Pathophysiology of digestion

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• Pathophysiology of digestion
• MD, Prof. Yu.I. Bondarenko

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Insufficiency of digestion. The reasons.
Manifestations

• The basic role of digestive system consists
  in digestion of components of food that enter
  into an alimentary canal (proteins, fats,
  carbohydrates), absorption of formed nutrients
  and removing from an organism end-products of
  metabolism.
• Numerous functions of digestive system are
  regulated by the central and autonomic nervous
  system, humoral and endocrine influences.
• Disorders of regulation cause disturbance of
  normal course of the processes in an alimentary
  canal, result in insufficiency of digestion and
  promote development of many diseases.

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Insufficiency of digestion

• It is pathological condition at which the
  digestive system does not provide assimilation of
  the nutrients that enter in the organism.
• hereditary insufficiency of digestion (some kinds
  malabsorption)
• acquired insufficiency of digestion

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Causes of digestion insufficiency
development

• 1. Alimentary (food) factors
• a) reception of bad and rough food
• b) dry rations
• c) irregular reception of food
• d) disbalanced meal (for example, reduction of
  the contain of vitamins, proteins in diet)
• e) abuse in alcohol
• 2. Physical factors
• Greatest role belonge to radiation which damage
  epithelial cells of the alimentary channel which
  have high mitotic activity

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• 3. Chemical agents Poisonings with inorganic
  and organic compounds.
• 4. Biological factors
• a) bacterium (for example, v.cholera, dysentery,
  typhoid, paratyphoid fever)
• b) bacterial toxins (for example, salmonellosis,
  staphylococcus infection)
• c) viruses (for example, adenoviruses)
• d) helminths
• 5. Organic effects
• a) congenital anomalies of digestive system
• b) postoperative conditions
• c) tumors of digestive system

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• 6. Disorders of nervous and humoral
  regulation
• a) psychoemotional disorders (neurotic and
  neurosis-like conditions)
• b) mental diseases (schizophrenia, maniac -
  depressive syndrome)
• c) organic diseases of the central nervous system
  (encephalites)
• d) lesions of peripheral structures of autonomal
  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.)

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Insufficiency of digestion may manifests
syndromes

• 1. Starvation
• 2. Dispeptic syndrome
• 3. Dehydratation
• 4. Disturbance of the acid-base balance
• 5. Intestinal autointoxication
• 6. Painful syndrome

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DISPEPTIC 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

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ANOREXIA

• Anorexia is a full absence of appetite while
  person need food
• Kinds of the anorexia
• ?) 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
  disturbance of the appetite centre after
  overexcitation of structures limbic systems (for
  example, painful syndrome during heart attacks,
  colics, peritonitis)

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ANOREXIA

• d) neurotic - is connected with excessive
  excitation of cortex brain and strong emotions
  (especialy 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 - is caused by organic
  lesion of the central nervous system
  (hypothalamus) and endocrine diseases
  (hypophysial cachexia, Addisons disease)

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Mechanisms of anorexia development

• 1. Reduction of excitability of the food centre
  (intoxical, dispeptic, neuroendocrinopathy
  anorexia)
• 2. Inhibition of neurons of the food centre
  (neurodynamic, neurotic, psychogenic anorexia)

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• The heartburn is a feeling of heat or burnings
  long esophagus.
• Development is connected with irritation of
  receptors of esophagus during pelting contents of
  stomach into one (reflux).
• It may be caused by
• ?) increase forming of gastric juice
• b) functional insufficiency of cardial sphincter

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• The eructation is 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
• ?) 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
• ?) 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

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• 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.

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• The mechanism of vomitting includes a number of
  consecutive stages. His pick out the following
  pathogenetic variants of vomitting
• ?) 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.

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• 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
• ?) alimentary - develops at reception with food a
  lot cellulose, starches (leguminous, cabbage, a
  potato)
• b) disorders of digestion (pathology of enzymes,
  disturbances of absorbtion, intestinal
  disbacterioses)

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• Disturbance of discharge of gases typically for
  such meteorism
• ?) 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

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• 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
• ?) 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.

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• Atonic constipations are
• ?) 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
  water-electrolyte metabolism

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• Diarrhea
• Pathogenetic variants of
  diarrheas
• ?) 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

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• 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.

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PAIN

• 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 pain at lesions of digestive
  organs
• The spastic mechanism. The pain is caused by a
  spasm of smooth muscles of different parts of the
  alimentary channel. In this case the reason of
  pain is constriction of the vessels which are
  located in the wall of hollow organs owing to
  that the ischemia develops. It cause appearance
  of metabolism products in the working organs, and
  their influence on pain receptors. At sharply
  arising strong spasm pain on colics type develops

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PAIN

• The hypotonic mechanism. At reduction of smooth
  muscles tone (hypotonia) the pain appears due to
  stretching the wall of hollow organs ( stomach,
  guts, gall bladder) by their contents. Thus the
  mechanical stretching of tissues causes
  irritation of the nervous endings
• Influence of biological active substances
  (histamine, serotonin, kinines, prostaglandins)
  on the nervous endings. These substances are
  formed and secreted at damage of cells and
  inflammation (gastritis, duodenitis, enteritis,
  colitis, cholecystitis). Especially a lot of
  these substances appear during acute pancreatitis.

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Functional disorders of digestive system

• 1. Disturbance of digestive system secretion
• ?) hypersecretion states
• 1 hypersalivation
• 2 gastric hypersecretion
• 3 pancreatic hypersecretion
• 4 hypercholia
• b) hyposecretion states
• 1 hyposalivation
• 2 gastric hyposecretion
• 3 pancreatic hyposecretion
• 4 acholia

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• 2. Disturbance of motor function of the
  alimentary channel
• 1 disturbance of chewing
• 2 disturbances of swallowing - dysphagia
• 3 gastric dyskinesia
• 4 intestinal dyskinesia
• 5 dyskinesia of gall bladder and biliary ducts
  
• 6 disturbances of defecation
• 3. Disturbance of digestive and absorptive
  functions - syndromes of maldigestion and
  malabsorption.

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Hydrochloric acid, pepsin, mucus secretion
disturbance

• Hydrochloric acid is secreted with parietal cells
  of mucous membrane of stomach. Their number in
  the healthy person is about 1 billion.
• Phases of secretion
• 1.Neurogenic (vagal)
• 2.Gastric (gastrine)
• 3.Intestinal that is regulated by intestinal
  hormones.
• In regulation of functional activity of parietal
  cells takes place nervous system (through
  mediator acethylcholine), and also various
  hormones (serotonin, insulin). The parietal cell
  contains receptors to histamine which is released
  from enterochromaphilic cells (ECL), gastrin and
  cholecystokinin (CCK-receptors), and also
  receptors for acethylcholine (M3-receptors),

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REGULATION OF OUTPUT HCL

• Stimulation of H2-histamine receptors is bring on
  formation cAMP, and stimulation of CCK-receptors
  and M3-receptors results to increasing of level
  of endocellular calcium (??).
• Stimulation of M3-receptors increases, not only
  total ?? into cell and due to increasing of
  level inositolthreephosphate (IP3) strengthens an
  output of endocellular ??.
• Gastrin, cholecystokinin and histamine also
  raise output of ?? due to action on IPh3 .
• Parietal cell has receptor to prostaglandin E2
  (PGE2)) which stimulation reduces level cAMP and
  results ihibition of hydrochloric acid secretion.
• Secretion of hydrochloric acid by parietal cell
  is carried out by principle of the proton pump in
  which K exchanges on H, 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
  cell.

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• Hypersecretion of hydrochloric acid plays the
  important role in development of several
  gastroenterologic illness, may be observed at
  hereditary conditioned increasing of weight
  parietal cells, the increased tone of a vagal
  nerve, stretching of antral part of stomach
  during disorder of emptying, increasing of
  secretion of gastrin, increasing quantity of
  ECL-cells in the mucous membrane of stomach (in
  the patients with carcinoid syndrome).
• The main cells of mucous membrane form pepsin .
  It is know seven types of pepsinogen. Disturbance
  of pepsin formation take place in the number
  gastroenterologic diseases (for example, stomach
  ulcer).

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• Gastric mucus is secreted by stomach mucous
  cells. Into structure of gastric musous contain
  glycosaminoglycans and glycoproteins.
• From sialic acids N-acethylneuraminic acid
  provides ability of gastric mucus to form
  water-insoluble viscose lay of stomach mucus
  membrane.
• Stimulating influence on formation of mucus
  result irritation of adreno- and
  cholinoreceptors, prostaglandins. Hydrolysis of
  lisosoms cause dehydratation of glycoproteins.
• Gastric mucus (together with bicarbonates) takes
  part in formation of mucus barrier which supports
  a gradient ?? between hollow of stomach and its
  mucus membrane and H.
• Disturbance of this barrier as a result of
  reduction the synthesis of prostaglandins in the
  wall of stomach.

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Gastric hypersecretion is characterized

• Increased quantity of gastric juice as after
  reception of food and also on the empty stomach
• Hyperaciditas and hyperchlorhydria - is increase
  of the common acidity and the maintenance of
  free hydrochloric acid of gastric juice
• Increasing of digestive ability of gastric juice

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• The disturbances of digestion connected with
  gastric hypersecretion, are caused with long
  delay food in the stomach (pylorus is closed,
  because neutralization of very acidic contents
  that goes into duodenum,it take a lot time).
• Consequences
• A little contents that enter into guts lead to
  reduction of gut peristaltic and constipation
  development.
• Processes of fermentation and formation gases is
  amplified in the stomach. It causes appearance of
  eructation and heartburn
• Motor activity of stomach is increased as a
  result hypertone and hyperkinesis of smooth
  muscles.

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Gastric hyposecretion is characterized

• 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 the 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)

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• Reduction of gastric secretion stipulated
  disturbance of digestion along alimentary
  channel.
• Insufficient formation of gastric juice that
  keeps pylorus opened also contents of stomach
  quickly passes into duodenum where environment
  becomes constantly alkaline. It causes inhibition
  of formation secretin.
• Insufficiently digested components of food
  irritate receptors of mucus membrane of guts
  that results in their strengthening of
  peristaltic and diarrhea develop.
• Besides an absence of a hydrochloric acid leads
  to development of microflora in the stomach.
• Activation of processes of rotting and
  fermentation is connected appearance such
  disturbance of digestion, as an eructation, the
  impose tongue etc.

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Disturbance of stomach motor function

• Disturbance of stomach motor function is
  called gastric diskinesia
• Trere are two kinds of gastric diskinesia
  hypertonic and hypotonic
• Hypertonic kind is characterized strengthening
  of peristaltic(hyperkinesia) and increasing of
  stomach muscles tone (hypertonia)
• The hypotonic kind, on the contrary, is
  characterized hypotonia and hypokinesia

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The reasons of motor gastric disturbance of
hypertonic type

• Some food factors (rough food, alcohol)
• Increase of gastric secretion
• Increase of vagal nerve tone
• Some gastrointestinal hormones (motilin)
• Hypertension and hyperkinesia of stomach leads
  to
• A long time delay of food in stomach that
  promotes increase of gastric secretion and
  development of ulcers of mucus membrane
• Development antiperistaltic of stomach that
  results in development of dispeptic disturbances
  (an eructation, nausea, vomitting)

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• One forms of diskinesia of stomach 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 stomach and its more
  expressed development in the area of pylorus. It
  promotes development of vomitting and eructation

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Causes of stomach motor activity reduction

• Alimentary factors (fat food)
• Reduction of gastric secretion (hypoacidic
  gastritis)
• Reduction of vagal nerve tone
• Action gastrointerstitial hormones
  (gastroinhibiting peptide, secretine etc.)
• Removal of stomach pylorus
• The common weakening of organism, an exhaustion,
  gastroptosis
• At hypotonic diskinesia time of staying of
  food in the stomach is shortened that lead to
  disturbance of its digestion. Action undigested
  components of food on receptors of mucus
  membrane of guts causes increase of peristaltic
  and diarrhea.

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ETIOLOGY OF GASTRIC ULCER

• Etiology of ulcer disease now is not
  established !
• In development of stomach and duodenal
  ulcers
• take place the following risk
  factors
• 1. Psychoemotional negative overstrains (negative
  emotions, conflict situations, feeling of
  constant alarm, overfatigue etc.)
• 2. Stress
• 3. Hereditary predisposition
• 4. Nutritional disorder live on dry ration,
  irregular reception of nutriment, eating of rough
  or pungent food, bad chawing of food, fast meal,
  absence of the teeth, the insufficient contents
  in food of proteins and vitamins
• 5. Chronic gastritis and duodenitis with
  increased secretion
• 6.The microbic factor - Helicobacter pylori
• 7. Harmful habits - smoking, abuse of alcohol

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• 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 stomach mucus membrane
  and duodenum.
• Sufficient of bicarbonates buffer, good
  regeneration of epithelial cells, blood supply of
  mucus membrane, normal formation of
  prostaglandins in wall of stomach are factors
  that protect mucus.
• Helicobacter pylori. These bacterias produce a
  lot of enzymes (urease, protease, phospholipase),
  damaging protective barrier of mucus membrane,
  and also various cytotoxins. The most pathogenic
  are Vac A-strains, that produce vacuolizing
  cytotoxin which results in formation
  cytoplasmatic vacuoles and destructions of
  epithelial cells, and the Sad A-strains which
  express gene associated with cytotoxin. This gene
  codes protein which has direct damaging effect on
  mucus membrane.
• Helicobacter pylori promotes liberation in a
  mucus membrane of stomach interleukines,
  lisosomal enzymes, TNFa, that causes development
  of inflammatory processes in mucus.

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STOMACH PEPTIC ULCER
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PEPTIC STOMACH ULCER
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STOMACH AND DUODENUM ULCER

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HYSTOLOGY OF THE STOMACH ULCER
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DUODENUM ULCERS
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ACUTE STOMACH ULCERS
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DUODENUM ULCER
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INFECTIOUSES AGENTS OF STOMACH
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HELICOBACTER PYLORI
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DUODENUM ULCER
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• Contamination of stomach mucus membrane by
  Helicobacter is accompanied by development
  superficial anthral gastritis and duodenitis and
  lead to increase level of gastrin with the
  subsequent increasing of hydrochloric acid
  secretion.
• Excess of hydrochloric acid, getting into lumen
  of duodenum, in conditions of deficiency of
  pancreatic bicarbonates promotes development of
  duodenitis (remodulation of epithelium of
  duodenal mucus membrane on gastric type) which
  are quickly contaminated by Helicobacter.
• Further at adverse current, especially when there
  are additional etiological factors (hereditary
  predisposition, 0 (1) group of blood, smoking,
  psychological an overstrain etc.), in area of
  metaplased mucus membrane ulcer defect is formed.
  
• However connection of occurrence of stomach
  ulcer with infection of mucus membrane of stomach
  by Helicobacter revealed not always.
  Approximately 5 of patients with ulcers of
  duodenum and of 15-20 patients with stomach
  ulcers, disease develops without participation of
  these microorganisms.

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Disturbance of intestinal functions

• Functions of intestines may be disordered owing
  to many organic diseases. In some cases these
  disturbances arise owing to disturbances of
  nervous regulation of small and large intestine
  motility
• Disturbance of digestion and absorbtion in
  intestines
• The complex of disturbances which occur in an
  organism as a result of disturbance of digestion
  and absorbtion processes, received the name of a
  syndrome maldigestion and malabsorption

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The syndrome maldigestion

• The syndrome of maldigestion is disturbances of
  primary digestion, caused by insufficient
  secretion into guts the digestive enzymes, in
  particular at pancreatic hyposecretion.
• This syndrome is characterized
• disturbance of digestion of fats (absence of
  lipase and phospholipase). About 60-80 of fat
  that get into guts is removed with feces
  steatorrhea (fat in feces)
• disturbance of absorption of fat-soluble vitamins
  cause the development hypovitaminosis A,D, E
  and K
• disturbance of digestion of proteins (absence of
  digestive proteases). About 30-40 of food
  protein are not adopted. In feces there is
  plenty of muscular fibres
• disturbance of digestion of carbohydrates
  (absence of amylase)
• disturbance of nucleinic acids digestion (absence
  of nucleases)

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The syndrome of malabsorption

• It is complex of symptoms which occur in a result
  of disturbance absorption of substances in guts.
  Disturbance of absorbtion in guts may be caused
  by the disturbances that occur at three levels
• Preenterocytic disturbance. Develop as a result
  of disturbances of processes of digestion before
  absorbtion
• Enterocytic. Disturbance of activity epithelial
  cells of intestinal mucus membrane
• Postenterocytic. Disturbance of the processes
  that provides utilization of absorbed substances
  into internal environment of an organism (blood,
  lymph).

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Preenterocytic disturbances

• Disturbances of primary digestion (the
  syndrome maldigestion). By origin they may be
  gastrogenic, pancreatogenic, hepatogenic,
  enterogenic, disregulated, iatrogenic (connected
  with long usage of antibiotics and other medical
  drugs)
• Disturbance of memrane digestion. More often it
  is caused by disturbance of formation and
  fixation of enzymes in plasmatic membrane of
  enterocytic microvillus
• Interstitinal enzymopathies- hereditary caused
  disturbances of digestive enzymes synthesis 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).

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The reasons of malabsorbtion may be such
enterocytic disturbances

• Reduction of absorption area ( condition after
  resection of gut, an atrophy of villus and
  microvillus)
• Hereditary and acquired disturbance of proteins
  formation - carriers monosaccharides (intolerance
  of glucose, galactose, fructoses), amino acids
  (tryptophanmalabsorbtion), ions 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 formation in enterocytes of
  transport complexes (chilomicrones, lipoproteids)

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The reasons of postenterocytic disturbances of
malabsorption

• Disturbances of blood circulation in a wall of
  guts, may be caused with disturbances of general
  hemodynamic (ischemia, venous hyperemia,
  thrombosis, embolism, reaction of vessels in an
  inflammation)
• Disturbances of lymph flow. Lymph circulation
  disorders may be connected to disturbances of
  constriction of intestinal wall fibres due to
  local reflex and act of villikinin.

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Disturbances of motor function of intestines

• Disturbances of motor function of guts is
  called intestinal diskinesia.
• There are two types of intestinal diskinesia
  hyperkinetic and hypokinetic.
• The first type is characterised strengthening of
  the peristalties, segmentary and pendulum-like
  movements. It manifastates by diarrhea.
• The second, on the contrary, is characterized
  weakeing of motor activity of guts as a result
  constipations appears.

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The reasons of intestinal diskinesias of
hyperkinetic type

• Increasing excitability of receptors of guts to
  adequate irritators, that accompanies with
  development of an inflammation of an intestine
  mucus membrane (enteritis, colics)
• Action on receptors of guts unusual, pathological
  irritators - undigested food (for example,
  achylia), products of rotting and fermentation,
  toxic substances etc.
• Increasing of excitability of the vagal nerve
  centres
• Increase of some gastrointerstitial hormones
  form that strengthening peristaltics of guts
  (motilin)
• Consequences intestinal diskinesias of
  hyperkinetic type
• Disturbances of digestion (digestion, absorbtion)
• Dehydratation
• Development of ungas acidosis (loss of
  hydrocarbonates)

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Intestinal dyskinesia of
hyperkinetic type

• It is manifestated with reduction of guts
  peristaltics. That results in appearance of
  constipations. In mechanisms of development it
  pick out two kinds of constipations spastic and
  atonic.
• Spastic constipations arise due to long time
  tonic reduction of smooth muscles constriction of
  guts (spasm) and may be caused by
  viscero-visceral reflexes, or action of toxic
  factors (for example, lead poisoning).
• Reason of development atonic constipations
  connected with reduction of contractive function
  of smooth muscles guts
• a poor feed, the low contents of cellulose in
  nutritient.

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• excessive digestion of food into stomach (for
  example, gastric hypersecretion)
• age changes of receptor system of guts in old
  men, and also structural changes of an intestinal
  wall in obesity
• decrease of tone vagal nerve
• disturbances intraintestinal innervation, for
  example, Girshprungs disease - absence of
  ganglion cells Auerbachs plexus in sigmoideum and
  rectum

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CONSEQUENCES OF THE INTESTINAL DYSKINESIA

• Intestinal dyskinesia of hypokinetic type lead
  to
• development of intestinal autointoxication
• occurrence meteorism
• formation of feces stones
• in extreme cases intestinal obstruction may
  develop

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