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1、2018/9/23,small intestine disease,1,SMALL INTESTINE DISEASE,2018/9/23,small intestine disease,2,The length of whole small intestine is about 2.5-2.8m in vitro. All can be divided into 3 parts : Duodenum Jejunum ileum,Anatomy,2018/9/23,small intestine disease,3,2018/9/23,small intestine disease,4,201
2、8/9/23,small intestine disease,5,Jejunum and ileum,The jejunum is 2/5 of the whole small intestine The ileum is 3/5 of the whole small intestine distally. The mesentery extends from the ligament of Treitz In the base, it is only 15cmWhile in the margin, it can extend as long as the length of small b
3、owel,2018/9/23,small intestine disease,6,Histology,The wall of small intestine Mucosa Submucosa Muscles Serosa Epithelium is the inner lining of mucosa and increases the surface area of mucosa with multiple villi,2018/9/23,small intestine disease,7,Small Intestine: Duodenum, Jejunum, Ileum,2018/9/23
4、,small intestine disease,8,2018/9/23,small intestine disease,9,It consists of 3 kinds of cells:,The absorptive cells are columnar cell with microvilli The exocrine cells include Goblet cells secreting mucin Paneth cells containing lysosomal enzymes The endocrine cells,2018/9/23,small intestine disea
5、se,10,Physiology,The functions of the small intestine: Digestion Absorption Secretion of gut hormones Barrier for microbes and toxins of lumen passing into the system Motility that can push chyme into distal portion,2018/9/23,small intestine disease,11,Barrier:,Both nonimmunologic and immunologic pr
6、ocesses provide protection. Non-immunologic defenses consist of Gastric Acidity and Enteric Proteolytic Enzymes, Mucin, Peristalsis, Rapid epithelium turnover, and bacterial Competitive Inhibition. Immunologic components include Gut-Associated Lymphoid Tissue (Peyer Patches, Lymphoid Follicles, Mese
7、nteric Lymph Nodes), Migratory Pathways, and Secretory IgA.,2018/9/23,small intestine disease,12,Intestinal Obstruction 肠梗阻,2018/9/23,small intestine disease,13,Defination,A blockade of the flow of intestinal content. Anatomic, functional changes but also systemically physiologic disorders. Intestin
8、e obstruction is a syndrome consisting of many diseases with the same symptoms.,2018/9/23,small intestine disease,14,2018/9/23,small intestine disease,15,2018/9/23,small intestine disease,16,Etiology and classification 1.According to its basic causes: mechanical, dynamic obstruction,and obstruction
9、of vascular supply origin 1). Mechanical obstruction from lesions within the wall of the intestine, intrinsic from extra-intestinal lesions , extrinsic from obstructing intra-luminal substances. congenital, inflammatory, neoplastic, or traumatic origin. Adhesions of postoperative, congenital origin,
10、 Hernias Intra-luminal foreign bodies,2018/9/23,small intestine disease,17,Causes of mechanical obstruction: 1hernia 2Adhesive obstruction 3Tumor in intestine 4Tumor outside intestine 5.congenital intestinal narrow 6 Intestine retortion 7Intestine narrow 8intussusception,2018/9/23,small intestine di
11、sease,18,from lesions within the wall of the intestine, intrinsic Inflammation Tumor in intestine,2018/9/23,small intestine disease,19,Tumor in colon,2018/9/23,small intestine disease,20,from extra-intestinal lesions , extrinsic Incarcerated hernia Adhesive obstruction,2018/9/23,small intestine dise
12、ase,21,from obstructing intra-luminal substances: obstruction caused by ascarids,2018/9/23,small intestine disease,22,2). Dynamic obstruction Paralytic obstruction: Nerval reflex or toxin stimulation, acute diffuse peritonitis, abdominal operation, retroperitoneal hematoma and infection. Spastic obs
13、truction in intestinal functional disorder or toxication. 3). Obstruction of blood supply origin thrombosis or embolism, then intestinal paralysis.,2018/9/23,small intestine disease,23,2.According to whether the vascular supply to intestinal wall is compromised, Simple and strangulation obstruction.
14、 Simple obstruction, without threat to the viability of the intestinal wall. Strangulation obstruction, the vascular supply is compromised.,2018/9/23,small intestine disease,24,3.According to obstruction level or site. Proximal, distal intestinal, or large bowel obstruction, or high and low obstruct
15、ion 4.According to the extent of obstruction Incomplete and complete obstruction, 5.According to mode of onset and progression of obstruction. Acute and chronic obstruction,2018/9/23,small intestine disease,25,6. Open-loop Obstruction: It is the most common type in which only a single site results i
16、n obstruction. Closed-loop Obstruction: It results when both limbs of the gut loop are obstructed or just one loop are obstructed but there is a valve in the proximal lumen. In this type of obstruction, the proximal gut could not decompression effectively such as colon obstruction.,2018/9/23,small intestine disease,26,7.Psudoobstruction: It is the rare paralytic obstuction of the intestine.,
