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Anatomy of duodenum, duodenum structure, PPT of duodenum, power point presentation duodenum

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Anatomy of duodenum, duodenum structure, PPT of duodenum, power point presentation duodenum

Text of Anatomy of duodenum, duodenum structure, PPT of duodenum, power point presentation duodenum

  • 1. 10 in / 25 cm

2. Shortest, dilated and most fixed proximal part of Small intestine. Devoid of mesentery Fixed to post. Abd. Wall. C shaped curvature Curved around head of pancreas Lies above umbilicus opp. to 1, 2 & 3 rd Lumbar Vertebrae Receives Bile duct and pancreatic duct. Interposed bet. Stomach and intestines (Both are active digestive areas in GIT) 3. 1 2 3 4. 25 cm long & Subdivided into 4 parts First / upper part 5 cm Second / vertical part 7.5 cm Third / horizontal part 10 cm Fourth / ascending part 2.5 cm 1st 2nd 5. Extends from pylorus to Sup. Duodenal flexure, directed upwards, backwards & to Right Length 5 cm (Surface projection 2.5 cm) prox. 2.5 cm movable. Attached to lesser omentum above and to greater omentum below. Distal 2.5 cm is fixed. Retroperitoneal. Covered with peritoneum only on anterior aspect. 6. Visceral relations: Anteriorly : Quadrate lobe of liver, and gall bladder. Posteriorly : Gastroduodenal art., bile duct, and portal vein. Superiorly : Epiploic foramen. Inferiorly : Head & neck of pancreas. 7. Relations of 1st part Duodenum sagittal section viewed from left side Posterior relations 8. a) Most movable part, behaves more of stomach than duodenum b) Supplied by end arteries c) May be affected by peptic ulcer d) Devoid of circular mucous fold e) Seen as duodenal cap / Bulb in Radiographs. Du Ulcer - Trefoil deformity) Barium meal Barium sulphate Double contrast Now replaced by Endoscopy CT / MRI 9. First part is supplied by end arteries a) Supra duodenal (Art.of Wilkie) S.D.A. Br. of Gastroduodenal supplies upper margin, upper 2/3rd of anterior surface Upper 1/3rd of posterior surface of prox. of first half. b) Retro duodenal branch Br. of gastroduodenal Supplies part of post. Surface c) Infra duodenal branch Br. of Rt. Gastro-epiploic artery Supplies lower margin C.T. S.M.A. I.P.D. S.D.A Rt.G.E.A. C.H.A H.A.P. G.D.A. S.P.D. Rt.G.E.A. 10. Begins at superior duodenal flexure opp. L1 vertebra passes vertically downwards - in front of hilum of Rt. Kidney - along Rt. Side of vertebral column in para vertebral gutter - Within Rt. Lateral plane - ends in inferior duodenal flexure opp. Lower border of L3 - continues with 3rd part Rt. Lat. Plane 11. It is retroperitoneal and fixed. Ant. Surface is covered with peritoneum , except near the middle where it is directly related to colon. Visceral relations: Anteriorly: Right lobe of liver, Transverse colon, Root of transverse mesocolon, Small intestine. 12. Posteriorly : Entirely non-peritoneal 1. Ant. Surface of Rt. Kidney close to hilum 2. Rt. Renal vessels, pelvis of Rt. Ureter 3. Rt. Psoas major muscle 4. Rt. Edge of inferior vena cava 5. Sometimes part of Rt. Supra renal 13. Laterally: Rt. Colic flexure Medially: Head of pancreas, Anastomoses of Superior & Inferior pacreaticoduodenal vessels Bile duct and Main pancreatic duct 14. Circular folds Plica Circularis Permanent, circular & thick. Major duodenal papilla (on post. Medial wall of 2nd part 10 cm distal to pylorus) Bile duct & pancreatic ducts open on summit (Ampulla of vater) Minor duodenal papilla 2 cms above major papilla Accessry pancreatic duct opens Plica Semicircularis arches above major papilla Plica longitudinalis vertical fold downwards from major papilla Sometimes vertical fold upwards from major papilla marks Bile duct 15. Bile duct Pancreatic duct Sphincter pancreaticus Sphincter Ampullae BD + PD (Ampulla of Vater) Hepato pancreatic ampulla Sphincter Choledochus (Choledochus = Bile duct) This sphincter is always present. Normally keeps lower end of bile duct closed. As a result, bile formed in the liver keeps accumulating in gall bladder and undergoes considerable concentration. With a fatty meal the sphincter opens and bile stored in the gall bladder is poured into the duodenum. Gall stones Cholecystitis (Major duodenal papilla) 16. Extends from inf. Duodenal flexure to front of aorta at L3 level Relations - Anteriorly : Covered by peritoneum except attachment of root of mesentery Ant. Surface crossed by Sup. Mesenteric vessels and root of mesentery 17. Posteriorly: Non peritoneal 1. Rt.psoas major muscle 2. Right ureter 3. Inf. Vena cava 4. RT. Gonadal vessels 5. Abdominal aorta 6. Origin of inferior Mesenteric art. 18. Extends from inf. Duodenal flexure to front of aorta at L3 level Relations Superiorly : Head of pancreas with uncinate process. Inferior pancreatico duodenal vessels Inferiorly : Few coils of jejunum 19. Extends from front of aorta to Duodeno-jejunal flexure DJ flexure is situated on the left side of L2 about 1.25 cm below transpyloric plan & 2.5 cms to left of median plane Kept in position by suspensory muscle of Duodenum Relations Anteriorly : Covered with peritoneum. Related to transverse colon & mesocolon Post. Inf. Surface of stomach separated by lesser sac 20. Posteriorly : Left crus of diaphragm Left psoas major muscle Left sympathetic trunk Left renal vessels Left Gonadal vessels Left supra renal vein Inferior mesenteric vein 21. Right side : Uncinate process of pancreas Left side : Left kidney and ureter Superiorly : Body of pancreas 22. Fibro muscular band, which suspends and supports the duodenojejunal flexure. Arises from the right crus of the diaphragm; close to the right side of the esophagus, passes downwards behind pancreas, and is attached to the posterior surface of the duodenojejunal flexure and the 3rd & 4th parts of duodenum. Made up of stripped muscle fibers in its upper part, Elastic fibers in its middle part, and plain muscle fibers in its lower part. 23. Mucous coat : simple columnar / occasional goblet cells, covered with villi Lamina propria : contains crypts of Leiberkuhn receive at their bottom openings of Brunners glands Submucous coat : Loose areolar tissue Blood vessels, lymphatics Meissners plexus Brunners glands Muscular coat: Outer longitudinal & inner circular (Separated by myenteric plexus) Serous coat from peritoneum - incomplete 24. Sub mucous coat - Duodenal glands of Brunner Open at bottom of crypts of Leiberkuhn Secretion Rich in bicarobonate ions (alkaline) Helps activation of trypsinogen from pancreas 25. Most of the duodenum except 1st part is supplied by Ventral & dorsal anastomoses of Sup & Inf Pancreatico duodenal arteries. Vasa Recta arises and supply adjacent areas of duodenum and head of pancreas 26. Veins Correspond to arteries and drain into sup. Mesenteric and portal vein 27. Lymph vessels drain into pancreatico-duodenal lymph nodes. Efferent vessels of these nodes drain into Coeliac and sup. Mesen. group of pre-aortic lymph nodes. Some vessels drain into the Hepatic nodes directly. All lymph reaching hepatic nodes Drain into the coeliac nodes 28. Sympathetic nerves are derived from coeliac and sup. Mesen. Plexuses. Preganglionic fibres come from T6 to T9 segments of spinal cord. Parasympathetic are derived from both vagus nerves . The myenteric (Auerbachs plexus) & Meisners plexuses Act as post ganglionic neurons for parasypathetic fibres only. 29. 1st part of Du is commonest site for Peptic ulcer. ACID PEPTIC DISEASE: Perforation of ant. Surface of D1 Trauma Alcohol smoking Ulcerogenic drugs (NSAID) 30. 1st part of Du is commonest site for Peptic ulcer. Third part vulnerable for injury as it lies anterior to vertebral column Herniation of intestines into para duodenal recesses.. Stenosis of duodenum by annular pancreas & Ca. Head of pancreas. Pressure from sup.mesen.art. / Shortening of ligament of Trietz. 31. Acid peptic disease and Duodenal trefoil appearance: Besides a genetic predisposition to acid peptic disease abnormal high secretion of acid and pepsin, reflux of bile and pancreatic juice to stomach, reduced amount of mucus or structurally deficient mucus, reduced submucosal blood flow, (stress and alcohol ingestion), reduced cell renewal or bicarbonate secretion are all contributory singly or in combination in the causation of acid peptic disease, Diet has a limited role in both causation and cure of the ailment. Emotional stress, delayed gastric emptying, cigarette smoking, use of ulcerogenic drugs 32. 1st part of Du is commonest site for Peptic ulcer. Narrowing of duodenum Congenital stenosis 33. Fore gut - Celiac axis - Digestive Mid gut - Sup. Mesenteric - Absorptive Hindgut - Inf. Mesenteric - Excretory 34. The 1st part and upper half of 2nd part derived from foregut. Rest of duodenum develops From most proximal part of midgut. Later duodenum falls to right, the mesoduodenum fuses with peritoneum of post. Abd. wall, resulting in most of the duodenum retroperitoneal. The mesoduodenum persists in relation to a small part of duodenum adjacent to pylorus. This is the part seen in radiographs as duodenal cap. Stomach lifted up