iSURG

cat bites is Pasteurella Multocida
@isurg@lemm.ee @eeeee@community.nodebb.org

Test to add some threads users
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The answer is E) Foramen Spinosum

And here instantly too. So this is working!

@medicine@mander.xyz @isurg@lemm.ee
Explain this image

The most likely cause is B. Detrusor overactivity.
Detrusor overactivity, also known as overactive bladder (OAB), is a condition where the bladder muscle contracts involuntarily, causing frequent urges to urinate. This condition is common in older adults, especially those with diabetes. The urge to urinate after every toilet visit, with a large volume, suggests this issue. Diabetic neuropathy can lead to changes in bladder function, contributing to detrusor overactivity.

Acute intermittent porphyria
Acute intermittent porphyria (AIP) is caused by a partial deficiency of the enzyme porphobilinogen deaminase (PBGD), also known as hydroxymethylbilane synthase (HMBS), which is inherited as an autosomal dominant trait, leading to the accumulation of porphyrin precursors.
AIP can be triggered or worsened by hormonal contraceptives, particularly those containing estrogen and/or progesterone, due to the potential for these hormones to increase the activity of an enzyme involved in porphyrin synthesis, leading to a buildup of toxic precursors.

@evehiclefan@mathstodon.xyz
Calcium

Hello, or Bonjour! Im replying from another Federated website so I hope this works.
I have a question, do you cater for vegetarians?
Are you able to make outfits from synthetic leatherette?

What is the arcuate line?
The arcuate line, also known as the semicircular line of Douglas, is a curved line found posterior to the rectus abdominis muscle bilaterally, between the umbilicus and the pubic symphysis. This anatomical finding may not always be present, and its exact position may vary.

Superior to the arcuate line, the external oblique aponeurosis (i.e., a thin layer of connective tissue that covers and supports the muscle) passes anterior to the rectus abdominis muscle. The aponeurosis of the internal oblique splits to surround the rectus abdominis muscle. Additionally, posterior to the rectus abdominis muscle is the aponeurosis of the transversus abdominis muscle, as well as the transversalis fascia. All of the aforementioned aponeuroses wrap around the rectus abdominis muscle, forming the rectus sheath. At the level of and posteriorly to the arcuate line, the aponeuroses of the internal oblique and transversus abdominis pass anteriorly to the rectus abdominis muscle, instead of surrounding the muscle
@isurg@lemm.ee

At which anatomical level is the pancreas found?
The pancreas is located at the level of L1, corresponding to the transpyloric plane.

Describe the anterior, posterior, superior, and lateral relations of the pancreas.
Posterior: Inferior vena cava (IVC), Portal vein, Aorta
Anterior: Stomach
Superior: Splenic artery
Lateral: Hilum of the spleen

Describe the arterial supply and venous drainage of the pancreas.

Arterial supply:
Splenic artery
Pancreaticoduodenal artery
Venous drainage:
Splenic vein
Pancreaticoduodenal vein

Which cells lie between the alveoli and secrete insulin?
The beta cells of the islets of Langerhans secrete insulin.

Where does the accessory duct of Santorini run from and to?
The accessory duct of Santorini runs from the lower part of the head of the pancreas and opens into the duodenum above the head.

At which point does the main duct of the pancreas open into the duodenum?
The main duct of the pancreas opens into the ampulla of Vater.

How does the pancreas develop?
The pancreas develops from a dorsal diverticulum of the duodenum and a smaller ventral outpouching from the side of the common bile duct. The ventral outpouching swings posteriorly to fuse with the lower aspect of the dorsal diverticulum. The main pancreatic duct is formed by the smaller ventral duct, while the dorsal diverticulum forms the accessory duct.

Describe the contents of the porta hepatis.

The porta hepatis is the gateway to the liver and contains several important structures:

Common hepatic duct: Carries bile from the liver.
Hepatic artery: Supplies oxygenated blood to the liver.
Portal vein: Transports deoxygenated blood from the gastrointestinal tract and spleen to the liver.
Autonomic nerve fibres: The sympathetic nerves originate from the coeliac axis, and parasympathetic fibres come from the vagus nerve.
Lymphatic vessels and lymph nodes: Drain lymph from the liver.

Explain the peritoneal attachments of the liver.

The liver is connected to the abdominal wall and diaphragm by various ligaments:

Right triangular ligament: A small fold of peritoneum between the upper and lower coronary ligaments at the posterior bare area of the liver.
Falciform ligament: Runs from the umbilicus to the liver and carries the ligamentum teres.
Left triangular ligament: Connects the posterosuperior part of the left lobe to the diaphragm and continues anteriorly as the left limb of the falciform ligament.

Describe the hepatic veins and their drainage into the inferior vena cava (IVC).

The hepatic veins are responsible for draining blood from the liver:

Three main hepatic veins: Right, central, and left hepatic veins drain into the IVC. The central vein often drains into the IVC via the left hepatic vein, but in some individuals, it may drain directly into the IVC.
Small hepatic venous tributaries: Drain blood directly from the liver's substance and enter the IVC more distally than the main veins.
Zones of drainage: The zones correspond to the right, middle, and left thirds of the liver. The plane of the falciform ligament roughly demarcates the boundary between the left and middle zones.

Outline the anatomical features of the biliary system.

The biliary system includes the structures responsible for bile formation and transport:
Hepatic ducts: The left and right hepatic ducts emerge from the liver and fuse at the porta hepatis to form the common hepatic duct.
Cystic duct: Joins with the common hepatic duct to form the common bile duct (CBD).
Common bile duct: Passes through the hepatoduodenal ligament and opens into the second segment of the duodenum.
Pancreatic duct: The CBD joins the pancreatic duct at the ampulla of Vater, where the sphincter of Oddi controls the release of bile and pancreatic juices into the duodenum.

Describe the anatomical features of the gallbladder.

The gallbladder stores and concentrates bile:
Location: Situated in the fossa between the right and quadrate lobes of the liver.
Capacity: Approximately 50 mL of bile.
Hartmann’s pouch: A small recess near the neck of the gallbladder where gallstones can form.
Vascular supply: Receives blood from the cystic artery, which is a branch of the right hepatic artery.
Venous drainage: Small veins drain into the right portal vein, as there is no distinct accompanying vein for the cystic artery.
Histology: Primarily composed of mucosa lined by mucous-secreting columnar cells. The gallbladder wall also contains smooth muscle, which helps with bile contraction.

Explain the embryological development of the gallbladder and its ducts.

The development of the gallbladder and hepatic system begins early in fetal life:
Liver and hepatic ducts: These structures form from a diverticulum of the ventral wall of the duodenum. This diverticulum differentiates into the liver and the hepatic ducts.
Gallbladder and cystic duct: A second diverticulum forms from the side of the hepatic duct and differentiates into the gallbladder and cystic duct.

C'est toi dans le painting @aemarielle@piaille.fr ?
Tres belle

What is the remnant of the left umbilical vein in the adult liver, and where is it located?
Answer: Ligamentum teres hepatis, found in the anterior left fossa.

it is also known as the round ligament of the liver, is a fibrous band that connects the liver to the umbilicus. It's a remnant of the umbilical vein, which carried blood from the placenta to the liver during fetal development.

Which hepatic structure is the remnant of the fetal ductus venosus, and what is its function in the fetal circulation?
Answer: Ligamentum venosum, the fibrous remnant of the ductus venosus, which functioned as a shunt for oxygenated blood from the left umbilical vein to the inferior vena cava.

Through which anatomical plane does the functional division of the liver occur?
Answer: Through the fossae of the gallbladder and inferior vena cava (IVC).

Name the three main hepatic veins and describe their drainage pathways.
Answer:
Right hepatic vein
Left hepatic vein
Central hepatic vein
The central hepatic vein usually drains into the left hepatic vein near its termination but may drain directly to the inferior vena cava (IVC). The right and left hepatic veins drain directly into the IVC.

What are the boundaries of Calot’s triangle and which structures are contained within it?
Answer: The liver, the cystic duct, and the common hepatic duct.

Where is Hartmann’s pouch typically located, and what is its clinical significance?
Answer: Hartmann’s pouch is located on the ventral aspect of the gallbladder, just proximal to the neck. It is a potential site for gallstone blockage.

What is the retroperitoneal space?
The retroperitoneal space is a potential anatomical space situated behind the posterior parietal peritoneum.

Name the retroperitoneal structures in the abdomen and pelvis.
The retroperitoneal structures include:
Kidneys
Adrenal glands
Ureters
Aorta
Inferior vena cava
Anal canal
Duodenum (excluding the first segment)
Ascending colon
Descending colon
Pancreas (excluding the tail)
What distinguishes a primary retroperitoneal organ from a secondary retroperitoneal organ?
Primary retroperitoneal organs were retroperitoneal during the entirety of embryological development, while secondary retroperitoneal organs were initially intraperitoneal and migrated to the retroperitoneum during development.

What are the three main compartments within the retroperitoneum and which structure is responsible for dividing them?
The three main compartments, divided by the perirenal fascia are:
Anterior pararenal space
Perirenal space
Posterior pararenal space

What is contained within the posterior pararenal space?
The posterior pararenal space contains pararenal fat.

What clinical signs might indicate a retroperitoneal hemorrhage?
Grey Turner’s sign – bruising of the flank
Cullen’s sign – periumbilical edema and bruising

Which lymph node groups are found within the retroperitoneum?
The inferior diaphragmatic nodes
The lumbar nodes

Which structure divides the greater sac into two, and what are the resulting compartments called?

Answer: The transverse colon divides the greater sac into the supracolic compartment (superior to the transverse colon) and the infracolic compartment (inferior to the transverse colon).

What foramen marks the opening between the greater and lesser sacs?

Answer: The epiploic foramen of Winslow.

What are the boundaries of the foramen of Winslow?

Anterior: The hepatoduodenal ligament and the free edge of the lesser omentum.
Posterior: Peritoneum/Inferior Vena Cava.
Superior: Caudate lobe of the liver.
Inferior: 1st part of the duodenum and the hepatic artery.

Describe the mechanism and indication for Pringle’s manoeuvre.

Answer: The Pringle’s manoeuvre involves compression of the hepatic artery, common bile duct, and portal vein as they run in the free edge of the foramen of Winslow. This manoeuvre is used to control bleeding from the liver.
Placing a finger into the foramen of Winslow and compressing the hepatic triad should not be carried out for more than 120 minutes due to the risk of reperfusion injury to the liver.

What are the boundaries of the lesser sac?

Anterior: Lesser omentum, visceral peritoneum along posterior stomach, and gastrocolic omentum.
Left lateral: Spleen, attached by the gastrosplenic and splenorenal ligaments.
Right: Foramen of Winslow.
Posterior: Visceral/parietal peritoneum covering the diaphragm, left kidney/adrenal gland, and duodenum.
Superior: Peritoneum covering the caudate lobe of the liver.

Describe the embryological development of the lesser sac.

Answer: The rotation of the stomach by 90 degrees causes the spleen to move left and the liver to move right, accommodating the growing abdominal organs. This twisting of the peritoneum results in the formation of the falciform ligament, lesser omentum, and coronary ligaments of the liver, creating the cavity of the lesser sac.

If a loop of intestine becomes strangulated in the lesser sac via the foramen of Winslow, how should this be managed?

Answer: Needle decompression should be performed, as none of the foramen's boundaries can be incised.

The boundaries of the epiploic foramen of Winslow cannot be incised because they are formed by critical structures that are not easily accessible or suitable for surgical incision without causing significant harm.

Anterior: The hepatoduodenal ligament and the free edge of the lesser omentum, which contain important structures like the common bile duct, hepatic artery, and portal vein. Incising these structures would compromise vital blood flow and biliary function.

Posterior: The peritoneum and the inferior vena cava (IVC). The IVC is a major vein responsible for returning deoxygenated blood from the lower body to the heart. Any damage to the IVC could result in severe bleeding and circulatory issues.

Superior: The caudate lobe of the liver. Incising the liver could lead to massive bleeding and liver damage.

Inferior: The first part of the duodenum and the hepatic artery. The duodenum is a critical part of the digestive system, and the hepatic artery supplies blood to the liver, gallbladder, and parts of the stomach. Damaging either could lead to serious complications.

Which structures are contained within the mesentery of the small intestine?

Answer: Superior mesenteric vessels, lymphatics, and autonomic nerve fibers.

From where does the small intestine derive its blood supply?

Answer: The small intestine mainly derives its blood supply from the Superior Mesenteric Artery (SMA). The ileocolic artery supplies the distal ileum.

Where does the lymph from the small intestine drain?

Answer: The lymph drains into the Superior mesenteric nodes.

Where is the site of absorption for vitamin B12 and bile salts?

Answer: The terminal ileum is the site of absorption for vitamin B12 and bile salts.

Which parts of the colon are retroperitoneal?

Answer: The ascending colon, descending colon, splenic flexure, hepatic flexure, and rectum are retroperitoneal.

Which characteristics of the large bowel help to differentiate it from the small bowel?

Answer: The presence of:
Teniae coli
Haustra
Epiploic appendages

At which section of the bowel does the teniae coli converge?

Answer: The appendix.

Which structure of the stomach does the transpyloric plane pass through, and at which vertebral level is it located?

Answer: The pylorus, located at L1.

Which structures lie posterior to the stomach?

Answer: Lesser sac, transverse mesocolon, left kidney, left suprarenal, spleen, splenic artery.

Which arteries supply the stomach, and from which vessels do they branch?

Answer:
Left gastric artery: Branches from the coeliac axis.
Right gastric artery: Branches from the hepatic artery.
Right gastroepiploic artery: Branches from the gastro-duodenal branch of hepatic artery.
Left gastroepiploic artery: Branches from the splenic artery.
Short gastric arteries: Branches from the splenic artery.

To which venous system does the venous drainage of the stomach drain into?

Answer: The portal venous system.

To which lymph nodes does the left third of the greater curvature of the stomach drain?

Answer: The aortic group via the suprapancreatic nodes.

Which nerves are responsible for the motor and secretory nerve supply of the stomach?

Answer: The anterior and posterior vagi.

What are the layers of the anterior abdominal wall from superficial to deep?

Skin
Camper’s fascia
Scarpa’s fascia
External abdominal oblique
Internal abdominal oblique
Transversus abdominis
Rectus abdominis
Pyramidalis
Preperitoneal fat
Parietal peritoneum

Which structures comprise the rectus sheath between the costal margin and the anterior superior iliac spine?

Anterior: External abdominal oblique aponeurosis and the anterior half of the internal abdominal oblique aponeurosis.
Posterior: Posterior half of the internal abdominal oblique aponeurosis and the transversus abdominis aponeurosis.

Which structures comprise the rectus sheath between the anterior superior iliac spine and the pubis?

Anterior: External abdominal oblique, internal abdominal oblique, and transversus abdominis.
Posterior: Transversalis fascia.

What are the boundaries of the abdomen?

Superior: Diaphragm
Inferior: Pelvic inlet
Anterior: Anterior abdominal wall
Posterior: Lumbar vertebrae, upper bony pelvis, psoas, and quadratus lumborum

Which dermatome is responsible for innervation of the skin over the epigastrium?

T7

Which dermatome is responsible for innervation of the skin over the umbilicus?

T10

Which arteries are responsible for the arterial supply of the skin of the anterior abdominal wall?

Superior and inferior epigastric arteries
Intercostal and lumbar arteries

Extended question
Which of the above incisions might commonly be used for the following open procedures, and why?

Appendicectomy
Incision: Gridiron
Reason: The Gridiron incision, also known as the McBurney's incision, is commonly used for appendectomy. It provides excellent access to the right lower quadrant of the abdomen, where the appendix is located. The incision is placed along the line between the anterior superior iliac spine and the umbilicus.

Cholecystectomy
Incision: Kocher
Reason: The Kocher incision is typically used for open cholecystectomy. It is a subcostal incision placed on the right side of the abdomen, under the ribs, which allows easy access to the gallbladder and biliary structures. It provides good exposure for dissection of the gallbladder from the liver.

Hysterectomy
Incision: Pfannenstiel
Reason: The Pfannenstiel incision is commonly used for abdominal hysterectomy, especially for elective procedures. It is a transverse incision made just above the pubic symphysis, providing good access to the pelvic organs while minimizing cosmetic concerns and avoiding damage to major abdominal muscles.

Emergency Laparotomy
Incision: Midline
Reason: The midline incision is commonly used for emergency laparotomy due to its rapid and wide access to the entire abdominal cavity. It allows the surgeon to quickly evaluate and address multiple abdominal issues such as trauma, bowel obstruction, or internal bleeding. The midline incision is versatile and can be extended if necessary.

@lily_mallory@piaille.fr
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