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(BQ) Part 1 book Netter''s surgical anatomy review P.R.N presents the following contents: Neck (skull and face fractures, thyroid diseases), back and spinal cord (vertebral fractures), thorax (breast diseases, esophageal diseases, ribs and thorax fractures), abdomen (appendix diseases, biliary diseases, colon diseases, gastroduodenal diseases,...).
Netter’s SURGICAL ANATOMY REVIEW P.R.N Robert B Trelease, PhD Professor Division of Integrative Anatomy Department of Pathology and Laboratory Medicine David Geffen School of Medicine University of California, Los Angeles Los Angeles, California Illustrations by Frank H Netter, MD Contributing Illustrators Carlos A.G Machado, MD John A Craig, MD 1600 John F Kennedy Blvd Ste 1800 Philadelphia, PA 19103-2899 NETTER’S SURGICAL ANATOMY REVIEW P.R.N ISBN: 978-1-4377-1792-1 Copyright © 2011 by Saunders, an imprint of Elsevier Inc All rights reserved No part of this book may be produced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system, without permission in writing from the publishers Permissions for Netter Art figures may be sought directly from Elsevier’s Health Science Licensing Department in Philadelphia PA, USA: phone 1-800-523-1649, ext 3276 or (215) 239-3276; or email H.Licensing@elsevier.com Notice Neither the Publisher nor the Author assumes any responsibility for any loss or injury and/or damage to persons or property arising out of or related to any use of the material contained in this book It is the responsibility of the treating practitioner, relying on independent expertise and knowledge of the patient, to determine the best treatment and method of application for the patient The Publisher Library of Congress Cataloging-in-Publication Data Trelease, Robert Bernard Netter’s surgical anatomy review P.R.N / Robert B Trelease ; illustrations by Frank H Netter : contributing illustrators, Carlos A.G Machado, John A Craig.— 1st ed p : cm Other title: Netter’s surgical anatomy review pro re nata Other title: Surgical anatomy review P.R.N Includes index ISBN 978–1–4377–1792–1 1. Anatomy, Surgical and topographical—Outlines, syllabi, etc. I. Netter, Frank H (Frank Henry), 1906–1991. II. Title. III. Title: Netter’s surgical anatomy review pro re nata. IV. Title: Surgical anatomy review P.R.N [DNLM: 1. Surgical Procedures, Operative—Atlases. 2. Anatomy—Atlases WO 517 T788n 2011] QM531.T742011 2010009655 611′.9—dc22 Acquisitions Editor: Elyse O’Grady Developmental Editor: Marybeth Thiel Editorial Assistant: Chris Hazle-Cary Publishing Services Manager: Linda Van Pelt Design Direction: Steve Stave Marketing Manager: Jason Oberacker Multimedia Producer: Adrienne Simon Working together to grow libraries in developing countries www.elsevier.com | www.bookaid.org | www.sabre.org Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 This book is dedicated to My parents, Florence and Robert Trelease (Sr.), who always supported my pursuit of learning and science; My wife, Barbara, and our daughters, Cristin and Heather, who have motivated all my work; My students, who have put anatomical knowledge to good use in caring for their patients This page intentionally left blank About the Author Robert B Trelease, PhD, is Professor in the Division of Integrative Anatomy, Department of Pathology and Laboratory Medicine, in the David Geffen School of Medicine (DGSOM) at UCLA In 1996, Dr Trelease became a founding member of and Faculty Advisor to the Instructional Design and Technology Unit (IDTU), part of the Center for Educational Development and Research, Dean’s Office, DGSOM IDTU currently provides and manages web server– and mobile device– based educational resources for all years of the medical school curriculum, as well as developing new teaching tools Dr Trelease currently serves as Acting Director of IDTU, in addition to teaching medical and dental gross anatomy, embryology, and neuroanatomy This page intentionally left blank Preface Netter’s Surgical Anatomy Review P.R.N is a justin-time, point-of-contact review of anatomy for the most commonly encountered, surgically treated diseases and diagnoses in medical student clerkships and general surgery residencies Dr LuAnn Wilkerson, Senior Associate Dean for Medical Education at David Geffen School of Medicine (DGSOM) at UCLA, first asked me to develop a PDA-based learning resource for clerkships, and this product grew out of that effort The most common diseases, conditions, and surgical procedures were informed by patient contact data logs developed by the Instructional Design and Technology Unit, including Dr Anju Relan, Katherine Wigan, Zhen Gu, and the author In addition to Dr Wilkerson, I thank Dr Jonathan Hiatt, Chief of General Surgery at UCLA, for his sound advice and consultation Most of all, I thank Dr Carmine Clemente, master anatomist, for inspiring me over many years with his love of teaching and by showing me how he created numerous books with fine anatomical art Thanks to Executive Associate Dean Dr Alan Robinson and my Department Chair Dr Jonathan Braun for steadfastly supporting anatomy teaching Robert B Trelease, PhD 214 Small Intestine Diseases • Submucosa: strongest layer, connective tissue, Meissner’s plexus (parasympathetic ganglion cells and neuronal network) • Muscularis n Inner circular muscle n Outer longitudinal layer n Auerbach’s plexus: myenteric neurons and parasympathetic ganglion cells • Serosa: peritoneum • Mucosal surface area specializations: microvilli, villi, plica circulares (valvulae conniventes) • Total absorptive surface for water and nutrient transfer: 200-550 cm2 • Water and nutrients absorbed across mucosa Endocrine Gut Functions • Cholecystokinin (CCK): secreted by cells of proximal intestine • Secretin: secreted by S cells of proximal intestine • Motilin: secreted by M cells of proximal intestine • Somatostatin (SMS): secreted by D cells throughout gut • Peptide YY (PYY): secreted by L cells of distal intestine • Glucagon-like peptide (GLP-2): secreted by L cells of distal intestine Innervation • Parasympathetic: vagus n Preganglionic fibers: posterior branches of right and left vagus distributed through celiac and superior mesenteric plexus Celiac branches of anterior and posterior vagal trunks Posterior vagal trunk Anterior vagal trunk Greater thoracic splanchnic nerves Lesser thoracic splanchnic nerves Superior mesenteric ganglion Intermesenteric (aortic) plexus Superior mesenteric artery and plexus Ileocolic artery and plexus Mesenteric branches Nerves of Small Intestine Ganglion cells are located in myenteric (Auerbach’s) and submucosal (Meissner’s) plexuses • Sympathetic n Preganglionic fibers from T8-T10 lateral column distributed via splanchnic nerves to celiac and superior mesenteric ganglia n 215 Small Intestine Diseases 216 Small Intestine Diseases Postganglionic fibers distributed through celiac and superior mesenteric plexuses along arterial branches • Sensory fibers, general visceral afferent n Vagal afferents distributed through celiac and superior mesenteric plexuses n Segmental afferents travel back (parallel to sympathetics) through celiac and superior mesenteric plexuses and splanchnic nerves to dorsal root ganglia and thoracic spinal cord segments n Vessels and Lymphatics Arterial Supply Celiac Artery Branches • Common hepatic artery n Gastroduodenal artery s Superior pancreaticoduodenal artery: to duodenum proximal to bile duct s Anastomoses with inferior pancreaticoduodenal Superior Mesenteric Artery Branches • Inferior pancreaticoduodenal artery (duodenum distal to bile duct); anastomoses with superior pancreaticoduodenal • Jejunal branches • Ileal branches • Ileocolic artery (with appendiceal branch) • Arcades link adjoining jejunal and ileal branches • Vasa rectae connect from arcades to bowel walls Marginal Artery • Connects superior and inferior mesenteric arteries Superior mesenteric artery and vein Anastomosis (inferior pancreaticoduodenal to 1st jejunal artery) Ileocolic artery Colic branch Ileal branch Jejunal and ileal (intestinal) arteries Anastomotic loops (arcades) Straight arteries (arteriae rectae) Arteries of Small Intestine 217 Small Intestine Diseases 218 Small Intestine Diseases Ileocolic vein Hepatic portal vein Superior mesenteric vein Jejunal and ileal (intestinal) veins Anastomotic loops Straight veins (venae rectae) Superior mesenteric artery and vein Jejunal and ileal (intestinal) vessels Relations of superior mesenteric vein and artery in root of mesentery Veins of Small Intestine Venous Drainage • Duodenal veins empty into splenic vein, superior mesenteric vein, and portal vein (which lies posterior to the first part) • Superior mesenteric vein (right portal drainage) receives jejunal, ileal, and ileocolic veins that run alongside of arterial counterparts Lymphatic Drainage • Peyer’s patches occur in greater numbers in more distal small bowel (e.g., ileum) • Peyer’s patches and intraluminal vessels drain into mesenteric nodes clustered around branches of superior mesenteric artery • Deeper drainage flows superiorly into nodes along aorta and into cisterna chyli Clinical Correlates Small Bowel Obstruction • Hernias are most common cause in absence of previous surgery • Adhesions are most common cause with previous surgery • Other causes include malignancy, inflammatory bowel disease, Meckel’s diverticulum, and volvulus • Midgut volvulus can occur in pediatric patients with malrotations Intussusception • Portion of bowel (intussusceptum) invaginates into an adjoining segment of bowel (intussuscipiens), causing obstruction • Can occur in adults owing to tumors; lead point is often a malignant tumor 219 Small Intestine Diseases 220 Small Intestine Diseases Celiac nodes Thoracic duct Superior mesenteric nodes (central superior group) Thoracic duct Cisterna chyli Intestinal lymphatic trunk Superior mesenteric nodes (juxtaintestinal group) Lymph Vessels and Nodes of Small Intestine Ileo-ileocolic intussusception Ileocolic intussusception Ileo-ileal intussusception (intussusceptum “spearheaded” by pedunculated tumor) Intussusception 221 Small Intestine Diseases 222 Small Intestine Diseases • Ileocolic is the most common kind in infants n Typically occurs between and 10 months n Timing (after months) suggests infectious etiology n Terminal mesenteric node enlargement may be an indicator n Enlarged parietal lymphoid aggregates may be lead points that induce invagination n Idiopathic s No other specific pathology is typically associated s More common in children < years s Viral infections and rotavirus vaccine have been implicated • Ileoileal n More common in children > years n Lead point may be a Meckel’s diverticulum, pancreatic rest, enteric duplication cyst, or hemangioma • Ileocolic and ileocecal intussusception can occur after trauma or abdominal surgery Diverticular Disease • Most intestinal diverticula are asymptomatic, discovered incidentally during other procedures • Acquired jejunoileal diverticula consist of outpocketing of mucosa and submucosa only n Occurring in