Duodenum

Introduction

• Do-deka-dactulos
• C shaped
• Shortest
• Widest
• Most fixed
• Extent -
• Situation -
• Length – 25 cm
• Parts - 4
• I – 5cm
• II –7.5cm
• III –10cm.
• IV – 2.5cm
 First part
• Begins –
• Course -
• Relations –
• Peritoneal -
• Visceral –
• Ant.
• Post.
• Superior
• Inferior
 Arterial supply of first part
• Its supplied by series of end arteries-
• Supra duodenal branch of gastroduodenal artery.
• Retro duodenal branch of gastroduodenal artery
•
 Peculiarities of first part
• It most movable part -behave like stomach
• Supply by end arteries
• May be affected peptic ulcer
• Its devoid of circular mucous fold.
• A triangular radio opaque shadow knows as
duodenal cap or bulb.
 Second part
• Begins -
• Relations –
• Peritoneal
• Visceral –
 Ant.
 Post.
 Medially
 Laterally
• Begins -
Third part
• Relations –
• Peritoneal
• Visceral
• Posterior -
Fourth part
 Relations -
 Peritoneal
 Visceral -
Anteriorly-
1. Transverse colon
and mesocolon
2. Lesser sac
3. Stomach
• Post. -
• Left
• Right
• Superior
INTERIOR OF DUODENUM
Ligament of treitz
 Ligament of treitz
• It k/w suspensory ligament.
• Arises rt crus of diaphragm.
• Its passes downward and forward by side of coeliac artery.
• Upper one third –striated muscle
• Meddle one third elastic tissue
• Lower one third –unstriped plain muscle

• Nerve supply-Phrenic nerve skeletal muscle ,autonomic nerve to smooth

muscle.
• Function-increase angle of duodenojejunal flexure.
Blood supply
 Arterial supply of first part
• Its supplied by series of end arteries-
• Supra duodenal branch of gastroduodenal artery.
• Retro duodenal branch of gastroduodenal artery
•
Venous drainage
Lymphatic drainage
 NERVE SUPPLY-
• Sympathetic innervation :derived from celiac and superior
mesenteric plexuses.
• Preganglionic fibers arises from T6 and T9 spinal segment.

• Parasympathetic innervation derived from right and left vagus.

Histology of duodenum
 SMALL INTESTINE
• GENERAL FEATURES
 It is about 6 m long.

 Is divided into 3 parts, viz., duodenum, jejunum and ileum.

 Is the principal site for absorption of products of digestion.

 It also secretes some hormones through enteroendocrine cells.

 Digestion is completed in small intestine.

 To facilitate absorption, the luminal surface area is increased 400–600-

fold by the presence of the following structures:
1. Plicae circulares (valves of Kerckring)
• Permanent circular folds of mucosa and submucosa—which increase the
surface area 2–3-fold.
2. Intestinal villi - Minute finger-like projections of mucosa containing a central
core of lamina propria with a single lacteal (blind ended lymphatic vessel),
capillary loops and smooth muscle cells derived from muscularis mucosa.
3. Microvilli -Very minute finger-like projections of plasma membrane of
absorptive columnar epithelial cells.These give a striated border to the
epithelium under LM. Increase the surface area 20-fold.
 Small intestine is composed of the following four layers:

1. Mucosa
Epithelium- It is made of simple columnar absorptive epithelium with
goblet cells.
 The epithelium and the underlying lamina propria shows finger-like
evaginations called intestinal villi.

 Epithelium also shows tubular invagination from the base of the villi
into the lamina propria known as crypts of Lieberkuhn (intestinal
glands), these crypts are lined by columnar and goblet cells.

 Apart from these cells Paneth cells are found at the base, which secrete
lysozyme, an antibacterial enzyme controlling the intestinal flora.

 The crypts open at the base of the villus in the intervillous space and the
Epithelium is renewed every 3–5 days.
• Lamina propria- It is the connective tissue that contains fibroblasts, mast cells,
plasma cells, lymphocytes + crypts of Lieberkuhn + lacteals + capillary loops.

Muscularis mucosa- consist of an inner circular and outer longitudinal coat of

smooth muscle fibers and extend into the circular fold.

• 2. Submucosa-It shows regional variations, e.g. Presence of Brunner’s gland

in duodenum Peyer’s patches in ileum,None of the above in jejunum.

• 3. Muscularis externa- consist of an inner circular and outer longitudinal coat of

smooth muscle fibers .
• Myenteric plexus of nerve and ganglia are present between these two layers.
• This coat is responsible for the peristaltic waves.
• 4.Serosa –whole of jejunum and ileum have a single layer of squamous cells
resting on basement membrane .
• Part of duodenal wall have either serosa or adventitial covering.
 Duodenum
 The villi are leaf-like.
 Muscularis mucosa is disrupted.
 Presence of Brunner’s glands (mucous) in the submucosa. These glands are
branched coiled tubular structures opening into the bottom of the crypts.
 The enteroendocrine cells present in the mucosa secrete hormone like,
urogastrone that inhibits HCl secretion in the stomach and secretin and
cholecystokinin that regulate pancreatic secretion.
 Jejunum
• The mucouse membrane contain long club-shaped intestinal villi lined by
simple columnar epithelium with goblet cells.
• Lamina propria -reveals cut section of lieberkuhn, diffused lymphocytes and
connective tissue.
• Muscularis mucosae -two usual layers.
• Sub mucosa -has connective tissue ,nerve plexus ,ganglionic cells and blood
vessels but absence of Brunner’s glands and Peyer’s patches.
Muscularis externa- consist of an inner circular and outer longitudinal coat of
smooth muscle fibers.
jejunum have a single layer of squamous cells resting on basement membrane
 Ileum
short slender finger-like intestinal villi lined by simple columnar epithelium
with goblet cells.
 Peyer’s patches (lymphoid aggregations) in the submucoa
 M cells (antigen-presenting cells) are found overlying the lymphoid follicles.
 Clinical
anatomy
• Duodenal cap -
 Clinical anatomy
• 1st part of duodenum is one of the commonest site of peptic
ulcer.

• Duodenal diverticula are seen along its concave border where

arteries enter duodenal wall.
 Clinical anatomy
• Congenital stenosis and obstruction of 2nd part of duodenum
may occur at site of opening of bile duct.
THANK YOU