Presentation duodenal perforation.pptx

Duodenal ulcers occur when there is a disruption to the surface of the mucosa of the duodenum. These ulcers are part of peptic ulcer disease, which involves the stomach and first part of the duodenum. This activity reviews the evaluation and treatment of duodenal ulcers and explains the interprofessional team's role in improving care for patients with this condition

1. Dr. Pawan Panthi First Year Resident General Surgery NGMCTH DUODENAL ULCER PERFORATION

2. Introduction In Latin, "duodenum" means 12 fingers, which is roughly the length of duodenum ( 25 to 30 cm ) C-shaped L1-L3 Continuation of  pylorus proximally and with jejunum distally .

3. Segments of duodenum D uodenal bulb : connects to undersurface of the liver via hepatoduodenal ligament, which contains portal vein, hepatic artery and common bile duct.   S econd or descending segment : Just above the inferior vena cava and right kidney, with head of pancreas lying in a C-shaped concavity. T hird segment runs from right to left in front of the aorta and inferior vena cava, with superior mesenteric vessels in front of it. The fourth segment continues as the jejunum.

4. Layers From innermost to the outermost layer M ucosa Submucosa Muscularis Ser osa

5. Blood supply

6. Blood supply and lymphatics P roximal segment : G astroduodenal artery and its branches including superior pancreaticoduodenal artery. D istal segment : S uperior mesenteric artery and inferior pancreaticoduodenal artery. The venous drainage follows the arteries and ultimately drains into the portal system. Lymphatic: Pancreaticoduodenal lymph nodes located along pancreaticoduodenal vessels and superior mesenteric lymph nodes.

7. Nerve supply P arasympathetic nervous system : I ncludes branches of the anterior and posterior vagus trunks. S ympathetic nervous : B ranches of the celiac plexus which originate from T5 through T9.

8. Surgical importance The duodenojejunal flexure is the sudden turn which is usually identified during surgery by the location of the inferior mesenteric vein, which is located to the immediate left. The duodenojejunal flexure is attached to the posterior abdominal wall by the ligament of Treitz . Except for the first segment, the rest of the duodenum is retroperitoneal and has no mesentery and is fixed to the posterior abdominal cavity. The distal end of the common bile duct joins with the pancreatic duct to form the biliopancreatic ampulla which opens on the dome of the major duodenal papilla, located on the second segment of the C-shaped duodenum. This anatomical landmark is important for gastroenterologists as they do endoscopic retrograde cholangiopancreatography (ERCP) procedures to cannulate the major papilla of the duodenum.

9. Function Neutralization of the acidic gastric juice M echanical digestion of chyme M ixing of bile and pancreatic enzymes A bsorption of water, electrolytes and nutrients

10. Sign and symptoms sudden, severe pain in the upper middle area of the abdomen tenderness in the abdomen distention of the abdomen feeling of fullness and  abdominal bloat nausea and vomiting severe indigestion constipation fever