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Duodenum
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<h2 id="overview">Overview</h2> <p>The duodenum is the first section of the <a href="/facts/Small_intestine/1AQ8RJ4m">small intestine</a> in most <a href="/facts/Higher_vertebrates/TeLtDTrJ">higher vertebrates</a>, including <a href="/facts/Mammals/phSwTzBo">mammals</a>, <a href="/facts/Reptiles/04n1uKf1">reptiles</a>, and <a href="/facts/Birds/RJF6zwLP">birds</a>. In <a href="/facts/Fish/fln4gH9V">fish</a>, the divisions of the small intestine are not as clear, and the terms <i>anterior intestine</i> or <i>proximal intestine</i> may be used instead of duodenum.<a class="footnote-ref" id="fnref:6" href="#fn:6"><sup>6</sup></a> In mammals the duodenum may be the principal site for <a href="/facts/Iron/QK1JYy8E">iron</a> absorption.<a class="footnote-ref" id="fnref:7" href="#fn:7"><sup>7</sup></a> </p><p>In humans, the duodenum is a C-shaped hollow jointed tube, 25–38 centimetres (10–15 inches) in length, lying adjacent to the <a href="/facts/Stomach/Q4PPDGT6">stomach</a> (and connecting it to the small intestine). It is divided anatomically into four sections. The first part lies within the <a href="/facts/Peritoneum/BotJhUr0">peritoneum</a> but its other parts are <a href="/facts/Retroperitoneal/UCoKE1WL">retroperitoneal</a>.<a class="footnote-ref" id="fnref:8" href="#fn:8"><sup>8</sup></a>: 273 </p> <h3>Parts</h3> <p>The <i>first</i> or <i>superior part</i> of the duodenum is a continuation from the <a href="/facts/Pylorus/920mWuBz">pylorus</a> to the transpyloric plane. It is superior (above) to the rest of the segments, at the <a href="/facts/Vertebral/Nuw1kV7o">vertebral</a> level of <a href="/facts/Lumbar_vertebrae/BytnlsNy">L1</a>. The <a href="/facts/Duodenal_bulb/S9lUT625">duodenal bulb</a>, about 2 cm (3⁄4 in) long, is the first part of the duodenum and is slightly dilated. The duodenal bulb is a remnant of the mesoduodenum, a <a href="/facts/Mesentery/ax1WaKRp">mesentery</a> that suspends the organ from the posterior abdominal wall in fetal life.<a class="footnote-ref" id="fnref:9" href="#fn:9"><sup>9</sup></a> The first part of the duodenum is mobile, and connected to the liver by the <a href="/facts/Hepatoduodenal_ligament/88HRSbFK">hepatoduodenal ligament</a> of the <a href="/facts/Lesser_omentum/4WLrRSvj">lesser omentum</a>. The first part of the duodenum ends at the corner, the <i>superior duodenal flexure</i>.<a class="footnote-ref" id="fnref:10" href="#fn:10"><sup>10</sup></a>: 273 </p><p>Relations: </p> <ul><li>Anterior <ul><li><a href="/facts/Gallbladder/RPdkQzQM">Gallbladder</a></li> <li><a href="/facts/Quadrate_lobe_of_liver/CLDaMpPB">Quadrate lobe of liver</a></li></ul></li> <li>Posterior <ul><li><a href="/facts/Bile_duct/hBFPcYkS">Bile duct</a></li> <li><a href="/facts/Gastroduodenal_artery/gVe2gzXY">Gastroduodenal artery</a></li> <li><a href="/facts/Portal_vein/pfyB986q">Portal vein</a></li> <li><a href="/facts/Inferior_vena_cava/XS3U5RmV">Inferior vena cava</a></li> <li><a href="/facts/Head_of_pancreas/r0WPGjAq">Head of pancreas</a></li></ul></li> <li>Superior <ul><li><a href="/facts/Neck_of_gallbladder/RPdkQzQM">Neck of gallbladder</a></li> <li><a href="/facts/Hepatoduodenal_ligament/88HRSbFK">Hepatoduodenal ligament</a> (<a href="/facts/Lesser_omentum/4WLrRSvj">lesser omentum</a>)</li></ul></li> <li>Inferior <ul><li><a href="/facts/Neck_of_pancreas/r0WPGjAq">Neck of pancreas</a></li> <li><a href="/facts/Greater_omentum/AzB2w9YV">Greater omentum</a></li> <li><a href="/facts/Head_of_pancreas/r0WPGjAq">Head of pancreas</a></li></ul></li></ul> <p>The <i>second</i> or <i>descending part</i> of the duodenum begins at the superior duodenal flexure. It goes <a href="/facts/Anatomical_terms_of_location/IpJ1fq2f">inferior</a> to the lower border of vertebral body L3, before making a sharp turn <a href="/facts/Lateral_and_medial/IpJ1fq2f">medially</a> into the <i>inferior duodenal flexure</i>, the end of the descending part.<a class="footnote-ref" id="fnref:11" href="#fn:11"><sup>11</sup></a>: 274 </p><p>The <a href="/facts/Pancreatic_duct/tLKRDmSE">pancreatic duct</a> and <a href="/facts/Common_bile_duct/9TsYu0sc">common bile duct</a> enter the descending duodenum, through the <a href="/facts/Major_duodenal_papilla/1CNVEb1T">major duodenal papilla</a>. The second part of the duodenum also contains the minor duodenal papilla, the entrance for the <a href="/facts/Accessory_pancreatic_duct/tLKRDmSE">accessory pancreatic duct</a>. The junction between the embryological <a href="/facts/Foregut/ngnGu9bV">foregut</a> and <a href="/facts/Midgut/n6Ewuzfk">midgut</a> lies just below the major duodenal papilla.<a class="footnote-ref" id="fnref:12" href="#fn:12"><sup>12</sup></a>: 274 </p><p>The <i>third</i>, <i>horizontal</i> or <i>inferior part</i> of the duodenum is 10~12 cm in length. It begins at the <i>inferior duodenal flexure</i> and passes transversely to the left, passing in front of the <a href="/facts/Inferior_vena_cava/XS3U5RmV">inferior vena cava</a>, <a href="/facts/Abdominal_aorta/W0hEwh5X">abdominal aorta</a> and the <a href="/facts/Vertebral_column/Nuw1kV7o">vertebral column</a>. The <a href="/facts/Superior_mesenteric_artery/A2gV85a4">superior mesenteric artery</a> and <a href="/facts/Superior_mesenteric_vein/F4PfMbcc">vein</a> are <a href="/facts/Anterior/IpJ1fq2f">anterior</a> to the third part of the duodenum.<a class="footnote-ref" id="fnref:13" href="#fn:13"><sup>13</sup></a>: 274 This part may be compressed between the aorta and SMA causing <a href="/facts/Superior_mesenteric_artery_syndrome/ycxrEu0s">superior mesenteric artery syndrome</a>. </p><p>The <i>fourth</i> or <i>ascending part</i> of the duodenum passes upward, joining with the <a href="/facts/Jejunum/PU0q1Syr">jejunum</a> at the <a href="/facts/Duodenojejunal_flexure/YzQvGeh8">duodenojejunal flexure</a>. The fourth part of the duodenum is at the vertebral level L3, and may pass directly on top, or slightly to the left, of the <a href="/facts/Aorta/ov2Gp9h4">aorta</a>.<a class="footnote-ref" id="fnref:14" href="#fn:14"><sup>14</sup></a>: 274 </p> <h3>Blood supply</h3> <p>The first (superior) part of the duodenum, right after the <a href="/facts/Pylorus/920mWuBz">pylorus</a> of the stomach, is not supplied by the arcades. Instead, it is supplied by the <a href="/facts/Supraduodenal_artery/whncEkq0">supraduodenal artery</a> and posterior superior pancreaticoduodenal artery, along with some branches of the <a href="/facts/Right_gastroepiploic_artery/MrGfagLs">right gastroepiploic artery</a> and the anterior superior pancreaticoduodenal artery. In many people part of the first centimeter of the duodenum is also supplied by branches of the <a href="/facts/Right_gastric_artery/zxh2slML">right gastric artery</a>.<a class="footnote-ref" id="fnref:15" href="#fn:15"><sup>15</sup></a> </p><p>The remaining three parts (descending, horizontal, and ascending) of the duodenum are supplied by two arcades (rings) of arteries, one anterior (in front) of the duodenum and pancreas and one posterior to (behind) them. Each arcade is made of two <a href="/facts/Anastomosis/fScK17o8">anastomosed</a> (connected) arteries. The superior artery of each arcade comes from the <a href="/facts/Superior_pancreaticoduodenal_artery/eQ9Lk0B8">superior pancreaticoduodenal artery</a>, which arises from the <a href="/facts/Celiac_artery/VfwtrY1D">celiac artery</a> via the <a href="/facts/Gastroduodenal_artery/gVe2gzXY">gastroduodenal artery</a>. The inferior artery of each arcade comes from the <a href="/facts/Inferior_pancreaticoduodenal_artery/FW2Ro0j7">inferior pancreaticoduodenal artery</a>, a branch of the <a href="/facts/Superior_mesenteric_artery/A2gV85a4">superior mesenteric artery</a>. The anterior arcade is formed by the anterior superior pancreaticoduodenal artery and the anterior inferior pancreaticoduodenal artery; the posterior arcade is formed by the posterior superior pancreaticoduodenal artery and the posterior inferior pancreaticoduodenal artery.<a class="footnote-ref" id="fnref:16" href="#fn:16"><sup>16</sup></a><a class="footnote-ref" id="fnref:17" href="#fn:17"><sup>17</sup></a> </p><p>Vessels from the arcades supply the <a href="/facts/Muscular_layer/RMTK24S0">muscularis externa</a> (muscular layer) before forming a <a href="/facts/Plexus/m7yyz8Dz">plexus</a> (network of blood vessels) in the <a href="/facts/Submucosa/kBgDSnhu">submucosa</a> (a layer of connective tissue) called the <a href="/facts/Submucosal_plexus/uNvHR2fQ">submucosal plexus</a>. Vessels continue from the submucosal plexus through the <a href="/facts/Muscularis_mucosae/I7NRmALL">muscularis mucosae</a> (another thin muscular layer) before forming another plexus under the <a href="/facts/Epithelium/ecKHcHC3">epithelium</a> of the <a href="/facts/Intestinal_villus/zrkCPIlY">villi</a>, the layer where nutrients are absorbed. These vessels entering the duodenum from the arcades are sometimes called <a href="/facts/Vasa_recta_(intestines)/L1j4zXLU">vasae rectae</a> or arteriae rectae.<a class="footnote-ref" id="fnref:18" href="#fn:18"><sup>18</sup></a> </p><p>The venous drainage of the duodenum mainly follows the arteries, ultimately draining into the <a href="/facts/Portal_venous_system/DtbasewB">portal system</a>. The venous arcades are usually superficial to the arterial arcades. The anterior superior pancreaticoduodenal vein drains into the <a href="/facts/Right_gastroepiploic_vein/GrpVXC6V">right gastroepiploic vein</a>, as do the veins of the lower first part of the duodenum and the pylorus (subpyloric veins). The upper first part of the duodenum is drained by suprapyloric veins, which can drain into the <a href="/facts/Portal_vein/pfyB986q">portal vein</a> or the posterior superior pancreaticoduodenal vein, which drains into the portal vein. The inferior veins of the arcades drain into the <a href="/facts/Superior_mesenteric_vein/F4PfMbcc">superior mesenteric</a>, <a href="/facts/Inferior_mesenteric_vein/tIoEE72V">inferior mesenteric</a>, <a href="/facts/Splenic_vein/FFmXaggy">splenic</a>, or first <a href="/facts/Jejunal_veins/cJpKtbhl">jejunal vein</a>.<a class="footnote-ref" id="fnref:19" href="#fn:19"><sup>19</sup></a> </p><p>Embryologically, the duodenum arises from both the <a href="/facts/Foregut/ngnGu9bV">foregut</a> and <a href="/facts/Midgut/n6Ewuzfk">midgut</a>, constituting the boundary between the two. However, the "midgut" is defined surgically as the parts of the intestine supplied by the superior mesenteric artery. Since the duodenum is supplied both by the <a href="/facts/Celiac_artery/VfwtrY1D">celiac artery</a> and the superior mesenteric artery, these two definitions are similar but not exactly the same.<a class="footnote-ref" id="fnref:20" href="#fn:20"><sup>20</sup></a> </p> <h3>Lymphatic drainage</h3> <p>The <a href="/facts/Lymph_vessel/jND0hlDu">lymphatic vessels</a> follow the arteries in a retrograde fashion. The anterior lymphatic vessels drain into the pancreatoduodenal <a href="/facts/Lymph_node/vkwfcQjH">lymph nodes</a> located along the superior and inferior pancreatoduodenal arteries and then into the pyloric lymph nodes (along the gastroduodenal artery). The posterior lymphatic vessels pass posterior to the head of the pancreas and drain into the superior mesenteric lymph nodes. Efferent lymphatic vessels from the duodenal lymph nodes ultimately pass into the celiac lymph nodes. </p> <h3>Histology</h3> <p>Under <a href="/facts/Microscopy/GpHlElDS">microscopy</a>, the duodenum has a <a href="/facts/Intestinal_villus/zrkCPIlY">villous</a> <a href="/facts/Mucosa/oIw0vyel">mucosa</a>. This is distinct from the mucosa of the <a href="/facts/Pylorus/920mWuBz">pylorus</a>, which directly joins the duodenum. Like other structures of the <a href="/facts/Gastrointestinal_wall/lKhz0AUT">gastrointestinal tract</a>, the duodenum has a <a href="/facts/Mucosa/oIw0vyel">mucosa</a>, <a href="/facts/Submucosa/kBgDSnhu">submucosa</a>, <a href="/facts/Muscularis_externa/RMTK24S0">muscularis externa</a>, and <a href="/facts/Adventitia/rSyJHUkx">adventitia</a>. Glands line the duodenum, known as <a href="/facts/Brunner%2527s_gland/XrF34qNb">Brunner's glands</a>, which secrete <a href="/facts/Mucus/hnlBuHAy">mucus</a> and <a href="/facts/Bicarbonate/zzSVVAl1">bicarbonate</a> in order to neutralise stomach acids. These are distinct glands not found in the ileum or jejunum, the other parts of the small intestine.<a class="footnote-ref" id="fnref:21" href="#fn:21"><sup>21</sup></a>: 274–275 </p> <h3>Variation</h3><p> The duodenum's close anatomical association with the pancreas creates differences in function based on the position and orientation of the organs. The congenital abnormality, annular pancreas, causes a portion of the pancreas to encircle the duodenum. In an extramural annular pancreas, the pancreatic duct encircles the duodenum which results in gastrointestinal obstruction. An intramural annular pancreas is characterized by pancreatic tissue that is fused with the duodenal wall, causing duodenal ulceration.<a class="footnote-ref" id="fnref:22" href="#fn:22"><sup>22</sup></a></p> <h3>Gene and protein expression</h3> <p class="note">Further information: <a href="/facts/Bioinformatics/D5x2L8ee">Bioinformatics § Gene and protein expression</a></p> <p>About 20,000 protein coding genes are expressed in human cells and 70% of these genes are expressed in the normal duodenum.<a class="footnote-ref" id="fnref:23" href="#fn:23"><sup>23</sup></a><a class="footnote-ref" id="fnref:24" href="#fn:24"><sup>24</sup></a> Some 300 of these genes are more specifically expressed in the duodenum with very few genes expressed only in the duodenum. The corresponding specific proteins are expressed in the duodenal mucosa, and many of these are also expressed in the small intestine, such as <a href="/facts/Alanine_aminopeptidase/eF8tn42c">alanine aminopeptidase</a>, a digestive enzyme, <a href="/facts/Angiotensin-converting_enzyme/n6hlpyJh">angiotensin-converting enzyme</a>, involved in controlling <a href="/facts/Blood_pressure/VtqqSM2J">blood pressure</a>, and <a href="/facts/RBP2/uyC023Rf">RBP2</a>, a protein involved in the uptake of <a href="/facts/Vitamin_A/5ewDf9LF">vitamin A</a>.<a class="footnote-ref" id="fnref:25" href="#fn:25"><sup>25</sup></a> </p> <h2 id="function">Function</h2> <p>The duodenum is largely responsible for the breakdown of food in the small intestine, using <a href="/facts/Enzymes/DSI1Fh7y">enzymes</a>. The duodenum also regulates the rate of emptying of the stomach via hormonal pathways. <a href="/facts/Secretin/M77lRJbo">Secretin</a> and <a href="/facts/Cholecystokinin/VILtAKuT">cholecystokinin</a> are released from cells in the duodenal <a href="/facts/Epithelium/ecKHcHC3">epithelium</a> in response to acidic and fatty stimuli present there when the <a href="/facts/Pylorus/920mWuBz">pylorus</a> opens and emits gastric <a href="/facts/Chyme/zty06x48">chyme</a> into the duodenum for further digestion. These cause the <a href="/facts/Liver/Rtp4Fk2b">liver</a> and <a href="/facts/Gallbladder/RPdkQzQM">gallbladder</a> to release <a href="/facts/Bile/7c5ufDao">bile</a>, and the <a href="/facts/Pancreas/r0WPGjAq">pancreas</a> to release bicarbonate and digestive enzymes such as <a href="/facts/Trypsin/wrwS23rh">trypsin</a>, <a href="/facts/Lipase/nPgIyNBS">lipase</a> and <a href="/facts/Amylase/H1MPNNVL">amylase</a> into the duodenum as they are needed.<a class="footnote-ref" id="fnref:26" href="#fn:26"><sup>26</sup></a> </p><p>The duodenum is a critical contributor to the regulation of food intake<a class="footnote-ref" id="fnref:27" href="#fn:27"><sup>27</sup></a> and glycemic control.<a class="footnote-ref" id="fnref:28" href="#fn:28"><sup>28</sup></a> As the first part of the small intestine, the duodenum is the initial site of nutrient absorption in the gastrointestinal tract. The duodenum senses nutrient intake and composition, and signals to the liver, pancreas, adipose tissue and brain<a class="footnote-ref" id="fnref:29" href="#fn:29"><sup>29</sup></a> through the direct and indirect<a class="footnote-ref" id="fnref:30" href="#fn:30"><sup>30</sup></a> release of several key hormones and signaling molecules, including the <a href="/facts/Incretin/kbgYIfGR">incretin</a> peptides <a href="/facts/Glucose-dependent_insulinotropic_polypeptide/VyhleUdR">Glucose-dependent insulinotropic polypeptide</a> (GIP) and <a href="/facts/Glucagon-like_peptide-1/BAzQx5pJ">Glucagon-like peptide-1</a> (GLP-1),<a class="footnote-ref" id="fnref:31" href="#fn:31"><sup>31</sup></a> as well as <a href="/facts/Cholecystokinin/VILtAKuT">Cholecystokinin</a> (CCK) and <a href="/facts/Secretin/M77lRJbo">Secretin</a>. The duodenum also signals to the brain directly via vagal afferents enabling neural control over food intake and glycemia.<a class="footnote-ref" id="fnref:32" href="#fn:32"><sup>32</sup></a> Intestinal secretion of GIP and GLP-1 stimulates glucose-dependent insulin secretion from pancreatic beta-cells, known as the incretin effect.<a class="footnote-ref" id="fnref:33" href="#fn:33"><sup>33</sup></a> Incretin peptides, principally GLP-1 and GIP, regulate islet hormone secretion, glucose concentrations, lipid metabolism, gut motility, appetite and body weight, and immune function.<a class="footnote-ref" id="fnref:34" href="#fn:34"><sup>34</sup></a> </p><p>The villi of the duodenum have a leafy-looking appearance, which is a histologically identifiable structure. <a href="/facts/Brunner%2527s_glands/XrF34qNb">Brunner's glands</a>, which secrete <a href="/facts/Mucus/hnlBuHAy">mucus</a>, are only found in the duodenum. The duodenum wall consists of a very thin layer of cells that form the <a href="/facts/Muscularis_mucosae/I7NRmALL">muscularis mucosae</a>. </p> <h2 id="clinical-significance">Clinical significance</h2> <h3>Ulceration</h3> <p class="note">Main article: <a href="/facts/Peptic_ulcer_disease/peMGnYCd">Peptic ulcer disease</a></p> <p>Ulcers of the duodenum commonly occur because of infection by the bacteria <i><a href="/facts/Helicobacter_pylori/9q4H68LP">Helicobacter pylori</a></i>. These bacteria, through a number of mechanisms, erode the protective mucosa of the duodenum, predisposing it to damage from gastric acids. The first part of the duodenum is the most common location of ulcers since it is where the acidic chyme meets the duodenal mucosa before mixing with the alkaline secretions of the duodenum.<a class="footnote-ref" id="fnref:35" href="#fn:35"><sup>35</sup></a> Duodenal ulcers may cause recurrent abdominal pain and <a href="/facts/Dyspepsia/axnCu0gn">dyspepsia</a>, and are often investigated using a <a href="/facts/Urea_breath_test/KeAnw8Qx">urea breath test</a> to test for the bacteria, and <a href="/facts/Endoscopy/L4V1fGPN">endoscopy</a> to confirm ulceration and take a <a href="/facts/Biopsy/A0TdRRlr">biopsy</a>. If managed, these are often managed through <a href="/facts/Antibiotic/sF1kIfxg">antibiotics</a> that aim to eradicate the bacteria, and <a href="/facts/Proton-pump_inhibitors/JIpwabbk">proton-pump inhibitors</a> and <a href="/facts/Antacid/CP9PeyQ8">antacids</a> to reduce the gastric acidity.<a class="footnote-ref" id="fnref:36" href="#fn:36"><sup>36</sup></a> </p> <h3>Celiac disease</h3> <p>The <a href="/facts/British_Society_of_Gastroenterology/lN6B49Ck">British Society of Gastroenterology</a> guidelines specify that a duodenal biopsy is required for the diagnosis of adult <a href="/facts/Celiac_disease/AKd5PkTc">celiac disease</a>. The biopsy is ideally performed at a moment when the patient is on a gluten-containing diet.<a class="footnote-ref" id="fnref:37" href="#fn:37"><sup>37</sup></a> </p> <h3>Cancer</h3> <p>Duodenal cancer is a cancer in the first section of the small intestine. Cancer of the duodenum is relatively rare compared to <a href="/facts/Stomach_cancer/HJjYtkqS">stomach cancer</a> and <a href="/facts/Colorectal_cancer/nV592sW7">colorectal cancer</a>; malignant tumors in the duodenum constitute only around 0.3% of all the gastrointestinal tract tumors but around half of cancerous tissues that develop in the small intestine.<a class="footnote-ref" id="fnref:38" href="#fn:38"><sup>38</sup></a> Its histology is often observed to be <a href="/facts/Adenocarcinoma/TU7W6WbJ">adenocarcinoma</a>, meaning that the cancerous tissue arises from glandular cells in the <a href="/facts/Epithelial_tissue/ecKHcHC3">epithelial tissue</a> lining the duodenum.<a class="footnote-ref" id="fnref:39" href="#fn:39"><sup>39</sup></a> </p> <h3>Obesity and Diabetes</h3> <p>A <a href="/facts/Western_diet/6fdL7lIc">western diet</a> induces duodenal mucosal hyperplasia and dysfunction that underlie insulin resistance, type 2 diabetes and obesity.<a class="footnote-ref" id="fnref:40" href="#fn:40"><sup>40</sup></a><a class="footnote-ref" id="fnref:41" href="#fn:41"><sup>41</sup></a> Diet-induced duodenal mucosal hyperplasia consists of increased mucosal mass,<a class="footnote-ref" id="fnref:42" href="#fn:42"><sup>42</sup></a> increased villus length,<a class="footnote-ref" id="fnref:43" href="#fn:43"><sup>43</sup></a><a class="footnote-ref" id="fnref:44" href="#fn:44"><sup>44</sup></a><a class="footnote-ref" id="fnref:45" href="#fn:45"><sup>45</sup></a><a class="footnote-ref" id="fnref:46" href="#fn:46"><sup>46</sup></a> decreased crypt density,<a class="footnote-ref" id="fnref:47" href="#fn:47"><sup>47</sup></a> proliferation of enteroendocrine cells,<a class="footnote-ref" id="fnref:48" href="#fn:48"><sup>48</sup></a> increased enterocyte mass,<a class="footnote-ref" id="fnref:49" href="#fn:49"><sup>49</sup></a> and an accumulation of lipid droplets in the mucosa.<a class="footnote-ref" id="fnref:50" href="#fn:50"><sup>50</sup></a><a class="footnote-ref" id="fnref:51" href="#fn:51"><sup>51</sup></a> Diet induced duodenal dysfunction includes increased duodenal nutrient absorption,<a class="footnote-ref" id="fnref:52" href="#fn:52"><sup>52</sup></a><a class="footnote-ref" id="fnref:53" href="#fn:53"><sup>53</sup></a><a class="footnote-ref" id="fnref:54" href="#fn:54"><sup>54</sup></a><a class="footnote-ref" id="fnref:55" href="#fn:55"><sup>55</sup></a> altered duodenal hormone secretion,<a class="footnote-ref" id="fnref:56" href="#fn:56"><sup>56</sup></a><a class="footnote-ref" id="fnref:57" href="#fn:57"><sup>57</sup></a> and altered intestinal vagal afferent neuronal function.<a class="footnote-ref" id="fnref:58" href="#fn:58"><sup>58</sup></a> </p> <h3>Inflammation</h3> <p>Inflammation of the duodenum is referred to as <a href="/facts/Duodenitis/8flz6o4k">duodenitis</a>. There are multiple known causes.<a class="footnote-ref" id="fnref:59" href="#fn:59"><sup>59</sup></a> Celiac disease and inflammatory bowel disease are two of the known causes.<a class="footnote-ref" id="fnref:60" href="#fn:60"><sup>60</sup></a> </p> <h2 id="etymology">Etymology</h2> <p>The name <i>duodenum</i> is <a href="/facts/Medieval_Latin/gyLMjaCX">Medieval Latin</a>, short for <i>intestīnum duodēnum digitōrum</i>, meaning "intestine of twelve finger-widths (in length)", genitive of <i>duodēnī</i>, "twelve each", (related to <i>duodecim</i> "twelve"). Coined by Gerard of Cremona (d. 1187) in his Latin translation of "Canon Avicennae", "اثنا عشر" itself a loan-translation of Greek dodekadaktylon (δωδεκάδάκτυλον), literally "twelve fingers long". The intestine part was so called by the Greek physician <a href="/facts/Herophilus/pSd5dwpM">Herophilus</a> (c. 335–280 BCE) for its length, about equal to the breadth of 12 fingers.<a class="footnote-ref" id="fnref:61" href="#fn:61"><sup>61</sup></a> </p><p>Many languages use <a href="/facts/Calque/A9M3UtAo">calques</a> for this word. For example, <a href="/facts/German_language/oWaQIDA8">German</a> <i>Zwölffingerdarm</i>, <a href="/facts/Dutch_language/yIB5lbsx">Dutch</a> <i>Twaalfvingerige darm</i> and <a href="/facts/Turkish_language/C5X56Ijp">Turkish</a> <i>Oniki parmak bağırsağı</i>. </p> <h2 id="additional-images">Additional images</h2> <h2 id="see-also">See also</h2> <p class="note">This article uses <a href="/facts/Anatomical_terminology/n3IASQlr">anatomical terminology</a>.</p> Wikimedia Commons has media related to Duodenum. Look up <i>duodenum</i> in Wiktionary, the free dictionary. <ul><li><a href="/facts/Pancreas/r0WPGjAq">Pancreas</a></li> <li><a href="/facts/Choledochoduodenostomy/sYlsb9jY">Choledochoduodenostomy</a> - a surgical procedure to create a connection between the common bile duct (CBD) and an alternative portion of the duodenum.</li></ul> <h2 id="external-links">External links</h2> Look up <i>duodenum</i> in Wiktionary, the free dictionary. <ul><li><a href="https://www.proteinatlas.org/humanproteome/duodenum">Duodenum</a> at the <a href="https://www.proteinatlas.org">Human Protein Atlas</a></li> <li><a href="http://www.wesnorman.com/Duodenum.htm">Duodenum</a> at The Anatomy Lesson by Wesley Norman (Georgetown University)</li></ul> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>"NCI Dictionary of Cancer Terms". National Cancer Institute. Retrieved 2022-06-07. The first part of the small intestine. It connects to the stomach. 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