Papilla Duodeni Major: Structure, Function & Diseases

By the papilla duodeni major, physicians mean a mucosa-fold elevation in the duodenum. The ducts of the pancreas and bile open into this elevation. The sphincter of the papilla thus controls the release of bile and digestive enzymes into the small intestine as needed.

What is the greater papilla duodeni?

The papilla duodeni major is a fold of mucosa in the duodenum. This anatomic structure is also known as the duodenal large wart. In technical language, the wart-like structure is also called papilla vateri or Vater’s papilla. These names refer to the first describer, Abraham Vater, who discovered the structure in the 18th century. The mucosal fold appears in the form of a small elevation and is located in the posterior and descending part of the duodenum. Both the bile duct and the pancreatic duct open into this papilla. The papilla duodeni major can be distinguished from the papilla duodeni minor. This “small duodenal papilla” is also located in the posterior descending part of the duodenum. It provides an orifice for the pancreas, but not for bile. This smaller mucosal fold is not preserved in all humans, but is more commonly seen in dogs and horses, which naturally have an additional pancreatic duct.

Anatomy and structure

In the duodenum, the common bile duct and the pancreatic duct open into the same excretory duct. This common excretory duct of the pancreas and bile drains into the large papilla of the duodenum. At the mouth of the pancreatic and bile ducts, a sphincter muscle called the sphincter Oddii muscle is located in the papilla. This ring-shaped sphincter first forms the elevation that gives the papilla duodeni major its shape. The musculature of the sphincter corresponds to smooth muscle and contracts in response to commands from the digestive nerves. Occasionally, the pancreatic duct also opens into an additional and separate papilla, which is then called the papilla duodeni minor. However, this minor papilla never forms a common orifice of the bile duct and pancreas, as does the papilla duodeni minor.

Function and Tasks

The tasks of the papilla duodeni major are predominantly related to the sphincter muscle, Musculus sphincter Oddii. This muscle closes or opens the orifice ducts of the bile and pancreas. To do this, the muscle contracts and relaxes again. Thus, on the one hand, the papilla duodeni major regulates the emptying of bile from the common bile duct. On the other hand, the anatomical structure also regulates the secretion of the pancreas from the pancreatic duct on the basis of the sphincter contractions. Important digestive enzymes are formed in the pancreas. Without these enzymes, the digestive tract could not break down ingested food. Thus, by regulating pancreatic emptying, the greater papilla duodeni controls the release of these enzymes to the small intestine. Bile is also released to the duodenum as needed. Just as digestion could not occur smoothly without digestive enzymes from the pancreas, it could not occur without bile. Bile aids in the digestion of fats and the absorption of vitamins by the intestines. As long as bile is not needed in the intestine, the sphincter of the papilla duodeni major remains tense. On the other hand, when bile is needed, the sphincter opens. The bile thus drains directly into the duodenum via the common bile duct. The papilla duodeni major precisely and expediently matches the concentration of pancreatic secretion and bile, and its sphincter is controlled by the autonomic nervous system of digestion, called the enteric nervous system, and is thus not subject to consciousness.

Diseases

When bile or pancreatic secretions accumulate, it is usually related to functional impairments of the respective orifices. Such functional impairments often have to do with a benign or even malignant tumor that constricts the ducts, preventing fluid from passing through. The common orifice of the pancreas and bile can also be affected by tumors. Such tumors in the papilla vateri are also called papillary tumors. They are usually adenocarcinomas. They often develop from benign adenomas of the surrounding mucosal tissue.Even such a benign adenoma can already cause congestion of pancreatic and bile fluid. Indigestion, abdominal pain, nausea, jaundice and inflammation of the pancreas are among the most common accompanying symptoms of this disease. Papillary tumors are usually detected early enough to avoid serious consequences. The main reason for the high rate of early detection is jaundice, which may occur even before degeneration and, together with typical accompanying symptoms, can alert the physician to a disorder of papillary function. Many papillary tumors are benign. This is especially true for small papillary tumors without bleeding or induration. Such do not necessarily have to be removed from the papilla duodeni major. They may be observed over a period of time. However, because of the risk of degeneration of such appearances, removal may be useful even when it is not absolutely necessary. Apart from tumorous diseases, the sphincter of the papilla may also be affected by paralytic phenomena. Bile and pancreatic secretions then flow unimpeded into the small intestine. However, because the activities of the entire digestive tract are controlled by an autonomic nervous system, this phenomenon is rare.