Diagram showing the small intestine
|Artery||Superior mesenteric artery|
|Vein||Hepatic portal vein|
|Nerve||Celiac ganglia, vagus |
|Lymph||Intestinal lymph trunk|
The small intestine (or small bowel) is the part of the gastrointestinal tract following the stomach and followed by the large intestine, and is where much of the digestion and absorption of food takes place. The small intestine is composed of a duodenum, jejunum, and ileum. It receives bile juice and pancreatic juice through the hepatopancreatic duct, controlled by the sphincter of Oddi. In invertebrates such as worms, the terms "gastrointestinal tract" and "large intestine" are often used to describe the entire intestine. This article is primarily about the human gut, though the information about its processes is directly applicable to most placental mammals. The primary function of the small intestine is the absorption of nutrients and minerals found in food. (A major exception to this is cows; for information about digestion in cows and other similar mammals, see ruminants.)
The average length of the small intestine in an adult human male is 6.9 m (22 ft 8 in), and in an adult female 7.1 m (23 ft 4 in). It can vary greatly, from as short as 4.6 m (15 ft) to as long as 9.8 m (32 ft). It is approximately 2.5–3 cm in diameter. The surface area of the human small intestinal mucosa averages 30 square meter (Helander HF, Fändriks L. Surface area of the digestive tract – revisited. Scand J Gastroenterol 49: 681-9, 2014.)
The small intestine is divided into three structural parts:
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:
|serosa||1st part serosa, 2nd - 4th adventitia||normal||normal|
|muscularis externa||longitudinal and circular layers, with Auerbach's (myenteric) plexus in between||same as duodenum||same as duodenum|
|submucosa||Brunner's glands and Meissner's (submucosal) plexus||no BG||no BG|
|mucosa: muscularis mucosae||normal||normal||normal|
|mucosa: lamina propria||no PP||no PP||Peyer's patches|
|mucosa: intestinal epithelium||simple columnar. Contains goblet cells, Paneth cells||Similar to duodenum||?|
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. Most of the digestive enzymes that act in the small intestine are secreted by the pancreas and enter the small intestine via the pancreatic duct. Enzymes enter the small intestine in response to the hormone cholecystokinin, which is produced in the small intestine in response to the presence of nutrients. The hormone secretin also causes bicarbonate to be released into the small intestine from the pancreas in order to neutralize the potentially harmful acid coming from the stomach.
- Proteins are degraded into small peptides and amino acids before absorption. Chemical breakdown begins in the stomach and continues in the small intestine. Proteolytic enzymes, including trypsin and chymotrypsin, are secreted by the pancreas and cleave proteins into smaller peptides. Carboxypeptidase, which is a pancreatic brush border enzyme, splits one amino acid at a time. Aminopeptidase and dipeptidase free the end amino acid products.
- Lipids (fats) are degraded into fatty acids and glycerol. Pancreatic lipase breaks down triglycerides into free fatty acids and monoglycerides. Pancreatic lipase works with the help of the salts from the bile secreted by the liver and the gall bladder. Bile salts attach to triglycerides to help emulsify them, which aids access by pancreatic lipase. This occurs because the lipase is water-soluble but the fatty triglycerides are hydrophobic and tend to orient towards each other and away from the watery intestinal surroundings. The bile salts emulsify the triglycerides in the watery surroundings until the lipase can break them into the smaller components that are able to enter the villi for absorption.
- Some carbohydrates are degraded into simple sugars, or monosaccharides (e.g., glucose). Pancreatic amylase breaks down some carbohydrates (notably starch) into oligosaccharides. Other carbohydrates pass undigested into the large intestine and further handling by intestinal bacteria. Brush border enzymes take over from there. The most important brush border enzymes are dextrinase and glucoamylase which further break down oligosaccharides. Other brush border enzymes are maltase, sucrase and lactase. Lactase is absent in most adult humans and for them lactose, like most poly-saccharides, are not digested in the small intestine. Some carbohydrates, such as cellulose, are not digested at all, despite being made of multiple glucose units. This is because the cellulose is made out of beta-glucose, making the inter-monosaccharidal bindings different from the ones present in starch, which consists of alpha-glucose. Humans lack the enzyme for splitting the beta-glucose-bonds, something reserved for herbivores and bacteria from the large intestine.
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 the small intestine is lined with simple columnar epithelial tissue. Structurally, the mucosa is covered in wrinkles or folds called plicae circulares, which are considered permanent features in the wall of the organ. They are distinct from rugae which are considered non-permanent or temporary allowing for distention and contraction. From the plicae circulares 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 the plicae circulares, 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 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:
- Iron is absorbed in the duodenum.
- Vitamin B12 (Extrinsic factor) and bile salts are absorbed in the terminal ileum.
- Water and lipids are absorbed by passive diffusion throughout the small intestine.
- Sodium bicarbonate is absorbed by active transport and glucose and amino acid co-transport.
- Fructose is absorbed by facilitated diffusion.
The small intestine 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.
- Small intestine obstruction or obstructive disorders
- Infectious diseases
- Tropical sprue
- Tape worm (Diphyllobothrium latum, Taenia Solium, Taenia solium, Hymenolepsis nana)
- Hookworm (e.g. Necator americanus, Ancylostoma duodenale)
- Nematodes (e.g. Ascaris lumbricoides)
- Other Protozoa (e.g. Cryptosporidium parvum, Isopora belli, Cyclospora, Microsporidia, Entamoeba histolytica)
- Bacterial Infections
- Enterotoxigenic E. coli
- Salmonella enterica
- Clostridium difficile (antibiotic-associated colitis, Pseudomembranous Colitis
- Mycobacterium (disseminated Mycobacterium tuberculosis)
- Whipple's Disease
- Vibrio (Cholera)
- Enteric (Typhoid) Fever (Salmonella enterica var. typhii) and Paratyphoid fever
- Bacillus cereus
- Clostridium perfringens (Gas Gangrene)
- Viral Infections
- Small bowel bacterial overgrowth syndrome
- Neoplasms (Cancers)
- Developmental, Congenital or Genetic Conditions
- Duodenal (Intestinal) Atresia
- Hirschsprung's Disease
- Meckel's Diverticulum
- Pyloric Stenosis
- Pancreas Divisum
- Ectopic Pancreas
- Enteric duplication cyst
- Situs Inversus
- Cystic Fibrosis
- Persistent Urachus
- Disachharidase (lactase) deficiencies
- Primary Bile Acid Malsorption
- Gardner Syndrome
- Familial Adenomatous Polyposis Syndrome (FAP)
- Other Conditions
- Crohn's disease, and the more general Inflammatory Bowel Disease
- Typhlitis (neutropenic colitis in the immunosuppressed
- Coeliac disease (Sprue or Non-Tropical Sprue)
- Mesenteric ischemia
- Embolus or Thrombus of the Superior Mesenteric Artery or the Superior Mesenteric Vein
- Arteriovenous malformation
- Gastric dumping syndrome
- Irritable Bowel Syndrome
- Duodenal (Peptic) Ulcers
- Gastrointestinal perforation
- Lymphatic Obstruction due to various causes
- Diabetic Neuropathy
- Radiation Enterocolitis
- Drug Induced Injury
- Diversion Colitis
- Mesenteric cysts
- Peritoneal Infection
- Sclerosing Retroperitonitis
In other animals
The small intestine is found in all tetrapods and also in teleosts, although its form and length vary enormously between species. In teleosts, it 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, 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 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, 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 the entire length of the intestine, which is not subdivided into different regions.
The small intestine lies behind the greater omentum.
Small intestine in situ, greater omentum folded upwards.
Third state of the development of the intestinal canal and peritoneum, seen from in front (diagrammatic). The mode of preparation is the same as in Fig 400
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Notes and references
- Physiology at MCG 6/6ch2/s6ch2_30
- "Elsevier: Gray's Anatomy, 40th Edition".
- "Lea Brothers and Co. 1907: Surgical Applied Anatomy".
- Silk DB (1974). "Progress report. Peptide absorption in man". Gut 15 (6): 494–501. doi:10.1136/gut.15.6.494. PMC 1413009. PMID 4604970.
- Romer, Alfred Sherwood; Parsons, Thomas S. (1977). The Vertebrate Body. Philadelphia, PA: Holt-Saunders International. pp. 349–353. ISBN 0-03-910284-X.
- Sherwood, Lauralee (2006). Fundamentals of physiology: a human perspective (Third ed.). Florence, KY: Cengage Learning. p. 768. ISBN 0-534-46697-4.
- Solomon et al. (2002) Biology Sixth Edition, Brooks-Cole/Thomson Learning ISBN 0-03-033503-5
- Townsend et al. (2004) Sabiston Textbook of Surgery, Elsevier ISBN 0-7216-0409-9
- Thomson A, Drozdowski L, Iordache C, Thomson B, Vermeire S, Clandinin M, Wild G (2003). "Small bowel review: Normal physiology, part 1.". Dig Dis Sci 48 (8): 1546–64. doi:10.1023/A:1024719925058. PMID 12924651.
- Thomson A, Drozdowski L, Iordache C, Thomson B, Vermeire S, Clandinin M, Wild G (2003). "Small bowel review: Normal physiology, part 2.". Dig Dis Sci 48 (8): 1565–81. doi:10.1023/A:1024724109128. PMID 12924652.