This document summarizes key details about the duodenum and pancreas. It describes the four parts of the duodenum, their locations, relations, features, and applied anatomy. It discusses the major and minor duodenal papillae and their openings. It then describes the pancreas, including its head, neck, body, and tail; their locations, borders, surfaces, and relations. It notes the arterial supply, venous drainage, lymphatic drainage, and nerve supply of both organs. It concludes with brief descriptions of acute pancreatitis and annular pancreas.

1. Duodenum & Pancreas
Dr. Prabhakar Yadav
Associate Professor
Department of Human Anatomy
B.P. Koirala Institute of Health Sciences

2. Duodenum -shortest, widest & most fixed
part of the small intestine.
Extent: Pylorus to duodenojejunal flexure.
Shape: ‘ C’ shaped
Location: above the level of umbilicus,
opposite 1st , 2nd & 3rd lumbar vertebrae.
Parts:
1. Superior (1st ) part: 5 cm (2 inches) long
2. Descending (2nd ) part: 7.5 cm (3 inches)
3. Horizontal (3rd ) part: 10 cm (4 inches)
4. Ascending (4th ) part: 2.5 cm (1 inch)

3. FIRST PART
Relation:
Anteriorly: Quadrate lobe of liver & GB.
Posteriorly: Portal vein, gastroduodenal
artery & common bile duct .
Superiorly: Epiploic foramen
Inferiorly: Head & neck of pancreas.
Features
•Initial 2.5 cm- no circular folds in mucous
membrane - duodenal cap
•Proximal 2.5 cm is movable.
•1st Part : site for duodenal ulcer- because
it is supplied by end arteries and receives
acidic chyme from stomach.

4. Kissing ulcer:
1st part of duodenum presents ulcer
on the anterior and posterior walls .
If anterior wall perforate:
content enter grater sac.
If posterior wall perforates: erodes
gastroduodenal artery leading to
fatal haemorrhage.
If posterior wall perforates: contents
enter the lesser sac.

5. Applied Anatomy:
Peptic Ulcer: occur in site of pepsin & HCL secreation - lower end of oeosphagus, stomach, 1st
part of duodenum, meckel’s diverticulum
Blood group O- duodenal ulcer.
Duodenal ulcer:
 epigastric pain – due to hunger
 pain relieved by food
 pain shows periodicity for number of
weeks.
 pain wakes patient at night at 2-3 am
Gastric ulcer:
 epigastric pain – due to hunger
 pain is made worse by food – pt. become
anorexic and shows weight loss.
 periodicity is less marked

6. SECOND PART
Relations :
Anteriorly:
• Gallbladder,
• Right lobe of liver,
• Transverse colon, root of transverse
mesocolon,
• coils of small intestine.
Posteriorly:
• Right kidney, right renal vessels,
• Right edge of IVC
• Right psoas major muscle.
Medially: Head of the pancreas.
Laterally:
Right colic flexure & right lobe of liver.

7. Features:
•2nd part -receives bile duct, main &
accessory pancreatic ducts.
• is the only part of intestine supplied
by double rows of vasa recta, arising
from anterior and posterior
pancreaticoduodenal arterial arcades.

8. Third Part:
Relations
Anteriorly:
Root of the mesentery, superior mesenteric
vessels & coils of jejunum.
Posteriorly:
Right psoas major,
right ureter,
IVC, abdominal aorta & right gonadal vessels.
Superiorly:
Head of the pancreas & uncinate process.
Inferiorly: Coils of the jejunum.
Applied Anatomy:
Obstruction of the third part -pressure of
superior mesentric artery over aorta

9. Fourth part:
Relations
Anteriorly: Transverse colon and
transverse mesocolon.
Posteriorly: Left psoas major muscle, left
sympathetic chain, left gonadal vessels &
inferiormesenteric vein.
Superiorly: Body of the pancreas.
To the left: Left kidney and left ureter.
To the right: Upper part of root of
mesentery.

10. INTERIOR OF THE DUODENUM
circular folds (valves of Kerckring)- begin in second part and become large & closely set below of
major duodenal papilla.
1. Major duodenal papilla: Conical projection on posteromedial wall , 8–10 cm distal to pylorus.
Site for opening of common hepatopancreatic duct
2. Minor duodenal papilla: small conical projection, situate 6-8 cm distal pylorus.
Accessory pancreatic duct opens on its summit.
3. Arch of plica semicircularis: forms an arch above major duodenal papilla like a hood
4. Plica longitudinalis: vertical tortuous fold of mucous membrane extending downward from major
duodenal papilla.
Applied Anatomy:
ERCP- major duodenal
Papilla is catheterized and a
radiopaque material is
filled in the bile and pancreatic
ducts

11. :SUSPENSORY MUSCLE OF DUODENUM
(LIGAMENT OF TREITZ)
• Fibromuscular band- suspends duodenojejunal
flexure from right crus of the diaphragm.
Attachment:
•Upper end- attached to right crus of diaphragm
• Lower end- attached to posterior surface of
duodenojejunal flexure, third & fourth part of
duodenum
made up of :
(a) Striated muscle fibres - upper part.
(b) Elastic fibres - middle part.
(c ) Smooth muscle fibres -lower part
Function:
Fixes duodenojejunal flexure & prevents it from
being dragged down by weight of small intestine.
Applied Anatomy:
•Normally its contraction increases the angle of
duodenojejunal flexure.
•Sometimes it is attached only to flexure, and then
its contraction may narrow the angle of the
flexure, causing partial obstruction of the gut.

12. ARTERIAL SUPPLY:

13. VENOUS DRAINAGE
The veins correspond to the arteries & drain into
the splenic, superior mesenteric, and portal veins.
LYMPHATIC DRAINAGE
Most lymph vessels drain to pancreaticoduodenal
nodes. coeliac and superior mesenteric lymph
nodes intestinal lymph trunk cisterna chyli.
NERVE SUPPLY
Sympathetic nerves :T9–T10 segments of the spinal cord
parasympathetic nerves : vagus
through coeliac and superior mesenteric plexuses. From these
plexuses, fibres run along arteries of the duodenum to supply it.

14. PANCREAS
• Soft, lobulated, elongated , obliquely
placed, retort- shaped, exoendocrine gland
•Exocrine part secretes pancreatic
Juice - digestion of lipids, Carbohydrates &
proteins
• Endocrine part secretes Insulin - maintain
glucose level
• Lies on posterior abdominal wall in
epigastric & left hypochondriac regions.
• is retroperitoneal organ except the tail,
lies in lienorenal ligament.
Applied Anatomy:
Dificiency of insulin- DM- Type- II
Dificiency of pancreatic enzymes- digestive
disturbance

15. Lies -opposite to T12–L3 vertebrae.
PARTS AND RELATIONS
Head : Enlarged flattened right end of
pancreas, situated within concavity of
duodenum, opposite L1 and L3
External Features
3 borders-superior, Inferior & Right lateral
2 surfaces- Anterior & Posterior
1 process-
uncinate process: projects from lower &
left part of head towards left.

16. Relation:
Superior border:
(a) first part of the duodenum, and
(b) superior pancreaticoduodenal artery.
Inferior border:
(a) third part of the duodenum, and
(b) inferior pancreaticoduodenal artery.
Right lateral border:
(a) second part of the duodenum
(b) Anterior & posterior pancreaticoduodenal
arterial arcades
(c) Terminal part of bile duct

17. Anterior surface: from above downward
(a) First part of duodenum
(b) transverse colon
(c) Root of transverse mesocolon
(d) jejunum.
Posterior surface:
(a) IVC, (b) Terminal parts of renal veins
(c) bile duct (d) right crus of diaphragm.
Relation of Uncinate process :
(a) Anteriorly: Superior mesenteric vessels
(b) Posteriorly: Abdominal aorta
Applied Anatomy:
Courvoisier's law: presence of a palpable
gallbladder which is nontender and
accompanied with jaundice, the cause is
unlikely to be gallstones. This sign
implicates possible malignancy of GB or
pancreas

18. NECK OF THE PANCREAS
constricted part –connects head with body.
2.5 cm long
External Features
2 surfaces: Anterior and posterior.
2 borders: Upper and lower.
Relations
Anterior surface : peritoneum covering the
posterior wall of the lesser sac & pylorus.
Posterior surface : commencement of portal
vein.

19. Body:
•Extent- Neck to tail
• Lies in transpyloric plane
External Features
is triangular on cross-section
3 borders -anterior, superior & inferior.
3 surfaces: Anterior, posterior, & inferior
A part of the body projects upwards
beyond rest of the superior border, a little
left to the neck- Tuber omentale

20. Relations:
Anterior border: Provides attachment to root of transverse mesocolon.
Superior border: Related to coeliac trunk above tuber omentale, hepatic artery to right &
splenic artery to left .
Inferior border: related to superior mesenteric vessels at its right end
Anterior surface: Lesser sac & stomach.
Inferior surface: duodenojejunal flexure, coils of jejunum & left colic flexure.

21. Posterior surface is related to:
(a) aorta and origin of the superior mesenteric artery,
(b) left kidney and left suprarenal glands,
(c) Left renal vessels
(d) splenic vein usually lies in a groove below the level of splenic artery.
(e) Left crus of diaphragm

22. TAIL:
•Lies at the level of T12 vertebra
•left extremity of the pancreas
•lies in the lienorenal ligament along with
splenic vessels
•contains largest number of islets of
Langerhans

23. Main pancreatic duct (Wirsung )
Accessory pancreatic duct (santorini)
• Main duct begins in tail
gradually increases in size
and opens in duodenum 10
cm away from pyloric
orifice .
• Accessory duct 2 cm above
it

24. ARTERIAL SUPPLY

25. Venous drainage

26. Lymphatic drainage:
Most of the pancreatic lymphatic vessels end in the pancreaticosplenic nodes &some end in
pyloric lymph nodes. superior mesenteric or celiac lymph nodes intestinal
lymph trunk to reach the cisterna chyli Thoracic suct

27. Nerve supply:
Parasympathetic : Vagus nerve-controls the
pancreatic secretion.
Sympathetic : T6-T10- vasomotor

28. Acute pancreatitis:
• acute inflammation of pancreas.
•Causes: IGETSMASHED
•activated pancreatic enzymes leak into the substance of pancreas and initiates autodigestion of gland.
• presentation: severe pain in the epigastric region radiating to back, fever, nausea, and vomiting.
•Lab Ix: serum amylase, level is raised four times.
Annular Pancreas:

29. THANK YOU