Abdominal Organs Flashcards
1
Q
Lesser omentum
A
Originates on lesser curvature of stomach
Extends up to the underside of the diaphragn
Extensds and inserts on posterior aspect of liver
Extends down onto duodenum where it has a free lower border
Behind lesser omentum is the lesser lac (oomental bursa)
Arises from vertral mesentery
2
Q
Greater omentum
A
Arises greater curvature of the stomach
Free lower border
Posterior aspect is attached to the transverse colon to form the gastro-colic ligament
Extends to form the gastro-splenic ligament
Arrives at posterior wall of abdomen
Arises from dorsal mesentery
3
Q
Ventral mesogastrium
A
Liver develops here
4
Q
Dorsal mesogastrium
A
Spleen develops here
5
Q
Epiploeic foramen
A
Entrance to the lesser sac
6
Q
Ligaments of the liver
A
Falciform ligament
Ligamentum teres: runs in free border of falciform
Coronary ligament
Right and left triangular ligaments
Lesser omentum: inseting at porta hepatis
7
Q
Runs through hepatic notch
A
Ligamentum teres
Remnants of umbilical vein
8
Q
Porta hepatis
A
Site of hepatic artery and portal vein entrance
Exit of hepatic ducts
9
Q
Foregut attachments
A
Ventral mesogastrium
Dorsal mesogastrium
10
Q
Ligaments of the spleen
A
Anteriorly: Gastro-splenic ligament (extension of greater omentum)
Posteriorly: Lieno-renal ligament (to L kidney)
11
Q
Surface marking of spleen
A
Ribs 9-11
12
Q
Branches of the ceoliac trunk
A
Left gastric artery
Common hepatic –> Hepatic and Gastroduodenal
Hepatic –> R gastric
Spelnic
13
Q
Posterior relations of the pancreas
A
Body of L1
IVC
Aorta and SMA
Left Kidney
14
Q
Entrance of the lesser sac
A
Epiploic foramen of Winslow
Posterior free edge of lesser omentum
hepatoduodenal ligament
15
Q
Borders of Callot’s triangle
A
Medial: Common hepatic duct
Inferior: Cystic duct
Superior: Inferior surface of the liver
Clinical point: during laparoscopic cholecystectomy it used to permits safe ligation and division of the cystic duct and cystic artery
If one can’t delineate Callot’s triangle you are at risk of ligating the right hepatic artery–> convert to open or do a subtotal
16
Q
Contents of Callot’s Triangle
A
Right hepatic artery
Cystic artery: crosses Callot’s
Lympoh node of Lund
Lymphatics
BORDERS:
Medial: Common hepatic duct
Inferior: Cystic duct
Superior: Inferior surface of the liver
17
Q
Pringle manoeuvre
A
Haemostatic clamp placed across the hepatoduodenal ligament during haemorrhage
Stops blood flow in hepatic artery and portal vein
If bleeding persists: think IVC trauma
18
Q
Cell type of the peritoneum
A
Mesothelium: simple squamous epithelial cells
19
Q
Retroperitoneal organs
SAD PUCKER
A
Supra-renal (Adrenal)
Aorta + IVC
Duodenum (with exception of duodenal cap - first proximal 2cm)
Pancreas (except tail)
Ureters
Colon: ascending and descending
Kidneys
Esophagus (oesophagus)
Rectum
20
Q
Development of visceral and parietal peritoneum
A
Parietal peritoneum: Somatic mesoderm
Visceral perineum: Splanchnic mesoderm
21
Q
Mid-inguinal point
A
Mid-point between ASIS and pubic symphysis
= Femoral pulse
22
Q
Mid-point of the inguinal ligament
A
Mid-point between ASIS and PT
= Deep inguinal ring in transversalis fascia
23
Q
Borders of the inguinal canal
A
Anterior border
=Aponeurosis of external oblique
Posterior border
=Transversalis fascia
Roof
=Internal oblique
Rectus abdominis
Transversalis fascia
Floor
=Inguinal ligament and lacunar ligament medially (both thickenings of external oblique aponeurosis)
24
Q
Contents of the inguinal canal
A
1) Spermatic cord OR round ligament
2) Ilioinguinal nerve - commonly damaged during hernia repair
- Does not pass through deep ring, only superficial ring
3) Genital branch of genitofemoral nerve
-Supplies cremaster muscle + anterior scrotum
/ mons pubis + labia majora
25
Position of the superficial inguinal ring
Superior and lateral to PT
26
Borders of Hesselbach's triangle
Medial: Lateral border of rectus andominis muscle
Lateral: Inferior epigastric artery
Inferior: Inguinal ligament
27
Borders of Hesselbach's triangle
Medial: Lateral border of rectus abdominis muscle
Lateral: Inferior epigastric artery
Inferior: Inguinal ligament
28
Ligament unique to the lumbar spine
Iliolumbar ligament
Tip of the transverse process of the L5 --> posterior part of the inner lip of the iliac crest
29
Definition of foregut
Extends up to the entry of the bile duct at the duodenum
Supplied by coeliac trunk
30
Definition of midgut
From entry of bile duct in duodenum --> distal transverse colon
Supplied by superior mesenteric artery
31
Hindgut
From distal transverse colon to ectodermal part of anal canal
Supplied by inferior mesenteric artery
32
Complications of Malrotation
Occurs when the midgut fails to undergo 270 counterclockwise spin
Duodenojejunal flexure may not become fixed retroperitoneally and hangs freely from the foregut, lying to the right of the abdomen
Caecum may also be free and may obstruct the second part of the duodenum because of peritoneal bands (of Ladd) passing across it
Base of the mesentery is then very narrow as it is
not fixed at either end, and the whole of the midgut
may twist around its own blood supply, i.e. volvulus
neonatorum.
33
Exomphalos
Persistence of midgut herniation after birth
34
Separation of structures within cloaca
Rectum, anus and genitourinary tracts develop at the end of the 9th week
35
Development of anal canal
Anal canal develops from the end of the hindgut
(endoderm)
And an invagination of ectoderm, the proctodeum
36
Imperforate anus
The anal membrane separates the hindgut (endoderm) from the proctodeum (anal pit) (ectoderm)
Eventually the anal membrane breaks down and
continuity is established between the anal pit and
the hindgut.
Failure of the anal membrane to rupture or anal pit
to develop results in imperforate anus
37
Attachment of diaphragmatic crus
Right crus: L3 vertebral body
Left crus: L2 vertebral body
These attachments are below the remainder of the attachment of the diaphragm at the inferior thoracic aperture
38
Medial arcuate ligament
Arises from transverse process of L1
39
Lateral arcuate ligament
Arises from rib XII
40
Gubernaculum
Connects to primordia of scrotum in males
Connects to the labia majora in females
41
Coeliac trunk arises
Upper border of L1
42
Superior mesenteric artery arises
Lower border of L1
43
Inferior mesenteric artery arises
L3
44
Formation of IVC
Left iliac vein crosses midline at L5 to join right iliac vein
= IVC
45
Prevertebral plexus
Sympathetic components: T5- L2
Parasympathetic components: Vagus nerve, S2-S4
Visceral sensoru fibres
Lies on anterior and lateral surface of aorta --> Innervates the abdominal viscera
46
Arcuate line
Midway point between umbilicus and pubic symphysis
~1/3 way down rectus abdominis
-Inferior to it, the rectus abdomens lies directly on top of transversalis fascia
47
Innervation of external oblique
Innervated by anterior rami of T7 - T12
Lower 6 thoracic nerve
O: muscular slips from outer surface of lower eight ribs
Ribs V - VII
I: lateral lips of iliac crest
Aponeurosis ending as line alba
F:
- compress abdominal contents
- flex trunk
48
Innervation of internal oblique
Innervated by anterior rami of T7-12 and L1
O: thoracolumbar fascia, iliac crest between origins of external oblique and transversus abdominis
I: Inferior border of lower three ribs, lines alba, pubic crest and pectineal line
F:
- compress abdominal contents
- flex trunk
49
Innervation of transversus abdominis
Innervated by anterior rami of T7-12 and L1
O: thoracolumbar fascia, medial lip of iliac crest,
lateral 1/3 of inguinal ligament costal cartilages of lower 6 ribs VII - XII
I: lines alba, pubic crest and pectineal line
F:
-compress abdominal contents
50
Innervation of rectus abdominis
Innervated by anterior rami T7-12
O: pubic crest, pubic tubercle and pubic symphysis
I: costal cartilages of ribs V - XII
xiphoid process
F:
- compress abdominal contents
- flex trunk
51
Innervation of pyramidalis
Innervated by anterior ramus T12
O: Front of pubis and pubis sympthysis
I: linea alba
F: tenses linea alba
52
Arterial supply to superior anterior abdominal wall
Musculophrenic artery
-Terminal branch of the internal thoracic artery
53
Arterial supply to inferior anterior abdominal wall
Medially: superficial epigastric artery (not superior)
Lateral: Superficial circumflex iliac artery
Both branches of femoral artery
54
Arterial supply to the deep structures in the anterior abdominal wall
Superior: superior epigastric artery (branch of internal thoracic artery)
Lateral: 10th, 11th intercostal and subcostal artery
Inferior: inferior epigastric artery and deep circumflex iliac artery
-both branches of external iliac artery
55
Depth of superior and inferior epigastric arteries
Both enter rectus sheath and lie deep to rectus abdominis
Superior and epigastric arteries anastomose with one another under the rectus abdominis
56
Lymphatic drainage of the abdominal wall
Above umbilicus --> axillary nodes
Below umbilicus --> superficial inguinal nodes
Deep --> parasternal nodes
57
Deep inguinal ring
Mid-inguinal point
Evagination of transversalis fascia
Continues as internal spermatic facia
58
Superficial inguinal ring
Superior and lateral to PT
Evagination of external oblique
Reinforced with medial and lateral crus
- medial crus inserting on pubic symphysis
- lateral crus inserting onto PT
Continues as external spermatic fascia
59
Conjoint tendon
Reinforces posterior wall of inguinal canal at medial third
Formed by insertion of transverses abdominis and internal oblique --> pubic crest and pectineal line
60
Ilio-inguinal nerve in the inguinal canal
Does not pass through the deep inguinal ring
L1
Branch of the lumbar plexus
Enters abdominal wall from posterior by piercing transversus abdominis and internal oblique
Passes into inguinal canal and exits through superficial ring
61
Contents of the spermatic cord
Ductus deferens
```
Artery to ductus deferens (branch of inferior vesicle artery)
Testicular artery (branch of abdominal artery)
Cremasteric artery and vein (branch of inferior epigastric veins)
```
Pampiniform plexus of veins (testicular veins)
Genital branch of the genitofemoral nerve
--> cremasteric muscle
Sympathetic and visceral afferent nerve fibres
Lymphatics
Remnants of processus vaginalis
62
Layers of the spermatic cord
External spermatic facia = external oblique
Cremasteric fascia = internal oblique
Internal oblique = transversus abdominal
63
Round ligament
Passes through inguinal canal and has same coverings as spermatic cord
Inserts into connective tissue of labia majora
From connection at uterus the round ligament continues as the ligament to the ovary
64
Cremasteric reflex
Cremaster innervated by genital branch of genitofemoral nerve L1/L2
Stimulation to upper medial thigh sensed by olio-inguinal nerve --> L1
Reflex arc to genitofemoral --> L1/L2 --> cremaster
65
Borders of Hesselbach's Triangle
Inferior: inguinal canal
Medial: lateral border of rectus abdominis
Lateral: inferior epigastric artery
66
Arterial supply to greater omentum
Right and left gastro-omental arteries
67
Arises from ventral mesentery
Lesser omentum
68
Arsies from dorsal mesentery
Greater omentum
69
Borders of lesser omentum
Lesser curvature of stomach
First part of duodenum
Inferior surface of liver
70
Ligaments of the lesser omentum
Hepatigastric ligament: stomach and liver
Hepatoduodenal ligament: dudodenum to liver
- Ends as a free border = omental foramen
- contains hepatic artery proper, portal vein and bile duct
- right and left gastric vessels lie in between layers of lesser omentum near lesser curvature of stomach
71
The "Mesentery"
Double layered fold of peritoneum
Connects jejunum and ileum to the posterior abdominal wall
Superior attachment: duodenojejunal junction
Passes right and inferiorly
Inferior attachment: ileocaecal junction near upper border of right sacro-iliac joint
72
Mesentry x 3
The mesentry - jejunum and ileum
Transverse mesocolon - transverse colon
-anterior aspect of transverse mesocolon adherent to posterior aspect of greater omentum
Sigmoid mesocolon - sigmoid colon
73
Oesophageal hiatus
Right crus of the diaphragm
T10
Anterior vagal trunk
Posterior vagal trunk
74
Arerial supply to the abdominal oesophagus
Oesophageal branches from left gastric artery (from coeliac trunk)
Oesophageal branches from left inferior phrenic artery (from abdominal aorta)
75
Arterial supply to the stomach
Left gastric artery from coeliac trunk
Right gastric artery from hepatic artery proper
Right gastro-omental artery from gastroduodenal artery
Left gastro-omental artery from splenic artery
Posterior gastric artery from splenic artery (variant)
76
Length of small bowel
6 - 7m
77
Length of dueodenum
20 - 25cm
78
Sections of the duodenum
1: superior
- intraperitoneal
- L1
2: descending
- retroperioneal
- extends to L3
- duodenal papilla
3: inferior
-retroperitoneal
-longest section
-crosses IVC, aorta, vertebral column
R--> L
4: ascending
- passes upwards to left of aorta
- L2
- duodenojejunal flexure
79
Superior part of duodenum
1st part - intraperitoneal
Extends from pyloric orifice --> neck of gallbladder
Lies just right of L1
Passes anteriorly to bile duct, gastroduodenal artery, portal vein and IVC
Most ulcers occur here
80
Descending part of duodenum
2nd part - retroperitoneal
Extends form neck of gallbladder to lower border of L3
Anterior surface is crossed by transverse colon
Lies in front of right kidney
On its medial side is head of pancreas
Contains:
Major duodenal papilla
Minor duodenal papilla
81
Inferior part of duodenum
3rd part - retroperitoneal
Longest section
Passes Right --> Left
Crosses IVC, aorta, vetrebral column
The superior mesenteric artery + vein pass anteriorly in front
82
Ascening part of duodenum
4th part - retroperitoneal
Passes upwards to left of aorta
Upper border of L2
--> terminates as duodenojejunal flexure
83
Ligament of Trietz
Fold of peritoneum containing muscle fibres
= suspensory ligament of duodenojejunal flexure
84
Arterial supply to duodenum
Gastroduodenal artery
-->Supraduodenal artery
Pancreaticoduodenal artery
First jejunal branch of SMA
85
Characteristics of jejunum
Right upper quadrant
Larger diameter
Thicker walled
More plicae circularis
Less arterial arcades
Longer vasa recta
86
Arterial supply to jejunum
Jejunal arteries from superior mesenteric artery
87
Characteristics of the ileum
Right lower quadrant
Thinner walls
Fewer plicae circularis
Shorter vasa recta
More mesenteric fat
More arterial arcades
88
Arterial supply to ileum
Ileal arteries from superior mesenteric artery
Ileal branch from ileocolic artery which is in turn a branch of the superior mesenteric artery
89
Mesoappendix
Supplies appendix
Suspended from terminal ileum
Supplied by appendicular artery, branch of ileocolic artery which is a branch of SMA
90
Arterial supply to the caecum
Anterior cecal artery, a branch of the ileocolic artery
Posterior cecal artery, a branch of the ileocolic artery
91
Phrenicocolic ligament
Ligament attaching left colic flexure to the diaphragm
92
Blood-less mobilisation of colon
Supply to ascending and descending colon tends to be on inner wall
If divided down lateral parabolic gutters the main vessels are avoided
93
Sigmoid colon position
Begins just above pelvic brim
Extends to S3 --> rectum
94
Artery supply to ascending colon
Colic branch of the iliocolic artery
Anterior cecal branch of the iliocolic artery
Posterior cecal branch of the iliocolic artery
Right colic artery of the SMA
95
Arterial supply to transverse colon
Right colic artery form SMA
Middle colic artery from SMA
Left colic artery from INFERIOR mesenteric artery
96
Arterial supply to descending colon
Left colic artery of the IMA
97
Arterial supply to sigmoid
Sigmoidal arteries of the IMA
98
Rectosigmoid junction level
S3
99
Arterial supply to the rectum
Superior rectal artery from IMA
Middle rectal artery from INTERNAL ILIAC artery
Inferior rectal artery from INTERNAL PUDENDAL artery
100
Ladd's bands
Pathological connection between caecum and undersurface of liver
--> Small bowel volvulus and duodenal obstruction
Occurs on malrotation of the bowel
101
Recesses around the liver
Subphrenic recess
-Divided by the falciform ligament
Hepatorenal recess
102
Ligaments of the liver
Falciform ligament: attaches anterior aspect to anterior abdominal wall
Hepatogastric ligament: liver to stomach
Hepatodudodenal ligament: liver to duodenum
Attachment of liver to the diaphragm:
- Right triangular ligament
- Left triangular ligament
- Anterior coronary ligament
- Posterior coronary ligaments
103
Attachments of the liver to the diaphragm
Right triangular ligament
Left triangular ligament
Anterior coronary ligament
Posterior coronary ligaments
104
Coronary ligaments of the liver
Anterior coronary ligament marked by reflection of peritoneum
-start of bare area superior surface
Posterior coronary ligament also marked by reflection of peritoneum
-end of bare area
Where the coronary ligaments join on the sides they form the right and left triangular ligaments
105
Quadrate lobe
Visible from anterior view of liver
Bound on the left by the ligament teres
Bound on the right by the gallbladder fossa
Functionally related to left liver
106
Caudate lobe
Visible from posterior view of the liver
Bound on the left by fissure for the ligament venosum
Bound on the right by the groove for the IVC
Functionally distinct
107
Ligamentum teres
Extension of falciform ligament
Remnant of umbilical vein
108
Position of the gallbladder
Lying in visceral surface of right lobe of liver in fossa between right love and quadrate lobe
109
Arterial supply to the gallbladder
Cystic artery, branch of the right hepatic artery
110
Peritoneal part of the pancreas
Nearly all of the pancreas is secondary retroperitoneal apart from small part of the tail
111
Uncinate process of pancreas
Passes posterior to superior mesenteric vessels
112
Neck of the pancreas
Anterior to superior mesenteric vessels
113
Tail of the pancreas
Passes between layers of the splenorenal ligament
114
Arterial supply to the pancreas
Gastroduodenal artery, branch of common hepatic artery
Pancreaticoduodenal artery, branch of gastroduodenal artery
Dorsal pancreatic artery. branch of inferior pancreatic artery, branch of splenic artery
Greater pancreatic artery, branch of splenic artery
115
Dorsal bud of pancreas
Forms main head, body and tail
116
Ventral bud of pancreas
Part of the head and uncinate process
117
Bifid ventral bud of pancreas
Causes bifid uncinate process which encircles duodenum
Undergoes atresia during development --> may cause polyhydramnios
May cause recurrent vomiting as a neonate
118
At formation of bile duct: orientation
Bile duct lies to the right of hepatic artery proper
Usually lies to the right of and anterior to portal vein
Omental forman lies posterior to the structures at this point
119
Orientation of bile duct to superior duodenum
Bile duct passes POSTERIOLY to first part of the duodenum
120
Surface anatomy of the spleen
Rib IX - X
121
Spleen development
Develops in dorsal mesentery
122
Ligaments of the spleen
Connected to the greater curvature of the stomach = gastrosplenic ligament
-Contains short gastric and gastro-omental vessels
Connected to the left kidney = splenorenal ligament
-Contains splenic vessels
123
Left liver segments
I
II
III
IV
124
Right liver segments
V
VI
VII
VIII
125
Liver segment I
Caudate lobe
126
Attachment of scarpa's fascia
Extends down to deep fascia of thigh 2.5cm below inguinal ligament
Extends into perineum as Colle's fascia
127
Attachment of Camper's fascia
=superficial fatty fascia
Extends down to penis and scrotum
128
Colle's fascia
Extension of scarpa's fascia
Attached to the perineal body, perineal membrane and laterally to the rami of the pubis and ischium
129
Migration of testis not possible below Scarpa's
An ectopic testis in the groin cannot descend any lower into the thigh because of the attachment of Scarpa’s fascia to the deep fascia of the thigh
130
Nerve supply of abdominal muscles
Lower 6 thoracic spinal nerve supply
- rectus abdominis
- external oblique
Lower 6 thoracic spinal nerves + iliohypogastric + ilioinguinal nerves supply
- internalonblique
- transversus abdominis
131
Nerve damaged in kocher's incision
9th intercostal nerve lies at lateral point of incision
Results in weakness of upper rectus --> incisional hernia
132
Contents of spermatic cord `
Three arteries:
1) testicular artery
2) cremasteric artery
3) artery to the vas
Three nerves:
1) genital branch of the genitofemoral to cremaster
2) sympathetic nerves
3) ilioinguinal nerve (actually lies on the cord and not within it)
Three other structures:
1) vas deferens
2) pampiniform plexus of veins
3) lymphatics
133
Femoral sheath
Prolongation of transversalis fascia anteriorly and iliacus fascia posteriorly prolonged over the:
- Femoral artery
- Femoral vein
- Femoral canal
(but not the nerve)
134
Boundaries of the femoral ring
Superior entrance to the femoral canal
Anterior: inguinal ligament
Posterior: pectinal ligament
Laterally: femoral vein
Medially: lacunar liagment
Clinical point: abnormal obturator artery can run close to lacunar ligament and is at risk during femoral hernia repair
135
Contents of femoral canal
Fat
Lymphatics
Lymph node (Cloquet’s node)
136
Umbilical folds of peritoneum
Median umbilical fold: obliterated urachus
Medial umbilicla fold: obliterated umbilical artery
Lateral umbilical fold: inferior epigastric artery
137
Obliterated urachus
Median umbilical fold: obliterated urachus
138
Obliterated umbilical artery
Medial umbilicla fold: obliterated umbilical artery
139
Lateral umbilical fold
Inferior epigastric artery
140
Epiploic foramen free edge
Free edge of lesser omentum containing
bile duct to the right
hepatic artery to the left
portal vein behind
Portal vein is POSTERIOR
141
Borders of epiploic foramen
Anteriorly: free edge of lesser omentum containing
bile duct to the right, hepatic artery to the left and
portal vein behind
Posteriorly: inferior vena cava (IVC).
Inferiorly: first part of duodenum.
Superiorly: caudate process of the liver.
142
Boundaries of right subhepatic space
Renal well of Rutherford Morrison
Above: liver with gallbladder attached
Behind: posterior abdominal wall and kidney
Below: duodenum
143
Boundaires of left subhepatic space
= lesser sac
144
Posterior abscess drainage
Usually USS or CT guides percutaneous
If not possible --> posterior abscesses can be
accessed by an incision below or through the bed
of the 12th rib
145
Origin and insertion of quadratus lumborum
O: iliolumbar ligament and adjacent iliac crest
I: Medial 1/2 lower border of 12th rib
+ 4 tendons to L1-L4 transverse process
146
Structures anterior on quadratus lumborum
Colon
Kidney
Subcostal nerve
Iliohypogastric nerve
Ilioinguinal nerve
Subcostal nerve
147
Bifurcation of common iliac artery
Level of sacroiliac joint
148
Differences between right vs left common iliac artery
Right common iliac artery is the longer, the aorta being on the left side of the spine
Left common iliac vein crosses behind right
common iliac artery
Left common iliac artery is crossed anteriorly by inferior mesenteric artery
149
Lumbar sympathectomy
e.g. for plantar hyperhidrosis
Usually the second, third and fourth ganglia are excised with the intermediate chain
150
Parts of the oesophagus
Cervical
Thoracic
Abdominal
151
Thoracic oesophagus
Passes downwards through superior and posterior mediastinum
Two vagus nerves form plexus on oesophagus within posterior mediastinum
- left anteriorly
- right posteriorly
Passes right to meet the midline at T5
Passes forwards and left to meet diaphragm at T10
Anterior relations:
Left common carotid
Left main bronchus - constricts it
Posterior relations:
Thoracic duct
Hemiazygous vein
Descending aorta below
152
Abdominal oesophagus
Passes through diaphragm at T10
Lies in a groove on the posterior surface of the LEFT lobe liver with left crus behind it
153
Blood supply to the oesophagus
Cervical: inferior thyroid artery
Thoracic: aortic branches
Abdominal: left gastric and inferior phrenic arteries
154
Venous drainage of the oesophagus
Cervical: inferior thyroid veins
Thoracic: azygous vein
Abdominal
- portal: left gastric
- systemic: azygous vein
155
Nerve supply to the oesophagus
Upper 1/3
- parasympathetic via recurrent laryngeal nerves
- sympathetic from middle cervical ganglion carried via the inferior thyroid artery
Lower (below root of lung)
-vagus nerve and sympathetic nerves form oesophageal plexus
156
Three narrowing of oesophagus
Commencement of oesophagus
-17cm from incisors
Point at which it crosses left main bronchus
-28cm from incisors
Termination into cardia of stomach
-43cm from incisors
157
Oesophageal porto-systemic anastomoses
Lower oesophagus
Azygous vein of systemic venous circulation anastomoses with left gastric vein of portal circulation
= varices
158
Left atrium pathology on a barium swallow
Left atrial enlargement causing oesophageal posterior displacement may be noted on a barium swallow
Left atrial enlargement = mitral stenosis
159
Incisuria angularis
Notch on lesser curve that indicates transition from body to pyrloric antrum of the stomach
160
Prepryloric vein of Mayo
Junction of pylorus with duodenum marked by a constant vein = prepyloric vein of Mayo
-crosses vertically
161
Blood supply to the stomach
Lesser curve
- Left gastric artery, branch coeliac trunk, runs along lesser curve
- -> anastomoses with right gastric artery, branch of hepatic artery
Greater curve
- Right gastroepiploic artery, arises from gastroduodenbal artery of hepatic artery
- -> anastomoses with left gastroepiploic artery
Splenic artery
- left gastroepiploic artery
- short gastric arteries
Rich blood supply, can ligate three of four arteries and it still be adequately perfused
162
Gastric cancer presenting with jaundice
Nodal infiltration through the hepatic nodes --> porta hepatis
Increase in size here --> compression of bile duct. = jaundice
163
Lymphatic drainage of stomach
Splenic area --> splenic lymph nodes --> pancreatic --> coeliac nodes
Cardia --> left gastric --> coeliac nodes
Hepatic artery branches --> coeliac nodes
Right gastroepiploeic branches --> coeliac nodes
Retrograde spread to hepatic lymph nodes --> porta hepatis --> jaundice
164
Innervation of pyloric sphincter
Anterior vagus nerve
165
Vagal innervation coeliac plexus
Posterior vagus nerve
166
Vagus supply to liver
Anterior vagus nerve --> hepatic branch
167
Anterior and posterior nerves of Latarjet
= vagus anterior and posterior branches to cardia of stomach
168
Posterior stomach ulcer
--> erodes into pancreas
--> radiated back pain
169
Lesser curvature stomach ulcer
Likely to erode into left and right gastric arteries
--> Haematemsis and melaena
170
Area that contains G cells and mucin secreting cells
Pyloric antrum + distal 30%
171
Blood supply to duodenum
Superior pancreaticoduodenal artery, arising from gastroduodenal artery
Inferior pancreaticoduodenal artery, arising from SMA
These two also supply head of pancreas
172
Posterior duodenal ulcers
Erode into gastroduodenal artery passing behind it
173
Small bowel mesentery
Commences left of L2 at DJ flexure
Extends to right sacroiliac joint
15cm
174
Posterior relations of small bowel mesentery
As the small bowel mesentery descends to right sacroiliac joint it pass anteriorly to:
- 3rd part of duodenum
- aorta
- IVC
- right poses major muscle
- right ureter
- right gonadal vessel
- right iliacus muscle
175
Location of appendix
Posteromedial caecum
2.5 cm below ileocaecal valve
176
Posterior relations of ascending colon
Iliacus
Quadrates lumborum
Perirenal fascia over lateral right kidney
177
Posterior relations to transverse colon
Right kidney
Second part of duodenum
Pancreas
Small bowel
Left kidney
178
Phrenicocolic ligament
Fold of peritoneum from
| Diaphragm --> splenic flexure
179
Posterior relations of sigmoid colon
External iliac vessels
Left ureter
Rests on the bladder
180
Appendices epiploicae
Fat-filled scattered over surface of colon
Most numerous: sigmoid
Absent on caecum, appendix, rectum
181
Blood supply to appendix
Appendicular artery, branch of ileocolic artery
Has its own mesentery - descends from ileum as a triangular fold
182
Thrombosis of appendicular artery
=End artery
Hence, gangrene of appendix develops rapidly
Thrombosis may occur with inflammation of appendix
183
Lumen off appendix
Very wide at brith
Very narrow in elderly
Hence obstruction tends to occur in early adulthood as narrowing reaches critical point
Appendicitis is rare at extremes of age
184
Peritoneal covering of rectum
Posterior edge: always EXTRAperitoneal
Upper third: anterior and sides covered in peritoneum
Middle third: anterior aspect only covered in peritoneum
Lower third: all extraperitoneal
185
Valves of Houston
Three lateral inflections in rectum
Left --> right --> left
186
Anterior relation of rectum
```
Males: rectovesical pouch
-base of bladder
-seminal vesicles
-prostate
Denovilliers fascia lies in front of rectum separating it from prostate
```
Female: rectourterine pouch (of Douglas)
-posterior vaginal wall
187
Marginal artery of Drummond
Each artery from SMA and IMA branches with its neighbour for length of colon forming the marginal artery
188
Superior rectal artery
Branch of IMA
Supplies rectum and upper 1/2 anal canal
Middle rectal artery supplies muscular coat of rectum
189
Inferior rectal artery
Branch of internal Iliac artery
Supplies lower 1/2 of anal canal
190
Position of haemorrhoids
Superior rectal artery reaches rectum
- -> divides into two branches
- run either side of rectum
- ->right branch divides into two further branches
Three branches descend to level of anal valves and anastomose with branches of inferior rectal artery
-accompanied by tributaries of the superior rectal vein draining into portal system
Final position: one on the leftism two on the right
3, 7, and 11
191
Columns of Morgagni
Vertical columns in the mucosa in the middle of the anal canal
192
Anal valves of Ball
At distal end of columns of morgagni there are some valve-like folds
= anal valves
Behind the anal valves are the anal sinuses which are the opening of the anal glands
193
Lining of upper half of anal canal
Columnar epithelium
Derives from endoderm
194
Lining of lower half of anal canal
Stratified squamous epithelium
Derived from ectoderm
195
Cancer of upper 1/2 of anal canal
= columnar epithelium --> adenocarcinoma
196
Cancer of lower 1/2 of anal canal
= stratified squamous epithelium = squamous cell carcinoma
197
Nerve supply to upper 1/2 anal canal
Parasympathetic supply
Insensate
Injecting haemorrhoids here will be painless
198
Nerve supply to lower 1/2 anal canal
Somatic innervation from inferior rectal nerve
Sensitive to pain
199
Venous drainage of anal canal
Upper 1/2 --> porta drainage
Lower 1/2 --> systemic drainage
200
Lymphatic drainage of upper 1/2 anal canal
Along superior rectal vessels --> abdominal nodes
201
Lymphatic drainage of lower 1/2 anal canal
Inguinal nodes
Rectal cancer invading lower anal canal may spread to inguinal lymph nodes
202
Branches of celiac trunk
T12
Left gastric artery
Splenic artery
Common hepatic artery
203
Left gastric artery
Smallest of branches from celiac trunk
--> Oesophageal branches that ascend up to oesophageal junction
Left gastric artery then turns to the right and descends along lesser curvature of stomach
- -> anastomoses with right gastric artery
- -> supplies both surfaces of stomach
204
Splenic artery
Largest branch of celiac trunk
Courses to left on superior border of pancreas
Travels in splenorenal ligaments
Supplies neck, body an dtail of pancreas
Enters hilum of spleen
Branches
- short gastric arteries --> gastrosplenic ligament --> supply fundus of stomach
- left gastro-omental branch --> right, along greater curvature of stomach
- --> anastomoses with right gastro-omental artery
205
Common hepatic artery
Branch of celiac trunk
Runs to the right
Divides into two terminal branches
- hepatic artery proper
- gastroduodenal artery
206
Hepatic artery proper
One of two terminal branches of the common hepatic artery, which branches from the celiac trunk
Ascends towards liver in free edge of lesser omentum (anterior to portal vein)
Runs left to bile duct
Divides into right and left hepatic arteries
- right hepatic artery branches --> cystic artery to gallbladder
207
Cystic artery
Branch of right hepatic artery close to the liver
Right hepatic artery is a branch of hepatic artery porper, which in turn is a branch of the common hepatic artery of the celiac trunk
--> gallbladder
208
Gastroduondeal artery
One of two terminal branches of the common hepatic artery
At upper border of superior duodenum gives of:
- posterior superior pancreaticoduodenal artery
- supraduodenal artery
Gastroduodenal artery then continues descending posterior to superior duodenum --> reaches lower border of superior duodenum
Divides into terminal branches
-right gastro-omental artery
-anterior superior pancreaticoduodenal artery
209
Right gastro-omental artery
Terminal branch of gastroduodneal artery, which is a branch of the common hepatic artery of the celiac trunk
Branches from gastroduodenal artery at lower limit of superior part of duodenum
From here, the right gastro-omental artery passes along greater curvature of stomach
- branches to stomach and greater omentum
- anastomoses with left gastro-omental artery (from splenic artery)
210
Anterior superior pancreaticoduodenal artery
Terminal branch of gastroduondeal artery of common hepatic artery of celiac trunk
Branches at lower limit of superior duodenum
Anterior superior pancreaticoduodenal artery descends along with posterior superior pancreaticoduodenal artery to supply head of pancreas and duodenum
Both of these vessels then anastomose with corrosponding anterior and posterior inferior pancreaticoduodenal arteries (branch of SMA)
211
Superior mesentaric artery
L1 - lower part
Crossed anteriorly by splenic vein and neck of panceas
Posteriorly:
- left renal vein
- unicnate process
- inferior part of duodenum
Branches
- first: inferior pancreaticoduodenal artery
- jejnunal branches
- ileal branches
- middle colic
- right colic
- ileocolic
212
Inferior pancreaticoduodenal artery
First branch of SMA (right hand side)
Divies immediately into anterior and posterior inferior pancreaticoduodenal arteries
Anastomose superiorly with anterior and posterior superior pancreaticoduodenal arteries of gastroduodenal artery
Supplies
- uncinate process of pancreas
- duodenum
213
Narrow windows in mesentry
Long narrow-spaced vasa recta
= jejunum
214
Broad windows in mesentry
Spaced-out short vasa recta
= ileum
215
Middle colic artery
First of the big three right-side branches from SMA
Emerges from beneath pancreas
Enters transverse mesocolon
Divides into right and left branches
- right branch anastomoses with right colic
- left branch anastomoses with left colic (branch of IMA)
216
Right colic artery
Second of the big three right-side branches from SMA
Passes to righ tin a retroperitoneal position --> ascending colon
Nearing colon it divides:
Descending branch - anastomoses with iliocolic
Ascending branch - anastomoses with middle colic
217
Iliocolic artery
Final / third of the big three right-side branches from SMA
Passes to right iliac fossa
Divides into:
Superior branch: passes upwards to anastomose with right colic artery
Inferior branch:
- colic artery
- cecal artery --> anterior and posterior cecal
- appendicular artery
- ileal branches
218
Inferior mesenteric artery
L3
Passes anteriorly to aorta intially
Passes to left side as it descends
Branches:
- left colic artery
- several sigmoid branches
- superior rectal artery
219
Left colic artery
First branch of IMA
Ascends retroperitoneally, divides into:
- ascending branch
- descending branch
Ascending branch
- passes anteriorly to left kidney --> enters transverse mesocolon --> passes superiorly to supply upper part of descending colon + distal transverse colon
- anastomoses with branch of middle colic artery
Descending branch
- lower descending colon
- -> anastomoses with 1st sigmoid artery
220
Sigmoid arteries
Two - four branches of IMA
Within sigmoid mesocolon
Supply lowest part of descending colon and sigmoid colon
First branch anastomoses superiorly with descending branch of left colic artery
221
Superior rectal artery
Terminal branch of IMA
Descends into pelvic cavity in the sigmoid mesocolon
Cross left common iliac vessels
SIII: divides into two terminal branches
- descend on either side of the rectum
- continue inferiorly to level of internal spinchter
- -> anstomosing with branches of middle rectal artery (from internal iliac artery) AND inferior rectal arteries
222
Atherosclerosis of inferior mesenteric artery
Watershed area between SMA and IMA the most clinically significant
--> between middle colic and left colic arteries = splenic flexure vulnerable
IMA atherosclerosis disease means that the marginal artery is relied upon for hindgut perfusion
As celiac and SMA vessels narrow this reaches a critical ischaemia point --> mesenteric angina post meals
If acute occlusion --> ischaemia splenic flexure --> mucous sloughing, risk of perforation
223
Formation of portal vein
L2
Posterior to neck of pancreas
Superior mesenteric vein joins with splenic vein Tr
224
Tributaries to the portal vein
Rigth and left gastric veins
Cystic veins
Para-umbilical veins
```
Superior mesenteric vein
Splenic vein (+inferior mesenteric vein)
```
225
Branches of portal vein
Approaching the liver it divides into right and left branches
226
Porto-systematic anastomoses
Portal: left gastric vein
AND
Systemic: azygous system
Portal: superior rectal vein
AND
Systemic: middle and inferior rectal veins
Portal: para-umbilical veins
AND
Systemic: anterior abdominal wall veins
227
Prota hepatis
Entry-point to liver
- Common-hepatic duct anteriorly
- Hepatic artery in middle
- Portal vein posteriorly
Lymph nodes which, when enlarged by malignancy, may compress the bile ducts and cause obstructive jaundice
-gastric malignancy --> jaundice
228
Left triangular ligament of liver
Continuous with part of falciform ligament
When traced to the right and posteriorly, joins the lesser omentum in the fissure for the ligamentum venosum
Contains no blood veseels
- can be divided so left lobe of liver can be re-tracted to visualise oesophagus
229
Liver origin of lesser omentum
Arise from ligamentum venosum and porta hepatis
230
Right hemihepatectomy
Segments
| V, VI, VII and VIII
231
Left hemihepatectomy
Segments
| II, III and IV.
232
Hepatic veins
Three
Right
Central
Left
Caudate - own indepdendent hepatic vein
233
Calot’s triangle
Medial – common hepatic duct.
Inferior – cystic duct.
Superior – inferior surface of the liver
Contents:
Right hepatic artery – formed by the bifurcation of the common hepatic artery into right and left branches.
Cystic artery – typically arises from the right hepatic artery and traverses the triangle to supply the gall bladder
Lymph node of Lund – the first lymph node of the gallbladder
234
Path of cystic artery
Cystic artery passes behind the common hepatic
| duct and cystic duct
235
Blood supply to pancreas
Splenic artery via arteria pancreatica magna.
Supply to head and uncinate process
- superior pancreaticoduodenal artery, branch of gastroduodenal artery
- inferior pancreaticoduodenal artery, branch of superior mesenteric artery.
236
Contents of gastrosplenic ligament
Short gastric and left gastroepiploic vessels
237
Contents of lienorenal ligament
Splenic artery and vein, lymph nodes
AND
Pancreatic tail
238
Ribs overlying spleen
9th, 10th and 11th
239
Splenunculi
Commonly: hilum, tail of pancreas, ometum, small bowel mesentery
May hypertrophy post splenectomy and cause recurrence of exacerbation of condition e.g. thrombocytopenic purpura
240
Renal hilum, anterior --> posterior
Renal vein
Renal artery
Pelvis of the ureter
VAP
241
Tributaries to left renal vein
Adrenal vein
Gonadal vein
Longer vs right
Passes anteriorly to aorta
242
Lymphastic drainage of kidney s
Para-aortic lymph nodes
243
Floatign kidney
Hypermobility of kidney in fascial compartment
Can be moved up and down
BUT NOT side-to-side
244
Major calyces
Two per kidney
+ 12 minor
245
Pelvic cource of ureter
Each ureter enters the pelvis by crossing the bifurcation of the common iliac artery
Runs down to ischial spine, crossing the obturator nerve
Crosses anterior branches of the internal iliac artery
Turns medial to reach the bladder and passes below the vas deferens just before entering the bladder
246
Blood supply to ureter
Renal arteries (may receive a considerable contribution from a lower polar artery)
Testicular or ovarian artery
Internal iliac artery
Inferior vesical arteries
247
Pyramidal adrenal
RIGHT
Superior pole of kidney
248
Cresenteric adrenal
LEFT
Medial border of kidney
249
Venous drainage right adrenal
RIght into IVC
Short adrenal vein --> IVC
250
Venous drainage left adrenal
Drains via longer vein into the left renal vein, then into IVC
251
Sympathetic innervation of medulla of adrenal
Greater splanchnic pre-ganglionic neurons
252
Blood supply to bladder
Superior and inferior vesical arteries
Branches of the anterior division of the internal iliac artery
253
Lymphatic drainage of the bladder
--> internal iliac nodes --> para-aortic nodes
254
Interureteric ridge
Raised fold of mucosa between entry of two ureters into bladder
255
Anterior and posterior relations to prostate
Anteriorly:
-pubic symphysis separated by the extraperitoneal fat of the retropubic space
(cave of Retzius)
Posteriorly:
-rectum separated by the fascia of Denonvilliers
256
Lobes of the prostate
Posterior lobe: lies posterior to the urethra and
inferior to the plane defined by the course of the ejaculatory ducts
Single median lobe: lies between the ejaculatory ducts
and posterior to the urethra
Two lateral lobes (right and left lobes): separated
by a shallow posterior median groove, which can
be felt on rectal examination
Anterior to the urethra there is a narrow isthmus
only, consisting of mainly fibromuscular tissue
257
Capsules of the prostate
True capsule: a thin, fibrous sheath surrounding the
prostate
False capsule: condensed extraperitoneal fascia
continuous with the fascia surrounding the bladder
and with the fascia of Denonvilliers posteriorly
--> prostatic venous plexus lies between the true and
false capsules
Pathological capsule: benign prostatic hypertrophy compresses normal peripheral part of the gland, creating a capsule
Enucleation of the prostate for benign prostatic
hypertrophy, enters plane between the adenomatous
mass and the pathological capsule
258
Blood supply to prostate
Inferior vesicular artery
| -branch of internal iliac artery
259
Venous drainage of prostate
Prostatic venous plexus (between true and false capsule)
--> drains into the internal iliac vein on each side
Some venous blood drains posteriorly around the rectum to the valveless vertebral veins of Batson
-->this may explain why prostatic carcinoma metastasizes early to the bones of the lumbar spine
and pelvis
260
Vertebral veins of Batson
Some venous blood from prostate drains posteriorly around the rectum to the valveless vertebral veins of Batson
-->this may explain why prostatic carcinoma metastasizes early to the bones of the lumbar spine
and pelvis
261
Location of seminal vesicles
Lie one on each side in the interval between the base of the bladder anteriorly and the rectum posteriorly
Lie lateral to the termination of vas deferens.
Each seminal vesicle has a common drainage with its neighbouring vas via the common ejaculatory duct
The normal vesicles are usually impalpable on
rectal examination; however, if they are enlarged
by infection, e.g. tuberculosis, they become
palpable.
262
Blood supply to uterus
Uterine artery. branch from internal iliac artery
Runs in base of broad ligament
2cm lateral to cervix --> passes anterior and superior to URETER
Reaches uterus at level of internal os, divies into ascending and descending branches
Then ascends up the lateral side of the body of the uterus --> laterally and inferiorly to the uterine tube
Terminates by anastomosing with the terminal branches of the ovarian artery
263
Lymphatic drainage of the uterus
Fundus:
-ovarian vessels -> para- aortic lymph nodes
-some drains via ound ligament to the inguinal nodes
Metastases from the fundus of the uterus therefore may occur in the inguinal nodes
Body
-drains via lymphatics in the broad ligament to the iliac lymph nodes
Cervix drains in three directions:
- laterally via the broad ligament to the external iliac nodes
- posteriorly in the uterosacral fold to the sacral lymph nodes
- posterolaterally along the uterine vessels to the internal iliac nodes
264
Part of fallopian tube not covered in peritoneum
Intramural part
265
Broad ligament of uterus
Fold of peritoneum: connects uterus to pelvic sidewalls
Contains or attaches to:
- fallopian tube in its free edge
- round ligament
- ovarian ligament
- uterine vessels and branches of the ovarianvessels
- mesovarium attaching the ovary to its posterior aspect
- lymphatics.
In base of the broad ligament, ureter passes forwards to the bladder lateral to and then immediately above the lateral fornix of the vagina
266
Lymphatic drainage of the vagina
Upper and middle 1/3 --> external iliac nodes
Lower 1/3 --> superficial inguinal nodes
267
Ganglion impar
Communication between two sides of sympathetic chain over lower end of coccyx
268
Splanchnic Nerves
Thoracic, lumbar and sacral:
-carry preganglionic sympathetic fibres from sympathetic trunk --> ganglia in prevertebral plexus
Pelvic splanchnic nerve (parasympathetic root)
- carry preganglionic PARAsympathetic nerve fibres from anterior rami of S2, S3 and S4
- -> extension of of prevertebral plexus = inferior hypogastric plexus
269
Greater splanchnic nerve
5th - 9th thoracic ganglia
--> travels to ceoliac ganglia in abdomen (prevertebral plexus)
270
Lesser splanchnic nerve
9th - 10th / 11th thoracic ganglion
--> travls to aorticorenal ganglion
271
Least splanchnic nerve
12th throacic ganglia
--> travels to renal plexus
272
Thoracic splanchnic nerves
Greater --> celiac ganglion
-5th - 9th thoracic ganglia
Lesser -->aorticorenal ganglion
-9th - 10th thoracic ganglia
Least --> renal plexus
-12th throacica ganglia
273
Lumbar splanchnic nerve
Sympathetic outfllow from lumbar region
| --> prevertebral plexus
274
Sacral splanchnic nerve
Sympathetic outflow from sacral region
--> inferior hypogastric plexus
275
Pelvic splanchnic nerve
PARAsympathetic outflow
Originate form S2 - S4
Preganglionic parasympathetic fibres pass to inferior hypogastric plexus
- -> supply parasympathetic input from transverse colon onwards
- -> ascending branches supply hindgut
276
Celiac plexus
Two celiac ganglion
Single SMA ganglion
Two aorticorenal ganglion
277
Aortic plexus
IMA ganglion
278
Innervation of psoas major
Innervated by anterior rami L1 - L3
O:
- lateral surfaces of bodies of T12 - L5 vertebrae
- transverse process of L1 - L5
- intervertebral discs between T12 - L5
I: lesser trochanter of femur
F: hip flexion and flexion of trunk against gravity
279
Innervation of psoas minor
Innervated by anterior rami of L1
O: lateral surfaces of vertebral bodies T12 - L1
I: pectineal line of the pelvic brim and iliopubic eminemce
F: flexion of lumbar column
280
Innervation of quadratus lumborum
Innervated by aterior rami T12 - L4
O:
- transverse process L5
- iliolumbar ligament
- iliac crest
I:
- transverse process L1 - L4
- inferior border of rib 12
F: depresses and stabilises rib 12, lateral bending of trunk
281
Innervation of iliacus
Innervated be femoral nerve (L2 - L4)
O:
- upper 2/3rds iliac fossa
- anterior sacroiliac ligament
- iliolumbar ligament
- upper lateral surface of sacrum
I: lesser trochanter of femur
F: hip flexion and flexion of trunk against gravity
282
Origin of right crus
L 1 - L3
283
Origin of left crus
L2
284
MedIAN arcuate ligament
Connects crura together across midline
| Passes anterior to aorta
285
MedIAL acruate ligament
Tendinous arch lateral to crura
Formed by fascia over psoas major
- Medial attachment to L1-2 vertebral body
- Lateral attachment to transverse process L1
286
Lateral arcuate ligament
Situation just lateral to medIAL arcuate ligament
Formed by fascia passing over quadratus lumborum
- Medial attachment T12 -L1 transverse process
- Lateral attachment at 12th rib
287
Passes through musculature of right crus
Oesophagus at T10
```
anterior branch of vagus
posterior branch of vagus
left gastric artery
left gastric vein
lymph
```
288
Structures passing through medIAL arcuate liagment
Sympathetic trunk
Least splanchnic nerves
289
Structures passing through left crus
Hemiazygous vein
290
Coverigns of the kindye
Surrounded by peripnephric fat
Enclosed in renal fasica (including adrenals) = Gerotas fascia
Then covered in peritoneum on anterior seurface (retroperitoneal structures)
Then covered by paranephric fat
291
Right renal artery
Longer vs left renal artery
Passes posterior to IVC
292
Renal arteries
As each renal artery approaches the hilum it divides:
- anterior branch
- posterior branch
293
Order of renal hilum
VAP
Anterior: Renal vein
Middle: Renal artery
Posterior: Ureter (pee)
294
Left venal vein
Larger vs rigth renal vein
Corsses to right anterior to abominal aorta
BUT posterior to SMA
-can be compressed by an aneursym of either vessel
295
Lymphatic drainage of kidney
Lateal aortic lumbar nodes
296
Number of major calices
2 - 3 major calices --> renal pelvis
297
Constiction point of ureter
First: uretopelvic junction
Second: ureter passes common iliac or external iliac vessels at pelvic brom
Third: uretes enter bladder
298
Blood supply to ureters
Upper end: renal arteries
Middle: abomdinal aorta, testicular / ovairan arteries, common iliac arteries
Pelvic: internal iliac arteries
299
Visceral innervation of ureters
Afferent fibres --> T11 - L2 spinal roots
Referred loin - groin pain
300
Innervation oesophagus
Oesophageal plexus
Vagus nerve
- upper sphincter: fibres from nucleus ambiguus
- lower sphincter: dorsal motor nucleus
301
Lymphatic drainage of oesophagus
Superior 1/3: deep cervical nodes
Middle 1/3: superior and posterior mediastinal nodes
Lower 1/3: left gastric and celiac nodes
