DYING, CARE OF THE
Gastric surgery interferes with the nor-
mal mechanism for emptying food from
the stomach (see
If a meal
containing a high level of carbohydrates
is “ dumped” too quickly from the sto-
mach, the upper intestine may swell.
This, together with excessive amounts
of certain hormones released into the
bloodstream, causes the symptoms of
early dumping. As sugars are absorbed
from the intestine, they rapidly increase
the blood glucose level, causing excess
hormone release. This may, in
turn, later lower the blood glucose level
below normal, causing the symptoms
of late dumping.
A person who has had a gastrectomy
can prevent symptoms by eating fre-
quent, small, dry meals that contain no
refined carbohydrates. Symptoms may
also be prevented by lying down for a
rest after a large meal. Adding
to food is also sometimes effective.
The upper area of the first part of the
; this is revealed in a
A raw area in the w all of the
(the first part of the small intestine)
due to erosion of its inner surface lin -
ing. Duodenal and gastric
ulcers are types of
similar causes, symptoms, and treatment.
Inflammation of the
part of the small intestine), producing
vague gastrointestinal symptoms. It is
diagnosed by oesophagogastroduoden-
of the walls of the upper digestive tract
with a flexible viewing instrument. The
treatment for duodenitis is similar to that
for a duodenal ulcer (see
The first part of the small intestine. The
duodenum begins at the duodenal cap,
just beyond the pylorus (the muscular
valve at the lower end of the stomach). It
extends to the ligament of Treitz, w hich
marks the boundary with the second part
of the small intestine (the jejunum). (See
Location of the duodenum
The duodenum is about 25 cm long
and C-shaped; it forms a loop around
the head of the
Ducts from the
it through a small opening. Digestive
enzymes in the pancreatic secretions and
chemicals in the bile are released into
the duodenum through this opening.
Two fused kidneys on one side of the
body. Another structural abnormality of
the kidney is duplex renal pelvis, in
w hich a single kidney has two renal
pelvises (urine-collecting chambers). A
w hich there are two ureters leading from
one kidney. The ureters may open into
the bladder, or, in females, one may open
into the vagina. These malformations
arise during formation in the
Surgical correction may be necessary to
prevent complications such as infections.
Duplication of part or all of the
There may be two uteri joined to one
vagina, or two uteri with two vaginas.
A more common condition is
in w hich a band of tissue (sep-
divides the uterine cavity into
two spaces instead of one.
A disorder of the hand in w hich one or
more fingers become fixed in a bent
position. In about half of the cases, both
hands are affected. In most cases there
is no apparent cause, but the disease
may be, in part, inherited. Men over
the age of 40 are most often affected.
The tissues just under the skin in the
fingers or palm become thickened and
shortened, w hich causes difficulty in
straightening the fingers. Surgery can
correct deformity of the fingers, but in
some cases the condition recurs.
A band of tissue in the hand thickens and
contracts, gradually pulling the fingers into
a permanently bent position.
) covering the brain.
A congenital (present at birth) form of
opening of the mitral valve, w hich is
situated on the left side of the
Lung disorders caused by dust particles
inhaled and absorbed into the lung
tissues. There, they may cause
(formation of scar tissue) and progres-
sive lung damage. The main symptoms
are a cough and breathing difficulty. It
may take at least ten years of exposure
to dusts containing coal, silica, talc, or
asbestos before serious lung damage
sensitivity to moulds on hay or grain
may lead to allergic
installation of dust extraction machin-
ery, have reduced the incidence of dust
diseases, and replacements have been
especially hazardous sub-
stances such as asbestos.
Deep vein thrombosis (see
A drug that is derived from the female
It is used to
menstrual problems (see
given together w ith an
women after or during the menopause.
Dydrogesterone may be prescribed to
or to prevent
swollen ankles, weight gain, breast ten-
derness, and nausea.
dying, care of the
Physical and psychological care that is
given with the aim of making the final
months or days of a dying person’s life
emotional distress as possible.
Carers may include doctors, nurses,
and other medical professionals, coun-
sellors, social workers, clergy, and the
person’s family and friends.