Expo Fisiología Del Aparato Gastrointestinal en El RN

 

FISIOLOGÍA DEL APARATO GASTROINTESTINAL EN EL NEONATO This website stores data such as cookies to enable essential site functionality, as well as marketing, personalization, and analytics. You may change your settings at any time or accept the default settings.

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MR JOSÉ E. SANTIAGO NEONATOLOGIA HNERMMONTALVO

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Supervivencia RNEMBP depende de "habilidad" de adaptación a vida extrauterina.  Uno de esos factores de adaptación depende de adecuada ingesta de nutrientes que determinarán This website stores data such as cookies to enable essential site functionality, as well as marketing, personalization, and analytics. You may change your settings at any time  or accept the default settings.

desarrollo intelectual y físico satisfactorios a largo plazo. Adecuada ingesta depende: grado maduración TGI, digestión, absorción y actividad motora intestinal.

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DESARROLLO GASTROINTESTINAL DESARROLLO  

Lebenthal y Lee proponen que este desarrollo está gobernado por la interacción de cuatro determinantes: This website stores data such as cookies to enable essential site functionality, as well as marketing,  personalization, and analytics. You may change your settings at any time or accept the default settings.

Dotación genética: La secuencia programada de nucleótidos de ADN controla la progresión y

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expresión del desarrollo del organismo. Reloj biológico: la secuencia temporal predeterminada de eventos que está genéticamente controlada y es específica de especies.

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DESARROLLO GASTROINTESTINAL DESARROLLO 

Mecanismos reguladores: las influencias hormonales, neurológicas y endocrinológicas que afectan la

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expresión de la carga genética.

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Influencias ambientales: factores tales como la cantidad y calidad de los alimentos pueden cambiar cambiar el potencial para el desarrollo inherente de la carga genética.

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EMBRIOLOGÍA 

El intestino se desarrolla desde 3 germinaciones: 1.Endodermo Cel. epiteliales de mucosa y

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origen de componentes neurales.   2.Mesodermo esplácnico Cél. mesenquimales y

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músculo. 3. Ectodermo

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periferie intestinal.

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EMBRIOLOGÍA 

EL TGI aparece hacia la 4°semana de gestación como un tubo de epitelio estratificado y se extiende desde

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la1.Intestino boca hasta la cloaca y se divide en 3 partes: anterior (esófago, estómago, duodeno proximal, hígado y páncreas).

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2.Intestino colon transverso.medio (intestino delgado hasta 2/3 del 3.Intestino posterior (resto de colon ) Marketing

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DESARROLLO DEL TUBO DIGESTIVO INTESTINO ANTERIOR

Faringe Esófago Torácico Esófago  Abdomi  Abd ominal nal ORIGENES DERIVADOS DEL ENDODERMO Estómago Duodeno Bolsas Faringes Pulmones Parénquima y Epitelio Hepático Vesiculas y Conductos •

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Esbozos Pancreáticos

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DESARROLLO DEL TUBO DIGESTIVO

INTESTINO MEDIO This website stores data such as cookies to enable essential site functionality, as well as marketing, personalization, and analytics. You may change your settings at any time or accept the default settings.

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Mitad Inferior del Duodeno Yeyuno Ileon Ciego  Apendic  Ape ndice e Colon Ascendente 2/3 Colon Transverso

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DESARROLLO DEL TUBO DIGESTIVO

INTESTINO POSTERIOR This website stores data such as cookies to enable essential site functionality, as well as marketing, personalization, and analytics. You may change your settings at any time or accept the default settings.

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ENDODERMO

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1/3 Izquierdo del Colon Transverso Colon Descendente Colon Sigmoides Recto ORIGENES DERIVADOS DEL

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Seno urogenital y sus derivados

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DESARROLLO ANA DESARROLLO ANATÓMICO TÓMICO   Manifestaciones especializadas del TGI desta destacan can en eell II y III trimestre del embarazo. This website stores data such as  to enable essential site cookies functionality, as well as marketing, personalization, and analytics. You may change your settings at any time or accept the default settings.

A las 14 semanas: Páncreas: dos tipos de células. Estómago e hígado: tejido diferenciado. ID: criptas y vellosidades.  A las 20 semanas:

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semejaLaaldiferenciación del RNAT. anatómica del intestino

fetal

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DESARROLLO ANATÓMICO TÓMICO DESARROLLO ANA Crecimiento del ID e IG: 4 semanas: intestino es un simple tubo.  5 semana: empieza a alargarse más rápido que el tronco.  40 semanas: intestino 1000 veces más largo que a las 5 semanas.  RNAT tiene una talla en el rango 45.5 - 53.5 cm.: la longitud del ID es de 200-300 cm (4-5 veces la talla). 

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Capacidad gástrica: 30 ml 5/5/12  

DESARROLLO ANATÓMICO TÓMICO DESARROLLO ANA Crecimiento del ID e IG: Si el ID mide 253 cm. comprende: Duodeno: 5 cm. Yeyuno e íleon: 248 cm.

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Colon del RNAT mide en promedio 45 cm (1/6 longitud del ID). Superficie intestinal: 2000000 cm2.

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DESARROLLO ANATÓMICO TÓMICO DESARROLLO ANA 

Existen numerosos tipos de células en el intestino delgado:

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Epitelio absortivo intestinal. Células de Paneth: defensinas y péptidos péptidos (inmunidad innata)

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Células de Globet: secreción mucosa.

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Células enteroendocrinas

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Células M  

The neonatal gastrointestinal tract.Neoreviews.2003:4:7 5/5/12

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MIGRACIÓN DEL ENTEROCITO This website stores data such as cookies to enable essential site functionality, as well as marketing, personalization, and analytics. You may change your settings at any time or accept the default settings.

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48 horas

96 horas

The neonatal gastrointestinal 5/5/12 tract.Neoreviews.2003:4:7  

DESARROLLO DESARROLL O FISIOL FISIOLÓGICO ÓGICO

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Células endocrinas : 12 -18 semanas. semanas.

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La función de la membrana con borde en cepillo se mantiene inmadura durante el tercer trimestre.

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Hormonas GI y péptidos.

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MADURACIÓN ESTRUCTURAL DEL TGI ESÓFAGO Desarrollo glándulas This website stores data such as cookies to enable essential site functionality, as well as marketing, personalization, and analytics. You may change your settings at any time or accept the default settings.

superficiales Aparecen las células escamosas

20 semanas 28 semanas

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ESTÓMAGO 14 semanas Formación glándulas gástricas INTESTINO DELGADO Marketing

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Aparecen criptas y vellosidades

14 semanas

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MADUR MADURACIÓN ACIÓN FUNCIONAL DEL TGI FUNCIÓN

Deglución líquido amniótico  This website stores data such as cookies to enable essential site functionality, as well as marketing, personalization, and analytics. You may change your settings at any time or accept the default settings.

Reflejo Succión succión /deglución coordinadas EEI competente Peristaltismo: Desorganizado/fortuito Privacy Policy Contracciones organizadas Marketing Complejos motores Personalization Enzimas detectables en mucosa: Analytics Lactasa/Sucrosa- isomaltasa/glucoamilasa Save Accept All Secreción pancreática : Detectable

SEMANA DE GESTACIÓN

18 semanas 18 – 24 semanas semanas 34-36 Meses de vida <31 semanas 31 -34 semanas 34 semanas 10 semanas

 

Totalmente madura 16 semanas 5/5/12

 

DESARROLL OLLO O ESTRUCTUR ESTRUCTURAL AL Y DESARR FUNCIONAL DEL TGI

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DESARROLLO DESARROLL O FISIOL FISIOLÓGICO ÓGICO INGESTIÓN DE LÍQUIDO AMNIÓTICO:  Deglución fetal: 450 ml/día líquido amniótico (III 

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trimestre).

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DESARROLLO DESARROLL O FISIOL FISIOLÓGICO ÓGICO 

Esfínter gastroesofágico: 

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Presión EEI RNPT: 4cmH2O Presión EEI RNAT: 28cmH2O

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DESARROLL O FISIOL FISIOLÓGICO ÓGICO DESARROLLO 

El RGE se ha implicado como una de las causas de la apnea y bradicardia en RN de muy bajo peso al nacer

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(MBPN).

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DESARROLLO MOTOR DESARROLLO 

La actividad motora intestinal desplaza el contenido intraluminal de una región especializada del intestino a

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la próxima.

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El término “motilidad” comprende todos los aspectos del desarrollo motor: succión, deglución, vaciamiento gástrico y tránsito intestinal.

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DESARROLL O FISIOL FISIOLÓGICO ÓGICO DESARROLLO 

Páncreas e hígado

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La amilasa esta presente semana 16.  Tripsina, amilasa y lipasa secretadas en duodeno a

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las 31 semanas.  Los ácidos biliares se secretan a las 22 semanas.

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DESARROLLO FUNCIONAL DE LAS ENZIMAS ENZIMA S PANCRE ANCREÁ ÁTICAS

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DESARROLL O FISIOL FISIOLÓGICO ÓGICO DESARROLLO

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SUCCIÓN 

La conducta de la succión nutritiva es afectada por la edad gestacional y la edad postnatal

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<32s Movimientos de boca no producen presión negativa efectiva

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32-36s  Patrón de succión inmaduro caracterizado por pequeños periodos de 4 a 7 succiones a ritmo de, Marketing

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1 a 1,5 segundos  No se asocia con deglución

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SUCCIÓN >36s  Patrón maduro de succión  Períodos prolongados de 10-30 succiones a ritmo ritmo de 1,5-2”  Deglución se da 1-4 veces en cada periodo de succión  Este patrón maduro es alcanzado en 1-2s postnatales en infantes de 34-36 s y en 3-5 días en infantes >37 s.

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La succión inmadura es la principal razón para la 5/5/12 alimentación nasogástrica en infantes pretérmino

 

SUCCIÓN NO NUTRITIVA Es única en la especie  No resulta en el vaciado de leche en la cavidad oral  Este patrón de conducta oral puede ser espontáneo o estimulado por un chupón  La succión no nutritiva se desarrolla antes de la succión nutritiva  Los movimientos espontáneos de la boca son evidenciados in útero a las 18s de gestación 

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SUCCIÓN NUTRITIVA 

Es iniciada por estimulación intraoral e involucra una una combinación de compresiones rítmicas del pezón o la tetina para entregar le leche dentro de la boca y presión negativa para vaciarla dentro de la cavidad oral.

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El flujo, magnitud de presión negativa, y la frecuencia frecuencia de succión son factores importantes para regular el

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volumen de leche. 5/5/12  

MOTILIDAD INTESTINAL VACIAMIENTO GÁSTRICO:  Existe un retraso en el vaciamiento gástrico relacionado a RGE.  Retrasa el vaciamiento gástrico: Estimulación receptores duodenales por grasa, ácidos, CHO,

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triptófano o incremento de la osmolaridad.  Incremento de la densidad calórica 0,2-0,66 Kcal /ml disminuye la tasa de vaciamiento gástrico en los RN de Marketing

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32 -39 Sem.  Osmolaridad 279-448mOsm /L no alteran vaciamiento 5/5/12  

MOTILIDAD INTESTINAL VACIAMIENTO GÁSTRICO This website stores data such as cookies to enable essential site functionality, as well as marketing,  personalization, and analytics. You may change your settings at any time or accept the default settings.

El patrón de VG es afectado por la composición de los alimentos.  Más rápido: TGCM que TGCL. Polímeros de glucosa que lactosa o glucosa. Leche humana que fórmula.

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Densidad calórica directamente relacionada al VG. 5/5/12  Alteran el VG: trastornos electrolíticos, 

 

MOTILIDAD INTESTINAL 28 sem: motilidad intestinal poco desarrollada.  27-30 sem: patrones de motilidad desorganizados.  33-34 sem: patrón de motilidad maduro.  Transito gastroanal: 8-96h en RNPT. 

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El DMI puede ser inducida por:  cortico terapia materna y neonatal.  alimentación hipocalórica temprana.

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El rec recee tor de la motili motilina na su libera liberació ciónn cíc cíclic licaa no

MOTILIDAD INTESTINAL Alimentación trófica acorta el tiempo de tránsito intestinal.  Son efectivos volúmenes tan bajos como 4 ml/kg/d. ml/kg/d.  Infusiones lentas (2 horas) incrementan la respuesta motora duodenal y el VG en RNPT*.  Fórmulas diluidas (6.6 cal/onza) no son tan efectivas como las fórmulas concentradas (13.2-21 cal/onza) para estimular la la motilidad intestinal.  Leche humana: efecto positivo sobre la MI. 

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MOTILIDAD INTESTINAL TRÁNSITO INTESTINAL PROLONGADO EN EL RNPT: This website stores data such as cookies to enable essential site functionality, as well as marketing,  personalization, and analytics. You may change your settings at any time or accept the default settings.

Capa muscular intestinal inmadura.  Ondas peristálticas no coordinadas.

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Incremento en el número de ondas antiperistálticas.  Secreción disminuida de hormonas GI. Marketing

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5/5/12  

MOTILIDAD INTESTINAL 

La motilidad colónica está pobremente desarrollada hasta cerca al término de la gestación.

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RNPT demora el pasaje de meconio. RNAT pasa su primer meconio en las 48 horas de vida.

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RNPT puede demorar en eliminar eliminar su primer meconio hasta después de la primera semana de vida.

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Tiempo total del TI (boca-ano) en el RNAT:13.4± 4.4 horas. 5/5/12

 

MOTILIDAD INTESTINAL INTOLERANCIA ORAL se presenta cuando: This website stores data such as cookies to enable essential site functionality, as well as marketing,  personalization, and analytics. You may change your settings at any time or accept the default settings.

El tiempo de vaciamiento gástrico es mayor.  Tienen una actividad motora intestinal anormal.

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Las fórmulas con densidades calóricas pueden inhibir la respuesta GI en neonatos conaltas intolerancia oral.

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5/5/12  

DIGESTIÓN DE PROTEÍNAS 

Secreción gástrica es limitada en el RN MBPN (10% adulto)

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En las primeras 24 -48h: pH intragastrico 5.5 -7.0. La secreción ácida se duplica de la primera a cuarta semana de vida postnatal.

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Uso de inhibidores H2?.  El acido gástrico sirve como barrera frente a microorganismos. 

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5/5/12  

DIGESTIÓN DE PROTEÍNAS

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Disminución de enzimas relacionadas a la digestión

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de proteínas esta limitada en RNPT. 3-8 meses: Secreción de pepsina desarrollada.

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Niveles de pepsina menores en RNPT.

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5/5/12  

DIGESTIÓN DE PROTEÍNAS

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5/5/12  

DIGESTIÓN DE LÍPIDOS 50% del contenido energético no proteico  Acido linoleico y linolénico. linolénico. 

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El recién nacido presenta función pancreática inmadura.  La lipasa estimulada por los ácidos biliares está presente en la LM.  RN MBPN: La concentración duodenal de ácidos biliares es baja debido a una menor síntesis y reabsorción ileal.

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Menor absorción de lípidos : Ácidos grasos de cadena 5/5/12 larga.

 

DIGESTIÓN DE LÍPIDOS

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DIGESTIÓN DE LÍPIDOS

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DIGESTIÓN DE CARBOHIDRATOS Lactosa de LM, polímeros de glucosa, sucrosa.  Las enzimas intestinales (lactasa, sucrasa , maltasa, isomaltasa y glucoamilasa) están maduros en el RNAT.  La actividad de la amilasa pancreática son bajos.  RNPT: La sucrasa, maltasa e isomaltasa están maduras.  La actividad de la lactasa incrementa desde las 24 a 40 sem (< 25%) 

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La NEM incrementa la actividad de la actividad de la 5/5/12 lactasa en el RNPT.

 

DIGESTIÓN DE CARBOHIDRATOS

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5/5/12  

INMUNIDAD INTESTINAL El intestino es estéril intraútero  Sistema inmune innato:  Epitelio intestinal  Células de globet (secretan mucina) 

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Células Paneth: péptidos antimicrobianos, lisozimade y fosfolipasa A2).Eficiente:24 semanas de gestación.

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Los enterocitos y cel de globet aparecen 8 semanas.  Flora comensal*The *The intestinal Inmune barrier.Neoreviews.2009:10 5/5/12  

INMUNIDAD INTESTINAL

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Las células de Paneth producen péptidos antimicrobian os

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INMUNIDAD This website stores data such as cookies to enable essential site functionality, as well as marketing, personalization, and analytics. You may change your settings at any time or accept the default settings.

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INTESTINAL

5/5/12  

NUTRICIÓN ENTERAL MÍNIMA Estimula la liberación de hormonas digestivas y la actividad enzimática. Inmunonutrientes.  Favorece flujo sanguíneo y motilidad intestinal. 

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5/5/12  

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