ABDOMEN VIVAS

2011-2, 2009-1&2, 2008-1&2, 2007-1, 2006-2, 2005-1&2, 2003-2, (aorta) 2003-1 (of urinary tract)Photo: Abdomen (pg 262)What structures can you identify on this photograph?IVC(23), Ureters(40), Common iliacs(3/4), Inguinal lig(24), Testicular a&v(39), Aorta(1), Bladder(2), Int/Ext iliac(25/7/8), Femoral vessels(9/12), Psoas(32), Genitofemoral nerve (15/10/14), IMA(22)

Describe the course of the ureters, and identify the “narrow” points- 25-30 cm long, retroperitoneal in the abdomen- Run from renal hilar (L1: (R) below (L) above), arise posterior to artery (which is posterior to vein)- Inferiorly on psoas (over branches of genitofem. n)- Crossed by gonadal vessels (testicular or ovarian) and ductus (vas) deferens- Marked on Xray as running medial to tips of transverse processes- Surface anatomy is line 5cm lateral to L1 spinous process to PSIS - Pass over pelvic brim at bifurcation of common iliacs - On lateral wall of pelvis inclining medially to ischial spine and insert post wall of bladder at VUJ - Narrow points are PUJ, pelvic brim, VUJ

What is the arterial blood supply of the ureter?Upper: Renal arteries, sometimes gonadal vessels alsoMidportion: Branches off abdominal aorta Inferiorly (pelvic): Branches of common iliacs

2011-2, 2005-2 (identify structures incl solid organs)Xray Abdomen:

On this Xray , please demonstrate the transpyloric plane 2010-2 (discussion) - Transverse section located at the midpoint between the jugular notch and upper border of the

pubic symphysis, or half-way between the xiphisternum and umbilicus- Roughly a hand’s breadth below xiphoid process- Passes through lower border of L1

What are the anatomical structures transected at the transpyloric plane? 2010-2 L1 verterba Pylorus SMA originConus medullaris Neck and body of pancreas SMV to hepatic portal veinUpper pole (R) kidney Hilum of (L) kidney Fundus of gallbladderRoot of transverse mesocolon Duodenal junction Hepatic and splenic flexures

2010-2, 2009-2 and 2007-2 (photo), 2003-2Discussion: Abdominal Aorta – Branches

2009-2, 2007-2 (venous structures), 2007-1 (adjacent (L) kidney)Identify the structures visible in this photo (pg 254)Kidneys (21/9), ureters (25/15), psoas major (10), diaphragm (4), adrenals (24/13), IVC (7), left renal vein (12), right renal vein (23), aorta (1), coeliac trunk (2), common hepatic artery (3), splenic artery (26), right crus (19), superior mesenteric artery (28), (R) gonadal v. (20)

Name the branches of the coeliac trunk and what do they supply- Arises at T12- Supplies foregut- Supplies liver, stomach, spleen, oesophagus and

superior part of duodenum and pancreas

Branches:- Common hepatic -> gastroduodenal, (R) gastric and

hepatic (-> cystic and (L) and (R) hepatic)- (L) gastric (oespohageal branches)- Splenic

Name the branches of the abdominal aorta Anterior midline branches (unpaired)

- T12: Coeliac trunk- L1: Superior mesenteric- L3: Inferior mesenteric

Lateral branches (paired)- L1: Supra-renal- L1: Renal- L2: Gonadal

Posterolateral (paired)- L2: Subcostal- T12: Inferior phrenic- L1-4: Lumbar

Describe the anatomy of the superior mesenteric artery 2010-2 - Origin L1 level- Midgut vessel- Pancreas above, duodenum below- (L) renal vein below

Outline the expected course of abdo aorta 2011-2, 2007-2- Enters abdo at T12- Left of midline- Bifurcation at L4 just below umbilicus

2008-1Describe the branches of the abdominal aorta that supply the gut Anterior midline branches (unpaired)

- T12: Celiac trunk- L1: Superior mesenteric- L3: Inferior mesenteric

Describe the arterial supply of the stomachLesser curvature – left gastric (from coeliac trunk)Lesser curvature – right gastric (from hepatic)Posterior gastric from splenicShort gastric arteries from distsl splenicLeft gastro-omental (gastro-epiploic) from splenicGreater curvature -  right gastro-omental (gastro-epiploic) from gastroduodenal (from hepatic)

Describe the arterial supply of the colon- Superior mesenteric from aorta -> middle colic, right colic, Ileocolic- Inferior mesenteric artery -> left colic, sigmoid arteries- Marginal artery -> Anastamosis

2010-1, 2009-1, 2008-2, 2006-2Identify the intra-abdominal structures visible on this CT scan

Describe the relations of the right kidney 2010-1

- Liver- Porta hepatis - Duodenum- IVC- Pancreas- Splenic vein- Kidneys- Spleen- Aorta- Coeliac trunk- Crus of diaphragm- Small bowel

- Surrounded by peri-nephric fat- Superiorly: Right adrenal, liver, portal vein (Supero-laterally- Right lobe of liver)- Medially: Psoas, vertebrae (T12 – L3) - Posteriorly: 11th & 12th Ribs + abdominal muscles (Transversus abdominus, Internal oblique,

external oblique), deep back muscles (erector spinae/quadratus Iumborum) - Anteriorly: Gall bladder, duodenum, ascending colon- Antero-medially: (R) renal vein, IVC, pancreas more anteriorly

What are the relations of the pancreas 2009-1 - Posteriorly: IVC, portal vein, (R) renal vein/artery, bile duct, sup mesenteric vessels, aorta, L2

verterbrae, (L) kidney and (L) adrenal- Lateral to right: duodenum in a C shape around head - Lat to left: hilum of spleen - Anteriorly: stomach, peritoneum, lesser omentum, bowel, sup and inf panc-duod arteries

Which structures are retroperitoneal? 2008-2 Liver, spleen, kidneys, pancreas, aorta, IVC

Demonstrate the potential spaces for fluid collection in the supine position. 2008-2 - Hepatorenal space (aka subhepatic or Morison’s pouch)- Splenorenal space

Describe the relationships of the spleen 2006-2

- Lies deep to and along plane of 9th and 11th ribs in left upper quadrant

- Inferiorly: Left kidney and splenic flexure colon - Superiorly and laterally: diaphragm- Medial: stomach and pancreas- Vascular supply: splenic a. and veins lie deep

2006-2Abdo CT – relations of liverPlease identify the relations of the liver as seen in this CT slice- Chest wall and ribs- Crus diaphragm- Kidney and adrenal gland- IVC- Duodenum- Gallbladder

What is the blood supply of liver- (L) and (R) hepatic arteries (from hepatic, from coeliac trunk)- Portal vein- Hepatic veins

What level do you think this CT slice is taken: Probably L1