MEDICAL LECTURES BY DR ELIO GAETA: 2ND LECTURE

November 13, 2023

𝗦𝘁𝗿𝗲𝘀𝘀𝘀 & 𝗔𝗽𝗽𝗮𝗿𝗮𝘁𝗼 𝗗𝗶𝗴𝗲𝗿𝗲𝗻𝘁𝗲 - 𝗠𝘂𝗰𝗼𝘀𝗮 𝗘𝘀𝗼𝗳𝗮𝗴𝗲𝗮

Today we present the second medical lecture, written by Professor Gaeta. Enjoy your reading!

" When we talk about the stresses of modern life, we mean mental but especially relational emotional discomfort with the outside world that sometimes reflects very negatively on the function of our internal organs and systems.

The digestive system is among the first to be affected, and thinking about the development of the human being this obviously should not surprise us.

The infant, in fact, comes from the so-called maternal-fetal complex, that is, from an internal world, and comes into vital relationship for the first time with the external world through the orifice that represents precisely the gateway to the digestive system: the mouth.

He then goes out to discover the world around him by bringing all the objects he encounters to his mouth.

A small skit to testify to the importance of the mouth in the early years of life.

A 4-year-old grandson of mine promises every night to give up the pacifier "in 100 days."

For us 100 is a definite number, for him 100 days obviously means never.

So let's explain what the digestive system is, that is, that long duct that begins at the mouth and ends at the anus-to understand the significance of its structure both morphologically and histologically we must refer to its embryonic origin, that is, the primitive intestine that was closed at both ends.

Embryonic origin we will cover separately in a post devoted to it.

The wall of this long tube is lined on the inside with a mucosa that at the labia and anal orifice is in continuity with the skin of the labia and perineum, respectively.

We define mucosa as the lining of all internal cavities communicating with the outside, the layer therefore innermost in the wall that directly faces the lumen of the organ.

All mucous membranes consist of two layers: an epithelial layer and a more or less thick connective layer called the "tonaca propria" of the mucosa.

We will see that the mucous membranes of the individual tracts of our digestive system have specific anatomical and functional characteristics.

All epithelia are not vascularized and therefore receive oxygen and nutrients from the underlying layers by diffusion.

The tonaca propria, on the other hand, which supports the epithelium, consists of connective tissue in which many structures are immersed: glands, blood and lymph vessels, lymphatic tissue, and nerves.

The lining epithelium of the stomach has no special metabolic functions of absorption and digestion since it is merely a conduit for passing the food bolus to the stomach.

Its only function then, like the epithelia of the oral cavity, pharynx and vagina is solely and exclusively to resist mechanical trauma.

The esophageal epithelium must be very robust and resistant therefore of a multilayered pavimentous type like that of the oral cavity, pharynx, vocal cords and vaginal cavity.

Resistant yes you have mechanical trauma but unfortunately not to the chemical trauma that makes us so desperate.

The esophagus suffers and sometimes becomes diseased in GERD because, unlike the gastric epithelium, it is not protected from the acidic aggression of gastric juice.

That's why you get that burning sensation all along the esophageal tract that also affects the throat and sometimes the tongue.

Sometimes esophageal spasm can also occur when the peristaltic waves that are supposed to push the food bolus toward the stomach occur in a totally disordered and uncoordinated manner such that the bolus comes to a halt and is crushed by the muscle spasm at one point in the esophagus.

This disorder is also called nutcracker esophagus and causes the patient back pain or more often angina-like pain that terribly frightens the sufferer by simulating a heart attack that is not there.

Anatomy teaches us that the esophagus and left atrium of the heart are in very close contact with each other and the brain, that is, we, cannot accurately identify the origin of pain.

In this case as in many other similar cases, we speak of referred pain, that is, when the subject feels pain in an area of the body even far away from the point of origin.

This close relationship between the esophagus and left atrium of the heart is used in cardiology to perform transesophageal ultrasound of the heart for example in cases where clot formation is suspected within the atrial cavities such as in atrial fibrillation.

𝑪𝒐𝒏𝒔𝒊𝒈𝒍𝒊 𝒑𝒓𝒂𝒕𝒊𝒄𝒊 𝒑𝒆 𝒍𝒊𝒎𝒊𝒕𝒂𝒓𝒆 𝒊𝒍 𝒓𝒆𝒇𝒍𝒖𝒔𝒔𝒐: