SMALL INTESTINE

SMALL INTESTINE
one of the most important organs for immune defense
largest endocrine organ of the body
Starts from the pylorus and ends at the cecum

3 parts:
1. Duodenum
2. Jejunum
3. Ileum
ANATOMY
A. Duodenum:
Retro-peritoneal
The duodenum is demarcated from
the stomach by the pylorus and from
the jejunum by the ligament of Treitz
Supplied by the celiac artery & SMA
B. Jejunum:
Occupies upper left of the abdomen
Thicker wall and wider lumen than the
ileum
Mesentery has less fat and forms only
1-2 arcades
C. Ileum:
Occupies the lower right; has more fat
and forms more arcades
Contains Payers patches
 The small intestine
contains internal mucosal
folds known as plicae
circulares or valvulae
conniventes
 NORMAL EMBRYOLOGY

Primitive Gut Tube

Incorporation of the yolk
sac during craniocaudal
and lateral folding of the
embryo.
Foregut
Midgut
Hindgut
 CANALIZATION
Week 3 - The celiac and superior mesenteric arteries and veins are
derived from the vitelline vascular system, which in turn is derived
from blood vessels formed within the splanchnopleuric mesoderm
Week 4 - the mesoderm of the embryo splits.
Week 5 - duodenum becomes a retroperitoneal structure
Week 6 - lumen of the developing bowel becomes obliterated as
bowel epithelial proliferation accelerates
Week 8 - Recanalization due to cell degeneration
Week 9 - lumen of the developing bowel becomes obliterated as
bowel epithelial proliferation accelerates. crypt-villus architecture
Week 12 - Organogenesis is complete
 FOREGUT

Foregut gives rise to:

Esophagus
Stomach
Liver
Gallbladder and bile ducts
Pancreas
Upper Duodenum
 MIDGUT
Lower Duodenum Cranial portion of the midgut.
Jejunum, ileum, cecum, appendix, ascending colon, and
proximal 2/3 of transverse colon Develop as the midgut loop
herniates through the primitive umbilical ring during umbilical
herniation at week 6.
The loop then rotates 270 degrees counterclockwise around
the superior mesenteric artery and returns to the abdominal
cavity.
 HINDGUT
Distal 1/3 of the transverse
colon, descending colon and
sigmoid colon develop from
the cranial end of the
hindgut.
Upper anal canal develops
from the terminal end of the
hindgut with the urorectal
septum dividing the upper
anal canal and the urogenital
sinus.
 ENTERIC NERVOUS SYSTEM

Collection of neurons in the GI tract.

Controls motility, exocrine and endocrine
secretion and microcirculation.
Regulates immune and inflammatory
process.
Functions independent of CNS.
 DEVELOPMENT OF ENTERIC
NERVOUS SYSTEM

Primarily derived from the vagal

segment of neural crest cells.
Cells initially migrate to the cranial
section and then caudally
Hindgut ganglia receive contributions of
cells from the cranial and sacral
segments of the neural crest cells
Interstitial cells of Cajal arise from the
local gut mesenchyme
 DEVELOPMENT OF THE ENTERIC
NERVOUS SYSTEM
Nerve cell bodies are grouped into ganglia
Ganglia are connected to bundles of nerves forming two
plexus
Myenteric (Auerbachs)
Submucosal (Meissners)
 ENTERIC NERVOUS SYSTEM
Myenteric plexus
Lies between the circular and longitudinal
muscles
Regulates
Motility
Secretomotor function to mucosa
Connections to
gallbladder and pancreas
sympathetic ganglia
esophageal striated muscle
 ENTERIC NERVOUS SYSTEM

Submucosal plexus
Lies between circular muscle layer and the muscularis
mucosa
Regulates:
Glandular secretions
Electrolyte and water transport
Blood flow
Similar structure found in gallbladder, cystic duct,
common bile duct and the pancreas
 PHYSIOLOGY
A. Digestion & Absorption:
. Solutes can traverse the epithelium by active or passive transport.
. Passive transport of solutes occurs through diffusion or convection and is driven by
existing electrochemical gradients.
. Active transport is the energy-dependent net transfer of solutes in the absence of
or against an electrochemical gradient.
- Water and Electrolyte Absorption and Secretion
. 8-9 L of fluid enters the small intestine daily. Most of this volume consists of
salivary, gastric, biliary, pancreatic, and intestinal secretions.
. normal conditions, the small intestine absorbs over 80% of this fluid, leaving
approximately 1.5 L that enters the colon
 Gut epithelia have two
pathways for water
transport:
(a)the paracellular route,
which involves transport
through the spaces
between cells
(b)the transcellular route,
through apical and
basolateral cell
membranes
- Carbohydrate Digestion and Absorption
Pancreatic amylase is the major enzyme of starch digestion,
although salivary amylase initiates the process.
The terminal products of amylase-mediated starch digestion
are oligosaccharides, maltotriose, maltose, and -limit
dextrins. These products, are unable to undergo absorption in
this form. They must first undergo hydrolytic cleavage into
their constituent monosaccharides;
these hydrolytic reactions are catalyzed by specific brush
border membrane hydrolases that are expressed most
abundantly in the villi of the duodenum and jejunum.
The three major monosaccharides that represent the terminal
products of carbohydrate digestion are glucose, galactose,
and fructose.
-Protein Digestion and Absorption
Protein digestion begins in the stomach with
action of pepsins.
Digestion continues in the duodenum with the
actions of a variety of pancreatic peptidases.
These enzymes are secreted as inactive
proenzymes
In response to the presence of bile acids,
enterokinase is liberated from the intestinal
brush border membrane to catalyze the
conversion of trypsinogen to active trypsin;
trypsin in turn activates itself and other
proteases.
The final products of intraluminal protein
digestion consist of neutral and basic amino
acids and peptides two to six amino acids in
length
- Fat Digestion and Absorption
fat is in the form of long-chain
triglycerides; includes phospholipids
such as lecithin, fatty acids,
cholesterol, and fatsoluble vitamins.
Over 94% of the ingested fats are
absorbed in the proximal jejunum.
fats is solubalization of them into an
emulsion by the mechanical actions of
mastication and antral peristalsis
Bile acids act as detergents that help
in solubalization of the lipolysis by
forming mixed micelles
- Vitamin and Mineral Absorption
In the duodenum, R protein is hydrolyzed by pancreatic enzymes
The cobalamin-intrinsic factor complex is able to escape hydrolysis by
pancreatic enzymes, allowing it to reach the terminal ileum, which expresses
specific receptors for intrinsic factor
Other water-soluble vitamins for which specific carriermediated transport
processes have been characterized include ascorbic acid, folate, thiamine,
riboflavin, pantothenic acid, and biotin.
Fat-soluble vitamins A, D, and E : absorbed through passive diffusion.
Vitamin K : absorbed through both passive diffusion and carrier-mediated
uptake.
Calcium is absorbed through both transcellular transport and paracellular
diffusion. The duodenum is the major site for transcellular transport
Iron and magnesium : absorbed through both transcellular and paracellular
routes
B. Barrier and Immune Function:
1. Major source of IgA
2. Integrity of the GUT wall prevents bacterial translocation into the wall of the
intestine and abdominal cavity which can lead to sepsis
3. Gut associated lymphoid tissue part of the immune defense system which clears
the abdominal cavity of pathogenic bacteria found in Peyers patches
C. Motility
Contraction of the outer longitudinal muscle layer results in
bowel shortening;
contraction of the inner circular layer results in luminal
narrowing.
Contractions of the muscularis mucosa contribute to mucosal
or villus motility, but not to peristalsis.
C. Endocrine Function: