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In the current study buy cheap cytoxan 50mg line medicine for depression, seven of the nine participants who switched doctors (Anne generic cytoxan 50 mg on line symptoms checker, April buy cytoxan 50mg with visa symptoms 7 days after ovulation, Diane buy 50mg cytoxan treatment hepatitis b, Karen, Kim, Leanne, Shawna) had conducted health information-seeking. Two of the 15 participants who participated in some form of self-advocacy made statements that indicated a personal belief that “doctor knows best. Research by Deber, Kraetschmer, Urowitz, and Sharpe (2007) revealed that individuals over age 55 tend to favor a paternalistic approach from their doctors. Benbassat, Pilpel, and Tidhar (1998) argued that older patients may expect a paternalistic type of doctor-patient relationship because it was the cultural norm in the recent past. Karen stated, “When I was younger I did not argue with my doctor because I always thought they knew best. But after years of mistreatment I finally took the bull by the horns…I went through 5 Endos before I found one who knew what she was doing. Although she adopted a more autonomous role as a patient when her doctor switched her medication from Armour thyroid to Synthroid in 1958, Kim appears to be more tolerant of paternalistic behavior from male doctors than from female doctors. More specifically, Kim stated, “I’m more likely to argue with a female doctor if I think her approach is wrong. If I feel a male doctor’s approach to thyroid care is wrong for me, I simply don’t go back to him and begin looking for another doctor. Both Karen and Kim demonstrated autonomous behaviors when they sought health information and eventually switched doctors. However, Kim’s differing reactions to female versus male doctors’ approaches suggest an internalization of status beliefs (culture-based beliefs in which a higher status is associated with one group over another; Peck & Connor, 2011; Rashotte & Webster, 2005). In other words, Kim may be more willing to tolerate a paternalistic approach from a male doctor than from a female doctor because, on a subconscious level, she believes that male doctors are 179 higher in status than female doctors. In addition, older patients are more likely to accept their doctor’s advice without question (Kennelly & Bowling, 2001). However, research also indicates that female patients with a higher educational attainment tend to desire active involvement in the decision making process with their doctors (Flynn et al. Although Kim is less likely to argue with a male doctor than a female doctor, both Karen and Kim appeared to move from passive to autonomous roles when they sought health information and new doctors when they became dissatisfied with their treatment. Theme 3: Doctor-Patient Communication Participants’ responses to interview questions regarding communication indicated that their experiences with thyroid disease treatment were impacted by their ability to communicate with their doctors. Doctor-patient communication appeared to be influenced by the participant’s desire to be informed, the participant’s level of trust in her doctor, and by being female. The subthemes within Theme 3: Doctor-Patient 180 Communication are Subtheme 1: Desire to Be Informed, Subtheme 2: Role of Trust (lack of trust in doctor, treatment refusal, secret-keeping, and self-treatment), and Subtheme 3: Role of Gender (no preference for specific doctor gender, preference for female doctor, being taken seriously, and presence of emotion). Six of the 16 total participants expressed a desire for their doctors to inform them about the results of lab work and treatment options. Research indicates that although the majority of patients seek information about their diagnoses and treatment options from external sources (e. She stated, “I will tell them what I know, what I want to know and [learn] what their opinion is and their thoughts. Similarly, Emily conducted her own research but did not seek a new doctor despite expressing frustration that her doctor “doesn’t come forward with all she’s thinking unless [Emily] push[es] the conversation. In addition, patients believe that their doctors need to know their entire medical history in order to provide good care (Flynn et al. Regarding Anne’s desire for information exchange with her doctor, she explained, “I have some work to do to figure out how I can either get her to make me understand where she is coming from…or if I can get her to understand that I am backsliding again. Furthermore, almost 40% of the participants felt less informed regarding their treatment options than about diagnostic information. Research suggests that individuals with chronic illness keep current with information regarding their illness in an attempt to gain control over their health (Leach & Schoenberg, 2008; Mirzaei et al. Of particular importance to patients with chronic illness is information about recent treatment advances and the potential outcomes and side effects of treatments (Mirzaei et al. Kim explained that she is in a “wait- and-see mode” regarding how she feels after switching from a synthetic medication to a natural thyroid medication. She stated, “I need to get the testing done to see where my frees are on the new product. Murtagh (2006) asserted that doctors demonstrate respect for their patients’ autonomy by ensuring that they are fully informed. According to Carlsen and Aakvik’s (2006) study, patients prefer doctors who readily offer them health information. As previously mentioned, patient satisfaction and trust in one’s doctor are common in patient-centered approaches in which doctors respect patient autonomy, listen attentively, and answer questions (Copeland et al. In responding to interview questions regarding communication, nine out of the 16 total participants indicated that their ability to communicate with their doctors was influenced by their level of trust in their doctors. Four of these nine participants explicitly expressed distrusting their doctors, six refused treatment, three engaged in secret-keeping, and six engaged in self-treatment. Within Subtheme 2: Role of Trust are the following subthemes: lack of trust in doctor, treatment refusal, secret-keeping, and self-treatment. Four out of the nine participants who indicated that their ability to communicate with their doctors was influenced by their level of trust in their doctors explicitly expressed distrusting their doctors. Shawna shared that after continually being told by her doctor that her lab work was “normal” and learning otherwise through her own research, she is “keeping a folder of [her] labs now,” explaining, “I have learned to get copies of them and not believe what the doctor’s office tells me. Research indicates that trust in one’s doctor is necessary for patients to feel comfortable in sharing their symptoms and illness experiences (Copeland et al. In the current study, all participants who expressed distrusting their doctors had also reported feeling unheard, invalidated, and dismissed by their doctors. Trust in one’s doctor has been shown to be a predictor of patient adherence to medical advice (Houle et al. Six out of the nine participants who indicated that their ability to communicate with their doctors was influenced by their level of trust in their doctors explained that they had refused treatment. Jenna shared that her doctor “doesn’t listen” and “blows [her] off a lot” when she attempts to discuss her research. According to Anne, her doctor does not take her seriously and “did not understand when [she] was upset” at the doctor’s suggestion of taking Synthroid when there was a shortage in Armour thyroid. Similarly, Michelle explained that doctors would not listen 185 when she told them she did not feel well on Synthroid. She stated, “I finally had to go off of Synthroid (on my own) after a year because I felt so bad on it. Numerous studies have revealed that doctors’ ability to communicate with their patients enhances their patients’ level of comfort and trust in the doctors’ treatment recommendations (Copeland et al. Participants in Epstein and Street’s (2001) study also reported that feeling understood by one’s doctor is a prerequisite to trust. Additional reasons given by patients for not trusting and refusing their doctors’ treatment advice is feeling as if they have not received good care from their doctors in the past (Sharf, Stelljes, & Gordon, 2005), and receiving inadequate information from one’s 186 doctor regarding the potential side effects of treatment (Fukaya, 2000). Research by Piette, Heisler, Krein, and Kerr (2005) indicated that the level of trust in one’s doctor is a stronger predictor of medication compliance among patients with high out-of-pocket costs than the expense of the medication. According to Lee and Lin (2010), trust in the doctor-patient relationship increases the likelihood of full patient disclosure. Patient disclosure is particularly important in cases in which doctors and patients do not agree on the treatment approach because, with full patient disclosure, doctors might be better equipped to appropriately modify the patient’s treatment plan (Lee & Lin, 2010). Three out of the nine participants who indicated that their ability to communicate with their doctors was influenced by their level of trust in their doctors explained that they had kept secrets from their doctors. The finding of “secret-keeping” in the current study prompted a perusal of the literature for studies related to the issue of patients withholding information from their doctors. A thorough search of the literature, using the search terms secret-keeping, withholding information, lying, and disclosure, in relation to trust resulted in numerous studies related to patients seeking pain medication (e. However, a gap in the literature was discovered 187 regarding the practice of secret-keeping by patients in an attempt to regain control over their own health.

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Pancreatic lipase liberates the free Vitamin from the ester during digestion purchase 50 mg cytoxan mastercard symptoms after hysterectomy, but it is re-esterified in the intestinal mucosa cytoxan 50 mg fast delivery medications look up. Source: A rich source is Liver discount cytoxan 50mg fast delivery medications you can take when pregnant, but leafy vegetables and some fruits provide the largest amount of β-carotene Liver 50 mg cytoxan visa treatment dry macular degeneration, egg yolk, butter and milk are good sources of β-carotene. Functions β-carotene has an antioxidant role and prevents the development of diseases in which the action of free radicals is implicated. Retinal: Vitamin A is necessary for vision mediated by the rod cells, so deficiency often presents as “Night blindness”, the first symptom of Vit. The visual pigment, rhodopsin is found in the rod-cells of the retina and is formed by the binding of 11-cis retinal to the apoprotein opsin. When rhodopsin is exposed to light it gets decomposed (bleached), retinal dissociate and isomerized and reduced to all-trans retinol. This reaction is accompanied by conformational change and elicits a nerve impulse perceived by the brain as light. The All-trans –retinol in the absence of light is converted back to 11-cis retinol by isomerase present in the cytoplasm of the rod cells. This recombines with scotopsin and rhodopsin to generate another cycle of action on exposure to light. Vit A deficiency Vit A affects growth and differentiation of epithelial cells leading to defective epitheliazation, a condition affecting the cornea of the eye. Severe Vit A deficiency leads to progressive keratinization of the cornea and possibly permanent blindness. Vit A deficiency predisposes to gastrointestinal and respiratory tract infections. Plasma [Vitamin A] may be decreased in states of severe protein deficiency,due to lack of its carrier protein. Low plasma [Vitamin A]has been shown to be associated with an increased risk of developing cancer. Effect on Skin The deficeiency causes dryness and roughness of skin developing keratosis of hair folliciles with concomitant deficiency of Vit-B complex. Osteoclastic activity is also hampered, causing defective bone formation Effect on general Metabolism Zinc is necessary to maintain normal plasma concentration of Vit A. This vitamin is also necessary for the conversion of trioses to glucose perhaps indirectly through adrenal cortex that synthesizes hormones concerned with Gluconeogenesis. The first pro-vitamin D3 (chloecalciferol) with rupture of the bond between C9 and C10. It is a photolytic process involving no enzyme and slows down with aging because of the decrease of 7- dehydrocholesterol. Hydroxylation at C21 takes place in the endoplasmic reticulum of hepatocytes in a non-regulating process. Disturbance in enetrohepatic circulation can thus lead to deficiency of this vitamin. The main site for further hydroxylation at the 1 position is in the renal tubules. It crosses cell membrane bind to cytoplasmic receptor to form a complex, which is translocated to the nucleus. Bone: It promotes synthesis of osteocalcin which is needed for bone mineralization. Ricketes is characterized by the production of soft pliable bones due to defective mineralization secondary to calcium deficiency. Vit D deficiency is also characterized by low concentration of calcium in blood in association with increased serum alkaline phosphatase. In adults the deficiency produce Osteomalacia due to decreased absorption of calcium and phosphorous, maintains a low plasma level resulting in weak mineralization of bones. D level enhances calcium absorption leading to hypercalcemia and metastatic calcium deposits. There is a tendency to develop kidney stones from the hypercalciuria, secondary to hypercalcemia. It exists in the diet as a mixture of eight closely related compounds called Tocopherols. Functions The main function of Vit E is as an antioxidant, in particular a membrane antioxidant associated with lipid membrane structure. It provides protection from the action of peroxides by converting them to a product that is conjugating with glucuronic acid and excreted in bile. Source: The richest source is vegetable oil, and nuts 180 Deficiency Vit E deficiency is a rare but found in complication of prolonged and severe steatorrhoea, and of prolonged parenteral nutrition. Deficiency of Vit E causes anemia in children with cystic fibrosis of pancreas are found to be tocopherol deficient as a result of stetorrhoea. There are three types, Menaquinone (K2 )present in animals ,Phylloquinone (K1) present in Plants. Like vit E, the absorption of Vitamin k is dependent on appropriate fat absorption. Functions It is the only one acting as co-enzyme from the group of Fat soluble vitamins. It is required for post translational modifications of several proteins required in the coagulation cascade. Activation is carried out by the carboxylation of specific glutamate residues on the prothrombin by Vit K dependent enzyme. The presence of a second carboxyl group on the glutamate (γ- 181 carboxy glutamate) side chain confers phospholipids binding properties on the Prothrombin in 2+ the presence of Ca. Deficiency It is widely distributed in nature and produced by the intestinal micro flora. However, it is found in patients suffering from Liver diseases (obstructive jaundice), in new born infants and in patients with malabsorption. The placenta is inefficient at passing maternal Vit K to the fetus and immediately after birth the circulation concentration drops, but recovers on absorption of foods. In addition the gut of the new born is sterile, so that the intestinal micro flora does not provide a source of vit K for several days after birth. This is the reason why adults who are on prolonged antibiotic treatment require supplementation of Vit. D dependent Carboxylation reactions are used in the treatment of thrombosis related diseases. Warfarin, which inhibit the action of Vit K - probably via the mechanisms involved in the regeneration of the active hydroquinone. Thests to asses Vitamin K status include the prothrombin time-an important test in the investigation and management of jaundiced patients and of those on anticoagulant treatment. Some elements are needed at high concentrations, required more than 100mg per day. Sodium and Potassium: They are important in cell, muscle physiology, transmission of messages and other biological processes. Since both are widely distributed, deficiency of the two elements is rarely found. It is usually seen in patients with dehydration, on steroid therapy or excess sodium intake. Hyponatremia: It is common in patients who are in diuretics or excessive sweating, kidney disease, diarrhea and congestive heart failure. Other causes are decreased excretion by the kidney, diseases like Anuria, tissue damage or Diabetes Mellitus. Hypokalemia: Low potassium is not due to dietary deficiency but due to conditions like vomiting, diarrhea. Calcium and Phosphate: Major parts (90%) of them are found in the form of crystal lattice in the bone. People, who get enough sunlight, exercise regularly, on high protein diet, require 300- 400mgs per day.

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Disinfectants should be made up freshly clinical conditions which may lead to suspicion of and supplies should not be shared with other areas discount cytoxan 50mg symptoms glaucoma. There is no evidence to cohort nursing of patients colonized or infected with show that walls can harbour organisms; the same organism should be carried out order 50 mg cytoxan visa medicine 44334. In some cases purchase 50mg cytoxan with amex medicine cabinet home depot, the patient may be it should be disposed of before hands are washed order cytoxan 50 mg fast delivery symptoms 7 days past ovulation. Further screening of patients may to the patient area so that everyone entering wears be required to ensure that they are no longer a it. Individual bags should be kept for each Give an example of a precaution infected patient and once filled double bagged to to prevent cross infection through each of the 5 common routes. This is not an exhaustive list; healthcare settings Although it is not any more virulent than may have to produce similar lists to cover their Methicillin-sensitive Staphylococcus aureus, needs. Strict measures the appropriate precautions specific to their route are essential where such patients are cared for. Measures required to prevent cross infection with Now carry out Learning Activity 3. However, daily washing with an antiseptic is recommended, with particular attention given to commonly contaminated sites, such as the axillae and groin. Nasal carriage should be treated using mupirocin ointment three times a day for five days. Mupirocin may be applied to infected lesions (but not large Page 23 areas such as pressure sores) for up to five days. Module 1 Page 23 Infection control in special circumstances There are certain areas within healthcare settings manage, control, and investigate any outbreaks, where additional infection control measures must and provide feedback and advice to health staff. These include intensive or critical Producing and implementing local and national care units and units where immunocompromised standards and policies are also important parts of patients get nursing care (for example, transplant the team’s function. Audit of practice is essential to ensure that infection Management of patients in such units often control measures are carried out properly and requires the use of invasive devices. Health staff should be aware of the should only be used where absolutely necessary and importance of audit and always be involved. The risk of areas where audits may be useful include: infection is greatly increased in such units, due in • handwashing; part to the presence of various pieces of invasive • environmental cleanliness; equipment. All • decontamination procedures; and methods of • patient outcomes, for example, postoperative decontamination wound infections. The measures taken to prevent and control spread of number of visitors may need to be limited and infection are essential in everyday practice. Such they must be advised on the precautions to be documentation will alert healthcare workers to the followed. Thorough, correct handwashing is the recommended precautions and in turn help to most important measure that can be carried out to control nosocomial infections. Occupational health staff and infection control Other considerations staff often work closely together to provide It is recommended that infection control teams protection to staff from infectious diseases. These teams, Immunizations which should be made available consisting of an infection control doctor and include hepatitis B. In addition, occupational infection control nurse, should be consulted on all exposures to patient blood or body fluids should infection-related matters. The team should always be reported, as steps must be taken to protect regularly conduct surveillance, and audit and and reassure exposed healthcare workers. This can recommend best practice to prevent or control be done swiftly and effectively by trained nosocomial infections. Page 24 Module 1 Summary of key points The health status of the staff is clearly an important • The principles of infection control and prevention factor in limiting cross infection to susceptible are essential in the everyday care of patients within patients, particularly in high-risk areas such as healthcare settings. Illnesses (coughs and colds) as well as conditions • We continually share our environment with many (eczema and psoriasis) among healthcare staff must different microorganisms. Occupational health and infection and their pathogenicity is extremely important for control officers should work closely together when healthcare workers. More detailed information about individual diseases, including definitions, epidemiology within Europe, modes of transmission, methods of prevention, treatment options, and practical nursing care can be found in Modules 3 – 6 of this manual. A suspension of dead, attenuated, or otherwise modified microorganisms for inoculation to produce immunity to a disease by stimulation of antibodies 2. A preparation of the virus cowpox Page 41 Module 2 Page 41 Basic principles of immunization It is widely acknowledged that the two most Immunization occurs when a specific resistance to important public health interventions, which have an infectious disease is induced by the had the greatest impact on the world’s health, are administration of a vaccine. In addition, immunization has been shown to be one of the safest and most cost- Active immunization involves the stimulation of effective interventions known. This can be achieved by the Edward Jenner administration of: produced the very • live attenuated organisms: the organism’s first vaccine over two pathogenicity is reduced by sequential subculturing hundred years ago. He took some material from a cowpox • toxoid: the inactivated products of an organism pustule and scratched it into the arm of a young (for example, diphtheria, tetanus); boy. The boy developed a cowpox pustule and mild • components of organisms: such as capsular fever but remained well when subsequently polysaccharides (for example, meningococcal, inoculated with smallpox. The first vaccine had pneumococcal); and been discovered and indeed, as a consequence, the • genetically engineered viral products (for example, original meaning of “vaccine” was “protection hepatitis B). One hundred and seventy years later, following a targeted global vaccination Passive immunization does not induce an antibody programme, smallpox had been completely response; rather it involves the direct transfer of eradicated. It was to be almost one hundred years later before Immunity is gained immediately but is short-lived. A child to be prepared by taking blood from actively who had been bitten by a rabid dog was inoculated immunized donors (e. Active immunization is preferred to passive The discoveries of Jenner and Pasteur formed the immunization for the following reasons: basis for vaccine production. Now there are many • it confers long term immunity, and different types of vaccine. Page 42 Module 2 Administration of vaccines Passive immunization is generally reserved for Consent (written or implied) must be obtained situations where: from parents or guardians of small children before • rapid immunity is needed (for example, for post- any vaccine is given. It is important to understand exposure treatment of a tetanus-prone wound), and local policy on informed consent. Doctors and nurses who administer vaccines must have suitable training in the appropriate techniques. A primary course of immunization may consist of Training for anaphylaxis should be undertaken and one or more doses of vaccine depending upon the suitable drugs and equipment should be available individual vaccine. A All vaccines vary full course of immunization may consist of a slightly, but all come primary course of vaccine followed by one or more packaged with a boosters. Boosters of vaccine are given at varying manufacturer’s data intervals depending upon the individual vaccine. Vaccines needing to be reconstituted with diluent should be used within the manufacturer’s time recommendations. Generally vaccines are administered via the oral, intramuscular, subcutaneous or intradermal routes. Vaccines that are not administered via the correct route may be sub-optimal or cause harm. If the skin is cleaned with alcohol prior to the administration of a vaccine, the alcohol should be allowed to dry first. Correct vaccine administration techniques hepatitis B can be administered if appropriate. If immunization is delayed because of be disposed of safely, usually in a sharps bin for mild illness, there is a risk that the child may not incineration. Throughout the world, lost opportunity Administration of more than one vaccine because of false contraindications is a major cause When more than one live attenuated vaccine is to of delay in completing the immunization schedule. All other vaccines can be given malignant disease, therapy with immuno- within any time schedule.

She is likely to continue aminosalicylates buy cytoxan 50mg without a prescription medications used for fibromyalgia, and patients often remain on corticosteroids 50 mg cytoxan medications grapefruit interacts with. Potentially buy cytoxan 50 mg otc medicine 512, although controlled evidence for their use is sparse and more study is needed cheap 50mg cytoxan with mastercard treatment wax. Patients with pouchitis (which may occur following some surgical procedures for ulcerative colitis) may have significant clinical improvement fol- lowing the use of metronidazole. Ciprofloxacin is also useful for pouchitis, and concurrent use with metronidazole appears to be superior to either antibacterial alone. Ciprofloxacin alone may also be of potential use for disease control in ulcerative colitis, but data in the absence of other standard treatments are lack- ing. Discuss the general mechanisms of Cthese cellular needs by removing the substances from the external environment regulating digestive function. Identify the roles of enzymes and process is another important step in maintaining homeostasis. This chapter briefly gastrointestinal hormones in the discusses the basic digestive processes: motility, secretion, digestion, and absorption. It also reviews the anatomy of the digestive tract and discusses techniques used in the 4. Identify the difference between Motility is the process whereby muscular contractions mix and move the contents of abnormal and normal gastrointesti- nal assessment findings. The smooth muscle of the digestive tract maintains a con- stant low level of contraction known as tone. Tone maintains a steady pressure on the digestive tract contents and prevents permanent stretching. Propulsive movements (peristalsis) push the contents forward through the digestive tract at varying speeds. Mixing movements promote digestion by mixing food with the digestive juices and fa- cilitate absorption by increasing contact of intestinal contents with the absorbing sur- faces of the digestive tract (Clark, 2005). Digestion refers to the breakdown of food structure by enzymes produced within the digestive system so that the nutrients locked in the complex foods become available for absorption and use. For instance, a carbohydrate molecule is too large to be able to be absorbed into the circulation. Enzymes will first break down this large molecule into smaller molecules called monosaccharides. The monosaccharides are then able to be absorbed across the epithelial cells and into circulation. Proteins are degraded into amino acids and small polypeptides, and fats are degraded into monoglycerides and free fatty acids. Unless an individual has a malabsorption problem, 100% of food digested is absorbed; therefore, caloric intake is regulated at the level of ingestion. Absorption refers to the process whereby the products that result from digestion are transferred from the digestive tract lumen into the blood or lymph. Chemoreceptors are sensitive to the chem- cosal folds increase the absorptive surface area of the small in- ical components of the chyme (i. Mechanoreceptors (pressure receptors) are sensitive to must cross the mucus layer, the epithelium, the interstitial the stretch or tension within the wall of the digestive tract. This section examines the four basic digestive processes— The autonomous smooth muscle function consists of self- motility, secretion, digestion, and absorption—at each organ induced electrical activity in the smooth muscle, referred to along the digestive tract. The digestive tract, also called the al- as the basic electrical rhythm or pacesetter potential. Pacesetter imentary canal, is a series of hollow organs joined in a long cells do not have a constant resting potential, but rather display tube running from the mouth to the anus (Figure 31-1). The membrane potential may eventually reach the thres- In the mouth, the first step in the digestive process is chewing. Saliva initiates digestion of carbo- The second factor involved in the regulation of digestive hydrate through the action of salivary amylase (Martini & tract function is the intrinsic nerve plexi. These cells are primar- Esophagus ily responsible for coordinating local activity within the diges- tive tract, such as motility and secretion of enzymes and The esophagus is primarily involved with swallowing, the hormones (Clark, 2005). The The third factor is the extrinsic nerves that originate out- esophagus secretes mucus to protect the mucosal membranes side the digestive tract and innervate the various digestive or- from any sharp edges of the food products as well as from any gans (i. The upper the act of chewing not only results in an increase in salivary se- sphincter is the pharyngoesophageal sphincter. This sphinc- cretions in the mouth but, via input from the vagus nerve, also ter remains closed except during swallowing and prevents large increases secretions from the stomach, pancreas, and liver in volumes of air from entering the digestive tract. These hormones can exert either excitatory or in- The stomach is a J-shaped saclike chamber that is divided into hibitory influences on smooth muscle and exocrine gland cells three sections: the fundus, body, and antrum. The wall of the digestive tract of the stomach is the pyloric sphincter, which acts as a barrier contains three types of sensory receptors that respond to these between the stomach and the small intestine. These secretions are all released into the lumen of the stomach (Martini & Bartholomew, 2000). Endocrine cells, called G cells, which are located in the py- loric region of the stomach, secrete the hormone gastrin into the blood. No food or water is absorbed into the blood from the stomach, although alcohol and aspirin are absorbed from this site (Martini & Bartholomew, 2000). Control of gastric secretion involves three phases: the cephalic phase, the gastric phase, and the intestinal phase. Distention of the stomach and the chem- ical content of food are responsible for increasing gastric secre- tions during this phase. The intestinal phase of gastric secretion encompasses factors originating in the small intestine that in- fluence gastric secretion. While the other phases are excitatory, this phase is inhibitory, helping to shut off gastric secretions as the chyme begins to be emptied into the small intestine (Martini & Bartholomew, 2000). The digested food into the duodenum at a rate that does not exceed exocrine portion consists of acinar cells, which secrete three the small intestine’s capacity to handle it. In the antrum (lower stomach), which continues the carbohydrate digestion that was initiated peristaltic contractions are responsible for gastric emptying. Factors in the duode- an inactive state and become activated only when they reach num are also of primary importance in controlling the rate of the lumen of the small intestine, although both amylase and gastric emptying. Pancreatic enzymes are and/or acid in the chyme, the osmolarity of the chyme, and most effective at breaking down their specific nutrients in a duodenal distention. Three types of secretory cells are found in The exocrine secretions are regulated primarily by two the walls of the pits. Both of these mucus that provides a mucosal barrier, protecting the stomach hormones are released from the duodenal mucosa. Approximately 500 mL of chyme enter the large which in turn stimulates the pancreatic duct cells to secrete intestine from the ileum; of this amount, about 350 mL are sodium bicarbonate. No ence of fat in the chyme, which results in the stimulation of digestion and minimal absorption occur in the large intestine. In addition to water and sodium being absorbed, vitamin K, which is synthesized by bacteria in the lumen of the colon, is Liver absorbed as well (Martini & Bartholomew, 2000). The liver performs a wide variety of functions and, in fact, is the Organs that help with digestion, but are not part of the di- most important metabolic organ in the body. Bile is secreted by the liver and is concentrated and The tongue is composed of voluntary skeletal muscle and is im- stored in the gallbladder between meals. Another important function of the tongue is taste; bile, via the common bile duct, into the duodenum. Micelles Salivary Glands transport the water-insoluble products of fat digestion to the in- The salivary glands produce saliva. The most important sali- testinal wall where they can be absorbed (Sherwood, 2004).

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