Type of test Fluid analysis

Normal findings

Volume: 2-4 mL/kg body weight

HCO3 (bicarbonate): 90-130 mEq/L

Amylase: 6.6-35.2 units/kg

Trypsin-like immunoreactivity: 10-57 ng/mL Trypsin: ≥ 1:96

Chymotrypsin: by report

Test explanation and related physiology

Cystic fibrosis (CF) is an inherited disease characterized by abnormal secretion by exocrine glands within the bronchi, small intestines, pancreatic ducts, bile ducts, and skin. Because of this abnormal exocrine secretion, children with CF develop mucus plugs that obstruct their pancreatic ducts and can lead to significant mal absorption, steatorrhea, and diarrhea. The pancreatic enzymes cannot be expelled into the duodenum and therefore are either completely absent or present only in diminished quantities within the duodenal aspirate. Bicarbonate and other neutralizing fluids cannot be secreted from the pancreas.

In this test, secretin and pancreozymin are used to stimulate pancreatic secretion of these enzymes and bicarbonate into the duodenum. The duodenal contents are then aspirated and examined for pH, bicarbonate, and pancreatic enzyme levels. Amylase is the most frequently measured enzyme.

Trypsinogen, another pancreatic exocrine enzyme, is measured in the serum as trypsin-like immunoreactivity. This test is used to support the diagnosis of chronic pancreatitis. Levels diminish as exocrine function becomes impaired. It is important to note that serum levels of trypsinogen are used in newborn screening for CF. This simply involves a heel prick blood specimen collected on a filter paper on day 2 to 4 of life to measure trypsinogen by an immunoassay. When levels are elevated, confirmatory tests are done.

When any of these pancreatic enzymes are measured in the serum, they can reflect acute inflammation of the pancreas. Likewise, in patients with burned-out chronic pancreatitis, serum measurements of these pancreatic enzymes are low. Pancreatic enzymes can also be measured in the stool and are more easily accessed for testing. Most commonly stool for trypsin and chymotrypsin are tested and are a measure of pancreatic function. Stool for elastase also is a measure of pancreatic function.

A physician obtains the duodenal contents in approximately 2 hours in the x-ray department. Discomfort and gagging may occur during placement of the Dreiling tube.

Procedure and patient care

Before

* Explain the procedure to the patient and parents.

* Instruct the adult patient to fast for 12 hours before testing.

• Determine pediatric fasting times according to the patient’s age. During

 • Note the following procedural steps:

 1. With the use of fluoroscopy, a Dreiling tube is passed through the patient’s nose and into the stomach.

2. The distal lumen of the tube is placed within the duodenum and the proximal lumen within the stomach.

 3. Both lumens are aspirated. The gastric lumen is continually aspirated to avoid contamination of the gastric con tents in the duodenum aspirate.

 4. A control specimen of the duodenal juices is collected for 20 minutes.

5. The patient is tested for sensitivity to secretin and pancreozymin by low-dose intradermal injection.

 6. If no sensitivity is present, these hormones are administered intravenously. Secretin can be expected to stimulate pancreatic fluid and bicarbonate secretion. Pancreozymin can be expected to stimulate pancreatic enzyme secretion.

7. Four duodenal aspirates are collected at 20-minute intervals and placed in the specimen container.

 8. Each specimen is analyzed for pH, volume, bicarbonate, and amylase levels.

 • Note that a physician performs this test in the laboratory or at the patient’s bedside.

After

• Place the aspirated specimens on ice. Send them to the chemistry laboratory as soon as the test is completed.

• Give appropriate nose and mouth care after removal of the tube.

• Allow the patient to resume a normal diet.

Abnormal findings

Increased levels

- Acute pancreatitis

Decreased levels

- Cystic fibrosis

- Sprue

- Chronic pancreatitis

اخر الاخبار

اخبار العتبة العباسية المقدسة

قسم الشؤون الفكرية يستعد لافتتاح موكب سقّاء عاشوراء في النجف الأشرف

المجمع العلميّ يُجري اختبارات نظريّة وتطبيقيّة لطلبته في قضاء الحمزة الشرقيّ

لطلبتها وملاكاتها جامعة الكفيل تواصل تنظيم الورشة التدريبية للإسعافات الأولية استعدادًا لزيارة الأربعين

مصنع الجود للمحاليل الوريدية: نحرص على إنتاج دواءٍ آمن وفعّال بأيدٍ وطنيّة دعمًا للقطّاع الصحي العراقي

المزيد

الآخبار الصحية

"شعور لا مفر منه" في الحياة يهدد حياة الملايين بالموت المبكر!

أعراض للخرف قد تظهر في المشي.. كيف نكتشفها؟

ماذا يحدث لسكر الدم عند شرب القهوة؟

سرطان القلب.. لماذا يعد من أندر أنواع السرطانات؟

المزيد

الآخبار التكنلوجية

صهر أردوغان يطلق منصة تواصل جديدة.. تنافس فيسبوك ؟!

غوغل تطلق "مرشد الويب" لتنظيم نتائج البحث بالذكاء الاصطناعي

بعد 20 عاما.. رصد أصغر أفعى في العالم مجددا في بربادوس !

ذكر أم أنثى؟.. دراسة تنسف الاعتقاد الشائع حول جنس المولود

المزيد

مواضيع ذات صلة

Partial thromboplastin time, activated (APTT, Partial thromboplastin time [PTT])

parathyroid scan (Parathyroid scintigraphy)

parathyroid hormone (PTH, Parathormone)

Paracentesis (Peritoneal fluid analysis, Ascitic fluid cytology, Peritoneal tap)

Clinical Immunology Laboratory (Diagnostic Testing)

Determination of Type D and Rh Phenotype

Determination of the ABO Group

Platelet and Granulocyte Antigens and Antibodies

pancreatobiliary fish testing

pancreatic elastase (PE, EL1, Elastase-1, Fecal Elastase)

Trends in Immunoassay Automation

Flow Cell Cytometry