Ampulla of Vater

Not to be confused with the Duodenal cap also known as the Duodenal Ampulla, the first part of the duodenum.

Ampulla of Vater
A diagram of the Biliary system. Note that the ampulla of Vater is behind the Major duodenal papilla.
The Major duodenal papilla, seen on duodenoscopy at the time of ERCP. This is the protrusion of the ampulla of Vater into the duodenum.
Latin	Ampulla hepatopancreatica, ampulla Vaterii
Gray's	subject #250 1199
MeSH	Ampulla+of+Vater

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. Small intestine: 15. Duodenum, 16. Jejunum
17. Pancreas: 18: Accessory pancreatic duct, 19: Pancreatic duct.
20-21: 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 ampulla of Vater, also known as the hepatopancreatic ampulla, is formed by the union of the pancreatic duct and the common bile duct. The ampulla is specifically located at the major duodenal papilla.

The ampulla of Vater is an important landmark, halfway along the second part of the duodenum, that marks the anatomical transition from foregut to midgut (and hence the point where the celiac trunk stops supplying the gut and the superior mesenteric artery takes over).

Function

Various smooth muscle sphincters regulate the flow of bile and pancreatic juice through the ampulla: the sphincter of the pancreatic duct, the sphincter of the bile duct, and the hepatopancreatic sphincter (Sphincter of Oddi).

The sphincter of Oddi controls the introduction of bile and pancreatic secretions into the duodenum, as well as preventing the entry of duodenal contents into the ampulla.

Related disorders

• Pancreatitis can result from a failure of pancreatic secretions to drain properly. One possible cause of impaired drainage of pancreatic juice is blockage of the hepatopancreatic ampulla. A common culprit to cause blockage is a gallstone in the common bile duct.

Eponym

The eponymical term "ampulla of Vater" is named after Abraham Vater (1684–1751), a German anatomist who first published a description of it in 1720.

Hepato - pancreatic anatomy: The gall bladder has a duct that leaves the organ called the cystic duct.The cystic duct moves into the common bile duct. This duct breaks off into the right and left bile duct. The common bile duct feeds into the duodenum via the ampulla of Vater. The ampulla of Vater is the site where the common bile duct and the pancreatic duct converge. Leading from the pancreas is the pancreatic duct. The pancreatic duct delivers substances such as sodium hydrogencarbonate and digestive enzymes to the duodenum. The bile from the gall bladder contains salts which emulsify the fat droplets which are large, into much smaller units. This provides a large surface area for the lipase enzymes to act on. The sodium hydrogencarbonate neutralises the acidic chyme, creating alkaline conditions as enzymes such as chymotrypsin and amylase work best at these pH.

Additional images

• 

  The pancreatic duct.

• 

  Carcinoma of Ampulla

References

• "Ampulla, hepatopancreatic." Stedman's Medical Dictionary, 27th ed. (2000). ISBN 0-683-40007-X
• Moore, Keith L. and Arthur F. Dalley. Clinically Oriented Anatomy, 4th ed. (1999). ISBN 0-683-06141-0