jejunum ileum

JEJUNUM and JEJUNUM and ILEUMILEUM

Dr. Aldwin A. YanezaDr. Aldwin A. Yaneza

Dept. of AnatomyDept. of Anatomy

Jejunum and IleumJejunum and Ileum Jejunum starts at Jejunum starts at

duodenojejunal flexureduodenojejunal flexure 6-7 m long6-7 m long 2/5 2/5 jejunum, jejunum, 3/53/5 ileum ileum CoiledCoiled Covered by greater Covered by greater

omentumomentum No clear line of demarcationNo clear line of demarcation Localization is ofLocalization is of surgical surgical

importanceimportance

No clear line of distinction between No clear line of distinction between the two parts. But important to the two parts. But important to recognize either segment, especially recognize either segment, especially in performing gastrojejunostomy or in performing gastrojejunostomy or tube jejunostomy for feeding.tube jejunostomy for feeding.

JejunumJejunum Latin Latin jejunusjejunus = EMPTY = EMPTY Often emptyOften empty ThickerThicker More vascularMore vascular RedderRedder Lies in umbilical regionLies in umbilical region Circular folds [ Circular folds [ plica circulares plica circulares

or valves of Kerckringor valves of Kerckring] of ] of mucous membranes are large mucous membranes are large and well developedand well developed

IleumIleum ThinThin Less vascularLess vascular Less red Less red Lies in hypogastric and right Lies in hypogastric and right

inguinal regioninguinal region Plicae circulares are small in Plicae circulares are small in

superior ileum and absent in superior ileum and absent in terminal ileumterminal ileum

Lymph follicles are aggregated as Lymph follicles are aggregated as Peyer patchesPeyer patches located at the anti- located at the anti-mesenteric sidemesenteric side

Site of an outpouching called Site of an outpouching called Meckel’s diverticulumMeckel’s diverticulum

Ends at ileocecal junctionEnds at ileocecal junction

Meckel’s DiverticulumMeckel’s Diverticulum Most common malformation of Most common malformation of

GITGIT In 1 -2 % of poplnIn 1 -2 % of popln Fingerlike pouchFingerlike pouch Remnant of embryonic yolk stalkRemnant of embryonic yolk stalk Same layers as wall of ileumSame layers as wall of ileum May contain gastric epithelium May contain gastric epithelium

and secrete acid cause ulcerand secrete acid cause ulcer 3 -6 cm long 3 -6 cm long Fr antimesenteric border of Fr antimesenteric border of

ileumileum Within 50 cm of ileocecal Within 50 cm of ileocecal

junctionjunction When inflammed , mimics acute When inflammed , mimics acute

appendicitisappendicitis

MESENTERYMESENTERY Double layerDouble layer of peritoneum w/c of peritoneum w/c encloses an organ and encloses an organ and

connects it to abdominal wallconnects it to abdominal wall Contains fat, lymph nodes, BV, nerves going to viscusContains fat, lymph nodes, BV, nerves going to viscus Named after viscus it attachesNamed after viscus it attaches

Stomach – mesogastriumStomach – mesogastrium Transverse colon – transverse mesocolonTransverse colon – transverse mesocolon Sigmoid colon – mesosigmoidSigmoid colon – mesosigmoid Ovary - mesovariumOvary - mesovarium

Most mobile parts of intestine Most mobile parts of intestine Transverse colon, small intestineTransverse colon, small intestine

None in retroperitoneal viscus None in retroperitoneal viscus Ascending colon , kidney, parts of duodenumAscending colon , kidney, parts of duodenum

MesenteryMesentery Suspends jejunum & ileumSuspends jejunum & ileum Fan shapedFan shaped Root [ 15 cm long ] is Root [ 15 cm long ] is

directed obliquely, directed obliquely, inferiorly, and to the right inferiorly, and to the right

Root crosses the ff strucRoot crosses the ff struc Duodenum,3Duodenum,3rdrd part part AortaAorta IVCIVC Psoas majorPsoas major Right ureterRight ureter R gonadal vesselsR gonadal vessels

MesenteryMesentery Consists of 2 layers of Consists of 2 layers of

peritoneumperitoneum Bet are jejunal and ileal Bet are jejunal and ileal

bld vessels,lymphatics, bld vessels,lymphatics, nervesnerves

Less fatLess fat in mesentery of in mesentery of jejunumjejunum

Prominent arterial Prominent arterial arcadesarcades in jejunum in jejunum

Arterial supplyArterial supply SSuperior uperior MMesenteric esenteric AArt or rt or

SMASMA Branches: Jejunal arteryBranches: Jejunal artery Ileal arteryIleal artery Arterial arcades Arterial arcades

Arteries in mesentery unite Arteries in mesentery unite Shorter/more complex in Shorter/more complex in

ileumileum Vasa rectaVasa recta

Straight vessels w/c arise fr Straight vessels w/c arise fr arterial arcadesarterial arcades

Longer in jejunumLonger in jejunum Shorter in ileumShorter in ileum

Venous drainageVenous drainage SSuperior uperior MMesenteric esenteric VVein or ein or

SMVSMV Accomp SMAAccomp SMA Crosses duod/ horiz.part Crosses duod/ horiz.part

and unicinate processand unicinate process Terminates by uniting Terminates by uniting

with splenic vein to with splenic vein to become portal veinbecome portal vein

Lymphatic DrainageLymphatic Drainage Mesenteric Lymph nodesMesenteric Lymph nodes

3 locations:3 locations:

1.Close to the wall of the 1.Close to the wall of the intestineintestine

2.Amongst arterial arcades2.Amongst arterial arcades

3.Along proximal part of SMA3.Along proximal part of SMA

Nerve SupplyNerve Supply ParasympatheticParasympathetic

VagusVagus Stimulate:Stimulate:

increase motility of the bowel,increase motility of the bowel, increase secretion of increase secretion of

intestinal gland intestinal gland vasodilation of blood vesselsvasodilation of blood vessels

SympatheticSympathetic Superior mesenteric ganglionSuperior mesenteric ganglion Stimulate:Stimulate:

reduce motility of the bowelreduce motility of the bowel reduce secretion of intestinal reduce secretion of intestinal

gland gland vasconstriction of blood vasconstriction of blood

vesselsvessels

Jejunum- Jejunum- HistologyHistology

Ileum- Ileum- HistologyHistology

Peyers patches

ComparisonComparisonCriteria Jejunum IleumCriteria Jejunum Ileum Diam large smallDiam large small Wall thick thinWall thick thin Plicae many fewPlicae many few Art arc 1-2 manyArt arc 1-2 many V recta long shortV recta long short Fat/mes less moreFat/mes less more Xray feathery smoothXray feathery smooth

CodeCode

Jej Jej IleumIleum

DDenzelenzel Diameter *Diameter * WWashingtonashington Wall *Wall * PPlayslays Plicae *Plicae * AA Arterial arcade Arterial arcade ** VVillain inillain in Vasa recta *Vasa recta * X-X-ratedrated Xray Xray ** FFilMilM Fat in mesentery Fat in mesentery **

Training DayTraining Day

Breast of Eva MendezBreast of Eva Mendez

Future CarsFuture Cars

BIODIESELBIODIESEL

1% Coconut Methyl Ester + 99 % 1% Coconut Methyl Ester + 99 % Petroleum.Petroleum.

BiodegradableBiodegradable non-toxicnon-toxic free of sulfur and aromaticsfree of sulfur and aromatics reduces serious air pollutants reduces serious air pollutants

such as particulates, carbon such as particulates, carbon monoxide, hydrocarbons monoxide, hydrocarbons

P40/li but unleaded is P40/li but unleaded is P42/liP42/li

Golf cartsGolf carts

Electric PowerElectric Power

Dodge Dodge ZeosZeos

Chevrolet VoltChevrolet Volt

Volvo RechargeVolvo Recharge

Plug-in Prius HybridPlug-in Prius Hybrid

Hydrogen PoweredHydrogen Powered

Honda ClarityHonda Clarity

Hydrogen fuelling Hydrogen fuelling stationstation

Solar CarsSolar Cars

Water fuel carWater fuel car

Segment?Segment?

No plicae No plicae circularescirculares

Near appendixNear appendix Thin walledThin walled Answer: ILEUMAnswer: ILEUM

Segment?Segment?

Smaller diameterSmaller diameter With diverticulum[arrowWith diverticulum[arrow]] Answer: ILEUMAnswer: ILEUM

Segment?Segment?

Larger diameterLarger diameter Thick wallThick wall RedderRedder Answer: JEJUNUMAnswer: JEJUNUM

Segment?Segment?

Thick wallThick wall Prominent plicae Prominent plicae

circcirc Answer: JejunumAnswer: Jejunum

Segment?Segment?

Encroaching fatEncroaching fat Ans: ILEUMAns: ILEUM

SegmentSegment

Large diameterLarge diameter More on upper More on upper

abdomenabdomen Thick walledThick walled Ans: JEJUNUMAns: JEJUNUM

Clinical CorrelationClinical Correlation

A 34 yo,male, was rushed to the ER for stab A 34 yo,male, was rushed to the ER for stab wound at right lower quadrant. He had wound at right lower quadrant. He had eviscerated intestine [which has numerous eviscerated intestine [which has numerous arcades and short vasa recta] from the SW site arcades and short vasa recta] from the SW site [ 4 cm]. What is this segment? [ 4 cm]. What is this segment?

ILEUMILEUM

A 34 yo M was admitted for anal bleeding A 34 yo M was admitted for anal bleeding Endoscopy [inserted into anus]was immediately Endoscopy [inserted into anus]was immediately performed which saw the bleeding segment performed which saw the bleeding segment about 4 cms distally from the cecum and where about 4 cms distally from the cecum and where the mucosa is smooth and not thrown into the mucosa is smooth and not thrown into folds. Diagnosis?What is the bleeding folds. Diagnosis?What is the bleeding segment?segment?

Lower GI Bleeding Lower GI Bleeding IleumIleum Lower GI Bleeding 2 to ileitisLower GI Bleeding 2 to ileitis

A 18 F will undergo surgery for bleeding A 18 F will undergo surgery for bleeding diverticulitis. Where is the location? diverticulitis. Where is the location? Where[quadrant] will you place the incision? Where[quadrant] will you place the incision? What structures will be encountered?What structures will be encountered?

IleumIleum Right lower quadrantRight lower quadrant StructuresStructures

SkinSkin Subcutaneous, FasciaSubcutaneous, Fascia EO, IO, TAEO, IO, TA Parietal peritoneumParietal peritoneum

A 86 F with stroke and unable to swallow is A 86 F with stroke and unable to swallow is scheduled for insertion of a feeding tube scheduled for insertion of a feeding tube jejunostomy. Where will the surgeon make the jejunostomy. Where will the surgeon make the incision? How will he know if the segment he incision? How will he know if the segment he grasped is the JEJUNUM?grasped is the JEJUNUM?

Left upper quadrantLeft upper quadrant Thick walledThick walled Larger diameterLarger diameter Few arterial arcadeFew arterial arcade Long vasa rectaLong vasa recta Less fat in the mesenteryLess fat in the mesentery

ILEOSTOMYILEOSTOMY

Dilated jejunum

Sutures after resection and anastomosis

Gastrojejunostomy- connect Gastrojejunostomy- connect the jejunum to the body of the jejunum to the body of

stomachstomach

Body of stomach

jejunum

GI TBGI TB

Segment?Segment?

Clue 1: The small Clue 1: The small intestine was adherent to intestine was adherent to the uterusthe uterus

Clue 2: My incision was Clue 2: My incision was below the umbilicusbelow the umbilicus

Answer:Answer: ILEUMILEUM

Prepare for QuizPrepare for Quiz

Set A firstSet A first

Quiz Set AQuiz Set A

Tabulate the 7 differences between Tabulate the 7 differences between jejunum and ileum.jejunum and ileum.

Quiz Set BQuiz Set B

1. What is the arterial supply of small 1. What is the arterial supply of small intestines?intestines?

2. What is the venous drainage?2. What is the venous drainage? 3. What are the nerve supplies?3. What are the nerve supplies? 4. What are the actions of No 3?4. What are the actions of No 3? 5. Where are the lymph nodes located?5. Where are the lymph nodes located? 6. How do you call the mucosa of the 6. How do you call the mucosa of the

jejunum thrown into folds?jejunum thrown into folds? 7. What is a Meckels diverticulum?7. What is a Meckels diverticulum?