DOCSLIB.ORG

Distance Between Major and Minor Duodenal Papilla from Pylorus – a Cadaveric Study M

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Distance Between Major and Minor Duodenal Papilla from Pylorus – a Cadaveric Study M International Journal of Anatomy and Research, Int J Anat Res 2018, Vol 6(2.2):5239-45. ISSN 2321-4287 Original Research Article DOI: https://dx.doi.org/10.16965/ijar.2018.167 DISTANCE BETWEEN MAJOR AND MINOR DUODENAL PAPILLA FROM PYLORUS – A CADAVERIC STUDY M. Pairoja Sultana *1, C.K. Lakshmidevi 2. *1Assistant professor in Anatomy, ACSR Govt. medical college, Nellore, Andhra Pradesh, India. 2 Professor and Head of the department of Anatomy, ACSR Govt. medical college, Nellore, Andhra Pradesh, India. ABSTRACT Introduction: Without the knowledge of the normal pattern of the duct system and its variations, a radiologist can’t interpret an Endoscopic Retrograde Cholangiopancreatography (ERCP) picture. So it becomes important to study the anatomy of pancreatic ducts, their relation to each other, to common bile duct and to duodenum in the available human cadavers. The present paper is about the study of distance between minor and major duodenal papilla from pylorus which was carried out on 96 cadaveric specimens of human duodeno-pancreas. To visualise and to see distance between minor and major duodenal papillae is necessary for the endoscopist who aims to perform the dilation, stenting, or papillotomy of the minor papilla. Materials and Methods: The study was conducted in 96 (64 male and 32 female) cadavers. Major and minor duodenal papillae were visualized through eosin dye installation in both common bile duct and the accessory pancreatic duct. The measurement of distance between the duodenal papillae and to pylorus was done in cm. Results: In the present work, the mean ± SD of the Distance between pylorus to MAP is 8.05 ± 1.71 cm, pylorus to MIP is 6.19 ± 1.49 cm, the major to minor duodenal papilla was on an average 2.02 ± 0.40 cm, these distances were more in males as compared to females. But the size of Orifice of MAP in specimens is 7.25 ± 1.25 mm more in females as compared to males. Conclusion: The length of the duct shows sexual dimorphism; the length being more in males than females. KEY WORDS: Pancreatic duct, endoscopic retrograde pancreatography (ERCP), major duodenal papilla, minor duodenal papilla. Address for Correspondence: Dr. M. Pairoja Sultana, Assistant professor in Anatomy, 3rd floor, flat no.305. Besides Nursing hostel, ACSR Govt. medical college, darrgametta SPSR Nellore-524004, Andhra Pradesh, India. E-Mail: [email protected] Access this Article online Journal Information Quick Response code International Journal of Anatomy and Research ICV for 2016 ISSN (E) 2321-4287 | ISSN (P) 2321-8967 90.30 https://www.ijmhr.org/ijar.htm DOI-Prefix: https://dx.doi.org/10.16965/ijar Article Information Received: 23 Feb 2018 Accepted: 05 Apr 2018 Peer Review: 26 Feb 2018 Published (O): 05 May 2018 DOI: 10.16965/ijar.2018.167 Revised: None Published (P): 05 May 2018 INTRODUCTION or pancreatic duct (e.g Ascariasis, Clonorchiasis) The management of mechanical causes of acute were identified by the Endoscopic retrograde recurrent pancreatitis (ARP), including choledo- cholangiopancreatography (ERCP) [1]. Ampul- cholithiasis, ampullary masses (benign and lary adenomas and carcinomas create an malignant), congenital variants of biliary and obstruction to pancreatic exocrine secretion and pancreatic anatomy (e.g. pancreas divisum, bile flow [2]. Duodenoscopy is mandatory in the choledochoceles), sphincter of Oddi dysfunction investigation of ARP. This author believes that (SOD), pancreatic stones and strictures, and every trainee in gastroenterology should learn parasitic disorders involving the biliary tree and/ to use a side-viewing duodenoscope, not for Int J Anat Res 2018, 6(2.2):5239-45. ISSN 2321-4287 5239 M. Pairoja Sultana, C.K. Lakshmidevi. DISTANCE BETWEEN MAJOR AND MINOR DUODENAL PAPILLA FROM PYLORUS – A CADAVERIC STUDY. ERCP but to be able to assess duodenal lesions, the ventral pancreatic bud, a condition including those involving the major and minor called pancreatic divisum [6], or when patent papilla. For adenomas and cancers limited to the and ligated [4]. mucosa (T1 lesions) by endoscopic ultrasound Embryology: The pancreas forms from the (EUS) examination, endoscopic resection is an embryonic foregut and is therefore of endoder- option [3]. So it is mandatory now to know the mal origin. Pancreas develops by the formation surgical anatomy of major and minor duodenal of ventral and dorsal buds and its ducts develop papillae. Moreover a very few studies are from the ducts of these buds. At the 6-7th week reported on the surgical anatomy. of gestation, the ventral pancreas fuses with the Major duodenal papilla (MAP): At the level of dorsal pancreas to form the Main Pancreatic the second or third lumbar vertebrae the major Duct (MPD). The accessory pancreatic duct is duodenal papilla (papilla of Vater) is situated in formed from the portion of the dorsal bud which the 2nd part of the duodenum, 7–10 cm from gives rise to the upper pancreatic head [8]. The the pylorus. It is surrounded by the sphincter of pancreas presents a complicated embryogenesis Oddi, and receives a mixture of pancreatic between the 5th and the 7th week of gestation enzymes and bile from the Ampulla of Vater, [9, 10]. At the 6-7th week of gestation, the which drains both the pancreatic duct and ventral pancreas fuses with the dorsal pancreas. biliary system [4]. The junction between the A disorder during the complicated embryologi- foregut and midgut occurs directly below the cal development of the pancreas can lead to major duodenal papilla [5]. This is seen from the congenital abnormalities. Complete agenesis of duodenum as lying within a mucosal fold. The the pancreas and agenesis of the ventral MAP is occasionally found in the third part of pancreas are unknown congenital abnormalities the duodenum, the level of the vertebrae may because complete agenesis of the pancreas is be L2-3, and in about 10% of people, it may not incompatible with life and the agenesis of the receive bile. Additionally, in a small number of ventral pancreas is extremely rare [11]. people, the primary papilla for draining the MATERIALS AND METHODS pancreas may in fact be the accessory pancre- atic duct [4]. The present study title with “Distance between Minor duodenal papilla (MIP): The minor Major and Minor duodenal papilla – a cadaveric duodenal papilla (Santorini’s minor caruncle) is study” was done in the department of Anatomy contained within the 2nd part of the duodenum and forensic medicine, Govt. Medical College and situated 2 cm proximal to the MAP, and thus in the period of Nov 2014 to Dec 2017 with 96 5–8 cm from the opening of the pylorus. Cadaver specimens of pancreas along with the The gastroduodenal artery lies posterior [4]. The c-loop duodenum (1st, 2nd, and 3rd parts). Cases duct is an embryological remnant, however in a of septicemia, surgery in the pancreaticobilliary small majority of people drains the pancreas [4]. region and duodenal or peptic ulcer were MIP is a remnant of the opening of the accessory excluded from the study. All the cadavers and pancreatic duct, which drains the dorsal pancre- medico legal cases were belongs to 30 to 80 atic bud during foetal development. The MIP years age group and sexes had been included. functioning sphincter of Helly, and the duct The duodenum was opened along the converse the accessory pancreatic duct of Santorini. In border. The specimen was fixed by keeping in 10% of people, the MIP is the prime duct for 10% formalin for 3 days and then washed and drainage of the pancreas [4], although in others fixed on wooden board with paper pins. The main it may not be present at all [5]. Pain from the pancreatic duct and accessory pancreatic ducts region will be referred to the epigastric region along were dissected. A 16 gauge needle was of the abdomen due to its associated passed down through cut end of the common dermatomes. When patent, the MIP may be bile duct and eosin was injected. Appearance associated with recurrent pancreatitis. This is of dye in duodenum helped us to locate the major particularly common in a subset of people, when duodenal papilla. Minor duodenal papilla was the dorsal pancreatic bud fails to fuse with also visualized similarly through injection in the Int J Anat Res 2018, 6(2.2):5239-45. ISSN 2321-4287 5240 M. Pairoja Sultana, C.K. Lakshmidevi. DISTANCE BETWEEN MAJOR AND MINOR DUODENAL PAPILLA FROM PYLORUS – A CADAVERIC STUDY. Fig. 1: C-Loop duodenum along with the pancreas. Fig. 5: Showing common bile duct (CBD) (arrow) and main pancreatic duct entering in to Duodenum (star). Fig. 2: Major Duodenal papilla (MAP). accessory pancreatic duct. We performed precise measurements of its distance between the duodenal papillae. Distance between papil- lae was measured in cm. RESULTS Table 1: Showing the number of cadavers included in the study and Gender distribution. Cases Gender Number % Male 64 66.67 Fig. 3: Minor Duodenal papilla (MIP). Female 32 33.33 Total 96 100 Table 2: Showing the prevalence of MIP in specimens. MIP Gender present % absent % Male 60 93.75 4 6.25 Female 30 93.75 2 6.25 Total 90 93.75 6 6.25 Table 3: Showing the location of MAP in Duodenum in specimens. No. of Percentage S. No Location of MAP Cases (%) Fig. 4: Distance between MAP (arrow) to Pylorus (star). Junction of first & 1 4 4.17 second part 2 Second part 87 90.6 Junction of second & 3 5 5.21 third part 4 Total 96 100 Table 4: Showing the Distance between pylorus and MAP in specimens. Distance (cm) Sex p-value Mean ± SD Male 8.13 ± 1.97 0.43 Female 7.89 ± 1.0 Total 8.05 ± 1.71 Int J Anat Res 2018, 6(2.2):5239-45.
Load more

Recommended publications
  • Fecal Incontinence/Anal Incontinence
    Fecal Incontinence/Anal Incontinence What are Fecal incontinence/ Anal Incontinence? Fecal incontinence is inability to control solid or liquid stool. Anal incontinence is the inability to control gas and mucous in addition to the inability to control stool. The symptoms range from mild release of gas to a complete loss of control. It is a common problem affecting 1 out of 13 women under the age of 60 and 1 out of 7 women over the age of 60. Men can also be have this condition. Anal incontinence is a distressing condition that can interfere with the ability to work, do daily activities and enjoy social events. Even though anal incontinence is a common condition, people are uncomfortable discussing this problem with family, friends, or doctors. They often suffer in silence, not knowing that help is available. Normal anatomy The anal sphincters and puborectalis are the primary muscles responsible for continence. There are two sphincters: the internal anal sphincter, and the external anal sphincter. The internal sphincter is responsible for 85% of the resting muscle tone and is involuntary. This means, that you do not have control over this muscle. The external sphincter is responsible for 15% of your muscle tone and is voluntary, meaning you have control over it. Squeezing the puborectalis muscle and external anal sphincter together closes the anal canal. Squeezing these muscles can help prevent leakage. Puborectalis Muscle Internal Sphincter External Sphincter Michigan Bowel Control Program - 1 - Causes There are many causes of anal incontinence. They include: Injury or weakness of the sphincter muscles. Injury or weakening of one of both of the sphincter muscles is the most common cause of anal incontinence.
    [Show full text]
  • Mouth Esophagus Stomach Rectum and Anus Large Intestine Small
    1 Liver The liver produces bile, which aids in digestion of fats through a dissolving process known as emulsification. In this process, bile secreted into the small intestine 4 combines with large drops of liquid fat to form Healthy tiny molecular-sized spheres. Within these spheres (micelles), pancreatic enzymes can break down fat (triglycerides) into free fatty acids. Pancreas Digestion The pancreas not only regulates blood glucose 2 levels through production of insulin, but it also manufactures enzymes necessary to break complex The digestive system consists of a long tube (alimen- 5 carbohydrates down into simple sugars (sucrases), tary canal) that varies in shape and purpose as it winds proteins into individual amino acids (proteases), and its way through the body from the mouth to the anus fats into free fatty acids (lipase). These enzymes are (see diagram). The size and shape of the digestive tract secreted into the small intestine. varies in each individual (e.g., age, size, gender, and disease state). The upper part of the GI tract includes the mouth, throat (pharynx), esophagus, and stomach. The lower Gallbladder part includes the small intestine, large intestine, The gallbladder stores bile produced in the liver appendix, and rectum. While not part of the alimentary 6 and releases it into the duodenum in varying canal, the liver, pancreas, and gallbladder are all organs concentrations. that are vital to healthy digestion. 3 Small Intestine Mouth Within the small intestine, millions of tiny finger-like When food enters the mouth, chewing breaks it 4 protrusions called villi, which are covered in hair-like down and mixes it with saliva, thus beginning the first 5 protrusions called microvilli, aid in absorption of of many steps in the digestive process.
    [Show full text]
  • Anatomy of Major Duodenal Papilla Influences ERCP Outcomes
    Journal of Clinical Medicine Article Anatomy of Major Duodenal Papilla Influences ERCP Outcomes and Complication Rates: A Single Center Prospective Study Gheorghe G. Balan 1 , Mukul Arya 2, Adrian Catinean 3, Vasile Sandru 4,*, Mihaela Moscalu 1 , Gabriel Constantinescu 5, Anca Trifan 1 , Gabriela Stefanescu 1,* and Catalin Victor Sfarti 1 1 Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; [email protected] (G.G.B.); [email protected] (M.M.); [email protected] (A.T.); [email protected] (C.V.S.) 2 New York Presbitarian Brooklyn Methodist Hospital, New York, NY 11215, USA; [email protected] 3 Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; [email protected] 4 Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania 5 Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; [email protected] * Correspondence: [email protected] (V.S.); [email protected] (G.S.) Received: 27 March 2020; Accepted: 25 May 2020; Published: 28 May 2020 Abstract: Background: Endoscopic retrograde cholangiopancreatography (ERCP) has been one of the most intensely studied endoscopic procedures due to its overall high complication rates when compared to other digestive endoscopy procedures. The safety and outcome of such procedures have been linked to multiple procedure- or patient-related risk factors. The aim of our study is to evaluate whether the morphology of the major duodenal papilla influences the ERCP outcomes and complication rates. Methods: A total of 322 patients with a native papilla have been included in the study over an eight month period.
    [Show full text]
  • Vocabulario De Morfoloxía, Anatomía E Citoloxía Veterinaria
    Vocabulario de Morfoloxía, anatomía e citoloxía veterinaria (galego-español-inglés) Servizo de Normalización Lingüística Universidade de Santiago de Compostela COLECCIÓN VOCABULARIOS TEMÁTICOS N.º 4 SERVIZO DE NORMALIZACIÓN LINGÜÍSTICA Vocabulario de Morfoloxía, anatomía e citoloxía veterinaria (galego-español-inglés) 2008 UNIVERSIDADE DE SANTIAGO DE COMPOSTELA VOCABULARIO de morfoloxía, anatomía e citoloxía veterinaria : (galego-español- inglés) / coordinador Xusto A. Rodríguez Río, Servizo de Normalización Lingüística ; autores Matilde Lombardero Fernández ... [et al.]. – Santiago de Compostela : Universidade de Santiago de Compostela, Servizo de Publicacións e Intercambio Científico, 2008. – 369 p. ; 21 cm. – (Vocabularios temáticos ; 4). - D.L. C 2458-2008. – ISBN 978-84-9887-018-3 1.Medicina �������������������������������������������������������������������������veterinaria-Diccionarios�������������������������������������������������. 2.Galego (Lingua)-Glosarios, vocabularios, etc. políglotas. I.Lombardero Fernández, Matilde. II.Rodríguez Rio, Xusto A. coord. III. Universidade de Santiago de Compostela. Servizo de Normalización Lingüística, coord. IV.Universidade de Santiago de Compostela. Servizo de Publicacións e Intercambio Científico, ed. V.Serie. 591.4(038)=699=60=20 Coordinador Xusto A. Rodríguez Río (Área de Terminoloxía. Servizo de Normalización Lingüística. Universidade de Santiago de Compostela) Autoras/res Matilde Lombardero Fernández (doutora en Veterinaria e profesora do Departamento de Anatomía e Produción Animal.
    [Show full text]
  • 4L Eosinophilic Granuloma of Gastro-Intestinal Tract Caused by Herring Parasite Eustoma Rotundatum
    BsrrmsH 2 May 1964 MEDICAL JOURNAL 1141 4L Eosinophilic Granuloma of Gastro-intestinal Tract Caused by Herring Parasite Eustoma rotundatum B. STERRY ASHBY,* M.B., F.R.C.S.; P. J. APPLETONt M.B., B.S. IAN DAWSON,4 M.D., M.R.C.P. Brit. med.JY., 1964, 1, 1141-1145 For over 25 years sporadic reports have been appearing in the came from many countries in many different parts of the world. literature of cases of eosinophilic granuloma arising in various The essential details of these cases are recorded in Table I parts of the gastro-intestinal tract. Kaiiser (1937) described and Fig. 1. the first cases. In a search of the literature, which although The one feature common to all these case reports is the extensive is not claimed to be exhaustive, 47 papers were microscopical appearance of the lesion. No matter which part found, describing a total of 89 cases. They occurred through- of the alimentary tract is involved, the histological description out the alimentary tract from pharynx to rectum, though the is the same-an oedematous connective-tissue stroma with an majority were in the stomach and small intestine, and they increase of capillaries and lymphatics, and showing a massive diffuse eosinophil-cell infiltration, usually confined to the sub- * Surgical Registrar, Westminster Hospital and Medical School London. the muscularis mucosae and t House-Surgeon, Westminster Hospital and Medical School, Iondon. mucosa but sometimes splitting t Reader in Pathology, Westminster Hospital and Medical School, spreading into the muscle layer. The mucosa is almost always London. intact.
    [Show full text]
  • Overview of Gastrointestinal Function
    Overview of Gastrointestinal Function George N. DeMartino, Ph.D. Department of Physiology University of Texas Southwestern Medical Center Dallas, TX 75390 The gastrointestinal system Functions of the gastrointestinal system • Digestion • Absorption • Secretion • Motility • Immune surveillance and tolerance GI-OP-13 Histology of the GI tract Blood or Lumenal Serosal Side or Mucosal Side Structure of a villus Villus Lamina propria Movement of substances across the epithelial layer Tight junctions X Lumen Blood Apical membrane Basolateral membrane X X transcellular X X paracellular GI-OP-19 Histology of the GI tract Blood or Lumenal Serosal Side or Mucosal Side Motility in the gastrointestinal system Propulsion net movement by peristalsis Mixing for digestion and absorption Separation sphincters Storage decreased pressure GI-OP-42 Intercellular signaling in the gastrointestinal system • Neural • Hormonal • Paracrine GI-OP-10 Neural control of the GI system • Extrinsic nervous system autonomic central nervous system • Intrinsic (enteric) nervous system entirely with the GI system GI-OP-14 The extrinsic nervous system The intrinsic nervous system forms complete functional circuits Sensory neurons Interneurons Motor neurons (excitatory and inhibitory) Parasympathetic nerves regulate functions of the intrinsic nervous system Y Reflex control of gastrointestinal functions Vago-vagal Afferent reflex Salivary Glands Composition of Saliva O Proteins α−amylase lactoferrin lipase RNase lysozyme et al mucus O Electrolyte solution water Na+ , K + - HCO3
    [Show full text]
  • Anatomy of Small Intestine Doctors Notes Notes/Extra Explanation Please View Our Editing File Before Studying This Lecture to Check for Any Changes
    Color Code Important Anatomy of Small Intestine Doctors Notes Notes/Extra explanation Please view our Editing File before studying this lecture to check for any changes. Objectives: At the end of the lecture, students should: List the different parts of small intestine. Describe the anatomy of duodenum, jejunum & ileum regarding: the shape, length, site of beginning & termination, peritoneal covering, arterial supply & lymphatic drainage. Differentiate between each part of duodenum regarding the length, level & relations. Differentiate between the jejunum & ileum regarding the characteristic anatomical features of each of them. Abdomen What is Mesentery? It is a double layer attach the intestine to abdominal wall. If it has mesentery it is freely moveable. L= liver, S=Spleen, SI=Small Intestine, AC=Ascending Colon, TC=Transverse Colon Abdomen The small intestines consist of two parts: 1- fixed part (no mesentery) (retroperitoneal) : duodenum 2- free (movable) part (with mesentery) :jejunum & ileum Only on the boys’ slides RELATION BETWEEN EMBRYOLOGICAL ORIGIN & ARTERIAL SUPPLY مهم :Extra Arterial supply depends on the embryological origin : Foregut Coeliac trunk Midgut superior mesenteric Hindgut Inferior mesenteric Duodenum: • Origin: foregut & midgut • Arterial supply: 1. Coeliac trunk (artery of foregut) 2. Superior mesenteric: (artery of midgut) The duodenum has 2 arterial supply because of the double origin The junction of foregut and midgut is at the second part of the duodenum Jejunum & ileum: • Origin: midgut • Arterial
    [Show full text]
  • Distribution of Digestive Enzymes in Cockroaches
    Volume 24: Mini Workshops 311 Distribution of Digestive Enzymes in Cockroaches Flora Watson California State University, Stanislaus Department of Biological Sciences 801 W. Monte Vista Avenue Turlock, CA 95382 [email protected] Flora Watson is an Associate Professor in the Department of Biological Sciences at California State University, Stanislaus. She teaches lower and upper division Human and Animal Physiology courses at CSU, Stanislaus. Her research interest involves using immunohistochemistry to study the effects of cigarette smoke exposure on brain, lung and liver tissues of mice. Reprinted From: Watson, F. 2003. Distribution of digestive enzymes in cockroaches. Pages 311-316, in Tested studies for laboratory teaching, Volume 24 (M. A. O’Donnell, Editor). Proceedings of the 24th Workshop/Conference of the Association for Biology Laboratory Education (ABLE), 334 pages. - Copyright policy: http://www.zoo.utoronto.ca/able/volumes/copyright.htm Although the laboratory exercises in ABLE proceedings volumes have been tested and due consideration has been given to safety, individuals performing these exercises must assume all responsibility for risk. The Association for Biology Laboratory Education (ABLE) disclaims any liability with regards to safety in connection with the use of the exercises in its proceedings volumes. © 2003 Flora Watson Abstract The digestive tract of a cockroach is a tube modified into subdivisions, which serve specialized digestive functions: food reception, conduction and storage, internal digestion, absorption, conduction, and formation of feces. The three divisions of the cockroach digestive tract are the foregut, midgut, and the hindgut. The enzyme reaction in the digestive tract can be determined either by determining the amount of substrates (starch and proteins) in an enzyme-reaction mixture, or measuring the presence of product present.
    [Show full text]
  • Short Bowel Syndrome with Intestinal Failure Were Randomized to Teduglutide (0.05 Mg/Kg/Day) Or Placebo for 24 Weeks
    Short Bowel (Gut) Syndrome LaTasha Henry February 25th, 2016 Learning Objectives • Define SBS • Normal function of small bowel • Clinical Manifestation and Diagnosis • Management • Updates Basic Definition • A malabsorption disorder caused by the surgical removal of the small intestine, or rarely it is due to the complete dysfunction of a large segment of bowel. • Most cases are acquired, although some children are born with a congenital short bowel. Intestinal Failure • SBS is the most common cause of intestinal failure, the state in which an individual’s GI function is inadequate to maintain his/her nutrient and hydration status w/o intravenous or enteral supplementation. • In addition to SBS, diseases or congenital defects that cause severe malabsorption, bowel obstruction, and dysmotility (eg, pseudo- obstruction) are causes of intestinal failure. Causes of SBS • surgical resection for Crohn’s disease • Malignancy • Radiation • vascular insufficiency • necrotizing enterocolitis (pediatric) • congenital intestinal anomalies such as atresias or gastroschisis (pediatric) Length as a Determinant of Intestinal Function • The length of the small intestine is an important determinant of intestinal function • Infant normal length is approximately 125 cm at the start of the third trimester of gestation and 250 cm at term • <75 cm are at risk for SBS • Adult normal length is approximately 400 cm • Adults with residual small intestine of less than 180 cm are at risk for developing SBS; those with less than 60 cm of small intestine (but with a
    [Show full text]
  • Studies of the Function of the Human Pylorus : and Its Role in The
    +.1 Studúes OlTlæ Ftrnctíon OJTIrc Humanfolonts And,Iß R.ole InTlæ Riegulø;tíon OÍ Cústríß Drnptging David R. Fone Departments of Medicine and Gastroenterology, Royal Adelaide Hospital University of Adelaide August 1990 Table of Contents TABLE OF CONTENTS . SUMMARY vil DECLARATION...... X DED|CAT|ON.. .. ... xt ACKNOWLEDGMENTS xil CHAPTER 1 ANATOMY OF THE PYLORUS 1.1 INTRODUCTION.. 1 1.2 MUSCULAR ANATOMY 2 1.3 MUCOSAL ANATOMY 4 1.4 NEURALANATOMY 1.4.1 Extrinsic lnnervation of the Pylorus 5 1.4.2 lntrinsic lnnervation of the Pylorus 7 1.5 INTERSTITIAL CELLS OF CAJAL 8 1.6 CONCLUSTON 9 CHAPTER 2 MEASUREMENT OF PYLORIC MOTILITY 2.1 INTRODUCTION 10 2.2 METHODOLOG ICAL CHALLENGES 2.2.1 The Anatomical Mobility of the Pylorus . 10 2.2.2 The Narrowness of the Zone of Pyloric Contraction 12 2.3 METHODS USED TO MEASURE PYLORIC MOTILITY 2.3.1 lntraluminal Techniques 2.3.1.1 Balloon Measurements. 12 t 2.3 1.2 lntraluminal Side-hole Manometry . 13 2.3 1.9 The Sleeve Sensor 14 2.3 1.4 Endoscopy. 16 2.3 1.5 Measurements of Transpyloric Flow . 16 2.3 'I .6 lmpedance Electrodes 16 2.3.2 Extraluminal Techniques For Recording Pyl;'; l'¡"r¡iit¡l 2.3.2.'t Strain Gauges . 17 2.3.2.2 lnduction Coils . 17 2.3.2.3 Electromyography 17 2.3.3 Non-lnvasive Approaches For Recording 2.3.3.1 Radiology :ï:: Y:1":'1 18 2.3.9.2 Ultrasonography . 1B 2.3.3.3 Electrogastrography 19 2.3.4 ln Vitro Studies of Pyloric Muscle 19 2.4 CONCLUSTON.
    [Show full text]
  • Molecular Embryology of the Foregut
    Author manuscript, published in "Journal of Pediatric Gastroenterology & Nutrition 2011;52 Suppl 1:S2-3" DOI : 10.1097/MPG.0b013e3182105a1a Molecular embryology of the foregut. Sandrine Faure, Ph.D. and Pascal de Santa Barbara, Ph.D. INSERM ERI 25, EA4202, Muscle and Pathologies Address correspondence and reprint requests to Pascal de Santa Barbara, Ph.D., 371 Avenue Doyen Giraud, 34295 Montpellier, FRANCE (e-mail: [email protected]). Supported by grants from Agence Nationale pour la Recherche (ANR-07-JCJC-0112), Association Française contre les Myopathies, Région Languedoc-Roussillon (Chercheur d’Avenir) and Ligue Contre le Cancer (Comité de l’Aude). Key words: foregut; Shh; Bmp; adriomycin; endodermal-mesenchymal interaction inserm-00595617, version 1 - 25 May 2011 The digestive and respiratory systems have different physiological functions (nutrition, food transit and evacuation for the first; breathing and oxygen supply to the blood for the second) and are generally considered and studied as two independent structures. Nevertheless, although at birth they are separated, they both derive from a common and transient developmental structure, the foregut, which is the anterior part of the gastrointestinal (GI) tract (1). The GI tract is a remarkably complex, three-dimensional, specialized and vital system that is derived from a simple tube-like structure. The vertebrate GI tract includes the luminal digestive system (i.e., esophagus, stomach, intestine and colon, which we will designate on the whole as "gut") and the GI-tract derivatives (i.e., thyroid, lungs, liver and pancreas). The gut is composed of three germ layers: mesoderm (which forms the smooth muscle layer), endoderm (which forms the epithelial lining) and ectoderm (which includes the enteric nervous system).
    [Show full text]
  • Small & Large Intestine
    Small & Large Intestine Gastrointestinal block-Anatomy-Lecture 6,7 Editing file Objectives Color guide : Only in boys slides in Green Only in girls slides in Purple important in Red At the end of the lecture, students should be able to: Notes in Grey ● List the different parts of small intestine. ● Describe the anatomy of duodenum, jejunum & ileum regarding: (the shape, length, site of beginning & termination, peritoneal covering, arterial supply & lymphatic drainage) ● Differentiate between each part of duodenum regarding the length, level & relations. ● Differentiate between the jejunum & ileum regarding the characteristic anatomical features of each of them. ● List the different parts of large intestine. ● List the characteristic features of colon. ● Describe the anatomy of different parts of large intestine regarding: (the surface anatomy, peritoneal covering, relations, arterial & nerve supply) Small intestine The small intestine divided into : Fixed Part (No Mesentery): Free (Movable) Part (With Parts Duodenum* Mesentery): Jejunum & Ileum Shape C-shaped loop coiled tube Length 10 inches 6 meters (20 feet) Transverse Colon separates the Beginning At pyloro-duodenal junction at duodeno-jejunal flexure stomach/liver from the jejunum/ileum Termination At duodeno-jejunal flexure at ileo-ceacal flexure Peritoneal Covering Retroperitoneal mesentery of small intestine Divisions 4 parts --------- Foregut (above bile duct opening in 2nd part )& Midgut Embryological origin Midgut (below bile duct opening in 2nd part) So 2nd part has double
    [Show full text]