This document summarizes various anatomical structures and their blood supply. It discusses the arteries associated with gastric ulcers in different locations. It also reviews the blood supply to the liver, the course of the psoas major muscle, structures within the femoral sheath, the origin of the uterine artery, and pelvic anatomy. Key nerves like the hypoglossal and recurrent laryngeal nerves are also outlined.

1. MRCS Revision
Anatomy
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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. 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. 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. 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. 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. Pelvis

8. Pelvis 2

9. Uterus

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. 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. Inferior/recurrent laryngeal nerve

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