Small bowel (small intestine)
General
Normal anatomy

Author: Hanni Gulwani, M.D. (see Authors page)

Revised: 9 February 2018, last major update August 2012

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed search: Anatomy[TI] small bowel[TIAB]
Cite this page: Gulwani, H. Normal anatomy. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/smallbowelnormalanatomy.html. Accessed July 18th, 2018.
Definition / general
  • Extends from gastric pylorus to ileocaecal valve
  • 6 meters long, divided into duodenum, jejunum, ileum

  • Duodenum:
    • 25 cm long, from pyloric sphincter to ligament of Treitz, mostly retroperitoneal, fixed in position
    • Common bile duct (CBD) and pancreatic duct enter second part of duodenum posteromedially at ampulla of Vater (eMedicine: Duodenal Anatomy [Accessed 9 February 2018)

  • Jejunum:
    • 240 cm long, 40% of remainder of bowel, begins at ligament of Treitz
    • Has prominent circular mucosal folds (folds of kerckring) that increase absorptive surface

  • Ileum:
    • 360 cm long, distal 60% of postduodenal bowel
    • Mucosa has transverse folds, prominent in proximal ileum, flat / absent at terminal ileum

  • Ileocecal valve:
    • At end of small bowel
    • 2 lip structure containing adipose tissue and lymphoid tissue

  • Lymph nodes:
    • Duodenum drains to portal and pyloric nodes
    • Jejunum and proximal ileum drain to mesenteric nodes and nodes around superior mesenteric artery, terminal ileum drains to ileocolic nodes
    • Lacteals are lymphatic channels in villi for chylomicrons

  • Intestinal immune system consists of:
    • Peyer patches in ileum (ovoid lymphoid follicles, partly mucosal and partly submucosal, in antimesenteric side of terminal ileum)
    • Small intestinal goblet cells, which deliver low molecular weight soluble antigens from intestinal lumen to CD103+ lamina propria dendritic cells, which regulates development of T cells (Nature 2012;483:345)
    • M (membranous) cells, part of follicle associated epithelia (MALT) in small bowel and colon, which transfer antigen macromolecules from lumen to lymphocytes
    • T cells, usually CD8+ and scattered in surface epithelium
    • Lamina propria contains CD4+ T cells and B cells
    • Mucosa associated lymphoid tissue: lymphoid nodules, mucosal lymphocytes, appendiceal lymphoid follicles and mesenteric nodes (Annu Rev Cell Dev Biol 2000;16:301)

  • Neuromuscular function:
    • Anterograde and retrograde peristalsis mixes food and promotes maximal contact of nutrients with mucosa
    • Colonic peristalsis prolongs contact with mucosa
    • Peristalsis is mediated via myenteric plexus and autonomic innervation (sympathetic thoracolumbar, parasympathetic vagal)
    • Also through interstitial cells of Cajal (pacemaker cells) and smooth muscle cells
    • Vagal receptors are abundant in duodenum and scattered throughout wall
Diagrams / tables

Images hosted on other servers:

Duodenum

Gross images

Images hosted on other servers:

Ileum and terminal ileum

Microscopic (histologic) images

Images hosted on PathOut server:

Images contributed by Dr. Grigory Demyashkin, I. M. Sechenov First Moscow State Medical University (Russia):

6 - 8 week embryo:

Upper left: small intestine;
bottom left: esophagus;
center: stomach; top right:
pancreas; right: liver

Small intestine, epithelium

Left: small intestine; bottom:
stomach; center: gonad and
kidney primary (mesonephros);
right: symphysis



Images hosted on other servers:

Peyer patches

Lymph nodes: lacteals



Images contributed by Dr. Suhail Muzaffar, City Hospital (United Kingdom):