Epithelium of the stomach glands is a highly specialized tissue consisting of several cellular differons, the cambium for which is poorly differentiated epitheliocytes in the region of the necks of the glands. These cells are intensively marked with the introduction of N-thymidine, often divide by mitosis, making up the cambium both for the surface epithelium of the gastric mucosa and for the epithelium. gastric glands. Accordingly, the differentiation and displacement of newly emerging cells go in two directions: towards the surface epithelium and into the depths of the glands. Renewal of cells in the epithelium of the stomach occurs in 1-3 days.
Highly specialized cells are much slower to renew themselves epithelium gastric glands.

Major exocrinocytes produce the proenzyme pepsinogen, which acidic environment turns into active form pepsin is the main component gastric juice. Exocrinocytes have a prismatic shape, well-developed granular endoplasmic reticulum, basophilic cytoplasm with secretory zymogen granules.

Parietal exocrinocytes- large, rounded or irregularly angular cells located in the wall of the gland outward from the main exocrinocytes and mucocytes. The cytoplasm of cells is sharply oxyphilic. It contains numerous mitochondria. The nucleus lies in the central part of the cell. In the cytoplasm there is a system of intracellular secretory tubules that pass into intercellular tubules. Numerous microvilli protrude into the lumen of the intracellular tubules. H and Cl ions, forming hydrochloric acid, are removed from the cell to its apical surface through the secretory tubules.
parietal cells they also secrete the internal factor of Castle, which is necessary for the absorption of vitamin Bi2 in the small intestine.

Mucocytes- mucous cells of a prismatic shape with a light cytoplasm and a compacted nucleus, displaced to the basal part. Electron microscopy reveals a large number of secretory granules in the apical part of the mucous cells. Mucocytes are located in the main part of the glands, mainly in the body of their own glands. The function of cells is the production of mucus.
Endocrinocytes of the stomach are represented by several cellular differons, for the names of which letter abbreviations are accepted (EC, ECL, G, P, D, A, etc.). All these cells are characterized by a lighter cytoplasm than others. epithelial cells. hallmark endocrine cells is the presence in the cytoplasm of secretory granules. Since the granules are able to reduce silver nitrate, these cells are called argyrophilic. They are also intensely stained with potassium dichromate, which is the reason for the other name of endocrinocytes - enterochromaffin.

Based on the structure of secretory granules, as well as taking into account their biochemical and functional properties, endocrinocytes are classified into several types.

EC cells the most numerous are located in the body and bottom of the gland, between the main exocrinocytes and secrete serotonin and melatonin. Serotonin stimulates the secretory activity of the main exocrinocytes and mucocytes. Melatonin is involved in the regulation biological rhythms functional activity of secretory cells depending on light cycles.
ECL cells produce histamine, which acts on parietal exocrinocytes, regulating the production of hydrochloric acid.

G cells called gastrin-producing. They are found in large numbers in the pyloric glands of the stomach. Gastrin stimulates the activity of the main and parietal exocrinocytes, which is accompanied by increased production of pepsinogen and hydrochloric acid. In people with high acidity of gastric juice, an increase in the number of G-cells and their hyperfunction is noted. There is evidence that G-cells produce enkephalin, a morphine-like substance first discovered in the brain and involved in the regulation of pain.

P cells secrete bombesin, which enhances smooth contractions muscle tissue gallbladder, stimulates the release of hydrochloric acid by parietal exocrinocytes.
D cells produce somatostatin, a growth hormone inhibitor. It inhibits protein synthesis.

VIP cells produce a vaso-intestinal peptide that dilates blood vessels and lowering blood pressure. This peptide also stimulates the secretion of hormones by the cells of the pancreatic islets.
A-cells synthesize enteroglucagon, which breaks down glycogen to glucose, similar to glucagon A-cells of the pancreatic islets.

Most endocrinocytes secretory granules are located in the basal part. The contents of the granules are secreted into the lamina propria of the mucous membrane and then enters the blood capillaries.
muscularis mucosa formed by three layers of smooth myocytes.

Submucosa of the stomach wall represented by loose fibrous connective tissue with vascular and nerve plexuses.
Muscular layer of the stomach consists of three layers of smooth muscle tissue: outer longitudinal, middle circular and inner with oblique direction of muscle bundles. The middle layer in the pyloric region is thickened and forms the pyloric sphincter. The serous membrane of the stomach is formed by superficially lying mesothelium, and its basis is loose fibrous connective tissue.

In the wall of the stomach located submucosal, intermuscular and subserous nerve plexuses. In the ganglia of the intermuscular plexus, vegetative neurons of the 1st type predominate, in the pyloric region of the stomach there are more neurons of the 2nd type. Conductors go to the plexuses from vagus nerve and from the border sympathetic trunk. Excitation of the vagus nerve stimulates the secretion of gastric juice, while excitation of the sympathetic nerves, on the contrary, inhibits gastric secretion.

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Intestinal juice is a product of the activity of the Brunner, Lieberkühn glands and cells of the entire mucous membrane of the small intestine, it is a cloudy, viscous liquid.

Up to 2.5 liters of intestinal juice is excreted per day in a person. The secretion of intestinal juice enzymes differs in principle from the secretion of enzymes by other digestive glands. The secreting cells of the salivary, gastric and pancreatic glands secrete digestive juice and retain their integrity, and the separation of intestinal juice is associated with the death of glandular cells. In the mucous membrane of the small intestine, on the one hand, intensive neoplasm of cells occurs, and on the other hand, continuous desquamation, rejection of dead cells with the formation of mucous lumps, therefore, during centrifugation, intestinal juice is divided into liquid and dense parts.

Liquid part of intestinal juice formed aqueous solutions organic and inorganic substances, mainly coming from the blood, and a small amount of the contents of the destroyed cells of the intestinal epithelium. Inorganic substances contained in the liquid part of the juice, mainly chlorides, bicarbonates and phosphates of sodium, potassium, calcium; organic substances - proteins, amino acids, urea and other metabolic products of the body. The pH of the secret is 7.2-7.5, with intensive secretion, the pH of the juice rises to 8.6.

The dense part of the intestinal juice It has the appearance of mucous lumps of a yellowish-gray color, consists of destroyed epithelial cells, their enzymes and mucus (the secret of goblet cells) and has more enzymatic activity than liquid.

Intestinal juice enzymes

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There are more than 20 enzymes in the intestinal juice that are involved in digestion.

They hydrolyze peptides and peptones of proteins cleaved in the stomach to amino acids, fats to glycerol and fatty acids, and carbohydrates to monosaccharides.

Intestinal juice contains peptidases: aminopolypeptidases, dipeptidases, leucineamine peptidases, etc., combined common name- uh ripsins.

Proteolytic enzyme secretion human intestinal goblet cells - inhibin.

Cleavage of nucleotides and nucleic acids in the intestinal juice is carried out by nucleotase and nuclease.

Lipolytic enzymes small intestinal juice are lipase, phospholipase, cholesterolesterase.

Amylolytic enzymes intestinal juice: amylase, lactase, sucrase.
A special place is occupied by gamma-amylase, which has specific features, it is strongly associated with the lipoprotein membrane of epitheliocytes and practically does not desorb into the intestinal cavity. Gamma-aminase is involved in the breakdown of polysaccharides and completes the hydrolysis of dextrins and oligosaccharides, which are formed during the hydrolysis of starch. An important enzyme in the intestinal juice is enterokinase, which activates pancreatic trypsinogen.

Digestion in the small intestine

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Digestion in the small intestine is a three-link system of food assimilation:

1. Cavitary digestion,

2. Membrane digestion,

3. Suction.

cavity digestion in the small intestine is carried out due to digestive secrets and their enzymes, which enter the cavity of the small intestine (pancreatic secret, bile, intestinal juice) and act on the food substance that has undergone enzymatic processing in the stomach. Large molecular substances are hydrolyzed to oligomers by the type of abdominal digestion. Under the influence of enzymes, the hydrolysis of oligomers is completed in the area of ​​the glycocalyx and microvilli of epitheliocytes.

Membrane digestion. Enzymes that carry out membrane digestion, have different origins. Some of them are adsorbed from the cavity of the small intestine, where they enter as part of the pancreatic and intestinal juices. These enzymes are associated with the glycocalyx of the microvilli. Other enzymes are transferred from enterocytes and are fixed on the cytoplasmic membranes of microvilli. Those enzymes that are adsorbed on the membranes of microvilli of enterocytes have more long time useful work than those that work in the intestinal cavity.

Regulation of intestinal juice secretion.

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Secretory cells of the glands of the mucous membrane of the small intestine are excited by local exposure: secretion is carried out at the location of the food bolus, as a result of the influence of mechanical stimuli that cause the release of a large amount of mucus, while the juice contains a small amount of enzymes.

A powerful chemical irritant of the secretory cells of the glands of the mucous membrane of the small intestine are products of protein digestion by gastric juice, pancreatic juice, fatty acids, milk sugar.

The specific action of chemical stimuli is called enzymatic adaptation. The action of each chemical stimulus causes the release of intestinal juice with a certain set of enzymes. So, for example, fatty acids stimulate the formation of lipase by the intestinal glands, a diet with a reduced protein content leads to a sharp decrease in enterokinase activity in intestinal juice. However, not all intestinal enzymes are involved in the processes of specific enzyme device. The production of peptidases does not undergo significant changes even with a sharp lack of protein for 5 months. The formation of lipase in the intestinal mucosa does not change with either increased or reduced fat content in food. Thus, there are both adapting enzymes and enzymes that do not participate or only weakly participate in adaptation processes.

The reflex mechanism underlies the response of the glands of the intestinal mucosa to irritation of mechano- and chemoreceptors. The excitation that occurs in the receptors of the mucous membrane of the small intestine is transmitted through sensory fibers to the central nervous system, from where regulatory stimuli come to the glandular apparatus of the intestine. Parasympathetic Influences enhance intestinal secretion, sympathetic - inhibit.

The activity of the intestinal glands stimulated by hormones of the enteric system: GIP, VIP, motilin; somatostatin inhibits their activity. Enterocrinin and duocrinin, secreted from the intestinal mucosa, stimulate the Lieberkün and Brunner glands.

The activity of the glands of the intestinal mucosa is also influenced by hormones general action, in particular, hormones of the adrenal cortex, which activate the formation of adaptable intestinal enzymes, contribute to a more complete implementation of specific nerve impulses that regulate the intensity of production of various enzymes. Corticosteroids cause an increase in enterokinase secretion, while the release of alpha-glucosidase and peptidases does not change.

DIGESTION IN THE SMALL INTESTINE

intestinal secretion

Intestinal juice is a cloudy, viscous liquid, is a product of the activity of the entire mucous membrane of the small intestine, has a complex composition and different origin. Up to 2.5 liters of intestinal juice is excreted per day in a person.

In the crypts of the mucous membrane of the upper part of the duodenum, duodenal, or Brunner's, glands are laid. The cells of these glands contain secretory granules of mucin and zymogen. The structure and function of the Brunner glands are similar to those of the pyloric glands. The juice of the Brunner glands is a thick, colorless liquid of slightly alkaline reaction, which has little proteolytic, amylolytic and lipolytic activity. Intestinal crypts, or Lieberkün's glands, are embedded in the mucous membrane of the duodenum and the entire small intestine and surround each villus.

Many epithelial cells of the crypts of the small intestine have a secretory ability. Mature intestinal epitheliocytes develop from undifferentiated borderless enterocytes that predominate in crypts. These cells have proliferative activity and replenish intestinal cells that are desquamated from the tops of the villi. As they move toward the apex, the borderless enterocytes differentiate into absorptive villus cells and goblet cells.

Intestinal epithelial cells with a striated border, or absorbent cells, cover the villus. Their apical surface is formed by microvilli with outgrowths cell wall, thin filaments that form the glycocalyx, and also contains many intestinal enzymes translocated from the cell where they were synthesized. Enzymes are also rich in lysosomes located in the apical part of the cells.

Goblet cells are called unicellular glands. The mucus-filled cell has characteristic appearance glasses. The secretion of mucus occurs through breaks in the apical plasma membrane. The secret has enzymatic, including proteolytic, activity.

Enterocytes with acidophilic granules, or Paneth cells, in a mature state also have morphological features secretions. Their granules are heterogeneous and are excreted into the lumen of the crypts by the type of merocrine and apocrine secretion. The secret contains hydrolytic enzymes. The crypts also contain Argentaffin cells that perform endocrine functions.

The contents of the small intestine loop, even isolated from the rest of the intestine, are the product of many processes (including desquamation of enterocytes) and bilateral transport of high- and low-molecular substances. This, in fact, is intestinal juice.

Properties and composition of intestinal juice. Centrifugation separates the intestinal juice into liquid and solid parts. The ratio between them varies depending on the strength and type of irritation of the mucous membrane of the small intestine.

The liquid part of the juice is formed by a secret, solutions of inorganic and organic substances transported from the blood, and partially by the contents of the destroyed cells of the intestinal epithelium. The liquid part of the juice contains about 20 g/l of dry matter. Among the inorganic substances (about 10 g/l) are chlorides, bicarbonates and phosphates of sodium, potassium, and calcium. The pH of the juice is 7.2-7.5, with increased secretion it reaches 8.6. The organic substances of the liquid part of the juice are represented by mucus, proteins, amino acids, urea and other metabolic products.

The dense part of the juice is a yellowish-gray mass that looks like mucous lumps and includes undestroyed epithelial cells, their fragments and mucus - the secret of goblet cells has a higher enzymatic activity than the liquid part of the juice (G.K. Shlygin).

In the mucous membrane of the small intestine, there is a continuous change in the layer of cells of the surface epithelium. They are formed in the crypts, then move along the villi and exfoliate from their tops (morphokinetic, or morphonecrotic, secretion). Complete renewal of these cells in humans takes 1-4-6 days. Such a high rate of formation and rejection of cells provides a sufficiently large number of them in the intestinal juice (in humans, about 250 g of epitheliocytes are rejected per day).

Mucus forms a protective layer that prevents excessive mechanical and chemical effects of chyme on the intestinal mucosa. The activity of digestive enzymes is high in mucus.

The dense part of the juice has a much greater enzymatic activity than the liquid part. The main part of the enzymes is synthesized in the intestinal mucosa, but some of them are transported from the blood. There are more than 20 different enzymes in the intestinal juice that are involved in digestion.

The main part of intestinal enzymes takes part in parietal digestion. Carbohydrates are hydrolyzed by α-glucosidases, α-galactazidase (lactase), glucoamylase (γ-amylase). The α-glucosidases include maltase and trehalase. Maltase hydrolyzes maltose, and trehalase hydrolyzes trehalose by 2 molecules of glucose. α-Glucosidases are represented by another group of disaccharidases, which include 2-3 enzymes with isomaltase activity and invertase, or sucrase; with their participation, monosaccharides are formed.

The high substrate specificity of intestinal disaccharidases in their deficiency causes intolerance to the corresponding disaccharide. Genetically fixed and acquired lactase, trehalase, sucrase and combined deficiencies are known. A significant population of people, especially the peoples of Asia and Africa, has been diagnosed with lactase deficiency.

In the small intestine, the hydrolysis of peptides continues and ends. Aminopeptidases make up the bulk of the peptidase activity of the enterocyte brush border and cleave the peptide bond between two specific amino acids. Aminopeptidases complete the membrane hydrolysis of peptides, resulting in the formation of amino acids - the main absorbable monomers.

Intestinal juice has lipolytic activity. In the parietal hydrolysis of lipids, intestinal monoglyceride lipase is of particular importance. It hydrolyzes monoglycerides of any hydrocarbon chain length, as well as short chain di- and triglycerides, and to a lesser extent medium-chain triglycerides and cholesterol esters.

Row food products contains nucleoproteins. Their initial hydrolysis is carried out by proteases, then RNA and DNA cleaved from the protein part, respectively, are hydrolyzed by RNA and DNases to oligonucleotides, which, with the participation of nucleases and esterases, are degraded to nucleotides. The latter are attacked by alkaline phosphatases and more specific nucleotidases, releasing nucleosides that are then absorbed. Phosphatase activity of intestinal juice is very high.

The enzyme spectrum of the mucous membrane of the small intestine and its juice changes under the influence of certain long-term diets.

regulation of intestinal secretion. Eating, local mechanical and chemical irritation of the intestine enhance the secretion of its glands with the help of cholinergic and peptidergic mechanisms.

In the regulation of intestinal secretion, local mechanisms play a leading role. Mechanical irritation the mucous membrane of the small intestine causes an increase in the release of the liquid part of the juice. Chemical stimulants of the secretion of the small intestine are the products of digestion of proteins, fats, pancreatic juice, hydrochloric and other acids. Local impact products of digestion of nutrients causes the separation of intestinal juice rich in enzymes.

The act of eating does not significantly affect intestinal secretion, at the same time, there are data on the inhibitory effects on it of irritation of the antrum of the stomach, modulating effects of the central nervous system, on the stimulating effect on the secretion of cholinomimetic substances and the inhibitory effect of anticholinergic and sympathomimetic substances. Stimulate intestinal secretion of GIP, VIP, motilin, inhibits somatostatin. The hormones enterocrinin and duocrinin, produced in the mucous membrane of the small intestine, stimulate the secretion of intestinal crypts (Lieberkün's glands) and duodenal (Brunner's) glands, respectively. These hormones have not been isolated in purified form.

The human small intestine is part of the digestive tract. This department is responsible for the final processing of substrates and absorption (suction).

What is the small intestine?

The human small intestine is a narrow tube about six meters long.

This part of the digestive tract got its name because of the proportional features - the diameter and width of the small intestine is much smaller than those of the large intestine.

The small intestine is divided into the duodenum, jejunum and ileum. The duodenum is the first segment of the small intestine, located between the stomach and the jejunum.

Here the most active processes of digestion take place, it is here that pancreatic and gallbladder enzymes are secreted. The jejunum follows the duodenum, its average length is one and a half meters. Anatomically, the jejunum and ileum are not separated.

The mucous membrane of the jejunum on inner surface covered with microvilli that absorb nutrients, carbohydrates, amino acids, sugar, fatty acids, electrolytes and water. The surface of the jejunum increases due to special fields and folds.

Vitamin B12 and other water-soluble vitamins are absorbed in the ileum. In addition, this area of ​​the small intestine is also involved in the absorption of nutrients. The functions of the small intestine are somewhat different from those of the stomach. In the stomach, food is crushed, ground and primarily decomposed.

In the small intestine, the substrates are decomposed into their constituent parts and absorbed for transport to all parts of the body.

Anatomy of the small intestine

As we noted above, in the digestive tract small intestine immediately follows the stomach. The duodenum is the initial section of the small intestine, following the pyloric section of the stomach.

The duodenum begins at the bulb, bypasses the head of the pancreas, and ends in the abdominal cavity with the ligament of Treitz.

The peritoneal cavity is a thin connective tissue surface that covers some of the abdominal organs.

The rest of the small intestine is literally suspended in the abdominal cavity by a mesentery attached to the posterior abdominal wall. This structure allows you to freely move the sections of the small intestine during surgery.

The jejunum occupies the left side of the abdominal cavity, while the ileum is located in the upper right side of the abdominal cavity. The inner surface of the small intestine contains mucous folds called circular circles. Such anatomical formations are more numerous in the initial section of the small intestine and are reduced closer to the distal ileum.

The assimilation of food substrates is carried out with the help of primary cells epithelial layer. Cubic cells located throughout the entire area of ​​the mucous membrane secrete mucus that protects the intestinal walls from an aggressive environment.

Enteric endocrine cells secrete hormones into the blood vessels. These hormones are essential for digestion. The squamous cells of the epithelial layer secrete lysozyme, an enzyme that destroys bacteria. The walls of the small intestine are closely connected with the capillary networks of the circulatory and lymphatic systems.

The walls of the small intestine are composed of four layers: mucosa, submucosa, muscularis, and adventitia.

functional significance

The human small intestine is functionally connected with all organs of the gastrointestinal tract, digestion of 90% of food substrates ends here, the remaining 10% are absorbed in the large intestine.

The main function of the small intestine is to absorb nutrients and minerals from food. The digestion process has two main parts.

The first part involves the mechanical processing of food by chewing, grinding, whipping and mixing - all this takes place in oral cavity and stomach. The second part of food digestion involves the chemical processing of substrates, which uses enzymes, bile acids, and other substances.

All this is necessary in order to decompose whole products into individual components and absorb them. Chemical digestion occurs in the small intestine - it is here that the most active enzymes and excipients are present.

Ensuring digestion

After rough processing of products in the stomach, it is necessary to decompose the substrates into separate components available for absorption.

1. The breakdown of proteins. Proteins, peptides and amino acids are affected by special enzymes, including trypsin, chymotrypsin and intestinal wall enzymes. These substances break down proteins into small peptides. Protein digestion begins in the stomach and ends in the small intestine.
2. Digestion of fats. This purpose is served by special enzymes (lipases) secreted by the pancreas. Enzymes break down triglycerides into free fatty acids and monoglycerides. An auxiliary function is provided by bile juices secreted by the liver and gallbladder. Bile juices emulsify fats - they separate them into small drops available for the action of enzymes.
3. Digestion of carbohydrates. Carbohydrates are classified into simple sugars, disaccharides and polysaccharides. The body needs the main monosaccharide - glucose. Pancreatic enzymes act on polysaccharides and disaccharides, which promote the decomposition of substances to monosaccharides. Some carbohydrates are not completely absorbed in the small intestine and end up in the large intestine, where they become food for intestinal bacteria.

Absorption of food in the small intestine

Decomposed into small components, nutrients are absorbed by the mucous membrane of the small intestine and move into the blood and lymph of the body.

Absorption is provided by special transport systems of digestive cells - each type of substrate is provided with a separate method of absorption.

The small intestine has a significant internal surface area, which is essential for absorption. Circular circles of the intestine contain a large number of villi that actively absorb food substrates. Modes of transport in the small intestine:

• Fats undergo passive or simple diffusion.
• Fatty acids are absorbed by diffusion.
• Amino acids enter the intestinal wall by active transport.
• Glucose enters through secondary active transport.
• Fructose is absorbed by facilitated diffusion.

For a better understanding of the processes, it is necessary to clarify the terminology. Diffusion is a process of absorption along the concentration gradient of substances, it does not require energy. All other types of transport require the expenditure of cellular energy. We found out that the human small intestine is the main section of food digestion in the digestive tract.

Watch the video about the anatomy of the small intestine:

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Causes and treatment of increased gas formation in adults

Flatulence is called excessive gas formation in the intestines. As a result, digestion is difficult and disrupted, nutrients are poorly absorbed, and the production of enzymes necessary for the body is reduced. Flatulence in adults is eliminated with the help of drugs, folk remedies and diets.

1. Causes of flatulence
2. Diseases that provoke flatulence
3. Flatulence during pregnancy
4. The course of the disease
5. Flatulence treatment
6. Medicines
7. Folk recipes
8. Power correction
9. Conclusion

Causes of flatulence

The most common cause of flatulence is malnutrition. An excess of gases can occur in both men and women. This condition is often provoked by foods that are high in fiber and starch. As soon as they accumulate more than the norm, the rapid development of flatulence begins. The cause is also carbonated drinks and products from which a fermentation reaction occurs (lamb, cabbage, legumes, etc.).

Often, increased flatulence appears due to a violation of the enzyme system. If they are not enough, then a lot penetrates into the terminal sections of the gastrointestinal tract undigested food. As a result, it begins to rot, fermentation processes are activated with the release of gases. An unhealthy diet leads to a lack of enzymes.

A common cause of flatulence is a violation of the normal microflora of the large intestine. With its stable operation, part of the resulting gases is destroyed by special bacteria, for which this is a source of vital activity. However, when they are overproduced by other microorganisms, the balance in the intestine is disturbed. Gas causes an unpleasant smell of rotten eggs during bowel movements.

The cause of flatulence can also be:

1. Stress, causing muscle spasms and slowing down of the intestines. At the same time, sleep is disturbed. Most often, the disease occurs in women.
2. Surgical operations, after which the activity of the gastrointestinal tract decreases. The progress of the food mass slows down, which provokes the processes of fermentation and decay.
3. Adhesions and tumors. They also interfere with the normal movement of food masses.
4. Milk intolerance causes gas buildup.

Morning flatulence can be caused by a lack of fluid in the body. In this case, the bacteria begin to intensively release gases. Only pure water helps to reduce them. Eating at night also contributes to increased gas formation. The stomach does not have time to rest, and part of the food is undigested. Fermentation appears in the intestines.

In addition to these reasons, there is "senile flatulence of the intestine." Often, gases accumulate during sleep. Their excessive increase appears against the background of age-related changes in the body, due to lengthening of the intestine, atrophy of the muscular wall of the organ, or a decrease in the number of glands that are involved in the release of digestive enzymes. With gastritis, gases often accumulate during sleep.

Diseases that provoke flatulence

Increased gas formation can be caused by a number of diseases:

1. With duodenitis, the duodenum becomes inflamed and the synthesis of digestive enzymes is disrupted. As a result, rotting and fermentation of undigested food begins in the intestines.
2. With cholecystitis during inflammatory process obstructed flow of bile. Since it does not enter the duodenum sufficiently, the organ begins to function incorrectly.
3. With gastritis in the gastrointestinal tract, the level of acidity changes and proteins are broken down very slowly. This disrupts the peristalsis of the intestines of the digestive tract.
4. With pancreatitis, the pancreas is deformed and swells. Healthy tissues are replaced by fibrous ones, in which there are almost no living cells. Because of structural changes reduced production of digestive enzymes. There is a deficiency of pancreatic juice, and as a result, the digestion of food is disturbed. Because of this, gas emission is greatly increased.
5. With enteritis, the mucosa of the small intestine is deformed. As a result, the absorption of food and its processing are disturbed.
6. The same thing happens during colitis. The balance of the intestinal microflora is disturbed. These changes lead to increased gas production.
7. In cirrhosis, the liver cannot secrete bile properly. As a result, fats are not digested into fully. Increased gas formation usually occurs after fatty foods.
8. During acute intestinal infections the causative agent penetrates most often through the mouth with contaminated food or water. After that, harmful microorganisms begin to multiply rapidly and release toxins ( toxic substances). They have a negative effect on the muscles of the intestine. Because of this, the removal of gases from the body is disrupted, and they begin to accumulate. There is severe bloating.
9. With obstruction of the gastrointestinal tract, its peristalsis is disturbed due to a mechanical obstacle (helminths, neoplasms, foreign bodies etc.).
10. With irritable bowel syndrome, the sensitivity of the receptors of its walls changes. This disrupts the motility of the organ, mainly the colon, absorption and secretion. As a result, pronounced flatulence appears.
11. With intestinal atony, the rate of movement of feces and chyme is significantly reduced, which causes the accumulation of gases.
12. With diverticulitis of the intestine, the level of pressure in it is disturbed. Its increase leads to lesions of the muscle layer, defects appear. False diverticulitis is formed and severe flatulence appears.
13. With neurosis nervous system overexcited. As a result, intestinal peristalsis is disturbed.

Flatulence during pregnancy

In women during pregnancy, flatulence occurs for a number of reasons:

• intestinal compression;
• hormonal changes in the body;
• stress;
• violation of the microflora in the intestine;
• malnutrition;
• diseases of the gastrointestinal tract.

Treatment of flatulence during pregnancy is carried out strictly according to the doctor's recommendations. During this period, women cannot take many medicines, and not all folk methods are suitable. A pregnant woman should:

• follow a diet;
• chew food thoroughly;
• exclude carbonated drinks from the diet.

At the same time, a woman needs to be active and wear loose clothing. Flatulence cannot be treated on its own. Medications should only be prescribed by a doctor. Without his consultation, you can use activated charcoal. It absorbs all toxins and harmful substances. Linex has the same effect.

The course of the disease

The course of the disease is divided into two types:

1. The first is when flatulence manifests itself after an increase in the abdomen due to the accumulation of gases. Their discharge is very difficult due to intestinal spasm. This is accompanied by pain in the abdomen and a feeling of fullness.
2. In another variant, gases, on the contrary, intensively exit the intestines. Moreover, this process becomes regular. This phenomenon causes pain in the intestines. But even those around the patient can hear loudly how his stomach rumbles and boils due to the transfusion of the contents.

Flatulence treatment

Medicines

Therapy begins with the elimination of concomitant diseases that provoke strong gas formation.

• Pre- and probiotic preparations are prescribed (Biobacton, Acylact, etc.). Antispasmodics help reduce pain (Papaverine, No-Shpa, etc.).
• Enterosorbents are used to eliminate sudden gas formation ( Activated carbon, Smecta, Enterosgel and others).
• Drugs are also prescribed that eliminate increased gas formation. Adsobents (activated carbon, Polysorb, etc.) and defoamers (Espumizan, Disflatil, Maalox plus, etc.) are prescribed.
• Flatulence is also treated with enzymatic preparations (Pancreatin, Mezim Forte, etc.).
• When vomiting, Metoclopramide or Cerucal is prescribed.

When flatulence appears for the first time, Espumizan can be used to quickly eliminate symptoms. It belongs to defoaming drugs and collapses gas bubbles immediately in the intestine. As a result, heaviness in the abdomen and pain quickly disappear. Mezim Forte and activated charcoal help to eliminate the same symptoms in a short time.

Folk recipes

Folk remedies for bloating and excessive gas formation:

1. Dill seeds (1 tablespoon) are poured with a glass of boiling water. Infuse until completely cooled. The remedy is filtered and drunk in the morning.
2. Crushed carrot seeds. They need to drink 1 tsp. per day for bloating.
3. A decoction is prepared from dandelion roots. Crushed and dried plant in the amount of 2 tbsp. l. pour 500 ml of boiling water. After the product has cooled, it is filtered. The decoction is divided into 4 parts and gradually drunk during the day.
4. Ginger root is crushed and dried. The powder is consumed in a quarter of a teaspoon per day, after which it is washed down with plain water.
5. An infusion is made from St. John's wort, yarrow and marsh cudweed. All plants are taken in crushed dried form, 3 tbsp. l. The infusion is taken to reduce gas formation.

Increased gas formation can be cured within a day. To do this, parsley root (1 tsp) is infused for 20 minutes in a glass of cold water. Then the mixture is slightly warmed up and drunk every hour in a big gulp until the liquid in the glass runs out.

An infusion of dried thyme and dill seeds helps to quickly get rid of flatulence. They are taken in 1 tsp. and pour 250 ml of boiling water. The product is infused for 10 minutes under a tightly closed lid. From above it is covered with a towel, then filtered. Infusion should be drunk every hour for 30 ml. The last dose should be before dinner.

Power correction

Treatment for flatulence includes diet. It is an auxiliary, but mandatory addition. Flatulence during sleep is often caused by food eaten for dinner.

1. All foods with coarse fiber are removed from the diet.
2. You can not eat legumes, cabbage and other foods that cause fermentation in the intestines.
3. If lactose intolerance is observed, the amount of milk sugar and calories in the diet is reduced.
4. Meat and fish should be lean, steamed or boiled. Bread is eaten dried or stale.
5. Of vegetables, carrots, beets, cucumbers, tomatoes and spinach are allowed.
6. You can eat fat-free yogurt and cottage cheese.
7. Porridges are prepared only from brown rice, buckwheat or oatmeal.
8. It is necessary to abandon fried foods, smoked meats and pickles.
9. Do not drink carbonated and alcoholic drinks.
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The residence time of the contents (digestible food) in the stomach is normal - about 1 hour.

Anatomy of the stomach

Anatomically, the stomach is divided into four parts:

• cardiac(lat. pars cardiaca) adjacent to the esophagus;
• pyloric or gatekeeper (lat. pars pylorica), adjacent to the duodenum;
• body of the stomach(lat. corpus ventriculi), located between the cardiac and pyloric parts;
• fundus of the stomach(lat. fundus ventriculi), located above and to the left of the cardial part.

In the pyloric region, they secrete gatekeeper's cave(lat. antrum pyloricum), synonyms antrum or anthurm and channel gatekeeper(lat. canalis pyloricus).

The figure on the right shows: 1. The body of the stomach. 2. Fundus of the stomach. 3. Anterior wall of the stomach. 4. Large curvature. 5. Small curvature. 6. Lower esophageal sphincter (cardia). nine. Pyloric sphincter. 10. Antrum. 11. Pyloric canal. 12. Corner cut. 13. A furrow that forms during digestion between the longitudinal folds of the mucosa along the lesser curvature. 14. Folds of the mucous membrane.

The following anatomical structures are also distinguished in the stomach:

• anterior wall of the stomach(lat. paries anterior);
• back wall stomach(lat. paries posterior);
• lesser curvature of the stomach(lat. curvatura ventriculi minor);
• greater curvature of the stomach(lat. curvatura ventriculi major).

The stomach is separated from the esophagus by the lower esophageal sphincter and from duodenum- pyloric sphincter.

The shape of the stomach depends on the position of the body, the fullness of food, functional state person. With average filling, the length of the stomach is 14–30 cm, the width is 10–16 cm, the length of the lesser curvature is 10.5 cm, the greater curvature is 32–64 cm, the wall thickness in the cardia is 2–3 mm (up to 6 mm), in the antrum 3 -4 mm (up to 8 mm). The capacity of the stomach is from 1.5 to 2.5 liters (the male stomach is larger than the female one). The mass of the stomach of a “conditional person” (with a body weight of 70 kg) is normal - 150 g.

The wall of the stomach consists of four main layers (listed starting from the inner surface of the wall to the outer):

• mucosa covered by a single layer of columnar epithelium
• submucosa
• muscular layer, consisting of three sublayers of smooth muscles:
• inner sublayer of oblique muscles
• middle sublayer of circular muscles
• outer sublayer of longitudinal muscles
• serous membrane.

Between the submucosa and the muscular layer is the nervous Meissner (synonymous with submucosal; lat. plexus submucosus) a plexus that regulates the secretory function of epithelial cells between the circular and longitudinal muscles - Auerbach's (synonymous with intermuscular; lat. plexus myentericus) plexus.

The mucous membrane of the stomach

The mucous membrane of the stomach is formed by a single-layer cylindrical epithelium, its own layer and muscular plate, which forms folds (the relief of the mucous membrane), gastric fields and gastric pits, where the excretory ducts of the gastric glands are localized. In its own layer of the mucous membrane are tubular gastric glands, consisting of parietal cellsproducing hydrochloric acid; chief cellsproducing the pepsin proenzyme pepsinogen, and additional (mucous) cells that secrete mucus. In addition, mucus is synthesized by mucous cells located in the layer of the superficial (integumentary) epithelium of the stomach.

The surface of the gastric mucosa is covered with a continuous thin layer of mucous gel, consisting of glycoproteins, and under it is a layer of bicarbonates adjacent to the surface epithelium of the mucous membrane. Together they form a mucobicarbonate barrier of the stomach, protecting epitheliocytes from the aggression of the acid-peptic factor (Zimmerman Ya.S.). The composition of mucus includes antimicrobial activity immunoglobulin A (IgA), lysozyme, lactoferrin and other components.

The surface of the mucous membrane of the body of the stomach has a pit structure, which creates conditions for minimal contact of the epithelium with the aggressive intracavitary environment of the stomach, which is also facilitated by a powerful layer of mucous gel. Therefore, the acidity on the surface of the epithelium is close to neutral. The mucous membrane of the body of the stomach is characterized by a relatively short path for the movement of hydrochloric acid from the parietal cells into the lumen of the stomach, since they are located mainly in the upper half of the glands, and the main cells are in the basal part. An important contribution to the mechanism of protection of the gastric mucosa from the aggression of gastric juice is made by the extremely rapid nature of the secretion of the glands, due to the work of the muscle fibers of the gastric mucosa. The mucous membrane of the antral region of the stomach (see the figure on the right), on the contrary, is characterized by a “villous” structure of the surface of the mucous membrane, which is formed by short villi or convoluted ridges 125–350 µm high (Lysikov Yu.A. et al.).

Children's stomach

In children, the shape of the stomach is unstable, depending on the constitution of the child's body, age and diet. In newborns, the stomach has a round shape, by the beginning of the first year it becomes oblong. By the age of 7–11, the shape of a child's stomach does not differ from that of an adult. In children infancy the stomach is horizontal, but as soon as the child begins to walk, he takes a more vertical position.

By the time the child is born, the fundus and cardial section of the stomach are not sufficiently developed, and the pyloric section is much better, which explains frequent regurgitation. Regurgitation is also facilitated by swallowing air during sucking (aerophagy), with improper feeding technique, a short frenulum of the tongue, greedy sucking, too rapid release of milk from the mother's breast.

Gastric juice

The main components of gastric juice are: hydrochloric acid secreted by parietal (parietal) cells, proteolytic, produced by chief cells and non-proteolytic enzymes, mucus and bicarbonates (secreted by additional cells), internal factor of Castle (production of parietal cells).

The gastric juice of a healthy person is practically colorless, odorless and contains a small amount of mucus.

Basal, not stimulated by food or otherwise, secretion in men is: gastric juice 80-100 ml / h, hydrochloric acid - 2.5-5.0 mmol / h, pepsin - 20-35 mg / h. Women have 25-30% less. About 2 liters of gastric juice are produced in the stomach of an adult per day.

The gastric juice of an infant contains the same ingredients as the gastric juice of an adult: rennet, hydrochloric acid, pepsin, lipase, but their content is reduced, especially in newborns, and increases gradually. Pepsin breaks down proteins into albumins and peptones. Lipase breaks down neutral fats into fatty acids and glycerol. Rennet (the most active of the enzymes in infants) curdles milk (Bokonbaeva SD and others).

Stomach acidity

The main contribution to the total acidity of gastric juice is made by hydrochloric acid produced by parietal cells of the gastric fundic glands, located mainly in the fundus and body of the stomach. The concentration of hydrochloric acid secreted by the parietal cells is the same and equal to 160 mmol / l, but the acidity of the secreted gastric juice varies due to a change in the number of functioning parietal cells and neutralization of hydrochloric acid by the alkaline components of gastric juice.

Normal acidity in the lumen of the body of the stomach on an empty stomach is 1.5-2.0 pH. The acidity on the surface of the epithelial layer facing the lumen of the stomach is 1.5–2.0 pH. Acidity in the depth of the epithelial layer of the stomach is about 7.0 pH. Normal acidity in the antrum of the stomach is 1.3–7.4 pH.

Currently, the only reliable method for measuring the acidity of the stomach is considered to be intragastric pH-metry, performed using special devices - acidogastrometers, equipped with pH probes with several pH sensors, which allows you to measure acidity simultaneously in different areas of the gastrointestinal tract.

The acidity of the stomach in conditionally healthy people(without any subjective sensations in gastroenterological terms) changes cyclically during the day. Daily fluctuations in acidity are greater in the antrum than in the body of the stomach. The main reason for such changes in acidity is the longer duration of nocturnal duodenogastric refluxes (DGR) compared to daytime ones, which throw duodenal contents into the stomach and, thereby, reduce acidity in the gastric lumen (increase pH). The table below shows the average values ​​of acidity in the antrum and body of the stomach in apparently healthy patients (Kolesnikova I.Yu., 2009):

The total acidity of gastric juice in children of the first year of life is 2.5–3 times lower than in adults. Free hydrochloric acid is determined at breastfeeding after 1-1.5 hours, and with artificial - 2.5-3 hours after feeding. The acidity of gastric juice is subject to significant fluctuations depending on the nature and diet, the state of the gastrointestinal tract.

Motility of the stomach

With regard to motor activity, the stomach can be divided into two zones: proximal (upper) and distal (lower). There are no rhythmic contractions and peristalsis in the proximal zone. The tone of this zone depends on the fullness of the stomach. When food is received, the tone of the muscular membrane of the stomach decreases and the stomach reflexively relaxes.

motor activity various departments stomach and duodenum (Gorban V.V. and others) The figure on the right shows a diagram of the fundic gland (Dubinskaya T.K.): 1 - layer of mucus-bicarbonate 2 - surface epithelium 3 - mucous cells of the neck of the glands 4 - parietal (parietal) cells 5 - endocrine cells 6 - chief (zymogenic) cells 7 - fundic gland 8 - gastric fossa Microflora of the stomach Until recently, it was believed that due to bactericidal action gastric juice, the microflora that penetrated the stomach dies within 30 minutes. but modern methods microbiological research it has been proven that this is not the case. The amount of various mucosal microflora in the stomach in healthy people is 10 3 -10 4 / ml (3 lg CFU / g), including 44.4% of cases revealed Helicobacter pylori(5.3 lg CFU / g), in 55.5% - streptococci (4 lg CFU / g), in 61.1% - staphylococci (3.7 lg CFU / g), in 50% - lactobacilli (3, 2 lg CFU / g), in 22.2% - fungi of the genus Candida(3.5 lg cfu/g). In addition, bacteroids, corynebacteria, micrococci, etc. were sown in the amount of 2.7–3.7 lg CFU/g. It should be noted that Helicobacter pylori were determined only in association with other bacteria. The environment in the stomach turned out to be sterile in healthy people only in 10% of cases. By origin, the microflora of the stomach is conditionally divided into oral-respiratory and fecal. In 2005, in the stomach of healthy people, strains of lactobacilli were found that adapted (like Helicobacter pylori) to exist in the sharply acidic environment of the stomach: Lactobacillus gastricus, Lactobacillus antri, Lactobacillus kalixensis, Lactobacillus ultunensis. In various diseases (chronic gastritis, peptic ulcer, stomach cancer), the number and diversity of bacteria colonizing the stomach increase significantly. At chronic gastritis the largest number mucosal microflora was found in the antrum, with peptic ulcer- in the periulcerous zone (in the inflammatory roller). Moreover, often the dominant position is occupied by Helicobacter pylori, and streptococci, staphylococci,