The small intestine or small bowel is an organ in the gastrointestinal tract where most of the absorption of

nutrient A nutrient is a substance used by an organism to survive, grow, and reproduce. The requirement for dietary nutrient intake applies to animals, plants, fungi, and protists. Nutrients can be incorporated into cells for metabolic purposes or excr ...

s from food takes place. It lies between the stomach and large intestine, and receives

bile Bile (from Latin ''bilis''), or gall, is a dark-green-to-yellowish-brown fluid produced by the liver of most vertebrates that aids the digestion of lipids in the small intestine. In humans, bile is produced continuously by the liver (liver b ...

and pancreatic juice through the pancreatic duct to aid in

digestion Digestion is the breakdown of large insoluble food molecules into small water-soluble food molecules so that they can be absorbed into the watery blood plasma. In certain organisms, these smaller substances are absorbed through the small intest ...

. The small intestine is about long and folds many times to fit in the abdomen. Although it is longer than the large intestine, it is called the small intestine because it is narrower in diameter. The small intestine has three distinct regions – the duodenum, jejunum, and ileum. The duodenum, the shortest, is where preparation for absorption through small finger-like protrusions called villi begins. The jejunum is specialized for the absorption through its lining by enterocytes: small nutrient particles which have been previously digested by enzymes in the duodenum. The main function of the ileum is to absorb vitamin B₁₂, bile salts, and whatever products of digestion that were not absorbed by the jejunum.

Structure

Size

The length of the small intestine can vary greatly, from as short as to as long as , also depending on the measuring technique used. The typical length in a living person is . The length depends both on how tall the person is and how the length is measured. Taller people generally have a longer small intestine and measurements are generally longer after death and when the bowel is empty. It is approximately in diameter in newborns after 35 weeks of gestational age, and in diameter in adults. On abdominal X-rays, the small intestine is considered to be abnormally dilated when the diameter exceeds 3 cm. On

CT scan A computed tomography scan (CT scan; formerly called computed axial tomography scan or CAT scan) is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers ...

s, a diameter of over 2.5 cm is considered abnormally dilated. The surface area of the human small intestinal mucosa, due to enlargement caused by folds, villi and microvilli, averages .

Parts

The small intestine is divided into three structural parts. * The duodenum is a short structure ranging from in length, and shaped like a "C". It surrounds the head of the pancreas. It receives gastric chyme from the stomach, together with digestive juices from the

pancreas The pancreas is an organ of the digestive system and endocrine system of vertebrates. In humans, it is located in the abdomen behind the stomach and functions as a gland. The pancreas is a mixed or heterocrine gland, i.e. it has both an en ...

( digestive enzymes) and the

liver The liver is a major organ only found in vertebrates which performs many essential biological functions such as detoxification of the organism, and the synthesis of proteins and biochemicals necessary for digestion and growth. In humans, it ...

(

). The digestive enzymes break down proteins and bile

emulsifies An emulsion is a mixture of two or more liquids that are normally immiscible (unmixable or unblendable) owing to liquid-liquid phase separation. Emulsions are part of a more general class of two-phase systems of matter called colloids. Altho ...

fats into micelles. The duodenum contains Brunner's glands, which produce a mucus-rich alkaline secretion containing bicarbonate. These secretions, in combination with bicarbonate from the pancreas, neutralize the stomach acids contained in gastric chyme. * The jejunum is the midsection of the small intestine, connecting the duodenum to the ileum. It is about long, and contains the circular folds, and intestinal villi that increase its surface area. Products of digestion (sugars, amino acids, and fatty acids) are absorbed into the bloodstream here. The suspensory muscle of duodenum marks the division between the duodenum and the jejunum. * The ileum: The final section of the small intestine. It is about 3 m long, and contains villi similar to the jejunum. It absorbs mainly vitamin B12 and bile acids, as well as any other remaining nutrients. The ileum joins to the cecum of the large intestine at the ileocecal junction. The jejunum and ileum are suspended in the abdominal cavity by mesentery. The mesentery is part of the

peritoneum The peritoneum is the serous membrane forming the lining of the abdominal cavity or coelom in amniotes and some invertebrates, such as annelids. It covers most of the intra-abdominal (or coelomic) organs, and is composed of a layer of mesot ...

. Arteries, veins, lymph vessels and nerves travel within the mesentery.

Blood supply

The small intestine receives a blood supply from the celiac trunk and the superior mesenteric artery. These are both branches of the aorta. The duodenum receives blood from the

coeliac trunk The celiac () artery (also spelled ''coeliac''), also known as the celiac trunk or truncus coeliacus, is the first major branch of the abdominal aorta. It is about 1.25 cm in length. Branching from the aorta at thoracic vertebra 12 (T12) in ...

via the superior pancreaticoduodenal artery and from the superior mesenteric artery via the inferior pancreaticoduodenal artery. These two arteries both have anterior and posterior branches that meet in the midline and anastomose. The jejunum and ileum receive blood from the superior mesenteric artery. Branches of the superior mesenteric artery form a series of arches within the mesentery known as arterial arcades, which may be several layers deep. Straight blood vessels known as vasa recta travel from the arcades closest to the ileum and jejunum to the organs themselves.

Microanatomy

The three sections of the small intestine look similar to each other at a microscopic level, but there are some important differences. The parts of the intestine are as follows: Cross Section of a Small Intestine

Gene and protein expression

About 20,000 protein coding genes are expressed in human cells and 70% of these genes are expressed in the normal duodenum. Some 300 of these genes are more specifically expressed in the duodenum with very few genes expressed only in the small intestine. The corresponding specific proteins are expressed in glandular cells of the mucosa, such as fatty acid binding protein FABP6. Most of the more specifically expressed genes in the small intestine are also expressed in the duodenum, for example FABP2 and the

DEFA6 Defensin, alpha 6 (DEFA6) also known as human alpha defensin 6 (HD6) is a human protein that is encoded by the ''DEFA6'' gene. ''DEFA6'' is expressed in the Paneth cells of the ileum. Function The alpha defensins are a family of microbicida ...

protein expressed in secretory granules of Paneth cells.

Development

The small intestine develops from the midgut of the primitive gut tube. By the fifth week of

embryo An embryo is an initial stage of development of a multicellular organism. In organisms that reproduce sexually, embryonic development is the part of the life cycle that begins just after fertilization of the female egg cell by the male sperm ...

logical life, the ileum begins to grow longer at a very fast rate, forming a U-shaped fold called the

primary intestinal loop Primary or primaries may refer to: Arts, entertainment, and media Music Groups and labels * Primary (band), from Australia * Primary (musician), hip hop musician and record producer from South Korea * Primary Music, Israeli record label Works * ...

. The loop grows so fast in length that it outgrows the abdomen and protrudes through the umbilicus. By week 10, the loop retracts back into the abdomen. Between weeks six and ten the small intestine rotates anticlockwise, as viewed from the front of the embryo. It rotates a further 180 degrees after it has moved back into the abdomen. This process creates the twisted shape of the large intestine. File:Sobo 1906 399.png, First stage of the development of the intestinal canal and the peritoneum, seen from the side (diagrammatic). From colon 1 the ascending and transverse colon will be formed and from colon 2 the descending and sigmoid colons and the rectum. File:Sobo 1906 400.png, Second stage of development of the intestinal canal and peritoneum, seen from in front (diagrammatic). The liver has been removed and the two layers of the ventral mesogastrium (lesser omentum) have been cut. The vessels are represented in black and the peritoneum in the reddish tint. File:Sobo 1906 401.png, Third state of the development of the intestinal canal and peritoneum, seen from in front (diagrammatic). The mode of preparation is the same as in Fig 400

Function

Food from the stomach is allowed into the duodenum through the pylorus by a muscle called the pyloric sphincter.

Digestion

The small intestine is where most chemical digestion takes place. Many of the digestive enzymes that act in the small intestine are secreted by the

and

and enter the small intestine via the pancreatic duct. Pancreatic enzymes and

from the gallbladder enter the small intestine in response to the hormone cholecystokinin, which is produced in the response to the presence of nutrients. Secretin, another hormone produced in the small intestine, causes additional effects on the pancreas, where it promotes the release of bicarbonate into the duodenum in order to neutralize the potentially harmful acid coming from the stomach. The three major classes of nutrients that undergo digestion are

protein Proteins are large biomolecules and macromolecules that comprise one or more long chains of amino acid residues. Proteins perform a vast array of functions within organisms, including catalysing metabolic reactions, DNA replication, respon ...

lipid Lipids are a broad group of naturally-occurring molecules which includes fats, waxes, sterols, fat-soluble vitamins (such as vitamins A, D, E and K), monoglycerides, diglycerides, phospholipids, and others. The functions of lipids incl ...

s (fats) and

carbohydrate In organic chemistry, a carbohydrate () is a biomolecule consisting of carbon (C), hydrogen (H) and oxygen (O) atoms, usually with a hydrogen–oxygen atom ratio of 2:1 (as in water) and thus with the empirical formula (where ''m'' may or ...

s: * Proteins are degraded into small peptides and

amino acid Amino acids are organic compounds that contain both amino and carboxylic acid functional groups. Although hundreds of amino acids exist in nature, by far the most important are the alpha-amino acids, which comprise proteins. Only 22 alpha ...

s before absorption. Chemical breakdown begins in the stomach and continues in the small intestine. Proteolytic enzymes, including

trypsin Trypsin is an enzyme in the first section of the small intestine that starts the digestion of protein molecules by cutting these long chains of amino acids into smaller pieces. It is a serine protease from the PA clan superfamily, found in the d ...

and

chymotrypsin Chymotrypsin (, chymotrypsins A and B, alpha-chymar ophth, avazyme, chymar, chymotest, enzeon, quimar, quimotrase, alpha-chymar, alpha-chymotrypsin A, alpha-chymotrypsin) is a digestive enzyme component of pancreatic juice acting in the duod ...

, are secreted by the

and cleave proteins into smaller peptides. Carboxypeptidase, which is a pancreatic brush border enzyme, splits one amino acid at a time. Aminopeptidase and dipeptidase free the end amino acid products. * Lipids (fats) are degraded into

fatty acid In chemistry, particularly in biochemistry, a fatty acid is a carboxylic acid with an aliphatic chain, which is either saturated or unsaturated. Most naturally occurring fatty acids have an unbranched chain of an even number of carbon atoms, ...

s and

glycerol Glycerol (), also called glycerine in British English and glycerin in American English, is a simple triol compound. It is a colorless, odorless, viscous liquid that is sweet-tasting and non-toxic. The glycerol backbone is found in lipids know ...

. Pancreatic lipase breaks down triglycerides into free fatty acids and monoglycerides. Pancreatic lipase works with the help of the salts from the

secreted by the

and stored in the gall bladder. Bile salts attach to triglycerides to help emulsify them, which aids access by pancreatic lipase. This occurs because the lipase is water-soluble but the fatty triglycerides are hydrophobic and tend to orient towards each other and away from the watery intestinal surroundings. The bile salts emulsify the triglycerides in the watery surroundings until the lipase can break them into the smaller components that are able to enter the villi for absorption. * Some carbohydrates are degraded into simple sugars, or monosaccharides (e.g.,

glucose Glucose is a simple sugar with the molecular formula . Glucose is overall the most abundant monosaccharide, a subcategory of carbohydrates. Glucose is mainly made by plants and most algae during photosynthesis from water and carbon dioxide, usi ...

). Pancreatic amylase breaks down some carbohydrates (notably

starch Starch or amylum is a polymeric carbohydrate consisting of numerous glucose units joined by glycosidic bonds. This polysaccharide is produced by most green plants for energy storage. Worldwide, it is the most common carbohydrate in human diets ...

) into oligosaccharides. Other carbohydrates pass undigested into the large intestine and further handling by intestinal bacteria. Brush border enzymes take over from there. The most important brush border enzymes are dextrinase and glucoamylase, which further break down oligosaccharides. Other brush border enzymes are maltase, sucrase and lactase. Lactase is absent in some adult humans and, for them, lactose (a disaccharide), as well as most polysaccharides, is not digested in the small intestine. Some carbohydrates, such as

cellulose Cellulose is an organic compound with the formula , a polysaccharide consisting of a linear chain of several hundred to many thousands of β(1→4) linked D-glucose units. Cellulose is an important structural component of the primary cell wall ...

, are not digested at all, despite being made of multiple

units. This is because the cellulose is made out of beta-glucose, making the inter-monosaccharidal bindings different from the ones present in starch, which consists of alpha-glucose. Humans lack the enzyme for splitting the beta-glucose-bonds, something reserved for herbivores and bacteria from the large intestine.

Absorption

Digested food is now able to pass into the blood vessels in the wall of the intestine through either

diffusion Diffusion is the net movement of anything (for example, atoms, ions, molecules, energy) generally from a region of higher concentration to a region of lower concentration. Diffusion is driven by a gradient in Gibbs free energy or chemical p ...

or active transport. The small intestine is the site where most of the nutrients from ingested food are absorbed. The inner wall, or mucosa, of the small intestine, is lined with simple columnar epithelial tissue. Structurally, the mucosa is covered in wrinkles or flaps called circular folds, which are considered permanent features in the mucosa. They are distinct from

rugae In anatomy, rugae are a series of ridges produced by folding of the wall of an organ. Most commonly rugae refers to the gastric rugae of the internal surface of the stomach. Function A purpose of the gastric rugae is to allow for expansion of ...

which are considered non-permanent or temporary allowing for distention and contraction. From the circular folds project microscopic finger-like pieces of tissue called villi (

Latin Latin (, or , ) is a classical language belonging to the Italic branch of the Indo-European languages. Latin was originally a dialect spoken in the lower Tiber area (then known as Latium) around present-day Rome, but through the power ...

for "shaggy hair"). The individual epithelial cells also have finger-like projections known as microvilli. The functions of the circular folds, the villi, and the microvilli are to increase the amount of surface area available for the absorption of

s, and to limit the loss of said nutrients to intestinal fauna. Each villus has a network of

capillaries A capillary is a small blood vessel from 5 to 10 micrometres (μm) in diameter. Capillaries are composed of only the tunica intima, consisting of a thin wall of simple squamous endothelial cells. They are the smallest blood vessels in the body: ...

and fine lymphatic vessels called lacteals close to its surface. The epithelial cells of the villi transport nutrients from the lumen of the intestine into these capillaries (amino acids and carbohydrates) and lacteals (lipids). The absorbed substances are transported via the blood vessels to different organs of the body where they are used to build complex substances such as the proteins required by our body. The material that remains undigested and unabsorbed passes into the large intestine. Absorption of glucose in the small intestine

Absorption of glucose in the small intestine

Absorption of the majority of nutrients takes place in the jejunum, with the following notable exceptions: *

Iron Iron () is a chemical element with symbol Fe (from la, ferrum) and atomic number 26. It is a metal that belongs to the first transition series and group 8 of the periodic table. It is, by mass, the most common element on Earth, right in ...

is absorbed in the duodenum. * Folate (Vitamin B9) is absorbed in the duodenum and jejunum. * Vitamin B12 and bile salts are absorbed in the terminal ileum. Vitamin B12 will only be absorbed by the ileum after binding to a protein known as intrinsic factor. * Water is absorbed by

osmosis Osmosis (, ) is the spontaneous net movement or diffusion of solvent molecules through a selectively-permeable membrane from a region of high water potential (region of lower solute concentration) to a region of low water potential (region of ...

and

s by passive diffusion throughout the small intestine. * Sodium bicarbonate is absorbed by active transport and

and

co-transport *

Fructose Fructose, or fruit sugar, is a ketonic simple sugar found in many plants, where it is often bonded to glucose to form the disaccharide sucrose. It is one of the three dietary monosaccharides, along with glucose and galactose, that are absorb ...

is absorbed by facilitated diffusion.

Immunological

The small intestine supports the body's

immune system The immune system is a network of biological processes that protects an organism from diseases. It detects and responds to a wide variety of pathogens, from viruses to parasitic worms, as well as Tumor immunology, cancer cells and objects such ...

. The presence of gut flora appears to contribute positively to the host's immune system. Peyer's patches, located within the ileum of the small intestine, are an important part of the digestive tract's local immune system. They are part of the lymphatic system, and provide a site for antigens from potentially harmful bacteria or other microorganisms in the digestive tract to be sampled, and subsequently presented to the immune system.

Clinical significance

The small intestine is a complex organ, and as such, there are a very large number of possible conditions that may affect the function of the small bowel. A few of them are listed below, some of which are common, with up to 10% of people being affected at some time in their lives, while others are vanishingly rare. * Small intestine obstruction or obstructive disorders ** Meconium ileus ** Paralytic ileus ** Volvulus ** Hernia **

Intussusception Intussusception may refer to: * Intussusception (medical disorder) Intussusception is a medical condition in which a part of the intestine folds into the section immediately ahead of it. It typically involves the small bowel and less commonly t ...

** Adhesions ** Obstruction from external pressure ** Obstruction by masses in the lumen ( foreign bodies, bezoar, gallstones) *

Infectious diseases An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable d ...

** Giardiasis ** Ascariasis ** Tropical sprue ** Tape worm (''

Diphyllobothrium latum ''Diphyllobothrium'' is a genus of tapeworms which can cause diphyllobothriasis in humans through consumption of raw or undercooked fish. The principal species causing diphyllobothriasis is ''D. latum'', known as the broad or fish tapeworm, ...

'', ''

Taenia solium ''Taenia solium'', the pork tapeworm, belongs to the cyclophyllid cestode family Taeniidae. It is found throughout the world and is most common in countries where pork is eaten. It is a tapeworm that uses humans as its definitive host and p ...

'', '' Hymenolepis nana'') ** Hookworm (e.g. '' Necator americanus'', ''

Ancylostoma duodenale ''Ancylostoma'' is a genus of nematodes that includes some species of hookworms. Species include: : '' Ancylostoma braziliense'', commonly infects cats, popularly known in Brazil as ''bicho-geográfico'' : '' Ancylostoma caninum'', commonly infe ...

'') ** Nematodes (e.g. '' Ascaris lumbricoides'') ** Other Protozoa (e.g. '' Cryptosporidium parvum'', '' Cyclospora'', '' Microsporidia'', '' Entamoeba histolytica'') ** Bacterial infections *** Enterotoxigenic ''

Escherichia coli ''Escherichia coli'' (),Wells, J. C. (2000) Longman Pronunciation Dictionary. Harlow ngland Pearson Education Ltd. also known as ''E. coli'' (), is a Gram-negative, facultative anaerobic, rod-shaped, coliform bacterium of the genus '' Esc ...

'' *** '' Salmonella enterica'' *** ''

Campylobacter ''Campylobacter'' (meaning "curved bacteria") is a genus of Gram-negative bacteria. ''C