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DUODENUM & PANCREAS

DUODENUM & PANCREAS. Dr. Mujahid Khan. Duodenum. It is a “C” shaped tube About 10 inches (25 cm) long It joins the stomach to the jejunum It receives openings of bile and pancreatic ducts Curves around the head of the pancreas. Duodenum.

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DUODENUM & PANCREAS

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  1. DUODENUM & PANCREAS Dr. Mujahid Khan

  2. Duodenum • It is a “C” shaped tube • About 10 inches (25 cm) long • It joins the stomach to the jejunum • It receives openings of bile and pancreatic ducts • Curves around the head of the pancreas

  3. Duodenum • First inch of duodenum resembles stomach as its anterior and posterior surfaces are also covered with peritoneum • Lesser omentum attached to its upper border • Greater omentum attached to its lower border • Remainder of the duodenum is retroperitoneal, only partially covered by peritoneum • Is divided into four parts for the purpose of description

  4. 1st Part of Duodenum • It is 2 inches (5 cm) long and begins at pylorus • Situated in the epigastric and umbilical regions • Lies on the transpyloric plane

  5. Relations • Anteriorly: Quadrate lobe of the liver and gall bladder • Posteriorly: The lesser sac, gastroduodenal artery, bile duct, portal vein and IVC • Superiorly: The entrance into the lesser sac • Inferiorly: Head of the pancreas

  6. 2nd Part of Duodenum • Is 3 inches (8 cm) long and runs vertically downward in front of the hilum of the right kidney • Halfway down its medial border, the bile duct and main pancreatic duct pierce the duodenal wall by major duodenal papilla • The accessory pancreatic duct if present, opens a little higher up on the minor duodenal papilla

  7. Relations • Anteriorly: The fundus of gall bladder, right lobe of liver, and the transverse colon • Posteriorly: Hilum of the right kidney and the right ureter • Laterally: Ascending colon, right colic flexure, and the right lobe of the liver • Medially: Head of the pancreas, bile duct, and the main pancreatic duct

  8. 3rd Part of Duodenum • Is 3 inches (8 cm) long • Runs horizontally to the left on the subcostal plane • Passing in front of the vertebral column • Following the lower margin of the head of the pancreas

  9. Relations • Anteriorly: The root of mesentery of small intestine, superior mesenteric vessels • Posteriorly: The right ureter, right psoas muscle, IVC, and the aorta • Superiorly: Head of the pancreas • Inferiorly: Coils of jejunum

  10. 4th Part of Duodenum • Is 2 inches (5 cm) long • Runs upward and to the left of the duodenojejunal flexure • The flexure is held in position by a peritoneal fold, ligamentum treitz

  11. Relations • Anteriorly: The beginning of the root of the mesentery and coils of jejunum • Posteriorly: The left margin of aorta, and the medial border of the left psoas muscle

  12. Mucous Membrane of Duodenum • Is thick and smooth in the first part • In the remainder parts is thrown into numerous circular folds called plicae circulares

  13. Blood Supply of Duodenum • The upper half is supplied by superior pancreaticoduodenal artery, a branch of gastroduodenal artery • The lower half is supplied by the inferior pancreaticoduodenal artery, a branch of the superior mesenteric artery

  14. Pancreas • The pancreas is both an exocrine and an endocrine gland • Produces a secretion that hydrolyzes the carbohydrates, proteins and fats • The endocrine portion of the gland is islets of langerhans produces insulin and glucagon hormones • These hormones play a key role in carbohydrate metabolism

  15. Pancreas • It is an elongated structure • Lies in the epigastrium and left upper quadrant • It is soft and lobulated, situated on the posterior abdominal wall behind the peritoneum • It is divided into head, neck, body and tail

  16. Pancreas • Head: Is a disc shaped and lies within the concavity of the duodenum, has a process behind the superior mesenteric vessels called uncinate process • Neck: Is the constricted portion, connects the head to the body, lies in front of the origin of the superior mesenteric artery from the aorta

  17. Pancreas • Body: Runs upward and to the left across the midline and is somewhat triangular in cross section • Tail: Passes forward in the splenicorenal ligament and comes in contact with the hilum of the spleen

  18. Relations • Anteriorly: Transverse colon and the attachment of the transverse mesocolon, the lesser sac and the stomach • Posteriorly: Bile duct, the portal and splenic veins, IVC, the aorta, the origin of superior mesenteric artery, the left suprarenal gland, the left kidney, and the hilum of the spleen

  19. Pancreatic Ducts • The main duct of the pancreas begins in the tail • Runs the length of the gland, receiving numerous tributaries • Opens into the second part of the duodenum with the bile duct on the major duodenal papilla

  20. Pancreatic Ducts • Sometimes the main duct drains separately into the duodenum • The accessory duct, if present, drains the upper part of the head • Opens a little above the main duct on the minor duodenal papilla • The accessory duct frequently communicates with the main duct

  21. Blood Supply • Arteries: The superior and inferior pancreaticoduodenal arteries • Veins: The corresponding veins drain into the portal vein

  22. Thankyou

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