外科学课件14、Small intestine disease.pptx

外科学课件14、Small intestine disease.pptx

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,Smallintestinedisease,DepartmentofgeneralsurgeryDr.YaxuWang,Chapter1AnatomyandPhysiology,Theprimaryroleofthesmallintestineisthedigestionandabsorptionofdietarycomponentsaftertheyleavethestomach.Exocrinesecretionsfromtheliverandpancreasenablecompletedigestionofthefoodstuffs.Theenlargedsurfaceareaofthesmallintestinalmucosathenabsorbsthesenutrients.,Chapter1AnatomyandPhysiology,Inadditiontoitsroleindigestionandabsorption,thesmallbowelisthelargestendocrineorganinthebodyandisoneofthemostimportantorgansofimmunefunction.Givenitsessentialroleandcomplexity,itisamazingthatdiseasesofthesmallbowelarenotmorefrequent.,Chapter1AnatomyandPhysiology,Inthischapter,thenormalanatomyandphysiologyofthesmallintestinearedescribed,aswellasdiseaseprocessesinvolvingthesmallbowel,whichinclude:

obstructioninflammatorydiseasesneoplasms,Chapter1AnatomyandPhysiology,Theentiresmallintestine,whichextendsf1r.oAmnatthoempyylorustothececum,measures300to550cm：

duodenallengthatabout20to35cmj2e.jPuhnyasliolelongythat100to110cmileallengthat150to160cm.,Chapter1AnatomyandPhysiology,1.AnatomyThereisnoobviouslineofdemarcationbetweenthejejunumandtheileum;however,thejejunumiscommonlyconsideredtomakeuptheproximaltwofifthsofthesmallintestine,andtheileummakesuptheremainingthreefifths.,1.1Neurovascular-LymphaticSupply,Thesmallintestineisservedbyrichvascular,neural,andlymphaticsupplies,alltraversingthroughthemesentery.肠系膜Thebaseofthemesenteryattachestotheposteriorabdominalwalltotheleftofthesecondlumbarvertebraandpassesobliquelytotherightandinferiorlytotherightsacroiliacjoint.右侧骶髂关节,Chapter1AnatomyandPhysiology,1.Anatomy,1.1Neurovascular-LymphaticSupply,Thebloodsupplyofthesmallbowel,exceptfortheproximalduodenumthatissuppliedbybranchesoftheceliacaxis,comesentirelyfromthesuperiormesentericartery.,Chapter1AnatomyandPhysiology,1.Anatomy,1.1Neurovascular-LymphaticSupply,Thebloodsupplyofthesmallbowel,exceptfortheproximalduodenumthatissuppliedbybranchesoftheceliacaxis,comesentirelyfromthesuperiormesentericartery.,Chapter1AnatomyandPhysiology,1.Anatomy,1.1Neurovascular-LymphaticSupply,Thesuperiormesentericarterycoursesanteriortotheuncinateprocessofthepancreasandthethirdportionoftheduodenum,whereitdividestosupplythepancreas,distalduodenum,entiresmallintestine,andascendingandtransversecolon.Venousdrainageofthesmallbowelparallelsthearterialsupply,withblooddrainingintothesuperiormesentericvein,whichjoinsthesplenicvein,thentothetheportalvein.Theinnervationofthesmallbowelisprovidedbybothparasympatheticandsympatheticdivisionsoftheautonomicnervoussystem,whichinturnprovidetheefferentnervestothesmallintestine.,Chapter1AnatomyandPhysiology,1.Anatomy,1.2MicroscopicAnatomy,Thesmallbowelwallconsistsoffourlayers:

Serosa浆膜muscularispropria肌层Submucosa粘膜下mucosa黏膜,Chapter1AnatomyandPhysiology,1.Anatomy,Chapter1AnatomyandPhysiology,DigestionandAbsorptionFunctionThecomplexprocessofdigestionandeventualabsorptionofnutrients,water,electrolytes,andmineralsisthemainroleofthesmallintestine.Thesmallbowelis,primar1ily.rAesnpoanstibolemforyabsorptionofthedietarycomponents（carbohydrates,proteins,andfats）,aswellasions,vitamins,andwater.EndocrineFunctionInfact,thesmallbowelisthelargestendocrineorganinthebody.ImmuneFunction,Thesmallintestineservesasamajorimmunologicbarrierinadditiontoitsimportant,rolein2di.gPeshtioynsanidoelnodgocryinefunction.Asaresultofconstantantigenicexposure,theintestinepossessesabundantlymphoidcells（i.e.,BandTlymphocytes）andmyeloidcells（macrophages,neutrophils,eosinophils,andmastcells）.Todealwiththeconstantbarrageofpotentialtoxinsandantigens,theguthasevolvedintoahighlyorganizedandefficientmechanismforantigenprocessing,humoralimmunity,andcellularimmunity.,Chapter2Inflammatorydiseases,1.CrohnsDisease克罗恩病2.Tuberculosisofintestine肠结核3.Typhoidenteritis伤寒4.Acutehemorrhagicenteritis急性出血性肠炎,1.CrohnsDiseaseCrohnsdiseaseisachronic,transmuralinflammatorydisease慢性透壁性炎症ofthegastrointestinaltractofunknowncause.AlthoughCrohnsdiseasemostcommonlyaffectstheendofthesmallintestine（theileum）andthebeginningofthelargeintestine（thecolon）,itmayinvolveanypartoftheGItract.可涉及消化道全长小肠末，大肠始常发炎性溃疡,Chapter2Inflammatorydiseases,1.CrohnsDiseaseThediseaseisnamedafterDr.BurrillB.Crohnin1932.Crohnsandarelateddisease,ulcerativecolitis溃疡性结肠炎,arethetwomaindiseasecategoriesthatbelongtoalargergroupofillnessescalledinflammatoryboweldisease（IBD）.炎性肠病Becausethesymptomsofthesetwoillnessesaresosimilar,itissome