The duodenum has four parts with different anatomical relationships and blood supply. The first part is anterior to the liver and posterior to major blood vessels. The second part is anterior to the gallbladder and colon and posterior to renal vessels. The third part is anterior to major abdominal vessels and posterior to the inferior vena cava. The fourth part is anterior to the transverse colon and posterior to left abdominal structures. It receives its blood supply from branches of the celiac trunk and superior mesenteric artery, and drains into the splenic, superior mesenteric, and portal veins. Its nerve supply comes from the celiac plexus.

1. DUODENUM

3. RELATIONS
FIRST PART
Anterior – Quadrate lobe of the liver
Posterior – Portal vein, gastroduodenal artery, and bile-duct.
The vena cava is behind these.
Superior - Epiploic foramen and hepatic artery (horizontal
part)
Inferior - Head of the pancreas

7. SECOND PART
Anterior - Gall-bladder, transverse colon, and small gut
Posterior - Rt. Renal vessels, the pelvis and surrounding areas
of the rt.kidney
Right - Hepatic flexure of the colon
Left - Head of the pancreas. It is pierced about the
middle by the bile
and pancreatic ducts.

8. THIRD PART
Anterior - Superior mesenteric vessels, the root of the
mesentery, the transverse colon and mesocolon
Posterior - Inferior vena cava, aorta, gonadal vessels of both
sides, the left sympathetic trunk, and the left psoas
Superior - Head of the pancreas
Inferior - Small gut

9. FOURTH PART
Anterior- Transverse mesocolon, and transverse colon
Posterior - Left psoas major, left sympathetic trunk, left renal and
testicular vessels and inferior mesenteric artery
Superior - Pancreas
Inferior - Jejunum
Right - Aorta
Left - Left Kidney
and ureter

14. ARTERIAL SUPPLY
• Derived from coeliac trunk:
Superior pancreaticoduodenal (branch of
gastroduodenal which in turn is a branch of
hepatic artery)
• Derived from Superior mesenteric artery:
Inferior pancreaticoduodenal
• Additional supply from:
Supraduodenal/ Right gastric/ Right
gastroepiploic arteries

17. Venous drainage
• Splenic
• Superior mesenteric
• Some veins directly in to portal vein

18. Lymphatic drainage
• Pancreaticoduodenal nodes
Pyloric Hepatic Coeliac
nodes
• Lower down: to preaortic lymph node around superior
mesenteric artery

19. • Nerve supply
• Coeliac plexus- Gets sympathetic component from
both greater splanchnic nerves & branches from
both the vagus nerves

20. Duodenal cap