. Collect the gastric secretion samples from 15 to 15 minutes for another hour. The HCl will be measured in each sample and results are noted in a table. INTERPRETATION Histamin stimulates the HCl acid secretion in normo and hyperreactive persons, but doesn’t produce a response in atrophic gastritis. Following its description by Kowalewski in 1949 and then by Kay in 1953, the augmented histamine test was introduced into routine clinical practice. Histamine was administered in a dose of 40 µg/kg in this test. Previously histamine was applied in lower doses but this did not produce maximal acid output. After intravenous or subcutaneous administration of dose 40 µg/kg/h, histamine can induce acid secretion reaching maximal acid output. This dose was established as a standard in further investigations. After histamine administration the peak secretory effect usually occurred during the first postinjection hour. Even though the protective treatment preceeds the histamin administration, some adverse events can appear: headache, tachicardia, hypoptension, abdominal pains, gastric hemorrhage. b. Histalog test has the same significance and the advantages that it doesn’n neccesits previous treatment with antihistaminics and the adverse events are rare. c. Insulin test (Hollander) is based on the stimulative role of hypoglycemia - induced with insulin- on gastric secretion, due to vagus dorsal nucleus stimulation. This test provides information about the efficacy of vagotomy in gastric ulcer operated patients. For all tests, the gastric acid flow has to be determined. d. Pentagastrin was approved in 1967as a stimulant of gastric acid secretion instead of histamine. Pentagastrin appeared to be safer for patients and the secretory response to pentagastrin was found to be identical to that of gastrin and histamine e. Ethanol and caffeine were previously employed as stimulators for gastric acid secretion. The response of a stomach to ethanol or caffeine was much smaller, as compared to pentagastrin, histamine or a meal. Therefore, ethanol and caffeine are no longer used for routine gastric secretory testing in humans. Normal and pathological HCl secretion BASAL MAXIMAL STIMULATION Volume Basal acid flow Volume Maximal acid flow (ml) mEq/hour (ml) mEq/hour Normal 50 2,2 + 1,5 200 20 + 4 Gastric ulcer 40-50 1,2 + 0,5 200-250 14+ 6 Duodenal ulcer 80-100 3,5 + 2 300-350 30 + 10 HCL ACID DOSAGE IN GASTRIC JUICE The gastric juice acidity is expressed into mEq/l of HCl or into mEq/h, representing the basal acid flow. In the gastric juice, HCl exists in two froms: free and combined (with different proteins). PRINCIPLE: Using titrimetric method, the gastric juice acidity is neutralized by a NaOH n/10 solution, in the presence of fenolftalein and Topffer reactive (0, 25 para dymethylaminobenzen in alchohol) as indicators. MATERIALS: NaOH n/10, Topffer reactive, fenolftalein 1% in alchohol, pipets, Erlenmeyer glasses, test tubes, burette. The Topffer reactive has yellow-orange colour. The free HCl turns the colour into red. PROCEDURE: Take 10 ml of gastric juice in an Erlenmeyer glass and add 3-4 drops of Topffer reactive. In the presence of free HCl the solution turns into red. Add from burette drop by drop NaOH n/10, till the colour turns into yellow-orange. Note the number of used ml of NaOH solution to neutralize the free HCl with N1. Add 2- drops of fenolftalein and continue the titration until the colour turns into pink, indicating the boung HCl neutralization and an excess of NaOH. Note the number of ml NaOH used to neutralize the combined HCl with N2. The total acidity = N1 +N2 The results will be expressed into clinical units (the number of ml from NaOH n/10 solution used to neutralize the HCl from 100 ml gastrci juice) or into grams HCl for 100 or 1000ml gastric juice. Calculation for Clinical Units (Javorski): Free HCl = N1 x 10 C.U. Combined HCl = N2 x10 C.U. Total HCl = (N1+N2) x 10 C. U. Calculation for grams of HCl /1000 ml: use the equivalent gram of HCl solution n/10 = 0,00365. Free HCl = N1 x 0,00365 x 100 g HCl %0 Combined HCl = N2 x 0,00365 x 100 g HCl %0 Total HCl = (N1+N2) x 0,00365 x 100 g HCl %0 The normal values of gastric juice acidity are: C.U. g %0 Free HCl 15 1 Combined HCl 25 1-2,5 Total HCl 40 2-3,5 Calculation in mEq/l: 1Eq HCl = 36,5 g 1mEq HCl = 0,0365 g Free Acidity in mEq/l = N1 x 0,00365 x 100/0,0365 = N1 x 10 Combined Acidity in mEq/l = N2 x 0,00365 x 100/0,0365 = N2 x 10 Total acidity in mEq/l = (N1+ N2) x 0,00365 x 100/0,0365 The normal value for the total acidity = 100-120 mEq/l. Gastric acidity in different diseases THE EVIDENCE OF FREE HCl ACID IN GASTRIC JUICE PRINCIPLE: Heat till evaporation gastric juice in the presence of fluoroglucin solution MATERIALS: porcelain capsula, filtered gastrci juice, gas burner, Gunsburg reactive (alchoholic solution of vanilin and fluroglucin). PROCEDURE: Add on a porcelain capsula few drops of gastric juice and then 3-4 drops of Gunsburg reactive. Heat in small flame. In the presence of free HCl in gastric juice, a red colour will appear. The free HCl determination should be done using fresh gastric juice, because free HCl volatilizes. HAY REACTION PRINCIPLE: The emulsification is base don the property of the bile salts to reduce the superficial tension forces between water and fats. MATERIALS: test tubes, oil, bile salts solution (urine or diluted bile), sulphur flower (powder) PROCEDURE: Take 3-4 ml of solution containing the bile salts into a test tube and pure water in another and intersperse some sulphur flower in both. After few minutes, in the presence of bile salts the sulphur flower falls at the bottom of the tube (right). In the absence of the bile salts, the sulphur flower remains at liquid surface (left).  THE LACTIC ACID EVIDENCE IN GASTRIC JUICE THE BERG REACTION PRINCIPLE: Lactic acid is not a normal compound of gastric juice. It can appear only in pathological statuses, characterize by the decreasing of HCl secretion. In hypo/anacidity, the intestinal bacterial flora advances into stomach producing a contamination.. In this conditions, the glucose from food will be transformed by bacteria into lactic acid. The hypo/anacidity is a high risk status because of its association with gastric cancer and pyloric stenosis. MATERIALS: Berg reactive (FeCl3 solution 30% in acidic solution), test tubes, gastric juice PROCEDURE: in the presence of ferric salts, lactic acid gives iron lactate which is yellow. Take 8-10 ml of Berg reactive in a test tube and add 2 ml of gastric juice. In the presence of lactic acid, the solution turns into yellow. THE UFFALMAN REACTION MATERIALS: Uffalman reactive (FeCl3 solution 30% in phenol 4%), test tubes, gastric juice. Uffalman reactive is violet. PROCEDURE: Take 5-6 ml of Uffalman reactive in a test tube and add 1 ml of gastric juice. In the presence of lactic acid, the solution turns from violet into yellow.