Abdominal anatomy Flashcards
1
Q
What structures do we pass through in midline incision?
A
Skin Campers Scarpas Linea alba Transversalis fascia Extra-peritoneal fat Parietal peritoneum
2
Q
Whats structures do we pass through in a grid-iron incision?
A
Skin Campers Scarpas EO IO TA Transversalis fascia Extra-peritoneal fat Parietal peritoneum
3
Q
Transverse incision - what structures do we pass through?
A
Skin campers Scarpas ±EO depending how lateral Anterior rectus fascia Rectus ± IO depending how lateral TA TF EP fat Parietal peritoneum
4
Q
What level is the transpyloric plane, what is at this level?
Remember the story….
A
L1
Pylorus of the stomach Left hilum of kidney fundus with the gallbladder Neck of the pancreas 2nd part of the duodenal DJ flex him L +R colic flexure SMA, portal vein Spleen
5
Q
Subcostal plane?
A
Margin of 10th costal cartilage
6
Q
Intercostal plane?
A
Highest point of iliac crest = L4
7
Q
Intertubercular plane?
A
L5
8
Q
Levels of the: IMA, aortic bifurcation, IVC formation from common iliac veins?
A
L3, L4, L5
9
Q
Difference between superficial fascia above and below umbillicus
A
Above = 1 layer
Below = Campers fascia and Scarpas fascia
Campers = superficial fatty layer
Scarpas = membranous deep layer
- It is the Scarpas fascia that is only really found below umbilicus
10
Q
How does Campers fascia continue inferiorly in men vs women?
A
Men = continues to penis, after losing fat becomes continuous with scrotum - dartos fascia
Women - retains some fat > labium majora
11
Q
How does Scarpas fascia continue inferiorly?
A
Continues into thigh and just under inguinal ligament fuses with deep fascia of thigh = fascia lata
Continues into anterior perineum = attaches to ischiopubic rami + posterior perineal membrane = Colle’s fascia
In men = blends with superficial layers as it passes over penis, before continuing to scrotum to become dartos fascia
In men you also have extensions reaching dorsum of penis as fungiform ligament
Women = continues to become labia majora and perineum
In midline it is firmly attached to linea alba and symphysis pubis
12
Q
External oblique - origin, insertion, innervation?
A
Origin = outer surface of lower 8 ribs (5-12)
Insertion = anterior 2/3rds - outer lip of iliac crest
Aponeurosis in midline with linea alba
Innervation = Ventral rami of lower 6 spinal thoracic nerves
13
Q
Internal oblique - origin, insertion and innervation?
A
Origin = From thoracolumbar fascia - anterior 2/3rds of iliac crest and lateral 2/3rds of inguinal ligament Insertion = lower 3 ribs
Ventral rami of lower 6 spinal thoracic nerves
14
Q
Transversus abdominus - origin, insertion and innervation?
A
Origin = inner aspect of costal cartilages of lower 6 ribs, anterior 2/3rds of iliac crest, lateral 1/3rd of inguinal ligament
Insertion = Pubic crest and pectineal line
Ventral rami of lower 6 spinal thoracic nerves
15
Q
Why is transversalis fascia unique?
A
All flat muscles (EO, IO, TA) are surrounded by fascia
But the deep fascia of the transversalis abdominus is more developed = transversalis fascia
16
Q
Which abdominal muscle forms the anterior wall of inguinal canal?
A
Aponeurosis of external oblique
17
Q
Which abdominal muscles lower border forms inguinal ligament?
What other ligaments does inguinal ligament form medially?
A
External oblique
Lacunar ligament attaches to pectin pubis of superior pubic ramus
Coopers ligament extends to pectin pubis of pelvic brim
18
Q
Rectus abdominus - origin, insertion and innervation?
A
Origin = pubic symphysis, crest and tubercle Insertion = costal cartilage of rib 5-7 and xiphoid process
Ventral rami of lower 6 spinal thoracic nerves
19
Q
Rectus sheath above costal margin vs above arcuate line vs below arcuate line?
A
Above costal margin = anterior sheath is only external oblique
Above arcuate line:
Internal oblique splits to anterior and posterior sheath
Anterior with EO
Posterior with TA
Below arcuate line all muscle go to anterior sheath = no posterior sheath
20
Q
What is the arcuate line?
A
Where inferior epigastric vessels enter the rectus sheath
21
Q
How are the greater sac and omental bursa of peritoneal cavity connected?
A
Epiploic foramen
22
Q
What is boundaries of epiploic foramen?
A
Anterior = portal vein, hepatic artery and bile duct
- These are all enclosed in the hepatoduodenal ligament
Posterior = IVC
Superior = caudate lobe of liver
Inferior = First part of duodenum
23
Q
Superficial blood supply of abdominal wall?
A
Superior wall = Musculophrenic and internal thoracic
Inferior = Femoral artery via superficial epigastric and superficial circumflex
24
Q
Deeper blood supply of abdominal wall?
A
Superior = superior epigastric (Terminal branch of internal thoracic)
Inferior = inferior epigastric and deep circumflex of iliac (both branches of external iliac)
Laterally = intercostal and subcostal
25
Lymphatic drainage of abdominal wall?
Above umbilicus = axillary
| Below = superficial inguinal
26
Where does the greater omentum attach?
Greater curve of the stomach and 1st part of duodenum
Then passes inferiorly over transverse colon and jejunum
Then turns posteriorly and ascends to join posterior border of transverse colon
27
What two arteries lie with greater omentum, and where do they originate from?
Left and right gastro-epiploic
```
Left = splenic
Right = terminal branch of gastroduodenal (from common hepatic artery)
```
28
Where does lesser omentum attach?
How can we divide it?
Lesser curve of stomach and first part of duodenum
To the inferior surface of liver
Into hepatoduodenal ligament and hepatogastric ligament
29
What is significant about hepatoduodenal ligament?
Is anterior border of epiploic foramen
Houses:
Portal vein
Hepatic artery proper
Bile duct
30
Which arteries lie between the two layers of the lesser omentum?
Left and right gastric
31
What are the three peritoneal folds which attach organs to posterior abdominal walls?
1. Mesentery - connect jejunum and ileum to posterior wall.
2. Transverse mesocolon - begins at head + body of pancreas
3. Sigmoid mesocolon - joins sigmoid colon to posterior abdominal wall. Contains sigmoid and superior rectal vessels.
32
Where does oesophagus begin and end?
Where does it pierce the diaphragm ?
C6 to T11
T10
33
Narrowings of the oesophagus?
ABCD
Arch of aorta
Left main stem bronchus
Cricoid cartilage
Diaphragmatic orifice
34
Histology of oesophagus?
Mucosa = non-keratinised squamous epithelium
Submucosa = glandular tissue
Muscularis externa
Adventitia
NO SEROSAL LAYER
35
Muscularis externa of oesophagus in upper vs lower?
```
Upper = striated
Middle = both
Lower = smooth
```
36
Upper middle lower oesophagus - artery, vein and lymphatic supply?
Artery: Inferior thyroid, aortic branches, left gastric
Veins: Inferior thyroid, azygous system, left gastric
Lymphatics = Deep cervical, mediastinal, gastric
37
Nerve supply of oesophagus?
```
Upper = recurrent laryngeal
Lower = oesophageal plexus = vagus
```
38
Arterial supply of the stomach?
Left gastric from coeliac trunk
Right gastric from common hepatic
Left gastro-epiploic from splenic artery
Right gastro-epiploic from the gastroduodenal
39
three main branches of coeliac axis, and the some of the main branches of these as well?
Left gastric
Common hepatic > right gastric, gastroduodenal and proper artery hepatic, cystic.
- GDA:
right gastro-epiploic + superior pancreaticoduodenal, duodenal branches
Splenic > Left gastro-epiploic, short gastric and pancreatic
40
What does the right gastro-epiploic pass through?
The layers of the greater omentum
41
Relations to the coeliac axis?
```
Inferior = pancreatic body and renal vein
Right = coeliac ganglion and liver
Left = Coeliac ganglion and gastric cardia
```
42
4 parts of the duodenum and their relations?
Superior part = from pyloric orifice to neck of gallbladder at L1
- Passes anterior to bile duct, gastroduodenal artery, IVC and portal vein
Descending part = neck of gallbladder down to L3
- Anterior = transverse colon
- Posterior = right kidney
Medial = head of the pancreas
Inferior part = Crosses IVC, aorta and vertebral bodies
-crossed anteriorly by SMA and SMV
Ascending part = upwards to the left of the aorta to about L2
- terminates at duodojejunal flexure
43
what ligament surrounds duodenojejunal flexure?
Suspensory ligament of duodenum / Ligament of Treitz . This is a fold of the peritoneum.
44
Where are the two papilla in the duodenum?
Both in descending duodenum:
Major papilla = CBD and pancreatic duct
Minor papilla = accessory pancreatic duct and junction of midgut and foregut
45
Whats the arterial supply of duodenum?
Coeliac axis = ant and post. SUPERIOR pancreaticoduodenal, supraduodenal
SMA = ant and post. INFERIOR pancreaticoduodenal, 1st jejunal branch
46
Jejunal blood supply vs ileal?
Wall structure?
Both from SMA
Jejunal has longer vasa recta
Ileum has more dominant double layered arcade, smaller vasa recta
Ileum is thinner walled and has less prominent place circulares
47
Where does Meckels diverticulum love and what is it?
Would be found on the anti-mesenteric border of the ileum
It is a remnant of the vitelline duct
48
What are the four lobes of liver?
Which Couinaud segments make these up?
Falciform ligament vs cantiles line?
L = 1-4
R = 5-8
```
quadrate = 4
caudate = 1
```
Cantiles line is a line separating right and left lobe anatomically. Falciform ligament divides left lobe through segments 4a/b on right and 2/3 on left.
49
Blood supply to each liver lobe?
```
L = left hepatic
R = right hepatic
```
Caudate = both left and right hepatic
50
What separates the caudate and quadrate?
What does this structure contain?
Porta hepatis. Quadrate anterior, caudate posterior
Common hepatic duct, hepatic artery, portal vein, symp. and parasympathetic fibres + lymphatic drainage
51
What makes up the portal triad, and its relation to each other?
Hepatic artery
Portal vein
Bile duct
Artery medial to duct
Vein posterior to both
52
Ligaments of the liver - Falciform: What it splits up, what it contains, where it runs from and what it splits into itself?
Falciform:
Splits left lobe into medial and lateral
2 layer fold of peritoneum from umbilicus to the anterior liver surface
Free edge contains ligamentum teres = remant of umbilical vein.
On superior surface it splits into the coronary and left triangular ligament
53
Blood supply to the liver?
Venous drainage ?
Left and right hepatic artery from hepatic artery proper
Portal vein takes 70% of blood supply to liver, hepatic artery = 30%
Venous drainage:
Blood is dispersed by sinusoids to central veins of liver lobules = drain to hepatic veins = drain to IVC
Caudate lobe drains directly into IVC
54
Borders of the epiploic foramen?
Anterior = free border of lesser omentum = hepatoduodenal ligament
> contains bile duct, portal vein and hepatic artery
Posterior = IVC
Superior = caudate lobe
Inferior = 1st part of the duodenum + hepatic artery
55
What is the Pringles manoeuvre?
When you clamp the epiploic foramen in a difficult cholecystectomy / liver trauma
This will clamp the portal vein and hepatic artery which sit in the anterior border (hepatoduodenal ligament)
56
Relations of the liver?
anterior = diaphragm and xiphoid process
```
Postero-infeiror:
Oesophagus, stomach and duodenum
Hepatic flexure of colon
Right kidney
Gall bladder
IVC
```
57
Cell type of gallbladder?
Columnar epithelium
58
Relations of the gallbladder?
Anterior = liver
Posterior = peritoneum, transverse colon and 1st part of duodenum
Either side = liver
59
Vascular supply of gallbladder?
Cystic artery = branch of right hepatic
| Venous = directly to liver
60
Path of the bile in the biliary system?
Bile collects in cannaliculi between hepatocytes and drains via collecting ducts in portal triad
(Then stored in gallbladder where it is concentrated)
This drains via left and right hepatic duct which becomes common hepatic duct > at its origin: hepatic artery = medial, portal vein = posterior
Then joined by cystic duct from gallbladder = CBD
This passes down behind duodenum, through the head of pancreas to drain via ampulla of Vater into duodenum.
Pancreatic duct joins it here
Sphincter of Oddi prevents duodenal reflux
61
Boundaries of Calots triangle?
Common hepatic duct, cystic duct, inferior lobe of liver
62
Pancreatic relation?
Head sits in duodenal curve
Body lies behind the stomach and DJ flexure
Tail close to hilum of spleen
63
Arterial supply to pancreas?
```
Head = pancreaticoduodenal
Tail = splenic
```
64
Which parents of the duodenum are retroperitoneal?
1st part lies within the peritoneum
| Rest is retroperitoneal
65
Which parts of the colon are retroperitoneal?
Posterior aspect of ascending and descending colon
66
Embryology of the colon?
Midgut = second part of duodenum to 2/3rds along the transverse colon
Hindgut = distal 1/3rd of transverse colon to anus
67
General arterial supply of different parts of the colon?
Ascending = ileo-colic and right colic (SMA)
Transverse = Right colic and middle colic (SMA) + left colic (IMA)
Descending colon = IMA + marginal artery from right colon
68
Important colonic relations:
Ascending and descending colon
Splenic flexure
Hepatic flexure
Asc. + Desc. colon = ureters and gonadal vessels
Spleen = spleen and tail of pancreas
Hepatic = gall bladder + liver
69
Caecum blood supply and relations?
Ileo-colic artery
```
Anterior = greater omentum
Posterior = Psoas + iliacus, femoral and genitofemoral nerve, gonadal vessels + ureter
```
70
Where is appendix located, how can it be identified surgically and what suspends it?
Base of caecum
Conversion of taenia coli at base allows identification
- useful as 74% retrocaecal
suspended from terminal ileum by mesoappenidx - which contains appendicular vessels
71
Appendix blood supply?
Appendicular + anterior/posterior caceai = SMA via ileocolic
72
Where is McBurneys point?
1/3rd way along from ASIS to umbilicus
73
What connects transverse colon to pancreas?
| What attaches to superior aspect of transverse colon and what lies within this?
Transverse mesocolon
Greater omentum attaches to superior aspect - contains middle colic artery and vein
74
At what level does descending colon become sigmoid?
L3/L4
| This is the level where it becomes wholly intraperitoneal again
75
Significance of para-colic gutters in surgery?
Immediately lateral to ascending and descending colon = para-colic gutter
Medial to colon is lost of vessels, so you must mobilise the colon from the para-colic gutters, dissecting the lateral peritoneum in surgery
76
Which artery requires high ligation during right semi-colectomy?
Right colic
77
What levels do your SMA and IMA branch off the abdominal aorta?
Immediate path of each?
L1
L3
SMA travels underneath neck of pancreas
IMA travels inferiorly and immediately crosses to the left of the aorta
78
Where does the IMA become the superior rectal artery?
At level of left common iliac
79
Branches of SMA?
Inferior pancreaticoduodenal (anterior and posterior)
Jejunal and ileal arcades (ileum has extra arcades)
Right colic, middle colic and ileocolic
80
Branches of IMA?
Left colic
3 sigmoid arteries
Terminal branch = superior rectal
81
Is spleen intra or extraperitoneal?
Intraperitoneal
82
Which two ligaments attach to spleen?
Splenorenal attaches posteriorly and links it to left kidney = contains splenic vessels
Splenogastric attaches anteriorly and links it to greater curvature of stomach = short gastric and gastroepiploic
83
What vessels must be ligated in splenectomy and what structure is at risk of damage?
Short gastric vessels ligated (within gastrosplenic ligament)
Tail of pancreas may be injured
- leave a drain in = amylase raised
84
Blood film post-splenectomy?
Initially reticulocytosis and platelet count raised
Then granulocytosis - mainly neutrophils, then lymphocytes
Blood film = Howell jolly, target cells, pappenheimer + irregularly contracted erythrocytes
85
Blood supply to and from the spleen?
Splenic artery from coeliac axis
| Splenic vein. Joined by IMV, the goes on to unite with SMV.
86
Level of abdominal aorta?
T12 - L4
87
What accompanies aorta through diaphragm?
Azygous vein and thoracic duct at T12
88
How does the IVC, azygous, cisterna chyli?
all on the right
89
Branches of the coeliac trunk and their path?
Left gastric - ascends to cardioesophageal junction, gives off oesophageal branches then descends along lesser curvature of the stomach
Splenic artery - travels in splenorenal ligament.
- gives off short gastric prior to spleen and L gastroepiploic
- L gastroepiploic runs along greater curvature of stomach to anastomose with the right one
Common hepatic:
- gives off hepatic artery proper and gastrodudoenal
- hepatic artery proper ascends towards liver, travels in free edge of lesser omentum (Medial to bile duct, anterior to portal vein).
- gastroduodenal then gives off supraduodenal, superior pancreaticoduodenal (anterior and posterior) and right gastroepiploic
90
Branches of the SMA and what anastomoses with what?
1. Inferior pancreaticoduodenal:
Divides immediately into anterior and posterior branches which anastomose with the superior equivalents.
2. Middle colic = transverse colon
Emerges beneath the pancreas, then enters mesocolon where it gives right and left branches
- right anastomoses with right colic of SMA
- Left with left colic of IMA
3. right colic = ascending colon
Near colon it divides into ascending and descending branch
descending = ileocolic anastomoses
ascending = middle colic anastomoses
4. Ileocolic = ileum and caecum and appendix etc
Superior branch = anastomoses with right colic
Inferior branch divides giving: colic (1st part of ascending), caecal, appendicular, ileal branches
- ileal branch then anastomoses with SMA
91
What passes anterior and posterior to SMA?
```
Anterior = neck of pancreas and splenic vein
Posterior = Left renal vein and uncinate process and inferior duodenum
```
92
What ligament does the splenic artery travel in?
Splenorenal
93
Which branches of the SMA and IMA enter the transverse mesocolon?
SMA = Only the middle colic, where it then branches into the left and right branches
IMA = Left colic
94
Which branches of IMA enter the sigmoid mesocolon?
Sigmoid
Superior rectal
95
Branches of IMA?
1. Left colic:
-Ascending branch passes anterior to left kidney and enters transverse mesocolon.
Supplies superior descending colon, and anastomoses with middle colic
-Descending branch supplies inferior descending colon. and anastomoses with 1st branch of sigmoid
2. Sigmoid = 2-4 branches, which descend to the left in sigmoid mesocolon.
Supply lower descending colon
Anastomoses superiorly with left colic, inferiorly with superior rectal artery
3. Superior rectal = terminal branch
At level of S3 forms two terminal branches
These branches anastomose with the middle and inferior rectal arteries, which come from the internal iliac and pudendal respectively.
96
Arterial supply of the rectum?
```
Superior = IMA
Middle = internal iliac
Inferior = Pudendal
```
97
What veins combine to form the portal vein?
Where does this occur?
Splenic vein and SMV
occurs posterior to the neck of the pancreas at level of L2
98
What does the splenic vein drain?
Short gastric
L gastroepiploic
Pancreatic veins
IMV
99
What does the IMV drain?
Rectum, sigmoid and up to splenic flexure
Initially begins as the superior rectal vein
Receives sigmoid and left colic
100
What does the SMV drain?
```
Inferior pancreaticoduodenal
Ileo-colic
right and middle colic
Ileal and jejunal
R gastroepiploic
```
101
When does the IVC form?
At L5 when two common iliacs join
102
Tributaries of IVC?
```
Common iliacs
Lumbar veins
Right gonadal
Renal veins
Right suprarenal
Inferior phrenic
Hepatic
```
103
Muscles of the posterior abdominal wall?
Psoas major = flexes thigh at hip
Origin = T12-L5 laterally and intervertebral discs + transverse processes
Insertion = lesser trochanter of femur
Anterior rami of L1-L3
Psoas minor = weak flexor lumbar column
Origin = lateral surface of T12 / L1
Insertion = Pectineal line of pelvic brim + iliopubic eminence
Anterior rami of L1
Quadratus lumborum = acts laterally to flex
Origin = Medial aspects of iliac crest and iliolumbar ligament
Insertion = 12th rib
Anterior rami of T12-L3
Iliacus = flexion of thigh at hip joint
Origin = upper 2/3rds of iliac crest + upper/lateral sacrum
Insertion = lesser trochanter of femur
Femoral nerve
104
What makes up the abdominal pre-vertebral plexus?
from diaphragm to SMA = coeliac plexus
SMA to aortic bifurcation = Abdominal aortic plexus
Aortic bifurcation to common iliac bifurcation = superior hypogastric plexus
105
Where is processus vaginalis in relation to the gubernaculum?
What is the processus vaginalis?
What does gubernaculum eventually form in men vs women
PV is anterior to gubernaculum
It essentially is an extension of the peritoneal cavity. Formed when the gubernaculum guides down the testis.
In men it becomes a ligament tethering the testicles
In women it becomes the round ligament and ovarian ligament
106
Deep ring vs superficial ring location?
Deep ring is located at the mid inguinal point. Immediately lateral to inferior epigastric vessels.
Superficial ring is located just superior to pubic tubercle = opening in aponeurosis of external oblique.
107
Mid-inguinal point vs midpoint of inguinal ligament?
Mid-inguinal point = ASIS to pubic symphysis = femoral artery !!
Mid point of the inguinal ligament = ASIS to pubic tubercle, deep inguinal ring
108
Borders of the inguinal canal?
```
Roof = TIT = TF, internal oblique, TA
Floor = inguinal canal (inguinal ligament is aponeurosis of external oblique)
Anterior = external oblique aponeurosis
Posterior = TF and IE
```
109
Contents of the spermatic cord?
Contents of inguinal canal in women?
MEN: runs from deep inguinal ring down to the testis.
3 layers: External oblique = external cremasteric fascia, IO = cremasteric muscle and fascia, TF = internal spermatic fascia
3 arteries = cremasteric, deferential and testicular
3 nerves = genital branch of genitofemoral, sympathetic chain (+ Ilio-inguinal sits outside the cord)
3 other = venous plexus, vas deferens, lymphatics
Women = round ligament + genital branch of GF and ilio-inguinal
110
Direct vs indirect inguinal?
Inguinal hernias = ABOVE and LATERAL to pubic tubercle.
Direct = through hesselbachs triangle, medial to epigastric vessels, old people
Indirect = patent processus vaginalis, will descend into scrotum, via deep ring, young people
111
Borders of Hesselbach's triangle?
```
Medially = lateral border anterior rectus muscles
laterally = inferior epigastric vessels
inferiorly = inguinal ligament
```
112
Ilioinguinal nerve - nerve roots + path it travels?
L1 ventral rami
Passes inferolaterally through the psoas major, on top of quadratus lumborum.
Pierces internal oblique travelling deep to external oblique aponeurosis
Enters inguinal canal and exits via superficial ring to reach skin
113
What does ilioinguinal nerve supply?
Abdominal muscles it passes through
Skin to scrotum, femoral triangle and pubic symphysis
Dorsum of penis
114
How can ilioinguinal nerve be injured in hernial repair?
In mesh repair can get entrapped = neuroma = severe groin pain
115
Femoral triangle borders?
Roof and floor?
Inguinal ligament, sartorius and adductor longus
```
Roof = fascia lata
Floor = Pectineus, Iliopsoas, iliacus and adductor longus
```
116
Contents of femoral triangle ?
```
Femoral canal
Femoral artery, nerve and vein
Inguinal LN's
Femoral branch of GF and lateral cutaneous nerve
Great saphenous vein
```
117
What encloses the femoral artery, vein and lymphatics
femoral sheath
Each of the three structures in the femoral sheath are enclosed in a compartment
118
Which is the most medial compartment in the femoral sheath?
Each of the three structures in the femoral sheath are enclosed in a compartment, most medial is....
Femoral canal
119
Borders of the femoral canal?
Contents?
```
LMAP - FLIP
Lateral = femoral vein
medial = lacunar ligament
Anterior = inguinal ligament
Posterior = pectineal ligament
```
Lymphatics and Cloquet's node
120
Which muscle lies posterior to femoral vein?
Illiacus
121
What is the roof and floor of femoral triangle?
```
Roof = fascia lata
Floor = pectinous, Iliopsoas and adductor longus
```
122
Where do you find femoral hernias?
Below and lateral to pubic tubercle
123
Kidneys in relation to peritoneum?
Retroperitoneal
124
Order of structures at renal hilum?
Renal vein most anterior
Then renal artery
Then ureter
125
Fascial covering of kidney?
Gerota's fascia - divide into anterior and posterior
They both fuse together on top of the adrenals
Posterior part fuses with psoas major fascia
Anterior part fuses with connective tissue of IVC and aorta
126
What is Gerota's fascia a continuation of?
Transversalis fascia
127
What does left renal vein cross between?
Passes anterior to abdominal aorta, but posterior to the SMA
128
What does the right renal artery pass behind?
IVC
129
Levels of the right and left renal artery?
| Branches?
Right = L2, left = L1
Each has branch to the adrenals = suprarenal
Before reaching the organ each renal artery branches into 4/5 segmental branches
130
Adrenal gland embryology:
| What cell type is the cortex from vs medulla?
```
Cortex = mesoderm
Medulla = ectoderm from neural crest cells
```
131
What are adrenal rests?
Small bits of ectopic adrenal tissue
Small yellow round nodules
Common in neonates
Commonly found in broad ligament / spermatic cord
132
what must commonly be mobilised in anterior open adrenal surgery?
Hepatic flexure and right colon
133
Arterial supply of the adrenals?
Superior adrenal = inferior phrenic branch
middle adrenal = aorta directly
Inferior adrenal = renal artery branch
134
Venous drainage of adrenals?
Right is directly into the IVC: this is often avulsed in surgery, requires stinky clamp and 6/0 proline suture
Left goes into left renal vein
135
If you avulsed the right adrenal vein during surgery what would you do?
Satinsky clamp + 6/0 prolene suture
136
Which serves innervate abdominal wall?
T7-L1
T7-T11 leave intercostal space and travel between internal oblique and transversus abdominus.
137
Crura and ligaments of the diaphragm?
Muscular sheets anchored to lumbar vertebrae via a L+R crura
Crura connected across midline via MEDIAN arcuate ligament
Lateral to crura is MEDIAL arcuate ligament, which attaches to L1 and L3.
LATERAL arcuate ligament = thickening of fascia that covers quadratus lumborum.
138
Arterial supply of diaphragm?
Superiorly:
From internal thoracic = musculophrenic and pericardiophrenic
From thoracic aorta = Superior phrenic
Inferiorly:
Directly from abdominal aorta = Inferior phrenic
