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The jejunum and ileum Slide 1 The jejunum and ileum Slide 2 The jejunum and ileum Slide 3 The jejunum and ileum Slide 4 The jejunum and ileum Slide 5 The jejunum and ileum Slide 6 The jejunum and ileum Slide 7 The jejunum and ileum Slide 8 The jejunum and ileum Slide 9 The jejunum and ileum Slide 10 The jejunum and ileum Slide 11 The jejunum and ileum Slide 12 The jejunum and ileum Slide 13 The jejunum and ileum Slide 14 The jejunum and ileum Slide 15 The jejunum and ileum Slide 16 The jejunum and ileum Slide 17 The jejunum and ileum Slide 18 The jejunum and ileum Slide 19 The jejunum and ileum Slide 20 The jejunum and ileum Slide 21 The jejunum and ileum Slide 22 The jejunum and ileum Slide 23 The jejunum and ileum Slide 24 The jejunum and ileum Slide 25 The jejunum and ileum Slide 26 The jejunum and ileum Slide 27 The jejunum and ileum Slide 28 The jejunum and ileum Slide 29 The jejunum and ileum Slide 30 The jejunum and ileum Slide 31 The jejunum and ileum Slide 32 The jejunum and ileum Slide 33 The jejunum and ileum Slide 34 The jejunum and ileum Slide 35
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The jejunum and ileum

  1. 1. The Jejunum and Ileum [L. jejunus, empty] [L. fr. G. eileb, to roll up, twist] Dr M Idris Siddiqui
  2. 2. The jejunum and the ileum • The jejunum begins at the duodenojejunal flexure. • Together, the jejunum and ileum are 5 to 7 metres long.(avg 6m) • The jejunum and ileum are the greatly coiled parts of the small intestine. • They are covered to varying extents by the greater omentum. • Although there is no clear line of demarcation, the character of the intestine gradually changes.
  3. 3. The differences between the duodenum and small intestine Duodenum Small intestine proper Short in length (25 cm) Long in length (avg 6 m) Supplied by two rows of vasa recta Supplied by single row of vasa recta Presence of Brunner glands in submucus coat Absence of glands in submucus coat
  4. 4. The jejunum • The jejunum is middle part of the small intestine in humans and most higher vertebrates. • It lies between duodenumand the ileum. • The jejunum arises from the duodenojejunal flexure.
  5. 5. Ileum • Part of the small intestine beyond the jejunum and up to to the ileocecal valve i.e. before the colon(large intestine). • The wall itself is made up of folds, each of which has many tiny finger-like projections known as villi on its surface. – The function of the ileum is mainly to absorb vitamin B12 and bile salts and whatever products of digestion were not absorbed by the jejunum.
  6. 6. STRUCTURE OF the small intestine • The wall structure of the small intestine includes four layers. – From inside to outside, these are: • Mucosa • Submucosa • Muscle layer • Serosa
  7. 7. MESENTERY OF THE SMALL INTESTINE • It is a broad fan-shaped fold of the peritoneum, which suspends the small intestine (jejunum and ileum) to the posterior abdominal wall. • It has the root (connected margin) as well as free margin (intestinal margin). • The root extendsfrom the duodenojejunal flexure to the ileocaecal junction and is connected to an oblique line throughout the posterior abdominal wall. – The duodenojejunal flexure lies to the left side of second lumbar vertebra, whereas ileocaecal junction lies at the right sacroiliac joint.
  8. 8. Differences Between The Jejunum And Ileum Features Jejunum Ileum Location Umbilical region Hypogastric region Walls Thicker and more vascular Thinner and less vascular Lumen Wider and often found empty (diameter = 4 cm) Narrower and often found full (diameter = 3.5 cm) Circular folds/plicae circulares (valves of Kerckring) Longer and closely set Smaller and sparsely set Villi More, larger, thicker, and leaf- like Less, shorter, thinner, and finger-like Aggregated lymph follicles (Peyer’s patches) Small, circular, and few in number, and found only in the distal part of the jejunum Large oval and more in number and found throughout the extent of ileum being maximum in the distal part Mesentery Contains less fat and becomes semitranslucent between the vasa recta called peritoneal windows Contains more fat and there are no peritoneal windows between the vasa recta
  9. 9. The Mesentery Fold of peritoneum that suspends the small intestine from the posterior abdominal wall • Broad and a fan- shaped • Consists of two peritoneal layers
  10. 10. The mesentery • The jejunum and ileum are attached to the posterior abdominal wall by the root of the mesentery (about 15 cm long) is directed obliquely. • It extends from the duodenojejunal junction on the left side of vertebra L2 to the ileocolic junction and the right sacroiliac joint. • Between these two points, the root of the mesentery crosses: 1) The horizontal (3rd & 4rh ) parts of the duodenum 2) Aorta 3) Inferior vena cava 4) Psoas major muscle 5) Right ureter 6) Right testicular (or ovarian) vessels
  11. 11. Contents of mesentery Between the two layers of the mesentery are 1) Coils of intestine 2) The superior mesenteric artery 3) The superior mesenteric vein 4) Lymph nodes, i. Small nodes in free border of the mesentery ii. Medium sized in middle iii. Large sized at root of the mastery 5) A variable amount of fat, and 6) Autonomic nerves.
  12. 12. Blood Supply of the Jejunum and Ileum • The arterial supply to the jejunoileum is from the superior mesenteric artery. • The superior mesenteric artery arises from the aorta at the level of the L1 vertebrae, immediately inferior to the coeliac trunk. • It moves in between layers of mesentery, splitting into approximately 20 branches. • These branches anastomose to form loops, called arcades. From the arcades, long and straight arteries arise, called vasa recta.
  13. 13. Venous Drainage of the Jejunum and Ileum • The superior mesenteric vein drains the jejunum and ileum. • This accompanies the superior mesenteric artery, lying anterior and to its right in the root of the mesentery. • This vein unites with the splenic vein to form the portal vein
  14. 14. Lymphatic Drainage of the Jejunum and Ileum • The lacteals in the intestinal villi empty their milk-like fluid (L. lactis, milk) into a plexus of lymph vessels in the walls of the jejunum and ileum. • These lymph vessels pass between the two layers of mesentery to the mesenteric lymph nodes. • From here, the lymph drains ultimately to the thoracic duct.
  15. 15. Innervation of the Jejunum and Ileum • The innervation is through the superior mesenteric plexus extensions along the arteries. • The sympathetic supply is from the greater splanchnic and lesser splanchnic nerves. • The parasympathetic supply is from the posterior vagal trunk via the coeliac plexus.
  16. 16. Ileal Diverticulum (of Meckel) • An ileal diverticulum (of Meckel) is a congenital anomaly that occurs in 1 to 2% of the population. • A remnant of the vitello-intestinal duct, the diverticulum usually appears as a finger-like pouch. • The diverticulum is usually located 30 to 60 cm from the ileocecal junction in infants and 50 cm in adults. • It may be free (74%) or attached to the umbilicus (26%). it may also include areas of acid-producing gastric tissue, pancreatic tissue, or jejunal or colonic mucosa. • An ileal diverticulum may become inflamed and produce pain mimicking that produced by appendicitis. • If gastric tissue is in diverticulum, a peptic ulcer may occur here.
  17. 17. Trauma to the Jejunum and Ileum • Because of its extent and position, the small intestine is commonly damaged by trauma. • The extreme mobility and elasticity permit the coils to move freely over one another in instances of blunt trauma. • Material from large wounds leaks freely into the peritoneal cavity. • The presence of the vertebral column and the prominent anterior margin of the first sacral vertebra may provide a firm background for intestinal crushing in cases of midline crush injuries.
  18. 18. Tumors and Cysts of the Mesentery of the Small Intestine • The line of attachment of the small intestine to the posterior abdominal wall should be remembered. • It extends from a point just to the left of the midline about 2 in. (5 cm) below the transpyloric plane (L1) downward to the right iliac fossa. • A tumor or cyst of the mesentery, when palpated through the anterior abdominal wall, is more mobile in a direction at right angles to the line of attachment than along the line of
  19. 19. Pain Fibers from the Jejunum and Ileum • Referred pain from this segment of the gastrointestinal tract is felt in the dermatomes supplied by the 9th, 10th, and 11th thoracic nerves. • Strangulation of a coil of small intestine in an inguinal hernia first gives rise to pain in the region of the umbilicus. • Only later, when the parietal peritoneum of the hernial sac becomes inflamed, does the pain become more intense and localized to the inguinal region
  20. 20. Mesenteric Arterial Occlusion • The superior mesenteric artery, a branch of the abdominal aorta, supplies an extensive territory of the gut, from halfway down the second part of the duodenum to the left colic flexure. • Occlusion of the artery or one of its branches results in death of all or part of this segment of the gut. • The occlusion may occur as the result of an embolus, a thrombus, an aortic dissection, or an abdominal aneurysm
  21. 21. Mesenteric Vein Thrombosis • The superior mesenteric vein, which drains the same area of the gut supplied by the superior mesenteric artery, may undergo thrombosis after stasis of the venous bed. • Cirrhosis of the liver with portal hypertension may predispose to this condition.
  22. 22. Atresias and Stenoses • Congenital intestinal atresia is a major cause of intestinal obstruction in infants. As in the duodenum, jejunoileal atresia occurs.
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