Exam 4 Flashcards
Abdomen
Section of the trunk between the thorax and the pelvis
Abdominal Regions
Right/Left Hypochondriac, Epigastric, Right/Left Lumbar, Umbilical, Right/Left Inguinal, and Hypogastric/Pubic
Why are the Abdominal Regions important?
Help to describe the locations of abdominal organs and pathologies, including the location of symptoms such as pain
Transpyloric Plane
Anteriorly crosses tips of 9th costal cartilages and posteriorly lower 1st lumbar vertebra, many organs found here (pylorus, superior part of duodenum, duodenojejunal flexure, fundus of gallbladder)
What is beneath the Muscle Layer?
The transversal is fascia (extraperitoneal fat) and the peritoneum (deeper layer)
What are the two fasciae beneath the skin?
Fatty Fascia (Campers Fascia) and the Deep Membranous Layer (Scarpas Fascia)
What is the Superficial Perineal Fascia
Also called Colle’s Fascia, attaches to the ischiopubic rami of the hip bone and fuses laterally to the deep fascia of the thigh
Lumbar Puncture
Needle inserted into the back either superior or inferior to the spinous process, L3-L5 vertebrae, purpose to withdraw CSF
Superficial Abdominal Muscle Innervation
6 lower intercostal nerves and L1
Function of Superficial Muscles
Compress abdominal viscera, flex and rotate the trunk (lumbar vertebrae), expiratory muscles
External Abdominal Oblique Muscles
On the 5-12 ribs, fibers point towards the pubic symphysis, assists in exhaling, is part of forming the thicker structure called the Iguinal Ligament
Internal Abdominal Oblique Muscles
Fan shaped muscle, fibers point towards breast, assists in exhaling, forming part of the rectus sheath (cranial and middle and caudal sections)
Cremaster Muscle
Spermatic cord a continuation of the caudal section, reflex innervation femoral branch of the genitogmeoral nerve and/or inguinal nerve (Afferent) and genital branch of the genitofemoral nerve, L1-L2 (Efferent)
Transversus Abdominis
Runs transversely and merges into the aponeurosis, forming the posterior layer of the rectus sheath superior to the arcuate line, innervation intercostal nerves T7-T11
Rectus Abdominis
Stabilizes pelvis and supports the abdominal viscera, helps with expirations and rotation of trunk, contraction can produce force, innervated by intercostal nerves and subcostal nerve (T7-T12)
Pyramidalis
Small, triangular muscle that lies anterior to the inferior section of the rectus abdomens in the rectus sheath but can be absent in some people, though to tense up the linea alba
Rectus Sheath
Aponeurosis of the abdominal muscles (external and internal obliques) surrounding the rectus abdominis, terminates in curved edge, arcuate line
Contents of Rectus Sheath
Rectus abdominis muscle, inferior/superior epigastric vessels, pyramidalis, lymphatic muscles, anterior primary rami of five lower intercostal nerves (including subcostal)
Vessels/Innervation of Rectus Sheath
Inferior/Superior epigastric vessels, subcostal nerve, costal nerve
Iliohypogastric and Ilioinguinal Nerves
Not in the rectus sheath, innervate the pubic area,
external genitalia and medial and upper parts of the thigh
Inguinal Ligament
At iliac crest, aponeurosis of external abdominal oblique rolls on itself to form this ligament
Superficial Inguinal Ring
Opening the aponeurosis of the external abdominal oblique in the inferomedial section, directly above the inguinal ligament, attaches to front of pubic symphysis
Deep Inguinal Ring
Opening in the Transversalis Fascia, in the hypogastric region
Transversalis Fascia
Deep fascia beneath the anterolateral abdominal wall muscles
Inguinal Canal
Lies within the anterolateral abdominal wall muscles, contains the spermatic cord or the round ligament of the uterus
Cryptorchidism
The absence of one or both testes in the scrotum, due to failure of the testes to descend in the inguinal canal during development
Hernia
Break of small or large intestine that pushes out
Most Common Type of Herniation?
Direct and indirect inguinal hernias
Indirect Hernia’s
Lateral to epigastric vessels, passes through the inguinal canal (inside spermatic cord), high risk of strangulation/ infarct, congenital and acquired, in younger people, bigger in size
Direct Hernia’s
Medial to epigastric vessels, don’t pass through the inguinal canal (parallels spermatic cord), low risk of strangulation/ infarct, are almost always acquired, middle age man (over 40), smaller in size
Umbilical Hernia
Can happen to newborn’s due to e=weak abdominal walls
Omental (Epiploic) Foramen or Foramen of Winslow
Site of internal herniation and strangulation of part of intestine into the lesser sac, surgery should be done from the other side and not touching the ports hepatic, and the artery to gall bladder (cystic artery) can be reached through this foramen
Peritoneum
Serous membrane, lines the body cavities, think layer of simple squamous epithelium, two layers (parietal and visceral)
Intraperitoneal Organs
Connected to the peritoneum, stomach, spleen, parts of intestines
Retroperitoneal Organs
Lie behind the peritoneum, partly covered on one surface, Suprarenal (adrenal) glands, Aorta/Inferior Vena Cava, Duodenum (second and third segments), Pancreas, Ureters, Colon (ascending and descending only), Kidneys, Esophagus, Rectum
Mesentery
Double layer of peritoneum containing the blood and lymphatic vessels, nerves and fat, connects intestines to posterior abdominal wall for a neurovascular connection between the organ and the body wall
Mesentery Root
From the L2 vertebra to the ileocecal junction
How to gain access to lesser sac and posterior wall of stomach?
Cut through the transverse mesocolon which raises when the greater omentum raises
Second Large Intestine Mesentery
Sigmoid Mesocolon
Lesser Omentum Location
Between the lesser curvature of the stomach and the ports hepatic of the liver
Greater Omentum
Apron-like fold of peritoneum, extending downward toward greater curvature of the stomach, and then passes behind the transverse colon, and attaches to the posterior abdominal wall
Greater Omentum Function
Prevents the visceral peritoneum from adhering to the parietal peritoneum, protects against infection or inflammatory confidants, can move toward an infected area waling off infections and forms adhesions, can act as an insulator
Example of the Greater Omentum in Action
During appendicitis, greater omentum moves toward the infected and enlarged appendix and surrounds it so that if rupture occurs the consequences are lessened
Subphrenic Spaces Location
Between the diaphragm and the liver on both sides of the falciform ligament
Right Subphrenic Space
Hepatorenal pouch of Morison, site of fluid accumulation during complications, respiratory problems can occur particularly after surgery (peritonitis)
Paracolic Gutters or Recesses
Supracolic and infracolic compartments are connected by this, which lies between the posterolateral abdominal wall and the lateral aspect of the ascending or descending colon
Rectouterine Pouch
In females, deep part of the pelvic cavity and is the site of fluid accumulation (Pelvic Inflammatory Disease)
Pouch Behind Urinary Bladder (Male and Female)
Rectovesical Pouch and Vesicouterine Pouch
Peritonitis
Inflammation and pain of the peritoneum after abdominal inner, perforated ulcer or infections like appendicitis
Ascites
The peritoneum exudates fluid and cells in response to injury or infection (liver cirrhosis)
Paracentesis
Puncturing the peritoneal cavity for aspiration of the fluid
Beer Belly
Called Ascites, increase in blood pressure of portal view, fluid now into interstitial space, affects those with liver cirrhosis and treatment is paracentesis
Where is the esophagus, stomach and intestine derived from?
The primordial foregut,
midgut and hindgut
Esophagus Location
C6 to T10/T12 and lies on the vertebral column
3 Esophagus Narrowings
Upper sphincter, Aortic narrowing, Diaphragmatic narrowing
Esophagus Function
Transporting the bolus to the stomach
Esophagus Innervation
Sympathetic and Parasympathetic (Vagus)
Cardia
Location of esophagus meeting the stomach
Blood Supply of Esophagus
Inferior Thyroid Artery (Upper)
Thoracic Aorta/Bronchiole Arteries (Middle)
Left Gastric Artery/Inferior Phrenic Artery (Lower)
Esophagus Drainage
Inferior thyroid vein, azygos, hemiazaygos, and gastric veins (gastric veins are draining into portal vein, via Porto Caval Anastomosis)
Esophagus Cell Type
Stratified non-keratinized squamous epithelium (at the Cardia switches to columnar, due to more acidic environment)
Esophageal Varices
Patients with liver cirrhosis, bleeding in the esophagus
Esophageal Atresia
Distal end of esophagus is closed, congenital, treatment is to cut section and reconnect the esophagus
Achalasia
Failure of sphincter muscles to open, results in cardio spasm and fluid build up and creates a mega esophagus
Barrett’s Esophagus
Sphincter is not tight and acid from stomach causes metaplasia of squamous epithelium due to acid injury, can cause cancer, acquired
Stomach Parts
Fundus, body, pyloric antrum
Cardia of Stomach
Location of heartburn
Stomach Function
Hold food as a reservoir and assist in some digestion
Food in Stomach
Receptive relaxation controlled by vagus nerve, next is retropulsion (mixing), caudad and distal antrum are contracting, caudad region sends food to duodenum
Stomach Digestion
Mechanical (3 layers of muscles to churn) and enzymatic (breaks down proteins)
3 Muscle Layers of Stomach
Longitudinal muscle layer, circular muscle layer, oblique muscle layer overlying the mucosa
Sphincters of the Stomach
Lower Esophageal Sphincters or Cardiac Sphincter and Pyloric Sphincter
Cells of Stomach
Top layer is the simple columnar epithelium
Histology of Stomach
Gastric pit and gland, muscularis mucosae, submucosa, muscles layers, myenteric plexus, serosa
Gastric Pit Cells
Parental, Chief and Enteroendrocrine (G)
Chief Cells
Produce pepsinogen
Pepsinogn
Protein splitting enzyme active by HCl in the stomach which turns it into pepsin to break down the food
Parietal Cells
Produce HCl and intrinsic factor
G Cells
Produce gastrin, to stimulate acid secretion and growth of parietal cells
Section of Gastric Juices
Nervous section by the vagus nerve activated by state smell and sight, gastric sectarian stimulated by food ingestion
Blood Supply of the Stomach
Left gastric artery - Celiac artery
Right gastric artery - common hepatic artery, short gastric artery, the left gastro
epiploic artery - splenic artery
Right gastroepiploic artery - gastro-duodenal artery common hepatic artery
Drainage of the Stomach
Left and right gastric veins, the splenic vein (the left gastroepiploic vein and short gastric veins) which all drain to portal vein
Lymphatics of the Stomach
Gastric and celiac nodes
Innervation stomach
Parasympathetic (vagus nerve, motor, secretomotor, sensory) and Sympathetic (Splanchnic Nerves, inhibit peristalsis and gastric secretion and cause pain or pyloric contraction)
Vomiting Increasing Stomach pH
Metabolic alkalosis may result in vomiting, preventing the gastric H+ from reaching small intestine and pancreas section is missing so blood is now alkaline
Hiatal Hernia
protrusion of part of the stomach into the mediastinum through the esophageal hiatus of the diaphragm. Often painful and mixed with other chest pains including the cardiac ischemia
2 main types of Hiatal Hernia
Sliding and paraesophageal
Sliding Hiatal Hernia
when abdominal part of the esophagus and cardia and even part of the fundus slide up through the esophageal hiatus. *Regurgitation and heart b
Paraesophageal Hiatal Hernia
Cardia doesn’t move but part of the fundus and
peritoneum passes through the esophageal hiatus. *Usually no regurgitation
Gastric Ulcers Not Responding to Drugs
Clip part of the vagus nerve because it is in charge of secretion of HCl
What is needed to have an Ulcer?
Acid
Sympathetic Innervation of Stomach
Splanchnic nerves, celiac ganglion, which are to inhibit peristalsis and pyloric contraction and gastric secretion
Operation Performed to Correct Gastroesophageal Reflux
Fundoplication, upper portion of the stomach (the fundus) is wrapped (plicated)
around the lower portion of the esophagus and anchored securely below the diaphragm
Gastritis
Inflammation of the gastric mucosa which is erosive or non-erosive, can be chronic or acute (due to infection or toxicity)
Hypertriophic Gastritis
Giant rugal folds simulating cancer, mucosa is atrophic and associated protein loss, also called Menetrier’s Disease
Gastric Ulcers
Due to defective mucosal barrier, on the lesser curvature, has a pain which is increased by eating, vagotomy is surgical procedure
Vagotomy
Treating gastric ulcers not responding to drudger perforated ulcers, control gastric secretion, pylorus, reroute or remove so gastrin production is less
Surgical treatment of Gastric Ulcers
Hemigastrectomy, Billroth I and II, vagotomy and antrectomy
Postvagotomy Syndrome
Alkaline reflux gastritis, Afferent loop syndrome, Dumping syndromes
Hypertrophic Pyloric Stenosis
Progressive hypertrophy of circular muscles in pyloric
sphincter, causing a narrow pyloric lumen which may obstruct food passage, male infants
Treatment - Longitudinal pyloromyotomy, leaving the mucosa intact
Small Intestine Function
Digestion and absorption, enzymatic breakdown
Contractions in Small Intestine
Segmental (back and forth) and Peristaltic or Propulsive (in one direction)
Small Intestine Parts
Duodenum, jejunum and ileum, duodenum is almost entirely retroperitoneal, Jejunum and ileum are mobile and are intraperitoneal
Small Intestine Wall
Serosa, Musculares Externa, Submucosa, Mucosa
Small Intestine Cells
Simple columnar epithelial tissue with mucous producing cells
Villi
Fingerlike extensions of the epithelium and lamina propria that increase the mucosal surface
Duodenum
L1/L3 to T12, C shaped and around the pancreas, 4 parts
Functions of Duodenum
Regulation of gastric and gallbladder emptying in response to acidic chyme
Ulcer Common Location
Duodenum
Duodenum Ulcers
Frequent due to increased acid production in stomach
Bruner’s Glands
Produce an alkaline solution in duodenum, to protect mucosa from acidic chyme and optimize pH for pancreas enzymes
1st Part of Duodenum
Contains duodenal cap and common site for ulcers
3rd Part of Duodenum
Crossed by the superior mesenteric artery and vein and anterior to IVC and abdominal aorta
2nd Part of Duodenum
Has the major duodenal papilla, common opening for the common bile duct, and the main pancreatic duct, contains sphincter of Oddi
4th Part of Duodenum
Has the duodenojejunal flexure at L1/L2
Mobility of Duodenum
The beginning of the 1st part and part of the 4th part are covered by the peritoneum (have some mobility) the rest of duodenum is not mobile
Hormones of the Duodenum (regulate gallbladder and stomach)
Secretin, cholecystokinin, enterogastrone
Secretin
Inhibits gastric secretion
Cholecystokinin
Interacts with liver and induces gallbladder contraction after interaction with fatty chyme
Enterogastrone
Inhibits stomach peristalsis
Peyer’s Patches
Important part of the immune system by monitoring intestinal bacteria populations and preventing the growth of pathogenic bacteria in the intestines, especially in the ileum
Treitz Ligament
Used in surgery to locate the duodenojejunal flexure, which can cause obstruction which will have bile stained vomiting
Blood Supply to Duodenum
Branches of the celiac trunk via the gastroduodenal artery and superior pancreaticoduodenal artery, superior mesenteric artery via the inferior pancreaticoduodenal artery
Innervation of Duodenum
Sympathetic and Parasympathetic, submucosal plexus of Meissner and myenteric plexus of Auerbach, vagus nerve
Duodenal Atresia
discontinuity of the lumen owing to failed recanalization, bile-containing vomitus and distended stomach, double bubble sign
Kerchkring Folds
Project into lumen of the gut and increase surface area
Jejunum
Begins at the duodenojejunal junction, absorption of the digested food, particularly folate
Jejunum Characteristics
Left upper quadrant, more vascular, red color, thick wall, long vasa recta, less Arcades, less fat, window in the mesentery, no or very few payer’s patches, large and many circular folds
Ileum
Ends at ileocecal junction, absorption of the digested food, particularly B12
Ileum Characteristics
Right lower quadrant, less vascular, pale pink, thin wall, short vasa recta, more arcades, more fat, no window in the mesentery, many peyer’s patches, low and fewer circular folds.
Blood Supply of Small Intestine
Various branches of the superior mesenteric artery, called jejunal and ill arteries
Drainage of the Small Intestine
Carried by the superior mesenteric vein to portal vein and liver
Innervation of Small Intestine
Sympathetic (splanchnic nerves) to inhibit peristalsis and contraction of ileocecal sphincter, parasympathetic (vagus nerve) to cause peristalsis and glandular secretion
Meckel’s Diverticulum
Pouch formed in allium, congenital, vitelline duct that connects the yolk sac and primitive gut, duct disappears normally, symptoms of it remaining are similar to appendicitis , ulceration and GI bleeding, biopsy of pouch L5
Large Intestine
Longitudinal muscles in 3 bands, has teniae which results in haustras
Large Intestine Function
Water absorption
Ileocecal Junction
Complication when herniated small intestine in this area
Vermiform Appendix
Can be inflamed and irritate peritoneum, and build up fluid, sympathetic nerves, appendectomy uses McBurney’s point, and saves the iliohypogastric nerve. if not muscle weakness and direct inguinal hernia will result
Blood Supply of Colon
Ileococlic artery, cecal artery, appeniduclar right colic and middle colic arteries
Marginal Arteries
Important due to connection if blockage of mesenteric arteries
Rectum
Alimentary tract, follows convexity of sacral flexure and is S shaped from lateral view
Puborectalis Function
Muscle for continued fecal continence, part of levatotr and muscle, called rectal sling, contracts during peristaltic contraction
Houston’s Valves
Three Transverse Rectal Folds
Ampulla
Filleted terminal part of rectum, when filled urges to defecate, maintains integrity
Anal Canal
Called Anorectal Junction, terminal part of large intestine
Cell types of Anal Canal
Simple columnar until pectinate line and then stratified squamous
Blood Supply of Anal Canal/Rectum
Superior rectal artery muddle rectal artery inferior rectal artery
Veins of Anal Canal/Rectum
Superior rectal vein drains into inferior mesenteric vein and portal vein, middle and inferior rectal veins drain into internal iliac vein
Portocaval Anastomoses
Body has a bypass or alternative pathways to gut for blood, but will have complications when used, such as rectal vertices
Innervation of Rectum/Anal Canal
Sympathetic (subhypogastric plexus) and Parasympathetic for stretching, inferior rectal nerve responds to pain touch and temperature
Prolapse of Tissue in Anal Canal (internal)
Painless bleeding
Prolapse of Tissue in Anal Canal (external)
blood cots in veins, bleeding my inferior rectal branch of Duodendal nerve, more likely if pregnant, chronically constipated or crones disease
Hirschsprung’s Disease
Congenital megacolon, deficiency of gallino cells in Moisteners submucosal plexus and myenteric plexus of Auerbach, associated with down syndrome and chagas tease, decal retention and abdominal dissection, functional obstruction, colon back up
Pancreas
Retroperitoneal, head, neck, body, tail, endocrine and exocrine organ
Pancreas Function
Pinkish and glandular accessory digestive gland, which is retroperitoneal and lies
Endocrine Secretion of Pancreas
Secretion started by Secretin, increase bicarbonate secretion and cholecystokinin, both simulate bile secretion, and malaise to break down carbs and proteins, all activated in small intestine by enterokinase
Exocrine Secretion of Pancreas
Cells in the islets of langerhans, in tail, with glycogen and insulin and somatostatin all which go into the blood
Exocrine Secretion Path of Pancreas
Main pancreatic duct joins the common bile duct to form the Hepatopancreatic duct and then ampulla of Vater in the wall of the duodenum and open through major duodenal papilla to the 2nd part of the duodenum
Blood Supply to Pancreas
Superior and inferior pancreaticoduodenal arteries and arteries from the splenic artery
Veins of Pancreas
Corresponding veins and finally to the portal vein
Innervation of Pancreas
Sympathetic and parasympathetic (vagus)
Pancreatitis
Acute or chronic, stones from gall bladder in ampulla of valor, disruption and inflammation, back up of enzymes which start to a activate in pancreas and self digit, vomiting, diarrhea, pain in epigastric region, back and left hypochondriac region, yellow skin from backed up billy reuben, pain can even be in shoulder
Liver Function
Bile, metabolic function such as breakdown of alcohol, hormones, toxins
Endoplasmic Reticulum of Liver
Rough for protein synthesis and Smooth for detoxification
Round Ligament of Liver
Teres Ligament, remnant of umbilical vein which carried blood to fetus, the inferior borer of liver
Ligamentum Venosum
Ductus venosus, remnant for bypassing portal vein
Cooper Cells
Hepatocytes to filter blood in hepatic lobules
Disse’s Space
Ito cells are here as fat storage cells
Kupffer
Microphages for breakdown or swallowing
Cirrhosis of Liver
Hepaticytes overworked, constantly braking down making H2S2 product and this exposure os killing the liver cells so chronic inflammation, and now fibrosis which means compromised blood flow
Any vein directly leading to Portal Vein during Cirrhosis of Liver
affected and enlarged
Gall Bladder
Stores Bile
Gall Bladder Simulation
Cack stimulates contraction and bile byproducts; billy reuben and bile salts
Gall Stones
Cholelithiasis, happen when bile salts cholesterol fall out of solution, dislodge in the common hepatic duct, cause jaundice, can effect liver and pancreas too
Predisposed to Gall Stones
Females, the fertile forty to fifty and fatty and fair
Treatment for Gall Bladder
Nerves to be broken down, change in diet or meds, or remove gall bladder
Gallbladder Blood Supply
Cystic artery coming from the right hepatic artery
Spleen
Recycling environment, in left hypochondriac region, organ of immune system, intraperitoneal
Spleen Function
Site of RBC formation while in womb and then red bone marrow production and maturation of lymphocytes
Spleen Damage
During trauma, too much blood from splenic artery
Splenic Rupture
Causes sever bleeding, splenomegaly (enlarged spleen) in portal hypertension
Blood Supply of Spleen
Splenic artery from celiac trunk
Veins of Spleen
Splenic vein and superior mesenteric vein join to become portal vein
Innervation of Spleen
Sympathetic and parasympathetic (vagus nerve)
Kidney
Bean shape, retroperitoneal organs, T12-L3, right is lower than left
Function of Kidneys
Metabolic waste breakdown using water
Nephron Types
Cortical and Juxta Medullary
To Filter Must Have
Capillary bed and renal corpuscle
Glomerulus
Blod filtered into capsule with selective membrane, high pressure, forces waste out of section
Urinanalysis
Blood cells or proteins in urine, filtration is broken
What process of kidney uses the most energy?
Reabsorption
Macula Densa Cells
PH and sodium chloride changes noticed by these cells, radiation receiption
Juxtaglomerular
Mechanical, respond to pressure, feel the pressure of lack there of
When is Renin released?
Little pressure in the kidney
Renin
Interacts in blood and converts angiotensinogen made in liver, which changes to angiotensinogen 1 and goes to lungs were it becomes angiotensinogen 2 and os then released in blood to increase pressure
Ase Inhibitor
To avoid hypertension due to RAAS, if the pressure change is only in kidney then problem
Erythropoietin
Secreted by kidneys, for RBC maturation, when more oxygen needs to be carried around body
Kalikrein
Produced by kidneys, cause vascular expansion via other molecules
Prostaglandins
Kidneys produce large quantities
Ureter
Transitional epithelium, transport urine to bladder
Ureter Constrictions Locations
Renal pelvis, iliac vessels, urinary bladder
Ureters cross Males
Vas deferenses in pelvic cavity
Ureters cross Females
Uterine artery and vein on each side
Kidney Stones
Obstruct ureter, pain and bleeding from mucosal injury
Blood Supply of Kidney
Renal arteries from descending abdominal aorta
Vein of Kidney
Renal vein to IVC, right side longer than left
Innervation of Kidney
Little parasympathetic and sympathetic, lumbar and splenic
Juxtaglomerular Apparatus
Consists of the Macula densa, granulated juxtaglomerular cells of the pole cushion and a group of extraglomerular mesangial cells which continue to the intraglomerular mesangium, produces Renin
Glomerulonephritis
Arterioles swelling, bacterial infections
Pyelonephritis
Inflammation of renal pelvis
Polycystic Disease
Congenital, cysts cause inflammation and constriction
Adrenal Glands
Top of kidney, superior (renal) middle (aorta) and inferior (renal) suprarenal artery
Adrenal Glands Cortex
3 areas, regulate electrolyte and water balance, produce steroid hormones from cholesterol as a common precursor
Anterior Pituitary Produces
ACTH regulates adrenal gland
Adrenal Medulla
Adrenaline, fight or flight
Veins of Adrenal Glands
Renal viens to IVC
Innervation of Adrenal Glands
Sympathetic and Parasympathetic, medulla
Diaphragm and posterior abdominal wall contents
Psoas major and minor muscles, the quadratum lumborum muscle, the lumbar plexus and its related nerves, for support
Vagotomy Consequences
Alkaline reflux, gastritis, denaturing proteins, dumping syndrome if innervation is severed
