Gastric bypass surgery: MedlinePlus Medical Encyclopedia You will have general anesthesia before this surgery. You will be asleep and pain-free. There are 2 steps during gastric bypass surgery: The first step makes your stomach smaller. Your surgeon uses staples to divide your stomach into a small upper section and a larger bottom section. The top section of your stomach (called the pouch) is where the food you eat will go. The pouch is about the size of a walnut. It holds only about 1 ounce (oz) or 28 grams (g) of food. Because of this you will eat less and lose weight. The second step is the bypass. Your surgeon connects a small part of your small intestine (the jejunum) to a small hole in your pouch. The food you eat will now travel from the pouch into this new opening and into your small intestine. As a result, your body will absorb fewer calories. Gastric bypass can be done in two ways. With open surgery, your surgeon makes a large surgical cut to open your belly. The bypass is done by working on your stomach, small intestine, and other organs. Another way to do this surgery is to use a tiny camera, called a laparoscope.

This camera is placed in your belly. The surgery is called laparoscopy . The scope allows the surgeon to see inside your belly. In this surgery: The surgeon makes 4 to 6 small cuts in your belly. The scope and instruments needed to perform the surgery are inserted through these cuts. The camera is connected to a video monitor in the operating room. This allows the surgeon to view inside your belly while doing the operation. Advantages of laparoscopy over open surgery include: Shorter hospital stay and quicker recovery. Less pain. Smaller scars and a lower risk of getting a hernia or infection. This surgery takes about 2 to 4 hours. Why the Procedure is Performed Weight-loss surgery may be an option if you are very obese and have not been able to lose weight through diet and exercise. Doctors often use the body mass index (BMI) and health conditions such as type 2 diabetes and high blood pressure to determine which people are most likely to benefit from weight-loss surgery. Gastric bypass surgery is not a quick fix for obesity. It will greatly change your lifestyle. After this surgery, you must eat healthy foods, control portion sizes of what you eat, and exercise .

If you do not follow these measures, you may have complications from the surgery and poor weight loss. Be sure to discuss the benefits and risks with your surgeon. This procedure may be recommended if you have: A BMI of 40 or more. Someone with a BMI of 40 or more is at least 100 pounds (45 kilograms) over their recommended weight. A normal BMI is between 18.5 and 25. A BMI of 35 or more and a serious medical condition that might improve with weight loss. Some of these conditions are obstructive sleep apnea , type 2 diabetes , and heart disease. Risks Gastric bypass is major surgery and it has many risks. Some of these risks are very serious. You should discuss these risks with your surgeon.

Risks for anesthesia and surgery in general include: Allergic reactions to medicines Risks for gastric bypass include: Gastritis (inflamed stomach lining), heartburn, or stomach ulcers Injury to the stomach, intestines, or other organs during surgery Leaking from the line where parts of the stomach have been stapled together Poor nutrition Scarring inside your belly that could lead to a blockage in your bowel in the future Vomiting from eating more than your stomach pouch can hold Before the Procedure Your surgeon will ask you to have tests and visits with other health care providers before you have this surgery. Some of these are: A complete physical exam. Blood tests, ultrasound of your gallbladder, and other tests to make sure you are healthy enough to have surgery. Visits with your doctor to make sure other medical problems you may have, such as diabetes, high blood pressure, and heart or lung problems, are under control. Nutritional counseling. Classes to help you learn what happens during the surgery, what you should expect afterward, and what risks or problems may occur afterward. You may want to visit with a counselor to make sure you are emotionally ready for this surgery. You must be able to make major changes in your lifestyle after surgery.

If you smoke, you should stop several weeks before surgery and not start smoking again after surgery. Smoking slows recovery and increases the risks for problems. Tell your doctor or nurse if you need help quitting. Tell your surgeon or nurse: If you are or might be pregnant What medicines, vitamins, herbs, and other supplements you are taking, even ones you bought without a prescription During the week before your surgery: You may be asked to stop taking medicines that make it hard for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin), and others. Ask your doctor which drugs you should still take on the day of your surgery. Prepare your home for after the surgery. On the day of surgery: Follow instructions about when to stop eating and drinking. Take the drugs your doctor told you to take with a small sip of water. Arrive at the hospital on time. After the Procedure Most people stay in the hospital for 1 to 4 days after surgery. In the hospital: You will be asked to sit on the side of the bed and walk a little on the same day you have surgery.

You may have a (tube) catheter that goes through your nose into your stomach for 1 or 2 days. This tube helps drain fluids from your intestine. You may have a catheter in your bladder to remove urine. You will not be able to eat for the first 1 to 3 days. After that, you can have liquids and then pureed or soft foods. You may have a tube connected to the larger part of your stomach that was bypassed. The catheter will come out of your side and will drain fluids. You will wear special stockings on your legs to help prevent blood clots from forming. You will receive shots of medicine to prevent blood clots. You will receive pain medicine. You will take pills for pain or receive pain medicine through an IV, a catheter that goes into your vein. You will be able to go home when: You can eat liquid or pureed food without vomiting. You can move around without a lot of pain. You do not need pain medicine through an IV or given by shot. Be sure to follow instructions for how to care for yourself at home .

Outlook (Prognosis) Most people lose about 10 to 20 pounds (4.5 to 9 kilograms) a month in the first year after surgery. Weight loss will decrease over time. By sticking to your diet and exercise from the beginning, you lose more weight. You may lose one half or more of your extra weight in the first 2 years. You will lose weight quickly after surgery if you are still on a liquid or pureed diet. Losing enough weight after surgery can improve many medical conditions, including: Dumping syndrome References Buchwald H. Laparoscopic Roux-en-Y gastric bypass. In: Buchwald H, ed. Buchwald's Atlas of Metabolic and Bariatric Surgical Techniques and Procedures. Philadelphia, PA: Elsevier Saunders; 2012:chap 6. Buchwald H. Open Roux-en-Y gastric bypass. In: Buchwald H, ed. Buchwald's Atlas of Metabolic and Bariatric Surgical Techniques and Procedures. Philadelphia, PA: Elsevier Saunders; 2012:chap 5. Halperin F, Ding SA, Simonson DC, et al.

Roux-en-Y gastric bypass surgery or lifestyle with intensive medical management in patients with type 2 diabetes: feasibility and 1-year results of a randomized clinical trial. JAMA Surg. 2014;149(7):716-726. PMID: 24899464 . Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2015;386(9997):964-973. PMID: 26369473.\ . Richards WO. Morbid obesity. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier; 2012:chap 15. Thompson CC, Morton JM. Surgical and endoscopic treatment of obesity.

In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 8. Read More Stomach Click to View Pic Stomach The stomach is the main food storage tank of the body. If it were not for the stomach’s storage capacity, we would have to eat constantly instead of just a few times each day. The stomach also secretes a mixture of acid, mucus, and digestive enzymes that helps to digest and sanitize our food while it is being stored. Anatomy of the Stomach Gross Anatomy The stomach is a rounded, hollow organ located just inferior to the diaphragm in the left part of the abdominal cavity. Located between the esophagus and the duodenum, the stomach is a roughly crescent-shaped enlargement of the gastrointestinal tract. The inner layer of the stomach is full of wrinkles known as rugae (or gastric folds ). Rugae both allow the stomach to stretch in order to accommodate large meals and help to grip and move food during digestion.

The stomach can be divided into four regions based on shape and function: The esophagus connects to the stomach at a small region called the cardia. The cardia is a narrow, tube-like region that opens up into the wider regions of the stomach. Within the cardia is the lower esophageal sphincter, a band of muscle tissue that contracts to hold food and acid inside of the stomach. The cardia empties into the body of the stomach, which forms the central and largest region of the stomach. Superior to the body is a dome shaped region known as the fundus. Inferior to the body is a funnel shaped region known as the pylorus. The pylorus connects the stomach to the duodenum and contains the pyloric sphincter. The pyloric sphincter controls the flow of partially digested food (known as chyme) out of the stomach and into the duodenum. Microscopic Anatomy Microscopic analysis of the stomach’s structure reveals that it is made of several distinct layers of tissue: the mucosa, submucosa, muscularis, and serosa layers. The innermost layer of the stomach is known as the mucosa, and is made of mucous membrane.

The mucous membrane of the stomach contains simple columnar epithelium tissue with many exocrine cells. Small pores called gastric pits contain many exocrine cells that secrete digestive enzymes and hydrochloric acid into the lumen, or hollow region, of the stomach. Mucous cells found throughout the stomach lining and gastric pits secrete mucus to protect the stomach from its own digestive secretions. The mucosa of the stomach is much thicker than the mucosa of the other organs of the gastrointestinal tract due to the depth of the gastric pits. Deep inside the mucosa is a thin layer of smooth muscle known as the muscularis mucosae. The muscularis mucosae layer allows the mucosa to form folds and increase its contact with the stomach’s contents. Surrounding the mucosa is the submucosa layer of the stomach. The submucosa is made up of various connective tissues, blood vessels, and nerves. Connective tissues support the tissues of the mucosa and connect it to the muscularis layer. The blood supply of the submucosa provides nutrients to the wall of the stomach.

Nervous tissue in the submucosa monitors the contents of the stomach and controls smooth muscle contraction and secretion of digestive substances. The muscularis layer of the stomach surrounds the submucosa and makes up a large amount of the stomach’s mass. The muscularis is made of 3 layers of smooth muscle tissue arranged with its fibers running in 3 different directions. These layers of smooth muscle allow the stomach to contract to mix and propel food through the digestive tract. The outermost layer of the stomach surrounding the muscularis layer is the serosa – a thin serous membrane made of simple squamous epithelial tissue and areolar connective tissue. The serosa has a smooth, slippery surface and secretes a thin, watery secretion known as serous fluid. The smooth, wet surface of the serosa helps to protect the stomach from friction as it expands with food and moves to mix and propel the food. Physiology of the Stomach Storage In the mouth , we chew and moisten solid food until it becomes a small mass known as a bolus. When we swallow each bolus, it then passes through the esophagus to the stomach where it is stored along with other boluses and liquids from the same meal.

The size of the stomach varies from person to person, but on average it can comfortably contain 1-2 liters of food and liquid during a meal. When stretched to its maximum capacity by a large meal or overeating, the stomach may hold up to 3-4 liters. Distention of the stomach to its maximum size makes digestion difficult, as the stomach cannot easily contract to mix food properly and leads to feelings of discomfort. After the stomach has been filled with food from a meal, it stores the food for about 1-2 hours. During this time, the stomach continues the digestive process that began in the mouth and allows the intestines, pancreas , gallbladder , and liver to prepare to complete the digestive process. At the inferior end of the stomach, the pyloric sphincter controls the movement of food into the intestines. The pyloric sphincter is normally closed to keep food and stomach secretions within the stomach. Once chyme is ready to leave the stomach, the pyloric sphincter opens to allow a small amount of chyme to pass into the duodenum . This process, known as gastric emptying, slowly repeats over the 1-2 hours that food is stored in the stomach.

The slow rate of gastric emptying helps to spread out the volume of chyme being released from the stomach and maximizes the digestion and absorption of nutrients in the intestines . Secretion The stomach produces and secretes several important substances to control the digestion of food. Each of these substances is produced by exocrine or endocrine cells found in the mucosa. The main exocrine product of the stomach is gastric juice – a mixture of mucus, hydrochloric acid, and digestive enzymes. Gastric juice is mixed with food in the stomach to promote digestion. Specialized exocrine cells of the mucosa known as mucous cells secrete mucus into the lumen of the stomach and into the gastric pits. This mucus spreads across the surface of the mucosa to coat the lining of the stomach with a thick, acid- and enzyme-resistant barrier. Stomach mucus is also rich in bicarbonate ions, which neutralize the pH of stomach acid. Parietal cells found in the gastric pits of the stomach produce 2 important secretions: intrinsic factor and hydrochloric acid. Intrinsic factor is a glycoprotein that binds to the vitamin B12 in the stomach and allows the vitamin to be absorbed in the small intestine .

Vitamin B12 is an essential nutrient for the formation of red blood cells. Hydrochloric acid protects the body by killing pathogenic bacteria naturally found in food. Hydrochloric acid also helps to digest proteins by denaturing them into an unfolded shape that is easier for enzymes to digest. The protein digesting enzyme pepsin is activated by exposure to hydrochloric acid inside the stomach. Chief cells, also found within the gastric pits of the stomach, produce two digestive enzymes: pepsinogen and gastric lipase. Pepsinogen is the precursor molecule of the very potent protein-digesting enzyme pepsin. Because pepsin would destroy the chief cells that produce it, it is secreted in its inactive pepsinogen form. When pepsinogen reaches the acidic pH found in the stomach thanks to hydrochloric acid, it changes shape and becomes the active enzyme pepsin. Pepsin then breaks dietary proteins into their amino acid building blocks. Gastric lipase is an enzyme that digests fats by removing a fatty acid from a triglyceride molecule. G cells are endocrine cells found at the bottom of the gastric pits.

G cells release the hormone gastrin into the bloodstream in response to many stimuli, such as signals from the vagus nerve ; the presence of amino acids in the stomach from digested proteins; and the stretching of the stomach wall during a meal. Gastrin travels through the blood to various receptor cells throughout the stomach where it stimulates the glands and muscles of the stomach. Glandular stimulation by gastrin leads to increased secretion of gastric juice to increase digestion. Stimulation of smooth muscles by gastrin leads to stronger contractions of the stomach and the opening of the pyloric sphincter to move food into the duodenum. Gastrin also binds to receptor cells in the pancreas and gallbladder where it increases the secretion of pancreatic juice and bile. Digestion Digestion in the stomach can be divided into 2 classes: mechanical digestion and chemical digestion. Mechanical digestion is the physical division of a mass of food into smaller masses while chemical digestion is the chemical conversion of larger molecules into smaller molecules. The mixing action of the stomach walls allows mechanical digestion to occur in the stomach. The smooth muscles of the stomach produce contractions known as mixing waves that mix the boluses of food with gastric juice.

This mixing leads to the production of the thick liquid known as chyme. While food is being physically mixed with gastric juice to produce chyme, the enzymes present in the gastric juice chemically digest large molecules into their smaller subunits. Gastric lipase splits triglyceride fats into fatty acids and diglycerides. Pepsin breaks proteins into smaller amino acids. The chemical digestion begun in the stomach will not be completed until chyme reaches the intestines, but the stomach prepares hard-to-digest proteins and fats for further digestion. Hormonal control The activity of the stomach is under the control of several hormones that regulate the production of stomach acid and the release of food into the duodenum. Gastrin, produced by the G cells of the stomach itself, increases the activity of the stomach by stimulating increased gastric juice production, muscle contraction, and gastric emptying through the pyloric sphincter. Cholecystokinin (CCK), produced by the mucosa of the duodenum, is a hormone that acts to slow gastric emptying by contracting the pyloric sphincter. CCK is released in response to food rich in proteins and fats, which are difficult for the body to digest.

By inhibiting gastric emptying, CCK allows food to be stored in the stomach longer to promote improved digestion by the stomach and to give the pancreas and gallbladder time to release enzymes and bile to increase digestion in the duodenum. Secretin, another hormone produced by the duodenum's mucosa, responds to the acidity of chyme entering the duodenum from the stomach. Secretin travels through the bloodstream to the stomach where it slows the production of gastric juice by the exocrine glands of the mucosa. Secretin also promotes the production of pancreatic juice and bile that contain acid-neutralizing bicarbonate ions. The net effect of secretin is to protect the intestines from the damaging effects of acidic chyme. Prepared by Tim Taylor, Anatomy and Physiology Instructor The Stomach (Human Anatomy): Picture, Function, Definition, Conditions, and More Human Anatomy Next The stomach is a muscular organ located on the left side of the upper abdomen. The stomach receives food from the esophagus. As food reaches the end of the esophagus, it enters the stomach through a muscular valve called the lower esophageal sphincter. The stomach secretes acid and enzymes that digest food.

Ridges of muscle tissue called rugae line the stomach. The stomach muscles contract periodically, churning food to enhance digestion. The pyloric sphincter is a muscular valve that opens to allow food to pass from the stomach to the small intestine. Stomach Conditions Gastroesophageal reflux : Stomach contents, including acid, can travel backward up the esophagus. There may be no symptoms, or reflux may cause heartburn or coughing. Gastroesophageal reflux disease (GERD) : When symptoms of reflux become bothersome or occur frequently, they’re called GERD. Infrequently, GERD can cause serious problems of the esophagus. Dyspepsia : Another name for stomach upset or indigestion. Dyspepsia may be caused by almost any benign or serious condition that affects the stomach. Gastric ulcer (stomach ulcer) : An erosion in the lining of the stomach, often causing pain and/or bleeding. Gastric ulcers are most often caused by NSAIDs or H. pylori infection. Peptic ulcer disease : Doctors consider ulcers in either the stomach or the duodenum (the first part of the small intestine) peptic ulcer disease.

Gastritis : Inflammation of the stomach, often causing nausea and/or pain. Gastritis can be caused by alcohol, certain medications, H. pylori infection, or other factors. Stomach cancer : Gastric cancer is an uncommon form of cancer in the U.S. Adenocarcinoma and lymphoma make up most of the cases of stomach cancer. Zollinger-Ellison syndrome (ZES) : One or more tumors that secrete hormones that lead to increased acid production. Severe GERD and peptic ulcer disease result from this rare disorder. Gastric varices: In people with severe liver disease, veins in the stomach may swell and bulge under increased pressure. Called varices, these veins are at high risk for bleeding, although less so than esophageal varices are. Stomach bleeding : Gastritis, ulcers, or gastric cancers may bleed. Seeing blood or black material in vomit or stool is usually a medical emergency. Gastroparesis (delayed gastric emptying) : Nerve damage from diabetes or other conditions may impair the stomach’s muscle contractions. Nausea and vomiting are the usual symptoms.

Continued Stomach Tests Upper endoscopy (esophagogastroduodenoscopy or EGD) : A flexible tube with a camera on its end (endoscope) is inserted through the mouth. The endoscope allows examination of the esophagus, stomach, and duodenum (the first part of the small intestine). Computed tomography (CT scan) : A CT scanner uses X-rays and a computer to create images of the stomach and abdomen. Magnetic resonance imaging : Using a magnetic field, a scanner creates high-resolution images of the stomach and abdomen. pH testing : Using a tube through the nose into the esophagus, acid levels in the esophagus can be monitored. This can help diagnose or change treatment for GERD. Barium swallow : After swallowing barium, X-ray films of the esophagus and stomach are taken. This can sometimes diagnose ulcers or other problems. Upper GI series : X-rays are taken of the esophagus, stomach, and upper part of the small intestine. Gastric emptying study: A test of how rapidly food passes through the stomach. The food is labeled with a chemical and viewed on a scanner.

Stomach biopsy : During an endoscopy, a doctor can take a small piece of stomach tissue for tests. This can diagnose H. pylori infection, cancer, or other problems. H. pylori test : While most people with H. pylori infection don't develop ulcers, simple blood or stool tests can be done to check for infection in people with ulcers or to verify that the infection is wiped out after treatment.. Stomach Treatments Histamine (H2) blockers : Histamine increases stomach acid secretion; blocking histamine can reduce acid production and GERD symptoms. Proton pump inhibitors : These medicines directly inhibit the acid pumps in the stomach. They must be taken daily to be effective. Antacids : These medicines can help against the effects of acid but don't kill bacteria or stop acid production. Endoscopy : During an upper endoscopy, tools on the endoscope can sometimes stop stomach bleeding, if present. Motility agents : Medicines can increase contraction of the stomach, improving symptoms of gastroparesis. Stomach surgery : Cases of severe stomach bleeding, ruptured ulcers, or cancer require surgery to be cured. Antibiotics : H.

pylori infection can be cured with antibiotics, which are taken with other medicines to heal the stomach. WebMD Image Collection Reviewed by William Blahd, MD on March 04, 2016 Sources Digestive System Digestive System El aparato digestivo The first step in the digestive process happens before we even taste food. Just by smelling that homemade apple pie or thinking about how delicious that ripe tomato is going to be, you start salivating — and the digestive process begins in preparation for that first bite. Food is our fuel, and its nutrients give our bodies' cells the energy and substances they need to operate. But before food can do that, it must be digested into small pieces the body can absorb and use. About the Digestive System Almost all animals have a tube-type digestive system in which food enters the mouth, passes through a long tube, and exits as feces (poop) through the anus. The smooth muscle in the walls of the tube-shaped digestive organs rhythmically and efficiently moves the food through the system, where it is broken down into tiny absorbable atoms and molecules.

During the process of absorption, nutrients that come from the food (including carbohydrates, proteins, fats, vitamins, and minerals) pass through channels in the intestinal wall and into the bloodstream. The blood works to distribute these nutrients to the rest of the body. The waste parts of food that the body can't use are passed out of the body as feces. Every morsel of food we eat has to be broken down into nutrients that can be absorbed by the body, which is why it takes hours to fully digest food. In humans, protein must be broken down into amino acids, starches into simple sugars, and fats into fatty acids and glycerol. The water in our food and drink is also absorbed into the bloodstream to provide the body with the fluid it needs. continue How Digestion Works The digestive system is made up of the alimentary canal (also called the digestive tract) and the other abdominal organs that play a part in digestion, such as the liver and pancreas. The alimentary canal is the long tube of organs — including the esophagus, stomach, and intestines — that runs from the mouth to the anus. An adult's digestive tract is about 30 feet (about 9 meters) long.

Digestion begins in the mouth, well before food reaches the stomach. When we see, smell, taste, or even imagine a tasty meal, our salivary glands, which are located under the tongue and near the lower jaw, begin producing saliva. This flow of saliva is set in motion by a brain reflex that's triggered when we sense food or think about eating. In response to this sensory stimulation, the brain sends impulses through the nerves that control the salivary glands, telling them to prepare for a meal. As the teeth tear and chop the food, saliva moistens it for easy swallowing. A digestive enzyme called amylase, which is found in saliva, starts to break down some of the carbohydrates (starches and sugars) in the food even before it leaves the mouth. Swallowing, which is accomplished by muscle movements in the tongue and mouth, moves the food into the throat, or pharynx. The pharynx, a passageway for food and air, is about 5 inches (12.7 centimeters) long. A flexible flap of tissue called the epiglottis reflexively closes over the windpipe when we swallow to prevent choking.

From the throat, food travels down a muscular tube in the chest called the esophagus. Waves of muscle contractions called peristalsis force food down through the esophagus to the stomach. A person normally isn't aware of the movements of the esophagus, stomach, and intestine that take place as food passes through the digestive tract. At the end of the esophagus, a muscular ring or valve called a sphincter allows food to enter the stomach and then squeezes shut to keep food or fluid from flowing back up into the esophagus. The stomach muscles churn and mix the food with acids and enzymes, breaking it into much smaller, digestible pieces. An acidic environment is needed for the digestion that takes place in the stomach. Glands in the stomach lining produce about 3 quarts (2.8 liters) of these digestive juices each day. Most substances in the food we eat need further digestion and must travel into the intestine before being absorbed. When it's empty, an adult's stomach has a volume of one fifth of a cup (1.6 fluid ounces), but it can expand to hold more than 8 cups (64 fluid ounces) of food after a large meal.

previous continue Role of the Intestines By the time food is ready to leave the stomach, it has been processed into a thick liquid called chyme. A walnut-sized muscular valve at the outlet of the stomach called the pylorus keeps chyme in the stomach until it reaches the right consistency to pass into the small intestine. Chyme is then squirted down into the small intestine, where digestion of food continues so the body can absorb the nutrients into the bloodstream. The small intestine is made up of three parts: the duodenum, the C-shaped first part the jejunum, the coiled midsection the ileum, the final section that leads into the large intestine The inner wall of the small intestine is covered with millions of microscopic, finger-like projections called villi. The villi are the vehicles through which nutrients can be absorbed into the body. The liver (located under the ribcage in the right upper part of the abdomen), the gallbladder (hidden just below the liver), and the pancreas (beneath the stomach) are not part of the alimentary canal, but these organs are essential to digestion. The liver produces bile, which helps the body absorb fat. Bile is stored in the gallbladder until it is needed.

The pancreas produces enzymes that help digest proteins, fats, and carbs. It also makes a substance that neutralizes stomach acid. These enzymes and bile travel through special channels (called ducts) directly into the small intestine, where they help to break down food. The liver also plays a major role in the handling and processing of nutrients, which are carried to the liver in the blood from the small intestine. From the small intestine, undigested food (and some water) travels to the large intestine through a muscular ring or valve that prevents food from returning to the small intestine. By the time food reaches the large intestine, the work of absorbing nutrients is nearly finished. The large intestine's main function is to remove water from the undigested matter and form solid waste that can be excreted. The large intestine is made up of three parts: The cecum is a pouch at the beginning of the large intestine that joins the small intestine to the large intestine. This transition area expands in diameter, allowing food to travel from the small intestine to the large. The appendix, a small, hollow, finger-like pouch, hangs at the end of the cecum. Doctors believe the appendix is left over from a previous time in human evolution.

It no longer appears to be useful to the digestive process. The colon extends from the cecum up the right side of the abdomen, across the upper abdomen, and then down the left side of the abdomen, finally connecting to the rectum. The colon has three parts: the ascending colon; the transverse colon, which absorb fluids and salts; and the descending colon, which holds the resulting waste. Bacteria in the colon help to digest the remaining food products. The rectum is where feces are stored until they leave the digestive system through the anus as a bowel movement. previous continue Digestive System Problems Nearly everyone has a digestive problem at one time or another. Some conditions, like indigestion or mild diarrhea , are common; they result in mild discomfort and get better on their own or are easy to treat. Others, such as inflammatory bowel disease (IBD), can be ongoing and troublesome and should be discussed with a GI specialist or gastroenterologist (doctors who specialize in the digestive system). Problems With the Esophagus Problems affecting the esophagus may be congenital (present at birth) or noncongenital (developed after birth). Examples include: Congenital conditions.

Tracheoesophageal fistula is a connection between the esophagus and the trachea (windpipe) where there shouldn't be one. In babies with esophageal atresia, the esophagus comes to a dead end instead of connecting to the stomach. Both conditions are usually detected soon after a baby is born — sometimes even before — and require surgery to repair. Noncongenital conditions. Esophagitis (inflammation of the esophagus) can be caused by infection, certain medications, or gastroesophageal reflux disease (GERD) . With GERD, the esophageal sphincter (the valve that connects the esophagus with the stomach) doesn't work well and allows the acidic contents of the stomach to move backward up into the esophagus. GERD often can be corrected through lifestyle changes, such as dietary adjustments. Sometimes, though, it requires treatment with medication. previous continue Problems With the Stomach and Intestines Almost everyone has had diarrhea or constipation . With diarrhea, muscle contractions move the contents of the intestines along too quickly and there isn't enough time for water to be absorbed before the feces are pushed out of the body.

Constipation is the opposite: The contents of the large intestines do not move along fast enough and waste materials stay in the large intestine so long that too much water is removed and the feces become hard. Other common stomach and intestinal disorders include: Gastrointestinal infections can be caused by viruses, by bacteria (such as Salmonella, Shigella, Campylobacter, or E. coli), or by intestinal parasites (such as amebiasis and giardiasis ). Abdominal pain or cramps, diarrhea, and sometimes vomiting are the common symptoms of gastrointestinal infections. These usually go away on their own without medicines or other treatment. Appendicitis , an inflammation of the appendix, most often affects kids and teens between 11 and 20 years old, and requires surgery to correct. The classic symptoms of appendicitis are abdominal pain, fever, loss of appetite, and vomiting. Gastritis and peptic ulcers arise when a bacterium, Helicobacter pylori , or the chronic use of drugs or certain medications weakens the protective mucous coating of the stomach and duodenum, allowing acid to get through to the sensitive lining beneath.

This can irritate and inflame the lining of the stomach (gastritis) or cause peptic ulcers, which are sores or holes in the lining of the stomach or the duodenum that cause pain or bleeding. Medications usually successfully treat these conditions. Inflammatory bowel disease (IBD) is chronic inflammation of the intestines that affects older kids, teens, and adults. There are two major types: ulcerative colitis, which usually affects just the rectum and the large intestine; and Crohn's disease, which can affect the whole gastrointestinal tract from the mouth to the anus as well as other parts of the body. They are treated with medications and, if necessary, intravenous (IV) feedings to provide nutrition. In some cases, surgery may be necessary to remove inflamed or damaged areas of the intestine. Celiac disease is a disorder in which the digestive system is damaged by the response of the immune system to a protein called gluten, which is found in wheat, rye, and barley and a wide range of foods, from breakfast cereal to pizza crust.

People with celiac disease have difficulty digesting the nutrients from their food and may have diarrhea, abdominal pain, bloating, exhaustion, and even depression when they eat foods with gluten. Symptoms can be managed by following a gluten-free diet. Celiac disease runs in families and can become active after some sort of stress, such as surgery or a viral infection. A doctor can diagnose celiac disease with a blood test and by taking a biopsy of the small intestine. Irritable bowel syndrome (IBS) , a common intestinal disorder, affects the colon and may cause recurrent abdominal cramps, bloating, constipation, and diarrhea. There is no cure, but IBS symptoms may be treated by changing eating habits, reducing stress, and making lifestyle changes. A doctor may also prescribe medications to relieve diarrhea or constipation. No one test is used to diagnose IBS, but a doctor may identify it based on symptoms, medical history, and a physical exam. previous continue Problems With the Pancreas, Liver, and Gallbladder Conditions affecting the pancreas, liver, and gallbladder often affect the ability of these organs to produce enzymes and other substances that aid in digestion.

Examples include: Cystic fibrosis is a chronic, inherited illness that not only affects the lungs but also causes the production of abnormally thick mucus to block the ducts or passageways in the pancreas. This mucus also prevents digestive juices from entering the intestines, making it difficult to properly digest proteins and fats. This causes important nutrients to pass out of the body unused. To help manage their digestive problems, people with cystic fibrosis can take digestive enzymes and nutritional supplements. Hepatitis , a condition with many different causes, is when the liver becomes inflamed and may lose its ability to function. Viral hepatitis, such as hepatitis A, B, or C, is highly contagious. Mild cases of hepatitis A can be treated at home; however, serious cases involving liver damage may require hospitalization. The gallbladder can develop gallstones and become inflamed — a condition called cholecystitis. Although gallbladder conditions are uncommon in kids and teens, they can happen in those who have sickle cell disease or are being treated with certain long-term medicines. Keeping Digestion on Track The kinds and amounts of food a person eats and how the digestive system processes that food play key roles in maintaining good health.

Eating a healthy diet is the best way to prevent common digestive problems. Stomach Location (Anatomical Position), Parts and Pictures | Healthhype.com Home » Current Health Articles » Stomach Location (Anatomical Position), Parts and Pictures Stomach Location (Anatomical Position), Parts and Pictures Tweet The stomach is a hollow organ that lies between the esophagus (food pipe) and duodenum (small intestine). It is an expanded part of the gastrointestinal tract (gut) that plays an important role in the digestion of food. The churning of food and gastric acid secretion breaks down food into smaller particles and simpler compounds for further digestion and subsequent absorption in the small intestine. Certain nutrients and substances are also absorbed in the stomach. Parts of the Stomach The stomach has four parts : Cardia This is the area where the esophagus meets with the stomach – esophagogastric junction (Z-line). The passage of food through this area is regulated by the lower esophageal sphincter (LES) or cardiac sphincter. Fundus This is the uppermost area of the stomach that lies just under the diaphragm. It ends in line with the cardia.

Body This is the largest part of the stomach between the fundus and pylorus. Pylorus This is the area through which the gastric contents flow out of the stomach and into the duodenum. It is divided into the pyloric antrum which lies next to the body and the pyloric canal which lies next to the duodenum. The passage of food from the stomach into the duodenum is regulated by the pyloric sphincter. Stomach Position The anatomical position of the stomach varies during respiration (breathing in and out), after eating or when empty and whether a person is lying down (supine), sitting or standing. In the supine position the stomach occupies the right upper quadrant (RUQ) and left upper quadrant (LUQ) or more specifically the epigastrium (E), left hypochondrium (LH), umbilical (U) and left lateral/lumbar (LL) / left flank regions. Location of Parts of the Stomach Due to varying positions of the stomach, it is best assessed when lying down (supine). Individual variations of size and shape of the stomach may also have to be taken into account.

The image above is only intended to guide the reader to the location of the stomach and structures may be out of scale. When supine, the parts of the stomach are located as follows : Posterior (behind) the left 6th costal cartilage. Fundus Posterior (behind) to and slightly superior (above) the left 6th rib. Pylorus Lies above and below the junction of the epigastric and umbilical regions with the pyloric antrum being in line with the midline of the the body. The pyloric canal lies to the left of the antrum. Greater Curvature Extends from the 5th intercostal space (above the left 6th rib) and curves down the left hypochondrium (LH). Enters the upper middle (anteromedial) part of the left lateral/flank region (LL) and meets with the pyloric antrum in the umbilical region. Lesser Curvature Extends from the cardia to superior (uppermost) aspect of the pyloric antrum (in the lower part of the epigastrium) at a junction known as the angular incisure.

Body Stomach | Define Stomach at Dictionary.com stomach 1. Anatomy, Zoology. a saclike enlargement of the alimentary canal, as in humans and certain animals, forming an organ for storing, diluting, and digesting food. such an organ or an analogous portion of the alimentary canal when divided into two or more sections or parts. any one of these sections. 2. Zoology. any analogous digestive cavity or tract in invertebrates. 3. the part of the body containing the stomach; belly or abdomen. 4. I have no stomach for this trip. 6. to endure or tolerate (someone or something): I can't stomach your constant nagging. 8. Obsolete. to be offended at or resent. Origin of stomach 1300-50; Middle English stomak < Latin stomachus gullet, stomach < Greek stómachos orig., opening; akin to stoma Synonyms 7. bear, stand, abide, countenance. Dictionary.com Unabridged Examples from the Web for stomach Expand Contemporary Examples Sara says Hubbard, while he was writing Dianetics, kicked her stomach several times to attempt to cause a miscarriage.

Still Jim Honor Willsie Morrow It governs the breast and stomach; its colours are green and russet-brown. British Dictionary definitions for stomach Expand noun 1. (in vertebrates) the enlarged muscular saclike part of the alimentary canal in which food is stored until it has been partially digested and rendered into chyme related adjective gastric 2. the corresponding digestive organ in invertebrates 3. desire, appetite, or inclination: I have no stomach for arguments 5. an archaic word for temper 6. an obsolete word for pride verb (transitive; used mainly in negative constructions) 7. to tolerate; bear: I can't stomach his bragging 8. to eat or digest: he cannot stomach oysters Word Origin C14: from Old French stomaque, from Latin stomachus (believed to be the seat of the emotions), from Greek stomakhos, from stoma mouth Collins English Dictionary - Complete & Unabridged 2012 Digital Edition © William Collins Sons & Co. Ltd.

1979, 1986 © HarperCollins Publishers 1998, 2000, 2003, 2005, 2006, 2007, 2009, 2012 Word Origin and History for stomach Expand n. c.1300, "internal pouch into which food is digested," from Old French estomac, from Latin stomachus "stomach, throat," also "pride, inclination, indignation" (which were thought to have their origin in that organ), from Greek stomachos "throat, gullet, esophagus," literally "mouth, opening," from stoma "mouth" (see stoma ). Applied to the openings of various internal organs, especially the stomach, then to the stomach itself. Some 16c. anatomists tried to correct the sense back to "esophagus" and introduce ventricle for what we call the stomach. Meaning "belly, midriff, part of the body that contains the stomach" is from late 14c. Figurative senses in Latin extended into Middle English (cf.

"relish, inclination, desire," 1510s). Stomach ache is from 1763. v. "to tolerate, put up with," 1570s, from stomach (n.), probably in reference to digestion; earlier sense was opposite: "to be offended at, resent" (1520s), from Latin stomachari "to be resentful," from stomachus (n.) in its secondary sense of "pride, indignation." Related: Stomached; stomaching. Online Etymology Dictionary, © 2010 Douglas Harper Expand stomach definition An organ in the digestive system , on the left side of the body behind the lower rib cage, that receives chewed food from the esophagus . Tiny glands in the stomach's lining secrete gastric juice, which contains acids , mucus , and enzymes . This fluid , along with the muscular churning actions of the stomach, helps transform food into a thick, semifluid mass that can be passed into the small intestine for digestion . The American Heritage® New Dictionary of Cultural Literacy, Third Edition Copyright © 2005 by Houghton Mifflin Company.

Published by Houghton Mifflin Company. All rights reserved. Slang definitions & phrases for stomach Expand verb To tolerate: can't stomach her inaneness The Dictionary of American Slang, Fourth Edition by Barbara Ann Kipfer, PhD. and Robert L. Chapman, Ph.D. Copyright (C) 2007 by HarperCollins Publishers. Idioms and Phrases with stomach Expand What Is Stomach Cancer? What Is Stomach Cancer? About Stomach Cancer What Is Stomach Cancer? Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other areas of the body. To learn more about how cancers start and spread, see What Is Cancer? S tomach cancer, also called gastric cancer, is a cancer that starts in the stomach. To understand stomach cancer, it helps to know about the normal structure and function of the stomach. The stomach After food is chewed and swallowed, it enters the esophagus, a tube that carries food through the neck and chest to the stomach.

The esophagus joins the stomach at the gastroesophageal (GE) junction, which is just beneath the diaphragm (the thin sheet of breathing muscle under the lungs). The stomach is a sac-like organ that holds food and starts to digest it by secreting gastric juice. The food and gastric juice are mixed and then emptied into the first part of the small intestine called the duodenum. Some people use the word stomach to refer to the area of the body between the chest and the pelvic area. The medical term for this area is the abdomen. For instance, some people with pain in this area would say they have a “stomachache,” when in fact the pain could be coming from the appendix, small intestine, colon (large intestine), or other organs in the area. Doctors would call this symptom abdominal pain, because the stomach is only one of many organs in the abdomen. Stomach cancer should not be confused with other cancers that can occur in the abdomen, like cancer of the colon (large intestine) , liver , pancreas , or small intestine because these cancers may have different symptoms, different outlooks, and different treatments.

Parts of the stomach The stomach has 5 parts: Cardia: The first portion (closest to the esophagus) Fundus: The upper part of the stomach next to the cardia. Body (corpus): The main part of the stomach, between the upper and lower parts Antrum: The lower portion (near the intestine), where the food is mixed with gastric juice Pylorus: The last part of the stomach, which acts as a valve to control emptying of the stomach contents into the small intestine. The first 3 parts of the stomach (cardia, fundus, and body) are sometimes called the proximal stomach. Some cells in these parts of the stomach make acid and pepsin (a digestive enzyme), the parts of the gastric juice that help digest food. They also make a protein called intrinsic factor, which the body needs to absorb vitamin B12. The lower 2 parts (antrum and pylorus) are called the distal stomach. The stomach has 2 curves, which form its inner and outer borders. They are called the lesser curvature and greater curvature, respectively. Other organs next to the stomach include the colon, liver, spleen, small intestine, and pancreas.

The stomach wall has 5 layers: The innermost layer is the mucosa. This is where stomach acid and digestive enzymes are made. Most stomach cancers start in this layer. Next is a supporting layer called the submucosa. Outside of this is the muscularis propria, a thick layer of muscle that moves and mixes the stomach contents. The outer 2 layers, the subserosa and the outermost serosa, wrap the stomach. The layers are important in determining the stage (extent) of the cancer and in helping to determine a person’s prognosis (outlook). As a cancer grows from the mucosa into deeper layers, the stage becomes more advanced and the prognosis is not as good. Development of stomach cancer Stomach cancers tend to develop slowly over many years. Before a true cancer develops, pre-cancerous changes often occur in the inner lining (mucosa) of the stomach. These early changes rarely cause symptoms and therefore often go undetected. Cancers starting in different sections of the stomach may cause different symptoms and tend to have different outcomes. The cancer’s location can also affect the treatment options. For example, cancers that start at the GE junction are staged and treated the same as cancers of the esophagus.

A cancer that starts in the cardia of the stomach but then grows into the GE junction is also staged and treated like a cancer of the esophagus. (For more information, see Esophagus Cancer .) Stomach cancers can spread (metastasize) in different ways. They can grow through the wall of the stomach and invade nearby organs. They can also spread to the lymph vessels and nearby lymph nodes. Lymph nodes are bean-sized structures that help fight infections. The stomach has a very rich network of lymph vessels and nodes. As the stomach cancer becomes more advanced, it can travel through the bloodstream and spread to organs such as the liver, lungs, and bones. If cancer has spread to the lymph nodes or to other organs, the patient’s outlook is not as good. Types of stomach cancers Different types of stomach cancer include: Adenocarcinoma About 90% to 95% of cancers of the stomach are adenocarcinomas. When the term stomach cancer or gastric cancer is used, it almost always refers to an adenocarcinoma. These cancers develop from the cells that form the innermost lining of the stomach (known as the mucosa).

Lymphoma These are cancers of the immune system tissue that are sometimes found in the wall of the stomach. About 4% of stomach cancers are lymphomas. The treatment and outlook depend on the type of lymphoma. For more detailed information, see Non-Hodgkin Lymphoma . Gastrointestinal stromal tumor (GIST) These are rare tumors that start in very early forms of cells in the wall of the stomach called interstitial cells of Cajal. Some of these tumors are non-cancerous (benign); others are cancerous. Although GISTs can be found anywhere in the digestive tract, most are found in the stomach. For more information, see Gastrointestinal Stromal Tumor (GIST) . Carcinoid tumor These are tumors that start in hormone-making cells of the stomach. Most of these tumors do not spread to other organs. About 3% of stomach cancers are carcinoid tumors. These tumors are discussed in more detail in Gastrointestinal Carcinoid Tumors . Other cancers Other types of cancer, such as squamous cell carcinoma, small cell carcinoma, and leiomyosarcoma, can also start in the stomach, but these cancers are very rare.

The information in the remainder of this document refers only to adenocarcinoma of the stomach. Celiac Trunk Anatomy, Diagram & Function | Body Maps Your message has been sent. OK We're sorry, an error occurred. We are unable to collect your feedback at this time. However, your feedback is important to us. Please try again later. Close Celiac trunk The first major branch of the abdominal aorta, the celiac trunk is responsible for supplying oxygen-rich blood to the stomach, spleen, liver, esophagus, and also parts of the pancreas and duodenum. Along with the superior and inferior mesenteric arteries, it is one of three frontal branches of the abdominal aorta, the largest artery in the abdominal cavity. Although the celiac trunk is only one of three arteries that branches off the abdominal aorta, it is essential to many major organs. Each of the branches of the abdominal aorta services separate areas. Therefore, without the celiac trunk, the organs it supplies would not receive enough blood, making them unable to function properly. There are three main divisions of the celiac trunk: the left gastric artery, the common hepatic artery, and the splenic artery.

The left gastric artery runs along the smaller curve of the stomach and connects to the lower esophagus, while the common hepatic artery supplies blood to the liver, duodenum, pancreas, and part of the stomach. The splenic artery supplies blood to the spleen, which supports the immune system by producing antibodies. ICD-10-PCS Body Parts ICD-10-PCS Body Parts Body Parts Body parts are the fourth character in our ICD-10-PCS code in the Medical and Surgical Related Sections. You might remember that Character #2 was body system. Let's talk about the two real quick so we understand the difference between body parts and body systems. Body System The body system character 2 identifies the general anatomical region involved in the procedure. Remember, there are 31 body systems in ICD-10-PCS for the Medical and Surgical Section (character 0) 0 Anatomic Regions, Lower Extremities The body systems are unique to the Section - the 31 systems above are only for the Medical and Surgical Section. For example, in the Obstetrics section the only body system is 0 = Pregnancy.

In the Administration section there is a Body System of E = Physiological Systems and Anatomical Regions. Body Parts Like Body Systems, body parts are unique to the section you are in - however they are always the 4th character in our ICD-10-PCS code. There are WAY more body parts then there were body systems.

For example - here is just a very small sample of body parts for the Medical Surgical Section (0): Body Part 1st Toe, Left 1st Toe, Right Includes: Hallux Abdomen Muscle, Left Abdomen Muscle, Right Includes: External oblique muscle Internal oblique muscle Pyramidalis muscle Rectus abdominis muscle Transversus abdominis muscle Abdominal Aorta Includes: Inferior phrenic artery Lumbar artery Median sacral artery Middle suprarenal artery Ovarian artery Testicular artery Abdominal Sympathetic Nerve Includes: Abdominal aortic plexus Auerbach's (myenteric) plexus Celiac (solar) plexus Celiac ganglion Gastric plexus Hepatic plexus Inferior hypogastric plexus Inferior mesenteric ganglion Inferior mesenteric plexus Meissner's (submucous) plexus Myenteric (Auerbach's) plexus Pancreatic plexus Pelvic splanchnic nerve Renal plexus Solar (celiac) plexus Splenic plexus Submucous (Meissner's) p

lexus Superior hypogastric plexus Superior mesenteric ganglion Superior mesenteric plexus Suprarenal plexus Abducens Nerve Includes: Eleventh cranial nerve Acoustic Nerve Includes: Cochlear nerve Eighth cranial nerve Scarpa's (vestibular) ganglion Spiral ganglion Vestibular (Scarpa's) ganglion Vestibular nerve Vestibulocochlear nerve Adenoids Adrenal Gland Adrenal Gland, Left Adrenal Gland, Right Adrenal Glands, Bilateral Includes: Suprarenal gland Includes: Duodenal ampulla Hepatopancreatic ampulla Anal Sphincter Includes: External anal sphincter Internal anal sphincter Ankle Bursa and Ligament, Left Ankle Bursa and Ligament, Right Includes: Calcaneofibular ligament Deltoid ligament Ligament of the lateral malleolus Talofibular ligament Ankle Joint, Left Ankle Joint, Right Includes: Inferior tibiofibular joint Talocrural joint Anterior Chamber, Left Anterior Chamber, Right Includes: Aqueous humour The left column explains what the body part name is and the right

 colum explains all the things that are covered under that body part.

For example - the Abdominal Aorta body part includes the inferior phrenic artery, lumbar artery, median sacral artery, middle suprarenal artery, ovarian artery, and the testicular artery. True or False? Body Parts When we look up a procedure in the index in ICD-10-PCS, we know we always get the first three character of Section, Body System, and Root operation. We very often also get the fourth character - Body Part. For example - when I look up an appendectomy I get: If it is a an excision then my first four characters are ODBJ and if it is a resection (meaning they took out the whole appendix) then I am at ODTJ. J is the fourth character on both of these - J must stand for appendix. When I go to the table to look this up (I will say mine is a resection) - I see this: You can see that appendix is already highlighted for me as I was given the first four characters in the index. Within a specific Section and body system I have body part characters with the same meaning. In this case - all of the body part characters in the Gastrointestinal System (D) are consistent.

Below you will see another code table for the Gastrointestinal system in the Medical and Surgical Section. This time my root operation is for Repair instead of resection You will note that the body part character for esophagus, upper is 1 on both of these - the stomach, pylorus is 7 on both of these - the appendix is J on both of these codes. These body part characters DO NOT carry over into other Body Systems however. For example - if I move out of the Gastrointestinal System and into the Upper veins you will see that the body part character of 1 now means Hemiazygos vein, the body part character of 7 now means Axillary Vein, right, and the body part character J does not exist. True or False? Body Part Key At the end of the pdf version of the ICD-10-PCS book you will find a body part key. This key tells you which body part you should use. For example Accessory phrenic nerve Use: Upper Leg Muscle, Right Upper Leg Muscle, Left You can also access the Body Part Key here: Given this table - answer the questions below What would your fourth character (body part) be?

What would your fourth character (body part) be? What would your fourth character (body part) be? Now - of course the operative report will not always be so clear - they may very well say calcaneus and you will not be able to find that in the body part column - you would have to look at the body part key and know that calcaneus codes to the body part talus or that the olecranon process codes to the ulna body part or that the gluteal vein codes to the hypogastric vein body part. True or False? Body Part Coding Guidelines The Body Part Guidelines are found under B4 in the Official ICD-10-PCS Coding Guidelines. They are all follows: B4. Body Part General guidelines B4.1a If a procedure is performed on a portion of a body part that does not have a separate body part value, code the body part value corresponding to the whole body part. Example: A procedure performed on the alveolar process of the mandible is coded to the mandible body part. B4.1b If the prefix "peri" is combined with a body part to identify the site of the procedure, the procedure is coded to the body part named.

Example: A procedure site identified as perirenal is coded to the kidney body part. Branches of body parts B4.2 Where a specific branch of a body part does not have its own body part value in PCS, the body part is coded to the closest proximal branch that has a specific body part value. Example: A procedure performed on the mandibular branch of the trigeminal nerve is coded to the trigeminal nerve body part value Bilateral body part values B4.3 Bilateral body part values are available for a limited number of body parts. If the identical procedure is performed on contralateral body parts, and a bilateral body part value exists for that body part, a single procedure is coded using the bilateral body part value. If no bilateral body part value exists, each procedure is coded separately using the appropriate body part value. Example: The identical procedure performed on both fallopian tubes is coded once using the body part value Fallopian Tube, Bilateral. The identical procedure performed on both knee joints is coded twice using the body part values Knee Joint, Right and Knee Joint, Left.

Coronary arteries B4.4 The coronary arteries are classified as a single body part that is further specified by number of sites treated and not by name or number of arteries. Separate body part values are used to specify the number of sites treated when the same procedure is performed on multiple sites in the coronary arteries. Examples: Angioplasty of two distinct sites in the left anterior descending coronary artery with placement of two stents is coded as Dilation of Coronary Arteries, Two Sites, with Intraluminal Device. Angioplasty of two distinct sites in the left anterior descending coronary artery, one with stent placed and one without, is coded separately as Dilation of Coronary Artery, One Site with Intraluminal Device, and Dilation of Coronary Artery, One Site with no device. Tendons, ligaments, bursae and fascia near a joint B4.5 Procedures performed on tendons, ligaments, bursae and fascia supporting a joint are coded to the body part in the respective body system that is the focus of the procedure. Procedures performed on joint structures themselves are coded to the body part in the joint body systems.

Example: Repair of the anterior cruciate ligament of the knee is coded to the knee bursae and ligament body part in the bursae and ligaments body system. Knee arthroscopy with shaving of articular cartilage is coded to the knee joint body part in the Lower Joints body system. Skin, subcutaneous tissue and fascia overlying a joint B4.6 If a procedure is performed on the skin, subcutaneous tissue or fascia overlying a joint, the procedure is coded to the following body part: • Shoulder is coded to Upper Arm • Elbow is coded to Lower Arm • Wrist is coded to Lower Arm • Hip is coded to Upper Leg • Knee is coded to Lower Leg • Ankle is coded to Foot Fingers and toes B4.7 If a body system does not contain a separate body part value for fingers, procedures performed on the fingers are coded to the body part value for the hand. If a body system does not contain a separate body part value for toes, procedures performed on the toes are coded to the body part value for the foot. Example: Excision of finger muscle is coded to one of the hand muscle body part values in the Muscles body system.

Question: """Gastric"" applies to which part of the body?"
Answer: Stomach