2. Severe haematemesis – gastric ulcer
and the affected arteries
• Posterior gastric ulcer – splenic artery
• Lesser curve gastric ulcer – left gastric artery
• Greater curve gastric ulcer – gastroepiploic artery
• Posterior duodenal ulcer – gastroduodenal branch of right gastric artery
• Inferior pancreaticoduodenal (branch of superior mesenteric) artery supplies lower part of 2nd part of
duodenum – well clear of ulceration site
• Celiac artery branches (arises from aorta at T12):
– L gastric artery ( branch into oesophageal and gastric branches)
– Common hepatic artery ( branch into proper hepatic artery, R gastric artery and gastroduodenal artery(branch
into superior pancreaticoduodenal artery))
– Splenic artery (dorsal pancreatic artery, greater pancreatic artery, left gastro-omental artery, short gastric artery)
• Superior and inferior mesenteric arteries arise from aorta at L1 and L3 respectively
3. Hepatic blood supply
• Blood supply to liver = 25% of resting cardiac output
– 25% from hepatic artery
– 75% from hepatic portal vein (from GI tract and spleen)
• Normal portal pressure = 5-7mmHg ( increases after
meals)
• Both vessels enter liver via porta hepatis.
• Caudate lobe receives an independent blood supply
from hepatic portal vein and artery and its branch of
hepatic vein drains directly into inferior vena cava
4. Psoas major muscle
• Flexes thigh at hip joint
• It joins illiacus muscle (origin: inner aspect of
iliac wing of pelvis), and becomes iliopsoas
muscle and inserts on lesser trochanter of
femur = flexes thigh at hip joint
5. Femoral sheath
• Femoral sheath ends 4cm
inferior to inguinal ligament
• Medial wall of fem sheath is
pierced by great saphenous
vein and lymphatic vessels
• It is divided by 2 ventral septa
into 3 compartments:
– Lateral (contains fem. artery)
– Intermediate (contains fem. vein)
– Medial (a space called fem. canal)
• Fem. canal contains efferent
lymphatic vessels and a lymph
node
• Entrance of fem canal = fem
ring = site of fem hernia
6. Uterine Artery
• Arises from internal iliac
artery (may also arise
from umbilical artery)
• Lies anterosuperior to
ureter near lateral
portion of fornix
– Risk of ureteric damage
during hysterectomy
– Esp. left ureter as it lies
very close to lat. Aspect of
cervix
• Point of crossing b/w
uterine artery and ureter
= 2 cm superior to ischial
spine
10. Uterus 2
• Uterus is normally bent anteriorly b/w cervix and body
of uterus
• Commonly anteverted (inclined anteriorly) but
frequently retroverted in older woman
• 3 layers: perimetrium, myometrium and endometrium
• Uterine body is enclosed b/w layers of broad ligament
– freely mobile
• Uterus covered by peritoneum anteriorly and
superiorly except for vaginal part of cervix
• Uterus is supported by pelvic floor
11. Hypoglossal Nerve
• Supplies all intrinsic muscles of the tongue but
not the palate (the palatoglossus muscle supplied
by vagus nerve)
• No sensory component
• Genioglossus muscle protrudes the tongue
• In paralysis, tongue deviates towards the affected
side. (e.g. damaged left hypoglossal nerve =
tongue deviates to left
• Left submandibular salivary gland excision = risk
of damaging hypoglossal nerve
13. Inferior/recurrent laryngeal nerve 2
• A branch of vagus nerve
• Supplies all muscles of larynx except cricothroid
muscle (supplied by superior laryngeal branch of
vagus nerve)
• Sensory component – supplies larynx inferior to
vocal cords
• Damage recurrent laryngeal nerve:
– Larynx is anaesthetic inferior to vocal cord on affected
side
– Paralysed cord seen to lie in ‘paralytic’ position:
slightly abducted from midline and does not move on
phonation
