small intestine patho
TRANSCRIPT
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Intestinal disease
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• Small intestine measurements taken at autopsy ( cadaver examination ), because of endoscope and coloscope cant reach small intestine (iluem) so its suggests that adult lengths of small intestine between 3 & 9 meters.
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Histology of small intestine
• Once we have a duodenal biopsy we have to count lymphocyte, if they are more than 20 mean inflammation
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Why ?because the presence of goblet cells ( which secretes mucus along the whole intestines ) is not sufficient to protect the duodenum from the gastric acids .
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Brunner’s glands
• tuboalveolar( or tubule-acinar ) glands .
• have ducts that open directly into the crypts of lieberkuhn .
• Has Urogastrone : an enzyme that is secreted to the blood ,it goes to the parietal cells and inhibits their acid secretion .
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folding of lamina propria and epithelium
Goblet cells : (uni-cellular ) that secrete mucinogen (mucus precursor ) to lubricate the small intestine
I , S cells
Paneth cells (defense cell) :Apical eosinophilic granules: secrete lysozymes
ente
rocy
te
Intestinal gland
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Paneth cell
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• Paneth مع الفرن
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Rough endoplasmic reticulum
Basal nuclei
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Rich in goblet cells.
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• As we going from duodenum to ileum number of lymphocytes are increased
• why ?
• Coz the food will converted to fecal material >> that’s increase number of bacteria>> and should be balance between bacteria and inflammatory cells .
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• Atresia : absence of canalization where as stenosis is narrowing of lumen >
• Duodenal Atresia is associated with Down syndromefailure to recanalize(trisomy 21).
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there is a reminant of the yolk sac
“persistence”
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• Located in distal ileum usually within (2 feet )
• the blend segment or pouch is about (2inch) long.
• most common malformation of GIT (2% of population ).
• true diverticulum its mean that bulging part have 3 layers not 2(false)” more common”.
The complication of this disease are pain and bleeding which may mimicappendicitis therefor , during appendectomy , ileum should be checked for presence of meckel's diverticulum , if it is found to be present itshould be removed with appendix
its role of 2
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• Heterotopic rests of gastric mucosa and pancreatic tissue (rare ) .
• heterotopic means displacement of an organ from its normal location
infracolic compartment.
supracolic compartment.
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Meckel diverticula may contain ectopic gastric mucosa (which can ulcerate surrounding mucosa with pain and bleeding) or ectopic pancreas (which is of no consequence unless it forms a mass large enough to predispose to intussusception).
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“malrotation of midgut”
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Volvulus
• Mostly in small intestine; large intestine especially sigmoid and cecum.
• Rare.but
Most common
In adults.
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The nervous system in GI has 2 networks (plexuses) of nerves :(Enteric Nervous System):
• 1.Meissener’s submucosal plexus:-
- related to the secretory function.
- it Stimulates the contraction of muscularismucosa and the contraction of the endothelial and other cells in ( glands and blood vessels )
- Neurotransmitter Vasoactive Intestinal Peptides (VIP) and Nitric Oxide (NO) cause the smooth muscle contraction and thus increase blood flow to intestinal epithelium.
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• 2. Auerbach’s myenteric plexus قوي =أورباخ
-within the muscularis externa > (between the inner circular and the outer longitudinal >movement.
-They are excitatory , but some are inhibitatory(They secrete (VIP) which inhibit intestinal sphinctre muscles like: pyloric sphinctre & ileocecal valve .
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Functional
anatomical
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May be associated with other congenital
anomalies like :
1 – hydrocephalus 2 –VSD 3 -Meckel’s
diverticulum
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• Classification of diarrheal disorders :-
• 1- Secretory diarrhea :-
-Secretory diarrhea means that there is an increase in the active secretion, or there is an inhibition of absorption.
-There is little to no structural damage
-The most common cause of this type of diarrhea is a cholera toxin that stimulates the secretion of anions,
especially chloride ions. Therefore, to maintain a charge balance in the lumen, sodium is
carried with it, along with water
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• 2- Osmotic diarrhea
• occurs when too much water is drawn into the bowels. If a person drinks solutions with excessive sugar or excessive salt, these can draw water from the body into the bowel and cause osmotic diarrhea.
• Osmotic diarrhea can also be the result of maldigestion :(e.g., pancreatic disease or Coeliac disease), in which the nutrients are left in the lumen to pull in water.
• Or it can be caused by osmotic laxatives (which work to alleviate constipation by drawing water into the bowels)
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• 3- Exudative diarrhea:-
• Exudative diarrhea occurs with the presence of blood and pus in the stool. This occurs with inflammatory bowel diseases,( bacterial).
• 4- Malabsorption diarrhea :-
• unabsorbed nutrients & fat.
• 5- Deranged motility diarrhea :-
• decreased intestinal retention time; decreased motility. WHY??
• Because it leads to bacterial overgrowth infection diarrhea
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