Surgical Gastroenterology



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Overview


What is the stomach?

The stomach is an organ of digestion. It has a saclike shape and is located between the esophagus and the intestines. Almost every animal has a stomach.

The human stomach is a muscular, elastic, pear-shaped bag, lying crosswise in the abdominal cavity beneath the diaphragm. It changes size and shape according to is position of the body and the amount of food inside. The stomach is about 12 inches (30.5 cm) long and is 6 inches. (15.2 cm) wide at its widest point. The stomach's capacity is about 1 qt (0.94 liters) in an adult.

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Food enters the stomach from the esophagus. The connection between the stomach and the esophagus is called the cardiac sphincter. The cardiac sphincter prevents food from passing back to the esophagus. Heart burn is the sensation when stomach juices (gastric juice) is allowed to seep through the sphincter into the esophagus. Once the food enters the stomach, gastric juices are used to break down the food. Some substances are absorbed muscle lining of the stomach. One of the substances the stomach absorbs is alcohol.

The other end of the stomach empties into the duodenum. The duodenum is the first section of the small intestine. The pyloric sphincter separates the stomach from the duodenum.

The stomach is composed of five layers. Starting from the inside and working our way out, the innermost layer is called the mucosa. Stomach acid and digestive juices are made in the mucosa layer. The next layer is called the submucosa. The submucosa is surrounded by the muscularis, a layer of muscle that moves and mixes the stomach contents. The next two layers, the subserosa and the serosa are the wrapping for the stomach. The serosa is the outermost layer of the stomach.
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What does a Stomach Ulcer affect?

The main thing that a stomach ulcer affects is the nerves surrounding it. The nerves become agitated and cause a great amount of pain. However, stomach ulcers can cause hemorrhages from the erosion of a major blood vessel; a tear in the wall of the stomach or intestine, with resultant peritonitis; or obstruction of the gastrointestinal tract because of spasm or swelling in the area of the ulcer.


Risks of Developing a Stomach Ulcer

  • Family history of ulcers
  • Smoking
  • Excess alcohol consumption
  • Use of nonsteroidal anti-inflammatory medications (aspirin) or corticosteroids.
  • Zollinger-Ellison syndrome
  • Improper diet, irregular or skipped meals
  • Type O blood (for duodenal ulcers)
  • Stress does not cause an ulcer, but may be a contributing factor
  • Chronic disorders such as liver disease, emphysema, rheumatoid arthritis may increase vulnerability to ulcers

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Diagnosing an Ulcer


To see whether symptoms are caused by an ulcer, the doctor may do an upper gastrointestinal (GI) series or an endoscopy. An upper GI series is an x ray of the esophagus, stomach, and duodenum. The patient drinks a chalky liquid called barium to make these organs and any ulcers show up more clearly on the x ray.

An endoscopy is an exam that uses an endoscope, a thin, lighted tube with a tiny camera on the end. The patient is lightly sedated, and the doctor carefully eases the endoscope into the mouth and down the throat to the stomach and duodenum. This allows the doctor to see the lining of the esophagus, stomach, and duodenum. The doctor can use the endoscope to take photos of ulcers or remove a tiny piece of tissue to view under a microscope. This procedure is called a biopsy.

If an ulcer is bleeding, the doctor can use the endoscope to inject drugs that promote clotting or to guide a heat probe that cauterizes the ulcer.


How does H. pylori cause a peptic ulcer ?

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H. pylori weakens the protective mucous coating of the stomach and duodenum, which allows acid to get through to the sensitive lining beneath. Both the acid and the bacteria irritate the lining and cause a sore, or ulcer.

H. pylori is 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 "safe" area-the protective mucous lining. Once there, the bacterium's spiral shape helps it burrow through the lining



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