Anatomy Recall

Question 1

What are the structures around the brachial artery in the cubital fossa?

Answer 1

• From medial → lateral; Mother Buys Ten Rabbits
• Median nerve
• Brachial artery
• Tendon of bicep brachii
• Radial nerve

Question 2

What is the length of the oesophagus and landmarks?

Answer 2

• Oesophagus is 25cm long; surrounded by adventitia
• 15, 25 and 40cm from the incisors [in OGD] are used as landmarks
• 15cm = UES at C6 level [lower border of cricoid cartilage]
• 25cm = Start of middle 1/3 of oesophagus at T4 level [bifurcation of trachea]
• 40cm = Gastro-esophageal junction at T10-T11 level

Question 3

Describe the gross anatomy of duodenum

Answer 3

• Duodenum is 12 finger breadths long
• Divided → 4 parts [D1→D4; 2, 3, 4, 1 inches]
• Retroperitoneal [except 1st part of D1]
• Unique features of each part
• D1 → 2 parts
  
  • 1^st part = Intraperitoneal, mobile, forms inferior border of epiploic foramen
  • 2^nd part = retroperitoneal
• D2 – where ampulla of Vater inserts → major duodenal papilla
• D3 – crossed over by SMA/SMV [compressed between SMA and AA in SMA syndrome in abnormally acute angle between vessels ∵X retroperitoneal fat]

Question 4

What are the boundaries of the epiploic foramen?

Answer 4

• Epiploic foramen aka foramen of Winslow = communication between lesser sac and greater omentum [peritoneum of abdominal cavity]
• Boundaries
• Anterior – free edge of lesser sac [carries portal vein, bile duct and hepatic artery]
  
  • Portal vein most posterior of the 3 structures
• Posterior – IVC
• Superior – caudate lobe of liver
• Inferior – 1^st part of D1

Question 5

Outline the arterial supply of the stomach

Answer 5

• At T12 level – abdominal aorta gives off coeliac trunk
• Coeliac trunk → 3 branches
• Left gastric a. → Lesser curvature + anastomose with R. gastric a.
  
  • Also gives oesophageal branch
• Splenic a.
  
  • Gives off short gastric a. → fundus
  • Gives off L. gastro-epiploic a → greater curvature + anastomose with R counterpart
• Common hepatic a. → 2 branches
  
  • Hepatic a.
    
    • Gives off R gastric a.
    • Continues & gives R/L Hepatic, Cystic a.
• Gastroduodenal a.
  
  • Gives off R. gastro-epiploic a.
  • Gives superior pancreatico-duodenal