DUODENUM Fixed to the posterior abdominal wall (RETROPERITONEAL) Occupies epigastric & umbilical regions Follows a C-shaped course,

rse, around the head of pancreas Extend from the pylorus to the doudeno-jejunal flexure

Arterial supply : artery 1. supra-duodenal 2. superior pancreatico-duodenal 3. inferior pancreatico-duodenal

from celiac trunk gastro-duodenal (from celiac truck) superior mesenteric artery
FOURTH PART

length

beginning

FIRST PART - 2 inches - 1st inch is mobile (covered by peritoneum anteriorly & posteriorly) - at the pylorus - an inch to the right of median plane - at the level of L1 (transpyloric plane)

SECOND PART - 3 inches - only covered by peritoneum anteriorly

THIRD PART - 4 inches

- 1 inch

descends vertically from the level of L1 to the level of L3

lies horizontally - opposite to the level of L3

ascends from the level of L3 to the level of L1 - 1 inch to the left of median plane at duodeno-jejunal flexure - transverse colon - transverse mesocolon

Peritoneal recesses - superior duodenal recess - inferior duodenal recess - para-duodenal recess - retro-duodenal recess

relations : anterior - quadrate lobe of the liver - gall bladder - neck of pancreas - portal vein - bile duct - gastro-duodenal junction superior epiploic foramen - right lobe of the liver - gall bladder - transverse colon - coils of jejunum hilum of right kidney - superior mesenteric vessels (in the root of mesentery) - coils of small intestine from right to left - right ureter - aorta - right psoas major - IVC - right gonadal vessels - inferior mesenteric artery superior head of pancreas

posterior

- left sympathetic chain - left psoas major - left gonadal & renal vessels

inferior head of pancreas

medial - head of pancreas - bile duct - pancreatico-duodenal arteries lateral hepatic flexure of large intestine

medial - head of pancreas - aorta

inferior coils of small intestine left kidney

lateral

Jejunum and ileum Forms the mobile part of the small intestine Suspended from posterior abdominal wall by a mesentery Characteristic Position Diameter Wall Circular folds (Plica circularis) Arterial Arcades Fewer and simple Numerous and complex Jejunum Upper 2/5 Wider Thicker, red Larger, numerous Ileum Lower 3/5 Narrower Thin, pale Fewersmaller Attached border (root of mesentery): - 15 cm long, - extends from duodeno-jejunal flexure to iliocecal junction Structures crossed by the root of the mesentery : - 3rd part of duodenum - Abdominal aorta - IVC - Right psoas major - Right ureter - Right gonadal vessels - Right genitor-femoral nerve Contents of the mesentery 1. Superior mesenteric vessels in its root 2. Jejunum and ileum in the free border 3. Jejunal and ileal areteries and their arterial arcades 4. Extraperitoneal tissue and fat 5. Sympathetic nerve fibers 6. Lymph vessels (lacteals) 7. Mesenteric LN (arranged in three groups: large, medium, and small) Mesentery of small intestine - fan- shaped peritoneal fold - has an 2 borders anterior free border contains the jejunum and ileum 6 meter long

posterior attached border the root of mesentery 6 inches long

Lymphatic follicles (Peyers patches) Fat in mesentery

Solitary, few

Aggregated, numerous More fat, no windows

Less, there is windows

Meckels diverticulum = persistence of proximal portion of yolk stalk (vitelline duct) - common malformation of digestive tract (2%) - more prevalent in males - about 25cm ( 2 inches long) - located 30100cm (2 feet) from ileocecal valve - usually asymptomatic but: May become inflamed (mimicking appendcitis) or bleed May be attached to umbilicus by a fibrous cord (distal end of yolk stalk) causing intestinal obstruction by compressing adjacent intestinal loops, or cause discharge