Disorders of digestive system

1. The pathophysiology
of a digestion
http://openedo.mrsu.ru/course/view.php?id=279&sectionid=1890
Professor of Pathophysiology Department
Vlasova Tatyana Ivanovna
v.t.i@bk.ru

2. The system of a digestion
 1. Afferent link of a regulation. These are taste
receptors of an oral cavity, of a tongue,
receptors of esophagus, of a stomach, of an
intestine and main digestive glands, of a liver,
a pancreas. An olfaction is the top respiratory
tracts.
 2. A CNS is the alimentary center, its motoric
components - search, intake and motility of a
nutrition and secretor components - juices.
 3. Effectors or executive mechanism: an oral
cavity, an esophagus, a stomach, an intestine
and the main digestive glands - a liver and a
pancreas.

3. The failure of digestion is a state when digestive tract isn't capable to
acquire the feedstuffs. That leads to deep disturbances of metabolic
processes, depression of organism resistance, falling working capacity,
consumption.
 The Main functions of the digestive tract (DT):
 1.The Function of digestion is a set of the physical,
chemical, physiological reactions promoting transformation of
complex substances in simple. These processes are provided
with motor, secretory reactions, processes of an absorption.
 2. Bactericidal function. The pathogenic flora dies in a
gastric acid.
 3. Excretory function. Digestive tract provides removal of
toxic substances.
 4. Hemopoietic function. In a stomach the internal factor of
Kasl (Castle's intrinsic) is formed.
 5. Regulation of the acid-base equilibrium.
 6. Regulation of water-salt exchange
 7. Incretion function. In digestive tract hormones are
formed.
 8. Intestinal micro flora synthesizes a series of vitamins.

4. The factors, which disturb the organs of the digestive
system
physical
A bulky food
biologic
chemical
A very hot or a
very cold food
microbes
An alcohol
An foreign body
The excess or
the lack of the
vitamins
The tobacco
combustion
products
A nutrient additive
A medicine The toxins of the
microbes
The toxins
A radiation
The helminthes
THE MAIN REASONS OF A DIGESTION DISTURBANCE
IN THE STOMACH AND THE INTESTINE

5. The main reasons of A DIGESTION DISTURBANCE
IN THE STOMACH AND THE INTESTINE
The disturbances of its regulation
mechanisms
The poverty/the lack of
biological active
elements
The disturbances of the other organs
and the other physiological systems
A biogenic amine
A renal system
The poverty/ the lack of
the neurogenic effects
A prostaglandin parasympathetic
sympathetic
A peptide
A blood circulation
A hormone
The endocrine glands
A hepatic
The factors, which disturb the organs
of the digestive system

6. The typical forms of the digestion
disturbances
Anatomic principle of classification:
Disturbance of digestion in a mouth; Swallowing disturbance;
Dysfunction of an esophagus; Dysfunction of a stomach;
Dysfunction of an intestine; Disturbance of digestion with
participation of bile and enzymes of a pancreas.
Physiologic principle of classification:
Taste disturbance, Disturbances of appetite; Secretion
disturbance (hypo - hyper secretory states); Motility disturbance
(refluxes, vomiting, diarrhea, spastic and atonic constipations);
Disturbance of an absorption (sprue).

7. The basic diseases are
- Peptic ulcer of a stomach and duodenum;
- Gastroezophageal reflux;
- Inflammatory diseases (gastritises,
enteritis, colitis, pancreatitis, hepatitises);
- Diverticular illness;
- gallstone disease;
- oncoma.

8. THE DYSPEPSIA
 This is functional disturbance of
digestion bound to disharmony
between quality, quantity of a nutrition
and ability of an organism to digest it.
 Allocate simple (a nutritional
reforage) and toxic forms of
dyspepsias.

9. The typical forms of the taste disorders
A hypergeusia or
A hypogeusia
The disturbances of a receptor
mechanism
an ageusia a parageusia a dysgeusia

10. The hypothalamic level
a leptin, a serotonin,
a cholecystokinin, a
somatostatin, a
calcitonin.
a neuropeptide Y, a gamma-
aminobutyric acid, a
dopamine, an insulin, the
beta-endorphins, the
enkephalines.
A hunger
A bellyful

11. The disorders of an
appetite
1) the pathological intensification - a
hyperrexia
2) the pathological decrease - a hyporexia
3) a dysorexia
4) a quick saturability

12. The pathological
intensification of appetite
(a hyperrexia).
a hyperrexia is combined with the
increased consumption of food – a
polyphagia. At extreme extent of
rising of appetite there is a bulimia
("wolf hunger"). It is observed at a
lesion the ventromedial
hypothalamus.
Can arise at:
- intoxications,
- disturbance and diseases of a CNS
(organic changes, neurosises, an
aphrenia – at people),
- pathologies of endocrine glands
(thyrotoxicosis, diabetes mellitus,
pancreas tumors, etc.)
- resections of a cardial part of a
stomach (at the person and small
animals).

13. The pathological loss of appetite
(a- & hyporexia)
It is characterized by a loss of appetite up to an
anorexia ( the full refusal of food). It is observed at
a lesion the ventromedial hypothalamus. At the
same time at the person has the aphagia ( a
complete cessation of meal).
Allocate 5 types of an anorexia:
- intoxical (tumors),
- dyspeptic (it is bound to gastrointestinal
diseases),
- neurodynamic (develops as a result of inhibition
of the alimentary center),
- neurotic (stresses, neurosises are the reasons),
- neuropsychiatric (it is characteristic of people).

14. •The dysrexia
•The quick saturability

15. The digestion disturbances in the oral
cavity
The disturbance of digestion in an oral cavity arises for
the following reasons:
The possible consequences are:
1) oral cavity diseases (stomatites, ulites, parodontitis, etc.)
2) disadvantage or lack of teeth
3) pathology of the joint and muscles of a mandible (fractures
of bones, atrophy of muscles)
4) disorders of a function of salivary glands (hypo – and
hypersalivation).
1) a mechanical damage of a mucosa of a stomach
2) a disturbance of gastric secretion and motility.

16. A metabolic
disease
an intoxication a virulent disease
the stones in a
salivary ducts
An anemia an age
The reasons of a hypoptyalism in the oral
cavity

17. an irritatory agent
a vessel constriction
a salivary center in medulla
the sympathetic nerves
a small quantity of saliva
the reduction of water in a gland
A mechanism

18. The reasons:
an exaltation of
receptors of an
oral cavity
an exaltation of
the center of
salivation
a boring of the
nerves innervating
salivary glands
an influence of m-
cholinomimetics
(pharmacological
drugs)
an influence of
humoral
regulatory factors
Hypersalivation

19. an irritatory agent
a vascular distention
a salivary center in medulla
the parasympathetic nerves
a big quantity of saliva
the water in a gland
A mechanism of an hypersalivation

20. The disturbance of motive
function of an esophagus
An achalasia
the
gastroesop
hageal
reflux
a diffusive
esophageal
spasm

21. The disturbances of an esophagus
functions
The reasons:
 Pathology of a
smooth musculation of
gastroesophageal
sphincter
 - the Disturbances of a
vegetative regulation
of gastroesophageal
sphincter activity
 - the Depression of
production of
Gastrinum regulating
gastroesophageal
sphincter activity.
the Risk groups:
Newborns,
Pregnant women,
Smokers ,
a Reception of medicines (Sodium
nitritums, m-h.bl., TTsA, and / Sa,
Progesteronum, Pg, β-а.бл.,
narcotics, Euphyllinum, a Nutrition
(alcohol, chocolate, fried and fat
products, Coca-Cola, Pepsi Cola
(рН 2,5), red wine (рН 3,25), orange
juice (рН 3,5)).

22. The disturbances of digestion
in a stomach
 Motor function
 Secretion
 Reservoir function
 Absorption
 Excretion

23. The typical disturbances of a secretory stomach
function
The pathologic type of a
gastric secretion
The change of a
quantity of an
acid
The change of an
acidity of an acid
The
disturbance
of secretory
dynamic
The disturbance of
a mucus
production
The disturbance of
a pepsin syntesis
An increase An increase
An increase
An hyperacidity
A decrease
An absence
A decrease
A decrease
An inacidity
An absence
An absence
An hypacidity

24. The disturbances of secretion function of
a stomach
 the hypersecretion is the augmentation of a
gastric juice quantity, a rising of its acidity
and the digesting ability.
The reasons:
 Increase of n. vagus tone ,
 Increasing influence of gastrin (tumor
of gastrin producing tissue)

25. the digestion at the hyperacidity
A slow
evacution
The
reinforcement of
the fermentation
process
The
decreased
intestinal
motility
The ulcers in
a gastric
mucosa
An acid
regurgitation,
an epigastric
burning
CONSTIPATION
A pain, a
nausea
A gastric
ulcer

26. The disturbances of secretory function
of a stomach
 The HYPOSECRETION- ⇓ the quantity of a
gastric acid ⇓ its acidity.
 The hypoacidity/ anacidity + ahilia
Reasons
 ⇓ mass of secretory cells (hypo-, atrophic forms of
gastritis, tumors), sympathicotonia, gastrin
deficiency, protein and vitamin deficiency, intake of
drugs (holinoblockers).

27. The digestion at the hypoacidity
The
hypoacidity
The
disturbances
in the
digestion
Enhanced
bacterial
fermentation
A
malabsorption
A
disbacterios
is
A rotten
eructation
DIARRHE
A
An anemia
The
infections

28. THE DISTURBANCES OF MOTOR FUNCTION OF
THE STOMACH is followed by clinical implications,
such as:
An
eructation
A demping
syndrom A vomitig
A gastric
burning
A nausea
A hiccup
the reasons:
•activation n. vagus→ motility activation;
•sympathetic nerves activation → motility oppression;
•Primary change of a stomach muscles (collagenose);
•APUD cell disorders.

29. THE DISTURBANCES OF MOTOR FUNCTION OF THE
STOMACH
A peristole disorder
The disturbance of an alimentary evacuation
A change of a
stomach tonus
A change of a
vermicular movement
A change of a
sphincter tonus
Hyper-
tonus
hyperkinesis
A decrease
Atonia
Hypo-
tonus
An increase hypokinesis
A spasm
fast slow

30. The hiccup is the consensual, periodically repeating strong and short
inspiration as a result of a diaphragm spastic stricture when a glottis is
narrowing.
Epigastric burning is a burning sensation in epigastrium and behind
a breastbone, when there is the gastric contents in an esophagus.
The vomiting is a consensual ejection of a stomach contents through
an oral cavity.
The dumping syndrome is characterized by unpleasant feelings
after meal, it is connected with fast entering of a nutrition in an
intestine.
The nausea represents the feeling of a nagging pain and a pressure
in epigastrium. it is followed by unpleasant taste in an oral cavity, by a
plentiful salivation, by the general delicacy and the giddiness.
The eructation is an exit from a stomach of the swallowed air or
gases formed as a result of fermentative or putrefactive processes

31. Disturbances of excretion
stomach function
Excreation function of a stomach is one of
extrarenal ways of removal of metabolites
from blood flow for providing a
homeostasis.
In a gastric cavity there are the exchange products and the substances
which are harmful for an organism.
The stimulation of ά-and β-adrenoreceptors will mobilize excretory
function of a stomach.
A stress, a hypoxia, corticosteroids, Prostaglandins E are the
stimulators of excretory function of a stomach.
The metabolites (urea, uric acid, creatine, creatinine) circulating in a
blood, and also HP and their metabolites can be excreated by a
gastrointestinal wall in its cavity.

32. The disturbance of incretion
function
BAS location function
Parotin Salivary glands reduces in a blood the Ca2 level + and
promotes body height and influences on the
skeleton and teeth structure
Gastrinum 1
Gastrinum 2
A cell of a
stomach
They are developed by special endocrine
cells of a stomach. Getting to a blood, they
affect special receptors of glandular cells
and stimulate releasing of a gastric acid.
Secretin Mucous layer of
a duodenum
inhibits the production of gastric juice,
stimulates the production of alkaline
substrates which neutralize acidic content
received from the stomach into the
duodenum and alkalify it medium
cholecystokini
n
Mucous layer of
a duodenum
This hormone enforces the elaboration of a
pancreas juice: the amylase, the lipase, etc.
Affecting on a gall bladder, it enforces a bile
flow.

33. The gastric ulcer - is the local defect of a mucosa (sometimes with capture of
a submucousa) which is formed under the influence of acid, Pepsinum and bile, and
causing trophic disturbances on this site.
Etiology
The stress
Heredity
Helicobacter pylori
Disorder in the alimentation
An alcohol, a tobacco
The medicines

34. The peptic and gastric ulcer
* Group of heterogeneous diseases
* Chronic recurrent duration.
* It is characterized by development of defect of a mucosa
of a stomach or of an intestine
* It is characterized by disorders of their secretion, motor,
digesting and absorbtion function.
H.pylori.
H.pylori►a gastritis► a gastric ulcer

35. The schematic image of a stomach ulcer pathogenesis: 1. H.pylori gets through
a mucus layer in a stomach and is attached to epithelial cells;
2. Bacteria catalyze the transformation of the urea into the ammonia,
neutralizing the acid medium of a stomach; 3. reproduce, migrate and form the
infectious center; 4. As a result of the mucous destruction, the inflammations
and death of cells of an epithelium are formed the gastric ulcer.

36. HEALTH
ULCER
In a pathogenesis of a peptic and gastric ulcer the
disturbances of equilibrium between the damaging and
protective factors have major importance.
The factors of resistance
The factors of aggression

37. The factors of aggression:
 The reinforcement of influence of an acid-peptic
factor (production of HCL and Pepsinum);
 the disturbance motor function of a stomach and of
a duodenum (the refluxes of bile in antral
department of a stomach);
 the exogenous chemicals (NSAIDs, ethanol,
nicotine);
 the Infection of a gastroduodenal mucosa
bacterium of H. Pylori;
 the Gas and metabolic acidosis;
 the APUD-system hormones (Histaminum,
Gastrinum, intestinal hormones).

38. Protective functions of the slime
 Protective function of mucus
 cells and its active neogenesis (it interferes to catabolic effect of
hormones at the stress);
 a secretion of bicarbonates in a stomach;
 a microcirculation in a mucosa;
 a cytoprotection is the ability of Prostaglandins to prevent or soften
the mucous damages of a stomach (↑ a blood stream, ↑ production
of HCO3 and the mucus, stimulate a restoration of an epithelium,
etc.);
 a secretin, a somatostatin;
 the immune protection.

39. The etiological factors of a gastric ulcer
neurogenic social
alimentory
The poverty of the
stomach walls protection
genetic
medicine
endocrine
infections

40. Complications of a gastric ulcer
 a hemorrhage,
 a perforation,
 a penetration,
 a neoplastic transformation,
 a stricture formation

41. The disturbance of digestion in an
intestine
1. The disturbances of a biliary
excretion.
2. The disturbances of external
secretion of a pancreas.
3. The disturbances of secretion
function of a small bowel and
parietal digestion.
4. The disturbance of an absorption
in an intestine.
5. The disturbance of motive function
of an intestine.

42. The disturbances of a digestion at
the hypocholia and the acholia
hypocholia
steatorrhea
The absence
of an
emulsionizing
of lipides
The disturbance
of a pariental
digestion
Putrefactive
process
biliary dyskinesia
The disturbance of an
absorption of vit.,, Ca
A weakening of
a vermicular
movement
hepatitis,cirrhos
is
The disturbance
of an
absorption of a
cholesterol
Disturbance of
fermentation of
proteins
infections
The disturbance
of an absorption
of vit. К

43. The reasons of disorders of the
pancreas function:
 a neurogenic inhibition of the pancreas function (an
avagotony, a poisoning with Atropinum);
 a development of allergic reactions;
 the injuries of an abdominal cavity;
 the toxinfections (the typhoid, the paratyphoids);
 the nutritional factors (excess of meal, of animal fats,
etc.);
 a tumoral process;
 a duodenitis;
 an alcohol influence;
 an acute and a chronic pancreatitis.

44. Digestive disorders with pancreatic
achylia
achylia
A
emaciation
The disturbance
of digestion and
of absorption of
lipids
The disturbance
of digestion and
absorption of
proteins
The disturbance
of digestion and
absorption of
carbohydrates
The loss of
Са, Mg, Zn
A muscular
fibre in feces
pancreatitis,
tumor
Butter stool
A polyfecalia
nausea
Diarrhea

45. Disturbances of a parietal
(membranous) digestion:
 After a cavitary digestion oligomer
settle on microvillis where there is a
hydrolysis in a zone of an
enterocytes border with a formation
of monomers.
 The final stage of digestion occurs
on a surface of membranes through
which then the final products of
hydrolysis are carried out.

46. A section of a small bowel

47. A pathogenesis of the disturbances
of a membranous digestion
 the structural changes of a brush border . These
changes arise at an intestine mucosa
inflammation, its infectious and toxic lesions,
tumors, disturbance of a delivery.
 The disorders of membranous digestion can arise
owing to the acquired or heriditary failure of
enteral enzymes.
 the motive disorders of a small bowel and
microvillis can be the corner stone of disturbances
of membranous digestion.

48. The disturbances of a parietal
(membranous) digestion
A clinic:
- a syndrome of "malabsorption",
the persistent diarrheas,
a fecal matter is liquid, plentiful, foamy;
- an alimentary substrates aren't
acquired, and join in a bacterial
metabolism - an intestinal
endointoxication;

49. The malabsorption syndrome
 It is the symptom-complex which is formed as a result of
disturbance of intestinal digestion and an absorption.
 The implications of a syndrome of an insufficient
absorption are very variable: an increased fatigue, a
muscular delicacy, an diarrhea, a meteorism, a
polyhypovitaminosis, an albuminous failure, a glossites,
a stomatitis, a macrocytic and an iron deficiency
anemias, an ostealgias and an osteoporosis, an
eczema, a tetany and a parasthesias, a peripheric
neuropathy, an amenorrhea, etc.

50. The malabsorption syndrome forms:
 Gastrogenic (and agastric): a chronic gastritis with a secretion
failure, a stomach resection, a dumping syndrome;
 Hepatogenic : a chronic hepatitis, a liver cirrhosis, a cholestasia;
 Pancreatogenic: a chronic pancreatitis, a mucoviscidosis, a
pancreas resection;
 Enterogenic :
- Noninfectious: an enzyme corporal (a failure of disaccharidases,
lactases, saccharases);
- Infectious: bacterial, virus, helminths;
 Vascular: a chronic intestinal ischemia (a glycemic enteritis, an
ischemic colitis);
 Endocrine: a diabetic enteropathy;
 Other: medicinal, radioactive, toxic (alcoholic, uremic).

51. The intestinal malabsorption
 The CONGENITAL,
hereditarily caused
disturbance of an
absorption is bound or to
deficiency of enzymes
(for example, lactases),
or to a failure of
enzymes - transmitters
of separate monomers:
glucoses, fructose,
amino acids, etc. In this
case there is an isolated
disturbance of an
absorption of these
substances.

52. The Gee's disease
 The disease represents the investigation of
a hypersensitivity to gluten which grains of
the cereals.
 Gluten is an albuminous part of a vegetable
gelatin of grains of wheat, rye, barley, oats.
One of the fractions of gluten is a gliadine
which can have toxic effect on a mucosa of
a small bowel.
 The Gee's disease is a polygenic disease.

53. The Gee's disease pathogenesis
 The enzymopathic hypothesis treats a Gee's disease as an
intestinalny enzymopathy. A congenital deficiency of the specific
peptidase splitting toxic fraction of a gliadine is the cornerstone of it.
 The immunopathological hypothesis units the emergence of the
disease with a pathological reaction of system of immunity to gluten.
Really, in a blood we can find the circulating antibodies to gluten.
The pathological changes of a mucosa of an intestine owing to a
Gee's disease are characterised by signs of an autoimmune lesion
(the growth of the plasmocytes, the eosinocytes).
 The synthetic theory says that the gluten which isn't split owing to an
enzymopathy interacts with cells of system of mononuclear
phagocytes in a submucous layer of a wall of an intestine that leads
to their activation as the initial moment of an autoimmune lesion.

54. The pathologies causing development of the
acquired malabsorption.
 A radiolesion of an intestine (radiative enteritis) is a consequence of the radiation
therapy of malignant tumors ⇒ the intestine strictures, a fibrous degeneration of its
walls. The leading link of a pathogenesis of a syndrome at a radiative enteritis is a
disturbance of microcirculation in a wall of an intestine and a mesentery, a loss of
circulatory and lymphatic microvessels.
 An insulin-dependent diabetes mellitus ⇒ due to the disturbances of an innervation
of an intestine causing changes of a motility of an intestine; the oppressions of a
motility owing to intensive bacterial body height in its lumen; the poverty of the
pancreas exocrine function.
 A Crohn's disease is a chronic inflammatory disease of walls of the organs making
the digestive channel which causes their pathological changes at any level from an
oral cavity to an anus. We can diagnose it more often to people from 12 to 30 or
about 50 years. Men are ill more often than women. It is a polygenic disease. A
probability to suffer from this disease at relatives of a probands higher , than at other
representatives populations. There is an opinion that the Crohn's disease is an
autoimmune disease (there is an increase of number of certain T lymphocytes, the
pathological clones of T-cells).
 A small absorbing area of an internal surface ⇒ the investigation of an extensive
resection of a small intestine (a Crohn's disease, an ischemic necrosis, etc.).

55.  a steatorrhea
 a loss in weight (at the first stage of
malabsorption - to 5-10 kg, at the seconde
stage - over 10 kg, at the third stage- over 20
kg)
 The hypoavitaminoses, the trophic disorders.
The skin becomes dry with the lowered
turgor, hair also becomes dry, dim, there is a
hair loss. The changes of nail plates, their
fragility, and also illnesses of gums, a tongue
hyperemia, a smoothness of its papillas are
observed. A poverty of trace substances.
The disturbance of an absorption. A
symptomatology:

56. The reinforcement of an intestinal
absorption
A high penetration of an intestinal wall
A absorption a non-fermentation
nutrition
An intoxication An allergy

57. The forms of the intestinal motor function
disturbances
A
constipation
A diarrhea
exudative
secretory
hyperosmolaric
hyperkinetic
alimentary
mechanical
neurogenic
rectal

58. The diarrhea.
It is a very pluricausal syndrome.
The pathogenetic classification of a diarrhea:
 Secretory. The leading link of a pathogenesis ⇒ an increase of a sodium
cation secretion in an intestine lumen as the reason of big quantity of
osmols → ↑ the number of fecal masses through their colliquation (at
cholera).
 Exudative ⇒ an inflammation of walls of an intestine ↓ a low intestinal
absorption (at an ulcerative colitis, a shigellosis, an amebiasis).
 As result of a low intestinal absorption: a) osmotic b) because of loss of a
part of an intestine (↓ an absorbing surface); c) owing to disorders of a
motility of an intestine. Pathogenesis ⇒↓ time of intestinal absorption (a
hyperthyroidism, an irritable bowel syndrome).

59. A constipation
 At a constipation (obstipatio) the
intervals between acts of a defecation
in comparison with individual
physiological norm are enlarged or the
intestine is systematically insufficiently
emptied. As a rule, the chronic delay
of bowel emptying more than 48 h is
considered as an intestinal
obstruction.

60. The constipation
The constipation
can be:
hyperkinetic or
hypokinetic.
 Etiological
character of the
constipations :
alimentary,
neurogenic,
inflammatory,
proctogenic,
mechanical,
medicamental,
endocrine,
electrolytic.

61. The hyperkinetic
constipation.
 The psychogenic constipation (a
mental overstrain, a depression, a
schizophrenia, a narcomania)
 The reception of medicines the (iron
preparations, calcium, the
tranquilizers, the ganglioblocking
agents, antacids, etc.).

62. An acute intestinal obstruction (Ileus)
 This pathological state owing to the fast termination of a
passage of intestinal contents in the aboral direction
which is characterized first of all by rapid increase of a
dehydration and a deficiency of extracellular liquid
volume, an exo - and endogenic intoxication, and also
disorders of a systemic and periphery circulation.
 It causes the factors action of a mechanical (a
mechanical obstruction), and the nonmechanical nature
(dynamic).

63. An acute intestinal obstruction
In a pathogenesis distinguish:
1.The dynamic intestinal obstruction:
a) paralytic (a paralysis of an intestinal musculation (peritonitis, serious abdominal cavity operations, injuries)
b) spastic develops at a spastic stricture (the poisoning with salts of serious metals, a disease of cholic ways, etc.)
2. The mechanical intestinal obstruction:
a) a strangulated intestinal obstruction (the infringement of an intestinal loop in a hernial and at the
adhesion in the abdominal organs, at a cicatrix or a tumor. At the same time the intestinal wall is compressed and
its blood supply suffers.
b) an obturation (it is caused by mechanical closing of an intestine lumen with a tumor, the fecal stones, the
helminths or the foreign matters). At this form the intestine lumen is closed, but the circulation in an intestinal wall
is initially not broken.
c) the admixed forms (an intestine invagination)
3. A thromboembolic obstruction of an intestine develops as a result of a disturbance of a circulation
in an intestinal wall at a clottage or paralysis of its vessels.
On the level of obstruction allocate:
1. Enteric obstruction
a) high
b) low
In a pathogenesis distinguish:
1.The dynamic intestinal obstruction:
a) paralytic (a paralysis of an intestinal muscles, peritonitis, serious abdominal cavity operations, injuries)
b) spastic develops at a spastic stricture (the poisoning with salts of serious metals, a disease of cholic ways, etc.)
2. The mechanical intestinal obstruction:
a) a strangulated intestinal obstruction (the infringement of an intestinal loop in a hernial and at the
adhesion in the abdominal organs, at a cicatrix or a tumor. At the same time the intestinal wall is compressed and
its blood supply suffers.
b) an obturation (it is caused by mechanical closing of an intestine lumen with a tumor, the fecal stones, the
helminths or the foreign matters). At this form the intestine lumen is closed, but the circulation in an intestinal wall
is initially not broken.
c) the admixed forms (an intestine invagination)
3. A thromboembolic obstruction of an intestine develops as a result of a disturbance of a circulation
in an intestinal wall at a clottage or paralysis of its vessels.
On the level of obstruction allocate:
1. Enteric obstruction
a) high
b) low
2. Colic obstruction

64. The pathogenesis of an
intestinal obstruction:
 the disturbances of water and
electrolytic exchange
 the disturbances of the acid base
equilibrium
 an endogenous intoxication

65. The intestinal intoxication.
 The increased proliferation of microbes in a small bowel ⇒ a
premature deconjugation of bile acids and their loss with a feces
masses. The excess of the bile acids, the diarrhea, a steatorrhea
increases motility of a large intestine →, and the deficiency of the
bile acids leads to the disturbance of an absorption of liposoluble
vitamins and the development of a gallstone disease.
 The bacterial toxins and metabolites (Phenolums) can connected
with Vit. B12.
 Some microorganisms possess a cytotoxic action and damage an
epithelium of a small bowel →•
a length of villuses and an
excavation of cryptás.
 An antibacterial drugs suppress the elaboration of normal intestinal
microflora → there are staphilococci, proteas, yeast mushrooms,
enterococci) ⇒ a disturbance of processes of digestion and an
absorption.

66. The conditions of the disturbance of
barrier function of an intestine
 a disturbance of motive function of an
intestine
 a disturbance of secretion function of
an intestine
 an inflammatory processes in an
intestine wall
 a disturbance of microcirculation of a
wall of an intestine.

67. an intestinal intoxication
A toxic injures of the organs
and the fibrosis
The disturbances in the system of a
detoxication (a liver,a kidney, lungs)
A multiple organ failure

68. Thank you for your attention!