T3 L7: Applied anatomy

• Identify the structures in the transpyloric plane.

  1. Stomach
  2. Pancreas
  3. spleen
  4. transverse colon
  5. descending colon
  6. left kidney
  7. aorta
  8. right kidney & right renal artery
  9. IVC
  10. SMA
  11. transverse colon
  12. duodenum
  13. pylorus
  14. splenic vein / hepatic portal vein

  
• What are the structures labelled in this CT scan?

  1 - Liver

  2 - Heart

  
• What are the structures labelled in this CT scan?

  1 - liver

  2 - spleen

  3 - oesophagus

  4 - stomach

  5 - aorta

  
• What is the relationship between inferior vena cava and liver?

  as you go down, inferior vena cava gets closely associated with posterior surface of the liver
• What are the structures labelled?

  kidneys

  
• What are the structures labelled?

  1 - Common hepatic artery

  2 - Pancreas

  3 - Splenic artery

  4 - Hepatic portal vein

  
• What is the structure labelled?

  Splenic vein joining hepatic portal vein

  
• What are the structures labelled here?

  1 - IVC and renal veins

  2 - Renal artery branching from aorta

  
• Case 1: What abdominal wall layers must be incised to access the abdominal cavity when using the Pfannenstiel incision?

  below Arcuate line:

  1. Skin
  2. Camper's fascia (superficial fatty layer)
  3. Scarpa's fascia (deep membranous layer)
  4. Anterior rectus sheath, formed by aponeuroses of:
  5. External oblique
  6. Internal oblique
  7. Transversus abdominis
  8. Rectus abdominis
  9. Transversalis fascia
  10. Parietal peritoneum

  
• Case 1: What abdominal wall layers would be incised if the supraumbilical transverse incision was made instead?

  Above Arcuate line: Supraumbilical

  1. Skin
  2. Camper's fascia (superficial fatty layer)
  3. Scarpa's fascia (deep membranous layer)
  4. Anterior rectus sheath, formed by aponeuroses of:
  5. external oblique
  6. internal oblique
  7. Rectus abdominis
  8. Posterior rectus sheath, formed by aponeuroses of:
  9. Internal oblique
  10. Transversus abdominis
  11. Transversalis fascia
  12. Parietal peritoneum

  
• Case 1: What abdominal wall layers would be incised if the sub-umbilical midline incision was made instead?

  1. Skin
  2. Camper's fascia (superficial fatty layer)
  3. Scarpa's fascia (deep membranous layer)
  4. Linea alba
  5. Transversalis fascia
  6. Parietal peritoneum

  
• Case 2: What is the most likely diagnosis and why?

  Direct inguinal hernia

  more likely in biological males

  bulge began recently after heavy lifting (acquired)

  
• Case 2: What route does a direct inguinal hernia take in relation to the inguinal canal?

  pushes through posterior wall of the canal and out through superficial inguinal ring

  
• Case 2: What forms the posterior wall of the inguinal canal?

  Transversalis fascia

  reinforced medially by the conjoint tendon

  
• Case 2: Where is the superficial inguinal ring located?

  closes to pubic tubercle, through aponeurosis of external oblique

  
• Case 3: What is the most likely diagnosis?

  Alcoholic cirrhosis with portal hypertension

  
• Case 3: What are prominent vascular markings on the surface of the abdomen called and why are these formed?

  Caput medusae

  formed when venous pressure in the portal system is high

  driving blood flow through areas where there is portal systemic anastomosis

  in this case: anastamosis between paraumbilical and epigastric veins

  
• Case 3: What other anastomoses between the portal and systemic circulatory systems exist?

  Oesophagus - oesophageal veins and left gastric vein

  Anal canal - superior rectal vein and inferior/middle rectal veins

  
• Case 4: What organs are most likely to be affected when a patient presents with epigastric pain?

  organs of the foregut (stomach, duodenum, pancreas, liver, gallbladder, spleen)

  
• Case 4: Gastric contents exiting a posterior perforation of the stomach wall will accumulate in which space?

  Lesser sac (omental bursa)

  
• Case 4: How is the lesser sac connected to the greater sac?

  epiploic foramen

  
• Case 4: What structure is useful in locating the connection between the lesser and greater sac?

  Hepatoduodenal ligament / portal triad

  
• Case 4: What structures are located within the hepatoduodenal ligament?

  hepatic portal vein

  proper hepatic artery

  common bile duct

  lymphatic vessels

  nerves from hepatic plexus