1288 



THE ORGANS OF DIGESTION 



of the first portion, being at first trivial elevations irregularly placed. They 

 become higher, regular, and more numerous farther on, and near the termination 

 of the duodenum are strongly marked and closely placed transverse or spiral folds 

 (Fig. 1013 and p. 1290). In the descending portion (Fig. 1013), to the side and 

 rear, is a longitudinal fold (plica longitudinalis duodeni), which is formed by the 

 projection of the bile duct and pancreatic duct beneath the mucous membrane. 



The camncula major of Santorini or the bile papilla is a projection in the lower 

 part of the longitudinal fold. At the summit of this papilla the bile duct and pan- 

 creatic duct empty into the duodenum. One inch above and half an inch 

 or more in front of the bile papilla is a much smaller papilla, the camncula 

 minor of Santorini (papilla duodeni [Santorini]}, on the summit of which the acces- 

 sory pancreatic duct of Santorini opens when present. 



FIRST GASTRO- 



PART OF DUODENAL 

 DUODENUM ARTERY 



CASTRO- 

 DUODENAL CCELIAC 

 VEIN AXIS 



INFERIOR 

 PANCREATICO- 

 DUODENAL 

 VEIN 



PANCREATICO- 



DUODENAL 



SUPERIOR 



ARTERY 



INFERIOR 

 PANCREATICO- 

 DUODENAL 

 ARTERY 



COMMON BILE DUCT 



ANASTOMOSIS OF THE 

 TWO PANCREATICO- 

 DUODENAL ARTERIES 



FIG. 1015. The bloodvessels of the duodenum. (Poirier and Charpy.) 



Structure of the Duodenum. (See Structure of the Small Intestine, p. 1290.) 



Vessels and Nerves. The arteries (Fig. 1015) supplying the duodenum are the pyloric and 

 pancreaticoduodenal branches of the hepatic, and the inferior pancreaticoduodenal branch 

 of the superior mesenteric. The veins (Fig. 1015) correspond to the arteries. The superior 

 duodenal vein passes into the superior mesenteric, and the inferior duodenal vein passes into 

 the portal. The lymphatics pass along with the pancreaticoduodenal arteries, lymph nodes 

 being present here and there, and terminate in the nodes about the coeliac axis. The nerves 

 are derived from the solar plexus. 



Applied Anatomy. Ulcer of the duodenum is more common than used to be thought. The 

 portion of the duodenum between the pylorus and the bile papilla is about four inches in length, 

 and is called by the Mayo brothers the vestibule of the duodenum. Here the acid gastric juice 

 enters and may produce an ulcer. The portion of the duodenum below the vestibule is not 

 liable to ulcer, because it is protected by the alkaline bile and pancreatic juice. 



A duodenal ulcer may perforate a large duodenal vessel and cause death from hemorrhage, 

 or may perforate the intestine and produce septic peritonitis. A perforated ulcer is treated 

 by laparotomy and closure of the perforation. Occasionally ulceration of the duodenal glands 

 (Curling's ulcer) may occur in cases of extensive burns of the skin, but is not a very common 

 complication, 



The Jejunum and Ileum (Figs. 958, 987). 



The remainder of the small intestine from the termination of the duodenum 

 comprises the jejunum and ileum ; the former name being given to the upper two- 

 fifths and the latter to the remaining three-fifths. Spalteholz and others call all of 

 the small intestine below the duodenum the intestinum tenue mesenteriale. There 



