“GASTRIC FLUID”
acidity
CHIPPAI 
Physiology
 G cells stimulation: vagus nerve stimulation,
presence of food and fluid
 Hcl – produced by PARIETAL cells; stimulated by
GASTRIN ( stimulated by vagus nerve )
 Pepsinogen, pepsin  for protein digestion
Measurement of gastric acidity
 Peptic ulcer
 Pernicious anemia
 Zollinger-Ellison syndrome – most significant
(increased acidity of gastric fluid/hcl)
 Monitoring of surgery
 Drug analysis
COLLECTION
 Nasal (levin) or oral (rehfuss)
intubation/aspiration
 Fasting state (12 hours)
 No excessive swallowing
**saliva – neutralize acidity of gastric fluid
 15 minutes spx interval ( 4 samples )
TESTS FOR GASTRIC ACIDITY
PHYSICAL APPEARANCE:
 Normal color - Translucent, pale gray with
MUCUS
 Volume: >75 ml – used with titratable acidity to
determine total acid output
**anacidity – failure to produce gastric fluid to
have ph less than 6.0
 Odor – faint acrid/ pungent
 pH – determined by measuring gastric pH and
stomach wall pCO2 using TONOMETRY
BASAL GASTRIC ACIDITY
1. Basal Acid output
 Sum of all acid outputs of 4 spx
 Collection: 1 hr, 4 spx, 15 mins
 Test: volume, pH, titratable acidity, acid
output
 Normal: 30-60 mL (volume)
 CS: markedly elevated acidity
(ZOLLINGER-ELLISON SYNDROME)
**gastrin hyper secretion  increasing
** every after maka collect ng gastric
fluid, mag stimulate nnmn tayo ng
gastrin thru the production of gastrin.
**SHAMP
TEST MEALS
1. Ewald’s – bread, weak tea, water
2. Boas – oats
3. Riegel’s – Mashed potato, beef steak
**SHAM FEEDING- stimulate gastric fluid ( hcl ) para
mag taas ang gastric fluid volume
**Minsan ma swallow ang test meals ng patients in post
stimulation  resort chemical stimulation 
POSTSTIMULANTION GASTRIC ACIDITY
STIMULANTS:
 PENTAGASTRIN - (no discomfort, rapid)
**synthetic; advantage: rapid 15 mins
 HISTAMINE – (with discomfort)
**/pentagastrin histamine = 15 mins interval –
1 hr
 Histalog (slow)
- Maximum acid output – hourly acid output
** get acidity of each sample and divide 4 
- Peak Acid output – total of 2 highest 15 mins
specimens x 2
Qualitative 
TITRATALE TOTAL ACIDITY
- Measurement of concentration of both ionize
and nonionize hydrogen
- Titant: 0.1 N NaOH – ph 7
- pH Indicator: Phenol red
- End point: Faint Pink
- Normal value: 50-75%
- Actual acid output: TA x spx volume
FREE HCL
- Measuring the hcl not incorporated to subs of
gastric
- Titrant: 0.1 N NaOH
- pH Indicator: Dimenthylanimobenzol
- End point: Canary Yellow
- Normal value: 25-50% acidity
COMBINED ACIDITY

- Measuring the hydrogen combined with

proteins
**konti lg ang hcl combined to proteins = lower
acidity.
- Titrant: 0.1 N NaOH
- Ph indicator: Na Alizarin
- End point: Violet
- Normal value: 10-15% Acidity

QUALITATIVE TESTS

1. Dimethylaminobenzol
Positive = CHERRY RED
2. Gunzberg
Positive = PURPLISH RED
Reagents: Phloroglucin, Vanillin, Alcohol
3. Boas
Positive: ROSE RED
Reagent: Resorcinol, Cane sugar, Alcohol

TERMS

a. Euchlorydia – normal free hcl of gf

b. Hyperchlorydia – increase free hcl (peptic ulcer,
zollinger Ellison syndrome
c. Hypochlorydia –decrease free hcl ( cancer)
d. Achlorydia – absence of free hcl (no acidity)
“BRONCHOALVEOLAR LAVAGE AND SPUTUM 2. Odor
ANALYSIS” A. Foul / Putrid
- Lung Gangrene
**washing – lavage - Advanced necrotizing tumor
**always indicative of bacterial infection
- Evaluation of immunocompromised patients,
B. Sweetish
interstitial lung dse and airway dse.
- Bronchiectasis
CELLS - TB
3. Color
 Macrophage: 56-80% - COLORLESS/TRANSLUCENT: made up of
 Lymphocytes: 1-15% mucus only
 Neutrophil: <3% - WHITE/ YELLOW: push
 Eosinophil: <1-2% - GRAY: pus and epithelial cells
 Ciliated columnar bronchial EC: 4-17% - BRIGHT GREEN OR GREENISH: bile,
infection of P. aeruginosa
MOST COMMON PATHOGENS - RED OR BRIGHT RED: fresh blood or
hemorrhage (tb, bronchiectasis)
 P. carinii - ANCHOVY SAUCE OR RUSTY BROWN: Old
 T. gondi blood, pneumonia
 S.stercoralis - PRUNE JUICE: pneumonia, chronic cancer of
 L. pneumophila the lungs
 C. neoformans - OLIVE GREEN OR GRASS GREEN: Cancer
 H. capsulatum - BLACK: inhalation of dust or dirt, carbon,
 M. tuberculosis charcoal, anthracosis and heavy smokers
 M. pneumonia 4. Consistency
 Influenza A and B A. Mucoid: asthma and bronchitis
 Respiratory Syncytial Virus B. Serous or Frothy: Lung edema
C. Mucopurulent: bronchiectasis and TB with
CYTOLOGIC STUDIES cavities
5. Structure
 Sulfur granules – Actinomyces - Dittrich’s Plug – indicative bronchitis and
 Hemosiderin Laden Macrophage bronchial acid; yellow/gray material; pin
 Langerhans cells head in size; has foul odor when crushed
 Cytomegalic cells – cmv ( residents: wbcs) - Pneumoliths – lung stones
 Fat droplets seen in fat embolism with OIL RED - Bronchial Cast – line cast; indicative of
O STAIN LOBAR pneumonia (s. pneumonia)
 Lipid laden alveolar macrophage using SUDAN - Curshmann’s Spiral – coiled mucus strands;
II STAIN indicative of bronchial acid
 Dust particles indicative of pneumonicoses - Layer Formation
( too much inhalation of dust ) or asbestos
exposure

SPUTUM ANALYSIS

1. Volume
A. Scanty (small volume)
- Bronchial Asthma ** baba – undissolved granules
- Acute Bronchitis Mid – water
- Early pneumonia Taas – foam/bubbles
B. Large
- Bronchiectasis
- Lung abscess
- Edema
- Gangrene
MICROSCOPIC EXAM

1. Unstained
- Elastic fibers - TB
- Charcot-Leyden crystals – eosin
degradation; degree of allergic rxn
- Pigmented cells – heart failure cells
- Myelin globules
- Fungi – candida albicans, h. capsulatum,
Cryptococcus neoformans ( porulosis
- Parasites – paragonimus westermani,
helminths
2. Stained
- Neoplastic
- Bacteria
- Leukocytes, epithelial cells

** Creola bodies –clumps ciliated columnar ec;

because of shedding bronchial mucusa;
bronchial asthma

BRONCHIAL ASTHMA DIAGNOSIS 

 CHARCOT – LEYDEN – crystalloids

containing galactin 10
 CURSHMANN SPIRAL – from shed epith
 CREOLA BODIES