Jejunum and Ileum Location and Description

Jejunum and Ileum Location and Description

The small intestine DOUDENUM duodenum

The duodenum is a c-shaped Concave tube About 10 in length. It joins the stomach to the jejunum. It curves around the head of the pancreas to the left and backwards. It is important because it receives

the opening of the bile and pancreatic ducts. duodenum.cont Most of the duodenum is retroperitoneal except the 1st inch & last inch This short segment( 1st inch) has the lesser

omentum on its upper border, the greater omentum on its lower border, and the lesser sac posterior to it The duodenum extends from the pylorus to the jejunum It is divided into 4 parts.

Site of duodenum - The duodenum is situated in the epigastric and umbilical regions - for purposes of description, is divided into four parts

Right lobe of liver Falciform ligament Gallbladder Pancreas Duodenum L-3 Parts of the duodenum & Their relations

Parts of the duodenum &Their relations 1st part of Duodenum - The first part is 2 inches long. - It begins from the pyloduodenal junction - At the level of the transpyloric line

- Runs upward and backward at the level of the 1st lumbar vertebra 1 inch to the right. Relations of 1st part of doudenum Ant. - The liver (quadratus lobe) - gall bladder

Relations of 1st part of duodenumcont Sup. - the epiploic foramen Relations of 1st part duodenumcont post. - The lesser sac

- gastroduodenal Artery - the Bile duct - portal vein - I.V.C Inf. The head of the pancreas. 2nd part of duodenum It is 3(3 inch) long

runs downward vertically on the right side In front of the Rt.kidney next to the 3rd and 4th lumbar vertebrae. halfway of it, The bile duct and the main pancreatic duct pierce the medial wall, and then form the ampulla that opens in the

major duodenal papilla. The accessory pancreatic duct (if present) opens in the minor duodenal papilla more superiorly. Hepaticopancreatic ampulla (Ampulla of Vater)

Relations of2nd part of duodenum Ant. The gallbladder (fundus) Right lobe of the liver Transverse colon coiled of small intestine. Post. Hilum of Rt. Kidney Rt. Ureter.

Lateral. Right colic flexure Ascending colon Right lobe of the liver. Medial. - Head of pancreas - Bile and pancreatic ducts. 3rd part of duodenum

4 long Runs horizontally to the left On the subcostal plane. Runs in front of the vertebral column Under the lower margin of the head of pancreas Above the coils of the

jejunum. Relations of 3rd part of duodenum :Anteriorly The root of the mesentery of the small intestine the superior mesentericvessels contained within the mesentry coils of jejunum: Posteriorly The right ureterthe right psoas muscle the inferior vena cava the aorta: Superiorly

The head of the pancreas : Inferiorly Coils of jejunum 4 part of duodenum..cont th 1 long Runs upward to the left

End in the duodejejunal junction at the level of the 2nd lumbar vertebrae 1 to the left. The junction (flexure) is held in position by the ligament of Treitz, which is attached to the right crus of the diaphragm (duodenal recess). Relation of 4 part of duodenum th

Ant. - The beginning of the root of the mesentery - coils of the jejunum. Post. - Lt. psoas major - the sympathetic chain left margin of the aorta. Sup.

- Uncinate process of the pancreas. Blood supply of duodenum Arteries 1- upper half (1st part + upper1/2 of 2nd part) is supplied by the superior pancreaticoduodenal artery, a branch of the gastroduodenal artery . 2- The lower half (lower of 2nd part +3rd+4th part) is

supplied by the inferior pancreaticoduodenal artery, a branch of the superior mesenteric artery Arterial supply and venous drainage of the duodenum Blood supply for duodenum Veins of duodenum

The superior pancreaticoduodenal vein drains into the portal vein The inferior vein joins the superior mesenteric vein . Lymphatic drainage The lymph vessels follow the arteries 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. Nerve supply Sympathetic nerve parasympathetic nerves from:

1- The celiac plexus 2- Superior mesenteric plexus. Jejunum and Ileum Location and Description The jejunum and ileum measure about 20 ft (6 m) long the upper two fifths is the jejunum & the lower 3/5 is the ileum Each has distinctive features

there is a gradual change from one to the other The jejunum begins at the duodenojejunal flexure the ileum ends at the ileocecal junction. The coils of jejunum and ileum are freely mobile and are attached to the posterior abdominal wall by a fanshaped fold of peritoneum known as the mesentery of the small intestine SMALL INTESTINES ANATOMY

jejunum ileum Anatomical position of small intestine Structure of the Villi in the Small Intestine

32 mesentery of the small intestine - fan-shaped fold of peritoneum - The long free edge of the fold encloses the mobile intestine. - The short root of the fold is continuous with the parietal peritoneum on the posterior abdominal wall

- Along a line that extends downward and to the right from the left side of the second lumbar vertebra to the region of the right sacroiliac joint Root of the mesentery Contents of the mesentery - The branches of the superior mesenteric artery and vein

- Lymphatic vessels & lymphatic nodes - nerves Difference between Jejunum & Ileum jejunum Ileum length

Proximal 2/5 Distal 3/5 site in the upper part of the peritoneal cavity below the left

side of the transverse mesocolon in the lower part of the cavity and in the pelvis wall thicker wall& redder

Thinner & less redder Arcades in mesentery -simple ,only one or two arcades -with long infrequent branches -Long vase recta numerous

short terminal vessels arise from a series of three or four or even more Arcade Short vase recta- Fat in mesentery the fat is deposited near the root

it is scanty near the intestinalwall Less in amount appearwindow the fat is deposited throughout mesentery Big amountNo window appear- Difference between Jejunum & Ileum jejunum

Ileum Diameter wider smaller villi

numerous Less numerous Plicae circularis(the permanent enfolding of the mucous membrane& submucosa

: They are larger- 1 more numerous- 2 closely set- 3 they are: 1- smaller 2- more widely separated

3- in the lower part they are absent . No or few Aggregations of lymphoid tissue (Peyer's patches) are present in the mucous membrane

Lymphatic follicles Blood supply of Jejunum & Ileum Arteries: The arterial supply is from branches of the superior mesenteric artery . The intestinal branches arise from the left side of the artery and run in the mesentery to reach the gut.

They anastomosis with one another to form a series of arcades. The lowest part of the ileum is also supplied by the ileocolic artery. Blood supply for jejunum & Ileum Veins: The veins correspond to the branches of the

superior mesenteric artery Drain into the superior mesenteric vein. Lymphatic Drainage of jejunum & ileum The lymph vessels pass through many intermediate mesenteric nodes Finally reach the superior mesenteric nodes around the origin of the superior mesenteric artery.

Lymph Drainage of jejunum & ileum Nerve Supply of jejunum & Ileum The nerves are derived from the sympathetic and parasympathetic (vagus) Nerves from the superior mesenteric plexus. Nerve supply for small intestine

Congenital anomaly of small intestine Meckel's Diverticulum:

a congenital anomaly of the ileum Present in 2% of people 2 feet from iliocecal junction 2 inch long contains gastric or pancreatic tissue Remains of vitelline duct of embryo Meckel's Diverticulum

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