Digestion in the small and large intestines. What happens in the human small intestine Processes in the small intestine

16.08.2020 Drugs

Food from the stomach enters the small intestine, more specifically, into the duodenum. The duodenum is the thickest part of the human small intestine, its length is about 30 cm. The jejunum (length about 2.5 m), the ileum (length about 3 m) are also referred to as the small intestine.

Internal walls duodenum in essence, they consist 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 are. carbohydrates under the influence of digestive juices, enzymes are broken down in such a way that the body can easily assimilate them. In the duodenum, first of all, the pancreatic duct, also the bile duct, opens. So, the food here is influenced by:

intestinal juice;
pancreatic juice;
bile.

Digestion types in the small intestine

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

Such particles fall into the cavity between the villi, which cover the mucous membrane in this section with a dense layer. Parietal digestion is carried out here. The concentration of enzymes is much higher here. And therefore, 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 rather small. Before food can enter the large intestine, the body must have time to take all the nutrients from the processed food.

Small intestine absorption

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 bloodstream are transported through a vein to the liver. This, of course, is important for the body, for the very reason that not only useful substances, but also various toxins, poisons can be consumed with food - this is primarily due to the environment, as well as to a large intake of drugs, poor-quality food and etc. In the departments 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 is already the final process of digestion, namely the formation feces.

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, basically only the formation of feces and fermentation takes place. That is why it is so important to monitor the health and normal functioning of the small intestine, since 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 affecting 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 with 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 of the most important digestive enzymes (aminopeptidases, dipeptidases).

2. Pancreatic (pancreatic) juice

The pancreas is the second largest in the human body. The weight can reach 100g, and the length 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 of the pancreatic juice is secreted when eating highly fatty foods.

The endocrine gland simultaneously synthesizes several hormones that provide important action for processed food:

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

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

3. Bile

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

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

Into the intestine healthy person up to 1 liter of bile is secreted per day. It consists mainly of fats, cholesterol, mucus, soap, and lecithin.

Possible diseases

As mentioned earlier, problems with the small intestine can lead to dire consequences - the body will receive less nutrients necessary for the normal functioning of the body. This is why it is so important to identify any problem on early stage to begin treatment as soon as possible. So, possible diseases small intestine:

Chronic inflammation. It can occur after a severe infection due to a decrease in the amount of enzymes produced. In this case, first of all, a strict diet is prescribed. Also, inflammation can develop after surgery as a result of the ingress of pathogenic bacteria or some kind of infection.
Allergy. It can manifest itself as a component of the overall allergic reaction organism on the action of an allergen, or else have a local location. Pain in this case is a reaction to the ingress of an allergen. First of all, it is worth excluding its effect on the body.
Gluten enteropathy is a serious illness accompanied by emergency... The disease consists in the inability of the body to fully process and assimilate proteins. As a result, there is a strong intoxication of the body with unprocessed food particles. Throughout his life, the patient will have to follow a strict diet, completely excluding grains and other foods containing gluten from the diet.

The causes of diseases of the small intestine

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

smoking, alcohol abuse;
unhealthy diet (too much food consumed, abuse of fatty, smoked, salty and spicy foods);
too much consumed drugs;
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 likelihood of soon forgetting about the problem without any consequences for the body.

DIGESTION IN THE SMALL INTESTINE

There are 2 types of food digestion: CALENDAR AND MEMBRANE. The first is carried out by intestinal juice, the second - by enzymes. Initial stages digestion takes place in the cavity of the gastrointestinal tract. As a result of membrane hydrolysis, monomers are formed, which are transported into the blood.

The assimilation of nutrients is carried out in 3 stages: cavity digestion - membrane digestion - absorption. The last stage includes the processes that ensure the transfer of substances from the small intestine to the blood and lymph. Absorption takes place in the small intestine.

MOTOR FUNCTION OF THE SMALL INTESTINAL

The motility of the small intestine provides mixing of its contents with digestive secretions, the movement of the contents through the intestine, an increase in intraintestinal pressure, which helps to filter solutions from the intestinal cavity into the blood and lymph. Consequently, the motility of the small intestine promotes hydrolysis and absorption of nutrients.

REGULATION OF SMALL INTESTINAL MOTOR.

The motility is altered by irritation of the spinal cord and medulla oblongata, hypothalamus, limbic system, cerebral cortex. Irritations of the nuclei of the anterior and middle sections of the hypothalamus mainly excite, and the posterior ones inhibit the motility of the stomach, small and large intestine.

HUMORAL REGULATION... Serotonin, histamine, gastrin, motilin, vasopressin, oxytocin increase, and secretin inhibits small intestine motility.

SUCTION OF WATER AND MINERAL SALTS. Water enters the digestive tract as part of food and liquids drunk, secretions of the digestive glands. A certain amount of water is absorbed from the digestive tract into the blood, a small amount into the lymph. Absorption of water begins in the stomach, but it occurs most intensively in the small and especially the large intestine. Absorbs sodium, potassium and chlorine.

SUCTION OF PROTEIN HYDROLYSIS PRODUCTS... Proteins are absorbed mainly in the intestines after their hydrolysis to amino acids. The absorption of different amino acids occurs at different rates in different parts of the small intestine.

Sodium transport stimulates the absorption of amino acids.

The absorption of fructose (and some other monosaccharides) does not depend on sodium transport, it is active. The absorption of carbohydrates by the small intestine is enhanced by certain amino acids.

The absorption of glucose is enhanced by hormones of the adrenal glands, pituitary gland, thyroid gland, as well as serotonin, acetylcholine. Somatostatin inhibits the absorption of glucose, to a lesser extent - histamine.

SUCTION OF LIPID HYDROLYSIS PRODUCTS... The main amount of fat is absorbed into the lymph, therefore, 3-4 hours after a meal, the lymphatic vessels are filled with a large amount of lymph.

The rate of hydrolysis and lipid absorption are regulated by the central nervous system. The parasympathetic nerves accelerate and the sympathetic nerves slow down the absorption of lipids. The hormones of the adrenal cortex stimulate their absorption, thyroid gland and the pituitary gland, as well as hormones produced in the duodenum.

COLOR MOTOR FUNCTION

The entire process of digestion in an adult lasts 1 to 3 days, of which the greatest time is spent on the stay of food residues in the large intestine. Her motility provides a RESERVOIR FUNCTION - the accumulation of contents, the absorption of a number of substances from it, mainly water, its promotion, the formation of feces and their removal.

The content of the cecum makes small and long movements in one direction or the other due to the slow contractions of the intestine. The colon is characterized by several types of contractions: small and large pendulum-like, peristaltic and antiperistaltic, propulsive.

Irritation of rectal mechanoreceptors inhibits the motility of the overlying parts of the small intestine. Serotonin, adrenaline, glucagon also inhibit it.

The large intestine is rich in microorganisms. The destruction of undigested food remains. Organic acids and toxic substances are formed. One part is dehumidified in the liver, the other is excreted. Decomposition of cellulose. Synthesizes vitamins K and group B. The presence of normal microflora protects the body and improves immunity.

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

What is the small intestine?

Vitamin B12 is absorbed in the small intestine.

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

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

In the small intestine, the duodenum, the jejunum and the ileum are isolated. The duodenum is the first segment of the small intestine located between the stomach and the jejunum.

Here the most active digestion processes take place, it is here that the enzymes of the pancreas and gallbladder are released. The jejunum follows the duodenum, its length is on average one and a half meters. Anatomically, the lean and ileal intestines are not separated.

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

Vitamin B12 is absorbed in the ileum and others water-soluble vitamins... In addition, this area of the small intestine is also involved in the absorption of nutrients. The function of the small intestine is somewhat different from that of the stomach. In the stomach, food is crushed, grinded and decomposed primarily.

In the small intestine, substrates are decomposed to constituent parts and absorbed for transport to all parts of the body.

Small intestine anatomy

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 with the bulb, bypasses the head of the pancreas and ends in abdominal cavity a bunch of Trinity.

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

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 parts of the small intestine during the operation.

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 lining of the small intestine contains mucous folds called circular circles. Such anatomical structures are more numerous in the initial part of the small intestine and contract closer to the distal ileum.

The assimilation of food substrates is carried out with the help of the 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.

Enteral 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 tightly connected with the capillary networks of the circulatory and lymphatic systems.

The walls of the small intestine are composed of four layers: mucosa, submucosa, muscular and adventitious membranes.

Functional relevance

The small intestine is divided into several sections.

The human small intestine is functionally connected with all organs of the gastrointestinal tract, here the digestion of 90% of food substrates ends, the remaining 10% is assimilated 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 mechanical processing of food by chewing, chopping, whipping and mixing - all this takes place in oral cavity and stomach. The second part of food digestion involves chemical processing of substrates, which uses enzymes, bile acids, and other substances.

All this is necessary in order to break down whole foods into individual components and absorb them. Chemical digestion takes place in the small intestine - this is where the most active enzymes and excipients are found.

Digestion support

In the small intestine, proteins are decomposed and fats are digested.

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

Decomposition of proteins. Proteins, peptides and amino acids are acted upon by special enzymes, including trypsin, chymotrypsin, and intestinal wall enzymes. These substances break down proteins into small peptides. The process of digesting proteins begins in the stomach and ends in the small intestine.
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 are divided into small drops available for the action of enzymes.
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, promoting the decomposition of substances into monosaccharides. Some carbohydrates are not completely absorbed in the small intestine and travel to the large intestine where they become food for intestinal bacteria.

Absorption of food in the small intestine

Decomposed to small components, nutrients are absorbed by the mucous membrane of the small intestine and transferred to 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 absorption method.

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

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

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

Watch in 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 in it for about 8 hours. The initial section of the small intestine is called the duodenum, and the ducts of the liver and pancreas flow into it.

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

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

There are 3 processes in the small intestine:

1) Motor skills - includes

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

2) There are 2 types of digestion in the intestine:

the cavity is due to enzymes secreted digestive glands intestinal wall (amylase, lipase, trypsin) and pancreas (amylase, lipase, trypsin):
- amylase decomposes starch to glucose;
- lipase breaks down fats to glycerol and fatty acids;
- trypsin breaks down proteins into amino acids.
parietal (membrane) digestion is due to larger and more effective enzymes attached to the membrane of the epithelium.

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 device

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, and the intestine, which consists of the small and large intestine. Also, the digestive system includes auxiliary organs (liver and gallbladder, salivary glands and others).

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

Processes in the small intestine

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

Under the action of enzymes and bile, as well as intestinal juice, digested products are broken down and absorbed through the smallest villi into circulatory system... The action of enzymes in 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 cavity digestion 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 the final breakdown of nutrient complex substances into simple ones is carried out with the help of enzymes.

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

How does digestion work in the small intestine?

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

Digestion in the small intestine

The inner walls of the duodenum are inherently 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 are. carbohydrates under the influence of digestive juices, enzymes are broken down in such a way that the body can easily assimilate them. In the duodenum, first of all, the pancreatic duct, also the bile duct, opens. So, the food here is influenced by:

Digestion types in the small intestine

Small intestine absorption

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

Three points affecting 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 with the general process of digestion of this department.

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).

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

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

3. Bile

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

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

Possible diseases

As mentioned earlier, problems with the small intestine can lead to dire consequences - the body will receive less 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 treatment as soon as possible. So, possible diseases of the small intestine:

Chronic inflammation. It can occur after a severe infection due to a decrease in the amount of enzymes produced. In this case, first of all, a strict diet is prescribed. Also, inflammation can develop after surgery as a result of the ingress of pathogenic bacteria or some kind of infection.
Allergy. It can manifest itself as a component of the general allergic reaction of the body to the action of an allergen, or it can be locally located. Pain in this case is a reaction to the ingress of an allergen. First of all, it is worth excluding its effect on the body.
Gluten enteropathy is a serious illness accompanied by a medical emergency. The disease consists in the inability of the body to fully process and assimilate proteins. As a result, there is a strong intoxication of the body with unprocessed food particles. Throughout his life, the patient will have to follow a strict diet, completely excluding grains and other foods containing gluten from the diet.

The causes of diseases of the small intestine

smoking, alcohol abuse;
unhealthy diet (too much food consumed, abuse of fatty, smoked, salty and spicy foods);
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 likelihood of soon forgetting about the problem without any consequences for the body.

Signs of intestinal obstruction and what to do about it

Causes of intestinal obstruction

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

Fecal stones - are formed inside the large intestine with prolonged stagnation and compaction of feces. As a rule, in old age.
Tangles of worms (more often - elongated types of helminths, for example - ascaris). Tangles of worms can form in other human cavities - for example, in blood vessels or the heart.
Hair clumps - enter the esophagus through the mouth with the addiction of chewing or sucking hair. Over time, they accumulate and form tangles of various sizes.
Foreign bodies - enter the intestines through the mouth, esophagus and stomach. In 60% of cases in children, pathology occurs precisely for this reason. Ingestion of foreign objects can form obstruction of any part of the digestive tract (esophagus, thin or thick sections). Localization of the process in the intestinal cavity is determined by weakened intestinal motility. Weak movement of fecal masses is formed with excessively high-calorie and fatty foods, insufficient mobility, and also while taking certain medications. Thus, bowel obstruction in a child after swallowing foreign body may be the result of slow movement of feces.
Tumors of adjacent organs - compress the intestines inside the abdominal cavity.

The listed reasons for obstruction are called obstructive. Besides them, there are strangulation reasons. These are physiological changes in the location of the intestine, in which acute intestinal obstruction is formed.

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

Dynamic bowel 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 intestinal muscles), then the movement of feces can be normalized with an antispasmodic.

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

Signs and symptoms of bowel obstruction

Signs of intestinal 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 the physical body (stone, ball), then the pains are paroxysmal, then appear, then disappear. If there is a volvulus of the intestinal loop, the pain will be present constantly, but it will change its intensity (the pain is stronger, then weaker). The localization of pain corresponds to the place of formation of the obstruction. At the same time, over time, the pain will intensify, every hour it will get worse.
Vomiting is possible already in the first early period if an obstacle has formed at the beginning of the small intestine.
Stool cessation and gas formation (occurs at the beginning of the pathology - if an obstacle has formed in the lower parts 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 abdomen visible to the naked eye.
Severe and frequent vomiting - is formed due to the constant flow of toxins that flows from the stagnation zone into the bloodstream, and then into the liver.
Stool termination (if the obstacle is located in the upper intestine, then the urge to defecate does not stop immediately, but only in the middle period). A blockage in the upper part is called an obstruction of the small intestine. It is in the thin section that the 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 attachment bacterial infection... Against the background of stagnation of feces, the protective function of the mucous membrane of the intestinal wall decreases. Pathogenic bacteria get inside, causing widespread inflammation, followed by a rise in temperature. A blood test at this moment shows a large number of leukocytes (more than 10 million units).
The urge to go to the toilet stops a little, urine ceases to be produced due to general dehydration of the body. The tongue becomes dry, the pressure decreases - which are also signs of dehydration.
The rate of respiration and heart rate increases (due to a decrease in pressure).
Signs of damage (inflammation) of the peritoneum (the medical name for inflammation is peritonitis) is 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:

In the impassable part of the intestine, waste products accumulate - feces.
Stool stagnation becomes a source of toxins. They penetrate the wall into the bloodstream and are carried throughout the body.
Severe intoxication occurs (general poisoning of the body - sepsis, peritonitis). It is accompanied by symptoms traditional for poisoning - nausea, vomiting, headache, weakness.
The bowel walls in the bend zone are deprived of normal blood supply. When the blood flow is completely blocked, they die off quickly, in a few minutes. With partial overlap, toxins from their own vital activity accumulate in the cells. As a result, inflammation, edema, pain are formed.
With necrosis or inflammation of the intestinal wall, the absorption process stops. Toxins stop entering the bloodstream. But along with this, nutrients and water cease to enter the blood. Water restriction and vomiting lead to general dehydration.

The processes described above are fatal within 24 hours 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 impaired in the opening of the intestinal wall (hernia). Or intestinal asthenia or intestinal spasm (obstruction) may form.

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

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

Vomiting after feeding.
No bowel movements and no meconium escaping within 24 hours of birth.

What does partial obstruction mean?

Partial intestinal obstruction occurs when the intestinal lumen is incompletely blocked. In this case, part of the feces can move towards the exit.

Partial blockages are caused by tumors and adhesions. They narrow the intestinal lumen, and over time, they can block it completely.

The symptoms in this case are as follows:

Pain (not as severe as with complete obstruction).
Nausea, vomiting is possible.
Abdominal distention (not as severe as when the intestines are completely blocked).

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

What to do with intestinal obstruction

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

Conservative treatment and gold 6 hours

The first 6 hours of the development of pathology 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 a spasm of the intestinal walls, antispasmodics are needed to facilitate the movement of feces.
Colonoscopy is a sounding of the colon through anus probe (endoscope). The use of a colonoscopy in some cases allows you to break through an 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 patient's fault, sometimes the doctor does not understand the process and mistakenly sends the sick woman to the gynecological department). Surgery is required to treat and save the patient's life.

When surgical treatment is required

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

If the cause is a hernia, the intestine is adjusted, 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). They do the same with volvulus - the loop is straightened and the condition of the intestinal wall is assessed. If there is no tissue necrosis, the intestine is not cut.

In the presence of a foreign body, the intestine must be opened in order to remove the existing clot, lump or stone. In parallel with the surgical intervention, a person is injected with antibiotics (if the infection process was present), anti-inflammatory drugs.

The need for diet and nutritional control

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

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

What diet is prescribed for intestinal obstruction?

Fractional meals - up to 8 times a day, in small portions.
All food is ground into a liquid gruel and consumed warm (it is better to abstain from hot and cold food).
What you can: jelly, slimy broths, jelly, juices, low-fat broths (from poultry), grated oatmeal, curd soufflé, sour milk. Later (after a few days) steam meatballs, various mashed cereals, and an omelet are added.
Caloric 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. Also, salt intake is limited to a minimum.

Intestinal obstruction is a dangerous pathology. The possibility of her successful treatment is determined by the time when the patient was taken to the doctor. Medical statistics confirm the fact that operating within the first 6 hours of a blockage almost always leads to recovery. Operation in the late period (one day after the onset of the first symptoms) - has 25% of deaths. Therefore, at the slightest suspicion of obstruction (bloating, absence of stool, pain), immediately consult a doctor.

Small intestine

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

Structure

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

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

2. The jejunum. Located in the middle of the abdominal cavity. Its hinges lie very loosely, covered with peritoneum on all sides. This intestine got its name due to the fact that during autopsy of corpses, pathologists almost always find it empty;

3. The ileum - located in the lower part of the abdominal cavity. It differs from other parts 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 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 the small intestine is at least 16.5 square meters.

Small intestine functions

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 consists in the breakdown of nutrients and their further absorption. Thanks to this, only indigestible and indigestible foods enter the colon.
Endocrine function. In the walls of the small intestine there are special cells that produce peptide hormones, which not only regulate intestinal function, but also affect other internal organs of the human body. Most of these cells are located in the duodenum;
Motor function. Due to the longitudinal and circular muscles, wave-like contractions of the walls of the small intestine occur, pushing the chyme forward.

Diseases of the small intestine

All diseases of the small intestine have similar symptoms and are manifested by abdominal pain, flatulence, rumbling, diarrhea. Stool is plentiful several times a day, with remnants of undigested food and a lot of 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 full treatment within a few days, ends with a full recovery. With long-term chronic enteritis with frequent exacerbations, patients develop extraintestinal symptoms of the disease due to impaired absorption of the small intestine. They complain about losing weight and general weakness, they often have anemia. Deficiency of B vitamins and folic acid leads to cracks in the corners of the mouth (seizures), stomatitis, glossitis. Insufficient intake of vitamin A in the body is the cause of dry cornea and impaired twilight vision. Disorders of calcium absorption can cause the development of osteoporosis and pathological fractures arising on its background.

Small intestine rupture

Among all organs of the abdominal cavity, the small intestine is most susceptible to traumatic injury. This is due to the insecurity and considerable 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 injury to the small intestine is a direct and sufficiently strong blow to the abdomen, leading to the pressing of the intestinal loops against the pelvic bones or spine and damage to their walls.

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

The only treatment for a ruptured small intestine is emergency surgery. In the course of surgery, bleeding is stopped (hemostasis), the source of intestinal contents entering the abdominal cavity is eliminated, normal intestinal permeability is restored and the abdominal cavity is thoroughly sanitized.

The earlier from the moment of injury to the small intestine, the operation is performed, the more chances for the victim to recover.

Biology and medicine

Small intestine functions

Due to the movements of the small intestine, the acidic chyme coming from the stomach is mixed with 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 the destroyed desquamated epithelial cells of the intestinal mucosa. As a result of the continuous regeneration process, the cells are regenerated. In the small intestine, the chemical processing of food and the absorption of products, as well as mechanical stirring and movement of it in the direction of the large intestine, continue. Endocrine cells produce various hormones and biologically active substances. In humans, the absorption surface of the small intestine, due to the presence of folds of the mucous membrane, villi and microvilli of intestinal epithelium 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. In this case, in the intestinal cavity under the influence of enzymes of intestinal and pancreatic juices, bile, only the breakdown of nutrient molecules into separate fragments occurs. The final cleavage occurs due to membrane digestion, which takes place on the surface of the microvilli cells of the intestinal epithelium. They contain a large number of active enzymes involved in the breakdown and absorption of food. A.M. Ugolev (1967) discovered parietal digestion, which, in contrast to cavity digestion, which occurs in the intestinal lumen, occurs on the surface of microvilli. The latter produce a number of their own digestive enzymes, adsorb on their surface some enzymes from the intestinal lumen and food substances, which are most intensively broken down and absorbed. As a result of the breakdown of proteins, amino acids are formed, fats - glycerin and fatty acids, carbohydrates - monosaccharides. During the breakdown of nutrients, many of their properties, including harmful ones, are lost. This prevents foreign protein from entering the body.

Rhythmic contraction of the villi promotes the absorption of substances, which is carried out in the direction from outer surface epithelial cells (facing into the lumen of the intestine) to the inner (facing the blood and lymphatic capillaries). Amino acids and monosaccharides are absorbed into the bloodstream; 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 digestion height of 00 ml / min. At the beginning of the XX century I.P. Pavlov showed that in each section of the digestive system, various enzymes are produced that are involved in the breakdown of proteins, fats and carbohydrates. He studied their interaction and regulation of excretion, the joint activity of the digestive organs and the influence of one department on another. In 1904, Pavlov was awarded the Nobel Prize in Physiology or Medicine for his work on the physiology of digestion, thanks to which a clearer understanding of the vital aspects of this issue was formed.

What processes take place in the small intestine?

Answers and explanations

Digestion processes take place in three stages:

1) cavity digestion: proteins are broken down to amino acids, carbohydrates - to glucose, fats - to fatty acids and glycerin;

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 glycerin into the lymph and then into the blood.

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

Goblet cells - produce parietal mucus and bactericidal substances.

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

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

Volvulus

Acute surgical pathology of the peritoneum, which consists in twisting any part of the intestine or part of it around the mesentery or its axis. At the same time, the lumen of the intestine is blocked, the mesenteric nerves and vessels are squeezed, a mechanical obstacle arises in the digestive tract.

Signs of volvulus should not only cause alertness, but make them 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

In general, males are twice as likely to be affected by this disease as females, although women are ahead of men in terms of the prevalence of volvulus of the cecum.

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

Twisting of the colon is most common, among them 80% of the twisting in the sigmoid region; 15% - in the cecum; 3% - in the transverse colonic; 2% - in the area of the splenic flexure.

Average age of patients with pathology sigmoid colon- 60 years old, the probability of this pathology grows by old age.

Caecal volvulus occurs in the younger population (mean age 50). The average age of cases in some countries, for example, India, where the majority are vegetarians, is even less - 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 one-twentieth share of all patients with obstruction; among them, volvulus of the large intestine is a tenth of the total number of obstruction of this localization.

The regions of the "volvulus belt", where volvulus 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 gestation is its volvulus. Presumably, the rapidly growing uterus displaces this colon, causing the colon to twist. The vast majority of bloat in expectant mothers (3/4) is observed in the last three months of gestation.

Causes of volvulus

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

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

But volvulus from persimmon is quite likely. Persimmons, containing an abundance of tannin, cannot be digested by the children's stomach, they get stuck in a large lump, which the intestines cannot move to the exit. This can cause intussusception - a part of one intestine being pulled into the other. Of course, for this you need to eat more than one fruit or its half. Volvulus in children can be caused not only by persimmons, but also by excessive absorption of tangerines, bananas and food unsuitable for the child (smoked meats, herring, etc.).

The causes of intestinal volvulus often lie in the anatomical features of the structure 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 absence of intestinal motility, congenital diaphragmatic hernia, less often, but can lead to volvulus in infants. Early bottle-feeding can cause this condition. Cases of intussusception in infants - tightening of a part of the narrowed intestine into the normal lumen, leading to obstruction, in pediatric practice Not unusual.

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 blocked by meconium, which has an abnormal density.

In patients over a year old, 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 the contents of the lump, which has been confused, then every movement of its muscles leads to twisting of the bowel bends.

Risk factors

Exit from a prolonged fasting regime, accompanied by overeating, which activates intestinal motility and can provoke bloat.
Systematic overeating (especially at night) causes excessive filling of the bowel curves, while simultaneously activating its motility, which can lead to volvulus of one or more intestinal loops.
A sharp increase in pressure inside the peritoneum, even insignificant, due to trauma, unusually hard physical labor, loads with weak muscles of the press can cause dislocation of the intestines and provoke this pathology.
Cicatricial and adhesive changes connective tissue abdominal cavity resulting from surgery and inflammation.
A diet that includes mostly coarse, raw, high-fiber food, which activates intestinal peristalsis.
Frequent, so-called, food poisoning, i.e. infection with pathogens, accompanied by dyspeptic manifestations.
Constipation (constipation) is a provoking factor of volvulus of the sigmoid colon, mainly, it happens in elderly people.
Mesosigmoiditis, which can result in mesenteric deformity and volvulus of the sigmoid colon
A foreign body can close the intestinal lumen (obstruction), and a neoplasm, pregnancy can squeeze it from the outside (strangulation), which will lead to twisting.
Poisoning, taking potent medications (suppressing intestinal motility, laxatives), some diseases of the central nervous system cause spasms or paralysis of the intestinal muscles.
Massive helminthic invasion also sometimes causes volvulus.

Basically, twisting of the small intestine is caused by malformations, cicatricial and adhesive changes in 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, surgical manipulations in the intestines. The vast majority of volvulus of the large intestine occurs in the sigmoid region.

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

Pathogenesis

Regardless of the root cause, the development of pathology occurs as follows - the intestine turns, sometimes and repeatedly, and its lumen is completely blocked, the contents of the intestine stop, the nerves and mesenteric vessels are compressed, 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 bowel loops, the first signs of the disease appear - an acute pain that instantly struck, 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 knock on the swollen part of the abdomen, it will sound like a drum roll.

Accompanying symptoms are 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 one can hear sounds similar to the splash of water.

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

The types of bloat are classified according to the levels where it occurs:

small intestine;
cecum;
sigmoid colon;
transverse colon.

Normally, the angle of rotation of the bends of the small intestine is up to 90º. Rotation by an angle greater than 180º causes clinical symptoms, this movement may involve one or more folds of the small intestine. The cecum is nearby, therefore, signs of volvulus will look similar.

Small (cecum) volvulus characterized by the following clinic:

The onset of severe pain during volvulus is determined by the cessation of blood supply to this area of the intestine. Acute pain, persistent, continuous, stitching or cutting, felt in the upper abdomen. It is constantly increasing, becoming unbearable.

With this type of volvulus, patients show anxiety, agitation, sometimes screaming in pain. They usually pull the knees up to the chest, but this does not relieve the pain.

In front of the site of twisting, an accumulation of intestinal contents is formed, which provokes obstruction of the intestinal loops, activates its peristalsis, visible visually, 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 cecum are twisted, then asymmetric swelling is observed in the navel area due to the accumulation of fecal masses above the level of volvulus.

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

Constipation and the accumulation of gases that cannot find a way out begins later, since the motility of the large intestine is still normal, feces and gases continue to be released. If you immediately consult a doctor with suspicion of volvulus of the small intestine, this stage can be bypassed, but in the case of a long time, the excretion of feces and gases may stop.

Violated general state- signs of dehydration, weakness, dizziness, fainting appear. The symptoms of intoxication of the body are increasing - muscle pain, tachycardia, pallor, high fever, perspiration on the forehead.

Colon volvulus 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.

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 mainly due to painful irritation. Vomiting of feces begins later, with the development of peritonitis.

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

The abdomen is noticeably swollen and asymmetrical. The upper sections on the right side of the abdomen are enlarged - the sigmoid colon 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 chest, squeezing the lungs and upsetting the respiratory process, disrupting the work of 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 by the angle of bowel rotation: partial volvulus (up to 270 °), complete (°), if the bowel is twisted several times - repeated. Typically, the bowel curves are twisted in a clockwise direction.

Congenital volvulus manifests itself in the first hours of a child's life. The first symptoms are pain syndrome (the baby is restless, is capricious all the time, crying), vomiting, hypotension, abdominal asymmetry, decreased intestinal motility. Gas discharge is impaired, meconium may escape, but normal feces are not observed, mucus is released from the anus (full volvulus), or stool leaves in small portions, the volume of which becomes less and less (partial).

Volvulus in children manifested by high fever, acute abdominal pain, vomiting, blood or mucus in the feces. The child eats and sleeps poorly, often cries, is capricious, draws his legs to his stomach. Attacks come and go unexpectedly; in the intervals between us, the child can vomit twice. Intense gas formation occurs, after a while constipation begins, and gases cease to escape. When viewed from a child, a seal in the lower abdomen is noticeable.

Fetal volvulus is difficult to diagnose; it is treated after the baby is born. This pathology is often accompanied by polyhydramnios in the mother and other malformations, for example, Down's disease.

Complications and consequences

If the patient does 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. The patient may feel that there is no need to worry anymore. This misconception can be fatal.

With volvulus, the blood supply to the twisted part of the intestinal wall and its innervation completely cease. According to numerous evidences of medical research, the further quality of life of the patient, and often the 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-twisting 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 comatose). If the body is deprived of about a fifth of the water, death is possible.

The intestinal wall, deprived of blood supply, loses its strength, breaks through, and the accumulated contents poured into the peritoneum and causes its 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 bowel bends, which can provoke a recurrence of any form of obstruction of the digestive tract.

Diagnosis of volvulus

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

There are no laboratory tests to confirm or disprove the diagnosis of volvulus. However, some tests are done to identify 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: excess of the norm in the number of leukocytes and erythrocyte sedimentation rate; a decrease in the norm of the number of erythrocytes and the content of hemoglobin. 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.

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

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

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

On the most common X-ray, obstruction of bowel loops and the presence of obstruction are visible, and an X-ray with a barium enema determines the typical localization of volvulus, oral administration of barium suspension before X-ray is used to confirm the twisting of the small intestine (in particular, in pediatrics).

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

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

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

Regardless of the term, applies ultrasonography, it can reveal obstructive changes, fluid in the peritoneum, etc.

What should be examined?

Differential diagnosis

Differential diagnosis is carried out on the basis of medical history, laboratory and instrumental examinations. The volvulus 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 cecum has to be differentiated from appendicitis, ruptured ovarian cysts, other obstructions, and infections of the genitourinary organs.

Visual inspection data are of decisive importance in differentiation.

Who to contact?

Treatment of volvulus

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

Until the ambulance team arrives, it is necessary to comfortably accommodate the patient. Do not feed or drink as bowel movements can worsen twisting and induce vomiting. Do not give any medicines in any way, they can change clinical picture and make it difficult to diagnose. Do not rinse the stomach, do not give an enema, do not warm the stomach.

Hospitalization and surgical treatment- the only thing that allows you to save the life of the patient.

An exception is uncomplicated volvulus of the sigmoid colon. The ability to straighten 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 pumping a barium solution to the site of volvulus through the rectal colon. Arises high blood pressure and bloat unfolding may occur. If unwinding does not occur, surgical intervention is used.

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

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

Through the incision, the intestinal loops are unwound 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 over. The abdominal cavity is washed with antiseptics, a drainage tube is installed and sutured

If complications are detected, the volume of the operation increases: the dead loops are removed, an anastomosis is applied, or, in case of peritonitis, the ends of the intestine are brought to the surface of the abdominal wall (ileostomy), which allows the patient to adjust the nutritional process when the intestines are disconnected and continue anti-inflammatory treatment. When the condition is normalized, 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 volvulus of the patient, a long rehabilitation awaits; during this period, some restrictions must be observed. Reconstructive postoperative measures consist of bed rest, pain relief, postoperative wound treatment, physiotherapy procedures, breathing exercises, and dietary nutrition.

Postoperative patients must adhere to strict bed rest to avoid suture divergence. 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 walk for a short time in the ward and in the corridor. Light physical activity after surgery improves blood circulation, precedes pressure sores and reduces the risk of blood clots.

An important point in the rehabilitation process is effective pain relief.

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

At the very beginning after the operation, drugs are used that effectively relieve severe pain, such as 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 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, and respiratory depression. Long-term use causes drug addiction.

Contraindicated in respiratory dysfunction, dystrophy, elderly patients.

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

Ketorolac- an active analgesic, relieves fever, swelling and inflammation. Inhibitor of prostaglandin production. Prevents blood clots. It is indicated for postoperative pain.

Can be combined with narcotic pain relievers. 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.

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

Drotaverinum- an active antispasmodic that has a relaxing effect on the smooth muscles of the gastrointestinal tract and blood vessels... Has an analgesic effect, dilating blood vessels and contributing to their saturation with oxygen.

Drotaverine hydrochloride crosses 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 undesirable phenomena 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%), examined and again several layers of gauze soaked in an antiseptic are applied and secured with a sterile bandage.

Betadine is a complex antiseptic, which is a combination of iodine with polyvinylpyrrolidone. Contact with the skin 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. Has a bactericidal, fungicidal effect, destroys viruses and protozoa. Acts longer than products containing inorganic iodine, practically does not irritate the treated surface. It has an effect until the color disappears from the skin surface. Contraindicated in case of 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 medicines which contain mercury.

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

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

Diet food

Several days immediately after the elimination of volvulus with ectomy of a 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.

Natural nutrition begins with a zero diet, the goal of which is to provide the body with a minimum of essential nutrients, while simultaneously preventing the active contraction of intestinal smooth muscles and gas formation, which negatively affects tissue healing in the operated area.

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

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

Then diet number 1a, which involves eating six times a day, everything - 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; steamed fish of low-fat varieties in the form of a soufflé; jelly, jelly, not strong tea, fresh 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, when you are discharged from the hospital, diet No. 1 is prescribed. There are fewer and fewer restrictions - the food temperature is warm or room temperature, products that activate the secretion of gastric juice and intestinal peristalsis are not recommended. Allowed the use of lactic acid products, crackers, low-fat cookies, yesterday's bread. The first and second courses are boiled and steam, their ingredients are crushed.

The transition to a normal lifestyle takes about one and a half months.

Alternative medicine

Volvulus should not be attempted at home. The use of traditional medicine or homeopathic medicines will not solve the problem, but will only aggravate it. But as a prevention of volvulus, in the recovery period folk treatment and homeopathy can help. However, before considering alternative treatments, you should seek the advice of your healthcare professional.

Volvulus can be provoked by various reasons. For some of them, for example, congenital pathologies, recipes of traditional medicine are unlikely to work. Most others are amenable to adjustment.

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

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

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

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

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

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

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

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

It helps very well with overeating calamus root, eat half a teaspoon of crushed calamus root and wash down with water.

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

Consequences food poisoning can be leveled by accepting infusion of chicory: Boil 25g of crushed dry raw materials with a glass of boiling water, wrap and leave overnight. Drink three to four doses a day before meals for half an hour. It is necessary to drink the infusion of chicory, after clearing the stomach, for which they drink three glasses of salted water. You can clear your stomach several times.

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

Homeopathy also applies to conservative methods treatment, therefore, eliminate this problem homeopathic remedies unacceptable.

There are many drugs available to prevent bloat and fight chronic constipation and inflammatory bowel disease, 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 dry mucous membranes of the anal passage, rectum, the same sensations in the mouth, strong thirst, on the tongue - plaque, there is no urge to defecate; bloating; can be used by pregnant women;

Hydrastis (Hydrastis) - chronic constipation in patients who have been taking laxatives for a long time; pregnant women who want to eat meat, not vegetable dishes;

Natrium muriaticum (Natrium muriaticum) - cracks, ruptures of the anus with bleeding; stitching after stool; overdried mucous membranes; all this causes anger in the patient; paresthesia of the rectal part of the intestine; constipation in patients with displacement internal organs small pelvis; sick sweats, very weak, like salty.

Homeopathic remedies should be prescribed by a homeopathic doctor who will study the patient's history, lifestyle, habits and addictions. All this is taken into account when prescribing, and self-medication, even with homeopathic preparations used in negligible doses, is unsafe.

Prophylaxis

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

Prevention of this disease consists, first of all, in adherence to the diet. Prolonged fasting with excess satiety afterwards, eating large amounts of food vegetable origin increases the risk of bowel twisting.

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

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 normalizes intestinal motility and contributes to a more rapid release of the body from feces.

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

Treat acute inflammatory processes organs of the peritoneum and intestinal infections which can lead to the development of adhesions and other complications.

Forecast

The prognosis of volvulus directly depends on the speed of seeking medical help. With timely treatment, it is favorable, and wasting time can be fatal.

Medical Expert Editor

Alexey Portnov

Education: Kiev National Medical University. A.A. Bogomolets, specialty - "General Medicine"

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Processes occur in the human small intestine

The Human Small Intestine: Anatomy, Function, and Digestion of Food

In the anatomy of the digestive system, 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 food 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 (absorption).

What is the small intestine?

Vitamin B12 is absorbed in the small intestine.

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

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

In the small intestine, the duodenum, the jejunum and the ileum are isolated. The duodenum is the first segment of the small intestine located between the stomach and the jejunum.

The mucous membrane of the jejunum on the inner surface is covered with microvilli that absorb nutrients, carbohydrates, amino acids, sugar, fatty acids, electrolytes and water. The surface of the jejunum is enlarged by 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 function of the small intestine is somewhat different from that of the stomach. In the stomach, food is crushed, grinded and decomposed primarily.

In the small intestine, substrates are decomposed to constituent parts and absorbed for transport to all parts of the body.

Small intestine anatomy

The small intestine is in contact with the pancreas.

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

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

The walls of the small intestine are composed of four layers: mucosa, submucosa, muscular and adventitious membranes.

Functional relevance

The small intestine is divided into several sections.

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, chopping, whipping and mixing - all of which takes place in the mouth and stomach. The second part of food digestion involves chemical processing of substrates, which uses enzymes, bile acids, and other substances.

Read: Small intestine: length and role in the digestion process

Digestion support

In the small intestine, proteins are decomposed and fats are digested.

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

Decomposition of proteins. Proteins, peptides and amino acids are acted upon by special enzymes, including trypsin, chymotrypsin, and intestinal wall enzymes. These substances break down proteins into small peptides. The process of digesting proteins begins in the stomach and ends in the small intestine.
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 are divided into small drops available for the action of enzymes.
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, promoting the decomposition of substances into monosaccharides. Some carbohydrates are not completely absorbed in the small intestine and travel to the large intestine where they become food for intestinal bacteria.

Absorption of food in the small intestine

Decomposed to small components, nutrients are absorbed by the mucous membrane of the small intestine and transferred to 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 absorption method.

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

Read: Small intestine: length and role in the digestion process

Watch in the video about the anatomy of the small intestine:

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

Digestion in the small intestine

intestinal juice;
pancreatic juice;
bile.

Digestion types in the small intestine

Small intestine absorption

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

Three points affecting 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 with the general process of digestion of this department.

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).

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

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

3. Bile

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

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

Possible diseases

Chronic inflammation. It can occur after a severe infection due to a decrease in the amount of enzymes produced. In this case, first of all, a strict diet is prescribed. Also, inflammation can develop after surgery as a result of the ingress of pathogenic bacteria or some kind of infection.
Allergy. It can manifest itself as a component of the general allergic reaction of the body to the action of an allergen, or it can be locally located. Pain in this case is a reaction to the ingress of an allergen. First of all, it is worth excluding its effect on the body.
Gluten enteropathy is a serious illness accompanied by a medical emergency. The disease consists in the inability of the body to fully process and assimilate proteins. As a result, there is a strong intoxication of the body with unprocessed food particles. Throughout his life, the patient will have to follow a strict diet, completely excluding grains and other foods containing gluten from the diet.

The causes of diseases of the small intestine

smoking, alcohol abuse;
unhealthy diet (too much food consumed, abuse of fatty, smoked, salty and spicy foods);
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 likelihood of soon forgetting about the problem without any consequences for the body.

ozdravin.ru

Digestion process in the human body: by time

Nutrition is complex process, as a result of which substances necessary for the body are received, digested and absorbed. For the last ten years, a special science devoted to nutrition has been actively developing - nutritiology. In this article, we will look at the process of digestion in the human body, how long it takes and how it does without the gallbladder.

The structure of the digestive system

The digestive system is represented by a set of organs that ensure the assimilation of nutrients by the body, which are a source of energy for it, which is necessary for cell renewal and for growth.

The digestive system consists of: the mouth, pharynx, esophagus, stomach, small, large and rectum.

Digestion in the human oral cavity

The digestion process in the mouth consists in grinding food. In this process, there is a vigorous processing of food with saliva, the interaction between microorganisms and enzymes. After saliva treatment, some of the substances dissolve and their taste is manifested. The physiological process of digestion in the oral cavity consists in the breakdown of starch into sugars by the amylase enzyme contained in saliva.

Let's follow the action of amylase using an example: while chewing bread for a minute, you can feel a sweet taste. The breakdown of proteins and fats in the mouth does not occur. On average, the process of digestion in the human body takes about 15-20 seconds in time.

Digestion department - stomach

The stomach is the widest part of the digestive tract, has the ability to grow in size, and can hold a huge amount of food. As a result of the rhythmic contraction of the muscles of its walls, the process of digestion in the human body begins with thorough mixing of food with gastric juice, which has an acidic environment.

A lump of food that has entered the stomach is in it for 3-5 hours, undergoing mechanical and chemical processing during this time. Digestion in the stomach begins with the exposure of food to gastric juices and of hydrochloric acid, which is present in it, as well as pepsin.

As a result of digestion in the human stomach, proteins are digested with the help of enzymes to low molecular weight peptides and amino acids. The digestion of carbohydrates in the stomach that begins in the mouth stops, which is explained by the loss of their activity by amylases in an acidic environment.

Digestion in the stomach cavity

The digestion process in the human body occurs under the action of gastric juice containing lipase, which is capable of breaking down fats. In this case, great importance is given to the hydrochloric acid of gastric juice. Under the influence of hydrochloric acid, the activity of enzymes increases, denaturation and swelling of proteins is caused, and a bactericidal effect is exerted.

The physiology of digestion in the stomach is that food enriched with carbohydrates, which is in the stomach for about two hours, the evacuation process takes place faster than food containing proteins or fats, which lingers in the stomach for 8-10 hours.

In the small intestine, food that is mixed with gastric juice and partially digested, being in a liquid or semi-liquid consistency, passes through simultaneous intervals in small portions. In what department is the digestion process in the human body still going on?

Digestion department - small intestine

Digestion in the small intestine, into which a lump of food enters from the stomach, is assigned the most important place from the point of view of biochemistry of assimilation of substances.

In this section, the intestinal juice consists of an alkaline medium due to the arrival of bile, pancreatic juice and secretions from the intestinal walls into the small intestine. The digestive process in the small intestine is not fast for everyone. This is facilitated by the presence of an insufficient amount of the enzyme lactase, which hydrolyzes milk sugar associated with the indigestibility of whole milk. In the process of digestion in this part of a person, more than 20 enzymes are consumed, for example, peptidase, nuclease, amylase, lactase, sucrose, etc.

The activity of this process in the small intestine depends on three divisions passing into each other, of which it consists - the duodenum, the jejunum and the ileum. The bile formed in the liver enters the duodenum. Here food is digested thanks to the pancreatic juice and bile that act on it. Pancreatic juice, which is a colorless liquid, contains enzymes that promote the breakdown of proteins and polypeptides: trypsin, chymotrypsin, elastase, carboxypeptidase and aminopeptidase.

The role of the liver

An important role in the process of digestion in the human body (we will briefly mention this) is assigned to the liver, in which bile is formed. The peculiarity of the digestive process in the small intestine is due to the assistance of bile in emulsifying fats, absorbing triglycerides, activating lipase, also helps to stimulate peristalsis, inactivate pepsin in the duodenum, has a bactericidal and bacteriostatic effect, increases hydrolysis and absorption of proteins and carbohydrates.

Bile does not consist of digestive enzymes, but is important in the dissolution and absorption of fats and fat-soluble vitamins. If bile is not produced enough or is secreted into the intestines, then there is a violation of the processes of digestion and absorption of fats, as well as an increase in their excretion in its original form with feces.

What happens in the absence of a gallbladder?

A person is left without a so-called small sac, in which bile was previously deposited "in reserve".

Bile is necessary in the duodenum only if there is food in it. And this is not a permanent process, only in the period after a meal. After some time, the duodenum is emptied. Accordingly, the need for bile disappears.

However, the liver does not stop working there, it continues to produce bile. It is for this that nature created the gallbladder, so that the bile secreted in the intervals between meals does not deteriorate and is stored until the need for it appears.

And then the question arises about the absence of this "storehouse of bile". As it turns out, a person can do without a gallbladder. If you do the operation on time and do not provoke other diseases associated with the digestive organs, then the absence of the gallbladder in the body is easily tolerated. The time of the digestion process in the human body is of interest to many.

After surgery, bile can only be stored in bile ducts... After the production of bile by the liver cells, it is released into the ducts, from where it is easily and continuously sent to the duodenum. Moreover, this does not depend on whether the food is accepted or not. It follows that after the gallbladder is removed, food must be taken frequently and in small portions for the first time. This is because there is not enough bile to process large portions of the bile. After all, there is no more place for its accumulation, but it enters the intestine continuously, albeit in small quantities.

Often, the body takes time to learn to function without the gallbladder, to find the necessary place to store bile. This is how the digestion process goes in the human body without the gallbladder.

Digestion department - large intestine

The remnants of undigested food move into the large intestine and are in it for about 10 to 15 hours. Here the following digestive processes take place in the intestine: absorption of water and microbial metabolism of nutrients.

In digestion, which occurs in the large intestine, the ballast substances of food play a huge role, which include indigestible biochemical components: fiber, hemicellulose, lignin, gums, resins, waxes.

The structure of food affects the rate of absorption in the small intestine and the time of movement through the gastrointestinal tract.

Part of dietary fiber that is not broken down by enzymes belonging to the gastrointestinal tract is destroyed by the microflora.

The large intestine is the site of the formation of feces, which include: undigested food debris, mucus, dead cells of the mucous membrane and microbes that continuously multiply in the intestine, and which cause fermentation and gas formation. How long does the digestion process in the human body take? This is a common question.

Splitting and absorption of substances

The absorption of nutrients occurs throughout the hairy digestive tract. There are about 30-40 villi per 1 square millimeter of mucosa.

For the process of absorption of substances that are soluble in fats, or rather fat-soluble vitamins, to take place, fats and bile must be present in the intestines.

The absorption of water-soluble products such as amino acids, monosaccharides, mineral ions takes place with the participation of blood capillaries.

In a healthy person, the entire digestion process takes from 24 to 36 hours.

This is how long the digestion process in the human body takes.

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Digestion in the human small intestine

The role of the small intestine in digestion is very important and, one might say, is the final stage in the hydrolysis of food to the final substances that our body needs.

Overview of the Human Small Intestine

The main stages of digestion are enclosed in the small intestine, which is the longest organ, with a suction surface area of almost 200 square meters. It is in this part gastrointestinal tract most nutrients are absorbed, as well as poisons, toxins, drugs, and xenobiotics that enter the body orally. In addition to digestion, absorption and transportation of all these substances, hormone secretion and immune defense functions are performed in the small intestine.

The small intestine includes 3 sections:

duodenum;
jejunum;
ileum.

However, there is no pronounced border between the last two sections.

All parts of the small intestine are layered and have 4 membranes:

mucous membrane;
submucosal;
muscular;
serous.

How does digestion work in the small intestine?

Food from the stomach enters the duodenum, where it is exposed to bile, as well as pancreatic enzymes and intestinal juices. Digestion in the small intestine of a person works to a greater extent on the absorption of nutrients, and therefore it is here that the final splitting of the eaten food takes place with the help of intestinal juice, which includes three groups of enzymes. At the same time, there are two types of digestion in the small intestine: cavity and parietal. In contrast to the strip digestion, parietal digestion in the small intestine carries about 80% of the final stages of hydrolysis and at the same time the absorption of substances used in food.

Enzymes produced by the glands of the small intestine can only break down short chains of peptides and sugars that get there as a result of the preliminary "work" with food of other organs. After the complete breakdown of food into glucose, vitamins, amino acids, fatty acids, minerals and others, an important process of their absorption into the blood takes place. Thus, the cells of the entire human body are saturated.

The cells of the epithelium of the small intestine also form a so-called mesh, through which only completely decomposed substances will be passed, and unchanged molecules of starch or protein, for example, cannot penetrate and are transported for further "processing".

(lat. jejunum) and the ileum (lat. ileum). The jejunum and the ileum do not have a clear boundary between themselves. Usually, the first 2/5 of the total length are allocated to the jejunum, and the remaining 3/5 are allocated to the ileum. In this case, the ileum has a larger diameter, its wall is thicker, it is richer in supply with vessels. in relation to the midline, the loops of the jejunum lie mainly on the left, the loops of the ileum on the right.

The small intestine is separated from the upper parts of the digestive tract by the pyloric valve acting as a valve and from the large intestine by the ileocecal valve.

The wall thickness of the small intestine is 2-3 mm, with contraction - 4-5 mm. The diameter of the small intestine is not uniform. In the proximal part of the small intestine, it is 4–6 cm, in the distal part, 2.5–3 cm. The small intestine is the longest part of the digestive tract, its length is 5–6 m. The mass of the small intestine of a “conventional person” (with body weight 70 kg) normal - 640 g.

The small intestine occupies almost the entire lower floor of the abdominal cavity and partially the pelvic cavity. The beginning and end of the small intestine are fixed by the mesentery root to the posterior wall of the abdominal cavity. The rest of the mesentery provides its mobility and position in the form of loops. On three sides they are bordered by the colon. Above - the transverse colon, on the right - the ascending colon, on the left - the descending colon. Intestinal loops in the abdominal cavity are located in several layers, the surface layer is in contact with the greater omentum and the anterior abdominal wall, deep adjacent to the posterior wall. The jejunum and ileum are covered on all sides by the peritoneum.

The wall of the small intestine consists of four membranes (often the submucosa is referred to as the mucous membrane and then the small intestine is said to have three membranes):

mucous membrane, subdivided into three layers:

epithelial
lamina of its own with indentations - Lieberkühn's glands (intestinal crypts)
muscle plate

submucosa formed by connective tissue, blood vessels and nerves; in the submucosa, on the side of the muscle layer, there is the Meissner nerve plexus
the muscular membrane, consisting of the inner circular (in which, despite the name, the muscle fibers run obliquely) and the outer longitudinal layers of smooth muscles; between the circular and longitudinal layers is the Auerbach nerve plexus
the serous membrane, which is a visceral layer of the peritoneum, consisting of dense connective tissue and covered from the outside with squamous epithelium.

The mucous membrane of the small intestine has a large number of circular folds, most clearly observed in the duodenum. The folds increase the absorption surface of the small intestine approximately threefold. In the mucous membrane, lymphoid formations are located in the form of lymphoid nodules. If in the duodenum and jejunum they are found only in a single form, then in the ileum they can form group lymphoid nodules - follicles. The total number of such follicles is approximately 20-30.

Small intestine functions

In the small intestine, the most important stages of digestion take place. A large number of digestive enzymes are produced in the lining of the small intestine. Partially digested food from the stomach, chyme, in the small intestine is exposed to the action of intestinal and pancreatic enzymes, as well as other components of intestinal and pancreatic juices, bile. In the small intestine, the main absorption of food digestion products into the blood and lymphatic capillaries takes place.

The small intestine also absorbs most of the orally administered drugs, poisons and toxins.

The residence time of the contents (chyme) in the small intestine is normally about 4 hours.

Functions of various parts of the small intestine (Sablin O.A. and others):

Endocrine cells and hormone levels in the small intestine

The small intestine is an essential part of the gastroenteropancreatic endocrine system. It produces a number of hormones that regulate the digestive and motor activity of the gastrointestinal tract. V proximal the small intestine has the largest set of endocrine cells among other organs of the gastrointestinal tract: I-cells producing cholecystokinin, S-cells - secretin, K-cells - glucose-dependent insulinotropic polypeptide (GIP), M-cells - motilin, D-cell and - somatostatin, G-cells - gastrin and others. The Lieberkun glands of the duodenum and jejunum contain the vast majority of all I-cells, S-cells and K-cells of the body. Some of these endocrine cells are also located in the proximal jejunum and even smaller in the distal jejunum and ileum. In addition, the distal ileum contains L-cells that produce the peptide hormones enteroglucagon (glucagon-like peptide-1) and the YY peptide.

		Small intestine
Hormone		duodenal	skinny	iliac
gastrin	gastrin content	1397 ± 192	190 ± 17	62 ± 15
gastrin	number of producer cells	11–30	1–10	0
secretin	secretin content	73 ± 7	32 ± 0.4	5 ± 0.5
secretin	number of producer cells	11–30	1–10	0
cholecysto- kinin	cholecystokinin content	26.5 ± 8	26 ± 5	3 ± 0.7
cholecysto- kinin	number of producer cells	11–30	1–10	0
pancreatic polypeptide (PP)	PP content	71 ± 8	0.8 ± 0.5	0.6 ± 0.4
pancreatic polypeptide (PP)	number of producer cells	11–30	0	0
ISU	GUI content	2.1 ± 0.3	62 ± 7	24 ± 3
ISU	number of producer cells	1–10	11–30	0
motilin	motilin content	165.7 ± 15.9	37.5 ± 2.8	0,1
motilin	number of producer cells	11–30	11–30	0
enteroglucagon (GLP-1)	content of GLP-1	10 ± 75	45.7 ± 9	220 ± 23
enteroglucagon (GLP-1)	number of producer cells	11–30	1–10	31
somatostatin	somatostatin content	210	11	40
somatostatin	number of producer cells	1–10	1–10	0
VIP	VIP content	106 ± 26	61 ± 17	78 ± 22
VIP	number of producer cells	11–30	1–17	1–10
neurotensin	neurotensin content	0.2 ± 0.1	20	16 ± 0.4
neurotensin	number of producer cells	0	1–10	31

Small intestine in children

The small intestine in children occupies an unstable position, which depends on the degree of its filling, body position, the tone of the intestines and muscles of the peritoneum. Compared with adults, it has a relatively large length, and the intestinal loops lie more compactly due to the relatively large liver and the underdevelopment of the small pelvis. After the first year of life, as the small pelvis develops, the location of the loops of the small intestine becomes more constant. In the small intestine infant contains relatively many gases, which gradually decrease in volume and disappear by the age of 7 years (in adults, there is normally no gas in the small intestine). To other features of the small intestine in infants and early age include: high permeability of the intestinal epithelium; poor development of the muscle layer and elastic fibers of the intestinal wall; tenderness of the mucous membrane and a high content of blood vessels in it; good development of villi and folds of the mucous membrane with insufficient secretory apparatus and incomplete development of nerve pathways. This contributes to the easy occurrence of functional disorders and favors the penetration into the blood of non-split food constituents, toxic-allergic substances and microorganisms. After 5-7 years, the histological structure of the mucous membrane no longer differs from its structure in adults (

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