DUODENUM AND PANCREAS. 445 



it leaves the abdomen by an aperture in the tendinous centre of the dia- 

 phragm, on the right of, and higher than the aortic opening. 



Its connections with vessels are not the same as those of the aorta. 

 Beneath it are the right lumbar, renal, capsular, and diaphragmatic 

 arteries; and crossing over it below the kidney is the spermatic. Super- 

 ficial to it beneath the pancreas is the beginning of the vena portae. Off- 

 sets of the solar plexus of nerves descend on it, as on the aorta. 



CONNECTIONS OF THE DUODENUM AND PANCREAS. 



Dissection. To see satisfactorily the duodenum and the pancreas the 

 intestinal tube, beyond the duodenum, is to be removed in the following 

 way : a double ligature is to be placed on the upper part of the jejunum, 

 another on the lower end of the sigmoid flexure of the colon, and the gut 

 is to be cut through at the points at which it is tied. The detached piece 

 of the intestinal tube is to be taken away by cutting through the vessels, 

 and the peritoneum connecting it to the wall of the abdomen. After it 

 has been separated, it is to be set aside for future study whilst the body is 

 turned. 



The student should moderately inflate the stomach and duodenum 

 from the cut extremity of the latter, and remove the loose peritoneum 

 and the fat ; whilst cleaning them, he should lay bare the larger vessels 

 and nerves. 



On turning upwards the stomach the pancreas may be traced from the 

 spleen on the one hand to the duodenum on the other (fig. 145). By 

 pulling forwards the duodenum, the common bile duct may be found, 

 posteriorly, between the intestine and the head of the pancreas ; and 

 some of the pancreas should be removed, to show its duct entering the 

 duodenum. 



DUODENUM (fig. 145, D). The first part of the small intestine, or the 

 duodenum, begins at the pyloric end of the stomach, and crossing the 

 spinal column, ends on the left side of the second lumbar vertebra. It 

 makes a curve around the head of the pancreas, and occupies the right 

 hypochondriac, right lumbar, and umbilical regions of the abdomen. 

 From its winding course around the pancreas it is divided into three parts 

 superior transverse, vertical, and inferior transverse. 



The superior transverse part is free and movable, like the stomach ; it 

 measures about two inches in length, and is directed from the pylorus to 

 the neck of the gall bladder, ascending slightly between one point and the 

 other. In front it is overlapped by the liver, as well as by the gall blad- 

 der when this is distended ; and behind it are the bile duct and the vena 

 portae:. 



The vertical part is fixed almost immovably by the peritoneum and the 

 pancreas. It is nearly three inches in length, and descends from the gall 

 bladder as far as the third lumbar vertebra. Superficial to this part is the 

 right bend of the colon ; and beneath it are the kidney and its vessels. 

 On its inner side is the head of the pancreas, with the common bile-duct. 

 The ducts of the liver and pancreas pour their contents into this portion 

 of the duodenum. 



The inferior transverse part is the longest of the three, and is continued 

 across the spinal column to end in the jejunal portion of the small intes- 

 tine. As it crosses the spine, it ascends from the third to the level of the 



