DUODENUM

(Doc Lucion)
Four parts of Duodenum
Duodenum is divided into four parts:
A. First (superior) part [L1]
B. Second (descending) part [L1-L3]
C. Third (horizontal/inferior) part [L3]
D. Fourth (ascending) part [L3-L2]

First (superior) part of Duodenum

 It is 5 cm long
 Lies anterolateral to body of L1 vertebrae
 Most movable part

Openings in second part of Duodenum

1. Common opening of bile duct and main
pancreatic duct: on summit of major duodenal
papilla
2. Opening of accessory pancreatic duct (one inch
higher): on summit of minor duodenal papilla

DUODENUM Suspensory Ligament of Treitz

 From the pylorus of the stomach down to the entry of
the jejnum
 First, widest, thickest
 Mostly fixed except for the first part of the duodenum
 Level of L1-L3
 Epigastric region, and a portion of the right upper
quadrant

Features of Duodenum
 It is the first part of
small intestines, 25 cm
long
 It is retroperitoneal
except first inch of first
part of duodenum
 It has four parts, C-
shaped
 Second part has
opening of common
bile duct and pancreatic ducts, major duodenal papilla
and minor duodenal papilla

MCV
Major Duodenal Papilla
 The major duodenal papilla is a projection that
protrudes into the duodenum that allows the exit of
bile and pancreatic fluid Lymphatic vessels follow the artery
 Elevation of the mucosal fold, circular  Anterior lymphatic vessels – pancreaticoduodenal
lymph nodes
Arteries of the Duodenum  Efferent lymphatic vessels from the duodenal lymph
 Arise from the celiac trunk and the superior nodes – celiac lymph nodes
mesenteric artery
 The celiac trunk, via the gastroduodenal artery and
its branch, the superior pancreaticoduodenal
artery, supplies the duodenum proximal to the entry
of the bile duct into the descending part of the
duodenum
 The superior mesenteric artery, through its branch,
the inferior pancreaticoduodenal artery, supplies
the duodenum distal to the entry of the bile duct

Nerves of the Duodenum

 Vagus nerve - parasympathetic
 Greater and lesser (abdominopelvic) splanchnic
Veins of the duodenum drain into the hepatic portal vein nerves by way of the celiac and superior mesenteric
through the superior mesenteric and splenic vein plexuses
 Nerves are next conveyed to the duodenum via the
periarterial plexus extending to the
pancreaticoduodenal arteries

Hepatic Portal Vein

 Short, wide vein; length: 3 inches
 The main channel of the portal venous system
 Formed by the superior mesenteric and splenic
veins
 75-80% of the blood to the liver

MCV
  Portal blood, containing about 40% more oxygen
than blood returning to the heart from the systemic
circuit
 Carries virtually all of the nutrients absorbed by the
alimentary tract to the sinusoids of the liver
 Part of the portal triad in the hepatoduodenal
ligament

Tributaries of the Portal Vein

 Superior mesenteric vein
 Splenic vein
 Left gastric or Coronary vein
 Right gastric vein
 Cystic vein
 Right gastroepiploic and pancreaticoduodenal
veins

Hepatic ducts
 The right and left hepatic ducts emerge at the porta
hepatis from the right and left lobes of the liver
 The arrangement of structures at the porta hepatis
from behind forwards is
o The branches of the portal vein
o Hepatic artery
o Hepatic ducts

Porta hepatis
 Deep fissure through which the neurovascualar
structures and hepatic ducts enter and leave

*Cholesterol is the major component of bile

MCV