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• 3. Aminopeptidases
Hydrolyze most of the peptide segments
Absorption
• Only the absorption of calcium and iron is
regulated
• Most absorption occurs in the duodenum and
jejunum (mostly)
• Small intestine has an abundant reserve
absorptive capacity but if the terminal ileum is
removed, vitamin B12 and bile salts are not
properly absorbed
Mucosal Lining Turnover
• Shallow invagination in small intestine crypts of Lieberkϋhn
secrete water and salt and contributes to succus entericus
• Function also as nurseries produce new stem cells that migrate
up the villi and push off the older cells at the tip of lumen into
lumen every 3 days (hence the tip of villus has the highest digestive
and absorptive activity)
• Crypt cells are very sensitive to radiation due to this high turnover
• Dead cells are digested and cell constituents are absorbed into the
blood and reclaimed for synthesis of new cells
• Paneth cells (for defense purposes):
• 1. Lysozyme lyses bacteria’s cell wall
• 2. Defensins small proteins with antimicrobial powers
Physiology of Large Intestine
• Colon receives 500 mL of chyme each day
• Contents delivered to colon consist of indigestible
food residues (cellulose), unabsorbed biliary
components and the remaining fluid
• Colon extracts more water and salt feces
• Main function: store feces before defecation
• Cellulose and other indigestible food residues
provide bulk and help maintain regular bowel
movements by contributing to the volume of the
colonic contents
Motility
• Gastrocolic reflex when food enters the
stomach, mass movements are triggered in the
colon (Mediated by gastrin and extrinsic
autonomic nerves). It triggers the defecation
reflex as it moves food further in preparation for
the next food.
• Most of the time slow and non-propulsive (for
absorptive and storage function)
• Main motility Haustral contractions initiated
by BER of colon (30 mins elapse before next
contraction)
Defecation Reflex
• Internal anal sphincter (smooth muscle) relax and
rectum & sigmoid colon contract more vigorously
• External anal sphincter (skeletal muscle) also
relaxes defecation occurs
• If defecation is delayed, the distended rectal wall
gradually relaxes and the urge to defecate
subsides until the next mass movement
• Assisted by voluntary straining movements
contraction of abdominal muscles and a forcible
expiration against a closed glottis increased
intra-abdominal pressure
Secretion
• No enzymes
• Secretion consists of alkaline (NaHCO3) mucous
solution protect mucosa from mechanical and
chemical injury
• Mucus provides lubrication to facilitate passage of
feces
• NaHCO3 neutralizes irritating acids produced by local
bacterial fermentation
• Secretion increases by mechanical and chemical
stiulation mediated by short reflexes and PNS
• Colonic bacteria digests some of the cellulose for their
use
Absorption
• Absorbs salt and water; sodium is actively
absorbed, chloride follows passively down the
electrical gradient and water follows osmotically
• Feces 100g of water and 50g of solid
(cellulose, bilirubin, bacteria, and small amounts
of salt)
• Main waste product excreted in feces bilirubin
• Bacteria 1/3 dry weight of feces
Embryology of Small Intestine
• The cephalic limb of the loop develops into
the distal part of the duodenum, the jejunum,
and part of the ileum.
• The caudal limb becomes the lower portion of
the ileum, the cecum, the appendix, the
ascending colon, and the proximal two-thirds
of the transverse colon.
Embryology of Small Intestine
• As a result of the rapid growth and expansion of
the liver, the abdominal cavity temporarily
becomes too small to contain all the intestinal
loops, and they enter the extraembryonic cavity
in the umbilical cord during the sixth week of
development (physiological umbilical herniation)
• Coincident with growth in length, the primary
intestinal loop rotates around an axis formed by
the superior mesenteric artery
Embryology of Small Intestine
• Rotation of 270 degree counterclockwise occurs
• Rotation occurs during herniation (about 90°), as
well as during return of the intestinal loops into
the abdominal cavity (remaining 180°)
• During the 10th week, herniated intestinal loops
begin to return to the abdominal cavity.
• The proximal portion of the jejunum, the first
part to reenter the abdominal cavity, comes to lie
on the left side
Gastroschisis
• Body wall closure fails in abdominal region
• Intestinal loops herniate into abd. cavity
affected loops of bowel might be damaged by
amniotic fluid
• Usually lies to the right of umbilicus
• Occurs more commonly in mother <20 yrs
with elevated AFP
Omphalocele
• Failure of physiological umbilical herniation
• Loops of bowel, other viscera and liver may
herniate
• Umbilical cord is covered by amnion no
damage
• Associated with cardiac abnormalities and
neural tube defects
• Elevated AFP in mother
Meckel’s Diverticulum
Rule of 2’s:
• 2% of population
• 2% are symptomatic
• Symptomatic before age of 2
• Found within 2 feet (40-60cm) of ileocecal valve
on antimesenteric border
• 2x more common in male
• Approximately 2 inches in length (5 cm)
• 2 common types of ectopic tissues: gastric &
pancreas
Intestinal Atresia
• Hypertrophic pyloric stenosis (not part of
intestinal atresia) : Single-bubble sign
• Duodenal atresia : Double-bubble sign
• Jejunal atresia: Triple-bubble sign
Definition of Diarrhea
• Diarrhea is defined as stool weight greater
than 200 g per day but this definition has
limited value in clinical practice.
Anticholinergics
• Decrease intestinal muscle tone and peristalsis of
GI tract Slowing the movement of fecal matter.
• Inhibit secretion of fluids into GI tract.
Examples :
• –Belladonna alkaloids
• –Atropine
• –Hyoscyamine
Side effects of Anticholinergics
• Urinary retention & hesitancy, impotence
• Headache, dizziness, confusion, anxiety,
drowsiness
• Dry skin, rash, flushing
• Blurred vision, photophobia, increased
intraocular pressure
• Hypotension, hypertension, bradycardia,
tachycardia
Colloidal Bismuth Compound