Anatomy - Hepp-Couinaud bilioenteric anastomosis - general and visceral surgery

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  • Biliary tract

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    The bile duct drains bile from the liver into the duodenum. This way, bile aids in the digestion of lipids in the food. The intrahepatic biliary tract comprises the right and left hepatic duct (ductus hepaticus dexter et sinister) which descend from the liver. Their union forms the common hepatic duct (CHD – ductus hepaticus communis). Along its course to the duodenum, it is joined by the cystic duct (ductus cysticus) from the gallbladder (vesica biliaris). The union of the common hepatic duct and the cystic duct forms the common bile duct (CBD – ductus choledochus) which drains into the duodenum. The major duodenal papilla (papilla of Vater) is a sphincter muscle controlling the bile flow from the common bile duct into the duodenum.

  • Jejunum

    • The jejunum is one of three sections of the small intestine. It extends from the duodenum to the ileum.
      Its colloquial German term of “Leerdarm” or “empty bowel” stems from the fact that in most dead patients it is empty.*

    The jejunum is plicated in numerous loops and with its mesentery attaches to the posterior abdominal wall. The corresponding segment of the mesentery is called mesojejunum. When considered together with the ileum, which begins at the jejunum and terminates at the cecum, the radix mesenterii or root of the mesentery extends from the duodenojejunal flexure to the ileocecal valve.

    • Since the loops of the jejunum are quite mobile, they shift their positions. While the beginning of the jejunum is well defined by the duodenojejunal flexure at the level of the second lumbar vertebra, the boundary between the jejunum and ileum is not well defined.
      Like any other hollow viscus, the jejunum is lined with a mucous membrane (tunica mucosa). On the outside the mucous membrane is enclosed by a double layer of smooth muscle (tunica muscularis), while the serosa is a reflection of the peritoneum over the exterior of the jejunum.
    • The superior mesenteric artery supplying the jejunum, ileum, appendix, ascending colon and the proximal two thirds of the transverse colon courses in the proximal section of the mesenteric root.
    • The arterial supply of the jejunum derives from the jejunal arteries, which are branches of the superior mesenteric artery. The veins of the jejunum drain into the superior mesenteric vein which parallels the superior mesenteric artery on the right and then courses posterior to the head of the pancreas to the portal vein.
    • The jejunum is primarily innervated by the enteric nervous system. Peristalsis is controlled by the mesenteric plexus (Auerbach plexus), while the mucous membrane is innervated by the submucous plexus (Meissner plexus). In addition, the jejunum is also regulated by the sympathetic and parasympathetic nervous systems (in particular the vagus nerve).

    Ieiunus is Latin for fasting, hungry, meager *

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