The structure of the duodenum
The duodenum (duodenum) is the initial part of the small intestine should be immediately after the pylorus (pylorus). Then
the intestine is left somewhat backwards, turns down, descends along the anterior surface of the right kidney, and turns left, climbing obliquely upwards, passes into the jejunum. The name of the intestine due to its length, it is part of the widths of twelve fingers.
Anatomy duodenum is closely associated with the biliary system, and pancreas. On the inner surface of the descending part of the duodenum is the papilla of Vater (major duodenal papilla, or). Here, through the sphincter of Oddi opens the common bile duct, pancreatic duct (some people the pancreatic duct may directly fall into the common bile duct). On 8-40 mm above the major duodenal papilla is a small duodenal papilla. Through it opens an additional pancreatic duct. This structure is anatomically variable.
Histological structure of the duodenal mucosa epithelium it provides stability to aggressive composition of gastric juice, bile, pancreatic enzymes.
Functions of the duodenum
One of the main functions of the duodenum is to bring the pH of the stomach the food coming from the pulp to alkaline, which will not irritate the distal intestine and is suitable for the processes of membrane digestion. It is in this intestine begins the process of intestinal digestion.
The second important feature of the duodenum is to initiate and regulate the enzymatic activity of the pancreas and liver, which depends on the chemical composition and acidity coming chyme.
The third function is to regulate the duodenum reflex opening and closing of the pylorus, which depends on the acidity and chemical composition of the contents of the intestine, as well as the regulation of gastric acid secretion due to humoral factors ensuring the secretory activity of the stomach.
The most frequent diseases of the duodenum is an inflammation of the duodenum (duodenitis), duodenal ulcer, cancer (cancer of the duodenum).
Duodenitis - an inflammation of the duodenum, namely its mucosa. The cause of duodenitis are foodborne poisoning by toxic substances that affect the mucous membrane irritating the digestive tract, excessive consumption of spicy foods, especially in combination with alcohol, mucosal damage by foreign bodies.
For inflammation of the duodenum characterized by symptoms such as epigastric pain, weakness, nausea, vomiting, fever. Catarrhal and erosive and ulcerative form duodenitis usually ends within a few days of self-healing, with repeated defeat possible chronic process. Complications duodenitis include the development of acute pancreatitis, intestinal bleeding, perforation of the wall of the duodenum.
Treatment duodenitis is an adequate diet therapy, admission binders and envelop drugs, antispasmodics and anticholinergics.
Duodenal ulcer is caused by exposure to H. pylori infection. Predisposes to the development of this disease hereditary factors, neuro-psychological features of the person, food factor, the influence of drugs, bad habits.
Symptoms of the disease are epigastric pain within a few hours after eating, epigastric pain at night, heartburn, nausea, vomiting. Complications of the disease include bleeding, penetration, malignancy (malignant lesions), pyloric stenosis, as well as perforation of the duodenal wall.
Treatment consists of taking Helicobacter agents (antibiotics, bismuth preparations), symptomatic therapy, diet therapy.
Cancer of the duodenum
Cancer of the duodenum is most often localized in okolososochkovoy region (descending part), at least - in the upper or lower horizontal part
. Duodenal cancer, unlike gastric cancer, characterized by a low tendency to form metastases
. Normally limited to the defeat of regional lymph nodes
. A feature of the clinical picture of cancer of the duodenum is the fact that the small size of the tumor does not give symptoms, as not difficult passage of intestinal contents and does not cause intoxication
. Consequently, symptoms occur at a sufficient increase in the tumor and compression of adjacent organs
. Symptoms associated with difficult flow of bile into the intestine: pain in the right upper quadrant, nausea, loss of appetite
. When compression of the pancreatic duct pancreatitis develop varying degrees of severity
. When large-sized tumors clinic associated with the phenomena of stenosis: characteristic nausea, flatulence, fullness, belching, heartburn
. Characterized by such common symptom is weight loss, anemia, appetite disorders
. Successful treatment depends on timely diagnosis of cancer of the duodenum
. Treatment of this disease promptly - circular resection of the affected bowel department at peripapillary cancer also removed the big duodenal papilla, pancreatic duct