Body in Health

 What and where are the stages of digestion

 What are the different anatomic abdominal regions
o There are nine main regions of the abdomen. Regions 1-3 comprise the upper
abdomen, regions 4-6 are the middle abdomen and the regions 7-9 make up the
lower abdomen.
o The upper abdomen:
 Region 1 is the right hypochondriac region. This houses the liver,
gallbladder, right kidney and small intestine
 Region 2 is the epigastric region. This houses the stomach, liver and the
pancreas; as well as the adrenal glands and the first part of the small
intestine (the duodenum)
 Region 3 is the left hypochondriac region, which houses the spleen, colon,
left kidney and the pancreas
o The middle abdomen:
 Region 4 this is known as the right
lumbar region. This contains the liver,
gallbladder and ascending colon
 Region 5 is the umbilical region, this is
around your belly button area and is
home to the small intestine
 Region 6 is known as the left lumbar
region. This contains the descending
colon and the left kidney
o The lower abdomen:
 Region 7 is the right iliac region. This is home to the appendix, caecum, and
the right iliac fossa
 Region 8 is the hypogastrium region (below the stomach). This contains the
bladder, part of the sigmoid colon, the anus and many organs of the
reproductive system
 Region 9 is the left iliac region. It contains the descending colon, the sigmoid
colon and the left iliac fossa
 What is the anatomy/histology/functions of the stomach
o Anatomy
 o Histology: the stomach is made of the same four layers as most of the rest of the
alimentary canal.
 Mucosa: this consists only of surface mucus cells, which secrete a protective
coat of alkaline mucus. A vast number of gastric pits on the surface of the
epithelium (which give the appearance of a pincushion) mark the entry of
the gastric gland, which secretes complex digestive gastric juice. Located on
the middle region of the gastric glands are parietal cells, which produce
both hydrochloric acid and intrinsic factor. HCl is needed to kill the bacteria
that we ingest and activate the protein-digesting enzyme, pepsin. Intrinsic
factor is a glycoprotein necessary for the absorption of vitamin B12 in the
small intestine
 Submucosa
 Muscularis externa (smooth muscle),
 Serosa
o Function
 How is acid produced in the stomach:
Secretion of gastric juices is controlled by nerves and hormones. There are three phases of
gastric secretion, and they’re called cephalic, gastric and intestinal phases. However, once
gastric secretion begins, all three phases occur simultaneously.
o Cephalic phases (reflexive), takes place before food enters the stomach. The smell,
taste and sight of food triggers this phase, causing the increased secretion of gastric
juices to prepare the stomach for digestion
o Gastric phase, this is set in motion by local and hormonal mechanisms triggered by
the entry of food into the stomach. When food enters the stomach, it causes
distention of the stomach which activates the stretch receptors. This stimulates the
parasympathetic neurons to release acetylcholine, which induces the secretion of
gastric juices
o Intestinal phase has both excitatory and inhibitory elements. The duodenum has a
major role in regulating the stomach and its emptying. When partially digested food
fills the duodenum, intestinal mucosal cells release a hormone called intestinal
(enteric) gastrin, which further excites gastric juice secretion
http://library.open.oregonstate.edu/aandp/chapter/23-4-the-stomach/
https://opentextbc.ca/anatomyandphysiology/chapter/23-4-the-stomach/
Body in Disease
 What are the causes and symptoms of stomach ulcers (medication)
o Aetiology:
 H.pylori bacteria infections are common; the infection doesn’t usually cause
symptoms. The bacteria live in the stomach lining, affecting people of all
ages, and can irritate the stomach lining making it more vulnerable to
damage from the stomach acid.
 NSAIDs; they can cause damage to the gastrodeodenal mucosa via several
mechanisms, including topical irritation to the epithelium, impairment of the
barrier properties of the mucosa, suppression of gastric prostaglandin
synthesis, reduction of gastric blood flow. With the addition of HCl, this
means that the repair and haemostasis is impaired and several growth
factors that are important in mucosal defence and repair are inactivated
 Lifestyle factors: spicy foods, stress and alcohol
o Symptoms: stomach pain (sometimes extends up to the neck and down to the back),
indigestion, heartburn, loss of appetite, nausea, vomiting and weight loss. Some
people also fine they burp or become bloated after eating fatty foods.
 Dietary links to ulceration
 What are the main complications of stomach ulcers
Complications of stomach ulcers are fairly uncommon, but they may include the following
o Internal bleeding: it can occur when an ulcer develops at the site of a blood vessel.
This can be chronic (leading to anaemia, fatigue, breathlessness, heart palpitations)
or acute/severe (causing blood in vomit or black, sticky tar-like stool)
o Perforation: this is the split or tear of the stomach lining. This enables the bacteria
that live in the stomach to escape and infect the peritoneum (peritonitis). This can
lead to sepsis
o Gastric outlet obstructions: sometimes an inflamed or scarred stomach can obstruct
the normal passage of food through the digestive system
 How do stomach ulcers cause nausea, heartburn and epigastric fullness
o This may be due to Gastric outlet obstructions, as mentioned above
 How does H pylori cause stomach ulcers
o The H. pylori bacteria weaken the protective mucosa coating of the stomach and
duodenum, thus allowing acid to get through to the sensitive lining beneath. Both
the acid and the bacteria irritate the lining and cause a sore, or ulcer. The H. pylori
are able to survive in stomach acid because it secretes enzymes that neutralize the
acid. This mechanism allows H. pylori to make its way to the protective mucous
lining. Once there, the bacterium’s spiral shape helps it burrow through the lining.
 How does the bacteria spread
o Researchers are still unsure how H.pylori spreads. However it’s speculated that it
may spread person-to-person by saliva, faecal contaminated food and water
 Structure of H pylori and how it helps it survive In the stomach
o H. pylori are unique in its ability to thrive in the human stomach. It does this by
activating its own cytoplasmic urease, which converts urea into carbon dioxide and
 ammonia. The ammonia first neutralises the gastric acid that enters the outer
membrane of the bacteria, preventing acidification at the inner membrane. This
allows the bacteria to colonise the stomach.
 What is the healing process of ulceration
 How does stress affect the body
 What is referred pain
o Also known as reflective pain, this is pain perceived at a location other than the site
of the painful stimulus (or source)

Procedures and treatments

 What is consent to operation and the form

o This is the principle that a person must give permission before they receive any type
of medical treatment, test or examination. Consent from a patient is needed
regardless of the procedure. Consent can be given verbally or in writing
 What are the pharmacological options available to reduce acid production
 Diagnostic treatments to stomach ulcers (endoscopy)
o A water-soluble gastroduodenogram will show any leakage from the duodenum or
its sealing. This can be a useful test when one is considering non-operative
treatment or in the situation where the diagnosis is in doubt
 What is the appropriate surgery for perforated ulcers
o In about 40-50% of cases the ulcer self-heals with omentum or by fusion of the
duodenum
o Laparoscopic Surgery: only advantage is the decreased postoperative pain. This a
type of surgical procedure that allows a surgeon to access the inside of the abdomen
and pelvis without having to make large incisions in the skin
o Anterior longitudinal duodenotomy
 What are non-surgical options for stomach ulcers
o Treatment will depend on what caused the ulcer and the extent of the ulceration
 If it is caused by H. pylori a course of antibiotics and a proton pump inhibitor
(PPI) is recommended
 If it is caused by NSAIDs a course of PPI medication is recommended
 Alternative medication is known as H2-receptor antagonists
 What are the psychological effects of stress