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Abdomen
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Blood supply to the bowel comes from three main branches of the aorta – coeliac axis, superior and inferior mesenteric arteries. Coeliac axis and branches – left gastric, common hepatic, splenic arteryThe coeliac axis comes off at the T12 level and supplies the foregut structures such as liver, stomach, spleen, pancreas and the duodenum.Superior mesenteric artery (SMA) and branches – ileocolic artery, right colic artery, middle colic arteryThe SMA originates at L1, and supplies the embryonic midgut structures such as the duodenum, pancreas, small bowel, caecum, ascending colon and two-thirds of the transverse colon until the splenic flexure.Inferior mesenteric artery (IMA) and branches – left colic artery, sigmoid artery, superior rectal arteryThe IMA comes off at L3 and supplies the hindgut structures, such as the remaining one third of the transverse colon, descending colon, sigmoid and rectum (Figures 3.3 and 3.4).
The gastrointestinal system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Sharon J. White, Francis A. Carey
It is important to know the blood supply of the intestines, because this determines the site and pattern of ischaemic damage, and is also followed by lymphatics, thereby determining the routes of spread of carcinoma. The superior mesenteric artery supplies the entire small intestine apart from the first half of the duodenum. This artery also supplies the right side of the colon and most of the transverse colon. In the small intestine, the terminal branches of the superior mesenteric artery are end-arteries, with few anastomoses between them. In the large bowel there is a degree of distal and proximal anastomosis between all of the supplying vessels. The inferior mesenteric artery supplies the distal transverse, the descending and the sigmoid colon, and the upper part of the rectum. The middle and inferior rectal arteries, branches of the internal iliac, and internal pudendal arteries supply the remainder of the rectum. The venous drainage of the bowel, apart from the anal canal, is via the portal system to the liver. This is the reason why primary gastrointestinal malignancies frequently spread to the liver, producing hepatic metastases.
Gastrointestinal tract and salivary glands
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
The superior mesenteric artery arises about 1 cm below the coeliac axis, again from the anterior aspect of the abdominal aorta. It supplies the duodenum distal to the ampulla, the whole of the small intestine, the caecum, the ascending colon and proximal two-thirds of the transverse colon. The inferior mesenteric artery is smaller than the superior mesenteric and arises from the abdominal aorta 3–4 cm above its bifurcation. It supplies the distal third of the transverse colon, the descending colon, the sigmoid colon and the rectum.
Total mesorectal excision – 40 years of standard of rectal cancer surgery
Published in Acta Chirurgica Belgica, 2020
J. Votava, D. Kachlik, J. Hoch
The TME can be defined as a sharp dissection and a complete removal of the mesorectum, containing pararectal lymph nodes, along with its intact enveloping fascia [15]. Operative steps of the TME as described by Heald [16] are: 1. ligation of the inferior mesenteric artery at its origin; 2. mobilization of the left colic flexure; 3. transection of the left-sided colon at the junction between the descending and sigmoid colon; 4. sharp dissection in the avascular plane into the pelvis ventrally to the presacral fascia (of Waldeyer) and outside the enveloping visceral fascia of the rectum; 5. division of the lymphatic vessels and middle rectal vessels ventrolaterally at the level of the pelvic floor, 6. inclusion of all pelvic fat tissue and lymphatic structures to the level of the pelvic floor.
A 9.5-year-old boy with recurrent neurological manifestations and severe hypertension, treated initially for polyarteritis nodosa, was subsequently diagnosed with adenosine deaminase type 2 deficiency (DADA2) which responded to anti-TNF-α
Published in Paediatrics and International Child Health, 2020
Sezgin Sahin, Amra Adrovic, Kenan Barut, Selen Baran, Eda Tahir Turanli, Nur Canpolat, Osman Kizilkilic, Ozan Ozkaya, Ozgur Kasapcopur
Investigations. Haemoglobin was 9.8 g/dL, haematocrit 31.6%, MCV 59.6 fl, platelets 230 × 109/L, leucocytes 10.7 × 109/L [neutrophils 58%, polymorphonuclear leucocytes (PNL) lymphocytes, 31.0% and monocytes 10.0%]. Erythrocyte sedimentation rate (ESR) was 94 mm/h (<20) and C-reactive protein (CRP) 234 mg/L (<10). Owing to widespread myalgia, muscle enzymes were estimated but were within normal limits, as were analyses of electrolytes, liver and renal function and D-dimer levels. Screening tests for thrombophilia did not yield any tendency to thrombosis. Components of cell-mediated immunity and serum IgA (178 mg/dL), IgM (131 mg/dL) and IgE (20 mg/dL) were within normal limits. However, serum IgG was 1933 mg/dL (reference range for Turkish children aged 9 is 646–1620 [17]. Electromyography and nerve conduction studies of lower limbs demonstrated asymmetrical axonal polyneuropathy. There was no response to visual evoked potential and electroretinogram tests of the right eye. While brain MRI findings were compatible with hypertensive encephalopathy in the left prefrontal cortex, electroencephalography was normal. Conventional cranial and visceral angiography was performed to elucidate the malignant hypertension and neurological findings. Angiography of brain was normal. However, visceral angiography demonstrated irregularities and stenosis in some of the branches of the inferior mesenteric artery and renal interlobar arteries bilaterally (Figures 1 and 2).
Routine CT scan one year after surgery can be used to estimate the level of central ligation in colon cancer surgery
Published in Acta Oncologica, 2019
Ditte Louise E. Munkedal, Mona Rosenkilde, Nicholas P. West, Soren Laurberg
The available images included scans undertaken prior to surgery, 2 days after surgery and approximately 1 year after surgery. The study radiologist first assessed the images taken 1 year after surgery in order to identify the residual arterial stump and measure its length. If this was not possible, the preoperative CT-scan was used for identification. Afterwards, the CT-scan performed 2 days after surgery was used as a control. On the right side only, the ileocolic artery was measured from its origin at the superior mesenteric artery to the ligation. On the left side only, the inferior mesenteric artery was measured from its origin at the aorta to the ligation. The arterial stumps were classified as: a normal vessel (Figure 1(a)), thrombosed (visible thrombosis within the vessel, Figure 1(b)), a fibrotic line (mostly degenerated, Figure 1(c)) and not visible.