Which of the following gastrointestinal secretions normally do not contain bicarbonate? 1. Stomach 2. Saliva 3. Duodenal 4. Ileal Select the correct answer using the code given below.
2 and 4
As per the key, the correct option is 2 and 4, taking saliva and ileal secretions as the ones without a defining bicarbonate content. In the scheme intended here, the alkaline bicarbonate-rich secretions are those that neutralise acid and protect mucosa: gastric surface mucous cells secrete an adherent bicarbonate-rich mucus gel (the gastric mucosal barrier, prostaglandin E2 dependent), and duodenal Brunner's gland secretion is markedly alkaline, buffering chyme from the pylorus. Saliva is instead characterised by amylase, mucin, potassium and thiocyanate, and ileal succus entericus by water, sodium, chloride and enzymes such as enterokinase.
Options 1, 2 and 3, 1 and 3 only and 1, 3 and 4 all include the stomach or duodenum, contradicting the gastric bicarbonate barrier and the alkaline Brunner's gland output, so none matches the key.
Key point: Loss of alkaline lower gastrointestinal fluid (fistula, high-output ileostomy, diarrhoea) causes a normal anion gap hyperchloraemic acidosis; loss of acidic gastric juice by vomiting causes a hypokalaemic hypochloraemic metabolic alkalosis.
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