Disorders of the small intestine and vermiform appendix
Alfred Cuschieri, George Hanna in Essential Surgical Practice, 2015
Anatomy The small intestine is divided into three anatomical portions: duodenum, jejunum and ileum. However, in surgery, the duodenum, which forms the first 25 cm, is considered with the stomach because of various pathologies which affect both organs, such as peptic ulceration. At postmortem the average length of the small intestine in situ is about 7 m, with a reported range of 4.3-10.3 m when the measurement is made along the antimesenteric border. These estimates have to be regarded as approximate and are certainly not exact in view of the distensibility of the small intestine, the flaccid state after death and indeed the method of measurement (usually by tape) used in these postmortem studies. The length of the intestine (less the duodenum) when measured along its attached or mesenteric border, is only 4.6 m.
Disorders of the stomach and duodenum
Alfred Cuschieri, George Hanna in Essential Surgical Practice, 2015
The stomach has an irregular pyriform shape tapering towards the duodenum and curved anteriorly so that its proximal (cardiac) orifice at the junction with the oesophagus and the distal end (pyloric sphincter) are at a more posterior plane near the retroperitoneum than the middle section (body) of the organ. It is anatomically divisible into three parts: the fundus, body and pyloric regions (antrum and pyloric canal). The fundus is the globular proximal portion to the left of the oesophagus separated from it by the cardiac notch and attached by fascia to the left crus and adjacent diaphragm and the gastrophrenic peritoneal fold. The pyloric region extends from the angular notch on the lesser curvature to the pyloric sphincter and consists of the antrum (proximal tapering portion) and the pyloric canal (tubular distal part just proximal to the pyloric sphincter), which is made up of a thickening of the circular muscle coat discontinuous with the equivalent muscle layer of the duodenum. The site of the pylorus is marked by a shallow superficial serosal notch and by the two veins of Mayo (superior and inferior) that cross its anterior surface. The anterior wall of the stomach is more voluminous that the posterior wall and this is important in antireflux surgery.
The Duodenum and Small Bowel
E. George Elias in CRC Handbook of Surgical Oncology, 2020
Primary neoplasms of the small intestine, including the duodenum, are uncommon tumors that are encountered infrequently in clinical practice when compared to other GI malignancies. Small bowel tumors can be either benign or malignant, with 40% of these tumors being benign and 60% being malignant. Most of the cases of small bowel neoplasms, benign or malignant, are diagnosed after the patient has persistent symptoms. Sarcomas of the small bowel are frequently encountered in the ileum. The most common one is leiomyosarcoma. Neurosarcomas including neurofibrosarcomas and malignant schwanomas are very rare tumors in the bowel. Metastatic tumors can be encountered in the small bowel. This could be the result of peritoneal seeding, or hematogenous spread. The prognostic factors for tumors of the small bowel and duodenum depend mainly on whether these tumors are benign or malignant. The surgical management of malignant tumors can be categorized into three areas: potentially curative, emergency, and palliative.
Differential inhibition of human liver and duodenum sulphotransferase activities by quercetin, a flavonoid present in vegetables, fruit and wine
Published in Xenobiotica, 2001
F. Marchetti, C. De Santi, M. Vietri, A. Pietrabissa, R. Spisni, F. Mosca, G. M. Pacifici
1. Quercetin is a natural flavonoid present in vegetables, fruit and wine, and is known to inhibit sulphotransferase. Drugs are often taken orally and the intestinal mucosa is an early site of drug metabolism. The aims of this investigation were to study the inhibition of dopamine, (-)-salbutamol, minoxidil and paracetamol sulphation by quercetin in the duodenal mucosa and liver and to compare the IC 50 in these tissues. 2. The rates (pmol min -1 mg -1) of sulphation of 4-nitrophenol were 343 92 (liver) and 164 22 (duodenum; p = 0.031), of dopamine were 15 11 (liver) and 656 516 (duodenum; p = 0.049), of (-)-salbutamol were 153 31 (liver) and 654 277 (duodenum; p = 0.018), of minoxidil were 156 47 (liver) and 105 7 (duodenum; n.s.), and of paracetamol were 229 86 (liver) and 328 187 (duodenum; n.s.). 3. The IC 50 of quercetin for 4-nitrophenol was 48 11 nM (liver) and 56 1 nM (duodenum, n.s.), for dopamine was 5.7 0.7 µM (liver) and 170 12µM (duodenum, p < 0.0001), for (-)-salbutamol was 54 4 nM (liver) and 16 8µM (duodenum; p = 0.025), for minoxidil was 134 22 nM (liver) and 3 0.3 µM (duodenum, p = 0.013), and for paracetamol was 57 7 nM (liver) and 35 1 µM (duodenum; p = 0.0002). 4. Quercetin inhibited the sulphation of 4-nitrophenol, dopamine, (-)-salbutamol, minoxidil and paracetamol both in liver and duodenum. With dopamine, (-)-salbutamol, minoxidil and paracetamol as substrates, quercetin was a more potent inhibitor in the liver than the duodenum. Such a difference may reflect the different composition of sulphotransferase forms in the liver and duodenum.
Sulfation of R(--)-apomorphine in the human liver and duodenum, and its inhibition by mefenamic acid, salicylic acid and quercetin
Published in Xenobiotica, 2002
M. Vietri, F. Vaglini, A. Pietrabissa, R. Spisni, F. Mosca, G. M. Pacifici
1. The aims were to study the sulfation of R-(--)-apomorphine (hereafter apomorphine) in the human liver and duodenum, and to study the rate of inhibition of apomorphine sulphation by mefenamic acid, salicylic acid and quercetin also in the human liver and duodenum. 2. A rapid and sensitive method was developed to measure the sulfation rate of apomorphine in the human liver and duodenum. The method was based on the use of 0.4 µM 3'-phosphoadenosine-5'-phosphosulfate- [35 S] (PAPS) and 50µM apomorphine. The unreacted PAPS was precipitated with barium hydroxide, barium acetate and zinc sulfate. 3. The rate of apomorphine sulfation (mean ± SD and median) was 261 ± 82 and 242 pmol min -1 mg -1, respectively (liver), and 433 ± 157 and 443 pmol min -1 mg -1, respectively (duodenum). The apomorphine sulfation rate was higher in the duodenum than in the liver (p = 0.0005). 4. Apomorphine sulfation was correlated with SULT1A1 activity in the liver (r 2 = 0.363, p = 0.005) and duodenum (r 2 = 0.494, p = 0.0005), but it did not correlate with SULT1A3 activity both in the liver and duodenum. 5. The K m estimate of apomorphine sulfation rate was 20 ± 3.6 (liver) and 6.5 ± 0.2 µM (duodenum, p = 0.024), and the V max estimate was 248 ± 99 (liver) and 636 ± 104 pmol min -1 mg -1 (duodenum, p = 0.018). 6. Mefenamic acid, salicylic acid and quercetin were potent inhibitors of apomorphine sulfation rate in the liver, and the IC 50 estimates were 16 ± 0.2 nM, 54 ± 8.6 µM and 18 ± 2.8 nM, respectively. These compounds were poor inhibitors of apomorphine sulfation in the duodenum. 7. Apomorphine is sulfated by the human liver and duodenum, the highest activity being associated with the duodenum. The K m of apomorphine sulfotransferase is in the order of µM both in the liver and duodenum. The non-steroidal anti-inflammatory drug mefenamic acid and the natural flavonoid quercetin inhibit the hepatic sulfation of apomorphine with an IC 50 in the order of nM.
Morphometry of Normal Duodenal Mucosa
Published in Scandinavian Journal of Gastroenterology, 1989
The morphometric variability of normal duodenal mucosa was assessed in bioptic specimens obtained from bulb, second and third duodenum. Biopsies were obtained from 82 cases ranging in age from 18 to 67 years. The results demonstrate a great variability in villous shape and height without mean height differences in relation with age of subjects or site of biopsies. Subvillous thickness of lamina propria, intraepithelial lymphocyte count, inflammatory cell count in lamina propria and goblet cell number did not show significant differences. Superficial gastric metaplasia was seen in 8.5 % of bulbar biopsies, 3.6 % of biopsies taken in the second duodenum but it was constantly absent in the third duodenum. Brunner's glands above the muscularis mucosa were seen in 45 % of bulbar biopsies, 23 % of biopsies of second duodenum and in 4.6 % of biopsies of third duodenum.