Small Intestines 2 MUCOSA Goblet Paneth Enterochromophin

1.2 WALL

The  wall of the intestine consists of four layers starting  from

the  lumen  these layers are mucosa,  submucosa,  muscularis  and

serosa (peritoneum).

I11 Small Intestine (SI)

Ingested food on arrival in the SI transits out in 2-4 hours by a contraction of longitndinal propalsive peristalsis segmental in is also seen frequently and mixes the chyme and provides contact with intestinal absorptive mucosa. Thus contractions occur 12 per minute in the duodening 9 per minute in the jejunum and 7 per minute in the leum and are controled by a slow wave pattern from the antrum. Distension and peristalsis in the terminal item open the ileocecal valve competence of this valve prevents colon bacteria from entry to the SI.

1.3 SPECIAL CELLS IN THE MUCOSA

GLOBLET CELLS

These cells are present in villi and crypts.  These cells secrete

mucus. 

ENTEROCHROMAFFIN CELLS

These are present in crypts of the small intestine.  They do  not

contact  the intestinal lumen and their secretions flow into  the

blood  vessels  in the wall and cause their effect  as  endocrine

cells.

PANETH CELLS

These  are  also in the crypts.  They secrete  large  amounts  of

protein, and their function is not fully understood.

UNDIFFERENTIATED CELLS

These  are  present  in the base of crypts.   They  multiply  and

differentiate   and  their  function  is  to  replace  the   lost

absorptive cells on the surface of the mucosa.

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Small Intestines 1 Anatomy lymphatics

SMALL INTESTINE

1. ANATOMY

The length of the human small intestine after its separation from

the mesentery is 6 to 8 meters.

*  In  life because of muscle tone in the wall of the  intestines

   the length is about 3 meters.  The mucosal surface provides  a

   larger area for absorption surface.

*  The  surface  of the mucosa shows finger like villi  of  1  mm

   height and each villi shows a brush border of microvilli (Fig.

   18.1) further increases the area  of contact with the contents

   and thus the absorption surface.

*  The   mucosa  also  secretes  3  litres  of  alkaline   succus

   entericus.

The  small intesinte receives its blood supply from the  superior

mesenteric artery a branch of the abdominal aorta.

Absorption

The absorbing surface of the small bowel is over 20c m² as a result of folds, villi, and microvilli which provide increased surface area. Absorption can occur either actively or passively. The active form is transcellular, carrier mediated, and energy dependent. Passive absorption can occur through the tight junctions between cells, a process referred to as paracellular diffusion. Passive diffusion also can occur transcellularly by diffusion, concentration gradient, or convection.

1.1 LYMPHATICS

The  peyer's  patches are the equivalent of lymph nodes  and  are

aggregation  of lymphoid tissues of the sub-mucosa of  the  small

intestine.   They  are more in number in the ileum but  are  also

present in the jejunum.  The lymphatic drainage from these  areas

passes  into  lymphnodes  placed  closed  to  the  wall  of   the

intestine.  The next group are placed further away in the arcades

of  mesenteric  and 3rd set are around  the  superior  mesenteric

arcades.   These finally drain into the cisterna chyli.  This  is

the major route of absorbed fats (lipids) in to the circulation

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LIVER & BILLIARY TRACT 21 Short Notes Courvoisier"s Law Splenoportogram ERCP Post cholcystectomy Syndrome

COURVOISIER'S LAW

In  cases  of  obstructive  jaundice  where  the  gallbladder  is

palpable,  the  cause  is unlikely to  be  gallstones  (carcinoma

gallbladder  or  carcinoma  of pancreas Fig. 17.6).   A  plan  of

action in a case of jaundice is given into in Fig. 17.7.

Short Note

Splenoportogram

This is method of visualizing the splenic vein and portal  system

by injection of radio opaque dye into the spleen by direct needle

puncture.

Short Note

ERCP

Endoscopic  retrograde-  cholangio-pancreatography  a  method  of

outlining the bile and pancreatic ducts used when ultrasound,  CT

and   MRI scans have failed to provide information  required.  An

endoscope  is introduced in the duodenum and the opening of  bile

passages  catheterised.  Radio  opaque  dye  injected  and  x-ray

obtained outlining the ducts.

SN

Post Choleystectomy Syndrome

This  is  the persistence of symptoms in patient  of  cholecystis

after cholecystomy sometime this symptoms appear many years after

cholecystectomy.  These  symptoms may be due to a  hiatus  hernia

pancreatites   or  a  narrow  sphincter  of  oddi.  These   three

conditions need to be investigated.

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LIVER BILLIARY TRACT 20 Cancer Gall Bladder

CARCINOMA OF THE GALLBLADDER

Carcinoma of the gallbladder accounts for 4% of all carcinomas.

Approximately 80% of the patients in most series are females

The  relationship  between  gallstones and  carcinomas  has  been

emphasized for many years.

Approximately  80% of the tumours are adenocarcinomas, while  the

remainder are undifferentiated or squamous cell carcinomas.   The

routes of metastases are spread-

*  Along   the  lymphatics  to  pancreatic  or  duodenal   nodes,

   localised

*  Involvement of venules and veins leades to the invation of the

   liver

The presentation may be with signs and symptoms of  cholecystitis

and cholelithiasis.

Nearly half the patients are jaundice and in most cases there  is

a palpable right upper quadrant mass.

TREATMENT

Surgical treatment is achieved with cholecystectomy and  regional

lymphadenectomy.

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