Ravi MBBS MD JIPMER MAMS The Duodenum dudekadaktulos Shortestwidest amp most fixed part of SI Extends pylorus to duodenojejunal flexure C shape Level of ID: 932229
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Slide1
The Duodenum
Dr
. Kumar Satish
Ravi
M.B.B.S
., M.D
.(JIPMER
),
MAMS
Slide2The Duodenum“dudekadaktulos”Shortest,widest & most fixed part of S.I.
Extends- pylorus to
duodenojejunal
flexure
C shape, Level of
umblicus
- L1,2,3.
25 cm long- 5, 7.5, 10, & 2.5 cm.
Mostly retroperitoneal & fixed.
Slide3The duodenumRelationships of superior part
Anteriorly
Quadrate lobe of
liver
Gallbladder
PosteriorlyCommom bile duct Gastroduodenal a.Portal v.Superioely Omental foramenHepati ArtInferiorly Head & Neck of pancreas
Slide4Relationships of descending partAnteriorlyLiver, Gall bladder
Transverse colon and
mesocolon
Loops of small intestine
Posteriorly
Right renal, hilum and ureterRight renal vesselsIVC , Psoas majorMediallyHead of pancreasCommon bile duct and pancreatic ductLaterally Right colic flexure
Slide5Relationships of horizontal partSuperiorly -Head of pancreas,
Uncinate
pr
Inferiorly
Loops of small intestine
AnteriorlyRadix of mesenterySuperior mesenteric a. and v. Posteriorly -Psoas majorRight ureterInferior vena cavaAbdominal aorta – testi art, IMA
Slide6Relationships of ascending partRight Head of pancreas and abdominal aorta
Left
Left kidney and
ureter
Slide7Ant.- Transverse colon & meso.,Lesser sac & stomachPost.- Lt. sympathetic chain,Lt. psoas
major,Lt.renal
vessels, Lt. testicular vessels & I.M.V.
Slide8Suspensory muscle of DuodenumLigament of TreitzFibromuscular band which suspends & supports the
duodenojejunal
flexure.
Arises from Rt. Crus of the diaphragm- DJ Flexure & 3
rd
– 4th part of duodenum.
Slide9Ligament of Treitz
Slide10Blood supply
Arteries
Superior
pancreaticoduodenal
a.
Inferior pancreaticoduodenal a.1st Part- Rt. Gastric a., supraduodenal a. of wilkie(hepatic a.)Veins－follow arteries, draining directly into superior mesenteric and hepatic portal veins
Slide11Lymphatic Drainage-Pancreaticoduodenal nodes Hepatic nodes
Coeliac
n. & Sup.
Mes
. N
int. lymph trunk Cisterna chyli
Slide12Nerve Supply-Sympathetic- T9 & T10Parasympathetic- Vagus
-
coeliac
plexus-
duodenum along its arteries.