Download MBBS Duodenum Lecture PPT

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Assistant Professor

Dept of Anatomy

NMCH,Jamuhar

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DUODENUM

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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

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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 (4

inches)

4. Ascending (4th ) part: 2.5 cm (1

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inch)

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FIRST PART


FIRST 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 PART


SECOND 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 aorta


FOURTH PART

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Fourth part:

Relations

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Anteriorly: Transverse colon and

transverse 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 DUODENUM

circular 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 hood

4. 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 of

duodenojejunal 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 of

duodenojejunal 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, causing

partial obstruction of the gut.

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DUODENAL RECESSES(FOSSAE)

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ARTERIAL SUPPLY


VENOUS DRAINAGE

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The veins correspond to the

arteries & drain into

the splenic, superior mesenteric,

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and portal veins.

LYMPHATIC DRAINAGE

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Most lymph vessels drain to

pancreaticoduodenal

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 cord

Parasympathetic 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 it


APPLIED ANATOMY

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Kissing ulcer-1st part of duodenum

presents 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: erodes

gastroduodenal 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