Small Intestine

Small Intestine
Muhammad Rashid
muhammad.rashid@rmi.edu.pk
Small Intestine
• The small intestine is the longest part of the alimentary canal and extends from the pylorus of
the stomach to the ileocecal junction.
• The greater part of digestion and food absorption takes place in the small intestine.
• It is divided into three parts:
The duodenum
The jejunum
The ileum
duodenum
• The duodenum is a C-shaped tube, about 10 in. (25 cm) long, which joins the stomach to the
jejunum.
• It receives the openings of the bile and pancreatic ducts. The duodenum curves around the
head of the pancreas.
• The remainder of the duodenum is retroperitoneal, being only partially covered by
peritoneum.
Small intestine
• The duodenum is situated in the epigastric and umbilical regions and, for purposes of
description, is divided into four parts.
• First Part of the Duodenum
• The first part of the duodenum begins at the pylorus and runs upward and backward on the
trans pyloric plane at the level of the 1st lumbar vertebra.
• Anteriorly: The quadrate lobe of the liver and the gallbladder
• Posteriorly: The lesser sac (first inch only), the gastroduodenal artery, the bile duct, portal
vein, and the inferior vena cava.
• Superiorly: The entrance into the lesser sac.
• Inferiorly: The head of the pancreas
Parts of duodenum
Second Part of the Duodenum
• The second part of the duodenum runs vertically downward in front of the hilum of the right
kidney on the right side of the 2nd and 3rd lumbar vertebrae.
• About halfway down its medial border, the bile duct and the main pancreatic duct pierce the
duodenal wall. They unite to form the ampulla that opens on the summit of the major
duodenal papilla.
Anteriorly: The fundus of the gallbladder and the right lobe of the liver, the transverse colon,
and the coils of the small intestine.
Posteriorly: The hilum of the right kidney and the right ureter.
Laterally: The ascending colon and the right lobe of the liver
Medially: The head of the pancreas, the bile duct, and the main pancreatic duct
Third Part of the Duodenum
• The third part of the duodenum runs horizontally to the left on the subcostal plane, passing
in front of the vertebral column and following the lower margin of the head of the pancreas.
• Anteriorly: The root of the mesentery of the small intestine, the superior mesenteric vessels
contained within it, and coils of jejunum
• Posteriorly: The right ureter, the right psoas muscle, the inferior vena cava, and the aorta.
• Superiorly: The head of the pancreas
• Inferiorly: Coils of jejunum
Fourth Part of the Duodenum
• The fourth part of the duodenum runs upward and to the left to the duodenojejunal flexure.
• Anteriorly: The beginning of the root of the mesentery and coils of jejunum
• Posteriorly: The left margin of the aorta and the medial border of the left psoas muscle
Major duodenal papilla
• At the site where the bile duct and the main pancreatic duct pierce the medial wall of the
second part is a small, rounded elevation called the major duodenal papilla
Blood Supply
• Arteries
The upper half is supplied by the superior pancreaticoduodenal artery, a branch of the
gastroduodenal artery. The lower half is supplied by the inferior pancreaticoduodenal artery, a
branch of the superior mesenteric artery.
Veins
The superior pancreaticoduodenal vein drains into the portal vein; the inferior vein joins
the superior mesenteric vein
Lymph Drainage
• The lymph vessels follow the arteries and drain upward via pancreaticoduodenal nodes to the
gastroduodenal nodes and then to the celiac nodes and downward via pancreaticoduodenal
nodes to the superior mesenteric nodes around the origin of the superior mesenteric artery.
• Nerve Supply
• The nerves are derived from sympathetic and parasympathetic (Vagus) nerves from the celiac
and superior mesenteric plexuses.
Jejunum and Ileum
• The jejunum begins at the duodenojejunal flexure, and the ileum ends at the ileocecal
junction.
• The coils of jejunum and ileum are freely mobile and are attached to the posterior abdominal
wall by a fan-shaped fold of peritoneum known as the mesentery of the small intestine.
• The root of the mesentery permits the entrance and exit of the branches of the superior
mesenteric artery and vein, lymph vessels, and nerves into the space between the two layers
of peritoneum forming the mesentery.
The jejunum can be distinguished from the ileum by the following
features:
• The jejunum lies coiled in the upper part of the peritoneal cavity below the left side of the
transverse mesocolon; the ileum is in the lower part of the cavity and in the pelvis.
• The jejunum is wider bored, thicker walled, and redder than the ileum. The jejunal wall feels
thicker than ileum wall.
• The jejunal mesentery is attached to the posterior abdominal wall above and to the left of the
aorta, whereas the ileal mesentery is attached below and to the right of the aorta
Blood Supply
• Arteries
• The arterial supply is from branches of the superior mesenteric artery. The intestinal branches
arise from the left side of the artery and run in the mesentery to reach the gut. They
anastomose with one another to form a series of arcades. The lowest part of the ileum is also
supplied by the ileocolic artery.
• Veins
The veins correspond to the branches of the superior mesenteric artery and drain into the
superior mesenteric vein.
• Lymph Drainage
• The lymph vessels pass through many intermediate mesenteric nodes and finally reach the
superior mesenteric nodes, which are situated around the origin of the superior mesenteric
artery.
• Nerve Supply
• The nerves are derived from the sympathetic and parasympathetic (Vagus) nerves from the
superior mesenteric plexus

Small Intestine

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