「基礎醫學-生理學」消化系統

食道 

食道位於頸部和胸部,為一肌肉管,內襯為複層鱗狀上皮 

腹膜

包裹著腹腔內的器官,處於腹腔的中央。腹膜反摺構成肝鐮韌帶、小網膜及腸繫膜,肝圓韌帶是肝鐮狀韌帶邊緣部分的退化組織,非腹膜反摺構成。

腹膜內器官

器官表面均被腹膜包覆,一般器官活動性較大:胃、十二指腸上部、空腸、回腸、盲腸、闌尾、橫結腸、乙狀結腸、脾、卵巢、輸卵管

腹膜間器官

器官表面大部分被腹膜覆蓋的器官:肝膽、升降結腸、直腸上部、膀胱、子宮

腹膜後器官

僅有一面被腹膜覆蓋的器官:十二指腸升結腸、降結腸、直腸下 1/3位於腹膜後、腎上腺、腎、胰臟(解剖位置位於腹上區,位於後腹腔,有內分泌和外分泌的功能;內分泌主要分泌胰島素(insulin)、升糖素(glucagon)、體抑素(somatostatin);外分泌主要是分泌消化液消化蛋白質、脂肪和澱粉

腹部的各部位解剖位置:
109年第二次護理師高等考試基礎醫學考題:左季肋區器官應受傷而大量出血,最可能受傷的器官為脾臟(脾臟解剖位置位於左季肋區,是身體內部最大的淋巴組織,負責製造抗體及各種免疫功能。

胃 

位於上腹部,較靠近胸腔,處於膈膜下,稍微偏左,賁門部和食道相接,幽門部和十二指腸相接。 

胃壁的肌肉層依其走向由內而外可分為三層:內斜層、中環層和外縱層。
The muscular layer of the stomach can be divided into three layers from the inside out according to its direction: the inner oblique layer, the middle circular layer, and the outer longitudinal layer.
「內斜中環外縱」
內斜層:位於胃壁的最內層,呈斜行走向,主要功能是幫助胃的收縮和蠕動。
The inner oblique layer is located in the innermost layer of the stomach, with a slanting direction. Its main function is to help the stomach contract and move.
中環層:位於胃壁的中間層,呈環行走向,主要功能是幫助胃的收縮和蠕動。
The middle circular layer is located in the middle layer of the stomach, with a circular direction. Its main function is to help the stomach contract and move.
外縱層:位於胃壁的最外層,呈縱行走向,主要功能是幫助胃的排空。
The outer longitudinal layer is located in the outermost layer of the stomach, with a longitudinal direction. Its main function is to help the stomach empty.

胃的黏膜層位於胃的內壁,為單層柱狀上皮,分泌胃酸、胃蛋白酶和胃黏液。胃酸幫助消化食物和殺死細菌,胃蛋白酶有助於蛋白質的消化,胃黏液則有保護胃壁免受胃酸腐蝕的作用。

胃腺細胞中,黏液頸細胞的分泌物質和大腸杯狀細胞的相似,都是分泌黏液

腸道壁

位於腹腔內,包圍著消化道的組織。
 

十二指腸 

連接在胃的下方,黏膜為單層柱狀上皮,
布氏腺(Brunner's glands)位於十二指腸的黏膜下層,特別是十二指腸附近的第一部分,也就是十二指腸球部。主要分泌鹼性黏液,有保護黏膜層的作用,同時有助於中和來自胃的酸性胃液,以保護腸道免受酸性刺激。

小腸

微粒(micelle)

是一種由脂肪分子、膽鹽和水分組成的球形結構。它們在消化系統中的主要功能是促進脂肪消化和吸收,也可增加脂肪在小腸中的停留時間,從而提高脂肪的消化和吸收效率。
Micelles are spherical structures composed of fatty acids, bile salts, and water. Their main function in the digestive system is to promote the digestion and absorption of fats, and they can also increase the residence time of fats in the small intestine, thereby improving the efficiency of fat digestion and absorption.

脂肪是一種不溶於水的物質,因此很難被人體吸收。微粒可以將脂肪分子包裹起來,使它們變得水溶性,從而更容易被小腸中的絨毛細胞吸收。
Fats are insoluble in water, making them difficult for the body to absorb. Micelles can encapsulate fatty acids, making them water-soluble and easier for villus cells in the small intestine to absorb.

微粒的形成需要膽鹽的幫助。膽鹽是一種由肝臟分泌的物質,它可以降低脂肪表面張力,使脂肪分子聚集在一起。
The formation of micelles requires the help of bile salts. Bile salts are substances secreted by the liver that can lower the surface tension of fats, causing fatty acids to aggregate.

微粒的形成過程如下:
The process of micelle formation is as follows:

膽鹽在小腸中與脂肪分子結合,形成脂肪-膽鹽複合物。
Bile salts bind to fatty acids in the small intestine to form a fat-bile salt complex.
脂肪-膽鹽複合物在小腸中的攪拌作用下,形成微粒。
The fat-bile salt complex forms micelles under the stirring action of the small intestine.
微粒在小腸中的絨毛細胞表面被吸收。
Micelles are absorbed at the surface of villus cells in the small intestine.
微粒的形成對人體脂肪的消化和吸收至關重要。如果缺乏膽鹽,就會導致脂肪消化不良,出現腹瀉、便秘等症狀。
The formation of micelles is essential for the digestion and absorption of fats in the human body. If bile salts are lacking, it can lead to fat malabsorption, resulting in diarrhea, constipation, and other symptoms.

迴腸

位於小腸的後半部,從十二指腸的一部分到結腸之前,處於腹腔中央。
迴腸主要負責吸收食物中的養分,如蛋白質、碳水化合物、脂肪等,將其進行分解並進入血液循環。

降結腸 

位於腹腔內,黏膜為單層柱狀上皮,由左上部往下彎曲至左下部,是結腸的一部分。

分化差(poorly-differentiated)表示腫瘤細胞的外觀和結構與正常結腸細胞差異較大(腫瘤細胞與正常細胞形態相似度較低),通常是指腫瘤細胞的分化程度較低,細胞形狀和結構變得不規則,並且失去了正常結腸細胞的特徵。
Poorly-differentiated tumors are characterized by cells that have a significantly different appearance and structure from normal colon cells. This means that the tumor cells are less similar to normal colon cells in terms of their shape, size, and organization. In addition, poorly-differentiated tumors may have lost some of the features that are characteristic of normal colon cells.

胰臟

位於腹腔內,靠近胃的後方,橫跨於脊椎前面,連接著脾臟。主要分泌胰液,其中包含消化酵素,這些酵素能夠幫助分解蛋白質、碳水化合物和脂肪,以利於營養物質的吸收和利用。同时胰臟也分泌胰島素等荷爾蒙,調節血糖水平。

腸泌素對胰島素的分泌屬於前饋(feedforward)調節。

前饋(feedforward)調節:
前饋調節是一種生理調節機制,它在刺激或事件發生之前,透過神經或荷爾蒙信號調節相關生理過程。這種調節機制預先準備身體以應對未來的需求。

在腸泌素對胰島素分泌的情境中,前饋調節指的是腸道中的特定刺激(例如食物進入消化道)觸發腸泌素的釋放,進而通過神經或荷爾蒙信號影響胰島素的分泌,以調節血糖水平。

正回饋(positive feedback):
正回饋是一種機制,其中一個變化導致另一個變化,這些變化相互增強,使系統更加遠離原始的平衡狀態。正回饋通常不常見於生理調節,因為它可以導致系統失控。

負回饋(negative feedback):
負回饋是最常見的調節機制,它在變化發生時將系統帶回原始的平衡狀態。當某一指標遠離理想值時,負回饋會啟動調節機制,將系統調整回到平衡狀態。這樣的例子包括體溫、血糖、血壓等的調節。

反射:
反射是一種自動且無意識的生理或神經反應,通常涉及感覺器官的刺激和神經系統的傳遞。這些反射通常是瞬間的,例如當手碰到熱物體時,會迅速收回手來。

腎臟

貝他 2-小球蛋白(beta2-microglobulin): 這是一種存在於幾乎所有細胞表面的蛋白質(一種與細胞表面受體結合的蛋白質),通常與MHC-I複合體(主要組織相容性複合體 I)相關。它與免疫系統的細胞激素反應有關,並且也與腎功能有關,因此在一些腎臟疾病時可能會升高,可用來評估腎功能。

肝臟與膽囊 

位於上腹部,腹膜下,較靠近膈膜,偏右。肝臟製造膽汁由膽囊儲存其濃縮後注入十二指腸,膽汁功能是乳化脂質。

血清類澱粉 A 蛋白質(serum amyloid A protein): 這是一種在肝臟中合成的蛋白質,如果身體內有細菌感染、發炎或組織損傷時會增加,主要參與免疫反應,來調節免疫細胞的活動。

前白蛋白(transthyreitin/prealbumin): 這是一種在肝臟合成的蛋白質,是一種在血漿中運輸甲狀腺激素和維生素A的蛋白質。它也被用作衡量蛋白質營養狀態的指標,因為其血清濃度可能在營養不良或發炎時下降。

總膽管The Common Bile Duct

總膽管是由總肝管與膽囊管會合而成的管路,長約10-12公分,位於十二指腸後方。總膽管的主要作用是將膽汁從肝臟和膽囊傳遞到小腸。
總膽管是由總肝管(Common Hepatic Duct)與膽囊管(Cystic Duct)會合形成的,是肝臟和膽囊分泌的膽汁匯流而成的管路,連接膽囊與胰臟,位於腹腔中央。
The common bile duct is a duct that is formed by the confluence of the common hepatic duct and the cystic duct. It is about 10-12 centimeters long and is located posterior to the duodenum. The main function of the common bile duct is to transport bile from the liver and gallbladder to the small intestine.

總肝管The Common Hepatic Duct

總肝管是肝臟內部膽管系統的一部分,將肝臟內產生的膽汁收集起來,並將其送往總膽管。總肝管的主要作用是運輸肝臟產生的膽汁,其中包含有助於消化的脂肪分解酵素、膽酸和膽固醇等成分。
The common hepatic duct is a part of the intrahepatic biliary system that collects bile produced in the liver and sends it to the common bile duct. The main function of the common hepatic duct is to transport bile produced by the liver, which contains components that aid in digestion, such as fat-digesting enzymes, bile acids, and cholesterol.

膽囊管The Cystic Duct

膽囊管是連接膽囊和總膽管的管道,其主要作用是將膽囊內積存的濃縮膽汁輸送至總膽管。有助於膽汁的運輸、儲存和釋放,以維持消化系統的正常功能
The cystic duct is a duct that connects the gallbladder to the common bile duct. Its main function is to transport concentrated bile stored in the gallbladder to the common bile duct. It helps in the transport, storage, and release of bile to maintain the normal function of the digestive system.

肝胰壺腹The Ampulla of Vater

肝胰壺腹是由總膽管與主胰管會合而形成,位於十二指腸第二段的末端。肝胰壺腹的括約肌可以控制膽汁和胰液的流入十二指腸。
The ampulla of Vater is formed by the union of the common bile duct and the main pancreatic duct. It is located at the distal end of the second segment of the duodenum. The sphincter of Oddi, located within the ampulla of Vater, controls the flow of bile and pancreatic juice into the duodenum.

膽汁的運輸和分泌Transport and Secretion of Bile

膽汁是由肝臟產生的,在膽囊中儲存和濃縮。當食物進入十二指腸時,膽汁會從膽囊排出,通過總膽管和肝胰壺腹流入十二指腸,幫助消化脂肪。
Bile is produced by the liver and stored and concentrated in the gallbladder. When food enters the duodenum, bile is released from the gallbladder and flows into the duodenum through the common bile duct and the ampulla of Vater to aid in the digestion of fats.

總膽管、膽囊管、總肝管與肝胰壺腹是膽道系統的重要組成部分,負責將膽汁從肝臟和膽囊輸送到十二指腸,幫助消化脂肪。
The common bile duct, cystic duct, common hepatic duct, and ampulla of Vater are important components of the biliary system, responsible for transporting bile from the liver and gallbladder to the small intestine to aid in fat digestion.

上皮細胞

腸道的上皮細胞源自胚胎發育過程中的外胚層。在消化系統中,腸道上皮細胞構成了腸道的內膜,它們在吸收營養物質、水分和電解質方面扮演著重要角色。因此,大部分腸道腫瘤,包括結腸癌、直腸癌等,通常是源自腸道的上皮細胞,腺癌是起源於腺上皮細胞的惡性腫瘤也稱為腺癌(adenocarcinoma)。
Epithelial cells of the intestine originate from the ectoderm in the embryonic development process. In the digestive system, epithelial cells of the intestine form the inner lining of the intestine, and they play an important role in the absorption of nutrients, water, and electrolytes. Therefore, most intestinal tumors, including colorectal cancer, are usually derived from epithelial cells of the intestine. Adenocarcinoma is a malignant tumor that originates from glandular epithelial cells, also known as adenocarcinoma.

消化道的梅氏神經叢(Meissner's plexus)

位於腸道壁黏膜下層,是自主神經的一部分,可. 控制消化道之分泌。
體制素(somatostatin)又稱生長素抑制因子,於消化道胃和十二指腸分泌。

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