1 / 61

Small bowel

Small bowel. Anatomy. Small bowel 75 % of the total length of GI Length: 260 cm by living persons 5 – 7 m post mortem Parts: jejunum 2/5 length ileum 3/5 length . Anatomy. Wall of small intestine: 1. Serous layer 2. Muscular layer smooth muscle

aram
Download Presentation

Small bowel

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Small bowel

  2. Anatomy Small bowel75 % of the total length ofGI Length: 260 cm by living persons 5 – 7 m post mortem Parts:jejunum 2/5 length ileum 3/5 length

  3. Anatomy Wall of small intestine: 1. Serous layer 2. Muscular layer smooth muscle 3. Submucosa fibroelastic tissue, blood and lymphatic vessels 4. Mucosa

  4. Microanatomy Wall of small intestine: Circular plices - Kerkring-i enlarge 3 x the surface of mucosa Villi intestinales enlarge 10 x enlarge 3 x the surface of mucosa Microvilli enlarge 30 x surface of mucosa total enlargement 900 x !! Epithelium - enterocytes - absorb cell - goblet cells – mucin production

  5. Anatomy Blood supply: a.mesenterica superior a. pancreaticoduodenalis inferior - pancreas duodenum aa. jejunales – one arcades- jejunum aa. ileae – 2-4 arcades - ileum a. ileocolica – colon ascendens and caecum a. colica dextra – colon ascendens a. colica media – colon transversum

  6. Blood supply of small bowel

  7. Bood supply of large bowel

  8. Physiology digestion: 1. Intraluminal phase: chymus is mixed with enzymes from enterocytes, pancreas, bile, stomach 2. Absorb phase : in the wall of bowel absorbtion of nutrients, water, minerals, vitamins 3. Transport phase

  9. Physiology Motility: 1. Peristaltic Circular contractions in distal direction fr.= 10/min., transit time in small bowel is 1- 6 hr. • Segmental contractions: to mix the content

  10. Absorbtion

  11. Absorbtion

  12. Mesentery - functions 1. mechanical support for bowel 2. blood supply 3. lymphatic drainage of nutrients 4. immunological barrier

  13. Physiology Functional disorder 1. : Maldigestion – intraluminal disorder lack of bile, stomach acid, or pancreatic intestinal juice Malabsorbtion – disorder in the phase of absorbtion or transport

  14. Physiology Other functional disorders 2. : Diarrhea ( osmotic, infection, ) Blind sac sy ( stasis of enteral content in a blind sac, what leads to bacterial contamination and deconjugation a of bile acids - diarrhea) Short bowel sy ( after extent resections, leads to depletion of water, minerals, nutrients, vitamins) requires parenteral nutrition

  15. Diagnostics specific enteroclysis- „small bowel enema“ study enteroscopy - double balloon - push - on table - capsule

  16. Double balloon enteroscopy

  17. Double balloon enteroscopy

  18. Push enteroscopy

  19. PILLCAM - hi-tech capsule enteroscopy

  20. Capsule endoscopy

  21. On table enteroscopy- bleeding from adenoma

  22. Enteroscopy- A-V malformation

  23. Enteroscopy necrotizing colitis, adenoma

  24. Non specific Laboratory X-ray Ultrasound CT MRI Gastroscopy Colonoscopy AG, scintigraphy- bleeding

  25. Plane X-ray

  26. Plane X- ray , lateral

  27. Barium enema

  28. Barium enema study

  29. Barium enema study- MC

  30. Angiography

  31. Exomphalos

  32. Surgical treatment

  33. Meckel´s diverticulum remnant of omphaloenteteric duct, which did not obliterate Pathology : 1-2%, situated on the antimesenterial site of bowel Clinical presentation : inflammation, bleeding, torsion, ileocaecal invagination Dg: not easy Therapy : resection of diverticulum

  34. Meckel´s diverticulum

  35. Ileocoecal invagination

  36. Mesenterial cysts Pathology :on the mesenterial site of bowel, Symptoms : chronic pain, palpable mass, can be signs of compression Dg : X-ray, ultrasound, CT, MRI Therapy : resection of bowel and mesentery

  37. Mesenterial cyst

  38. Crohn´s disease- IBD Granulomatous inflammation, which extends diffusely through the entire thickness of the bowel wall Can affect whole GI, but most commonly in small and large bowel ( skip lesions) Etiology: not known Pathology: a/acute inflammation b/chronic inflammation c/ complications

  39. Clinical features Acute- pain, diarrhea, fever Chronic- malabsorbtion, extraintestinal Complications: obstruction, fistulas, bleeding, perforation, perianal MC Dg :History, examination, barium enema, endoscopy (cobblestone surface), ultrasound, CT, biopsy Ulcerative colitis

  40. Crohn´s disease

  41. Endoscopy

  42. Endoscopy

  43. Endoscopy

  44. Small bowel enema

  45. CT

  46. Crohn´s disease

  47. Crohn´s disease Thickened wall by inflammatory oedema Crohn´s disease Fissured ulcers

  48. Extraintestinal presentation

  49. Treatment Dietary : without fiber, avoiding malabsorbtion, elementary diet. 2. Parenteral nutrition: 3. Drugs - 5-ASA ( sulphasalazine) - steroids- parenteral, p.o, topical - azathioprin ( IMURAN ) - Metronidazol 0,5- 1,5 - monoclonal antibodies anti TNF alfa (Remicade)

More Related