The Abdomen Flashcards
What causes portal hypertension?
Cirrhosis of the liver leads to compression and distortion of the vessels in the liver, increasing the pressure
what are two points of anastemosis caused by portal hypertension?
Superior rectal artery/vein (IMA) + Interal illiac vein = Varicies and heamarroids
Left gastric vein/ Oesophageal branches + azygos vein = Oesophageal Varicies
What is the diameter of a early AAA ?
> 4cm
surgery required at >5cm
> 6cm then critical ~50% rupture
What is teh diameter of a normal AA ?
1-1.5 cm
Where does the IVC originate?
When the common illiac merge at L5.
What two veins drain into the L renal vein?
Left Gonadal
L suprarenal
what are the branches of the abdominal aorta
3 walls
- phrenic
- lumbar (L1-L4)
- median sacral (after teh bifercation)
3 to the Gut
- Coeliac
- SMA
- IMA
3 to Glands
- suprarenal
- renal
- gonadal
What are the borders of the foramen of winslow/epiploic foramen?
Anterior = hepato-duodenal ligamnet (portal triard)
Posterior = IVC
Superior = 1st part of Duodenum
Posterior = Left Lobe of the liver
What is in the porta hepatis?
The common hepatic Duct (anterior and left)
propper heatic artery (anterior and right)
portal vein (most posterior)
What forms the portal vein ?
The confluence of the superior mesenteric and splenic vein at the level of L1
the NECK of the pancrease in anterior
where does the inferior mesenteric vein enter the portal system?
Via the splenic vein
What is carried in teh splino-renal ligament?
connects the hillum of the spleen to the left kidney
The splenic artery, vein and the pancreatic tail are carried within it
Where does the transverse mesocolon attach?
Attaches to The anterior surface of the pancrease
Where are the IVC and aorta in relation to the pancreas
They pass posteriorly behind the head of the pancreas
where does the SMA lie in relation to the pancreas?
Initially posterior to the neck of the pancrease but passes anteriorly across the uncinate process.
what part of the pancrease is intra-peritoneal?
The tail of the pancreas
Describe the blood suply of the Pancreas
Pancreatic branches of the splenic artery.
Head is additioanly supplied
- Superior pancreatico-duodenal artery (branch of gastroduodenal)
- Inferior pancreatico-duodenal artery (branch of SMA)
Where does the Middle colic artery supply?
Branch of the SMA, it supplies the transverse colon.
branches of the the middle colic artery, form anastomosis when the IMA is occuled, and can supply the desending –> rectum
What atery is affected in a posterior duodenal ulcer?
Gastroduodenal artery
what artery is affected in a posterior gastric ulcer?
Splenic
what structures can be found at the level of L1/Transpyloric plane?
Origin of SMA
The pancreatic neck
The first part of the duodenum
Pylorus
Renal Hilar
The duojejunal flexure
The gall bladder fundus
The origin of the hepatic portal vein
Right and left flexures of the colon
What nerves are bloacked when repairing a inguinal hernia ?
Truncular ilioinguinal and iliohypogastric nerve
what is the antomical landmark of the femoral nerve?
below the inguinal ligament and 1cm lateral to the pulse of the femoral artery.
what is the anatomical landmark of the block for the obturator nerve?
4cm medial to the pubic tubercle and 3cm cephalad to the tendon of the adductor longus muscle
at what level does the sigmoid loose its mesentary and become the rectum?
s3
complication of a left suded distal colonic resection?
damage to parasympathetic nerves in the pelvis resulting in impared contraction of the detrusor muscels
at what level is the cardio oesphageal junction ?
T11
