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Awaiting moderation 2418 Article |
Stomach and duodenum STOMACH AND DUODENUM
The narrow oesophageal passage suddenly balloons out into a strange shape a bit like a football. This is the stomach, and is a repository for all food eaten. It may take a large amount of food, and digestion continues rapidly in this area.
The stomach wall is lined with very important glands which produce two vital chemicals. One is hydrochloric acid, and this is extremely potent. It is similar to the acid plumbers clean metal surfaces with preparatory to soldering. You have all seen the way in which it sizzles and fizzes when it touches the metal, burning away dirt and impurities, cleansing the surface so that the new solder will adhere.
Q. Are you trying to say the G.I. system is a drain pipe?
A. Not really — I am simply pointing out how strong this acid is, for it bears enormous importance to events which commonly produce major internal problems. If you ever vomit (and who hasn't at some stage), notice how hot and burning the feeling is as the acid contents come up the oesophagus and into the mouth. You can feel the discomfort all the way up, and even the mouth and tongue seem on fire. This is due to the burning effect of the powerful hydrochloric acid, or HQ, to use chemical terms.
Q. What is the acid used for?
A. The acid acts on the food, and helps to digest it further. It also kills germs, and is very important in preventing germs which may adversely affect the body from penetrating the bowel where they could cause adverse symptoms and other diseases.
Q. What happens if there is too much acid present?
A. I am glad you asked. The effect may be serious. It can happily attack the food and prepare it for digestion and absorption by the bowel later on. But if there is too much present, then it will attack itself! Imagine this. The stomach wall produces acid to help digest food, but in so doing, it may start to digest itself. It sounds crazy, but this is exactly what takes place. At first only a small part of the stomach lining may be involved, but as time progresses, this may become both more extensive and deeper.
Q. That must mean an ulcer develops.
A. That is correct. Excessive stomach acid production, a condition called hyperchlorhydria, may predispose to the formation of one or more stomach ulcers. These are commonly called peptic ulcers, or gastric ulcers.
Q. What if there is no acid present?
A. In some people, a condition called achlorhydria, is present. This means there is a marked reduction in acid production by the stomach wall glands. It may be entirely absent. These people will never, but never develop ulcers. On the other hand, however, they are more likely to develop other disorders. There is a greater risk of germs passing into the bowel. Also, a vital product called vitamin B12 is not absorbed, and a serious condition called pernicious anaemia may develop. In turn, vitamin B12 deficiency may lead to a serious nervous disorder as the years pass.
Ideally, the stomach walls produce the correct amount of acid so the digestion may proceed in a normal, orderly manner. In the average person in good health, this is generally what happens.
Q. You said another chemical was produced by the stomach walls. What is it called?
A. The other one is called pepsin, and it mixes with the acid. In fact, the acid stimulates the pepsin glands to work and, hand in hand, the two chemicals attack the food, and help to break it down into a form acceptable to the intestinal system a bit further down. Once again, pepsin plays a part in the formation of ulcers.
Q. Do these chemicals cause cancer of the stomach?
A. Cancer of the stomach is a fairly common disease, but doctors do not think it is caused by these chemicals. Certainly a cancer may be associated with a stomach ulcer, but the two are believed to be related by chance.
If a cancer is developing, it may erode the stomach lining and have the appearance of an ulcer, rather than acids chewing into the lining and causing the ulcer. We will talk more about stomach cancer later on, but I must say that it is a serious disease, is often difficult to diagnose early, produces very few early symptoms, and appears to be increasing in frequency in Australia. Fortunately, ulcer symptoms often lead to a full examination where the young cancer is picked up. This is indeed fortunate for otherwise it could be missed until too late. Treated early, there is a good chance of long term survival. If left, it is a one way ticket to doom.
Q. What happens to the food after it rolls around in the stomach for the required period of time?
A. It then proceeds via a narrow canal and valve called the pylorus into the next part of the system called the duodenum. This is simply the next part of the G.I. tract, and is much narrower than the stomach. Here digestion goes a step further, as various other chemicals called enzymes are pumped into it from other organs where they are manufactured. Certain ones are made in the pancreas. Others are made in the liver, stored in the gall bladder and, under stimulation from the duodenum, the gall bladder contracts, and collectively the chemicals come down via a little tube called the common bile duct to spurt into the duodenum and mix with food. You may have heard of the bile salts. These are present in greenish coloured fluid (called "bile"), and the main function is to help break down fats in the food to a form which is readily digested by the intestine lower down.
Q. Is that why some people say they feel liverish?
A. Correct. Some feel "bilious", or "liverish", specially after a big, fatty meal. This is because too many demands are being made on the bile system and the liver to manufacture more, or simply because the system cannot cope with all the fat.
Q. What about ulcers in the duodenum?
A. Once more this tube is affected by excessive amounts of acid and pepsin that come through from the stomach. Its walls are very sensitive to the savage attacks, and duodenal ulcers (which also go under the general name of peptic ulcers) are common in Australia. In fact, duodenal ulcers are one of the most common causes of serious recurring abdominal pain in this country. What is more, they may lead to important consequences if left untreated. But more of that later on.
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