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SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
The duodenum receives blood from the gastroduodenal artery, which is a branch of the common hepatic artery. The gastroduodenal artery lies just behind the superior part of the duodenum. It has two main branches: the right gastroepiploic and the superior pancreaticoduodenal, which is further divided into anterior and posterior parts. The left gastric vein is located in the lesser curvature of the stomach and the splenic vein joins the superior mesenteric vein to form the portal vein.
Anatomy of the Pharynx and Oesophagus
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
The venous drainage is initially via a complex network or plexus of veins that lies in the submucosal layer. Drainage from here is into a perioesophageal venous plexus, the point of origin of the oesophageal veins. The cervical oesophagus drains into the inferior thyroid vein via the brachiocephalic veins. The thoracic part of the oesophagus drains predominantly into the azygos veins, but also to a lesser extent into the hemiazygos and intercostal veins in the thorax, as well as to the bronchial veins. Inferiorly, the abdominal oesophagus drains into the left gastric vein. It meets the oesophageal vein at the lesser curvature of the stomach and drains from here into the portal vein. Knowledge of this anastomosis occurring at the level of the central diaphragmatic tendon (vertebral level T8) between the portal and systemic venous system is useful when diagnosing oesophageal varices. Portal obstruction can result in the formation of oesophageal varices in these veins, and throughout the upper gastrointestinal system, which, if ruptured, can result in life-threatening haemorrhaging.
Answers
Published in Thomas Hester, Iain MacGarrow, Surgical SBAs for Finals with Explanatory Answers, 2018
Portal hypertension (> 15 cm H2O) can cause collateral formation, importantly left gastric vein to oesophageal vein, forming varices and to a lesser extent the other collaterals listed in the question stem. Splenomegaly occurs due to portal congestion and can be associated with leucopaenia and thrombocytopaenia as a result of hypersplenism.
Preparation of long-acting microspheres loaded with octreotide for the treatment of portal hypertensive
Published in Drug Delivery, 2021
Bing Han, Huan Tang, Qiming Liang, Ming Zhu, Yizhuo Xie, Jinglin Chen, Qianwen Li, Juan Jia, Yan Li, Zhihui Ren, Dengli Cong, Xiaofeng Yu, Dayun Sui, Jin Pei
After that, the rats were anesthetized, fixed in supine position and incised in the middle abdomen. The mesenteric vein and portal vein were exposed. The PC intubation filled with heparin saline and connected with a pressure transducer was inserted conversely into the mesenteric vein. After the pressure curve was stabilized, the pressure of the mesenteric vein was determined, considering that the pressure of the right atrium was zero. The intubation followed the mesenteric vein to the main portal vein. The pressure of portal vein was determined by the above method. The anterior mesenteric vein at the punctured site was then ligated. The main left gastric vein was exposed and punctured in the direction of reverse blood flow to measure the pressure of the left gastric vein. Finally, the puncture site of the blood vessel was ligated.
Efficacy of laparoscopic gastric bypass vs laparoscopic sleeve gastrectomy in treating obesity combined with type-2 diabetes
Published in British Journal of Biomedical Science, 2021
Y Yan, F Wang, H Chen, X Zhao, D Yin, Y Hui, N Ma, C Yang, Z Zheng, T Zhang, N Xu, G Wang
For the laparoscopic gastric bypass group, patients were placed at the supine position after general anaesthesia with tracheal intubation. Then, pneumoperitoneum was established using a 10-mm Veress needle (Johnson & Johnson, USA), and CO2 gas was introduced at 15 mmHg. After establishing pneumoperitoneum, a 12-cm Trocar tube was introduced, and the 5-holes method was used to introduce the laparoscopies. Two 5-mm puncture devices were placed at positions of 5 cm of the left flat navel and under 5 cm of the left anterior axillary rib, respectively. Then, a 12-mm puncture device was placed under the right central clavicle rib, and a 5-mm puncture device was placed under the xiphoid process. After determining and fixing the His angle, the gastric ligament near the lesser curvature of stomach between the first and second branches of the left gastric vein was incised. After the fundus and posterior wall of the stomach were completely disconnected, the gastric sacculus (15 ~ 25 mL) was formed by incision from the small curvature of stomach lateral to the fundus of the stomach. Then, the jejunum was dismembered at the position of 75–120 cm from the Treitz ligament, and side to side anastomoses of the jejunum and gastric sacculus was performed. Afterwards, the mesenteric hiatus was closed, and the abdominal cavity was flushed. A gastric inflation test was performed to observe the effects. After removing the resected tissues, a double lumen casing drainage tube was placed under the gastrointestinal anastomotic opening, gastric stump, and intestinal end to the side anastomotic opening. Then, the incisions were sutured.
Variations in the vascular and biliary structures of the liver: a comprehensive anatomical study
Published in Acta Chirurgica Belgica, 2018
Burak Veli Ülger, Eyüp Savaş Hatipoğlu, Özgür Ertuğrul, Mehmet Cudi Tuncer, Cihan Akgül Özmen, Mesut Gül
With the exception of the lower part of the anal canal, venous blood from the gastrointestinal tract, spleen, and pancreas drains into the hepatic portal vein via a network of capillaries. The hepatic portal vein is formed by the fusion of the superior mesenteric and splenic veins at the level of the second lumbar vertebra, behind the neck of the pancreas, in front of the inferior vena cava. The vein then courses right to the porta hepatis, running behind the choledoc duct and proper hepatic artery in the hepatoduodenal ligament. The left gastric vein (also known as the coronary vein), which carries venous blood from the stomach and the esophagus, drains medially into the hepatic portal vein at the upper edge of the pancreas. The right gastric and superior pancreaticoduodenal veins also drain directly into the hepatic portal vein. In the porta hepatis, the hepatic portal vein, which is about 8 cm in length, divides into the left and right branches that enter the liver with the left and right branches of the proper hepatic artery. The right branch of the hepatic portal vein then divides into anterior and posterior branches, and the anterior branch divides further into branches draining segments V–VIII of the liver. The posterior branch gives rise to branches draining segments VI–VII. The left branch of the hepatic portal vein also divides into anterior and posterior branches draining segments II and III and segments I and IV, respectively. Variations in the portal hepatic vein are less common than variations in the proper hepatic artery. Covey et al. [11] identified five variations in the hepatic portal vein by examining computed tomographic images of 200 patients. Blood from the interlobular arteries and veins located in the portal triad around the liver lobules passes through the sinusoids and drains to the central veins of the liver. The hepatic veins formed by the association of these central veins are called the right, left, and intermediate hepatic veins; all drain into the inferior vena cava. The right hepatic vein drains principally into the posterior segments of the right lobe and courses in the right portal fissure between the anterior and posterior segments, whereas the left hepatic vein drains principally into the left lateral segment. The intermediate hepatic vein drains into the left medial segments and the anterior segments of the right lobe. Veins of segment I drain into the inferior vena cava via the caudate veins [12]. In recent years, imaging has revealed frequent variations in the hepatic veins. Barbaro et al. found that the medial and intermediate hepatic veins fused to form a single root in 65–85% of the subjects and then drained into the inferior vena cava [12].