GROUP 4 PRESENTATION

TOPIC:-SMALL INTESTINE AND CELLS

LECTURAL IN CHARGE: DR ADEOLA SALAMI
 1. GROUP MEMBERS
Adeyanju Maria KDU/NUR/24230
2. Olojede Ayomide Elizabeth KDU/MLS/23026
3. Whab Mutiat Tope KDU/NUR/23081
4. Adeniji Adedamola Serah KDU/MLS/23003
5. Akintade Peter Olasunkanmi KDU/MLS/23010
6. Bakare Aishat Motirola KDU/NUR/23087
7. Oloruntoba Elizabeth Aanuoluwapo KDU/MLS/23027
8. Abdul Raheem Alimot Eniola KDU/NUR/002
9. Ologede Favour Oluwajomiloju KDU/NUR/23065
10. Sarumoh Adedoyin Rejoice KDU/NUR/23088
11. Adekunle Kayofoluwa Esther KDU/MLS/23001
12. Tairu Rafat Ayoka KDU/NUR/23080
13. Akande Aminat Adedayo KDU/NUR/23017
14. Alabi Testimony KDU/NUR/23024
15. Adeyanju Precious Oyindamola KDU/MLS/23038
16. Lugboso Bunmi Iredele KDU/MLS/23039
17. Akinbode Marvellous Abigail KDU/MLS/23009
18. Ojo Stella Adenike KDU/MLS/23020
19. Adekanye Oluwasikemi Miracle KDU/NUR/24227

Table of Contents
1. Introduction to the Small Intestine
Function of small intestine
 - Anatomy and Structure
- Function in Digestion and Absorption

-Structure of the Small Intestine Wall

Physiology of small intestine

2. Glands of the Small Intestine

- Crypts of Lieberkühn
- Brunner’s Glands
3. Cellular Structure of the Small Intestine
- CELLS OF THE SMALL INTESTINE EPITHELIUM
- Enterocytes, Goblet Cells, Paneth Cells, and Stem Cells
- Role of Microvilli and the Brush Border
- Polarity of Cells
Transport system
4. Secretion and Hormonal Regulation
- Digestive Enzymes, Mucus Secretion, Enteroendocrine Hormones (e.g., Secretin,
Cholecystokinin) and pH Regulation
5. Propulsive Movements and Peristalsis
- Peristalsis and Segmentation
- Role of the Ileocecal Valve
- Coordination of Motility
6. Clinical Correlates
- Celiac Disease
- Crohn’s Disease
- Lactose Intolerance
- Small Intestinal Bacterial Overgrowth (SIBO)
1. Introduction to the Small Intestine
The small intestine is a crucial organ in the digestive system responsible for the absorption of

nutrients. It is approximately 6 meters long and consists of three sections: the *duodenum,

jejunum, and ileum. The small intestine serves as the site for the breakdown of food through

digestive enzymes and bile, facilitating the absorption of carbohydrates, proteins, fats, vitamins,

and minerals. It is lined with specialized cells and structures, including villi and microvilli, that

maximize its absorptive capacity

The small intestine is the body major digestive organ. Within its twisted passageways, usable

nutrients are finally prepared for their journey into the cells of the body. The small intestine is a

muscular tube extending from the pyloric sphincter to the large intestine. It is the longest section

of the alimentary tube with an average length of 2 to 4m in a living person. Except of the initial

part of the small intestine, which mostly lies in a retroperitoneal positon, the small intestine

hangs in sausage-like coils in the abdominal cavity, suspended from the posterior abdominal wall

by the fan-shaped mesentery. The large intestine encircles and frames it in the abdominal cavity.

Function of the Small Intestine

The small intestine serves multiple crucial functions that contribute to the body’s overall well-

being.

Chemical Digestion: The small intestine is the site where most chemical digestion occurs.

Enzymes secreted from the pancreas and bile from the liver are released into the small intestine

to break down proteins, carbohydrates, and fats. The digestive enzymes, such as amylase, lipase,

and proteases, work to convert large macromolecules into simpler, absorbable forms, like amino

acids, simple sugars, and fatty acids.

Absorption: Once food is digested, the small intestine absorbs essential nutrients, including

amino acids, glucose, fatty acids, and vitamins. The absorption process primarily occurs in the
jejunum, where the large surface area provided by the villi and microvilli ensures efficient uptake

of nutrients into the bloodstream. Specialized transport mechanisms, like sodium-dependent co-

transporters and facilitated diffusion, ensure that nutrients enter the cells of the enterocytes and

then move into the circulation.

Immune Function: The small intestine also plays an important role in immune defense. It is home

to GALT (Gut-associated lymphoid tissue), which includes Peyer's patches—clusters of

lymphoid follicles that monitor and protect the intestine from pathogens. These immune

structures help identify harmful microorganisms and trigger immune responses, preventing

infections and maintaining gut health.

Endocrine Function: The small intestine also secretes important hormones that regulate

digestion. For example, secretin stimulates the pancreas to release bicarbonate, which neutralizes

stomach acid in the duodenum. Cholecystokinin (CCK) stimulates the release of bile from the

gallbladder and pancreatic enzymes, facilitating digestion. Gastrin, produced by cells in the

stomach and duodenum, helps regulate gastric acid secretion and motility.

Anatomy and Structure

The small intestine is divided into three main parts:
- Duodenum: The first section of the small intestine, where digestion occurs. It receives bile and
pancreatic enzymes that assist in the digestion of fats, proteins, and carbohydrates.
- Jejunum: The middle section, primarily involved in nutrient absorption. It contains the most
villi, which increase its surface area for absorption.
- Ileum: The final section of the small intestine, where absorption of vitamins and minerals
occurs. It connects to the large intestine via the ileocecal valve, which regulates the flow of
material.
Diagram of the small intestine highlighting the duodenum, jejunum, and ileum
Structure of the Small Intestine Wall

The wall of the small intestine is organized into four concentric layers, each with unique

structures and functions that facilitate digestion, absorption, movement, and protection. From

innermost to outermost, the layers are:-

1. Mucosa (Innermost Layer): This is the most active layer in digestion and absorption. It has

three sub-layers:

a. Epithelium: this is made of simple columnar epithelial cells, it also contains villi (finger-like

projections) that increase surface area. Microvilli on enterocytes form the brush border, which

further increases surface area and contains enzymes (e.g., disaccharidases, peptidases) which

includes various cell types such as;

i. Enterocytes– for absorption and enzyme secretion.

ii. Goblet cells– for mucus secretion.

iii. Paneth cells– for antimicrobial defense.

iv. Enteroendocrine cells– for hormone secretion.

v. Stem cells– for regeneration.

b. Lamina Propria: A layer of loose connective tissue that supports the epithelium. It contains:

i. Capillaries– for absorption of nutrients into the bloodstream.

ii. Lacteals– lymphatic vessels for absorption of lipids.

iii. Immune cells– macrophages, plasma cells, and lymphocytes for defense.

c. Muscularis Mucosae: this is a thin layer of smooth muscle, it provides local movement of the

mucosa to enhance absorption and lymph flow.

2. Submucosa: This layer lies beneath the mucosa and consists of: Dense irregular connective

tissue Blood vessels and lymphatics– for nutrient transport; Nerve plexus (Meissner’s plexus)–

part of the enteric nervous system; regulates secretions and local blood flow.

In the duodenum, it contains Brunner’s glands which secrete alkaline mucus (rich in

bicarbonate) to neutralize gastric acid and protect the epithelium and also provide a suitable pH

for pancreatic enzymes.

3. Muscularis Externa: this is responsible for peristalsis and segmentation movements, this

layer has two layers of smooth muscle: Inner circular layer( compresses and mixes intestinal

contents) and Outer longitudinal layer (shortens the intestine during movement). Between these

two muscle layers lies the Myenteric plexus (Auerbach’s plexus), a network of neurons that

control gut motility. These movements help mix chyme, enhance digestion, and propel contents

forward.

4. Serosa (Outer Layer): This is also called the visceral peritoneum, it is a thin layer of loose

connective tissue covered by simple squamous epithelium (mesothelium). It protects the intestine
and secretes serous fluid to reduce friction with other abdominal organs. In parts of the

duodenum that are retroperitoneal (behind the peritoneum), this outer layer is called adventitia

instead of serosa.

SOME FEATURERS OF THE SMALL INTESTINE WALL

a. Plicae Circulares (Circular Folds): This is a large permanent folds of mucosa and

submucosa. It increases surface area and slow down movement of chyme for better absorption.

Its most prominent in jejunum and reduced in ileum.

b. Villi: This is found on the mucosa, it’s a finger-like projections (0.5–1.5 mm tall) that greatly

increase surface area. The core of villus contains: Capillaries (for carbohydrate and protein

absorption); Lacteal (for fat absorption); Smooth muscle fibers (to help villus movement and

lymph flow).

c. Microvilli: It is a microscopic projections on the apical surface of enterocytes and form the

brush border. It contain digestive enzymes (brush border enzymes). The huge surface area

increase (estimated total of 200 m² for the whole small intestine).

This multi-layered design of the small intestine wall is essential for: Efficient digestion (via

enzymes and secretions); Maximum absorption (via large surface area and transport

mechanisms); Protection (via mucus, immune cells, and pH buffering) and Motility (via muscle

layers and enteric nerves).

Physiology of the Small Intestine

The small intestine's complex physiology ensures that food is properly digested and absorbed,

allowing the body to utilize nutrients efficiently.

Motility: Two key movements, peristalsis and segmentation, facilitate the passage of chyme

through the small intestine. Peristalsis is the wave-like muscle contractions that push chyme
forward, while segmentation allows the chyme to mix and come into contact with the intestinal

lining for nutrient absorption. Segmentation increases the time that nutrients remain in the small

intestine, allowing for maximum absorption.

Digestion: The small intestine's digestive process is highly dependent on enzymes and bile.

Pancreatic enzymes like amylase (which breaks down carbohydrates), lipase (which breaks down

fats), and proteases (which break down proteins) are released into the small intestine to further

break down food into absorbable nutrients. Bile, produced by the liver and stored in the

gallbladder, emulsifies fats, aiding in their digestion and absorption.

2. Glands of the Small Intestine

Several glands are present in the small intestine that aid in digestion, protection, and immune
defense.
Crypts of Lieberkühn

These are simple tubular glands of intestine which open into the lumen of intestine between the

villi. Intestinal glands are lined by columnar cells. Lining of each gland is continuous with

epithelial lining of the villi.

Epithelial cells lining the intestinal glands undergo division by mitosis at a faster rate. Newly

formed cells push the older cells upward over the lining of the villi. These cells which move to

villi are called enterocytes, which secrete the enzymes. Old enterocytes are continuously shed

into lumen along with enzymes.

 DIAGRAM OF INTESTINAL GLAND AND VILLUS

The crypts of lieberkuhn are found in the mucosa of the small intestine, specifically between

the bases of the villi. It is also present throughout the small intestine (duodenum, jejunum, and

ileum) and also in the large intestine, but they are most active in the small intestine.

Structure: Each crypt is a pit-like invagination of the epithelium that extends down into the

lamina propria. At the base of each crypt are actively dividing stem cells, which migrate upward

to renew the intestinal lining.

Cells Found in Crypts of Lieberkühn

1. Enterocytes (Absorptive cells)– Located higher up on the villi but also found in crypts; absorb

nutrients.

2. Goblet cells– Secrete mucus to lubricate and protect.

3. Paneth cells– Located at the base of the crypts; secrete lysozyme, defensins, and other

antimicrobial substances.

4. Enteroendocrine cells– Secrete various hormones like secretin, cholecystokinin (CCK), GIP,

and motilin.

5. Stem cells– Divide continuously to regenerate all intestinal epithelial cell types every 3–5

days.

Functions

 It helps in the secretion of succus entericus (intestinal juice).

 Renewal of the intestinal epithelium.

 It host defenses via Paneth cells

 It helps in hormonal regulation of digestion and motility.

 Local immunity via interaction with lymphoid tissue.

BRUNNER’S GLAND:

These are compounnd of tubuloalveolar glands located only in the submucosa of the duodenum.

In addition to intestinal gland, the first part of duodenum contains some mucus glands called

Brunner glands. These glands penetrates muscularis mucosa and extend up to submucus coat of

the intestinal wall. Brunner glands open into the the lumen of intestine directly. These glands

secretes mucus and traces enzymes. It is found in the duodenum but not found in the jejunum or

ileum.

Structure: it’s a branched, coiled glands that open into the base of the crypts of Lieberkühn and

surrounded by connective tissue and capillaries.

Secretions: it produces a thick, alkaline mucus that is rich in: Bicarbonate ions (HCO₃⁻);

mucin; urogastrone (an epidermal growth factor that inhibits gastric acid secretion and promotes

healing).

Functions

 It neutralizes acidic chyme from the stomach to protect the intestinal mucosa.

 It provides an alkaline environment optimal for the action of pancreatic enzymes.

 It helps to lubricates the mucosa to facilitate the passage of chyme.

 It contributes to local immune defense through mucus barrier.

 It promotes epithelial cell renewal and repair.

Regulation of Secretion:

 It is stimulated by: Vagal (parasympathetic) stimulation, secretin (in response to acidic

chyme), tactile or chemical irritation.

 It is Inhibited by: Sympathetic stimulation, which can reduce mucus secretion and

increase risk of ulceration.

SUCCUS ENTERICUS:

Succus entericus is a watery, enzyme-rich secretion produced by the crypts of Lieberkühn in the

mucosa of the small intestine. About 1 to 2 liters per day are produced.

Composition: It contains water about 99.5%; Mucus (from goblet cells) Digestive enzymes,

including:

 Disaccharidases, this break down sugars, for example; maltase, sucrase, lactase

 Peptidases: This break down proteins, for example; aminopeptidase, dipeptidase.

 Nucleotidases and nucleosidases: it digest DNA/RNA

 Electrolytes and bicarbonate ions, which is slightly high in succus entricus.

Functions

 It helps to complete digestion of carbohydrates, proteins, and nucleic acids

 This provides an aqueous environment for enzyme activity.

 It neutralizes chyme in conjunction with Brunner’s gland secretions.

 It lubricates intestinal contents to prevent mucosal injury .

3. Cellular Structure of the Small Intestine

The cellular composition of the small intestine is tailored for efficient digestion, absorption, and
protection.
Enterocytes
These are the most abundant cells and are responsible for the *absorption of nutrients. Their
microvilli form the brush border, which greatly increases the surface area for nutrient uptake.
Goblet Cells
These cells secrete mucus that helps protect the epithelial lining from digestive enzymes and
mechanical injury.
Paneth Cells
Located at the base of the crypts of Lieberkühn, Paneth cells secrete antimicrobial substances
like defensins to defend the small intestine against pathogenic microorganisms.
Stem Cells
Located in the crypts of Lieberkühn, stem cells continuously regenerate the epithelial cells of

the small intestine, ensuring its integrity and function.

CELLS OF THE SMALL INTESTINE EPITHELIUM

CELLS SECRETORY PRODUCTS FUNCTION

Enterocyte(columnar cells) Pepsinogen, renin, It’s the final digestion of food

disaccharides, dipeptidase, and absorption of nutrients.

enterokinase, urease.

Argentaffin cells Serotonin . Modulates intestinal motility

 and secretion.

Goblet cells Mucus . Lubrication and protection of

the intestinal lining.

Paneth cells Cytokines, defensins, Antibacterial action and

lysosomal enzymes. maintaining gut immunity .

Enterochromaffin cells Serotonin. It stimulates intestinal

peristalsis and secretion.

Enterochromaffin-like cells Histamine. It stimulates acid secretion by

parietal cells.

Enteroendocrine cells Various gastrointestinal Regulation of digestive

hormones. processes.

G cells Gastrin. It stimulates gastric acid

secretion.

S cells Secretin. It stimulates secretion of

bicarbonate-rich pancreatic

juice.

I cells Cholecystokinin . It stimulates gallbladder

contraction and enzyme

secretion from the pancreas.

K cells Glucose-dependent It stimulates insulin release,

insulinotropic peptide or inhibits gastric secretion.

gastric inhibitory peptide.

M cells Motilin. It regulates migrating motor

 complex .

L cells Glucagon-like peptide-1, Enhances insuin secretion,

glucagon-like peptide-2’, slows gastrc emptying and

peptide YY. reduces appetite.

Unnamed cells Vasoactive intestinal It releases smooth muscle,

polypeptide, substance P. increases water and

electrolyte secretion.

Polarity of Cells
The cells in the small intestine exhibit polarity, with distinct apical and basolateral surfaces.
The apical surface is exposed to the lumen (the cavity inside the intestine) and is equipped with
*microvilli* to enhance nutrient absorption. The basolateral surface interfaces with the
underlying tissues, where nutrients are transported into the bloodstream.

Schematic diagram of Enterocyte polarity, showing the microvilli and basolateral surface of the
cell
Diagram Cell types, enterocyte, atlas of plant and animal histology
Transport Systems in the Small Intestine
The small intestine has highly specialized mechanisms for transporting nutrients from the lumen
into the bloodstream or lymphatic system.
Active Transport: One of the most critical transport mechanisms in the small intestine is active
transport, which uses energy to move nutrients against concentration gradients. For example, the
sodium-glucose co-transporter helps absorb glucose by coupling it with sodium ions, which are
absorbed into enterocytes and then transported into the blood.
Facilitated Diffusion: Fructose and some other nutrients are absorbed by facilitated diffusion, a
process that doesn't require energy. This mechanism relies on specific transporters that allow
these molecules to move across the enterocyte membrane from high to low concentration.
Fat Absorption: Fats are emulsified by bile salts into small droplets known as micelles, which
enable the absorption of fatty acids and monoglycerides into enterocytes. Inside the cells, these
molecules are reassembled into triglycerides and packaged into chylomicrons, which are
transported through the lymphatic system and eventually enter the bloodstream.
Water and Electrolyte Absorption: The small intestine is also crucial for maintaining fluid
balance. Water is absorbed passively through osmosis, while electrolytes, including sodium and
potassium, are absorbed through active transport mechanisms. This helps regulate the body’s
fluid balance and ensures homeostasis.
4. Secretion and Hormonal Regulation
The small intestine secretes several substances to facilitate digestion, protect itself, and regulate
the digestive process.
Digestive Enzymes
The enterocytes of the small intestine secrete enzymes such as lactase, sucrase, and maltase,
which break down complex sugars into simpler molecules that can be absorbed.
Mucus Secretion
The*goblet cells secrete mucus that helps lubricate and protect the intestinal lining from
mechanical stress and digestive enzymes.
Enteroendocrine Hormones
Cells in the small intestine secrete hormones like:
- Secretin: Stimulates the pancreas to release **bicarbonate*, neutralizing acidic chyme.
- Cholecystokinin: Stimulates the gallbladder to release bile and the pancreas to release
digestive enzymes
pH Regulation
The duodenum is slightly alkaline (pH 7-8) due to the secretion of alkaline mucus and
bicarbonate from Brunner’s glands. This neutralizes the acidic chyme from the stomach,
providing a favorable pH for enzyme activity in digestion.
 Diagram of the pH gradient across the small intestine, highlighting the transition from acidic to
*alkaline*.
*5. Propulsive Movements and Peristalsis
The small intestine uses propulsive movements to move food along and mix it with digestive
enzymes for efficient absorption.
Peristalsis
This is a wave-like muscle contraction that moves food through the small intestine. It helps
propel the food along the digestive tract.
Segmentation
In addition to peristalsis, the small intestine also undergoes *segmentation*, which involves
alternating contractions that mix the food with digestive enzymes and increase absorption
efficiency.
Ileocecal Valve
The ileocecal valve regulates the flow of material from the ileum(small intestine) to the cecum
(large intestine). It prevents backflow of material and regulates the passage of digested material.

- Diagram illustrating *peristalsis* and *segmentation* in the small intestine.

6. Clinical Correlates
Several clinical conditions can affect the small intestine and impair its function, leading to
What is celiac disease?
Celiac disease is a chronic (long-term) digestive and immune disorder that damages your small
intestine. The damage may prevent your body from absorbing vitamins, minerals, and other
nutrients from the food you eat. This can lead to malnutrition and other serious health problems
Celiac disease is triggered by eating foods that contain gluten. Gluten is a protein found in
wheat, barley, rye, and other grains. It may also be in other products like vitamins and
supplements, hair and skin products, toothpastes, and lip balm.
Celiac disease is different from gluten sensitivity. Both involve problems with gluten and can
cause some of the same symptoms, such as abdominal (belly) pain and fatigue. But gluten
sensitivity does not damage the small intestine like celiac disease does.
Wheat allergy, a type of food allergy, is also different. With both celiac disease and wheat
allergy, your immune system is reacting to wheat. But with wheat allergy, you can have some
different symptoms, such as itchy eyes or trouble breathing. And a wheat allergy will not cause
long-term damage to the small intestine.
What causes celiac disease?
The exact cause of celiac disease is not known. Research suggests that celiac disease only
happens in people who have certain genes and eat food that contains gluten. Researchers are
studying other factors that may play a role in causing the disease.
Who is more likely to develop celiac disease?
Celiac disease is more common if you:
Have a family member who has the disease
Have Down syndrome, Turner syndrome, or Williams syndrome
Are White
Are female
What are the symptoms of celiac disease?
The symptoms of celiac disease can be different from person to person. Sometimes the symptoms
may come and go. Some people may not notice any symptoms.
Some of the possible symptoms affect your digestive system. Digestive symptoms are more
common in children than in adults. The digestive symptoms include:
Bloating (feeling fullness or swelling in your belly)
Chronic (long-term) diarrhea or greasy, bulky, unusually bad-smelling stool (poop)
Constipation
Gas
Lactose intolerance because of damage to the small intestine
Nausea and vomiting
Pain in the abdomen (belly)
Weight loss in adults, or not enough weight gain in children
Some people with celiac disease have symptoms that affect other parts of the body, such as:
Fatigue
Depression and anxiety
Irritability (in children)
Dermatitis herpetiformis, an itchy rash with blisters (mainly in adults)
Bone or joint pain
Symptoms involving the mouth, such as canker sores or dry mouth
What other problems can celiac disease cause?
Over time, celiac disease can cause other health problems, especially if it is not treated. These
problems can include:
Malnutrition
Anemia, especially iron-deficiency anemia
Bone loss
Nervous system problems such as headaches, balance problems, or peripheral neuropathy
Reproductive problems, such as missed menstrual periods and miscarriages in women and
infertility in men and women
How is celiac disease diagnosed?
If you have symptoms of celiac disease, your health care provider will look for signs that you
might have celiac disease. To do this, your provider will get your medical and family history and
do a physical exam.
If your provider thinks that you could have celiac disease, you will have some tests. Providers
most often use blood tests and biopsies of the small intestine to diagnose celiac disease. The
biopsy would be done during an upper gastrointestinal (GI) endoscopy. For this procedure, your
provider uses an endoscope (a flexible tube with a camera) to see the lining of your esophagus,
stomach, and small intestine. It also allows your provider to take a sample of tissue for a biopsy.
What are the treatments for celiac disease?
The treatment for celiac disease is following a gluten-free diet for the rest of your life. Sticking
with a gluten-free diet will treat or prevent many of the symptoms and other health problems
caused by celiac disease. In most cases, it can also heal damage in the small intestine and
prevent more damage.
NIH: National Institute of Diabetes and Digestive and Kidney Diseases
What is Crohn's disease?
Crohn's disease is a chronic (long-lasting) disease that causes inflammation in your digestive
tract. It can affect any part of your digestive tract, which runs from your mouth to your anus. But
it usually affects your small intestine and the beginning of your large intestine.

Crohn's disease is an inflammatory bowel disease (IBD). Ulcerative colitis and microscopic
colitis are other common types of IBD.
What causes Crohn's disease?
The cause of Crohn's disease is unknown. Researchers think that an autoimmune reaction may
be one cause. An autoimmune reaction happens when your immune system attacks healthy cells
in your body. Genetics may also play a role, since Crohn's disease can run in families.
Stress and eating certain foods don't cause the disease, but they can make your symptoms worse.
Who is more likely to develop Crohn's disease?
There are certain factors that may raise your risk of Crohn's disease:

Family history of the disease. Having a parent, child, or sibling with the disease puts you at
higher risk.
Smoking. This may double your risk of developing Crohn's disease.
Certain medicines, such as antibiotics, birth-control pills, and nonsteroidal anti-inflammatory
drugs (NSAIDs) such as aspirin or ibuprofen. These may slightly increase your chance of
developing Crohn's.
A high-fat diet. This may also slightly increase your risk of Crohn's.
What are the symptoms of Crohn's disease?
The symptoms of Crohn's disease can vary, depending where and how severe your inflammation
is. The most common symptoms include:
Diarrhea
Cramping and pain in your abdomen
Weight loss
Some other possible symptoms are:
Anemia, a condition in which you have fewer red blood cells than normal
Eye redness or pain
Fatigue
Fever
Joint pain or soreness
Nausea or loss of appetite
Skin changes that involve red, tender bumps under the skin
Stress and eating certain foods such as carbonated (fizzy) drinks and high-fiber foods may make
some people's symptoms worse.
A physical exam, including:
Checking for bloating in your abdomen.
Listening to sounds within your abdomen using a stethoscope.
Tapping on your abdomen to check for tenderness and pain and to see if your liver or spleen is
abnormal or enlarged.
Various tests, including:
Blood and stool tests.
A colonoscopy.
An upper GI endoscopy, a procedure in which your provider uses a scope to look inside your
mouth, esophagus, stomach, and small intestine.
Diagnostic imaging tests, such as a CT scan or an upper GI series. An upper GI series uses a
special liquid called barium and x-rays. Drinking the barium will make your upper GI tract
more visible on an x-ray.
What are the treatments for Crohn's disease?
There is no cure for Crohn's disease, but treatments can decrease inflammation in your
intestines, relieve symptoms, and prevent complications. Treatments include medicines, bowel
rest, and surgery. No single treatment works for everyone. You and your provider can work
together to figure out which treatment is best for you:
Medicines for Crohn's include various medicines that decrease the inflammation. Many of these
medicines do this by reducing the activity of your immune system. Certain medicines can also
help with symptoms or complications, such as nonsteroidal anti-inflammatory drugs and anti-
diarrheal medicines. If your Crohn's causes an infection, you may need antibiotics.
Bowel rest involves drinking only certain liquids or not eating or drinking anything. This allows
your intestines to rest. You may need to do this if your Crohn's disease symptoms are severe. You
get your nutrients through drinking a liquid, a feeding tube, or an intravenous (IV) tube. You
may need to do bowel rest in the hospital, or you may be able to do it at home. It will last for a
few days or up to several weeks.
Surgery can treat complications and reduce symptoms when other treatments are not helping
enough. The surgery will involve removing a damaged part of your digestive tract to treat:
Fistulas
Bleeding that is life threatening
Intestinal obstructions
Side effects from medicines when they threaten your health
Symptoms when medicines do not improve your condition
Changing your diet can help reduce symptoms. Your provider may recommend that you make
changes to your diet, such as:
Avoiding carbonated drinks
Avoiding popcorn, vegetable skins, nuts, and other high-fiber foods
Drinking more liquids
Eating smaller meals more often
Keeping a food diary to help identify foods that cause problems
In some cases, your provider may ask you to go on a special diet, such as a diet that is:
High calorie
Lactose free
Low fat
Low fiber
Low salt
If you are not absorbing enough nutrients, you may need to take nutritional supplements and
vitamins.
National Institute of Diabetes and Digestive and Kidney Diseases
Key Points for small intestine cancer
Small intestine cancer is a rare disease in which malignant (cancer) cells form in the tissues of
the small intestine.
There are five types of small intestine cancer.
Diet and health history can affect the risk of developing small intestine cancer.
Signs and symptoms of small intestine cancer include unexplained weight loss and abdominal
pain.
Tests that examine the small intestine are used to diagnose and stage small intestine cancer.
Certain factors affect prognosis (chance of recovery) and treatment options.
Small intestine cancer is a rare disease in which malignant (cancer) cells form in the tissues of
the small intestine.
The small intestine is part of the body’s digestive system, which also includes the esophagus,
stomach, and large intestine. The digestive system removes and processes nutrients (vitamins,
minerals, carbohydrates, fats, proteins, and water) from foods and helps pass waste material out
of the body. The small intestine is a long tube that connects the stomach to the large intestine. It
folds many times to fit inside the abdomen.
The small intestine is a long tube-like organ that connects the stomach to the large intestine. The
small intestine includes the duodenum, jejunum, and ileum.
There are five types of small intestine cancer.
The types of cancer found in the small intestine are adenocarcinoma, sarcoma, neuroendocrine
tumors, gastrointestinal stromal tumor, and lymphoma. This summary discusses adenocarcinoma
and leiomyosarcoma (a type of sarcoma).
Adenocarcinoma starts in glandular cells in the lining of the small intestine and is the most
common type of small intestine cancer. Most of these tumors occur in the part of the small
intestine near the stomach. They may grow and block the intestine.
Leiomyosarcoma starts in the smooth muscle cells of the small intestine. Most of these tumors
occur in the part of the small intestine near the large intestine.
Diet and health history can affect the risk of developing small intestine cancer.
Anything that increases a person's chance of getting a disease is called a risk factor. Not every
person with one or more of these risk factors will develop small intestine cancer, and it will
develop in some people who don't have any known risk factors. . Risk factors for small intestine
cancer include the following:
Eating a high-fat diet.
Having Crohn disease.
Having celiac disease.
Having familial adenomatous polyposis (FAP).
Signs and symptoms of small intestine cancer include unexplained weight loss and abdominal
pain.
These and other signs and symptoms may be caused by small intestine cancer or by other
conditions. Check with your doctor if you have any of the following:
Pain or cramps in the middle of the abdomen.
Weight loss with no known reason.
A lump in the abdomen.
Blood in the stool.
Tests that examine the small intestine are used to diagnose and stage small intestine cancer.
Procedures that make pictures of the small intestine and the area around it help diagnose small
intestine cancer and show how far the cancer has spread. The process used to find out if cancer
cells have spread within and around the small intestine is called staging.
In order to plan treatment, it is important to know the type of small intestine cancer and whether
the tumor can be removed by surgery. Tests and procedures to detect, diagnose, and stage small
intestine cancer are usually done at the same time. In addition to asking about your personal
and family health history and doing a physical exam, your doctor may perform the following
tests and procedures:
Blood chemistry studies: A procedure in which a blood sample is checked to measure the
amounts of certain substances released into the blood by organs and tissues in the body. An
unusual (higher or lower than normal) amount of a substance can be a sign of disease.
Liver function tests: A procedure in which a blood sample is checked to measure the amounts of
certain substances released into the blood by the liver. A higher than normal amount of a
substance can be a sign of liver disease that may be caused by small intestine cancer.
Endoscopy: A procedure to look at organs and tissues inside the body to check for abnormal
areas. There are different types of endoscopy:
Upper endoscopy: A procedure to look at the inside of the esophagus, stomach, and duodenum
(first part of the small intestine, near the stomach). An endoscope is inserted through the mouth
and into the esophagus, stomach, and duodenum. An endoscope is a thin, tube-like instrument
with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are
checked under a microscope for signs of cancer.
Capsule endoscopy: A procedure to look at the inside of the small intestine. A capsule that is
about the size of a large pill and contains a light and a tiny wireless camera is swallowed by the
patient. The capsule travels through the digestive tract, including the small intestine, and sends
many pictures of the inside of the digestive tract to a recorder that is worn around the waist or
over the shoulder. The pictures are sent from the recorder to a computer and viewed by the
doctor who checks for signs of cancer. The capsule passes out of the body during a bowel
movement.
Double balloon endoscopy: A procedure to look at the inside of the small intestine. A special
instrument made up of two tubes (one inside the other) is inserted through the mouth or rectum
and into the small intestine. The inside tube (an endoscope with a light and lens for viewing) is
moved through part of the small intestine and a balloon at the end of it is inflated to keep the
endoscope in place. Next, the outer tube is moved through the small intestine to reach the end of
the endoscope, and a balloon at the end of the outer tube is inflated to keep it in place. Then, the
balloon at the end of the endoscope is deflated and the endoscope is moved through the next part
of the small intestine. These steps are repeated many times as the tubes move through the small
intestine. The doctor is able to see the inside of the small intestine through the endoscope and
use a tool to remove samples of abnormal tissue. The tissue samples are checked under a
microscope for signs of cancer. This procedure may be done if the results of a capsule endoscopy
are abnormal. This procedure is also called double balloon enteroscopy.
Laparotomy: A surgical procedure in which an incision (cut) is made in the wall of the abdomen
to check the inside of the abdomen for signs of disease. The size of the incision depends on the
reason the laparotomy is being done. Sometimes organs or lymph nodes are removed or tissue
samples are taken and checked under a microscope for signs of disease.
Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for
signs of cancer. This may be done during an endoscopy or laparotomy. The sample is checked by
a pathologist to see if it contains cancer cells.
Upper GI series with small bowel follow-through: A series of x-rays of the esophagus, stomach,
and small bowel. The patient drinks a liquid that contains barium (a silver-white metallic
compound). The liquid coats the esophagus, stomach, and small bowel. X-rays are taken at
different times as the barium travels through the upper GI tract and small bowel.
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the
body, taken from different angles. The pictures are made by a computer linked to an x-ray
machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up
more clearly. This procedure is also called computed tomography, computerized tomography, or
computerized axial tomography.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a
computer to make a series of detailed pictures of areas inside the body. This procedure is also
called nuclear magnetic resonance imaging (NMRI).
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis and treatment options depend on the following:
 The type of small intestine cancer.
 Whether the cancer is in the inner lining of the small intestine only or has spread into or
beyond the wall of the small intestine.
 Whether the cancer has spread to other places in the body, such as the lymph nodes,
liver, or peritoneum (tissue that lines the wall of the abdomen and covers most of the
organs in the abdomen).
 Whether the cancer can be completely removed by surgery.
 Whether the cancer is newly diagnosed or has recurred.
 Stages of Small Intestine Cancer

Treatment Option Overview

 Treatment of Small Intestine Adenocarcinoma
 Treatment of Small Intestine Leiomyosarcoma
 Treatment of Recurrent Small Intestine Cancer
Definition & Facts for Irritable Bowel Syndrome
What is IBS?
Irritable bowel syndrome (IBS) is a group of symptoms that occur together, including repeated
pain in your abdomen and changes in your bowel movements, which may be diarrhea,
constipation, or both. With IBS, you have these symptoms without any visible signs of damage or
disease in your digestive tract.
IBS is a functional gastrointestinal (GI) disorder. Functional GI disorders, which doctors now
call disorders of gut-brain interactions, are related to problems with how your brain and your
gut work together. These problems can cause your gut to be more sensitive and change how the
muscles in your bowel contract. If your gut is more sensitive, you may feel more abdominal pain
and bloating. Changes in how the muscles in your bowel contract lead to diarrhea, constipation,
or both.
Does IBS have another name?
In the past, doctors called IBS colitis, mucous colitis, spastic colon, nervous colon, and spastic
bowel.
Type of IBS
IBS with constipation (IBS-C)
With IBS-C, on days when you have at least one abnormal bowel movement
more than a quarter of your stools are hard or lumpy and
less than a quarter of your stools are loose or watery
IBS with diarrhea (IBS-D)
In IBS-D, on days when you have at least one abnormal bowel movement
more than a quarter of your stools are loose or watery and
less than a quarter of your stools are hard or lumpy
IBS with mixed bowel habits (IBS-M)
In IBS-M, on days when you have at least one abnormal bowel movement
more than a quarter of your stools are hard or lumpy and
more than a quarter of your stools are loose or watery
How common is IBS?
Studies suggest that about 12 percent of people in the United States have IBS.1
Who is more likely to develop IBS?
1.Women are up to two times more likely than men to develop IBS
2.People younger than age 50 are more likely to develop IBS than people older than age 50
Factors that can increase your chance of having IBS include:
 having a family member with IBS
 a history of stressful or difficult life events, such as abuse, in childhood
 having a severe infection in your digestive tract
 Woman talking with a health care professional in a doctor’s office.
 Women are two times more likely than men to develop IBS.
Small intestinal bacterial overgrowth (SIBO) is a condition where excessive
bacteria populate the small intestine, leading to symptoms like bloating, gas, and
diarrhea. It can result from various factors, including surgery, disease, and structural
problems that slow the passage of food in the digestive tract. Treatment often involves
antibiotics and addressing the underlying cause.
Here's a more detailed explanation:

What is SIBO?
 SIBO occurs when there's an abnormal increase in bacterial populations in the small
intestine, which typically has fewer bacteria than the colon.
 The excess bacteria can interfere with nutrient absorption, potentially leading to
malnutrition and other complications.
Causes:
 Surgery:
Complications from abdominal surgery, such as the formation of pouches or blockages
in the small intestine, can contribute to SIBO.
 Disease:
Conditions that slow down the movement of food through the small intestine, such as
diabetes or scleroderma, can create a breeding ground for bacteria.
 Structural problems:
Anomalies in the small intestine, such as strictures or diverticulosis, can also lead to
bacterial overgrowth.
 Medications:
Some medications, like proton-pump inhibitors, can affect the digestive system and
contribute to SIBO.
Symptoms:
 Gastrointestinal:
Bloating, gas, abdominal pain, diarrhea, and constipation are common symptoms.
 Nutritional deficiencies:
SIBO can interfere with the absorption of nutrients, potentially leading to malnutrition.
Diagnosis:
 Breath test:
 A breath test can help detect the presence of excess bacteria in the small intestine.
 Small bowel aspirate and culture:
In this procedure, a sample of intestinal fluid is collected and cultured to identify the
bacteria present.
Treatment:
 Antibiotics: Antibiotics are commonly used to eliminate the excess bacteria.
 Addressing underlying causes: Treating the underlying conditions that contribute to
SIBO, such as surgery or disease, is also important.
 Dietary changes: In some cases, dietary changes, like avoiding high FODMAP foods,
may be helpful in managing symptoms, according to Johns Hopkins Medicine.
Important Note: SIBO is generally not a life-threatening condition, but severe cases
can lead to malnutrition

Lactose intolerance in the small intestine occurs because the body doesn't produce
enough of the enzyme lactase, which is needed to digest lactose, a sugar found in milk
and dairy products. Normally, lactase breaks down lactose into simpler sugars that the
small intestine can absorb. When lactase is deficient, undigested lactose passes into
the large intestine, where bacteria ferment it, causing symptoms like bloating, gas, and
diarrhea.

Here's a more detailed explanation:

 Lactase Deficiency:
Lactose intolerance is primarily caused by a deficiency of lactase, an enzyme that
breaks down lactose.
 Lactose Breakdown:
Normally, lactase in the small intestine breaks down lactose into glucose and galactose,
which can be absorbed into the bloodstream.
  Undigested Lactose:
When lactase is deficient, lactose remains undigested in the small intestine.
 Large Intestine Fermentation:
The undigested lactose then travels to the large intestine, where bacteria ferment it,
producing gas, fluid, and other byproducts.
 Symptoms:
These byproducts can cause symptoms like bloating, gas, abdominal cramps, diarrhea,
and nausea.

References

Guyton, A. C., & Hall, J. E. (2021). Textbook of Medical Physiology (14th ed.). Elsevier.
Boron, W. F., & Boulpaep, E. L. (2017). Medical Physiology (3rd ed.). Elsevier.
Gray, H. (2020). Gray's Anatomy: The Anatomical Basis of Clinical Practice (42nd ed.). Elsevier.
Junqueira, L. C., & Carneiro, J. (2021). Basic Histology: Text and Atlas (15th ed.). McGraw-Hill
Education.
Ross, M. H., & Wilson, R. L. (2021). Anatomy and Physiology in Health and Illness (12th ed.).
Churchill Livingstone.
- Silverthorn, D.U. (2018). Human Physiology: An Integrated Approach (8th ed.). Pearson
Education.
- Barrett, K.E. (2017). Gastrointestinal Physiology (8th ed.). Elsevier.
- Yamada, T. (2015). Textbook of Gastroenterology (6th ed.). Wolters Kluwer.
[1] Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. Journal of
the American Medical Association. 2015;313(9):949–958.

[2] Lacy BE, Mearin F, Chang L, et al. Bowel disorders. Gastroenterology.

2016;150(6)

This content is provided as a service of the National Institute of Diabetes and

Digestive and Kidney Diseases (NIDDK), part of the National Institutes of
Health.
Lin Chang, M.D., David Geffen School of Medicine, University of California Los
Angeles