First and shortest (9–11 in., or 23–28 cm) segment of the small intestine. It curves down and then up from the pylorus of the stomach, where chyme enters it. Ducts from the pancreas and gallbladder bring in bicarbonate to neutralize stomach acid, pancreatic enzymes to further digestion, and bile salts to break up fats. Nutrient absorption begins in the lower duodenum, which has a mucous lining. Exposure to stomach acid makes the upper duodenum susceptible to peptic ulcers, the duodenum's most common problem. Compression of the lower duodenum between the liver, pancreas, and major blood vessels can require surgery.
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The duodenum also regulates the rate of emptying of the stomach via hormonal pathways. Secretin and cholecystokinin are released from cells in the duodenal epithelium in response to acidic and fatty stimuli present there when the pyloris opens and releases gastric chyme into the duodenum for further digestion. These cause the liver and gall bladder to release bile, and the pancreas to release bicarbonate and digestive enzymes such as trypsin, lipase and amylase into the duodenum as they are needed.
New studies have shown that around 80% of obese people who had gastric bypass surgery (bypassing the duodenum) were cured of their Type 2 Diabetes. However, the disappearance of their diabetes came long before the actual weight loss. When the same operation was performed on diabetic rats, they too were rid of their diabetes. However, when the operation was reversed in the animals, the diabetes returned. This shows that preventing food from entering the duodenum can have a dramatic impact on people suffering from Type 2 Diabetes.
The pancreatic duct and common bile duct enter the descending duodenum, commonly known together as the hepatopancreatic duct (or pancreatic duct in the United States), through the major duodenal Papilla. This part of the duodenum also contains the minor duodenal papilla, the entrance for the accessory pancreatic duct. The junction between the embryological foregut and midgut lies just below the major duodenal papilla.
The duodenum receives arterial blood from two different sources. The transition between these sources is important as it determines the foregut from the midgut. Proximal to the 2nd part of the duodenum (approximately at the major duodenal papilla - where the bile duct enters) the arterial supply is from the gastroduodenal artery and its branch the superior pancreatoduodenal artery. Distal to this point (the midgut) the arterial supply is from the superior mesenteric artery, and its branch the inferior pancreatoduodenal artery supplies the 3rd and 4th sections. The superior and inferior pancreatoduodenal arteries (from the gastroduodenal artery and SMA respectively) form an anastomotic loop between the celiac trunk and the SMA; so there is potential for collateral circulation here.
The venous drainage of the duodenum follows the arteries. Ultimately these veins drain into the portal system, either directly or indirectly through the splenic or superior mesenteric vein.
The lymphatic vessels follow the arteries in a retrograde fashion. The anterior lymphatic vessels drain into the pancreatoduodenal lymph nodes located along the superior and inferior pancreatoduodenal arteries and then into the pyloric lymph nodes (along the gastroduodenal artery). The posterior lymphatic vessels pass posterior to the head of the pancreas and drain into the superior mesenteric lymph nodes. Efferent lymphatic vessels from the duodenal lymph nodes ultimately pass into the celiac lymph nodes.
Adenocarcinoma of the third and fourth portion of the duodenum: a case report and review of the literature.(Case Report)(Case study)
Aug 18, 2008; Authors: Haridimos Markogiannakis (corresponding author) ; Dimitrios Theodorou ; Konstantinos G Toutouzas ; Georgia...