Normal Duodenus, El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy

 

 
The video clip displays second and third portion. The duodenum, into which the stomach opens, is about 25 cm long, C-shaped and begins at the pyloric sphincter. It is almost entirely retroperitoneal and is the most fixed part of the small intestine.

Duodenum.

 The video clip displays second and third portion.

 The duodenum, into which the stomach opens, is about 25 cm
 long, C-shaped and begins at the pyloric sphincter. It is almost
 entirely retroperitoneal and is the most fixed part of the small
 intestine.

 For more endoscopic details download the video clips by
 clicking on the endoscopic images, wait to be downloaded
 complete then press Alt and Enter; thus you can observe
 the video in full screen.

 All endoscopic images shown in this Atlas contain
 video clips.

Duodenum the intestinal villis are observed. The gastrointestinal tract is considered one of the largest immune organs of the body. Disruption of bowel mucosa not only compromises digestive and absorptive functions, but also vital immune functions. Gut-associated lymphatic tissue (GALT) confers specific immunity in the form of secretory immunoglobulin-A (sIgA) while specialized cells in the mucosa, such as macrophages, natural killer cells, mast cells and intraepithelial lymphocytes, protect against absorption of intestinal toxins and pathogens. Non-specific immunity is conferred by gastric acidity, mucus, motility, digestive enzymes and normal bacterial flora. Chronic permeability defects and associated mucosal damage may therefore lead to considerable compromise of immune function.

Video Endoscopy with Magnifying.

 Duodenum the intestinal villis are observed.

 The gastrointestinal tract is considered one of the
 largest immune organs of the body. Disruption of bowel
 mucosa not only compromises digestive and absorptive
 functions, but also vital immune functions.

 Gut-associated lymphatic tissue (GALT) confers specific
 immunity in the form of secretory immunoglobulin-A
 (sIgA) while specialized cells in the mucosa, such as
 macrophages, natural killer cells, mast cells and
 intraepithelial lymphocytes, protect against absorption
 of intestinal toxins and pathogens. Non-specific
 immunity is conferred by gastric acidity, mucus, motility,
 digestive enzymes and normal bacterial flora. Chronic
 permeability defects and associated mucosal damage
 may therefore lead to considerable compromise of
 immune function.

Magnifying Endoscopy. The intestinal villis are observed. To know the more detailed findings of the small intestinal mucosa with the use of a magnifying endoscope. Most cells formed from the undifferentiated columnar cell at the base of the crypt, migrate along the sides of the villi up to the tip of the villi where they are sloughed off. As they migrate they differentiate into the absorptive columnar cell or the goblet cell. This is a continuous process whereby the cells of the epithelium are replaced every 3 days. The rapidly replicating undifferentiated columnar cells are almost continually undergoing mitosis which makes them especially sensitive to the effects of radiation therapy, cancer chemotherapy and various toxins and enzymes of microbial cells. When their reproduction is interrupted, the other cells of the epithelium continue to migrate and slough off. This disrupts the epithelium which causes 3 major effects: compromization of the first line of microbial defense, malabsorption and diarrhea. The intestine absorbs both exogenous fluids and its own secretions. The secretions of the intestine and digestive glands are so great that, were they not resorbed, death from dehydration would result in 24 hours.

Magnifying Endoscopy.

 Magnifying Duodenoscopy of the duodenal bulb, the
 intestinal villis are observed.

 To know the more detailed findings of the small intestinal
 mucosa with the use of a magnifying endoscope.

 Most cells formed from the undifferentiated columnar cell at
 the base of the crypt, migrate along the sides of the villi up to
 the tip of the villi where they are sloughed off. As they
 migrate they differentiate into the absorptive columnar cell
 or the goblet cell. This is a continuous process whereby the
 cells of the epithelium are replaced every 3 days. The rapidly
 replicating undifferentiated columnar cells are almost
 continually undergoing mitosis which makes them especially
 sensitive to the effects of radiation therapy, cancer
 chemotherapy and various toxins and enzymes of microbial
 cells. When their reproduction is interrupted, the other cells
 of the epithelium continue to migrate and slough off. This
 disrupts the epithelium which causes 3 major effects:
 compromization of the first line of microbial defense,
 malabsorption and diarrhea.

 The intestine absorbs both exogenous fluids and its own
 secretions. The secretions of the intestine and digestive
 glands are so great that, were they not resorbed, death from
 dehydration would result in 24 hours.

                                         Medline.
Magnifying Duodenoscopy of the duodenal bulb. The intestinal villis are observed.

Magnifying Duodenoscopy.

 Magnifying Duodenoscopy of the duodenal bulb.
 The intestinal villis are observed.
 

A normal papilla Vater. A normal papilla Vater, these pictures taken through a forward-viewing gastroscope. Vater, Abraham (1684-1751), German anatomist. Vater was a professor of anatomy and botany and later of pathology and therapeutics at Wittenberg. In 1710 he first noted the ampulla that has been named after him, but he did not publish a description of it until 1720. In 1717 he described the terminal capsules of certain sensory nerve fibers. They were later described by the Italian anatomist Filippo Pacini in 1840. Now these corpuscles are more commonly identified with Pacini than with Vater.

Papilla of Vater.

     A normal papilla Vater, this picture was taken
    through a forward-viewing gastroscope.

 Vater, Abraham (1684-1751), German anatomist. Vater was a
 professor of anatomy and botany and later of pathology and
 therapeutics at Wittenberg. In 1710 he first noted the ampulla
 that has been named after him, but he did not publish a
 description of it until 1720. In 1717 he described the terminal
 capsules of certain sensory nerve fibers. They were later
 described by the Italian anatomist Filippo Pacini in 1840. Now
 these corpuscles are more commonly identified with Pacini than
 with Vater.

 

Vaterīs papilla major and minor. The main papilla of Vater is a small nipple-like structure on the wall of the duodenum, in its "second part." The papilla forms the main exit hole for the bile and pancreatic juices which flow down the bile duct and pancreatic duct. Rarely there are two separate holes close together within the same papillary nipple. The papilla remains closed at rest, because of the activity of a muscular valve (sphincter). The sphincter (of Oddi, another Italian) surrounds the exit of the bile duct and pancreatic duct. It opens by reflex action when foods enter the stomach, so that juices can be released to help in their digestion. In most people there is a second smaller (minor, or accessory) papilla, situated about 2 cm (3/4 inch) above the main papilla, and slightly to its right. This is the exit hole for Santorini's duct. The minor papilla acts as a useful safety valve when the main papilla is not able to function correctly, but becomes the main site of drainage for pancreatic juices in the rare congenital disease of pancreas divisum.

Video Endoscopic Sequence 1 of 2.

 Vaterīs papilla major and minor.

 The main papilla of Vater is a small nipple-like structure on the
 wall of the duodenum, in its "second part." The papilla forms the
 main exit hole for the bile and pancreatic juices which flow down
 the bile duct and pancreatic duct. Rarely there are two separate
 holes close together within the same papillary nipple. The papilla
 remains closed at rest, because of the activity of a muscular valve
 (sphincter). The sphincter (of Oddi, another Italian) surrounds the
 exit of the bile duct and pancreatic duct. It opens by reflex action
 when foods enter the stomach, so that juices can be released to
 help in their digestion.

 In most people there is a second smaller (minor, or accessory)
 papilla, situated about 2 cm (3/4 inch) above the main papilla,
 and slightly to its right. This is the exit hole for Santorini's duct.
 The minor papilla acts as a useful safety valve when the main
 papilla is not able to function correctly, but becomes the main site
 of drainage for pancreatic juices in the rare congential disease of
 pancreas divisum.
The papilla major being retracting and become hidden in a duodenal diverticula.

Video Endoscopic Sequence 2 of 2.

 In the video clip you can see the papilla major being
 retracting and become hidden in a duodenal diverticula. 
Emerging bilis from the papilla. In this sequence of video clips you can appreciate the bilis emerging from the papilla.

 

Video Endoscopic Sequence 1 of 3.

Emerging Bilis from the papilla.

 In this endoscopic sequence of video clips you can
 appeciate the bilis that emerged from the papilla.
Emerging bilis from the papilla.

Video Endoscopic Sequence 2 of 3.

 Emeging Bilis from the papilla.
Emerging bilis from the papilla .

Video Endoscopic Sequence 3 of 3.

 Emerging bilis from the papilla.
A normal appearing papilla. A normal papilla Vater seen to the left in these pictures taken through a forward-iewing endoscope.

A normal appearing papilla.

 A normal papilla Vater seen to the left in these pictures
 and video clips are taken through a forward-viewing
 endoscope.
  
Ampulla of Vater. The main papilla of Vater (named after an Italian) is a small nipple-like structure on the wall of the duodenum, in its "second part." The duodenum is the upper part of the small intestine, into which food flows from the stomach. The papilla forms the main exit hole for the bile and pancreatic juices which flow down the bile duct and pancreatic duct. Rarely there are two separate holes close together within the same papillary nipple. The papilla remains closed at rest, because of the activity of a muscular valve (sphincter). The sphincter (of Oddi, another Italian) surrounds the exit of the bile duct and pancreatic duct. It opens by reflex action when foods enter the stomach, so that juices can be released to help in their digestion. In most people there is a second smaller (minor, or accessory) papilla, situated about 2 cm (3/4 inch) above the main papilla, and slightly to its right. This is the exit hole for Santorini's duct. The minor papilla acts as a useful safety valve when the main papilla is not able to function correctly, but becomes the main site of drainage for pancreatic juices in the rare congenital disease of pancreas divisum.

 Ampulla of Vater.

 The main papilla of Vater (named after an Italian) is a small
 nipple-like structure on the wall of the duodenum, in its "second
 part." The duodenum is the upper part of the small intestine, into
 which food flows from the stomach. The papilla forms the main
 exit hole for the bile and pancreatic
 juices which flow down the bile duct and pancreatic duct. Rarely
 there are two separate holes close together within the same
 papillary nipple. The papilla remains closed at rest, because of the
 activity of a muscular valve (sphincter). The sphincter (of Oddi,
 another Italian) surrounds the exit of the bile duct and pancreatic
 duct. It opens by reflex action when foods enter the stomach, so
 that juices can be released to help in their digestion. In most
 people there is a second smaller (minor, or accessory)
 papilla, situated about 2 cm (3/4 inch) above the main papilla, and
 slightly to its right. This is the exit hole for Santorini's duct. The
 minor papilla acts as a useful safety valve when the main papilla is
 not able to function correctly, but becomes the main site of
 drainage for pancreatic juices in the rare congential disease of
 pancreas divisum.

Duodenal bulb seen in retroflexed maneuver.. The pylorus is seen. Adult endoscope was used.The video clip shows the endoscope pass from the bulb to the antrum.

Duodenal bulb seen in retroflexed maneuver.

 The pylorus is seen. Adult endoscope was used. The video
 clip shows the endoscope pass from the bulb to the antrum.
 
 
Duodenum in retroflexed maneuver.

Duodenum in retroflexed maneuver.

 
Papilla of Vater. With frenulum and prominent plica longitudinalis.

Papilla of Vater.

 With frenulum and prominent plica longitudinalis.
  
 
Papilla of Vater. The papilla of Vatter is found at the medial aspect at the midpoint of the c loop. The papilla is bordered by the plica longitudinalis from the above and by another longitudinal fold, the frenulum, from below. The plica longitudinalis corresponds to the intraduodenal portion of the common bile duct, it windens as it approaches the papilla and ends in a bulging transverse fold. The preputium, which occasionally covers the papilla itself. The shape of the papilla may be hemispheric, papillary, or flat. It not only varies from patient to patient but its appearance may change somewhat during the examination.

Papilla of Vater.

 The papilla of Vatter is found at the medial aspect at the
 midpoint of the c loop. The papilla is bordered by the
 plica longitudinalis from the above and by another
 longitudinal fold, the frenulum, from below.
 The plica longitudinalis corresponds to the intraduodenal
 portion of the common bile duct, it windens as it
 approaches the papilla and ends in a bulging transverse
 fold.
 The preputium, which occasionally covers the papilla
 itself.
 The shape of the papilla may be hemispheric, papillary, or
 flat. It not only varies from patient to patient but its
 appearance may change somewhat during the examination.