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

May is coming - the last calendar month of spring. It just so happened that in the spring the most weakened, in need of our support and attention, are the organs of the gastrointestinal tract. So, we continue the theme "Health all year round." In March, we already took care of the stomach, 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 the place where the active absorption (assimilation) of food takes place. You and I remember that absorption is a physiological process associated with the transfer of nutrients into the internal environment of the body. This process occurs with varying intensity throughout the digestive tract.

The process of digestion begins in the oral cavity, where food is crushed, soaked with 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 partly in the pelvic area, forming "loops" due to repeated bends. Mixing and movement of the food mass in the small intestine occurs as a result of coordinated contractions of the 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 across the folded 12 fingers). But, as they say, "the spool is small, but expensive"!

The duodenum is the main biochemical "laboratory" of the body. Here, under the influence of the secrets of the pancreas and spleen, bile, digestive juices of the intestine itself, the primary splitting 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 is two interrelated processes - cavitary and parietal (membrane) digestion.

In the process of abdominal digestion, digestive juice enzymes are secreted into the intestinal cavity. Under the action 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.

Cavitary digestion provides the initial hydrolysis of nutrients to intermediate products, and parietal (or membrane) - hydrolysis of the intermediate and final stages of digestion, as well as the transfer 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 dramatically 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 that are in the intestinal cavity cannot penetrate. This is one of the most important reasons for limiting the growth of bacteria in the small intestine.

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

Amino acids (protein end products) 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 the intestinal juice, carbohydrates are transported into the blood mainly in the form of glucose.

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

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

The completeness of absorption of the end products of digestion depends on the intensity of the motility of the small intestine. With violent motility, most of the end products do not have time to be absorbed and pass into the large intestine as a “transit”, not digested.

The basis of health is the purity of our body. And it is not conceivable without the purity of the gastrointestinal tract. To be healthy, the intestines must be kept in perfect order!

And what happens to our intestines in modern life? Refined food, overeating, lack or insufficiency of dietary fiber in the diet, sedentary lifestyle lead to the accumulation of decay products. In numerous folds of the intestine, they form petrified "blockages" in which toxic substances accumulate. The "gifts" of modern ecology - heavy metals, radioactive substances, exhaust gases, carcinogens - are deposited on the intestinal walls, killing the beneficial microflora and poisoning the body.

Violation of the intestines leads to overweight, headache, nausea, sallow complexion. Chronic diseases are aggravated and new ones appear.

How can we protect our small intestine and activate its work?

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

By their chemical nature, bee products and plants are a huge complex of formulas, selected and combined by the most talented chemist in the Universe - Nature. Everything that is done by Nature adds a small piece of health to our body, capable of displacing 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 postponing for the next “Monday”, which will come!? Month after month, throughout the year, you will strengthen and improve all the 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 in a glass of raw clean water at a comfortable temperature).

2. Hey Pee Wee - water propolis extract. 5% propolis extract prepared with bidistilled shung water improves the function of digestion, increases the body's resistance, and preserves the 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 digestion of food. The combination of isomalt and bee products normalizes carbohydrate metabolism, promotes weight correction.

4. Glade - honey composition. A classic combination of high-quality honey with bee pollen. 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 from the book by T.I. Andronova "The Art of Rejuvenation and Active Longevity"

(Novosibirsk, 2009)

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The small intestine: length and role in digestion

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

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

The structure and physical parameters of the small intestine

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

The small intestine is the part of the gastrointestinal tract where the main process of digestion and assimilation of food takes place.

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

The diameter of the small intestine along its entire length varies 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 is reduced, it is 4-5 cm. The entire small intestine is differentiated into the following sections:

1. Duodenum. It starts from the pylorus 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 process - the ampulla, is located behind the peritoneum. The position of the duodenum may vary slightly from person to person. Yes, and in the same person at different ages, it can also vary. It depends on the 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 section of the small intestine.
3. Ileum. It is a smooth muscle hollow organ and forms the lower part of the small intestine. It has a length of 1.3 to 2.6 m 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 those produced by the gallbladder and pancreas, help break down food.

So it is here that proteins are broken down into amino acids, carbohydrates into simple sugars, which allows them to be absorbed faster and more efficiently.

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

• The duodenum begins the process of intestinal digestion. It is in it that the hydrolysis of fats, proteins and carbohydrates occurs. The duodenum brings the acidity of the food mass arriving from the stomach to an indicator that does not irritate the lower sections of the small intestine. Regulates the production of bile and enzymes involved in the process of digestion.
• The jejunum performs motor and suction functions.
• The ileum provides a transport-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 sections 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.

About the small intestine, see the video:

Features of the process of digestion in the small intestine

After the stomach, the food mass, which has an acidic reaction, enters the duodenum. It is in it that the process of digesting carbohydrates, fats and proteins takes place 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 small 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 tissues. Fats, in turn, enter the lymphatic system.

Diseases of the small intestine

Malabsorption is a deficiency in the 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 region and increased gas formation.

Malfunctions in the work 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, potatoes.

Malfunctions in the production of enzymes and the breakdown of food gruel are more serious disorders in the functioning of the small intestine. In case of failures in the process of normal digestion of food, the body does not receive all the nutrients it needs, and this can provoke hair loss, unreasonable 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 is a deficiency in the absorption of certain nutrients. This syndrome can be primary or acquired, develop due to genetic factors or diseases of the internal organs.
• Maldigestia is an insufficiency of the 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 can help diagnose bowel disease.

The definition of diseases of the small intestine is 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 movement of red blood cells, as well as a stool test for the presence of helminths.

Research methods that allow diagnosing bowel diseases include:

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

Methods for the treatment of 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 the elimination of the underlying disease.

If a patient has an enzyme deficiency, he is prescribed drugs 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 is carried out bypassing the gastrointestinal tract and is carried out by intravenous infusion.

Intestinal dysbacteriosis 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 work of the small intestine manifest themselves in the form of too liquid bowel movements, then the patient may be prescribed drugs that cause hardening of the feces.

They usually contain an increased amount of bismuth and calcium. Insufficient adhesion of fatty acids, which provokes the formation of liquid stools, is treated with ordinary activated charcoal. All disorders in the functioning of the small intestine require a visit to a doctor for an examination and the appointment of adequate drug therapy.

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How are the sections of the small intestine different?

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 of which is the absorption of nutrients from the liquid by its walls.

How it works

The complex processes of digestion take place in the small intestine.

The small intestine is similar in structure to the thick one, but has less thick and strong walls, the diameter of the inner lumen also differs (thinner in the thin one). When considering, it is quite difficult to distinguish between 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 is different throughout its length:

• In the proximal section, it averages 5 cm
• In the distal - 3 cm

The peritoneum closes the small intestine almost completely, remains 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 different:

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

Wall structure

The walls of the large intestine are made up of layers:

1. Mucosal
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 small intestine, except for the duodenum, where the glands and longer villi of the epithelial tissue are located. The villi are similar in shape to the leaves of trees, from which the inner surface of the intestine thickens significantly. A network of capillaries supplies blood to the villi, between which there are recesses that open the intestinal ducts to perform a digestive function.

The mucous layer consists of many circular and longitudinal folds.

Depending on the blood supply to the intestine, the color of the mucosa changes, in all departments it is pink, and in the ileum it is gray-pink. The muscular layer consists of longitudinal and circular smooth muscles. The serous part is the peritoneum, which covers the duodenum only in the region of the ampulla. All over the inside of the small intestine are lymph nodes and Peyer's patches (clumps of lymph nodes).

Read: Pancreas: normal sizes and deviations

How does digestion work

Sections of the small intestine: schematic

The food coming from the stomach has an increased acidity. In the intestine, it normalizes and creates conditions for the normal activity of enzymes and the activation of pancreatic fluid. The intestine contains more than 98% liquids and less than 2% solids.

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

1. Protein digestion through enzyme activity
2. Breakdown of carbohydrates
3. Synthesis of fats occurs last with the participation of limpases.

With the help of the villi, carbohydrate and protein components are absorbed, which then enter the liver through the veins, and 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.

Enzymes are also produced in the small intestine that help break down incoming food into components. After splitting, proteins are synthesized into amino acids, carbohydrates into simple sugars, fats into components that do not interfere with the absorption of nutrients.

Departments

There are the following sections of the small intestine:

1. duodenal
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 completely 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:

• ascending
• descending
• Horizontal
• Upper

Human intestine: 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 examining the intestines

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

The descending part goes from the right side of the spine down to the third vertebra, then bends to the left. The length of this part usually varies in the region of 8-10 cm. The duodenum is in close proximity to:

• Right kidney
• Cookie
• common bile duct

The pancreas is connected to this section of the intestine through the common pancreatic duct, which is connected to the bile duct by a groove. The horizontal section of the intestine corresponds to the third lumbar vertebra and to the inferior vena cava. Further, 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 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 parental peritoneum. The jejunum is connected to the stomach, in its curved part, by the omentum.

Ileum

The lean intestine passes 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-like bends, the last of which go 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, splitting food into its constituent parts, and hormone production. In this part of the intestine, many drugs that have entered the body orally are absorbed, and toxins enter the bloodstream through its walls. It is very important to maintain intestinal health to monitor your diet and drink more fluids to regulate its work.

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

A video lecture will acquaint you with 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. p. 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 are absorbed here, as well as vitamins, most of the water and salts.

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 impregnate it in the duodenum, as well as under the influence of numerous enzymes produced by the glands of the small intestine.

The absorption process takes place on a very large surface, since the mucous membrane of the small intestine forms many folds. The mucosa is densely dotted with villi - a kind of finger-like protrusions (the number of villi is very large: in an adult it reaches 4 million). In addition, there are microvilli on the epithelial cells of the mucosa. All this increases the absorptive 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 blood flow throughout the body, penetrate through the capillary walls into the intercellular spaces and further into the cells. Another part (for example, glycogen) is deposited in the liver.

Scheme 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 - caecum; 14 - appendix (appendix); 15 - rectum. In the large intestine (see Fig. p. 12), the absorption of water is completed and the formation of feces occurs. 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 site of abundant reproduction of microorganisms. 1 g of feces contains several billion microbial cells. The intestinal microflora is involved in the final decomposition of the components of digestive juices and undigested food residues, synthesizes enzymes, vitamins (B groups and vitamin K), as well as other physiologically active substances that are absorbed in the large intestine. In addition, the intestinal microflora creates an immunological barrier against pathogenic microbes. Thus, animals raised in sterile conditions without microbes in the intestines are much more susceptible to infection than animals raised under normal conditions. Thus, it has been shown that the intestinal microflora contributes to the development of natural immunity.

The microbes present in a healthy intestine perform another protective function: they have a pronounced antagonism in relation to "foreign" bacteria, including pathogens, and thereby protect the host's body from their introduction and reproduction.

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

Intestinal microflora decomposes an excess of pancreatic juice enzymes (trypsin and amylase) and bile, 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 caecum (see Fig. p. 13), food slurry 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 gradually turn into feces. This is facilitated by the movements of the large intestine, mixing the food slurry and favoring the absorption of water. An average of 150-250 g of formed feces is produced per day, approximately one third of which are bacteria.

The nature of the stool and its quantity depend on the composition of the food. When eating predominantly plant foods, stool masses are much larger 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 arterial blood pressure rises, the pulse quickens by 15-20 beats per minute. Most healthy people have a bowel movement once a day.

The liberation of the intestine from feces is provided by active peristalsis, which occurs when the receptors of the intestinal walls are irritated by feces. When eating foods containing enough vegetable fiber, its coarse undigested fibers irritate the nerve endings in the muscles of the small intestine, and especially the large intestine, and thereby cause peristaltic movements that accelerate the movement of the food gruel. A lack of fiber makes it difficult to release the intestines, since weak peristalsis, and even more so its absence, causes a long delay in the intestines of food residues, which can cause various diseases of the digestive system (for example, dysfunction of the gallbladder, hemorrhoids). In chronic constipation, the feces become severely dehydrated because the large intestine absorbs excess water, which normally must be removed with the feces. In addition, too long a stay of feces in the large intestine (i.e. chronic constipation) violates the intestinal "barrier", and the intestinal walls begin to pass 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 (suction).

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 part of the digestive tract got its name because of the proportional features - the diameter and width of the small intestine is 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 the jejunum.

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

The mucosa 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 area of ​​the small intestine is also involved in the absorption of nutrients. The functions of the small intestine are somewhat different from those of the stomach. In the stomach, food is crushed, ground and primarily decomposed.

In the small intestine, the substrates are decomposed 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 immediately follows the stomach. The duodenum is the initial section of the small intestine, following the pyloric section of the stomach.

The duodenum begins at 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 that covers some of the abdominal organs.

The rest of the small intestine is literally suspended in the abdominal cavity by a mesentery attached to the posterior abdominal wall. This structure allows you to freely move the sections of the small intestine during surgery.

The jejunum occupies the left side of the abdominal cavity, while the ileum is located in the upper right side of the abdominal cavity. The inner surface of the small intestine contains mucous folds called circular circles. Such anatomical formations are more numerous in the initial section of the small intestine and are reduced 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 that protects the intestinal walls from an aggressive environment.

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

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

functional significance

The small intestine is made up of several sections.

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

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

The first part involves the mechanical processing of food by chewing, grinding, whipping and mixing - all this takes place 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 - it is here that the most active enzymes and excipients are present.

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 available for absorption.

1. The breakdown of proteins. 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. Protein digestion begins in the stomach and ends in the small intestine.
2. Digestion of fats. This purpose is served by special enzymes (lipases) secreted by the pancreas. Enzymes break down triglycerides into free fatty acids and monoglycerides. An auxiliary function is provided by bile juices secreted by the liver and gallbladder. Bile juices emulsify fats - they separate them into small drops available for the action of enzymes.
3. Digestion of carbohydrates. Carbohydrates are classified into simple sugars, disaccharides and polysaccharides. The body needs the main monosaccharide - glucose. Pancreatic enzymes act on polysaccharides and disaccharides, which promote the decomposition of substances to monosaccharides. Some carbohydrates are not completely 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 provided 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. Circular circles of the intestine contain a large number of villi that actively absorb food substrates. Modes of transport in the small intestine:

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

For a better understanding of the processes, it is necessary to clarify the terminology. Diffusion is a process of absorption along the concentration gradient of substances, it does not require energy. All other types of transport require the expenditure of cellular energy. We found out 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 has a length of 5-6 m, food spends about 8 hours in it. The first section of the small intestine is called the duodenum, into which the ducts of the liver and pancreas flow.

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

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

There are 3 processes in the small intestine:

1) Motor skills - includes

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

2) Digestion in the intestines is of 2 types:

• cavitary is 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 to 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 epithelium membrane.

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

Answer or solution 2

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. Also, the digestive system 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, which are the following types of intestines:

Processes 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 the remaining food to the following departments. The food entering the small intestine is a porridge that has been previously processed by 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 promotes the conversion of proteins and fats, as well as carbohydrates into simpler substances. In addition to the absorption of nutrients in the small intestine, the absorption of drugs, poisons and toxins is carried out.

The processes of processing nutrients in the digestive system can also be divided according to the place of their passage, while cavitary and parietal digestion are 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 a 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 surface 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 being involved in the absorption, digestion and transportation of food, the small intestine is also involved in the production of hormones and protects the immune system from foreign proteins.

How does digestion take place in the small intestine?

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

Digestion in the small intestine

Food from the stomach enters the small intestine, 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 layer of mucus are small glands, the enzyme of which promotes the breakdown of proteins. carbohydrates. This is where fats and proteins come in. carbohydrates under the action of digestive juices, enzymes are broken down in such a way that the body can easily assimilate them. First of all, the pancreatic duct, also the bile duct, opens into the duodenum. So, food is affected here:

Types of digestion in the small intestine

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

Such particles enter the cavity between the villi, which cover the mucous membrane in this section with a dense layer. This is where parietal digestion takes place. The concentration of enzymes is much higher here. And so, in this way, the process is noticeably accelerated.

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 small. Before the food reaches the large intestine, the body needs time to take all the nutrients from the processed food.

absorption of the small intestine

Due to the huge number of different villi, folds and sections, as well as the special structure of the lining epithelial cells, the intestine 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 in this way are transported through the vein to the liver. This, of course, is important for the body, for the very reason that not only useful substances can be consumed with food, but also various toxins, poisons - this is primarily due to the environment, as well as a large intake of drugs, low-quality food and etc. In the parts of the liver, such blood is disinfected and purified. In 1 minute, the liver is able to process up to 1.5 liters of blood.

Finally, through the sphincter, the remnants of unprocessed food from the ileum enter the large intestine, and there the final process of digestion, namely the formation of feces, is already taking place.

It should also be noted that digestion practically does not occur in the large intestine. Basically only fiber is digested, and then also under the action 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. That is why it is so important to monitor the health and normal functioning of the small intestine, because if there are any problems with the duodenum, then the processing of the consumed food will not be completed properly and, accordingly, the body will not receive a number of nutrients.

Three points that affect the absorption of food

1. Intestinal juice

It is produced directly by the glands of the small intestine itself and is supplemented by its action of the general process of digestion of this department.

The consistency of intestinal juice is a colorless, cloudy liquid, with an admixture of mucus, as well as epithelial cells. Has an alkaline reaction. The composition includes more than 20 major 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 is 22 cm. In fact, 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 breaking down 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 action of lipase is enhanced after interaction with bile;
• maltase. It is responsible for the breakdown to 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 certain food, the more enzymes are produced that are necessary specifically for its breakdown.

3. Bile

The largest gland in the human body is the liver. It is she who is responsible for the synthesis of bile, which subsequently accumulates in the gallbladder. The volume of the gallbladder is relatively small - about 40 ml. Bile in this department of the human body is contained in a very concentrated form. Its concentration is about 5 times higher than the initially produced hepatic bile. Just all the time, mineral salts and water are absorbed into the body from it, and only a concentrate remains, which has a thick greenish consistency with a lot of pigments. Bile enters the human small intestine about 10 minutes after a meal 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 section 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 terrible consequences - the body will not receive the nutrients necessary for the normal functioning of the body. That is why it is so important to identify any problem at an early stage in order to start treating it as soon as possible. So, possible diseases of the small intestine:

1. Chronic inflammation. May occur after a severe infection due to a decrease in the amount of enzymes produced. In this case, prescribe, first of all, a strict diet. Also, inflammation can develop after surgery as a result of pathogenic bacteria or some kind of infection.
2. Allergy. It can manifest itself as a component of a general allergic reaction of the body to the action of an allergen, or it can have a local location. Pain in this case is a reaction to an allergen. First of all, it is necessary to exclude its effect on the body.
3. Celiac disease is a serious illness accompanied by an emergency. The disease is the inability of the body to fully process and absorb proteins. As a result, there is a strong intoxication of the body with unprocessed food particles. For the rest of his life, the patient will have to follow a strict diet, 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;
• malnutrition (too much food consumed, abuse of fatty, smoked, salty and spicy);
• too many drugs consumed;
• stress, depression;
• infectious diseases (advanced stages).

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

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

Signs of bowel obstruction and what to do about it

Causes of intestinal obstruction

Bowel obstruction can occur for a variety of reasons. There are mechanical and dynamic causes of its occurrence. A mechanical cause is a physical obstruction that has formed (or got) inside the lumen and blocked it. The dynamic cause is the physiological state of the intestine, in which its walls are unable to evacuate feces to the outside.

• Fecal stones - are formed inside the large intestine during prolonged stagnation and compaction of feces. Usually in old age.
• Balls of worms (more often - elongated types of helminths, for example - roundworm). Balls of worms can form in other human cavities - for example, in blood vessels or the heart.
• Lumps of hair - enter the esophagus through the mouth with the addiction of biting or sucking hair. Over time, they accumulate and form balls of various sizes.
• Foreign bodies - enter the intestine through the mouth, esophagus and stomach. In 60% of cases in children, pathology occurs precisely for this reason. Ingestion of foreign objects can form 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 the weakened peristalsis of the intestine. Weak promotion of feces is formed with excessively high-calorie and fatty foods, insufficient mobility, as well as while taking certain medications. Thus, intestinal obstruction in a child after swallowing a foreign body may be the result of a slow movement of feces.
• Tumors of neighboring organs - compress the intestines inside the abdominal cavity.

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

• Wrapping of intestinal loops around itself.
• Confusing several loops, tying them in a knot.
• Strangulation of the intestine in a hernia.
• Compression of the intestinal cavity with adhesions (which may be on neighboring abdominal organs). In this case, adhesive obstruction of the intestine is formed. It can be complete or partial.
• Inflammatory processes leading to swelling and swelling of the intestinal wall.

Dynamic intestinal obstruction is formed without a physical obstacle (stone or lump). It is determined by the state 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 causes, doctors distinguish dynamic causes of obstruction. There are two of them - muscle spasm in the walls or their paralysis. Intestinal obstruction in the elderly is often formed precisely for this reason.

Signs and symptoms of bowel obstruction

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

• The first signs of pathology are formed in the form of pain. If the intestinal lumen is blocked by a physical body (a stone, a ball), then the pains are paroxysmal in nature, then they appear, then they disappear. If there is a volvulus of the intestinal loop, the pain will be constantly present, but will change its intensity (it hurts more or less). Localization of pain corresponds to the place of formation of obstruction. At the same time, over time, the pain will intensify, every hour it will become worse.
• Vomiting is possible already in the first early period, if the obstruction has formed at the beginning of the small intestine.
• The cessation of stool and the formation of gases (occurs at the beginning of the pathology - if the obstruction has formed in the lower sections of the large intestine).

• Persistence of pain. They cease to intensify and weaken, acquire a permanent 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.
• Strong and frequent vomiting - is formed due to the constant flow of toxins that comes from the stagnation zone into the blood, and then to the liver.
• The cessation of stool (if the obstruction is located in the upper intestines, then the urge to defecate does not stop immediately, but only in the middle period). Blockage of the upper part is called obstruction of the small intestine. It is in the thin section that blockage is formed 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, causing extensive inflammation with a subsequent 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 stops little by little, 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 frequency of respiration and heartbeat increases (due to a decrease in pressure).
• Signs of damage (inflammation) of the peritoneum (the medical name for inflammation is peritonitis) are 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 forms a number of pathological processes that lead to death. How fatal complications develop:

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

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

Bowel obstruction in children

Intestinal obstruction in newborns is formed with congenital defects in the development of the abdominal organs. In this case, the intestinal cavity can be squeezed by neighboring organs, or infringed in the opening of the intestinal wall (hernia). Or, intestinal asthenia or spasm (obstruction) may form.

If such violations 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 the original feces (meconium). This leads to necrosis of intestinal tissues, as well as to perforation of the intestine, blood poisoning, and death.

Most bowel defects in newborns are laid in the early period of intrauterine development (before the 10th week). Anomalies 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 passage of meconium within 24 hours of 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 can move towards the exit.

Tumors and adhesions are the cause of partial blockage. They narrow the lumen of the intestine, and over time, 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 intestine).

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

What to do with bowel obstruction

In most cases, the treatment of bowel 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, obstruction can be cured without surgery.

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

• With spasm of the intestinal walls to facilitate the movement of feces, antispasmodics are needed.
• Colonoscopy is the probing of the large intestine through the anus with a probe (endoscope). The use of colonoscopy in some cases allows you to break through the obstruction in the intestine.
• Enemas. Partial bowel obstruction can be flushed out 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 ongoing process and mistakenly sends the sick woman to the gynecological department). Surgery is required to treat and save the life of the patient.

When surgery is required

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

If the cause was a hernia, the intestine is set, 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 tissues are not dead). Similarly, they act with volvulus of the intestines - the loop is straightened and the state of the intestinal wall is assessed. If there is no tissue necrosis, the intestines are not cut.

In the presence of a foreign body, the intestine is necessarily opened - in order to remove the existing clot, lump or stone. In parallel with surgery, a person is given injections of antibiotics (if an infection process was present), anti-inflammatory drugs.

The need for diet and nutrition control

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

Throughout the acute period, with blockage of the intestine, nutrition is generally contraindicated for a person. During the first days after the operation, there is also no food. A person is fed with a dropper (a glucose solution is injected through a vein). After 24 hours - the patient is allowed liquid food.

What diet is prescribed for intestinal obstruction?

• Fractional nutrition - up to 8 times a day, in small portions.
• All food is ground into a liquid gruel and consumed warm (it is better to refrain from hot and cold food).
• What you can: jelly, mucous decoctions, kissels, juices, low-fat broths (from poultry), grated oatmeal, curd soufflé, sour milk. Later (after a few days) steam meatballs, various pureed cereals, scrambled eggs 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 the operation, 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 was taken to the doctor. Medical statistics confirm the fact that surgery within the first 6 hours of blockage almost always leads to recovery. The operation in the late period (one day after the onset of the first symptoms) has a 25% death rate. Therefore, at the slightest suspicion of obstruction (bloating, lack of stool, pain) - immediately see a doctor.

Small intestine

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

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 caecum. Anatomically, the small intestine is conventionally divided into three sections:

1. Duodenum. It is located in the back of the abdominal cavity and in its shape resembles the letter "C" .;

2. The jejunum. It is located in the middle part of the abdominal cavity. Its loops lie very freely, covered with peritoneum on all sides. This gut got its name due to the fact that at the autopsy of corpses, pathologists almost always find it empty;

3. Ileum - located in the lower part of the abdominal cavity. It differs from other sections of the small intestine in 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 the enzymes of the intestinal juice into smaller components. Digestion in the small intestine also involves the active absorption of nutrients. Inside its cavity, the mucous membrane forms numerous outgrowths and villi, which significantly increases the area of ​​the suction surface. So in adults, the area of ​​\u200b\u200bthe 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 consider them in more detail:

• The secretory function of the small intestine is the production of intestinal juice by the cells of its mucous membrane, which contains such enzymes as alkaline phosphatase, disaccharidase, lipase, cathepsins, peptidase. All of them decompose the nutrients contained in the chyme into simpler ones (proteins into amino acids, fats into water and fatty acids, and carbohydrates into monosaccharides). An adult secretes about 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 is the breakdown of nutrients and their further absorption. Due to this, only indigestible and indigestible products enter the large intestine.
• endocrine function. In the walls of the small intestine there are special cells that produce peptide hormones, which not only regulate the function of the intestine, 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. Stools several times a day, copious, with remnants of undigested food and much mucus. Blood in it is extremely rare.

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

Rupture of the small intestine

Among all the organs of the abdominal cavity, the small intestine is most susceptible to traumatic injuries. This is due to the insecurity and significant length of this section of the intestine. 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 damage to the small intestine is a direct and rather strong blow to the stomach, which leads to pressing the intestinal loops against the pelvic bones or the spine and damaging their walls.

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

The only treatment for a 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 carefully sanitized.

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

Biology and medicine

Functions of the small intestine

Due 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, 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, the chemical processing of food and the absorption of products continue, as well as mechanical mixing and its promotion in the direction of 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 mucosal folds, villi and microvilli of intestinal epithelial cells reaches 200 m2. During digestion, the secretion of bile and its release into the intestinal lumen increases dramatically.

In the small intestine, food is digested and its components are absorbed. At the same time, in the intestinal cavity, under the influence of enzymes of intestinal and pancreatic juices, bile, only the splitting of food molecules into separate fragments occurs. The final splitting occurs due to membrane digestion, which is carried out on the surface of the microvilli of the intestinal epithelium. They found a large number of active enzymes involved in the breakdown and absorption of food products. A.M. Ugolev (1967) discovered parietal digestion, which, in contrast to cavitary digestion occurring in the intestinal lumen, takes place 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 food substances 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. With the breakdown of nutrients, many of their properties, including harmful ones, are lost. This prevents foreign protein from entering the body.

Rhythmic contractions of the villi contribute to the absorption of substances, which is carried out in the direction from the outer surface of the epithelial cells (facing the intestinal lumen) to the internal (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 is facilitated by high blood flow in the small intestine, which during meals is 400 ml / min, and at the height of digestion is 00 ml / min. As early as the beginning of the 20th century, I.P. Pavlov showed that various enzymes are produced in each section of the digestive system, which 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 the vital aspects of this issue.

What processes take place in the small intestine?

Answers and explanations

Digestion occurs 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 are digested, penetrating into the spaces between the villi;

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 mucosa 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 - are involved in the recognition of pathogens and their particles, and activate lymphocytes.

Volvulus

Acute surgical pathology of the peritoneum, which consists in the twisting of any part 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 squeezed, and a mechanical obstruction occurs in the digestive tract.

Signs of intestinal volvulus should not only cause alertness, but make you urgently seek medical help, since this condition poses a real threat to life. The rapid increase in intoxication and dehydration can lead to the death of the patient during the first day.

ICD-10 code

Epidemiology

Overall, males are twice as likely to be affected by this condition than females, although females are more common than males in terms of the incidence of volvulus.

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

The most common torsion of the colon, among them 80% of volvulus in the sigmoid region; 15% - in the caecum; 3% - in the transverse colon; 2% - in the area of ​​the splenic flexure.

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

Volvulus of the caecum affects a younger population (mean age 50 years). The average age of cases in some countries, such as India, where the majority are vegetarians, is even lower - 33 years.

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

Africans suffer from this pathology twice as often as others. According to US medical statistics: patients with volvulus - about 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 "belt of volvulus", where volvulus of the colon is mainly caused by its obstruction, include some African countries, Asian (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 the period of bearing a child is its volvulus. Presumably, the rapidly growing uterus moves this intestine, which provokes torsion of the large intestine. The vast majority of torsion in expectant mothers (3/4) is observed in the last three months of gestation.

Causes of volvulus

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

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

But volvulus of the intestines from persimmons is quite likely. Persimmon, containing an excess of tannin, the children's stomach does not digest, it gets stuck in a large lump that the intestines cannot move to the exit. This can cause intussusception - the retraction of part of one intestine into another. Of course, for 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 the immoderate consumption of tangerines, bananas and food that is unsuitable for a child (smoked meats, herring, etc.).

The causes of intestinal 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 often, but can lead to volvulus in infants. Early artificial feeding can cause this disease. Cases of intussusception in infants - the tightening of a part of the narrowed intestine into the normal lumen, leading to obstruction, is not uncommon in pediatric practice.

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

Sometimes the intestinal lumen is clogged with meconium, which has an abnormal density.

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

• 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 that have strayed into a coma, then each movement of its muscles leads to twisting of the bowel bends.

Risk factors

1. Exit from a prolonged fasting regimen, accompanied by overeating, which activates intestinal motility and can provoke volvulus.
2. Systematic overeating (especially at night) causes excessive filling of the intestinal folds, while 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 trauma, unusually hard physical labor, loads with weak abdominal muscles can cause dislocation of the intestines 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 rough, raw, high-fiber foods that activate intestinal motility.
6. Frequent, so-called food poisoning, ie. infection with pathogenic microorganisms, accompanied by dyspeptic manifestations.
7. Constipation (constipation) is a provoking factor for volvulus of the sigmoid colon, mainly it happens in elderly people.
8. Mesosigmoiditis, which can result in mesenteric deformity and volvulus of the sigmoid colon
9. A foreign body can close the intestinal lumen (obturation), and a neoplasm, pregnancy can squeeze it from the outside (strangulation), which will lead to twisting.
10. Poisoning, taking potent drugs (suppressing intestinal motility, laxatives), some diseases of the central nervous system cause spasms or paralysis of the intestinal muscles.
11. Massive helminthic invasion also sometimes causes volvulus.

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

Colon volvulus 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 on the intestines. The vast majority of volvulus of the large intestine occurs in the sigmoid part.

With complete volvulus of the intestine, a closed obstruction of the affected sections is formed, their innervation and ischemia eventually 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 membrane stops and it necrotizes. Necrosis of the intestinal lining increases its permeability to toxins that enter the peritoneum, and fecal peritonitis develops.

Symptoms of volvulus

Immediately after twisting the loops of the intestine, the first signs of the disease appear - an acute pain instantly struck, more often 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 like a drum roll.

Accompanying symptoms - hypotension, constipation and flatulence without gas, weakness, gray-earthy pallor. Sweat appears on the face, delirium may even begin. The patient speaks with difficulty and breathes heavily, in the abdomen you can hear sounds like splashing water.

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

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

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

Normally, the angle of rotation of the bends of the small intestine is up to 90º. Rotation greater than 180º causes clinical symptoms, and one or more flexures of the small intestine may be drawn into this movement. The caecum is nearby, therefore, signs of its 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. Sharp pain, unrelenting, continuous, stabbing or cutting, felt in the upper abdomen. It is constantly intensifying, becoming unbearable.

With this type of volvulus, patients show anxiety, agitation, and sometimes scream in pain. As a rule, they draw their knees to their chest, but this does not relieve the pain.

In front of the place of twisting, an accumulation of intestinal contents is formed, which provokes obstruction of intestinal loops, activates its peristalsis, visually noticeable, this may be accompanied by gurgling sounds in the abdomen and cramping pains.

If the loops of the lower parts of the small intestine or the caecum are twisted, then there is an asymmetric swelling in the navel zone due to the accumulation of fecal masses above the level of torsion.

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

Constipation and accumulation of flatulence that does not find an outlet begins later, since the motility of the large intestine is still normal, feces and gases continue to be released. If you immediately contact a doctor with suspicion of volvulus of the small intestine, this stage can be bypassed, but in the case of a long time, the release of feces and gases may stop.

The general condition is disturbed - there are signs of dehydration, weakness, dizziness, fainting. The symptoms of intoxication of the body are growing - muscle pain, tachycardia, pallor, high fever, perspiration on the forehead.

Volvulus of the colon more common, its most common localization is in the sigmoid colon.

Its symptoms are similar to those of volvulus of the small intestine, 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 be given to the lumbar region. The nature of the pain is constant, occasionally - paroxysmal.

Vomiting of undigested food and bile occurs simultaneously with pain and is repeated two or three times without relief. Vomiting in this case is caused to a greater extent by painful irritation. Vomiting of faeces begins later, with the development of peritonitis.

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

The abdomen is markedly distended 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 up the abdominal organs, which press on the diaphragm, reducing the volume of the chest, squeezing the lungs and upsetting the respiratory process, disrupting the heart. This is manifested by shortness of breath, arrhythmia, tachycardia, chest pain.

Occasionally happens volvulus of the transverse colon, symptomatology resembling volvulus of the sigmoid colon.

Forms

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

Congenital volvulus of the intestines manifests itself in the first hours of a child's life. The first symptoms are pain (the baby is restless, naughty, crying all the time), vomiting, hypotension, abdominal asymmetry, and decreased intestinal motility. The passage of flatus is disturbed, meconium may come out, but normal feces are not observed, mucus is discharged from the anus (complete volvulus) or the stool leaves in small portions, the volume of which is getting smaller (partial).

Intestinal volvulus in children manifested by high fever, acute pain in the abdomen, vomiting, blood or mucus in the feces. The child eats and sleeps poorly, often cries, is naughty, draws his legs to his stomach. Attacks come and go unexpectedly, in the intervals between us the child can vomit twice. Intensive gas formation occurs, after a while constipation begins, and the gases stop leaving. On examination, the child noticeably compaction in the lower abdomen.

Volvulus in the fetus is difficult to diagnose, it is treated after the birth of the child. This pathology is often accompanied by polyhydramnios in the mother and other malformations, such as Down's disease.

Complications and consequences

If the patient did not go to the doctor at the first symptoms, after a few hours the development of peritonitis begins. The body temperature rises and a false improvement in well-being occurs. It may seem to the patient that there is no longer any need to worry. This delusion can lead to fatal consequences.

When volvulus completely stops the blood supply to the twisted part of the intestinal wall and its innervation. According to numerous testimonies of medical research, the further quality of life of the patient, and often life itself, directly depends on the timeliness of the provided medical care.

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

• volvulus is manifested by frequent vomiting when the body loses a lot of water and electrolytes;
• the liquid drunk by a person is absorbed in the large intestine, and during volvulus, especially of 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 (up to coma). If the body is deprived of about a fifth of the water, a fatal outcome is possible.

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

Adhesive disease - the formation of connective tissue adhesions that appear in places of inflammation. Causes dislocation of the folds of the intestine, 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, laboratory data and instrumental examinations. Questioning and examining the patient help to suggest the cause of the disease and prescribe further examination.

There are no laboratory tests confirming or refuting the diagnosis of intestinal volvulus. However, some tests are done to detect complications (gangrene, peritonitis) and for differential diagnosis.

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

A biochemical blood test can show an increase in the level of lactate dehydrogenase, a decrease in albumin, potassium and chlorine.

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

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

Studies of the acid-base state of the blood - in 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.

On the most common x-ray, obstruction of the bowel loops and the presence of obstruction are visible, and the barium enema x-ray determines the typical localizations of intestinal volvulus, oral administration of barium suspension before x-ray is used to confirm twisting of the small intestine (particularly in pediatrics).

Computed tomography is appropriate in cases of volvulus of the blind and small intestines. The tomogram shows a spiral, the so-called "sign of the storm", obstructive changes in the intestine and thickening of its walls, mesentery edema.

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

If a volvulus is suspected in women during pregnancy, the diagnosis is difficult because 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, colonoscopy due to a possible miscarriage.

Regardless of the period, ultrasound 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 the medical history, laboratory and instrumental examinations. Torsion of the small intestine is differentiated from neoplasms, diverticulosis, adhesive and calculous formations. With this pathology of the sigmoid colon, its malignant neoplasm, diverticulosis, mesenteric ischemia, etc. are excluded. Twisting of the caecum has to be differentiated from appendicitis, rupture of an ovarian cyst, other obstructions, and urinary tract infections.

Visual inspection data are of decisive importance in differentiation.

Who to contact?

Treatment of volvulus

The disease poses a serious danger to the life of the patient, at the first symptoms you should immediately seek medical help.

While the ambulance team has not arrived, it is necessary to place the patient comfortably. Do not feed or drink as bowel movements can only aggravate torsion and provoke vomiting. In no case should you give any medicines, they can change the clinical picture and make it difficult to diagnose. Do not wash the stomach, do not give an enema, do not warm the stomach.

Hospitalization and surgical treatment is the only thing that saves the life of the patient.

The exception is uncomplicated volvulus of the sigmoid colon. The ability to spread the volvulus of the sigmoid colon through the anus is dictated by its proximity to the anus. This procedure is carried out in a medical institution by specialists. It consists in injecting a solution of barium to the place of inversion through the rectal intestine. Increased pressure occurs and the torsion can be straightened. If untwisting 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, 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 detected, the volume of the operation increases: dead loops are removed, anastomosis is applied, or, in case of peritonitis, the ends of the intestine are brought to the surface of the abdominal wall (ileostomy), which makes it possible to establish the process of feeding the patient when the intestine is separated 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 took place without removing part of the intestine, patients recover quickly. After resection of the volvulus of the intestines, the patient expects a long rehabilitation, during this period some restrictions must be observed. Restorative postoperative measures consist of bed rest, anesthesia, postoperative wound treatment, physiotherapy, breathing exercises, and dietary nutrition.

Postoperative patients should observe strict bed rest in order to avoid divergence of the sutures. A day after the operation, you can begin to do simple gymnastics with your hands (raise-lower, bend-unbend), careful turns from one side to the other. After another day or two, it is recommended to get out of bed and take a short walk around the ward and in the corridor. Light physical activity after surgery improves circulation, prevents bedsores and reduces the risk of blood clots.

An important point in the rehabilitation process is effective anesthesia.

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

At the very beginning after the operation, narcotic drugs 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 pain sensations without turning off consciousness, while maintaining the rest of the 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. Prolonged use causes drug dependence.

Contraindicated in respiratory dysfunction, dystrophy, elderly patients.

Non-steroidal anti-inflammatory drugs, such as indomethacin or ketorolac, are used to relieve manifestations of inflammation and pain in the area of ​​the postoperative suture.

Ketorolac- an active analgesic, relieves fever, swelling and inflammation. Prostaglandin production inhibitor. Prevents thrombosis. Indicated for postoperative pain.

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

To relax the muscles of the intestine, inactivate its motility and prevent spasms, antispasmodics are used.

Drotaverine- an active antispasmodic that acts relaxing on the smooth muscles of the gastrointestinal tract and blood vessels. It has an analgesic effect, dilating blood vessels and contributing to 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 intramuscularly at 40 - 80 mg with an interval of eight hours. The drug is well tolerated, allergic reactions and other adverse events are extremely rare.

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

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

All patients after surgical interventions are shown breathing exercises: accelerated deep inhalations and exhalations or inflation of balloons for ventilation of the lungs as a prevention of the development of hypostatic pneumonia and other respiratory complications. Such gymnastics is recommended to be done several times a day, especially during prolonged bed rest.

Diet food

A few days immediately after the elimination of volvulus with ectomy of part of the intestine, nutrients, liquid, trace elements and vitamins are administered to the patient intravenously through a dropper. After three to four days, the patient's condition stabilizes and you 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 preventing the active contraction of intestinal smooth muscles and gas formation, which negatively affects the healing of tissues in the operated area.

The zero diet involves frequent (8 times a day) meals in small portions (no more than 300g) only in a liquid state. Food and drink are heated to 45ºС, the daily norm of liquid is about two liters, the food is not salty.

You can eat: a weak broth from dietary meats - veal, rabbit, turkey breast and mashed soups; decoction of rice pureed porridge; fat-free 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 a warm, liquid and pureed form.

You can eat: pureed buckwheat, rice, semolina porridge in broth or milk diluted with water (1:4); mashed cereal soups in vegetable broth; steamed protein omelet; steam fish of low-fat varieties in the form of a soufflé; jelly, jelly, not strong tea, sweet fruit juices.

In the absence of complications, they switch to diet No. 1b, which, in addition to the previous one, includes: crackers from white bread; steam cutlets and meatballs; boiled (steam) vegetables, meat and fish in the form of mashed potatoes; sour cream.

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

The transition to a normal lifestyle takes about a month and a half.

Alternative medicine

Intestinal volvulus should not be attempted to be eliminated at home. The use of traditional medicine or homeopathic medicines will not solve the problem, but only aggravate it. But as a prophylaxis of intestinal volvulus, in the recovery period, alternative treatment and homeopathy can help. However, before embarking on alternative treatment, you should consult with your doctor.

Intestinal torsion can be caused by various reasons. For some of them, for example, congenital pathologies, traditional medicine recipes are unlikely to work. Most of the others are fixable.

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

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

There is a “broom” salad from raw grated beets, carrots and finely chopped cabbage with vegetable oil in the morning for breakfast.

Infusion of beets on the water. Peel 0.5 kg of root crops, chop, pour a liter of boiling water, let it brew for three to four hours. Then pour 150 g of granulated sugar and a teaspoon of dry yeast, put in a dark place for a day. Drain after a day. Consume ½ cup three to four times a day. Relaxes the muscles of the intestine, has anticonvulsant and antiseptic action, normalizes peristalsis.

Whey kvass with celandine. For 3 liters of whey, you will need a glass of finely chopped celandine grass and granulated sugar. Mix celandine with granulated sugar, pour onto a piece of gauze, tie it into a knot, place in a bowl with whey, cover with gauze and put in a dark place for 14 days. Remove the bundle, wring out, drain. Store a jar of kvass in the refrigerator, under a nylon lid. Drink ½ cup twice a day half an hour before meals. The course is 14 days, after two or three days, drink the rest of the 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 100 g of crushed raw materials with a liter of water, simmer for one hour on a low flame (do not boil). Let cool, strain.

Eat five or six times a day one tablespoon half an hour before or one hour after a meal.

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

Helps yarrow infusion: brew a teaspoon with a top of boiling water, after a minute - drain, cool a little - drink.

The consequences of food poisoning can be leveled by taking chicory infusion: 25 g of crushed dry raw materials brew a glass of boiling water, wrap and leave overnight. Drink a day in three to four doses before meals for half an hour. It is necessary to drink an infusion of chicory after clearing the stomach, for which they drink three glasses of salted water. You can clean the stomach more than once.

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

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

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

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

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

Hydrastis (Gidrastis) - 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 embittered; paresthesia of the rectal part of the intestine; constipation in patients with displacement of the internal organs of the small pelvis; the sick are sweating, very weak, they like salty things.

Homeopathic preparations should be prescribed by a homeopathic doctor who will study the patient's history, his lifestyle, habits and addictions. All this is taken into account when prescribing, and self-medication, even with homeopathic medicines used in negligibly small 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 is, first of all, in compliance with the diet. Prolonged fasting followed by excessive satiety, eating large amounts of plant foods increases the risk of bowel torsion.

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

It is necessary to get rid of difficulties with defecation in a timely manner. With a tendency to constipation due to weak intestinal motility, you need to eat more plant foods, which normalize intestinal mobility and contribute to a faster release of the body from feces.

For constipation caused, for example, by neoplasms, products that stimulate intestinal motility should be removed from the daily menu. Since in this case, active intestinal motility can provoke a turn of the intestine.

Timely 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 intestinal volvulus directly depends on the speed of seeking medical help. With timely treatment, it is favorable, and delaying time can be fatal.

Medical Expert Editor

Portnov Alexey Alexandrovich

Education: Kyiv National Medical University. A.A. Bogomolets, specialty - "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 the final processing of products is provided 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 (suction).

Vitamin B12 is absorbed in the small intestine.

A human is a narrow tube about six meters long.

This part of the digestive tract got its name because of the proportional features - the diameter and width of the small intestine is much smaller than those of the large intestine.

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

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

The mucosa 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 area of ​​the small intestine is also involved in the absorption of nutrients. The functions of the small intestine are somewhat different from those of the stomach. In the stomach, food is crushed, ground and primarily decomposed.

In the small intestine, the substrates are decomposed 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 immediately follows the stomach. The duodenum is the initial section of the small intestine, following the pyloric section of the stomach.

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

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

The rest of the small intestine is literally suspended in the mesentery attached to the posterior abdominal wall. This structure allows you to freely move the sections of the small intestine during surgery.

The jejunum occupies the left side of the abdominal cavity, while the ileum is located in the upper right side of the abdominal cavity. The inner surface of the small intestine contains mucous folds called circular circles. Such anatomical formations are more numerous in the initial section of the small intestine and are reduced 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 that protects the intestinal walls from an aggressive environment.

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

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

functional significance

The small intestine is made up of several sections.

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

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

The first part involves the mechanical processing of food by chewing, grinding, whipping and mixing - all this takes place 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 - it is here that the most active enzymes and excipients are present.

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 available for absorption.

1. The breakdown of proteins. 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. Protein digestion begins in the stomach and ends in the small intestine.
2. Digestion of fats. This purpose is served by special enzymes (lipases) secreted by the pancreas. Enzymes break down triglycerides into free fatty acids and monoglycerides. An auxiliary function is provided by bile juices secreted by the liver and gallbladder. Bile juices emulsify fats - they separate them into small drops available for action.
3. Digestion of carbohydrates. Carbohydrates are classified into simple sugars, disaccharides and polysaccharides. The body needs the main monosaccharide - glucose. Pancreatic enzymes act on polysaccharides and disaccharides, which promote the decomposition of substances to monosaccharides. Some carbohydrates are not completely absorbed in the small intestine and enter 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 provided 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. Circular circles of the intestine contain a large number of villi that actively absorb food substrates. Modes of transport in the small intestine:

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

For a better understanding of the processes, it is necessary to clarify the terminology. Diffusion is a process of absorption along the concentration gradient of substances, it does not require energy. All other types of transport require the expenditure of cellular energy. We found out that the human small intestine is the main department for digesting food 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 multicomponent processes in which a significant number of organs are involved.

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

Anatomy of the small intestine

The process of digestion 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 the point of view of anatomy and therefore is not used in scientific medicine.

The organ got its name due to the fact that the studies revealed a difference in the thickness of the walls of the large and small intestines. In the small intestine, the walls are correspondingly thinner and therefore more capable of stretching.

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

The small intestine is the longest among the other organs of the human body. It reaches 6 m and occupies the lower third of the peritoneum, and also partially - the cavity of the small pelvis. The diameter of the small intestine in different places is different 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. So that these loops do not twist with each other, and the intestine itself is fixed, the human digestive system provides for the presence of such an organ as the mesentery.

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

The presence of the mesentery in the human body was known back in the time 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, following from 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 spine.

The location of the duodenum resembles the shape of a horseshoe and has several sections: the 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, it occupies the central part of it. The department got its name due to the fact that when examining corpses, the intestine turned out to be empty.

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

The ileum ends at the beginning of the colon () intestine. The separation of these organs is carried out by the presence of the ileocecal valve, which is also known in anatomy as the Bauhin's valve.

Functions of the small intestine

Intestine - schematic

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 provides a high suction 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 layer 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 along the intestines.

The outer shell 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 with the help of digestive enzymes (catalyst proteins), which are secreted by the glands of the small intestine. These enzymes include trypsin, enterokinase, kinasogen, nuclease for protein digestion, lipase for fat processing, sucrase, phosphatase, maltase, lactase, amylase for carbohydrate decomposition.
• The absorption of nutrients obtained as a result of food processing by the walls of the intestine, from where they enter the circulatory system and further to the internal organs that need them.
• Mechanical pushing of the food bolus and its residues through the intestines in the direction of 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 state, excluding various pathologies.

The process of digestion 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 in the entire process of absorption and processing of food entering the gastrointestinal tract.

When X-ray studies of the activity of the departments 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, into the ileum - after an hour and a half, into the blind (upper colon) - after four hours. Eight hours later, the absorbed radiopaque mass completely fills the rectum.

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

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

These products, 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 pass only simple components.

After 7-8 hours from eating, the products split into individual nutrients enter the bloodstream, and the non-decomposable food residue is pushed further into the large intestine in order to be removed 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 as a result of exposure to various events:

1. congenital pathologies;
2. malnutrition;
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 such symptoms are detected, it is necessary not to postpone going to the doctor, who can accurately determine the causes and type of the disease and prescribe an effective therapy program.

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

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

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  Human small intestine: anatomy, functions and process…

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

Organ structure

The small intestine (intestinum tenue) departs 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 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 has the shape of a horseshoe, comparable in length to the width of 12 fingers, due to which it got its name;
• The jejunum (length 2–2.5 meters);
• Ileum (length 2.5–3 meters).

The wall of the small intestine is made up of the following layers:

• The mucous membrane - lines the inner surface of the body, 90% of its cells are enterocytes, which provide digestion and absorption. Has a relief: villi, circular folds, crypts (tubular protrusions);
• Own plate (submucosal layer) - an accumulation of fat cells, nerve and vascular plexuses are also located here;
• The muscular layer is formed by 2 shells: circular (inner) and longitudinal (outer). Between the membranes is the nerve plexus, which controls the contraction of the intestinal wall;
• Serous layer - covers the small intestine from all sides, with the exception of the duodenum.

The small intestine is supplied with blood 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 processes of digestion take place in the small intestine:

Enzymes

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

• Erepsin - breaks down peptides to amino acids;
• Enterokinase, trypsin, kinasogen - 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 the secretion of the pancreas;
• Vasointestinal peptide - stimulates hematopoiesis, affects the smooth muscles in the intestine;
• Gastrin - involved in digestion;
• Motilin - regulates intestinal motility);
• Cholecystokinin - causes contraction and emptying of the gallbladder;
• Gastroinhibiting polypeptide - inhibits the secretion of bile.

Functions of the small intestine

The main functions of the body include:

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

Diseases of the small intestine.