5 dudenum.pptx ppt for BAMS UG students Anantomy

dudenum

1. Duodenum

2. derivation Greek word dudekadactlos-12 fingers.

3. Definition & location Shortest, widest & most fixed part of G I Extends: pylorus to duodenojejunal flexure. Curved around the head of pancreas in form of letter ‘C’ Lies- above the level of umbilicus, opposite L1, L2 & L3

4. Length & parts 25 cm long 4 parts First or superior part- 5cm / 2 inches Second or descending part- 7.5 cm / 3 inches Third or Horizontal part- 10cm or 4 inches Fourth or ascending part- 2.5 cm or 1 inch

5. Peritoneal relations Retroperitoneal & fixed, except at its two ends where suspended by folds of peritoneum- mobile Anteriorly partly covered with peritoneum.

6. First part/ superior part Begins – at pylorus Passes – backward, upward to the right- meet 2 nd part at superior duodenal flexure.

7. Peritoneal relation Proximal 2.5cm is movable- attached lesser omentum -above, greater omentum - below. Distal 2.5cm is fixed – retroperitoneal- covered wt peritoneum only on its anterior aspect.

8. Visceral relations Antr - quadrate lobe liver & gallbladder Postr - Gatroduodenal A, bile duct & portal vein Superiorly- Epiploic formen Inferiorly- Head & neck of pancreas

9. Second part 7.5cm long Begins- Superior duodenal flexure, Passes downwards to reach lower border of 3 rd lumbar vertebra, it curves towards left at infr duodenal flexure- to become continuous wt 3 rd part.

10. Peritoneal relation Retroperitoneal & fixed. Antr surface is covered wt peritoneum, except where it is directly related to colon.

11. Visceral relation Anteriorly: Right lobe of liver Transverse colon Root of transverse mesocolon Small intestine. Posteriorly Antr surface of rt kidney near the medial border Right renal vessel Right edge of IVC Right psoas major

12. Medially Head of the pancreas The bile duct Laterally Right colic flexure

13. interior Major duodenal papilla : elevation, posteriomedially , 8-10 cm distal to the pylorus, hepatopancreatic ampulla opens Minor duodenal pappilla : 6-8cm distal to the pylorus Presents opening of accessory pancreatic duct Plica longitudinalis : Below the major duodenal pailla longitudinal fold

14. Third part 10cm long Begins- inferior duodenal flexure, on rt side of lower border of L3 Passes almost horizontally & slightly upwards infront of IVC, ends by joining 4 th part in front of abdominal aorta

15. Peritoneal relation Retroperitonial & fixed Its anterior surface is covered wt peritoneum, except in the median plane, where crossed by superior mesentric vessels & by root of mesentry .

16. Visceral relation Anteriorly: Supr mesentric vessels Root of mesentery Posteriorly : Right ureter Right psoas major Rt testicular or ovarian vessels IVC Abdominal aorta wt origin of infr mesentric A

17. Superiorly: Head of pancreas wt uncinate process Inferiorly: Coils of jejunum

18. Fourth part 2.5cm long Runs upwards on or immediately to the left of the aorta, up to the upper border of L2, where it turns forward to become continuous wt the jejunum at duodenojejunal flexure.

19. Peritoneal relation Mostly retroperitoneal & covered wt peritoneum only anteriorly. Terminal part suspended by uppermost part of the mesentery & is mobile

20. Visceral relation Anteriorly: Transverse colon Transverse mesocolon Lesser sac Stomach Posteriorly : Left symphathetic chain Lt renal A Lt gonadal A Inferior mesenteric vein

21. To the right: attachment of upper part of the root of the mesentry . To the left: Lt kidney Lt ureter . Superiorly: Body of pancreas

22. Suspensory muscle of Duodenum / ligament of treitz Fibromuscular band which suspends & support the duodenojejunal flexure Arises from right crus of diaphragm, close to the right side of esophagus, passes downward behind the pancreas & is attached to the posterior surface of duodenojejunal flexure & 3 rd & 4 th part of the dudenum .

23. Made up of: Striped muscle fibers in its upper part Elastic fibres in its middle part plain fibres in its lower part. Its contraction increases the angle of duodenojejunal flexure, sometimes it is attached only to the flexure, causing partial obstruction of the gut.

24. Arterial supply Fore gut- superior pancreaticoduodenal A(GDA) Midgut - inferior pancreaticoduodenal A (SMA) First part of duodenum receives additional supply from. Rt gastric A(PHA) Supraduodenal A of wilkie , - branch of common hepatic A Retroduodenal branch of gastroduodenal A Branches of Rt gastroepiploic A

25. Venous drainage Splenic Supr mesentric portal

26. Lymphatic drainage Pancreaticodudenal nodes- along the inside of curve of duodenum Hepatic nodes- coeliac nodes & partly superior mesentric nodes & via intestinal lymph trunk to Cisterna chyli

27. Nerve supply Symphathetic -T9 & T10 Parasymphathetic - vagus

28. Clinical Anatomy Skiagram – triangular shadow – duodenal cap 1 st part – commonest sites for peptic ulcer- in over busy young person wt tense & temperament Ulcer pain – rt half of epigastrium , releaved by meals, reappears in empty stomach 1 st part – liver, GB adherent or ulcerated Duodenal diverticula fairly frequent Congenital stenosis & obstruction of 2 nd part Duodenal carcinoma