Processes occur in the human small intestine. What happens in the human small intestine What processes occur in the human small intestine

May is approaching - the last calendar month of spring. It just so happens that in spring the organs of the gastrointestinal tract are the most weakened and in need of our support and attention. So, we continue the topic “Health all year round”. In March, we already took care of the stomach, and in April we paid attention to the large intestine. What's next?

May. The focus is on the small intestine, which consists of the duodenum, jejunum and ileum.

The small intestine is exactly the place where active absorption (digestion) of food occurs. We remember that absorption is a physiological process associated with the transition of nutrients into the internal environment of the body. This process occurs with varying intensity throughout the digestive tract.

The digestion process begins in the oral cavity, where food is crushed, soaked in enzymes that are part of saliva, and sent to the stomach. In the stomach, the food mass (chyme) is mixed with gastric juice, partially digested and moved to the “initial” section of the small intestine - the duodenum, moving further into the jejunum and ileum.

What happens to food in the small intestine?

Functions of the small intestine

Let's start with the fact that the small intestine is very tightly packed in the abdominal cavity and partially in the pelvic area, forming “loops” due to repeated bends. Mixing and movement of food mass in the small intestine occurs as a result of coordinated contractions of transverse and longitudinal muscle fibers located in the walls of the intestines.

The length of the small intestine is approximately 5 meters, of which the duodenum accounts for only 25-30 centimeters (the name “duodenum” comes from its length, equal to the length in diameter of 12 fingers folded together). But, as they say, “small is the spool, but dear”!

The duodenum is the main biochemical “laboratory” of the body. Here, under the influence of the secretions of the pancreas and spleen, bile, and digestive juices of the intestine itself, the primary breakdown of food into plastic (“building”) and energy material occurs, which then continues in the jejunum and ileum.

The stage of mechanical and chemical processing of food is completed in the small intestine (water and mineral salts are absorbed in the large intestine).

Intestinal juice, which is secreted by special intestinal glands, takes an active part in digestion throughout the small intestine. Intestinal juice has a slightly alkaline reaction. It consists of various substances of organic and inorganic origin (enzymes, trace elements, mucoproteins, etc.), which break down the products of protein digestion into amino acids, carbohydrates into glucose, fats into glycerol and fatty acids.

Digestion in the small intestine consists of two interrelated processes - cavity and parietal (membrane) digestion.

During the process of cavity digestion, enzymes of digestive juice are released into the intestinal cavity. Under the influence of these enzymes, the initial hydrolysis of substances from the food mass to intermediate products occurs.

Parietal digestion is carried out at the border of the extracellular and intracellular environments by enzymes fixed on the cell membrane.

Cavity digestion ensures the initial hydrolysis of nutrients to intermediate products, and parietal (or membrane) digestion provides hydrolysis of the intermediate and final stages of digestion, as well as the transition of nutrients into the internal environment, that is, absorption.

The mucous membrane of the small intestine is covered with a huge number of so-called microvilli, which sharply increase the absorption surface of the walls. Due to this, intensive processes of digestion and absorption of hydrolysis products into the blood and lymphatic capillaries located in the wall of the small intestine are ensured.

Microvilli, forming a rather dense “brush” called a brush border, form a kind of bacterial filter through which microorganisms located in the intestinal cavity cannot penetrate. This is one of the most important reasons for limiting bacterial growth in the small intestine.

So, the main absorption process occurs in the small intestine. This process is based on physical laws - diffusion, filtration, osmosis and the active activity of epithelial cells of the intestinal mucosa.

Amino acids (end products of protein) enter the blood through microvilli.

Carbohydrates (glucose, fructose, galactose) are absorbed into the blood by diffusion and with the help of carriers (active transport). This process is facilitated by sodium ions. Since fructose is partially converted into glucose in the slightly alkaline environment of intestinal juice, carbohydrates are transported into the blood mainly in the form of glucose.

The products of fat breakdown are absorbed into the lymph, not into the blood. In this case, glycerin is easily absorbed, and fatty acids in the form of fat droplets (chylomicrons) first combine with alkaline and bile acids, forming soaps, in order to pass through the microvilli, in which glycerin and soaps combine and form neutral fat, which appears in the lymphatic system. vessel in the form of droplets of newly formed fat.

Thus, the body extracts energy from food for its work and our physical activity, as well as material for building cells.

The completeness of absorption of the final products of digestion depends on the intensity of small intestinal motility. With rapid motility, most of the final products do not have time to be absorbed and pass into the large intestine in “transit”, not absorbed.

The basis of health is the cleanliness of our body. And it is unthinkable without the cleanliness of the gastrointestinal tract. To be healthy, your intestines need to be kept in perfect order!

What happens to our intestines in modern life? Refined food, overeating, lack or insufficiency of dietary fiber, and a sedentary lifestyle lead to the accumulation of breakdown products. In numerous folds of the intestine, they form fossilized “blockages” in which toxic substances accumulate. The “gifts” of modern ecology settle on the intestinal walls - heavy metals, radioactive substances, exhaust gases, carcinogens - killing beneficial microflora and poisoning the body.

Intestinal dysfunction leads to excess weight, headaches, nausea, and sallow complexion. Chronic diseases worsen and new ones appear.

How to protect our small intestine and activate its work?

And again the Bee and all the gifts of the hive come to our aid!

Bee products and plants, by their chemical nature, are a huge complex of formulas, selected and combined by the most talented chemist in the Universe - Nature. Everything that Nature has done adds a small piece of health to our body, which can displace the same piece of disease. And so every day!

So let's take care of prevention and every month we will take care of that organ that especially needs support and strengthening. Start this wellness course right now, without putting it off until the next “Monday”, which when else will come!? Month after month, throughout the year, you will strengthen and heal all systems of your body. After all, there are 12 months in a year, and there are 12 systems in our body.

In May to help the small intestine

1. Honey water in the morning on an empty stomach (a teaspoon of honey per glass of raw clean water at a comfortable temperature).

2. Hey Pee Wee - aqueous propolis extract. A 5% propolis extract prepared with double-distilled shung water improves digestive function, increases the body's resistance, and preserves beneficial intestinal microflora.

3. Apiformula-3 - contains isomalt, pollen, propolis, natural honey, beeswax, as well as extracts of elecampane root, calamus, sage leaf, fennel fruit, dandelion root and licorice. Dragee improves the functional state of the pancreas and small intestine, helps the processes of physiological absorption of food. The combination of isomalt and bee products normalizes carbohydrate metabolism and promotes weight correction.

4. Polyanka - honey composition. A classic combination of high-quality honey with bee pollen. The honey composition has a general strengthening effect, restores and prevents disorders of motility and functions of the gastrointestinal tract.

Remember! The best way to prolong life is not to shorten it! Your greatest reward is a healthy lifestyle!

Materials used from the book by T.I. Andronova “The Art of Rejuvenation and Active Longevity”

(Novosibirsk, 2009)

.

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Small intestine: length and role in the digestive process

The small intestine is one of the most important segments of the digestive tract, in which the processing and absorption of nutrients from food occurs. What is the structure of this section of the intestine?

What is its relationship with the rest of the digestive tract and how does the digestion process occur in it? What consequences can lead to disturbances in the normal functioning of the small intestine? Detailed answers to these and other important questions will be provided in the next article.

Structure and physical parameters of the small intestine

The small intestine is located between the stomach and large intestine.

The small intestine is the section of the gastrointestinal tract in which the main process of digestion and absorption of food occurs.

It is located between the stomach and large intestine. This is the longest part of the digestive tract, its length on average is 5-6 meters, and its weight can reach 650 g.

The diameter of the small intestine varies along its entire length and ranges from 2-3 cm in the distal part to 4-6 cm in the proximal part. The thickness of the walls of the small intestine in the normal state is 2-3 mm, and when it contracts - 4-5 cm. The entire small intestine is differentiated into the following sections:

1. Duodenum. It starts from the turn of the stomach and has the shape of a horseshoe or an incomplete loop covering the pancreas. The main part of the duodenum, except for its small extension - the ampulla, is located behind the peritoneum. The position of the duodenum may vary slightly from person to person. And it can also vary for the same person at different ages. It depends on physique, fatness, age and other indicators.
2. Jejunum. It is located on the left side of the abdomen in the form of seven loops and is the upper part of the small intestine.
3. Ileum. It is a smooth muscle hollow organ and forms the lower part of the small intestine. It is 1.3 to 2.6 m long and is located in the lower right side of the abdominal cavity.

Functional features of the small intestine

The small intestine is a section of the digestive tract.

The small intestine is the part of the digestive tract that takes part in all stages of digestion.

The small intestine produces enzymes that, together with enzymes produced by the gallbladder and pancreas, help break down foods.

This is where proteins are broken down into amino acids and carbohydrates into simple sugars, which allows them to be absorbed faster and more efficiently.

Useful elements penetrate the capillaries of the circulatory, lymphatic and lymphatic systems and are transported to all organs and tissues of the human body. Each section of the small intestine also performs its own function:

• The duodenum begins the process of intestinal digestion. It is here that the hydrolysis of fats, proteins and carbohydrates occurs. The duodenum adjusts the acidity of the food mass arriving from the stomach to a level that does not irritate the lower parts of the small intestine. Regulates the production of bile and enzymes involved in the digestion process.
• The jejunum performs motor and absorption functions.
• The ileum provides transport and motor function. Responsible for the absorption of substances formed after the hydrolysis process. Produces a special food peptide that regulates eating and drinking behavior.

All parts of the small intestine are also part of the endocrine system, since they have a special function - the production of hormones. The main part of the cells that produce hormones is located in the duodenum and jejunum. Each type of cell produces its own hormone:

1. D cells – produce somatostatin;
2. G cells – gastrin;
3. I-cells – cholecystokinin;
4. K-cells – insulinotropic glucose-dependent polypeptide;
5. M cells – motilin;
6. S-cells – secretin.

   All these hormones regulate the process of digestion in the intestine and its transport and motor activity.

Watch the video about the small intestine:

Features of the digestive process in the small intestine

After the stomach, the food mass, which has an acidic reaction, enters the duodenum. It is here that the process of digesting carbohydrates, fats and proteins occurs so that they can be absorbed by the body. In the gut, food becomes more alkaline, which allows intestinal enzymes to break down nutrients into smaller compounds.

This is how the process of formation of simple sugars and amino acids occurs, which are then absorbed by the villi of the small intestine, transported into the circulatory system and sent to the liver tissue. Fats, in turn, enter the lymphatic system.

Diseases of the small intestine

Malabsorption is a lack of absorption of certain nutrients.

Among all possible diseases of the small intestine, defecation disorders (diarrhea or fecal retention) are the most common.

Very often, such disorders are accompanied by moderate pain in the abdominal area and increased gas formation.

Failures in the functioning of the small intestine are signaled by rumbling and a feeling of unusual movement in the peritoneum.

These symptoms may indicate increased gas formation caused by eating foods such as rye bread, cabbage, legumes, and potatoes.

Failures in the production of enzymes and the breakdown of food gruel are more serious disturbances in the functioning of the small intestine. If there is a disruption in the process of normal digestion of food, the body does not receive all the nutrients it needs, and this can cause hair loss, causeless weight loss, weakening of muscle and bone tissue, dryness and flaking of the skin, etc. There are several syndromes of pathological changes in digestion in the small intestine:

• malabsorption - insufficient absorption of certain nutrients. This syndrome can be primary or acquired, develop due to genetic factors or diseases of internal organs.
• Maldigestion is a lack of digestive function. Most often, this pathology occurs due to an insufficient amount of enzymes in the digestive juices of the intestine.

Methods for diagnosing intestinal diseases

Ultrasound will help diagnose intestinal diseases.

Diseases of the small intestine are determined based on the results of diagnostics and tests.

The patient may be prescribed a general blood test, in which special attention is paid to the rate of red blood cell movement, as well as a stool test for the presence of helminths.

Research methods that allow diagnosing intestinal diseases include:

1. radiography;
2. capsule examination;
3. endoscopy;
4. colonoscopy;
5. fiberoscopy.

Treatment methods for diseases of the small intestine

Lactobacterin is prescribed to restore microflora.

Restoring the normal functioning of all parts of the small intestine is possible only after eliminating the underlying disease.

If a patient is diagnosed with enzyme deficiency, he is prescribed medications with their synthetic substitutes.

If enzyme deficiency is accompanied by significant weight loss, then drugs for parenteral nutrition are prescribed.

In this case, the intake of nutrients bypasses the gastrointestinal tract and is carried out by intravenous infusion.

Intestinal dysbiosis is treated with antibiotic drugs with the obligatory restoration of beneficial microflora. For this, Lactobacterin, Bifikol and other drugs are prescribed. If disorders in the small intestine manifest themselves in the form of too liquid stools, then the patient may be prescribed medications that cause hardening of the stool.

They usually contain increased amounts of bismuth and calcium. Insufficient cohesion of fatty acids, which causes the formation of liquid feces, is treated with regular activated carbon. All disorders in the functioning of the small intestine require contacting a doctor for examination and prescribing adequate drug therapy.

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What are the differences between the parts of the small intestine?

The small intestine is the longest part of the entire digestive tract. This organ is the longest intestinal section. It is located next to the pylorus of the stomach and passes into the rectum. This part of the digestive tract allows you to perform many vital functions, the main one of which is the absorption of nutritional components from liquid by its walls.

How it works

Complex digestive processes occur in the small intestine

The small intestine is similar in structure to the large intestine, but has less thick and durable walls, the diameter of the internal lumen is also different (thinner in the small intestine). When examined, it is quite difficult to distinguish the thickness of the walls of the large and small intestines, since the small intestine has the ability to stretch greatly. The diameter of the small intestine differs throughout its entire length:

• In the proximal part it averages 5 cm
• Distal – 3 cm

The peritoneum covers the small intestine almost completely, remaining uncovered only at the junction with the peritoneum - in the mesentery. The location of the small intestine is interperitoneal. The motility of the small intestine is quite active and varied:

1. Several muscles contract at the same time
2. Tonic contractions (like stomach contractions)
3. Wave-like peristalsis: waves propagating from proximal to distal
4. Pendulum contractions (alternately: either longitudinal or circular muscle fibers)

Wall structure

The walls of the large intestine consist of layers:

1. Mucous
2. Submucosal
3. Muscular
4. Serous

Muscular consists of:

• inner circular layer
• outer longitudinal layer

The walls are evenly covered with a mucous layer throughout the entire part of the small intestine except the duodenum, where the glands and longer villi of epithelial tissue are located. The villi are similar in shape to tree leaves, which makes the inner surface of the intestine significantly thicker. A network of capillaries supplies blood to the villi, between which there are depressions that open the intestinal ducts to perform the digestive function.

The mucous layer consists of many circular and longitudinal folds.

Depending on the blood supply to the intestines, the color of the mucous membrane changes; in all sections it is pink, and in the ileum it is gray-pink. The muscular coat consists of longitudinal and circular smooth muscles. The serous part is the peritoneum, which covers the duodenum only in the area of ​​the ampulla. Throughout the inside of the small intestine there are lymph nodes and Peyer's patches (clusters of lymph nodes).

Read: Pancreas: normal sizes and deviations

How does digestion happen?

Sections of the small intestine: schematically

Food coming from the stomach has high acidity. In the intestine, it is normalized and conditions are created for normal enzyme activity and activation of pancreatic fluid. The intestines contain more than 98% liquids and less than 2% dry matter.

More than two liters of digestive enzymatic juice are produced in the intestines per day. After food intake, its amount in the intestines decreases. In the small intestine, food is digested into blood capillaries and lymphatic vessels. Stages of the small intestine:

1. Digestion of protein through enzyme activity
2. Breakdown of carbohydrates
3. Fat synthesis occurs last with the participation of lympase

With the help of villi, carbohydrate and protein components are absorbed, which then travel through the veins to the liver, fats are sent to the lymphatic vessels.

Part of the endocrine system

In addition to the digestive process, the small intestine performs an endocrine function. It consists in the production of cells of the gastropancreatic system responsible for enzymes. The small intestine produces a number of hormones that aid digestion.

Also, enzymes are produced in the small intestine that help break down incoming food into components. After breakdown, proteins are synthesized into amino acids, carbohydrates into simple sugars, and fats into components that do not interfere with the absorption of nutritional components.

Departments

There are the following sections of the small intestine:

1. duodenum
2. Jejunum
3. Iliac

Duodenum

The duodenum is located in close proximity to the pylorus of the stomach, it reaches a length of 20 cm and is almost entirely located in the retroperitoneal region, except for the part called the ampulla. The intestine surrounds the pancreas, resembling a horseshoe. It is customary to divide the duodenum into parts:

• Rising
• Descending
• Horizontal
• Upper

Human intestines: schematic representation

Parallel to the first lumbar vertebra is the ascending part of the small duodenum. You can also determine its location by the level of the twelfth thoracic vertebra.

Read: Modern and most effective methods of intestinal examination

This section is a loop up to 5 cm long. It ends in the descending part of the intestine. In close proximity to this organ is the liver with the common gastric duct.

The descending portion runs from the right side of the spine down to the third vertebra, then curves to the left. The length of this part usually varies around 8-10 cm. The duodenum is located in close proximity to:

• Right kidney
• Liver
• Common bile duct

The pancreas is connected to this part of the intestine through the common pancreatic duct, connected to the bile duct by a groove. The horizontal section of the intestine corresponds to the third lumbar vertebra and the inferior vena cava. Next, the horizontal part of the intestine goes up and passes into the ascending section.

The ascending part of the duodenum completes the loop and is located at the level of the second lumbar vertebra. Its bend passes into the jejunum. The ascending part of the duodenum is located next to:

• Mesenteric vein
• Mesenteric artery
• Abdominal aorta

Jejunum

This part of the intestine is similar in structure to the previous one. Both of these parts are called the mesenteric part of the small intestine. The jejunum forms seven loops and is located in the upper left part of the abdominal cavity. The posterior part of the jejunum is adjacent to the pariental peritoneum. The jejunum is connected to the stomach, in its curved part, by the omentum.

Ileum

The jejunum continues into the ileum, which is located on the right side of the lower abdomen. The ileum is similar in structure to the jejunum. It consists of many loop-shaped bends, the last of which extend into the small pelvis. The ileum is located next to the bladder and uterus.

The small intestine has a simple structure, but at the same time it performs many functions: digestion, absorption of nutrients, breakdown of food into its component parts and production of hormones. In this part of the intestine, many medications taken into the body orally are absorbed, and toxins enter the blood through its walls. To maintain intestinal health, it is very important to monitor your diet and drink more fluids to regulate its functioning.

Read: Anatomy of the human intestine: what's what

The video lecture will introduce you to the anatomy of the intestine:

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Intestines. Human digestive system

From the stomach, food passes into the duodenum, which is the initial section of the small intestine (its total length is about 7 m).

The duodenum (see Fig. item 10), in combination with the pancreas and liver, is the central node of the secretory, motor and evacuation activity of the digestive system. In the stomach, cell membranes are destroyed (i.e., partial breakdown of connective tissue proteins begins), while in the cavity of the duodenum, the main processes of digestion of proteins, fats and carbohydrates continue. Almost all products obtained as a result of the breakdown of nutrients, as well as vitamins, most of the water and salts, are absorbed here.

In the small intestine (see Fig. p. 11) the final breakdown of nutrients occurs. Food gruel is processed under the influence of pancreatic juice and bile, which permeate it in the duodenum, as well as under the influence of numerous enzymes produced by the glands of the small intestine.

The absorption process occurs over a very large surface, since the mucous membrane of the small intestine forms many folds. The mucous membrane is densely dotted with villi - peculiar finger-like protrusions (the number of villi is very large: in an adult it reaches 4 million). In addition, the epithelial cells of the mucous membrane have microvilli. All this increases the absorption surface of the small intestine hundreds of times.

From the small intestine, nutrients pass into the blood of the portal vein and enter the liver, where they are processed and neutralized, after which some of them are carried with the bloodstream throughout the body, penetrate through the walls of capillaries into the intercellular spaces and further into the cells. The other part (for example, glycogen) is deposited in the liver.

Diagram of the digestive organs: 1 - salivary glands; 2 - trachea; 3 - esophagus; 4 - diaphragm; 6 - liver; 6 - gallbladder; 7 - bile duct; 8 - stomach; 9 - pancreas; 10 - duodenum; 11 - small intestine; 12 - large intestine; 13 - cecum; 14 - vermiform appendix (appendix); 15 - rectum. In the large intestine (see Fig. p. 12) the absorption of water is completed and feces are formed. Colon juice is characterized by the presence of mucus; its dense part contains some enzymes (alkaline phosphatase, lipase, amylase, etc.).

The large intestine is a place of abundant proliferation of microorganisms. 1 g of feces contains several billion microbial cells. Intestinal microflora is involved in the final decomposition of the components of digestive juices and undigested food residues, synthesizes enzymes, vitamins (group B and vitamin K), as well as other physiologically active substances that are absorbed in the colon. In addition, the intestinal microflora creates an immunological barrier against pathogenic microbes. Thus, animals raised in sterile conditions without germs in the intestines are much more susceptible to infection than animals raised under normal conditions. Thus, it has been shown that intestinal microflora contributes to the development of natural immunity.

The microbes present in a healthy intestine perform another protective function: they have pronounced antagonism towards “foreign” bacteria, including pathogenic ones, and thereby protect the host body from their introduction and reproduction.

The protective functions of normal intestinal microflora are particularly affected when antibacterial drugs are introduced into the gastrointestinal tract. In experiments on dogs, suppression of normal microflora with antibiotics caused abundant growth of yeast-like fungi in the colon. Clinical observations have shown that too long-term use of antibiotics often causes severe complications caused by the rapid proliferation of antibiotic-resistant forms of staphylococci and Escherichia coli, which are no longer restrained by competing microorganisms.

Intestinal microflora decomposes excess pancreatic juice enzymes (trypsin and amylase) and bile, and promotes the breakdown of cholesterol.

In a person, about 4 kg of food mass passes from the small intestine to the large intestine per day. In the cecum (see Fig. p. 13), food gruel continues to be digested. Here, with the help of enzymes produced by microbes, fiber is broken down and water is absorbed, after which the food masses are gradually converted into feces. This is facilitated by the movements of the colon, mixing the food gruel and facilitating the absorption of water. An average of 150-250 g of formed feces is produced per day, approximately one third of which is bacteria.

The nature of feces and its quantity depend on the composition of the food. When eating predominantly plant foods, there is significantly more feces than when eating mixed or meat foods. After eating rye bread or potatoes, 5-6 times more feces are formed than after the same amount of meat.

The act of defecation has a reflex effect on the cardiovascular system. At this time, the maximum and minimum blood pressure increases, the pulse increases by 15-20 beats per minute. Most healthy people have one bowel movement per day.

The release of the intestines from feces is ensured by active peristalsis, which occurs when the receptors of the intestinal walls are irritated by feces. When consuming foods containing sufficient amounts of plant fiber, its coarse undigested fibers irritate the nerve endings in the muscles of the small intestine, and especially the large intestine, thereby causing peristaltic movements that accelerate the movement of food gruel. Lack of fiber makes it difficult to empty the intestines, since weak peristalsis, and even more so its absence, causes long-term retention of food residues in the intestines, which can cause various diseases of the digestive system (for example, dysfunction of the gallbladder, hemorrhoids). With chronic constipation, stool becomes severely dehydrated, as excessive absorption of water occurs in the colon, which under normal conditions must be removed with stool. In addition, the presence of feces in the colon for too long (i.e., chronic constipation) breaks the intestinal “barrier”, and the intestinal walls begin to let into the blood not only water with small molecules of nutrients, but also large molecules of decay products that are harmful to the body and fermentation - self-poisoning of the body occurs.

The human small intestine is part of the digestive tract. This department is responsible for the final processing of substrates and absorption (absorption).

What is the small intestine?

Vitamin B12 is absorbed in the small intestine.

The human small intestine is a narrow tube about six meters long.

This section of the digestive tract got its name due to its proportional features - the diameter and width of the small intestine are much smaller than those of the large intestine.

The small intestine is divided into the duodenum, jejunum and ileum. The duodenum is the first segment of the small intestine, located between the stomach and jejunum.

The most active digestive processes take place here; it is here that pancreatic and gallbladder enzymes are secreted. The jejunum follows the duodenum, its length on average is one and a half meters. Anatomically, the jejunum and ileum are not separated.

The mucous membrane of the jejunum on the inner surface is covered with microvilli that absorb nutrients, carbohydrates, amino acids, sugar, fatty acids, electrolytes and water. The surface of the jejunum increases due to special fields and folds.

Vitamin B12 and other water-soluble vitamins are absorbed in the ileum. In addition, this part of the small intestine is also involved in the absorption of nutrients. The functions of the small intestine are somewhat different from the stomach. In the stomach, food is crushed, ground and initially decomposed.

In the small intestine, substrates are broken down into their constituent parts and absorbed for transport to all parts of the body.

Anatomy of the small intestine

The small intestine is in contact with the pancreas.

As we noted above, in the digestive tract the small intestine follows immediately after the stomach. The duodenum is the initial section of the small intestine, following the pyloric section of the stomach.

The duodenum begins with the bulb, bypasses the head of the pancreas and ends in the abdominal cavity with the ligament of Treitz.

The peritoneal cavity is a thin connective tissue surface covering some of the abdominal organs.

The rest of the small intestine is literally suspended in the abdominal cavity by the mesentery, which is attached to the posterior abdominal wall. This structure allows parts of the small intestine to be freely moved during surgery.

The jejunum occupies the left side of the abdominal cavity, while the ileum is located on the upper right side of the abdominal cavity. The inner surface of the small intestine contains mucous folds called circular rings. Such anatomical structures are more numerous in the initial part of the small intestine and contract closer to the distal ileum.

The assimilation of food substrates is carried out with the help of primary cells of the epithelial layer. Cubic cells located throughout the entire area of ​​the mucous membrane secrete mucus, which protects the intestinal walls from an aggressive environment.

Enteric endocrine cells secrete hormones into the blood vessels. These hormones are essential for digestion. Flat cells of the epithelial layer secrete lysozyme, an enzyme that destroys bacteria. The walls of the small intestine are tightly connected to the capillary networks of the circulatory and lymphatic systems.

The walls of the small intestine consist of four layers: mucosa, submucosa, muscularis and adventitia.

Functional significance

The small intestine consists of several sections.

The human small intestine is functionally connected to all organs of the gastrointestinal tract; the digestion of 90% of food substrates ends here, the remaining 10% is absorbed in the large intestine.

The main function of the small intestine is to absorb nutrients and minerals from food. The digestion process consists of two main parts.

The first part involves the mechanical processing of food by chewing, grinding, beating and mixing - all this occurs in the mouth and stomach. The second part of food digestion involves the chemical processing of substrates, which uses enzymes, bile acids and other substances.

All this is necessary in order to decompose whole products into individual components and absorb them. Chemical digestion occurs in the small intestine - this is where the most active enzymes and excipients are found.

Ensuring digestion

In the small intestine, proteins are broken down and fats are digested.

After rough processing of products in the stomach, it is necessary to decompose the substrates into separate components accessible for absorption.

1. Protein decomposition. Proteins, peptides and amino acids are affected by special enzymes, including trypsin, chymotrypsin and intestinal wall enzymes. These substances break down proteins into small peptides. The process of protein digestion begins in the stomach and ends in the small intestine.
2. Digestion of fats. Special enzymes (lipases) secreted by the pancreas serve this purpose. Enzymes break down triglycerides into free fatty acids and monoglycerides. An auxiliary function is provided by bile juices secreted by the liver and gall bladder. Bile juices emulsify fats - they separate them into small drops accessible to the action of enzymes.
3. Digestion of carbohydrates. Carbohydrates are divided into simple sugars, disaccharides and polysaccharides. The body needs the main monosaccharide – glucose. Pancreatic enzymes act on polysaccharides and disaccharides, promoting the decomposition of substances into monosaccharides. Some carbohydrates are not fully absorbed in the small intestine and end up in the large intestine, where they become food for intestinal bacteria.

Absorption of food in the small intestine

Decomposed into small components, nutrients are absorbed by the mucous membrane of the small intestine and move into the blood and lymph of the body.

Absorption is ensured by special transport systems of digestive cells - each type of substrate is provided with a separate method of absorption.

The small intestine has a significant internal surface area, which is essential for absorption. The circular circles of the intestine contain a large number of villi that actively absorb food substrates. Types of transport in the small intestine:

• Fats undergo passive or simple diffusion.
• Fatty acids are absorbed by diffusion.
• Amino acids enter the intestinal wall using active transport.
• Glucose enters through secondary active transport.
• Fructose is absorbed by facilitated diffusion.

To better understand the processes, it is necessary to clarify the terminology. Diffusion is the process of absorption along a concentration gradient of substances; it does not require energy. All other types of transport require cellular energy. We have found that the human small intestine is the main section of food digestion in the digestive tract.

Watch the video about the anatomy of the small intestine:

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What happens in the human small intestine

It is 5-6 m long, food spends about 8 hours in it. The initial part of the small intestine is called the duodenum; the ducts of the liver and pancreas flow into it.

A large area of ​​the intestinal mucosa (about 500 m2) is necessary for the absorption of nutrients. It is created through:

• ring-shaped folds
• villi - outgrowths of the epithelium, which contain blood and lymphatic capillaries, as well as smooth muscle fibers.
• microvilli - outgrowths of the membrane of epithelial cells of the villi.

Three processes occur in the small intestine:

1) Motor skills - includes

• peristaltic movements (moving food along the intestines)
• pendulum-like movements (mixing food)
• contraction of smooth muscle fibers of the villi (blood and lymph are pushed out of the villi, and food is mixed around it)

2) Digestion in the intestines is of 2 types:

• cavitary occurs due to enzymes secreted by the digestive glands of the intestinal wall (amylase, lipase, trypsin) and the pancreas (amylase, lipase, trypsin):
  • amylase breaks down starch into glucose;
  • lipase decomposes fats into glycerol and fatty acids;
  • Trypsin breaks down proteins into amino acids.
• parietal (membrane) digestion occurs due to larger and more efficient enzymes attached to the epithelial membrane.

3) Absorption is the flow of substances from the intestinal cavity into the villous epithelial cells, and from there into the blood (amino acids and monosaccharides) and lymph (glycerol and fatty acids).

Answer or solution 2

The structure of the digestive system and small intestine

The digestive system of the human body serves to provide important functions. It is designed to nourish our body with useful substances and remove toxins. It consists of the digestive organs - the pharynx and mouth, the stomach and esophagus, as well as the intestines, consisting of the small and large intestines. The digestive system also includes auxiliary organs (liver and gallbladder, salivary glands and others).

The small intestine is located in the body immediately after the stomach and ends with the large intestine. It is divided into several parts, representing the following types of intestines:

Processes occurring in the small intestine

The small intestine is involved in processes such as the digestion of food with its subsequent absorption, as well as the movement of remaining food to the following sections. The food entering the small intestine is a porridge that has been pre-treated with saliva and gastric juice.

Under the action of enzymes and bile, as well as intestinal juice, digested products are broken down and absorbed through the smallest villi into the circulatory system. The action of enzymes in the small intestine helps convert proteins and fats, as well as carbohydrates, into simpler substances. In addition to the absorption of nutrients, the small intestine absorbs drugs, poisons and toxins.

The processes of processing nutrients in the digestive system can also be divided according to the place of their passage, with cavity digestion and parietal digestion being distinguished. The first type of digestion occurs in the mouth, after which it continues in other parts of the digestive tract and at the same time has different severity of the process. Parietal digestion takes place in three stages: it begins in the mucous layer, then continues in the glycocalyx and in the superficial membrane of the enterocyte, where with the help of enzymes the final breakdown of complex nutrients into simple ones is carried out.

In addition to the fact that the small intestine takes part in the processes of absorption, digestion and transportation of food, it is also involved in the production of hormones and protects the immune system against foreign proteins.

How does digestion occur in the small intestine?

How does digestion occur in the small intestine, what enzymes are involved in this, and the mechanism of their action?

Digestion in the small intestine

Food from the stomach enters the small intestine, or more specifically, the duodenum. The duodenum is the thickest section of the human small intestine, its length is about 30 cm. The small intestine also includes the jejunum (length about 2.5 m), ileum (length about 3 m).

The inner walls of the duodenum are essentially composed of many small villi. Under the mucus layer there are small glands whose enzyme helps break down proteins. carbohydrates. This is where fats and proteins are. Carbohydrates, under the influence of digestive juices and enzymes, are broken down so that the body can easily absorb them. First of all, the pancreatic duct and the bile duct open into the duodenum. So, the food here is affected by:

Types of digestion in the small intestine

Contact digestion: with the help of enzymes (maltase, sucrase), digestion occurs into simple particles such as amino acids and monosaccharides. This splitting occurs directly in the small intestine itself. But at the same time, small particles of food remain, which were broken down by the action of intestinal juice and bile, but not enough for them to be absorbed by the body.

Such particles fall into the cavity between the villi, which cover the mucous membrane in this section with a dense layer. Parietal digestion takes place here. The concentration of enzymes here is much higher. And therefore, in this way, the process speeds up noticeably.

The initial purpose of the villi, by the way, was to increase the total area of ​​the suction surface. The length of the duodenum is quite short. Before food reaches the large intestine, the body needs time to take all the nutrients from the processed food.

Small intestinal absorption

Thanks to the huge number of different villi, folds and sections, as well as the special structure of the lining epithelial cells, the intestines can absorb up to 3 liters of fluid consumed per hour (both consumed in pure form and with food).

All substances that enter the blood this way are transported through the veins to the liver. This is, of course, important for the body, for the very reason that not only useful substances can be consumed with food, but also various toxins and poisons - this is connected, first of all, with the environment, as well as with a large intake of medications, poor-quality food and etc. In the liver, such blood is disinfected and purified. In 1 minute, the liver can process up to 1.5 liters of blood.

Finally, through the sphincter, the remains of unprocessed food from the ileum enter the large intestine, and there the final process of digestion occurs, namely the formation of feces.

It should also be noted that in the large intestine, digestion practically no longer occurs. Basically, only fiber is digested, and then also under the influence of enzymes obtained in the small intestine. The length of the large intestine is up to 2 meters. In the large intestine, in fact, mainly only the formation of feces and fermentation occurs. This is why it is so important to monitor the health and normal functioning of the small intestine, because if any problems arise with the duodenum, the processing of consumed food will not be completed properly and, accordingly, the body will not receive a whole range of nutrients.

Three points affecting the absorption of food

1. Intestinal juice

It is produced directly by the glands of the small intestine and is complemented by its action to the general process of digestion in this department.

The consistency of intestinal juice is a colorless, cloudy liquid mixed with mucus and epithelial cells. Has an alkaline reaction. The composition includes more than 20 important digestive enzymes (aminopeptidases, dipeptidases).

2. Pancreatic (pancreatic) juice

The pancreas is the second largest in the human body. The weight can reach 100g, and the length can be 22 cm. Essentially, the pancreas is divided into 2 separate glands:

• exocrine (produces about 700 ml of pancreatic juice per day);
• endocrine (synthesizes hormones).

Pancreatic juice is essentially a clear, colorless liquid with a pH of 7.8 - 8.4. The production of pancreatic juice begins 3 minutes after eating and lasts 6-14 hours. Most pancreatic juice is secreted when eating highly fatty foods.

The endocrine gland simultaneously synthesizes several hormones that have an important effect on processed food:

• trypsin. Responsible for the breakdown of proteins into amino acids. Initially, trypsin is produced as inactive, but in combination with enterokinase it is activated;
• lipase. Breaks down fats into fatty acids or glycerol. The effect of lipase is enhanced after interaction with bile;
• maltase. It is responsible for the breakdown into monosaccharides.

Scientists have found that the activity of enzymes and their quantitative composition in the human body directly depends on the human diet. The more he consumes a particular food, the more enzymes are produced that are necessary specifically for its breakdown.

3. Bile

The largest gland in the body of any person is the liver. It is responsible for the synthesis of bile, which is subsequently accumulated by the gallbladder. The volume of the gallbladder is relatively small - about 40 ml. Bile in this part of the human body is contained in a very concentrated form. Its concentration is approximately 5 times higher than the initially produced liver bile. It’s just that mineral salts and water are absorbed into the body all the time, and only the concentrate remains, which has a thick greenish consistency with a large number of pigments. Bile begins to enter the human small intestine approximately 10 minutes after eating and is produced while the food is in the stomach.

Bile not only affects the breakdown of fats and the absorption of fatty acids, but also increases the secretion of pancreatic juice and improves peristalsis in each part of the intestine.

Up to 1 liter of bile is secreted into the intestines of a healthy person per day. It consists mainly of fats, cholesterol, mucus, soap and lecithin.

Possible diseases

As mentioned earlier, problems with the small intestine can lead to dire consequences - the body will not receive enough nutrients necessary for the normal functioning of the body. This is why it is so important to identify any problem at an early stage in order to begin treatment as quickly as possible. So, possible diseases of the small intestine:

1. Chronic inflammation. It may occur after a severe infection due to a decrease in the amount of enzymes produced. In this case, first of all, a strict diet is prescribed. Inflammation can also develop after surgery as a result of pathogenic bacteria or some kind of infection.
2. Allergy. It can manifest itself as a component of the body’s general allergic reaction to the action of an allergen or have a local location. Pain in this case is a reaction to an allergen. First of all, it is worth eliminating its effect on the body.
3. Celiac enteropathy is a serious disease accompanied by an emergency condition. The disease is the inability of the body to completely process and absorb proteins. As a result, severe intoxication of the body occurs with unprocessed food particles. The patient will have to follow a strict diet throughout his life, completely eliminating grains and other foods containing gluten from the diet.

Causes of diseases of the small intestine

Sometimes diseases of the small intestine can be associated with age-related changes, hereditary predisposition or congenital pathology. But there are a number of provoking factors that, if possible, should be excluded from life in order to prevent future health problems:

• smoking, alcohol abuse;
• unhealthy diet (too much food consumed, abuse of fatty, smoked, salty and spicy foods);
• too many medications consumed;
• stress, depression;
• infectious diseases (advanced stages).

Nausea, vomiting, diarrhea, weakness, abdominal pain are the most pronounced symptoms of pathologies, after detection of which you should immediately consult a doctor.

The sooner the disease is diagnosed and then treatment is started, the higher the likelihood of soon forgetting about the problem without any consequences for the body.

Signs of intestinal obstruction and what to do about it

Causes of intestinal obstruction

Intestinal obstruction can occur for various reasons. There are mechanical and dynamic causes of its occurrence. A mechanical cause is a physical obstacle that has formed (or entered) into the lumen and clogged it. The dynamic reason is the physiological state of the intestine, in which its walls are unable to evacuate feces out.

• Fecal stones are formed inside the large intestine during prolonged stagnation and compaction of feces. As a rule, in old age.
• Balls of worms (usually elongated types of helminths, for example, roundworms). Balls of worms can form in other human cavities - for example, in blood vessels or the heart.
• Hairballs - enter the esophagus through the mouth due to the harmful habit of gnawing or sucking hair. Over time, they accumulate and form balls of various sizes.
• Foreign bodies - enter the intestines through the mouth, esophagus and stomach. In 60% of cases in children, pathology occurs precisely for this reason. Ingestion of foreign objects can cause obstruction of any part of the digestive tract (esophagus, thin or thick sections). The localization of the process in the intestinal cavity is determined by weakened intestinal peristalsis. Poor movement of feces occurs due to excessively high-calorie and fatty foods, insufficient mobility, and also while taking certain medications. Thus, intestinal obstruction in a child after swallowing a foreign body may be a consequence of slow movement of feces.
• Tumors of neighboring organs compress the intestines inside the abdominal cavity.

The listed causes of obstruction are called obstructive. In addition to them, there are strangulation reasons. These are physiological changes in the location of the intestine, during which acute intestinal obstruction is formed.

• Wrapping intestinal loops around yourself.
• Intertwining several loops, tying them with a knot.
• Intestinal strangulation in a hernia.
• Compression of the intestinal cavity by adhesions (which may be on neighboring abdominal organs). In this case, adhesive intestinal obstruction is formed. It can be complete or partial.
• Inflammatory processes leading to tumors and edema of the intestinal wall.

Dynamic intestinal obstruction forms without a physical obstruction (stone or lump). It is determined by the condition of the intestinal walls. Therefore, sometimes it can be cured without surgery. For example, if dynamic obstruction is caused by excessive tension (spasm of the intestinal muscles), then the movement of feces can be normalized with an antispasmodic.

In addition to the listed mechanical reasons, doctors identify dynamic causes of obstruction. There are two of them - muscle spasm in the walls or their paralysis. Intestinal obstruction in older people often occurs precisely for this reason.

Signs and symptoms of intestinal obstruction

Signs of intestinal obstruction in adults and children at an early stage are as follows:

• The first signs of pathology appear in the form of pain. If the intestinal lumen is blocked by a physical body (stone, ball), then the pain is paroxysmal in nature, then appears and then disappears. If a torsion of the intestinal loop has occurred, the pain will be constantly present, but will change its intensity (it hurts stronger, sometimes weaker). The localization of pain corresponds to the site of obstruction formation. At the same time, over time, the pain will intensify, getting worse every hour.
• Vomiting is possible already in the first early period if an obstruction has formed at the beginning of the small intestine.
• Cessation of stool and formation of gases (occurs at the beginning of the pathology - if an obstruction has formed in the lower parts of the large intestine).

• Persistence of pain. They stop strengthening and weakening and acquire a permanently sharp character. The food has stopped completely, there is no peristalsis.
• Bloating is a physical increase in the volume of the abdominal cavity, visible to the naked eye.
• Severe and frequent vomiting is caused by a constant flow of toxins that flows from the stagnation zone into the blood and then into the liver.
• Stopping bowel movements (if the obstruction is located in the upper intestines, the urge to defecate does not stop immediately, but only in the middle period). A blockage in the upper part is called small intestinal obstruction. It is in the small section that blockages form more often (due to the relatively small diameter of the lumen, in the human small intestine its diameter can be only 2.5 cm).

It is characterized by general disorders of the vital functions of organs and systems:

• The temperature rises - this indicates the addition of a bacterial infection. Against the background of stagnation of feces, the protective function of the mucous membrane of the intestinal wall decreases. Pathogenic bacteria penetrate inside and cause widespread inflammation followed by a rise in temperature. A blood test at this moment shows a large number of leukocytes (more than 10 million units).
• The urge to go to the toilet gradually stops, urine stops being produced due to general dehydration of the body. The tongue becomes dry, the pressure decreases - which are also signs of dehydration.
• The breathing and heart rate increases (due to decreased blood pressure).
• Signs of damage (inflammation) of the peritoneum (the medical name for inflammation is peritonitis) - severe pain and a hard, tense abdomen.
• Sepsis develops - a purulent infection or blood poisoning.

Why is intestinal obstruction dangerous?

Intestinal obstruction in adults or children creates a number of pathological processes that lead to death. How lethal complications develop:

1. In the obstructed part of the intestine, waste products - feces - accumulate.
2. Stagnation of feces becomes a source of toxins. They penetrate the wall into the blood and spread throughout the body.
3. Severe intoxication occurs (general poisoning of the body - sepsis, peritonitis). It is accompanied by the traditional symptoms of poisoning - nausea, vomiting, headache, weakness.
4. The intestinal walls in the bend zone are deprived of normal blood supply. When the blood flow is completely blocked, they die quickly, within a few minutes. With partial overlap, toxins from their own vital activity accumulate in the cells. As a result, inflammation, swelling, and pain are formed.
5. When the intestinal wall becomes necrotic or inflamed, the absorption process stops. Toxins stop entering the blood. But at the same time, nutrients and water stop entering the blood. Restricted water intake and vomiting lead to general dehydration of the body.

The processes described above lead to death within 24 hours after the first signs of blockage (feeling unwell, nausea) appear.

Intestinal obstruction in children

Intestinal obstruction in newborns is formed due to congenital defects in the development of the abdominal organs. In this case, the intestinal cavity can be compressed by neighboring organs, or pinched in the opening of the intestinal wall (hernia). Or intestinal asthenia or spasm (obstruction) may develop.

If such disorders are accompanied by thick, dense meconium (which is also a pathology), then the intestinal contents stop moving along the passage. A newborn baby does not pass original feces (meconium). This leads to necrosis of intestinal tissue, as well as intestinal perforation, blood poisoning, and death.

Most intestinal defects in newborns develop in the early period of intrauterine development (before the 10th week). Abnormalities can cause complete bowel obstruction. In the presence of congenital pathology, the following signs of intestinal obstruction in children are formed:

• Vomiting after feeding.
• Lack of bowel movements and meconium passage within 24 hours after birth.

What does partial obstruction mean?

Partial intestinal obstruction occurs when the intestinal lumen is not completely blocked. In this case, part of the feces may move towards the exit.

The cause of partial blockage is tumors and adhesions. They narrow the lumen of the intestine, and over time, they can block it completely.

The symptoms in this case are as follows:

• Pain (not as severe as with complete obstruction).
• Nausea, possible vomiting.
• Abdominal bloating (not as severe as with a complete blockage of the intestines).

Treatment of partial obstruction can be conservative and non-surgical.

What to do if you have intestinal obstruction

In most cases, treatment of intestinal obstruction is an emergency operation. Sometimes conservative therapy is possible (if the process has just begun or the blockage of the lumen is not yet complete).

Conservative treatment and golden 6 hours

The first 6 hours of pathology development are called golden. During this period, the obstruction can be treated without surgery.

What to do if there is a partial blockage of the intestines:

• When there is spasm of the intestinal walls, antispasmodics are needed to facilitate the passage of feces.
• Colonoscopy is probing the colon through the anus with a probe (endoscope). The use of colonoscopy in some cases allows you to break through an obstruction in the intestine.
• Enemas. Partial intestinal obstruction can be cleared with frequent (every 20 minutes) enemas.

In most cases, the golden time is lost (and not always through the fault of the patient; sometimes the doctor does not understand the process taking place and mistakenly refers the sick woman to the gynecological department). Surgery is required to treat and save the life of the patient.

When is surgical treatment required?

What kind of surgery is necessary for intestinal obstruction is determined by the cause of the disease. Sometimes part of the dead intestine is removed, and the remaining edges are sewn together immediately during surgery. Sometimes the edges of the cuts are brought out, connected with a temporary tube and stitched together after a few weeks. In medical practice, such a resection is called stoma removal.

If the cause is a hernia, the intestine is reduced and the hernia is sutured. In this case, it is possible that there will be no need to remove part of the intestinal wall (if its tissue is not dead). The same is done for intestinal volvulus - the loop is straightened and the condition of the intestinal wall is assessed. If there is no tissue necrosis, the intestine is not cut.

If there is a foreign body, the intestine must be opened to remove the existing clot, lump or stone. In parallel with the surgical intervention, the person is given injections of antibiotics (if an infection process was present) and anti-inflammatory drugs.

The need for diet and nutrition control

The main consequence of the operation is the need for diet and strict nutritional control for a long time after surgical treatment. This is necessary to improve digestion and restore intestinal activity.

Throughout the acute period, when there is a blockage of the intestine, food is generally contraindicated for a person. There is also no food for the first 24 hours after the operation. The person is fed with a drip (a glucose solution is administered through a vein). After 24 hours, the patient is allowed liquid food.

What diet is prescribed for intestinal obstruction?

• Fractional meals - up to 8 times a day, in small portions.
• All food is ground into a liquid pulp and consumed warm (it is better to abstain from hot and cold food).
• What you can: jelly, mucous decoctions, jelly, juices, low-fat broths (from poultry), grated oatmeal, curd soufflé, sour milk. Later (after a few days) steamed meatballs, various pureed porridges, and omelet are added.
• Calorie intake is limited to 1000 kcal per day (during the first days after surgery) and up to 1800 kcal per day (one week after surgery).

The menu for intestinal obstruction after surgery should be gentle. For twelve months, a person should not eat food that causes fermentation - pickles, carbohydrates (sweets), citrus fruits, soda. Salt intake is also limited to a minimum.

Intestinal obstruction is a dangerous pathology. The possibility of its successful treatment is determined by the time when the patient is taken to the doctor. Medical statistics confirm the fact that surgery within the first 6 hours of blockage almost always leads to recovery. Late surgery (one day after the first symptoms appear) has a 25% mortality rate. Therefore, at the slightest suspicion of obstruction (bloating, lack of stool, pain), immediately consult a doctor.

Small intestine

The small intestine is located between the stomach and the cecum and is the largest section of the digestive system. The main function of the small intestine is the chemical processing of the bolus of food (chyme) and the absorption of the products of its digestion.

Structure

The small intestine is a very long (2 to 5 m) hollow tube. It starts from the stomach and ends in the ileocecal angle, at the point of its connection with the cecum. Anatomically, the small intestine is conventionally divided into three sections:

1. Duodenum. It is located in the back of the abdominal cavity and is shaped like the letter “C”;

2. Jejunum. Located in the middle part of the abdominal cavity. Its loops lie very freely, covered with peritoneum on all sides. This intestine got its name because when autopsying corpses, pathologists almost always find it empty;

3. Ileum - located in the lower part of the abdominal cavity. It differs from other parts of the small intestine in having thicker walls, better blood supply and a larger diameter.

Digestion in the small intestine

The food mass passes through the small intestine in about four hours. During this time, the nutrients contained in the food continue to be broken down by enzymes in the intestinal juice into smaller components. Digestion in the small intestine also involves active absorption of nutrients. Inside its cavity, the mucous membrane forms numerous outgrowths and villi, which significantly increases the absorption surface area. So in adults, the area of ​​the small intestine is at least 16.5 square meters.

Functions of the small intestine

Like any other organ in the human body, the small intestine performs not one, but several functions. Let's look at them in more detail:

• The secretory function of the small intestine is the production by the cells of its mucous membrane of intestinal juice, which contains enzymes such as alkaline phosphatase, disaccharidase, lipase, cathepsins, peptidase. All of them decompose the nutrients contained in chyme into simpler ones (proteins into amino acids, fats into water and fatty acids, and carbohydrates into monosaccharides). An adult secretes approximately two liters of intestinal juice per day. It contains a large amount of mucus, which protects the walls of the small intestine from self-digestion;
• Digestive function. Digestion in the small intestine involves the breakdown of nutrients and their further absorption. Thanks to this, only indigestible and indigestible foods enter the colon.
• Endocrine function. In the walls of the small intestine there are special cells that produce peptide hormones, which not only regulate intestinal function, but also affect other internal organs of the human body. Most of these cells are located in the duodenum;
• Motor function. Due to the longitudinal and circular muscles, wave-like contractions of the walls of the small intestine occur, pushing the chyme forward.

Diseases of the small intestine

All diseases of the small intestine have similar symptoms and are manifested by abdominal pain, flatulence, rumbling, and diarrhea. Stool occurs several times a day, profusely, with the remains of undigested food and a large amount of mucus. Blood in it is observed extremely rarely.

Among diseases of the small intestine, inflammation is most often observed - enteritis, which can be acute or chronic. Acute enteritis is usually caused by pathogenic microflora and, with full treatment, ends with complete recovery within a few days. With long-term chronic enteritis with frequent exacerbations, patients also develop extraintestinal symptoms of the disease due to impaired absorption function of the small intestine. They complain of weight loss and general weakness, and they often develop anemia. A deficiency of B vitamins and folic acid leads to cracks in the corners of the mouth (jams), stomatitis, and glossitis. Insufficient intake of vitamin A in the body causes dry corneas and impaired twilight vision. Impaired calcium absorption can cause the development of osteoporosis and the resulting pathological fractures.

Small bowel rupture

Among all the organs of the abdominal cavity, the small intestine is most susceptible to traumatic injury. This is due to the insecurity and significant length of this section of the intestine. An isolated rupture of the small intestine is observed in no more than 20% of cases, and more often it is combined with other traumatic injuries of the abdominal organs.

The most common mechanism of traumatic injury to the small intestine is a direct and fairly strong blow to the abdomen, leading to compression of the intestinal loops against the pelvic bones or spine and damage to their walls.

When the small intestine ruptures, more than half of the victims experience shock and significant internal bleeding.

The only treatment for small bowel rupture is emergency surgery. During surgery, bleeding is stopped (hemostasis), the source of intestinal contents entering the abdominal cavity is eliminated, normal intestinal patency is restored and the abdominal cavity is thoroughly sanitized.

The sooner the operation is performed from the moment of injury to the small intestine, the greater the chance of recovery for the victim.

Biology and medicine

Functions of the small intestine

Thanks to the movements of the small intestine, the acidic chyme coming from the stomach is mixed with the alkaline juices of the pancreas, liver and intestinal glands, and the intestinal contents are constantly in contact with the mucous membrane of the small intestine. During the day, a person secretes up to 2.5 liters of intestinal juice. Its numerous enzymes that break down proteins, fats, and carbohydrates come from destroyed desquamated epithelial cells of the intestinal mucosa. As a result of the continuous process of regeneration, the cells are restored. In the small intestine, chemical processing of food and absorption of products continues, as well as mechanical mixing and movement towards the large intestine. Endocrine cells produce various hormones and biologically active substances. In humans, the absorptive surface of the small intestine, due to the presence of folds of the mucous membrane, villi and microvilli of intestinal epithelial cells reaches 200 m2. During digestion, the secretion of bile and its release into the intestinal lumen increases sharply.

Digestion of food and absorption of its components occurs in the small intestine. At the same time, in the intestinal cavity, under the influence of enzymes of intestinal and pancreatic juices, bile, only the breakdown of food molecules into individual fragments occurs. The final breakdown occurs due to membrane digestion, which occurs on the surface of the microvilli cells of the intestinal epithelium. They contain a large number of active enzymes involved in the breakdown and absorption of food products. A.M. Ugolev (1967) discovered parietal digestion, which, unlike cavity digestion, which occurs in the intestinal lumen, occurs on the surface of microvilli. The latter produce a number of their own digestive enzymes, adsorb on their surface some enzymes from the intestinal lumen and nutrients that are most intensively broken down and absorbed. As a result of the breakdown of proteins, amino acids are formed, fats - glycerol and fatty acids, carbohydrates - monosaccharides. When food substances decompose, many of their properties, including harmful ones, are lost. This prevents foreign protein from entering the body.

Rhythmic contractions of the villi promote the absorption of substances, which occurs in the direction from the outer surface of the epithelial cells (facing the intestinal lumen) to the inner (facing the blood and lymphatic capillaries). Amino acids and monosaccharides are absorbed into the blood; water, mineral salts, vitamins, fatty acids and glycerin - into the lymph.

Active digestion and absorption are facilitated by high blood flow in the small intestine, which during meals is 400 ml/min, and at the height of digestion 00 ml/min. Back at the beginning of the 20th century, I.P. Pavlov showed that in each section of the digestive system various enzymes are produced that are involved in the breakdown of proteins, fats and carbohydrates. He studied their interaction and regulation of excretion, the joint activity of the digestive organs and the influence of one department on another. In 1904, Pavlov was awarded the Nobel Prize in Physiology or Medicine for his work on the physiology of digestion, which led to a clearer understanding of vital aspects of this issue.

What processes occur in the small intestine?

Answers and explanations

Digestion processes occur in three stages:

1) cavity digestion: proteins are broken down into amino acids, carbohydrates into glucose, fats into fatty acids and glycerol;

2) parietal digestion: food particles penetrating into the spaces between the villi are digested;

3) absorption: glucose and amino acids into the blood; fatty acids and glycerol into the lymph and then into the blood.

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Columnar cells - form villi that cover the entire mucous membrane of the small intestine, and also produce enzymes and participate in the transport of substances.

Goblet cells - produce parietal mucus and bactericidal substances.

Penet cells - produce lysozyme and other bactericidal substances that provide protection against pathogenic microflora.

M cells - participate in the recognition of pathogens and their particles, and activate lymphocytes.

Volvulus

Acute surgical pathology of the peritoneum, which consists of twisting of any section of the intestine or part of it around the mesentery or its axis. In this case, the intestinal lumen is blocked, the mesenteric nerves and vessels are compressed, and a mechanical obstacle occurs in the digestive tract.

Signs of volvulus should not only cause alertness, but also force you to urgently seek medical help, since this condition poses a real threat to life. A rapid increase in intoxication and dehydration can lead to the death of the patient within the first 24 hours.

ICD-10 code

Epidemiology

In general, this disease affects males twice as often as females, although women are ahead of men in terms of the prevalence of cecal volvulus.

On average, this pathology is common among middle-aged and elderly people.

Torsion of sections of the colon is the most common, among them 80% of torsions are in the sigmoid section; 15% - in the cecum; 3% – in the transverse colon; 2% – in the area of ​​the splenic flexure.

The average age of patients with sigmoid colon pathology is 60 years; with old age, the likelihood of this pathology increases.

The younger population is susceptible to cecal volvulus (average age 50 years). The average age of cases in some countries, such as India, where the majority are vegetarians, is even younger - 33 years.

In children, almost all cases are localized in the small intestine and are caused by developmental defects.

Africans suffer from this pathology twice as often as others. According to US medical statistics: patients with intestinal volvulus make up approximately a twentieth of all patients with obstruction; among them, volvulus of the large intestine is a tenth of the total number of obstructions of this localization.

The regions of the “volvulus belt,” where volvulus is mainly caused by colon obstruction, include some African countries, Asian countries (India, Iran), Brazil and Russia. In Brazil, this disease is associated with the spread of Chagas disease.

The second most important reason for the development of obstruction of the sigmoid colon during pregnancy is its volvulus. Presumably, the rapidly growing uterus displaces this intestine, causing the large intestine to twist. The vast majority of bloat in expectant mothers (3/4) is observed in the last three months of gestation.

Causes of volvulus

The reasons for the occurrence of this condition are very different, and sometimes, at first glance, very innocent. It can even occur during sleep - a change in position can cause volvulus. This can happen to a person who has been leading an unhealthy lifestyle for many years, eating poorly and, as a result, has problems with the gastrointestinal tract.

Parents often scare their children, claiming that chewing gum can cause volvulus; perhaps they themselves believe this. However, chewing gum does not cause active intestinal peristalsis, it is not digested by gastric juice and in the vast majority of cases is perfectly excreted by the intestines with feces.

But intestinal volvulus from persimmon is quite likely. A child's stomach cannot digest persimmons that contain excess tannins; they form a large lump that the intestines cannot move toward the exit. This can cause intussusception - the pulling of part of one intestine into another. Of course, to do this you need to eat more than one fruit or half of it. Intestinal volvulus in children can be caused not only by persimmons, but also by excessive consumption of tangerines, bananas and foods unsuitable for children (smoked meats, herring, etc.).

The reasons for volvulus often lie in the anatomical features of the structure of the organs of the digestive system. It is intrauterine developmental disorders that cause this disease in infants, most often it is an abnormally long mesentery and active intestinal motility. Congenital gigantism of the large intestine, congenital lack of intestinal motility, congenital diaphragmatic hernia, less common, but can lead to volvulus in infants. Early artificial feeding can cause this disease. Cases of intussusception in infants - the pulling of part of the narrowed intestine into the lumen of the normal one, leading to obstruction - are not uncommon in pediatric practice.

The cause of congenital volvulus is called malformations of the intestinal tube of the embryo or an anomaly in the fixation of the midgut.

Sometimes the intestinal lumen is blocked by meconium, which has abnormal density.

In patients older than one year, volvulus is caused, strictly speaking, by two factors:

• a malformation of the mesentery, which has a length that makes it possible to move in different directions,
• the inability of the intestine to move its contents huddled together, then every movement of its muscles leads to twisting of the bends of the intestine.

Risk factors

1. Exit from a prolonged fasting regime, accompanied by overeating, which activates intestinal motility and can provoke volvulus.
2. Systematic overeating (especially at night) causes excessive filling of the intestinal flexures, simultaneously activating its motility, which can lead to volvulus of one or more intestinal loops.
3. An acute increase in pressure inside the peritoneum, even a slight one, due to injury, unusually heavy physical labor, stress with weak abdominal muscles can cause dislocation of intestinal sections and provoke this pathology.
4. Cicatricial and adhesive changes in the connective tissue of the abdominal cavity resulting from surgical interventions and inflammation.
5. A diet that includes mostly coarse, raw, high-fiber foods that activate intestinal motility.
6. Frequent so-called food poisoning, i.e. infection with pathogenic microorganisms, accompanied by dyspeptic symptoms.
7. Constipation (constipation) is a provoking factor for volvulus of the sigmoid colon; this mainly happens in elderly people.
8. Mesosigmoiditis, which can result in deformation of the mesentery and volvulus of the sigmoid colon
9. A foreign body can close the intestinal lumen (obturation), and a neoplasm or pregnancy can compress it from the outside (strangulation), which will lead to torsion.
10. Poisoning, taking potent medications (suppressing intestinal motility, laxatives), and some diseases of the central nervous system cause spasms or paralysis of the intestinal muscles.
11. Massive helminthic infestation also sometimes causes volvulus.

Basically, torsion of the small intestine is caused by malformations, cicatricial and adhesive changes in connective tissue, and hernias.

Volvulus of the colon is mainly an acquired pathology. The reasons for this localization are the growth of scars and adhesions in the peritoneum, pregnancy, neoplasms, and surgical manipulations of the intestines. The vast majority of colonic volvulus occurs in the sigmoid portion.

With complete intestinal volvulus, a closed obstruction of the affected sections is formed; their innervation and ischemia ultimately cause gangrene and perforation of the intestinal wall.

Pathogenesis

Regardless of the root cause, the development of the pathology occurs as follows - the intestine rotates, sometimes repeatedly, and its lumen is completely blocked, the contents of the intestine stop, the nerves and vessels of the mesentery are pinched, the blood supply to the intestinal lining is stopped and it becomes necrotic. Necrosis of the intestinal lining increases its permeability to toxins that enter the peritoneum, and fecal peritonitis develops.

Symptoms of volvulus

Immediately after the intestinal loops are twisted, the first signs of the disease appear - an instantly striking acute pain, usually in the navel area, then reflex vomiting begins. A specific sign is that part of the abdomen is swollen and intestinal loops are visible on it. If you tap on the swollen part of the abdomen, the sound will be similar to drumming.

Accompanying symptoms are hypotension, constipation and gas formation without gas production, weakness, gray-sallow pallor. Sweat appears on the face, and delirium may even begin. The patient has difficulty speaking and breathing heavily; sounds similar to the splashing of water can be heard in the stomach.

Intestinal loops can twist anywhere in the intestine where there is a mesentery. The level of revolution determines the pathology clinic and treatment tactics.

Types of bloat are classified according to the levels where it occurred:

• small intestine;
• cecum;
• sigmoid colon;
• transverse colon.

Normally, the angle of rotation of the bends of the small intestine is up to 90º. Rotation of more than 180º causes clinical symptoms, and one or more flexures of the small intestine may be involved in this movement. The cecum is nearby, therefore, signs of volvulus will look similar.

Volvulus of the small (blind) intestine characterized by the following clinic:

The appearance of severe pain during volvulus is determined by the cessation of blood supply to this area of ​​the intestine. Acute pain that does not subside, is continuous, stabbing or cutting, is felt in the upper abdomen. It constantly intensifies, becoming unbearable.

With this type of volvulus, patients show anxiety, agitation, and sometimes cry out in pain. As a rule, they pull their knees towards their chest, but this does not relieve the pain.

An accumulation of intestinal contents forms in front of the twisting site, which provokes obstruction of the intestinal loops, activates its peristalsis, which is noticeable visually, this may be accompanied by gurgling sounds in the abdomen and cramping pain.

If the loops of the lower parts of the small intestine or cecum are twisted, then asymmetric swelling in the navel area is observed due to the accumulation of fecal matter above the level of the volvulus.

Volvulus of the small intestine is accompanied by vomiting, which begins simultaneously with pain (first vomiting with bile, later with an admixture of feces). Vomiting does not alleviate the patient's condition.

Constipation and accumulation of gases that cannot be released begin later, since the motility of the large intestine is still normal, feces and gases continue to be released. If you immediately consult a doctor with suspected small intestinal volvulus, this stage can be avoided, but if it continues for a long time, the release of feces and gases may stop.

The general condition is disturbed - signs of dehydration, weakness, dizziness, and fainting appear. Symptoms of intoxication of the body increase - muscle pain, tachycardia, pallor, high temperature, perspiration on the forehead.

Colon volvulus more common, its most common location is in the sigmoid colon.

Its symptoms are similar to those of small intestinal volvulus, but there are some differences.

The pain syndrome occurs acutely, but can sometimes develop gradually. It is felt mainly in the lower abdomen and can radiate to the lumbar area. The nature of the pain is constant, occasionally paroxysmal.

Vomiting of undigested food and bile appears simultaneously with pain and is repeated two or three times, without bringing relief. Vomiting in this case is caused largely by painful irritation. Vomiting of feces begins later, with the development of peritonitis.

Constipation and lack of gas production begins immediately. At first, active intestinal motility may be noticeable, but it fades over time.

The abdomen is noticeably swollen and asymmetrical. The upper sections on the right side of the abdomen are enlarged - the sigmoid colon has moved after being twisted. The accumulation of gases and feces in it stretches its loops, increasing in size. It moves upward the abdominal organs, which put pressure on the diaphragm, reducing the volume of the chest, squeezing the lungs and upsetting the respiratory process, disrupting the functioning of the heart. This is manifested by difficulty breathing, arrhythmia, tachycardia, chest pain.

Occasionally occurs transverse colon volvulus, symptoms reminiscent of sigmoid volvulus.

Forms

Classification of volvulus according to the angle of rotation of the intestines: partial volvulus (up to 270°), complete (°), if the intestine is twisted several times - repeated. As a rule, the bends of the intestine twist in a clockwise direction.

Congenital volvulus manifests itself in the first hours of a child’s life. The first symptoms are pain (the baby is restless, capricious and cries all the time), vomiting, hypotension, abdominal asymmetry, decreased intestinal motility. The passage of gases is disrupted, meconium may pass, but normal feces are not observed, mucus is released from the anus (complete volvulus) or stool passes in small portions, the volume of which becomes less and less (partial).

Volvulus in children manifested by high fever, acute abdominal pain, vomiting, blood or mucus in the feces. The child eats and sleeps poorly, often cries, is capricious, and presses his legs to his stomach. The attacks come and go unexpectedly; in the intervals between us the child can vomit twice. Intense gas formation occurs, after some time constipation begins, and gases cease to pass away. Upon examination, the child has a noticeable lump in the lower abdomen.

It is quite difficult to diagnose intestinal volvulus in the fetus; it is treated after the birth of the child. This pathology is often accompanied by polyhydramnios in the mother and other developmental defects, for example, Down's disease.

Complications and consequences

If the patient does not consult a doctor at the first symptoms, peritonitis begins to develop a few hours later. Body temperature rises and a false improvement in well-being occurs. The patient may feel that there is no need to worry anymore. This misconception can lead to fatal consequences.

During volvulus, the blood supply to the twisted part of the intestinal wall and its innervation are completely stopped. According to numerous evidence from medical research, the further quality of life of the patient, and often life itself, directly depends on the timeliness of medical care.

Possible complications: dehydration, perforation and necrosis of the intestinal wall; systemic purulent infection and intoxication; adhesive disease and repeated torsion of the intestines.

• volvulus is manifested by frequent vomiting, when the body loses a lot of water and electrolytes;
• The liquid a person drinks is absorbed in the large intestine, but during a volvulus, especially in the small intestine, it does not get there.

The result of dehydration is an increase in the load on the heart, hypotension, metabolic disorders, weakness, fainting (even coma). If the body is deprived of about a fifth of water, death is possible.

The intestinal wall, deprived of blood supply, loses its strength, breaks through, and the accumulated contents pour into the peritoneum and cause its inflammation (fecal peritonitis). It provokes necrotic changes in the tissue of the intestinal wall (gangrene develops). In this case, an urgent operation is required to remove part of the intestine and carry out antiseptic treatment of the abdominal cavity.

Adhesive disease is the formation of connective tissue adhesions that appear in areas of inflammation. Causes dislocation of intestinal bends, which can provoke a recurrence of any form of obstruction of the digestive tract.

Diagnosis of volvulus

Diagnosis of volvulus, like any other disease, is based on a survey, examination, data from laboratory tests and instrumental examinations. Questioning and examining the patient helps to suggest the cause of the disease and prescribe further examination.

There are no laboratory tests to confirm or refute the diagnosis of volvulus. However, some tests are done to identify complications (gangrene, peritonitis) and for differential diagnosis.

If intestinal volvulus is suspected, a clinical blood test is prescribed, which helps to identify indicator deviations characteristic of this disease: excess of the normal number of leukocytes and erythrocyte sedimentation rate; decrease in the normal number of red blood cells and hemoglobin content. These data suggest the presence of peritonitis and intestinal bleeding.

A biochemical blood test may show an increase in lactate dehydrogenase levels, a decrease in albumin, potassium and chlorine.

Liver tests in our case are usually normal; this analysis is done for differential diagnosis.

Stool analysis sometimes shows the presence of blood (necrosis of the intestinal mucosa).

Studies of the acid-base state of the blood - at different periods show different deviations from the norm.

Instrumental diagnostics – X-ray examination of the abdominal cavity (survey, irrigography, oral contrast), computed tomography, diagnostic laparoscopy.

The most common radiograph shows obstruction of the intestinal loops and the presence of obstruction, and an X-ray with a barium enema determines the typical localization of intestinal volvulus; oral administration of a barium suspension before radiography is used to confirm torsion of the small intestine (particularly in pediatrics).

Computed tomography is advisable in cases of cecal and small intestinal volvulus. The tomogram shows a spiral-shaped, so-called “storm sign”, obstructive changes in the intestine and thickening of its walls, swelling of the mesentery.

In children aged 4 to 10 months, in cases of obstruction, volvulus is differentiated from intussusception (retraction of a narrowed part of the intestine into an intestine with a normal lumen).

If volvulus is suspected in women during pregnancy, diagnosis is complicated by the fact that X-ray examination is contraindicated and is used only in the most extreme cases, diagnostic laparoscopy is not used due to the undesirability of anesthesia, and colonoscopy is not used due to a possible miscarriage.

Regardless of the period, ultrasound examination is used; it can reveal obstructive changes, fluid in the peritoneum, etc.

What needs to be examined?

Differential diagnosis

Differential diagnosis is carried out on the basis of medical history, laboratory and instrumental examinations. Volvulus of the small intestine is differentiated from neoplasms, diverticulosis, adhesions and calculous formations. With this pathology of the sigmoid colon, its malignant neoplasm, diverticulosis, mesenteric ischemia, etc. are excluded. Torsion of the cecum must be differentiated from appendicitis, rupture of an ovarian cyst, other obstructions, and infections of the genitourinary organs.

Visual inspection data are of decisive importance in differentiation.

Who to contact?

Treatment of volvulus

The disease poses a serious threat to the patient’s life; at the first symptoms, you should immediately seek medical help.

Until the ambulance team arrives, it is necessary to place the patient comfortably. Do not feed or water, as bowel movements can only worsen the torsion and cause vomiting. Do not give any medications under any circumstances; they may change the clinical picture and complicate diagnosis. Do not rinse the stomach, do not give an enema, do not warm the stomach.

Hospitalization and surgical treatment are the only things that can save the patient’s life.

The exception is uncomplicated sigmoid volvulus. The ability to straighten the sigmoid colon volvulus through the anus is dictated by its close location to the anus. This procedure is carried out in a medical institution by specialists. It consists of injecting a barium solution to the site of volvulus through the rectum. Increased pressure occurs and straightening of the volvulus may occur. If unwinding does not occur, surgical intervention is used.

Surgical techniques are selected individually, taking into account the location of the volvulus, the condition of the damaged parts of the intestine and the patient’s well-being.

Operations to eliminate this defect are performed under general anesthesia. A laparotomy incision (from top to bottom along the midline of the abdomen, the navel remains on the right) is needed for a good overview of the surgical field and accessibility for various manipulations.

Through the incision, the intestinal loops are untwisted and the accumulated contents are removed. If the intestinal loops are viable - after straightening, their normal appearance, motility and blood supply are restored, then the operation is completed. The abdominal cavity is washed with antiseptics, a drainage tube is installed and sutured.

If complications are identified, the scope of the operation increases: dead loops are removed, an anastomosis is performed, or in case of peritonitis, the ends of the intestine are brought to the surface of the abdominal wall (ileostomy), which allows the patient to be fed when the intestines are disconnected and continue anti-inflammatory treatment. When the condition returns to normal, the patient is operated on to restore the integrity of the intestine.

The principles of operations for different localizations of volvulus are similar, with some specific differences.

If the operation was performed without removing part of the intestine, patients recover quickly. After resection of a volvulus, the patient will have a long rehabilitation period; during this period, some restrictions must be observed. Postoperative rehabilitation measures consist of bed rest, pain relief, postoperative wound treatment, physiotherapeutic procedures, breathing exercises, and dietary nutrition.

Postoperative patients must observe strict bed rest to avoid suture dehiscence. A day after the operation, you can begin to do simple exercises with your hands (lifting and lowering, bending and unbending), careful turns from one side to the other. After another day or two, it is recommended to get out of bed and walk briefly around the ward and in the corridor. Light physical activity after surgery improves blood circulation, prevents the appearance of bedsores and reduces the risk of blood clots.

An important aspect of the rehabilitation process is effective pain relief.

Depending on the patient’s condition and individual sensitivity, painkillers of different groups are used.

At the very beginning after surgery, narcotics are used that effectively relieve severe pain, for example, morphine or omnopon.

Omnopon– a complex drug consisting of three narcotic analgesics (morphine, codeine, thebaine) and papaverine, which prevents spastic contractions of intestinal smooth muscles. Inhibits any painful sensations without turning off consciousness, while preserving other sensations.

Patients are prescribed subcutaneous injections at a dosage of 10 mg of the drug three to four times a day.

May cause nausea, vomiting, respiratory depression. Long-term use causes drug addiction.

Contraindicated for respiratory dysfunction, dystrophy, and elderly patients.

To relieve inflammation and pain in the postoperative suture area, non-steroidal anti-inflammatory drugs, for example, indomethacin or ketorolac, are used.

Ketorolac– active analgesic, relieves fever, swelling and inflammation. Inhibitor of prostaglandin production. Prevents thrombus formation. Indicated for postoperative pain.

Can be combined with narcotic painkillers. Patients are prescribed intravenously at a dosage of 30 mg at intervals of six hours. Like all non-steroidal anti-inflammatory drugs, it has a lot of contraindications and side effects from allergies to neuropsychiatric disorders. Not used in pediatrics, during pregnancy and lactation.

Antispasmodics are used to relax the intestinal muscles, inactivate its motility and prevent spasms.

Drotaverine– an active antispasmodic that has a relaxing effect on the smooth muscles of the gastrointestinal tract and blood vessels. It has an analgesic effect, dilating blood vessels and promoting their saturation with oxygen.

Drotaverine hydrochloride penetrates the placental barrier. Pregnant and lactating women and children 0-12 years old are not prescribed.

Patients are prescribed 40–80 mg intramuscularly at eight-hour intervals. The drug is well tolerated, allergic reactions and other adverse events are extremely rare.

Treatment of the wound after surgery is carried out from the first day until complete healing once or twice a day according to indications. It is performed to prevent purulent infection and inflammatory processes. Each time during the dressing process, the wound is washed with antiseptic agents, for example, betadine and alcohol (70%), inspected and reapplied with several layers of gauze soaked in antiseptic and secured with a sterile bandage.

Betadine is a complex antiseptic, which is a combination of iodine and polyvinylpyrrolidone. Contact with skin releases the active iodine ion from the compound, which reacts with cellular proteins to form iodamines. Can be used for a long time without the risk of developing immunity. It has a bactericidal and fungicidal effect, destroys viruses and protozoa. It lasts longer than products containing inorganic iodine and practically does not irritate the surface being treated. It has an effect until the color disappears from the surface of the skin. Contraindicated in cases of sensitization to iodine, increased thyroid function, pregnant and lactating women, and infants. Do not use in conjunction with other antiseptics for external use containing silver, hydroperite, chlorhexidine, enzymatic preparations and drugs containing mercury.

During the recovery period, the patient may be prescribed physiotherapeutic treatment: therapy - ultra-high frequency, laser, magnetic; diadynamics; electrophoresis.

All patients after surgical interventions are recommended to perform breathing exercises: accelerated deep inhalations and exhalations or inflating balloons to ventilate the lungs as a preventive measure for the development of hypostatic pneumonia and other respiratory complications. It is recommended to do such exercises several times a day, especially during periods of prolonged bed rest.

Diet food

For several days immediately after eliminating the volvulus with the removal of part of the intestine, nutrients, fluid, microelements and vitamins are administered to the patient intravenously through a drip. After three to four days, the patient’s condition stabilizes and he can eat naturally.

They begin natural nutrition with a zero diet, the purpose of which is to supply the body with a minimum of essential nutrients, while simultaneously preventing the active contraction of intestinal smooth muscles and gas formation, which negatively affects the healing of tissue in the operated area.

The zero diet involves frequent (8 times a day) meals in small portions (no more than 300g) only in liquid form. Food and drink are heated to 45ºC, the daily fluid intake is approximately two liters, the food is not salty.

You can eat: weak broth from dietary meats - veal, rabbit, turkey breast and puree soups; rice broth, pureed porridge; low-fat curd mass and rosehip drink; jelly and baked apple; jelly and not strong tea.

Then diet No. 1a, which involves eating six times a day, all in warm, liquid and mashed form.

You can eat: pureed buckwheat, rice, semolina porridge in broth or milk diluted with water (1:4); pureed cereal soups with vegetable broth; steamed egg white omelette; steamed fish of low-fat varieties in the form of soufflé; jelly, jelly, weak tea, fresh sweet fruits.

If there are no complications, they move on to diet No. 1b, which, in addition to the previous one, includes: white bread crackers; steam cutlets and meatballs; boiled (steamed) vegetables, meat and fish in the form of puree; sour cream.

Approximately two to three weeks after the operation, upon discharge from the hospital, diet No. 1 is prescribed. There are fewer and fewer restrictions - food temperature is warm or room temperature, foods that activate the secretion of gastric juice and intestinal motility are not recommended. It is allowed to eat lactic acid products, crackers, low-fat cookies, and day-old bread. The first and second courses are boiled and steamed, their ingredients are chopped.

The transition to a normal lifestyle occurs over about a month and a half.

Alternative medicine

Volvulus should not be treated at home. The use of traditional medicine or homeopathic medicines will not solve the problem, but will only worsen it. But as a preventive measure for volvulus, folk treatment and homeopathy can help in the recovery period. However, before undertaking alternative treatment, you should consult your doctor.

Volvulus can be caused by various reasons. For some of them, for example, congenital pathologies, traditional medicine recipes are unlikely to have an effect. Most others can be adjusted.

Chronic constipation is a serious risk factor for volvulus. Here you can successfully apply traditional treatment.

The simplest recommendations are to take a tablespoon of vegetable oil in your mouth on an empty stomach in the morning and swirl it in your mouth as long as you can stand it, spit out the remainder (they should be discolored) and rinse your mouth. This procedure also relieves intoxication of the body.

In the morning, for breakfast, there is a “broom” salad made from raw grated beets, carrots and finely shredded cabbage with vegetable oil.

Beetroot infusion on water. Peel, chop 0.5 kg of root vegetables, pour in a liter of boiling water, let it brew for three to four hours. Then add 150g of granulated sugar and a teaspoon of dry yeast, leave for a day in a dark place. After a day, strain. Drink ½ glass three to four times a day. Relaxes the intestinal muscles, has anticonvulsant and antiseptic effects, and normalizes peristalsis.

Whey kvass with celandine. For 3 liters of whey you will need a glass of finely chopped celandine herb and granulated sugar. Mix celandine with granulated sugar, pour onto a piece of gauze, tie in a knot, place in a bowl with whey, cover with gauze and place in a dark place for 14 days. Remove the knot, squeeze, strain. Store the jar of kvass in the refrigerator, under a nylon lid. Drink ½ glass twice a day half an hour before meals. The course is 14 days, after two or three days, drink the remaining kvass according to the scheme.

Herbal treatment can help not only with constipation, but also with overeating and food poisoning.

As a laxative, you can prepare a decoction of buckthorn bark: pour 100g of crushed raw material into a liter of water, simmer for one hour on low heat (do not boil). Let cool, strain.

Take one tablespoon five or six times a day, half an hour before or an hour after meals.

Helps very well with overeating calamus root, eat half a teaspoon of crushed calamus root and drink water.

Helps yarrow infusion: Brew a teaspoon with boiling water, after a minute - strain, cool slightly - drink.

The consequences of food poisoning can be neutralized by taking chicory infusion: Brew 25g of crushed dry raw materials with a glass of boiling water, wrap and leave overnight. Drink three to four times a day before meals, half an hour before meals. You need to drink chicory infusion after clearing your stomach, for which you drink three glasses of salted water. You can cleanse your stomach more than once.

The infusion is also prepared from dried raspberry leaves or mint. They are drunk on an empty stomach in the morning and at night. You should drink slowly, in small sips.

Homeopathy also refers to conservative methods of treatment, therefore it is unacceptable to eliminate this problem with homeopathic medicines.

To prevent bloat and combat chronic constipation, as well as inflammatory bowel diseases, there are many medications, such as:

Сausticum (Causticum) - used for constipation with hard, dry feces, sometimes with mucous discharge; defecation occurs with great difficulty and strain;

Bryonia (Bryonia) - with dryness of the mucous membranes of the anus, rectum, the same sensations in the mouth, severe thirst, coating on the tongue, no urge to defecate; bloating; can be used by pregnant women;

Hydrastis (Hydrastis) - chronic constipation in patients who have been taking laxatives for a long time; pregnant women who want to eat meat rather than vegetable dishes;

Natrium muriaticum (Natrium muriaticum) – cracks, ruptures of the anus with bleeding; after defecation, stabbing sensations; dry mucous membranes; all this makes the patient angry; paresthesia of the rectal part of the intestine; constipation in patients with displacement of the internal pelvic organs; patients sweat, are very weak, love salty foods.

Homeopathic medicines should be prescribed by a homeopathic physician who will study the patient’s medical history, lifestyle, habits and preferences. All this is taken into account when prescribing, and self-medication even with homeopathic medicines used in negligible doses is unsafe.

Prevention

Prevention of volvulus is a lifestyle that does not predispose to the development of this disease. In particular, this is of great importance for people with congenital anatomical features of the abdominal organs.

Prevention of this disease lies, first of all, in compliance with the diet. Prolonged fasting with excess saturation subsequently, eating large amounts of plant foods increases the risk of intestinal torsion.

It is recommended to eat regularly and variedly in small portions, 4-5 meals a day; for people at risk, give preference to liquid, crushed food. Eliminate very hot or cold, fatty, smoked, salty foods, and alcohol from the diet.

It is necessary to get rid of difficulties with defecation in a timely manner. If you are prone to constipation due to weak intestinal motility, you need to eat more plant foods, which normalize intestinal motility and help the body clear feces more quickly.

For constipation caused, for example, by neoplasms, foods that stimulate intestinal motility should be removed from the daily menu. Because in this case, active intestinal motility can provoke intestinal rotation.

Promptly treat acute inflammatory processes of the peritoneal organs and intestinal infections, which can lead to the development of adhesions and other complications.

Forecast

The prognosis of volvulus directly depends on the speed of seeking medical help. If treated in a timely manner, it is favorable, but delaying time can lead to death.

Medical Expert Editor

Portnov Alexey Alexandrovich

Education: Kyiv National Medical University named after. A.A. Bogomolets, specialty - “General Medicine”

The organs of the oral cavity, esophagus, gastrointestinal tract and auxiliary organs are distinguished. All parts of the digestive system are functionally interconnected - food processing begins in the oral cavity, and final processing of food is ensured in the stomach and intestines.

The human small intestine is part of the digestive tract. This department is responsible for the final processing of substrates and absorption (absorption).

Vitamin B12 is absorbed in the small intestine.

The human body is a narrow tube about six meters long.

This section of the digestive tract got its name due to its proportional features - the diameter and width of the small intestine are much smaller than those of the large intestine.

The small intestine is divided into the duodenum, jejunum and ileum. - This is the first segment of the small intestine, located between the stomach and jejunum.

The most active digestive processes take place here; it is here that pancreatic and gallbladder enzymes are secreted. The jejunum follows the duodenum, its length on average is one and a half meters. Anatomically, the jejunum and ileum are not separated.

The mucous membrane of the jejunum on the inner surface is covered with microvilli that absorb nutrients, carbohydrates, amino acids, sugar, fatty acids, electrolytes and water. The surface of the jejunum increases due to special fields and folds.

Other water-soluble vitamins are also absorbed in the ileum. In addition, this part of the small intestine is also involved in the absorption of nutrients. The functions of the small intestine are somewhat different from the stomach. In the stomach, food is crushed, ground and initially decomposed.

In the small intestine, substrates are broken down into their constituent parts and absorbed for transport to all parts of the body.

Anatomy of the small intestine

The small intestine is in contact with the pancreas.

As we noted above, in the digestive tract the small intestine follows immediately after the stomach. The duodenum is the initial section of the small intestine, following the pyloric section of the stomach.

The duodenum begins with the bulb, goes around the head and ends in the abdominal cavity with the ligament of Treitz.

The peritoneal cavity is a thin connective tissue surface covering some of the abdominal organs.

The rest of the small intestine is literally suspended in by the mesentery, which is attached to the posterior abdominal wall. This structure allows parts of the small intestine to be freely moved during surgery.

The jejunum occupies the left side of the abdominal cavity, while the ileum is located on the upper right side of the abdominal cavity. The inner surface of the small intestine contains mucous folds called circular rings. Such anatomical structures are more numerous in the initial part of the small intestine and contract closer to the distal ileum.

The assimilation of food substrates is carried out with the help of primary cells of the epithelial layer. Cubic cells located throughout the entire area of ​​the mucous membrane secrete mucus, which protects the intestinal walls from an aggressive environment.

Enteric endocrine cells secrete hormones into the blood vessels. These hormones are essential for digestion. Flat cells of the epithelial layer secrete lysozyme, an enzyme that destroys. The walls of the small intestine are tightly connected to the capillary networks of the circulatory and lymphatic systems.

The walls of the small intestine consist of four layers: mucosa, submucosa, muscularis and adventitia.

Functional significance

The small intestine consists of several sections.

The human small intestine is functionally connected with everything; the digestion of 90% of food substrates ends here, the remaining 10% is absorbed in the large intestine.

The main function of the small intestine is to absorb nutrients and minerals from food. The digestion process consists of two main parts.

The first part involves the mechanical processing of food by chewing, grinding, beating and mixing - all this occurs in the mouth and stomach. The second part of food digestion involves the chemical processing of substrates, which uses enzymes, bile acids and other substances.

All this is necessary in order to decompose whole products into individual components and absorb them. Chemical digestion occurs in the small intestine - this is where the most active enzymes and excipients are found.

Ensuring digestion

In the small intestine, proteins are broken down and fats are digested.

After rough processing of products in the stomach, it is necessary to decompose the substrates into separate components accessible for absorption.

1. Protein decomposition. Proteins, peptides and amino acids are affected by special enzymes, including trypsin, chymotrypsin and intestinal wall enzymes. These substances break down proteins into small peptides. The process of protein digestion begins in the stomach and ends in the small intestine.
2. Digestion of fats. Special enzymes (lipases) secreted by the pancreas serve this purpose. Enzymes break down triglycerides into free fatty acids and monoglycerides. An auxiliary function is provided by bile juices secreted by the liver and gall bladder. Bile juices emulsify fats - they separate them into small drops available for action.
3. Digestion of carbohydrates. Carbohydrates are divided into simple sugars, disaccharides and polysaccharides. The body needs the main monosaccharide – glucose. Pancreatic enzymes act on polysaccharides and disaccharides, promoting the decomposition of substances into monosaccharides. Some carbohydrates are not completely absorbed in the small intestine and end up in the small intestine, where they become food for intestinal bacteria.

Absorption of food in the small intestine

Decomposed into small components, nutrients are absorbed by the mucous membrane of the small intestine and move into the blood and lymph of the body.

Absorption is ensured by special transport systems of digestive cells - each type of substrate is provided with a separate method of absorption.

The small intestine has a significant internal surface area, which is essential for absorption. The circular circles of the intestine contain a large number of villi that actively absorb food substrates. Types of transport in the small intestine:

• Fats undergo passive or simple diffusion.
• Fatty acids are absorbed by diffusion.
• Amino acids enter the intestinal wall using active transport.
• Glucose enters through secondary active transport.
• Fructose is absorbed by facilitated diffusion.

To better understand the processes, it is necessary to clarify the terminology. Diffusion is the process of absorption along a concentration gradient of substances; it does not require energy. All other types of transport require cellular energy. We found out that the human small intestine is the main department of food digestion in.

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The human body has not yet been fully studied by scientists, and time after time new secrets of the body are revealed to us. is one of the most complex multi-component processes in which a significant number of organs are involved.

An important part of the digestive tract is the digestive tract, in which the process of breaking down consumed food into individual elements that are easily absorbed by the body occurs.

Anatomy of the small intestine

The digestion process is very complex

The small intestine is one of the main sections of the gastrointestinal tract, where food is digested.

It is often referred to as the “small intestine.” But this definition is incorrect from an anatomical point of view and therefore is not used in scientific medicine.

The organ received its name due to the fact that research revealed a difference in the thickness of the walls of the large and small intestines. The walls of the small intestine are correspondingly thinner and, as a result, more capable of stretching.

The diameter of the internal lumen (cavity) of a thin and healthy person is almost the same. This value decreases in the small intestine after the death of the body.

The small intestine has the greatest length among other organs of the human body. It reaches 6 m and occupies the lower third of the peritoneum, as well as partially the pelvic cavity. The diameter of the small intestine differs in different places and varies from 2.5 to 6 cm.

Due to the large length of the organ, the small intestine is located in the abdominal cavity in loops. To ensure that these loops do not twist among themselves, and the intestine itself is secured, the human digestive system provides for the presence of such an organ as the mesentery.

The mesentery is a double peritoneal layer, which is a thin film. It contains nerve plexuses, blood vessels and lymph glands.

The presence of the mesentery in the human body was known back in the days of the great scientist Leonardo da Vinci, but only relatively recently it became clear that this organ is complete and indivisible and performs certain functions in the body.

The structure of the small intestine includes 3 main sections:

• jejunum;
• ileum.

The small intestine begins with the duodenum, next to the pylorus of the stomach under the liver. The edge of the organ is located at the level of the first or second vertebra of the lumbar spinal column.

The location of the duodenum resembles the shape of a horseshoe and has several sections: upper, descending, horizontal and ascending parts. In the central part of the descending part of the duodenum there are large and small (not all people have) papillae.

The jejunum is the proximal part of the small intestine, that is, occupying its central part. The department received its name due to the fact that when examining corpses, the intestines turned out to be empty.

The jejunum is located on the left side of the peritoneum and has fewer blood vessels compared to the ileum, which is located on the right side of the abdominal cavity.

The ileum ends at the beginning of the large intestine. The separation of these organs is carried out by the presence of the ileocecal valve, which is also known in anatomy as the Bauhinian valve.

Functions of the small intestine

Intestines - schematically

The functions of the small intestine are partly determined by the structure of the tissues of this organ. Its inner surface is covered with a mucous membrane, which has a characteristic relief.

It is formed from intestinal glands (crypts), circular folds and intestinal villi. The structure of the mucous membrane ensures the high absorption capacity of the small intestine.

In the submucosal tissue, located immediately behind the mucosa, there are nerve plexuses, lymphatic and blood vessels, and lobules of adipose tissue.

The muscular lining of the small intestine consists of two layers of muscle cells separated by loose connective tissue. Thanks to the work of the muscles, the contents of the stomach are pushed further through the intestines.

The outer lining of the small intestine is represented by serous tissue - the actual film of the peritoneum, represented by a dense connective tissue membrane.

The purpose of the small intestine is to provide the following functions:

• Chemical processing of food using digestive enzymes (catalyst proteins), which are secreted by the glands of the small intestine. These enzymes include trypsin, enterokinase, kinaseogen, nuclease for the breakdown of proteins, lipase for the processing of fats, sucrase, phosphatase, maltase, lactase, amylase for the decomposition of carbohydrates.
• Absorption of nutrients obtained as a result of food processing by the intestinal walls, from where they enter the circulatory system and further to the internal organs that need them.
• Mechanical pushing of a bolus of food and its remains through the intestines towards the anus.
• Endocrine function - the production of biologically active elements necessary for the normal functioning of the body (serotonin, histamine, gastrin, secretin, etc.).

The small intestine is able to perform these functions in full only in the case of a normal condition, excluding various pathologies.

Digestion process in the small intestine

Digestive processes depend on proper nutrition

In the small intestine, the food bolus is digested and further decomposed into simpler components. Digestion in the small intestine is the main stage of the entire process of absorption and processing of food products entering the gastrointestinal tract.

During X-ray studies of the activity of parts of the small intestine, the approximate timing of the passage of the contrast mass through all its organs was established.

It has been established that, on average, the absorbed contents enter the jejunum half an hour after ingestion, the ileum after an hour and a half, and the cecum (upper colon) after four hours. Eight hours later, the absorbed radiopaque mass completely fills the rectum.

Digestion with proper nutrition occurs in approximately the same time frame.
When food enters the small intestine, gastric juice begins to secrete. Its production is stimulated by the following elements:

1. active hydrochloric acid that remained unneutralized and reached the beginning of the duodenum;
2. mechanical irritation of receptors located on the walls of the intestine by particles of food passing through them;
3. pancreatic juice coming from the duodenum;
4. conditioned reflexes triggered by the sight of food;
5. products of the breakdown of nutrients.

These foods, as well as fatty acids, vitamins and minerals, enter the circulatory system and are distributed throughout the human body. The intestinal epithelium is formed by cells that have selective permeability and allow only simple components to pass through.

After 7-8 hours from eating, the products broken down into individual nutrients enter the blood, and the non-decomposed food residue is pushed further into the large intestine with the aim of removing it from the body through the anus.

Causes and types of diseases of the small intestine

Due to many endo- and exogenous factors, the small intestine is susceptible to a number of diseases. The most common ones are:

• duodenal ulcer;
• duodenitis;
• celiac disease;
• enteritis;
• Meckel's diverticulum;
• intestinal obstruction.

These diseases appear due to exposure to various events:

1. congenital pathologies;
2. poor nutrition;
3. frequent stress;
4. environmental pollution;
5. food and chemical poisoning;
6. decreased immunity;
7. genetic inheritance, etc.

Diseases of the small intestine most often manifest themselves as general malaise, dyspeptic disorders, abdominal pain and other specific symptoms.

If you notice such symptoms, you should not delay visiting a doctor, who can accurately determine the causes and type of disease and prescribe an effective treatment program.

The small intestine is an organ of the gastrointestinal tract in which the main process of digestion of ingested food and its decomposition into simple nutrients takes place, which are subsequently delivered to all internal organs through the circulatory system.

This organ, like the entire human body, requires careful treatment. The food you eat requires special attention, since the body is not able to assimilate well all foods, some of which pose a direct threat to the functioning of the small intestine and human health in general.

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The small intestine is a tubular organ of the digestive system in which the transformation of bolus food into a soluble compound continues.

Organ structure

The small intestine (intestinum tenue) extends from the gastric pylorus, forms many loops and passes into the large intestine. In the initial section, the circumference of the intestine is 40–50 mm, at the end it is 20–30 mm, the length of the intestine can reach up to 5 meters.

Sections of the small intestine:

• The duodenum (duodenum) is the shortest (25–30 cm) and widest part. It is shaped like a horseshoe, comparable in length to the width of 12 fingers, which is how it got its name;
• Jejunum (length 2–2.5 meters);
• Ileum (length 2.5–3 meters).

The wall of the small intestine consists of the following layers:

• The mucous membrane lines the inner surface of the organ; 90% of its cells are enterocytes, which provide digestion and absorption. It has a relief: villi, circular folds, crypts (tubular protrusions);
• The lamina propria (submucosal layer) is an accumulation of fat cells, where the nerve and choroid plexuses are located;
• The muscle layer is formed by 2 membranes: circular (inner) and longitudinal (outer). Between the membranes is a nerve plexus that controls contraction of the intestinal wall;
• Serous layer - covers the small intestine on all sides, with the exception of the duodenum.

The blood supply to the small intestine is provided by the hepatic and mesenteric arteries. Innervation (supply of nerve fibers) comes from the plexuses of the autonomic nervous system of the abdominal cavity and the vagus nerve.

Digestion process

The following digestive processes occur in the small intestine:

Enzymes

To digest food bolus, the intestine produces the following enzymes:

• Erepsin – breaks down peptides into amino acids;
• Enterokinase, trypsin, kinaseogen - break down simple proteins;
• Nuclease - digests complex protein compounds;
• Lipase – dissolves fats;
• Lactose, amylase, maltose, phosphatase - break down carbohydrates.

The mucous membrane of the small intestine produces 1.5–2 liters of juice per day, which consists of:

• Disaccharidases;
• Enterokinases;
• Alkaline phosphatase;
• Nucleases;
• Cathepsin;
• Lipases.

The small intestine produces the following hormones:

• Somatostotin – prevents the release of gastrin (a hormone that enhances the secretion of digestive juices);
• Secretin – regulates pancreatic secretion;
• Vasointestinal peptide – stimulates hematopoiesis, affects smooth muscles in the intestines;
• Gastrin – participates in digestion;
• Motilin – regulates intestinal motility);
• Cholecystokinin - causes contraction and emptying of the gallbladder;
• Gastroinhibitory polypeptide – inhibits the secretion of bile.

Functions of the small intestine

The main functions of the body include:

• Secretory: produces intestinal juice;
• Protective: mucus contained in intestinal juice protects the intestinal walls from chemical influences and aggressive irritants;
• Digestive: breaks down food bolus;
• Motor: due to muscles, chyme (liquid or semi-liquid contents) moves through the small intestine, mixing with gastric juice;
• Absorptive: the mucous membrane absorbs water, vitamins, salts, nutrients and medicinal substances, which are distributed throughout the body through lymphatic and blood vessels;
• Immunocompetent: prevents the penetration and reproduction of opportunistic microflora;
• Removes toxic substances and waste from the body;
• Endocrine: produces hormones that affect not only the digestive process, but also other body systems.

Diseases of the small intestine.