1. © 2003 Science Press Internet Services FISIOLOGIA DIGESTIVA (BCM II) Clase 10: Fisiología del colon Dr. Michel Baró A.

2. © 2003 Science Press Internet Services The anatomy of the colon is shown

3. © 2003 Science Press Internet Services Circular and longitudinal muscle layers in colon

4. © 2003 Science Press Internet Services The layers of the colonic wall are shown

5. © 2003 Science Press Internet Services Normal colonic mucosa in biopsy specimen

6. © 2003 Science Press Internet Services Maturation process of colonic epithelial cells (3 a 5 días)

7. © 2003 Science Press Internet Services A human rectal columnar epithelial cell

8. © 2003 Science Press Internet Services Arterial blood supply to the colon is shown

9. © 2003 Science Press Internet Services The venous system that drains the colon is shown

10. © 2003 Science Press Internet Services The extrinsic innervation of the colon

11. © 2003 Science Press Internet Services Intrinsic innervation of the colonic wall

12. © 2003 Science Press Internet Services Ganglia in submucosal and myenteric plexuses

13. © 2003 Science Press Internet Services Lymph nodal drainage of the colon and anus (a)

14. © 2003 Science Press Internet Services Lymph nodal drainage of the colon and anus (b)

15. © 2003 Science Press Internet Services Scintigraphic pattern of colonic transit

16. © 2003 Science Press Internet Services Time a substance spends in each region of colon

17. © 2003 Science Press Internet Services Distinct motor patterns as measured by manometry Contracciones de corta duración: estacionarias, de mezcla Contracciones de larga duración: estacionarias o migratorias breves Contracciones de gran amplitud: movimientos de masa

18. © 2003 Science Press Internet Services Patterns of migration of contractions

19. © 2003 Science Press Internet Services Presence and intensity of short-duration contractions

20. © 2003 Science Press Internet Services Colonic electrical control or slow-wave activity Borde submucoso Borde mientérico

21. © 2003 Science Press Internet Services Electrical activity from the human colon SSB: Short spike burst. LSB: Long spike burst. MLSB: Migrating long spike burst

22. © 2003 Science Press Internet Services Patterns of motor and myoelectric activity (perros)

23. © 2003 Science Press Internet Services Development of high-amplitude propagating contractions

24. © 2003 Science Press Internet Services Colonic contents and motor activity in colon

25. © 2003 Science Press Internet Services Motility of colon over 24-hour period Colonic motility index

26. © 2003 Science Press Internet Services Gastrocolonic motor response to meal ingestion

27. © 2003 Science Press Internet Services Fecal bolus in the colon has been postulated

28. © 2003 Science Press Internet Services Mediation of both limbs of colonic peristaltic reflex

29. © 2003 Science Press Internet Services Motor activity of colon modulated by vagal activity (ferret) Actividad fásica espontánea del colon proximal

30. © 2003 Science Press Internet Services Colonic motor function can be significantly altered Am J Med 1951

31. © 2003 Science Press Internet Services Summary of small intestinal and colonic fluid balance

32. © 2003 Science Press Internet Services Major electrolyte transport mechanisms

33. © 2003 Science Press Internet Services Proposed pathways of active sodium transport in colon (a)

34. © 2003 Science Press Internet Services Proposed pathways of active sodium transport in colon (b)

35. © 2003 Science Press Internet Services The colon exhibits a net secretion of potassium

36. © 2003 Science Press Internet Services Sodium absorption and potassium secretion

37. © 2003 Science Press Internet Services The colonic lumen possesses a luxuriant flora

38. © 2003 Science Press Internet Services Fecal flora organisms

39. © 2003 Science Press Internet Services The anatomy of the rectum and anus

40. © 2003 Science Press Internet Services The muscular arrangement of the levator ani muscles

41. © 2003 Science Press Internet Services The histology of the rectal and anal mucosae

42. © 2003 Science Press Internet Services The arterial blood supply specific for the anus

43. © 2003 Science Press Internet Services Factors necessary for maintenance of fecal continence

44. © 2003 Science Press Internet Services The pressure profile of the anal canal

45. © 2003 Science Press Internet Services Triple loop mechanism of external anal sphincter

46. © 2003 Science Press Internet Services Epithelial nerve endings provide a specialized system

47. © 2003 Science Press Internet Services Fecal continence aided by highly compliant rectum (a)

48. © 2003 Science Press Internet Services Fecal continence aided by highly compliant rectum (b)

49. © 2003 Science Press Internet Services The reflex responsiveness of the anal region Reflejo inhibitorio rectoanal

50. © 2003 Science Press Internet Services Defecation involves a coordinated interaction

51. © 2003 Science Press Internet Services Summary of muscular actions required for defecation

52. © 2003 Science Press Internet Services Manometric and electromyographic responses to defecation

53. © 2003 Science Press Internet Services Alteraciones motoras del colon

54. © 2003 Science Press Internet Services Sagittal view of anorectal anatomy

55. © 2003 Science Press Internet Services Incontinencia fecal

56. © 2003 Science Press Internet Services Anorectal continence mechanisms

57. © 2003 Science Press Internet Services Diagnostic studies for fecal incontinence

58. © 2003 Science Press Internet Services Diagnostic studies for fecal incontinence

59. © 2003 Science Press Internet Services Anorectal function in neurogenic disorders

60. © 2003 Science Press Internet Services Fecal incontinence associated with spinal cord injury

61. © 2003 Science Press Internet Services Anorectal findings in spinal cord injuries

62. © 2003 Science Press Internet Services Fecal incontinence associated with pudendal neuropathy (A)

63. © 2003 Science Press Internet Services Fecal incontinence associated with pudendal neuropathy (B)

64. © 2003 Science Press Internet Services Fecal incontinence associated with pudendal neuropathy (C)

65. © 2003 Science Press Internet Services Fecal incontinence associated with pudendal neuropathy (D)

66. © 2003 Science Press Internet Services External sphincter electromyographic patterns (A)

67. © 2003 Science Press Internet Services External sphincter electromyographic patterns (B)

68. © 2003 Science Press Internet Services External sphincter electromyographic patterns (C)

69. © 2003 Science Press Internet Services Pudendal nerve latencies

70. © 2003 Science Press Internet Services Anal endosonography

71. © 2003 Science Press Internet Services Normal anatomy as viewed by anal endosonography (A)

72. © 2003 Science Press Internet Services Normal anatomy as viewed by anal endosonography (B) Esfinterotomía (interno)

73. © 2003 Science Press Internet Services Normal anatomy as viewed by anal endosonography (C) Desgarro obstétrico

74. © 2003 Science Press Internet Services Anorectal manometry in fecal incontinence (A)

75. © 2003 Science Press Internet Services Anorectal manometry in fecal incontinence (B) normal

76. © 2003 Science Press Internet Services Biofeedback (A)

77. © 2003 Science Press Internet Services Biofeedback (B)

78. © 2003 Science Press Internet Services Constipación

79. © 2003 Science Press Internet Services Colonic scintigraphy (A)

80. © 2003 Science Press Internet Services Colonic scintigraphy (B)

81. © 2003 Science Press Internet Services Colonic transit of markers

82. © 2003 Science Press Internet Services Colonic transit patters in chronic constipation (A)

83. © 2003 Science Press Internet Services Colonic transit patters in chronic constipation (B)

84. © 2003 Science Press Internet Services Colonic motor activity can be studied (A)

85. © 2003 Science Press Internet Services Colonic motor activity can be studied (B)

86. © 2003 Science Press Internet Services Propagating contractions in healthy control subjects vs constipated

87. © 2003 Science Press Internet Services Colonic motility within 30 mins after breakfast

88. © 2003 Science Press Internet Services Distal bowel in Hirschsprung's disease (A)

89. © 2003 Science Press Internet Services Distal bowel in Hirschsprung's disease (B)

90. © 2003 Science Press Internet Services Balloon manometry

91. © 2003 Science Press Internet Services Idiopathic megacolon

92. © 2003 Science Press Internet Services Rectal compliance in idiopathic megarectum

93. © 2003 Science Press Internet Services Using the Schuster-type balloon manometer y puborectal

94. © 2003 Science Press Internet Services Pressure changes and electromyographic recordings

95. © 2003 Science Press Internet Services Rectocele (A)

96. © 2003 Science Press Internet Services Rectocele (B)

97. © 2003 Science Press Internet Services Subtotal colectomy with ileorectal anastomosis

98. © 2003 Science Press Internet Services Diagnostic or Rome criteria

99. © 2003 Science Press Internet Services Barium enema in irritable bowel syndrome patient

100. © 2003 Science Press Internet Services Emotions and colon motility

101. © 2003 Science Press Internet Services Emotions and colonic motility (A) Delay stressor motor EMG Pneumograma

102. © 2003 Science Press Internet Services Emotions and colonic motility (B)

103. © 2003 Science Press Internet Services Emotions and colonic motility (C)

104. © 2003 Science Press Internet Services Visceral sensations

105. © 2003 Science Press Internet Services A 73-year-old woman with constipation

106. © 2003 Science Press Internet Services Fin