1. SMALL INTESTINE II ABSORPTION
DR. Sharique Ahmed Quadri
DR. ABDELRAHMAN MUSTAFA
Department of Basic Medical Sciences
Division of Physiology
Faculty of Medicine
Almaarefa Colleges

2. Small Intestine ‘ABSORPTION’
In small intestine, carbohydrate, protein, fat, electrolytes, vitamins and water are absorbed.
Absorption of calcium and iron is adjusted according to the body needs.
Most absorption occurs in duodenum and jejunum and very little in the ileum [as most absorption has already taken place].
About 50% of small intestine can be removed with little interference with absorption.
The vitamin B12 and bile salts are absorbed in terminal ileum [if the terminal ileum removed, their absorption will be effected].
Intestinal absorption could be passive or active.

3. Small Intestine ‘ABSORPTION’
Depressions of the mucosal surface between the villi are crypts of Lieberkuhn.
Crypts of Lieberkuhn secrete water and electrolyte along with the mucus secreted by the cells on the villus surface constitute succus entericus.

4. Small Intestine ‘ABSORPTION’
Structure of A Villus: Each villus has:
Epithelial cells:. At the luminal border the epithelial cells have carriers for absorption of nutrients and electrolyte.
Connective tissue core: formed by the lamina propria.
A capillary network: Each villus supplied by arteriole that break up into a capillary network within the villus core. The capillaries rejoin to form a venule that drains away the villus.
A terminal lymphatic vessel: Each villus supplied by a single blind ended lymphatic vessel known as the central lacteal, which occupies the center of the villus core.

5. Small Intestine ‘ABSORPTION’
The mucous lining of the small intestine is well adapted to the absorptive function of the small intestine for two reasons
Has a very large surface area.
The epithelial cells in the mucous lining have a variety of specialized transport mechanism.During absorption a substance must pass through the
epithelial cell
diffuse through the connective tissue and then
cross the wall of the capillary or lymph vessel.

6. Sodium and Water Absorption
Sodium absorbed by both passive and active transport.
Sodium enter the epithelial cells across the luminal border passively through the sodium channels or by secondary active transport by Na+ - Cl- symporter, Na+-H+ antiport or Na+-glucose symporter.
Sodium pumped out of the cell by Na+ K+ pump.
Water absorption followed the Na+.
Sodium absorption result in movement of the water by osmosis.

7. Carbohydrate Absorption
Glucose and galactose are both absorbed by secondary active transport , in which the symport carriers such as sodium and glucose cotransporter (SGLT) on the luminal membrane.
The glucose or galactose leave the cells down their concentration gradient via glucose transporter GLUT-2 to enter the blood.
Fructose is absorbed by facilitated diffusion. It enters the epithelial cells via GLUT-5 and enter the blood via GLUT-2

8. Proteins Absorption
Amino acids are absorbed in a similar way to glucose and galactose via the amino acid symporters.
The amino acid symporter are selective for different amino acids.
The glucose, galactose, amino acid all get a free ride on the energy expended for Na+ transport.

9. Fat Absorption
The micelle are water soluble particles carry the monoglycerides and free fatty acids within their lipid soluble interiors.
When the micelle approaches the absorptive epithelial surface, the monoglycerides and free fatty acids leave the micelle and passively diffuse through the lipid bilayer of the luminal membranes.

10. Fat Absorption
The monoglycerides and free fatty acids are resynthesized into triglycerides inside the epithelial cells.
These triglycerides aggregates and are coated with a layer of lipoprotein from the endoplasmic reticulum to form water-soluble chylomicrons.
Chylmicrons are extruded through the basal membrane of the cells by exocytosis. Chylmicrons enter the lymphatic vessels.

11. Iron Absorption
Ferrous iron (Fe+2) only a portion of ingested iron form that can be absorbed
Iron absorbed by different energy-dependent carriers for heme and Fe+2.
Iron absportion is controlled with the hormone hepcidin.
In the blood iron is carried bound to plasma protein transferrin.
Absorbed dietary iron that is not needed immediately is stored in the epithelial cells as ferrtin.
Dietary ion that was not absorbed is lost in the feces

12. Calcium and Vitamins Absorption
Calcium enter the luminal membrane of the small intestine epithelial cells down its electrochemical gradient through a specialized Ca+2 channel.
Calcium exit the basolateral membrane by Ca+2 ATPase pump and Na+ Ca+2 antiporter.
Vitamin D enhance calcium absorption
Water soluble vitamins are absorbed passively with water
Fat soluble vitamins are carried within the micelle.

13. Calcium and Vitamins Absorption
All nutrients absorbed through the small intestine enter the liver through the hepatic portal vein.
After passing through the liver join the systemic circulation.
Harmful substance that may have been absorbed are detoxified by the liver before entering the systemic circulation.

14. Diarrhea
Diarrhea: passage of highly fluid fecal matter, often with increase frequency of defecation.
Diarrhea can be beneficial in rapid loss of harmful materials.
Excessive loss of intestinal contents result in dehydration.
Causes:
Excessive motility result from local irritation by bacterial or viral infection.
Excess osmotically active particles such as in lactase deficiency
Toxins of Vibrio cholera.

15. Celiac Disease [Gluten Entropathy]
Malabsorption may be caused by damage or reducation of the surface area of the small intestine.
One of the common causes is Celiac Disease [Gluten Entropathy]. A condition in which the small intestine is sensitive to gluten (a protein constituent of wheat and barley)
This condition is a complex immunologic disorder in which exposure to gluten activates T-cell response that damage the intestinal villi causing decrease of the surface area for absorption. Therefore, absorption of all nutrients is impaired.

16. References Human physiology by Lauralee Sherwood, seventh edition
Text book physiology by Guyton &Hall,11th edition
Text book of physiology by Linda .s contanzo,third edition