Anatomy of the SMALL INTESTINE. Dr. Noman Ullah Wazir PMC

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2 Anatomy of the SMALL INTESTINE Dr. Noman Ullah Wazir PMC

3 SMALL INTESTINE The small intestine, consists of the duodenum, jejunum, and illium. It extends from the pylorus to the ileocecal junction were the illium joins the cecum. It is the primary site for absorption of the nutrients from ingested material.

4 The average length of the small intestine in an adult human male is 6.9 m, and in an adult female 7.1 m. It can vary greatly, from as short as 4.6 m to as long as 9.8 m. It is approximately cm in diameter.

5 LOCATION It is situated in the epigastric and umbilical regions. Duodenal part of the small intestine receives the bile and the pancreatic ducts.

6 DUODINUM It is the first, shortest, widest and the most fixed part of the small intestine. It pursues a C shaped course around the head of the pancreas. It begins at the pylorus on the right side and ends at the duodenojejunal junction on the left side (L2 vertebra).

7 PARTS OF DUODENUM The duodenum is divided into four parts: Superior (1 st ) part: Is short (5cm) and lies anterolaterally to the body of L1 vertebra. Descending (2 nd ) part : Is longer (7-10 cm) and descends along the right side of L1 to L3 vertebra. Horizontal or inferior (3 rd ) part: Is 6 to 8 cm long and crosses L3 vertebra. Ascending (4 th ) part: Is short (5cm) and begins at the left of L3 vertebra and rises superiorly as far as the superior border of L2 vertebra.

8 The first 2cm of 1 st part immediately distal to the pylorus has a mesentery and is mobile. Superior (1 st ) part This free part is ampulla ( duodenal cap). The distal 3cm of the superior part and other 3 parts have no mesentery and are immobile being retroperitoneal.

9 RELATIONS OF THE FIRST PART Anteriorly Gallbladder Quadrate lobe of liver Posteriorly Bile duct Gastroduodenal artery Portal vein Inferior vena cava Head of pancreas

10 Superior Neck of gallbladder Hepatoduodinal ligament (lesser omentum). Inferior Neck of pancreas Greater omentum Head of pancreas

11 SECOND PART OF DUODENUM The second (descending) part of the duodenum runs inferiorly. It curves around the head of pancreas, initially it lies to the right and parallel to the inferior vena cava. The bile and pancreatic ducts unite to for hepatopancreatic ampulla (Ampulla of Vater) and enters posteriomedial wall of 2 nd part of duodenum in major duodenal papilla.

12 The second part of the duodenum also contains the minor duodenal papilla, the entrance for the accessory pancreatic duct. The junction between the embryological foregut and midgut lies just below the major duodenal papilla.

13 THIRD PART OF DUODENUM (Inferior/Horizontal) part runs transversly to the the left, passing over the IVC, aorta and L3.

14 3 RD PART RELATIONS Anteriorly Small bowel mesentery root and superior mesenteric vessels. Posteriorly Right psoas muscle, right testicular or ovarian vessels, aorta and IVC. Superiorly pancreatic head Inferiorly loops of jejunum

15 FOURTH PART (Ascending) part passes superiorly, either anterior to, or to the left of, the aorta, until it reaches the inferior border of the body of the pancreas. The fourth part of the duodenum is at the level L2.

16 It curves anteriorly and terminates at the duodenojejunal flexure where it joins the jejunum. The duodenojejunal flexure is supported by suspensory muscle of the duodenum, the ligament of Treitz attached to the right crus of diaphragm.

17 ARTERIAL SUPPLY OF DUODENUM The duodenum receives arterial blood from two different sources. The transition between these sources is important as it demarcates the foregut from the midgut.

18 The upper half is supplied by the superior pancreaticoduodenal artery, a branch of the gastro duodenal artery. The lower half is supplied by the inferior pancreaticoduodenal artery, a branch of the superior mesenteric artery.

19 VENOUS DRAINAGE of DUODENUM The superior pancreaticoduode nal veins drain in to the portal vein; the inferior vein joins the superior mesenteric vein.

20 LYMPHATIC DRAINAGE The lymphatic vessels follow the arteries. The anterior lymphatic vessels drain into the pancreatoduodenal lymph nodes located along the superior and inferior pancreatoduodenal arteries and then into the pyloric lymph nodes (along the gastroduodenal artery).

21 The posterior lymphatic vessels pass posterior to the head of the pancreas and drain into the superior mesenteric lymph nodes. Efferent lymphatic vessels from the duodenal lymph nodes ultimately pass into the celiac lymph nodes.

22 NERVE SUPPLY The nerve are derived from sympathetic and parasympathetic (vagus) nerve from the celiac and superior mesenteric plexuses.

23 The second part of small intestine, the jejunum, begins at the duodenojejunal flexure. where the digestive tract resumes an intraperitoneal course. The ileum, ends at the ileocecal junction. Together, the jejunum and ileum are 6-7 m long, the jejunum constituting 2/5 th and the ileum 3/5 th of intraperitoneal section of the small intestine. Jejunum

24 LOCATION Most of the jejunum lies in the left upper quadrant of the infracolic compartment. whereas most of the ileum lies in the right lower quadrant. The terminal ileum lies in the pelvis.

25 The final section of the small intestine. It is about 3 m long, and contains villi similar to the jejunum. The ileum joins to the cecum of the large intestine at the ileocecal junction. The jejunum and ileum are suspended in the abdominal cavity by mesentery. The mesentery is part of the peritoneum. Arteries, veins, lymph vessels and nerves travel within the mesentery. ILEUM

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29 MESENTERY The mesentery is a fan shaped fold of peritoneum that attaches the jejunum and the ileum to posterior abdominal wall. The root of mesentery (15 cm) long is directed obliquely, inferiorly and to the right.

30 Arterial Supply Of Jejunum & Ileum Supplied by SMA via jejunal and ileal branches. These branches unite to form arterial arcades which give rise vasa recta.

31 Venous Drainage Of Jejunum & Ileum Via SMV which unites with the splenic vein to form the hepatic portal vein.

32 Lymph Drainage Of Jejunum & Ileum 3 groups of lymph nodes. 1. Juxta intestinal: located close to abdominal wall. 2. Mesentric: scattered among the arterial arcades. 3. Supperior central: located along the proximal part of SMA. Lymph from these nodes drain into the superior mesenteric nodes.

33 Inervation Of Jejunum & Ileum Sympathetic supply through superior mesenteric nerve plexus. Parasympathetic supply through posterior vagal trunk.

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