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Pastest Awad Notes Paper 1 2020 PASTEST NOTES 2020- AWAD PAPER 1 (APPLIED BASIC SCIENCE) Contents Anatomy ........................................................................................................................................................ 2 Abdominal Vessels .................................................................................................................................... 2 Abdominal Viscera .................................................................................................................................... 5 Abdominal wall and cavity ...................................................................................................................... 11 CNS, Brain................................................................................................................................................ 12 Lower limb .............................................................................................................................................. 26 Neck ........................................................................................................................................................ 30 Pelvis ....................................................................................................................................................... 33 Upper limb and breast ............................................................................................................................ 36 Spine........................................................................................................................................................ 39 Thorax ..................................................................................................................................................... 41 Embryology ............................................................................................................................................. 50 Surface Anatomy ..................................................................................................................................... 58 Immunology ............................................................................................................................................ 87 Pharma and Micro .................................................................................................................................. 95 Data interpretation and imaging .............................................................................................................. 107 Neurophysiology ................................................................................................................................... 142 Page | 1 Anatomy Abdominal Vessels Only the superior pancreaticoduodenal artery is a branch of the gastroduodenal artery. The inferior pancreaticoduodenal artery is a branch of the superior mesenteric artery. • The gastroduodenal artery, a branch of the common hepatic, gives off the superior pancreaticoduodenal artery which supplies the head and uncinate process of the pancreas. However, the body and tail of the pancreas are supplied mainly by the pancreatic branches of the splenic artery. The splenic artery is a branch of the coeliac axis as shown below. It has a tortuous course, passing along the superior border of the pancreas and posterior to the body of the stomach. It can be eroded into by a posterior gastric ulcer. • The gastroduodenal artery is a branch of the common hepatic artery. It runs behind the first part of the duodenum and is usually implicated in a bleeding posterior duodenal ulcer. The SMA is posterior to the splenic vein – it can be seen passing beneath the neck of the pancreas and under the splenic vein • The SMA lies to the left of the superior mesenteric vein. • The SMA arises at the level of L1. The inferior mesenteric artery (IMA) arises at L3. Both are midline branches of the aorta, however whilst the SMA runs inferiorly and to the right, the IMA runs to the left. • The SMA passes anterior to the left renal vein, Compression of the left renal vein between the SMA and the aorta is known as nutcracker syndrome. s ‘massive’ upper GI bleeding in an alcoholic patient. This makes oesophageal varices the most likely cause of the bleeding. The superficial oesophageal veins drain the lower third of the oesophagus to the left gastric vein. Portal hypertension secondary to alcoholic liver cirrhosis causes reversal of flow at portacaval anastomoses resulting in dilated superficial oesophageal veins (cf. caput medusae, anorectal varices) Page | 2 The hepatic artery (proper) is a branch of the common hepatic artery – it can be seen branching from it in the image below. It passes in the free edge of the lesser omentum (hepatoduodenal ligament) medial to the common bile duct and anterior to the portal vein. Clamping the free edge of the lesser omentum to achieve haemostasis in the liver is known as Pringle’s manoeuvre. The coeliac trunk is a direct branch of the aorta, arising at the level of T12. It trifurcates into the left gastric, splenic, and common hepatic arteries. The common hepatic artery bifurcates into the gastroduodenal artery and the hepatic artery proper, the latter then bifurcating into left and right branches. The right hepatic artery gives off the cystic artery, which supplies the gallbladder. The right renal artery usually arises slightly lower than the left. It passes posterior to the inferior vena cava (IVC), the right renal vein, the head of the pancreas and the duodenum – it can be seen emerging from behind the IVC in the image below. It divides before reaching the renal hilum and, as with the left renal artery, gives branches which supply the adrenal gland and the proximal ureter. It would not be safe to divide this vessel, although occasionally there can be accessory renal arteries present branching directly off of the aorta. Page | 3 The gonadal vessels originate from the abdominal aorta at the level of the L2 vertebra and descend into the pelvis anterior to the inferior vena cava as well as the ureters (‘water under the bridge’). It is important to identify the ureter and gonadal vessels during mobilisation of the left and right colon. The inferior vena (IVC) passes posterior to third part of the duodenum. After the IVC receives the hepatic veins, it passes through its aperture in the diaphragm at the level of T8. Each of the three holes has three structures passing through them: 1. Caval foramen – IVC, lymphatics, right phrenic nerve (left phrenic nerve pierces diaphragm separately) 2. Oesophageal hiatus – oesophagus, vagal trunks, left gastric vessels 3. Aortic hiatus – aorta, thoracic duct, azygous vein • The IVC forms the posterior boundary of the epiploic foramen (of Winslow). The anterior boundary is the portal vein, whilst the superior and inferior boundaries are the caudate lobe of liver and the first part of the duodenum, respectively The uterine artery arises from the anterior division of the internal iliac artery and runs medially on the levator ani towards the uterine cervix. It crosses above and in front of the ureter, to which it supplies a small branch, about 2 cm from the cervix. Reaching the side of the uterus, it ascends in a tortuous manner between the two layers of the broad ligament to the junction of the Fallopian tube and uterus. It then runs laterally towards the hilum of the ovary and ends by anastomosing with the ovarian artery. It supplies branches to the uterine cervix, the vagina, the body of the uterus, and from its terminal portion branches are distributed to the Fallopian tube and the round ligament of the uterus. Page | 4 The internal iliac artery is a branch of the common iliac artery – it is shown with its major branches in the image. It divides into two branches, the posterior division and the anterior division. • The posterior division gives off the superior gluteal artery (shown in turquoise) which supplies gluteus medius and minimis, and the lateral sacral (green). • The anterior division gives off the inferior gluteal artery which supplies gluteus maximus. All the muscles of the buttock are therefore supplied by the internal iliac artery, so compromise of this vessel would lead to visible buttock wasting. The blood supply of the penis is mainly derived from the pudendal artery (a branch of the internal iliac artery) and so this would also suggest the internal iliac artery was affected There is no coeliac vein. The venous drainage of the abdominal viscera is via the hepatic portal vein Prostate metastasis; the veins of the internal vertebral venous (Batson’s) plexus are clinically significant because they are valveless and can serve as a route for metastases. The portal vein runs in the free edge of the lesser omentum (hepatoduodenal ligament). The femoral vein is posterior to the artery in the adductor canal. As it exits the canal, it comes to lie medial to the artery. • The femoral artery gives off the descending genicular artery in the adductor canal. • The femoral artery lies anterior to the adductor longus. The profunda femoris is deep to adductor longus. Abdominal Viscera Page | 5 The pancreatic neck is anterior to the origin of the portal vein. The hepatic portal vein is formed of the confluence of the splenic and superior mesenteric veins, just posterior to the pancreatic neck, as shown below. It supplies 75% of all blood flow to the liver. The inferior vena cava lies posterior to its origin The anterior relations of the lesser sac are: 1. visceral peritoneum along the posterior stomach
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