Short Gut Syndrome Parents' Support Group
Join us on facebook

Next Support Group Meeting

February 27, 2010
10:30 a.m.

Taylorsville Library
4870 S. 2700 W.
Salt Lake City, UT
map it

Worms and Washing Machines:
How the Intestine Works

by Dr. W. Daniel Jackson, M.D., Gastroenterologist

worm

The function of the gastrointestinal tract is to get the nutrient molecules in our food into our body to be used in metabolism.  In some ways we are fancy worms with a tube running through our middle.  This tube has specialized segments, each with its own function that works in sequence to digest our food down to the molecules that our body can use for fuel and building material.  One way to look at the functional anatomy of our GI tract and understand the consequences of losing certain parts as in short bowel syndrome is to compare it to a washing machine.  In many ways we are:

Top-Loaders

washing machine digestive system

Fill Wash Tub:  Food or formula entering the mouth is mixed with salivary amylase enzyme to begin starch(carbohydrate) digestion, then swallowed into the stomach, where it meets acid and pepsin and gastric lipase enzymes to begin breaking down protein and fat.

Agitate/Mix:  The contractions of the stomach and the intestines help mix the food with the digestive enzymes and liquid to physically break down the food particles.

Add Detergent:  The food entering the first part of the intestine, the duodenum, passes by the little tubes or ducts that squirt in bile from the liver which acts like a detergent (green and slippery, just like Palmolive liquid) to emulsify fat, and enzymes from the pancreas which chemically break down the large food molecular chains into smaller molecules that can be absorbed. There are special enzymes for different protein chains of amino acids, carbohydrate chains of glucose sugar, and fatty acid chains.

Wash:  The jejunum [upper 2/5 (40%) of the small intestine after the short duodenum loop] is the wash cycle where the liquefied food is agitated with the enzymes to allow complete breakdown or digestion into small molecules that can be absorbed through the lining to go to the liver to be used by the body for energy and to growth.  Only part of the fluid absorption occurs here and the “clothes” or digested foods are still quite wet as they leave the jejunum.

Spin:   The ileum [lower 3/5 or 60% of the small intestine emptying into the large intestine] is the spin cycle where the majority of nutrients and liquid in the digested broken-down liquefied food or chyme is absorbed  before being allowed to go into the large intestine through the ileo-cecal valve lips that separate the ileum from the cecum or beginning of the large intestine.  The ileum can compensate and do all the digestive functions of the jejunum if necessary.  The last part of the ileum or terminal ileum has unique functions of absorbing Vitamin B12, important for nerve functions, and for immune function, including tolerance to foods.  The ileum also reabsorbs the bile acid detergent for recycling back to the liver.

Dryer:  The cecum or beginning of the intestine has lots of bacteria to break down or ferment food that was not fully digested or absorbed by the small intestine (especially the short bowel) including indigestible fiber.  This fermentation process produces fatty acids that can be salvaged and absorbed for additional nutrition as well as gas and acidic stools.  Mostly water absorption occurs in the slow moving large intestine. 

 

Normal nutrition and growth depends on:

Adequate intake of nutrients.

Digestion of nutrients: enzymatic hydrolysis(breakdown) of polymers(molecular chains)

Intra-lumenal: salivary amylase,gastric lipase, pancreatic enzymes

Mucosal brush-border enzymes: disaccharidases, peptidases

Absorption of nutrients across epithelial membranes(intestinal lining): 

Sufficient mucosal surface area:

  • intestinal length and radius dependent
  • villi and microvilli (absorptive fringe) increase surface area dramatically.

    Transit time:  motility (movement) regulation

  • No “dumping”: too fast transit causes diarrhea
  • No stasis: too slow transit allows bacterial colonization and fermentation

    Membrane Transport:  specialized transport processes

  • Monosaccharides: (sugars: glucose, galactose, fructose)
  • Amino acids, di- and tri-peptides (protein molecules)
  • Fatty acids:  Pinocytosis(absorption by engulfment)

  • Specialized segmental absorptive functions of the GI tract:

  • Mouth: glucose
  • Esophagus: none
  • Stomach: minimal
  • Duodenum: iron, Ca, Mg, Vits A, D, E, K
  • Jejunum: water soluble vitamins(C and B vitamins); Carbs, Fats, Proteins  [net secretion of water]
  • Ileum: Jejunal  functions plus: Vitamin B12, bile acids(95%); [net absorption of water]
  • Colon: short chain fatty acids from fermentation, water

    Loss of Jejunum: consequences:

    Loss of absorptive surface area

    Reduced absorption of Vitamins and trace minerals, especially iron and zinc

    More nutrients presented to the ileum for digestion and absorption

    Note: the Ileum may adapt to compensate for most digestive and absorptive functions

    Loss of Ileum: consequences

    Reduced absorptive surface area

    Loss of absorptive efficiency

    Loss of specialized absorptive functions

  • Bile acid malabsorption
  • Choleraic (bile salt induced) diarrhea
  • Diminished bile acid pool
  • Vitamin B12 malabsorption

    Altered Motility- rapid transit

  • Loss of ileal brake:  malabsorbed fat slows motility
  • Loss of ileocecal valve:
  • bacterial contamination of distal small bowel from colon
  • more rapid transit to colon?

    Normal Bowel Segment Length based on Gestational Age:

    Gestational Age Total Bowel Small Bowel Jejunum Ileum
    19-27 weeks 142 cm 115 cm 45 cm 70 cm
    27-35 weeks 218 cm 170 cm 70 cm 100 cm
    > 35 weeks 304 cm 250 cm 100 cm 150 cm

     

    Read about this topic on the web

    http://www.seattlechildrens.org/clinics-programs/transplant/intestine/how-the-small-intestine-works/ - How the Small Intestine Works, Seattle Children's Hospital

    http://www.cmaj.ca/content/vol166/issue10/images/large/21ff1.jpeg Diagram of absorption in the intestine, Canadian Medical Association Journal

    http://kidshealth.org/parent/general/body_basics/digestive.html Body Basics: Digestive System, KidsHealth



  • This website is created by parents for parents. This site does not provide medical or any other health advice, diagnosis, and/or treatment. This site and its services, including the information above, are for informational purposes only and are not a substitute for professional medical or health advice, examination, diagnosis, and treatment. Always seek the advice of your physician or other health care provider before starting any new treatment, making any changes to existing treatment, or altering in any way yours or your child's current care or diet regimen. Do not delay seeking or disregard medical advice based on the information on this site. Some of the information on this site may be incorrect or out of date. No health information on this site is regulated or evaluated by the Food and Drug Administration and therefore the information should not be used to diagnose, treat, cure, or prevent any disease without the supervision of a medical professional.