stomach

• Anatomy stomach
• Location of the stomach

Synonyms in a broader sense

ancient greek: Stomachos
Greek: Guest
Latin: Ventriculus
English: stomache

definition

From a formal point of view, the stomach is a bulge in the digestive tract that lies between the esophagus and the intestine and has the task of storing and mixing food. This hollow muscular organ forms gastric acid (HCL) and enzymes that pre-digest (chemically break down / break down) some components of the food in order to then pass the chyme on to the small intestine in portions.

Read more about the topic here: Tasks of the stomach

Anatomy of the stomach

Of the stomach is usually located in the left and middle upper abdomen directly below the diaphragm. The position, size and shape of the stomach varies greatly from person to person and depending on age, filling level and body position. If the stomach is moderately full, it is on average 25-30 cm long and has a storage capacity of 1.5 and in extreme cases even up to 2.5 liters.

The stomach is covered by ligaments that, among other things, are too liver and spleen pull, fastened in the abdominal cavity and thus stabilized. The stomach is curved like a fishing hook in the abdominal cavity, and with its convex side forms the great curvature of the stomach (large gastric curve / curvartura major) and with the concave side the small curvature of the stomach (lesser gastric curvature / curvatura minor).

The stomach can be divided into different sections:

• Stomach entrance / cardia / ostium cardiacum:
  The upper mouth of the stomach is an area of ​​1-2 cm where the esophagus joins the stomach. This is where the sharp transition from the esophageal mucosa to the Gastric mucosawhich can usually be seen well with the endoscope.
• Stomach base / fundus gastricus:
  Above the entrance to the stomach, the base of the stomach, which is also known as the “dome” or fornix (bulge) gastricus, curves upwards. The bottom of the stomach is usually filled with air that is involuntarily swallowed while eating. When people stand upright, the base of the stomach forms the highest point of the stomach, so that the air that has been collected can be seen particularly impressively as a "stomach bubble" in the X-ray image.
• Stomach body / corpus gastricum:
  The main part of the stomach is made up of the stomach body. Here there are deep longitudinal folds of the mucous membrane (plicae gastricae), which extend from the stomach entrance to the gatekeeper and which are also called the "stomach road".
• Porter section / pars pylorica:
  This section begins with an extended vestibule, the porter's cave (antrum pyloricum), followed by the porter's canal (canalis pyloricus) and ends with the actual gastric porter (pylorus). This is where the gastric sphincter muscle (sphincter pylori muscle) is located, which is formed by a strong ring-shaped muscle layer and closes the lower stomach mouth (ostium pyloricum). The pylorus closes the stomach outlet and periodically lets some food pulp (chyme) into the Duodenum (Duodenum) happen

Anatomy stomach

1. Esophagus (gullet)
2. Cardia
3. Body
4. small curvature
5. Fundus
6. great curvature
7. Duodenum (duodenum)
8. Pylorus
9. Antrum

Location of the stomach

1. Throat / throat
2. Esophagus / esophagus
3. Stomach entrance at the level of the diaphragm (diaphragm)
4. Stomach (gaster)

Layers and structure of the stomach wall

The stomach wall shows a characteristic layer structure under the microscope.

• The inside of the stomach wall is lined with mucous membrane (tunica mucosa). The lining of the stomach is divided into three sub-layers. The uppermost layer forms a covering tissue (lamina epithelialis mucosae), which forms a tough, neutral mucus that protects the gastric mucosa from mechanical, thermal and enzymatic damage. This is followed by a shifting layer (Lamina propria mucosae), in which the gastric glands (Galandulae gastricae) are embedded. Finally, there is a very narrow layer of autologous muscles (lamina muscularis mucosae), which can change the relief of the mucous membrane.
• The gastric mucosa is followed by a loose sliding layer (tela submucosa), which consists of connective tissue and in which a dense network of blood and lymph vessels runs, as well as a nerve fiber network, the submucosal plexus (Meissner plexus), which controls the gastric gland activity (secretion). This plexus works independently of the central nervous system (CNS), but can certainly be influenced by this via the autonomic nervous system.
• This is followed by a strong layer of stomach muscles (tunica muscularis).It is divided into three sub-layers, the fibers of which run in different directions: first an inner layer of small, oblique muscle fibers (fibrae obliquae), then a circular muscle layer (stratum circulare) and on the very outside an outer longitudinal muscle layer (stratum longitudinal). These muscles ensure the wave-like movement of the stomach (peristalsis), which is responsible for the constant mixing of the chyme with the gastric juice. A network of nerve fibers, the myenteric plexus (Auerbach plexus), runs between the circular and longitudinal muscle layers and controls the function of the muscles. Just like the submucosal plexus, this plexus works largely independently, but is regularly influenced by the vegetative nervous system.
• Another layer of connective tissue (Tela subserosa) follows.
• The conclusion is a covering of the peritoneum, which lines all organs. This coating is also called tunica serosa.

Figure stomach

1. Esophagus - Esophagus
2. Incision at the stomach entrance -
   Incisura cardialis
3. Stomach entrance -
   Ostium cardiacum
4. Gastric dome -
   Fundus gastricus
5. Stomach body -
   Corpus gastricum
6. Great curvature of the stomach -
   Curvatura major
7. Duodenum,
   horizontal part -
   Duodenum, pars horizontalis
8. Duodenum, upper part -
   Duodenum, pars superior
9. Stomach porter - Pylorus
10. Small curvature of the stomach -
    Curvatura minor
11. Stomach folds - Plicae gastricae

You can find an overview of all Dr-Gumpert images at: medical illustrations

Gastric glands

The gastric glands (Glandulae gastricae) lie in the lamina propria mucosae and can be found in the fundus and the body of the stomach. Up to 100 glands are located on 1mm2 of the surface of the mucous membrane. There are different cells in the wall of the glandular tube:

• Mucous cells:
  They produce the same neutral mucus as the surface cover cells (Epithelial cells).
  
• Adjacent cells:
  These cells lie fairly superficially in the gland and secrete an alkaline mucus, i.e. of the PH value is high due to the hydrogen carbonate ions (OH ions) it contains. This property is important to PH value control of the stomach and, if necessary, regulate it. The mucus covers the stomach lining and protects against self-digestion by the aggressive hydrochloric acid (HCl) and enzymes (self-digesting proteins). This type of cell is found particularly frequently in the cardia and fundus of the stomach.
  
• Main cells:
  These cells produce the inactive precursor enzyme pepsinogen, which is converted into the active enzyme pepsin after being released by the hydrochloric acid (HCl) and is responsible for the digestion of proteins. Since the enzyme only comes into contact with the hydrochloric acid at the surface of the gland, the enzyme prevents the glands from digesting themselves. This type of cell is mainly found in the corpus of the stomach.
  
• Parietal cells:
  These cells, which can be found in the gastric corpus in abundance, form plenty of hydrogen ions (H + ions), which are required for the formation of hydrochloric acid (HCL). The hydrochloric acid has a very low pH of 0.9-1.5. In addition, the parietal cells form the so-called intrinsic factor. This substance forms a complex with vitamin B12 in the intestine, which can then pass through the wall of the small intestine. This vitamin is of particular importance in the formation of blood cells (erythropoiesis), so patients who have had their stomach removed can develop anemia (anemia).
  
• G cells:
  These cells, which are primarily located in the antrum of the stomach, are able to produce the hormone gastrin. This hormone increases the production of HCl in the parietal cells.

Function of the stomach

The stomach acts as a reservoir for the food ingested. It can store food for hours and thus ensures that we can cover our daily nutritional needs with a few larger meals. The peristalsis causes the chyme (Chyme) mixed with gastric juice, the food chemically crushed, partially digested and then in portions into the Duodenum (duodenum) forwarded.

Read more about the topic here: Tasks of the stomach

Stomach acid

Of the Gastric juice / stomach acid contains acid (HCL), Mucus, electrolytes, intinsic factor and some enzymes, mainly pepsin.
The hydrochloric acid kills the bacteria ingested with food and protects against infections.
Pepsin is an enzyme that breaks down proteins. Interestingly, both hydrochloric acid and pepsin are of secondary importance for digestion, which is also shown by the fact that the digestive function is largely preserved after the stomach has been surgically removed. Of the Intrinsic factor however, it turns out to be very important as the absence of this substance can cause serious problems Anemia (Anemia) can occur.

Since the enzymes for the Fat digestion (Lipases) and Carbohydrate digestion (amylases) are only produced in very small quantities in the stomach, these food components are hardly digested at all in the stomach, but only in the intestine.

The gastric mucosa produces 2-3 liters of gastric juice every day. Compared to the fasting state, gastric juice release (gastric juice secretion) can increase by a factor of 100 when ingested food.

There are different stages of digestion in which nerve signals and different ones Hormones and mediators play a role:

Head phase / cephalic (vagal) phase:
Some food signals (smell, taste, appearance) cause the parasympathetic vagus nerve (Vagus nerve), a gastrin release from the G-cells and thus an increase in gastric juice production even before eating.

Gastric phase / gastric phase:
Here, the stretching stimulus caused by the ingestion of food is the one that reflexively increases gastric juice production via the vagus nerve. Some chemical stimuli such as protein breakdown products, alcohol and coffee cause an increased release of gastrin and histamine, which in turn increases gastric juice production.

Intestinal phase / intestinal phase:
The most important function here is to inhibit gastric juice production. If strongly acidic chyme passes into the duodenum, there is a risk of damaging the intestinal lining. This stimulus causes the hormone secretin to be released, which inhibits gastrin production. A reduction in gastrin in turn leads to a reduction in gastric acid production.

For more information, see: Stomach acid

The gastrointestinal flu

General information on gastrointestinal flu

The gastroenteritiswhich colloquial Abdominal influenza or Vomiting diarrhea is an inflammatory disease of the gastrointestinal tract and also literally means gastrointestinal inflammation. The typical symptoms of gastrointestinal flu are Vomit and diarrhea. You shouldn't have the "real flu" (Influenza) confound. Gastroenteritis is the leading cause of vomiting and diarrhea in children and adults. It used to be fatal in children as too much fluid was lost through vomiting and diarrhea. Today the number of deaths is limited from 2.5 million annually to around 2000.

Causes of gastrointestinal flu

A Abdominal influenza can be triggered by pathogenic (disease-causing) pathogens, including various Viruses (see below), bacteria and Protozoa belong.

The most common bacterial pathogen are Salmonella, Yersinia, Shigella, Campylobacter, Vibrio cholerae and Clostridium difficile.

The Protozoa (Protozoa) that can trigger gastrointestinal flu are, for example. Amoeba.

The mechanism underlying the various pathogens differs, but usually one results Damage to the lining of the stomach. As a result, the food can no longer be digested well and it becomes liquid Diarrhea and vomiting. Some bacteria also produce toxins (Toxins) which lead to an increased Loss of water and salt to lead. Toxins can also accumulate in spoiled foods, and so become a classic when they are consumed Food poisoning to lead.

In addition, gastrointestinal flu can be of a physical nature. So can ionizing radiation, for example in the context of cancer therapy, lead to damage to the gastric mucosa.

transmission

The Abdominal influenza is in most cases by means of a fecal-oral Smear infection transfer.

That means that at insufficiently cleaned hands infectious patients who can transmit pathogens to food or humans. Ultimately, the contaminated food is then consumed.

Other pathogens such as salmonella accumulate in foods that are not sufficiently heated, such as meat products. Only the noroviruses are so infectious that one Droplet infection is possible. When vomiting, the finest infectious droplets get into the air and can then infect relatives or hospital staff.

Symptoms and diagnosis

Until First symptoms appear can from the beginning of the infection up to 2 days pass away.

Then the gastrointestinal flu manifests itself through Loss of appetite, nausea, Vomit such as diarrhea. The diarrhea can be bloody.

Stomach discomfort and pain can occur. It also comes to general exhaustion and dizziness. In the case of inadequate hydration, symptoms of dehydration occur as a lot of fluids are lost through vomiting and diarrhea.

Usually it is about clinical anamnese no further microbiological diagnostics necessary. In the case of severe or special disease processes, you can Stool and blood samples Provide information about the type of pathogen in order to be able to clarify further therapeutic measures.

therapy

Therapy takes place symptom-oriented.

First of all it is important to those affected to protect against dehydration. To do this, they are given a solution with a mixture of glucose and salt (WHO rehydration solution) required. This can be so-called Probiotics be expanded. These are bacterial strains that belong to the natural intestinal flora and can thus support the natural intestinal activity. The solution can also be used for children and people for whom rehydration is not so successful as an infusion administered.

Can accompany Medication help, that stop vomiting (Antiemetics) or that Lower fever. Antibiotics are usually not prescribed.

Incidentally, at the beginning of the disease should only easily digestible carbohydrates are eaten (e.g. bananas, rusks and white bread) to protect the stomach and intestines.

Reporting requirement

In Germany there is one for some pathogens that cause gastrointestinal infections Reporting requirement.

These include Salmonella typhi, Vibrio cholerae, Norovirus, Rotavirus and EHEC.

For more information, see: Abdominal influenza

The gastrointestinal virus

General

There is no such thing as the gastrointestinal virus. Rather, it is a few different viruses that do one gastroenteritis (Gastrointestinal flu). Below you will find an overview and brief description of the respective viruses.

Rotaviruses

The Rota virus is a so-called RNA virus, which is the most common pathogen childhood gastrointestinal flu is. It is also an important nosocomial (hospital infection) pathogen on pediatric wards in clinics.

The Rota virus is over Smear infections (fecal-oral) transmitted and can be detected in the stool.

There is a Oral vaccination with a weakened (attenuated) live vaccine, which is recommended from the 6th week of life. The last dose should be given before the age of 26 weeks.

Without that vaccination Almost every child falls ill with Rotavirus by the age of five.

A There is therapy currently Not. But it should be on a adequate water supply be respected. The usual Duration of illness amounts 6-8 days.

There is a statutory requirement for Rota viruses Reporting requirement.

Adenoviruses

At Adenoviruses These are non-enveloped DNA viruses, of which there are 51 serotypes (subgroups) that cause diseases in humans.

You will mean Droplet infection or smear infection (fecal-oral) transfer. Mainly they solve Respiratory infections out. But there are also serotypes, especially in children Gastroenteritis (Inflammation of the gastrointestinal tract) or diarrhea trigger.

The viruses can be detected in swabs from throat swabs or in stool samples.

There is no therapy for adenoviruses. One treats therefore symptomatic. However, this is only necessary in the event of a severe course of the disease. A mild infection heals on its own.

Noroviruses

Noroviruses are very environmentally resistant RNA viruses. you will be ingested with food and by means of Smear infection (fecal-oral) transfer.

you are highly infectious and can also be sent via Droplet infection be transmitted. With gush-like vomiting, fine droplets get into the air, which are then inhaled by healthy people.

Classically they lead to Food poisoning when eating contaminated food. Noro viruses are very common, especially in young people Gastroenteritis (Inflammation of the gastrointestinal tract) with vomiting diarrhea.

The severe gastrointestinal flu usually lasts 1-3 days and stops by itself.

Since there is no causal therapy, only that symptomatic treated. Above all, it is important that dehydration balance. In the case of very old patients or small children, a short hospital stay may sometimes be necessary in order to control the fluid balance. This also applies to patients with other previous illnesses and general weakness.

There is a legal requirement for infections with noroviruses Reporting requirement.

Sapoviruses

Sapoviruses are also very environmentally resistant germs. Mainly they are through Smear infection transfer. You solve Gastroenteritis with children and are detected in the stool. Here, too, only one takes place purely symptomatic therapy.

Astroviruses

These viruses appear star-shaped in the electron microscope, which is why they are Astroviruses is called. You are too very environmentally resistant.

In children they solve acute gastrointestinal flu with fever, nausea, vomiting, abdominal pain and diarrhea.

They are the ones after the rota viruses second leading cause of gastroenteritis in children.

They can be detected in the chair.

Your therapy takes place symptomaticwhere gastrointestinal flu will clear up on its own after a few days.

For more information, see: Gastrointestinal virus

upset stomach

If one speaks colloquially that one has "upset one's stomach", that is usually one queasy feeling and nausea meant. This can be from stomach pain be accompanied. Then nausea often leads to Vomit and can have various causes.

The following is an overview of the various causes of a "sore stomach“.

Food poisoning

Most of the time, when you talk about having "spoiled your stomach", you mean one Food poisoning. At first glance, poisoning sounds like a life-threatening situation, but this is not the case in the cases mentioned here. Most of the time, it just arises through contaminated food.

The causative agent is mostly Staphylococcus aureus, a skin germ that can be transferred to meat by the butcher, for example.

It then accumulates on the food and multiplies there, especially after the food has been standing around for a long time.

Long cooking kills the germs though from, but eating undercooked food can cause poisoning. Some of the toxins formed by the germs can also survive cooking.

Other bacteria that can cause such poisoning are clostridia, molds and bacilli. The symptoms usually appear shortly after consuming the food and are quite severe.

therapy

First you should Drink plenty of waterto counteract fluid loss from vomiting and diarrhea.

A light food with easily digestible carbohydrates. These include, for example, white bread, rusks and pretzel sticks.

Flatulent foods such as dairy products, alcohol, raw vegetables and coffee should be avoided.

It doesn't hurt one To see a doctorwhen the discomfort is very severe.

Mostly are such stomach upsets self-limiting and stop after 1 to 3 days.

For bacterial infections, for example through Salmonella or Listeria, which lead to very severe diarrhea, is one Antibiotic therapy indexed.

If complaints like Problems with sight, swallowing, or speech occur, should be prompt a Called an emergency doctor become.

That can be an indication of a Botox poisoning be. Botulinum toxin or short Botox can in bloated food cans be included. One should absolutely discard and no longer consume.

A botulinum toxin poisoning is caused by a Antitoxin treated immediately.

forecast

Food poisoning or infections of this kind usually go away after 2 - 3 days if there is no fever and the diarrhea is not bloody.

The Complaints sound by themselves spontaneous from and a therapy is, if anything, only symptomatic makes sense.

For more complicated processes, which are caused by salmonella, for example, is one Antibiotic therapy indexed.

How can you calm the stomach?

If the stomach is irritated by infectious diseases such as gastrointestinal flu, inflammation or food poisoning, this can be very uncomfortable for those affected.

One is plagued by nausea, may lack appetite and feel uncomfortable. But the opposite can also be the case: You are hungry, but you don't really know what your stomach can handle in such a sensitive situation. Here are some ways you can calm your stomach:

In case of nausea

So-called help with nausea Antiemetics. These are drugs that prevent vomiting.

These include, for example Antihistamines or Dopamine antagonists. They work at the vomiting center of the brain stem and thus inhibit the urge to vomit.

But there is also natural fabricsthat relieve nausea. These are chamomile, ginger, peppermint and fennel. You can drink as tea and so calm his stomach well.

The warmth of the tea is also good for spasmodic pain.

In case of pain

stomach pain and Stomach cramps often occur in the context of gastrointestinal diseases, inflammation or a lot of stress.

Warmth and bed rest can provide relief.

Help here too natural means how chamomile, Caraway seed or linseedto calm the irritated stomach.

In addition, one should abstain from alcohol, caffeine and nicotine.

Often it also helps with the stress Relaxation exercises to reduce.

Acidic foods and eating too quickly or too quickly should be avoided. That can only put additional strain on the stomach.

So-called Antispasmodics, like for example Buscopan, relieve cramps. They can also help against stomach pain.

Help with excess acidity and a feeling of heartburn Antacidswhich neutralize stomach acid. In addition, there is still Proton pump inhibitorswhich inhibit the formation of stomach acid and thus relieve acid-related pain.