Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
20 Cards in this Set
- Front
- Back
|
What is the blood supply to the omentum?
|
The right and left gastroepiploic vessels provide the sole blood supply to the greater omentum.
Both are branches of the celiac trunk. The right gastroepiploic is a branch of the gastroduodenal artery, which is a branch of the common hepatic artery, which is a branch of the celiac trunk. The left gastroepiploic artery is the largest branch of the splenic artery, which is a branch of the celiac trunk. The right and left gastroepiploic vessels anastomose within the two layers of the anterior greater omentum along the greater curvature of the stomach. |
|
|
What is the blood supply, venous and lymphatic drainage to the large bowel?
|
Arterial supply to the colon comes from branches of the SMA and IMA. Flow between these two systems communicates via a "marginal artery" that runs parallel to the colon for its entire length.
Venous drainage usually mirrors colonic arterial supply, with the inferior mesenteric vein draining into the splenic vein, and the superior mesenteric vein joining the splenic vein to form the hepatic portal vein that then enters the liver. Lymphatic drainage from the entire colon and proximal two-thirds of the rectum is to the paraaortic lymph nodes that then drain into the cisterna chyli. The lymph from the remaining rectum and anus can either follow the same route, or drain to the internal iliac and superficial inguinal nodes. The pectinate line only roughly marks this transition. |
|
|
Rectus Sheath Anatomy Review picture
|
|
|
|
What is the blood supply of the stomach
|
Stomach is innervated by the vagas nuerve.
blood supply is from the left and right gastric, left and right gastroepiploic and short gastric arteries. constant NG suction results in hypokalemic metabolic alkylosis |
|
|
What is the blood supply for the small bowel
|
Entire small bowel (duodenum, jejunum and ileum is from SMA
|
|
|
enzymes of the small bowel
|
– Gastrin (D) promotes gastric acid and pepsinogen
production – CCK (D) promotes pancreatic enzyme secretion and gall bladder contraction – Secretin (D,J) causes water release, secretion of bile salts and inhibition of gastrin – Somatostatin (P) universal off switch – Gastrin releasing peptide (D,J,I) universal on switch - Motilin stimulates upper GI motility |
|
|
What is the most likely cause of a small bowel obstruction?
|
– Adhesions 60%
– Malignancy 20% – Hernias 10% – Crohn’s disease 5% – Miscellaneous 5% |
|
|
What cancers are most likely associated with the appendix
|
• Associated with carcinoid and primary
appendiceal carcinomas • Must be taken for mucinous ovarian tumors • Appendiceal artery arises from the ileocolic artery and MUST be ligated • Primary appendiceal tumors often diagnosed by gyneoncs as right ovarian tumors |
|
|
What veins are involved in the portal system?
|
• Splenic vein, SMV, IMV, gastric veins involved in the portal system
|
|
|
What are the boundaries of pelvic lymph node dissection?
|
– Lateral: genitofemoral nerve
– Medial: ureter – Inferior: deep iliac circumflex vein – Superior: inferior mesenteric artery or o Proximal: Common iliac artery o Distal: Circumflex iliac vein o Lateral: psoas muscle o Medial: Ureter o Posterior: Obturator nerve - need 4 nodes to validate adequate lymphadenectomy - removal of large nodes important in debulking in ovarian cancer and confers survival in endometrial cancer - Specific complications: vessel/ureter injury, obturator nerve injury, lymphocyst/lymphedema, hemorrhage |
|
|
What are the branches of the internal iliac artery?
|
• Posterior division of internal iliac artery
– Superior gluteal artery – Iliolumbar artery – Lateral sacral • Anterior division of internal iliac artery – Obturator artery – Uterine artery – Superior vesical artery – Inferior vesical artery – Umbilical ligament – Middle rectal artery – Internal pudendal artery • Inferior rectal artery • Labial arteries • Dorsal artery of the clitoris o Posterior Branches (“Ils”) • Iliolumbar artery • Lateral sacral artery • Superior gluteal artery o Anterior Branches (“Oh Sexy Uterus, MI Vagina Insists”) • Obturator artery • Superior vesical artery • Uterine artery • Middle rectal artery • Internal pudendal artery • Vaginal artery • Inferior gluteal artery |
|
|
What are the major pelvic nerves?
|
• Femoral nerve
Pelvic nerves – Nerve roots L2, L3, L4 – Provides motor function to the extensor muscles – Provides sensation to the thigh • Sciatic nerve – Nerve roots L4, L5, S1, S2, S3 – Largest nerve in the body – It divides into the tibial and peroneal nerves – Provides motor function to the distal extremity • Obturator nerve – Nerve roots L2, L3, L4 – Provides motor function to the adductor muscles • Pudendal nerve – Nerve roots S2, S3, S4 – Provides motor functions to the muscles of the pelvis and extern al anal sphincter – Provides sensation to the vulva and clitoris • Genitofemoral nerve – Nerve roots L1, L2 – Provides sensation to the thigh and vulva |
|
|
What is the blood supply/nervous supply to the vulva?
|
• Blood supply to the vulva
– Internal pudendal artery • Inferior rectal artery • Labial/ perineal arteries • Dorsal artery of the clitoris – External pudendal artery • Nervous supply to the vulva – Ilioinguinal nerve – Pudendal nerve • Labial/ perineal nerves • Dorsal nerve of the clitoris – Posterior femoral cutaneous nerve |
|
|
Topographic anatomy of the vulva (pic)
|
|
|
|
What are the borders of the femoral triangle and how are they in relation to the lymph drainage in that area?
|
• Borders: Inguinal ligament superiorly, sartorius
muscle laterally and adductor longus medially • Superficial inguinal lymph nodes above the cribriform fascia (6-8) • Femoral nerve, artery, and vein are found below the cribriform fascia • Deep inguinal lymph nodes (2-3) • Cloquet’s node deepest most superior lymph node before crossing inguinal ligament and thereby external iliac lymph nodes |
|
|
- Branches of Aorta
|
o Inferior phrenic arteries
o Celiac trunk: Hepatic (gives off right gastroepiploic to omentum), Splenic (gives off left gastroepiploic to omentum, short gastric arteries), Left gastric artery o Middle suprarenal arteries o Superior Mesenteric artery: gives off jejunal and ileal arteries to small bowel, right colic and iliocolic, anterior and posterior cecal, and appendicular arteries o Renal arteries o Ovarian arteries o Lumbar arteries o Inferior Mesenteric artery: gives off left colic, sigmoid, superior rectal artery o Median sacral artery - left ovarian vein drains into renal vein, right ovarian vein drains into aorta |
|
|
What is the course of the ureter?
|
- Enters pelvis by crossing over bifurcation of common iliac artery, just medial to ovarian vessels
- Descends attached to medial leaflet of pelvic sidewall peritoneum (medial to internal iliac branches and lateral to uterosacral ligament) - Traverses cardinal ligament 1-2cm lateral to cervix - Courses below uterine artery at level of uterine isthmus - Anteromedially to base of bladder, travels 1.5cm through wall to ureteric orifice - Blood supply from vessels it traverses: o Common iliac, internal iliac, uterine, vesicle vessels, all with vascular anastamoses along ureteric length. |
|
|
What are the most common sites of ureteric injury?
|
o Pelvic brim during clamping of IP ligament
o Uterine isthmic region during clamping of uterine artery o Pelvic sidewall during suturing of uterosacral ligament o Vaginal apex during clamping or suturing of cuff. |
|
|
What are the 5 umbilical ligaments?
|
o Median umbilical ligament: contains urachus (former joining of allantois to hindgut)
o Medial umbilical ligaments (2): contain obliteralted umbilical artery vessels o Lateral umbilical ligaments (2): contain inferior epigastric vessels |
|
|
What is hasselbach's triangle and what are its borders?
|
Location of direct hernias
o Inferior margin: inguinal ligament o Lateral margin: inferior epigastric vessels o Medial margin: lateral border of rectus |
