Month: December 2017

The Small Intestines

Blausen_0817_SmallIntestine_AnatomyThe small intestine or small bowel is the part of the gastrointestinal tract between the stomachand the large intestine, and is where most of the end absorption of food takes place. The small intestine has three distinct regions – the duodenumjejunum, and ileum. The duodenum is the shortest part of the small intestine and is where preparation for absorption begins. It also receives bile and pancreatic juice through the pancreatic duct, controlled by the sphincter of Oddi. The primary function of the small intestine is the absorption of nutrients and minerals from food, using small finger-like protrusions called villi


The length of the small intestine can vary greatly, from as short as 2.75 m (9.0 ft) to as long as 10.49 m (34.4 ft).[3] The average length in a living person is 3m-5m.[4][5] The length depends both on how tall the person is and how the length is measured.[3] Taller people generally have a longer small intestine and measurements are generally longer after death and when the bowel is empty.[3]

It is approximately 1.5 cm in diameter in newborns after 35 weeks of gestational age,[6] and 2.5–3 cm (1 inch) in diameter in adults. On abdominal X-rays, the small intestine is considered to be abnormally dilated when the diameter exceeds 3 cm.[7][8] On CT scans, a diameter of over 2.5 cm is considered abnormally dilated.[7][9] The surface area of the human small intestinal mucosa, due to enlargement caused by folds, villi and microvilli, averages 30 square meters.[10]


The small intestine is divided into three structural parts.

  • The duodenum is a short structure ranging from 20 cm (7.9 inches) to 25 cm (9.8 inches) in length, and shaped like a “C”.[11] It surrounds the head of the pancreas. It receives gastric chyme from the stomach, together with digestive juices from the pancreas (digestive enzymes) and the liver (bile). The digestive enzymes break down proteins and bile and emulsify 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 2.5 m long, and contains the plicae circulares, and 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. Arteries, veins, lymph vessels and nerves travel within the mesentery.[12]

Blood supply

The small intestine receives a blood supply from the coeliac trunk and the superior mesenteric artery. These are both branches of the aorta. The duodenum receives blood from the coeliac trunk 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.[13] 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.[13]


Gallstones, Hepatitis, or Cirrhosis


UntitledWhen you are diagnosed with gallstones, hepatitis, or cirrhosis of the liver, it’s doubtful that you are thinking of the whole system of which the liver and gallbladder are only single parts. While these are hardly insignificant parts, it may be helpful to understand that they are important cogs in a machine known as the hepatobiliary system. This system is essential for digestion and includes the liver, pancreas, bile ducts and the gallbladder.

Several ailments (hepatobiliary disease) can affect this system. Hepatobiliary disease includes a varied group of diseases of the liver and biliary system caused by viral, bacterial, and parasitic infections, cysts and tumors, toxic chemicals, alcohol consumption, poor nutrition, metabolic disorders, and cardiac failure. The two predominant diseases of the liver in the United States are viral hepatitis and cirrhosis; the predominant chronic disease of the biliary system is gallstones (cholelithiasis).

The liver is one of the largest organs in the human body and has many functions including:

  • Processing food and changing it into energy
  • Breaking down toxic substances in the body
  • Storing iron reserves, as well as vitamins and minerals
  • Creating bile, which aids in digestion

The pancreas is an organ behind the stomach and in front of the spine. The two primary functions of the pancreas are to produce fluids to help break down food and to produce hormones that help control blood sugar levels.

The biliary tract consists of the gallbladder and duct system. After being produced by the liver, bile is secreted into the bile ducts and stored in the gallbladder. Bile aids in the digestion of fats.

Often hepatobiliary diseases require surgery as part of treatment. Dr. Matthew Johnson is a Las Vegas Board Certified Robotic Surgeon, specializing in hernia surgery, foregut surgery, and hepatobiliary surgery. He also cares for patients in the fields of general surgery, trauma & acute care surgery, and critical care. To schedule an appointment with Dr. Johnson to discuss your robotic surgery options, call his clinic at (702) 369-7152.