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1、Intestine Diseases,Sun Libo China - Japan Union Hospital,Review of Anatomy and Physiology,I.Small Intestine Macroscopic anatomy Treitz ileocecal valve. 2/5 jejunum, 3/5 ileum Mesentery : fat, blood vessels, lymphatics, and nerves. superior mesentery artery and vein Microscopic anatomy 4 layers : muc
2、osa , submucosa, muscularis, and serosa.,Physiology of the small intestine 1. Digestion digests and absorbs nutrients from ingested food. 2. Secretion Alkaline mucus and some gastroenteral hormones 3. Motility The movement is composed of segmental contraction and peristalsis ( short, weak, propulsiv
3、e),II. Large Intestine Macroscopic anatomy1.5 m long , end of ileum rectum Right colon: cecum , ascending colon , hepatic flexure,and proximal transverse colon Left colon: the distal transverse colon,splenic flexure ,descending colon, and sigmoid colon. Blood supply: Superior mesentery artery the ri
4、ght colon .Inferior mesentery artery the left colon. Microscopic anatomy4 layers : mucosa, submucosa, muscularis, and serosa.,Physiology of large intestine 1. Digestion electrolytes and water from the ileal fluid 2. Secretion Alkaline mucus and some gastroenteral hormones 3. Motility Retrograde peri
5、stalsis (dominates in the right colon)Segmental contraction (in the transverse and descending colon)Mass movement ( a strong ring contraction over long distance in the transverse and descending colon),Major Contents,Inflammatory bowel diseases IBD Intestine Obstruction Vascular lesions of mesentery
6、Short bowel syndrome Polyps TumorCongenital diseases,Inflammatory bowel diseases IBD1) intestine tuberculosis 2) typhoid perforation 3) amoebic perforation4) nonspecific inflammatory diseases (Crohns Diseases, ulcerative colitis ) Surgical interventionperforation , obstruction , or hemorrhage ( blee
7、ding ),Vascular lesions of mesentery ( vascular occlusion or ischemia ),Mesentric arterial embolism or thrombosis cardiac diseasesMesenteric venous thrombosis Hepatic cirrhosis and haemal diseases Character - symptom severe , sign light Diagnosis - angiography Treatment - operation,Short bowel syndr
8、ome,Etiology intestine resection not long enough (100cm) digestive and absorption disfunction Treatment 1) nutrition support (TPN)12 year half compensation recover2) intestine transplantation immune rejection problem,Polyps and polyposis,Difference 100 or not Place:any where,but common in colon Pres
9、entation 1) change of defecation 2) rectal bleeding 3) ileus (obstruction) Treatment Endoscopic electrocautery snare Open operation,Congenital diseases,Classification : atresia ,stenosis,and malrotation Etiology: abnormal growth Diagnosis: 1) newborn 2) intestinal obstruction 3) upper gastrointestin
10、al series or barium enema evidence Treatment operation,Obstruction of Intestine ( Bowel ileus ),Etiology and classification I . Mechanical Obstruction inside ,outside the lumen, or intestine wall lesions . II. Adynamic (paralytic) ileus operation or acute peritonitis . . blood supply? simple or stra
11、ngulated ileus.,Change in physiology,1. Loss of body fluid : Metabolic acidosis -lower ( distal ) obstruction Metabolic alkalosis -high (proximal) obstruction 2. Infection and toxic symptoms Endogenous infection by bacteria inside the lumen 3. Shock Severe loss of liquid or infection . 4. Respiratio
12、n and circulation barrierCaused by the distension of intestine .,Clinical findings,Symptoms 1.Abdominal pain . variable , cramping peri-umbilical pain 2.Vomiting especially in proximal ( high ) 3.Abdominal distension . middle or distal bowel obstruction , and paralytic (adynamic ) obstruction 4.Diff
13、iculty of defecation and gas expelling.varies according to it is complete or not,Signs 1. Generally Dehydration , and shock at the late stage 2. LocallyInspection: Peristalsis in dilated loops may be visible in thinpatients .Palpation: mild tenderness Auscultation: Peristaltic rushes, gurgles, and h
14、igh pitchedtinkles are audible. Incarcerated hernia ?,Adjuvant examination,Laboratory findings early normal late hemoconcentration , leukocytosiselectrolyte abnormalities. Serum amylase is often elevated . X-ray findings Plain films ladderlike pattern of dilated smallbowel loops with air fluid level
15、s .Contrast media orally or by a nasogastric tube .proximal Barium enema distal,diagnosis and questions,Diagnosis : based above clinical findings and adjuvant examination Questions :(1) is or not ? (2) Mechanical or paralytic ( adynamic) ? (3) Simple or strangulated ? (4) high or lower ? (5) complet
16、e or not ? (6) the reason of obstruction ?,Indication of strangulation,1) severe colic pain 2) shock 3) peritonitis 4) visible or palpable dilated intestine loops 5) bowel bleeding 6) medical treatment is not successful 7) X-ray shows distended bowel loops that is not change with time.,Treatment,1.Conservative therapy 1) Nasogastric suction. 2) Fluid and electrolyte resuscitation. 3) Antibiotics used before operation. 4) Traditional Chinese medicine therapy .,
