Duodenum
First, smallest and widest part of human’s small intestine is referred as duodenum. It lies immediately next to the stomach and is separated from it by pyloric sphincter whereas it ends by joining the jejunum which is the next part of small intestine. Duodenum is seen as U shaped or horse shoe shaped macroscopically. Its length usually ranged from 23 to 28cm (10-12 inches). Anatomically, it has been divided into four parts and each part has its own relations with the organs around.
- First part: also known as Superior part (5cm)
- Second part: also known as Descending part (10cm)
- Third Part: also known as Horizontal part (7.5cm)
- Fourth part: also known as Ascending part (2.5cm)
Duodenum has quite thick mucosa generally, first part is smooth usually while other is rough and comprises of numerous circular folds, also called as plicae circularis.
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Duodenum
BLOOD SUPPLY
Duodenum receives its blood supply from several arteries:
- The proximal half of duodenum receives its blood supply from superior pancreaticoduodenal artery, which arises from gastroduodenal artery.
- The distal half of duodenum receives its blood supply from inferior pancreaticoduodenal artery, which arises from the superior mesenteric artery.
Venous drainage comprises of the superior pancreaticoduodenal and inferior pancreaticoduodenal veins which travel along with the arteries, and eventually drain into portal vein and superior mesenteric vein, respectively.
NERVE SUPPLY
The innervation is mainly supplied by:
- Celiac plexus from which originate the sympathetic nerves.
- Anterior and posterior vagi, which gives the hepatic and celiac branches to form parasympathetic nerves.
LYMPHATICS
The lymphatics correspond to the arterial supply and drain into two pathways:
- The pancreaticoduodenal nodes receives the lymph from proximal half of duodenum. Then, from here lymph travels towards gastroduodenal nodes and eventually drained into celiac nodes.
- The pancreaticoduodenal nodes receives the lymph from distal half which is eventually drained into the superior mesenteric nodes.
CLINICAL IMPORTANCE
- Being immediate next to the stomach, duodenal ulcers are common, which is known as Peptic Ulcer Disease.
- Duodenal Atresia (stenosis) is an important neonatal manifestation of Down Syndrome.
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