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32-399: The episode opens in a poker game. When it is interrupted by incoming wounded, Hawkeye and Margaret operate on a patient and Hawkeye insults Frank. However, Hawkeye's patient fails to improve after surgery. Hawkeye becomes overly concerned with the case, to the point of attacking Frank over comments at lunch, sleeping in post-op, snapping at Trapper for playing poker too loudly, and moving out of

64-413: A portion of the bowel twists around its mesentery, which can lead to obstruction and infarction . Volvulus in the elderly commonly occurs in the sigmoid colon, whereas in infants and children it is more likely to occur in the midgut. This may correct itself spontaneously or the rotation may continue until the blood supply of the gut is cut off completely. [REDACTED] This article incorporates text in

96-483: A sincere "Thanks, Frank." This episode features an alternate, jazzier arrangement of the opening theme music. Trapper makes a pun during the poker game comparing a "pair of twos" with paregoric . B movies referred to are Love Life of a Gorilla (1940), Bride of the Gorilla (1951), Bedtime for Bonzo (1951) and Bonzo Goes to College (1952). Sigmoid colon The sigmoid colon (or pelvic colon )

128-448: Is a complex organ, and as such, there are a very large number of possible conditions that may affect the function of the small bowel. A few of them are listed below, some of which are common, with up to 10% of people being affected at some time in their lives, while others are vanishingly rare. The small intestine is found in all tetrapods and also in teleosts , although its form and length vary enormously between species. In teleosts, it

160-424: Is about 5.5 metres (18 feet) long and folds many times to fit in the abdomen. Although it is longer than the large intestine, it is called the small intestine because it is narrower in diameter. The small intestine has three distinct regions – the duodenum , jejunum , and ileum . The duodenum, the shortest, is where preparation for absorption through small finger-like protrusions called villi begins. The jejunum

192-439: Is relatively short, typically around one and a half times the length of the fish's body. It commonly has a number of pyloric caeca , small pouch-like structures along its length that help to increase the overall surface area of the organ for digesting food. There is no ileocaecal valve in teleosts, with the boundary between the small intestine and the rectum being marked only by the end of the digestive epithelium. In tetrapods,

224-480: Is specialized for the absorption through its lining by enterocytes : small nutrient particles which have been previously digested by enzymes in the duodenum. The main function of the ileum is to absorb vitamin B 12 , bile salts , and whatever products of digestion that were not absorbed by the jejunum. The length of the small intestine can vary greatly, from as short as 3 metres (10 feet) to as long as 10.5 m ( 34 + 1 ⁄ 2  ft), also depending on

256-449: Is the part of the large intestine that is closest to the rectum and anus . It forms a loop that averages about 35–40 centimetres (14–16 in) in length. The loop is typically shaped like a Greek letter sigma (ς) or Latin letter S (thus sigma + -oid ). This part of the colon normally lies within the pelvis , but due to its freedom of movement it is liable to be displaced into the abdominal cavity . The sigmoid colon begins at

288-409: The abdominal cavity by mesentery . The mesentery is part of the peritoneum . Arteries, veins, lymph vessels and nerves travel within the mesentery. The small intestine receives a blood supply from the celiac trunk and the superior mesenteric artery . These are both branches of the aorta . The duodenum receives blood from the coeliac trunk via the superior pancreaticoduodenal artery and from

320-483: The ileocaecal valve is always present, opening into the colon. The length of the small intestine is typically longer in tetrapods than in teleosts, but is especially so in herbivores , as well as in mammals and birds , which have a higher metabolic rate than amphibians or reptiles . The lining of the small intestine includes microscopic folds to increase its surface area in all vertebrates, but only in mammals do these develop into true villi. The boundaries between

352-440: The midgut of the primitive gut tube . By the fifth week of embryological life, the ileum begins to grow longer at a very fast rate, forming a U-shaped fold called the primary intestinal loop . The loop grows so fast in length that it outgrows the abdomen and protrudes through the umbilicus . By week 10, the loop retracts back into the abdomen. Between weeks six and ten the small intestine rotates anticlockwise, as viewed from

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384-426: The pancreas and liver and enter the small intestine via the pancreatic duct . Pancreatic enzymes and bile from the gallbladder enter the small intestine in response to the hormone cholecystokinin , which is produced in the response to the presence of nutrients. Secretin , another hormone produced in the small intestine, causes additional effects on the pancreas, where it promotes the release of bicarbonate into

416-442: The public domain from page 1182 of the 20th edition of Gray's Anatomy (1918) Small intestine The small intestine or small bowel is an organ in the gastrointestinal tract where most of the absorption of nutrients from food takes place. It lies between the stomach and large intestine , and receives bile and pancreatic juice through the pancreatic duct to aid in digestion . The small intestine

448-417: The superior aperture of the lesser pelvis , where it is continuous with the iliac colon , and passes transversely across the front of the sacrum to the right side of the pelvis. It then curves on itself and turns toward the left to reach the middle line at the level of the third piece of the sacrum , where it bends downward and ends in the rectum . Its function is to expel solid and gaseous waste from

480-502: The Swamp to the supply tent. While Hawkeye retreats to the supply tent to reflect on the case, he is interrupted by his date (whom he turns away), Trapper (whom he turns away as well), two other soldiers, and Henry. Henry implies that Hawkeye is concerned more about his ego than about his patient. Hawkeye replies with a glib remark about Henry's intelligence, which ultimately insults Henry and allows Hawkeye some peace and quiet. While pondering

512-440: The arcades closest to the ileum and jejunum to the organs themselves. The three sections of the small intestine look similar to each other at a microscopic level, but there are some important differences. The parts of the intestine are as follows: About 20,000 protein coding genes are expressed in human cells and 70% of these genes are expressed in the normal duodenum. Some 300 of these genes are more specifically expressed in

544-461: The blood vessels to different organs of the body where they are used to build complex substances such as the proteins required by our body. The material that remains undigested and unabsorbed passes into the large intestine. Absorption of the majority of nutrients takes place in the jejunum , with the following notable exceptions: The small intestine supports the body's immune system . The presence of gut flora appears to contribute positively to

576-408: The case outside the supply tent, Hawkeye encounters Margaret and she theorizes that they made a mistake during surgery, eliciting extreme doubt from Hawkeye, who in turn insults her. During the night, Hawkeye has an epiphany and reopens the patient to find a small piece of shrapnel damage behind the sigmoid colon , at which point Frank states that "anybody could have missed that." Hawkeye responds with

608-518: The circular folds, the villi, and the microvilli are to increase the amount of surface area available for the absorption of nutrients , and to limit the loss of said nutrients to intestinal fauna. Each villus has a network of capillaries and fine lymphatic vessels called lacteals close to its surface. The epithelial cells of the villi transport nutrients from the lumen of the intestine into these capillaries (amino acids and carbohydrates) and lacteals (lipids). The absorbed substances are transported via

640-465: The duodenum in order to neutralize the potentially harmful acid coming from the stomach. The three major classes of nutrients that undergo digestion are proteins , lipids (fats) and carbohydrates : Digested food is now able to pass into the blood vessels in the wall of the intestine through either diffusion or active transport . The small intestine is the site where most of the nutrients from ingested food are absorbed. The inner wall, or mucosa, of

672-540: The duodenum with very few genes expressed only in the small intestine. The corresponding specific proteins are expressed in glandular cells of the mucosa, such as fatty acid binding protein FABP6 . Most of the more specifically expressed genes in the small intestine are also expressed in the duodenum, for example FABP2 and the DEFA6 protein expressed in secretory granules of Paneth cells . The small intestine develops from

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704-417: The duodenum, jejunum, and ileum are somewhat vague even in humans, and such distinctions are either ignored when discussing the anatomy of other animals, or are essentially arbitrary. There is no small intestine as such in non-teleost fish, such as sharks , sturgeons , and lungfish . Instead, the digestive part of the gut forms a spiral intestine , connecting the stomach to the rectum. In this type of gut,

736-430: The front of the embryo. It rotates a further 180 degrees after it has moved back into the abdomen. This process creates the twisted shape of the large intestine . Food from the stomach is allowed into the duodenum through the pylorus by a muscle called the pyloric sphincter. The small intestine is where most chemical digestion takes place. Many of the digestive enzymes that act in the small intestine are secreted by

768-406: The gastrointestinal tract. The curving path it takes toward the anus allows it to store gas in the superior arched portion, enabling the colon to expel gas without excreting faeces simultaneously. The sigmoid colon is completely surrounded by peritoneum (and thus is not retroperitoneal ), which forms a mesentery ( sigmoid mesocolon ), which diminishes in length from the center toward the ends of

800-400: The host's immune system. Peyer's patches , located within the ileum of the small intestine, are an important part of the digestive tract's local immune system. They are part of the lymphatic system, and provide a site for antigens from potentially harmful bacteria or other microorganisms in the digestive tract to be sampled, and subsequently presented to the immune system. The small intestine

832-544: The intestine itself is relatively straight but has a long fold running along the inner surface in a spiral fashion, sometimes for dozens of turns. This valve greatly increases both the surface area and the effective length of the intestine. The lining of the spiral intestine is similar to that of the small intestine in teleosts and non-mammalian tetrapods. In lampreys , the spiral valve is extremely small, possibly because their diet requires little digestion. Hagfish have no spiral valve at all, with digestion occurring for almost

864-404: The left piriformis , and left sacral plexus of nerves. In front, it is separated from the bladder in the male , and the uterus in the female , by some coils of the small intestine . Diverticulosis often occurs in the sigmoid colon in association with increased intraluminal pressure and focal weakness in the colonic wall. It is a common cause of hematochezia . Volvulus occurs when

896-450: The loop, where it disappears, so that the loop is fixed at its junctions with the iliac colon and rectum, but enjoys a considerable range of movement in its central portion. Pelvic splanchnic nerves are the primary source for parasympathetic innervation. Lumbar splanchnic nerves provide sympathetic innervation via the inferior mesenteric ganglion . Behind the sigmoid colon are the external iliac vessels , ovary, obturator nerve,

928-565: The measuring technique used. The typical length in a living person is 3–5 m (10– 16 + 1 ⁄ 2  ft). The length depends both on how tall the person is and how the length is measured. Taller people generally have a longer small intestine and measurements are generally longer after death and when the bowel is empty. It is approximately 1.5 centimetres ( 5 ⁄ 8 inch) in diameter in newborns after 35 weeks of gestational age , and 2.5–3 cm (1– 1 + 1 ⁄ 8  in) in diameter in adults. On abdominal X-rays ,

960-447: The small intestine is considered to be abnormally dilated when the diameter exceeds 3 cm. On CT scans , a diameter of over 2.5 cm is considered abnormally dilated. The surface area of the human small intestinal mucosa , due to enlargement caused by folds, villi and microvilli, averages 30 square metres (320 sq ft). The small intestine is divided into three structural parts. The jejunum and ileum are suspended in

992-571: The small intestine, is lined with intestinal epithelium , a simple columnar epithelium . Structurally, the mucosa is covered in wrinkles or flaps called circular folds , which are considered permanent features in the mucosa. They are distinct from rugae which are considered non-permanent or temporary allowing for distention and contraction. From the circular folds project microscopic finger-like pieces of tissue called villi ( Latin for "shaggy hair"). The individual epithelial cells also have finger-like projections known as microvilli . The functions of

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1024-466: The superior mesenteric artery via the inferior pancreaticoduodenal artery . These two arteries both have anterior and posterior branches that meet in the midline and anastomose . The jejunum and ileum receive blood from the superior mesenteric artery. Branches of the superior mesenteric artery form a series of arches within the mesentery known as arterial arcades , which may be several layers deep. Straight blood vessels known as vasa recta travel from

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