Anatomy of Small Intestine (SI)

Consisting of duodenum, jejunum & ileum

Primary site for absorption of nutrients from ingested materials

DUODENUM
The first & shortest part of SI, is also the widest & most fixed part
Pursues a C shaped course around the head of pancreas
Begins at the pylorus on the right side & ends at the duodenojejunal flexure (junction)
on the left side
Divisible into 4 parts:

i. Superior
Ascends from the pylorus & is overlapped by the liver & gallbladder
Proximal part has the hepatoduodenal ligament attached superiorly & the greater
omentum attached inferiorly

ii. Descending
Runs inferiorly, curving around the head of pancreas
Bile & main pancreatic ducts enter its posteromedial wall, usually unite to form the
hepatopancreatic ampulla, which opens on an eminence called major duodenal
papilla
Entirely retroperitoneal

iii. Inferior
Runs transversely to the left, passing over the IVC, aorta & L3 vertebra
Crossed by the SMA & SMV and root of the mesentery of jejunum and ileum
Superior to it is the head of pancreas & uncinate process

iv. Ascending
Runs superiorly & along the left side of the aorta to reach the inferior border of the
body of pancreas
Then it curves anteriorly to join the jejunum at the duodenojejunal flexure, supported
by attachment of a suspensory muscle of the duodenum (ligament of Treitz)
o Contraction of this muscle, widens the angle of the duodenojejunal flexure,
facilitating movement of the intestinal contents

First 2 cm of superior part, has a mesentery & is mobile which called ampulla (duodenal
cap)
Distal 3 cm of superior part & other 3 parts have no mesentery and are immobile because
they are retroperitoneal

Arteries: arise from celiac trunk & SMA

Celiac trunk gastroduodenal A. superior pancreaticoduodenal A. supplies
duodenum proximal to the entry of bile duct into the descending part
SMA inferior pancreaticoduodenal A. supplies duodenum distal to the entry of bile
duct
Anastomosis of sup. & inf. Pancreaticoduodenal A.
Veins: follows arteries & drain into hepatic portal vein
Lymphatic: follow the arteries
Anterior lymphatic vessels drain into pancreaticoduodenal lymph node & into the
pyloric lymph node (along gastroduodenal artery)
Posterior lymphatic vessels drain into superior mesenteric lymph nodes
Innervation: derive from vagus & greater and lesser (abdominopelvic) splanchnic nerves by
way of celiac & superior mesenteric plexus
JEJUNUM & ILEUM
Jejunum: begins at the duodenojejunal flexure
Ileum: ends at the ileocecal junction
Distinctive characteristics: Table 2.9
Mesentery is a fan shaped fold of peritoneum that attaches the jejunum & ileum to the
posterior abdominal wall
o Origin/root of the mesentery extends from duodenojejunal junction on the left side
of L2 vertebra to the ileocolic junction & the right sacro iliac joint

Arteries: SMA that arise from abdominal aorta & runs between layers of mesentery
Supplies via jejunal & ileum arteries
Arteries unite form loops (arterial cascade) & give rise to straight arteries (vasa
recta)

Veins: SMV unites with splenic vein hepatic portal vein

Lymphatic: lacteal (in intestinal villi & absorb fat)

Empty milk like fluid into lymphatic plexus lymphatic vessels between mesentery
(3 groups)
i. Juxta intestinal LN: close to intestinal wall
ii. Mesenteric LN: among arterial cascade
iii. Superior central node: along proximal SMA

Innervation:
Sympathetic fibers reach the superior mesenteric nerve plexus through
sympathetic trunks & thoracic abdominopelvic splanchnic nerves
Parasympathetic fibers derived from posterior vagal trunks