Vous êtes sur la page 1sur 34

Bowel components

Dow Jones Industrial Climbing Average Closing


Stock Report Awesome
Duodenum sigmoid
Jejunum Rectum
Ileum Anal canal
Cecum
Appendix
colon
Small Intestine
It extends from the pylorus to ileocaecal junction
Extent
6 m long
Divided into
Duodenum, Jejunum, Ileum

Duodenum
The duodenum is the proximal part of the small intestine.
Shortest & most fixed part
Course
extends from pylorus to duodo-jejunal flexure
25 cm long
forms a C-shape, the concavity of which is occupied by the pancreas
its course can be described in 4 parts: superior, descending, horizontal,
ascending
Lies just above the level of umbilicus
Opposite L1-L3

1
st
(Sup) Part
5cm long
begins at level of L1 to the Rt of midline
lies on transpyloric plane

Relations:
Peritoneal Relation
Proximal 1 inch is movable which is attached to lesser omentum above &
greater omentum below
The distal 1 inch fixed. It is retroperitoneal & covered with peritoneum on
anterior aspect

Visceral Relation
Anteriorly
quadrate lobe of liver
gallbladder
Visceral Relation
Posteriorly
gastroduodenal artery
common bile duct & portal vein
Superiorly
epiploic foramen
Inferiorly
head & neck of pancreas


2
nd
(Descending) Part
7.5 cm long
runs down vertically to Rt of L2 & L3

Perotoneal Relations:
Retroperitoneum, Fixed
Anterior part covered with Peritoneum except in middle where it is related
to colon
Visceral Relation
Anteriorly
Rt lobe of liver
transverse colon
Root of transverse mesocolon
Small Intestine
Posteriorly
Rt kidney
Rt. Renal vessels
Rt. Psoas major
laterally
Rt. Edge of IVC
Rt hepatic flexure
Medially
head of pancreas
bile duct



Interior of 2
nd
part of Duodenum
Major duodenal papilla
Is elevation present postero-medially 8 10 cm distal to pylorus.
Hepato-pancreatic ampulla opens at summit of papilla
Minor Duodenal papilla
6-8 cm distal to pylorus
Acessory pancreatic duct opens

3
rd
(Horizontal) Part
10 cm long
runs to the Lt. at / below subcostal plane (across L3)

Perotoneal Relations
Retroperitoneum & fixed
Covered by peritoneum anteriorly except in median plane where it is crossed
by superior mesenteric vessels & root of mesentery

Anteriorly Posteriorly Superiorly Inferiorly
1. roots of
mesentry
2. superior
mesenteric
vessels in it
1. Rt ureter
2. Rt psoas muscle
3. Rt. Testicular or
Ovarian vessels
4. IVC
5. aorta
1. head of pancreas
with uncinate
process
1. coils of
jejunum
Visceral Relations
4
th
(Ascending) Part
2.5cm long
runs upwards & to the Lt
ends at duodeno-jejunal flexure at level of L2

Peritoneal Relations
Retroperitoneum
The terminal part is suspened by uppermost part of mesentry & is mobile
Visceral Relations
Anteriorly
Transverese colon
Transverse mesocolon
Lesser sac & stomach
Posteriorly
Lt. Sympathetic chain
Lt. Renal vessels
Lt psoas muscle
Lt. Testicular vesels
Inferior mesenteric vein
Rt
Upper part of root of mesentery
Superior
Body of Pancreas
Lt.
Lt Kidney, lt. Ureter


Blood Supply
Superior Pancreatoduodenal artery Upto the opening of the bile duct
Inferior Pancreatoduodenal artery below the opening of the bile duct

First part gets additional supply from Right gastric artery, the supraduodenal
artery of Wilkie, retroduodenal branches of gatroduodenal artey and some
branches of Rt gastroepiploic artery

Blood supply of the small intestines
The intestines are mainly supplied by the
three unpaired branches of the abdominal
aortas:

Coeliac artery
Superior mesenteric artery
Inferior mesenteric artery
The coeliac artery emerges immediately after
the passage of the aorta through the aortic
hiatus of the diaphragm. It divides into a
branch to the spleen, the lienal artery, a
branch to the stomach, the left gastric artery,
and into the common hepatic artery, which
somewhat later becomes the right gastric
artery.
The superior mesenteric artery supplies the
whole small intestine and extends branches
up to the middle third of the transverse colon.
Up to this point, the innervation is taken over
by the vagus nerve (CN X).
The inferior mesenteric artery is responsible
for supplying blood to the left third of the
transverse colon and to the sigmoid colon
Venous Drainage
Veins correspond to arteries &
portal vein
superior mesenteric vein
Splenic vein
Thus the venous drainage is ultimately
into the portal vein

Lymphatic Drainage
Pancreaticoduodenal nodes present inside of the curve
From here to the hepatic nodes & then end in Coeliac node
Nerve Supply
Sympathetic arises from T9 & T10 spinal segments
Parasympathetic from Vagus


Jejunum & Ileum:
These parts of the small intestine extend from Duodeno Jejunal flexure to
ileocecal junction
They are suspended by mesentery & are thus free mobile
The upper 2/5 is arbitrarily designated
jejunum, there being no clear-cut
distinction between the 2
Mesentery
Fan shaped fold of peritoneum which suspends the coils of jejunum & ileum
from the posterior abdominal wall

Jejunum
Lies coiled in the upper part of the
peritoneal cavity.

Have wider lumen, thicker wall
and more red in color
WWW.SMSO.NET
Ileum
Lies coiled in the lower part of the
peritoneal cavity and in the pelvis.

Have smaller lumen, thinner wall
and less red in color.
Has Peyers Patches opposite
attachment of mesentery
(antimesenteric border).
WWW.SMSO.NET
Jejunum
Mesenteric vessels form only 1
or 2 arcades with long branches
passing to the jejunal wall.
In mesentery, fat is deposited
near root and is scanty (very
little) near the jejunal wall.
Ileum
Mesenteric vessel form 3 to 5
arcades with numerous short
branches.
In mesentery, fat extends from the
root to the ileal wall. .
Blood Supply
Branches of superior mesenteric artery
Venous Drainage
The veins correspond to the branches of the sup mesenteric art
They drain mainly into the sup mesenteric vein

Aggregated Lymphatic follicles or payers patches
Cintains 10 200 follicles aggregated in circular or oval patches with size of
2-10 cm they are placed length wise along antimesentric border of intestine

Glands of Intestine
Crypts of Lieberkuhn Mucous membrane of jejunum & Ileum
Secrete Digestive enzymes & mucous

Brunners Glands Sub- mucosa of Duodenum
Secretes mucous

Meckels Diverticulum
It is persistent proximal part of vitellointestinal duct which is present in
embryo & which normally disappears during 6
th
week of intrauterine life

It occurs in 2% subject
It is 2 inch long
Situated about 2 feet proximal to ileocaecal valve, attached to
antimesenteric border of ileum
Its apex may be free or attached to umbilicus, to mesentry or to any other
abdominal structure by fibrous band

Mohammed sanwar Hussain
Skype id-duckwick
Email-iamsanwar01@gmail.com