Small intestine

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

WikiDoc Resources for Small intestine
Articles
Most recent articles on Small intestine Most cited articles on Small intestine Review articles on Small intestine Articles on Small intestine in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Small intestine Images of Small intestine Photos of Small intestine Podcasts & MP3s on Small intestine Videos on Small intestine
Evidence Based Medicine
Cochrane Collaboration on Small intestine Bandolier on Small intestine TRIP on Small intestine
Clinical Trials
Ongoing Trials on Small intestine at Clinical Trials.gov Trial results on Small intestine Clinical Trials on Small intestine at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Small intestine NICE Guidance on Small intestine NHS PRODIGY Guidance FDA on Small intestine CDC on Small intestine
Books
Books on Small intestine
News
Small intestine in the news Be alerted to news on Small intestine News trends on Small intestine
Commentary
Blogs on Small intestine
Definitions
Definitions of Small intestine
Patient Resources / Community
Patient resources on Small intestine Discussion groups on Small intestine Patient Handouts on Small intestine Directions to Hospitals Treating Small intestine Risk calculators and risk factors for Small intestine
Healthcare Provider Resources
Symptoms of Small intestine Causes & Risk Factors for Small intestine Diagnostic studies for Small intestine Treatment of Small intestine
Continuing Medical Education (CME)
CME Programs on Small intestine
International
Small intestine en Espanol Small intestine en Francais
Business
Small intestine in the Marketplace Patents on Small intestine
Experimental / Informatics
List of terms related to Small intestine

In biology the small intestine is the part of the gastrointestinal tract (gut) between the stomach and the large intestine and comprises the duodenum, jejunum, and ileum. It is where the vast majority of digestion takes place.

In humans over 5 years old it is approximately 7 m (21 ft) long and can vary from 4-7 m (13.12-22.97 ft).

It is divided into three structural parts:

• Duodenum 26 cm (9.84 in) in length
• Jejunum 2.5 m (8.2 ft)
• Ileum 3.5 m (11.5 ft)

Although the small intestine is much longer than the large intestine (typically 4-5 times longer), it is referred to as such due to its comparatively smaller diameter. On average, the diameter of the small intestine of an adult human measures approximately 2.5-3cm, and the large intestine measures about 7.6 cm in diameter. This is where bile is released into, from the gall bladder.

Peristalsis

Food from the stomach is allowed into the duodenum by a muscle called the pylorus, or pyloric sphincter, and is then pushed through the small intestine by a process of muscular-wavelike contractions called peristalsis.

Extensions into lumen

The small intestine is the site where most of the nutrients from ingested food are absorbed and is covered in wrinkles or folds called plicae circulares. These 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 (The latin word meaning "shaggy hair"). The small intestine is lined with simple columnar epithelial tissue. The epithelial cells also have finger-like projections known as microvilli. The function of the plicae circulares, the villi and the microvilli is to increase the amount of surface area available for secretion of enzymes and absorption of nutrients.

Absorption

Small intestine

The purpose of these wrinkles and projections is to increase surface area for absorption of nutrients. Each villus is covered in microvilli, which increase the surface area manyfold. Each villus contains a lacteal and capillaries. The lacteal absorbs the digested fat into the lymphatic system which will eventually drain into the circulatory system. The capillaries absorb all other digested nutrients.

The surface of the cells on the microvilli are covered with a [[water layer," has a number of functions in absorption of nutrients.

Absorption of the majority of nutrients takes place in the jejunum, with the following notable exceptions:

• Iron is absorbed in the duodenum
• Vitamin B12 and bile salts are absorbed in the terminal ileum.
• Water and lipids are absorbed by passive diffusion throughout
• Sodium is absorbed by active transport and glucose and amino acid co-transport.
• Fructose is absorbed by facilitated diffusion.

Digestion

The digestion of proteins into peptides and amino acids principally occurs in the stomach but some also occurs in the small intestine. The small intestine is where the most chemical digestion takes place:

• peptides are degraded into amino acids. Chemical break down begins in the stomach and is further broken down in the small intestine. Proteolytic enzymes, trypsin and chymotrypsin, which are secreted by the pancreas 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 is secreted here. Pancreatic lipase breaks down triglycerides into free fatty acids and monoglycerides. Pancreatic lipase performs its job with the help of bile salts. Bile salts attach to triglycerides which aids in making them easier for pancreatic lipase to access. 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 are the "middle man" that holds 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.
• carbohydrates are degraded into simple sugars (e.g., glucose). In the small intestine pancreatic amylase breaks down carbohydrates into oligosaccharides. 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.

Histology

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:

Layer	Duodenum	Jejunum	Ileum
serosa	normal	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. Villi very long.	Similar to duodenum. Villi very short.

Small intestine disorders

• Small intestine cancer
• Small intestine obstruction ("high" mechanic ileus)
  • Obstruction from external pressure
  • Obstruction by masses in the lumen (foreign bodies, bezoar, gallstones)
• Paralytic ileus
• Maropthisis
• Crohn's disease
• Celiac disease
• Carcinoid
• Meckel's Diverticulum
• Gastric dumping syndrome
• Infectious diseases
  • Giardiasis
  • Scariasis
  • Tropical sprue
  • Tapeworm infection
• Mesenteric ischemia
• Short bowel syndrome
• Inguinal hernia

References

• Template:KMLEref
• 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. PMID 12924651.CS1 maint: Multiple names: authors list (link)
• 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. PMID 12924652.CS1 maint: Multiple names: authors list (link)

Additional images

• 

  Lower half of right sympathetic cord.

• 

  Topography of thoracic and abdominal viscera.

Template:Digestive system

Template:WikiDoc Sources