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small intestine

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  • Small intestine is the longest organ in the gastrointestinal (GI) tract, around 6 meters or 20 feet in length 

  • It is divided into 3 parts: Duodenum, Jejunum and Ileum 

  • Duodenum is 25 cm in length. The average length of the jejunum is 2 meters and ileum is 3 meters

  • The small intestine is the site of absorption of nutrients, water, and vitamins from food

  • The process of digestion and absorption usually takes 3 to 6 hours after food intake

  • On an average, 8 to 10 L of fluid will flow through the small intestine in a 24-hour period. It includes dietary intake, salivary fluid, and gastric, biliary, pancreatic, and intestinal secretions. Majority of fluid is absorbed in the small intestine and less than one litre of fluid is presented to the colon for absorption

  • The colon will absorb the rest of the water, allowing only a small amount to be excreted in the stool

  • The intestine is made up of four layers: the mucosa (innermost layer), submucosa, muscularis propria (muscle layer), and serosa (outer)

  • The main disorders of small bowel are related to obstruction, perforation, bleeding and malabsorption

What are the common small intestinal disorders?

  • Enteritis - Inflammation of the bowel 

  • Perforation 

  • Obstruction

    • Stricture - Fibrous thickening of the bowel (eg- TB, Crohn's disease)

    • Cancers

    • Foreign body

    • Worm Infestation

  • Mal absorption

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What are the common intestinal symptoms?

  • Pain abdomen (Colicky)

  • Vomiting

  • Abdominal distension

  • Constipation

  • Bleeding - malena, hematochezia

What are the common small bowel investigations?

  • X ray abdomen for bowel obstruction, perforation etc.

  • Barium meal follow through

  • Entire small bowel can not be assessed by routine endoscopy & colonoscopy mainly because of the length restriction of the endoscope

    • So, other modified techniques are used

      • Capsule endoscopy - it is a small capsule like material, which has inbuilt camera, battery & transmitter. Here, the patient swallows the capsule which slowly moves along the entire length of intestine & transmits the video images to receiver

      • Mother baby scope - one small scope passed through another scope

  • CT scan / MRI scan

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What are the commonly done small bowel surgeries ?

  • Resection & anastomosis - a segment of the intestine which is abnormal is resected and ends are joined together

  • Closure of peroration - Simply, perorated site is closed by sutures

  • Stricturoplasty - Surgical technique, which involves the enlargement of the stricture part of intestine

  • Ileostomy - Intestine is opened & brought out through the abdominal wall & anchored to skin. The fecal matter gets collected in the stoma bag, which is emptied frequently

  • Adhesiolysis or band release - adhesions or bands causing bowel obstruction are released

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