쉐도잉 연습: Abdominal Vasculature - Dissection Supplement - 영상으로 영어 말하기 배우기

Hello all this is Dr. Alsup

and in this dissection video we are going to talk through

how to identify the vasculature associated with both the abdominal wall and those associated with the intestine.

And so let's start with the abdominal wall first which is all about the epigastric vasculature.

We actually saw one of these in the thoracic wall dissection.

the superior epigastric which I am kind of outlining that vasculature right there.

The superior epigastric artery is one of the terminal branches of the internal thoracic artery

and it's the one that descends into the abdomen and you can see a bit of it here.

But the dominant supply for the abdominal wall as you can see here by the size is the inferior epigastric artery.

And then of course the vein is going to drain the similar area.

The inferior epigastric artery is a branch of the external iliac artery

and these arteries will anastomose or communicate deep to the rectus abdominis which you can see here has been reflected inferiorly.

You'll also be able to see this vasculature when the abdominal wall has been reflected.

So if you think about reflecting the anterior abdominal wall inferiorly

and looking at the deep surface you can still see the inferior epigastric vasculature either through the lateral umbilical fold

or if the peritoneums removed like in this particular image you can see it quite well.

And always remember that the inferior epigastric vasculature is going to be located medial to the deep inguinal ring.

All right moving to the deeper viscera and recall

that the superior mesenteric artery or the SMA

which you will often hear us refer to it as is

going to be the main blood supply to structures derived from the midgut.

So this includes the majority of the small intestine and a good amount of the large intestine too.

The SMA is large and it's relatively long as well,

particularly in comparison to the celiac trunk which we'll talk about more detail in other sessions.

And that celiac trunk is going to supply the foregut.

Branches that come off of the SMA towards the left are going to be branches that are destined for the small intestine,

whereas branches coming off on the right are going to be more heading towards the large intestine.

And we'll talk about those in more detail in a moment.

So you can see the multiple branches or the multiple jejunal and ileal branches of the SMA heading this way,

and as you will see in the next image these branches

will produce these very complex arterial arcades within the mesentery of the small intestine.

The SMV which I'm outlining right now is typically located just to the right of the superior mesenteric artery

and is typically fairly large in caliber kind of similar to the artery.

And we'll see this vein again as we talk through a bit more of the the structures

if we remove some of the viscera it's a little bit easier to see.

And real quick before I move on here are some of those arterial arcades

that we were talking about that forms within the mesentery and that goes to supply the small intestine.

So it's really complex in this region the veins will do a similar thing.

Okay

so in this image some of the small intestine has been

removed to focus a bit more on the blood supply on the right side of the large intestine.

Here is the SMA again,

here is the SMV, and note that the transverse colon has been reflected superiorly almost to where you can't see it.

You can see a little bit of it right there so the transverse colon has been reflected superiorly.

Typically the most inferior branch on the right for the SMA is going to be the ileocolic artery right here,

and it also tends to be one of the largest branches of the SMA.

The ileocolic will supply predominantly the cecum, but it will also send branches to the ileum

and also will give off branch to the appendix which you can see right here.

So that would be the appendicular artery right here.

Now before I move on to the next branch let's talk a little bit about the marginal artery

which I'm going to kind of trace

here and it will extend all the way over towards the left side of the body as well.

The marginal artery can be seen throughout the inferior border of the large intestine

and all of these branches of the SMA

and of the IMA on the other side

that will send branches to the marginal artery that will directly supply the large intestine.

So you'll see it kind of throughout the whole span or almost the whole span of the large intestine.

Occasionally there'll be kind of breaks in the marginal artery but oftentimes it'll pick back up again.

Okay moving on you have the right colic artery

which will supply the ascending colon in this case it's coming off of a common trunk with the ileocolic

and you can see extending to the marginal artery.

And lastly on this image you can see the middle colic artery

which is a bit out of place because recall the transverse colon has been reflected superiorly.

Okay in this view we are looking a bit more inferiorly than we were in the previous image.

Here is the SMA and as we move inferiorly on the descending aorta

or the abdominal aorta you can see what I'm outlining right here the IMA or inferior mesenteric artery.

Now you can see coming off of the IMA three major types of branches you will have the left

colic which will supply the descending colon through the marginal artery you can see a bit of the marginal artery right here.

The sigmoid arteries which I'm outlining right here are going to as its name would suggest supply the sigmoid colon.

These branches will descend inferior laterally and typically there are more than one sigmoid artery as is the case here.

And the branch

that descends a little bit more towards the midline is going to be the superior rectal artery

and it often looks like a continuation of the inferior mesenteric artery.

And right here you'll see a bit of the inferior mesenteric vein

and we'll talk about this in a bit more detail in the next image.

All right this last image is a good review image.

I would take some time on your own to kind of see what you can label

and then you can kind of refer back to the blue link images to see how you did.

There's a few things I really want to hone in on on this image.

First I want you to note again the marginal artery

and how it kind of extends throughout the whole inferior border or the majority of the inferior border of the large intestine.

The transverse colon again has been reflected superiorly so there is a bit longer of a span there than would be typical.

But what I really want to draw your attention to here is to review the SMA

and IMA and look at the same named veins.

So the SMA again,

so your SMA right here is going to be superior to the inferior mesenteric artery which is located right here.

The SMA has a prolific amount of branches all right compared to the inferior mesenteric artery.

There's going to be branches all over the place in terms of the SMA

and the SMV or the superior mesenteric vein is very closely associated with the SMA

so it's just right just to the right of the artery.

The inferior mesenteric artery is smaller in caliber

so it's going to be smaller it's going to have less branches

and I always like to think of the inferior mesenteric vein or your IMV as kind of doing its own thing.

It is quite,

it's comparatively quite a bit more lateral to the IMA than say what you have in comparison to the SMA

and the SMV.

So the inferior mesenteric vein is a bit more lateral to the inferior mesenteric artery.

The IMV's most typical pattern has it draining into the splenic vein

which is going to be kind of deep to these structures right here.

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The splenic vein and the superior mesenteric vein will join to form the hepatic portal vein.

101

Excellent that was a lot of vasculature fun.

102

Thank you for your time and attention here and please reach out if you have any clarification questions.

103

Have a great rest of your day.

쉐도잉이란? 영어 실력을 빠르게 키우는 과학적 방법

쉐도잉(Shadowing)은 원래 전문 통역사 훈련을 위해 개발된 언어 학습 기법으로, 다언어 학자인 Dr. Alexander Arguelles에 의해 대중화된 방법입니다. 핵심 원리는 간단하지만 매우 강력합니다: 원어민의 영어를 들으면서 1~2초의 짧은 지연으로 즉시 소리 내어 따라 말하는 것——마치 '그림자(shadow)'처럼 화자를 따라가는 것입니다. 문법 공부나 수동적인 청취와 달리, 쉐도잉은 뇌와 입 근육이 동시에 실시간으로 영어를 처리하고 재현하도록 훈련합니다. 연구에 따르면 이 방법은 발음 정확도, 억양, 리듬, 연음, 청취력, 말하기 유창성을 크게 향상시킵니다. IELTS 스피킹 준비와 자연스러운 영어 소통을 원하는 분들에게 특히 효과적입니다.

쉐도잉 연습: Abdominal Vasculature - Dissection Supplement - 영상으로 영어 말하기 배우기

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