Friday 17 June 2016

Stomach Pain -Gastric Ulcer-Cancer of the Stomach-Gastroscopy-

Stomach Pain
the stretching or spasmodic contraction of the smooth muscle is The main reason for  sensation of pain in the stomach which is caused by its walls and is referred to the epigastrium. It is believed that the paintransmitting fibers leave the stomach in company with the sympathetic nerves. They pass through the celiac ganglia and reach the spinal cord via the greater splanchnic nerves.

Gastric Ulcer
pepsin  is produced in The mucous membrane of the body of the stomach and, to a lesser extent, that of the fundus produce acid. The secretion of the antrum and pyloric canal is mucous and weakly alkaline. The secretion of acid and pepsin is controlled by two mechanisms: nervous and hormonal. The vagus nerves are responsible for the nervous control, and the hormone gastrin, produced by the antral mucosa, is responsible for the hormonal control. In the surgical treatment of chronic gastric and duodenal ulcers, attempts are made to reduce the amount of acid secretion by sectioning the vagus nerves (vagotomy) and by removing the gastrin-bearing area of mucosa, the antrum (partial gastrectomy). Gastric ulcers occur in the alkaline-producing mucosa of the stomach, usually on or close to the lesser curvature. A chronic ulcer invades the muscular coats and, in time, involves the peritoneum so that the stomach adheres to neighboring structures. An ulcer situated on the posterior wall of the stomach may perforate into the lesser sac or become adherent to the pancreas. Erosion of the pancreas produces pain referred to the back. The splenic artery runs along the upper border of the pancreas, and erosion of this artery may produce fatal hemorrhage. A penetrating ulcer of the anterior stomach wall may result in the escape of stomach contents into the greater sac, producing diffuse peritonitis. The anterior stomach wall may, however, adhere to the liver, and the chronic ulcer may penetrate the liver substance.


Cancer of the Stomach
Because the lymphatic vessels of the mucous membrane and submucosa of the stomach are in continuity, it is possible for cancer cells to travel to different parts of the stomach, some distance away from the primary site. Cancer cells also often pass through or bypass the local lymph nodes and are held up in the regional nodes. For these reasons, malignant disease of the stomach is treated by total gastrectomy, which includes the removal of the lower end of the esophagus and the first part of the duodenum; the spleen and the gastrosplenic and splenicorenal ligaments and their associated lymph nodes; the splenic vessels; the tail and body of the pancreas and their associated nodes; the nodes along the lesser curvature of the stomach; and the nodes along the greater curvature, along with the greater omentum. This radical operation is a desperate attempt to remove the stomach en bloc and, with it, its lymphatic field. The continuity of the gut is restored by anastomosing the esophagus with the jejunum.

Gastroscopy
Gastroscopy is the viewing of the mucous membrane of the stomach through an illuminated tube fitted with a lens system. The patient is anesthetized, and the gastroscope is passed into the stomach, which is then inflated with air. With a flexible fiberoptic instrument, direct visualization of different parts of the gastric mucous membrane is possible. It is also possible to perform a mucosal biopsy through a gastroscope














































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