Anatomy revision part 1

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Anatomy revision part 1

  1. 1. MRCS Revision AnatomyAwesomemedicalnotes.wordpress.com
  2. 2. Severe haematemesis – gastric ulcer and the affected arteries• Posterior gastric ulcer – splenic artery• Lesser curve gastric ulcer – left gastric artery• Greater curve gastric ulcer – gastroepiploic artery• Posterior duodenal ulcer – gastroduodenal branch of right gastric artery• Inferior pancreaticoduodenal (branch of superior mesenteric) artery supplies lower part of 2nd part of duodenum – well clear of ulceration site• Celiac artery branches (arises from aorta at T12): – L gastric artery ( branch into oesophageal and gastric branches) – Common hepatic artery ( branch into proper hepatic artery, R gastric artery and gastroduodenal artery(branch into superior pancreaticoduodenal artery)) – Splenic artery (dorsal pancreatic artery, greater pancreatic artery, left gastro-omental artery, short gastric artery)• Superior and inferior mesenteric arteries arise from aorta at L1 and L3 respectively
  3. 3. Hepatic blood supply• Blood supply to liver = 25% of resting cardiac output – 25% from hepatic artery – 75% from hepatic portal vein (from GI tract and spleen)• Normal portal pressure = 5-7mmHg ( increases after meals)• Both vessels enter liver via porta hepatis.• Caudate lobe receives an independent blood supply from hepatic portal vein and artery and its branch of hepatic vein drains directly into inferior vena cava
  4. 4. Psoas major muscle• Flexes thigh at hip joint• It joins illiacus muscle (origin: inner aspect of iliac wing of pelvis), and becomes iliopsoas muscle and inserts on lesser trochanter of femur = flexes thigh at hip joint
  5. 5. Femoral sheath • Femoral sheath ends 4cm inferior to inguinal ligament • Medial wall of fem sheath is pierced by great saphenous vein and lymphatic vessels • It is divided by 2 ventral septa into 3 compartments: – Lateral (contains fem. artery) – Intermediate (contains fem. vein) – Medial (a space called fem. canal) • Fem. canal contains efferent lymphatic vessels and a lymph node • Entrance of fem canal = fem ring = site of fem hernia
  6. 6. Uterine Artery • Arises from internal iliac artery (may also arise from umbilical artery) • Lies anterosuperior to ureter near lateral portion of fornix – Risk of ureteric damage during hysterectomy – Esp. left ureter as it lies very close to lat. Aspect of cervix • Point of crossing b/w uterine artery and ureter = 2 cm superior to ischial spine
  7. 7. Pelvis
  8. 8. Pelvis 2
  9. 9. Uterus
  10. 10. Uterus 2• Uterus is normally bent anteriorly b/w cervix and body of uterus• Commonly anteverted (inclined anteriorly) but frequently retroverted in older woman• 3 layers: perimetrium, myometrium and endometrium• Uterine body is enclosed b/w layers of broad ligament – freely mobile• Uterus covered by peritoneum anteriorly and superiorly except for vaginal part of cervix• Uterus is supported by pelvic floor
  11. 11. Hypoglossal Nerve• Supplies all intrinsic muscles of the tongue but not the palate (the palatoglossus muscle supplied by vagus nerve)• No sensory component• Genioglossus muscle protrudes the tongue• In paralysis, tongue deviates towards the affected side. (e.g. damaged left hypoglossal nerve = tongue deviates to left• Left submandibular salivary gland excision = risk of damaging hypoglossal nerve
  12. 12. Inferior/recurrent laryngeal nerve
  13. 13. Inferior/recurrent laryngeal nerve 2• A branch of vagus nerve• Supplies all muscles of larynx except cricothroid muscle (supplied by superior laryngeal branch of vagus nerve)• Sensory component – supplies larynx inferior to vocal cords• Damage recurrent laryngeal nerve: – Larynx is anaesthetic inferior to vocal cord on affected side – Paralysed cord seen to lie in ‘paralytic’ position: slightly abducted from midline and does not move on phonation

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