Enterohepatic circulation refers to the circulation of biliary acids from the liver, where they are produced and secreted in the bile, to the small intestine, where it aids in digestion of fats and other substances, back to the liver.
Endogenous bacteria play an important role in enterohepatic circulation.
It should not be confused with the hepatic portal system, which directs nutrient rich blood from the intestines to the liver.
Liver hepatocytes metabolize cholesterol to cholic acid and chenodeoxycholic acid. These lipid-soluble bile acids are conjugated mainly to glycine or taurine molecules to form water soluble primary conjugated bile acids, sometimes called "bile salts". These bile acids travel to the gall bladder during the interdigestive phase for storage and to the descending part of the duodenum via the common bile duct through the major duodenal papilla during digestion. 95% of the bile acids which are delivered to the duodenum will be recycled by the enterohepatic circulation.
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Due to the pH of the small intestine, most of the bile acids are ionized and mostly occur as their sodium salts which are then called "primary conjugated bile salts." In the lower small intestine and colon, bacteria dehydroxylate some of the primary bile salts to form secondary conjugated bile salts (which are still water soluble). Along the proximal and distal ileum, these conjugated primary bile salts are reabsorbed actively into hepatic portal circulation. Bacteria deconjugate some of the primary and secondary conjugated bile salts back to lipid soluble bile acids, which are passively absorbed into hepatic portal circulation. Finally, the conjugated bile acids which remained un-ionized conjugated bile acids are passively absorbed.
Venous blood from the ileum goes straight into the portal vein and then into the liver sinusoids. There, hepatocytes extract bile acids very efficiently, and little escapes the healthy liver into systemic circulation. If bile does escape, jaundice may be observed.
The net effect of enterohepatic recirculation is that each bile salt molecule is reused about 20 times, often multiple times during a single digestive phase.
Enterohepatic circulation also means that some molecules which would not otherwise be very toxic can become extremely hepatotoxic as they reach unexpectedly high hepatic concentrations. Drugs may remain in the enterohepatic circulation for a prolonged period of time as a result of this recycling process.
The pancreas is a gland organ in the digestive and endocrine system of vertebrates. It is both an endocrine gland producing several important hormones, including insulin, glucagon, and somatostatin, as well as an exocrine gland, secreting pancreatic juice containing digestive enzymes that pass to the small intestine. These enzymes help to further breakdown the carbohydrates, protein, and fat in the chyme.
Under a microscope, stained sections of the pancreas reveal two different types of parenchymal tissue. Lightly staining clusters of cells are called islets of Langerhans, which produce hormones that underlie the endocrine functions of the pancreas. Darker staining cells form acini connected to ducts. Acinar cells belong to the exocrine pancreas and secrete digestive enzymes into the gut via a system of ducts.
Structure Appearance Function
Islets of Langerhans Lightly staining, large, spherical clusters Hormone production and secretion (endocrine pancreas)
Pancreatic acini Darker staining, small, berry-like clusters Digestive enzyme production and secretion (exocrine pancreas)
The pancreas is a dual-function gland, having features of both endocrine and exocrine glands.
Main article: Endocrine pancreas
The part of the pancreas with endocrine function is made up of approximately a million cell clusters called islets of Langerhans. Four main cell types exist in the islets. They are relatively difficult to distinguish using standard staining techniques, but they can be classified by their secretion: Î± cells secrete glucagon (increase Glucose in blood), Î² cells secrete insulin (decrease Glucose in blood), Î´ cells secrete somatostatin (regulates/stops Î± and Î² cells), and PP cells secrete pancreatic polypeptide.
The islets are a compact collection of endocrine cells arranged in clusters and cords and are crisscrossed by a dense network of capillaries. The capillaries of the islets are lined by layers of endocrine cells in direct contact with vessels, and most endocrine cells are in direct contact with blood vessels, by either cytoplasmic processes or by direct apposition. According to the volume The Body, by Alan E. Nourse, the islets are "busily manufacturing their hormone and generally disregarding the pancreatic cells all around them, as though they were located in some completely different part of the body."
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The pancreas receives regulatory innervation via hormones in the blood and through the autonomic nervous system. These two inputs regulate the secretory activity of the pancreas.
Sympathetic (adrenergic) Parasympathetic (muscarinic)
Î±2: decreases secretion from beta cells, increases secretion from alpha cells M3 increases stimulation of alpha cells and beta cells
It lies in the epigastrium & left hypochondrium areas of the abdomen
It consists of:
Head: Lies within the concavity of the duodenum
Uncinate process: emerges from the lower part of head & lies deep to superior mesenteric vessels
Neck: The constricted part between the head and the body
Body: It lies behind stomach
Tail: It is the left end of the pancreas. It lies in contact with the spleen and runs in the lienorenal ligament
Superior pancreaticoduodenal artery from gastroduodenal artery
Inferior pancreaticoduodenal artery from superior mesenteric artery
Both run in the groove between the pancreas & duodenum & supply the head of pancreas.
Pancreatic branches of Splenic artery. The largest of those branches is called arteria pancreatica magna, it's occlusion although rare is fatal.
Supplies the neck, body & tail of pancreas
From Body & Neck of pancreas drain into splenic vein.
From head of pancreas drains into superior mesenteric vein & portal vein.
splenic lymph nodes
Celiac lymph nodes
Superior mesenteric lymph nodes
InÂ vertebrates, theÂ small intestineÂ is the part of theÂ gastrointestinal tractÂ (gut) following thestomachÂ and followed by theÂ large intestine, and is where the vast majority ofÂ digestionÂ and absorption of food takes place. InÂ invertebratesÂ such as worms, the terms "gastrointestinal tract" and "large intestine" are often used to describe the entireÂ intestine. This article is primarily about theÂ humanÂ gut, though the information about its processes are directly applicable to most mammals.Â (A major exception to this areÂ cows; for information about digestion in cows and other similar mammals, seeÂ ruminants.)
Size and divisions
The small intestine in an adult human measures on average about 5 meters (16 feet), with a normal range of 3 - 7 meters; it can measure around 50% longer at autopsy because of loss of smooth muscle tone after death. It is approximately 2.5-3 cm in diameter. Although the small intestine is much longer than theÂ large intestineÂ (typically around 3 times longer), it gets its name from its comparatively smaller diameter. Although as a simple tube the length and diameter of the small intestine would have a surface area of only about 0.5m2, the surface complexity of the inner lining of the small intestine increase its surface area by a factor of 500 to approximately 200m2, or roughly the size of a tennis court.
The small intestine is divided into three structural parts: ..
DuodenumÂ 26 cm (9.8 in) in length
JejunumÂ 2.5 m (8.2 ft)
IleumÂ 3.5 m (11.5 ft)
MicrographÂ of theÂ small intestinemucosaÂ showing theÂ intestinal villiÂ andcrypts of Lieberkühn.
The three sections of the small intestine look similar to each other at a macroscopic level, but there are some important differences.
The parts of the intestine are as follows:
longitudinal and circular layers, withAuerbach's (myenteric) plexusÂ in between
same as duodenum
same as duodenum
Brunner's glandsÂ andÂ Meissner's (submucosal) plexus
simple columnar. ContainsÂ goblet cells,Paneth cells
Similar to duodenum. Villi very long.
Similar to duodenum. Villi very short.
Digestion and absorption
Food from the stomach is allowed into the duodenum by a muscle called the pylorus, orÂ pyloric sphincter, and is then pushed through the small intestine by a process of muscular-wavelike contractions calledÂ peristalsis.
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The small intestine is where most chemical digestion takes place. Most of theÂ digestive enzymesÂ that act in the small intestine are secreted by theÂ pancreasÂ and enter the small intestine via theÂ pancreatic duct. The enzymes enter the small intestine in response to the hormonecholecystokinin, which is produced in the small intestine in response to the presence of nutrients. The hormoneÂ secretinÂ also causesbicarbonateÂ to be released into the small intestine from the pancreas in order to neutralize the potentially harmful acid coming from the stomach.
The three major classes of nutrients that undergo digestion areÂ proteins,Â lipidsÂ (fats) andÂ carbohydrates:
Proteins andÂ peptidesÂ are degraded intoÂ amino acids. Chemical breakdown begins in the stomach and continues in the small intestine. Proteolytic enzymes, includingÂ trypsinÂ andÂ chymotrypsin, are secreted by theÂ pancreasÂ and cleave proteins into smaller peptides. Carboxypeptidase, which is a pancreatic brush border enzyme, splits one amino acid at a time. Aminopeptidase and dipeptidase free the end amino acid products.
Lipids (fats) are degraded intoÂ fatty acidsÂ andÂ glycerol. Pancreatic lipase breaks down triglycerides into free fatty acids and monoglycerides. Pancreatic lipase works with the help of the salts from theÂ bileÂ secreted by theÂ liverÂ and theÂ gall bladder. Bile salts attach to triglycerides to helpÂ emulsifyÂ them, which aids access by pancreatic lipase. This occurs because the lipase is water-soluble but the fatty triglycerides are hydrophobic and tend to orient towards each other and away from the watery intestinal surroundings. The bile salts are the "middle man" that holds the triglycerides in the watery surroundings until the lipase can break them into the smaller components that are able to enter the villi for absorption.
SomeÂ carbohydratesÂ are degraded into simple sugars, orÂ monosaccharidesÂ (e.g.,Â glucose). Pancreatic amylase breaks down some carbohydrates (notablyÂ starch) into oligosaccharides. Other carbohydrates pass undigested into the large intestine and further handling by intestinal bacteria. Brush border enzymes take over from there. The most important brush border enzymes are dextrinase and glucoamylase which further break down oligosaccharides. Other brush border enzymes are maltase, sucrase and lactase. Lactase is absent in most adult humans and for them lactose, like most poly-saccharides are not digested in the small intestine. Some carbohydrates, such asÂ cellulose, are not digested at all, despite being made of multipleÂ glucoseÂ units.
Digested food is now able to pass into the blood vessels in the wall of the intestine through the process of diffusion. The small intestine is the site where most of the nutrients from ingested food are absorbed. The inner wall, or mucosa, of the small intestine is lined with simple columnarÂ epithelialÂ tissue. Structurally, the mucosa is covered in wrinkles or folds calledÂ plicae circulares, which are considered permanent features in the wall of the organ. They are distinct fromÂ rugaeÂ which are considered non-permanent or temporary allowing for distention and contraction. From the plicae circulares project microscopic finger-like pieces of tissue calledÂ villiÂ (LatinÂ for "shaggy hair"). The individual epithelial cells also have finger-like projections known asÂ microvilli. The function of the plicae circulares, the villi and the microvilli is to increase the amount of surface area available for the absorption ofÂ nutrients.
Each villus has a network ofÂ capillariesÂ and fine lymphatic vessels calledÂ lactealsÂ close to its surface. The epithelial cells of the villi transport nutrients from the lumen of the intestine into these capillaries (amino acids and carbohydrates) and lacteals (lipids). The absorbed substances are transported via the blood vessels to different organs of the body where they are used to build complex substances such as the proteins required by our body. This is called diffusion. The food that remains undigested and unabsorbed passes into the large intestine.
Absorption of the majority of nutrients takes place in theÂ jejunum, with the following notable exceptions:
IronÂ is absorbed in the duodenum.
Vitamin B12Â andÂ bile saltsÂ are absorbed in the terminal ileum.
Water andÂ lipidsÂ are absorbed by passive diffusion throughout the small intestine.
SodiumÂ is absorbed by active transport andÂ glucoseÂ andÂ amino acidÂ co-transport.
FructoseÂ is absorbed byÂ facilitated diffusion.
Autonomic neuropathy- B12 deficiency
Autonomic neuropathy is a form of polyneuropathy which affects the non-voluntary, non-sensory nervous system (i.e., the autonomic nervous system) affecting mostly the internal organs such as the bladder muscles, the cardiovascular system, the digestive tract, and the genital organs. These nerves are not under a person's conscious control and function automatically. Autonomic nerve fibers form large collections in the thorax, abdomen and pelvis outside spinal cord, however they have connections with the spinal cord and ultimately the brain. Most commonly autonomic neuropathy is seen in persons with long-standing diabetes mellitus type 1 and 2. In most but not all cases, autonomic neuropathy occurs alongside other forms of neuropathy, such as sensory neuropathy.
Autonomic neuropathy is one cause of malfunction of the autonomic nervous system, but not the only one; some conditions affecting the brain or spinal cord can also cause autonomic dysfunction, such as multiple system atrophy, and therefore cause similar symptoms to autonomic neuropathy.
The signs and symptoms of autonomic neuropathy include the following:
urinary bladder conditions: bladder incontinence or urine retention
gastrointestinal tract: dysphagia, abdominal pain, nausea, vomiting, malabsorption, fecal incontinence, gastroparesis, diarrhea, constipation
cardiovascular system: disturbances of heart rate (tachycardia, bradycardia), orthostatic hypotension, inadequate increase of heart rate on exertion
other: hypoglycemia unawareness, genital impotence, sweat disturbances
Mechanism of bruise
Increased distress to tissue causes capillaries to break under the skin, allowing blood to escape and build up. As time progresses, blood seeps into the surrounding tissues, causing the bruise to darken and spread. Nerve endings within the affected tissue detect the increased pressure, which, depending on severity and location, may be perceived as pain or pressure or be asymptomatic. The damaged endothelium (lining) of the affected capillaries releases endothelin, a hormone that causes narrowing of the blood vessel to minimize bleeding. As the endothelium is destroyed, the underlying von Willebrand factor is exposed and initiates coagulation, which creates a temporary clot to plug the wound and eventually leads to restoration of normal tissue.
During this time, larger bruises may change color due to the breakdown of hemoglobin from within escaped red blood cells in the extracellular space. The striking colors of a bruise are caused by the phagocytosis and sequential degradation of hemoglobin to biliverdin to bilirubin to hemosiderin, with hemoglobin itself producing a red-blue color, biliverdin producing a green color, bilirubin producing a yellow color, and hemosiderin producing a golden-brown color. As these products are cleared from the area, the bruise disappears. Oftentimes the underlying tissue damage has been repaired long before this process is complete.