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Hi, everyone. And thank you very much for joining today. So I'm Nathan. I'm one of the committee members of the Southwest Foundation Trainees Society. And we're very lucky today to have doctor Lin, who will be, uh, doing this lovely interactive teaching session on major abdominal vessels. So, to you, Doctor Lin, uh, hello, everyone. Yeah, I think, uh, you all can see my pipeline. Is that right? Yeah. Ok. Uh, so yeah, uh thank you for joining our session today. So today's session is about the, like the uh major abdominal does and then tr uh yeah, uh to introduce myself, my name is doctor to me, but it might be better to call me then. So now I'm currently working as a demonstrator in trauma orthopedic at the university hospitals limit and track. So I also finished my master's in 2020 too. And personally I am interested in uh, general surgery. So that's why I choose to give that the teaching session in the, the topic which is related to the, uh, general surgery. Ok. So, uh, before starting my question, like, uh, there are a few things I just would like to let you know. So the first thing is uh sometimes uh uh previously, yes, I did uh some of the teaching session and the other time I got like a feedback, like sometimes I speak uh very, pretty fast and explain it very fast. So if I explain too fast or if I speak too quickly and then at that time, yeah, uh please don't hesitate to let me or the host know so that um I will know that. And then another one thing is I just prepare the slide like the um uh knowledge sharing session so that I would like to do this session like the inter. So it would be great if you guys uh can like answer the questions uh from the chat boss or maybe from the uh and mute the uh am mute your mic and then, and answer the uh mic question. It will be very great. OK? So let's start our session. So first of all, uh the first one is the objective. So it's already announced in the uh our website. So to understand and appreciate the anatomy and the relative position of the major abdominal vessel and also the attribution. And then the second one is to identify potential complications related to either re or injury of the abdominal blood vessels during medical procedure. And then the, the last one is to apply the knowledge of this uh abdominal vessel and then tributaries in our pred scenarios and such as like this intervention, surgical procedures and also to get the diagnosis. So this is our objective. So contest today's session. So the first thing is uh we're gonna like to have uh I'm gonna share you about the abdominal aorta and also its branches, including the, the uh clinical importance also uh uh the frequently uh frequent uh sorry, the question which I frequently in the MRC SA and then the, and then we're gonna move to the inferior vena cava and it's trajectory. And then the last, but uh is the part of information. And uh also uh I also created some of the post session quizzes so that we can check uh our knowledge that we got from this session. OK. So uh let's start with the abdominal aorta. So as you can see in this uh in here, there's a abdominal uh aorta here. So I just would like to ask one some of the questions. So where does it stop? Like a push level? Does the abdominal aorta stop? Can someone tell me any response? Hello? Can you hear me? Yeah, we can hear you just waiting for our answer in the chat? Oh OK. Yeah, it's OK. So yeah. Uh so please don't afraid that's all right. If you uh let the answer uh raw or if you don't know they have the correct answer, that's OK. Any respond yet? Are we looking for the vertebral level? Uh Yeah, bra level. Yeah. So I push uh level of the bra uh abdominal aorta T 12. Uh Yes. Yeah. Right. Absolutely. So, yeah, that's the T 12. So as you can see here, uh so at the T 12 level, so the descending aorta it just like that passes through the uh diaphragm. And then uh so we, for example, we just change the name. It began as the uh abdominal aorta. OK. So another question is at which level like the vertebral level? That's it. And so as you can see here, this Levet is just standard by bifurcating into the two common iliac artery. So at which level that it done any idea about that? Sorry, I did I hear the voice. L4 L5. Uh Yeah. So yeah, the, the uh the answer is that uh uh lumbar body were 4 L4 level, uh L4 level, the A from the aorta is bi into the ci artery because that the, the level that the T and also L4 level. So these are uh the frequently asked question in the MRC S uh exam especially in the MRC S part A AAM. OK. Yeah. Thank you so much. So, OK. So let's go to the uh branches of the abdominal aorta. So then as you can see in here, there are so many branches and uh uh so many branches uh from that comes from the uh abdominal aorta. So some of the test and uh some of the people they just would like to memorize it like the according to the level and, and in the uh the another way is uh some of the tests, what they just mentioned about life or is a branches or the branches uh those kinds of things. So, from my point of view, so uh I like that the uh second uh weight and so I just cannot explain it according to this. So as you can see in this, so they are like the uh anterior branches and branches coming uh out from the abdominal aorta as you can see here this one, this one and also over there. Yeah, this is the pi branches and then the another one is also here is the uh uh one of the branches that comes out uh from the abdominal aorta. So there's like a four pi branches that comes out from the aorta. OK. And so the other branches are as you can see in this photo, these are the pa branches. OK. So can someone tell me or can someone have the any idea about uh what should this one be? What's the name of this uh branch? Mhm mhm Anyone any idea? Mhm OK. So yeah, it's OK. I'm gonna show it to you. So this is the like the cilia tra or CIA acid. Yeah, it's OK. What was it? So the, so the first branch of the abdominal aorta is the tract and then the other one is the superior midcenter artery. And then the next one here, that's the inferior midcenter artery. And then this one is the median sacral artery. So this whole uh artery, these are the uh branch of the abdominal aorta. However, as the one good thing to know is that the Amanda only this, as you can see here, celiac uh Celi, severe mi and inferior mi only this tree. They just uh supply the abdominal Vira because median secret artery, as you can see according to the is it gonna go down to the the uh sac region? And then um and it gives the blood supply to the area. So only these three branches, they're gonna give the blood supply to the um abnormal, right? And also this is the one of the uh question of the E MRC S. Ok. So anyone have the, so let's move to the level of this artery. So, and you have any idea at which vertebral level? Uh does the celiac or Celi tran it leave the abdominal aorta? Any idea about that? Which level? It might be? T 12? Yeah, perfect. Yeah. So yeah. Celi uh cli trans. So it just lead up from the aorta at the T 12 level. How about the super remi artery L1? Yeah, perfect. So, as you can see here, it's like the uh one vertebral level uh down to the Ciaran. So it's the L1. So how about the inferior midcentral artery? L3 uh Yeah, perfect. So that's uh in a level. Yeah, absolutely. Uh Very good. And we, so as you can see here uh at the combination of the abdominal aorta. So it just like the uh comes out from the um abdominal aorta. So that's at that four or level. And then after that, so this is the entire uh branches. So, and you have any question? OK. Now no questions in the chat at the moment. Sorry, no question. Oh OK. Thank you. Yeah. Yeah. And also yeah, there will be uh the question and answer session at the end. So, yeah, if you have that uh question and that you can ask later as well. OK. So now let's move to the pa branches of the abdominal aorta. So, so here, as you can see that's the inferior friend uh artery. So as uh because here is also cancel from the abdominal aorta at the t uh T 12 level. And then after that, it just goes upward because uh uh I think in this photo, there's like a no diaphragm because diaphragm will be over there. So at the T 12 level, inferior artery can from the abdominal aorta to supply the like the inferior part of the diaphragm. OK. And then the next one is like the here as you can see renal artery. So renal artery in the f as you can see is at the near the same level as the superior midcentral artery So renal artery comes out at the L1 region. So OK. And also major arena. In this photo, it just like the live, major arena and also uh uh and the statin is like the suprarenal um artery. So, suprarenal artery is just cancel out uh uh from the abdominal aorta and then at the L1 region, OK? L1 level and then the another one is the gonad gona artery. So in the main is it will be the uh testicular artery and in the female, it will be the uh ovarian artery. So it comes out from the abdominal aorta at the uh to level. And then the other ones are here, as you can see is the lumbar uh artery. So there would be four lumbar uh arteries. Um So lumbar artery, it comes out from the abdominal aorta, uh 124 level. So that would be the four lumbar artery. Ok. So I think now we got the, the main branches of the abdominal aorta and p uh branches and also p branches as well. Ok. Uh Am I clear so far any question anything? Uh none at the moment, but I'll let you know if there are. Ok. Thank you. Yeah. OK. So we're gonna move to the uh so uh yeah, so after that, we're gonna have move to the uh branches of the abdominal aorta. So this is like the uh just the overall and then we're gonna move to the everyone. So the first thing and I would like to explain is the ct trend and its branches. So before starting the CIA abdominal vis and especially like that uh gastrointest in the uh trap organs and the vis. So they develop uh according to the embryo origin. So they block from the three things like the full get may get and the hi get. So these three things uh so regarding the cli trend, so ran supplying the organs or the vitro which the blood from? Um uh how can I say uh a man the big and the he ciliare supply, the give the blood supply to the organ, which is the blood from. Which one do you think for the full organ and viron organ and visceral or get organic viscal? Which one do you think you've got 4 g? Yeah. Yeah. So gives the less supply uh to the organs and vis which are the block from the full get. So um um from the abdominal, yeah, abdominal vis point of view, the full get here the the the organs push at the block from the full gas. As you can see here is the lightest stem and there will be like the abdominal pushing of the esophagus stemma. And also, as you can see here, the uh first and then the second part of the uh Jardin. So these are the blood from the full and then the other structure which the blood from the uh uh as you can see in this photo spleen and also liver pancreas gallbladder. So the this structure I mentioned are the block from the as uh FG. So this structure they will get the blood supply from the celiac tract. OK. So Ciaran, as you can see here, Cilia um there's a ciliare. So ciliare has the ma main branches. So there's uh its main branches, 1233 main branches. So can someone have any idea what are the name of the, these three main branches of the ciliare? Any response? Um We've got left gastric splenic and hepatic. Oh yeah, perfect. Yeah. Uh um that's correct. So there's the left gastric, yeah. Um hepatic like a coma habit. It and also the, the splenic. So for me, I just uh uh not make uh pneumonia. So I just found that the pneumonia uh from one book. And so that's like the helpful for me. That's the like the L HS, for example, my left hand side or something like that. So when I see that the cilia and the LHs, it always appear in my um brain and in my mind. So uh for like the left artery and the h for hepatic and as for the splint. Yeah. Ok. So yeah, left gastric artery and here will be like the common hepatic artery. Unfortunately, uh I don't have any lab in this photo. So and also Splendid artery. Uh So as you can see here, left gastric artery is supplied to the, the left side of the laser curvature uh of the stem and from the uh splendid artery. So there are some of the uh the branches. So splendid artery. It gonna give less apply mainly to the uh spleen. And also it gives the branches like this short gastric artery uh to give the the uh to the part of the stem. And also it gives the branches to the uh left gastro epipleural the artery to give the right uh left side of the greater curvature of the stem. And also splendid artery gives uh uh the some pancreatic branches and then give the pancreatic uh of the of the pancreas. So, clinical uh importance of the, the splendid artery is while we did the, the splenectomy and then when we try to like it the artery and then at that time, we may uh we need to take the e extra care not to uh injure the uh pancreatic of the pancreas. So be because uh because uh sometimes it happen at the, at that time like that, we might need to do that, that uh just the pan or something like that. So that's the clinic uh uh importance. OK. So, and here, so we already finished left gastric artery and splenic artery. So let's move to the como the artery. So como artery, it gives the branches like the right gastric artery to get the, to get the, like the right side of the laser curvature of the stomach and also it also get the gastroduodenal artery uh in some of the test for the, like a variation Gastro Georgi art artery is uh uh from the, er, probably have the um uh uh Georgian artery is a branch of the artery or something like that. But however, in most of the population and then Georgian artery, it comes out from the common hepatic artery. So as you guys here, there's the gastro Georg artery. So uh gastro Georgia artery, so it passes through like the here is the pylori of the stem and this will be the first pillar of the stem. So the clinical importance and also the question we will see in the uh MRC S exam question about the E MRC S is uh like, for example, when a patient can uh on a patient who has the uh posterior, like uh uh Jord Asa or posterior gastric asa can with like the heme. And then what would be the, that uh what is the source of the those kind of questions when uh we will see and not we see. So artery here. And then after that como hepatic artery, as you can see, it also get like the three brothers, right, gastric artery, gastro geo artery and then the last one is the hepatic artery. Ok. So from the hepatic artery, as you can see in this photo, uh it can uh like a branch into like the right hepatic and the uh left hepatic artery. So, how about this one cystic artery? So, cystic artery is a branch of the right hepatic artery. So, as you can see in this photo, the cystic artery, they're gonna give the blood supply to the gallbladder. Ok. So I think here, yeah, we got everything and then the next one is this here as you can see too. Uh So Gastro J is uh it gonna give another two branches. So the first one is the superior conical Jorg artery. So, uh according to it, gonna give the blood supply to the uh Georgine and also uh it's gonna get the blood supply to the pancreas. So the next branch is the right gastroepiploic artery. So it's gonna give the blood supply to the uh right uh part of the uh greater curvature of the stem. So this is uh the like the branches of the C tract. So if you get like the left side L HS and then you get left gastric, yeah, spid and also uh left gas uh artery and the com have a plan. And also according to this photo, and I think you're gonna give uh which are the branches of each uh artery. OK. And that they are clinic uh importance as well. Ok. Uh Now, yeah. So let's move to the, yeah. So after the ce tract, we're gonna move to the superior medent artery, so superior uh according to the, the top origin. So we got the full get and the uh blood supply of the full uh full get. So mi get and the get. So uh superior mis artery gives the blood supply to the mire or er structure. What do you think? M I got? Yeah. So exactly. So it gives the um less supply to the make it. So, let's see here in the photo. So uh what are the uh stretch out and what are the um abdominal vis, uh which part of the abdominal vis, the blood from that we get? So, as you can see here, we already uh forget it. Um Sorry until the second part of the j it can block from the full game. So as you can see here, that part and four part of the JJ. And also I, and as you can hear, I appendis and, and the trans VCO like the uh proximate to type of the trans VCO. So these are the block from the big gap. So this structure, they're gonna get the blood supply from the superior mid artery. So super centric artery, some of that does mention that the first branch of the superior mi artery is the infra and J artery. So pancreas uh actually according to the origin, it can block from the full gap. However, from the blood subline point of view, uh the pancreas, it got the blood supply like the ju blood supply, it got the blood supply from like the Ciaran and also it goes uh c branch of the tract and also it get the blood subline for this artery. So the first branch of the sub midcentral artery is the inferior pancreat artery. And then after that severe midcentral artery, you're gonna give like the jejunum branch to supply the jejunum and also ilian branch to supply the ilium. And here you're gonna give like the i uh as you can hear, you're gonna give the ileocolic artery and, and here is like the right colate artery and then media artery as well. So uh here, as, as you can see here, there is the appendage and there will be the appendicular artery. So, uh so one of the, like the uh frequently asked question in the MRC S exam and the E MRC S is like is the, for example, when you are doing the uh laparoscopy or, or beast at that time, you like it uh umar artery. So a vicar artery is a branch of which artery. So that's the uh question. Uh We will see. So anyone have any idea like the Icar artery is the branch of which artery? Any idea, any response? E uh yeah. Uh There's a uh ileocolic uh artery. So, appendicular artery is a branch of the ileocolic artery. So, yeah. Ok. So I've been, so we got the, now we got the, the level of the superior I think we already mentioned it before. So is that the A one level and also I think uh we got the branches of the superior midcentral artery as that may. Ok. So now move to the inferior mid artery. So inferior midcenter artery, it gives the blood supply to the uh stretch out and Vira which can block from the Hi gu so as you can see here, so hi, get uh the out that block from the high gut. Uh just the one that of the trans colon, like the descending colon colon and also like the red, like the uh tape uh right hand and the upper part of the inner tendon. So these structures are the block on the higher. So if you run the central artery, you're gonna give the uh blood C line to go stretch out as you can see here, left colate artery and also another one. Yeah. Uh yeah, sub uh artery and also severe re artery. So this artery uh this artery uh can from the inferior mi artery. Ok. Uh Any anything, any question? So I can, sorry. No question. Yeah, thank you. Ok. So another one is like the common iliac artery. So uh as I already mentioned, abdominal aorta, it just end up by balt into the two common iliac arteries. So these are the the right and the left common iliac artery. And then after the common iliac artery, it gonna divide into internal ileal artery. And then external iliac artery. So into the ileal artery. Yeah, I gonna have uh explain it in the next slide. So about the external iliac artery. So it just gonna go down and then after passing through here is like the inguinated Lima. And then after that, it comes as the femoral artery and then can and go down uh into the uh of lower limb. Ok. So, and another one is the branch of, of the inter, the ileal artery. Uh I think there's so many like the pneumonia uh in the test for or even in the er, to be honest, I even don't remember what are the branches of the inter, the ial artery. Very hard about what I do is if you know the branches of the like uh uh ct severe midcentral artery, inferior mi artery and the, so the other things and then they push up uh from the, into the ileal artery. If you can't remember, it's an uh every branch of the inter, the ileal artery. So, some of the branches of the uh the ileal artery, uh like the electric secret artery, superior gluteal artery, uh the inferior gluteal artery to get that the gluteal region and also intern pudendal artery. And then another one is the middle re artery. Uh So one thing is I just would like to memorize about that, the middle retic artery because uh for the re artery, they are like the three re artery superior retina, middle re and inferior re artery. So these three branches of the uh re artery, they um uh how can I say uh their origins are different for is superior re artery. So it is a branch of the inferior midcentral artery, middle right artery. As you can see here is a branch of the inter iliac artery. And then above the inferior re artery is a branch of the inter pudendal artery. Ok. So like, for example, generally, we can see superior reta is from the ime and middle and uh mi and also inferior reta are from the uh inter I artery. Ok. So, and then the other artery like the uh artery uh in the female or in the middle that the art to the that is different and also like the vagina artery and inferior vasica artery. And the other one is like the obturator artery. So, superior vasica, inferior vasica to get the the bladder uh to get the supply to the bladder. So the those arteries are, are the block on them. Uh No, sorry, these arteries are the branches of the iliac artery. Ok. Uh Yeah. Am I clear so far? Any question, any pain right now, the the branches of the inter the ileal artery? So I think I explained about that the uh branches of cran severe midcentral artery, inferior, mid central uh artery and also like uh uh inter I artery for the other pair branches like these uh uh super uh sub in the artery, they're gonna get the blood supply to the uh suprarenal renal gland and also renal artery, renal artery is the, the L1 region. So it gonna get the blood supply to the kidney gona there. And also lumbar. So we don't have to say too much about uh those artery. Ok. So if, yeah, any uh uh if you don't uh any questions, we're gonna move to the second part, inferior vena cava. So as you can see here, this is the, you know, inferior vena cava. Um Yeah, to be specifically, that's the abdominal part of the inferior vena cava. OK. So where and how is the formation of the inferior vena cava? Like the at which level vertebra level? Um does it form? And also IVC is formed by like the union or which veins can someone tell me we have L5 and the common iliac? Yeah. So that's as far at the F I region and as far as you can see here by the combination of the two common. And also another question is at which level that, that it passed through the diaphragm as you can see here, it just passed through the diaphragm at qui level. Mm Sorry. T eight. Yeah. Perfect. So yeah, at the ta level. So it just passed through the diaphragm uh to enter into the thoracic cavity. Uh So here uh uh not related to the ABDO vessel, but However, that's the, uh, one of the pneumonia. Yeah. Now I used to memorize about the, the, uh, how do I say a culture? So there's like a, uh, fena cava, uh, or is, and then from the, uh, aorta. So they just pass through the, uh, diaphragm at a different level. For me, the pneumonia I use is like the V OA a 1012. So ap oa 8, 10. So if you give at the ta level and then esophagus at the T 10 level and the abdominal aorta at the T 12 level. Uh So that's useful for me. So I just would like to share it. Ok. So could you trace of the IVC? So as they already mentioned about it. So yeah, it is formed by the combination of the right and left com I VE at the uh le body level and also this is the median secret. So and then here are the, yeah, Lamar vein. Uh the yeah, second type called Lamba veins. And also another one is this one that's the uh gona vein. So uh gona vein, it would be uh the level of the uh gona vein will be at the uh two region. So uh what I F and then uh what I find is like uh for example, artery vein and lymph for them, they are uh related. So if you get the artery, like the artery, supplying level and then after that, uh you will find that it's really uh need to memorize is uh memorized the the brain and also for the lymph node. As so previously, we just mentioned that go artery uh at the level of L2 and here go veins are also at the level of the L2. So that's the one good thing is as you can see in this photo, right and left co vein. So they train into the different vein. So right go vein, it just drains to right into the inferior vena cava. However, left gon vein, it drains into the left uh renal vein. Ok. So because that's the commonly asked question in the MRC S exam and also like some of the uh the previous question as well. So they're gonna give you uh how I say some of the uh scenario like you have to do uh uh for example, left or, or something and uh where that left gona the vein drains into those kinds of questions. And also I think there's where they also uh for the clinic and important to because of the left gona, the vein drains into the left renal vein. So if there is that something like a pathology in the re vein, maybe uh r carcinoma or something that compress the left nerve vein who will get the left varicose uh yeah, very close vein of the testing. So that's the clinical importance as well. So, right nerve and yeah, left Renova, that would be like the uh uh one region and they are also Subra. So as you can see here, like the gonave uh Subra nerve vein, they are also drained into the uh different structure, right? Subra re vein drains directly into the IVC and then left uh Subra re vein drains into the left free nerve vein. Ok. So this and after that, there was the inferior friendly vein at the level of the ta the liver. And then uh the other things are there have the veins? OK. Uh Is there like yeah, any question or anything about the, the tributaries? So IVC and the letter, no questions at the moment or anything? OK. So uh as you can see here, so come on idiot and then lumbar re uh yeah, supra rene just the inferior friendly. So uh how about the, the venous drainage of the uh the other abdominal vis? Yeah. So like the gastrointestinal uh trap organs. So yeah, is that part of vein? So yeah. So where is the formation as you can see here? There's a formation of the portal vein. So where is the formation of the port vein at which level at the which uh vertebral level? Mhm Is it around L1 or L2? Uh Yeah. Yeah, it's around, yeah, the L1 region. So L1 region actually uh this is not related to the, yeah, abdominal uh that's uh but however, L1 region does the uh stretcher, another stretch line called what we call a plane called trans uh pyloric play. I think everyone is, yeah, familiar with this name. So, Transpire plate and uh L at the L1 level. So uh the structures uh like that are present in the transpyloric plate in level uh level, there are many structure and the then the form of poop is the one of them. So, yeah, correct. So that's the part is found at the level of the L1 level. Uh L1 and also the some of the variations, some of um books mentioned that for the information around the the head of the pancreas, some of the books mentioned that around the neck of the pancreas. Uh So uh to be honest, I'm not in that. So I'm not 100% sure which one is the car about. However, what we can say is for the pain is found at the at one. Yeah, uh for different level. And then how is it formed is formed by union, all of which bay and which bay splenic and inferior mesenteric. Uh One is called a splint because this is the portal vein. So portal vein is formed by superior centric and the splendid because as you can see inferior centric vein, it just drains into the splendid vein. So he has the splenic vein, inferior mi vein, it drains in the span and then after the sp it it continues and then it uh there's a union of superior as splene and then form that part. All right. Yeah. OK. So another one is the like the tributary of uh I mean, uh how do I say uh tr are like the super inferior? Uh So as I mentioned before, if you get that the arterial supply that the venous drainage will be easy for you, as we mentioned about uh that, that he gu structure that block from the uh sorry uh that out that the block from the high gap, it uh it got the apply from the inferior midcentral artery. So for the venous drainage, it gonna trade into the inferior midcentral vein. Ok. So as you can see here, superior re vein like this uh sigmoid vein and then left cool vein. So they're gonna dray into the inferior mi OK. So for the stretch out with the blood from the mid gap, they get the blood supply from the sei artery. So regarding the venous drainage, they're gonna drain into the uh superior central vein. So as you can see here, there is the uh yeah vein, right vein, ileo vein ive. So this vein and also like the pancreat ju so they're gonna trace into the uh superior mi central vein. So if you have the central vein, it drains into the splenic vein here. And then uh after that splenic vein and the uh there's a unit of the splenic vein and the uh CB central vein forms that water vein. So some of the uh and into the splenic vein, there'll be some of the structure like the uh short gastric vein and also on the left gastro vein, they're gonna drains into the uh splenic vein. After that and up into the portal vein, there will be like the cystic vein you're gonna drains into the uh portal vein. So, portal vein, uh where uh sorry. So from the border vein, the blast will be trained to the liver and then in the liver, they're gonna do some of the uh like the function of the uh function of the liver, like uh metabolize or like the details are fine, those kinds of things. And then after that, there will be the hepatic vein. So hepatic ve it drains that from the cava and then into the inferior vena cava. So like uh uh right Hepati, left Hepati and also uh central Hepati. So some of the s mentioned that there were two, but some of the just mentioned that there's a three. So right left and central Hepati vein, they're gonna drain the blood from the liver and then into the uh inferior vena cava at the T eight level. So after that, the inferior vena cava is gonna passes through the diaphragm and then goes up into the thoracic cavity. All right. So anything, any questions so far? No questions. Yeah.
