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of the field of academic study in which one concentrates or specializes; "his major field was mathematics"
a commissioned military officer in the United States Army or Air Force or Marines; below lieutenant colonel and above captain
a university student who is studying a particular field as the principal subject; "she is a linguistics major"
the principal field of study of a student at a university; "her major is linguistics"
greater in number or size or amount; "a major portion (a majority) of the population"; "Ursa Major"; "a major portion of the winnings"
greater in scope or effect; "a major contribution"; "a major improvement"; "a major break with tradition"; "a major misunderstanding"
have as ones principal field of study; "She is majoring in linguistics"
of a scale or mode; "major scales"; "the key of D major"
of full legal age
of greater importance or stature or rank; "a major artist"; "a major role"; "major highways"
of greater seriousness or danger; "a major earthquake"; "a major hurricane"; "a major illness"
of the elder of two boys with the same family name; "Jones major"
(botany) a tiny outgrowth on the surface of a petal or leaf
a small nipple-shaped protuberance concerned with taste, touch, or smell; "the papillae of the tongue"
a small projection of tissue at the base of a hair or tooth or feather
British statesman who was prime minister from 1990 until 1997 (born in 1943) (同)John Major, John R. Major, John Roy Major

PrepTutorEJDIC

『大きい』(『多い』)『ほうの』,いっそう重要な / (音階が)長調の,長音階の / 《英》《昔の学校で同姓または兄弟生徒を区別するために姓の後につけて》年長の,兄の / 《しばしばM-》陸軍(空軍)少佐 / 《米》専攻科目;専攻学生 / 《the majors》《米》=major leagues / (科目を)専攻する《+『in』+『名』》
乳頭;(毛根・歯根などにある)微小乳頭状突起物

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/07/18 21:05:13」(JST)

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The major duodenal papilla is an opening of the pancreatic duct into the duodenum. The major duodenal papilla is, in most people, the primary mechanism for the secretion of bile and other enzymes that facilitate digestion.

Structure

1. Bile ducts: 2. Intrahepatic bile ducts, 3. Left and right hepatic ducts, 4. Common hepatic duct, 5. Cystic duct, 6. Common bile duct, 7. Ampulla of Vater, 8. Major duodenal papilla
9. Gallbladder, 10–11. Right and left lobes of liver. 12. Spleen.
13. Esophagus. 14. Stomach. 15. Pancreas: 16: Accessory pancreatic duct, 17: Pancreatic duct.
18. Small intestine: 19. Duodenum, 20. Jejunum
21–22: Right and left kidneys (silhouette).

The anterior border of the liver is lifted upwards (brown arrow). Gallbladder with Longitudinal section, pancreas and duodenum with frontal one. Intrahepatic ducts and stomach in transparency.

The major duodenal papilla is situated in the second part of the duodenum, 7-10 cm from the pylorus, at the level of the second or third lumbar vertebrae. It is surrounded by the sphincter of Oddi, and receives a mixture of pancreatic enzymes and bile from the Ampulla of Vater, which drains both the pancreatic duct and biliary system.^[1] The junction between the foregut and midgut occurs directly below the major duodenal papilla.^[2] ^:274

The major duodenal papilla is seen from the duodenum as lying within a mucosal fold. The minor duodenal papilla is situated 2cm proximal.^[1]

Variation

The major duodenal papilla is occasionally found in the third part of the duodenum, the level of the vertebrae may be L2-3, and in about 10% of people, it may not receive bile. Additionally, in a small number of people, the primary papilla for draining the pancreas may in fact be the accessory pancreatic duct.^[1]

Clinical significance

History

The major duodenal papilla was first illustrated by Gottfreid Bidloo in 1685, although is sometimes called the papilla of Vater, after German anatomist Abraham Vater.^[1]

External links

pancreas at The Anatomy Lesson by Wesley Norman (Georgetown University)
digest-019—Embryo Images at University of North Carolina
Swiss embryology (from UL, UB, and UF) sdigestive/pankreas01

References

This article incorporates text in the public domain from the 20th edition of Gray's Anatomy (1918)

^ ^a ^b ^c ^d Skandalakis, editor in chief John E. (2004). Skandalakis' surgical anatomy : the embryologic and anatomic basis of modern surgery. Athens, Greece: PMP. pp. Chapter 16: Small Intestine; Chapter 21:Pancreas, sections titled "Major duodenal papilla". ISBN 9603990744.
^ Drake, Richard L.; Vogl, Wayne; Tibbitts, Adam W.M. Mitchell; illustrations by Richard; Richardson, Paul (2005). Gray's anatomy for students. Philadelphia: Elsevier/Churchill Livingstone. ISBN 978-0-8089-2306-0.

UpToDate Contents

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1. 非転移性カルチノイド腫瘍の治療およびサーベイランス treatment and surveillance of non metastatic carcinoid tumors
2. 膵胆管系の管腔内超音波検査 intraductal ultrasound of the pancreaticobiliary ductal system
3. 十二指腸乳頭部癌：疫学、臨床症状、診断および病期分類 ampullary carcinoma epidemiology clinical manifestations diagnosis and staging
4. 乳頭部癌：治療および予後 ampullary carcinoma treatment and prognosis
5. 乳頭部腺腫の臨床症状および診断 clinical manifestations and diagnosis of ampullary adenomas

English Journal

Neuroendocrine tumor of the ampulla of Vater with distant cystic lymph node metastasis: a case report.

Tsukagoshi M1,2, Hosouchi Y2, Araki K3, Mochida Y1, Aihara R1,2, Shirabe K4, Kuwano H1.
Surgical case reports.Surg Case Rep.2016 Dec;2(1):73. doi: 10.1186/s40792-016-0202-1. Epub 2016 Jul 25.
BACKGROUND: Neuroendocrine tumors (NETs) of the ampulla of Vater are rare and difficult to diagnose. We report a rare case of a small NET of the ampulla of Vater with metastasis to distant lymph nodes.CASE PRESENTATION: The patient was a 54-year-old man complaining of epigastric pain and melena. Upp
PMID 27457078

Poorly cohesive adenocarcinoma of the ampulla of Vater: a case report.

Yamauchi H1, Sakurai S2, Hagiwara K3, Yoshida T4, Tabe Y5, Fukasawa T6, Kiriyama S7, Fukuchi M8, Naitoh H9, Kuwano H10.
Surgical case reports.Surg Case Rep.2016 Dec;2(1):15. doi: 10.1186/s40792-016-0142-9. Epub 2016 Feb 15.
A 47-year-old Japanese male was submitted to pancreaticoduodenectomy for an ampullary cancer. Pathologically, the ampullary cancer was poorly cohesive adenocarcinoma without tubular structure. Moreover, locoregional lymph nodes were swollen with hypervascularity, plasmacytes infiltration, and hemorr
PMID 26943691

Primary squamous cell carcinoma of the ampulla of Vater: a case report.

Balci B1, Calik B2, Karadeniz T3, Sahin H4, Ugurlu L5, Aydin C6.
Surgical case reports.Surg Case Rep.2016 Dec;2(1):2. doi: 10.1186/s40792-016-0130-0. Epub 2016 Jan 8.
BACKGROUND: Primary squamous cell carcinoma of the ampulla of Vater is a very rare type of tumor, and the prognosis is not well known mainly due to a limited number of cases reported. Here, we aimed to report a case with primary squamous cell carcinoma of the ampulla of Vater.CASE PRESENTATION: A 54
PMID 26943678

Japanese Journal

先天性胆道拡張症の手術時に発見された重複総胆管の1例

日本小児外科学会雑誌 48(4), 731-737, 2012
NAID 110009470927

十二指腸乳頭部に関する内視鏡的考察

日本内視鏡学会誌 13(2), 227-235, 1971
NAID 130001645952

日本人十二指腸の肝膵管開口部の解剖学的研究

昭和医学会雑誌 20(6), 549-564, 1960
NAID 130001821192

「大十二指腸乳頭」

Major duodenal papilla
	Interior of the descending portion of the duodenum, showing bile papilla.
	The pancreatic duct.
Details
Identifiers
Latin	papilla duodeni major
Dorlands; /Elsevier	p_03/12610350
TA	A05.6.02.015
FMA	15074
	Anatomical terminology [edit on Wikidata]