ArticlesAnatomyAbdomenSmall intestine

ArticlesAnatomyAbdomenSmall intestine

Small intestine

Author: Jana Vasković, MD • Reviewer: Alexandra Osika
Last reviewed: November 03, 2023
Reading time: 11 minutes

The small intestine is the longest part of the digestive system. It extends from the stomach (pylorus) to the large intestine (cecum) and consists of three parts: duodenum, jejunum and ileum. The main functions of the small intestine are to complete digestion of food and to absorb nutrients.

Dysfunction of the small intestine can bring you some uneasy experiences such as diarrhea while travelling or worse, on a date. This article will discuss the anatomy, function and neurovasculature supply of the small intestines.

Key facts about the small intestine
Definition	A part of the alimentary tract which extends from the stomach (pyloric orifice) to the large intestine (ileal orifice)
Parts	Duodenum, jejunum, ileum
Blood supply	Arteries: celiac trunk, superior mesenteric artery Veins: hepatic portal vein, superior mesenteric vein
Innervation	Parasympathetic: vagus nerve (CN X) (through the submucosal (Meissner’s) and myenteric (Auerbach’s) nervous plexuses) Sympathetic: Thoracic splanchnic nerves
Function	Final stages of food digestion Absorption of nutrients and water
Clinical relations	Diarrhea, obstructive disorders, infectious diseases, neoplastic growths, congenital conditions, duodenal ulcer

Contents

Anatomy
1. Duodenum
2. Jejunum
3. Ileum
Histology
Function
Blood vessels
Innervation
Clinical relations
1. Duodenal ulcer
Sources
Related articles

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Anatomy

The small intestine is divided into the duodenum, jejunum, and ileum. Together these can extend up to six meters in length. All three parts are covered with the greater omentum anteriorly. The duodenum has both intraperitoneal and retroperitoneal parts, while the jejunum and ileum are entirely intraperitoneal organs. As the small intestine is the main site for the final stages of food digestion and its absorption, its gross and microanatomy are adjusted to that function.

Duodenum

The duodenum by definition is the first part of the small intestine. It extends from the pyloric sphincter of the stomach, wraps around the head of the pancreas in a C-shape and ends at duodenojejunal flexure. This flexure is attached to the posterior abdominal wall by a peritoneal fold called the suspensory muscle (ligament) of duodenum, also called the ligament of Treitz.

The duodenum has four parts: superior (duodenal bulb/ampulla), descending, horizontal and ascending. Among several features of the duodenum, we’ll list the two most important:

The superior part (duodenal bulb/ampulla) is the only intraperitoneal part, as the hepatoduodenal ligament and greater omentum attach to it.
The descending part of the duodenum has an opening called the major duodenal papilla (tubercle of Vater). The papilla contains the hepatopancreatic sphincter (sphincter of Oddi, Glissons’ sphincter) which regulates the emptying of the bile from the hepatopancreatic ampulla.

To learn more about the anatomy, histology and function of the duodenum check out our study materials.

Jejunum

The jejunum is the second part of the small intestine. It begins at the duodenojejunal flexure and is found in the upper left quadrant of the abdomen. The jejunum is entirely intraperitoneal as the mesentery proper attaches it to the posterior abdominal wall.

Learn the digestive system anatomy with our quizzes and free learning tools.

There is no clear line of demarcation between the jejunum and ileum, but there are some anatomical and histological differences that distinguish them:

The jejunum represents the proximal two-fifths of the jejunum-ileum continuum
The wall of the jejunum is thicker and its lumen is wider than in ileum
The jejunum contains more prominent circular folds of Kerckring

Ileum

The ileum is the last and longest part of the small intestine. It is found in the lower right quadrant of the abdomen, although the terminal ileum can extend into the pelvic cavity. The ileum terminates at the ileal orifice (ileocecal junction) where the cecum of the large intestine begins.

At the ileocecal junction, the lamina muscularis of the ileum protrudes into the lumen of the cecum forming a structure called the ileocecal fold. These muscular fibers form a muscular ring within the fold called the ileocecal sphincter which controls the emptying of ileal content into the large intestine.

Identify the main components of the digestive system with this beginner-friendly quiz.

Histology

Histologically, the small intestine has four layers. From internal to external, they are mucosa, submucosa, muscularis externa, and serosa. These layers are easy to remember using the mnemonic M.S.M.S. There are several unique features in the small intestine, which act to significantly increase its absorptive surface:

Circular folds (valves of Kerckring, plicae circulares) are the transverse folds of mucosa found predominantly in the distal duodenum and proximal jejunum
Intestinal villi are fingerlike extensions of intestinal mucosa which project into the lumen of the small intestine. Between the villi are intestinal glands (crypts of Lieberkuhn) which secrete intestinal juice rich in digestive enzymes.
Microvilli are projections found on the apical surface of each intestinal cell (enterocyte)

There are also features of the small intestine which are segment-specific:

Peyer's patches are part of gastrointestinal associated lymphoid tissue (GALT). They are found in ileum.
Brunner glands are found in the submucosa of the duodenum. They produce mucus rich in alkalines which protects the duodenum from the corrosive effects of gastric acid.

Master the microscopic anatomy of small intestine with our study unit or take the quiz if you already feel confident in this topic:

Function

The main functions of the small intestine are secretion and absorption. The epithelial cells of the small intestine secrete enzymes which digest chyme into the smallest particles, making them available for absorption. Concurrently the duodenum functions to mix food with bile and pancreatic enzymes to continue the digestion of carbohydrates, fats, and proteins.

Concerning absorption, carbohydrates and proteins are absorbed in the duodenum and jejunum respectively. The jejunum also functions to absorb most fats. The ileum function involves absorption of vitamin B12, bile salts and all digestion products which were not absorbed in duodenum and jejunum. All three small intestine segments absorb water and electrolytes.

Take this specially designed quiz to see how your well your small intestine knowledge has stuck!

Blood vessels

The duodenum is supplied by the branches of the celiac trunk and superior mesenteric artery (SMA); the superior, middle and inferior pancreaticoduodenal arteries.

The jejunum and ileum are supplied by 15-18 branches of the SMA called the jejunal and ileal arteries. They anastomose with each other to form arterial arcades which send numerous straight arteries (vasa recta) to the jejunum and ileum.

The small intestines drain into the hepatic portal vein. The lymph of the small intestine is drained into the superior mesenteric lymph nodes.

Master the blood vessels of the small intestine with this set of study materials.

Innervation

The small intestine is innervated by branches of the vagus nerve (CN X) and thoracic splanchnic nerves. Their nerve branches extend throughout the entire length of the small intestine in the form of two plexuses:

Submucosal plexus (of Meissner) found in the submucosa of the small intestine and contains only parasympathetic input from the vagus nerve (CN X)
Myenteric plexus (of Auerbach) located in the muscularis externa of the small intestine, contains both sympathetic and parasympathetic nerve fibers

Learn to differentiate between these layers really easily using a mnemonic! Just memorise 'SMP & MAPS', which stands for:

Submucosal
Meissner's
Parasympathetic

Myenteric
Auerbach's
Parasympathetic
Sympathetic

Reinforce your knowledge about the innervation of the small intestine with this quiz:

Clinical relations

Diarrhea is the frequent passage of unformed stool. In most cases, the diarrhea is caused by microorganisms such as Escherichia coli, Salmonella and Shigella.
Obstructive disorders including paralytic ileus, a hernia or volvulus are common but can become complicated.
Infectious diseases such as tapeworm, tropical sprue or giardiasis are rare but severe when left untreated. More common infections such as the adenovirus or salmonella are seen in the west.
Neoplastic growths may include gastrointestinal stromal tumors (GIST), lymphomas and sarcomas.
Developmental, congenital or genetic conditions include pyloric stenosis, duodenal atresia and gastroschisis.
Other conditions or a miscellaneous mixture of diseases that can affect the small intestine include Crohn’s disease, coeliac disease, gastric dumping syndrome and irritable bowel syndrome to name but a few.

Duodenal ulcer

An ulcer is a defect of intestinal mucosa. Ulcers can appear in the stomach and/or duodenum, usually due to a bacterial infection of the pylorus of the stomach with Helicobacter pylori combined with the corrosive effect of gastric acid and pepsin.

Duodenal peptic ulcers are usually found in the ampulla of duodenum. They appear more often within the younger population, contrasting with gastric ulcers which are more prevalent in the older population. The most common symptom of duodenal ulcers is the presence of burning pain in the epigastric region of the abdomen around 2-3 hours after a meal. Depending on the severity of ulceration, pain can be followed by nausea and vomiting.

Sources

All content published on Kenhub is reviewed by medical and anatomy experts. The information we provide is grounded on academic literature and peer-reviewed research. Kenhub does not provide medical advice. You can learn more about our content creation and review standards by reading our content quality guidelines.

References:

Drake, R. L., Vogl, A. W., & Mitchell, A. W. M. (2015). Gray’s Anatomy for Students (3rd ed.). Philadelphia, PA: Churchill Livingstone.
Kasper, D. L., Hauser, S. L., Jameson, J. L., et al. (2015). Harrison’s Principles of Internal Medicine (19th ed.). New York, NY: McGraw-Hill Education.
Moore, K. L., Dalley, A. F., & Agur, A. M. R. (2014). Clinically Oriented Anatomy (7th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Ross, M. H., Pawlina, W. (2011). Histology (6th edition). Philadelphia, PA: Lippincott Williams & Wilkins.

Illustrations:

Duodenum structure (diagram) - Begoña Rodriguez
Small intestine blood vessels (diagram) - Irina Münstermann
Small intestine innervation (diagram) - Irina Münstermann

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