Stomach & Intestines Flashcards
Branches of Coeliac trunk
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Lt Gastric artery
- esophageal branches
Splenic artery
- Lt Gastroepiploic artery
- short gastric arteries
Common Hepatic artery
- Rt Gastric artery
- Gastroduodenal artery > Rt GE artery + Superior pancreaticoduodenal artery + Supraduodenal artery
- Proper hepatic artery > Lt Hepatic + Rt Hepatic ( Cystic artery htwat )
Blood supply of stomach
5
Lt Gastric artery ( Celiac ) Rt Gastric artery ( CHA ) Lt GE artery ( Splenic A ) Rt GR artery ( Gastroduodenal from CHA ) short Gastric arteries ( Splenic A )
Gastrosplenic ligament contains ?
Lt GE
Short gastric arteries
Linorenal ligament
Splenic artery
Tail of pancreas
which artery ruputures
in DU ?
in GU ?
DU - Gastroduodenal artery
GU - Splenic vessels
To gain access to Coeliac axis , which structure must be divided in surgery ?
Lesser omentum
Rectum
Length ?
Diameter ?
Extent ?
Length - 12-15cm
Diameter - 4cm ( in empty state )
Extent - S3 to tip of coccyx
Describe about folds of Rectum .
3 transverse rectal folds (or) valves of Houston
- left
- right
- left
Peritoneal coverings of Rectum
Superior 1/3 - anterior & lateral surfaces
Middle 1/3 - anterior only
Lower 1/3 - no peritoneal covering
Posterior - extraperitoneal
Anterior relations of rectum
male / female
Male
- rectovesicle pouch
- base of bladder
- seminal vesicle
- prostate
Female
- rectouterine pouch ( of Douglas )
- posterior wall of Vagina
Posterior relations of rectum
- Sacrum
- Coccyx
- lower sacral nerves
- middle sacral artery
What separates rectum & prostate in male ?
Fascia of Denonvilliers
Lateral relations of rectum
Levator ani
Coccygeus
Fascias anterior & posterior of rectum
Anterior - Denovillier fascia ( bet rectum & prostate )
Posterior - Waldeyer fascia ( bet rectum & sacrum coccyx )
Arteries supplying rectum & anal canal ( and their origin )
Superior rectal A ( IMA ) - above pectinate line
Middle rectal A ( IIA ) - below pectinate line
Inferior rectal A ( internal budendal artery of IIA )
Ischianal fossa boundaries
Anterior - UG diaphragm
Posterior - Gluteus maximus
Lateral - Ischial tuberosity , Obturator externus
Medial - Levator ani , anal sphincter
Importance of pectinate line
- It forms the junction between endoderm & ectoderm .
- Above - supplied by ANS
Below - by somatic nerves and is sensitive to pain - Above - Veins drain into portal system
Below - into system veins - Above - lymphatics drain into aortic LN
Below - drains into inguinal LN
Blood supply of Large Intestine
from SMA & IMA
SMA branches
Ileocolic > caecum & ascending colon
Right colic > ascending colon
Mid colic > transverse colon
IMA branches
Left colic > descending colon
Sigmoid branches > sigmoid colon
Superior rectal > rectum
Blood supply of appendix
Appendicular artery
from where it comes from Ileocolic artery
Blood supply of caecum
Ileocolic artery
Which structure can be identified at the point at which all the teania coli converge ?
Appendix base
Variable positions of the appendix
Retrocaecal ( 75% ) Pelvic ( 20% ) Preileal Postileal Paracaecal Subcaecal
What structure should be divide if the retrocaecal appendix is difficult to access ?
Lateral peritoneal attachments of the caecum
Large intestinal diameter
Caecum - 8 cm
Ascending - 6.5 cm
Descending - 6.5 cm
Transverse - 6 cm
Rectum - 6 cm
Abdominal aorta branches
Single / Visceral
- Coeliac trunk
- SMA
- IMA
Paired / Visceral
- Suprarenal
- Renal
- Gonadal
Paired / Parietal
- Inferior Phrenic
- Lumbar ( x4 )
- Common Iliac
Single / Parietal
- Middle sacral artery
How many unpaired visceral branches from Abdominal aorta ?
3
Levels of
Coeliac -
SMA -
IMA -
Coeliac - T12
SMA - L1
IMA - L3
Left kidney hilum level
L1
Most inferior single aortic branch from abdominal aorta
Middle sacral artery
At which level aorta bifurcates
L4
Most inferior anterior aortic branch
IMA
Coeliac plexus in relation to Aorta
Anterolateral to the aorta
What aortic branch leave aorta approximately 1cm below coeliac axis
SMA
Foregut structure and blood supply
Oesophagus
Stomach
Duodenum ( supra-ampullary )
Bld supply - Coeliac
Midgut structure and blood supply
Duodenum ( infra-ampullary ) Jejunum Ileum Caecum Appendix Ascending colon Descending colon Transverse colon ( Right 2/3 )
Bld supply - SMA
Hindgut structure and blood supply
Transverse colon ( Left 2/3 ) Descending colon Sigmoid colon Rectum Anus ( upper half )
Bld supply - IMA
SMA branches
Inferior pancreaticoduodenal artery Jejunal & Ileal artery Ileocolic artery ( gives to Appendicular artery ) Right colic artery Middle colic artery
Embryological strcture appendix derived from
Midgut
Blood supply of transverse colon
Middle colic artery
from SMA
IMA branches
AAA displaces left renal vein can affect which branch of aorta ?
SMA ( L1 )
same level as left renal vein ( L1 )
IVC branches
Right renal vein
Right adrenal vein
Right testicular vein
Left renal vein
( recieves left adrenal v & left testicular v )
Left တွေဆိုရင်အားလုံးမဝင်
Renal ကလွဲရင်
Bifurcation of IVC level
L5
How many functional valves does IVC have ?
0 (zero)
In AAA , a vessel lying transversely across the aorta
what is it ?
Left renal vein
Lymphatic drainage of Rectum
Superior to Dentate line
- Mesorectal lymph nodes
Internal iliac and then paraaortic nodes
Inferior to Dentate line
- Inguinal nodes
What are the important posterior relations that are at risk during a right hemicolectomy ?
Gondal vessels & Ureter
Branches of Abdominal aorta
and their levels
Single / Visceral
- Coeliac plexus ( T12 )
- SMA ( L1 )
- IMA ( L3 )
Paired / Visceral
- Suprarenal middle ( L1 )
- Renal ( L1-2 )
- Gonadal ( L2 )
Single / Parietal
- middle sacral artery ( L4 )
Paired / Parietal
- Inferior phrenic A ( T12 )
- Lumbar x4 ( L1-4 )
- Common Iliac ( L4 )
Openings of the diaphragm & structure passing through
I 8 - 10 EGGs - AT 12
IVC - T8
Esophagus - T10
Vagus
Aorta - T12
Azygos vein
Thoracic duct
Source of bleeding in the left paracolic gutter in mobilisation of left colon ?
Spleen
Blood supply of transverse colon
Middle colic artery
SMA
Gastroduodenal artery arise from
Common hepatic artery
