Intestinal obstruction due to volvulus of small intestine.
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Humans↗
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[Severe disturbance of intestinal absorption after resection of the small intestine].
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Celiac Disease↗
A congenital diverticulum of the small intestine; Meckel's diverticulum or duplication?
A diverticulum of the small intestine is a condition with only a low morbidity. This is generally a Meckel's diverticulum (MD). There is, however, the possibility of another congenital malformation, which can closely resemble a MD but has another etiology, the tubular duplication of the small intestine. In a period of three months six patients were treated with a MD with different clinical presentations and histologic findings and an invaginated duplication of the small intestine in a male adult patient. The diagnosis of a tubular duplication of the small intestine is not often considered when finding a diverticulum of the small intestine and such a malformation is too easily called a Meckel's diverticulum.
Adolescent↗
[Surgical therapy of ileus of the small intestine].
BACKGROUND AND AIMS: Small bowel obstruction is a disease the surgeon frequently is confronted with. In the present study the records of the patients (n = 202) with mechanical obstruction of the small intestine from the last four years were analysed and the results are critically compared with the literature. METHODS: In the reported retrospective study the length of patient's history, the cause of bowel obstruction, the preoperative examinations performed, the kind of surgical intervention and the postoperative management and outcome were investigated. RESULTS: The average patient's age was 62 years, the mean preoperative duration of symptoms was 6.5 days. 77% of the patients had underwent abdominal surgery prior to the obstruction. Conventional x-ray was performed in 92%, gastrographin passage in 46% and CT-scan in 23% of the cases. The average length of hospitalisation was 12 days. The overall postoperative morbidity was 21%, the mortality 2.5%. CONCLUSION: It could be shown that patient's history, clinical symptoms and conventional x-rays of the abdomen are sufficient for the indication of surgical intervention. In uncertain cases the examination of the passage with contrast medium is recommended. The surgical results of small bowel obstruction management have significantly improved over the past decades, today's mortality is lower than 5%.
Aged↗
Injury-induced inhibition of small intestinal protein and nucleic acid synthesis.
Small intestinal mucosal weight and nutrient absorption are significantly diminished early after cutaneous thermal injuries. Because these intestinal properties are highly dependent on rates of nucleic acid and protein synthesis, in vivo incorporation of thymidine, uridine, and leucine into small intestinal deoxyribonucleic acid, ribonucleic acid, and proteins were measured. Deoxyribonucleic acid synthesis was markedly decreased with the lowest thymidine incorporation in the jejunum (p less than 0.01); these findings were confirmed by autoradiographic identification of radiolabeled nuclei in the intestinal crypts. Protein synthesis was decreased by 6 h postinjury (p less than 0.01) but had returned to normal by 48 h. Consistent with a decreased rate of protein synthesis, ribonucleic acid synthesis was also decreased 18 h postinjury (p less than 0.01). These decreased deoxyribonucleic acid, ribonucleic acid, and protein synthesis rates are not likely a result of ischemia because in other studies of this injury model, intestinal blood flow was not significantly changed by the burn injury. Potentially, factors initiating the acute inflammatory reaction may directly inhibit nucleic acid and protein synthesis and lead to alterations in nutrient absorption and intestinal barrier function after injury.
Animals↗
Sarcoma-180 cells are more sensitive to heat than are mouse normal tissues: esophagus, stomach, small intestine, large intestine, liver, spleen, and kidney.
Sensitivity of various mouse tissues to heat was determined using mouse sarcoma-180 (S-180) cells and normal tissues: esophagus, stomach, small intestine, large intestine, liver, spleen, and kidney. The in vitro succinate dehydrogenase inhibition (SDI) test was used. The succinate dehydrogenase (SD) activity of tissue fragments was assayed, following exposure to a temperature of 43 degrees C (heat treatment) or 37 degrees C (control) for 1, 2, 5, or 10 hr. The sensitivity to heat treatment was estimated by the percentage of SD activity of the heat-treated cells, compared to that of the control cells. The decrease in SD activity following exposure to heat varied with the tissue. The SD activity decreased to a greater extent in the S-180 cells than in the normal tissues. In the normal tissues, the order of sensitivity to heat was stomach, spleen, large intestine, small intestine, esophagus, kidney and liver. These results show that hyperthermia is tissue selective, hence heat treatment of a malignant lesion should be carefully designed.
Animals↗
Comparison of absorption of erythorbic acid and ascorbic acid in guinea pig small intestine.
Both the ascorbic acid (AsA) and erythorbic acid (ErA) absorption in the small intestine of guinea pigs were determined by the perfusion of the small intestine using isotonic phosphate buffer recycled in situ. The absorption rate of AsA in the small intestine of guinea pigs was higher than that of ErA; however, Km of AsA absorption was lower than that of ErA in normal guinea pigs. In AsA-deficient guinea pigs, the absorption rates of both AsA and ErA were higher than those in normal ones. The absorption of AsA and ErA in the small intestine of guinea pigs was inhibited by ouabain. Furthermore, AsA and ErA inhibited each other's absorption. Based on the results, the net amount of the absorbed ErA in the small intestine may be lower than that of AsA, and ErA absorption mechanism seemed to be similar to that of AsA. The absorption rate of both AsA and ErA in the small intestine of guinea pig might be dependent on the AsA level in the tissues.
Animals↗
Molecular mechanisms in proximal tubular and small intestinal phosphate reabsorption (plenary lecture).
Renal and small intestinal (re-)absorption contribute to overall phosphate(Pi)-homeostasis. In both epithelia, apical sodium (Na+)/Pi-cotransport across the luminal (brush border) membrane is rate limiting and the target for physiological/pathophysiological alterations. Three different Na/Pi-cotransporters have been identified: (i) type I cotransporter(s)--present in the proximal tubule--also show anion channel function and may play a role in secretion of organic anions; in the brain, it may serve vesicular glutamate uptake functions; (ii) type II cotransporter(s) seem to serve rather specific epithelial functions; in the renal proximal tubule (type Ila) and in the small intestine (type IIb), isoform determines Na+-dependent transcellular Pi-movements; (iii) type III cotransporters are expressed in many different cells/tissues where they could serve housekeeping functions. In the small intestine, alterations in Pi-absorption and, thus, apical expression of IIb protein are mostly in response to longer term (days) situations (altered Pi-intake, levels of 1.25 (OH2) vitamin D3, growth, etc), whereas in renal proximal tubule, in addition, hormonal effects (e.g. Parathyroid Hormone, PTH) acutely control (minutes/hours) the expression of the IIa cotransporter. The type II Na/Pi-cotransporters operate (as functional monomers) in a 3 Na+:1 Pi stoichiometry, including transfer of negatively charged (-1) empty carriers and electroneutral transfers of partially loaded carriers (1 Na+, slippage) and of the fully loaded carriers (3 Na+, 1 Pi). By a chimera (IIa/IIb) approach, and by site-directed mutagenesis (including cysteine-scanning), specific sequences have been identified contributing to either apical expression, PTH-induced membrane retrieval, Na+-interaction or specific pH-dependence of the IIa and IIIb cotransporters. For the COOH-terminal tail of the IIa Na/Pi-cotransporter, several interacting PDZ-domain proteins have been identified which may contribute to either its apical expression (NaPi-Cap1) or to its subapical/lysosomal traffic (NaPi-Cap2).
Absorption↗
Expression of functional ICAM-1 and VCAM-1 adhesion molecules by an immortalized epithelial cell clone derived from the small intestine.
The role of small bowel-derived epithelial cells in regulating the accumulation of inflammatory cells within the inflamed gut epithelium is poorly understood because of the difficulties in culturing the epithelial cells in vitro. We have recently developed a cloned epithelial cell line (IEC-4.1) derived from the small intestine of BALB/c mice. In the present study, we examined whether IEC-4.1 cells could express adhesion molecules ICAM-1 and VCAM-1 and the molecular basis of macrophage adhesion to the epithelial cells. Northern blot analysis demonstrated that IEC-4.1 cells constitutively expressed ICAM-1 and VCAM-1 mRNA at low levels. Stimulation with LPS (12 microg/ml) or TNF-alpha (2.5 ng/ml) markedly upregulated ICAM-1 and VCAM-1 gene expression in IEC-4.1 cells. ICAM-1 mRNA started to increase 2 hr after LPS stimulation, peaked at 4 hr, and then decreased rapidly to the basal level at 8 hr. VCAM-1 mRNA had the similar pattern of upregulation but the increased VCAM-1 mRNA sustained over a longer period of time and did not return to the basal level until 24 hr after the stimulation. IEC-4.1 cells expressed very low basal levels of ICAM-1 and VCAM-1 on the cell surface as demonstrated by immunofluorescence staining and FACS analysis. Stimulation of IEC-4.1 cells with LPS or TNF-alpha markedly increased the surface expression of both ICAM-1 and VCAM-1, which correlated with the increased binding of macrophages to the stimulated IEC-4.1 cells. Adherence of macrophages to the IEC-4.1 cells was mediated by both LFA-1/ICAM-1 and VLA-4/VCAM-1 since blocking both adhesion pathways inhibited macrophage adhesion by about 90%. These findings suggest that small bowel-derived epithelial cells may be capable of expressing a defined set of functional adhesion molecules during mucosal inflammation.
Animals↗
Immediate endoscopic placement of long intestinal tube in partial obstruction of the small intestine.
A technique that allows for endoscopic placement of a long intestinal tube with an inflatable balloon well beyond the pylorus is described. This procedure has been successful in 24 patients; is well tolerated; removes air and fluid from the stomach, duodenum and upper part of the jejunum, and can be performed in less than 45 minutes. It uses equipment that is standard in all hospitals and can be performed by anyone experienced in performing endoscopy of the upper part of the gastrointestinal tract. It is safe, easy to perform and improves the efficacy of long tube decompression and, therefore, can be recommended in properly selected patients, with partial obstruction of the small intestine.
Endoscopy↗
Effect of omeprazole on changes in gastric and upper small intestine pH levels in patients with chronic pancreatitis.
Gastric and upper small intestine pH levels were measured continuously over 24 hours in patients with chronic pancreatitis, and values obtained before and after the administration of omeprazole were compared. Additionally, omeprazole was administered for 2 weeks and the fecal excretion of fat was compared before and after drug therapy. Postprandial gastric pH levels, initially 2.9 to 3.2, increased by 1.6 to 2.1 after treatment. Postprandial upper small intestine pH levels, initially 5.1 to 5.5, increased by 0.7 to 1.0. The lowest pH value of the upper small intestine was 2.2 to 2.4 postprandially; this was increased by > 1.0 after omeprazole, and the amplitude of pH variation was reduced. The cumulative proportions of intraintestinal pH strata of < or = 3, < or = 4, or < or = 5, and higher, initially being 16.4% to 17.1%, 27.4% to 31.7%, and 52.6% to 57.8%, respectively, were remarkably improved after drug treatment. Gastric pH and upper small intestine pH levels showed a positive correlation; an increase in gastric pH levels by 2 corresponded to an increase in small intestine pH levels by 1. After omeprazole administration, mean fecal excretion of fat was decreased to 4.1 +/- 2.6 g/d (range, 1.1 to 9.8 g/d) from 6.5 +/- 3.9 g/d (range, 1.6 to 13.5 g/d). Decreases in excretion of fat averaged 3.4 g/d (range, 2.2 to 4.5 g/d) in patients with steatorrhea. It was concluded that steatorrhea due to chronic pancreatitis can be improved to some extent by improving upper small intestine pH levels following the elevation of gastric pH levels after administration of omeprazole.
Adult↗
Healing of anastomoses after obstruction of small intestine.
Anastomotic healing after obstruction of the small intestine was investigated by measurements of development of strength, content of collagen and synthesis of collagen in standardized specimens taken at biopsy of the intestinal wall on both sides of the anastomosis. One hundred and sixteen male Wistar rats were used. Forty-eight rats were used for studies of synthesis of collagen by in vivo labeling with 100 microcuries of tritiated L-proline. Anastomoses performed after two days of obstruction in the ileum had a higher rate of complications than operations performed upon control rats (p less than 0.05). Obstruction of the small intestine resulted in increased content of collagen of the ileal wall as a consequence of increased synthesis of collagen, but this resulted in neither increased capacity to hold suture nor in any differences in development of strength between rats operated upon for obstruction of the small intestine and control rats. Increased turnover of collagen was noted in the vicinity of the anastomoses after obstruction, which might be related to the increased rate of complications found. Rats with complications accumulated more collagen in the intestinal wall after one week compared with rats with obstruction and uncomplicated healing. These rats had persistent obstruction or formation of granuloma, or both.
Anastomosis, Surgical↗
Surgery of the bovine small intestine.
Cattle require surgery for small-intestinal problems less frequently than they do for abomasal, forestomach, or large-intestinal problems. Close attention to local vascular anatomy is critical to success when intestinal resection is required. Cows with signs of severe abdominal pain may make rapid recoveries following prompt surgical treatment. This article discusses relevant anatomy of the small intestine and the diagnosis and treatment of intussusception, volvulus, obstruction by incarceration or entrapment, and duodenal obstruction.
Animals↗
Unconventional dose administrations: modifications of body and small intestine weights.
The modifications of body and small intestine weight were analyzed after abdominal irradiation in rats. Different doses were administered in single sessions, in two equal fractions with different splits, in multiple daily fractionations, varying the amount of the dose and the intervals among fractions. The results show that body weight gradually decreased after irradiation and only after many days it returned to control levels. Small intestine weight decreased starting from early intervals, and a rapid increase over controls was observed at 5 days. A return to control levels was reached later. Multiple-daily-fractionation (MDF) irradiation with 12 Gy (1200 rad) produced modifications less evident that the same dose administered in single session and appeared more similar to those observed after 6 or 8 Gy, according to the different splits used. The more marked the damage the lower the interval between fractions when a total dose of 12 Gy was administered in two fractions. The modifications after 6 Gy MDF were less marked than after a single session of the same magnitude, both in body and small-intestinal weight. In conclusion the MDF used in these experiments produced a damage very easily recovered by the organism in spite of the short time of dose administration.
Abdomen↗
[Gastrin is not implicated in intestinal adaptation after extensive resection of the small intestine in rats].
Because gastrin is thought to be a trophic agent for the digestive tract, we studied the effects of endogenous variations of plasma gastrin on the small intestinal mucosa after a 90 p. 100 jejunoileal resection in the rat. Hypogastrinemia was induced by antrectomy while hypergastrinemia resulted from vagotomy. Pyloroplasty had no effect on gastrinemia. Small bowel resection increased mucosal weight, DNA and protein content; these changes were more obvious in the jejunum and ileum than in the duodenum. Gastric operations performed before the resection did not significantly modify these parameters except for the level of protein. Our results indicate that endogenous gastrin plays no role in the adaptive growth response of the intestinal mucosa after extensive small bowel resection.
Adaptation, Physiological↗
Effects of protein deprivation on growth and small intestine morphology are not improved by glutamine or glutamate in gastrostomy-fed rat pups.
OBJECTIVES: Critically ill neonates often have their enteral intake severely limited shortly after birth. Whether glutamine (Gln) or glutamate (Glu) can preserve intestinal structure and function in the neonate undergoing limited enteral feeding is not clear. We hypothesize that Gln and Glu can similarly preserve intestinal structure in the developing small intestine of infant rats fed a low protein diet. METHODS: Using a gastrostomy-fed "pup-in-a-cup" rat model, the effects of Gln and Glu on the developing rat small intestine were examined. Four groups of 6- to 7-day-old pups were fed rat milk substitute (RMS) via gastrostomy tube. One group was provided 100% and three were provided 25% of the protein normally received from their mothers. Two of the groups fed 25% protein received additional Gln or Glu for 6 days. RESULTS: Pups receiving the 100% protein RMS were larger than pups receiving the 25% protein RMS with or without Gln/Glu supplementation (P < 0.001). Average villus height (P < 0.01) and area (P < 0.01) were greater in pups receiving 100% protein RMS than in pups given 25% protein RMS formula. There was no significant difference among the groups in mucosal maltase or alkaline phosphatase activities. Tight junction protein claudin-1 was significantly higher in the group fed 100% protein RMS diet, while occludin did not differ among the 4 groups. Neither Gln nor Glu increased claudin-1 or occludin in rats fed 25% protein. CONCLUSIONS: These results suggest that neither Gln nor Glu supplementation can substitute effectively for whole protein in the developing rat small intestine for the outcomes that were evaluated.
Alkaline Phosphatase↗
Characteristics of chloride ion influx in Amphiuma small intestine.
Net Cl- absorption by Amphiuma small intestine is electrogenic but associated with the secretion of HCO3-. To define the mechanisms of Cl- entry into the enterocytes the initial rate of uptake of 36Cl into isolated segments of small intestine was measured. Luminal extracellular space was measured using [3H]inulin. Cl- influx was saturable with a Km of 5.3 mM. When the mucosal medium Cl- concentration was 20 mM influx was linear for 5 min. Cl- influx in 5 min (JiCl) was not reduced by 4-acetamido-4'-isothiocyanostilbene-2,2'-disulfonic acid added to the serosal medium, although the Cl- current was abolished. Hence the luminal membrane was the barrier to Cl- uptake. Monovalent anions blocked Cl- influx in the order I- = SCN- = NO3- greater than Br- greater than F-. Anoxia and dinitrophenol reduced JiCl 33 and 71%, respectively. Substitution of medium Na+ with choline or N-methyl glucamine reduced JiCl 60-70%. Removal of medium K+ reduced influx 51%. After medium Na+ and K+ were both replaced influx was stimulated upon reexposure to (Na+ + K+); Na+ alone did not stimulate. JiCl was reduced 34% by furosemide. Neither amiloride nor SITS in the mucosal medium altered influx. JiCl was reduced by replacement of the HCO3- -CO2 buffer with either phosphate or N-2-hydroxyethyl-piperazine-N'-2-ethanesulfonic acid and by exposure to acetazolamide. Theophylline reduced influx 60%, whereas the Ca ionophore A23187 reduced net Cl- absorption and lowered JiCl by 17%. Norepinephrine (10(-5) M) in the serosal bathing medium stimulated Cl- influx 51%. These results indicate that Cl- influx into the intestinal mucosa occurs by a Na+- and, possibly, K+-dependent pathway. Cl- entry is under adrenergic influence.
Acetazolamide↗
Expression of the rat gamma-glutamyl transpeptidase gene from a specific promoter in the small intestine and in hepatoma cells.
In the small intestine and in HTC hepatoma cells, the gamma-glutamyl transpeptidase (GGT) single-copy gene is transcribed into a 2.5 kb and a 2.2 kb mRNA. Cloning of the GGT cDNA sequences from HTC cells demonstrates that the 2.5 kb mRNA (mRNA(IV-1)) differs from the other rat GGT transcripts by a 371-base unique leader sequence which maps in the gene as 2 separate exons upstream of the 3 promoters which have been previously characterized. We established that the transcription of these two mRNAs is initiated on a new promoter (promoter IV) and occurs in the small intestine, in the epididymis, and in some hepatoma cells. The primary transcript initiated on GGT promoter IV is then alternatively spliced into the 2.5 kb mRNA(IV-1) or the 2.2 kb mRNA(IV-2) which is shorter in its 5'-untranslated sequence. The rat GGT gene exhibits a complex transcriptional organization leading to the transcription of five mRNAs from four independent promoters in a tissue-specific manner. The expression of the GGT promoter IV in the HTC hepatoma cells as well as in the small intestine could reveal that the HTC-transformed cells originate from liver precursor cells which still have the capacity to evolve toward different lineages. Thus, the GGT promoter IV will be valuable to isolate factors involved in the differentiation and carcinogenic processes.
Animals↗