SMALL INTESTINE

2
 INTRODUCTION
The intestine, which is the longest part of the
digestive tube, is divided into small intestine
and large intestine.

Food has to be digested , metabolised and

stored for expulsion in the intestines.

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 THE SMALL INTESTINE
• The small intestine extends from the pylorus to
the ileocaecal junction.
• It is about 6 meter long.
• It is approximately 2.5–3 cm in diameter.
• The surface area of the human small intestinal
mucosa averages 30 square meter

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 THE SMALL INTESTINE
• The length is greater in males than in females.
• It receives bile juice and pancreatic juice
through the pancreatic duct, controlled by the
sphincter of Oddi.
• Ileocecal sphincter
– Transition between small and large intestine

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Regions of the Small Intestine

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 SMALL INTESTINE

The small intestine is divided

• Duodenum
• Jejunum
• Ileum.

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DUODENUM
 INTRODUCTION
• First, Shortest, widest, and most
fixed part of small intestine
• Do-deka-dactulos -12 fingers
breadth
• Length = combined width of 12
fingers
• Mostly retroperitoneal (except
1st part)
• C shaped, encloses the head of
the pancreas
• Location :- epigastric and
umbilical region
Subdivided into four parts
• First or upper part –2inches/ 5cm
• Second or vertical part –3inches/ 7.5cm
• Third or horizontal part –4inches/10cm
• Fourth or ascending part – 1inch/ 2.5cm
 Development
2 sources
Part proximal to opening of hepatopancreatic duct – from foregut
Distal – from midgut
Since foregut is supplied by celiac artery and the midgut is
supplied by superior mesenteric artery, duodenum is supplied by
branches of both arteries

Arterial supply
Upto level of opening of hetapopancreatic duct – sup.
Pancreaticoduodenal
Below – Inf. Pancreaticoduodenal
venous drainage – splenic , superior mesenteric and portal vein
Jejunum and Ileum
 Jejunum and ileum
• Measures about 20 feet (6m)
• Extent – duodenojejunal flexure to the ileocaecal junction
• Proximal 2/5th jejunum (8feet)
• Distal 3/5th ileum (12feet)
• Freely mobile

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 Attached to posterior
abdominal wall by
mesentery
 illeum
Jejunum

• External feature:
– Diameter : 4cm – 3.5 cm
– Proximal 2/5th – Distal 3/5th
– Occupies : hypogastric and pelvic
– Usually occupies umbilical region
region
 Differences between Jejunum and Illeum
Features Jejunum Illeum

Location Occupies upper part of the Occupies lower part of

intestinal areas the intestinal area

Walls Thicker and more vascular Thinner and less

vascular

Lumens Wider and often empty Narrower and often

loaded
Features a. Jejunum a. Ileum

Mesentry a. Arterial arcades 1 or 2 a. Arterial arcades 3 or

b. Vasa recta longer and 6
fewer b. Vasa recta shorter
c. Less fat and more numerous
d. Windows c. More fat
present/Translucent d. No
windows windows/opaque

Circular mucosal Larger and more closely set Smaller and sparse
folds
Villi Large, thick leaf like and Shorter,
more abundant thinner(fingerlike) and
less abundant
Peyer’s patches Absent Present
Lymphatic follicles Fewer More numerous
 Plicae circulares
• Plicae circulares: The circular folds
(valves of Kerckring) (also,plicae
circulares / valvulae conniventes) are large
valvular flaps projecting into the lumen of
the small intestine.
• They begin in the second part of the
duodenum.

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 The intestinal villi
• The intestinal villi are finger –like projections of
mucous membrane, just visible to the naked eye.
• They give the surface of the intestinal mucosa a
velvety appearance.
• They are large and numerous in the duodenum and
jejunum, but are smaller and fewer in the ileum.
• They are vary in density from 10 to 40 per sq.
millimeter, and are about 1 to 2 mm long.

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 Blood supply:-
– Branches from superior mesenteric artery and drained
by corresponding veins.
Lymphatic drainage
 Nerve supply
• Sympathetic – T10- T11
• Parasympathetic - vagus
 Development
• From midgut, development of midgut is
characterised by rapid elongation of the gut and its
mesentery, resulting in the formation of primary
intestinal loop.
• The cephalic limp of loop develops into the distal
part of the duodenum, the jejunum and part of the
ilium.
• The caudal limb of loops become lower portion of
ilium, the cecum, the appendix, ascending colon
and the proximal 2/3rd of the transverse colon
 Physiological umbilical herniation
• Development of primary intestinal loop is
characterised by rapid elongation, particularly
of cephalic limb.
• As a result of rapid growth and expansion of
liver, abdominal cavity temporarily becomes
smaller to contain the umbilical cord during
the 6th week of development resulting in the
physiological umbilical herniation.
 Rotation of the midgut
• Primary intestinal loop rotates around an axis
formed by the superior mesenteric artery.
• When viewed from the front , this rotation is
counter clockwise , approx 270* when
complete.
• 90* during herniation and 180* during return
to abdominal cavity.
• Retraction of loops occurs during 10th week.
 Congenital anomalies
• Omphalocele
• gastroschisis
 Applied anatomy
• Intussusception
• Volvulus
• Typhoid
• Paralytic ileus
Microscopy