Transcript Insufficiency of digestion

Pathologic
physiology of
digestion and liver
Insufficiency of digestion. The
reasons. Manifestations
• The basic role of digestive system consists in
digestion of components of food that get into a
alimentary chanel (proteins, fats, carbohydrates),
absorption of formed nutrients and removing from an
organism some end-products of metabolism.
Numerous functions of digestive system are adjusted
by the central and vegetative nervous system,
humoral and endocrine influences. Disorders of
regulation entail Disturbance of normal current of the
processes in an alimentary channel, result in
insufficiency of digestion and promote development
of many diseases.
• Insufficiency of digestion is a
pathological condition at which the
digestive system does not provide
assimilation of the nutrients that get
inside the organism. As a result
starvation can develop.
• Depending on ethiology there are
• hereditary caused (some kinds
malabsorption)
• acquired insufficiencies of digestion
Cause the development of
insufficiency of digestion
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1. Alimentary (food) factors:
a) reception of bad and rough food
b) live on dry rations
c) irregular reception of food
d) disbalanced meal (for example, reduction of the
maintenance of vitamins, proteins in a diet)
• e) overindulge in alcohol
• 2. Physical factors
• Among factors of this group the greatest role belonge
to radiation which effect epitheliac cells of the
alimentary channel which have high mitotic activity
• 3. Chemical agents
• Are the reason of disorders of digestion after
poisonings with inorganic and organic connections
during manufacture and in life.
• 4. Biological factors:
• a) bacteria (for example, v.cholera, causative
agents dysentery, a belly typhus, paratyphus)
• b) bacterial toxins (for example, at salmonellosises,
a staphylococcal infection)
• c) viruses (for example, adenoviruses)
• d) helminths
• 5. Organic effects:
• a) congenital anomalies of digestive system
• b) postoperative conditions
• c) tumours of digestive system
• 6. Disorders nervous and humoral regulation.
Disorders of digestion can develop during:
• a) psychoemotional disorders (neurotic and
neurosis-like conditions)
• b) mental diseases (schizophrenia, a manic depressive syndrome)
• c) organic diseases of the central nervous system
(encephalites)
• d) lesions of peripheral structures of vegetative
nervous system
• e) reflex disorder (various viscero-visceral reflexes)
• Disorders of humoral regulation of digestion may
be connected to disorders of synthesis and
secretion gastrointestinal hormones (gastrine,
secretin, cholecystokinin-pancreazymin etc.)
Insufficiency of digestion may be
shown by the following syndromes:
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Starvation
Dispeptic syndrome
Dehydratation
Disturbance of the acid-basic balance
Intestinal autointoxication
The painful syndrome
• Dispeptic syndrome includes different
combinations of the following symptoms:
• a) anorexia
• b) heartburn
• c) eructation
• d) nausea
• e) vomitting
• f) meteorism
• g) constipations
• h) diarrhea
• Anorexia is a full absence of appetite while person
need food
• It is pick out the following kinds anorexia:
• а) intoxical - develops during acute and chronic
poisonings (for example, salts of mercury, medical
products, bacterial toxins)
• b) dispeptic - arises at diseases of digestive
system, has more often behavior-reflex nature
• c) neurodynamic - develops as a result reciprocal of
braking the centre of appetite after overexcitation of
separate structures limbic systems (for example, a
painful syndrome during a heart attacks, colics, a
peritonitis)
• d) neurotic - it is connected with excessive
excitation of cortex of brain and strong
emotions (especialy with negative)
• e) psychogenic – is connected with conscious
restriction of food (for example, with an aim of
getting thin or as result of mental disorders)
• f) neuroendocrinopathy - it is caused by
organic lesins of the central nervous system
(hypothalamus) and endocrine diseases
(hypophysial cachexia, Addison’s disease)
Two mechanisms of anorexia
development :
• 1) reduction of excitability of the food centre
(intoxical, dispeptic, neuroendocrinopathy
anorexia)
• 2) braking of neurons of food centre
(neurodynamic, neurotic, psychogenic
anorexia)
• The heartburn is a feeling of heat or
burnings long gullet. Its development is
connected with irritation of receptors of a
gullet during pelting contents of a stomach
into a gullet (reflux).
• It may be caused by:
• а) a plenty of formed gastric juice
• b) functional insufficiency of cardial
sphincter
• The eructation is a sudden involuntary allocation into oral
cavity some gas from a stomach or a gullet, sometimes with
small portions of contents of a stomach
• The increasing of the contents of gases in stomach may be
caused by two reasons:
• а) receipt big quantity of gases with food and a drink (for
example, aerated drinks), siping of air (aerofagia)
• b) formation of gases in the stomach, it is especial at a long
delay there peep (at a stomach ulcer, cancer of a stomach)
• As a result of increasing of the contents of gases in a
stomach it is increased intrastomach pressure. It reflexly can
cause:
• а) reduction of muscles of a stomach wall
• b) a spasm of the gatekeeper
• c) a relaxation of muscles of aesophagal-gastric sphincter
• Thereof gases are superseded from a cavity of a stomach in
a gullet, to a drink. And then in an oral cavity
• The nausea is a burdensome sensation in
epigastric area breast and in the oral cavities,
quite often previous to vomitting and frequently
accompanying with the general weakness,
sweatness, increasing of salivation, coldness of
arms and legs, pallor of a skin, decrease of
arterial pressure that is connected to activation
parasympathic nervous system. In a basis of a
nausea is an excitation of the emetic centre, but
insufficient for occurrence of vomitting lays.
• Vomitting - the complex-reflex act which results
to eruption of contents of a stomach outside
through a mouth is a result of excitation of the
emetic centre which is situated in an oblong
brain.
• The mechanism of vomitting includes a number of
consecutive stages. His pick out the following pathogenetic
variants of vomitting:
• а) central - it is connected with increasing of excitability of
the emetic centre. It happens at diseases of the central
nervous system (meningitises, encephalities, tumours of a
brain), at excitation of cortex of the big hemispheres
(behavior-reflex vomitting) or receptors of a labyrinth
(vestibular vomitting);
• b) hematogenic-toxic - it is caused by direct action of toxic
substances which are in blood, on receptors that are in
emetic centre. It may be exogenous substances (carbonic
oxide, alcohol, medical products, toxins of bacteria) or toxic
products of an own metabolism which are collected during at
a uremia, hepatic insufficiency, decompensated diabetes
and others;
• c) visceral (reflex) – is a result of reflexes which are caused
from different receptors of internal organs. Such reflexogenic
zones are in a stomach, a mucous membrane of pharynx,
coronal vessels, peritoneum, biliary duct etc.
• Meteorism is a superfluous accumulation of
gases in the digestive channel due to their
increased formation or insufficient removing from
intestines
• Superfluous formation of gases underlies
development of the following kinds of meteorism:
• а) alimentary - develops at reception with food a
lot cellulose, starches (leguminous, cabbage, a
potato)
• b) at disorders of digestion (pathology of
enzymes, disturbances of absorbtion, intestinal
disbacterioses)
• Disturbance of discharge of gases typically
for such meteorism:
• а) mechanical - develops as a result of
Disturbance of passableness of intestines
(spasms, solderings, tumours)
• b) dynamic - arises at disorders of motor
function of intestines
• c) circular – is a result of the general and
local disorders of blood circulation
• It is pick out two mechanisms of development of
constipations - spastic and atonic.
• The first is caused by long constant reduction of
smooth muscles of guts, the second – because
of their atonia.
• To spastic constipations concern:
• а) inflammatory - arise owing to local spastic
reflexes with changed of mucous membrane;
• b) proctogenic - develop at a pathology
anorectal areas;
• c) mechanical - arise at impassability of guts;
• d) toxic – is result of poisonings lead, mercury,
thallium.
• Atonic constipations are:
• а) alimentary - develop at receipt light food
containing(not enough) cellulose
• b) neurogenic – is the result of disorders of
nervous regulation of a motility of guts
• c) hypodynamic - arise at bed patients, at old men,
people with very low motor activity
• d) constipations at anomalies of a thick gut
(Girshprungs disease)
• e) constipations in consequensce disorders waterelectrolyte metabolism
• Diarrheas are often empty of guts with discharging of diluted
and plentiful excrements.
• Pathogenetic variants of diarrheas:
• а) osmotic diarrhea. Develops when osmotic pressure is
increase because of intestinal contents at intake of substances
which are bad or are not absorbed at all (for example, laxative),
and also at disturbances of digestion and absorbtion
(syndromes maldigestion and malabsorbtion)
• b) secretory diarrhea. It is connected with activation of secretion
of ions (Na+ , Cl‾), that causes the strengthened secretion of
water into gap of guts (for example, during cholera)
• c) diarrhea, caused by braking of active transport of ions
through cellular membranes in guts (for example, congenital
chlordiarrhea - genetic defect of absorbtion of anions of chlorine
in illeum)
• d) diarrhea is caused by increase of permeability of an intestinal
wall (inflammatory)
• e) diarrhea at disturbance of an intestinal motility
• Intestinal autointoxication, as a rule, is connected
with infringement corelation between bacterias and
formation a plenty of toxic products of fermentation
and putrafaction.
• Dysbacteriosis is an infringement of a ratio between
separate kinds of microflora. Thus the quantity of
the bacteria causing processes of putrafaction and
fermentation is frequently increased. As a result
formation in guts of toxic products - hydrogen
sulphide, scatol, indole, phenols, putrescine,
cadaverine grows etc. If formation of these products
exceeds functional ability of a liver on them
detoxifcation, attributes of hepatic insufficiency
develop. Development of intestinal autointoxication
is promoted by reduction of intestinal
peristalsis(constipations), reduction of secretion of
intestinal juice, intestinal obstruction.
• The pain frequently accompanies with development
of diseases of the alimentary channel. Depending to
the reasons and pathogenesis pain may have
different characters.
• Distinguish the following mechanisms of occurrence
of a pain at lesions digestive organs:
• The spastic mechanism. The pain is caused by a
spasm of smooth muscles of different departments
of the alimentary channel. It is considered, that in
this case the reason of a pain is constriction of the
vessels which are laying in the wall of hollow organs
owing to what the ischemia develops. It cause
appearance of the products of metabolism from the
working organs, and their influense on pain
receptors. At sharply arising strong spasm pains on
colics type develops
• The hypotonic mechanism. At reduction of a tone of
smooth muscles (hypotonia) the pain appears from a
stretching the wall of hollow organs (a stomach, guts,
gall bladder) by their contents. Thus the mechanical
stretching of tissues causes irritation of the nervous
endings;
• Influence of biologically active substances
(histamine, serotonin, kinines, prostaglandins) on the
nervous endings. These substances formes and
secretion at damages of cells and inflammation
(gastritises, duodenities, enterities, colics,
cholecystitises). Especially a lot of these substances
appear during acute pancreatitis.
In a basis of indigestion the following
disturbances of functions of digestive
system may take place:
• 1. Disturbance of secretion in digestive system:
• а) hypersecretion conditions:
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1 hypersalivation
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2 gastric hypersecretion
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3 pancreatic hypersecretion
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4 hypercholia
• b) hyposecretion conditions:
• 1 hyposalivation
• 2 gastric hyposecretion
• 3 pancreatic hyposecretion
• 4 acholia
• 2. Disturbance of motor function of the alimentary
channel:
• 1 disturbance of chewing
• 2 disturbances of swallowing - dysphagia
• 3 gastric dyskinesias
• 4 intestinal dyskinesias
• 5 dyskinesia gall bladder and biliary ducts
• 6 disturbances defecation
• 3. Disturbance of absorbtive functions - a
syndrome malabsorbtion.
Disturbance of functions of a stomach
Disturbance of secretion of a hydrochloric
acid, pepsin, mucus
• Hydrochloric acid is excreted by parietal cells of a mucous
membrane of a stomach which number in the healthy person
is about 1 billion. Secretion of it is adjusted by difficult
mechanisms which include three interconnected phases of
secretion: neurogenic (vagal), gastric (gastrine) and intestinal
which is regulated by irritation of receptors and intestinal
hormones.
• In regulation of functional activity of parietal cells takes place
nervous system (through mediator acethylcholine), and also
various hormones (serotonin, insulin). The basic
mechanisms of regulation the functions of parietal cells of
stomach can be presented as follows. The parietal cell
contains receptors to histamine which is released from
enterochromaphilic cells (ECL), gastrin and cholecystokinin
(CCK-receptors), and also receptors for acethylcholine (M3receptors),
• Stimulation of H2-histamine receptors is bring on formation
cAMP, and stimulation of CCK-receptors and M3-receptors
results to increasing of a level of endocellular calcium (Са++).
Stimulation of M3-receptors increases, not only comming
Са++ into a cell and due to increasing of level
inositolthreephosphate (IP3) strengthens an output of
endocellular Са++. Gastrin, cholecystokinin and histamine
also raise output of Са++ due to action on IP3 . Parietal cell
has a receptor for prostaglandin E2 (PGE2)) which
stimulation reduces a level cAMP and results in braking
secretion of hydrochloric acid.
• Secretion of a hydrochloric acid by parietal cell is carried out
by a principle of the proton pump in which K+ exchanges on
Hˉ‾, and Cl‾ on HCO3‾. An important role in this process plays
H+, K+ -ATPase which, using energy of ATP, provides
transport H+ from parietal cells and K+ into the cell. The
difficult mechanism of regulation the production of
hydrochloric acid explains increasing or decreasing of its
secretion under the influense of numerous factors.
• Hypersecretion of a hydrochloric acid plays the
important role in development of sevsral
gastroenterologic, may be observed at is hereditary
caused increasing of weight parietal cells, the
increased tone of a vagal nerve, a stretching of
antral part of a stomach during disorder of emptying,
increasing of secretion of gastrin, increasing
quantity of ECL-cells in the mucous membrane of a
stomach (at patients with carcinoid syndrome).
• Besides a hydrochloric acid by the main cells of a
mucous membrane of a stomach it is formed pepsin
from pepsinogen. Now distinguish seven types of
pepsinogen. Disturbance of pepsin formation
functions of a stomach matters in appearance of
number gastroenterologic diseases (for example, a
stomach ulcer).
• Gastric mucus is secreted by mucous cells of a mucous
membrane of a stomach. Into structure of gastric musous
enter glycosaminoglycans and glycoproteins. From sialic
acids N-acethylneuraminic acid provides ability of gastric
mucus to form a water-insoluble viscose coverings mucus
membrane of a stomach. Secretion of gastric mucus takes
place continuously. Stimulating influence on formation of
mucus render irritation adreno- and cholinoreceptors,
prostaglandins. In process of mucus formation the certain
role plays stability of lisosoms. Hydrolasis of lisosoms cause
dehydratation of glycoproteins.
• Gastric mucus (together with bicarbonates) takes part in
formation of a mucus barrier which supports a gradient рН
between a hollow of a stomach and its mucus membrane
and late H+.
• Disturbance of this barrier as a result of reduction the
synthesis of prostaglandins in the wall of a stomach is one of
mechanisms of damage mucus membrane under action of
some medical products (aspirin, not steroid antiinflammatory drugs). On the contrary, synthetic
prostaglandins have cell protective properties, raise mucus
formation and prevent effect of a stomach.
Gastric hypersecretion is characteristed by:
• Increasing the quantity of gastric juice as
after reception of food, and also on the empty
stomach
• Hyperaciditas and hyperchlorhydria - is
increasing of the common acidity and the
maintenance of a free hydrochloric acid in
gastric juice
• Increasing of digestive ability of gastric juice
• The disturbances of digestion connected with
gastric hypersecretion, are caused by a long
delay food in the stomach (pilorus is closed,
because neutralization of very sour contents that
goes into duodenal gut, demands a lot of time).
• This circumstance has such consequences:
• in guts enter not enough contents that results in
reduction of peristaltics of guts and to
development of constipations
• in the stomach processes of fermentation and
formation gases amplify. It causes appearance
of an eructation and a heartburn
• motor activity of a stomach is increased as the
result hypertone and hyperkinesis of smooth
muscles develops
Gastric hyposecretion is are characterised by:
• Reduction the quantity of gastric juice on an
empty stomach and after reception of food
• Decreased or zero acidity of gastric juice
(hypo-or unacidity), reduction of the
contents in it or absence of a free
hydrochloric acid (hypo- or achlorhydria)
• Reduction of digesting ability of gastric juice
due to achylia (the full stop formation a
hydrochloric acid and enzymes)
• Reduction of gastric secretion results in disturbances of
digestion along alimentary channel.
• It is caused by insufficient formation of gastric juice that
keeps pylorus opened also contents of a stomach quickly
passes into a duodenal gut where environment becomes
constantly alkaline. Thus there is a hinder of formation
secretine as a result secretion of pancreatic juice is
decreased and processes of hollow digestion in guts are
broken.
• Insufficiently digested components of food irritate receptors
of a mucus membrane of guts that results in their
strengthening of peristaltics and diarrheas develop.
• Besides an absence of a hydrochloric acid in a stomach is
leads to the grow of microflora in the stomach.
• Activation of processes of rotting and fermentation is
connected with it in the stomach and appearance such
Disturbance of diggestion, as an eructation, the impose
tongue etc.
Disturbance of motor function of stomach
• Disturbance of motor function of stomach
is called gastric diskinesia
• Trere is two kinds of gastric diskinesia:
hypertonic and hypotonic
• Hypertonic kind is characterised by
strengthening of peristaltics(hyperkinesia)
and increasing of a tone of muscles of a
stomach(hypertonia)
• The hypotonic kind, on the contrary, is
characterized by a hypotonia and
hypokinesia
The reasons of motor gastric disturbance
of hypertonic type
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some food factors (rough food, alcohol)
increase of gastric secretion
increase of a tone of vagal nerve
some gastrointestinal hormones (motilin)
Hypertension and hyperkinesia of stomach leads to:
a long delay of food in stomach that promotes
increase of gastric secretion and development of
ulcers on a mucus membrane
• development antiperistaltics of stomach that results
in development of dispeptic disturbances (an
eructation, a nausea, vomitting)
• One forms of diskinesia of stomach of hypertonic
type is pylorospasm
• It is observed mainly in babies, especially in the
first weeks and months of life.
• Pylorospasm in children is caused by functional
disturbances of the nervous- muscular system of
pylorus part stomach. It is observed mainly at
the excitable children who have transferred
intra-uterine hypoxia, born in asphyxia with
attributes of a birth trauma of the central nervous
system
• At pylorospasmis marked weak development of
muscles in cardial parts of a stomach and its
more expressed development in the area of
pylorus. It promotes development of vomitting
and eructation
Causes of stomach motor activity reduction
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alimentary factors (fat food)
reduction of gastric secretion (hypoacid gastritises)
reduction of a tone of a vagal nerve
action overwhelming a motility of a stomach through
gastrointerstitial hormones (gastroingibitued peptide,
secretine etc.)
• removal of pylorus part of a stomach
• the common weakening of organism, an exhaustion,
gastroptosis
• At hypotonic diskinesias time of staying of food in the
stomach is shortened that conducts to disturbance of its
digestion. Action of the not digested components of food on
receptors of a mucus membrane of guts causes the increase
of peristalties and diarrheas.
The reasons and pathophysiologic
mechanisms of a stomach ulcer
• The stomach ulcer is chronic relapsing disease which is characterized by
formation of ulcer in a stomach and duodenum gut
• Ethiology of ulcer disease now residnally not established. It is
considered, that in development of stomach and duodenal ulcers take
place the following factors
• 1. Psychoemotional negative overstrains (negative emotions, disputed
situations, feeling of constant alarm, overfatigue etc.)
• 2. Stress
• 3. Hereditary predisposition
• 4. The error in a meal – live on dry ration, irregular reception peep, eating
of rough or pungent food, bad chawing of food, fast meal, absence of the
teeth, the insufficient maintenance(contents) in foodstuff of proteines and
vitamins
• 5. Chronic gastritis and duodenitis with increased secretion of glands of
mucus membrane
• 6.The microbic factor - Helicobacter pylori
• 7.Deleterious habits - smoking, overindulge of alcohol
• According to modern representations, pathogenesis of stomach
ulcer in general is reduced to disturbance of balance between
factors acid-peptic aggressions of gastric contents and elements of
protection of a mucus membrane of stomach and duodenalum.
Sufficient development of bicarbonates, good regeneration of
epithelial cells, the kept blood supply of a mucus membrane, normal
formation and the maintenance of prostaglandins in a wall of a
stomach, sufficient gastric formation of mucus are factors that
protect mucus membrane.
• During last years an important role in weakening of protective
properties of a mucus membrane of a stomach and a duodenum is
given to microorganisms Helicobacter pylori. These bacterias
produse a lot of enzymes (urease, protease, phospholipase),
damaging a protective barrier of a mucus membrane, and also
various cytotoxins. The most pathogenic are Vac A-stams, that
produce vacuolization cytotoxin which results in formation
cytoplasmatic vacuoles and destructions of epithelial cells, and the
Sad A-stams which express gene associated with cytotoxin. This
gene codes proteine which has direct damaging effect on a mucus
membrane. Helicobacter pylori romotes liberation in a mucus
membrane of a stomach interleukines, lisosomal enzymes, TNFα,
that causes development of inflammatory processes in the mucus
membrane of stomach. Pathophisiologic mechanisms of
development of duodenum ulcer gut in 95 % of cases associated
with Helicobacter.
• Contaminating the mucus membrane of the stomach by
Helicobacter is accompanied by development superficial
anthral gastritis and duodenitis and conducts to increasing a
level of gastrin with the subsequent increasing secretion of a
hydrochloric acid. The superfluous quantity of a hydrochloric
acid, getting into a lumen of duodenum, in conditions of
deficiency of pancreatic bicarbonates promotes development
of duodenitis and besides cause appearance in duodenum
sites gastric melatonin (reorganization of epithelial of
duodenal mucus membrane on gastric type) which are quickly
contaminated by Helicobacter. Further at adverse current,
especially when there are additional ethiologi factors
(hereditary predisposition, 0 (1) group of blood, smoking,
psychological an overstrain etc.), In sites of metaplased
mucus membrane ulcer defect is formed. However
connection of occurrence of a stomach ulcer with infection of
mucus membrane of stomach by Helicobacter revealed not
always. Approximately 5 % of patients with ulcers of a
duodenum gut and in 15-20 % of patients with stomach
ulcers, disease develops without participation of these
microorganisms.
Disturbance of intestinal functions
• Functions of intestines may be broken owing to
many organic diseases. In some cases these
disturbances arise owing to disturbances of
nervous regulation of a motility of a small and
large intestine
• Disturbance of digestion and absorbtion in
intestines
• The complex of disturbances which appear in
an organism as a result of disturbance of
processes of digestion and absorbtion, has
received the name of a syndrome maldigestion
and malabsorbtion
The syndrome maldigestion
• The syndrome maldigestion are disturbances of
primary digestion, caused by insufficient receiption
into guts the digestive enzymes, in particular at
pancreatic hyposecretion.This syndrome appearea in:
• disturbance of digestion of fats (absence of lipase and
phospholipase). About 60-80 % of fat that get into
guts is deduced with feaces – steatorrhea (fat in
feaces)
• disturbance of absorbtion of fat-soluble vitamins –
cause the development hypovitaminosis A, E and K
• disturbance of digestion of proteins (absence of
digestive proteases). About 30-40 % of food protein
are not acquired. In feaces there is a plenty of
muscular fibres
• disturbance of digestion of carbohydrates (absence of
amylases)
• disturbance of degrad of nucleinic acids (absence of
nucleases)
The syndrome of malabsorption
• It is complex of symptoms which appearing
results from disturbance absorbtion of
substances in guts. Disturbance of absorbtion
in guts may be caused by the disturbances that
appeare at three levels:
• Preenterocytic disturbance. Develop as a
result of disturbances of processes of digestion
before absorbtion;
• Enterocytic. From disturbance of activity
epithelial cells of intestinal mucus membrane;
• Postenterocytic. Are consequence of
disturbance of the processes that provides
receiption of soaked up substances into
internal environment of an organism (blood,
lymph).
Preenterocytic disturbances:
• Disturbances of motor function of the alimentary channel
• Disturbances of primary digestion (a syndrome
maldigestion). By origin they may be gastrogenic,
pancreatogenic, hepatogenic, enterogenic, disregulated,
iatrogenic (connected with long usage of antibiotics and
other medical products)
• Disturbance memrane digestion. More often they are
caused by disturbances of formation and embedding of
enzymes into plasmatic membrane of enterocytic
microvillus
• Interstitial pathology of enzymes a hereditary caused
disturbances of synthesis the digestive enzymes by
microvillus which provide processes of membrane
digestion. Among interstitial pathology of enzymes the
most often is intolerance to disaccharides (lactoses,
saccharoses, tregaloses) and insufficiency of peptidase
(gluten enteropathy, celiac disease).
The reasons of malabsorbtion may be
such enterocytic disturbances:
• reduction of absorbtion area (a condition after a
resection of a gut, an atrophy of villus and microvillus)
• hereditary caused and acquired disturbance of formation
of proteins - carriers monosaccharides (intolerance of
glucose, galactose, fructoses), amino acids
(tryptophanmalabsorbtion), ions of calcium
(hypovitaminosis D)
• disturbances of functioning ions pumps of enterocytes
(transport monosaccharides and amino acids is
connected with work of Na-K-pump)
• deficiency of energy (absorbtion the majority of
substances - process energydependent)
• disturbance of assembly in enterocytes of convey
complexes (chilomicrones, lipoproteids)
The reasons of malabsorbtion may be
such postenterocytic disturbance:
• Disturbances of blood circulation in a wall of guts,
may be caused by disturbances of general
haemodynamic in system v.reccurentis and local
disturbances (ischemia, venous hyperaemia,
thrombosis, embolia, reactions of vessels at an
inflammation);
• Disturbances lymph flow. Except of general
dosorders of lymph circulation they may be
connected to disturbances of reduction of fibers of
intestinal wall. Such reduction in norm is carried
out due to local reflexes with a part of submucus
nervous plexus and at participation of a hormone
villikinin.
Disturbances of motor function of
intestines
• Disturbances of motor function of guts refer to
intestinal diskinesia.
• There are two types of intestinal diskinesia:
hyperkinetic and hypokinetic.
• The first type is characterised by strengthening of
the peristalties, segmentary and pendulum-like
movements it has such manifastation as
diarrheas.
• The second, on the contrary, is characterized by
easing of motor activity of guts as a result
constipations appears.
The reasons of intestinal diskinesias of
hyperkinetic type:
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Increasing excitability of receptors of guts to adequate
irritators, that accompanies with development of an
inflammation of a mucus membrane of intestines (enteritis,
colics)
Action on receptors of guts unusual, pathological irritators not digested food (for example, for achylia), products of
rotting and fermentation, toxic substances etc.
Increasing of excitability of the centres of a vagal nerve
Increase of form of some gastrointerstitial the hormones that
strengthening periataltics of guts (motilin)
Consequences intestinal diskinesias of hyperkinetic type are:
disturbances of digestion (digestion, absorbtion)
dehydratation
secretory not gas acidosis (loss of hydrocarbonates)
• Intestinal dyskinesia of hypokinetic type are manifestated by
reduction of guts peristaltics. That results in appearance of
constipations. On mechanisms of development it is pick out two
kinds of constipations: spastic and atonic.
• Spastic constipations result from long tonic reduction of smooth
muscles of guts (spasm) and may be caused by viscerovisceral reflexes, or action of toxic factors (for example, a
poisoning by lead).
• Reason of development atonic constipations connected with
reduction of contractive of function of smooth muscles guts:
• a poor feed, the low contents of cellulose in consumed
foodstuffs
• excessive digestion peep in a stomach (for example, at gastric
hypersecretion)
• age changes of receptor system of guts in old men, and also
structural changes of an intestinal wall during adiposity
• decrease of tone vagal nerve
• disturbances intraintestinal innervation, for example, during
Girshprungs disease - absence of ganglion cells Auerbachs
plexus in sigmoideum and rectum
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Intestinal dyskinesia of hypokinetic type lead to:
development of intestinal autointoxication
occurrence meteorism
formation of feces stones
in extreme cases intestinal obstruction may develop