EMRCS anatomy Flashcards
At what level the cardio-oesophageal junction?
T11
At what level is the transpyloric plane?
L1
What structures can be found at the transpyloric plane?
(1) L1 vertebra
(2) pylorus of the stomach
(3) hilum of the spleen(the spleen lies more superiorly,and the left adrenal and ureter are unlikely to be injured in isolation)
(4) hilum of kidneys
- hilum of the left kidney(L1-left one)
- hilum of the right kidney(1.5 cm lower than the left one)
- the left kidney lies in this location and is the most likely structure to be injured
(5) neck of the pancreas
(6) sphincter of oddi
(7) 2nd part of the duodenum
(8) duodenojejunal flexture
(9) left and right colic flexture
(10) root of the transverse mesocolon
(11) fundus of the gall bladder(the most superficially located)
(12) origin of the superior mesentric artery
(13) origin of the portal vein
(14) end of the spinal cord(upper part of the conus medullaris)
(15) 9th costal cartilages
What is the other name for transpyloric plane?
(1) Transpyloric plane of Addison
(2) Plane of Addison
(3) Addison’s plane
Define the transpyloric plane
Halfway or midpoint between the jugular notch and the symphysis pubis,approximately the level of the L1 vertebra
What is the other name for transtubercular plane?
Intertubercular plane
Define the transtubercular(intertubercular)plane?
Horizontal line that runs between the superior aspect of the right and left iliac crests,approximately at the level of L5 vertebral body
Define the term(vertical planes )of the anterior abdominal wall
Vertical planes-run from the middle of the clavicle to the midinguinal point(halfway between the anterior superior iliac spine and the symphysis pubis).These planes are the mid-clavicular lines
Define the subcostal plane
Passes by the lowest part of the costal margin (10th costal cartilage),approximately at the level of L3 vertebra.
What is the other name for intercristal plane?
Supracristal plane
Define the intercristal(supracristal)plane
Passes by the highest point of iliac crest,approximately at the level of L4 vertebral body
How we can identify the transpyloric plane?
By asking the supine patient to sit up without using their arms.The plane is located where the lateral border of the rectus muscle crosses the costal margin
What is the the vertebral level of subcostal plane?
L3
What is the vertebral level of the intercristal(supracristal)plane?
L4 vertebral body
What is the vertebral level of intertubercular plane?
L5 vertebral body
What is the costal level of the subcostal plane?
10th costal cartilage
What is the vertebral level of inferior mesentric artery?
1) Leaves the aorta at L3.
2) It supplies the left colon and sigmoid.
3) Its proximal continuation with the middle colic artery is via the marginal artery.
What is the vertebral level of the bifurcation of aorta into common iliac arteries?
L4
What is the vertebral level of the formation of the IVC?
L5(union of common iliac veins)
What are the vertebral levels of the diaphragmatic apertures?
Mnemonic:VOA
(1) Vena cava T8
(2) Oesophagus T10
(3) Aortic hiatus T12
Discuss the midline abdominal incision
. Commonest approach to the abdomen
. Structures or layers divided:
(1) linea alba(Upper midline incisions will involve the
division of the linea alba)
(2) transversalis fascia
(3) extra peritoneal fat
(4) peritoneum(avoid falciform ligament above the
umbilicus)
. Bladder can be accessed via an extra peritoneal
approach through the space of Retzius
. Division of muscles will not usually improve access
in upper midline incision and they would not be
routinely encountered in this incision
What are the structures or layers divided in midline abdominal incision?
(1) linea alba(Upper midline incisions will involve the
division of the linea alba)
(2) transversalis fascia
(3) extra peritoneal fat
(4) peritoneum(avoid falciform ligament above the
umbilicus)
Discuss paramedian abdominal incision
. Location: parallel to the midline(about 3-4cm)
. Structures or layers divided or retracted:
(1) Anterior rectus sheath
(2) Rectus(retracted)
(3) Posterior rectus sheath
(4) Transversalis fascia
(5) Extra peritoneal fat
(6) Peritoneum
. Technique: Incision is closed in layers
What is the location of the paramedian abdominal incision?
parallel to the midline(about 3-4cm)