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Download MBBS Duodenum Lecture PPT

Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Latest Duodenum Lecture PPT

This post was last modified on 30 November 2021


DUODENUM

Dr. Swati Suman

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Assistant Professor

Dept 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

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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