Congenital hypertropic pyloric stenosis is quite a common condition in new-born babies and its cause is not known. The thickened sphincter at the pylorus is very strong and spastic. The stomach enlarges and becomes powerful from working against obstruction. Persistent vomiting develops and owing to the force of the stomach this is described as 'projectile vomiting'. Waves of peristalsis may be seen in the child's abdomen and the hard lump of muscle at the pylorus can readily be felt. Occasionally x-ray examination is used to prove the diagnosis. In severe and neglected cases, gastritis develops. The child becomes extremely ill from dehydration, and constipation is a constant feature, the stools being hard from dehydration and starvation. Many cases are treated by Eumydrin (methylatropine nitrate) which is an antispasmodic drug given with the feeds. Surgical operation is however very often necessary and in skilled hands is practically without risk; recovery is more rapid and certain after operation, than with medical treatment.
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The digestive system is responsible for processing food, breaking it down into usable proteins, carbohydrates, minerals, fats, and other substances, and introducing these into the bloodstream so that they can be used by the body. The digestive, or alimentary, tract begins at the mouth, where the teeth and tongue begin the breakdown of food, aided by saliva secreted by the salivary glands. The chewed food, combined with saliva, is swallowed, carrying it in peristaltic waves down the esophagus to the stomach. In the stomach, the food combines with hydrochloric acid which further assists in breaking it down. When the food is thoroughly digested, the fluid remaining, called chyme, is passed through the pylorus sphincter to the small intestine and large intestines. Within the long, convoluted intestinal canals, the nutrients are absorbed from the chyme into the bloodstream, leaving the unusable residue. This residue passes through the colon (where most of the water is absorbed into the bloodstream) and into the rectum where it is stored prior to excretion. This solid waste, called faeces, is compacted together and, upon excretion, passes through the anal canal and the anus. Along the way through the digestive tract, the pancreas, spleen, liver, and gall bladder secrete enzymes which aid in the digestive process.
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The oesophagus is the region of the alimentary canal following the pharynx. The walls of the
oesophagus are muscular and force food along by contractions. The oesophagus is composed of a thick muscle wall which is voluntary (striped) muscle in the upper part, and involuntary (smooth) muscle in the lower part. The oesophagus ends byjoining the cardiac orifice of the stomach a little less than four cm below the diaphragm. It therefore has three parts. The cervical portion in the lower part of the neck lies immediately behind the trachea with lobes of the thyroid on either side. The thoracic portion lies, in the upper part, close to the back of the trachea in front of the vertebral column. In the lower part the oesophagus passes a little to the left and is crossed by the left bronchus, later .lying immediately behind the pericardium until it pierces the diaphragm.
Except during the passage of food, the oesophagus is flattened like a muscle strap but can distend to 25 mm in diameter. With the exception of the pylorus it is the narrowest portion of the alimentary tract and the oesophagus itself has three constrictions where it becomes narrower than in the rest of its course. The first is at the upper end behind the cricoid cartilage; the second is at the level of the bifurcation of the trachea into right and left bronchus; while the third narrow point is where the oesophagus passes through the diaphragm. Unlike the abdominal parts of the alimentary tract, there is no peritoneal coat on the thoracic and cervical
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The pylorus is the sphincter muscle which serves as the valve controlling the lower opening of the stomach, where it empties into the duodenum. The pylorus only allows the food through after it has been properly processed by the digestive juices of the stomach. Once through the pylorus, the food is only partially digested. Further digestion takes place in the upper portion of the small intestine called the duodenum.
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The small intestine is descriptively divided into three sections: the duodenum, the ileum, and the jejunum. The duodenum accepts the digested food paste, called chyme, from the stomach, through the pylorus sphincter. The duodenum is about ten inches long and forms a curve around the head of the pancreas. The duodenum secretes digestive enzymes invertase and erepsin, necessary for digestion. The gall bladder, liver, and pancreas also deposit enzymes and bile into the duodenum. The jejunum is the intermediate section of the small intestine, measuring a little over two meters long. The jejunum carries digested food through the small intestine rapidly by peristaltic waves and, as a result, seldom has much food matter in it. It is connected to the abdominal wall by the mesentery. The ileum is the last, and longest, segment of the small intestine, measuring up to four meters or longer. Most of the absorption of useful food nutrients takes place in the ileum before it empties out into the cecum of the large intestine.
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The stomach (fundus) is one of the primary organs of the digestive system. It is located in the middle of the abdominal cavity and extends from the lower end of the esophagus to the duodenum. A curved sac, the stomach has a lesser curvature along the top and a greater curvature along the bottom. The bolus of chewed food paste enters the stomach from the esophagus, propelled by peristaltic waves. The cardiac gastric glands are located near the entrance to the stomach and lubricate the food as it comes in. The stomach secretes hydrochloric acid and the enzymes pepsin, rennin, and lipase which help digest the carbohydrates, proteins and fats in food. The stomach is lined with a durable mucous lining which protects it from the gastric juices so that the stomach itself is not digested. Occasionally, a portion of this lining wears thin and the digestive juices do aggravate the stomach lining. This condition is known as an ulcer and is a frequent occurrence which may affect the stomach, the lower esophagus, or the duodenum. The lower end of the stomach is guarded by the pylorus, a sphincter muscle which admits digested food into the duodenum after it has been adequately processed by the digestive juices.
The average stomach can hold about a liter, but can stretch to hold much more than this. When empty, or nearly empty, the stomach contracts to form folds, or rugae, in its mucous lining. Though it was once thought that the contractions of the stomach in the absence of food was what caused the sensation of hunger, it is now known that the primary impulse of hunger is due to low glucose levels in the bloodstream. However, the contraction of the stomach can often be felt, and this and the 'grumbling' heard as food is passed through the lower digestive tract also serve to remind one of the sensation of hunger.
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