Anatomy of the Intestines Flashcards
Is the duodenum mobile?
No
Where is the duodenum, in relation to the peritoneum?
- The proximal first segment is intraperitoneal
- The rest is secondarily retroperitoneal
Are the jejenum and ileum mobile?
Yes
Are the ascending and descending colon mobile?
No
Where are the ascending and descending colon, in relation to the peritoneum?
Secondarily retroperitoneal
Does the caecum have a mesentery?
No
What is the caecum commonly bound to?
The lateral abdominal wall
What is the caecum commonly bound to the lateral abdominal wall by?
A fold of peritoneum
What is the transverse colons mesentery called?
The transverse mesocolon
What is the transverse mesocolon adhered to?
The posterior wall of the omental bursa
How does the lumen diameter of the small intestine differ from the large intestine?
It is smaller
Describe the longitudinal muscle in the small intestine
Continuous layer
Describe the longitudinal muscle in the large intestine
Reduced to three bands- teniae coli
Does the small intestine have fatty tags?
No
Does the large intestine have fatty tags?
Yes, attached to its wall
What are the fatty tags of the large intestine called?
Appendices epiploicae
How does the wall of the small and large intestine differ?
- Small is smooth
- Large is sacculated
What does the saculated wall of the large intestine form?
Haustra
Describe the mucous membrane of the small intestine
Permanent folds
What are the mucous membrane folds of the small intestine called?
Plicae circulares
Describe the mucous membrane of the large intestine
Incomplete folds may be present
Describe the lymphoid tissue in the small intestine
Peyer’s patches
Describe the lymphoid tissue in the large intestine
None
How does the duodenum compare to the other sections of the small intestine?
- Shortest
- Widest
- Most fixed
How long is the duodenum?
25cm
What course does the duodenum persue?
A C-shaped course around the head of the pancreas
Where does the duodenum begin?
At the pylorus, on the right side
Where does the duodenum end?
At the duodenojejenal flexure (junction), on the left side
Where does the duodenojejunal junction occur?
At approximately the level of the L2 vertebrae, 2-3cm left of the midline
What does the duodenojejunal junction usually take the form of?
An acute angle
What is most of the duodenum fixed to?
The structures on the posterior abdominal wall
What fixes most of the duodenum to the posterior abdominal wall?
Peritoneum
What is the duodenum considered to be, with regards to the peritoneum?
Partly retroperitoneal
Label this diagram
- A - Liver
- B - Gallbladder
- C - Pylorus
- D - Duodenum
- E - Right colic flexure
- F - Duodenojejunal junction
- G - Ascending colon
- H - Stomach
- I - Pancreas
- J - Left colic flexure
- K - Transverse colon
- L - Jejenum
What parts is the duodenum considered to be divisible into?
- Superior part
- Descending part
- Inferior part
- Ascending part
How long is the superior part of the duodenum?
5cm
Where does the superior part of the duodenum lie?
Anterolateral to the body of the L1 vertebra
How long is the descending part of the duodenum?
7-10cm
Where does the descending part of the duodenum run?
Along the rght sides of L1-L3 vertebrae
How long is the inferior part of the duodenum?
6-8cm
Where does the inferior part of the duodenum cross?
The L3 vertebrae
How long is the ascending part of duodenum?
5cm
Where does the ascending part of the duodenum begin?
At the level of the L3 vertebra
What course does the ascending part of the duodenum take?
Rises superiorly as far as the superior border of the L2 vertebra
Label this diagram
- A - Hepatic portal vein
- B - Hepatic artery
- C - Bile duct
- D - Ampulla (duodenal cap)
- E - Supraduodenal artery
- F - Pylorus of stomach
- G - Gastroduodenal artery
- H - Anterior superior pancreaticduodenal artery
- I - Right gastro-epiploic artery
- J - Superior mesenteric vein and artery
- K - Anterior inferior pancreatico-duodenal artery
- L - Right colic artery and vein
- M - Ileocolic vein and artery
- N - Mesentery (cut edge)
- O - Middle colic artery
- P - Duodenojejunal junction
- Q - Pancreas
- R - Spleen
- S - Splenic vessels
- T - Oesophageal branches
- U - Left gastric artery and veins
- V - Lymph nodes
What is the duodenal cap/ampulla?
The first 2cm of the superior part of the duodenum
Where is the ampulla found?
Immediately distal to the pylorus
Does the ampulla have a mesentery?
Yes
Is the ampulla mobile?
Yes
Is the ampulla retroperitoneal?
No
What is the ampulla a common site of?
Ulceration
Why is the ampulla a common site of ulceration?
Because it is immediately distal to the pylorus
What can be a complication of an ampulla ulcer?
If the ulcer erodes backwards through the gastroduodenal artery, blood loss can be severe
What does the superior part of duodenum ascend from?
The pylorus
What is the superior part of the duodenum overlapped by?
The liver and gallbladder
Describe the relationship between the superior part of the duodenum and peritoneum?
- Peritoneum covers its anterior aspects
- It is bare of peritoneum posteriorly (exept for duodenal cap)
What does the the proximal part of the superior part of the duodenum have attached superiorly?
The hepatoduodenal ligament
What is the hepatoduodenal ligament part of?
The lesser omentum
What does the proximal part of the superior part of the duodenum have attached inferiorly?
The greater omentum
Where does the descending part of the duodenum run?
Inferiorly, curving around the head of the pancreas
What enters the descending part of the duodenum?
The bile and main pancreatic ducts
How do the bile and main pancreatic ducts enter the descending part of the duodenum?
Via the Ampulla of Vater
Where does the Ampulla of Vater enter the descending part of the duodenum?
Its posteromedial wall
Describe the relationship between the descending part of the duodenum and the peritoneum?
- It is entirely retroperitoneal
- The anterior surface of its proximal and distal thirds is covered with peritoneum
- The peritoneum reflects in its middle third
What is formed when the peritoneum reflects in the middle third of the descending part of the duodenum?
The double-layered mesentery of the transverse colon, the transverse mesocolon
How does the inferior part of the duodenum run?
Transversely right to left
What does the inferior part of the duodenum pass over?
The IVC, aorta, and L3 vertebra
What crosses the inferior part of the duodenum?
- The superior mesenteric artery and vein
- The root of the mesentery of the jejenum and ileum
Describe the relationship between the inferior part of the duodenum and the peritoneum
Is is completely covered in peritoneum apart from where structures cross it
What is the inferior part of the duodenum seperated from the vertebral column by?
- Right psoas major
- IVC
- Aorta
- Right testicular/ovarian vessels
Where does the ascending part of the duodenum run?
Superiorly, and along the left side of the aorta to reach the inferior border of the body of the pancreas
What happens to the ascending part of the duodenum when it reaches the inferior border of the body of the pancreas?
It curves anteriorly to join the jejenum at the duodenojejunal flexure
What is the ascending part of the duodenum spported by at the duodenojejunal flexure?
The attachment of a suspensory muscle of the duodenum (Ligament of Treitz)
What is the result of the contraction of the suspensory muscle of the duodenum?
It widens the flexure, facilitating movement
Where does the jejunum begin?
At the duodenojejenal flexure
What happens at the duodenojejunal flexure?
The digestive tract resumes an intraperitoneal course
Where does the ileum end?
The ileocaecal junction
How long are the jejunum and ileum together?
6-7m
What proportion of the intraperitoneal section of the small intestine is jejenum?
~2/5
What proportion of the intraperitoneal section of the small intestine is ileum?
3/5
Where does most of the jejeum lie?
In the left upper quadrant (LUQ) of the infracolic compartment
Where does most of the ileum lie?
In the right lower quadrant (RLQ)
Where does the terminal ileum usually lie?
In the pelvis
What happens to the terminal ileum in the pelvis?
It ascends, ending in the medial aspect of the cecum
What is the mesentery?
A fan-shaped fold of peritoneum
What does the mesentery do?
Attaches the jejenum and ileum to the posterior abdominal wall
What is found between the two layers of the mesentery?
- The superior mesenteric vessels
- Lymph nodes
- Variable amount of fat
- Autonomic nerves