Digestion and Elimination

• 1. Digestion is a north to south process.
• 2. The big 3 organd are:
• Stomach
• Pancreas
• Gallbladder
• 3. Digestion is fundamental in Nutritional Therapy - every cell that makes up every tissue that makes up every organ depends on the body's digestive system to provide the nutrients it needs to keep functioning.

1. Begins in the brain - the sight and smell of food trigger the salivary glands to begin producing saliva. (Parasympathetic mode for eating)

2. In the mouth teeth physically breakdown food into smaller parts, the salivary glands secrete saliva to moisten the food and help with swallowing.

3. Swallowed food (BOLUS) now continues south into the esophagus for travel to the stomach.

4. The stomach continues the mechanical breakdown of food along with a number of chemical activities.

5. In the stomach gastric juices are secreted from millions of tiny gastric glands located in the mucosal lining of the stomach - HCl triggers gastrin to be released into the bloodstream, HCl and pepsinogen begin breaking down proteins into peptides (smaller strings of amino acids)

• After the stomach churns the bolus and mixes it with gastric juice, the food breaks down even more into a paste called CHYME (very acidic)
• CHYME is released into the upper part of the small intestine (DUODENUM) through the PYLORIC sphincter.

• In the small intestine the acidity (1.5-3.0) of the CHYME triggers the small intestine (Dual role of digestive organ as well as gland) to secrete mucous.
• At the same time the intestinal walls are secreting mucous they are also secreting two hormones into the blood stream:
• Secretin
• Cholecystokinin (CCK)

• Still in the small intestine, SECRETIN stimulates the PANCREAS to release bicarbonate and pancreatic juice and CCK stimulates the GALLBLADDER to release BILE
• Once the CHYME pH reaches neutral the enzyme portion of the pancreatic juice is released to complete the chemical digestion of carbohydrate, proteins and fats.
• BILE is necessary to emulsify and absorb fats.

• Small intestine cont...
• By the time CHYME leaves the duodenum, it is almost totally digested.
• CARBS are broken down to GLUCOSE molecules
• PROTEINS are broken down into AMINO ACIDS and POLYPEPTIDES
• FATS are broken down into FATTY ACIDS and GLYCEROL molecules.
• Peristalsis moves these absorbable molecules into the jejunum.

• Small Intestine cont.....
• Millions of villi and microvilli absorb the nutrient molecules into the blood stream, where they are carried to the entire body:
• GLUCOSE, AMINO ACIDS and SHORT-CHAIN FATTY ACIDS are carried by the villi to the capillaries & into the LIVER
• LONG-CHAIN FATTY ACIDS require BILE for proper absorption and end up in the LYMPHATIC system.

• Digestion continues south:
• The left over CHYME from the SMALL INTESTINE (indigestible fibers, bile, water, sloughed off cells) get passed on to the LARGE INTESTINE through the ILEOCECAL VALVE

• In the LARGE INTESTINE:
• Recycles water
• recycles waste material which nourishes the colon cells
• captures any lost nutrients that are still available (with the help of the bowel flora) and converts the nutrients to vitamins K/B1/B2/B12 and Butyric acid
• Forms and expels feces.

• 1. Need to be in a PARASYMPATHETIC state for digestion - most people are in a SYMPATHETIC state when they eat - need to RELAX.
• 2. Not chewing food properly
• 3. Not enough acid in the stomach due to stress, excess carb consumption, nutrient deficiencies, allergies, excess alcohol.

1. Ridler's reflex - HCl point- Xiphoid process then down 1" and left 1" to locate - press medial to lateral M>L one finger (or thumb).

• Chapman Reflex - Stomach/Duodenum -
• Located 6th intercostal space on the left rib cage mid mammary line (almost always under the bra on ladies), one finger palpitation A>P

• Pancreas - Z ↓ 1" R
• 1" inferior and lateral to xiphoid process on the medial margin or edge of right ribcage, press medial to lateral M>L one finger palpitation.

• Gallbladder:
• Chapman Reflex - 6th R
• In the right 6th intercostal space, mid mammary - one finger palp A>P
• MURPHY'S sign - Liver/Gallbladder - Acute(under ribs R)
• position client knees bent - place finger tips 1.5-2" away from the curvature of ribs, ask client to take a deep breath in and when they exhale palpate A>P, ask the client to take one more breath and on the exhale gently change direction of palpation more deeply, inferior to superior I>S and under the ribcage. with your hand still under the ribcage ask the client to inhale one last time, this allows the diaphragm to push the gallbladder into your fingertips. be sure to watch the clients face and stop at any point when the feel discomfort or you cannot fairly easily go further, rate either tenderness or tension.
• Right thumb web: chronic gallbladder
• feel the right thumb web on the edge of the skin and the muscle RIGHT next to the bone at the base of the thumb, to locate pinch the muscle and then slide off and back onto the web until client indicates  tenderness or you feel nodulation, much like a BB.

• SMALL INTESTINE -
• Bennett's reflexes - Palpate 2-3"around the umbilicus
• Draw an imaginary circle and divide into quadrants, FIRST PALPATION - palpate with the flat of your fingers gently in all 4 quadrants - feeling for resistance or congestion.
• SECOND PALPATION - change to a deeper palp A>P and imagine you are separating the tissue as you work deeper, have the client rate tenderness for each quadrant.
• CHAPMAN REFLEXES - SMALL INTESTINES -
• 8th, 9th & 10th -
• check for tenderness in the spaces between 8th, 9th and 10th ribs R & L. Work from the back and draw hands around the sides between the tips of the ribs. If client is ticklish guide their hands and have them palpate and rate.

• LARGE INTESTINE:
• Large intestine/Colon palpation -
• with the edge of your fingers palpate deeply feeling for reststance/congestion or until the client feels tenderness in the surrounding lymphatic tissues. Start just inside the ASIS, right side, palpate side to side and concurrently A>P across the colon, upward to the ribcage (ascending colon), then across the abdomen (transverse colon) and the down the left side with side to side motion (descending colon). On exam the points are indicated A-B & B-C (A being the ASIS on the right, B being the mid point of the abdomen & C being the ASIS on the left - Record any tenderness in corresponding areas.
• CHAPMAN REFLEX COLON - Iliotibial band
• The iliotibial band runs down the exterior of the leg from the hip (greater trocanter) to the knee. This mirrors the large intestine palpation, if you dissect the in the middle of the abdomen and draw the ends down the iliotibial band, the palpations for tenderness on the iliotibial band will likely mirror the points of the colon. The Chapman should validate your findings for the colon.
• If only the iliotibial is tender at the midpoint this likely to indicate prostate/uterus weakness, not colon.
• ILEOCECAL VALVE - palpate 1/2 the distance between the right ASIS and the umbilicus, Palpate A>P feeling for tenderness, use a slightly circular motion (clockwise) to help move the tissue as you probe deeper.

North to South process, there are 7 points to LNT but the one with the highest rating North is where to start.

• 1. DIGESTIVE reaction - looks like a digestive problem i.e. diahrrhea, cramping, heartburn, constipation.
• 2. SENSITIVITY &/ ALLERGIC reaction - these look like sensitivity or allergy symptoms i.e. rashes, congestion etc.
• 3. HEALING reaction - Looks like the symptoms we are trying to fix i.e. flu like symptoms, or nausea.