Bowel, small

Gallbladder contraction ejects a bolus of bile acids into the small bowel where they participate in fat digestion. 

Several studies have demonstrated the production of mucosal damage and/or increased mucosal permeability by hydrogen peroxide, the hydroxyl radical, or by installation of xanthine or glucose oxidase (Gregaard et al., 1982 Parks et al., 1984 Joubert-Smith et al., 1991 Kohen etal., 1992). 

Allopurinol, which inhibits XO and scavenges superoxide, prevents the increase in free-radical production 

However, this will also prevent the formation of other cytotoxic species such as the hydroxyl radical. Further evidence that antioxidants prevent against the development of I/R injury comes from studies that show that previous ischaemic injury in the small intestine of rats results in prevention of further damage on subsequent ischaemic challenge in association with measured increases in mucosal glutathione peroxidase and catalase (Osborne et al., 1992). 

Conceivably, such drugs might also find a place in the treatment of other forms of mesenteric ischaemia and also in the realms of small bowel transplantation. 

---

Bacillus cereus Small bowel Invasion toxin... 

The theory underlying the pathophysiology of ischaemia-reperfusion injury, and the role of free radicals in this process has been discussed in detail above. The human colon contains relatively little XO (Parks and Granger, 1986) and so the arguments supporting a role for this enzyme in the pathogenesis of small bowel... 

Sanderson, I.R., Udeen, S., Davies, P.S.W., Savage, M.O. and Walker-Smith, J.A. (1987). Remission induced by an elemental diet in small bowel Crohn s disease. Arch. Dis. Child. 61, 123-127. 

Small bowel resection, severe diarrhea, intractable vomiting, bowel obstruction, and fistulas ° Critically ill patients with nonfunctioning GI tract... 

Gastrointestinal involvement may present initially as small bowel obstruction shortly after birth (known as meconium ileus) due to abnormally thick meconium that cannot be passed. Older CF patients may develop distal intestinal obstruction syndrome (DIOS), formerly called meconium ileus equivalent, which occurs due to fecal impaction in the terminal ileum and cecum. 

Pentasa Microgranule controlled-release capsule 250 mg 500 mg 2-4 g 2-4 g Small bowel Colon... 

Obstructing disorders Pyloric obstruction Small bowel obstruction Colonic obstruction Achalasia... 

Tegaserod maleate (Zelnorm) stimulates 5-HT4 receptors in the GI tract, thereby increasing intestinal secretion, peristalsis, and small bowel transit. It also reduces sensitivity related to abdominal distention. It has been shown to be more effective than placebo in improving global IBS symptoms and altered bowel habits in constipation-predominant IBS.21 Diarrhea is a possible adverse effect. 

Pelvic exam (females) (look for evidence of prolapse of bladder, small bowel, rectum, or uterus, or estrogen deficiency)... 

KUB An upright abdominal x-ray shows dilated loops of small bowel and free air under the diaphragm. 

In ovarian cancer patients, small bowel obstruction is a common complication of progressive disease. In general, laxatives should not be used in patients with small bowel obstructions. 

Debulking surgery is intended to relieve symptoms associated with complications such as small bowel obstructions and to help improve the patient s quality of life but does not have a curative intent. 

Major small bowel resection (e.g., short bowel syndrome)... 

Adult patients with less than 100 cm small bowel distal to the ligament of Treitz without a colon Adult patients with less than 50 cm of small bowel if the colon is intact... 

AA is 45-year-old woman admitted to the hospital with chief complaints of fever, abdominal pain, nausea, and vomiting for 2 days. She also reports decreased appetite and decreased oral intake for the past 3 to 4 days. The patient was discharged 2 weeks ago after having a small bowel resection for recurrent bowel obstruction. 

Small bowel resections (greater than 100 cm of small intestine remaining, colon intact)... 

The food, now in a liquid form known as chyme, passes through the pyloric sphincter into the duodenum, where stomach acid is neutralized. There is wide variation in lengths of the components of the small intestine (i.e., duodenum, jejunum, and ileum) between individuals (Table 98-1). Most absorption of digested carbohydrate and protein occurs within the jejunum. Most fat absorption occurs within the jejunum and ileum. In the small bowel, breakdown of macronutrients (i.e., carbohydrate, protein, and fat) occurs both within the lumen of the gut and at the intestinal mucosal membrane surface. The absorptive units on the intestinal mucosal membrane are infoldings known as... 

After absorption in the small bowel, remaining undigested food passes from the ileum through the ileocecal valve to the colon. A major role of the colon is absorption of fluid. Some of the water and sodium absorption achieved by the colon is facilitated by short-chain fatty acids (SFCAs) formed from digestion of certain dietary fibers by colonic bacterial enzymes. 

Severe hemorrhagic pancreatitis Severe necrotizing pancreatitis Necrotizing enterocolitis Diffuse peritonitis Small bowel obstruction Paralytic ileus... 

An advantage of feeding into the stomach is that the feedings can be delivered in either an intermittent or continuous fashion. This is unlike feedings directly into the small bowel,... 

---