Small Intestine

Question 1

Describe small intestine
( long - parts - peritoneal attachment)

Answer 1

1- the longest part of gut tube (6-7)
2- 3 parts ( duodenum , jejunum, ilieum)
3- duodenum is retroperitoneam so it is fixed
While jejuileum are intraperitoneal so are free mobile

Question 2

Describe the duodenum ?
( long - shape - beginning- ending - parts )

Answer 2

• 10 inch ( 25 cm)
• c shaped
• begins at the pylorus on the right side and ends at the duodenojejunal flexure Lt Side
• parts
1st
2nd
3rd
4rth

Question 3

Talk about 1 st part
(5)

Answer 3

1- 2 inch
2- begins from pyloduodenal junction. At the level of the transpyloric line at the level of l1
3- directed upward
4- retroperitoneal except 1st inch of 1st part ( it is considered as a part of stomach )
5- relations
superior :Free border of lesser omentum (VAD) + epiploic foramen
Inferior :pancreas..
Anterior: Liver

posterior :1-Bile duct
2-Gastroduadenal. Art.
3-portal vein

Question 4

Talk about 2 nd part
(4)

Answer 4

1- 3 inch
2- runs downward vertically
3-Structures open in the 2nd part of the duodenum (posteromedial aspect of 2nd part)
bile duct unites with the pancreatic duct forming a dilatation called (ampulla of Vater). The ampulla opens on an elevation called the major duodenal papilla.

While accessory pancreatic duct opens one-inch above the major duodenal papilla, forming a smaller elevation called the minor duodenal papilla.

4- relations
Anterior: 1- Liver (gall bladder).
2-Transverse colon
3 -coils of small intestice (jejunum, ileum)
Posterior :hilum of Rt Kidney

Question 5

Talk about 3rd part
(4)

Answer 5

1- 4 inch
2- at the level of l3
3- lies in a horizontal plane
4- relations

Anterior :1- sup-mesentric vessels.
2- small intestine

posterior : 1- rt psos major
2- Ivc
3- Abdominal aorta.
4. Inferior mesentric vessels

Question 6

Talk about 4rth part
(4)

Answer 6

1- 1 inch
2- runs upward
3- ends in duodenoejejunal junction at the level of the 2nd lumbar vertebrae. The junction (flexure) is held in position by the ligament of treitz
4- relations
Anterior :small intestine ( jejunum)
posterior : Lt psos major

Question 7

Blood supply of duodenum

Answer 7

1-superior pancreatico duodenal artery ~>gastrodudenal artery ~>hepatic artery ~> coeliac trunk ( supplies 1st part+ upper half of 2nd part which came from forgut)

2. inferior pancreaticodudenal artery ~>superior mesenteric artery. ( supplies lower part which came from midgut )

• Veins of the duodenum: both superior and inferior pancreatico-dudenal veins drain into superior mesenteric vein

Question 8

Lymphatic drainage of duodenum

Answer 8

drain upward-> via pancreaticoduodenal nodes - the gastroduodenal nodes -> the celiac nodes

drain downward -›via pancreaticoduodenal nodes-> the superior mesenteric nodes around the origin of the superior mesenteric artery

Question 9

Applied anatomy of duodenum

Answer 9

1- most common part to peptic ulcer
Posterior surface of 1 st inch if 1 st part
2- perforated peptic ulcer in posterior part of 1 st part ( less common ) can lead to bleeding as it makes erosion in gastroduodenal artery
3- perforated peptic ulcer in anterior part ( more common ) can lead the hcl and digested food to participate in iliac fossa causing irritation and pain
4- gall bladder is next to duodenum so when cholysyctitis it adheres to duodenum and if it has stones it will send it to duodenum leading to intestinal obstruction
5- duodenum rests on kidney and it is fat , when sudden drop of fat happens , nephrotosis can happen pulling duodenum with it
6- barium meal is used to observe the 1 st part

Question 10

Difference between gastric , duodenul ulcer

Answer 10

• gastric ~> weight loss ( stimulation of para ~> + gastric acidity ~> + pain )
  ف بتخاف تاكل
• duodenul ~> weight gain ( alkaline secretion بيعادل ال gastric acidity ) ف بترتاح مع الاكل

Question 11

Stapping 🔪🔪

Answer 11

1- aaw
2- liver
3- pylorduodenal junction
4- neck of pancreas
5- portal vein
6- ivc