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Uh So it's still loading. Yep, it's living off. Hello, everyone. Can you guys hear me? Yeah. Oh yeah, they can't respond by the way, they kind of look at stuff, but yeah, they probably can't do it right. Um So I'll just have a quick introduction for who I am and then we'll start with the teaching, teaching session um today. So thank you very much for joining um for my session today. My name is look um for name Knock Rongcheng, as you can see in my credentials. Uh I'm a third year medical student from the University of Buckingham, but I'm currently placed in water hospital um for my clinical rotations have a special interest in trauma and orthopedics and I happen to be one of the editors on this platform as well, trauma orthopedic editors. So, um yeah, without further a do, we can start this session, say this is my session outline. So basically what we're going to go through today, um Abdominal anatomy, of course. So what it entails um I have some key points here. Abdominal cavity, the interior abdominal wall, okay. Let's triangle peritoneum and the, you know, related MS centuries. The inguinal canal has a box triangle as well as the posterior abdominal wall. So, um I'll be trying to focus on mostly doing that to me. Um Expect of it. I believe there's another session which focus more on the clinical side on it. So, um yeah, go on to the next slide. So for what we was um talk about in detail and lower gi anatomy. So uh small intestine, we can divide into duodenum jejunum ileum, as well as the appendix. For the large intestine, we have the cecum colon rectum and the anal canal. So um let's make an official start. I guess that was the introduction. So abdominal and that to me, um If you guys have noticed my, I don't like to put on too much works on my slides because I don't want to um kind of overwhelm you guys with too many words on the slides. I don't like. That is my personal experience. I don't like reading slides for too many words on it. And so please forgive me if the slides are not uh details that you s you will expect them to be. So abdominal cavity, how can we divide the abdominal cavity? We can either divide it into four or nine areas based on the imaginary lines that we draw on the body. So if we are talking about, let me see, yes, if we talk about four quadrants, um these are the four quadrants that we will commonly divided on RUQ, right, AARP accordion, left, upper quadrant, right, lower quadrant and left, lower quadrant. And these are called the abdominal pelvic quadrants. Um But as you can see, these are not kind of very detailed lee divided areas and it might cause some clinical problems when we want to uh kind of pinpoint an accurate location for uh for example, the appendix or some some other anatomical structures. Um So in this case, we will want a more kind of detailed um division or more a smaller deficient of the abdominal wall. So that's why um clinicians they came up with the nine areas. So as you can see, um you also have, you have the right hypochondriac region, the epigastric which is in the middle, then you have two left hypochondriac region, then you have to right and left lumbar region as well. Um followed by the umbilical region um as the name suggests is around the umbilicus and then you have the right and left in Guana region as well as the Hipaa gastric region, which is also known as the pubic region. Um I'm not too sure how many of you guys are from my medical school Buckingham, but there are questions that I've been asked um about, you know, what, what line separates the, for example, the uh right hypochondria, any right lumbar region and what, as you can see the answer here will be the uh coast of plane or uh in another scenario, what line separates the right number from the right in Guano, for example, and it will be the inter tubes, circular planes. So it is worth just going over what lines defined these regions as well. It literally takes like what one minute and these are collectively known as the abdominal pelvic regions. And I hope you can appreciate that on the diagram daft attached here. Okay. So these are the basic deficients on how we can describe and pinpoint the anatomy of the abdominal wall. So um as you can see, these are the comparison of the nine regions for under four regions. As you can see, hopefully, you can appreciate the nine um region one is more accurate and more pinpoint more able to pinpoint than the four region want. So, um that's about it, about deficients and the contents of it. So, as I was mentioning, um the reason we want to define the abdominal wall into different regions, right is because we wanted to describe, you know, certain structures or like want to pinpoint down uh what exactly is happening or like what structures is being damaged or inflamed in this patient. So, um I've attached a table here as you can see. Um I have highlighted the kind of more important um structures that you will, you will see in in each area. Uh I won't go through every single one of them as you can just read them afterwards, but I'll just highlight them. Um the appendix very important um because well, appendicitis and you can see is in um this right lower box here. And then you also have the IVC and the AORTA in the umbilical region as well. So, yep, that's about the, that's about the content in the nine areas, right me finger. Then we talk about the actual layers of the anterior abdominal wall. So um hopefully you guys can appreciate your abdonimal abdominal wall is not one single layer. Well, in fact, it has uh nine layers. So if you can see the upper diagram up, left diagram over there uh goes from the skin, then it goes to the campus fascia, follow ballet scarpa's fascia and then the two oblique muscles external, followed by internal. Then another muscle which is called transfers, transfers abdominus muscle. Then it's the fashion trend of sellers, extraperitoneal tissue then is the prior to layer of the peritoneum. So from superficial too deep, there is your nine layers of um anterior abdominal wall, right? And I have hand drawn a another diagram on the right upper corner there. And hopefully, hopefully, you can see um the boundaries of the anterior abdominal wall. So on the inferior boundary, you have the pubis, then on the superior boundaries, you have the surface sternum as well as the costal margins um of your ribs. So um the lower diagram there is some um more kind of detailed description of the or another view of the anterior abdominal wall really. And uh I have been asked in exams about the layers, well, not every single layer, but they, I was asked the question named four layers like an order, you know, any four layers of the anterior abdominal wall. And um yeah, so you might want to go through them on your own time leaving on. So um I'm going to talk about something called the R quake line, also known as the arc rate line of Douglas. So what, what is this and why, why is it important this, this diagram might not show the importance of it or you might not appreciate the importance of it only from the diagram. Um But essentially this our quit line device is a division. Let's put it that way. It's a division between um how would I would it so sorry, let me, let me say it that way. So above the are quit line, what you would see is that the, if you can, can you see my arrow actually? Um that's fine. I'll just, I'll just word it. Um The upper neurosis of the internal oblique transversus abdominis muscle actually goes behind goes posterior two directors abdominus muscles, as you can see on the upper half of the diagram. But below the arc wait line, you can hopefully you can appreciate that. That actually doesn't go behind the Rectus Abdominus muscle. In fact, um all the upper neurosis goes in front of the Rectus abdominus muscles. So um this is one of the kind of niche anatomical facts that I was taught when I, when I was revising when I was taught that to me. So hopefully this will help you guys. And uh next one. Yeah. So color's triangle. It's another kind of an important anatomical structure uh the in the interior uh abdominal region as well. So what is the callus triangle? It is an anatomical space and the inferior border of it is by the cystic duct. Um then which is highlighted by green here. Uh There will be a more detailed diagram and then the superior border is formed by the inferior liver, which is well, the inferior border form inferior border of the liver forming a superior border of the chaos trying to go if that makes sense for you. And then the medial border is formed by the common hepatic duct. So let me see the next slide. Yes, this is uh more kind of detailed diagram if you don't know what I'm talking about. Um So we can start again. The uh to strangle is anatomical space with an inferior border formed by the cystic duct. Hopefully, you can see that superior border is formed by the inferior liver edge and the media border is formed by the common hepatic duct. So um these are the borders and I believe you guys also need to know the contents of the like um colors triangle. What like what is in the colors triangle essentially. Um So it includes the cystic artery as well as the right hepatic artery. Uh the lymph notes of Lund and other lymph emphatic notes um which is not shown in the diagram, but they're not as important. So, basically, the two arteries are the relatively more important um structures with indicator strangle. Um This try and go a fun fact is especially important for laparoscopic cholecystectomy, which is the removal of the gallbladder. Um Hopefully, you guys do do not need to know this fact. Uh I'll just put in a fun fact to make it more interesting and there will be different kind of anatomical variations between individuals. Um But generally speaking, the cystic artery arises from the right hepatic artery and the processes try and go to supply the gallbladder. Um Next one, the peritoneum um actually, am I going too far? So, are there any questions at this point? No. Okay. I will continue. Um So I'll go on to the peritoneum. So the peritoneum, what what is it peritoneum? Essentially a serious membrane lining of the abdominal cavity. Um uh As function is basically to cover and support many of the abdominal organs. It also carries some blood vessels, you know, lymphatic vessels and nerves to, to the organs of the abdomen. And do I have a diagram? Yes. So, uh organs within the intraperitoneal space are refers referred as the intraperitoneal organs. Um as the name suggest, um and these include like, you know, the stomach, the intestines, etcetera and the organs and the abdominal cavity behind the intraperitoneal space. They are called the retroperitoneal organs. Uh example of that will be the kidneys and the intraperitoneal organs or suspend the body mass century. Hopefully, you can see on the middle on the center of the diagram which is essentially fold of membranes that attaches the intestines or you know other organs to the abdominal wall to hold them in place, you know, prevent them from just sliding around um in your abdomen. Really? Uh Do I have another one? Okay. So, um this is a table to compare to two layers of peritoneum, the parietal and visceral. Uh hopefully you can appreciate that. And so while, while you guys have a read on that, I'll just tell you um some more facts about the peritoneum. The peritoneum is lined by the simple squamous cells also known as mesothelium. And it's uh consists of parietal and visceral layers. The parietal peritoneum lines the internal surface of the abdominal wall and it is derived from the somatic method. Um Hopefully, you guys remember your embryology. So, somatic method um uh receives the same somatic nerve supply as the region of the abdominal that allies as a result. Pain from the prior to peritoneum is well localized. Hopefully, that makes sense for you. Uh the visceral peritoneum and vagin eights to cover the majority of the abdominal viscera. It is the right derived from this plan splanchnic, Missouri, splanchnic splanchnic, I don't know how to pronounce it. But if you go through your embryology lectures, hopefully, you know what I'm talking about. Splanchnic Missouri and it receives the same autonomic nerve supply as the viscera that it covers. However, pain from the officer of peritoneum is poorly localized, unlike the parietal peritoneum. So instead pain from the officer of peritoneum is referred to the dermatome on the skin. So um it does, it's not easy to pinpoint and localized. Um exactly where the pain is coming from. If you have pain coming from the Officer of Peritoneum. And yep, the next slide, right, greater, less so uh sorry, greater, lesser omentum I should have assumed in July for this diagram. Uh So the momenta, what are they, they are essentially sheet like layers of fibers and fatty tissues and they can be generally divided into the greater and lesser omentum. Uh Both of them actually attaches to the uh to the stomach. So, for the greater momentum, um as the name suggests is the larger of the momenta and it attaches to the greater curvature of the stomach. As you can see on the right bottom corner of the, of the diagram, the greater curvature, the longer of the curvatures attaches there uh also attaches to the transverse colon and it is supplied by the gastro mental arteries. One important artery that runs through. Um There's um greater momentum is the gastroduodenal artery, why it's important, you might ask because it is an important source of gastrointestinal bleeding. Uh most commonly because of, you know, peptic ulcer, it um diseases. And so the greater momentum, the main function of it is to protect other organs from the spread of inflammation or diseases. So it acts like a barrier to, you know, prevent these diseases or inflammation from spreading to one compartment to the other. And so when you move onto the lesser momentum, hopefully, you can see from the diagram that attaches to the lesser curvature, the well, the shorter of the curvatures of the, of the stomach, it is also attached to the duodenum and deliver and say um we're going back to embryology again, the greater momentum is a derivative of the door. So embryonic peasantry, while the lesser momentum is derived from the eventual embryonic mess entry. So they also uh embryonic mess injury, greater momentum, venture embryonic Messan tree, lesser momentum. Um That's about it about greater, less momentum. Okay. This might seem like a very um overwhelming diagram. Um but it's not not that complicated. Hopefully, you can, you can, you can um few that way after you have take some, you have took some time to, to read about it. So I see something in the chart. Is there a question? Oh, thank you. Okay. So um right. So if you can, hopefully you can see the abdominal aorta is the big red chunk over here. Um Hopefully you guys all know what, what the abdominal aorta is basic, the main source of, of blood supply in, in your kind of trunk in your lower body. Um And you're in your abdomen, sorry. And then it divides into, well, the left gastric, the splenic and the common hepatic artery. So, from the abdominal aorta, I'll just repeat that. Um uh from the abdominal aorta, you have the left gastric artery, the splenic artery as well as the common hepatic artery. The these are like the three common free free primary arteries that that is in, derived from the aorta and then from uh from the common hepatic artery. Um as I mentioned earlier, you have a branch which is the gastroduodenal artery. Um I wouldn't memorize too much about the gastro gastro duodenal artery from my personal experience, at least for pre clinical phases. Um The only thing as I mentioned is an important source of gi bleeding because of peptic peptic ulcer disease is and um for the branches of the gastroduodenal uh artery. Um I wouldn't memorize it for preclinical purposes because I've never been asked and I have never heard anything particular about them. But obviously, if, if you guys are interested, you can obviously memorize them. And then so from the common hepatic artery, uh the branch that is derived next, it's called a proper hepatic artery. And there's a right gastric artery that splits from here as, as you can see and from the proper hepatic artery, sorry. Um You have the right and left hepatic artery as well as the cystic artery, which is from the right hepatic artery as well. So, um yeah, abdominal aorta gives rise to common hepatic artery goes right to proper proper hepatic artery and then right and left hepatic. So, yeah, that's the diagram for you. Um What I would do with these kind of diagram, I would uh kind of draw out a few times, use some draft paper or I don't know, maybe with your ipad, draw out a few times trying to memorize the name of the branches as well as you know, where they branch. Um Yeah, that is how I would revise them. So, moving on to inguinal canals. Um I'm sure a lot of you heard a lot about inguinal canals and you know, some, some relative, not relative related conditions to the inguinal canal. So um sorry, let me just set some water. Been talking for quite a while, haven't I? Yeah, say inguinal canal, let's let's push our time backwards too are very like beginning of life. Let's push the time backwards to the beginning of life. So during embry, a logical development, there is a structure of fibrous structure. His name is called the gubernaculum. The gubernaculum leads the go nuts from the abdomen and they descend to the future scrolled come or the labia depending on the agenda or the sex of the baby, the inguinal canal and specifically is powerfully by which the testes, which is mel and mel leaves the abdomen and enter the scrotum, the peritoneum. And the process also out pocus to form the processes fagina lease, which is essentially the lining of the inguinal canal through uh its way through the abdominal muscles. So it's basically a almost like a weakness in the abdominal war uh abdominal wall muscles that you know, allows for the testes to descend. And you know, so, but this kind of structure may persist or may not persist. Um you know, after birth or after puberty. So let me go to the next slide. And uh as I was saying, sorry, as I was saying, um this uh inguinal canal, uh Megace rises various problems. Uh The most common one is inguinal hernia and there are two types of inguinal hernia, direct and indirect inguinal hernia. So, direct inguinal hernia is more common and elderly. While indirect was more common in Children and young adults for indirect inguinal hernia, that the effect is not usually palpable. And it's behind the external bleak muscle and direct inguinal hernia. The defect might be palpable do around the pubic tubercle. Um If you know your anatomy with the pube, sorry, the pubis bonus kinda around your um humid region. Um Hopefully you guys know where that is uh uh near to your groin Ragen if that's making any sense for just, just Google where the pubis is and then uh indirect inguinal hernia. It occurs lateral to the inferior epigastric vessels which are um uh that's so that you know, help, help clinicians and help us to the differentiate indirect from direct inguinal hernia. So the inferior epigastric vessels, if the hernia orkest lateral to it is the indirect in guano hernia or cause media to, it is a direct inguinal hernia and the causes of uh indirect and direct in Ghana hernia is also different. So indirect inguinal hernia is due to the persistence of the processes for journalists which um you know, it fails to regress after birth or after development. While the direct in Ghana hernia is due to weakness and the abdominal musculature and the hassle backs triangle. And do I have a slide on the Yep? So hopefully, um this will give you a better idea of what I was just mentioning about. Um towards the top of the diagram, you can uh see the inferior epigastric vessels. And as you can see um the location where the um weakness or the hernia occurs is different between direct and direct. I don't know the difference. Hopefully you can see is about the ranks. Um so deep in Ghana ring is is near the entrance. Well, it's a superficial in Ghana ring is more um uh towards the end of it. So that is a diagram of that. Okay before we go um before we go on to the next topic some, some more fun facts for you guys. So the inguinal canal has two important rings. As I've just mentioned, deep and superficial ring, a deep ring is natural to the epigastric vessels. And it is a landmark for the entry for the internal opening of the inguinal canal. And it is created by the trans versus specialist. The superficial ring is superior to the pubic typical and it marks the external entry of the inguinal canal. So, um some common kind of contents that runs through the inguinal canal uh includes the ilioinguinal nerve. It is for the genital e kind of sensation purposes as well as the general branch of the genital of the moral nerve uh supplies uh the cream historic muscles um and mail specifically uh through the inguinal canal display, Matic court's run through it and females you have the round ligament that runs through it. So, yeah, that's some fun facts for you guys. And then we will move onto Hassleback Strangle. Um If that's what this, this is what Hesselberg Strangle if this work fuse familiar to you because we have just mentioned it not too long ago and say it is a clinically significant site of a potential weakness for the occurrence of direct inguinal hernias. And the medial border of it is formed by the lateral edges of directors abdominus, which is basically your your app muscles like, you know, when people work out and they get really jacked, you can see that kind of, you know, app muscle. This is the one and the lateral border is formed by the inferior epigastric vessels and the inferior border aspire the inguinal ligament. So these free structures kind of form a triangle, the green, uh the the triangle is highlighted in green. Hopefully, you can see that okay, moving on. Uh by the way, uh you guys have any questions, just feel free to type it in a chattel. Yeah, hopefully, I'm not overwhelming you guys with too much and that to me or um medical stuff here because we're moving on to the posterior abdominal wall. Um So what we will cover in the posterior abdominal wall is the muscles the fast year. Um The structures around the pelvic girdle as well as the um third vertebrae. So um let me just drink something because I my throat is drying up. Okay. So we will start with some muscle shoes. Um Quadratus Lumborum, what does it do? It basically extends and naturally flexes the vertebral column. Um Some more mundane facts about it. It is a quarter lateral shaped muscle and it's just superficial to the posterior major and mainly acts to facilitate the extension the natural of the lumbar vertebrae. There are some additional functions to it, including assisting and respiration by fixing the floating 12 rip and an inspiration. This can actually increase efficiency of that firm Actiq construction of flattening. Um I don't think you guys need to know this, but if this interests you, um you know, you can mark it down. So uh the innovation of it that is innovated by the anti ray might of the T 12 to L4 nerves um and originates from the iliac crest and insert into the transfers process of the L1 to L4 for to brain. Um I don't think you guys need to, you need to know that for preclinical purposes, you forgot you have the. So what's major say hip flexion, a lateral flexion of the uh vertebral column um or around that area? Really? So this what's measure is just natural to the lumbar vertebrae. Main actions of the muscles include flexion of the hip joint as well as electoral flexion of the vertebral column that is innovated by the entire A mind of L1 to L3 nerves, it attaches to the lesser trochanter of the femur. Um If you, if you know what I'm talking about, if you don't, don't worry. Um and it originates from the transfers process on the vertebral bodies of T 12 to L5. Um I would say for preclinical purposes, just know the innovation and Axion, maybe blood supply as well. But I definitely wouldn't say to memorize every, you know, original inception of every muscle. I do not think that is worth your time. Okay. Um So it's minor. Um So it's minor. Um interestingly uh quite, quite some people in the population do not have a source minor. Um, so, and the people that do have it, it is interior to this was major and it mainly acts to allow flexion of the vertebral column. And it is innovative about interior. It might of um, L1 and um, it doesn't really do a lot because even if it does do anything, it's, um, it's a very weak kind of Axion. Ilya kiss. So, um, Iliac is actually forms, well, some people consider them as like the same muscle group. Uh Iliac is and so was major. Somebody. Some people actually consider them as the same muscle group and collectively they are known as the hip. So was, and the uh iliopsoas muscle is um important as, as a major flexor on the hip. It flexes it as well as um externally or actually rotate it as well at the hip joint. See more facts about the L Yakis. Uh the iliac is, is a fan shaped muscles and, and it is just inferior to the posterior abdominal wall. Um And um it is innovated by the femoral nerve uh with the nerve root L 22 L4 and originates from the iliac fossa and the interior inferior iliac spine, which is A I I S. Um And then it combines with the tendon of the source major to attach to the lesser cancer of the femur next muscle diaphragm, interestingly enough, diaphragm S A muscle and a lot of people often forget diaphragm S A muscle and, but it is, and it's really important as well and undergoes contraction and relaxation um to produce changes in volume and pressure of the thoracic cavity and the lungs. And that by by doing this allows the process of inspiration and expiration has served attachments including the number for to grade the costal cartilages as well as the surface sternum arises from two main tenderness structure known as the left and right cruder. See are you are a left and right cruder. So the muscular parts of the diaphragm eventually meets and then fused in the middle to form a central tendon as innovated by free nick nurse. And uh it consists of a few hiatus which is essentially openings to allow the passage of some important structures. So including the inferior vena cava, the aorta and the esophagus. So um I don't know whether you can see from the diagram. The right dome is actually slightly um superior, slightly higher than the left dome. Um And this is basically because, well, the liver is too big and it pushes the right dome upwards more than the left does is and that's the reason why okay, going to the fascia. So um there's a layer of fashion located between the peritoneum, parietal peritoneum and the muscle of the posterior abdonimal. Although it is continuous with the transversus, specialists of the anterior abdominal wall, it can be named differently in different sections. So basically when it's near the sewers muscles, it's called the. So what's fascia? Um and then in a different area, it can be called the four call lumber fascia. And hopefully, you can see the different layers to them as well. And so the source fascia covers the source major muscle and also attached to the lumbar vertebrae. While the for Colombia fashion can be diverted to fight it too posterior, middle and anterior layers as you can see in the background, while the quadratus lumborum um send it down. Yeah, it is in the diagram, a sandwich basically between the anterior and middle layers. The deep back muscles are located between the middle and posterior layers. Uh fully, you can see those um basically the muscles right next to the vertebrate. Those are like the deep um back muscles also known as the erectile spine, Spanier spinning muscles. And that's, that's it. So we have talked about muscles then. Now it's time to talk about the vertebrae itself. So we're talking about, we're talking about the abdominal region. So are corresponding vertebrate would be the lumber vertebrate on it. So the lumbar vertebrae is actually like the largest uh one of the largest kind of vertebrate uh in the whole vertebral column. Um that there's five of them. Uh you can see uh they support the lumber spine and there's weight of any sapir structure. They're vertebral bodies are large and they can be described as kidney shaped while they're vertebral foramen is triangular, was shaped and shaped and they also have short and brought spinous processes and long and slender transverse processes. So they have both transfers and processes as well as spinous processes. There are several notable ligaments that are associated with the lumbar vertebrae. Um Do I have a diagram on that? Yes, I do. Ok. So you have the anterior and posterior longitudinal ligaments which covers the vertebral bodies and the intervertebral discs. There is also the ligamentum flavum and it connects the laminate of the neighboring vertebrae. There is also something called the interspinous ligament and it connects the spinous processes of neighboring for today and supraspinatus ligament, it connects the tips of neighboring spinous processes. So um hopefully, you can see that in the diagram. And uh yeah, I can, yeah, posterior is right here interior and to try uh to spin this as well. Hopefully, you can see that in diagram. So another kind of bony structure is the pelvic girdle. Um Earlier I was saying about the pubis. So now you can see where the pubis is. Um um I my personal experience um I always struggled to remember which part is ileum, which part is a scheme, which part is pubis. Uh But uh how I have managed to memorize them now is because the pubis is, you know, pubic synthesis. So, you know, it's the most medial of them. So pubis is what you know, right next to the pubic synthesis. Hopefully, that helps you with memorizing them and the ileum as well. Um ileum is basically where at the bone that gives rise to the ASIS anterior superior iliac spine. So therefore your most superior one is the ileum and you know, you know where your ileum is and you know where your pubis is, then the remaining one must be the SKM. So that is how I kind of remember remember the different parts of the pelvic girdle. And so there is a structure on the uh hopefully, you can see on the diagram, it's called acid tablet. Um And then it's quite important um in terms of mobility, uh it is where the ileum, the SKM and the pubis kind of fuses altogether. And it's also the where the femoral head kind of articulate with um on the hip joint as, as you know, the the hip joint is ball and socket joint. So, um so on one end, you have the femoral head, on the other end, you have the acetabulum. Um Well, you have a labor um outside of it, but it's the structure is called acetabulum. So you have the forced entry pelvis. Hopefully, you can see on the label diagram and then some other structures that you might want to know as the sacroiliac joints, sacred cost sitio synthesis and pubic synthesis. Uh But I wouldn't know too much about them. Um The falls pelvis um is more superior than a true pelvis and the lesser pelvis also known. Um uh no, I've just talked about them. Sorry. Uh But yeah, that's basically what you need to know about the pelvic go though. Uh So quiz time, hopefully I haven't bored. Um you guys too much and so we have a few questions. Hopefully you can put your hands, ear's into the chat. So we're in the nine deficients and the abdomen. Does the appendix lie? So I have purposely not mentioned tea specifically uh because I know I'm going to mention it here. Uh So where any nine deficients of the abdomen? Does the appendix lie? If anyone wants to put their answers in the chat? Okay. Oh, just wait for. Yep. I do appreciate there are different names um on, on the same kind of anatomical region. Uh But essentially is right in Guano or like ALEC region. Uh Oh, sorry. Uh But if, if you use another alternative name that is completely fine as well, uh I just tend to use um these two names for, for my own kind of study purposes. But if you know, if you use other names for the same anatomical structure, that is completely fine. So I wouldn't worry too much about it. Okay, next question. Oh, before next question, I just want to talk a little bit about something called the mcburney's point. So the mcburney's point uh is number one on the diagram. Number two is your umbilicus and number three is your right ASIS has to be the right side. So what, why does it have to be the right side because uh we use the mcburney's point to pinpoint or to locate where the appendix is. And this is especially important uh appendicitis. So, um if somebody asked you to, you know, oh, describe mcburney's point, uh you will say, you know, two thirds of distance from the umbilicus and one third of the distance from right ASIS. So ASIS is anterior superior early explain. So this is a point where you would um pinpoints or locate the appendix. And um it is also the point where evidente meas make their first incision, which is the, you know, the the actual surgery to treat appendicitis. This is where they make the incision. Okay. I know this is very worthy. So, um which of the following shows the correct order of the layers of the interior abdominal. Uh um as I've mentioned, I have been asked, there's quite a few times. So, um hopefully, this will help you memorize the anatomical structures of the NTM dominant war. Okay. I'll just go to the answer. So, yeah, you guys, all right. It's be um I just, for some reason, I just couldn't get over the fact that campus is more superficial than scar pass. But it is, and, and if, if we use kind of common sense, the muscles obviously lie deeper than the fascia. And, you know, so by that logic, it's um you can, you can appreciate the, the muscles lying deeper than the both the campus and the scarpa's Fashir. So you just, I would say just use some time to memorize the order of it. Okay. Um As I've mentioned, uh the five main muscles of the entire abdominal wall, the flat muscles, which is, you know, the three muscles that we have mentioned earlier, the external oblique, internal, oblique and transversus abdominus going from superficial deep. Um I think I haven't mentioned too much about the vertical muscles, but basically, there are two of them. The pure middle list is a very minor muscle which uh I don't know if you can see on the diagram is right next to the midline of your, of your abdomen towards your pubis. That is the pyramid Dallas muscle. I wouldn't worry too much about it. Uh Rectus Abdominus is the main vertical muscles uh in your anterior abdominal wall, which is essentially your apps muscle. So these five are the main muscles of the interior abdominal war, external oblique, internal oblique, transversus of dominance, which are the flat muscles and the vertical muscles are pyramid dollars and Rectus abdominus. Okay. Moving on. Um what is a mess entry? Um I've put this question because in my personal experience, I've always struggled to give an accurate kind of description of what a mess entry is like. Is it a membrane? Is it a you know, is it a sheet like what is it? Okay if you can wait for one more answer, maybe we will continue in case somebody wants to answer. Oh, and um I don't know how this kind of system works, but essentially I know the power points are not too detailed on uh on, on the in terms of content. But I have another kind of document accompanying this power point. And so hopefully they will upload bill for them to the platform. And yeah, okay, let's continue, I guess, say, oh sorry Nicole uh membrane, this organ that connects intestine to the back of the peritoneal cavity connects the blood supply to these organs. Yet very detailed description. I like it. So um the the definition I I went for not, not the best um definition, but I think it's quite enough for, you know, a general idea is essentially a fold of membrane. So yeah, it's not one single a of membrane, a fold of membrane attaches intestine to abdominal wall and host them in place. Um You might be able to find more detailed description of the mess injury, but that's I think it's the most kind of simple and gives you a great idea of what the mess injury is essentially. Okay name to differences between Director Anguiano and and direct inguinal hernias. So um if you guys remember the table um that is pressing a couple of stites slides earlier, what are the two differences between the direct and indirect inguinal hernias. Mhm. Indirect hernias, of course, due to pattern process of vaginal is while direct can be trauma or old age and direct happens in Children while direct happens in adults and elderly. Okay. Uh the cassettes indirectly to congenital defect and it's lateral to the inferior epigastric artery. Very good. I like the very epigastric part. Um Yeah, I think, I think, you know, um the other one that causes uh okay, I'll just, yeah, uh weekends of Latona will media to the inferior epigastric Archie. Um So yeah, essentially this um um table. So uh I wouldn't say artery, I would say vessels, very minor point but not so not essentially only the artery but the vessels and so like including veins and you know, so yeah, as you can see this table that we have went through earlier, essentially, it's what I'm looking for. Okay. Next one. Okay. I'm trying to switch up the question types here and um hopefully you guys can fill in the blank. There's something muscle and the something muscle combined to form the Iliopsoas uh muscle group and it is a strong something at the hip joint and it is innovated by this something nerve. Um I'm not too sure how other medical schools work, but for my medical school, this is quite a common question type. Say. Um Yeah, if anyone wants to put the question, put, put the answers into the chance. So what muscles combined to form the Iliopsoas muscle group. See you. Okay. Uh Are there any, any other other, um, answers before I continue? Okay. Okay. Yeah, Hamza, your, your answer is quite good but I would say so was, remember to specify. So was major because there is another muscle called, um, so was minor. So just be aware of that. So the PSA was major and the iliac is muscle, they combined to form the Iliopsoas muscle group. Um, that's funny. Oh Hamza, you said flexor at the hip joint? Okay. And Nicole you sent femoral enough. Okay. Let's continue. So yeah, you guys pretty much got moves of it, the doctors and the so as much so they combine to form a, the iliopsoas muscle grouped and there's a strong flex at the hip joint. It is innovated by the ephemeral enough, which is L 22, L4 um nerve roots if anyone wants to memorize them. Um Some people consider the iliopsoas must so as the kind of um muscle at the interior fi compartment, but um something that you need to be aware of that is that maze of the muscles in that compartment acts to extend the knee x um instead of flexing the hip. So you might want to be careful with that. But yeah, they are, they are strong flexes at the hip joint. You guys are correct. So that was our kind of mini quiz uh between my two sessions. Uh We have some more kind of general anatomy to go through. If, if you guys have any questions at this stage, we can go through them. Um If not, I'll just continue. Uh Am I talking too? So I think I'm talking to you. So am I, I'll try to speed up a bit. So, um the small intestine, uh quite a few main adaptive features, four of them in total, which uh well, basically serves to increase uh the absorption rate. So you have the micro feline which themselves actually on top of the V line. And do you have something called a PK secularists which are essentially the votes uh of the small intestine uh on which the that on which the V I oil locates on the last one is a long length for the small intestine which you know, increases absorption rate as well. And then uh I would just chip in some uh radiology. So if you can see the valves Khan inventors, that is the same, same word for pre K circulars. Um I don't know why they use so many different words for it. But um as you can see, these are basically the folks of your kind of intestine um and your, your valuation shouldn't look like this. Um It's just dilated um for some reason, but hopefully, you can see how they look like an radiology kind of um um diagram. Okay. So um this is the blood supply I was talking about earlier and so the celiac trunk is the first branching of the abdominal aorta. Then you have the superior mesenteric artery followed by the inferior mesenteric artery. And as you can see, they branch to supply the uh you know, intestine, the large intestine in particularly this one. And okay. So let's focus on uh different parts of the small intestine. First. You have to duodenum. Duodenum is the first part of your small intestine. It starts justice to, to the pilot expenditure of the stomach and, and so the duodenum jejunum junction of lecture, it wraps around the head of the pancreas on a C shaped manner. Uh The duodenum can actually be uh dividers uh further early into four parts of it, superior descending, horizontal and ascending and only the superior part is intraperitoneally. Um um The major, you have something called the major duodenum popular as well as the sphincter of Odai and they are located on the descending part of the duodenum. What they do is that they regulate bio emptying from the emperor of data into the duodenum. Uh There are something called brothers glands and they are found within something you case of duodenum, they produce out climb. UK is to protect the duodenum from exodus gastric secretions. The duodenum also acts to enhance the mixing of food with bio as well as some pancreatic enzymes for digestion of carbohydrates, fast proteins, etcetera. So for blood supply, uh it's mostly the senior trunk and the superior mesenteric artery and in particular, the superior, middle and inferior pancreatico uh do Audino arteries. So, um if you were a bit uh sorry, if you're a bit confused by, you know, what's the Ampule elevator? And what, what, what is the Cinco De, what is that? Hopefully, this diagram can solve your question. Uh It's basically where, you know, the bio and enters the, the, the gut. So this things of Odai is basically like um like a kind of contraction mechanism. So when it contracts about can, can go into the gut and when it relaxes is when you know, but I can go into the duct. So the emperor of beta, it's basically the, the final part of it that leads to the um swings of modi. And so they, they essentially regulating bowel emptying into the gut. Okay. Uh I thought I would um put some histology here as well. Brothers glands, as I have mentioned earlier uh in the duodenum and it's a compound tubular gland. Hopefully you guys can appreciate it in this histology side. And up there, you can see some crips as well. That's why, you know, it's, it's the gun, not, you know, not other parts. OK. Continuing, you have to get Jejunum and ileum. So it is a Jejunum is the second part of the small intestine and it begins at the duodenum jet, you know, junction of flexure and it's entirely intraperitoneally. Oh, um There is no kind of particular features that you can use to distinguish the duodenum from the sister Jejunum. But then there are several histological um differences that allows us to discuss, distinguish them. One of them is the pious patches, which is a part of the gout which is um uh that's associated lymphoid tissue G A L T uh smoothly, only found in the ileum. Um Other differences, the wall of the junior Miss FICA and it's Newman is wider than it is in the ileum. The Jet Union also contains more prominent plea case regularise and they had to absorb moves fats. The ilium is the last and the longest part of the small intestine, it terminates at the ileocecal junction or ileocecal 12 which is the where where the cecum begins as well. The ileocecal swing to controls the emptying of elio content into the cecum. And another important thing about the ileum, it acts to assault vitamin B 12 as well as power source and all kind of digestion products which we're not absorbed in the duodenum and Jejunum. But the most important part part is um vitamin B 12 is absorbed in the ileum. Um for blood supply. They are the Jejunum and ileum. They are supplied by branches of the SM A superior mesenteric arteries including the Juno and video arteries. They announced the most with each other and send faster rector which is kind of uh accompanying branches to the Jejunum and ileum small intestine then drain into the hepatic portal vein into the liver um than the lymph nodes of the small intestine strained into superior mesenteric lymph nodes. Um Yep, that's about it. Uh As you can see here, I've touched some histology slides here as well up yet as well. Um Not my label is gone. That's why I'll fix it before I upload it to the platform. So let's move on for the moment. So, um I wouldn't focus too much on this light on the diagram. I mean, basically this is how people will describe the position of uh the appendix. And as you can see, the most common position is retro cecal um position, which is 64%. You don't need to know that. Uh some people also use like the hands of the clock to describe the position of the appendix. Um But hopefully, you, you, you guys can see the most common position as retro Seiko. Uh So what is the appendix is a small blind ender part of the intestine that is attached to the cecum. It has large amount of lymphoid tissue. Uh But funny enough, it doesn't have a cynical uh functions in the human body. It is derived from mid gut and the embryo. And as the, as a result in rio vascular supply of it follows that of the mid gut by the branches of the sm uh superior mesenteric vessels. And the material supply is from the appendix color artery and in particular, which itself is from the uh ileocolic artery from the sm a superior superior mesenteric artery and ultimately, uh venous drainage is by the appendical er vein. So the mess entry, MS appendix contains both the arterial supplies as well as the venous drainage of the appendix. In terms of no supply, the superior mesenteric plexus allow sympathetic and parasympathetic innovation to the appendix and a polio polio colleagues, lymph nodes is responsible for lymph drainage is in this particular area. Okay. The cecum which is right above or right next to the appendix uh by by going into the cecum, we have officially entered the large intestine. So the cecum is the most proximal parts of the large intestine. Uh The whole cecum is intraperitoneal and it is separated from the ileum by the ileocecal 12. Uh We have mentioned earlier, the ileocecal five contributes to release contents from the ileum into the cecum. It also prevents the reflux of sickle content back into the small intestines because obviously, we wouldn't want that. The cecum is also derived from the med gut. So it follows the same neurovascular supply of the superior mesenteric vessels, artery blood suppliers by the ileocolic artery, which is from the SM A um ultimately uh for faint is also by ileocecal vein which ultimately enters the superior mesenteric vein as well. And let's be fun. So, the colon uh colon starts justice to, to the cecum and extends all the way to the anal canal as main function is to further of salt water and electrolytes upon recent digest food from this more intestine and like other parts of the volume, we can also divide the colon. Uh because we like dividing up things. Uh can we, we can divide it into four parts based on their anatomical position. The ascending colon, the transfers colon, the descending colon and the sigmoid colon and the ascending colon is the first part of the colon. Hopefully, you can appreciate that it's a retro peritoneum structure and it turns 90 degrees to the right upon a rifle at the right lobe of liver. Uh what that means? Basically, it turns 90 degrees anti uh towards the liver. Uh it forms the hepatic right uh colleague flexure and then at the right colleague flexure, the ascending colon ends and then the transverse colon starts at first travels transferred transversely across the abdomen. As you can see on the diagram until it reaches the position of the spleen. Then it turns 90 degrees in fear really following the left colic flexure also known as the splenic flexure. And then this is also where the transverse colon ends. Uh The transverse colon is intraperitoneal and the messenger very holding it in place. It's called transfers missile colon. So if you see transfer something muscle, something that is basically the medicine tree and you can pretty much derive kind of deduced what structure it is holding by the name. So for example, transfers missile colon, you know, you know, it's holding the transfers colon. And then so although the transverse colon is attached by the free nickel colic ligament to the diaphragm above it is also the least fixed part of the colon. So it's the most mobile. And then uh we were talking about left colic flexure being the end of transverse colon when we, so we entered the descending colon starting from the left column flexion as well. And uh basically the sense goes and fairly towards the pelvis. It passes over the left kidney and it's Richard peritoneal, it then turns immediately to become the sigmoid colon, which is our last part of, of the colon. Um So hopefully, you guys can appreciate ascending colon is called ascending colon because it's ascending. And you know, but why is Sigmund calling called sigmoid colon? Um My logical explanation of this is because it's s shaped. Uh you can't really see it on the diagram. But if you kind of imagine that on a three D kind of space is s shaped. Trust me on this. Uh it curves backwards on itself during its descent to the pelvis before reaching the midline and becomes the rectum. It is an intraperitoneal structure and it is attached by the medicine tree of the sigmoid mesocolon. So once the sigmoid metha column stops, the rectum starts, it is also relatively mobile. And um yeah. So the sigmoid colon ends and then the rectum begins. So do we have uh have the slides spread? I've just mentioned it. So that's fine. Uh So large intestine features, like how can you tell that it's a large intestine time? Not a lot, not a small intestine. So we have mentioned, you know, Valli Microvillus, I and your platelets, secularists about the the small intestine, but they're also kind of kind of some structures maybe not that visible, but that can, you know, help us to differentiate large intestine from small intestine. So you have detainee Colin if the harsh as as well as the mental appendicis is also known as a pit glottic appendages uh which is these kind of out pocketings. Hopefully you can see and that is basically how we can tell it. So um 10 year Colyte, what they are is basically free strips of muscle running longitudinally down the large intestine surface. And how Russia is basically the when 10 year Colyte contract and they shot in the intestinal wall, then you form individual house to if that makes sense. So the 10 year Colyte is muscles and the house to is formed by the tenure coli constructing and then the appendages are basically the out pockets, okay. Um arterial supply, as we have mentioned earlier. Um So the neurovascular supply of the large intestine is related to the embryo logical origin. So especially in this, in this part of the gut um is quite important to, to go through the embryology of it because basically the neurovascular supply, it's the same as it was in the kind of em biological situation and say the ascending colon and approximately two thirds of the transverse colon are derived from the mid gut. While the distance uh just a one third of the transverse colon, descending colon and sigmoid colon or derived from the hand gut structures have with a medical origin uh are supplied by the sm A superior mesenteric artery or the structures derived from the handgun are supplied by the I M A inferior mesenteric artery. Uh These S M A also give off some branches, the ileocolic and right colon arteries supplied ascending colon. While the ileocolic artery photographs rise to colic anterior cycle and posterior cecal branches to supply the ascending colon as the transverse colon is derived from both the mid gut and head gut. So you have both, you know blood supply by the S M A and the I M A. So the SM A gives rise to the right and middle colic arteries. While the I M A gets right to left colic archery, the descending colon is supplied by a single branch of the I M A which is the left colic artery moving on the sigmoid colon is abi supplied by the sigmoid arteries, which is eventually from the I M A as well. Um There are some marginal arteries that you can see in the diagram. Um they also exist and they are important for collateral blood supply to the colon and that is basically a tour supply of it. Uh lymphatics wise, uh I wouldn't know too much about it other than the important live notes, one important structure as well. It's called a system. Uh highlight. It's essentially a kind of small. Well, I wouldn't say it's more a collection of uh lymph nodes at the abdominal regions. So as a filter of the, you know, lymph that that is collected from, from the lymph vessels, okay. Finally, moving on to the rectum, we're almost there. Uh direct times say it is the most distal segment of the large intestine. Uh usually it starts around the S three level and it continued terminates and continues as the anal canal. The most important function of it is the temporary storage of thesis. Uh does not have any tenure colon hofstra on any uh any omental appendicis. Unlike the colon, there are two most important flexure is along the course of the rectum which is a sacred and anorectal flexure. The sacral flexure curves around along the anterior posterior axis and it follows the curve of the sacrum and coccyx. It is concave and tear lee. So the other flexure, the annual rectal flexure uh has also a curve along the anterior posterior axis, but then it is more uh convex anteriorly instead of concave. The, you know, rectal flexure is important for fino continents and the results from the muscle terms of the puborectalis muscle, the free lateral flexure is also present uh namely disappear, intermediate and inferior lateral flexure. Uh The ambulance is the final segment. Uh Basically the function of it is to relax. Uh too temporary store fees is for later defecation. Uh So the uh no, the blood supply of it. Uh three main arteries, superior rectal artery from the I M A middle rectal artery from the internal arteries, artery and the inferior inferior rectal artery from the internal pudendal artery, venous drainage. On the other hand is by the superior, middle and inferior rectal veins, the superior rectal veins empty into the portal venous system. While the middle and inferior rectal veins empty into the systemic venous system. Um So the rectum uh in terms of kind of innovation receives both sensory and autonomic innovation. The sensory fibers follow parasympathetic supply from the pelvic splanchnic splanchnic nerves as to to s four and the inferior hypogastric places. And on the other hand, sympathetic supply is from the lumber, splanchnic nerves as well as the superior and inferior hypogastric classes. Okay. Our last part of fit anal canal. It's the final part of the 80 I truck and it's uh the most important rules of them is basically defecation and maintaining fetal continents. It is with an anal triangle of the perineum and has internal external sphincters. So internal anal sphincter surrounds the upper two thirds of the anal canal and it is smooth muster which means that we cannot control um this sphincter voluntarily, the external anal sphincter. On the other hand, is a voluntary muscle basically, which means we can control it uh that surrounds lower two thirds of the anal canal. The two sphincters to some degree over that with each other. And the anal rectal rain is located at the junction between the rectum and the anal canal. They are formed from the fusion of the internal anal sphincter, external anal sphincter, as well as the pupil rectal this muscle. So the superior expert of the inner canal maintains identical epithelium as the rectum. The columnar epithelium. Do I have a slight on that one? Never mind? Uh So okay. Uh This is the Pectin pectinate line as well, which is uh one important structure that we want to, you know, look out for when we are talking about the anal canal. And you know, um so uh the pectinate line, it is formed by collection of, you know, anal valves. Uh it divides the anal canal, it's upper and lower gi uh lower and upper parts. And the G I track above the pectinate line is derived from the hindgut. While the counterpart below the pectinate line is derived from the back to them. So, in contracts to the Colonna columnar epithelium, the anal canal is actually lined by nonkeratinized advice, squamous epithelium. And further down at the level of the industry in tour group, the epithelium is transitioned gradually into the characterized stratified squamous epithelium. So it's not like a sharp cut is, you know, is going bit by bit until it's characterized stratified squamous. So hopefully, you can appreciate the significance of the pectinate line here. Uh So they have, you know, different blood supply, different venous drainage, nerve supply, lymphatics, blah, blah, blah. Uh This is all because they are from different embry, a logical origins. So, you know, it's important to know your embry a logic uh embryology kind of uh content. So another function of it, we can use the pectinate line to divide uh internal hemorrhoids from external hemorrhoids. So if it's below, then it's external hemorrhoid. If it's above it, then it's internal hemorrhoids, right? Okay. Our final part of this session, I apologize for the slow speed of it. And uh this is the last part of our session. So it will be great if you guys can participate as well. So how many parts can you duodenum can be divided into? And what are their respective names? I mentioned very briefly about their names, but let's focus on how many parts. Um can they do it? You know it can be divided to how many parts? Just give a number? 345. Okay. Okay. Let me give you guys the answer. So it's four uh the name off it. Uh Well, me personally, I memorize it because I, oh yeah, that's really, that's really good. Uh Yeah, horizontal transfers doesn't really matter that much. Um So I memorize them because I like, I think by memorizing these names allows me to, you know, you know, what direction it is going essentially. So it goes superior first, then in the sense goes across trans firstly or horizontally and then sends basically these sort of four parts of it. Okay. Um Okay, this is a very long question. Um You guys don't need to put it in the chart, like just have a think to yourself, uh describe the course that a football this will pass through after its exit from the stomach until defecation. That's just a really long question. I know. Uh But it's also really good revision of the whole kind of general anatomical course of your gut system. Um Just have a think to yourself, what structures were past three and yeah, okay. If you guys a couple of maybe half a minute, I guess, okay, five more seconds. Okay. So you'll go through firstly in the small intestine, the duodenum followed by the jet, you know, and then the ileum and then from the ileum, you go through the L U C called 12 into the Cecum, then the colon direct um finally the anal canal and then you, you know, go through the sphincters and then uh defecation of curse. Uh That's an answer. I apologize for revealing the answer early Duodenum, Jejunum, DMC. Calm colon rocks. Um Yes, very good. Uh Yeah, basically gives you a good kind of idea of the general overview of the gi tract. Okay. Um Histology questions. Uh Not my favorite questions uh as well. Uh I think I didn't go through too much about actually, I'll just give you guys the answer because I don't, I don't think I get, I um went through too much about it. I apologize for that. Uh So uh actually is hematology, it looks unstained, which is basically a type of stain. Um uh you know, uh scientists and lab people used to stain tissue to better visualize them. It's called hematology. You sustain. What are the two names of the structures and direct tangles? So I'll just review the answer. Uh give you guys a hint apparently. Uh So uh another hand, when you see um a Chinese stains red or pink or basically muscles and then, you know, blue are usually your epithelium say um I didn't mention this. I think I apologize for this. But hopefully, now you can see uh the there are two kind of plexuses that controls the autonomic activity of your, of your gut. So the guts kind of nervous system is very interesting. So uh it's kind of separate from the parasympathetic and sympathetic system but not really, is very, very interesting. And how do they achieve? This is by these two um Plexus, one is called the myenteric plus is the, the other is called the submucosa plexus. I apologize again. I then mentioned these earlier. So there's some mucosa plexus. Uh it's basically is located within the submucosa. And then the monetary plexus is located between the circular layer and the longitude and a layer of the gut muscle wall. So I'll just repeat it again, some mucosa plexus and the some mucosa myenteric plexus between the circular and the lodge itude and muscle of the muscle gut wall. So, you know, these plexus basically work together and they have specific rose. I wouldn't go too much into this. But all you need to know is that the sub mucosal plexus, it controls kind of release of contents uh from the gut into the, you know, gut lumen. That's the major role of it. While the my interest places plexus uh basic controls the muscle contractions. Uh as you know, you know, I got contracts, you know, uh differently, some also know as prosthesis. So, you know, we need something to coordinate. It just can't happen on its own, right. So the my interest plexuses like a local kind of power station to to coordinate these movements. Okay. Hopefully, you guys can appreciate the better the layers of the G I tract. So mucosa, some mucosa muscular is propria followed by the serious or or adventitia depending on these um location of it. And as I mentioned, there's some mucosa plexuses, any some mucosa and the monetary plexus is between your circular and longitude. Oh muscle say um yeah, this is kind of main thing I would say that you need to know about your kind of gut enteric nervous system. Okay. Uh As I mentioned earlier, H N E um uh came a toxin in they stay, they sell nuclear a purplish blue. Well, Nielsen's thinks the extra still in major like as well as the side top of some pink. That's why you see different colors. Uh I wouldn't know too much about it. Um The different kinds of things because there are so many okay uh system system, Kailai. Uh What is it? Why it's important, finger briefly mention it? Yes. Uh I think I over quite a bit that night. I would just wait a few uh lymphatic drainage. Okay. Kate say uh hopefully you guys can know by now if I didn't mention, I don't, I think I didn't mention quite specifically specifically about the roads of the system, Kailai. But uh now you can, now you can see uh it's basically a sack at the lower end of difference, a duct and it receives kind of fatty car from the intestines. The ascending and transfers colon has lymphatic drainage into the superior mesenteric note while the descending colon and sigmoid has lymphatic drainage into the inferior mesenteric notes. So most of them passed into the intestinal lymph trunks and further onto the cisternal Kailai. So basically, uh I said system Children, I mean, Kailai is where the lymph empties into the forensic duct is the main kind of drainage in the uh system. So before intercity, forensic duct, lymph nose kind of concentrate in the system, Kailai and then antisyphilitic duct. So it's kind of like a mini stop before it enters the systemic kind of um limb circulation. So that's the importance of it. Okay. Uh This is an extra question that I didn't mention about, but it might be interesting for you guys to have a guess. Uh It might has to do with the kind of embry a logical division that I've mentioned around pectinate line. You might not know the exact name of it, but maybe if you guys know the m biological division, you might be able to guess the answer. Squamous cell carcinoma. Okay. Uh Any other answers? Okay, maybe for the time being, I'll just go on to review the answer. So yes, it is squamous cell carcinoma. And if you guys remember the anal canal is lined by nonkeratinized, ratified squamous epithelium below you dip actinic nine. Therefore, the most likely malignancy will be a squamous cell carcinoma. So a little bit of extra information for you guys. And then, yeah, so that was basically the kind of my, my attempt to explain the whole t an anatomy and an hour and a half. Um obviously, that is not the whole um you know, the whole g eye anatomy, but I think I have covered the majority and the most important bits of it. And these are the kind of resources that I have used in my preclinical phase to help me study, teach me anatomy is a very, very good one. Um If you just browse the content is free, but if you want to kind of by the question banks, I think you have to pay like a subscription, can help, can help. I think if you just browse the browse, the content of them is also free as well. Uh If you purchase a subscription, I think you can unlock some more features, but I'm not too sure how, how it works. And then our university also have uh an app called Complete Anatomy. Uh It's a very cool app. It's basically like a uh you can just play around, you can just, you know, choose your, for example, um colon and then you can just spin it around, you know, see how, how it looks like how it looks like in the body, what position it is. Uh then uh uh osmosis I, they have very, I use it for like very good kind of summaries on your Monix. Um not only on G eye but maybe on M S K or I don't, you know, biochemist. Well, uh bacterial, uh some people use it, I don't use that much but it is still a very good resource um that I recommend uh geeky medics. It's uh mostly they deal with your are skis really, but they do have some, you know, useful content when it comes to revision and then so um this is my kind of uh my, my, my socials and my email. So, uh thank you very much for attending this session today. If you guys have any question, feel free to email me, drop me a message, whether it's about medical school or like G I um I check my emails quite frequently. So, uh but yeah, thank you very much for attending a session today and I hope you guys have benefited uh from the session. Uh James, do you have anything to say before you go, James here? No, James is not here. Okay. Uh But yeah, this is the end of our session. So feel free to lock off or you can stay behind you if you have any further questions that you would like to drop in the chat, I will be here for a while until everyone knocks off, I guess in case any question um in case there are any questions you would like to ask. Does anyone have funny questions, Nerd? Thank you, Nick. Oh uh Yeah, we can go back. Don't worry. Uh I think that I, I think I'll be allowed to upload these slides on after this talk. Not too sure how exactly it works, but um we'll figure out. So uh there you go. Um So uh the question I believe um is about medial and lateral kind of to the inferior epigastric vessels that you were confused wasn't it. So in direct one as lateral to the inferior epigastric vessels, while the direct one is media to the inferior epigastric vessels uh and the diet you're gram. Okay. Um I'll just go to the do deep knee diagram. So hopefully you can you go hopefully you can see it better here with the diagram. So yeah, Latrobe and media to the inferior epigastric vessels. Hopefully you can appreciate it better here. Could you go over the clinical? Yes, yes, yes. But is that, is that all right for you? Um media and nitro to the inferior epigastric vessels? That is that clear? Okay. I'll go to the ark rate line then. Um So basically, um the anatomical structure differs but you know, above, below the are quite line. And um as you can see on this upper diagram here, uh there is say so if you go to the upper diagram, you can see the rectus abdominus is surrounded both by like anteriorly and posteriorly. So, um you have a layer of tape or neurosis to uh surround them interior and posteriorly. And then below the arc rate line, uh there's only interior, a poor neurosis that is the kind of main anatomical difference between them and the level I would have to, I will have to admit my uh my incompetence and have a Google. I am really sorry. Okay. So the our quit line is roughly one for the distance from the pubic crest too. Um or do you want a spinal level? Let me try spinal level. Uh So it's about one third of the distance from the pubic rest to the umbilicus, one vote of the distance from the pubic crest to the umbilicus. So if you draw a line, basically it's about um you know, one third of distance. Yeah, I'll just type it in the chat saying that you cannot stay whatever one third of the distance um from people crest to the umbilicus. Yep. And um yeah, so basically that the April neurosis is basically what, what the difference is. And um yeah, um they, it has more to do with like um kind of surgical um interference because you know, when, when surgeons make that incision, they would want to know like especially if you want to make like an open incision, you want to know what, what structures you are cutting fruit and you know, what, what are you disturbing? Any kind of blood supply of it? Is there any, you know, muscles or bones in a way that kind of stuff? But uh another kind of difference is that, well, not, I wouldn't say it's, it's basically the same thing, but then if you can see below the are quick line that it doesn't have posterior eight point euros is right. So this might be a potential kind of sign of not sight, sight of weakness. Um As you can see, it doesn't have anything uh posteriorly to stop it from, you know, going elsewhere only has uh your interior a pa neurosis. If that makes sense, it's basically the same point um has both anterior and posterior above the are quit line of Douglas or just are great line and below where it doesn't have the posterior April neurosis. And therefore, it might, you know, create it be, it would be like a potential site of weakness. Hopefully, that makes sense if there is any questions, I hope that's clear for you guys. Um Yeah, as I was said, um so would it Mickley make it more likely for only as to appear? Um How do I answer this question? Um It's, it depends really uh because because, well uh depends on the kind of epidemics, epidemiology of, of the population as well as the um you know, what, what, what patient group we are talking about, but it is a site, essentially, it's a site of weakness uh in the abdominal wall. Uh But it, it uh in that sense. So it will, yes, it will make it more um likely to, to uh for hernias to appear. Yes. Um I don't think you need to know the name of it, but if it interests you, I'll type that name down of the specific type of hernia that might occur in this um our current line. It's called the split Jenny in hernia. Uh You don't need to know this, I think for preclinical purposes, but if that interests you of just um type of down split Gillian Spigelia in Yep, S P R G E. Yep. Yeah. Stay. Um, it's basically a kind of specific type of hernia that might be more likely to develop near this our quit line due to this weakness. But yeah, for preclinical purposes, I wouldn't worry too much about that. Is that all clear for you or we should like to ask more? Um I don't mind staying behind more as completely fine. No worries. Um Feel free to log off if you guys want to. Um I'll stay here and uh in the case that there are any more questions. Thank you very much. Thank you all for coming today. Okay. Um Ahmed and Rage. Do you guys have any questions or would you like to say anything otherwise um feel free to log off as well? No. Um as I've said, um I'll just go to the last page. Um feel free to just drop me a message or email if you guys want to ask anything and further. Uh let me just go to the go to that page long distance, isn't it? Yeah, but yeah, I'm feel free to drop me any, you know, emails or less suggest if you guys want um if you guys have any any more questions about G eye anatomy or like medical school in general um just maybe take a screech off. That may be. But yeah uh another case. Thank you very much for coming. Um all of you and may maybe hopefully see you guys soon. Um Yeah, that was that was it? Thank you very much.