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Which section is the shortest portion of the small bowel? What are the boundaries of this portion of bowel?

Begins @ pylorus of stomach & ends at ligament of Trietz (this is the beginning of the jejunum)


What are the 3 branches off of the celiac trunk?

left gastric
common hepatic


Is the duodenum intraperitoneal or retroperitoneal?

The first 2-3 cm are intraperitoneal...
the rest of the duodenum is retroperitoneal.


How many divisions are there to the duodenum?



Where is the ligament of Treitz found?

This is a suspensory muscle that marks the division b/w the duodenum & the jejunum.


What is the first portion of the duodenum?

This is the 2-3 cm that is intraperitoneal. It begins after the pylorus.
It is also referred to as the duodenal bulb.


What 3 vessels run behind the first part of the duodenum?

common bile duct
gastroduodenal artery


What is the clinical significance of the first portion of the duodenum?

This is the site for duodenal ulcer disease.
They can develop here b/c of the increased acidity of the stuff leaving the stomach & going straight here.


What are the 2 things that ulcers in this region can do? Where do they often do it?

Perforate: bile & acids into intraperitoneal space
-->usu happens on the anterior portion
Bleed: a ton of blood can leave the gastroduodenal artery b/c close to the aorta
-->usu happens on the posterior portion
-->needs to be ligated to stop the bleeding


What is the area behind the stomach called?

the lesser sac


How long is the second portion of the stomach? What is it commonly referred to as? Is it intraperitoneal or retroperitoneal?

Retroperitoneal now!!
8-10 cm
**the pancreas kind of snuggles up in there.


What important thing drains here?

This is where the pancreatic duct & common bile duct come together as the ampulla of Vater & drain.


What is another name for the ampulla of Vater?

hepatopancreatic ampulla


How long is the third portion of the duodenum? What is it also referred to as? What significant thing happens here? Intra or retroperitoneal?

5-8 cm in length
Horizontal portion
**proceeds horizontally from right to left
**the SMV & SMA cross anterior to the duodenum @ the third portion.


How long is the fourth portion of the duodenum? Intra or retroperitoneal? Where does it begin & end?

2-3 cm
Begins to the left of the SMV/SMA
Ends @ ligament of trietz (beginning of the jejunum)


What is the journey of the fourth portion of the duodenum? What is another name for it?

Ascending portion
It begins left of the SMV/SMA & has a short journey where it hikes superiorly & to the left. Then it takes a perilous dive after the ligament of trietz at which point it is the jejunum.


What is the blood supply to the duodenum very similar to? What are the 2 main arteries that are responsible?

very similar to the pancreas
1. superior pancreaticoduodenal artery
2. inferior pancreaticoduodenal artery


Starting w/ the abdominal aorta...& ending with the superior pancreaticoduodenal artery...describe the branching pathway.

Abdominal Aorta
Celiac Trunk
Common Hepatic Artery
Gastroduodenal Artery
Superior Pancreaticoduodenal Artery


Starting w/ the abdominal aorta...& ending with the inferior pancreaticoduodenal artery...describe the branching pathway.

Abdominal Aorta
Superior Mesenteric Artery
Inferior Pancreaticoduodenal Artery


Describe the venous drainage of the duodenum.

Most of the drainage of the duodenum goes into the superior mesenteric vein. This drains into the portal vein. It goes into portal circulation-->cycles thru the liver.


Describe the lymphatic drainage of the duodenum.

the lymph first drains into the pancreaticoduodenal lymph nodes. It then drains into the celiac nodes.


What's the deal w/ a malrotation of the small bowel?

@ 7-8 weeks the intestine exits the fetus to become properly rotated and goes back in. This is where a 270 degree rotation forms the C loop of the duodenum. This is also when the duodenum tucks underneath the superior mesenteric vessels. When it doesn't do this properly-->malrotation & problems.


What are the problems with malrotation?

the malrotation can make the mesentery very tight & easily turned about to strangle a blood vessel. This is called a mid gut volvulus. It can kill the bowel & cause short bowel syndrome.


What are the symptoms of malrotation & when do they usu show up?

could show up in a newborn, but not necessarily
bilious vomit (green)
This makes you think-->oh no! mid gut volvulus


What is a crus of the diaphragm? Plural--crura of the diaphragm?

tendinous structures that extend inferiorly into the diaphragm & attach to the vertebral column & create a tether for muscle contraction


What is the ligament of treitz really a continuation of?

the crus of the right diaphragm


What is the blood supply of the jejunum & ileum?

the SMA


The last chunk of the small intestine (jejunum & ileum) begins where & ends where? How long is the portion all together?

Begins @ ligament of Trietz
Ends @ ileocecal valve
6-7 meters


Which portion of the last chunk of small intestine (jejunum & ileum) is jejunum? What is the point of division?

The first 2/5 of this last chunk is jejunum. However, there is no structure that demarcates this.


What are important external differences b/w the jejunum & the ileum?

The jéjunum is thicker & more muscular than the ileum.