GI Small Large Intersting 05 02 2026

رؤى طيب أهلا وسهلا فيك اليوم زي ما كان عنا حكينا عليه رح نحكي على الجهاز الهضمي لنبتدي والجهاز الهضمي اللي بحكي عليه رح أمزج معه في هالأسبوع والأسبوع الجاي جراحة كمان بس قبل ما نحكي على الجراحة لازم نحكي على what is the function كل جزء من الجهاز الهضمي كل جزء من الجهاز الهضمي كل جزء من الجهاز الهضمي شو وظيفته لو تعرفنا على شو وظيفته ورح نتعرف على لو عملنا جراحة لهالجزء شو العواقب اللي حتكون على المريض فنبتدأ إن شاء الله this is an interactive شو معناته interactive معناته إنه رح يكون أسئلة وإن شاء الله تساعدكم بس لو فيكم تتفاعلوا معي لكان أسهل وللتفاعل ممكن يكون بالشات أنا عملته سهل كتير لتحسوا حالكم لتحسوا حالكم يعني داخلين في المشاركين ودخلين في المقرف طيب نبتدي إن شاء الله حيكون أسئلة and for each question just give me A or B or C في zoom chat ولا ممكن تدفع له بالreactions either thumbs up ولا thumbs down ولا سؤال أول ما يكون تفاعل ولا جواب رح الطالب اللي يكون دايماً سريع ولا سريعة بالآخر إن شاء الله رح يكون ناجح في الـ You're gonna be the winner, okay? And I'm going to be following this. طيب نحكي على الأناتومي. الآن الأناتومي فيه حكينا عنه بال بالأناتومي the basic بس I want to go into the anatomy بس I want to the anatomy to make sense معناته إنه سهل إنه نتعلم الأناتومي في كتاب و we see it rigid in a cadaver ولا in a diagram in a book بس It has to make sense. If I see my aunt and she tells me I have pain, عندي وجع في الجهة اليسرى, at the bottom on the left corner, I need to make sure that I understand not just شو العضو, what is the organ that exists in there, but what does that organ do. If I understand that I will understand التهاب هالعضو شوفي what is the repercussions. And then when I come in and ask the patients in the clinicals, then I can know what other questions to ask. For example, لو عندي وجع بال تحت الدلع بالجهة اليمنى، I understand إنه there is the gallbladder، بس كمان في The corner of the large intestine. And if I understand the large intestine, في بكتيريات بيساعدون على الهضم اللي بنسميهم microbiome. I understand then those microbiome maybe they have got food that they are having trouble digesting and they're making a lot of gas. And gas goes up, and that corner is up. So maybe it's the gallbladder. بس كمان maybe it's gas in the colon. So if I understand the function of the the organ, then it makes me understand how to interpret. ال ال the the complaints فإذا إف إف إذا ما تعلمت وظيفة العضو بقدر أحدد شو الأسئلة اللي ممكن أسألها وشو معناته الinterpretation of those symptoms فإحنا بنعرف إنه في a small intestine and a large intestine The small intestines begins with duodenum, الاثنى عشر، is jejunum، الصائم، the ileum. And these are three sections. They are existing anatomy books. They are existing. We hear them a lot, but we don't understand what's the difference between them. So duodenum. And let me see if I can get you a— let me see if I can get you an image so we know what we are talking about. So, you can see here the anatomy that we have. This is the duodenum. This is the jejunum. And this is the ileum right before we start the colon. Those are 3 sections of the small intestine. طيب، if we are going to talk about these, why are we separating them? What's the difference between them? Let's go over it. The difference is the following. ولو سمحتم، I am trying to switch between Arabic and English. لو في Aishi, you don't understand it? Ask me in the chat. I will answer it and I will translate it. Duodenum is the longest one, 25 centimeters. It's C-shaped. One, two, three. C-shaped. Because it's C-shaped, what does it have? The duodenum. Is right after the stomach. If it's right after the stomach, that's where we have— that's where we have the gallbladder. Let me show you what do I mean by that. You can see the gallbladder. We studied that before. In the session, أبلها كان فيه حكينا على الكبد وحكينا على المرارة وحكينا على البيلياري. So الكبد creates bile, and the bile starts to digest food. بس it creates it not when you need it. It creates it and it stores it. تخزينها بالمرارة، gallbladder. ولو في when there is bile that's needed, then food falls into the stomach. The stomach sends a message to the brain. The brain sends the message to the gallbladder, which contracts, sends the biliary Fluid into the common bile ducts, and that goes into the duodenum. That's when we start to have digestion happening. Is this clear? In the duodenum, why is that important? Because when you have iftihab. Small intestine, you start to have difficult problems, and you start to have corha ulcers. Ulcers—they're not always in the stomach. We don't have corha maida daimen. في مرات بنشوف قرح قرح بالاثن عشرين يوادنم. بس it's not common, it's not normal. Well, قرحة is not normal. بس على الأقل the most common ulcers happen in the stomach. If they happen in the duodenum, there is more problems. إما بيكون عنا problems في الهرمونات اللي بيعملوا الpepsin اللي بتكون في الduodenum. Pepsin is one of the Digestive enzymes اللي بتساعدنا على الهضم. فلما تكون البابسين طلعة كتير لإما بلا قدر الله ورم or tumor or because we have extra hormones making extra papain making extra chewing into the duodenum, you have ulcers. So sometimes you see ulcers in the stomach. Sometimes you see ulcers in the duodenum. في مرات بيكون البايل اللي بيعملها الكبد واللي بتكون مخزونة في المرارة. Sometimes that bile فيها مركبات أكثر more concentrated. لما تكون more concentrated it starts to sediment. لما تكون بالسادمنت بتعمل أحجار هدول الأحجار اللي بيكونوا جولستون جول بلادرستون ولا جولستونز فلما المرارة بتنقبض to contract to send the bile للهضم it contracts over a stone and it causes Pain. That pain عنده اسم اسمه biliary colic. The colic is a type of pain. في two colics اللي بنعملهم اللي بنعرفهم البيلياري كوليك والكيدني كوليك. هدول الاثنين بيكون فيهم contractions over stones وبيدوكم ألم اللي بيكون كلاسيك، فبيلياري كوليك is one of the reasons why you have pain in the stomach. دوادونال ولا جاستريك ألسر is another one. بس the you can understand the difference. لو ما في أكل بالمعدة ولا بالإتناعشري اللي بده بينهدم. وعندك enzymes كتيرة then you start to have abdominal pain بس الإنسان صائم ولا ما بده يأكل فلما بيجي pain before eating normally we think about stomach ulcer ولا duodenal ulcer لما تكون أكلت ويكون الجلد بلادر contracting to send the enzymes to digest. Then there is pain after eating, and we think about gallstones. فهمت علي؟ So once you understand الوظيفة، you start to understand and ask what questions with abdominal pain. ما ش الحال؟ Are you good? Perfect. Thank you, مرحبا. طيب لنروح مرة تانية. فكلمنا على الدوادنم والدوادنم في not only the bile but also the pancreatic juice. حكينا على شكراً أبو الأدهم. حكينا على البانكرياس، البانكرياس كمان عنده كنال اللي بيكون فيه أنزيمات تانية فيها البابسين وفيها أنزيمات تانية اللي بتساعدنا على هضم كمان لتركيباتها بتندمج مع البايو. بنجمعه بالدوادنم، فالpancreatic juice is في كمان عنده وظائف تانية. وبنشوف كمان بالدوادنم bronchial glands. هدول bronchial glands بيعملونا liquid that is called alkaline. مو acid زي stomach alkaline. في الدوادنم كمان بنشوف انه هذي اللي بيكون فيها الابسوربشن من الاكل بناخد الايرن والفوليك اسد فلما يكون سرجري جراحة اللي بتشيل الدوادنم بتشيل كمان السايتس او ابسوربشن Of iron and folates. So people that have duodenum resection, we have to give them intravenous iron and folates to replace because their body cannot extract those. ماشي الحال؟ رايحين على الججونم. الجيجونم فيه مترين ونص، أوكي؟ اللي هو أطول. في الجيجونم فيه the tallest villi and there is the maximum absorption. It absorbs اللي بتاخد الcarbohydrates، البروتين، فهذول مهمين كتير لأنه أي مرة في كينسر ولا أي مرة في يعني مشكلة للcirculation الدموية للportion of the jejunum and we cut it we have to replace all of that لأنه هذيك الحال احنا تركيبتنا إنه بناخد التغذية من various places of our intestines. So when we take an intestine out, ولا it dies because it doesn't have circulation like a stroke, then we have to take it out. We have to replace those things. Let's take a look. At what does it look like? So what does it look like in no? If you see here, if you see here, you will find hadul structures. Libetshufuhum al yamin bin samihum villus. And villus plural becomes villi.

Okay.

Mara, if folate is not absorbed from— is folate not absorbed from other parts of the GI tract? I know that folate can be absorbed widely. Yes. But not enough. Okay, the majority of the folate is absorbed where we discussed. It can be absorbed elsewhere. Okay, so لما نشوف small intestine and we cut it, I am a I am a fan. Of making sure that we combine anatomy, physiology, histology so we can understand the human body. هذه للهستولوجي لو عملنا تشريح لل الاثنى عشر شو بنشوف عنده الميوكوزة تحت الميوكوزة فيها سب ميوكوزة وتحت الميوكوزة فيها ال circular muscle المصل اللي بيعمل للقباضات to move the food from point A to point B وبعدين فيها السروسة سروسة اللي بتكون من الخارج so هدول ال layers of the intestinal walls لما بنشوف الميوكوزة شو بنشوف فيها بنشوف انه فيها Villi. وهدول الvilli فيهم circulation عشان يكون فيها الabsorption. Okay? Why do we have villi? Why do we have villi there? Why can't it just be the surface? It can just be a surface that is flat. Why do we have villi? هدول الزغابات, الvilli عشان نزيد مساحة السطح. لو عملتوا هدول villi, it triples or quadruples المساحة اللي بيحصل فيها الabsorption. So this is حكمة الله إنه عملنا to make sure everything is in small space. Hadulil villi, they increase the surface to increase the absorption without too much space. That's what we see on the villi. ممكن تشوفوا إنه في endocrine cells، في intestinal glands، cells of Paneth، goblet cells. هدول كل واحد فيهم عنده function. To create the mucus that is in the small intestine. ليس عدنا للهضم. Okay? مش كمان يسعدنا للهضم بس كمان it protects the surface. تحمي السطح لل intestines. So anything that we eat, even if it is bad for us, it doesn't injure. ما بتضر ال ال السطح تبع ال small intestine. Okay، نروح مرة تانية ونحكي على so now we understood that most carbs and proteins are absorbed in the jejunum ونروح للإليم الإليم فيه ثلاثة ونص مترات، بس هذا الناروست. And شو بنشوف فيه؟ بنشوف فيه payers patches. ليش is important؟ لأنه payers patches هدول فيهم lymphoid tissue. Lymphoid tissue حكينا عنه في circulation. تبع الدم وتبع الليمف. Two separate circulations. The circulation الأولى فيها الدم الدموية بنعرفها، بس ال lymphatic circulation هذه فيها كمان ال ال ال الجهاز المناعة. So the immune system. Okay؟ هذا اللي فيه lymph nodes فيه ال tonsils اللي عنا هناك لما يكون عنا infection they become big and inflamed لأنه بيكون فيها حرب ما بين منعتنا وما بين ال ال microbe اللي بيعمل ال the infection okay so when we are talking about lymphoid tissue we are talking about المناعة بس كمان بنحكي على الكانسر اللي اسمه الليمفوما في كانسر بالدم لوكيميا وفي كانسر بالليمفود بنسميه ليمفوما هدول الليمفومات في منهم اللي بيتركز على المالت هدول الـ Payers Patches ففي أمرض أمراض بتكون يعني Cancer of the Peyer's patches in the intestine. هذا المريض بيكون عنده lymphoma بس مركز في الilium. Okay? So ilium كمان اللي مهم فيه إنه that is the only site الوحيد اللي بيكون فيه ال ب vitamin B twelve. So لما بناخد ال الilium by surgery Out of the the abdomen, we have to replace the vitamin B12, and we have to give them the bile salts. لأن هناك بيكونوا البايل سولز بينندمجوا مع الأكل وبيعملوا تركيز والأفعال تبع البايل سولز. So when we don't have the ileum, بيكون عنا مشاكل هضم ومشاكل أنيميا نقص الدم بسبب نقص الفيتامين B12. أوكي وبعدين بالإليوم لش عشان بنروح لل الكولن ولا large intestine في ileocecal valve. It controls the flow of the food going from the small intestine to large intestine. أوكي So راح نروح لكمان لل and I'm going to ask you a question. Answer me in the chat. Where is the bile salts digesting the food? Duodenum, jejunum, ileum. A, B, or C? عملولي. واحد ال Excellence, Excellence, Excellence. So we're going to go to the large bowel. Excellence. A large bowel. في Let's go and look at the large bowel. A large bowel. When we talk about the large bowel, we always have to look what is in the large bowel. We are talking about the sigmoid colon. ما بين اليليوم والlarge colon there is a transition, the ileocecal valve. بعدين بنشوف السيمويد كولم. ومن السيجمويد كولن بيخرج السيكم وين بتكون الابنديسايتس هالسيكم ما بيعمل شي على اللي بنعرفه حكمة الله ما بنعرفها بس على الأقل لحد هلأ ما بنعرف شو وظيفة السيكم من السيكم من السيجمويد بنروح على الاسندنج كولن وهنيك بتشوفوا ان ما بين الاسندنج كولن والtransverse colon الأزرق من الorange للأزرق عندنا transverse colon المشكلة أنه هنيك بهالcorner that's where sometimes bowel gas goes وبيديك ألم كتير الواحد بينشغل هذا ألم المرارة ألم الكلي لأنه there's the kidney around this area. ألم الكبد، ألم just gas. ففي مرات بيكو بيروح الحد على المستعجلات وبيقولوله لا ما في مشكلة هذي gas. That's why لأنه this corner between the ascending colon and transverse colon. بعدين من transverse colon there is the Descending colon الأخضر وبعدين بن descending colon بنروح على السيكم الركتم والأناس. So بنحكي على big intestine this way.

Okay.

مرة كمان بنروح على السيكم الappendix. That's the first part. في كمان lymphoid tissue. Appendix. So when we cut it, we take away some lymphoid tissue. It takes the ileal contents, عبر ال ileocecal valve. لحد هلأ عندنا liquid. بعد ما يرجع ما ما ييجوا على الكولن، هنيك شو بنشوف؟ We absorb water. That's when liquid Start to become stool solid. فبالكولن كمان بنشوف فيه هاسترة. الهاسترة are the same thing as we saw villi in the small intestine. Something different. الفيلي صغيرة بالهاسترة أكبر بكتير وبنشوفها بالx-ray. لما بنشوف الx-ray of the colon we show the haustrations. Okay, it absorbs the sodium, but it absorbs the water, and it's as and when we say absorbs, تختو، and when we say secretes، بتدّي. فبيخرج من الكولن من من من from our body into the stool بيخرج ال potassium will bicarb. So when you check the stool, they are alkaline. When you check the liquid in the stomach and the duodenum and the ileum, etc. They are acid. That's when we start to see. شان هيك لما بتكون diarrhea, you lose bicarb. لما بتكون vomiting, you lose acid. Okay? شان هيك قلت لون قلت قلت لكم لما إنه لو بتفهموا الفيزيولوجي والأناتومي والهستولوجي بتساعد كتير على فهم شو بيوقع للمريض تبعكم؟ وشو بتسألوا؟ to understand why some things are going on في الكولن كمان فيه microbiome ونحن بنحكي على millions ما فيه ميتين ولا تلتمية millions of bacteria ما بنعرفها كلها بنعرف واحدة ولا اتنين ولا ثلاثة But we don't know all of it. How do they interact with each other? Hadil zail Amazon. We have not talked about all the species existing there. We know some. وفي كمان توازن بين species. فلما بيحصل إنه بندي antibiotics, that's why sometimes we say take a yogurt. To replace the microbiome. ليش؟ لأنه ال antibiotics kills some bacteria and leaves other bacteria. And بدخل بهالتوازن، ففي bacteria لما بتكون أكثر، it causes disease. For example، في disease اسمه colitis. Itis معناته التهاب، التهاب الكولن. في colitis That is caused by a bacteria called Clostridium difficile. Clostridium difficile, we use C. diff, C. diff, Clostridium difficile colitis or C. diff colitis. هذه ال C. diff colitis classically التوعة لما بندي بعض منا Antibiotics. وبتخلي بالتوازن فلما C. diff colitis is not anymore suppressed by others, it starts to become more. It overgrows and multiplies and causes inflammation. ف antibiotics cause C. diff colitis and C. diff colitis is treated by one type of antibiotics. Okay, ف لن لخص الكولن في بن we absorb sodium and water. We secrete potassium and bicarb. فيه microbiome that has an equilibrium and it ferments زي الخبز. You you you grow you ferment the carbs. That's why we create gas. لما نروح على rectum and the anus it's just once you created feces or stool نخزينها هناك لحد ما to go evacuate في الinternal sphincter الexternal sphincter السفينكتر اللي بيساعدنا على قبض وتخزين البراز okay so internal sphincter It's not up to us. External sphincter is when we open it so we can evacuate the stool.

Okay.

طيب. I want you to tell me, does the colon have villi? Yes or no? Put that in the chat, please. Okay. No or yes? Okay, maybe no. Maybe you have to give me yes or no. So I will wait for a few seconds. Does the colon have villi? Yes or no? No. Type okay. You are correct. It's a no. So I'm going to show you, and I'm going to put this in the chat as well. So when we are talking about the intestines and the colon. Oh, the chat room does not support files. Let me put that in. Okay, you can look in the WhatsApp, and in the WhatsApp, uh, I put the, the line histology. But what do you see in the small intestine? You see the muscularis, حكينا عنا. We see the intestinal villi and the crypts. El villi طلعين والcrypt حطين. Okay? We see all the glands. We see the muscularis. We see the lymphatics. We see the nerves. لما نروح على large intestines, no villi. We just see the crypts. We don't see the villi. Okay? في كمان السابموكوسا، الماسكولاريس، في nerves. All of this. هدول النور لساتنا بنفهم عليهم لأنه we we know sometimes that some people when they have trauma ولا psychological problems they have abdominal pain and that's because some of the nerves tend to make the muscles of our intestine spasm. Same thing as if we have the muscles of the neck tight because we're stressed. Same thing, we have muscles in our airways, bronchial tubes, and some people can't catch their breath when they are anxious. هدول النورز هم اللي بيساعدون على فهم why some people are anxious and it manifests this way. Okay. طيب، we will start, we will continue and finish the shared architecture. الميكوزا بنشوف فيها إنه فيها إبتيليوم، لامينا بروبريا and muscularis mucosa. الساب ميكوزا فيها connective tissue. شو معناته connective tissue؟ أنا ما كنتي بفهم عليه لأنه every single time they say that to me I didn't understand it. Well. لما بنبني دار ولا building ممكن يكون عنا windows ممكن يكون عنا roof بس من شان لا تسقط بنحكي على البناء الأساسي ok scaffolding هذا scaffolding بيساعدنا انه كله يكون متين فما ما فيه يسقط، okay? So connective tissue is the tissue that holds everything together. If we are talking about the bronch— the lung, عندنا bronchial tubes، عندنا alveoli ولا air sacs، عندنا ال ال circulation، بس هدول مو في ال في الهواء. They are put together by a connective tissue. Same thing when you have mucosa, when you have the glands, when you have the blood vessels, when you have a nurse, it has to have connective tissue, fibrocytes, and fibrous tissue. وفي ميسنر Plexus حكينا على nerves. هدول nerves مجين من brain. Whenever we have symptoms, لسات نحاكل. When I'm about to eat, my brain sends the message to prepare the secretions, to prepare. The muscles to move the food. El muscularis is the muscle. Hadal muscle, we don't have to act on it. It just works by itself. It knows what to do. وفي الأورباك Plexus. Hadul Plexus are just like a small little brain. It's a nerve ball, we call it. It puts together يعني almost like you have the electrical system through the city, بس لازم يكون central command, the headquarters of the electrical system. Okay? So هدول الplexus is in all places locally. They are the soldiers of the brain. وبعدين في outside الادفنتيشة ولا السيروسة هذي اللي من الخارج And it contains everything. Okay, a serosa. It contains the outside of the tube, but it connects to the peritoneum. فهي طبقة خارجية بتتصل بالبروتينيوم.

Okay.

So which um Which plexus it is controlling? Il il il motion, il motor. Which plexus moves the food, controls the motor? Is it our back? Well, the Meissner. Yalla, type it in the um in the chat. So I'm going to say it again. Which plexus controls motility? Meissner, Weller, Auerbach. Second, my alarm to tell me that I need to start working. So which We have our back. انتعكستم بالتانية يا دكتور. بعتذر منكم. So في our back number one وفي Meissner number two. So the our back plexus controls motility. The Meissner plexus Controls the secretion. Let me put them in the chat. So our back is called myenteric plexus. Myenteric plexus controls the Motility, and Meissner plexus controls secretion. Great job, great job. Thank you for making it fun. Yalla, we will finish, inshallah, talking about the small bowel physiology. Very, very, very important. مهم كتير. ف small bowel physiology إنه في segmentation three modes في bit to it breaks down the food. It occurs while you're eating. It segments the food and it mixes the food with enzymes. بس It doesn't move forward. It doesn't move. What is the function that moves is called peristalsis. فالبرستالسي ممكن تعطيك كوليك as well. ليش؟ لأنه it contracts to move the food, but if there is gas with the food, it contracts over gas and causes pain. So peristalsis, it's almost like عندكم long line of people هذا بيدل التاني التاني بيدل التالت تالت بيدل الرابع لو الرابع راح على التالت بياخد منه شغلة بس الشغلة لساتها ما وصلت للتالت بيوقع discoordination عدم انتظام so the peristalsis has to be coordinated and it propels The food all the way to the colon. It is controlled by the aurbach plexus, and it activates بتسرع بعد ال ال الأكل. Okay? والشغلة الثالثة اسمه migrating motor complex. هذا بيكون خلال الصوم خلال رمضان ولا خلال الجوع لو واحد ما فين ما عندنا من شيء نكله بيكون every ninety minutes there is a migratory motor complex to clean the gut هذا it's triggered by motilin okay and it is زي اللي ال ال cleaner of the house the housekeeper in بل لتنظف الأمعاء ف هلأ بنفهم شو what is the good thing about fasting? It helps clean anything that is stagnant there that may help. Okay. فلو ما في تنظيف ال ال ال small intestine, it there's a lots of things that we eat that may stay there. Maybe there is milk that is not good. Maybe there is yogurt that is expired. Maybe we ate food that has fungus in it. All of that, if we did not have the Motilin, it would not clean. Okay, so when something like this happens, you start to see bacteria overgrowth. Okay. شغلة تانية مهمة كتير اللي بتشوفوها هلأ بالأدوية الجديدة تبع الديابيتيز تبع الأوبيسيتي فهذول الـ transporters you have to remember them and the SGLT1 is glucose and galactose Okay, fructose is the GLUT5. The GLUT2 is where the sugars exit the bloodstream into. Pardon me, exit mil mil mil mil داخل المعي into the circulation. فاحنا بنحكي على extraction بناخد من الأكل على دم تبعنا لا نستفيد من التغذية بس how does it happen؟ These are the transporters. H plus cotransporters. These been semi cotransporters because they move sodium and H plus, the protons. El fats be be kawino shylomicrons or chylomicrons, and those move into the circulation. Right? So the bile salts create what we call micelles into the chylomicron. That's a whole different chapter. Will B12 تستعمل intrinsic factor complex, and it's only absorbed in the terminal ileum. This slide is very important. لأنو في أدوية تختص For example, بالglucose transporter. ليش؟ For example, my father for his diabetes استعمل المتفورمن، استعمل الدواء هال هالدواء والآخر والتالت كان عنده دايما يكون ايه ال ال الشكر normal بس بعد ما يأكل الشكر بيطلع كتير أكثر من اللي بيكون فشو استعملناله؟ استعملناله دواء لديابيتيز اللي بيدفاعل مع ال SGLT1 ويخفض له ال absorption of glucose that way he did not have that much increase in glucose بعد الأكل. Postprandial. فلما بنفهم الفيزيولوجي، now we understand that all diabetes is not the same. Some diabetics need insulin. Some diabetics need medication of glucose before eating. Some diabetics need or after eating. Some need both. ف now we understand what we call precision medicine, personalized medicine. Is everything clear so far? Is everything clear so far? Yes, thank you, Mara. Um, I'm, I'm not trying to replace your Teaching at the school, I'm trying to make you yani excited about how كل الأشياء اللي تعلمتوها في الحد هلا basic is very important لأنه now we're gonna start to integrate it لنساعد المرضى. It's why we went to medical school in the first place. يعني بنشوف هدول الأشياء حكمة الله كيف عمل هاد الأشياء كلها وكمان how those scientists discovered هدول الأدوية اللي بنشوفهم هلأ وبنستعملهم لنساعد المرضى تبعنا كيف يعني خمّموا فيهم كيف how did they think about them how did they invent them يعني it's أعجوبة والله يعني it's it's amazing the the human mind when it comes up with طيب هذا سؤال عملولي في ال في ال في chat which transporter is responsible for absorbing glucose from the intestinal lumen into the enterocyte GLT five SGLT1, GLT2, ولا PEPT1. I'll wait for it. ولا Amazing, excellent, and it is indeed. SGLT1. شو حكينا عنه؟ It co-transport glucose or galactose. The the the O's, the sugar اللي بال بال بالحليب. For co-transport glucose or galactose with the sodium. فا ب بقولون إنه sodium like a taxi of the the the glucose وبيستعملوا the road. Which is the SGLT1. لا يدخلوا على ال ال circulation. Okay, and the fructose uses SGLT5. The all three sugars are handled in SGLT2. So good job, fantastic, good job. Large bowel physiology is something else. تحكينا على كيف بن absorb all of this. فال large bowel عنده ثلاث أشياء مهمة كتير. The water and electrolytes. هنيك بناخد sodium. هنيك بناخد ال ال water. بنخرج water. So our body is very importantly deep in the water.

Okay?

Explain the answer C. The answer C. The answer C is the basal lateral exit transporter. Basal lateral exit transporter is اللي ما حكيت عنه إنه لما بنحكي على square اللي اللي هو السل الخلية بال بال بال intestine هدول transporters وين موجودين في اللي موجود بال بال سطح وفي اللي موجود على الأرض تبع الخلية ففي apical وفي basilar ال SGL2T موجود بال basal واللاترال مو موجود بالابيكو they just tell you where they are شو معناته معناته إنه is it absorbed in the interface directly ما بين الخلية وال المعي ولا لازم إنه يدخل على الخلية ويتعمل هناك شيء تاني منشان يدخل معه transporter For example, SGLT1 is apical. ستحتبع الخلية. والSGLT2 موجود بالبايزيلو لاترال. So it actually allows all the sugars to move, but it's not specific. It just is a door that is open for all of the sugars. بس ال SGLT1 مختص بالجلوكوز الجالكتوز فبنقول تسعين بالمية بيمر على اللي اختصاصه هديك لما يكون all sugars بيح بيحصل crowding traffic so it's not as quick it's not as good as it's not as specific. So GLT two ممكن يكون يمر به بس قليل مش as much as the as GLT one. Is that what you asked? ولا طيب large bowel We talked about the water and electrolytes. في يعني 1.5 liters of of stool enters the bowel. So I understand the SGLT1 from the GI lumen into the enterocytes, but the GLT2 from enterocytes into the blood, correct? It is both of them are from the GI lumen into the bloodstream. But the SGLT1 is at the top of the cell and the GLT2 is at the bottom and on the sides of the cell. Location-wise, they're in a different location. Okay. But both of them are from enterocytes to the bloodstream where they are. And who they let in. Okay, water and electrolytes fee liter and a half enter the bowel. بعد absorption ما بيفضل إلا ميت ميليتر. So you can tell this is huge. كمان الألدوسترون helps with the sodium. Okay, microbiome. Ashra to the power of eleven. That's how many millions of bacteria per milliliter, per milliliter. And what it does is carbohydrates, اللي فضلوا بال بال ال ال in the in the stools, they start to ferment them so they're easier to nourish. هدول to nourish إنه ال الخلايا طبعا الكولن لازمهم تغزيهم كمان فهذول الكاربيز اللي بقين they recycle them and they help nourish the colonocytes and المايكروبيون بيساعدنا على الimmunity على الinflammation ما بنفهم مية بالمية لساتنا it's a science that is just starting. والشغلة الثالثة of the large bowel is motility to move the stools. هدول ال لو لو تتذكروا الهواسترة الهواسترة are الهاسترة. Let me show them to you in so you know what I'm talking about. لما بنحكي على الهاسترة، بنحكي على these areas. Do you see them? So this is a hostra. وفي بين الهوسترى these spaces right here. Here are the hostras, and these are the spaces between them. Here are the hostras, and these are the spaces between them. Again, here are the hastras, and here's the spaces between them. And I showed them to you. حكيت لكم عليهم بال بال how do you see them in an image in the dissection? And now let's take a look at them in an X-ray. These are the haustras. Do you see them? These are the haustras, and these are the spaces between them. So these are the haustras right here, and this is the haustral fold. فلما الكولون becomes big and you could see it in the X-ray, we call it that we see the haustras of the colon. So I just wanted you to know, Achir, you are from a generation who now has ultrasound. Here's an ultrasound. You can start to see the haustras, and you can start to see the spaces between them, the haustral folds. Okay, but we're going to try to finish with the colon. And with the colon, we started to see water and electrolytes, the microbiome, and the motility. And because of those movements, we start to see that it propels the The stool. It's important to understand إنه كل شيء بيشتغل مرة واحدة، فأول signal اللي بيجي بيجي من الدماغ. ليش؟ عندنا بالمغرب بنقول بناكل بعينينا. معناته إنه when you see خير الله في طاولة وفيها شغلات بتشهي الله يعين أخواتنا وكلن اللي بفلسطين لما بتمروا بأوقات صعبة لما ما بتكون تغذية بنبدأ معكن بس if there is and you see a table that has things that you are hungry your your brain signals that there is food شو بيكون هالسجنل بيروح على الكبت to make new bile بس بتروح على المرارة اللي to contract that the bile is gonna go into the The duodenum. The pancreas بيشتغل على الpepsin وعلى and moves it into the ampulla of Vater and dumps it into the duodenum. The stomach starts to make acid ليستقبل الأكل ويشتغل على هدمه. The saliva فيها كمان enzymes so you start salivating so it breaks down the food that's going to be swallowed and the colon starts to have the peristalsis and the motility in order to move anything there. That's what we call the gastrocolic reflex.

Okay.

So the colon's most important routine physiological role is what? I need you to give me answers. Absorbs amino acids, reclaims water and electrolytes from luminal contents, chylomicrons formation and lymph entry, bile salt synthesis from cholesterol. Which one? Let me see the chat. Oops. ضاع منا أبو الأدهم. خايف منكم. You got everything right, girls.

Okay.

B and B. Amazing. Excellent. Let me see if he's here. أبو الأدهم. I was just joking. I know that you always have been over and over and over. So But so far we have heroes in the room, so everybody is getting it correctly. طيب، it's B. The colon بيغير 1.5 liters of liquid into about 100 cc's of solid stool. The amino acid absorption is small bowel. The chylomicron and bile salts occur every elsewhere. When the chylomicrons, they are occurring as the fat absorption will bile and occurs in the liver.

Okay.

Okay. Well, to finish, we're just going to say that when you have small bowel obstruction, either with a tumor Or with scar tissue, what do you have? You sometimes can have a hernia. Your intestine exits the abdomen. You can see hernia. ولا ال small bowel لما بيكون عنده peristalsis ب twists over itself, or one small bowel enters into the other and it blocks. It's called intussusception. بيعتبيت the pain that is intermittent. Lesh intermittent, and no, it only occurs with peristalsis. It's colic. It's very hard, and it lets go. And when you hear bowel sounds, they are very high pitched. There's a lot of them in the beginning, and in the end, it's tired. There are no bowel sounds. All of that starts to go back. So you have vomiting in the x-ray. You have Loops of intestine that are dilated, كبير كتير، and there is more air and fluid levels. بس ما في colon gas. ليش؟ لأنه هذه وقع بالsmall bowel. So the the large bowel did not receive anything. How do we treat it? Sometimes we just let it by itself, and we put a tube inside the stomach. We pump. Out what's there and rest everything, and hopefully afterwards it just either untwists or decompresses. Sometimes we have to go to surgery. Yeah, ilius. شو معناته الilius؟ معناته في there is a problem with the nerves, and the problem means that the intestines are paralyzed. They don't function. بعد السجري، they're still lazy. They haven't started. ولا Septic shock, sepsis, infection. ولا زي ما وقع لأبويا بياخد دواكتير للألم and opioids they reduce your peristalsis subjيك إليس.

Okay?

And when it comes to the to the inflammation. What you have is Crohn's disease. التهاب ممكن يحصل بأي segment of the GI, and it's not continuous. It's small patches here and there, but it is the entire thickness of the wall. Remember we talked about the mucosa, submucosa, and serosa and adventitia? All of this, all of them are ملتهبين. The ulcerative colitis—it's different. It only happens in the rectum proximally, from the rectum on proximally, and it's only in the colon. It's not in the ileum. It's not in the jejunum. It's only the colon.

Okay?

And it's continuous, and it's only the mucosa, not transmural. These are just some questions to keep in mind and to finish our conversation. When you have active bowel sounds, just because you have active bowel sounds doesn't mean no obstruction. The obstruction can be there, and the active bowel sounds might be that they are trying to overcome the obstruction. Number 2, if you have diarrhea with blood, it must be the small intestine. Wrong. Bloody diarrhea can also be with colitis. Number three, Crohn's disease only affects the ileum. Wrong. Crohn's disease can affect anywhere from the mouth to the anus. The terminal ileum is common, but not the only site. Okay. Now you're gonna give me A, B, or C. لا نختم إن شاء الله. Twenty-eight-year-old presents with bloody diarrhea. Urgency. Tenesmus means it feels like spasms. For 6 weeks, the colonoscopy shows continuous mucous infection, mucosal infection, starting at the rectum. Which statement is most consistent with the diagnosis? A, skip lesions. B, continuous is likely ulcerative colitis. C, terminal ileus involvement with fistula formation is likely. D, B12 deficiency due to ileal malabsorption. I love it. I love it. Yes, B. Moving on. Ulcerative colitis. It's defined by continuous mucosal inflammation starting at the rectum, extending proximally, no skip lesions, No transmural. Crohn has granuloma. It skips, and it can involve any GI symptom. And because it can involve the ileum, we have B12 absorption that is low. Ulcerative colitis does not have problems with B12. Alaina, welcome. Welcome. You did amazing. Excellent. How did it go? Do you understand what we did today? Was it a good session? So as usual, we have a recording, and I'm going to post it shortly. These slides will also be posted. I will put it on the LinkedIn channel. Please make sure that you visit the LinkedIn channel I made for you. That is— pardon me— the LinkedIn channel is where I post everything. I post questions for you. I post most of what is relevant to you. If I need to change something, if— or if you want to ask me questions, You can ask them on the WhatsApp or otherwise. آخر سؤال. Have you used Notebook LM? And if you did, share with me how was your perfect good job. I will talk to you soon, you guys. If you have not used Notebook LM, feel free to let me know next time. والله يحميكم ويعينكم وينوركم والله يرحم شهداء المسلمين. Excellent, Mara. I love it. Next time, share with us on WhatsApp what prompts you use it for, what kind of examples. Because if I know what you did, I can make it better by sharing with you other things. يلا سلام عليكم.