This journal is
indexed in Scopus
Year 2018 Vol. 26 No 3
I.N. KLIMOVICH 1, S.S. MASKIN 1, G.L. SNIGUR 1, 2, P.V. ABRAMOV 1, A.V. PAVLOV 1
INTESTINAL INSUFFICIENCY IN PATHOGENESIS OF ENDOTOXICOSIS IN HEMORRHAGIC HYPOTENSION
Volgograd State Medical University 1,
Volgograd Medical Scientific Center 2, Volgograd,
The Russian Federation
Objective. To clarify the role of the intestine in the potentiation of the systemic endotoxicosis with medium molecular peptides and the products of lipid peroxidation when modeling in animals severe bleeding from the upper sections of the gastrointestinal tract.
Methods. Severe bleedings from the upper gastrointestinal tract were modeled in Wistar rats. In dynamics, after 4 hours, 16 and 28 hours from the beginning of the experiment, the reperfusion injuries of the small intestine wall were studied as well as the integral indices of endotoxicosis severity in different regions of the blood stream - in the peripheral (inferior vena cava) blood and the blood flowing from the intestine (portal vein).
Results. 4 hours after the beginning of the experiment, the animals were observed the effects of reperfusion injury of the intestinal wall in the form of oxidative stress. However, no death and desquamation of enterocytes in the mucosal layer were noted. After 16 hours, the level of endotoxicosis was significantly higher (ð<0.05) in the blood flowing from the intestine, in comparison with the peripheral blood flow. In the mucous layer the foci of death and desquamation of enterocytes with the exposure of the basal membrane were found. After 28 hours the level of endotoxicosis increased, but the difference in endotoxicosis rates in different regions of the blood flow decreased, due to saturation of peripheral blood flow with the intestine toxins. Histological studies revealed necrotic changes in 2/3 of the mucosal layer of the intestine with partial necrosis of the surface sections of the villi. Correlation analysis between the total index of endotoxicosis in the blood from the portal vein and the degree of morphometric disturbances in the wall of the small intestine revealed a close relationship between the damage of the cellular elements of the small intestine wall and the toxicity of the blood flowing from it.
Conclusions. It has been established that as a result of reperfusion injury of the small intestine wall, pronounced inflammatory changes occur in it and its «barrier» function is violated. Products of the blood hydrolysis discharged into the lumen of the intestine and the products of lipid peroxidation, freely enter the mesenteric bloodstream, thereby substantially potentiating systemic endotoxicosis.
- Stepanov IuM, Zalevskii VI, Kosinskii AV. Zheludochno-kishechnye krovotecheniia. Dnepropetrovsk, Ukraina: Lira; 2011. 270 p. (in Russ.)
- Feinman M, Haut ER. Upper gastrointestinal bleeding. Surg Clin North Am. 2014 Feb;94(1):43-53. doi: 10.1016/j.suc.2013.10.004
- Gel’fand BR, Saltanov AI. (red). Intensivnaia terapiia: nats ruk. Moscow, RF: GEOTAR-Media; T. I; 2009. 960 p. (in Russ.)
- Fishman JE, Levy G, Alli V, Sheth S, Lu Q, Deitch EA. Oxidative modification of the intestinal mucus layer is a critical but unrecognized component of trauma hemorrhagic shock-induced gut barrier failure. Am J Physiol Gastrointest Liver Physiol. 2013 Jan 1;304(1):G57-63. doi: 10.1152/ajpgi.00170.2012
- Diebel ME, Diebel LN, Manke CW, Liberati DM, Whittaker JR. Early tranexamic acid administration: A protective effect on gut barrier function following ischemia/reperfusion injury. J Trauma Acute Care Surg. 2015 Dec;79(6):1015-22. doi: 10.1097/TA.0000000000000703
- Grootjans J, Hundscheid IH, Lenaerts K, Boonen B, Renes IB, Verheyen FK, Dejong CH, von Meyenfeldt MF, Beets GL, Buurman WA. Ischaemia-induced mucus barrier loss and bacterial penetration are rapidly counteracted by increased goblet cell secretory activity in human and rat colon. Gut. 2013 Feb;62(2):250-58. doi: 10.1136/gutjnl-2011-301956
- Zutphen LF, Baumans V, Beynen AC. Principles of laboratory animal science. Amsterdam: Elsevier; 1993. 389 p.
- Malakhova MIa. Metod registratsii endogennoi intoksikatsii: posobie dlia vrachei. S-Petersburg, RF; 1995. 33 p. (in Russ.)
- Bilenko MV. Ishemicheskie i reperfuzionnye povrezhdeniia organov (molekuliarnye mekhanizmy, puti preduprezhdeniia i lecheniia). Moscow, RF: Meditsina; 1989. 368 p. (in Russ.)
- Vladimirov IuA, Azizova OA, Deev AI, i dr. Svobodnye radikaly v zhivykh sistemakh. Itogi nauki i tekhniki. Biofizika. 1992;29. p. 3-250. (in Russ.)
- Kostiuk VA, Potapovich AI, Kovaleva ZhV. A simple and sensitive method of determination of superoxide dismutase activity based on the reaction of quercetin oxidation. Vopr Med Khimii. 1990;36(2).88-91. http://pbmc.ibmc.msk.ru/index.php/ru/article/PBMC-1990-36-2-88-ru (in Russ.)
- Petri A, Sebin K. Nagliadnaia meditsinskaia statistika. Leonov VP, red. Moscow, RF: GEOTAR-Media; 2009. 168 p. (in Russ.)
- Sarkisov DS, Perov IuL. Rukovodstvo po gistologicheskoi tekhnike. Moscow, RF: Meditsina; 1996. 242 p. (in Russ.)
- Ke S, Liu F, Zhu Z. Resveratrol improves intestinal injury in hemorrhagic shock rats by protection of mitochondria and reduction of oxidative stress. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2014 Dec;39(12):1259-65. doi: 10.11817/j.issn.1672-7347.2014.12.007 [Article in Chinese]
400131, The Russian Federation,
Volgograd, Pavshix Borcov Square, 1,
Volgograd State Medical University,
Department of Hospital Surgery,
Tel. office: 8(442) 71-87-62,
Tel. mobile.: +7 905-336-23-69
Igor’ N. Klimovich
Klimovich Igor’ N., MD, Associate Professor of the Department of Hospital Surgery, Volgograd State Medical University, Volgograd, Russian Federation.
Maskin Sergej S., MD, Professor, Head of the Department of Hospital Surgery, Volgograd State Medical University, Volgograd, Russian Federation.
Snigur Grigory L., MD, Associate Professor, Head of the Department of Biology, Volgograd State Medical University, Senior Researcher of the Laboratory of Morphology, Immunohistochemistry and Carcinogenesis, Volgograd Medical Scientific Center, Volgograd, Russian Federation.
Abramov Pavel V., Post-Graduate Student, the Department of Hospital Surgery, Volgograd State Medical University, Volgograd, Russian Federation.
Pavlov Alexandr V., Post-Graduate Student, the Department of Hospital Surgery, Volgograd State Medical University, Volgograd, Russian Federation.