- 40% of small intestine
- Few large vascular arcades (loops)
- Long vasa recta
- Large, tall, and closely packed plicae circulares
- Less fat in mesentery than ileum
- Locus of maximum water (90%) and nutrient absorption, except for B12, bile acids, iron, and folate
- 95% of water absorbed
Ileum - - - Jejunum and Ileum Figure - 60% of small intestine
- Many small vascular arcades (loops)
- Short vasa recta
- Large, low, and sparse plicae circulares, none distal
- More fat in mesentery than jejunum
- Maximum absorption of nonconjugated bile acids, with conjugated bile acids absorbed in terminal ileum
- B12 and folate maximally absorbed in terminal ileum
Endocrine Gut Functions - Cholecystokinin (CCK): secreted by cells of proximal intestine
- Secretin: secreted by S cells of proximal intestine
- Motilin: secreted by M cells of proximal intestine
- Somatostatin (SMS): secreted by D cells throughout gut
- Peptide YY (PYY): secreted by L cells of distal intestine
- Glucagon-like peptide 2 (GLP-2): secreted by L cells of distal intestine
- Diverticulectomy: most common treatment for uncomplicated diverticulitis
- Segmental resection indicated for complicated diverticulitis, neck <1/3 ileal diameter, or inflammation of the base
International University
Tuesday, June 7, 2011
Small intestine disease
Jejunum - - - Jejunum and Ileum Figure
Friday, June 3, 2011
Prostate disease
- Prostate anatomy
- Supported anteriorly by puboprostatic ligaments, central portions of the pubococcygeus, part of the levator ani muscles (anterior pelvic diaphragm)
- Supported inferiorly by the urogenital diaphragm (transversus perinei muscle and fascia), through which the urethra passes
Staging and Treatment ↓ - Tumor/node/metastasis (TNM) system used
- Gleason scoring system: additional scoring (1-5) from well differentiated (least aggressive) to poorly differentiated (most aggressive)
- Transrectal ultrasonography (TRUS) can provide an accurate image of the gland and guide needle biopsies
- CT can provide evidence of prostatic pathoanatomy, lymphadenopathy, and metastases
- Optimal treatment for localized prostate cancer remains controversial
- Intracapsular tumors, no metastases (on T1 and T2 MRI): irradiation, radical prostatectomy with pelvic lymph node excision, or no treatment depending on age, specifics
- Extracapsular tumors with metastases: hormonal treatment with luteinizing hormone releasing hormone blocker or testosterone blockers, potential orchiectomy; irradiation for pain of bony metastases, chemotherapy for hormone-resistant disease
- “Chemical castration”: luteinizing hormone releasing hormone (LHRH) antagonists suppress testosterone production in androgen-dependent tumors
- LHRH antagonists are also called GnRH antagonists (gonadotropin releasing hormone blockers)
- Alternatives or complements to prostatectomy: x-ray or particle beam therapy, brachytherapy (implanted radiation sources), and cryotherapy
Thursday, June 2, 2011
Pancreatic Disease
- Exocrine Functions ↓ | |
| |
- Endocrine Functions ↓ | |
|
Kidney Disease
Intrarenal Arteries and Renal Segments | |||||
|
Wednesday, June 1, 2011
Hernia
Nerves Near the Spermatic Cord ↓ | |
|
Monday, May 30, 2011
Esophageal Disease
ANATOMY OF THE ESOPHAGUS\
- cricopharyngeus, the first region of anatomical constriction
| |||||||||||||||||
Gastroduodenal Disease and Anatomy
Gastric Microscopic Anatomy | |
|
Most fixed portion of small bowel, surrounds head of the pancreas
Duodenal Microscopic Anatomy | |
|
- Inner Surface
- Mucosal surface area specializations: microvilli, villi, plica circulares (valvulae conniventes)
- Total absorptive surface: 200-550 cm2
Gastroduodenal Embryology | |
|
- Parasympathetic
- Left vagal trunk lies anterior as it crosses the gastroesophageal junction and runs anteriorly along the lesser curvature toward the duodenum
- Right vagal trunk lies posterior as it crosses the gastroesophageal junction and runs posteriorly along the lesser curvature toward the duodenum
- Ganglion cells are located in myenteric (Auerbach’s) and submucosal (Meissner’s) plexuses in stomach and duodenum
- Sympathetic
- Preganglionic fibers from T8-T10 lateral column distributed via splanchnic nerves
- Postganglionic fibers are distributed from ganglion cells in celiac and superior mesenteric ganglia, traveling along respective arterial branches
- Sensory fibers (general visceral afferent)
- Vagal afferents, including stretch, chemo-, and "satiety" receptors
- Segmental afferents travel back parallel to sympathetics, through the celiac and superior mesenteric plexuses and the splanchnic nerves to thoracic spinal nerves, dorsal root ganglia, and spinal segments
- Chronic
- Type A: in fundus, associated with autoimmune disease and pernicious anemia
- Type B: in antrum, associated with Helicobacter pylori
Peptic Ulcer :70%-80% in lesser curvature of the stomach | |||||
|
Subscribe to:
Posts (Atom)