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