Right Hemicolectomy
Right Hemicolectomy Surgery
Laparoscopic Right Colectomy Colon Cancer
Laparoscopic Colon Resection (Right Colectomy with Cholecystectomy)
Right Hemicolectomy
Right Hemicolectomy Surgery
Laparoscopic Right Colectomy Colon Cancer
Laparoscopic Colon Resection (Right Colectomy with Cholecystectomy)
Inguinal Hernias
http://www.vesalius.com/cfoli_frms.asp?VID=1450&StartFrame=1&tnVID=1451
This site has videos
Video #1
A 68-year-old woman presented to the emergency room with lower abdominal pain and a large reducible right lower quadrant hernia. CT scan showed the origin of the hernia in the right inguinal region with the sac extending cephalad and laterally between the internal and external oblique muscles
Video #2
The patient was taken to the operating room for laparoscopic repair of the hernia. The initial approach was transabdominal (TAP) to visualize the defect and reduce the hernia.
Video #3
The defect is shown after reduction of the hernia contents.
CT of the chest, abdomen, and pelvis
http://www.imaios.com/en/e-Anatomy/Thorax-Abdomen-Pelvis/Abdomen-Pelvis-CT
(The site has a free registration to access this link)
Labeled structures from top to bottom
(Note: I have not included the labels that you also see if you hover over the image. I will do that soon.)
1. Esophagus
2. Esophagus, right lobe of liver
3. Esophagus, right lobe of liver, liver (superior part)
4. Same
5. Same
6. Same
7. Same
8. Same
9. right lobe of liver, liver (superior part), caudate lobe, esophagus
CONTINUE COUNTING SLIDES FROM HERE…
5. right lobe of liver, liver (superior part), caudate lobe, esophagus, spleen
6. right lobe of liver, liver (superior part), caudate lobe, quadrate lobe, left lobe of liver, esophagus, spleen
7. right lobe of liver, liver (superior part), caudate lobe, quadrade lobe, left lobe of liver, esophagus, fundus of stomach, spleen
8. right lobe of liver, liver (superior part), caudate lobe, quadrade lobe, left lobe of liver, esophagus, Stomach (fundus of stomach, cardia, greater curvature), spleen
9. right lobe of liver, liver (superior part), caudate lobe, quadrade lobe, left lobe of liver, Stomach (fundus of stomach, cardia, greater curvature) spleen
10. right lobe of liver, liver (superior part), caudate lobe, quadrade lobe, left lobe of liver, Stomach (fundus of stomach, cardia, greater curvature) spleen
11. right lobe of liver, liver (superior part), caudate lobe, quadrade lobe, left lobe of liver, Stomach (fundus of stomach, cardia, greater curvature) spleen
12. Liver (right lobe of liver,caudate lobe, quadrade lobe, left lobe of liver); Stomach (fundus of stomach, greater curvature) spleen
13. Liver (right lobe of liver,caudate lobe, quadrade lobe, left lobe of liver); Aorta (abdominal aorta); Stomach (fundus of stomach, lesser curvature, greater curvature) spleen
14. Liver (right lobe of liver,caudate lobe, quadrade lobe, left lobe of liver); Aorta ; (abdominal aorta); PORTA HEPATIS (HEPATIC ARTERY “left branch red”); Stomach (fundus of stomach, lesser curvature, greater curvature) spleen
15. Liver (right lobe of liver,caudate lobe, quadrade lobe, left lobe of liver); Aorta ; (abdominal aorta; CELIAC TRUNK) ; Porta hepatis (hepatic artery “left branch red”) ; Stomach (fundus of stomach, lesser curvature, greater curvature) spleen
16. Liver (right lobe of liver,caudate lobe, quadrade lobe, left lobe of liver); Aorta ; (abdominal aorta; celiac trunk); Porta hepatis (hepatic artery “left branch red”) Stomach (fundus of stomach, lesser curvature, greater curvature) spleen (SPLENIC VEIN)
17. Liver (right lobe of liver,caudate lobe, quadrade lobe, left lobe of liver); Aorta ; (abdominal aorta; celiac trunk); Porta hepatis (hepatic artery “left branch red”); Stomach (fundus of stomach, lesser curvature, greater curvature) spleen (SPLENIC VEIN)
18. Liver (right lobe of liver,caudate lobe, quadrade lobe, left lobe of liver); Aorta ; (abdominal aorta; celiac trunk); Porta hepatis (PORTAL VEIN “left branch blue” anterior; hepatic artery “left branch red” posterior); Stomach (BODY OF THE STOMACH, lesser curvature, greater curvature) spleen (splenic vein, SPLENIC ARTERY)
[Neeter plate 290 for orientation of splenic artery]
19. Liver (right lobe of liver,caudate lobe, quadrade lobe, left lobe of liver); ADRENAL GLAND, Aorta ; (abdominal aorta; celiac trunk, LEFT GASTRIC ARTERY); Porta hepatis (portal vein “left branch blue” anterior; hepatic artery “left branch red” posterior); Stomach (body of the stomach, lesser curvature, greater curvature) spleen (splenic vein, splenic artery)
[My notes: I notice that the left gastric artery is headed anterior to the stomach, while the splenic artery is headed posterior to the stomach. Also, the left gastric artery is thinner than the splenic artery It's a way for me to distinguish them.]
[Netter plate 290 for orientation of left gastric artery]
20. Same
21. Same
22. Liver (right lobe of liver,caudate lobe, quadrade lobe, left lobe of liver); adrenal gland; KIDNEY (RENAL CORTEX) ; Aorta ; (abdominal aorta; celiac trunk, left gastric artery); Porta hepatis (portal vein “left branch blue” anterior; hepatic artery “left branch red” posterior); Stomach (body of the stomach, lesser curvature, greater curvature) spleen (splenic vein, splenic artery)
16. Liver (right lobe of liver, caudate lobe, quadrate lobe, lte lobe of liver
BELOW IS THE LIST OF ANATOMICAL PARTS INCLUDED IN THIS ABDOMINAL CT LEARNING MODULE
Intestines Blood Supply
Arteries
- middle colic artery
- superior mesenteric artery
- inferior mesenteric artery
- marginal artery
- right colic artery
- ileocolic artery
- left colic artery
- sigmoid arteries
- inferior mesenteric arteries

source: http://www.nytimes.com/imagepages/2007/08/01/health/adam/8831Bloodsupplyofthelargeintestine.html
Other images:
http://catalog.nucleusinc.com/generateexhibit.php?ID=316
http://www.vascularweb.org/patients/NorthPoint/Mesenteric_Ischemia.html
ADDITIONAL ARTICLES
ALL STUDENTS
Inspirational quotes for premedical students, medical students, and residents
Premedical students
How to determine the significance of your Science GPA .
How to determine your Science GPA .
Before you apply to the UCSF School of Medicine, there are a few things you should know
Related links: Kaplan MCAT
Related books: Examcrackers , Get Into Medical School: A Strategic Approach .
Medical Students
When the experience of medical school becomes too painful, you just have to stop and laugh at it all
How to choose 4th year electives before residency .
Match Day: A collection of videos of medical students on Match Day .
Surviving the scramble for a residency position: A guide for medical students .
Medical school graduation ceremonies and speeches: The captured moments .
Related books: Med School Confidential: A Complete Guide to the Medical School Experience: By Students, for Students .
UCSF SCHOOL OF MEDICINE
Before you apply to the UCSF School of Medicine, there are a few things you should know .
How to study for the Brain Mind and Behavior Block (Neurology and Psychiatry) at UCSF .
USMLE EXAMS
Multiple choice questions for medical students preparing for USMLE Step 1 .
How to study for the USMLE Step 3 exam .
Related links: Kaplan USMLE Programs
Related books: First Aid for the USMLE Step 1 2010; First Aid for the USMLE Step 2 CK; First Aid for the USMLE Step 2 CS, Third Edition .
Internship (General)
How to maintain patient safety, get help, and load the boat during internship and residency .
How to manage depression in internship and residency .
How to stay up 30 hours or go without sleep for long periods during your internship and residency .
Related books: The Washington Manual Internship Survival Guide
General Surgery Residency
Surgery Internship Survival Guide .
Why general surgery residents quit their training and how to prevent this from happening to you .
Related books: The ABSITE Review
Personality Types
How to succeed in medical school if you are an ENFJ personality type medical student .
IF YOU FOUND THESE ARTICLES HELPFUL, PLEASE SUBSCRIBE!
Angiograms of the Abdomen
http://info.med.yale.edu/surgery/anatomy/radiology/abdominal_angiogram_content.php
SLIDE 1
Angiograms of the abdomen
- is a composite of angiograms taken from different patients.
- The position of the transumbilical plane is approximated by the red line.
- The three images on the right are standard x-ray films with reverse contrast (a positive was made from the x-ray negative)
- The image on the left was reconstructed from a CT study
- The individual images with labels can be viewed on the following pages
- celiac trunk
- superior mesenteric artery
- inferior mesenteric artery
- abdominal aorta with branches of the celiac trunk deleted
SLIDE 2
SUMMARY
1. The celiac and SMA originate close to each other, which the IMA originated more distally close to the transumbilical plane
2. Note the gross differences in the distribution of the vessels
3. The celiac branches are superior and on both sides of the midline
4. The SMA branches are widely distributed, through heavily in the upper left quadrant
5. The IMA branches are entirely on the left
6. In your further studies you should be able to identify what organs the major branches are supplying and where the vessels are located (i.e. in mesenteries or retroperitoneal)
Diverticulitis on CT scan
http://info.med.yale.edu/surgery/anatomy/radiology/diverticulitis_content.php
SLIDE 1
Goals
To examine how diverticulitis affects the:
1. Wall of the colon
2. Lumen of the colon
3. Fat in the mesentery of the colon
SLIDE
Normal and diseases sigmoid colon are shown for comparison. The sigmoid colon is filled with contrast.
Compare:
- In the sigmoid colon: width of the colon, width of the lumen
- In the neighboring fat: stranding due to inflammatory response, normal fat
SLIDE 2
SUMMARY
1. Inflammation causes a thickening of the colon wall that narrows the lumen
2. Stranding is the radiographic appearance of an inflammatory response by the fat in the mesentery
Renal Cell Carcinoma CT Scan
http://info.med.yale.edu/surgery/anatomy/radiology/renal_ca_content.php
SLIDE 1
Renal Cell Carcinoma
- Why does the right kidney look like a donut with bright stuff in the donut hole?
– the kidney treats venous contrast like a waste product and concentrates it in the urine
- Why is the tumor in the left kidney duller than the rest of the donut?
– the tumor is hypovascular in relation to the renal parenchyma
- Is this section closer to the transpyrolic, subcostal, or umbilical plane? Why?
– the transpyloric: the superior mesenteric artery branches off the aorta; the pancreas is present; ribs are present; renal arteries (subcostal plane) ureters (which whould be bright with contrast, are absent)
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
——————
ADDITIONAL ARTICLES
ALL STUDENTS
Inspirational quotes for premedical students, medical students, and residents
Premedical students
How to determine the significance of your Science GPA .
How to determine your Science GPA .
Before you apply to the UCSF School of Medicine, there are a few things you should know
Related links: Kaplan MCAT
Related books: Examcrackers , Get Into Medical School: A Strategic Approach .
Medical Students
When the experience of medical school becomes too painful, you just have to stop and laugh at it all
How to choose 4th year electives before residency .
Match Day: A collection of videos of medical students on Match Day .
Surviving the scramble for a residency position: A guide for medical students .
Medical school graduation ceremonies and speeches: The captured moments .
Related books: Med School Confidential: A Complete Guide to the Medical School Experience: By Students, for Students .
UCSF SCHOOL OF MEDICINE
Before you apply to the UCSF School of Medicine, there are a few things you should know .
How to study for the Brain Mind and Behavior Block (Neurology and Psychiatry) at UCSF .
USMLE EXAMS
Multiple choice questions for medical students preparing for USMLE Step 1 .
How to study for the USMLE Step 3 exam .
Related links: Kaplan USMLE Programs
Related books: First Aid for the USMLE Step 1 2010; First Aid for the USMLE Step 2 CK; First Aid for the USMLE Step 2 CS, Third Edition .
Internship (General)
How to maintain patient safety, get help, and load the boat during internship and residency .
How to manage depression in internship and residency .
How to stay up 30 hours or go without sleep for long periods during your internship and residency .
Related books: The Washington Manual Internship Survival Guide
General Surgery Residency
Surgery Internship Survival Guide .
Why general surgery residents quit their training and how to prevent this from happening to you .
Related books: The ABSITE Review
Personality Types
How to succeed in medical school if you are an ENFJ personality type medical student .
IF YOU FOUND THESE ARTICLES HELPFUL, PLEASE SUBSCRIBE!
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.
Abdominal CT scan
http://info.med.yale.edu/surgery/anatomy/radiology/abdomen_ct_content.php
TOPICS
SLIDE 1
Goals
1. To understand vascular anatomy of the liver and how the vessels define the segmental anatomy of the liver
2. To review and understand the developmental anatomy and fetal circulation of the liver and what remnants are still present in the adult liver
3. To review colonic and small bowel anatomy and be able to predict where you may visualize different segments of bowel and axial CT
4. To understand the anatomy, relationships and orientation of the pancreas
5. To review and understand the relationships of major arterial and venous structures in the abdomen and pelvis and how they can be seen on axial CT
SLIDE 2
Questions
2. What is this high attenuation structure in the liver?
- this is the left portal vein.
1a. Do the portal veins divide the liver into segments?
- No. the hepatic veins do.
4a. What is this black line that runs through the liver?
- this is the fissure for the ligamentum teres
4b. What structure ran through this region?
- the umbilical vein
4c. What is this fissure anterior to the caudate lobe?
- this is the fissure for the ligamentum venosum
5a. what part of the colon is this?
- this is the distal transverse extending to the splenic flexure
5b. Why does the colon look white?
- the patient was given oral contrast
6. what portion of the pancreas is this?
- this is the tail
9. what portion of the colon is this?
- hepatic flexure
10. what is this venous structure extending from the left kidney to the IVC?
- this is the left renal vein
13. what portion of the colon is labeled by each arrow?
- ascending colon (black)
- descending colon (white)
14. What vessel is coming off the aorta?
- hint: it is colonic supply and below the level of the SMA
- inferior mesenteric artery
15. Look at the small bowel without contrast (white arrows) and the colon with contrast (black arrows) and note that the bowel wall is extremely thin. Normally it is approximately 3mm.
18. What is this small tubular structure partially filled with contrast on this and the subsequent image.
19. This is the appendix. Note this is normal; thin walled, filled with contrast and no inflammatory changes in the adjacent fat.
23. What portion of the colon is labeled with arrows?
- sigmoid colon
24. What vascular structures are marked by the arrows?
- the external iliac arteries and veins
26a. What is this fluid filled structure?
- the bladder
26b. What portion of bowel is this located posterior to the bladder and anterior to the sacrum?
- the rectum
26c. What is the significance of the space between the bladder and the sacrum?
- this is the most dependent portion of the peritoneal cavity in a male.
SLIDE 3
SUMMARY
- You will need to be able to navigate your way through CT and MRI images of the abdomen. This exercise focuses on important structures and represents an appropriate level of detail.
- You should become skilled at tracing structures superiorly and inferiorly to appreciate their relations in three dimensions.
Colon resection
http://info.med.yale.edu/surgery/anatomy/pdf/ResectAscendColon.pdf
Yale school of medicine
TOPICS
PAGE 1
- middle colic artery
- [...]
[need to copy info]
[add to categories]
Abdominal Landmarks
http://info.med.yale.edu/surgery/anatomy/graphics/abdominal_landmarks.htm
Yale school of medicine
Goals
- Relate internal structures of the abdomen to key planes and lines
- Relate internal structures of the abdomen to the skeleton
- Integrate this figure with plain x-ray films of the abdomen (“Abdomen and pelvis x-ray”) and the body painting exercise.
Topics below
- midclavicular line
- liver
- gallbladder
- spleen
- transpyloric plane
- subcostal plane
- kidney
- iliac crest / umbilical plane
- inguinal ligament / anterior superior iliac spine

CT Slice Through the Arch of the Aorta
http://info.med.yale.edu/surgery/anatomy/radiology/CT_aorta_content.php
TERMS
- right lung
- left lung
- heart chambers
- liver
- air in the stomach
- arch of aorta
- manubrium
- sternal angle (angle of louis)
SUMMARY
1. The aorta moves from right to left as it arches from anterior to posterior, so the plane of the imaging must be oblique to capture the entirety of the arch
2. The arch of the aorta is at the same level as the angle of Louis
3. The major vessels from the arch arise posterior o the manubrium
Chevron Incision Anatomy for Dissection
http://info.med.yale.edu/surgery/anatomy/graphics/chevron_content.php
Yale school of medicine
SLIDE 1 – Introduction
SLIDE 2
- anterior rectus sheath
- cut end of rectus abdominus
- posterior rectus sheath
- superior epigastric vessel
- xiphoid
SLIDE 3
- anterior rectus sheath
- cut end of rectus abdominus
- posterior rectus sheath
- finger under peritoneum
SLIDE 4
- Xiphoid process
- falciform ligament
- ligament teres
- right rectus
- superior epigastric vessels
Abdominal cross section anatomy at L5
Terms:
Left term: umbilical impression, ileum, rectus abdominis muscle, ileocecal junction, cecum, internal oblique muscle, external oblique muscle, psoas major muscle, iliacus muscle, body of L5 vertebra, lumbar cistern of subarachnoid space
Right term: common iliac arteries, ureter, ileum, descending colon, transversus abdominis muscle, lumbar plexus (ventral rami of L2-L4 becoming femoral and obturator nerves and L4 part of lumbosacral trunk), iliac crest, erector spinae muscle
Source:
Netter Anatomy
Abdominal cross section anatomy at L2
Terms:
Left side: greater omentum, pancreas with uncinate process, transverse colon, junction of 2nd and 3rd parts of duodenum, ascending colon, liver, right renal vein (entering inferior vena cava), right kidney, inferior vena cava, right crus of diaphragm, psoas major muscle, L1-L2 intervertebral disc
Right side: superior mesenteric vein, superior mesenteric artery, transverse colon, ileum, jejunum, perirenal fat, ureteropelvic junction, descending colon, renal fascia, left kidney, minor calyx and renal pelvis, pararenal fat, left renal artery, left renal vein (entering inferior vena cava), left crus of diaphragm, abdominal aorta
Source:
Netter Anatomy
Abdominal cross section anatomy at T12
Terms:
Left side: pyloric canal, pylorus, right colic (hepatic) flexure of colon, gallbladder, superior (1st) part of duodenum, hepatoduodenal ligament, portal triad (common bile duct, hepatic artery, portal vein), inferior vena cava, right suprarenal gland, right crus of diaphragm, pancreas
Right side: stomach, jejunum, transverse colon (acsending to left colic flexure), bifurcation of celiac trunk, descending colon (descending from left colic flexure), spleen, splenic artery and vein, left suprarenal gland, superior pole of left kidney, left crus of diaphragm, thoracic aorta, pancreas
Source:
Netter Anatomy
Terms listed:
Image A, superior to Image D, inferior.
Image A: left lobe of liver, inferior vena cava, stomach, aorta, right lobe of liver, rib, body of vertebra, spleen
Image B: stomach, inferior vena cava, aorta, right lobe of liver, right kidney, body of vertebra, left kidney, spleen
Image C: rectus abdominis muscle, transverse colon, ascending colon, inferior vena cava, aorta, descending colon, right lobe of liver, right kidney, body of vertebra, deep back muscles
Image D: Linea alba, ileum, ascending colon, right common iliac artery, left common iliac artery, descending colon, psoas muscle, body of vertebra, deep back muscles
Source
Netter Anatomy
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
Abdominal Arteries
Anatomical terms in order of mention (part 1)
Abdominal aorta; Celiac artery; Superior mesenteric artery; Inferior mesenteric artery; Celiac artery; Celiac axis; Stomach; Proximal; duodenum; Spleen; Liver; Pancreas; Upper abdomen; Rib cage; Liver; Celiac trunk; stomach; lesser omentum; fatty connective tissue of uppermost part of posterior abdominal wall; opening of the diaphragm for the esophagus; aorta; pancreas; celiac trunk; crura of the diaphragm; left gastric artery; common hepatic artery; ; splenic artery; pancreas; splenic artery; hilum of the spleen; common hepatic artery; hepatic artery; gastroduodenal artery; liver; common bile duct; portal vein; hepatic artery; liver; hepatic artery; right hepatic artery; left hepatic artery; portal hepaticus; portal vein; common hepatic artery; right gastric artery; right gastroepiploic artery; gastroduodenal artery; pancreaticoduodenal artery; head of the pancreas; duodenum; stomach; greater omentum; gastrohepatic ligament; greater curve; lesser omentum; lesser curve; right gastric artery; left gastric artery; right gastroepiploic artery; left gatroepiploic artery; splenic artery; distal duodenum; jejunum; ileum; celiac trunk; pancreas;
.
Anatomia SIstemica – ABDOMEN – ARTERIAS
Anatomical terms in order of mention (part 2)
celiac trunk; aorta; superior mesenteric artery; pancreas; superior mesenteric artery; splenic vein; left renal vein; pancreas; duodenum; superior mesenteric artery; pancreas; superior mesenteric vein; uncinate process of the pancreas; third part of the duodenum; mesentery; retroperitoneum; transverse mesocolon; greater omentum; transverse colon; superior mesenteric artery; duodenum; jejunum; ileum; ileocolic artery; cecum; right colic artery; middle colic artery; ascending colon; transverse colon; inferior mesenteric artery; distal colon; rectum; aorta; below pancreas and duodenum; L3; transverse mesocolon; descending colon; sigmoid colon; inferior mesenteric artery; distal part of the duodenum; aorta; inferior mesenteric artery; aorta; colon; left colic artery; ascending colon; distal part of the transverse colon; middle colon artery; transverse mesocolon; inferior mesenteric artery; sigmoid colon; superior rectal artery; pelvis; upper part of the rectum; lower part of the rectum; internal iliac artery;
Abdominal Arteries
CSULA BIO 200 B Arterial Division IV
Anatomical terms in order of mention
Abdominal aorta
Celiac trunk
Superior Mesenteric artery
Renal arteries
Gonadal arteries
Inferior mesenteric artery
Common iliac artery
External iliac artery
Internal iliac artery
Femoral artery
Deep femoral artery
Popliteal artery
Posterior tibial artery
Anterior tibial artery
Abdominal Aortic Aneurysm
PATIENT STORIES
Abdominal Aortic Aneurysm Survivor Story: Dave
AAA (Abdominal Aortic Aneurysm) Patient Story
VIDEOS FOR PATIENTS
Abdominal Aortic Aneurysm pt 1 of 2
Abdominal Aortic Aneurysm pt 2 of 2
Ischemic Colitis
Epidemiology, Clinical Features, High-Risk Factors, and Outcome of Acute Large Bowel Ischemia
Pneumoperitoneum
Chest x-ray, pneumoperitonuem, air under diaphragms
Pneumoperitoneum – Radiology & Imaging
Appendicitis Images
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Text Results (113) |
Short Bowel Syndrome
VIDEOS
Elizabeth Sees Hopkins Children’s GI Specialists for Short Bowel Syndrome
Short Bowel Syndrome toddler on the mend
Physiology of the Small Intestine, Colon, and Rectum
Physiology of the Small Intestine, Colon, and Rectum
Dr. Goodman’s Lecture on the Physiology of the Small Intestine, Colon, and Rectum pt. 2.mp4
Dr. Goodman’s Lecture on the Physiology of the Small Intestine, Colon, and Rectum pt. 3.mp4
Dr. Goodman’s Lecture on the Physiology of the Small Intestine, Colon, and Rectum pt. 4.mp4
Images of gallbladder polyps
IMAGES
Link: http://imaging.consult.com/imageSearch?query=gallbladder%20polyps
Cholecystostomy
IMAGING
http://imaging.consult.com/imageSearch?query=cholecystostomy&global_search=Search&modality=+&anatomicRegion=
Hemobilia
http://rad.usuhs.edu/medpix/master.php3?mode=print_case&pt_id=7153&showall=yes
Content below:
![]() Case of the Week – Patient Summary 7153Peer Reviewed and Certified – |
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| 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. |
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| Physical exam: Not Available | |
| Summary of Findings: | |
| Differential Diagnosis: | |
| Diagnosis: | |
Hemobilia |
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| Disease Discussion – Hemobilia | |
| Hemobilia means blood in the bile | |
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.
Inguinal anatomy
VIDEOS
Surgical Anatomy of Inguinal Canal
Anatomía de la Región Inguinal. Hernioplastia Laparoscópica TAPP
Anatomía de la región inguinal.
Liver Abscesses and Liver Cysts
VIDEOS
Laproscopic Removel Hydatid Cyst of Liver
Hydatid Cyst Excision From Liver ’s Description
Robotic LIVER CYSTS excision .K.Konstantinidis ATHENS MEDICAL CENTER
Toxic megacolon and sigmoid volvulus
Lecture about Toxic Megacolon and Sigmoid Volvulus by Dr. Carlos Balarezo in Riverside County Regional Medical Center produced by Ricardo Araujo
Anal Cancer Flashcards
Content of flashcards
| Term | Definition |
| Anal Cancer: Background | Anal Cancer: Background
Malignancies of the anal cancer are relatively uncommon and represent only 2-3% of all anorectal carcinomas. The position of the tumor in the anal canal relative to the dentate line is important with regard to the biologic behavior of the tumor. This is based on the lymphatic drainage in these two areas. Most tumors spread by direct extension and lymphatic drainage. Hematologic spread is less common. Anal tumors are classified into two groups based on location: 1) anal cana tumors 2) anal margin tumors mnt reid p.452 |
| Anal Cancer: Epidermoid carcinoma | Anal Cancer: Epidermoid carcinoma
- Epidermoid carcinoma (1-2% of all colorectal carcinomas) are referred to as squamous, basaloid, cloacogenic, or transitional carcinomas. - Although each has different histologic features, they exhiit similar biologic behavior and are thus grouped together. - typically seen in patients 50-70 years of age - seen more frequently in women - two cell types – squamous cell (keratinizing) and transitional cell (nonkeratinizing) - rectal pain, bleeding, or mass are common presenting symptoms - 40-50% have pelvic lymph node involvement at diagnosis, whereas 15-36% have inguinal nodal involvement and 10% have distant metastasis - excellent prognosis when discovered prior to nodal involvement and invasion to adjacent structures. - 80% of tumors are cured by chemotherapy/radiation therapy alone - chemotherapy with mitomycin C and 5-fluorouracil combined with radiation is the treatment of choice. - this may be followed by surgical rsection - abdominoperineal resection is indicated for residual disease or recurrence mont reid p.453 |
| Anal Cancer: Malignant melanoma | Anal Cancer: Malignant melanoma
- 0.5-1% of malignant anal tumors - anal canal is the 3rd most common site after skin and eyes - typically occurs adjacent to the dentate line - rectal bleeding is the most frequent complaint - most are not highly pigmented, and diagnosis is difficult - tumor is aggressive and often widely metastatic. abdominoperineal resection is indicated in selected patients. - tumors often radioresistant and unresponsive to chemotherapy - 5-yaer survival is <15% mont reid p.453 |
| Anal Cancer: Tumors of the anal margin
squamous cell carcinoma, basal cell carcinoma, bowen’s disease, paget’s disease of bone |
Anal Cancer: Tumors of the anal margin
squamous cell carcinoma, basal cell carcinoma, bowen’s disease, paget’s disease of bone - these tumors are similar to skin tumors elsewhere and are treated likewise - include squamous cell and basal cell carcinomas, Bowen’s disease, and Paget’s disease of bone mont reid p.453 |
| Anal Cancer / Bowen: surgery resident handbook | Anal Cancer / Bowen: surgery resident handbook
ANAL CANCER and BOWEN DISEASE Anatomy-loosely speaking, above dentate line is columnar, below is squamous. A 1cm transition zone (cloacogenic zone) is present which can contain columnar, cuboidal, or transitional epithelium. Anal canal = 4cm tube from anal verge (what you see looking from outside) to anorectal ring (about 2cm above dentate line) Anal margin = skin from anal verge to point 5cm away circumferentially. Is the intersphincteric space. Dentate line = transition point, located about 2cm above anal verge. Term “anal cancer” comprises 2 entities: anal canal cancer (anal verge to 2cm above dentate line) and anal margin (anal verge out to 5cm skin) cancer. Overlapping behavior and treatment. Typically well-differentiated and slow growing. Epidemiology: F:M 5:1, mean age 60s. Associated with HPV genotypes 16 and 18, anal receptive intercourse, immunosuppressed states (HIV, organ transplant) SSx: change in bowel habits, hematochezia, pain, urgency, tenesmus, pruritis. Workup: punch or wedge biopsy diagnostic. Stage with EUS, exam of inguinal nodes with FNA for suspicious nodes, CT abdomen/pelvis, CXR. ANAL CANAL LESIONS EPIDERMOID (SQUAMOUS) CARCINOMA Arises from the cloacogenic zone. Includes squamous cell carcinoma basaloid carcinoma cloacogenic mucoepidermoid carcinoma. generally spread to inguinal LNs. higher incidence of superior rectal LN metastasis. Staging of anal canal cancers T1 Tumor <2cm T2 Tumor 2-5cm T3 Tumor >5cm T4 Tumor of any size with invasion into adjacent organ N1 Perirectal nodes N2 Unilateral internal iliac or inguinal lymph nodes N3 N1 and N2, or bilateral N2. M1 diatant metastases Stage I T1N0M0 Stage II T2-3 N0M0 Stage IIIa T1-3N1M0, T40M0 Stage IIIb T4N1M0, anyT N2-3 M0 Stage IV M1 Treatment is wide local excision for small, well-differentiated, localized tumors confined to submucosa. All others receive Nigro protocol. Historically, anal canal cancers were treated with APR but results were poor: 50% recurrence rates, 5-yr survival 24-62%. In 1970s, sensitivity to chemoXRT established. NIGRO protocol: chemoradiation of 30Gy XRT of tumor, pelvic, and inguinal nodes from day 1 to 21, plus 5FU 1000mg/m^2 days 1-4 and 28-31 plus mitomycin C 15mg/m^2 on day1 If grossly disease disappears, no further treatment is necessary. LNs treated as well regardless of status, outcomes as good as formal LAN. Repeat Biopsy at 6wks. If pos, perform APR 4-6weeks after completion of radiation therapy OR repeat chemo (first line choice). Complete response >90%. 5yr sur 85%. Surveillance: Most recurrences are locoregionally. If nodal recurrence, treat with chemoXRT. anoscopy q3mos x 2years, then q6mos PE q3mos x 2years, then q6mos CT, LFTs, EUS: surveillance debatable. ANAL MARGIN LESIONS BASAL CELL CARCINOMA Rare. Local excision. BOWEN DISEASE SSx: discrete scaly, crusty, or moist plaques surrounding the anus. Diagnose with skin biopsy. Treat with wide local excsion. PERIANAL PAGET’S DISEASE Rare intraepidermal neoplasm of apocrine glands. Long preinvasive phase. PE reveals scaly or red plaque. Dx with biopsy. Workup with full colonoscopy because 50% incidence of synchronous adenocarcinoma. Rx with wide local excision. Negative margins a must. If underlying carcinoma, APR is required. SQUAMOUS CELL CARCINOMA Rare. Less aggressive than SCCs of the anal canal. Treat with local excision, not Nigro protocol. Metastasizes to inguinal LNs. BUSCHKE-LOWENSTEIN TUMOR – giant condyloma acuminatum. Tend to erode into adjacent sturctures. Local excision. Consider chemoXRT for larger lesions. |
| Anal cancer: Multiple choice question [copy and paste] |
Multiple choice question
A 57 year old woman sees blood on the toilet paper. Her doctor notes the presence of an excoriated bleeding 2.8cm mass at the anus. Boipsy confirms the clinical suspicoin of anal cancer. In planning the management of a 2.8cm epidermoid carcinoma of the anus, which of the following is the best initial mangement strategy? a. Abdominoperineal resection b. Wide local resection with bilateral inguinal node dissection c. Local radiation therapy d. Systemic chemotherapy e. Combined radiation therapy and chemotherapy The aswer is e. (Greenfield, pp1131-1136) Epidermoid cancers of the anal canal metastasize to inguinal nodes as well as to the perirectal and mesenteric nodes. The results for local radical surgery have been disappointing. Combined external radiation with synchronous chemotherapy (fluorouracil and mitomycin), also known as the Nigro protocol, has been used as the standard treatment of the disease, whereas radical surgical approaches are now generally reserved for treatment failures and recurrences. pretest usrgery p.220;338 questoin 338 |
Colectomy flashcards
Content of flashcards:
| Term | Definition |
March 4, 2010Anatomy ImagesAnatomy Images 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 ———————————— 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 ————————– 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 Anatomy ImagesAnatomy Images http://library.med.utah.edu/WebPath/HISTHTML/ANATOMY/VHF1550R.html Identify the following regions in the image above: Rectus abdominus – External oblique – Serratus posterior inferior – Latissimus dorsi – Sacrospinalis – Multifidus – Right lobe of liver – Left lobe of liver – Body of stomach – Spleen – Diaphragm – Descending aorta – Inferior vena cava – Left adrenal gland – Right adrenal gland – Vertebral body – Spinal cord Anatomy ImagesAnatomy Images Identify the following regions in the image above: Latissimus dorsi – Serratus anterior – External oblique – Rectus abdominis – Sacrospinalis – Sternum – Breast – Liver, right lobe – Left lower lobe – Right lower lobe – Esophagus – Descending aorta – Vertebral body – Spinal cord Liver PathologyLiver Pathology Normal
Steatosis
Cirrhosis
Pigmentary Disorders
Neoplasms
Viral Hepatitis
Miscellaneous Parenchymal Diseases
Hepatocellular CarcinomaHepatic AdenomaHepatic Adenoma
IMAGING OF HEPATITIC AENOMA HemochromatosisHemochromatosis
source: http://library.med.utah.edu/WebPath/TUTORIAL/IRON/IRON.html Portal HypertensionLiver CirrhosisLiver Cirrhosis
Fatty Liver or SteatosisLiver AnatomyMarch 3, 2010DiverticulosisColon PolypsColon Polyps
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