Trunk and Thorax Anatomy Flashcards
At what level does coeliac trunk come off aorta
T12
Branches of coeliac trunk
Left gastric
Splenic
Common hepatic
What level does SMA come off
L1
Branches of SMA
R colic
Middle colic
What level IMA comes off
L3
Branches of IMA
Left colic
Sigmoid arteries
Superior rectal
2 - coeliac trunk
11 - left gastric artery
20 - head of pancreas
19 - body of pancreas
29 - SMA
30 - SMV
5 - IMA
1 - Aorta
14 - sigmoid branches
16 - superior rectal
6 - left colic
Demonstrate surface marking of abdominal aorta
T12 - 4cm above the transpyloric plane in midline - transpyloric plane is halfway between suprasternal notch and the upper border of pubic symphysis
L4 - supra crestal line- line above iliac crests
A - abdominal aorta
B - Right common iliac
C - left common iliac
D - Left renal
E - right renal
G - Common hepatic artery
J - left hepatic
K - right hepatic
I - gastroduodenal
F - splenic
H - SMA
L - IMA
What does this CT show
AAA - suprarenal saccular aneurysm
Define aneurysm
Abnormal dilatation of artery
Pathogenesis of aneurysm
True - cystic medial necrosis
False - post traumatic
Risk factors for aneurysms
HTN, smoking, Marfan syndrome, syphilis, bicuspid aortic valve
What is an arterial dissection
Separation of the layers of the arterial wall with propagation proximally and distally
Right gonadal vein level
L2
Renal veins level
L1
Where does the left suprarenal vein drain
Left renal
Right drains directly to aorta
What level does the IVC receive hepatic and inferior phrenic veins
T8
Blood supply of adrenal glands
Superior suprarenal artery - from inferior phrenic
Middle suprarenal artery - from aorta
Inferior suprarenal artery - from renal
What are the anterior relations of the renal veins
Right - 2nd part of duodenum
Left - Body of pancreas, splenic vein, SMA
Blood supply of spleen
Splenic artery from coeliac trunk
It passes along the upper border of the pancreas
It is separated from the stomach by the lesser sac and then enters the lienorenal ligament to supply the spleen
What does the splenic vein drain to
Joins the IMV to form the portal vein
What ribs are the spleen related to
9,10,11
What does the splenic artery supply
Spleen
Upper border of pancreas
Short gastric and left gastroepiploic arteries
What are the parts of the pancreas
Head, uncinate process, neck, body, tail
What are the functions of the different islet cells of pancreas
alpha cells - glucagon
beta cells - insulin
D cells - somatostatin
Blood supply of pancreas
Head of pancreas
1 - superior pancreaticoduodenal artery from GDA
2 - Inferior pancreaticoduodenal - from SMA
Body and tail
1 - pancreatic branches of splenic artery
Which ducts drain the pancreas
- main pancreatic duct - duct of Wirsung- drains head, neck, body and tail - opens major duodenal papilla
- accessory pancreatic duct drains uncinate process and lower part of head - duct of santorini - opens minor duodenal papilla
6 - fundus
2 - body
18 - pyloric antrum
29 - pyloric canal
23 - D1
Embryology of pancreas
Ventral and dorsal parts
Ventral - from hepatic diverticulum and ties rise to lower part of head and uncinate process
Dorsal - Dorsal aspect of the duodenum and gives rise to upper part of head, neck, body and tail
3 - head
9 - neck
14 - SMA
15 - SMV
What are the first 2 organs injured in a stab to epigastrium
left lobe of the liver
Stomach
What demarcates left and right lobes of liver
Anatomical - falciform ligament anteriorly
Postero inferiorly - fissure for ligamentum teres and fissure of ligamentum venosum
Surgical - Imaginary line passing from the IVC to the gallbladder fossa
Structures in the porta hepatis
Anterior - right and left hepatic duct
Intermediate - hepatic artery
Posterior - portal vein
5 - common hepatic duct
11 - hepatic artery
20 - portal vein
17 - ligamentum teres
21 - quadrate lobe
2 - caudate lobe
9 -gallbladder
13 - IVC
25 - right triangular ligament
15 - left triangular ligament
23 - attached border of lesser omentum
What are the ligaments supporting the liver
1 - falciform ligament
2 - lesser omentum
3 - right and left triangular ligaments
4 - upper and lower coronary ligaments
Which structures pass through the free border of lesser omentum
portal vein
Common hepatic artery
Common bile duct
Why shoulder tip pain in cholecystitis
Inflamed GB irritates the diaphragm. The diaphragm nerve supply is the phrenic nerve which shares the the same nerve roots as the supraclavicular nerve supplying the shoulder tip
What is the surface marking of the gallbladder
At the angle between the 9th costal cartilage and the lateral margin of the rectus sheath
Blood supply of the stomach
Arteries along lesser curvature - left gastric (from coeliac), right gastric (from common hepatic)
Greater curvature - right gastroepiploic (from gastroduodenal artery), left gastroepiploic (from splenic) and sort gastric (from splenic)
Where is the GDA located and what is the clinical relevance
Posterior to D1 - posterior duodenal ulcer can cause bleeding from GDA
Venous drainage of stomach
Lesser curvature - left and right gastric vein - drain to portal vein
Greater curvature - right gastroepiploic (to SMV) and left gastroepiploic (splenic vein - joins portal vein)
Peritoneal relations of duodenum
First part is intra peritoneal
Other 3 parts are retro peritoneal
Blood supply of duodenum
1 - superior pancreatic duodenal artery (from GDA)
2 - inferior pancreatic duodenal artery (from SMA)
3 - branches from hepatic, right gastric, right gastroepiploic and supraduodenal arteries
Anterior relations of D1
Gallbladder and quadrate lobe of liver
Posterior relations of D1
Portal vein
GDA
CBD
Superior relations of D1
Epiploic foramen
Inferior relations of D1
Head and neck of pancreas
D2 anterior relations
Gallbladder, right lobe of liver, transverse colon, transverse mesocolon, jejunum
Posterior relations of D2
R kidney, right renal vessels, right edge of IVC, right psoas major
Medial and lateral relations of D2
Medial - head of pancreas
Lateral - same as anterior
Anterior relations of D3
Root of mesentery containing superior mesenteric vessels
Coils of jejunum
Posterior relations of D3
R psoas major
R ureter
R gonadal vessels
IVC
Abdominal aorta
IMA
