Lab Tests (small tips )

To ‘fast’ means no food or drink for 8-10 hours before the test. Typically, a person is fasting when he wakes in the morning, thus fasting tests means you have rested for the period of fasting too…for those 8-10 hours.

Persons working night shifts may sleep at 6 am and wake up past noon; the timing of ‘fasting + sleep’ could be considered fulfilled at 3 or 4 pm too.

May I drink water?

You are allowed to drink water in case you are thirsty. If you are dehydrated your veins may be difficult to find too. Drinking excess water because you have been now allowed may not help the tests, however.

To ‘fast’ means no food or drink for 8-10 hours before the test. Typically, a person is fasting when he wakes in the morning, thus fasting tests means you have rested for the period of fasting too…for those 8-10 hours.

Persons working night shifts may sleep at 6 am and wake up past noon; timing of ‘fasting + sleep’ could be considered fulfilled at 3 or 4 pm too.

May I drink water?You are allowed to drink water in case you are thirsty. If you are dehydrated your veins may be difficult to find too. Drinking excess water because you have been now allowed may not help the tests, however.

Animals do not eat cooked food. So, animals get very little fat in their normal diet. If any fat containing food comes by, the animal gut has the capacity to pick up ALL of it; never know when fat will be available again. The gut, thus; never will allow fat to go waste.

Humans eat cooked food; we use fat as a cooking medium beyond what we naturally need. God still has to make a “design change” to create a ‘brake’ on fat absorption. Even if you are obese, when you gut receives fat in meals the absorption is nearly 100%.

Lack of digestive enzymes (pancreatic, intestinal or both) affects the breaking down of fat, thus leading to bulky greasy stools. To know if you are not digesting fat, your doctor may advise an estimation of ‘fat in stools’; thus,‘fecal fat’.

This test could be in 2 forms; either the doctor wants to know if you are really losing fat (an answer – yes / no); else, he may want to know how much fraction of the consumed fat have you not absorbed (quantitative fecal fat estimation). The latter test is not required frequently.

You will be asked to finish 100 g of fat in a day, and then collect the next morning’s stool sample. We do have fat in our daily diet (milk, meat, butter, cooking oils and salad dressings, nuts, baked goods, etc.), but a way to ensure a fat intake is to buy a slab of butter (Amul butter 100 g). you could add fat to any food you will eat through the day (the curry, daal, rice, roti, etc.) so that the entire slab is consumed in 24 hours.

The stool collected the next day will be tested by a special stain to look for fat.

Whenever you pass stools, try and pass urine before you attempt to pass stools, this will prevent contamination. The sample is collected in a clean container provided by the lab. You could close it tight and keep it in a separate bag in a cool place or the bottom of the refrigerator.

Recurrent acute pancreatitis is a condition where a person could suffer episodes of recurrent pancreatic pain that need a short stay at the hospital to get better, never complicate to become serious illnesses, but remain a constant source of insecurity. The common causes of pancreatic pain may have been looked for and found normal.

Hereditary chronic pancreatitis in a condition where a person may have intermittent episodes of acute pancreatitis which in the long term may led to gradual deterioration of exocrine and endocrine function. In case there is a genetic cause for this, it will be revealed only by specific testing.

Loss of control on trypsinogen within the pancreas may cause abnormal activation of enzyme leading to an attack of pancreatitis. Five genetic factors have been found to prevent activation of trypsinogen to trypsin in the pancreas:

• The cationic trypsinogen gene (PRSS1)
• The pancreatic secretory trypsin inhibitor gene (SPINK1)
• The cystic fibrosis transmembrane conductance regulator gene (CFTR)
• The chymotrypsinogen gene (CTRC)
• The calcium sensing receptor (CASR)

The correct approach:Tests are usually advised after a genetic counsellor reviews records and obtains a three-generation pedigree. A counsellor elicits information about the health history in the whole family tree to see in case any member may have suffered episodes suggestive of pancreatic pain, else, if lab reports could be made available, they would see in case there were times the blood levels of amylase & lipase were raised. A counsellor will try to seek how many members had diabetes, exocrine pancreatic insufficiency, male infertility, chronic sinusitis and recurrent respiratory infection to suggest a cystic fibrosis trait. It is important that not only the patient but the whole extended family knows the significance of the exercise for the benefit of the person affected, and requesting the genetic test. Risk of recurrence in the offspring is dependent on the genotype found aberrant, and whether the transmission risk is autosomal dominant. Thus, for the patient, there could be implications of genetic testing beyond the management of the pancreatitis too.

The “short cut”:Genetic laboratories in commercial space do offer “direct to consumer” testing. Before you hit the internet, patients need to be aware they may be doing the testing without the benefit of prior genetic counselling. Furthermore, the quality & reliability of the testing may not bee known to them. The tests could be the standard Sanger method traditional DNA sequencing, or Next Generation Sequencing. In case a variant is detected, the report needs to be seen in the context of its clinical relevance.

A test done as a “diagnostic” for the person who has suffered pancreatitis coming positive, may raise the question as to whether the same will be “predictive” for siblings, who will want to know if they are carriers.

It is apparent that such complex disorders as chronic pancreatitis may need experts with a clinical as well as a genetic background who could tease out the finer nuances of the diseases to provide insights.