Transcript 01-duodenum & pancreas_Dr.Sanaa.ppt
The Duodenum
It is the first and widest part of the small intestine.
It lies in the vertebrae.
epigastric and umbilical regions, opposite the first 3 lumbar It is a C-shaped tube, about 10 inch. It has 4 parts, 2,3,3,and 2 inch long.
1 st part
lies along
transpyloric plane(L1V)
1in. to right of median plane.
3 rd part
lies along the
subcostal plane (L3V).
The Duodenum
1 st part of duodenum :
It lies opposite 1 st transpyloric plane.
lumbar V. on Parts & Relation of the Duodenum
1 st inch is the only movable part of duodenum, it is covered only anteriorly & posteriorly by peritoneum,which is continuous with lesser omentum above, and with greater omentum below. The remainder is retroperitoneal , partialy covered by peritonum (in front & sides only) and adherent to post.abd.wall.
Anteriorly : gallbladder.
qudrate lobe of liver +
Posteriorly : lesser sac , gastro-duodenal artery , bile duct , portal v.& I.V.C.
Superiorly : opening to lesser sac (epiploic foramen).
Inferiorly : head of pancreas.
The Duodenum
2 nd part of duodenum :
Lies on the right side of 2 nd 3 rd lumbar vertebrae.
&
Anteriorly : right lobe of liver & fundus of gallbladder , T.colon , and coils of small intestine.
Posteriorly : hilum of right kidney & right ureter.
Laterally : right lobe of liver , asc. colon , right colic flexure.
Medially : head of pancreas , bile duct & main pancreatic duct
The Duodenum
Root of mesentry lies in front of 3 rd & 4 th parts of Duodenum, containing superior mesenteric vessels.
3 rd part of duodenum :
It lies on the subcostal plne , passing in front of L3 vertebra.
Anteriorly : 1- root of mesentery of small intestine, containing superior mesenteric vessels. 2-coils of jejunum.
Posteriorly : I.V.C., aorta , right ureter & right psoas muscle.
Superiorly : head of pancreas.
Inferiorly : coils of jejunum.
The Duodenum
4 th part of duodenum :
It joins the duodenojejunal flexure , which is held in position by a peritoneal fold,the ligament of Treitz, that is attached to right crus of diaphragm.
Anteriorly : roots of mesentry + coils of jejunum.
Posteriorly : left psoas.
Root of mesentry lies in front of 3 rd & 4 th parts of Duodenum, containing superior mesenteric vessels.
Mucous Membrane & Duodenal Papillae
The M.M.of 1 st part of duodenum is
smooth
, but the remainder of duodenum , it is thrown into circular folds called the
plicae circulares.
Halfway
down the medial border of
2 nd part of duodenum
, the bile duct & the main pancreatic duct unite to form
hepato-pancreatic ampulla
that opens by
major duodenal papilla.-
the accessory pancreatic duct opens by a minor duodenal papilla above the major one.
Blood supply of Duodenum :
Arteries : upper ½ of duodenum
superior pancreatico-duodenal artery , a branch of gastroduodenal … by
lower ½ of duodenum
artery.
… by inferior pancreatico-duodenal artery, a branch of superior mesenteric
Veins : superior pancreatico-duodenal vein vein
drains into the portal vein.
Inferior pancreatico-duodenal
drains into the superior mesenteric vein.
Lymph Drainage & innervation of the Duodenum :
It follows the arteries
upward
via pancreatico duodenal nodes to gastro duodenal L.Ns.and
finally to celiac & hepatic L.Ns
…. and pancreatico-duodenal nodes to
downward superior mesenteric L.Ns.
via It is supplied by symp.& parasymp.vagal N.Fs.
Duodenal folds & Recesses :
They lie
close to the duodeno-jejunal junction,
as 4 small pocketelike pouches of peritoneum.
Sup.duodenal fold of peritonium :
on the left side of 4 th part of duodenum, it has lower free border (recess).
Inf.duodenal fold of peritonium :
on the left side of 4 th part of duodenum, it has upper free border (recess).
Duodenal folds & recesses :
Paraduodenal fold & recess of peritoneum
lies to left of 4 th part of duodenum.
It has free border which encloses
the inferior mesenteric vein
.
Duodenal folds & recesses :
The retroduodenal recess
is found
behind 3 rd & 4 th parts of duodenum.
The duodenum is connected to the posterior abdominal wall by a fold of peritoneum.
The Pancreas :
It is
exocrine gland
secrete
enzymes
for protein,fats & carbohydrates hydrolyzing.
It is
endocrine gland
that produce the
hormones
pancreatic islets( islets of Langerhans) insulin & glucagon by
It lies
in epigastrium & left upper quadrant, crosses transpyloric plane (L1 vertebra).
It lies on the post.abd.wall behind the peritoneum
( retroperitoneal ),
Parts of Pancreas :
The head
lies in the concavity of duodenum.
The uncinate process
from the lower part of the head and lies
behind
arises sup.mesenteric
vessels.
The neck
lies
in front
beginning of portal vein.
of the
The body.
The tail
passes in the
splenico-renal ligament
end in the hilum of spleen.
to
The Relation of Pancreas :
Anteriorly :
from right to left…. Transverse colon & mesocolon ,lesser sac & stomach.
Posteriorly :
from right to left…. Bile duct, portal vein, superior mesenteric vessels, splenic vein -- I.V.C., aorta. , Left psoas muscle.
Left kidney., Left suprarenal and hilum of spleen.
Pancreatic Ducts :
The main pancreatic duct
begins in the tail of pancreas and opens into middle of 2 nd part of duodenum by major duodenal papilla after joining the bile duct or drains separetely into the duodenum.
The accessory duct :
when present , drains the upper part of head and opens into the duodenum by minor duodenal papilla , a short distance above the main duct, frequently connects with the main duct.
Blood supply ,lymph drainage and innervation of Pancreas :
the arteries are :
Splenic artery , superior & inferior pancreatico-duodenal arteries.
The veins
as arteries, drain into the portal system.
Lymph nodes
mesenteric L.Ns.
lie along the arteries and drain into celiac & sup.
Nerve supply :
by symp.& parasymp.(vagal) N.Fs.
Cancer of head of pancreas leads to …… obstructive jaundice due to close relation of the head of pancreas to the bile duct.
Dudenal ulcer : at anterior wall of first inch of duodenum due to releasing acide chyme of stomach , may perforate into greater sac, above transverse colon which directs the escaping fluid into right iliac fossa,and confuse with perforated appendix.
posterior wall of 1 st Ulcer of part of duodenum may perforate the wall and erode gastrodudenal artery,causing a severe hemorrhage.
During Splenectomy tail of pancreas , sometimes results in damage of the which lies in the splenico-renal ligament , so the damaged pancreas releases enzymes that digest the surrounding tissues, leading to acute peritonitis.
Transpyloric plane (L1 vertebra) passes through :
Pylorus of stomach.
1 st part of duodenum.
Duodenojejunal junction.
Hilum of kidney.
Neck of pancreas.
Beginning of portal vein.
Abdominal aorta, at origin of sup.mesenteric artery.
Fundus of gall bladder (at tip of right 9 th costal cartilage).
Opening of lesser sac.
Longitudinal section of 2 nd part of duodenum :
showing
the hepato-pancreatic ampulla (ampulla of Vater)
which is surrounded by
sphincter of Oddi.
Note that the hepato pancreatic ampulla is pancreatic duct that
formed by
union of bile duct & main
opens
into lumen of duodenum
by major duodenal papilla.