The structure of the duodenum. The duodenum - where it is, how it hurts and how to check: symptoms and treatment of diseases, causes and nutrition

The duodenum is the initial section of the large intestine. It is located immediately after the pylorus. The intestine got its name due to the fact that its length is twelve transverse fingers of the hand.

The special structure of the mucous membrane of the organ allows its epithelium to remain resistant to the aggressive effects of digestive juice, bile secretion, and pancreatic enzymes. The bulb, the rest of the intestines and the head of the pancreas have a common blood circulation. In this article, we will take a closer look at the features of the structure and location of the intestine, and also find out how it can hurt.

Anatomy

Most people have different shapes. Even in the same person, the shape and location of the organ can change over time. First, let's talk about the structure of the duodenum.

Structure

The organ has several layers:

outer shell;
muscular layer with longitudinal and circular layers;
submucosa, due to which the mucosa can be collected in layers;
mucous layer covered with villi.

Location

The body has four main parts:

Upper, or initial. It is located approximately at the level of the first lumbar vertebrae or even the last thoracic.
Descending. It is located to the right of the lumbar and touches the kidney.
Bottom, or horizontal. It goes in the direction from right to left, and then passes near the spine and bends upward.
Rising. It forms a bend and is located at the level of the second lumbar vertebra.

Where is the duodenum located? Most often it is located at the level of the second or third lumbar vertebrae. Each person may have a different location and this is influenced by a large number of factors, such as age and weight. For example, in elderly and thin people, the organ is located somewhat lower than in young and well-fed subjects.

The photo clearly shows where the duodenum is located in humans

The intestine is in contact with other organs of the abdominal cavity from all sides:

liver;
bile ducts;
pancreas;
right kidney;
ureter;
ascending colon.

The length of the duodenum is 25-30 cm.

Functions

Let's highlight the main functions of the duodenum:

production of enzymes and duodenal juice necessary for normal digestion;
motor and evacuation function, that is, it is responsible for moving the food gruel;
secretory;
regulation of bile pancreatic enzymes;
support for communication with the stomach. She is responsible for opening and closing the gatekeeper.
adjustment of the acid-base balance of food. It makes the food bolus alkaline.

Since the duodenum is the initial section of the entire intestine, it is here that the processes of absorption of nutrients that come with food and drink are actively taking place. Here begins the stage of intestinal digestion.

Digestion

After the food bolus enters the initial section of the colon, it mixes with bile, the secret of the intestinal walls, and also with fluid from the pancreatic ducts. Then the acidic environment of food is neutralized by bile, thereby protecting the mucous membrane. In addition, bile breaks down fat and decomposes it into small emulsions, which speeds up the digestion process.

Under the influence of bile secretion, the breakdown products of fat dissolve and are absorbed into the intestinal walls, and complete absorption of vitamins and amino acids occurs. It is also worth noting that bile regulates intestinal motility, stimulating the contraction of its muscles. Due to this, the food bolus moves faster through the intestinal lumen and is evacuated from the body in a timely manner.

Pancreatic juice also plays an important role, with the help of which starch is digested, as well as proteins and fats. The glands in the duodenum produce intestinal juice, which is mostly mucus. This secret contributes to a better breakdown of proteins.

Given all of the above, we can say that the duodenum plays a huge role in the digestive process. It saturates the food bolus with the necessary enzymes and ensures further digestion.

DPC ensures the normal course of digestive processes

How does the duodenum hurt?

Given the fact that the duodenum starts from the stomach, and the ducts of the gallbladder and pancreas open into it, many of its diseases are associated with the malfunctioning of these organs:

increased acidity of the stomach leads to the fact that hydrochloric acid begins to corrode the mucous membrane of the duodenum;
low acidity of the stomach is fraught with the fact that coarse food that is poorly processed enters the intestine. It renders mechanical damage;
with pancreatitis and cholecystitis, there is a violation of the production of digestive enzymes, because of this, food is poorly crushed in the duodenum;
with hepatitis and cirrhosis, blood circulation is disturbed and, as a result, nutritional deficiencies occur.

But sometimes the occurrence of diseases of the duodenum is not affected by the existing pathologies of other organs, but by the person's lifestyle. Snacking on the go and in a hurry, insufficient chewing of food, overeating, too long breaks between meals - all this negatively affects the functioning of the gastrointestinal tract (GIT).

You can identify the cause of why an organ suffers by the way it hurts:

duodenitis caused by Helicobacter pylori. The pain occurs at night and on an empty stomach. It disappears after taking antisecretory and antacid drugs, as well as after eating. Unpleasant sensations may be accompanied by heartburn, belching and constipation;
duodenitis caused by diseases of the gallbladder and pancreas. Painful sensations occur in the right or left hypochondrium and intensify after eating fatty foods. Patients complain of bitterness in the mouth, nausea, and constipation, which is replaced by diarrhea;
inflammation associated with stomach cancer or atrophic gastritis. Pain and heaviness in the stomach;
ulcer disease. Pain in the form of colic, which are the result of spasm of the smooth muscles of the muscles.

By the way the duodenum hurts, you can understand the reason from which the organ suffers

Duodenitis

Duodenitis is an inflammation of the mucous membrane of the duodenum. The disease is acute and chronic, which occurs with relapses. In almost all recorded cases of duodenitis, a chronic process is observed.

Improper nutrition, bad habits, chronic diseases of the gastrointestinal tract - all this can serve as an impetus for the activation of the inflammatory response. Patients are concerned about pain in the upper abdomen, nausea, belching, heartburn, weakness. Inflammation of the duodenum can lead to peptic ulcers and even cancer.

Ulcer

Peptic ulcer is also accompanied by inflammation of the organ, only the appearance of ulcers on the surface of the mucous membrane is added to everything else. It is a chronic pathology with frequent relapses. If the disease is allowed to take its course, this can lead to atrophic changes, as well as fistulas and bleeding.

A duodenal ulcer can even cause death. Improper nutrition, taking potent drugs, chronic duodenitis - all this can lead to an ulcer. But the most common cause is still the bacterium Helicobacter pylori.

The infectious agent seriously damages the mucous membrane of the organ with the products of its vital activity. A characteristic symptom is hunger or night pains, which disappear half an hour after eating. The danger of peptic ulcer is that it can degenerate into cancer.

duodenostasis

These diseases affect the motor function of the organ, leading to the development of congestion. As a result, a mass accumulates in the lumen of the duodenum, consisting of undigested food, gastric juice and digestive enzymes. This leads to pain, nausea and vomiting.

These are chronic pathologies, which are characterized by a change in periods of remission and relapse. With exacerbation, pain appears in the right hypochondrium, which intensifies after eating. The patient loses his appetite, he may also be disturbed by constipation.

Tumor

A tumor in the duodenum can be either benign or malignant. For a long time, the pathological process may not manifest itself in any way. Cancer usually appears due to the germination of a tumor from other organs, most often the stomach.

According to statistics, most often the disease occurs in elderly people. The first symptoms of the disease go away with gastrointestinal disorders or digestive disorders. Then there are pains in the abdomen, weakness, lack of appetite, depression.

Untreated organ inflammation can lead to cancer

Helminths ultimately cause atrophic changes in the duodenal mucosa. As the pathological process progresses, patients develop skin rash, itching, abdominal pain, heartburn, and diarrhea.

erosion

Pathology causes an inflammatory reaction on the surface of the mucous membrane, while not affecting the muscle layer of the organ. Erosive areas on ultrasound look like thickened walls. Stressful situations, smoking, Helicobacter pylori, nutritional errors and much more can cause erosion.

Problems with stools, belching, and burning in the esophagus join the pain syndrome.

Obstruction

Chronic obstruction of an organ can develop for a number of reasons: malformations, incorrect rotation of the organ, vascular anomalies. Pathology manifests itself in the form of a painful outbreak in the right hypochondrium. Gallstone obstruction is most often diagnosed in older women. The stone migrates through the digestive canal and gets stuck in the small intestine.

Summing up, we can say with confidence that the duodenum is the most important organ of the digestive tract, contributing to the normal digestion of food. You can maintain the health of this organ with the help of proper nutrition, which should become your way of life.

If you experience discomfort in the area of the duodenum, immediately contact a specialist for an examination. Early diagnosis will help avoid serious bowel problems.

The small intestine, the initial section - duodenum 12 (duodenum), which controls the production of bile, enzymes, responsible for digestion. It is located in the region of 2-3 lumbar vertebrae, but over the course of life and age, its location may change. If the organ fails, digestion is disturbed, subsequent treatment, special diets, and an appropriate lifestyle are required.

Many other technologies are used in treatment:

Acupuncture. A doctor, specially trained in acupuncture skills, finds the points responsible for the diseased organ, in our case, the duodenum, then a course of treatment is prescribed. Acupuncture is more often applied to patients who have been diagnosed with the disease for the first time.
Laser acupuncture. The procedure is carried out on a special apparatus, the result is an acceleration of the healing of ulcerative processes. The main thing is to correctly determine the type of laser, the points themselves.
Information-wave therapy. The procedure is carried out with a special apparatus in the same way. This type of therapy is needed for prevention so that the disease does not develop. The therapy is effective during periods of exacerbation, more precisely - in the spring and autumn seasons.
antihomotoxic therapy. There is an intoxication of the body, there is a hit of toxic substances formed as a result of duodenal ulcer. Treatment is indicated by medication.

Doctors use additional methods known to them:

Folk methods

Do not forget about the treatment of folk remedies. This is a kind of alternative to some of the above methods.

Potato juice. Grate fresh potatoes, then squeeze the juice, drink before meals. It is advisable to drink the course. Relief is bound to follow.
Burdock. It can be treated with a decoction of the roots and leaves. Treatment continues until relief is felt.
Carrot juice. Squeeze and drink a course of thirty days.
Cabbage juice. After push-ups, drink, but only warm, before meals, for a course of three weeks. The ulcer scars, the stomach stops hurting.
Honey. It is more often used in conjunction with the listed products - butter, aloe juice, vegetable juices (carrots, onions, radishes, others), herbal infusions.
Fresh eggs. According to reviews, if you drink fresh chicken eggs in the morning before meals, and in the evening after dinner, the ulcer heals! Drink, of course, courses - seven days or more.
Propolis. Propolis tincture is made, diluted in water, consumed three times before meals, the course is one year. Then drink in the spring, autumn, a couple of years. The treatment is long-term, but the result is worth it. The inflammation goes away.
Water. In the morning it is bearable to drink hot boiled water before meals, one glass. Drink, thus, two months. The ulcer in the duodenum will heal.

With all methods, the rules and diet are observed. Pain-provoking foods should be removed from the diet. Try to make your diet rich in vitamins. Introduce new products daily, achieving variety. Women have an additional motivation in the form of an attractive figure as a result of proper nutrition.

Food is steamed or boiled, it should be consumed in a pureed, chopped, twisted form. With an ulcer, fractional nutrition is required, in small portions. To consolidate, an annual visit to the sanatorium will not be superfluous.

The intestine goes from left to right and backwards, then turns down and descends in front of the right to level II or the upper edge of the III lumbar vertebra; then it turns to the left, is located at first almost horizontally, crossing the inferior vena cava in front, and then goes obliquely up in front of the abdominal and, finally, at the level of the body of the I or II lumbar vertebra, to the left of it, passes into the jejunum. Thus, it forms, as it were, a horseshoe or an incomplete ring, covering the top, right and bottom of the head and partly the body.

The initial section of the intestine is the upper part, pars superior, which at first is somewhat expanded and forms an ampulla, ampulla; the second section is the descending part, pars descendens, then the horizontal (lower) part, pars horizontalis (inferior), which passes into the last section - the ascending part, pars ascendens. When the upper part passes into the descending one, the upper flexure of the duodenum, flexura duodeni superior, is noticeable, and when the descending part passes into the horizontal, the lower flexure of the duodenum, flexura duodeni inferior. Finally, when the duodenum passes into the jejunum, the steepest duodenal jejunal bend, flexura duodenojejunalis, is formed. The muscle that suspends the duodenum, m. suspensorius duodeni, which is a muscular-connective tissue cord attached to the left leg of the diaphragm. The length of the duodenum is 27-30 cm, the diameter of the widest descending part is 4.7 cm. A slight narrowing of the lumen of the duodenum is noted at the level of the middle of the length of the descending part, in the place where it is crossed by the right colon artery, and on the border between the horizontal and ascending parts where the intestine is crossed from top to bottom by the upper mesenteric vessels.

The wall of the duodenum consists of three membranes: mucous, muscular and serous. Only the beginning of the upper part (over 2.5-5 cm) is covered with peritoneum on three sides; the descending and lower parts are located retroperitoneally and are covered with adventitia.

The muscular membrane, tunica muscularis, of the duodenum has a thickness of 0.3-0.5 mm, more than the thickness of the rest of the small intestine. It consists of two layers of smooth muscles: the outer one is the longitudinal layer, stratum longitudinale, and the inner one is the circular layer, stratum circulare.

The mucous membrane, tunica mucosa, consists of an epithelial layer with a connective tissue plate underlying it, a muscular lamina of the mucous membrane, lamina muscularis mucosae, and a layer of submucosal loose fiber that separates the mucous membrane from the muscle. In the upper part of the duodenum, the mucous membrane forms longitudinal folds, in the descending and horizontal (lower) parts - circular folds, plicae circulares. Circular folds are permanent, occupying 1/2 or 2/3 of the circumference of the intestine. In the lower half of the descending part of the duodenum (rarely in the upper half), on the medial portion of the posterior wall, there is a longitudinal fold of the duodenum, plica longitudinalis duodeni, up to 11 mm long, distally it ends with a tubercle - the major papilla of the duodenum, papilla duodeni major, on top of which is located the mouth of the common bile duct and the pancreatic duct. Slightly above it, at the top of the small duodenal papilla, papilla duodeni minor, there is an orifice that occurs in some cases.

The mucous membrane of the duodenum, like the rest of the small intestine, forms small outgrowths on its surface - intestinal villi, villi intestinale, up to 40 of them per 1 mm 2, which gives it a velvety appearance. The villi are leaf-shaped, their height varies from 0.5 to 1.5 mm, and their thickness varies from 0.2 to 0.5 mm.

In the small intestine, the villi are cylindrical, in the ileum they are clavate.

In the central part of the villus there is a lymphatic capillary. Blood vessels are directed through the entire thickness of the mucous membrane to the base of the villus, penetrate into it, and, branching into capillary networks, reach the top of the villus. Around the base of the villi, the mucous membrane forms depressions - crypts, in which the mouths of the intestinal glands, glandulae intestinales, open. The glands are straight tubes reaching their bottom of the muscular plate of the mucous membrane. They are located throughout the mucous membrane of the small intestine, making up an almost continuous layer and interrupted only in the places of occurrence of group lymphatic follicles. The mucous membrane of the duodenum, villi and crypts are lined with a single-layer prismatic epithelium with an admixture of goblet cells; in the deepest part of the crypts are cells of the glandular epithelium. Branched tubular duodenal glands, glandulae duodenales, lie in the submucosa of the duodenum; most of them are in the upper part, their number decreases downwards. Throughout the mucous membrane of the duodenum there are single lymphatic follicles, folliculis lymphatici solitarii.

Topography of the duodenum.

The upper part of the duodenum is located to the right of the body of the I lumbar or XII thoracic vertebrae, for several centimeters from the pylorus intraperitoneally, so it is relatively mobile. From its upper edge follows the hepatoduodenal ligament, lig. hepatoduodenale.

The upper edge of the upper part adjoins the square lobe of the liver. The gallbladder is adjacent to the anterior surface of the upper part, which is sometimes connected to it by a small peritoneal ligament. The lower edge of the upper part is adjacent to the head of the pancreas. The descending part of the duodenum is located along the right edge of the bodies of I, II and III lumbar vertebrae. It is covered by the peritoneum on the right and in front. Behind the descending part is adjacent to the medial part of the right kidney and to the left - to the inferior vena cava. The middle of the anterior surface of the duodenum is crossed by the mesentery of the transverse colon with the right colonic artery embedded in it; above this place, the right flexure of the colon is adjacent to the anterior surface of the descending part.

At the medial edge of the descending part is the head of the pancreas, along the edge of the latter passes the anterior superior pancreatoduodenal artery, which gives feeding branches to both organs. The horizontal part of the duodenum is at the level of the III lumbar vertebra, crossing it from right to left, in front of the inferior vena cava; lies retroperitoneally. It is covered with peritoneum in front and below; only the place of its transition into the jejunum is located intraperitoneally; in this place, to its antimesenteric edge from the base of the mesentery of the transverse colon, there is a peritoneal upper duodenal fold, plica duodenalis superior (plica duodenojejunalis). The ascending part reaches the body of the I (II) lumbar vertebra.

At the border of the horizontal and ascending parts, the intestine is crossed almost vertically by the upper mesenteric vessels (artery and vein), and to the left - the root of the mesentery of the small intestine, radix mesenterii. The posterior surface of the ascending section is adjacent to the abdominal aorta. The upper edge of the lower part of the duodenum adjoins the head and body of the pancreas.

The duodenal-skinny bend, flexura duodenojejunalis, is fixed by the muscle that suspends the duodenum, m. suspensorius duodeni, and a bunch. The muscle is made up of smooth muscle fibers; the upper end starts from the left leg of the lumbar part of the diaphragm, the lower end is woven into the muscular membrane of the intestine .

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The duodenum is the initial section of the large intestine, which is located immediately after the pylorus.

The duodenum got its name due to the fact that its length is about 12 transverse dimensions of a finger.

The shape of the duodenum can vary from person to person: it can be C-, U-, or V-shaped.

This intestine is the "thickest" section of the small intestine and at the same time the shortest - its length usually ranges from 25 to 30 cm.

Structure

There are four departments.

Upper horizontal - is the initial section of the intestine, its length is 5-6 cm. It acts as a continuation of the pyloric section of the stomach; delimited from the next section by a sharp bend. So on x-ray images, the upper section has a spherical shape, then it was given another name - the duodenal bulb. The mucous membrane of the bulb has longitudinal folds, like the pylorus. Descending - located on the right side of the lumbar calving of the spinal column, its length ranges from 7 to 12 cm. At the transition site to the next section, a lower curvature is formed. In this section, the ducts of the pancreas, as well as the bile section of the stomach, enter the intestine. These ducts open into the lumen of the duodenum through the sphincter of Oddi, which is a smooth muscle located in the papilla of Vater. The main function of the sphincter of Oddi is to regulate the flow of bile and pancreatic digestive juice into the duodenal lumen. Also, this sphincter prevents the contents from being thrown back into the bile and pancreatic ducts. Lower horizontal - its length is from 6 to 8 cm; located in the direction from right to left; crosses the region of the spine in the transverse direction, after which it bends in the upper direction and passes into the ascending part. Ascending - has a length of 4 to 5 cm; this part is located to the left of the lumbar spine, forming the duodenal-jejunal curvature. It is followed by the mesenteric part of the small intestine.

At the site of the transition of the duodenum to the jejunum, there is another sphincter that prevents the reverse movement of food masses.

Fixation of the organ is achieved due to connective tissue fibers directed from its walls towards the organs of the retroperitoneal space. The upper part is more mobile than its other parts, so it can move to the sides after the pylorus.

The duodenum is distinguished by a special structure of the mucosa, due to which its epithelium is resistant to the aggressive environment of gastric acid, pepsin, bile and pancreatic enzymes.

The duodenal bulb, the rest of its sections and the head of the pancreas have a common blood circulation, which is carried out due to the superior mesenteric artery and branches of the celiac trunk.

Location

The duodenum is located most often at the level of the second and third lumbar vertebrae. Its position may vary slightly in different people depending on age, degree of fatness and a number of other factors. For example, in elderly or very thin people, this section of the intestine may be located somewhat lower than in young and relatively well-fed subjects.

In most cases, the upper section originates at the level of the last thoracic or first lumbar vertebrae. Then the intestine goes in the direction from left to right and down to the level of the third lumbar vertebra, after which it performs a lower bend and is located parallel to the upper section, but already from right to left at the level of the second lumbar vertebra.

The upper part of the duodenum in front and above is adjacent to the square lobe of the liver, as well as to the gallbladder.

The descending section with its back side is adjacent to the pelvis of the right kidney and the initial section of the ureter. On the other hand, the ascending colon, which is part of the large intestine, adjoins this part of the intestine.

The superior mesenteric artery adjoins the horizontal part of the duodenum in front. Also close to this site is the transverse colon.

The ascending section from the back is adjacent to the retroperitoneal tissue, from the front - to the loops of the small intestine.

On the anterior and posterior surface of the head of the pancreas are lymphatic vessels designed to drain lymph from the duodenum.

Functions

The duodenum performs the following functions.

Secretory - mixing food slurry (chyme) with digestive juices that have entered this section of the small intestine from the pancreas and gallbladder. In addition, the duodenum has its own (Brunner's) glands, which are actively involved in the formation of intestinal juice. Thanks to the intake of digestive enzymes, the chyme acquires a kind of "enzymatic charge", i.e. further digestion occurs in the subsequent sections of the small intestine. Motor - ensuring the process of movement of chyme, received from the stomach, through the small intestine. Evacuation - evacuation of chyme, enriched with digestive enzymes, to the following sections of the small intestine. Maintaining a feedback relationship with the stomach - reflex opening and closing of the gastric pylorus, depending on the level of acidity of the incoming food bolus. Regulation of the production of digestive enzymes by the pancreas and liver.

Thus, the process of intestinal digestion begins in the duodenum. In this case, the acidity of the food slurry is brought to an alkaline level, due to which the distal sections of the small intestine are protected from the irritating effects of acids.

Digestion

This section contains information about what happens to food in the body. The food slurry that enters the initial section of the small intestine from the stomach mixes with the fluid that comes from the pancreatic ducts, as well as with bile and the secretion of the intestinal walls.

Also, due to the action of bile, emulsification and breakdown of fat is carried out. Fat turns into an emulsion (very small droplets that are in the aquatic environment). Due to this, the surface area of the interaction of fats with the enzymes of the digestive juice is significantly increased and the process of digestion of food is accelerated.

Bile promotes the dissolution of fat breakdown products, as well as their absorption into the intestinal walls. In addition, bile is extremely important in the process of assimilation of fat-soluble vitamins, amino acids, cholesterol and calcium salts in the intestines.

Another function of bile is the regulation of intestinal peristalsis. Under the influence of this substance, the intestinal muscles contract, which accelerates the process of moving food through the intestines and its further evacuation from the body. In the future, all components of bile are almost completely excreted from the human body.

Pancreatic juice, which entered the duodenum from the pancreas, has the form of a clear liquid and is able to digest various nutrients: proteins, fats and starch. In the intestinal cavity, it is activated due to the action of other enzymes.

Intestinal juice, which is formed due to the action of the duodenal glands, consists of a significant amount of mucus and contains the enzyme peptidase, which promotes the breakdown of proteins. Also, these glands produce two types of hormones - cholecystokinin-pancreozymin and secretin, which enhance the secretory function of the pancreas and thus regulate its work.

In the absence of food in the duodenum, its contents have a slightly alkaline reaction, in which the pH is 7.2-8.0. When an acid food slurry enters the intestine, the acidity level also changes to the acid side, but then the gastric juice is neutralized and the pH shifts to the alkaline side.

Thus, the duodenum performs a number of important functions in the process of digestion, including saturation of the food bolus with digestive enzymes and ensuring the further process of digestion of food.

During the day, from 0.8 to 2.5 liters of pancreatic juice can enter the intestine. The amount of bile entering this organ ranges from 0.5 to 1.4 liters per day and depends on the nature of the diet and the individual characteristics of the human body.

The entire further process of digestion of food in the intestine depends on the normal functioning of the organ, so any malfunction in its functioning can lead to a number of disorders and diseases of the digestive system.

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The initial section of the small intestine, which has an important role in digestion and control of the production of bile and enzymes, is the duodenum. The structure of the walls and mucous membrane ensures the processing and passage of food through the intestinal tract. All nutrients are qualitatively digested: protein - to amino acids, fats - to fatty acids and glycerol, carbohydrates - to monosaccharides. Diseases of this section of the intestine disrupt the overall process of digestion and require treatment, followed by maintaining a diet and a healthy lifestyle.

The duodenum is an important part of the digestive system through which food exits the stomach.

Anatomy and histology

The length of the duodenum is 25-30 cm, and the diameter is up to 6 cm. It is located behind the stomach, bends around the head of the pancreas. Characterized by the shape of a horseshoe, angle, ring. The dense peritoneum covers the duodenum only on three sides. It is fixed, as a rule, at the level of 2-3 lumbar vertebrae, by connecting fibers.

The blood supply of the duodenum passes through the pancreatic-duodenal arteries, and the outflow of venous blood through the veins of the same name. Innervated by branches of the vagus nerve, nerve plexuses of the stomach, liver. In humans, there are 4 sections of the duodenum. The initial section is expanded and is called the bulb. The pancreatic ducts and bile enter the descending section. The intestine is resistant to enzymes, pepsin and gastric juice. The epithelium has dense membranes and is renewed in a short time.

The walls of the duodenum have the following structure of layers:

serous membrane; layer of muscle fibers; submucosa; mucous membrane.

Sections of the duodenum

The structure of the duodenum
Parts	Description
Upper (bulb)	It starts from the pyloric sphincter, 4 cm long. The location is oblique, from front to back. Forms a curve. The hepatoduodenal ligament is extended to this part from the liver.
descending	Up to 12 cm long, inactive. It is located at the level of the spine, in the lumbar region on the right side. A dense longitudinal fold of the mucous membrane contains the large duodenal papilla, into which the bile duct flows, and into the small papilla - the pancreatic tubule. Controls the flow of bile and pancreatic juice muscle contactor - the sphincter of Oddi.
horizontal part	6-8 cm long. Stretched from right to left across the spinal column and makes an upward bend.
ascending part	Section 4-5 cm long. It forms a curvature in the area of junction with the jejunum, to the left of the spine, coinciding with the lumbar region.

Functions performed

A feature of the human duodenum is the absorption of lipids and glucose.

The functions of this organ relate to the process of intestinal digestion. It has its own actively working glands. The muscular layer mixes intestinal juices and bile with food, and the final digestion of carbohydrates and fats takes place. The acidity of the digestive lump changes to the alkaline side, so as not to injure the subsequent sections of the intestine. Thus, this section of the small intestine is responsible for the functions of:

secretory: hormones, intestinal secretion enzymes; motor: mixing chyme and moving it through the small intestine; changing the pH of chyme from acid to alkaline; evacuation: pushing to the next section of the intestine; regulation of the production of bile and pancreatic enzymes; support for feedback from the stomach: reflex closure and the opening of the gatekeeper.

Digestion in the small intestine

Digestion in the duodenum has features, carried out with the help of intestinal juice, pancreatic enzymes. The environment in the organ cavity is alkaline. The gastric pylorus opens reflexively and food, like a semi-liquid slurry, enters the small intestine. While eating, bile enters the cavity, which stimulates the production of pancreatic enzymes, activates them, and enhances muscle peristalsis. Fat is broken down into an emulsion, facilitating enzymatic work and speeding up digestion.

Pancreatic juice, except for the digestion of fats, also breaks down proteins, starch. Own glands of the duodenum produce substances that promote the breakdown of proteins and increased secretion of the pancreas. These are the hormone secretin and the hormone cholecystokinin-pancreozymin. The nutrients split into components are easily absorbed into the intestinal wall.

All components of the intestinal secretion of an alkaline reaction neutralize the acidity of the food mass from the stomach so as not to injure the walls of subsequent sections. The process of digestion is regulated by the neuro-reflex way, through the sphincters that open and close, through the liquid media of the body through hormones, mechanical irritation of the mucous membrane.

Common diseases

The nature of diseases of this part of the intestine is inflammatory and non-inflammatory. A common inflammatory disorder is duodenitis. Due to acute damage to the intestinal mucosa, the entire digestive system suffers. Tumor diseases are found in people of age and are diagnosed late due to hidden symptoms. Placed more often in the descending department. With growth, the form is complicated by bleeding, intestinal obstruction. Dyskinesia (duodenostasis) is a violation of the motility of the intestine, which does not allow the chyme to leave the duodenum, causing a long stagnation and unpleasant symptoms.

Peptic ulcer is a chronic inflammation provoked by nervous overload, the activity of the bacterium Helicobacter pylori, an unhealthy lifestyle, and the use of irritating medications. Complications of peptic ulcer are dangerous, and when the wall of the affected area breaks through (perforation), there is a threat to the life of the patient.

An ulcer can lead to cancerous degeneration of intestinal cells, bleeding, perforation and inflammation of the peritoneum.

General symptoms

Pathology disrupts the structure of the surface of the duodenum, both secretory and motor functions are affected. It is advisable to consult a doctor at the first weak signs:

Digestive disorders (dyspepsia): heartburn, nausea, vomiting, diarrhea or constipation. Pain syndrome. Localization - epigastrium, right hypochondrium. Pain manifests itself both on an empty stomach and a couple of hours after eating. Changes in appetite: with ulcerative pathologies, the appetite is increased, since pain disappears with eating, with other diseases, a decrease in appetite is noted. Psychological discomfort: loss of strength, irritability. Bleeding: appear anemia, pallor, vomiting with blood impurities, black stools.

Diagnosis of diseases

The patient receives a referral for diagnosis from a gastroenterologist. At the reception, subjective complaints and sensations of the patient are listened to, the pain syndrome is checked (examination, palpation of the abdomen). After collecting an anamnesis, tests and a hardware examination (usually endoscopy) are prescribed. Methods of hardware diagnostics of these diseases require obligatory observance of the rules of preliminary preparation in order to obtain accurate results. Based on the results of a complete examination, a diagnosis is made and outpatient, inpatient or surgical treatment is prescribed. For diagnostics, the following research methods are used:

Endoscopic examination (fibrogastroduodenoscopy): probing allows you to check all parts of the duodenum, take a small area for histological analysis. Biopsy. Examination of a fragment of intestinal tissue to determine the nature of an ulcer or other formation. X-ray using a contrast agent. Analysis for Helicobacter pylori (feces, blood, breath tests). Ultrasound. The ultrasound method does not always allow an accurate diagnosis, therefore it is used as an additional one. A three-time fecal occult blood test. A clinical blood test.

Treatment and diet

Treatment of diseases of the human duodenum may include radical measures, as well as traditional medicine.

If there are no complications, then the prognosis for recovery is favorable. After a course of treatment, a medical examination is needed. To eliminate the recurrence of the problem in the fall and spring, the appointment of repeated two-week therapy helps. Drug treatment is aimed at eliminating the bacteria that causes inflammation, relieving symptoms and restoring the mucous membrane. At the initial stage, a conservative method of treatment is indicated, and in critical and advanced cases, a surgical one. It is recommended to treat diseases of the duodenum in the following ways:

Pharmacotherapy: acid-reducing drugs; antibacterial; drugs that reduce secretory function; analgesics; improving gastrointestinal motility; anti-inflammatory or healing drug; sedatives. Physiotherapy: warming compresses; electrophoresis; balneotherapy; physiotherapy exercises.

Treatment restores the functionality of the duodenum, but careful adherence to the doctor's recommendations and diet is necessary to maintain health. Violation of the diet and treatment provokes a relapse.

Nutrition for dysfunctions of the duodenum is sparing for the mucous membrane of the organ. Food is taken warm, but not hot, boiled or steamed, liquid or semi-liquid consistency. Low-fat varieties of fish and meat, cereals, boiled vegetables, mashed potatoes, fruits and berries without sour taste are recommended. You can drink weak tea, dried fruit compotes, rosehip broth, dilute the juice with water before drinking.

The duodenum in the human body plays an important role in the process of digestion. It is located at the very beginning of the intestine, so the absorption of nutrients and the processing of the food bolus are actively going on here. This part of the intestine is not immune from the development of many diseases. Their occurrence leads to significant digestive disorders, which negatively affects the well-being of a person as a whole.

01 Structure of the duodenum

The entire human intestine is conditionally divided into two sections - the large and small intestines. At the very beginning of the small intestine is the duodenum. It is so called because its length is approximately equal to twelve fingers, or fingers.

It is located between the stomach and the jejunum. The sphincter is located at the point of origin of the stomach. Anatomically, the duodenum is divided into four parts:

the upper part (duodenal bulb) is located in the region of the twelfth thoracic and first lumbar vertebrae, its length is 5-6 cm; the descending part goes to the right of the first three lumbar vertebrae, length 7-12 cm; the horizontal part is at the level of the third lumbar vertebra, length 6-8 cm; the ascending part rises to the second lumbar vertebra, 4-5 cm long.

The descending portion contains the pancreatic duct and the major duodenal papilla. The total length of the duodenum is 22-30 cm.

The intestinal wall has a layered structure:

the inner layer is represented by a mucous membrane with a large number of folds, villi and depressions; the middle layer, or submucosal, consists of connective tissue, in which the vascular and nerve plexuses are located; the third layer, the muscular one, provides contractions of the intestine during digestion; the outer serous layer provides protection from injury.

The duodenum is in contact with other internal organs from all sides:

liver and common bile duct; right kidney and ureter; pancreas; ascending colon.

This anatomy of the organ determines the characteristics of the diseases that occur in it.

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02 Functions

The duodenum performs an important function in the process of digestion. In its cavity, all digestive juices and enzymes are mixed:

gastric; pancreatic; bile; own enzymes.

All this allows you to process the food bolus as much as possible and break down the nutrients to such a state that they are fully absorbed in the intestinal wall. The greatest changes occur with food in this area.

Good blood supply to the intestinal wall ensures maximum absorption. The massive muscle layer promotes the movement of food masses into further sections of the intestine.

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03 Symptoms and treatment of diseases

In the duodenum, pathological processes can develop that lead to a violation of its function. This worsens a person's well-being and negatively affects the state of his health in general.

The most common diseases of the duodenum are:

inflammatory processes; the formation of ulcerative defects; tumor processes.

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04 Inflammatory diseases

The inflammatory process in the duodenum is called duodenitis. The clinical picture of inflammation of the duodenum is diverse and depends on the form of the disease.

Symptoms of different types of duodenitis:

In older people, in most cases, there is an asymptomatic form, which is detected by chance during a medical examination.

Since duodenitis is most often caused by the bacterium Helicobacter pylori, antibiotic therapy is prescribed for treatment. The standard regimen is the use of two antibiotics - Clarithromycin and Amoxicillin. As a symptomatic therapy, appoint:

antacids - Almagel, Gaviscon; proton pump inhibitors - omeprazole; astringents - De-nol; enzyme preparations - Pancreatin, Mezim.

In addition to drug therapy are diet, adherence to a healthy lifestyle, physiotherapy.

1. The diet is prescribed in such a way as to reduce the irritating effect of food on the inflamed mucous membrane. To do this, use frequent meals in small portions. Food should be mechanically and thermally gentle. 2. A healthy lifestyle means avoiding alcohol and smoking. Adequate physical activity is shown. 3. Physiotherapy is used after the relief of an acute inflammatory process. Assign electrophoresis with drugs, magnetotherapy, paraffin applications.

Even with adequate treatment, duodenitis often becomes chronic.

05 Duodenal ulcer

Peptic ulcer is understood as a condition in which an ulcerative defect is formed in the wall of the duodenum, penetrating beyond the submucosal layer. The disease is chronic, accompanied by alternating periods of remission and exacerbation. Peptic ulcer of the duodenum develops four times more often than the stomach.

The clinical picture of duodenal ulcer has some features:

during the period of remission, the patient is not disturbed by anything; the main symptomatology is observed in the period of exacerbation.

The main symptom of the disease is pain. Pain sensations have specific characteristics inherent in this particular disease. By the nature of the pain, it is highly likely to suggest a diagnosis:

pain in the epigastric region, more on the right side; irradiation of pain in the right hypochondrium or in the lumbar spine; characteristic are "hungry" and "night" pains that appear on an empty stomach, decrease after eating.

Associated symptoms are:

nausea; heartburn; belching; vomiting of sour contents; weight loss.

Exacerbations occur in the spring-autumn period, their duration is not more than 8 weeks. The remission period lasts from 4-6 months to several years.

Peptic ulcer disease is dangerous for its complications that occur in the absence of treatment or due to provoking factors.

Complications of duodenal ulcer:

Complication	Symptoms
intestinal bleeding	Vomiting like "coffee grounds", tarry stools. There are signs of internal bleeding - weakness, pale skin, increased heart rate, low blood pressure
Ulcer perforation	It develops suddenly, is characterized by dagger pains in the epigastric region. A state of collapse develops rapidly. The muscles of the anterior abdominal wall are tense, palpation of the abdomen is painful
Penetration of the ulcer - the transition of the defect to nearby organs	It is characterized by increased pain, they become permanent, have no connection with food intake. There is a mild fever
Pyloric stenosis	There is vomiting of food that a person ate the day before. Characterized by belching with a rotten smell. Examination of the abdomen shows increased peristalsis in the epigastric region
Malignancy - degeneration into a malignant tumor	It is often asymptomatic and is only detected on close examination. In some cases, there is a change in the nature of the course of the disease - the loss of seasonality and frequency of exacerbations

Treatment of uncomplicated peptic ulcer is carried out on an outpatient basis. Its goals are:

elimination of severe symptoms; healing of a peptic ulcer; suppression of Helicobacter pylori - the main cause of the disease.

06 Non-drug treatment

It is an important component of the general therapy of duodenal ulcer. Includes the appointment of a special diet, the rejection of bad habits, physiotherapy. Dietary nutrition implies frequent meals of small portions of food, adherence to the principles of mechanical and thermal sparing of the mucosa. Therapeutic diet No. 1 is prescribed:

lean meats and fish, steamed; dairy products; butter and vegetable oil; pasta; mucous soups; mashed cereals; vegetable and fruit purees.

Refusal of bad habits involves the exclusion of alcohol, nicotine. Physiotherapy is prescribed in addition to the main treatment during the period of subsiding exacerbation. use:

electrophoresis; paraffin applications; microwave therapy.

07 Medicines

The basis of drug treatment is the use of a group of PPIs - proton pump inhibitors. These drugs contribute to scarring of the ulcer, alleviate the pain syndrome.

If a patient is diagnosed with Helicobacter pylori during examination in the intestinal mucosa, he is prescribed a course of eradication therapy. The standard triple regimen includes the following drugs:

proton pump inhibitors - omeprazole or rabeprazole; Clarithromycin; Amoxicillin or Metronidazole.

Dosages are determined by the attending physician. With the ineffectiveness of this scheme, an additional drug of bismuth De-nol is prescribed. The course of treatment is two weeks, after which a control fibrogastroscopy is performed.

Surgical treatment is indicated in the development of complications.

08 Duodenal cancer

Symptoms of the tumor process in the duodenum are due to compression of it and adjacent organs. There are three main syndromes that accompany duodenal cancer.

Syndromes with duodenal tumor:

Syndrome	Origin	Symptoms
Compression or squeezing	Growth or compression of nerve endings by the tumor	The pain most often appears in the left hypochondrium and epigastrium. In some patients, irradiation to the spine or right shoulder blade is noted. When the bile duct is blocked, acute girdle pain occurs
Obturation, or blockage	Occurs when an enlarged tumor closes the bile duct, major duodenal papilla	There is icteric staining of the skin, intense itching, enlargement of the liver. Urine becomes dark and feces discolored
Intoxication	It is a consequence of poisoning the body with toxins that the tumor produces.	A person is worried about severe fatigue, weight loss, loss of appetite

The main treatment for duodenal cancer is surgery. The volume of surgical intervention depends on the location and size of the tumor, as well as the presence of metastases. If the tumor cannot be removed, palliative surgery is performed. Its goal is to restore the outflow of bile and pancreatic juice, intestinal patency.

In addition to surgical treatment, radiation therapy and chemotherapy are prescribed. With an inoperable tumor, these techniques become the main ones and are aimed at maximizing the life of patients.

09 Conclusion

The duodenum is an important section of the intestine that ensures proper digestion. Diseases that occur in the duodenum disrupt this process, which causes pathology in other organs. Each of the diseases requires adequate and complete treatment.

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Approximately ten percent of the population experienced such an ailment as a stomach and duodenal ulcer. The disease brings a lot of discomfort and requires mandatory treatment. Therefore, everyone should know where the duodenum is located and how it hurts.

Collapse

The length of the duodenum is about thirty centimeters. The body is divided into several parts:

descending department;
upper section;
ascending part;
Bottom part.

The intestine is not protected by the cover of the peritoneum, as it is located behind it and is adjacent to tissues that are not in the abdominal cavity. It cannot have a permanent shape: it can often be seen in the form of a horseshoe, less often in the form of a ring or an angle.

The position of the duodenum in the body is not constant and depends on the person's weight, age and other circumstances. In overweight people, the organ is slightly higher than in thin or elderly people.

Relative to the spine, the intestine also does not occupy one place. Most often it is located at the level of the lower back. Its top touches the portal vein, pancreas, gastroduodenal artery and bile duct. The walls of the intestine are separated by connective fibers and organs that are in the cavity behind the peritoneum. They fix the body. The most mobile is the upper part of the intestine, so it can move freely.

Knowing where the duodenum is located in a person and how it hurts, you can detect the disease in time and take the necessary measures. The most common signs include:

plaque on the tongue;
sores that appear in the oral cavity;
poor appetite.

When the diseases become chronic, the patient may experience periodontitis of the lower front teeth, as well as headaches, which usually occur three hours after eating. With peptic ulcer, not only the intestine suffers, but also the liver, pancreas.

The clinical picture of diseases depends on their type. Most often, the duodenum affects the following ailments:

Duodenitis.

These ailments affect the motor function of the organ, cause stagnation in the contents in the organ. A mushy mass accumulates in the intestine, consisting of underdigested food, gastric juice and digestive enzymes. The pain appears shortly after eating, may be accompanied by vomiting and nausea.

The disease is characterized by periods of remission and exacerbations. In the second case, the pains increase with food intake, are permanent in nature and are localized on the right side in the area under the ribs. Heaviness is felt under the spoon, the patient suffers from nausea and vomiting, constipation, which cause intoxication and weight loss.

With these ailments, the symptoms of how the duodenum hurts are as follows:

vomiting and nausea;
pain on the right side under the ribs;
lack of appetite;
constipation;
weight loss;
pain in the upper abdomen;
feeling of heaviness after eating.

Treatment is selected individually and involves complex therapy. It is designed to relieve exacerbation and symptoms, restore normal motor activity of the intestine.

How does the duodenum hurt with a peptic ulcer? The disease develops as a result of the action of pepsin and acid on the mucous membrane of the organ, proceeds with relapses, and after healing, a scar forms at the site of the ulcer. The main symptoms of the disease are dyspeptic syndrome and pain, which are most often localized in the upper abdomen. Unpleasant sensations are aggravated by exercise, eating spicy food, drinking alcohol and fasting.

With a typical ulcer, pain appears when eating, with an exacerbation it is seasonal. After taking antisecretory drugs, baking soda or antacids, pain decreases. Distinctive signs of the disease are disorders of the digestive system, nausea and vomiting, increased appetite. In many patients, hunger pains that manifest themselves at night are a sign of the disease. They are expressed by attacks, appear constantly or have a aching character.

When complicated, an ulcer can cause internal bleeding. Blood can be seen in the vomit and feces of the patient. In addition, an ulcer can spread to neighboring organs or a through hole appears in the intestine. Perforation is accompanied by sharp and intense pain, the patient may faint, his skin becomes pale. In such a situation, immediate hospitalization is necessary.

Duodenitis

The disease can occur in different forms:

chronic;
acute;
bulbous;
superficial;
erosive;
post-bulbar.

Symptoms of pain in the duodenum are expressed as follows:

Disorder of the digestive system.
Vomiting with blood.
Iron-deficiency anemia.
Decreased appetite.
Pain in the abdomen and chest.
Nausea.
Flatulence.
Weakness and dizziness.
Heaviness in the stomach after eating.

Symptoms of the disease may appear constantly or periodically. In rare cases, duodenitis does not manifest itself in any way, but in many patients it causes sharp pains in the abdomen.

duodenal cancer

If a patient has colon cancer, symptoms may include jaundice, fever, and itchy skin. With a disease of the first degree, pain appears, which occurs as a result of the fact that the tumor compresses the nerve fibers or there is a blockage of the bile duct. Most often, pain is felt in the right hypochondrium, but sometimes it can spread to other organs. One of the signs of the disease is itching. It causes an increased content of bilirubin in the blood and irritation of skin receptors with bile acids. Against the background of itching, the patient is noticeably agitated and insomnia.

The duodenum is an important part of the digestive system, connecting the stomach and small intestine. Knowing the symptoms and how the duodenum hurts, you can seek medical help in a timely manner and prevent the development of dangerous complications.