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The duodenal bulb (also ampulla of duodenum, duodenal ampulla, or duodenal cap) is the initial, dilated portion of (the superior part of) the duodenum [1] just distal to the stomach; it begins at the pylorus and ends at the neck of the gallbladder. It is normally about 5 centimeters long. [2]
The common duct then opens medially into the descending part of the duodenum at the major duodenal papilla. The common duct usually measures 2-10mm in length. [1] The ampulla of Vater is an important landmark halfway along the second part of the duodenum marking the transition from foregut to midgut. [citation needed]
The major duodenal papilla is situated in the second part of the duodenum, 7–10 cm from the pylorus, at the level of the second or third lumbar vertebrae. It is surrounded by the sphincter of Oddi , a circular muscle, and receives a mixture of pancreatic enzymes and bile from the Ampulla of Vater , which drains both the pancreatic duct and ...
The duodenal bulb is a remnant of the mesoduodenum, a mesentery that suspends the organ from the posterior abdominal wall in fetal life. [10] The first part of the duodenum is mobile, and connected to the liver by the hepatoduodenal ligament of the lesser omentum. The first part of the duodenum ends at the corner, the superior duodenal flexure.
The sphincter regulates the secretion of pancreatic juice and bile into the duodenum. [3] It also prevents reflux of duodenal contents into the ampulla of Vater. [4] By preventing reflux of the contents of the duodenum, the sphincter of Oddi prevents the accumulation of particulate matter and sludge in the bile ducts, reducing the risk of cholangitis.
Duodenal glands are situated within the mucosa and submucosa of the duodenum. They are most abundant near the pylorus, growing shorter and more sparse distally towards the terminal portion of the duodenum. [1] The duodenum can be distinguished from the jejunum and ileum by the presence of Brunner's glands in the submucosa. [citation needed]
Cancerous tumours arising from the CBD, the ampulla, or the portion of the duodenum near the ampulla can result in distal CBD obstruction. When the masses are incapable of being surgically removed, CDD can be performed. In some cases where the growing tumour occludes the new pathway, CDD will only provide palliative relief.
Ampulla of Vater 8. Major duodenal papilla 9. Gallbladder 10–11. Right and left lobes of liver 12. Spleen 13. Esophagus 14. Stomach 15. Pancreas: 16. Accessory pancreatic duct 17. Pancreatic duct 18. Small intestine: 19. Duodenum 20. Jejunum 21–22. Right and left kidneys