Absorption In the Small and Large Intestines: Journey from the

stomach to the bloodstream

Welcome! Today you will be diving deep into the small and large intestines of the human
body. You will learn about their structure, function, and how they absorb nutrients.

Here are the relevant theory pages that you will find useful:

• Digestive system

• Small intestine

o Wall composition of the small intestine

• Large intestine

o Wall composition of the large intestine

o Microbiota of the large intestine

• Cells of intestines

• Villi and microvilli

• Absorption dysfunction

• Common intestine diseases

Digestive System
The digestive system is designed to facilitate the transformation of food matter into its
nutrient components.
Figure 1: The digestive system is comprised of the following organs:

1. Mouth

2. Esophagus

3. Stomach

4. Small intestine

5. Large intestine

6. Liver

7. Gallbladder

8. Pancreas

The mouth, esophagus, stomach, small and large intestine, and liver are part of the
digestive tract through which food passes. In addition, the accessory organs, the
gallbladder and pancreas add secretions (enzymes) and are regulated by hormones in
response to the food consumed.

Mouth
The mouth is the point of entry of food into the digestive system. The food consumed is
broken into smaller particles by the chewing action of the teeth. The extensive chemical
process of digestion begins in the mouth. As food is being chewed, saliva, produced by the
salivary glands, mixes with the food. Another enzyme called lipase is produced by the cells
in the tongue. The lingual lipase begins the breakdown of fat components in the food. The
chewing and wetting action provided by the teeth and saliva prepare the food into a mass
called the bolus for swallowing. The tongue helps in swallowing by moving the bolus from
the mouth into the pharynx. The pharynx opens to two passageways: the trachea, which
leads to the lungs, and the esophagus, which leads to the stomach. The trachea has an
opening called the glottis, which is covered by a cartilaginous flap called the epiglottis.
When swallowing, the epiglottis closes the glottis and food passes into the esophagus and
not the trachea. This arrangement allows food to be kept out of the trachea.
Figure 1: Parts of the mouth: (1) nasal cavity, (2) lips, (3) jaw, (4) tongue, (5) larynx, (6) oral
cavity, (7) uvula, (8) pharynx, (9) esophagus, (10) teeth, (11) sublingual gland, (12)
submandibular gland, (13) parotid gland.

Esophagus
The esophagus is a tubular organ that connects the mouth to the stomach. The chewed and
softened food passes through the esophagus after being swallowed. The smooth muscles
of the esophagus undergo a series of wave like movements called peristalsis that push the
food toward the stomach. The peristalsis wave is unidirectional—it moves food from the
mouth to the stomach, and reverse movement is not possible. The peristaltic movement of
the esophagus is an involuntary reflex; it takes place in response to the act of swallowing.

Figure 1: The esophagus transfers food from the mouth to the stomach through peristaltic
movements.

Stomach
A large part of digestion occurs in the stomach. The stomach is a sac-like organ that
secretes gastric digestive juices. The pH in the stomach is between 1.5 and 2.5. This highly
acidic environment is required for the chemical breakdown of food and the extraction of
nutrients. When empty, the stomach is a rather small organ; however, it can expand to up
to 20 times its resting size when filled with food. This characteristic is particularly useful for
animals that need to eat when food is available.

The stomach is the major site for protein digestion.

Protein digestion is mediated by an enzyme called pepsin in the stomach chamber. Pepsin
is secreted by the chief cells in the stomach in an inactive form called pepsinogen. Pepsin
breaks peptide bonds and cleaves proteins into smaller polypeptides; it also helps activate
more pepsinogen, starting a positive feedback mechanism that generates more pepsin.

HCl is the primary acidic component of the stomach juices.

Another cell type, parietal cells, secrete hydrogen and chloride ions, which combine in the
lumen to form hydrochloric acid. Hydrochloric acid helps to convert the inactive
pepsinogen to pepsin. The highly acidic environment also kills many microorganisms in the
food and, combined with the action of the enzyme pepsin, results in the hydrolysis of
protein in the food. Chemical digestion is facilitated by the churning action of the stomach.
Contraction and relaxation of smooth muscles mixes the stomach contents about every 20
minutes. The stomach empties itself within two to six hours after a meal. Only a small
amount of the food/gastric juice mix, known as chyme, is released into the small
intestine at a time.

The stomach protects itself from being digested.

When digesting protein and some fats, the stomach lining requires protection from being
digested by pepsin. There are two key ways in which this is prevented. First, as previously
mentioned, the enzyme pepsin is synthesized in the inactive form. This protects the chief
cells, because pepsinogen does not have the same enzyme functionality of pepsin.
Second, the stomach has a thick mucus lining that protects the underlying tissue from the
action of the digestive juices. When this mucus lining is ruptured, ulcers can form in the
stomach. Ulcers are open wounds in or on an organ caused by bacteria (Helicobacter
pylori) when the mucus lining is ruptured and fails to reform.

Small intestine
The small intestine is the organ where the digestion of protein, fats, and carbohydrates is
completed. It is mainly responsible for mixing food with digestive juices and bringing it into
contact with the intestine lining for absorption. The small intestine absorbs 90% of
nutrients and water. It also moves food further down the gastrointestinal tract.

The small intestine is a long tube-like organ. Its inside is covered with the intestinal
epithelium that increases the surface area of the intestine and increase absorption
efficiency of the nutrients. The small intestine is surrounded by two layers of smooth
muscles that contract in a wavelike pattern. This peristaltic movement mixes the content
of the small intestine and slowly moves it towards the large intestine. Absorbed nutrients
in the blood are carried into the hepatic portal vein, which leads to the liver.
Figure 1: Components of the small intestine: (1) Muscle layers, (2) villi, (3) blood vessels,
(4) lumen, (5) lymphatic vessel, (6) absorptive enterocyte cells, (7) capillary, (8) artery, (9)
vein, (10) microvilli

The human small intestine is over 6 meters long and is divided into three parts:
the duodenum, the jejunum, and the ileum.

• Intestinal epithelium

• Duodenum

• Jejunum

• Ileum

Intestinal epithelium
The single columnar epithelium of the small intestine consists of different epithelial cells.
The palisade-like epithelial cells are tightly connected with cell junctions. The intestinal
epithelium is folded into finger-like projections called the villi. Each villus contains blood
and lymph vessels that efficiently distribute the nutrients that were absorbed by the cells
of the intestinal lining. These are key targets for pathogens, therefore the intestinal lining is
an important barrier that is well guarded by the immune system.
Figure 1: Components of the intestinal epithelium: (1) villi, (2) lymphatic vessel, (3) blood
vessels, (4) gland (crypt of Lieberkuhn), (5) epithelium , (6) lymphocytes, (7) lamina propria,
(8) goblet cell, (9) microvilli, (10) tight junction, (11) adhesive belt, (12) desmosome, (13)
gap junction, (14) nerve ending, (15) capillary.

• Cell types of intestinal epithelium

• Cell junctions

• Small intestine

Cell types of the intestinal epithelium

The intestinal epithelium consists of different cell types. The most abundant cells
are enterocytes, also known as intestinal absorptive cells, because their apical membrane
and glycocalix is packed with digestive enzymes and transporters. The enterocytes are not
only responsible for nutrient absorption, they also play an important role in processing
antigens and presenting them to T cells.

The brush cells are another type of epithelial cell with microvilli on the apical side. Although
brush cells have longer microvilli, they have a thinner glycocalix than enterocytes. The
function of brush cells is still under investigation, but it has been hypothesized that they have
a receptor role.

Goblet cells are easily distinguished from the other two cell types as they produce and
secrete mucus into the lumen of the small intestine. Mucus is mainly composed of mucin
glycoproteins, which form a gel-like layer covering the epithelial cells. This helps to protect
the cells from physical damage by acting as a lubricant and the gel-like web of
macromolecules also forms a barrier against bacteria cells.
Figure 1: Light microscopy image of a goblet cell surrounded by entherocytes.

Cell junctions
Cell junctions are molecular structures between cells that stabilize the tissue, form
barriers and allow for transport of molecules between two cells.

The largest cell junctions are called desmosomes. They are protein complexes that
connect the keratin fibers of two cells like a hook-and-loop fastener. Desmosomes help the
tissue to resist shearing forces.

Tissues that form a barrier, such as the intestinal epithelium, require individual cells to be
tightly connected to prevent any liquid escaping. This sealing function is performed by a
network of tight junctions. These strands of protein complexes connect the plasma
membrane of two neighboring cells forming a virtually impermeable barrier to fluid.

The tight junctions are supported by the adherens junctions. Adherens junctions are
anchor-like protein complexes similar to desmosomes, but they are linked to the actin
cytoskeleton.

Figure 1: Cell junctions and their location in the intestinal epithelium.

Small intestine
The small intestine is the organ where the digestion of protein, fats, and carbohydrates is
completed. It is mainly responsible for mixing food with digestive juices and bringing it into
contact with the intestine lining for absorption. The small intestine absorbs 90% of
nutrients and water. It also moves food further down the gastrointestinal tract.

The small intestine is a long tube-like organ. Its inside is covered with the intestinal
epithelium that increases the surface area of the intestine and increase absorption
efficiency of the nutrients. The small intestine is surrounded by two layers of smooth
muscles that contract in a wavelike pattern. This peristaltic movement mixes the content
of the small intestine and slowly moves it towards the large intestine. Absorbed nutrients
in the blood are carried into the hepatic portal vein, which leads to the liver.

Figure 1: Components of the small intestine: (1) Muscle layers, (2) villi, (3) blood vessels,
(4) lumen, (5) lymphatic vessel, (6) absorptive enterocyte cells, (7) capillary, (8) artery, (9)
vein, (10) microvilli

The human small intestine is over 6 meters long and is divided into three parts:
the duodenum, the jejunum, and the ileum.

• Intestinal epithelium

• Duodenum

• Jejunum

• Ileum

Duodenum
The “C-shaped,” fixed part of the small intestine is called the duodenum. The duodenum is
separated from the stomach by the pyloric sphincter which opens to allow chyme to move
from the stomach to the duodenum. In the duodenum, chyme is mixed with pancreatic juices
in an alkaline solution rich in bicarbonate that neutralizes the acidity of chyme and acts as a
buffer.
Pancreatic juices also contain several digestive enzymes, which are mixed with bile from
the liver and gallbladder, as well as digestive juices from gland cells of the intestinal wall
itself. These digestive juices break down the food particles in the chyme into glucose,
triglycerides, and amino acids. Some chemical digestion of food takes place in the duodenum
as well as absorption of fatty acids.

Jejunum
The second part of the small intestine, following the duodenum, is called the jejunum.
Here, hydrolysis of nutrients is continued while most of the carbohydrates and amino acids
are absorbed through the intestinal lining. The bulk of chemical digestion and nutrient
absorption occurs in the jejunum.

Ileum
The ileum, following the jejunum, is the last part of the small intestine - here the bile salts
and vitamins are absorbed into the blood stream. Undigested food is sent to the colon from
the ileum via peristaltic movements of the muscle. The ileum ends and the large intestine
begins at the ileocecal valve.

Large intestine
The large intestine reabsorbs water from the undigested food material and processes waste
material. The main functions of the colon are to extract water and mineral salts from
undigested food, and to store waste material. It is also inhabited by microorganisms that
break down proteins into amino acids and amino acids into smaller components producing
vitamin K and some B vitamins in the process.

The large intestine of a human is much smaller in length compared to the small intestine
but larger in diameter. It has three parts: the cecum, the colon, and the rectum.

Figure 1: The vermiform (1), “worm-like,” appendix can be found right where
the cecum (2) joins the ileum to the colon; the receiving organ for waste matter. The colon
is home to many bacteria or “intestinal flora” that aid in the digestive processes. The colon
can be divided into four regions, the ascending colon (3), the transverse colon (4),
the descending colon (5) and the sigmoid colon (6). The rectum (7) is the terminal end of
the large intestine and its primary role is to store the feces. The anus (8) is an opening at the
far-end of the digestive tract and is the exit point for the waste material.

Wall composition of the large intestine

The wall of the large intestine, similarly as in the case of the small intestine, contains four
layers of tissue found in the rest of the gastrointestinal tract: mucosa, submucosa,
muscularis, and serosa.

The structure of the large intestine is designed to facilitate its function. It produces thick
mucus that helps to push the digested food residues further down the intestinal tract. It
also absorbs water that hasn't been absorbed yet and forms waste matter that can be
removed in the final part of the tract. Therefore the wall of the large intestine lacks circular
folds and villi. It also does not have as many structural adaptations that increase surface
area. Its absorption is decreased and focused more on smoothly pushing the waste matter
and facilitating microbiota with breaking down proteins and producing vitamins.

Figure 1: The large intestine does not have any additional structures facilitating absorption
of nutrients as in the case of the small intestine. Instead, it is rich in intestinal glands that
produce mucus, facilitating food matter movement and absorption or residual nutrients
and water.

Microbiota of the large intestine

Gut microbiota is the community of microorganisms in the gastrointestinal tract. They are
mainly responsible for the final stage of digestion. They ferment remaining carbohydrates
and release hydrogen, carbon dioxide, and methane gases. They also convert proteins to
amino acids and break them down into simpler substances. One of the bacterial product
groups is vitamins that are crucial for normal metabolism, thus absorbed in the large
intestine.
Apart from assisting in the digestion and breakdown of food, microbiota also influences the
host organism's immune response, behavior, and mood.

There are two major groups of bacteria dominating the gastrointestinal tract: Firmicutes
(Lactobacillus and Streptococcus species) at 65% of the total, and Bacteroidetes at
around 30%. The remaining 5% comprises primitive bacterial groups
like E.coli and Bifidobacteria species. In reality, each person has a unique profile of
microbial species.

Cells of intestines
The epithelial layer of both small and large intestines contains many types of cells. Four of
them are particularly important in maintaining functions of both intestines: absorptive
cells, goblet cells, paneth cells, and enteroendocrine cells.

Absorptive cells are abundant in the epithelium of the small intestine. Their role is to
release enzymes that digest food and absorb nutrients using microvilli. In the large
intestine, absorptive cells are not so abundant but still present for absorption of water and
residues of nutrients that were not absorbed in previous parts of the intestinal tract.

Goblet cells are found scattered among other cells in the epithelium of many organs,
especially in the intestinal and respiratory tracts. Their main role is to secrete mucus.
Secretion of mucus from goblet cells is caused by irritating stimuli like food matter traveling
through the digestive tract. They are present in both small and large intestines. Their role is
vital in the large intestine, where they transfer waste matter through the colon and protect
the lining of the tract against bacteria and other microorganisms present in the large
intestine.

In the crevices of the small intestinal mucosa, cells form the intestinal glands. Besides
absorptive and goblet cells, intestinal glands also contain paneth cells and
enteroendocrine cells. Paneth cells secrete bactericidal enzymes and are capable of
phagocytosis. They provide host defense against unwanted microbes only in the small
intestine since they could harm digestive microbes located in the large
intestine. Enteroendocrine cells produce and release hormones in response to various
stimuli. Each type of enteroendocrine cell secretes different hormones: S cells secrete
secretin, CCK cells secrete cholecystokinin, and K cells secrete glucose-dependent
insulinotropic peptide. These cells are not present in the large intestine, as their function is
unnecessary.
Figure 1: Comparison of walls of the small and large intestine and four main types of cells
inhabiting these organs. Depending on the function of the intestine, the types and amounts
of cells are different.

Villi and microvilli

Circular folds are rich in villi - fingerlike projections of the mucosa. They continue
increasing the surface area of the intestine that can absorb substances. Each villus has a
layer of connective tissue with blood and lymphatic capillary embedded in it. Nutrients
absorbed by the most outer cells pass through the walls of capillaries and enter blood or
lymph.

Villi are rich in absorptive cells that are one of the most common intestine cells,
responsible for substance absorption. Microvilli are tiny projections of the membrane of
the absorptive cell. When seen through a light microscope, microvilli form a fuzzy line
called the brush border. By extending into the lining of the small intestine and increasing
the surface area of the membrane of absorptive cells, larger amounts of nutrients can be
absorbed in a shorter time.
Figure 1: Three levels of complexity of the structure of the small intestine. The lining of the
small intestine has circular folds, which are rich in villi. Each villus has absorptive cells that
contain microvilli. All structures increase absorption surface area of the intestine.

Absorption dysfunction
Absorption dysfunction (malabsorption) refers to the inability of the intestines to absorb
certain nutrients and fluids.

There are many factors causing malabsorption like food allergies, microbiome imbalances,
surgeries, autoimmune diseases, and mechanical damages to the intestines from
infections or accidents. In many cases, malabsorption is tightly related to intestine
diseases.

A significant increase in absorption can lead to nutrient deficiencies. The deficiencies

manifest themselves with various symptoms that can be observed. Depending on the type
of deficiency, different symptoms occur.

• Protein deficiency - Protein is broken down in the body into amino acids, which are
further used to build tissues and muscles. Severe lack of amino acid supply can
cause muscle wasting or even atrophy because there is insufficient source to build
the muscle tissue.

• Vitamin D deficiency - Active form of Vitamin D promotes optimal calcium

absorption from your diet. If the deficiency is severe, low calcium levels in the blood
can lead to muscle cramps, one of the signs of rickets.

• Vitamin B complex deficiency - Vitamin B complex is used by the body to produce

red blood cells that carry oxygen to all the cells and tissues. Deficiency in these
vitamins causes a decrease in red blood cell count, leading to fatigue or even
anemia.

• Lipid deficiency - Lipids are involved in many biological processes in your body. For
example, fat is an essential part of the structure of the skin cells, and lack of that
structure leads to dry skin rashes. Fatty molecules also promote hair growth, so if
the body has too little essential fat, it starts to lose hair. Fatty acids are also crucial
for the growth and stimulation of immune cells. Thus, lipid deficiency can decrease
immunity.

• Carbohydrate deficiency - Carbohydrates are fuel for your brain, muscles, and
organs, which are essential for their proper function. In the initial stages of
carbohydrate deficiency, your body uses its natural storage of them in the form of
glycogen. Conversion of glycogen to glucose (simple carbohydrate) requires water,
which, if not supplied constantly, can lead to dehydration and constipation. Not
enough carbohydrates will also influence your brain that uses most of it, causing
nausea and headache.
Common intestine diseases
The common intestine diseases are tightly connected with malabsorption.
Sometimes malabsorption is the cause of pathology; sometimes the roles are reversed.

Crohn’s disease

• Description: It is a chronic inflammatory disease of the small and large intestine

manifested through painful inflammatory patches

• Cause: Unknown. Some researchers try to connect the disease with some
autoimmune reactions. Genetics can also contribute to the probability of the
development of the disease.

• Symptoms: abdominal pain, diarrhea, weight loss, and fatigue

Irritable bowel syndrome

• Description: It is a chronic condition of inconsistent bowel movements that affects

the large intestine. The condition does not cause changes in bowel tissue or
increase the risk of cancer.

• Cause: Unknown. The following factors could be possible causes of the disease or
can contribute to the development of the symptoms: prolonged muscle
contractions, abnormalities in nerves of the digestive system, severe infection,
stressful events, drastic changes of gut microbiome

• Symptoms: abdominal cramping, bloating, diarrhea, constipation

Celiac disease

• Description: It is an immune disease in which your own body attacks the small
intestine upon eating food containing gluten.

• Cause: Genetic. The disease is inherited, and blood tests, family medical history,
and biopsy can easily detect the presence of the disease.

• Symptoms: They vary from individual to individual. They can be local (abdominal
pain, diarrhea) or global (irritation, depression).

Ulcerative Colitis

• Description: It is a condition causing inflammation and sores, named ulcers, in the

lining of the large intestine.

• Cause: Unknown. One possibility could be the malfunction of the immune system
where the immune cells attack tissues of the large intestine while fighting some
pathogen. It can also be genetic; however, there is no proof of that yet.

• Symptoms: abdominal pain, bloody diarrhea, weight loss, tiredness, anemia

The mentioned diseases are only a fragment of all conditions that can develop in the
gastrointestinal tract. Some are mild, like hemorrhoids or infections, while some can be
life-threatening and require rapid detection and treatment (cancer).
Liver
The liver carries out important roles such as the digestion of fats and the detoxification of
the blood.

The liver produces bile, a digestive juice that is required for the breakdown of the fatty
components within food in the duodenum. The liver also processes vitamins and fats, and
synthesizes many plasma proteins.

The liver is the largest internal organ of most animals, including humans.

Gallbladder
The gallbladder is a small organ that aids the liver by storing bile and concentrating bile
salts. When chyme containing fatty acids enters the duodenum, the bile is secreted from
the gallbladder into the duodenum.

Pancreas
The pancreas is an important gland in the animal digestive system that secretes digestive
juices. The chyme produced from the stomach is highly acidic in nature; the pancreatic
juices contain high levels of bicarbonate, an alkali that neutralizes the acidic chyme.
Additionally, the pancreatic juices contain a large variety of enzymes that
catabolize starches, disaccharides, proteins, and fats.