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DUODENUM
DUODENUM
DUODENUM
The duodenum is the short, widest and most fixed part of the small
intenstine.
Extension : From the pylorus to duodenojejunal flexure
Shape : curved around the head of pancreas in the form of letter ‘C’
Location : lies above the level of umbilicus, opposite to first, second
and third lumbar vertebrae
DEFINITION & LOCATION
DEFINITION & LOCATION
3
LOCATION
LENGTH, PARTS & PERITONEAL RELATIONS
LENGTH, PARTS & PERITONEAL RELATIONS
First or Superior Part
Third or Horizontal Part Fourth or Ascending Part
2.5 cm or 1 inch long
Second or Descending Part
5 cm or 2 inches long
10 cm or 4 inches long
7.5 cm or 3 inches long
5
Duodenum is 25 cm long and is divided into the following four parts :
PARTS OF DUODENUM
FIRST PART
FIRST PART
Proximal 2.5 cm is movable
attached to the lesser omentum above,
and to the greater omentum below
distal 2.5 cm is fixed
It is retroperitoneal i.e covered with
peritoneum only on its anterior aspect.
Peritoneal Relations
7
Begins at the pylorus, and passes backwards, upwards and to the right to
meet the second part at the superior duodenal flexure
Relations :
Visceral Relations
Anteriorly: Quadrate lobe of liver, and
gallbladder
Posteriorly: Gastroduodenal artery, bile duct
and portal vein
Superiorly: Epiploic foramen
Inferiorly: Head and neck of the pancreas.
ANTERIOR RELATIONS POSTERIOR RELATIONS
9
SECOND PART
SECOND PART
COURSE :
This part is about 7.5 cm long
It begins at the superior duodenal flexure, passes downwards to reach
the lower border of the third lumbar vertebra, where it curves towards
the left at the inferior duodenal flexure, to become continuous with the
third part.
10
SECOND PART
SECOND PART
RELATIONS :
Peritoneal Relations
retroperitoneal and fixed
Its anterior surface is covered
with peritoneum, except near the
middle, where it is directly
related to the colon
11
SECOND PART
SECOND PART
VISCERAL RELATIONS :
ANTERIOR
1. Right lobe of the liver
2. Transverse colon
3.Root of the transverse
mesocolon
4. Small intestine
POSTERIOR
1. Anterior surface of the
right kidney near the
medial border
2. Right renal vessels
3. Right edge of the
inferior vena cava
4. Right psoas major
MEDIAL
1. Head of the
pancreas
2. The bile duct
LATERAL
Right colic
flexure
ANTERIOR RELATIONS POSTERIOR RELATIONS
13
SECOND PART
SECOND PART
Interior of the second part of the duodenum shows the
following special features :
The major duodenal papilla is an elevation present posteromedially, 8 to 10 cm
distal to the pylorus. The hepatopancreatic ampulla opens at the summit of the
papilla.
1.
The minor duodenal papilla is present 6 to 8 cm distal to the pylorus, and presents
the opening of the accessory pancreatic duct.
2.
. Below major duodenal papilla, a longitudinal fold called plica longitudinalis is seen
3.
14
THIRD PART
THIRD PART
COURSE :
This part is about 10 cm long
It begins at the inferior duodenal flexure, on the right side of the lower
border of the third lumbar vertebra
It passes almost hori- zontally and slightly upwards in front of the inferior
vena cava, and ends by joining the fourth part in front of the abdominal aorta
15
THIRD PART
THIRD PART
RELATIONS :
Peritoneal Relations
retroperitoneal and fixed
Its anterior surface is covered with peritoneum, except
near the middle, where it is crossed by the superior
mesenteric vessels and by the root of the mesentery.
16
THIRD PART
THIRD PART
VISCERAL RELATIONS :
ANTERIOR
Superior
mesenteric vessels
1.
Root of mesentery
2.
POSTERIOR
Right ureter
1.
Right psoas major
2.
Right testicular or ovarian
vessels
3.
Inferior vena cava
4.
Abdominal aorta with
origin of inferior
mesenteric artery
5.
SUPERIOR
Head of the pancreas
with uncinate process
INFERIOR
Coils of jejunum
ANTERIOR RELATIONS POSTERIOR RELATIONS
18
FOURTH PART
FOURTH PART
COURSE :
This part is about 2.5 cm long
It runs upwards on or immediately to the left of the aorta, up to
the upper border of the second lumbar vertebra, where it turns
forwards to become continuous with the jejunum at the
duodenojejunal flexure
19
FOURTH PART
FOURTH PART
RELATIONS :
Peritoneal Relations
mostly retroperitoneal, and covered with peritoneum
only anteriorly
The terminal part is suspended by the uppermost part of
the mesentery, and is mobile
20
FOURTH PART
FOURTH PART
VISCERAL RELATIONS :
ANTERIOR
Transverse colon
1.
Transverse
mesocolon
2.
Lesser sac
3.
Stomach
4.
POSTERIOR
Left sympathetic
chain
1.
Left renal artery
2.
Left gonadal artery
3.
Inferior mesenteric
vein
4.
TO RIGHT
Attachment of the upper part of
the root of the mesentery
TO LEFT
Left kidney
1.
Left ureter
2.
SUPERIOR
Body of pancreas
ANTERIOR RELATIONS POSTERIOR RELATIONS
22
SUSPENSORY MUSCLE OF DUODENUM OR
SUSPENSORY MUSCLE OF DUODENUM OR
LIGAMENT OF TREITZ
LIGAMENT OF TREITZ
This is a fibromuscular band which suspends and supports the duodenojejunal flexure. It
arises from the right crus of the diaphragm, close to the right side of the oesophagus,
passes downwards behind the pancreas, and is attached to the posterior surface of the
duodenojejunal flexure and the third and fourth parts of the duodenum.
It is made up of:
a. Striped muscle fibres in its upper part
b. Elastic fibres in its middle part
c. Smooth muscle fibres in its lower part. Normally, its contraction increases the angle of
the duodenojejunal flexure. Sometimes it is attached only to the flexure, and then its
contraction may narrow the angle of the flexure, causing partial obstruction of the gut
SUSPENSORY LIGAMENT OF TREITZ
24
ARTERIAL SUPPLY
ARTERIAL SUPPLY
Up to the level of the opening, the duodenum is supplied by the superior
pancreaticoduodenal artery.
Below it is supplied by the inferior pancreaticoduodenal artery
Supply from :
The right gastric artery.
1.
The supraduodenal artery of Wilkie, which is usually a branch of the common hepatic
artery.
2.
The retroduodenal branches of the gastroduodenal artery.
3.
Some branches from the right gastroepiploic artery
4.
A
R
T
E
R
I
A
L
S
U
P
P
L
Y
26
VENOUS SUPPLY
VENOUS SUPPLY
The veins of the duodenum drain into :
Splenic vein
1.
Superior mesenteric vein
2.
Portal veins
3.
27
LYMPHATIC DRAINAGE
LYMPHATIC DRAINAGE
Most of the lymph vessels from the duodenum end in the pancreaticoduodenal nodes
present along the inside of the curve of the duodenum, i.e. at the junction of the pancreas
and the duodenum
From here the lymph passes partly to the hepatic nodes, and through them to the coeliac nodes; and
partly to the superior mesenteric nodes and ultimately via intestinal lymph trunk into the cisterna
chyli
Some vessels from the first part of the duodenum drain into the pyloric nodes, and
through them to the hepatic nodes
All the lymph reaching the hepatic nodes drains into the coeliac nodes
LYMPHATIC DRAINAGE
29
NERVE SUPPLY
NERVE SUPPLY
Sympathetic nerves from thoracic ninth and tenth spinal segments
Parasympathetic nerves from the vagus
pass through the coeliac plexus and reach the duodenum along its arteries
24
CLINICAL ANATOMY
CLINICAL ANATOMY
1. Duodenal diverticula :
-fairly frequent
-seen along its concave border, generally at points where arteries enter the duodenal
wall
2. Congenital stenosis :
-congenital stenosis and obstruction of the second part of the duodenum may occur
at the site of the opening of the bile duct
Other causes of obstruction are :
An annular pancreas
Pressure by the superior mesenteric artery on the third part of duodenum
Contraction of the suspensory muscle of the duodenum
24
CLINICAL ANATOMY
CLINICAL ANATOMY
3. Duodenal tarcinoma :
-cancer of duodenum
4. Common duodenal diseases :
1st part : Peptic ulcer
2nd part : Diverticula
3rd part : Compression
4th part : Internal hernia
Thank You!

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Anatomy of Duodenum- detailed ppt presentation for science students

  • 3. The duodenum is the short, widest and most fixed part of the small intenstine. Extension : From the pylorus to duodenojejunal flexure Shape : curved around the head of pancreas in the form of letter ‘C’ Location : lies above the level of umbilicus, opposite to first, second and third lumbar vertebrae DEFINITION & LOCATION DEFINITION & LOCATION 3
  • 5. LENGTH, PARTS & PERITONEAL RELATIONS LENGTH, PARTS & PERITONEAL RELATIONS First or Superior Part Third or Horizontal Part Fourth or Ascending Part 2.5 cm or 1 inch long Second or Descending Part 5 cm or 2 inches long 10 cm or 4 inches long 7.5 cm or 3 inches long 5 Duodenum is 25 cm long and is divided into the following four parts :
  • 7. FIRST PART FIRST PART Proximal 2.5 cm is movable attached to the lesser omentum above, and to the greater omentum below distal 2.5 cm is fixed It is retroperitoneal i.e covered with peritoneum only on its anterior aspect. Peritoneal Relations 7 Begins at the pylorus, and passes backwards, upwards and to the right to meet the second part at the superior duodenal flexure Relations : Visceral Relations Anteriorly: Quadrate lobe of liver, and gallbladder Posteriorly: Gastroduodenal artery, bile duct and portal vein Superiorly: Epiploic foramen Inferiorly: Head and neck of the pancreas.
  • 9. 9 SECOND PART SECOND PART COURSE : This part is about 7.5 cm long It begins at the superior duodenal flexure, passes downwards to reach the lower border of the third lumbar vertebra, where it curves towards the left at the inferior duodenal flexure, to become continuous with the third part.
  • 10. 10 SECOND PART SECOND PART RELATIONS : Peritoneal Relations retroperitoneal and fixed Its anterior surface is covered with peritoneum, except near the middle, where it is directly related to the colon
  • 11. 11 SECOND PART SECOND PART VISCERAL RELATIONS : ANTERIOR 1. Right lobe of the liver 2. Transverse colon 3.Root of the transverse mesocolon 4. Small intestine POSTERIOR 1. Anterior surface of the right kidney near the medial border 2. Right renal vessels 3. Right edge of the inferior vena cava 4. Right psoas major MEDIAL 1. Head of the pancreas 2. The bile duct LATERAL Right colic flexure
  • 13. 13 SECOND PART SECOND PART Interior of the second part of the duodenum shows the following special features : The major duodenal papilla is an elevation present posteromedially, 8 to 10 cm distal to the pylorus. The hepatopancreatic ampulla opens at the summit of the papilla. 1. The minor duodenal papilla is present 6 to 8 cm distal to the pylorus, and presents the opening of the accessory pancreatic duct. 2. . Below major duodenal papilla, a longitudinal fold called plica longitudinalis is seen 3.
  • 14. 14 THIRD PART THIRD PART COURSE : This part is about 10 cm long It begins at the inferior duodenal flexure, on the right side of the lower border of the third lumbar vertebra It passes almost hori- zontally and slightly upwards in front of the inferior vena cava, and ends by joining the fourth part in front of the abdominal aorta
  • 15. 15 THIRD PART THIRD PART RELATIONS : Peritoneal Relations retroperitoneal and fixed Its anterior surface is covered with peritoneum, except near the middle, where it is crossed by the superior mesenteric vessels and by the root of the mesentery.
  • 16. 16 THIRD PART THIRD PART VISCERAL RELATIONS : ANTERIOR Superior mesenteric vessels 1. Root of mesentery 2. POSTERIOR Right ureter 1. Right psoas major 2. Right testicular or ovarian vessels 3. Inferior vena cava 4. Abdominal aorta with origin of inferior mesenteric artery 5. SUPERIOR Head of the pancreas with uncinate process INFERIOR Coils of jejunum
  • 18. 18 FOURTH PART FOURTH PART COURSE : This part is about 2.5 cm long It runs upwards on or immediately to the left of the aorta, up to the upper border of the second lumbar vertebra, where it turns forwards to become continuous with the jejunum at the duodenojejunal flexure
  • 19. 19 FOURTH PART FOURTH PART RELATIONS : Peritoneal Relations mostly retroperitoneal, and covered with peritoneum only anteriorly The terminal part is suspended by the uppermost part of the mesentery, and is mobile
  • 20. 20 FOURTH PART FOURTH PART VISCERAL RELATIONS : ANTERIOR Transverse colon 1. Transverse mesocolon 2. Lesser sac 3. Stomach 4. POSTERIOR Left sympathetic chain 1. Left renal artery 2. Left gonadal artery 3. Inferior mesenteric vein 4. TO RIGHT Attachment of the upper part of the root of the mesentery TO LEFT Left kidney 1. Left ureter 2. SUPERIOR Body of pancreas
  • 22. 22 SUSPENSORY MUSCLE OF DUODENUM OR SUSPENSORY MUSCLE OF DUODENUM OR LIGAMENT OF TREITZ LIGAMENT OF TREITZ This is a fibromuscular band which suspends and supports the duodenojejunal flexure. It arises from the right crus of the diaphragm, close to the right side of the oesophagus, passes downwards behind the pancreas, and is attached to the posterior surface of the duodenojejunal flexure and the third and fourth parts of the duodenum. It is made up of: a. Striped muscle fibres in its upper part b. Elastic fibres in its middle part c. Smooth muscle fibres in its lower part. Normally, its contraction increases the angle of the duodenojejunal flexure. Sometimes it is attached only to the flexure, and then its contraction may narrow the angle of the flexure, causing partial obstruction of the gut
  • 24. 24 ARTERIAL SUPPLY ARTERIAL SUPPLY Up to the level of the opening, the duodenum is supplied by the superior pancreaticoduodenal artery. Below it is supplied by the inferior pancreaticoduodenal artery Supply from : The right gastric artery. 1. The supraduodenal artery of Wilkie, which is usually a branch of the common hepatic artery. 2. The retroduodenal branches of the gastroduodenal artery. 3. Some branches from the right gastroepiploic artery 4.
  • 26. 26 VENOUS SUPPLY VENOUS SUPPLY The veins of the duodenum drain into : Splenic vein 1. Superior mesenteric vein 2. Portal veins 3.
  • 27. 27 LYMPHATIC DRAINAGE LYMPHATIC DRAINAGE Most of the lymph vessels from the duodenum end in the pancreaticoduodenal nodes present along the inside of the curve of the duodenum, i.e. at the junction of the pancreas and the duodenum From here the lymph passes partly to the hepatic nodes, and through them to the coeliac nodes; and partly to the superior mesenteric nodes and ultimately via intestinal lymph trunk into the cisterna chyli Some vessels from the first part of the duodenum drain into the pyloric nodes, and through them to the hepatic nodes All the lymph reaching the hepatic nodes drains into the coeliac nodes
  • 29. 29 NERVE SUPPLY NERVE SUPPLY Sympathetic nerves from thoracic ninth and tenth spinal segments Parasympathetic nerves from the vagus pass through the coeliac plexus and reach the duodenum along its arteries
  • 30.
  • 31. 24 CLINICAL ANATOMY CLINICAL ANATOMY 1. Duodenal diverticula : -fairly frequent -seen along its concave border, generally at points where arteries enter the duodenal wall 2. Congenital stenosis : -congenital stenosis and obstruction of the second part of the duodenum may occur at the site of the opening of the bile duct Other causes of obstruction are : An annular pancreas Pressure by the superior mesenteric artery on the third part of duodenum Contraction of the suspensory muscle of the duodenum
  • 32. 24 CLINICAL ANATOMY CLINICAL ANATOMY 3. Duodenal tarcinoma : -cancer of duodenum 4. Common duodenal diseases : 1st part : Peptic ulcer 2nd part : Diverticula 3rd part : Compression 4th part : Internal hernia