Small Intestine: Duodenum

Question 1

Length of Duodenum

Answer 1

10 inches long

Question 2

length of 1st part duodenum

Answer 2

2 inches long

2,3,4,1

Question 3

Length of 2nd part duodenum

Answer 3

3 inches long

2,3,4,1

Question 4

Length of 3rd part duodenum

Answer 4

4 inches long

2,3,4,1

Question 5

Length of 4th part duodenum

Answer 5

1 inch long

2,3,4,1

Question 6

Site of duodenum

Answer 6

Partially in Epigastric region & partially in umbilical region

Question 7

Beginning of 1st part duodenum

Answer 7

from pyloric end of stomach, 1/2 inch right to midline at transpyloric plane (L1 vertebra) level

Question 8

2nd Part of duodenum ends at level —-

Answer 8

L3 Vertebra

Question 9

3rd part duodenum is horizontal, extending to the left at level —

Answer 9

L3 vertebra

Question 10

End of 4th part duodenum

Answer 10

at Duodenojejunal flexure, 1 inch left to midline, at level L2 vertebra

Question 11

Describe peritoneal Covering of duodenum

Answer 11

• Duodenum is retroperitoneal
• Peritoneum covers Anterior & peripheral parts of duodenum
• except 1st inch of 1st part as it’s mobile, so completely covered

Question 12

Ant, post, sup, inf relations of 1st inch 1st part duodenum

Answer 12

Ant:
* Greater sac
* Quadrate lobe of liver

Post:
* Neck of Pancreas
* Lesser sac

Sup:
* Lesser Omentum ( Containing
* Common Bile Duct
* Hepatic A
* Portal vein )
* epiploic Foramen

Inferior:
* Head of Pancreas
* Greater omentum (attachement)

Question 13

Ant, post, inf relations of 2nd inch 1st part duodenum

Answer 13

Ant:
* Quadrate lobe of liver (like 1st inch)
* Lesser Sac (like 1st inch)
* Neck of gall bladder

Post:
* Gastroduodenal A
* Common bile duct
* Portal V
* IVC

Inf: head of Pancreas

Question 14

2nd, 3rd & 4th part duodenum common anterior relation

Answer 14

Coils of jejunum

Question 15

Ant, post, med, lat relations of 2nd part duodenum

Answer 15

Ant:
* Upper part: lesser sac + inf surface of right lobe of liver
* Middle part: transverse colon
* Lower Part: coils of jejunum

Post:
* Hilum of right kidney
* right Renal Vessels
* Right pelvis ureter
* Right psoas major

Med:
* Head of pancreas
* Sup & inf pancreaticoduodenal A
* Ampulla of Vater

Lat:
* Right lobe of liver
* Right Colic Flexure
* Ascending Colon

Question 16

Ant, post, sup, inf relations 3rd part duodenum

Answer 16

Ant:
* Root of Small intestine mesentery containing Sup. mesenteric vessels
* Coils of jejunum

Post:
* IVC
* Aorta
* Inferior Mesenteric A origin
* Right ureter
* Right psoas major
* Right Gonadal A

Sup:
* Head of pancreas & uncinate process

Inf: coils of jejunum

Question 17

Ant, post, med, lat relations 4th part duodenum

Answer 17

Ant:
* Coils of jejunum

Post:
* Left gonadal A
* Left sympathetic Chain

Med:
* uncinate process
* head of pancreas
* Abdominal Aorta

Lat:
* Coils of jejunum
* Hilum of left kidney

Question 18

Describe Arterial Supply of duodenum

Answer 18

1st part 1st inch:
* Supraduodenal A (br from gastroduodenal A/ Hepatic A)
* Additional supply from Right gastric & right gastro-epiploic A

1st part 2nd inch & 2nd part upper 1/2:
* Superior pancreaticoduodenal (from gastroduodenal A)

Rest of Duodenum:
* Inferior pancreaticoduodenal A (from sup. mesenteric A)

Question 19

Clinical points for duodenum

Answer 19

• marked at operation by ligament of Treitz
• most common site for peptic Ulcer