Magnitude of functional adaptation after intestinal resection

1999 ◽  
Vol 276 (5) ◽  
pp. R1265-R1275 ◽  
Author(s):  
Timothy P. O’Connor ◽  
Mandy M. Lam ◽  
Jared Diamond
Keyword(s):  
Small Intestine ◽  
Glucose Uptake ◽  
Safety Factor ◽  
Time Course ◽  
Intestinal Adaptation ◽  
Intestinal Resection ◽  
Functional Adaptation ◽  
Glucose Load ◽  
Uptake Capacity ◽  
Small Intestinal

Intestinal adaptation after resection has been much studied, but rarely examined in an integrative context. Hence we assessed the effects of resection and subsequent adaptation on the quantitative relationship between dietary glucose load and gut capacity to transport glucose. The ratio of capacity to load is termed the “safety factor.” Our objectives were to determine 1) the time course of intestinal adaptation after resection, 2) whether adaptation is quantitatively complete, 3) whether survival requires maintaining a safety factor of at least 1.0 for glucose transport, 4) the effect of altered energy demands on adaptation, and 5) the relationship between the amount of tissue removed and the magnitude of functional adaptation. We performed 80% resection of the small intestine on Sprague-Dawley rats and measured small intestinal glucose uptake capacity, dietary glucose load, and gut gross morphology at 1, 5, and 10 wk postsurgery. Nearly all aspects of adaptation were complete by 1 wk postsurgery. After resection, remnant small intestine mass increased by over fivefold within 1 wk, to reach 50–70% of its preresection value. However, mass-specific glucose uptake activity was reduced, so that intestinal regeneration restored uptake capacity to only 33% of control values. Increased energetic demands had only modest effects on intestinal adaptation. Although the safety factor for small intestinal glucose uptake remained <1.0 (i.e., capacity < load) after adaptation to resection, nearly all rats survived. Hindgut fermentation of nonabsorbed nutrients appeared to contribute to that survival, despite inadequate small intestinal capacity. After less massive resection surgeries (25, 50, and 75% resections), the percent increase in glucose uptake capacity increased with the amount of tissue removed.

Nutrient-stimulated GLP-2 release and crypt cell proliferation in experimental short bowel syndrome

2005 ◽  
Vol 288 (3) ◽  
pp. G431-G438 ◽  
Author(s):  
G. R. Martin ◽  
L. E. Wallace ◽  
B. Hartmann ◽  
J. J. Holst ◽  
L. Demchyshyn ◽  
...  
Keyword(s):  
Cell Proliferation ◽  
Time Course ◽  
Intestinal Adaptation ◽  
Intestinal Resection ◽  
Small Bowel Resection ◽  
Crypt Cell ◽  
Crypt Cell Proliferation ◽  
Proximal Intestine ◽  
The Relationship ◽  
Over Time

Glucagon-like peptide-2 (GLP-2) is an enteroendocrine peptide that is released in response to luminal nutrients and has unique trophic actions in the gastrointestinal tract. These features suggest GLP-2 may be important in controlling intestinal adaptation. We examined the relationship over time of GLP-2 production and adaptation to intestinal resection, the effects of resection-induced malabsorption on GLP-2 production, and the correlation of endogenous serum GLP-2 levels with adaptation as measured by crypt-cell proliferation (CCP). We initially examined the effect of nutrient malabsorption, induced by a 90% resection of the proximal intestine studied on day 4, on the time course and levels of GLP-2 release. Secondly, the degree of malabsorption was varied by performing intestinal transection or 50, 75, or 90% resection of proximal small intestine. Finally, the relationship of GLP-2 levels over time with adaptation to a 90% resection was examined by determining GLP-2 levels on days 7, 14, and 28, and correlating this with intestinal adaptation, as assessed by morphology and CCP rate. A 90% resection significantly increased basal and postprandial GLP-2 levels, with a net increase in nutrient-stimulated exposure over 90 min; GLP-2 exposure (integrated levels vs. time) increased 12.7-fold in resected animals ( P < 0.001). Basal and postprandial GLP-2 levels significantly correlated with the magnitude of intestinal resection ( r2 = 0.71; P < 0.001), CCP ( r2 = 0.48; P < 0.005), and nutrient malabsorption (protein, P < 0.001; fat, P < 0.005). The increase in CCP was maintained to 28 days after small bowel resection and was associated with an ongoing elevation in GLP-2 release. These findings suggest that GLP-2 is important in initiating and maintaining the small intestinal adaptive response to resection.

Humoral growth factor after small intestinal resection in the dog

1982 ◽  
Vol 60 (10) ◽  
pp. 1322-1325 ◽  
Author(s):  
Yves Caussignac ◽  
France David
Keyword(s):  
Monolayer Culture ◽  
Bowel Resection ◽  
Intestinal Adaptation ◽  
Intestinal Resection ◽  
Growth Stimulation ◽  
Small Bowel Resection ◽  
Proximal Small Bowel ◽  
Kidney Fibroblast ◽  
Small Intestinal ◽  
Intestinal Transection

The serum of dogs with a 50% proximal small bowel resection is capable of growth stimulation in small intestinal epithelioid cells in monolayer culture. This overstimulation by postresection serum is not seen when dogs undergo either a small intestinal transection or a simple laparotomy or with baby hamster kidney fibroblast cells in culture. The effect does not seem to be represented by a gastrinlike molecule. This study lends support to the hypothesis that a humoral factor is involved in small intestinal adaptation after partial resection.

scholarly journals Analysis of therapeutic results and complications after colic surgery in 434 horses

2008 ◽  
Vol 53 (No. 1) ◽  
pp. 12-28 ◽  
Author(s):  
J. Mezerova ◽  
Z. Zert ◽  
R. Kabes ◽  
L. Ottova
Keyword(s):  
Small Intestine ◽  
Postoperative Period ◽  
Paralytic Ileus ◽  
Abdominal Cavity ◽  
Adhesion Formation ◽  
Intestinal Resection ◽  
Colon Surgery ◽  
Common Finding ◽  
Intestinal Surgery ◽  
Small Intestinal

Out of the total number of 434 horses that underwent colic surgery, small intestine was operated in 195 (44.9%) patients, caecum in 10 (2.3%) horses, large colon surgery was performed in 196 (45.2%) cases and small colon surgery in 14 (3.2%) horses. In 12 patients (2.8%) two different parts of the gastrointestinal tract were affected simultaneously, one horse suffered from peritonitis, torsion of the uterus developed in two mares and three animals had negative surgical findings. Of 434 horses, 371 (85.5%) survived. After small intestinal surgery, 159 patients (81.5%) recovered from anaesthesia and were discharged home as well as seven horses (70%) after caecal surgery, 175 horses (89.3%) after large colon surgery and 14 horses (100%) following small colon surgery. 75 out of 103 horses (72.8%) were discharged home after the small intestinal resection and 89 of 98 horses (90.8%) with small intestinal problems where no resection was needed. In total, 43 of the patients that underwent one surgery did not survive the immediate postoperative period. The most frequent lethal complications in horses following the small intestinal surgery included peritonitis (five horses) and paralytic ileus (four horses) and in horses with large colon problems it was typhlocolitis (six cases). Relaparotomy was indicated in 41 of 434 horses (9.4%) that recovered from colic surgery. 21 out of the 41 (51.2%) relaparotomised colic patients were released from the clinic. All successfully repeated surgeries were carried out to overcome primary small intestine ileus problems, and in 14 of these cases (66.7%) resection and anastomosis were performed. The most common finding, diagnosed in 9 of 21 reoperated horses, was paralytic ileus. Of 20 relaparotomised horses that did not survive, three animals were lost after the introduction of anaesthesia, nine horses were euthanised after the abdominal cavity revision, one horse did not recover after the surgical procedure and seven horses did not survive the postoperative period. In 15 of 20 dead horses, the cause of the first surgical intervention was small intestinal ileus, in other four horses there was a large colon problem and in the last patient, it was a stomach disease. In 13 of 15 (86.7%) horses with small intestinal problems and in three of four (75%) patients with large colon disease, either resection or bypass was performed. In the remaining four non-surviving horses of 20 relaparotomised ones, peritonitis and/or adhesion formation was diagnosed at the second surgery, in three horses anastomosis complications were the main problem. Peritonitis or paralytic ileus led to death or euthanasia in four of seven horses that recovered after relaparotomy.

CHOICE OF SURGERY TACTICS IN PATIENTS WITH HIGH RISK OF ANASTOMOTIC LEAK DEVELOPMENT

2020 ◽  
pp. 25-28
Author(s):  
M. Ye. Tymchenko
Keyword(s):  
Small Intestine ◽  
Surgical Treatment ◽  
Abdominal Cavity ◽  
Intestinal Resection ◽  
Surgery Complications ◽  
Intestinal Anastomoses ◽  
Post Surgery ◽  
Intestinal Stoma ◽  
Small Intestinal ◽  
Surgical Tactics

Intestinal resection is one of the most common surgeries performed on urgent indications, the most difficult is the decision in favor of the formation of primary anastomosis in the case of primary infection of abdominal cavity, multiple defects of the intestinal wall, as well as the general serious condition of a patient. In order to improve the methods of diagnosis and prevention of post−surgery complications, as well as personification of surgical tactics of treatment in the patients undergoing anastomotic surgeries in intestine, the results of treatment of 96 patients were analyzed. The level of serum cryoglobulins was determined by the method of A. E. Kalovidoris with modifications. The results of surgical treatment were evaluated according to the classification of D. Dindo et al. (2004). The use of cryoglobulin levels before surgery can significantly affect surgical tactics: at a low degree it is possible to perform resection of a segment of small intestine with the formation of primary small intestinal anastomoses; at average − it is possible to perform small−intestinal anastomoses with unloading intestinal stoma or with the location of the anastomosis extraperitoneally (if possible) and decompression of the anastomosis with an incubation probe; at high − it is expedient to supplement performance of an anastomosis with a variant of an enterostomy or "delayed" anastomoses, at a severe general condition of patients it is expedient to form final small intestinal stoma. Determining the level of cryoglobulinemia as a marker of the prognosis of failure of the sutures of intestinal anastomoses and the use of differentiated surgical tactics depending on the level of this index contributes to a significant improvement in direct results of surgical treatment of the patients undergoing resection of small intestine segments. The proposed tactics virtually eliminate the implementation of multi−stage surgical interventions and helps to reduce the duration of treatment of patients, reduce the level of post−surgery complications and mortality. Key words: cryoglobulinemia, surgical treatment, small intestine, anastomoses.

scholarly journals Na+/glucose co-transporter abundance and activity in the small intestine of lambs: enhancement by abomasal infusion of casein

2003 ◽  
Vol 89 (5) ◽  
pp. 573-580 ◽  
Author(s):  
Sameer J. Mabjeesh ◽  
Dafna Guy ◽  
David Sklan
Keyword(s):  
Small Intestine ◽  
Glucose Uptake ◽  
Brush Border ◽  
Brush Border Membrane ◽  
Membrane Vesicles ◽  
Control Group ◽  
Abomasal Infusion ◽  
Group A ◽  
Small Intestinal ◽  
Infusion Period

The purpose of the present study was to determine the effect of abomasal casein infusion on glucose uptake and abundance of the Na+/glucose co-transporter (SGLT1) 1 in the ovine small intestine. Lambs (body weight 35 (SEM 1·0) kg) were surgically fitted with abomasal infusion catheters and were fed diets containing equal portions of wheat hay and cracked maize. Lambs were infused with either 500 g water/d or with 500 g water containing 35 g casein/d. The infusion period lasted 10 d, after which lambs were killed, exsanguinated and eviscerated. Brush border membrane vesicles (BBMV) were prepared using mucosa from different small intestinal regions. Intake and total tract digestibility of nutrients were similar between treatments and averaged 1134, 1142 and 486 g/d and 67, 70, and 94 % for DM, organic matter and non-structural carbohydrates respectively. Crude protein (N×6·25) digestibility was 15 % greater in the casein-infused than control lambs. Glucose uptake to BBMV ranged from 101 to 337 pmol/mg protein per s along the small intestine and was greatest in the mid-section of the small intestine. In the mid-jejunum, glucose uptake was greater (P<0·07) in lambs infused with casein and averaged 120 pmol/mg protein per s compared with 68 pmol/mg protein per s in the control group. SGLT1 affinity was similar between treatments and averaged 104 μM in the different segments of the small intestine of lambs. However, lambs infused with casein exhibited similar values along the small intestine and affinity averaged 106 μm, while in the control group a greater affinity (85 μm) was measured in the mid-jejunum. SGLT1 protein abundance was correlated with glucose uptake in the BBMV in the casein-treated lambs, but not in the control group. These results suggest that glucose uptake along the small intestine of lambs is influenced by casein or its derivatives in the small intestine via SGLT1 affinity and activity at the brush border membrane, and that SGLT1 activity may be regulated by post-translational events affected by amino acids and peptides.

Analysis of cloned cDNAs differentially expressed in adapting remnant small intestine after partial resection

1996 ◽  
Vol 271 (2) ◽  
pp. G347-G356 ◽  
Author(s):  
B. D. Dodson ◽  
J. L. Wang ◽  
E. A. Swietlicki ◽  
D. C. Rubin ◽  
M. S. Levin
Keyword(s):  
Small Intestine ◽  
Adaptive Response ◽  
Binding Protein ◽  
Intestinal Adaptation ◽  
Intestinal Resection ◽  
Partial Resection ◽  
Differentially Expressed ◽  
Cdna Clones ◽  
Regional Patterns ◽  
Fatty Acid Binding

After partial resection, the remnant small intestine undergoes an adaptive response. Little is known about the molecular and cellular basis of intestinal adaptation. To identify genes transcriptionally regulated in response to loss of functional bowel surface area, we have isolated cDNAs differentially expressed in the adaptive ileum 48 h after 70% proximal small intestinal resection. A cDNA library constructed from the remnant ileum of rats subjected to resection was screened using subtractive hybridization techniques. Several groups of cDNA clones that were induced during intestinal adaptation were isolated. The first included liver fatty acid binding protein, apolipoprotein A-IV, cellular retinol binding protein II, and ileal lipid binding protein. These all encode proteins involved in the absorption, metabolism, and trafficking of nutrients. A second group included the catalytic subunit of protein phosphatase 1 delta, a 78-kDa glucose-regulated protein (grp 78; a glucose-regulated member of the 70-kDa heat-shock protein family), and several pancreatitis-associated proteins. A third group of induced genes contained novel cDNAs. To better characterize the adaptive response, the temporal, spatial, and cellular patterns of expression of several of these genes were analyzed with the use of immunohistochemical and in situ hybridization techniques. These studies indicate that during early adaptation, genes involved in nutrient trafficking, protein processing, and cell cycle regulation are transcriptionally regulated in the residual small intestine in distinct temporal and regional patterns consistent with a complex multifaceted response to intestinal resection.

scholarly journals MORPHOLOGICAL CHANGES OF THE SMALL INTESTINE IN ACUTE STRANGULATIVE INTESTINAL OBSTRUCTION IN THE STAGE OF DECOMPOSITION IN CHILDREN

2018 ◽  
Vol 8 (3) ◽  
pp. 28-33 ◽  
Author(s):  
A. E. Solovev ◽  
I. V. Vasin ◽  
O. А. Kul’chitskij
Keyword(s):  
Small Intestine ◽  
Intestinal Obstruction ◽  
Morphological Changes ◽  
Intestinal Resection ◽  
Intestinal Wall ◽  
Intestinal Necrosis ◽  
Morphological Studies ◽  
Intestinal Strangulation ◽  
Small Intestinal ◽  
Adhesive Obstruction

Purpose. The purpose was to determine the depth and prevalence of pathomorphological changes in the small intestine of children at the distance from the visible border of necrosis with decompensated acute strangulated intestinal obstruction (ASIO) to determine the minimum possible length of intestinal resection.Material and methods. Morphological studies of a resected fragment of the small intestine were performed in 24 children aged 3 days to 18 years who had undergone a surgery for ASIO with intestinal necrosis. Strangulated adhesive obstruction was found in 17 children, five children had congenital intestine torsion and two children faced small intestinal strangulation in the congenital mesenteric defect. The postsurgical material was studied morphologically using histological stains with the distance of 3 cm between the section.Results. The depth, prevalence of the morphological changes in the small intestinal wall, intensity and length of morphological changes in children with decompensated ASIO were determined.Conclusion. A differentiated approach to the selection of resection scope in the proximal and distal directions from the visible border of ASIO-related necrosis is necessary. The distances are twice shorter in children as compared to adults. Refusal from extensive resections will enable to reduce the rate of short bowel syndrome in children.

scholarly journals Small Intestine Ultrasound Findings on Horses Following Exploratory Laparotomy, Can We Predict Postoperative Reflux?

Animals ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. 1106
Author(s):  
Gabriel Cuevas-Ramos ◽  
Lara Domenech ◽  
Marta Prades
Keyword(s):  
Small Intestine ◽  
Postoperative Period ◽  
Intestinal Resection ◽  
Exploratory Laparotomy ◽  
Abdominal Ultrasound ◽  
Control Group ◽  
Postoperative Reflux ◽  
Intestinal Pathology ◽  
Ultrasound Findings ◽  
Small Intestinal

Postoperative reflux (POR) is a well-recognized complication after colic surgery in horses, particularly when presenting small intestinal pathology. Even though much has been written about the pathophysiology and management of POR, additional clinical studies are needed to better understand and anticipate this complication. The aim of the study was to provide clinical evidence of ultrasound findings in the postoperative period (three days). The study is based on transcutaneous abdominal ultrasounds of the caudoventral abdomen during the postoperative period (three days), in 58 horses, presented for an exploratory laparotomy, and compared to 20 horses that underwent general anesthesia for an elective surgical procedure. Small intestine (SI) images and videos were analyzed for loop number, loop diameter, wall thickness, motility, and echogenic type of loop contents. Ultrasound findings of horses that had a large colon pathology were similar to those of the control group. Interestingly, horses that presented an SI pathology had significantly thicker SI walls, increased loop diameter, slower motility, and hypoechoic contents, particularly in horses that had undergone small intestinal resection and anastomosis. Although the number of horses that developed POR in our study was too small for statistical analysis, they all had the aforementioned ultrasonographic changes. Abdominal ultrasound, during the postoperative period (three days), was a useful method to identify horses with abnormal small intestinal parameters. Further investigation as to whether these parameters can be used to predict POR in a larger population is warranted.

Intestinal adaptation during lactation in the mouse. II. Altered intestinal processing of a dietary protein

1993 ◽  
Vol 264 (6) ◽  
pp. G1126-G1132
Author(s):  
P. R. Harmatz ◽  
P. W. Carrington ◽  
V. Giovino-Barry ◽  
R. A. Hatz ◽  
K. J. Bloch
Keyword(s):  
Small Intestine ◽  
Surface Area ◽  
Dietary Protein ◽  
Intestinal Adaptation ◽  
Intestinal Morphology ◽  
Prolonged Contact ◽  
Intestinal Segments ◽  
Wet Weight ◽  
Small Intestinal ◽  
And Control

We previously demonstrated in lactating mice a six- to eightfold increase in the intestinal uptake of the dietary protein, ovalbumin (OVA), administered by gavage. In this study, we tested the possibility that alterations in intestinal morphology, transit time, reduced luminal proteolysis, and enhanced association with the intestinal surface might account for the increased uptake of the protein observed in lactating mice. We found that these animals had a significant increase in length, wet weight, and surface area of the small intestine. No change in the number of Peyer's patches was noted. Intestinal transit was assessed by gavage administration of 125I-OVA and 10 mg OVA and localization of the peak of radioactivity 15, 30, and 60 min after feeding. Although motility (distance traveled per unit time) was not different in lactating and control mice at 15 and 30 min, the fraction of the small intestine traversed by the peak of radioactivity was less in lactating mice. Digestion of 125I-OVA administered by gavage with 10 mg unlabeled OVA was examined by trichloroacetic acid precipitation and gel permeation of the resulting fragments. Lactating and control mice did not show differences in digestion of 125I-OVA by either measurement. The association of 125I-OVA with small intestinal segments, however, was enhanced in lactating mice, especially in the second and third segments of the small intestine. Thus several factors including an increase in length and surface area of the small intestine, prolonged contact of protein with the small intestinal absorptive surface, and enhanced association of the protein with the intestinal surface contribute to increased uptake.(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals Laparoscopic-assisted disinvagination and polypectomy for multiple intussusceptions induced by small intestinal polyps in patients with Peutz-Jeghers syndrome: a case report

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Masaaki Yamamoto ◽  
Kazuya Iwamoto ◽  
Rei Suzuki ◽  
Yosuke Mukai ◽  
Tomohira Takeoka ◽  
...  
Keyword(s):  
Small Intestine ◽  
Genetic Disorder ◽  
Vena Cava ◽  
Intestinal Resection ◽  
Hamartomatous Polyps ◽  
Intestinal Polyps ◽  
Small Intestinal ◽  
Peutz Jeghers Syndrome ◽  
Hands And Feet ◽  
Laparoscopic Assisted

Abstract Background Peutz–Jeghers syndrome (PJS) is a very rare autosomal dominant genetic disorder characterized by hamartomatous polyps in the gastrointestinal tract and hyperpigmentation of the lips, hands, and feet. The hamartomatous polyps in the small intestine often cause intussusception and bleeding. Case presentation A 62-year-old male was hospitalized for treatment of deep vein thrombosis and pulmonary embolism. In the small intestine, computed tomography showed three small polyps with intussusceptions. Since the patient had gastrointestinal polyposis and pigmentation of his lips, fingers, and toes, he was diagnosed with PJS. After an inferior vena cava filter was placed, he underwent laparoscopic-assisted surgery. The polyps causing intussusception were resected as far as possible without intestinal resection, since they had caused progressive anemia and might cause intestinal obstruction in the future. The patient was discharged from the hospital on postoperative day 9 without complications. Conclusions Laparoscopic-assisted disinvagination and polypectomy is a useful, minimally invasive treatment for multiple intussusceptions caused by small intestinal polyps in patients with PJS.

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