DUODENUM
Dr. Swati Suman
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Assistant ProfessorDept of Anatomy
NMCH,Jamuhar
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DUODENUM?
INTRODUCTION
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?
Duodenal recesses
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?RELATIONS
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Blood supply
?
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Interior of duodenum?
Lymphatic drainage
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Suspensory ligaments
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?Nerve supply
of duodenum
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Applied anatomy
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Duodenum -shortest, widest &
most fixed
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part of the small intestine.
Extent: Pylorus to duodenojejunal
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flexure.Shape: ` C' shaped
Location: above the level of umbilicus,
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opposite 1st , 2nd & 3rd lumbar
vertebrae.
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Parts:1. Superior (1st ) part: 5 cm (2 inches)
long
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2. Descending (2nd ) part: 7.5 cm (3
inches)
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3. Horizontal (3rd ) part: 10 cm (4inches)
4. Ascending (4th ) part: 2.5 cm (1
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inch)
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FIRST PARTFIRST PART
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Relation:Anteriorly: Quadrate lobe of liver & GB.
Posteriorly: Portal vein, gastroduodenal
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artery & common bile duct .
Superiorly: Epiploic foramen
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Inferiorly: Head & neck of pancreas.Features
?Initial 2.5 cm- no circular folds in mucous
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membrane - duodenal cap
?Proximal 2.5 cm is movable.
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?1st Part : site for duodenal ulcer-because
it is supplied by end arteries and receives
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acidic chyme from stomach.
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SECOND PARTSECOND PART
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Relations :Anteriorly:
? Gallbladder,
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? Right lobe of liver,
? Transverse colon, root of transverse
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mesocolon,? coils of small intestine.
Posteriorly:
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? Right kidney, right renal vessels,
? Right edge of IVC
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? Right psoas major muscle.Medially:
Head of the pancreas.
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Laterally:
Right colic flexure & right lobe of liver.
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THIRD PART
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Third Part:Relations
Anteriorly:
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Root of the mesentery, superior mesenteric
vessels & coils of jejunum.
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Posteriorly:Right psoas major,
right ureter,
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IVC, abdominal aorta & right gonadal vessels.
Superiorly:
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Head of the pancreas & uncinate process.Inferiorly:
Coils of the jejunum.
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Applied Anatomy:
Obstruction of the third part -pressure of
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superior mesentric artery over aortaFOURTH PART
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Fourth part:
Relations
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Anteriorly: Transverse colon andtransverse mesocolon.
Posteriorly: Left psoas major muscle,
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left sympathetic chain, left gonadal
vessels & inferiormesenteric vein.
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Superiorly: Body of the pancreas.To the left: Left kidney and left ureter.
To the right: Upper part of root of
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mesentery.
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INTERIOR OF THE DUODENUMcircular folds (valves of
Kerckring)- begin in second
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part and become large &
closely set below of major
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duodenal papilla.1. Major duodenal papilla:
2. Minor duodenal papilla:
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3. Arch of plica semicircularis:
4. Plica longitudinalis:
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1. Major duodenal papilla: Conical
projection on posteromedial wall ,
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8?10 cm distal to pylorus.Site for opening of common
hepatopancreatic duct
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2. Minor duodenal papilla: small
conical projection, situate 6-8 cm
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distal pylorus.Accessory pancreatic duct opens
on its summit.
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3. Arch of plica semicircularis:
forms an arch above major
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duodenal papilla like a hood4. Plica longitudinalis: vertical
tortuous fold of mucous
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membrane extending downward
from major
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duodenal papilla.SUSPENSORY MUSCLE OF DUODENUM
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(LIGAMENT OF TREITZ)? Fibromuscular band- suspends duodenojejunal
flexure from right crus of the diaphragm.
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Attachment:
?Upper end- attached to right crus of diaphragm
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? Lower end- attached to posterior surface ofduodenojejunal flexure, third & fourth part of
duodenum
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made up of :
(a) Striated muscle fibres - upper part.
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(b) Elastic fibres - middle part.(c ) Smooth muscle fibres -lower part
Function:
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Fixes duodenojejunal flexure & prevents it from
being dragged down by weight of small intestine.
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Applied Anatomy:
?Normally its contraction
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increases the angle ofduodenojejunal flexure.
?Sometimes it is attached only
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to flexure, and then its
contraction may narrow the
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angle of the flexure, causingpartial obstruction of the gut.
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DUODENAL RECESSES(FOSSAE)--- Content provided by FirstRanker.com ---
ARTERIAL SUPPLYVENOUS DRAINAGE
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The veins correspond to thearteries & drain into
the splenic, superior mesenteric,
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and portal veins.
LYMPHATIC DRAINAGE
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Most lymph vessels drain topancreaticoduodenal
nodes. coeliac and superior
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mesenteric lymph
nodes intestinal lymph trunk
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cisterna chyli.NERVE SUPPLY
Sympathetic nerves :T9?T10
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segments of the spinal cordParasympathetic nerves : vagus
through coeliac and superior
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mesenteric plexuses. From these
plexuses, fibres run along arteries
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of the duodenum to supply itAPPLIED ANATOMY
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Kissing ulcer-1st part of duodenumpresents ulcer on the anterior and
posterior walls .
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If anterior wall perforate:
content enter grater sac.
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If posterior wall perforates: erodesgastroduodenal artery leading to
fatal haemorrhage.
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If posterior wall perforates: contents
enter the lesser sac.
APPLIED ANATOMY
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Peptic Ulcer: occur in site of pepsin & HCL secreation - lower end of
oeosphagus, stomach, 1st part of duodenum, meckel's diverticulum
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Blood group O- duodenal ulcer.Duodenal ulcer:
-epigastric pain ? due to hunger
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-pain relieved by food
-pain shows periodicity for number of
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weeks.-pain wakes patient at night at 2-3 am
Gastric ulcer:
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- epigastric pain ? due to hunger
-pain is made worse by food ? pt. become
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anorexic and shows weight loss.-periodicity is less marked