The headlines have been jarring:

“Screening Procedure Fails to Prevent Colon Cancer Deaths in Large Study,” offered Bloomberg.

“In a Gold-Standard Trial, an Invitation to Colonoscopy Reduced Cancer Incidence but Not Death,” observed Statnews.

“Colonoscopy Fails to Reduce Rate of Cancer Deaths in Trial” volunteers realclearscience.com.

Have you heard about the 10-year follow-up of the large, multicenter, randomized Northern-European Initiative on Colorectal Cancer (NordICC) trial?

Researchers recruited healthy individuals in Poland, Norway, Sweden, and the Netherlands between 2009 and 2014. Most came from Poland (54,258), followed by Norway (26,411) and Sweden (3,646). The study authors did not include data from the Netherlands because of data protection law.

Should we ditch colon cancer screening?

Let’s get right to the recent report published in the New England Journal of Medicine:

The real-world risk of colorectal cancer and associated death rates appeared lower among people who had a single screening colonoscopy (compared with those not having the procedure), although only modestly so.

The researchers determined that the number needed to invite to undergo screening to prevent one case of colorectal cancer is 455. This number gives us an estimate of the effect of screening colonoscopy in the general population. Or does it?

The researchers determined outcomes based on intention-to-screen. In other words, they compared all subjects invited to have a colonoscopy screening with those who received no invitation or screening.

Here are some other study outcomes:

• The 10-year colorectal cancer risk was 0.98 percent for the screened individuals, compared with 1.2 percent for the unscreened subjects. While this 18 percent risk reduction sounds great, the absolute difference is small.
• The risk of death appeared similar in the invited group (0.28 percent) versus 0.31 percent in the usual care drop. Again, a nice relative drop (10 percent) but not particularly different in absolute numbers.
• The risk of death from any cause appeared similar in the invited and usual-care group members, at 11.03 percent and 11.04 percent, respectively.

My take — Colon cancer screening

The colonoscopy benefits would have been greater had more individuals had colorectal screening. Only 42 percent of those invited had a colonoscopy.

When the scientists adjusted for this low participation level, they discovered this:

Had all those invited to undergo screening had it, the 10-year risk of colorectal cancer would have dropped from 1.22 percent to 0.84 percent, and the risk of colorectal cancer–related death would have fallen from 0.30 percent to 0.15.

The NordICC is the first randomized trial to quantify the possible benefits of colonoscopy screening on the risk of colorectal cancer and related death.

Longer follow-up is needed to understand better whether colonoscopy is effective in this real-world analysis. Drs. Jason Dominitz and Douglas Robertson comment on the possible reasons for the low reduction in incident cancer and deaths observed in the NordICC study.

In an editorial that accompanied the study publication, they note that other studies suggest an approximate halving (40 to 69 percent) in the incidence of colorectal cancer and an up to seven-eighths (29 to 88 percent) decrease in the risk of death with colonoscopy.

We must take such observations in context: Historical non-randomized studies likely overestimate the real-world effectiveness of colonoscopy, given a lack of adjustment for incomplete adherence to testing. In addition, there is a tendency for healthier individuals to seek preventative care.

In the United States, colonoscopy is the main screening tool for colorectal cancer. In other places, participation rates may be quite different. In this sense, the real-world results in the USA may be closer to the results seen in the per-protocol analysis of this study.

I look forward to seeing if greater improvements in outcome emerge when the NordICC state has a 15-year follow-up. Finally, if the modest effectiveness of screening colonoscopy is real, can we afford to use this expensive screening tool? Or should we turn to less-invasive tactics such as FIT (fecal immunochemical testing)?

But Dr. Maas said that “around half of the patients in the study did not undergo colonoscopy, which may have negatively impacted the results. I will end with this observation about this study: Colonoscopy cannot possibly work if an individual does not have it. We need more evidence to guide us about the use of colonoscopy.

Thank you for joining me in the exploration of the effectiveness of colonoscopy.

The post Is Colonoscopy Effective? A New Study Raises Questions appeared first on Medika Life.

Not too long ago, our family joined the rare disease community. For years, our child exhibited a multitude of disconnected symptoms that all seemed to have different explanations, if they had explanations at all. The growing list included dizziness, rapid heart rate, stomach aches, rib pain, joint pain, unexpected dislocations, migraines and others.

Spider-Web-like Health Ecosystem

The symptoms accumulated, along with a cascade of specialist appointments, diagnostic tests and treatments. So did the hours of speaking – and negotiating – with our health insurance carrier. Along the way, we encountered all sorts of personalities in our spider-web-like health ecosystem, most compassionate and wanting to help our child, others bewildered or frustrated, and still others deaf to our worries and requests. The boldest and best among the health professionals we worked with were those willing to confess their uncertainty. In medicine, the response “I don’t know” is now an act of courage.

Fifty years ago, when modern medicine came of age, there were far fewer treatments for common, non-communicable diseases such as high blood pressure, cardiovascular diseases or mental illness. While medicine has become more advanced and specialized, it has also become increasingly fragmented. The important family physician – who should have sufficient time and compensation to coordinate care – is often out-of-the-loop as patients rush to a myriad of medical specialists – each hyper-focused on their piece of the biological puzzle.

Fee-for-service care disadvantages primary care medicine and a patient’s coordinated care.  This financial model may work for simple – in and out – cases, but when it comes to chronic illnesses, it does not. Add to that the complexity of electronic medical record systems with limited interoperability. Now, specialists face “telephone-game” obstacles to accessing colleagues’ clinical notes and diagnostic data for a shared patient.

Now, shift from common non-communicable diseases to needle-in-the-haystack conditions.  It’s baffling for patients, parents and providers.  Over time, doctors may even become frustrated with these patients. People with multiple, disparate symptoms with no “one pill to heal them all” are sometimes labeled problem patients owned by no one. In these circumstances, young female patients often experience gender bias and provider judgments that the puzzling symptoms must be “in their heads.”

Communication is Part of the Care

When you hear hoofbeats behind you, think horses, not zebras. As 14^th-Century theologian and philosopher William of Occam would suggest, the more common explanation is the correct diagnosis. But medical students – and the doctors they become – need to be careful not to develop a foolish consistency.  This is not the Middle Ages of Medicine.  It is the 21^st Century of miracle medicine where patients must have a voice.

While it is easier to treat confusing and contradictory symptoms than to ask why a patient is experiencing them, savvy doctors rely more on their patients’ collaboration to help them solve medical mysteries. Information, communication, and advocacy can build a bridge linking doctors and patients.

Traumatized by the Medical System

But, most often in healthcare, the gatekeepers – providers and payers – feel they know best. This overconfidence can quickly unravel in the face of the challenges of rare whack-a-mole diseases. Physicians trying to help feel helpless and grasp at straws when their initial diagnoses and treatments do not solve their patient’s problems. Over time, many patients are traumatized by a medical system that seeks to help, but is seen as fallible.  As different solutions are sought, the system pays more and more for that same patient over time. The patient’s underlying illness remains unaddressed. No one wins.

This two-decade journey to arrive at my child’s diagnosis (Ehlers Danlos Syndrome) has taught me several lessons.

• TEAM:  Any successes result from the passion of individuals —parents, physicians, payers or policymakers — who are determined to work together to find solutions and willing to listen.

• TECH:  Good health information begins to force our fragmented health system to converge around the patient. When data is accessible, artificial intelligence finds needle-in-a-haystack solutions, uniting the myriad of like cases so that health professionals can learn, engage, and arrive at answers sooner.  Physicians who also engage patients promptly through the EHR system are more than answering the questions of anxious patients; they demonstrate partnership in the care.

• TRUST: I have seen how critical advocacy is. As a health communicator, I have been fortunate to serve on the boards of organizations such as the American Academy of Pain Medicine Foundation, American Heart Association, Leukemia & Lymphoma Society, The Marfan Foundation and Let’s Win for Pancreatic Cancer, which unite healers and patients, and participate in the Centers for Medicare and Medicaid Part D Working Group: all great forums for accurate information that improve public health through informed decisions.

These lessons all point to passionate, informed collaboration as the key to restoring clarity and sanity to the fragmented health system and driving quality care for patients, whether they have common ailments or rare conditions. I integrate these lessons into my work to benefit clients and, most importantly, change the lives of the patients they serve.

Our family’s lives were changed by one cardiologist who dared to utter a simple sentence: “You need a team.” Her idea to put one together should not have been so revelatory, nor so atypical, but it was. She understood collaboration fundamentally and saw patients and their caregivers as her partners in healing.

Collaboration – Overused Word; Underused Strategy

For those whose work touches patient care and public health, I encourage you to collaborate, talk, and merge your experiences with others. Remember, this work directly touches people’s lives. This work makes a difference. Give thought to how you can bond with others to change the course of care. Collaboration is an often-overused word but is too often underplayed as a behavior.

I call on my readers and colleagues to look to the innovators of ideas, products and relationships and recognize that through collaboration with each other, we have an opportunity to recast the health ecosystem. Recognize that our work is a life-saving effort about being part of people’s transformational moments. And be courageous enough to know when you don’t know.  From there, we can begin the journey toward healing, together.

The post Looking for Zebras: Medical Mysteries and Transformational Patient Moments appeared first on Medika Life.

DO YOU GET HEARTBURN? Stomach contents heading back into the esophagus (gastroesophageal reflux) are not unexpected. For many, these episodes are fleeting and do not cause symptoms or injury to the esophagus.

Gastroesophageal reflux becomes a problem when it causes significant damage to the esophagus or symptoms.

Today we look at the physiology of gastroesophageal reflux, causes, symptoms, diagnosis, and potential non-medical interventions for management.

We’ll end with the observation that those who sleep on their left side have less potentially harmful stomach acid than others.

What is reflux (GERD)?

At your stomach’s entrance is a functional valve, a muscle ring known as the lower esophageal sphincter (LES). Usually, the LES closes after food passes through it.

If the sphincter does not entirely close (or it opens too frequently), stomach acid can move backward into your esophagus. With this retrograde acid flow, one can experience symptoms such as burning chest discomfort or heartburn.

WebMD offers that if acid reflux symptoms happen more than twice per week, you may have acid reflux disease, also known as gastroesophageal reflux disease (GERD).

If your symptoms of acid reflux occur more than twice weekly, you may have gastroesophageal (acid) reflux disease.

Reflux: Common risk factors

A common cause of acid reflux is a hiatal hernia. This condition happens when the upper stomach and the lower esophageal sphincter slip above the diaphragm (the muscle separating your stomach from the chest). If you have a hiatal hernia, acid can more easily move up into your esophagus, causing acid reflux disease.

Other risk factors for acid reflux disease include:

• Being overweight or obese
• Consuming large meals or lying down right after eating
• Eating certain foods, for example, such as spicy or fatty foods. Some get heartburn from citrus, tomato, mint, garlic, or onions.
• Drinking beverages such as alcohol, carbonated drinks, coffee, or tea
• Smoking
• Being pregnant
• Taking certain medicines (aspirin, ibuprofen, certain muscle relaxers, and some blood pressure medicines are examples)

Reflux (GERD): Symptoms

The Mayo Clinic (USA) explains that common symptoms of gastroesophageal reflux disease (GERD) include:

• Chest pain
• Heartburn (a burning sensation in your chest, typically after eating). Heartburn can be worse at night.
• Swallowing difficulty
• Regurgitation of food or sour liquid
• Lump in your throat sensation

This burning can occur anytime but is often worse after eating. For many, heartburn gets worse when they recline or lie in bed, making getting good sleep a challenge.

The Mayo Clinic offers that you should seek immediate medical care if you have chest pain (especially if you also have shortness of breath or jaw or arm pain). These may be symptoms of a heart attack.

Make an appointment with your doctor if you have severe or frequent GERD symptoms. Also, check-in with your healthcare provider if you use over-the-counter medications for heartburn more than twice weekly.

The perils of GERD

Did you know that more than 75 percent of individuals with asthma have GERD? Those with asthma are twice as likely to have GERD as those without the condition.

Gastroesophageal reflux disease may worsen asthma symptoms, and asthma drugs can worsen GERD. But treating GERD often helps to relieve asthma symptoms. The mechanism of action is not clear.

GERD (chronic acid reflux) can be dangerous or even life-threatening. It’s not the GERD per see that is the issue; instead, chronic GERD can promote:

• Esophagus inflammation (esophagitis). Stomach acid can irritate and inflame the esophagus lining, culminating in heartburn, chest pain, bleeding, or challenges swallowing.
• Barrett’s esophagus. About ten percent of those with chronic GERD develop this condition. Here, the long-term damage from acid hitting the esophagus lining can cause cells to be abnormal; when this occurs, we call it Barrett’s esophagus, a risk factor for esophagus cancer.
• Esophagus cancer. Adenocarcinoma is a cancer type that typically develops in the lower esophagus. Squamous cell carcinoma more commonly affects the middle and upper esophagus.
• Strictures. The damaged esophagus sometimes becomes scarred, resulting in narrowing of the structure. Strictures can make drinking or eating challenging.

GERD and sleep position

Medicines can help with GERD. Many can benefit from lifestyle interventions. For example, try sleeping on your left side. This position appears to be the best sleeping one for people with GERD, as it reduces reflux episodes. On the other hand, sleeping on your back can make reflux more likely.

An old-school trick is to raise the head of the bed. Propping it up (not just putting more pillows under your head) by at least six inches may reduce your reflux when you are lying down.

You can find some more intense interventions for GERD here:Treatment for GER & GERD | NIDDKYour doctor may recommend that you make lifestyle changes and take medicines to manage symptoms of gastroesophageal…www.niddk.nih.gov.

GERD — my take

If you have symptoms of GERD, please discuss them with a healthcare provider. Having a good weight can help us dodge acid reflux. In addition, don’t eat overly large meals or lie down immediately after eating.

Be careful with spicy or fatty foods, citrus, tomato, garlic, mint, and onions. I try to avoid peppermint in the evening but have no trouble with it during other times of the day.

I don’t drink alcohol but do consume e risk-increasing coffee and tea. I am sure you are not surprised that I don’t smoke. Finally, be careful with the medicines such as aspirin, ibuprofen, certain muscle relaxers, and some blood pressure medicines.

The post Heading Off Heartburn appeared first on Medika Life.

Researchers are increasingly reporting health benefits associated with the consumption of moderate amounts of black coffee. Do you drink three to five cups daily? Good for you — we have some evidence that you may be lowering your risk of Parkinson’s disease, type 2 diabetes, heart disease, and some forms of cancer.

Of course, it is best if you dodge milk, sugar, and fattening flavorings many of us tend to add.

Let’s look at some new research that highlights the importance of genetics in determining our preferences when adding cream and sugar to coffee and regarding chocolate types. By the end, you’ll understand why some call coffee a “cup of Joe.”

Coffee consumption is common.

More than 150 million Americans join me in my coffee drinking habit. The developed world accounts for nearly 72 percent of the world’s beverage consumption.

In the United States, the average adult’s consumption is roughly two cups daily. There is great variability in content by coffee type and retailer. Here’s a breakdown:

• Brewed coffee (8 ounces; 235 mL) — 133 mg (range 102–200)
• Instant coffee (8 ounces; 235 mL) — 93 mg (range 27–173)
• Coffee, decaffeinated (8 ounces; 235 mL) — 5 mg (range 3–12)
• Espresso (1 ounce; 30 mL) — 40 mg (range 30–90)
• Espresso, decaffeinated (1 ounce; 30 mL) — 4 mg

Males consume more coffee than females on average, at least in the USA. Consumption appears lower among African-Americans than among whites.

Tea consumption is on the rise

Tea to the English is really a picnic indoors. — Alice Walker

While tea is not the primary focus today, I wanted to share with you some interesting statistics.

More and more Americans are drinking tea. The Tea Association of the USA offers that 87 percent of consumption is black tea, 12.5 percent green tea, and the small remaining percentage oolong and herbal teas.

More than 80 percent of consumers in the United States drink tea, with millennials the most likely at more than 87 percent. On any given day, more than half of Americans drink tea. The highest consumption is in the Northeast and South regions, respectively.

Consumers prefer tea over coffee in Asia, Argentina, Chile, Paraguay, and Uruguay. Behind water, tea is the second most commonly consumed beverage globally. People take in three times as much tea as coffee.

Trivia question: Did you know that as much as 80 percent of tea consumed in the States is iced? I love that (without additives) it is nearly fat-free and has no sodium, carbonation, or sugar.

Tea contains flavonoids, natural substances that appear to have antioxidant properties. Tea flavonoids can help neutralize free radicals (which we believe can contribute to chronic disease).

Black coffee, dark chocolate, and genes

The greatest tragedies were written by the Greeks and Shakespeare … neither knew chocolate. — Sandra Boynton

Do you like your coffee black? If you answered yes, you probably also prefer dark and bitter chocolate. Recently writing in Nature Scientific Reports, Dr. Cornelis and colleagues analyzed types of coffee drinkers, separating black coffee lovers from those who prefer their coffee with cream and sugar (or more).

Let’s get right to the findings:

Coffee drinkers with a genetic variant reflecting a faster caffeine metabolism prefer bitter, black coffee. The same genetic variant is present in people who prefer plain rather than sweetened tea. We can find the gene change in those who prefer dark chocolate over milk chocolate.

Now it gets even more interesting: The researchers don’t think the coffee or tea preference is secondary to the taste of the drinks. Instead, they believe that people with this gene “prefer black coffee and tea because they associated bitter flavor with the improved mental alertness they crave from caffeine.”

In essence, we equate caffeine’s bitterness with a brain stimulation effect; this is a learned behavior and preference. The same holds for preferring dark chocolate over milk: Think caffeine, think bitter (and choose dark chocolate).

Dark chocolate has limited amounts of caffeine but also contains theobromine, a caffeine-related nervous system stimulant. High doses of theobromine may dampen your mood and increase your heart rate.

Researchers look forward to looking at genetic preferences for other bitter foods. Cornelis observes that bitter foods are “generally associated with more health benefits.”

Let’s hope that those genetically predisposed to prefer dark chocolate (or black coffee) are more likely to engage in other health-promoting behaviors.

Coffee shops

Do you have a favorite coffee shop? I searched for outstanding coffee and chocolate, cafes, and museums on my last visit to Barcelona. Here is a cafe that I highly recommend: Granja M. Viader.

This historical cafe dates back to 1870, and the owners do an excellent job placing memorabilia on the walls. Picasso enjoyed its chocolates, and I loved (repeat: loved) the fresh churros. If you miss your childhood, consider a Cacaolat, a vintage refreshment.

Now, a trivia question: What is coffee sometimes called “Joe?” The use of the term dates back to the early 1900s when Joseph Daniels served as Secretary of the US Navy. A new biography explains that Daniels attempted to “imbue the navy with a strict morality.”

The Secretary increased the number of chaplains, discouraged prostitution at naval bases, and banned alcohol consumption. Stewards purchased more coffee to substitute for the beverage, and Daniels’ name became associated with coffee. Less than pleased folks called it “a cup of Joeseph Daniels,” a label soon shortened to a “cup of Joe.”

Thank you for joining me. I hope you have a health- and joy-filled 2022.

The post Like Dark Chocolate or Black Coffee? Here’s Why appeared first on Medika Life.

“life is either
a daring adventure
or quiet moments spent with chocolate
and your tortured sanity.”
― Ben Ditmars

We begin with this observation: You may improve your blood flow and pressure by consuming dark chocolate. Here’s how the magic may happen — Flavanols in dark chocolate can stimulate the inner lining of our arteries, in turn leading these blood vessels to make nitric oxide.

Nitric oxide can then signal the arteries to relax. The result? Resistance to blood flow drops, resulting in blood pressure reduction. But do we have real-world data to support this observation? Indeed, we have some evidence of a mild effect on blood pressure.

In support of our observations, researchers at Harvard Medical School and Brigham and Women’s Hospital showed that flavanol-rich cocoa causes blood vessel widening via activation of the nitric oxide system. This finding supports the idea that nitric oxide is the agent through which dark chocolate protects against adverse heart events.

To see if cocoa consumption leads to blood pressure lowering, scientists in Cologne (Germany) searched for studies that assessed blood pressure before and after consuming cocoa products or black or green tea for at least one week.

The researchers identified five randomized clinical studies of cocoa. After the cocoa, the average systolic (top number) and diastolic (bottom number) blood pressure dropped by about 5 mm Hg and 8 mm Hg, respectively. On the other hand, black or green tea did not affect blood pressure. The study authors concluded this:

“Consumption of foods rich in cocoa may drop blood pressure, but tea has no such effect.”

Other studies demonstrate a mild positive effect of cocoa consumption on blood pressure. The improvement is typically slight.

Dark chocolate and heart health

Back to the real world. Is there any evidence that any of this translates into improvements in health? A small study from the Netherlands offers hope that we lovers of dark chocolate can improve our cardiovascular health.

We know that small and relatively short-term clinical studies show that cocoa can improve blood vessel function and reduce blood pressure. Dutch researchers examined 470 older men free of chronic diseases at baseline to better understand whether longer-term cocoa is related to blood pressure and cardiovascular death.

Scientists examined blood pressure (of participants in the Zutphen Elderly Study) at baseline and five years later. The researchers also determined causes of death during 15 years of follow-up, assessed food intake, and estimated cocoa intake.

One-third of the subjects consumed no cocoa at study entry. For the food consumers, the average intake was 2.11 grams daily. Let’s get to the findings:

• The average systolic (top number) blood pressure in the highest one-third of cocoa intake appeared about 4 mm Hg lower, and the average diastolic (bottom number) blood pressure by just over 2 mm Hg.
• Compared with the lowest one-third of cocoa intake, the men in the highest third appeared one-half less likely to die of cardiovascular disease, and all-cause death also appeared about 50 percent lower over 15 years.

“Well, he should have some chocolate, at the very least,’ said Madam Pomfrey”
― J.K. Rowling, Harry Potter and the Prisoner of Azkaban

A separate study revealed chocolate consumption to be inversely associated with heart artery plaque. Here are the odds ratios by the amount of chocolate consumed:

• No chocolate 1.0
• Chocolate one to three times per month 0.94
• Chocolate once per week 0.78
• Chocolate at least twice weekly 0.68

Put more simply, eating chocolate at least twice per week appeared associated with a one-third lower risk of developing coronary artery plaque.

Moreover, you may lower your LDL “bad” cholesterol with your dark chocolate consumption. Look at the results of this 2017 experiment with participants consuming almonds, with or without dark chocolate.

Here are the findings from the randomized feeding trial: Consumption of almonds alone, with or without dark chocolate, improves cholesterol (lipid) profiles. The study authors concluded this: “Incorporating almonds, dark chocolate, and cocoa into a typical American diet without exceeding energy needs may reduce the risk of coronary heart disease.”

Now I need to challenge my enthusiasm for dark chocolate. The studies I offer you are either relatively small or observational. The latter type of study does not allow us to establish a causal relationship between chocolate consumption and improved cardiovascular health. And the change in blood pressure is small. So take all of this with a grain of salt (I prefer sea salt!).

Please don’t head out and consume vast quantities of chocolate. Too many calories! I prefer to have a couple of squares after dinner. By limiting myself, the experience becomes even more special. Aim for dark chocolate that has at least 70 percent cocoa content.

Thank you for joining me today.

The post How You Can Use Dark Chocolate For Heart Health appeared first on Medika Life.

Cardia

The cardia is the portion of the stomach surrounding the cardioesophageal junction, or cardiac orifice (the opening of the esophagus into the stomach). Tumors of the cardioesophageal junction are usually coded to the stomach.

Fundus

The fundus is the enlarged portion to the left and above the cardiac orifice.

Body

The body, or corpus, is the central part of the stomach.

Pyloric antrum

The pyloric antrum is the lower or distal portion above the duodenum. The opening between the stomach and the small intestine is the pylorus, and the very powerful sphincter, which regulates the passage of chyme into the duodenum, is called the pyloric sphincter.

The stomach is suspended from the abdominal wall by the lesser omentum. The greater omentum attaches the stomach to the transverse colon, spleen and diaphragm.

The common mesentery suspends the small intestine. The parietal peritoneum lies over the duodenum and other structures, such as the abdominal aorta. Because they lie behind the peritoneum, they are called retroperitoneal structures.

Layers of the stomach wall

The stomach is made up of several layers of tissue:

• The mucosa (mucous membrane) is the inner lining of the stomach. When the stomach is empty the mucosa has a ridged appearance. These ridges (rugae) flatten out as the stomach fills with food.
• The next layer that covers the mucosa is the submucosa. It is made up of connective tissue that contains larger blood and lymph vessels, nerve cells and fibres.
• The muscularis propria (or muscularis externa) is the next layer that covers the submucosa. It is the main muscle of the stomach and is made up of 3 layers of muscle.
• The serosa is the fibrous membrane that covers the outside of the stomach. The serosa of the stomach is also called the visceral peritoneum.

Function

The stomach has 3 main functions:

• temporary storage for food, which passes from the esophagus to the stomach where it is held for 2 hours or longer
• mixing and breakdown of food by contraction and relaxation of the muscle layers in the stomach
• digestion of food

The mucosa contains specialized cells and glands that produce hydrochloric acid and digestive enzymes to help digest food. The mucosa in the cardiac and pyloric regions of the stomach release mucus that helps protect the lining of the stomach from the acid produced for digestion. Other specialized cells in the mucosa of the pylorus release the hormone gastrin into the blood. Gastrin helps to stimulate the release of acid and enzymes from the mucosa. Gastrin also helps the muscles of the stomach to start contracting.

Food is broken down into a thick, acidic, soupy mixture called chyme. The pyloric sphincter relaxes once chyme formation is complete. Chyme then passes into the duodenum. The duodenum plays a big role in absorption of the food we eat. The stomach does not play a big role in absorption of food. It only absorbs water, alcohol and some drugs.

The post The Stomach appeared first on Medika Life.

The small intestine extends from the pyloric sphincter to the ileocecal valve, where it empties into the large intestine. The small intestine finishes the process of digestion, absorbs the nutrients, and passes the residue on to the large intestine. The liver, gallbladder, and pancreas are accessory organs of the digestive system that are closely associated with the small intestine.

The small intestine is divided into the duodenum, jejunum, and ileum. The small intestine follows the general structure of the digestive tract in that the wall has a mucosa with simple columnar epithelium, submucosa, smooth muscle with inner circular and outer longitudinal layers, and serosa. The absorptive surface area of the small intestine is increased by plicae circulares, villi, and microvilli.

Exocrine cells in the mucosa of the small intestine secrete mucus, peptidase, sucrase, maltase, lactase, lipase, and enterokinase. Endocrine cells secrete cholecystokinin and secretin.

The most important factor for regulating secretions in the small intestine is the presence of chyme. This is largely a local reflex action in response to chemical and mechanical irritation from the chyme and in response to distention of the intestinal wall. This is a direct reflex action, thus the greater the amount of chyme, the greater the secretion.

Large Intestine

The large intestine is larger in diameter than the small intestine. It begins at the ileocecal junction, where the ileum enters the large intestine, and ends at the anus. The large intestine consists of the colon, rectum, and anal canal.

The wall of the large intestine has the same types of tissue that are found in other parts of the digestive tract but there are some distinguishing characteristics. The mucosa has a large number of goblet cells but does not have any villi. The longitudinal muscle layer, although present, is incomplete. The longitudinal muscle is limited to three distinct bands, called teniae coli, that run the entire length of the colon. Contraction of the teniae coli exerts pressure on the wall and creates a series of pouches, called haustra, along the colon. Epiploic appendages, pieces of fat-filled connective tissue, are attached to the outer surface of the colon.

Unlike the small intestine, the large intestine produces no digestive enzymes. Chemical digestion is completed in the small intestine before the chyme reaches the large intestine. Functions of the large intestine include the absorption of water and electrolytes and the elimination of feces.

Rectum and Anus

The rectum continues from the sigmoid colon to the anal canal and has a thick muscular layer. It follows the curvature of the sacrum and is firmly attached to it by connective tissue. The rectum ends about 5 cm below the tip of the coccyx, at the beginning of the anal canal.

The last 2 to 3 cm of the digestive tract is the anal canal, which continues from the rectum and opens to the outside at the anus. The mucosa of the rectum is folded to form longitudinal anal columns. The smooth muscle layer is thick and forms the internal anal sphincter at the superior end of the anal canal. This sphincter is under involuntary control. There is an external anal sphincter at the inferior end of the anal canal. This sphincter is composed of skeletal muscle and is under voluntary control.

The post The Intestinal Tract appeared first on Medika Life.

The liver is a dark reddish-brown color, and is shaped a bit like a wedge. It weighs about 3 pounds. The liver has 2 lobes. Both are made up of 8 segments that have of 1,000 small lobes called lobules. These lobules are connected to small tubes (ducts) that lead to larger ducts that form the common hepatic duct. The common hepatic duct sends the bile made by the liver cells to the gallbladder and the first part of the small intestine (duodenum) through the common bile duct.

The liver holds about 1 pint (13%) of your body’s blood supply. There are 2 blood vessels that send blood to the liver. They are:

• Hepatic artery. This sends oxygen-rich blood to the liver.
• Hepatic portal vein. This sends nutrient-rich blood to the liver.

Functions of the liver

The liver has more than 500 vital functions. All the blood leaving the stomach and intestines passes through the liver. The liver processes this blood. It breaks down, balances, and creates nutrients. It also processes medicines and other chemicals. The liver:

• Makes bile, which helps carry away waste and break down fats in the small intestine during digestion
• Makes certain proteins for blood plasma
• Makes cholesterol and proteins to help carry fats through the body
• Converts excess glucose into glycogen for storage and makes glucose as needed 
• Controls blood levels of amino acids, which are the building blocks of proteins
• Processes hemoglobin for its iron and then stores the iron
• Converts ammonia to urea, which is then excreted in urine
• Clears medicines, drugs and other substances from the blood
• Controls blood clotting
• Helps prevent infections by making immune factors and removing bacteria from the blood
• Clears bilirubin from the blood 

When the liver has broken down harmful substances, this waste is excreted into the bile or blood. Waste in bile enters the intestine and leaves the body in the form of feces. Waste in blood is filtered out by the kidneys, and leaves the body in the form of urine.

Anatomical Position

The liver is predominantly located in the right hypochondrium and epigastric areas, and extends into the left hypochondrium.

When discussing the anatomical position of the liver, it is useful to consider its external surfaces, associated ligaments, and the anatomical spaces (recesses) that surround it.

Anatomical Structure

The structure of the liver can be considered both macroscopically and microscopically.

Macroscopic

The liver is covered by a fibrous layer, known as Glisson’s capsule.

It is divided into a right lobe and left lobe by the attachment of the falciform ligament. There are two further ‘accessory’ lobes that arise from the right lobe, and are located on the visceral surface of liver:

• Caudate lobe – located on the upper aspect of the visceral surface. It lies between the inferior vena cava and a fossa produced by the ligamentum venosum (a remnant of the fetal ductus venosus).
• Quadrate lobe – located on the lower aspect of the visceral surface. It lies between the gallbladder and a fossa produced by the ligamentum teres (a remnant of the fetal umbilical vein).

Separating the caudate and quadrate lobes is a deep, transverse fissure – known as the porta hepatis. It transmits all the vessels, nerves and ducts entering or leaving the liver with the exception of the hepatic veins.

Microscopic

Microscopically, the cells of the liver (known as hepatocytes) are arranged into lobules. These are the structural units of the liver.

Each anatomical lobule is hexagonal-shaped and is drained by a central vein. At the periphery of the hexagon are three structures collectively known as the portal triad:

• Arteriole – a branch of the hepatic artery entering the liver.
• Venule – a branch of the hepatic portal vein entering the liver.
• Bile duct – branch of the bile duct leaving the liver.

The portal triad also contains lymphatic vessels and vagus nerve (parasympathetic) fibres.

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It descends downward into the superior mediastinum of the thorax, positioned between the trachea and the vertebral bodies of T1 to T4. It then enters the abdomen via the oesophageal hiatus (an opening in the right crus of the diaphragm) at T10.

The abdominal portion of the oesophagus is approximately 1.25cm long – it terminates by joining the cardiac orifice of the stomach at level of T11.

Anatomical Structure

The oesophagus shares a similar structure with many of the organs in the alimentary tract:

• Adventitia – outer layer of connective tissue.
  • Note: The very distal and intraperitoneal portion of the oesophagus has an outer covering of serosa, instead of adventitia.
• Muscle layer – external layer of longitudinal muscle and inner layer of circular muscle. The external layer is composed of different muscle types in each third:
  • Superior third – voluntary striated muscle
  • Middle third – voluntary striated and smooth muscle
  • Inferior third – smooth muscle
• Submucosa
• Mucosa – non-keratinised stratified squamous epithelium (contiguous with columnar epithelium of the stomach).

Food is transported through the oesophagus by peristalsis – rhythmic contractions of the muscles which propagate down the oesophagus. Hardening of these muscular layers can interfere with peristalsis and cause difficulty in swallowing (dysphagia).

Oesophageal Sphincters

There are two sphincters present in the oesophagus, known as the upper and lower oesophageal sphincters. They act to prevent the entry of air and the reflux of gastric contents respectively.

Upper Oesophageal Sphincter

The upper sphincter is an anatomical, striated muscle sphincter at the junction between the pharynx and oesophagus. It is produced by the cricopharyngeus muscle. Normally, it is constricted to prevent the entrance of air into the oesophagus.

Lower Oesophageal Sphincter

The lower oesophageal sphincter is a physiological sphincter located in the gastro-oesophageal junction (junction between the stomach and oesophagus). The gastro-oesophageal junction is situated to the left of the T11 vertebra, and is marked by the change from oesophageal to gastric mucosa.

The sphincter is classified as a physiological (or functional) sphincter, as it does not have any specific sphincteric muscle. Instead, the sphincter is formed from four phenomena:

• The oesophagus enters the stomach at an acute angle.
• The walls of the intra-abdominal section of the oesophagus are compressed when there is a positive intra-abdominal pressure.
• The folds of mucosa present aid in occluding the lumen at the gastro-oesophageal junction.
• The right crus of the diaphragm has a “pinch-cock” effect.

During oesophageal peristalsis, the sphincter is relaxed to allow food to enter the stomach. Otherwise at rest, the function of this sphincter is to prevent the reflux of acidic gastric contents into the oesophagus.

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Location of the Pancreas

The pancreas is located behind the stomach in the upper left abdomen. It is surrounded by other organs including the small intestine, liver, and spleen. It is spongy, about six to ten inches long, and is shaped like a flat pear or a fish extended horizontally across the abdomen.

The wide part, called the head of the pancreas, is positioned toward the center of the abdomen. The head of the pancreas is located at the juncture where the stomach meets the first part of the small intestine. This is where the stomach empties partially digested food into the intestine, and the pancreas releases digestive enzymes into these contents.

The central section of the pancreas is called the neck or body. The thin end is called the tail and extends to the left side.

Several major blood vessels surround the pancreas, the superior mesenteric artery, the superior mesenteric vein, the portal vein and the celiac axis, supplying blood to the pancreas and other abdominal organs.

Almost all of the pancreas (95%) consists of exocrine tissue that produces pancreatic enzymes for digestion. The remaining tissue consists of endocrine cells called islets of Langerhans. These clusters of cells look like grapes and produce hormones that regulate blood sugar and regulate pancreatic secretions.

Functions of the Pancreas

A healthy pancreas produces the correct chemicals in the proper quantities, at the right times, to digest the foods we eat.

Exocrine Function:

The pancreas contains exocrine glands that produce enzymes important to digestion. These enzymes include trypsin and chymotrypsin to digest proteins; amylase for the digestion of carbohydrates; and lipase to break down fats. When food enters the stomach, these pancreatic juices are released into a system of ducts that culminate in the main pancreatic duct. The pancreatic duct joins the common bile duct to form the ampulla of Vater which is located at the first portion of the small intestine, called the duodenum. The common bile duct originates in the liver and the gallbladder and produces another important digestive juice called bile. The pancreatic juices and bile that are released into the duodenum, help the body to digest fats, carbohydrates, and proteins.

Endocrine Function:

The endocrine component of the pancreas consists of islet cells (islets of Langerhans) that create and release important hormones directly into the bloodstream. Two of the main pancreatic hormones are insulin, which acts to lower blood sugar, and glucagon, which acts to raise blood sugar. Maintaining proper blood sugar levels is crucial to the functioning of key organs including the brain, liver, and kidneys.

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