UCSF Students

March 27, 2010

Cholangiogram

Filed under: 12th Rib, Ampulla, Cholangiogram, Common Bile Duct, Duodenum Anatomy, Gallbladder Anatomy, Hepatoduodenal Ligament, L1 Vertebra, L2 Vertebra, L3 Vertebra, Liver Anatomy, Pancreas Anatomy, Pancreatic Duct, Transpyloric Plane — Tags: — admin @ 3:38 am

Cholangiogram

http://info.med.yale.edu/surgery/anatomy/radiology/cholangiogram_content.php

SLIDE 1
Goals:
1. Relate the hepatoduodenal ligament and second portion of the duodenum to bony landmarks
2. Relate the pancreas to bony landmarks and the duodenum

SLIDE 2
- The gallbladder was removed
- To examine the integrity of the biliary system during surgery, a catheter was inserted in the ampulla of the duodenum.
Question 1. Besides the biliary tree, what other structure should be filed with contrast dye?
- the pancreatic duct, because it empties into the ampulla along with the bile duct.

SLIDE 3
Identify the following landmarks
- 12th rib
- L1 vertebrae
- L2 vertebrae
- catheter
- common bile duct and gallbladder
- pancreatic duct
- hepatoduodenal ligament
- 3rd portion of the duodenum (filled with contrast)
- infer the 2nd portion of the duodenum

SLIDE 4
SUMMARY
- The pancreatic and common bile ducts empty into the middle of the 2nd portion of the duodenum
- This portion of the duodenum is to the right of midline between L1 and L3; the 3rd portion crosses the midline at L3
- The body of the pancreas crosses the midline at L2
- The hepatoduodenal ligament begins near the midline near the L1/L2 disc (transpyloric plane) and angles towards the liver

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Surgery Internship Survival Guide .

Why general surgery residents quit their training and how to prevent this from happening to you .

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How to succeed in medical school if you are an ENFJ personality type medical student .

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March 26, 2010

Abdominal CT of Cholangiocarcinoma

Filed under: Abdominal Aorta, Adrenal Anatomy, Caudate Lobe, Celiac Trunk, Cholangiocarcinoma, Cholecystectomy, Colon Anatomy, Common Bile Duct, Common Hepatic Artery, Common Hepatic Duct, Hepatic Portal Vein, Hepatic Veins, Inferior Vena Cava, Kidney, Left Gastric Artery, Liver Anatomy, Pancreas Anatomy, Pancreas CT Scan, Splenic Artery, Splenic Flexure, Splenic Vein, Stomach Anatomy, Stomach CT Scan, Superior Mesenteric Vein — Tags: — admin @ 9:56 pm

Abdominal CT of Cholangiocarcinoma

http://info.med.yale.edu/surgery/anatomy/radiology/abdomen_ct_2_content.php

TOPICS

SLIDE 1
Questions
10a. What is the contrast containing structure posterior to the liver?
- IVC
10b. What are the contrast containing structures dumping into the IVC?
- The right, middle and left hepatic veins
11. What anatomically divides the liver into lobes (right and left) and segments?
- The hepatic veins. Middle hepatic vein divides the right and left lobes. Right hepatic splits the right lobe into anterior and posterior segments. The left hepatic lobe divides the left lobe into medial and lateral segments.
12. What lobe of the liver is marked with the arrows?
- the caudate lobe
13. Can you identify the bright structure surrounded by the black arrows?
- this is the left portal vein
14. Can you identify the bright structure marked by the black arrows?
- this is the right portal vein
15a. Can you identify the low attenuating structure marked by black arrows?
- this is the common hepatic duct
15b. What branch of the aorta is marked by the black arrow?
- this is the celiac trunk
15c. What are the branches of the celiac trunk?
- common hepatic, splenic and left gastric
17. What is this fluid and air filled structure between the liver and spleen?
- this is the stomach
17b. What portion of the colon do you see anterior to the spleen and next to the stomach?
- this is the splenic flexure
17c. what part of the pancreas is this?
- this is the body
17d. what part of the pancreas is this?
- this is the tail and usually extends further over toward the spleen
18a. What is the low attenuation structure (black arrows) adjacent to the pancreas (white arrows)?
- common bile duct
18b. What are the metallic structures anterior to the common bile duct?
Hint: does this patient have a gallbladder?
- these are clips from a cholecystectomy
18c. What is this vein just behind the pancreas?
- splenic vein (the left most arrow is the portal vein)
18d. What venous structure does this join to make up the portal vein?
- the splenic vein joins the superior mesenteric vein to make up the portal vein
19. What is the structure anterior and near the superior aspects of the left kidney?
- the left adrenal gland
20. Do you see the SMV in this image? Try tracing it from the junction of the splenic and portal veins. Trace the vein superiorly, where the splenic vein comes to join it from the portal vein.
21a. What part of the pancreas are these arrows defining?
Hint: it is the most inferior portion of the pancreas
- this is the pancreatic head
21b. What is this small pointed area medial to the head of the pancreas?
Hint: it is the most inferior portion of the pancreas
- this is the uncinate process
21c. What is this high attenuating structure (artery) just anterior to the uncinate process?
- the superior mesenteric artery
22a. What is this low attenuating structure in the pancreatic head?
- this is the intrapancreatic portion of the common bile duct.
22b. What is this tiny low attenuating structure in the pancreas?
- this is the pancreatic duct
23a. What are these 2 vascular structures?
- IVC (white arrow)
- Aorta (black arrow)
23b. Why is the aorta filled with contrast and the IVC is not?
Hint: Do we give our injections in the artery or vein? And do we inject in the upper or lower extremity?
- We inject intravenously in the upper extremity (arm), so the blood goes to the SVC to heart to arterial system then to lower extremity venous system
24. Do you see this patient’s tumor?
Hint: it is very subtle, it is right where the CBD enters the duodenum at the ampulla.
- If you picked up that tumor, you have a promising career in radiology!
25. What part of the colon is this?
Hint: it is anterior on a long mesentery
- this is the transverse colon

SUMMARY
- The exercise emphasizes important anatomy that should be traced superiorly and inferiorly to appreciate the three-dimensional structure

- The tumor is difficult to see in many images. Rather than focussing on pathology in the image you should be able to explain in simple terms how this tumor contributed to the patient’s jaundice.

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March 15, 2010

T12 Abdominal Cross Section

Filed under: Abdominal Aorta, Abdominal CT scan, Adrenal Anatomy, Azygos Vein, Common Hepatic Artery, Common Hepatic Duct, Cystic Duct Anatomy, Diaphragm, Erector Spinae Muscle, External Oblique Muscle, Falciform Ligament, Gallbladder Anatomy, Gastrosplenic Ligament, Hepatic Artery Proper, Hepatic Portal Vein, Inferior Vena Cava, Intercostal Muscles, Intercostal Nerves, Intercostal Vessels, Kidney, Latissimus Dorsi, Left Gastric Artery, Left Gastric Vein, Lesser Omentum, Linea Alba, Liver Anatomy, Liver CT scan, Parietal Peritoneum, Pleura, Rectus Abdominis, Rectus Sheath, Serratus, Short-Gastric-Vessels, Spleen Anatomy, Splenic Artery, Splenic Vein, Splenorenal Ligament, Stomach Anatomy, Superior Epigastric Vessels, Thoracic Duct, Transversalis Fascia, Transversus Abdominus — Tags: — admin @ 11:05 am

T12 Abdominal cross section anatomy

Anatomical terms:
Right side:
Liver, falciform ligament, superior epigastric vessels, hepatic nerve plexuses, transversalis fascia, parietal peritoneum, visceral peritoneum of liver, diaphragm, inferior diaphragmatic fascia, hepatic artery proper (bifurcation), common hepatic duct, gallbladder, cystic duct, hepatic portal vein, costodiaphragmatic recess of pleural cavity, pleura, intercostal vessels and nerve, omental foramen (epiploic foramen of Winslow), common hepatic artery (retroperitoneal), inferior vena cava, omental bursa (lesser sac), right lesser and least splanchnic nerves, right sympathetic trunk, right crus of diaphragm, azygos vein, thoracic duct, anterior longitudinal ligament, celiac ganglia, abdominal aorta, body of T12 vertebra

Left side:
Linea alba, rectus sheath, rectus abdominis muscle, lesser omentum, left gastric artery and vein, external oblique aponeurosis, transversus abdominis muscle, 8th costal cartilage, diaphragmatic slip of origin, 7th costal cartilage, external oblique muscle, diaphragm, stomach, gastrosplenic ligament and short gastric vessels, 8th rib, spleen, serratus anterior muscle, intercostal muscles, splenorenal ligament with splenic vessels, parietal peritoneum on posterior wall of omental bursa, left gastric artery, left kidney, left suprarenal gland, 12th rib, latissimus dorsi muscle, erector spinae muscle (iliocostalis, longisimus, spinalis);

Source
Netter Anatomy

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March 8, 2010

Images of gallbladder polyps

Filed under: Gallbladder Polyps — Tags: , — admin @ 7:42 am

Images of gallbladder polyps

IMAGES
Link: http://imaging.consult.com/imageSearch?query=gallbladder%20polyps

Search Results for gallbladder AND polyps
Image Results (2) Text Results (34)

http://imaging.consult.com/imageSearch?query=gallbladder%20polyps
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Cholecystostomy

Filed under: Cholecystostomy — Tags: , — admin @ 4:56 am

Cholecystostomy

IMAGING

http://imaging.consult.com/imageSearch?query=cholecystostomy&global_search=Search&modality=+&anatomicRegion=

Search Results for cholecystostomy
Image Results (14) Text Results (19)

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Hemobilia

Filed under: Hemobilia — Tags: — admin @ 4:03 am

Hemobilia

http://rad.usuhs.edu/medpix/master.php3?mode=print_case&pt_id=7153&showall=yes

Content below:

MedPix® Home PageCase of the Week – Patient Summary 7153
Peer Reviewed and Certified –
Contributed by: Michael Anthony Riel
Approved by: James G. Smirniotopoulos, M.D. –
Demographics: 50 y.o. woman
History & Chief complaint:
8 days post liver biopsy. Anticoagulation started for central line thrombus.
Physical exam: Not Available
Click on Thumbnail to Magnify

.

Magnify Hemobilia
Figure: Hemobilia

Magnify Hemobilia
Figure: Hemobilia

Magnify Hemobilia
Figure: Hemobilia


Summary of Findings:

Differential Diagnosis:

Diagnosis:
More Like This ? Hemobilia
Disease Discussion –  Hemobilia
Hemobilia means blood in the bile
Case and/or Image Source: Michael Anthony Riel
Submitted by: Michael Anthony Riel – Author Info
Affiliation: Walter Reed Army Medical Center
Approved By: James G. Smirniotopoulos, M.D. – Editor Info
Affiliation: Uniformed Services University

Text and Images may be Copyrighted © 1999 – 2009 by the Original Content Contributors.
Copyrighted materials are reproduced here with their Permission. The MedPix® Classification Schema copyright © 1999-2010 by J.G.Smirniotopoulos,M.D.

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March 7, 2010

Jaundice

Filed under: Jaundice — Tags: , , , , , , — admin @ 5:14 pm

Jaundice

Jaundice Part 1

Jaundice Part 2

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Gallbladder Polyps on EUS

Filed under: EUS, Gallbladder Polyps — Tags: — admin @ 4:27 pm

Gallbladder Polyps on EUS

GALLBLADDER POLYPS EUS CHRISTOS KARALIS MD.wmv

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Biliary Dyskinesia

Filed under: Biliary Dyskinesia — Tags: — admin @ 3:14 pm

Biliary Dyskinesia

Coming soon..

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Gallbladder Ultrasound

Filed under: Abdominal Ultrasound, Biliary Colic, Cholecystitis, Cholelithiasis, Colorectal Surgery, Gallbladder Ultrasound — Tags: — admin @ 2:48 pm

Gallbladder Ultrasound

ultrasound in gallbladder evaluation

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Choledochal Cysts

Filed under: Choledochal Cysts — Tags: — admin @ 6:20 am

Choledochal Cysts

PATIENT STORIES
Parker LaBonte – choledochal cyst

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March 4, 2010

Anatomy Images

Filed under: Adrenal Anatomy, Aorta, Biliary Tract Anatomy, Colon Anatomy, External Oblique Muscle, Inferior Vena Cava, Kidney, Latissimus Dorsi, Liver Anatomy, Multifidus, Pancreas Anatomy, Psoas Major, Rectus Abdominis, Sacrospinalis, Serratus, Small Intestine Anatomy, Spinal Cord, Spleen Anatomy, Splenic Vein, Stomach Anatomy, Vertebral Column — Tags: — admin @ 12:13 pm

Anatomy Images

Upper abdomen, female

http://library.med.utah.edu/WebPath/HISTHTML/ANATOMY/VHF1600R.html

Identify the following regions in the image above: Rectus abdominus – External oblique – Serratus posterior inferior – Latissimus dorsi – Sacrospinalis – Multifidus – Psoas major – Right lobe of liver – Left lobe of liver – Gallbladder – Body of stomach – Right kidney – Left kidney – Descending aorta – Inferior vena cava – Vertebral body – Spinal cord

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Abdomen, female

http://library.med.utah.edu/WebPath/HISTHTML/ANATOMY/VHF1650R.html

Identify the following regions in the image above: Rectus abdominus – External oblique – Internal oblique – Latissimus dorsi – Psoas major – Sacrospinalis – Multifidus – Right kidney – Left kidney – Ascending colon – Transverse colon – Descending colon – Jejunum – Descending aorta – Inferior vena cava – Left adrenal gland – Vertebral body – Apophyseal joint – Spinal cord

————————–

Lower abdomen, female

http://library.med.utah.edu/WebPath/HISTHTML/ANATOMY/VHF1700R.html

Identify the following regions in the image above: Rectus abdominus – External oblique – Sacrospinalis – Multifidus – Psoas major – Ascending colon – Transverse colon – Descending colon – Descending aorta – Jejunum – Mesentery – Inferior vena cava – Vertebral body – Spinal canal

————————————

Upper abdomen, male L1 level

http://library.med.utah.edu/WebPath/HISTHTML/ANATOMY/VHM1550R.html

Identify the following regions in the image above: Rectus abdominus – External oblique – Latissimus dorsi – Serratus posterior inferior – Sacrospinalis – Multifidus – Body of stomach – Colonic splenic flexure – Jejunum – Pancreas – Spleen – Diaphragm – Descending aorta – Inferior vena cava – Gallbladder – Liver – Vertebral body – Spinal cord

—————–

Upper abdomen, male L1 level

http://library.med.utah.edu/WebPath/HISTHTML/ANATOMY/VHM1560R.html

Identify the following regions in the image above: Rectus abdominus – External oblique – Latissimus dorsi – Serratus posterior inferior – Sacrospinalis – Multifidus – Body of stomach – Pylorus – Duodenal bulb – Colonic splenic flexure – Colonic hepatic flexure – Jejunum – Pancreas – Spleen – Diaphragm – Descending aorta – Inferior vena cava – Left adrenal gland – Right adrenal gland – Gallbladder – Liver – Vertebral body – Spinal cord

————————–

Upper abdomen, male L1-L2 level

http://library.med.utah.edu/WebPath/HISTHTML/ANATOMY/VHM1580R.html

Identify the following regions in the image above: Rectus abdominus – External oblique – Latissimus dorsi – Sacrospinalis – Multifidus – Pyloric antrum – Colonic splenic flexure – Colonic hepatic flexure – Jejunum – Pancreas – Splenic vein – Spleen – Diaphragm – Descending aorta, celiac axis branch – Inferior vena cava – Left adrenal gland – Right adrenal gland – Left kidney – Right kidney – Gallbladder – Liver – Intervertebral disc – Spinal cord

—————————————–

Abdomen, male L2 level

http://library.med.utah.edu/WebPath/HISTHTML/ANATOMY/VHM1600R.html

Identify the following regions in the image above: Rectus abdominus – Transversus abdominis – Intercostal m. – External oblique – Internal oblique – Latissimus dorsi – Sacrospinalis – Multifidus – Erector spinae m. – Psoas major – Uncinate process of pancreas – Transverse colon – Jejunum – Descending colon – Spleen tip – Left kidney – Right kidney – Crus of diaphragm – Liver – Descending aorta, superior mesenteric branch – Inferior vena cava – Superior mesenteric vein – Vertebral body – Conus medullaris
——————————————–

Abdomen, male L3-L4 level

http://library.med.utah.edu/WebPath/HISTHTML/ANATOMY/VHM1650R.html

Identify the following regions in the image above: Rectus abdominus – External oblique – Internal oblique – Latissimus dorsi – Sacrospinalis – Multifidus – Psoas major – Quadratus lumborum – Iliocostalis – Longissimus dorsi – Spinalis dorsi – Ascending colon – Descending colon – Transverse colon – Jejunum – Left kidney – Right kidney – Left ureter – Right ureter – Descending aorta – Inferior vena cava – Superior mesenteric vein – Intervertebral disc – Cauda equina
———————————————

Lower abdomen, male L4 level

http://library.med.utah.edu/WebPath/HISTHTML/ANATOMY/VHM1700R.html

Identify the following regions in the image above: Linea alba – Rectus abdominus – External oblique – Internal oblique – Transversus abdominis – Sacrospinalis – Multifidus – Erector spinae muscle group (iliocostalis, longissimus dorsi, spinalis dorsi) – Psoas major – Quadratus lumborum – Ascending colon – Descending colon – Ileum – Descending aorta – Inferior vena cava – Vertebral body – Superior articular process – Inferior articular process – Apophyseal joint – Spinal canal with cauda equina – Thoracolumbar fascia
——————————————-

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March 3, 2010

Physiology of the pancreas liver and biliary tract

Filed under: Biliary Tract Physiology, Liver Physiology, Pancreas Physiology — Tags: — admin @ 9:10 am

Physiology of the pancreas liver and biliary tract

Dr. Goodman’s Lecture on the Physiology of the Pancreas, Liver, and Biliary Tree pt. 1.mp4

Dr. Goodman’s Lecture on the Physiology of the Pancreas, Liver, and Biliary Tree pt. 2.mp4

Dr. Goodman’s Lecture on the Physiology of the Pancreas, Liver, and Biliary Tree pt. 3.mp4

Dr. Goodman’s Lecture on the Physiology of the Pancreas, Liver, and Biliary Tree pt. 4.mp4

Dr. Goodman’s Lecture on the Physiology of the Pancreas, Liver, and Biliary Tree pt. 5.mp4

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Anatomy of the pancreas liver and biliary tracts

Filed under: Biliary Tract Anatomy, Liver Anatomy, Pancreas Anatomy — Tags: , , — admin @ 7:27 am

Anatomy and physiology of the pancreas, liver, and biliary tracts

VIDEOS

Dr. Goodman’s Lecture on the Anatomy of the Pancreas, Liver, and Biliary Tree pt. 1.mp4

Dr. Goodman’s Lecture on the Anatomy of the Pancreas, Liver, and Biliary Tree pt. 2.mp4

Dr. Goodman’s Lecture on the Anatomy of the Pancreas, Liver, and Biliary Tree pt. 3.mp4

Dr. Goodman’s Lecture on the Anatomy of the Pancreas, Liver, and Biliary Tree pt. 4.mp4

  • Normal liver in situ, gross
  • Normal liver, external, gross
  • Normal liver, cut surface, gross

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    February 27, 2010

    Biliary Tract

    Filed under: Biliary Tract, Uncategorized — Tags: — admin @ 8:31 am

    Biliary Tract

    coming soon…

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    February 17, 2010

    Cholecystitis

    Filed under: Acalculous Cholecystitis, Biliary Colic, Cholecystitis — Tags: , , — admin @ 12:46 pm

    Cholecystitis

    TOPICS COVERED
    - BILIARY COLIC
    - CHOLECYSTITIS
    - ACALCULOUS CHOLECYSTITIS

    Flashcards

    http://www.flashcardmachine.com/531533/2mi6

    Test yourself on topics: acalculous cholecystitis, cholecystitis

    VIDEOS
    Cholecystitis – Colelithiasis

    Histopathology Gallbladder–Acute cholecystitis

    Cholecystitis

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    January 30, 2010

    Cholelithiasis

    Filed under: Cholelithiasis — Tags: , , — admin @ 7:23 am

    Cholelithiasis

    Flashcards
    http://www.flashcardmachine.com/417289/3vi9

    More coming soon….

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    January 28, 2010

    Biliary Tract Anatomy

    Filed under: Biliary Tract — Tags: , , , , — admin @ 9:31 am

    Biliary Tract Anatomy
    IMAGES
    Biliary tract anatomy .
    Biliary ducts and gallbladder .

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