Duodenum

Question 1

Site

Answer 1

1. Small intestine proximal part
2. Lies partly in epigastric and partly in umbilical regions

Question 2

Length

Answer 2

10 inches long

Question 3

Shape

Answer 3

C-shape with concavity to left

Question 4

Parts

Answer 4

4 parts

Question 5

1st part

Answer 5

1. 2 inches long
2. Extends horizontally to right from stomach pyloric end 1/2 inch to right of midline at Transpyloric plane (1st lumbar vertebra) level

Question 6

2nd part

Answer 6

1. 3 inches long
2. Extends vertically downwards from 1st part right end to end at 3rd lumbar vertebra level

Question 7

3rd part

Answer 7

1. 4 inches long
2. Extends horizontally from 2nd part lower end to left at 3rd lumbar vertebra level

Question 8

4th part

Answer 8

1. 1 inch long
2. Extends vertically upwards from 3rd part left end to join jejunum at duodenojejunal flexure 1 inch to left of midline at 2nd lumbar vertebra level

Question 9

Extent

Answer 9

1. Begins at L1 vertebra level
2. Ends at L2 vertebra level and its lowest part (3rd part) lies at L3 vertebra level

Question 10

Peritoneal covering and recesses

Answer 10

1. Retroperitoneal structure fixed to posterior abdominal wall except it’s 1st inch which is mobile and completely covered by peritoneum
2. Peritoneum covers duodenum anterior and along periphery only

Question 11

4 recesses related to duodenum terminal part

Answer 11

1. Superior duodenal recess
2. Inferior duodenal recess
3. Paraduodenal recess
4. Retroduodenal recess

Question 12

4 recesses related to duodenum terminal part

Answer 12

1. Superior duodenal recess
2. Inferior duodenal recess
3. Paraduodenal recess
4. Retroduodenal recess

Question 13

Superior duodenal recess

Answer 13

1. On left side of duodenum 4th part upper end behind superior duodenal fold
2. It’s opening looks downwards and related to inferior to inferior mesenteric vein which runs in fold edge

Question 14

Inferior duodenal recess

Answer 14

1. On left side of duodenum 4th part lower end behind inferior duodenal fold
2. It’s opening looks upwards and not related to vessels

Question 15

Paraduodenal recess

Answer 15

1. Little to left of duodenum whole 4th part behind Paraduodenal fold
2. Its opening looks to right with inferior mesenteric vein present in overlying fold

Question 16

Retroduodenal recess

Answer 16

1. Behind duodenum 3rd and 4th
2. In front of aorta
3. Opening is directed downwards and to the left

Question 17

Relations 1st part: 1st inch

Answer 17

1st inch duodenal cap
Only mobile part
Anterior:
1. Liver quadrate lobe separated from it by greater sac
Posterior:
1. Pancreas Neck, separated from it by lesser sac
Superior:
1. Lesser omentum right free border attachment (containing common bile duct, hepatic artery, and portal vein)
2. Epiploic foramen behind it
Inferior:
Greater omentum attachment with pancreas head behind it

Question 18

Relations 1st part: 2nd inch

Answer 18

Anterior:
1. Liver quadrate lobe separated from it by greater sac
2. Gall bladder neck, at junction between 1st and 2nd parts
Posterior:
1. Gastroduodenal artery
2. Common bile duct to right of artery
3. Portal vein, behind artery and duct
4. IVC posterior to portal vein
Inferior:
1. Pancreas head

Question 19

Relations 2nd part: anterior

Answer 19

1. Upper part:
   Related to inferior surface of liver right lobe separated from it by greater sac
2. Middle part:
   Crossed by transverse colon
3. Lower part:
   Related to jejunum coils

Question 20

Relations 2nd part: posterior

Answer 20

1. Right kidney hilum with renal vein, renal artery, and ureter pelvis
2. Right Psoas major

Question 21

Relations 2nd part: medial

Answer 21

1. Pancreas head
2. Ampulla of Vater, opens in middle of duodenum 2nd part Posteromedial aspect
3. Superior and inferior pancreatico-duodenal arteries in groove between duodenum 2nd part and pancreas head

Question 22

Relations 2nd part: lateral

Answer 22

1. Liver right lobe
2. Ascending colon
3. Right colic flexure

Question 23

Relations 3rd part: anterior

Answer 23

1. Root of small intestine mesentery (containing superior mesenteric vessels)
2. Jejunum coils

Question 24

Relations 3rd part: posterior

Answer 24

1. Right Psoas major separated from it by right ureter
2. IVC separated from it by gonadal artery
3. Abdominal aorta separated from it by inferior mesenteric artery

Question 25

Relations 3rd part: superior

Answer 25

Pancreas head and its uncinate process

Question 26

Relations 3rd part: inferior

Answer 26

Jejunum coils

Question 27

Relations 4th part: anterior

Answer 27

Jejunum coils

Question 28

Relations 4th part: posterior

Answer 28

1. Left sympathetic chain 2. Left gonadal artery

Question 29

Relations 4th part: medial

Answer 29

1. Uncinate process of pancreas head 2. Abdominal aorta

Question 30

Relations 4th part: lateral

Answer 30

1. Jejunum coils 2. Left kidney hilum

Question 31

Atrial supply: 1st part 1st inch

Answer 31

1. Supplied by supraduodenal artery (branch of gastroduodenal or hepatic artery) 2. Additional supply from right gastric and gastroepiploic arteries

Question 32

Atrial supply: 1st part 2nd inch and 2nd part upper 1/2 (duodenum foregut part)

Answer 32

Supplied by superior pancreatico-duodenal artery (branch of gastroduodenal artery)

Question 33

Atrial supply: Duodenum remaining parts (duodenum midgut part)

Answer 33

Supply by inferior pancreatico-duodenal artery (branch of superior mesenteric artery)

Question 34

Venous drainage

Answer 34

Accompanies the atrial supply to drain into portal circulation (splenic, superior mesenteric, and portal veins)

Question 35

Lymphatic drainage

Answer 35

1. Hepatic node 2. Superior mesenteric node 3. Pyloric node

Question 36

Applied anatomy

Answer 36

1. Duodenum end (duodenojejunal junction) is marked at operation by ligament of Treitz (Suspensory ligament of duodenum) 2. Fibromuscular band suspends and fixes duodenojejunal flexure 3. Arises from diaphragm right crus and descends behind pancreas to gain attachment into posterior surface of duodenojejunal flexure 3rd and 4th parts of duodenum

Question 37

Peptic ulcer site

Answer 37

Duodenum is the most common site for it