Anatomy of Small
intestine
-Dr. Damini
EMBRYOLOGY
• The primitive gut is formed by the endodermal lining, the yolk sac which
is enveloped by the developing embryo as a result of cranial and caudal
folding during the 4th week of gestation.
• Endodermal layer epithelial lining
• Splanchnic mesoderm muscular connective tissue and other layers
• Duodenum – is a primitive foregut structure ; rest of the small intestine –
midgut
• 5th week – herniation (persists upto 10 weeks)
• Vitellointestinal duct
• Note – duodenum develops partly from the foregut and partly from
the midgut.
• The opening of the bile duct into the second part of the duodenum
represents the junction of the foregut and midgut.
• -- hence the blood supply of the upper and lower half of the
duodenum differs
Gross anatomy
• Entire small intestine extends from pylorus to the cecum (270-290cm)
• Upper part – fixed - Duodenum (~20cm)
• Lower part – mobile – convoluted tubule
• Jejunum (~100cm)
• Ileum (~150cm)
• The coils of the jejunum and ileum are freely mobile
• Attached to the posterior abdominal wall by a fan shaped fold of
peritoneum known as the mesentery of the small intestine.
• The long free edge encloses the mobile intestine.
• The short root continues with the parietal peritoneum on the
posterior abdominal wall.
• The root of the mesentery permits entrance and exit of the branches
of the SMA, vein, lymphatic vessels, nerves into the space between
the 2 layers of the peritoneum forming the mesentery.
Wall
Duodenum
• The duodenum is a short structure (about 20-25 cm long) continuous
with the stomach and shaped like a “C”
• It lies above the level of the umbilicus, opposite 1st, 2nd , 3rd lumbar
vertebrae
• It surrounds the head of the pancreas
• It receives gastric juices from the stomach, together with digestive
juices from the pancreas (digestive enzymes) and gall bladder (bile)
• The digestive enzymes break down the proteins and bile and emulsify
fats into micelles.
Duodenum is divided
into 4 parts :
First (superior) part
Second (descending)
part
Third (horizontal) part
Fourth (ascending) part
Relations of the First part of
duodenum
Relations of second part of
duodenum
• Second part is 8-10 cm long, descends along the right sides of L1 through L3 vertebrae
Interior of second part of duodenum
• About half way down its medial border the bile duct and main
pancreatic duct pierce into the duodenal wall.
• Unite to form the ampulla – opens on the summit of the major
duodenal papilla
• The accessory pancreatic duct if present opens a little higher up
(1.9cm from major) on minor duodenal papilla
Relations of third part of duodenum
Suspensory muscle of the
duodenum / Ligament of Treitz
This is a fibromuscular band which suspends and supports the
duodenojejunal flexure
Blood supply of Duodenum
Arterial Supply Venous Supply
• Superior pancreaticoduodenal • The veins of the duodenum
artery (branch of drain into the splenic, superior
gastroduodenal artery supplies mesenteric, portal veins
upper half) • (superior pancreaticoduodenal
• Inferior pancreaticoduodenal vein drains into the portal vein)
artery (branch of the SMA
supplies the lower half )
Lymphatic drainage
• The upper duodenum drains upward via the pancreaticoduodenal
nodes to the gastroduodenal nodes and then to the celiac nodes
• The lower duodenum drains downwards via the pancreaticoduodenal
nodes to the superior mesenteric nodes around the origin of the SMA
infront of the aorta.
Nerve supply
Physiology
• The stomach initiates the
process of digestion with the
breakdown of solids to
particles 1 mm or smaller,
which are then delivered to the
duodenum, where pancreatic
enzymes, bile and brush
border enzymes continue the
process of digestion and
eventual absorption through
the small intestinal wall.
Carbohydrate digestion
• Brush border of small intestine contains lactase, maltase, sucrase-
isomaltase, trehalase – which split the disaccharides as well as other
small glucose polymers into their monosaccharides
• Lactase glucose & galactose
• Maltase maltose & 2 glucose
• Carbs absorbed as monosaccharides
• -- transported by active transport – 3 membrane carrier mechanisms
• SGLT - 1, GLUT - 5, GLUT - 2
Protein digestion
• Initiated in the stomach- gastric acid denatures proteins
• Pancreatic trypsinogen secreted in inactive form from pancreas –
activated by enterokinase – forms trypsin
• Trypsin then activates other pancreatic proteolytic enzyme precursors
• Endopeptides (trypsin, chymotrypsin,elastase) act on peptide bonds –
removes single amino acid from the carboxyl end of the peptide
• The amino acids, dipeptides, tripeptides are transported through the
microvilli epithelial cell membrane portal venous system
Fat digestion
• Essentially all fat digestion occurs in the small intestine – breakdown of
fat globules by water soluble digestive enzymes – emulsification
• This process is facilitated by bile from the liver, which contains bile salts
and phospholipid lecithin
• Secondary to amphipathic nature – micelles can be formed – small
spherical globules composed of 20-40 molecules of bile salts with sterol
nucleus that is highly is highly fat soluble and a hydrophilic polar group
that projects outwards.
• Enterohepatic circulation – total bile acid pool (2-3g), recirculates 6 times
every 24 hours, almost all bile salts reabsorbed 0.5g lost in stools daily
Absorption
Movements of small intestine
• Food particles are propelled through the small bowel by a complex
series of muscle contractions.
• Peristalsis consists of intestinal contractions at 1-2 cm/sec
• Helps in movement of intestinal chyme through the intestine
• Pacesetter potentials which originate in the duodenum, initiate a
series of contractions in the fed state that propel food throughout the
small bowel.
• During the interdigestive period (fasting period) between meals, the
bowel is regularly swept by cyclical contractions every 75-90 minutes.
• Sympathic activity inhibits motor function, parasympathetic activity
stimulates it.
• Types of movements of small intestine :-
• Rhythmic segmentation contractions
• Peristaltic movements
Migratory motor complex
• The periodic intense electrical activity seen in the empty stomach or
small intestine that last 3-6 min and spread from stomach to ileum is
called migratory motor complex.
• “sweeper”
• Segmentation movements – distension of the small intestine with
chyme stretches the intestinal wall and initiates segmentation
movements
• There are localized concentric contractions (about 1-2cm in length)
spaced at intervals along the intestine. They divide the intestine into
spaced segments.
• Maximum frequency is present in the duodenum (12 per min) and
proximal jejunum. In terminal ileum it is 8-9/min.
GI Hormones
Hormone Produced by Primary effect – Primary effect – inhibits
stimulates (+) (-)
Gastrin Antrum, duodenum (G cells) Gastric acid, pepsinogen
secretion
Cholecystokinin Duodenum, jejunum (I cells) Pancreatic enzyme secretion Relaxes sphincter of Oddi
GB contraction Inhibits gastric emptying
Secretin Duodenum (S cells) Release of water and bicarb Gastric acid secretion and
from pancreatic ductal cells, motility
flow and alkalinity of bile
Somatostatin Pancreatic islet (D cells), “universal switch off”
antrum, duodenum Inhibits release of all GI
hormones
Hormone Produced by Primary effect – Primary effect – inhibits
stimulates (+) (-)
Gastrin releasing peptide Small bowel “universal switch on”
Stimulates release of all GI
hormones except secretin
Gastrin inhibitory peptide Duodenum, jejunum (K cells) Pancreatic insulin release in Gastric acid and pepsin
response to hyperglycemia secretion
Motilin Duodenum, jejunum Upper GIT motility
Vasoactive intestinal peptide Neurons throughout the GIT Vasodilator, neuropeptide Gastric acid secretion
Open to all -
•Thank you
