The Digestive System and How It Works
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The Anatomy of the Rectum and Anal Canal
BASIC SCIENCE identify the rectosigmoid junction with confidence at operation. The anatomy of the rectum The rectosigmoid junction usually lies approximately 6 cm below the level of the sacral promontory. Approached from the distal and anal canal end, however, as when performing a rigid or flexible sigmoid- oscopy, the rectosigmoid junction is seen to be 14e18 cm from Vishy Mahadevan the anal verge, and 18 cm is usually taken as the measurement for audit purposes. The rectum in the adult measures 10e14 cm in length. Abstract Diseases of the rectum and anal canal, both benign and malignant, Relationship of the peritoneum to the rectum account for a very large part of colorectal surgical practice in the UK. Unlike the transverse colon and sigmoid colon, the rectum lacks This article emphasizes the surgically-relevant aspects of the anatomy a mesentery (Figure 1). The posterior aspect of the rectum is thus of the rectum and anal canal. entirely free of a peritoneal covering. In this respect the rectum resembles the ascending and descending segments of the colon, Keywords Anal cushions; inferior hypogastric plexus; internal and and all of these segments may be therefore be spoken of as external anal sphincters; lymphatic drainage of rectum and anal canal; retroperitoneal. The precise relationship of the peritoneum to the mesorectum; perineum; rectal blood supply rectum is as follows: the upper third of the rectum is covered by peritoneum on its anterior and lateral surfaces; the middle third of the rectum is covered by peritoneum only on its anterior 1 The rectum is the direct continuation of the sigmoid colon and surface while the lower third of the rectum is below the level of commences in front of the body of the third sacral vertebra. -
Coffee and Its Effect on Digestion
Expert report Coffee and its effect on digestion By Dr. Carlo La Vecchia, Professor of Medical Statistics and Epidemiology, Dept. of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy. Contents 1 Overview 2 2 Coffee, a diet staple for millions 3 3 What effect can coffee have on the stomach? 4 4 Can coffee trigger heartburn or GORD? 5 5 Is coffee associated with the development of gastric or duodenal ulcers? 6 6 Can coffee help gallbladder or pancreatic function? 7 7 Does coffee consumption have an impact on the lower digestive tract? 8 8 Coffee and gut microbiota — an emerging area of research 9 9 About ISIC 10 10 References 11 www.coffeeandhealth.org May 2020 1 Expert report Coffee and its effect on digestion Overview There have been a number of studies published on coffee and its effect on different areas of digestion; some reporting favourable effects, while other studies report fewer positive effects. This report provides an overview of this body of research, highlighting a number of interesting findings that have emerged to date. Digestion is the breakdown of food and drink, which occurs through the synchronised function of several organs. It is coordinated by the nervous system and a number of different hormones, and can be impacted by a number of external factors. Coffee has been suggested as a trigger for some common digestive complaints from stomach ache and heartburn, through to bowel problems. Research suggests that coffee consumption can stimulate gastric, bile and pancreatic secretions, all of which play important roles in the overall process of digestion1–6. -
Evaluation of Abnormal Liver Chemistries
ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries Paul Y. Kwo, MD, FACG, FAASLD1, Stanley M. Cohen, MD, FACG, FAASLD2, and Joseph K. Lim, MD, FACG, FAASLD3 1Division of Gastroenterology/Hepatology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA; 2Digestive Health Institute, University Hospitals Cleveland Medical Center and Division of Gastroenterology and Liver Disease, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; 3Yale Viral Hepatitis Program, Yale University School of Medicine, New Haven, Connecticut, USA. Am J Gastroenterol 2017; 112:18–35; doi:10.1038/ajg.2016.517; published online 20 December 2016 Abstract Clinicians are required to assess abnormal liver chemistries on a daily basis. The most common liver chemistries ordered are serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase and bilirubin. These tests should be termed liver chemistries or liver tests. Hepatocellular injury is defined as disproportionate elevation of AST and ALT levels compared with alkaline phosphatase levels. Cholestatic injury is defined as disproportionate elevation of alkaline phosphatase level as compared with AST and ALT levels. The majority of bilirubin circulates as unconjugated bilirubin and an elevated conjugated bilirubin implies hepatocellular disease or cholestasis. Multiple studies have demonstrated that the presence of an elevated ALT has been associated with increased liver-related mortality. A true healthy normal ALT level ranges from 29 to 33 IU/l for males, 19 to 25 IU/l for females and levels above this should be assessed. The degree of elevation of ALT and or AST in the clinical setting helps guide the evaluation. -
Jaw Movement Dysfunction Related to Parkinson's Disease and Partially Modified by Levodopa
Journal ofNeurology, Neurosurgery, and Psychiatry 1996;60:41-50 41 Jaw movement dysfunction related to Parkinson's J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.60.1.41 on 1 January 1996. Downloaded from disease and partially modified by levodopa Lee T Robertson, John P Hammerstad Abstract also have difficulties in the production of clear Objectives-To test the hypotheses that speech5 and with the automatic clearing of the Parkinson's disease can differentially throat or swallowing.3 Although the same produce deficits in voluntary and rhyth- peripheral structures are involved in various mic jaw movements, which involve differ- oral motor acts, such as speaking, swallowing, ent neuronal circuits, and that levodopa or chewing, distinct basal ganglia circuits may treatment improves specific components be used to generate the various motor pat- of the motor deficit. terns.6 The neural circuits involved in volun- Methods-Patients with idiopathic tary movement of the mandible may be Parkinson's disease and control subjects different from those used for force production were tested on a series of jaw motor tasks whereas those circuits regulating chewing may that included simple voluntary move- include portions of circuits for voluntary ment, isometric clenching, and natural movement and force as well as additional cir- and paced rhythmic movements. Jaw cuits to process specific sensory input. A major movements were measured by changes in basal ganglia circuit is the projection from the electromagnetic fields and EMG activity. globus pallidus and substantia nigra reticulata, Patients with Parkinson's disease with via the thalamus, to the primary motor cortex, fluctuations in motor responses to lev- the supplementary motor cortex, and the pre- odopa were tested while off and on. -
Ingestion in Mammals Introductory Article
Ingestion in Mammals Introductory article Christine E Wall, Duke University, Durham, North Carolina, USA Article Contents Kathleen K Smith, Duke University, Durham, North Carolina, USA . Introduction . Capture Ingestion in mammals is distinguished from that of other vertebrates by mastication, . Oral Transport suckling, and complex food transport and swallowing. The teeth, cranial bones, and . Mastication musculature of the head reflect these distinguishing features. Swallowing . Suckling Introduction Ingestion is a series of biologically complex activities lized for live prey capture and killing (Figure 1b). In some (capture, incision, transport, mastication, swallowing and, mammals, particularly in herbivores, the canines are in infant mammals, suckling) performed by the oral absent, leaving a space, called a diastema, between the apparatus. The oral apparatus includes the dentition, the incisors at the front of the mouth and the premolars and masticatory muscles, numerous bones of the cranium, the molars at the back of the mouth (Figure 1c). squamosal–dentary joints connecting the lower jaw to the The premolars and molars are commonly referred to as skull, the tongue, and many other structures in the head. the postcanine dentition or the cheek teeth. These teeth are Mammals are distinguished from other vertebrates in sometimes used during food capture, but they are many aspects of ingestion. For example, in most other specialized to initiate the digestive process by breaking vertebrates, mastication does not occur. Also, food down the food so that it is the proper size and consistency transport and swallowing are less complex in other for swallowing and further digestion by the gut. Premolars vertebrates and generally involve the coordination of and molars have bumps (called cusps), ridges (called crests fewer muscles and other soft tissue structures. -
Chewing Practice
FEEDING AND EATING Chewing practice Speech Pathology Some children find chewing foods difficult. This might simply be because they haven’t had enough practice with foods other than purées. Some children might gag, refuse or spit out chewy solids or lumps. Chewing is a skill that children learn with practice such as mouthing objects and foods. Early chewing is usually established between 6 and 9 months of age. Exposure and practice with different textures of food between 6 and 10 months old may help a child accept a larger range of different foods as they get older. Teeth or no teeth • Use a gum-brush, training toothbrush, your finger, or your child’s finger to move food to the side of her There are many steps to learning to chew. Children can mouth to practise chewing. practise these skills before they have teeth. • Give long, thick strips of very chewy foods (e.g. crusty Some ideas to help develop bread, or dried strips of mango). Show her how to hold the food and move her jaw up and down. Help her hold chewing skills the food on her back gums. No teeth: early chewing skills • Practise chewing with foods that dissolve. These are • Give a gum-brush or training toothbrush foods that melt in the mouth with saliva so are easier to practise munching. to swallow (e.g. wafer or baby rice cracker). • Give ‘hard munchable’ foods such as a rusk Always supervise your child closely to make sure she does or a whole uncooked carrot for her to mouth. -
Mouth Esophagus Stomach Rectum and Anus Large Intestine Small
1 Liver The liver produces bile, which aids in digestion of fats through a dissolving process known as emulsification. In this process, bile secreted into the small intestine 4 combines with large drops of liquid fat to form Healthy tiny molecular-sized spheres. Within these spheres (micelles), pancreatic enzymes can break down fat (triglycerides) into free fatty acids. Pancreas Digestion The pancreas not only regulates blood glucose 2 levels through production of insulin, but it also manufactures enzymes necessary to break complex The digestive system consists of a long tube (alimen- 5 carbohydrates down into simple sugars (sucrases), tary canal) that varies in shape and purpose as it winds proteins into individual amino acids (proteases), and its way through the body from the mouth to the anus fats into free fatty acids (lipase). These enzymes are (see diagram). The size and shape of the digestive tract secreted into the small intestine. varies in each individual (e.g., age, size, gender, and disease state). The upper part of the GI tract includes the mouth, throat (pharynx), esophagus, and stomach. The lower Gallbladder part includes the small intestine, large intestine, The gallbladder stores bile produced in the liver appendix, and rectum. While not part of the alimentary 6 and releases it into the duodenum in varying canal, the liver, pancreas, and gallbladder are all organs concentrations. that are vital to healthy digestion. 3 Small Intestine Mouth Within the small intestine, millions of tiny finger-like When food enters the mouth, chewing breaks it 4 protrusions called villi, which are covered in hair-like down and mixes it with saliva, thus beginning the first 5 protrusions called microvilli, aid in absorption of of many steps in the digestive process. -
Common Bile-Duct Mucosa in Choledochoduodenostomy Patients--- Histological and Histochemical Study
HPB Surgery 1988, Vol. 1, pp. 15-20 (C) 1988 Harwood Academic Publishers GmbH Reprints available directly from the publisher Printed in Great Britain Photocopying permitted by license only COMMON BILE-DUCT MUCOSA IN CHOLEDOCHODUODENOSTOMY PATIENTS--- HISTOLOGICAL AND HISTOCHEMICAL STUDY E. ELEFTHERIADIS*, V. TZIOUFA 1, K. KOTZAMPASSI and H. ALETRAS Departments of Surgery and Pathology1, University of Thessaloniki, Greece We describe the histological and histochemical changes of the common bile-duct mucosa in specimens obtained by means of peroral cholangioscopy, 1-12 years after choledochoduodenal anastomosis. Our findings- hyperplasia of the superficial epithelium, metaplastic goblet cells containing predominantly acid sialomucins, and pyloric-like gland formation containing neutral mucins- express a morphological and functional differentiation of the common bile-duct mucosa that probably facilitates its survival in a different environment. We consider that these adaptive changes may explain the uneventful long-term postoperative period of choledochoduodenostomized patients. KEY WORDS" Common bile duct, choledochoduodenal anastomosis, adaptation, peroral cholangio- scopy. INTRODUCTION After choledochoduodenal anastomosis (CDA), the common bile-duct mucosa (CBDM) is exposed to a different environment, no longer being protected by the sphincter of Oddi. Although, theoretically, this new environment i.e. gastric acid and food flowing through the anastomosis- should affect it, both clinical practice and experimental data have shown no evidence -
Engineering Aspects of Food Processing - P.P
CHEMICAL ENGINEEERING AND CHEMICAL PROCESS TECHNOLOGY – Vol. V - Engineering Aspects of Food Processing - P.P. Lewicki ENGINEERING ASPECTS OF FOOD PROCESSING P.P. Lewicki Warsaw University of Life Sciences (SGGW), Warsaw, Poland The State College of Computer Science and Business Administration in Lomza, Poland Keywords: Metabolic energy requirement, food production, wet cleaning, dry cleaning, homogenization, membrane filtration, cyclones, clarifixator, coating, extrusion, agglomeration, fluidization, battering, uperisation, pasteurization, sterilization, baking, chilling, freezing, hydrocooling, cryoconcentration, glazing, extrusion-cooking, roasting, frying, thermoplasticity, logistics. Contents 1. Introduction 2. Food industry 3. Food processing 3.1. Mechanical Processes 3.2. Heat Transfer Processes 3.3. Mass Transfer Processes 3.4. Materials Handling 3.5. Hygiene of Processing 3.6. Food Engineering 4. Concluding remarks Glossary Bibliography Biographical Sketch Summary The main aim of this chapter is to show the impact of chemical and process engineering on the development of nowadays food industry. The contribution presents food as a substance needed to keep a man alive, which is consumed every day and must be produced in enormous amounts. Food industry is a manufacturer of food, employs hundred of UNESCOthousands of employees and uses– considerableEOLSS quantities of energy and water. Basic processes used in food processing are briefly described. They are divided into three groups of unit operations that are mechanical processes and heat and mass transfer processes. In each group of unit operations specificity of the process is emphasized. AtSAMPLE the same time, it is shown howCHAPTERS theories of momentum, heat and mass transfer developed by chemical engineering are applied in designing food-processing equipment. The question of hygienic design and processing of safe food is explicitly stressed. -
Inside the Minds: the Art and Science of Gastroenterology
Gastroenterology_ptr.qxd 8/24/07 11:29 AM Page 1 Inside the Minds ™ Inside the Minds ™ The Secrets to Success in The Art and Science of Gastroenterology Gastroenterology The Art and Science of Gastroenterology is an authoritative, insider’s perspective on the var- ious challenges in this field of medicine and the key qualities necessary to become a successful Top Doctors on Diagnosing practitioner. Featuring some of the nation’s leading gastroenterologists, this book provides a Gastroenterological Conditions, Educating candid look at the field of gastroenterology—academic, surgical, and clinical—and a glimpse Patients, and Conducting Clinical Research into the future of a dynamic practice that requires a deep understanding of pathophysiology and a desire for lifelong learning. As they reveal the secrets to educating and advocating for their patients when diagnosing their conditions, these authorities offer practical and adaptable strategies for excellence. From the importance of soliciting a thorough medical history to the need for empathy towards patients whose medical problems are not outwardly visible, these doctors articulate the finer points of a profession focused on treating disorders that dis- rupt a patient’s lifestyle. The different niches represented and the breadth of perspectives presented enable readers to get inside some of the great innovative minds of today, as experts offer up their thoughts around the keys to mastering this fine craft—in which both sensitiv- ity and strong scientific knowledge are required. ABOUT INSIDETHE MINDS: Inside the Minds provides readers with proven business intelligence from C-Level executives (Chairman, CEO, CFO, CMO, Partner) from the world’s most respected companies nationwide, rather than third-party accounts from unknown authors and analysts. -
Introduction to the Microbiology of Food Processing.Pdf
United States Department of Agriculture Food Safety and Inspection Service Introduction TO THE Microbiology OF Food Processing August 2012 Small Plant News Guidebook Series Small Plant News is a four-page, four-color newsletter published by the U.S. Department of Agriculture’s (USDA) Food Safety and Inspection Service (FSIS). It is targeted to small and very small Federal- and State-inspected establishment owners and operators who produce meat, poultry, and processed egg products. Small Plant News’s mission is to support the “FSIS’ Strategic Implementation Plan for Strengthening Small and Very Small Plant Outreach” by providing pertinent information for plant owners and operators so they can produce safe food and, ultimately, ensure the success of their livelihoods. The newsletter strives to do this through: ✔ Informing and educating small and very small plant owners and operators on FSIS news with current and meaningful information in an easy-to-read format. ✔ Assisting plant owners and operators in incorporating FSIS rules and regulations into their daily operational practices with “plain language” information. ✔ Fostering small and very small plants’ ability to stay in business and produce the safest food by providing essential tips that will encourage the highest sanitation standards, paperwork compliance, and cost-saving measures. ✔ Honoring FSIS’ obligations to small and very small plants by providing a mechanism that increases two-way dialogue between plants and the Agency. Back issues of Small Plant News are available on FSIS’ Web site at www.fsis.usda.gov. Or you may call the Small Plant Help Desk at (877) 374-7435 to order back copies. -
Acute Liver Failure J G O’Grady
148 Postgrad Med J: first published as 10.1136/pgmj.2004.026005 on 4 March 2005. Downloaded from REVIEW Acute liver failure J G O’Grady ............................................................................................................................... Postgrad Med J 2005;81:148–154. doi: 10.1136/pgmj.2004.026005 Acute liver failure is a complex multisystemic illness that account for most cases, but a significant number of patients have no definable cause and are evolves quickly after a catastrophic insult to the liver classified as seronegative or of being of indeter- leading to the development of encephalopathy. The minate aetiology. Paracetamol is the commonest underlying aetiology and the pace of progression strongly cause in the UK and USA.2 Idiosyncratic reac- tions comprise another important group. influence the clinical course. The commonest causes are paracetamol, idiosyncratic drug reactions, hepatitis B, and Viral seronegative hepatitis. The optimal care is multidisciplinary ALF is an uncommon complication of viral and up to half of the cases receive liver transplants, with hepatitis, occurring in 0.2%–4% of cases depend- ing on the underlying aetiology.3 The risk is survival rates around 75%–90%. Artificial liver support lowest with hepatitis A, but it increases with the devices remain unproven in efficacy in acute liver failure. age at time of exposure. Hepatitis B can be associated with ALF through a number of ........................................................................... scenarios (table 2). The commonest are de novo infection and spontaneous surges in viral repli- cation, while the incidence of the delta virus cute liver failure (ALF) is a complex infection seems to be decreasing rapidly. multisystemic illness that evolves after a Vaccination should reduce the incidence of Acatastrophic insult to the liver manifesting hepatitis A and B, while antiviral drugs should in the development of a coagulopathy and ameliorate replication of hepatitis B.