I
DYING, CARE OF THE
CAUSES
Gastric surgery interferes with the nor-
mal mechanism for emptying food from
the stomach (see
digestion
) .
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
insulin
hormone release. This may, in
turn, later lower the blood glucose level
below normal, causing the symptoms
of late dumping.
PREVENTION
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
guar gum
to food is also sometimes effective.
duodenal cap
The upper area of the first part of the
duodenum
; this is revealed in a
barium X-
ray examination
.
duodenal ulcer
A raw area in the w all of the
duodenum
(the first part of the small intestine)
due to erosion of its inner surface lin -
ing. Duodenal and gastric
(stomach)
ulcers are types of
peptic ulcer
,
and have
similar causes, symptoms, and treatment.
duodenitis
Inflammation of the
duodenum
(the first
part of the small intestine), producing
vague gastrointestinal symptoms. It is
diagnosed by oesophagogastroduoden-
oscopy (see
gastroscopy
): examination
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
peptic ulcer
) .
duodenum
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
,
opposite page.)
The duodenum is about 25 cm long
and C-shaped; it forms a loop around
the head of the
pancreas
.
Ducts from the
pancreas,
liver
,
and
gallbladder
feed into
it through a small opening. Digestive
enzymes in the pancreatic secretions and
chemicals in the bile are released into
the duodenum through this opening.
duplex kidney
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
third possibility
is
duplex
ureter,
in
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
embryo
.
Surgical correction may be necessary to
prevent complications such as infections.
duplex uterus
Duplication of part or all of the
uterus
.
There may be two uteri joined to one
vagina, or two uteri with two vaginas.
A more common condition is
septate
uterus
,
in w hich a band of tissue (sep-
tum)
divides the uterine cavity into
two spaces instead of one.
Dupuytren’s contracture
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.
Dupuytren’s contracture
A band of tissue in the hand thickens and
contracts, gradually pulling the fingers into
a permanently bent position.
dura mater
The
outer
of the
three
membranes
(
meninges
) covering the brain.
Duroziez’s disease
A congenital (present at birth) form of
mitral stenosis
(a
narrowing
of the
opening of the mitral valve, w hich is
situated on the left side of the
heart
) .
dust diseases
Lung disorders caused by dust particles
inhaled and absorbed into the lung
tissues. There, they may cause
fibrosis
(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
develops (see
pneumoconiosis
) .
Hyper-
sensitivity to moulds on hay or grain
may lead to allergic
alveolitis
.
Preventive
measures,
such
as
the
installation of dust extraction machin-
ery, have reduced the incidence of dust
diseases, and replacements have been
found for
especially hazardous sub-
stances such as asbestos.
DVT
Deep vein thrombosis (see
thrombosis,
deep vein
).
dwarfism
See
shortstature
.
dydrogesterone
A drug that is derived from the female
sex hormone
progesterone
.
It is used to
treat
premenstrual syndrome
and certain
menstrual problems (see
menstruation,
disorders of
).
Dydrogesterone is
also
given together w ith an
oestrogen drug
as
hormone
replacement
therapy
to
women after or during the menopause.
Dydrogesterone may be prescribed to
treat
endometriosis
or to prevent
miscar-
riage
.
Possible
side
effects
include
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
as free
from
pain,
discomfort,
and
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.
D
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