WEEK 1 - Anatomy and Physiology of the Digestive System - PDF

PRELIMS FRIDAY THIRD YEAR - 2ND SEMESTER/A.Y. 2024-2025 7:00AM–12:00 PM WEEK 1 LECTURER: PROF....

PRELIMS FRIDAY THIRD YEAR - 2ND SEMESTER/A.Y. 2024-2025 7:00AM–12:00 PM WEEK 1 LECTURER: PROF. EARL JOHN S. AMADO, RN, MSN TRANSCRIBED BY: JUSTINE DIANE P. DULDULAO BSN 3-YB-1B THE DIGESTIVE SYSTEM ANATOMY AND PHYSIOLOGY OF THE DIGESTIVE SYSTEM Digestive System Every cell of the body requires nutrients, yet most cells The organs of the digestive system can be separated into cannot leave their position in the body and travel to a food two main groups: source. q Alimentary canal Therefore, the food must be converted to a usable form q Accessory digestive organs. and then delivered to the cells. The digestive system, with the assistance of the circulatory ORGANS OF THE ALIMENTARY CANAL system, is a complex set of organs, glands, and ducts that The alimentary canal, also called the gastrointestinal tract, work together to transform food into nutrients for cells. is a continuous, hollow muscular tube that winds through the ventral body cavity and is open at both ends. Its organs include the following: o Mouth o Pharynx o Esophagus o Stomach o Small intestine o Large intestine ALIMENTARY CANAL MOUTH - Food enters the digestive tract through the mouth, or oral cavity, a mucous membrane-lined cavity. ü Lips ü Cheeks ü Palate FUNCTIONS OF THE DIGESTIVE SYSTEM ü Uvula ü Ingestion ü Vestibule ü Propulsion ü Oral cavity proper ü Food breakdown: mechanical digestion and chemical ü Tongue digestion ü Lingual frenulum ü Absorption ü Palatine tonsils ü Defecation/ elimination ü Lingual tonsil ALIMENTARY CANAL PHARYNX Ingestion - Food must be placed into the mouth before it can be acted on; this is an active, voluntary process called ingestion. - From the mouth, food passes posteriorly into the oropharynx and laryngopharynx. Propulsion - If foods are to be processed by more than one Oropharynx digestive organ, they must be propelled from one organ to the Laryngopharynx next, swallowing is one example of food movement that depends largely on the propulsive process called peristalsis Oropharynx- The oropharynx is posterior to the oral cavity. (involuntary, alternating waves of contraction and relaxation of Laryngopharynx- The laryngopharynx is continuous with the the muscles in the organ wall). esophagus below; both of which are common passageways for food, fluids, and air. Food breakdown: Mechanical Digestion- Mechanical digestion prepares food for further degradation by enzymes by physically fragmenting the foods into smaller pieces, and examples of mechanical digestion are: mixing of food in the mouth by the tongue, churning of food in the stomach, and segmentation in the small intestine. Food breakdown: Chemical Digestion- The sequence of steps in which the large food molecules are broken down into their building blocks by enzymes is called chemical digestion. Absorption- Transport of digested end products from the lumen of the GI tract to the blood or lymph is absorption, and for ALIMENTARY CANAL ESOPHAGUS absorption to happen, the digested foods must first enter the mucosal cells by active or passive transport processes. - The esophagus or gullet, runs from the pharynx through the Defecation/Elimination- Defecation is the elimination of diaphragm to the stomach. indigestible residues from the GI tract via the anus in the form Mucosa of feces. Submucosa Muscularis Externa Serosa Intrinsic Nerve Plexuses Page 1  q SIZE AND FUNCTION - About 25 cm (10 inches) long, it is essentially a passageway that conducts food by peristalsis to the stomach. q STRUCTURE - The walls of the alimentary canal organs from the esophagus to the large intestine are made up of the same four basic tissue layers or tunics. ACTIVITIES OCCURRING IN THE MOUTH, PHARYNX, AND ESOPHAGUS The activities that occur in the mouth, pharynx, and esophagus are food ingestion, food breakdown, and food propulsion. PHARYNGEAL-ESOPHAGEAL PHASE The 2nd phase, the involuntary pharyngeal-esophageal phase, FOOD INGESTION AND BREAKDOWN transports food through the pharynx and esophagus; the Once food is placed in the mouth, both mechanical and parasympathetic division of the autonomic nervous system chemical digestion begin. controls this phase and promotes the mobility of the digestive organs from this point on. PHYSICAL BREAKDOWN First, the food is physically broken down into smaller particles by chewing. FOOD ROUTES All routes that the food may take, except the desired route distal CHEMICAL BREAKDOWN into the digestive tract, are blocked off; the tongue blocks off the mouth; the soft palate closes off the nasal passages; the larynx Then, as the food is mixed with saliva, salivary amylase begins the rises so that its opening is covered by the flaplike epiglottis. chemical digestion of starch, breaking it down into maltose. STIMULATION OF SALIVA When food enters the mouth, much larger amounts of saliva pour out; however, the simple pressure of anything put into the mouth and chewed will also stimulate the release of saliva. PASSAGEWAYS The pharynx and the esophagus have no digestive function; they simply provide passageways to carry food to the next processing site, the stomach. FOOD PROPULSION – SWALLOWING AND PERISTALSIS For food to be sent on its way to the mouth, it must first be swallowed. DEGLUTITION Deglutition, or swallowing, is a complex process that involves the coordinated activity of several structures (tongue, soft palate, pharynx, and esophagus). BUCCAL PHASE OF DEGLUTITION The first phase, the voluntary buccal phase, occurs in the mouth; once the food has been chewed and well mixed with saliva, the bolus (food mass) is forced into the pharynx by the tongue. Page 2  q LOCATION - The C-shaped stomach is on the left side of the abdominal cavity, nearly hidden by the liver and STOMACH ENTRANCE the diaphragm. Once food reaches the distal end of the esophagus, it q FUNCTION - The stomach acts as a temporary “storage presses against the cardioesophageal sphincter tank” for food as well as a site for food breakdown. (lower esophageal sphincter (LES)), causing it to q SIZE - The stomach varies from 15 to 25 cm in length, open, and food enters the stomach. but its diameter and volume depend on how much food it contains; when it is full, it can hold about 4 liters (1 gallon) of food, but when it is empty it collapses inward on itself. ALIMENTARY CANAL STOMACH q STOMACH MUCOSA - The mucosa of the stomach is a simple columnar epithelium composed entirely of - Different regions of the stomach have been named, and mucous cells that produce a protective layer of they include the following: bicarbonate-rich alkaline mucus that clings to the o Cardiac Region stomach mucosa and protects the stomach wall from o Fundus being damaged by acid and digested by enzymes. o Body q GASTRIC GLANDS - This otherwise smooth lining is o Pylorus dotted with millions of deep gastric pits, which lead o Rugae into gastric glands that secrete the solution called o Greater Curvature gastric juice. o Lesser Curvature q INTRINSIC FACTOR - Some stomach cells produce intrinsic factor, a substance needed for the absorption of vitamin b12 from the small intestine. q CHIEF CELLS - The chief cells produce protein- digesting enzymes, mostly pepsinogens. q PARIETAL CELLS - The parietal cells produce corrosive hydrochloric acid, which makes the stomach contents acidic and activates the enzymes. q ENTEROENDOCRINE CELLS - The enteroendocrine cells produce local hormones such as gastrin, that are important to the digestive activities of the stomach. q CHYME - After food has been processed, it resembles heavy cream and is called chyme. ACTIVITIES OF THE STOMACH o Lesser Omentum - The activities of the stomach involve food breakdown and o Greater Omentum food propulsion. FOOD BREAKDOWN - The sight, smell, and taste of food stimulate parasympathetic nervous system reflexes, which increase the secretion of gastric juice by the stomach glands. - GASTRIC JUICE - Secretion of gastric juice is regulated by both neural and hormonal factors. - GASTRIN - The presence of food and a rising pH in the stomach stimulate the stomach cells to release the hormone gastrin, which prods the stomach glands to produce still more of the protein- digesting enzymes (pepsinogen), mucus, and hydrochloric acid. - PEPSINOGEN - The extremely acidic environment that hydrochloric acid provides is necessary, because it o Stomach Mucosa activates pepsinogen to pepsin, the active protein-digesting o Gastric Glands enzyme. o Intrinsic Factor - RENNIN - Rennin, the second protein-digesting enzyme o Chief Cells produced by the stomach, works primarily on milk protein o Parietal Cells and converts it to a substance that looks like sour milk. o Enteroendocrine o Cells Page 3  FOOD ENTRY As food enters and fills the stomach, its wall begins to stretch (at the same time as the gastric juices are being secreted). STOMACH WALL ACTIVATION Then the three muscle layers of the stomach wall become active; they compress and pummel the food, breaking it apart physically, all the while continuously mixing the food with the enzyme-containing gastric juice so that the semifluid chyme is formed. o Microvilli o Villi o Lacteal FOOD PROPULSION o Circular folds Peristalsis is responsible for the movement of food towards the digestive site until the intestines. PERISTALSIS Once the food has been well mixed, a rippling peristalsis begins in the upper half of the stomach, and the contractions increase in force as the food approaches the pyloric valve. PYLORIC PASSAGE o Peyer’s patches The pylorus of the stomach, which holds about 30 ml of chyme, acts like a meter that allows only liquids and very small particles to pass through the pyloric sphincter; and because the pyloric sphincter barely opens, each contraction of the stomach muscle squirts 3 ml or less of chyme into the small intestine. ENTEROGASTRIC REFLEX When the duodenum is filled with chyme and its wall is o Ileocecal Valve stretched, a nervous reflex, the enterogastric reflex, occurs; this reflex “puts the brakes on” gastric activity and slows the emptying of the stomach by inhibiting the vagus nerves and tightening the pyloric sphincter, thus allowing time for intestinal processing to catch up. ALIMENTARY CANAL SMALL INTESTINE - The small intestine is the body’s major digestive organ. o Hepatopancreatic ampulla q LOCATION - The small intestine is a muscular tube extending from the pyloric sphincter to the large intestine. q SIZE - It is the longest section of the alimentary tube, with an average length of 2.5 to 7 m (8 to 20 feet) in a living person. q SUBDIVISIONS - The small intestine has three subdivisions: the duodenum, the jejunum, and the ileum, which contribute 5 percent, nearly 40 percent, o Duodenal papilla and almost 60 percent of the small intestine, o Circular folds respectively. Page 4  q ILEOCECAL VALVE - The ileum meets the large ABSORPTION intestine at the ileocecal valve, which joins the large Absorption of water and of the end products of digestion and small intestine. occurs all along the length of the small intestine; most q HEPATOPANCREATIC AMPULLA - The main pancreatic substances are absorbed through the intestinal cell plasma and bile ducts join at the duodenum to form the membranes by the process of active transport. flasklike hepatopancreatic ampulla, literally, the ”liver- pacreatic-enlargement”. q DUODENAL PAPILLA - From there, the bile and pancreatic juice travel through the duodenal papilla and enter the duodenum together. q MICROVILLI - Microvilli are tiny projections of the DIFFUSION plasma membrane of the mucosa cells that give the Lipids or fats are absorbed passively by the process of cell surface a fuzzy appearance, sometimes referred diffusion to as the brush border; q the plasma membranes bear enzymes (brush border enzymes) that complete the digestion of proteins and carbohydrates in the small intestine. DEBRIS q VILLI - Villi are fingerlike projections of the mucosa that give it a velvety appearance and feel, much like At the end of the ileum, all that remains are some water, indigestible food materials, and large amounts of bacteria; the soft nap of a towel. this debris enters the large intestine through the ileocecal q LACTEAL - Within each villus is a rich capillary bed and valve. a modified lymphatic capillary called a lacteal. q CIRCULAR FOLDS - Circular folds, also called plicae circulares, are deep folds of both mucosa and submucosa layers, and they do not disappear when food fills the small intestine. q PEYER’S PATCHES - In contrast, local collections of FOOD PROPULSION lymphatic tissue found in the submucosa increase in number toward the end of the small intestine. Peristalsis is the major means of propelling food through the digestive tract. ACTIVITIES OF THE SMALL INTESTINE - The activities of the small intestine are food breakdown and absorption and food propulsion. PERISTALSIS FOOD BREAKDOWN AND ABSORPTION The net effect is that the food is moved through the small - Food reaching the small intestine is only partially digested. intestine in much the same way that toothpaste is squeezed from the tube. DIGESTION carbohydrate and protein digestion has begun, but virtually no fats have been digested up to this point. CONSTRICTIONS Rhythmic segmental movements produce local constrictions BRUSH BORDER ENZYMES of the intestine that mix the chyme with the digestive juices, The microvilli of small intestine cells bears a few important and help to propel food through the intestine. enzymes, the so-called brush border enzymes, that break down double sugars into simple sugars and complete protein digestion. ALIMENTARY CANAL LARGE INTESTINE - The large intestine is much larger in diameter than the small intestine but shorter in length. PANCREATIC JUICE o Cecum Foods entering the small intestine are literally deluged with o Appendix enzyme-rich pancreatic juice ducted in from the pancreas, o Ascending colon as well as bile from the liver; pancreatic juice contains o Transverse colon enzymes that, along with brush border enzymes, complete o Descending colon the digestion of starch, carry out about half of the protein o Sigmoid colon digestion, and are totally responsible for fat digestion and o Anal canal digestion of nucleic acids. CHYME STIMULATION When chyme enters the small intestine, it stimulates the mucosa cells to produce several hormones; two of these are secretin and cholecystokinin which influence the release of pancreatic juice and bile. Page 5  o External anal sphincter millions of bacteria, and just enough water to allow their o Internal involuntary sphincter smooth passage. - PROPULSION OF THE RESIDUE AND DEFECATION - When presented with residue, the colon becomes mobile, but its contractions are sluggish or short- lived. - HAUSTRAL CONTRACTIONS - The movements most seen in the colon are haustral contractions, slow segmenting movements lasting about one minute that occur every 30 minutes or so. - PROPULSION - As the haustrum fills with food residue, the distension stimulates its muscle to contract, which propels the luminal contents into the next haustrum. - MASS MOVEMENTS - Mass movements are long, slow- moving, but powerful contractile waves that move over large areas of the colon three or four times daily and force the contents toward the rectum. - RECTUM - The rectum is generally empty, but when feces are forced into it by mass movements and its wall is q SIZE - About 1.5 m (5 feet) long, it extends from the stretched, the defecation reflex is initiated. ileocecal valve to the anus. - DEFECATION REFLEX - The defecation reflex is a spinal q FUNCTIONS - Its major functions are to dry out (sacral region) reflex that causes the walls of the sigmoid indigestible food residue by absorbing water and to colon and the rectum to contract and anal sphincters to eliminate these residues from the body as feces. relax. q SUBDIVISIONS - It frames the small intestines on three - IMPULSES - As the feces is forced into the anal canal, sides and has the following subdivisions: cecum, messages reach the brain giving us time to make a appendix, colon, rectum, and anal canal. decision as to whether the external voluntary sphincter q CECUM - The saclike cecum is the first part of the large should remain open or be constricted to stop passage of intestine. feces. q APPENDIX - Hanging from the cecum is the wormlike - RELAXATION - Within a few seconds, the reflex contractions appendix, a potential trouble spot because it is an end and rectal walls relax; with the next mass movement, ideal location for bacteria to accumulate and multiply. the defecation reflex is initiated again. q ASCENDING COLON - The ascending colon travels up the right side of the abdominal cavity and makes a turn, the right colic (or hepatic) flexure, to travel across ACCESSORY DIGETSIVE ORGANS the abdominal cavity. - Other than the intestines and the stomach, the following q TRANSVERSE COLON - The ascending colon makes a are also part of the digestive system: turn and continuous to be the transverse colon as it q TEETH travels across the abdominal cavity. q SALIVARY GLANDS q DESCENDING COLON - It then turns again at the left q PANCREAS colic (or splenic) flexure, and continues down the left q LIVER side as the descending colon. q GALLBLADDER q SIGMOID COLON - The intestine then enters the pelvis, where it becomes the S-shaped sigmoid colon. q ANAL CANAL - The anal canal ends at the anus which ACCESSORY DIGESTIVE ORGANS TEETH opens to the exterior. q EXTERNAL ANAL SPHINCTER - The anal canal has an Permanent teeth external voluntary sphincter, the external anal Incisors sphincter, composed of skeletal muscle. Canines q INTERNAL INVOLUNTARY SPHINCTER - The internal Premolars and molars involuntary sphincter is formed by smooth muscles. Crown Enamel ACTIVITIES OF THE LARGE INTESTINE Root - The activities of the large intestine are food breakdown and Dentin absorption and defecation. Pulp cavity Root canal FOOD BREAKDOWN AND ABSORPTION - What is finally delivered to the large intestine contains few nutrients, but that residue still has 12 to 24 hours more to spend there. q FUNCTION - The teeth tear and grind the food, breaking it - METABOLISM - The “resident” bacteria that live in its lumen down into smaller fragments. metabolize some of the remaining nutrients, releasing gases (methane and hydrogen sulfide) that contribute to the odor of feces. ACCESSORY DIGESTIVE ORGANS SALIVARY GLANDS - FLATUS - About 50 ml of gas (flatus) is produced each day, Three pairs of salivary glands empty their secretions into much more when certain carbohydrate- rich foods are the mouth eaten. - ABSORPTION - Absorption by the large intestine is limited to PAROTID GLANDS - The large parotid glands lie anterior to the absorption of vitamin K, some B vitamins, some ions, the ears and empty their secretions into the mouth. and most of the remaining water. SUBMANDIBULAR AND SUBLINGUAL GLANDS - The - FECES - Feces, the more or less solid product delivered to submandibular and sublingual glands empty their the rectum, contains undigested food residues, mucus, secretions into the floor of the mouth through tiny ducts. Page 6  SALIVA - The product of the salivary glands, saliva, is a LABORATORY ASSESSMENTS mixture of mucus and serous fluids. BARIUM SWALLOW TEST SALIVARY AMYLASE - The clear serous portion contains an A barium swallow test is a special type of imaging test that enzyme, salivary amylase, in a bicarbonate-rich juice that uses barium and X- rays to create images of your upper begins the process of starch digestion in the mouth. gastrointestinal (GI) tract. Your upper GI tract includes the ACCESSORY DIGESTIVE ORGANS PANCREAS back of your mouth and throat (pharynx) and your esophagus. Only the pancreas produces enzymes that break down all categories of digestible foods. Why are barium swallow tests used? A barium swallow can help a doctor identify problems in the food pipe, stomach, or bowel. A barium swallow test may q LOCATION -The pancreas is a soft, pink triangular be used if someone has any of the following conditions: gland that extends across the abdomen from the o frequent, painful heartburn spleen to the duodenum; but most of the pancreas lies o gastric reflux, where food or acid keeps coming posterior to the parietal peritoneum, hence its location back up the food pipe is referred to as retroperitoneal. o difficulty eating, drinking, or swallowing q PANCREATIC ENZYMES - The pancreatic enzymes are This test can give a doctor information about how the secreted into the duodenum in an alkaline fluid that person is swallowing. It can also reveal if someone has any neutralizes the acidic chyme coming in from the of the following in their food pipe, stomach, or the first part stomach. of the bowel: q ENDOCRINE FUNCTION - The pancreas also has an o ulcers endocrine function; it produces hormones insulin and o abnormal growths glucagon. o blockages ACCESSORY DIGESTIVE ORGANS LIVER o narrowing The liver is the largest gland in the body. BARIUM SWALLOW TEST PROCEDURE LOCATION - Located under the diaphragm, more to the right side of the body, it overlies and almost completely covers ü People who are undergoing a barium swallow should not the stomach. eat or drink for a few hours before the test. In some cases, FALCIFORM LIGAMENT - The liver has four lobes and is the doctor may ask the person to stop taking medication suspended from the diaphragm and abdominal wall by a before the test. delicate mesentery cord, the falciform ligament. ü Some hospitals recommend not chewing gum, eating FUNCTION - The liver’s digestive function is to produce bile. mints, or smoking cigarettes after midnight the night before BILE - Bile is a yellow-to-green, watery solution containing a barium swallow test. bile salts, bile pigments, cholesterol, phospholipids, and a ü The test takes around 60 minutes and will take place in the variety of electrolytes. X-ray department of the hospital. A person will need to BILE SALTS - Bile does not contain enzymes but its bile change into a hospital gown. salts emulsify fats by physically breaking large fat globules ü In the X-ray room, the person drinks the barium liquid. It into smaller ones, thus providing more surface area for the often has a chalky taste but can sometimes be flavored. fat-digesting enzymes to work on. ACCESSORY DIGESTIVE ORGANS GALLBLADDER While in the gallbladder, bile is concentrated by the removal of water. LOCATION - The gallbladder is a small, thin-walled green sac that snuggles in a shallow fossa in the inferior surface of the liver. CYSTIC DUCT - When food digestion is not occurring, bile ü A person will lie on a tilting table for part of the backs up the cystic duct and enters the gallbladder to be examination. stored. ü In some cases, a person will be given an injection to relax their stomach. ü A person will be standing for some parts of the examination, and lying down on a tilting table for other parts. This allows the liquid to travel through the body, and for the radiologist and radiographer to take a selection of images. Page 7  ü People do not have to stay in hospital after the test and are Once the entire colon is filled further pictures are taken in free to go home as soon as it is complete. The results individual positions to obtain complete views. usually arrive within 1-2 weeks. The radiographer ensures all pictures are valid. The rectum is emptied of barium and the catheter BARIUM ENEMA TEST removed. A barium enema is an X-ray procedure used to examine the The patient passes barium for several hours after the rectum and colon, often used as a complement to lower procedure. gastrointestinal (GI) endoscopy. BARIUM ENEMA TEST RISK AND SIDE EFFECTS Patients may feel ü nauseous after a barium swallow test or ü become constipated. Drinking lots of fluids can help to relieve constipation. Symptoms of nausea should improve as the barium passes through the system. It is normal for people to have white-colored stools the first few times they use the toilet after having a barium swallow test. It is a diagnostic tool for patients with: Some people might worry about being exposed to radiation ü Lower GI bleeding as part of the X-ray process. However, the amount of ü Altered bowel habit radiation a person is exposed to is minimal. ü Abdominal pain Sometimes, the injection given to relax the stomach can ü To screen for polyps and colorectal cancer cause temporary blurred vision. Contraindications include: ü Acute colitis/diverticulitis, BARIUM ENEMA TEST SPECIAL CONSIDERATIONS ü Recent polypectomy or colonic biopsy People should not have a barium swallow test if they are ü Older patients (>70 years old) pregnant. ü pregnancy. If someone has glaucoma or heart problems and needs to have a barium swallow, the doctor may not give the BARIUM ENEMA TEST PATIENT PREPARATION stomach-relaxing injection. If someone has diabetes then the doctor will schedule a Bowel preparation: morning appointment for the barium swallow. ü This varies, but often involves a period of low-residue People who use insulin will be asked to miss their morning diet and oral/laxative washout. dose and maybe the previous evening’s dose. They should Preparation is vital for good views of the bowel: bring their insulin and some food to have after the test. ü The patient should receive full instructions on However, those who take long-acting insulin should preparation and the procedure. continue taking this. BARIUM ENEMA TEST BARIUM ENEMA TEST MINOR COMPLICATIONS THE PROCEDURE The patient is cannulated and may be given intravenous ü Constipation. antispasmodic medication (for example hyoscine ü Abdominal discomfort. butylbromide) to make the procedure more comfortable ü Rectal bleeding. and to aid the passage of barium. ü Flatus. The patient is positioned in a left lateral position on an X- ray table. BARIUM ENEMA TEST MAJOR COMPLICATIONS A digital rectal examination is then performed. A rectal catheter is lubricated and inserted into the rectum. This has two connectors. One connector is for passing ü Colonic perforation. barium and the other is for insufflating air. ü Hemorrhage. The patient is placed prone. ü Oversedation. ü Cardiac arrhythmia. Liquid barium is passed via a giving set into the catheter. It is passed slowly to prevent the patient experiencing discomfort or an urge to defecate. X-ray screening takes place as the barium is passed so the radiologist can observe filling. The amount instilled GASTROSCOPY depends on the patient. The radiologist stops once the A gastroscopy is a procedure where a thin, flexible tube rectum is filled and the barium continues to pass around called an endoscope is used to look inside the esophagus the colon. The radiologist may change the patient’s position (gullet), stomach and first part of the small intestine as necessary in order to aid filling. (duodenum). Once the contrast reaches the splenic flexure, the patient It's also sometimes referred to as an upper gastrointestinal returns to the prone position and air is insufflated. As air endoscopy. The endoscope has a light and a camera at one enters, the colon inflates and the images of the mucosa end. The camera sends images of the inside of your become clearer. esophagus, stomach and duodenum to a monitor. Radiography staff may assist in moving the patient to aid filling and to provide reassurance. Why a gastroscopy may be used? Screening continues until the radiologist identifies the gastroscopy can be used to: caecum, by seeing the appendix or by seeing barium ü investigate problems such as difficulty swallowing entering the small bowel. (dysphagia) or persistent abdominal (tummy) pain Page 8  ü diagnose conditions such as stomach ulcers or gastro- ü The patient then lie on your left side. esophageal reflux disease (GERD) ü The scope is inserted through the esophagus (food ü treat conditions such as bleeding ulcers, a blockage in pipe) to the stomach and duodenum. The duodenum the esophagus, non-cancerous growths (polyps) or is the first part of the small intestine. small cancerous tumors ü Air is put through the scope to make it easier for the ü A gastroscopy used to check symptoms or confirm a doctor to see. diagnosis is known as a diagnostic gastroscopy. ü The lining of the esophagus, stomach, and upper ü A gastroscopy used to treat a condition is known as a duodenum is examined. Biopsies can be taken therapeutic gastroscopy. through the scope. Biopsies are tissue samples that are looked at under the microscope. ü Different treatments may be done, such as stretching GASTROSCOPY THE PROCEDURE or widening a narrowed area of the esophagus. A gastroscopy often takes less than 15 minutes, although it ü After the test is finished, the client will not be able to may take longer if it's being used to treat a condition. have food and liquid until their gag reflex returns (so It's usually carried out as an outpatient procedure, which you do not choke). means you won't have to spend the night in hospital. EGD MINOR COMPLICATIONS Before the procedure, your throat will be numbed with a local anesthetic spray. You can also choose to have a ü The test lasts about 30 to 60 minutes. sedative, if you prefer. This means you will still be awake, ü Constipation. but will be drowsy and have reduced awareness about ü Abdominal discomfort. what's happening. ü Rectal bleeding. The doctor carrying out the procedure will place the ü Flatus. endoscope in the back of your mouth and ask you to swallow the first part of the tube. It will then be guided EGD MAJOR COMPLICATIONS down your esophagus and into your stomach. The procedure shouldn't be painful, but it may be ü Colonic perforation. unpleasant or uncomfortable at times. ü Hemorrhage. ü Oversedation. What are the risks? ü Cardiac arrhythmia. A gastroscopy is a very safe procedure, but like all medical procedures it does carry a risk of complications. Possible complications that can occur include: ü a reaction to the sedative, which can cause problems with your breathing, heart rate and blood pressure ü internal bleeding ü tearing (perforation) of the lining of your esophagus, stomach or duodenum ESOPHAGOGASTRODUODENOSCOPY (EGD) a test to examine the lining of the esophagus, stomach, and first part of the small intestine (the duodenum). How the Test is Performed? EGD is done in a hospital or medical center. The procedure uses an endoscope. This is a flexible tube with a light and camera at the end. The procedure is done as follows: ü During the procedure, breathing, heart rate, blood pressure, and oxygen level are checked. Wires are attached to certain areas of the body and then to machines that monitor these vital signs. ü The patient receives medicine into a vein to help you relax. The patient should feel no pain and not remember the procedure. ü A local anesthetic may be sprayed into the mouth to prevent you from coughing or gagging when the scope is inserted. ü A mouth guard is used to protect the teeth and the scope. Dentures must be removed before the procedure begins. Page 9