stomach and duodenumun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows)...
TRANSCRIPT
![Page 1: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/1.jpg)
STOMACH AND DUODENUM
Qais K.Baqer FCABS FICMS FICS
Consultant Gastrointestinal& Hepatobiliary Surgeon
![Page 2: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/2.jpg)
• Recognize and understand:• The anatomy & the physiology.• the most appropriate investigations.• the Helicobacter pylori.• The gastritis & peptic ulcer diseases.• The presentation of gastric cancer.• Duodenal obstruction and tumours.
![Page 3: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/3.jpg)
Surgical anatomy
• Function:• Reservoir .• Mechanical breakdown of food.
• Parts:• Layers:
![Page 4: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/4.jpg)
Blood supply• From coelic axis:• Lt Gastric a.• Rt Gastric a.• Rt Gastroepiploic a.•Lt Gastroepiploic a.• short Gastric aa. ( vasa brevia)
![Page 5: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/5.jpg)
Venous drainage
![Page 6: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/6.jpg)
Lymphatic
![Page 7: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/7.jpg)
Nerve supply
• Intrinsic N: • Myenteric plexus (Auerbach).• Submucosal plexis (Meissner),
•Extrinsic N:•Ant. Vagus.• post. Vagus.
![Page 8: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/8.jpg)
Gastric epith. Mucus producing Cells…Mucous (Visid mucopolysacccharide ).
Parietal cells HCl, IF. Chief cells pepsinogen I, II.... Pepsin.
Endocrine cells: G cells…. Gastrin. D cells….. Somatostatin
Enterochromaffin –
like cells: Histamin. Duodenum: Brunner’s glands…mucous . Endocrin cells…CCK, Secretin.
![Page 9: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/9.jpg)
The taste or smell of food, tactile sensations of food in the mouth, or even thoughts of food stimulate the medulla oblongata (green arrow).
Taste or smell of foodTactile sensation in mouth
Medulla oblongata
Cephalic Phase
![Page 10: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/10.jpg)
Parasympathetic action potentials are carried by the vagus nerves to the stomach (pink arrow).
Vagus nerves
Cephalic Phase
![Page 11: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/11.jpg)
Preganglionic parasympathetic vagus nerve fibers stimulate postganglionic neurons in the enteric plexus of the stomach.
Vagus nerves
Cephalic Phase
![Page 12: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/12.jpg)
Cephalic Phase
Postganglionic neurons stimulate secretion by parietal and chief cells and stimulate gastrin secretion by endocrine cells.
Gastrin
Stomach
![Page 13: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/13.jpg)
Cephalic Phase
Gastrin is carried through the circulation back to the stomach (purple arrow), where it stimulates secretion by parietal and chief cells.
GastrinCirculation
Secretionsstimulated
![Page 14: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/14.jpg)
Stomach
Local reflexesstimulated by
stomach distention
Distention
Secretionsstimulated
Vagus nervesMedulla
oblongata
Gastric Phase
1
2
3
![Page 15: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/15.jpg)
Intestinal Phase
Local reflexes inhibit gastric secretion (orange arrows).
pH<2or lipids
Localreflexes
Decreasedgastric
secretions
Mechanism Two
![Page 16: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/16.jpg)
Chyme in the duodenum with a pH less than 2 or containing fat digestion products (lipids) inhibits gastric secretions by three mechanisms.
pH<2or lipids
Intestinal Phase
![Page 17: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/17.jpg)
Intestinal Phase
Sensory vagal action potentials to the medulla oblongata (green arrow) inhibit motor action potentials from the medulla oblongata (pink arrow).
pH<2or lipids
Medullaoblongata
Vagusnerves
Vagusnerves
Mechanism One
Decreasedgastric
secretions
![Page 18: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/18.jpg)
Intestinal Phase
Local reflexes inhibit gastric secretion (orange arrows).
pH<2or lipids
Localreflexes
Decreasedgastric
secretions
Mechanism Two
![Page 19: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/19.jpg)
Secretin, gastric inhibitory polypeptide, and cholecystokinin produced by the duodenum (brown arrows) inhibit gastric secretions in the stomach.
Secretin, gastric inhibitorypeptide, cholecystokinin
pH<2or lipids
Decreasedgastric
secretions
Circulation
Mechanism Three
Intestinal Phase
![Page 20: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/20.jpg)
Gastric Emptying (antral pump or antral mil)
PHASE I: period of quiescence after clearance of food lasting( 40min).PHASE II: MMC from the fundus at rate of 3/min lasting (40 min).PHASE III: duodenal slow waves at rate of 10/min lastiing (10min).This 90 min cycle repeatedFrom Duodenum MMC move 5-10 cm/min reaching terminal ileum after 9o min.
![Page 21: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/21.jpg)
Investigation1- OGD:Use: Dx & RX.Safe. but morb. mort # 0.Needs Experience.Under Sedation.+ Resuscitation equip.
![Page 22: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/22.jpg)
2- Radiology: plain & contrast
![Page 23: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/23.jpg)
3- Ultrasound1- conventional USS.2-Endoscopic ( EUS).
• Staging:T: 90%.N: 80%Can demostrate hepatic secondries.• Assess gastric emptying.
3- Laparoscopic US.
![Page 24: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/24.jpg)
4- CTS & MRI
![Page 25: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/25.jpg)
5- CTS/ PET Scan (Positron Emission Tomography). Fluorodeoxy glucose as tracer.
![Page 26: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/26.jpg)
6- Laparoscopy
![Page 27: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/27.jpg)
7- Gastric emptying study
![Page 28: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/28.jpg)
8- Angiography
![Page 29: STOMACH AND DUODENUMun.uobasrah.edu.iq/lectures/9111.pdfproduced by the duodenum (brown arrows) inhibit gastric secretions in the stomach. Secretin, gastric inhibitory peptide, cholecystokinin](https://reader036.vdocument.in/reader036/viewer/2022071510/612f9cae1ecc515869438f93/html5/thumbnails/29.jpg)
Test for H. pylori detection:
Serology IgG.
Rapid ureas test.
Urea breath test.
Histology, culture.