Every so often during my weekly paediatric endoscopy list, a striking image comes up on the screen, that makes me stop and reflect on the wonders of the human body.
Here you can see a healthy-looking duodenum, from a recent paediatric endoscopy of the upper Gastrointestinal (GI) tract. This type of diagnostic endoscopy is also known as an Oesophago-gastro-duodenoscopy (OGD for short) or Gastroscopy.
The duodenum, the first, and shortest part of the small intestine, derives its name from the Latin word duodeni. This refers to its length being approximately 12 finger-breadths.
Partially digested stomach contents, in an acidic semi-fluid mass known as chyme, leave the stomach via the pylorus and enter the duodenum. Here further digestive processes take place.
To help get your bearings with the image here, I'll explain a little more about some of the terminology and jargon used by an endoscopist. The central cavity of any hollow tube within the body is knows as its lumen. Having a good clear view of the lumen is essential during endoscopic procedures such as an OGD or colonoscopy. When trying to describe where a specific or noticeable feature or point of interest is during a procedure, and for ease of reference, endoscopists tend to compare the lumen of the bowel to a clock face.
The protrusion visible at the 9 o'clock position, is the duodenal papilla. This is an important landmark seen during endoscopic procedures involving the upper gastrointestinal tract such as an OGD or ERCP. The latter is a specialised type of endoscopy used to look at the gall bladder, pancreas and their associated pipework (or ducts to be more formal).
Digestive juices from the gallbladder and the pancreas are transported downstream via these sophisticated pipes (ducts) to just behind or upstream of the papilla. They are mixed together, then squirted through the papilla, into the lumen of the duodenum, to mix with the chyme and help with digestion. These digestive juices contain:
- Bile salts that help emulsify fat
- Pancreas enzymes to help digest food
- Bicarbonate to neutralise the acidity of the chyme and protect the lining of the small intestine from acid damage.
Anyone who has experienced the pain brought on by a gallstone lodged in some of the ducts draining the gallbladder or pancreas, can testify to the fact that it is almost impossible to stand during such an episode. Although less common in children, gallstones can occur and are associated with bowel conditions such as Crohn's disease.
I couldn't help but think how fitting are the words of the blessing for good health "Asher Yatzar". "Blessed... who has formed man with wisdom and created within him many openings and hollow spaces. It is obvious and known before Your Seat of Honor, that if even one of them would be opened, or one of them would be sealed, it would be impossible [to survive and] to stand before You.”
This is recited at times most of us take for granted, after going to the loo for a wee or a poo for example. There was just something about this image that made me recognise the importance of being grateful for simple things, such as all our pipes and tubes being in good working order.
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