Fistula duodenum

The gut technique of in situ-perfused isolated intestinal segments in rats is used to determine the rates of intestinal absorption or intestinal secretion of a candidate compound, as well as in combination with a bile fistula to detect the hepatobiliary elimination of a candidate compound. By perfusion of intestinal segments (duodenum, proximal and distal part of the jejunum, and ileum) the site of intestinal absorption or secretion of a candidate compound can be determined. 

The lack of blood supply restricts the use of in vitro preparations to short-time incubation studies only. Long-time experiments which allow determination of lipid absorption under steady-state conditions can be performed by perfusion of an intestinal segment in situ or by infusion of lipids into the duodenum of a rat with a lymph fistula. A comparison of in vitro and in vivo techniques has been made by Clark [54]. 

Bleeding esophageal varices Nonoperative management of secreting cutaneous fistulas of the stomach, duodenum, small intestine, or pancreas... 

III. — Secretions caused with animals with temporary fistulas by introduction of HCl in the duodenum. 

Pancreatic secretion is controlled neurologically and hormonally. When food is given to a dog whose stomach has been disconnected from the duodenum and directly connected to the skin of the abdomen, and a pancreatic fistula is produced, the act of eating stimulates the secretion of pancreatic juice. Vagotomy suppresses this effect. Direct stimulation of the vagus also stimulates pancreatic secretion. In addition stimulation of the sympathetic system influences pancreatic secretion, but this is more likely an indirect effect of vasodilation of the gland and the musculature of the... 

Figure 9-5. E. S. London s pylorus fistula dog in use. The cannula is fitted with a balloon that occludes the duodenum so that the gastric fluid drips from the upper half of the cannula into the dish on ice. Duodenal fluid is draining through tube a into bottle of. Tubes b and c are for injecting fluid into the duodenum and for blowing up the balloon that occludes the duodenum. (From London ES. Methodische Angaben. Hoppe-Seylers Z Physiol Chem 53 240-243, 1907.)...

Fig. 2.29. Crohn s stenosis and Duodenal fistula. Double Contrast barium study shows an irregular narrowing of the postbulbar duodenum due to lonstanding Crohn s duodenitis. There is also a duodenal-biliary fistula occurring as a complication of the Crohn s disease. Cholecystectomy clips are noted...

The radiological findings of Crohn s disease of the distal duodenum are similar to those of the rest of the small bowel and terminal ileum, with skip lesions, cobble stoning, asymmetry, and in the more advanced stage of the disease, strictures causing eccentric narrowing. Other features of Crohn s disease such as sinuses, fistulas, sacculations, and inflammatory pseudopolyps are uncommon in the duodenum (Fielding et al. 1970 Levine 1987 Hizawa etal. 1994). 

Primary tuberculosis of stomach and duodenum is very rare and usually develops secondary to pulmonary tuberculosis. Simultaneous involvement of the duodenum occurs in 10% of patients. There is increased incidence in patients with AIDS. The radiological appearances are classified as predominantly ulcerative or hypertrophic type (Tishler 1979 Agrawal et al. 1999). The ulcerative form is more frequent and consists of multiple large and deep ulcerations, sometimes with antral fistulas (Fig. 5.10). In the hypertrophic form, there is thickening of stomach and duodenal folds which can lead to pyloric stenosis and gastric outlet obstruction. A narrowed antrum can mimic a linitis plastica appearance. There is usually extensive lymph node involvement in the adjacent areas (Tishler 1979 Agrawal et al. 1999). Sarcoidosis and syphilis have identical appearances on conventional barium studies, both ulcerative and hypertrophic (Fig. 5.11). 

Bile may be obtained in two forms fistula bile, the fresh secretion of the liver and gall-bladder bile, which has been stored and concentrated previous to being poured into the duodenum. The daily secretion of fistula bile is fairly constant, and usually between 600 and 700 ml, in twenty-four hours. 

The mixed secretion of the small glands of the duodenum, jejunum and ileum constitutes the intestinal juice, or succus entericus. As obtained from an experimental fistula in the dog, it is an alkaline liquid of pH 8-10, and contains a great variety of enzymes, which complete the hydrolyses begun by the catalysts of the earlier secretions. 

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