外科学课件14、Small intestine disease.pptx

1、,Small intestine disease,Department of general surgeryDr.Ya xu Wang,Chapter 1 Anatomy and Physiology,The primary role of the small intestine is the digestion and absorption of dietary components after they leave the stomach.Exocrine secretions from the liver and pancreas enable complete digestion of

2、 the foodstuffs.The enlarged surface area of the small intestinal mucosa then absorbs these nutrients.,Chapter 1 Anatomy and Physiology,In addition to its role in digestion and absorption,the small bowel is the largest endocrine organ in the body and is one of the most important organs of immune fun

3、ction.Given its essential role and complexity,it is amazing that diseases of the small bowel are not more frequent.,Chapter 1 Anatomy and Physiology,In this chapter,the normal anatomy and physiology of the small intestine are described,as well as disease processes involving the small bowel,which inc

4、lude:obstructioninflammatory diseasesneoplasms,Chapter 1 Anatomy and Physiology,The entire small intestine,which extends f1r.oAmnatthoempyylorus to the cecum,measures 300 to 550 cm：duodenal length at about 20 to 35 cmj2e.jPuhnyasliolelongyth at 100 to 110 cmileal length at 150 to 160 cm.,Chapter 1 A

5、natomy and Physiology,1.AnatomyThere is no obvious line of demarcation between the jejunum and the ileum;however,the jejunum is commonly considered to make up the proximal two fifths of the small intestine,and the ileum makes up the remaining three fifths.,1.1 Neurovascular-Lymphatic Supply,The smal

6、l intestine is served by rich vascular,neural,and lymphatic supplies,all traversing through the mesentery.肠系 膜 The base of the mesentery attaches to the posterior abdominal wall to the left of the second lumbar vertebra and passes obliquely to the right and inferiorly to the right sacroiliac joint.右

7、侧骶髂关节,Chapter 1 Anatomy and Physiology,1.Anatomy,1.1 Neurovascular-Lymphatic Supply,The blood supply of the small bowel,except for the proximal duodenum that is supplied by branches of the celiac axis,comes entirely from the superior mesenteric artery.,Chapter 1 Anatomy and Physiology,1.Anatomy,1.1

8、Neurovascular-Lymphatic Supply,The blood supply of the small bowel,except for the proximal duodenum that is supplied by branches of the celiac axis,comes entirely from the superior mesenteric artery.,Chapter 1 Anatomy and Physiology,1.Anatomy,1.1 Neurovascular-Lymphatic Supply,The superior mesenteri

9、c artery courses anterior to the uncinate processof the pancreas and the third portion of the duodenum,where it divides to supply the pancreas,distal duodenum,entire small intestine,and ascending and transverse colon.Venous drainage of the small bowel parallels the arterial supply,with blood drainin

10、g into the superior mesenteric vein,which joins the splenic vein,then to the the portal vein.The innervation of the small bowel is provided by both parasympathetic and sympathetic divisions of the autonomic nervous system,which in turn provide the efferent nerves to the small intestine.,Chapter 1 An

11、atomy and Physiology,1.Anatomy,1.2 Microscopic Anatomy,The small bowel wall consists of four layers:Serosa浆膜muscularis propria肌层Submucosa粘膜下mucosa 黏膜,Chapter 1 Anatomy and Physiology,1.Anatomy,Chapter 1 Anatomy and Physiology,Digestion and Absorption FunctionThe complex process of digestion and even

12、tual absorption of nutrients,water,electrolytes,and minerals is the main role of the small intestine.The small bowel is,primar1ily.rAesnpoanstibolemforyabsorption of the dietary components(carbohydrates,proteins,and fats),as well as ions,vitamins,and water.Endocrine FunctionIn fact,the small bowel i

13、s the largest endocrine organ in the body.Immune Function,The small intestine serves as a major immunologic barrier in addition to its important,role in2di.gPeshtioyn sanidoelnodgocryine function.As a result of constant antigenic exposure,the intestine possesses abundant lymphoid cells(i.e.,B and T

14、lymphocytes)and myeloid cells(macrophages,neutrophils,eosinophils,and mast cells).To deal withthe constant barrage of potential toxins and antigens,the gut has evolved into a highly organized and efficient mechanism for antigen processing,humoral immunity,and cellular immunity.,Chapter 2Inflammatory

15、 diseases,1.Crohns Disease 克罗恩病 2.Tuberculosis of intestine肠结核 3.Typhoid enteritis 伤寒4.Acute hemorrhagic enteritis急性出血性肠 炎,1.Crohns DiseaseCrohns disease is a chronic,transmural inflammatorydisease慢性透壁性炎症 of the gastrointestinal tract of unknown cause.Although Crohns disease most commonly affects th

16、e end of the small intestine(the ileum)and the beginning of the large intestine(the colon),it may involve any part of the GI tract.可涉及消化道全长小肠末，大肠始常发炎性溃疡,Chapter 2Inflammatory diseases,1.Crohns DiseaseThe disease is named after Dr.Burrill B.Crohn in 1932.Crohns and a related disease,ulcerative colitis溃疡性 结肠炎,are the two main disease categories that belong to a larger group of illnesses called inflammatory bowel disease(IBD).炎性肠病Because the symptoms of these two illnesses are so similar,it is some