The ileal pH ranges between 7 and 8, making it suitable for absorption of Vitamin

B12 and bile salts. The mucosal lining is specially designed with plicae circularis,
intestinal villi, and microvilli, which help in the absorption, which are more
[3]
prominent in the proximal, than in the distal ileum. The thumb-like villi resemble
the Christmas tree and are lined by simple columnar cells while the crypts of
Lieberkuhn are seen at the base of the mucosa. Cell regeneration takes place in the
crypt base, and the new cells migrate to the mucosal surface by 4-5 days, to maintain
a crypt to the villous ratio of around 1:4. [4],[5] Along with the vessels in lamina propria,
thin muscle fibers extend up to the villus tip, the contraction of which results in
villous movement. Ileal mucosa hosts a lot of cells with known diverse functions, as:
The stem cells, undifferentiated cells, goblet cells, paneth cells, absorptive cells,
enteroendocrine cells and M cells. The microvilli on the enterocytes increase the
luminal surface area to approximately 14-40 folds. It is covered by a glycocalyx coat,
which hosts various protective proteases, lysozymes, lactase, etc., secreted by the
underlying paneth cells. The acidic mucin-rich goblet cells are present at uniform
distances in between the absorptive cells and are highlighted by the alcian blue
staining at pH 2.5. These goblet cells also have a turnaround time similar to the
enterocytes; hence loss of goblet cells in ileal biopsy, suggests acute epithelial injury.
The paneth cells are flask-shaped, situated in between the crypt basal cells and are
identified by the presence of eosinophilic granules containing zinc, growth factors,
antimicrobial proteins like cryptdins and are destined to protect the enterocytes and
stem cells. The enteroendocrine cells are also present in the crypt base and can be
identified in a hematoxylin and eosin stained slide by the presence of a clear halo
around them. Among these, the 5 hydroxytryptamine containing cells predominate,
however, substance P, serotonin, vasoactive intestinal polypeptide, and somatostatin D
secreting cells are also noted. The hormones released by them, help in the regulation
[6]
of ileal secretion, absorption, motility, and mucosal cell proliferation. The mucosal
or submucosal nodular, encapsulated aggregates of about 2-5 cm in length,
[7]
comprising up to 300 lymphoid follicles, are called the Peyer's patches. The
mucosal lining epithelium just above the Peyer's patches is called mucosal dome,
which comprises the microfold cells (M), characterized by lack of mucin-secreting
ability and presence of microfolds, instead of the microvilli. Luminal antigens after
being picked up by the M cells, are included into the cytoplasmic pinocytotic vacuoles
and are then transported to the submucosal antigen presenting cells. Hence, these cells
are critical in producing intestinal immune reactive effector cells and memory cells. [8],
[9]
These effector cells then migrate and infiltrate the surface mucosal epithelium
(intraepithelial lymphocytes [IELs]). In physiological conditions, up to 4 lymphocytes
[10]
per 100 IELs are noted in the ileum. Like other parts of small intestinal (SI), the
mucularis propria consists of an inner circular and outer longitudinal muscle layers
with a myenteric plexus in between. The serosa is the outermost layer, comprising
loose fibrous-collagenous tissue

H and E photomicrograph of oriented ileal mucosa ((a) 40) with paneth cells
((b) 100) peyer's patches and M cells (arrows) ((c) 40 and (d) 100).
Chromogranin stain shows enteroendocrine cells ((e) 100). Features of
acute ileitis: inflammed edematous villi ((f) 40) crypt abscesses, muco-
depletion (arrow) ((g) 100) ulceration ((h) 40) flattened epithelium ((i) 100)
and maintained test tube rack appearance of crypts ((j) 40). Features of
chronic ileitis: distorted crypt architecture with branching ((k) 40; (l) 100)
loss of mucosal crypts ((m) 40) pyloric metaplasia ((n) 40) and hypercrinia
(arrows) ((o) 40)

PH ileum berkisar antara 7 dan 8, sehingga cocok untuk penyerapan Vitamin B12 dan
garam empedu. Lapisan mukosa dirancang khusus dengan circularis plika, vili usus,
dan mikrovili, yang membantu dalam penyerapan, yang lebih menonjol di proksimal,
daripada di ileum distal.[3]Vili ibu jari seperti menyerupai pohon Natal dan dilapisi
oleh sel-sel kolumnar sederhana sementara kriptus dari Lieberkuhn terlihat di dasar
mukosa. Regenerasi sel terjadi di dasar bawah tanah, dan sel-sel baru bermigrasi ke
permukaan mukosa 4-5 hari, untuk menjaga crypt untuk rasio vili dari sekitar 1: 4. [4].
[5]
Seiring dengan kapal di lamina propria, serat otot tipis memperpanjang hingga
ujung vili, kontraksi yang menyebabkan gerakan vili. mukosa ileum host banyak sel
dengan fungsi yang beragam dikenal, sebagai: Sel-sel induk, sel-sel dibeda-bedakan,
sel goblet, Paneth sel, sel-sel absorptive, sel enteroendokrin dan sel M. Mikrovili pada
enterosit meningkatkan luas permukaan luminal sekitar 14-40 lipatan. Hal ini ditutupi
oleh mantel glycocalyx, yang menjadi tuan rumah berbagai protease pelindung,
lysozymes, laktase, dll, yang disekresikan oleh sel-sel Paneth yang mendasari. Sel-sel
goblet kaya musin asam yang hadir pada jarak seragam di antara sel-sel serap dan
disorot oleh pewarnaan biru alcian pada pH 2,5. Sel-sel goblet juga memiliki waktu
penyelesaian mirip dengan enterosit; maka hilangnya sel goblet di biopsi ileum,
menunjukkan cedera epitel akut. Sel-sel Paneth yang flask berbentuk, terletak di
antara sel-sel basal crypt dan diidentifikasi oleh kehadiran butiran eosinophilic
mengandung zinc, faktor pertumbuhan, protein antimikroba seperti cryptdins dan
ditakdirkan untuk melindungi enterosit dan sel induk. Sel-sel enteroendokrin juga
hadir di dasar bawah tanah dan dapat diidentifikasi dalam hematoxylin dan eosin
geser patri oleh kehadiran halo jelas di sekitar mereka. Di antaranya, 5 sel
hydroxytryptamine mengandung mendominasi, namun, substansi P, serotonin,
polipeptida intestinal vasoaktif, dan somatostatin D sel mensekresi juga mencatat.
Hormon-hormon yang dikeluarkan oleh mereka, membantu dalam regulasi sekresi
ileum, penyerapan, motilitas, dan proliferasi sel mukosa.[6] Mukosa atau submukosa
nodular, dikemas agregat sekitar 2-5 cm panjangnya, terdiri dari sampai dengan 300
[7]
folikel limfoid, disebut patch Peyer. Epitel lapisan mukosa di atas patch Peyer
disebut kubah mukosa, yang terdiri dari sel m (M), ditandai dengan kurangnya
kemampuan mucin mensekresi dan kehadiran microfolds, bukan mikrovili tersebut.
antigen luminal setelah dijemput oleh sel M, termasuk ke dalam vakuola pinocytotic
sitoplasma dan kemudian diangkut ke sel-sel antigen submukosa menyajikan. Oleh
karena itu, sel-sel ini sangat penting dalam memproduksi usus kekebalan reaktif sel
efektor dan sel memori.[8].[9]Sel-sel efektor ini kemudian bermigrasi dan menyusup
epitel mukosa permukaan (limfosit intraepithelial [IELs]). Dalam kondisi fisiologis,
hingga 4 limfosit per 100 IELs dicatat di ileum.[10]Seperti bagian lain dari usus kecil
(SI), yang mucularis propria terdiri dari lingkaran dalam dan luar lapisan otot
memanjang dengan pleksus myenteric di antara. serosa adalah lapisan terluar, terdiri
jaringan fibrosa-kolagen longgar

H dan E fotomikrograf dari berorientasi mukosa ileum ((a) 40) dengan sel
Paneth ((b) 100) patch Peyer dan sel M (panah) ((c) 40 dan (d) 100).
Chromogranin noda menunjukkan sel enteroendokrin ((e) 100). Fitur ileitis
akut: inflammed villi edema ((f) 40) abses crypt, muco-deplesi (panah) ((g)
100) ulserasi ((h) 40) diratakan epitel ((i) 100) dan dipelihara tabung rak
penampilan kriptus ((j) 40). Fitur ileitis kronis: terdistorsi arsitektur crypt
dengan percabangan ((k) 40; (l) 100) kehilangan diabadikan mukosa ((m)
 40) metaplasia pyloric ((n) 40) dan hypercrinia (panah) (( o) 40)