Introduction
Shayne C. Gad in Toxicology of the Gastrointestinal Tract, 2018
The stomach has four main regions: the cardia, fundus, body, and pylorus (Figure 1.2). The cardia surrounds the superior opening of the stomach. The rounded portion superior to and to the left of the cardia is the fundus. Inferior to the fundus is the large central portion of the stomach, called the body. The region of the stomach that connects to the duodenum is the pylorus; it has two parts—the pyloric antrum, which connects to the body of the stomach, and the pyloric canal, which leads into the duodenum. When the stomach is empty, the mucosa lies in large folds, called rugae, that can be seen with the unaided eye. The pylorus communicates with the duodenum of the small intestine via a sphincter called the pyloric sphincter. The concave medial border of the stomach is called the lesser curvature, and the convex lateral border is called the greater curvature.
Short Bowel Syndrome
John K. DiBaise, Carol Rees Parrish, Jon S. Thompson in Short Bowel Syndrome Practical Approach to Management, 2017
The stomach divides into two functionally different parts: the fundus, where solid food is held while it is being broken down by gastric secretions, and the antrum, which acts as a grinding unit that allows only food particles of <2 mm to pass through the pylorus. During fasting, the interdigestive MMC occurs about every 90–120 minutes (range, 50–140) and lasts for 5–10 minutes in any one area and takes about 90 minutes to travel from the stomach to the ileum. The MMC is strongly propulsive and is responsible for clearing the last part of a meal and indigestible materials from the stomach and small intestine, thus serving a “housekeeper” function [30]. Loss of the MMC may occur in some gut dysmotility disorders and is associated with small intestinal bacterial overgrowth. After an extensive distal ileal resection, the MMC cycle was found to be shorter, but jejunal contraction frequency and amplitude were not changed [31].
Surgical Treatment of the Obese Individual
G. Michael Steelman, Eric C. Westman in Obesity, 2016
Several other newer procedures are becoming increasingly used for weight reduction. Gastric sleeve surgery is the most common of these procedures. A gastric sleeve procedure is a restrictive procedure in which the stomach is resected along the greater curvature, leaving a tubular stomach of 60 to 80 cm. The antrum and pylorus of the stomach are preserved. The procedure has been performed in patients with Crohn’s disease, ulcerative colitis, cardiomyopathy with low ejection fraction, and renal transplant patients. A review by Iannelli et al. (25) revealed a mean weight loss of 83% at 12 months, although Almogy et al. (26) revealed an excess weight loss of 45.1% at 12 months. Mortality rate in the reviewed studies by Iannelli et al. (25) is 0.9% and morbidity is 10.3%. This procedure is often used as part of a two-stage approach for the superobese patient with second-stage duodenal switch. Oberbach et al. (27) report using the gastric sleeve and gastric bypass in 10 adolescent cases.
Systematic review on gastric electrical stimulation in obesity treatment
Published in Expert Review of Medical Devices, 2019
Alimujiang Maisiyiti, Jiande Dz Chen
Upon food ingestion, the proximal stomach relaxes to accommodate the ingested food, a physiological process called gastric accommodation. Gastric accommodation is controlled by a vago-vagal reflex triggered by meal ingestion and mediated by the activation of inhibitory nitrergic motor neurons in the gastric wall which produce fundic relaxation. Gastric accommodation to a meal consists of relaxation of the proximal stomach, providing the meal with a reservoir and enabling a volume increase without a rise in gastric pressure [11]. Whereas, the function of the distal stomach, the antrum, is to generate peristalsis to push the ingested food through the pylorus to the duodenum, a process called gastric emptying. Gastric emptying is determined by the propulsive antral contractions and the appreciate opening of the pylorus. The frequency and coordination of the antral contractions are determined by the gastric pace-making activity [12] that is also called the slow wave due to its slow rhythm (3 cycles/min). Disruption of this pace-making activity impairs antral contractions and leads to delayed gastric emptying [12].
Comparative study on the gastrointestinal- and immune- regulation functions of Hedysari Radix Paeparata Cum Melle and Astragali Radix Praeparata cum Melle in rats with spleen-qi deficiency, based on fuzzy matter-element analysis
Published in Pharmaceutical Biology, 2022
Yugui Zhang, Jiangtao Niu, Shujuan Zhang, Xinlei Si, Tian-Tian Bian, Hongwei Wu, Donghui Li, Yujing Sun, Jing Jia, Erdan Xin, Xingke Yan, Yuefeng Li
The upper part of the small intestine starts from the pylorus of the stomach, and its lower part is connected with the large intestine via the ileocecal valve, which is divided into duodenum, jejunum and ileum. The HE staining results of duodenum, jejunum and ileum showed obvious injuries in SQD model compared with normal. The main reason may be related to the diarrhoea symptoms of SQD rats. Three parts of the small intestine had more crypt cells, the villi were shortened and indistinct, the villi tips were partially necrotic and detached, the villus epithelial cells were damaged and detached, and edoema was obvious. The intestinal glands were obviously degenerated, and the submucosa was slightly congested and severely oedematous, with a small amount of inflammatory cell infiltration. After treatment, the number, arrangement and morphological structure of glandular cells in each part of the small intestine were significantly improved, the length of villi increased, and edoema was relieved. In particular, HRPCM (18.9 g/kg) and ARPCM (18.9 g/kg) were more significant (Figure 10).
Gastroparesis managed with peroral endoscopic pyloromyotomy
Published in Baylor University Medical Center Proceedings, 2020
Jessica S. Clothier, Steven G. Leeds, Ahmed Ebrahim, Marc A. Ward
The patient was taken to the operating room where formal EGD was performed, followed by POP. POP should always be performed in the operating room or endoscopy suite under general anesthesia. A high-definition, standard-length upper endoscope is required and carbon dioxide insufflation is absolutely necessary. A full diagnostic EGD is conducted prior to the operation. This is done to ensure that no anatomical abnormalities exist and to remove any retained food that might be present. The endoscope is fitted with a transparent dissecting cap to enable tissue retraction while operating within the submucosal space. POP is performed in similar fashion to POEM and includes the same operative steps: (1) submucosal injection, (2) linear mucosotomy, (3) submucosal tunnel creation, (4) myotomy, and (5) mucosotomy closure (Figure 1). The injection and mucosotomy are performed in the antrum of the stomach approximately 3 cm proximal to the pylorus and in the posterior greater curve.