Duodenal papillae are elevated openings that are found on the duodenum. Two of these openings typically exist in the small intestine, and they are called the major and the minor duodenal papillae. Bile and pancreatic juice enter the small intestine by way of the major papilla in order to aid the digestive process. The small intestine consists of not only the duodenum, but also the jejunum and the ileum. It is attached to the stomach and is where a lot of the digestion process takes place.
The major papilla is located in the descending, or second portion of the duodenum. This papilla is also called the Papilla of Vater. This is the opening where pancreatic juice and bile pass into the duodenum from the pancreatic and common bile ducts. The two ducts combine and form what is called the hepatopancreatic ampulla, or what is commonly known as the ampulla of Vater. A sphincter called the sphincter of Oddi regulates the opening of the duodenal papilla by opening and closing to allow the digestive juices coming from the ampulla of Vater to enter.
Many people also have what is called the minor duodenal papilla, but it is not present in everyone. This is because some people have an accessory pancreatic duct, or what is known as the duct of Santorini. The location of the minor papilla is somewhat above its major counterpart and also leads into the duodenum. It may serve as a backup to the major duodenal papilla in the event that it is not working properly, but it is most often inactive or non-functioning.
Potential problems associated with the duodenal papillae include blockage caused by gallstones. Gallstones may move from the gallbladder and become lodged in the papilla. When this occurs the secretions of pancreatic juice and bile are hindered from entering the duodenum and can cause a back-up. The resulting build-up of pancreatic fluid can result in pancreatitis, or inflammation of the pancreas. In addition, jaundice may occur from bile backing up into the bloodstream. To prevent complications such as these, doctors often surgically remove the gallstones.
Familial adenomatous polyposis (FAP), is another potential concern regarding the duodenal papilla. This is a hereditary condition that can leave potentially cancer-causing polyps on the papilla. The number of polyps is often extensive and requires routine side-view endoscopic screening to ensure that they have not become cancerous. In addition, biopsies may be necessary, particularly if the polyps appear unusual or overly large.