NaHCO3 HCl H+ Cl in Visual Studio .NET

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Fig 127 Approximate acid-base balance is preserved within the small intestine
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Severe diarrhea and metabolic acidosis
Whenever the intestinal neutralization equation becomes unbalanced, morbidity often results Consider, for instance, a severe bout of diarrhea (die-uh-REEah) This is an excessive amount of liquid stool owing (-rrhea) out through (dia-) the anus Many times, diarrhea is only a symptom of some more general GI problem One frequent cause is gastroenteritis (gas-troh-en-ter-EYE-tis) Gastroenteritis is an in ammation of (-itis) the mucosal (myew-KOH-sal) lining of both the stomach (gastr) and intestines (enter) We often hear it nicknamed the stomach u or intestinal u But what is speci cally meant is usually gastroenteritis accompanied by such bothersome symptoms as painful abdominal (ab-DAHM-ih-nal) cramping and diarrhea There are any number of possible causes for such a u, such as infection of the lower GI tract with pathogenic bacteria or viruses When prolonged diarrhea occurs, the contents of the intestines (rather than the stomach) are primarily lost Such contents chie y include sodium bicarbonate (NaHCO3 ) base, lots of water, and lots of electrolytes (e-LEK-troh-lights) Common electrolytes include sodium chloride (NaCl) and other compounds that are broken down (lyt) by passing an electrical (electr) current through solutions containing them With so much base or alkali (NaHCO3 ) lost from the intestines, there is very little left to buffer or sop up the huge number of H+ ions being released by the HCl entering from the stomach Hence, metabolic acidosis may occur This is an abnormal condition of too much body acid (or not enough base) due to metabolic causes An important metabolic cause in this case, of course, is the severe diarrhea accompanying gastroenteritis Along with losing a lot of base, dehydration from water loss may also be present, along with an electrolyte imbalance Summarizing the above information yields what we will call the diarrhea syndrome:
EXCESSIVE DIARRHEA (often due to gastroenteritis) Excessive loss of NaHCO3 base, water, and electrolytes from the intestines, while plenty of HCl remains in the stomach
Metabolic acidosis, dehydration, and electrolyte imbalance
Now, the walls of the duodenum, unlike those of the stomach, are not protected from being dissolved and digested by the H+ ions from HCl This is because the stomach mucosa secretes a 1-mm-thick layer of highly alkaline (AL-kah-lin) mucus that buffers (sops up) most H+ ions before they do too
Disorders of Digestive Tract
much damage But the poor duodenum, unfortunately, lacks this protective mucous lm When too much unbuffered acid and its H+ ions are left behind in the duodenum, therefore, a duodenal (dew-AH-deh-nal) ulcer (UL-sir) may result An ulcer is literally a sore, an area of necrotic (dead) tissue that may also become a deep ulcer crater Summarizing, we have:
Metabolic acidosis (too much stomach HCl left unbuffered within duodenum) Excessive number of H+ ions eat away at lining of duodenum Duodenal ulcer (ulcer crater)
[Study suggestion: Look back at Figure 125 Draw in a small dark oval in the wall of the duodenum, just below the pyloric sphincter Now, give the oval area its correct medical name]
Severe vomiting and metabolic alkalosis
Metabolic acidosis is one destructive complication of acid-base imbalance An exactly opposite complication is called metabolic alkalosis Metabolic alkalosis is an excessive amount of body base or alkali (or a de ciency of body acid) resulting from metabolic causes One common metabolic cause is excessive vomiting, also called emesis (EM-eh-sis) Looking back at the intestinal neutralization equation: if we vomit, large quantities of gastric juice are lost from the stomach This gastric juice, of course, is rich in HCl The vomit also contains lots of water and electrolytes from the stomach But the sodium bicarbonate (base) levels in the duodenum are left mostly unaffected This situation creates what we can call the vomiting syndrome:
EXCESSIVE VOMITING (often associated with gastroenteritis) Excessive loss of HCl, water, and electrolytes from the stomach, while NaHCO3 base remains in the duodenum
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