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Let’s continue our USMLE Review with Anatomy from the Gold Standard USMLE Step 1 Audio Review program.
Play USMLE Audio MP3 04 03 Anatomy Small Intestine 8 Below
Begin 04 03 Anatomy Small Intestine 8 Transcription
Because of these many anastomotic connections, the normal twisting of the mesentery does not normally cut off circulation to portions of the small intestine. However, sometimes an internal hernia or external hernia can lead to strangulation of a part of the bowel.
When the vessels in the mesentery do become compressed, which are shut off first?
- The veins in the mesentery are closed off first.
What does this lead to?
- It leads to the arteries continuing to pump blood into the coil of bowel.
This leads to what two results?
- Edema and swelling.
Edema and swelling eventually obstructs what vessels?
- The arteries, in turn.
What can be the grim final result of this type of strangulation?
Internal hernias may be caused when a loop of small intestine is caught in what sort of normal structure?
- In one of the peritoneal recesses.
What abnormality of the mesentery itself can sometimes cause an internal hernia?
- An abnormal hole in the mesentery. There are four closely related niches or recesses that are the most likely place for small intestinal loops to get into during disease process and form internal hernias.
All four of these are closely related to what part of the small intestine?
- The duodenojejunal flexure, where the small intestine goes from being retroperitoneal to intraperitoneal. There is a blind cavity here leading into the four recesses.
On which side of the duodenojejunal flexure is it?
- It is on the left.
What is the name for the recess leading back under the ascending portion of the duodenum from left to right?
- The retroduodenal recess.
And from the same general area, there is a niche leading up and to the left and this is called?
- The superior duodenal recess.
There is another niche from the same area going directly left and this is called?
- The paraduodenal recess.
And finally there is another recess going straight down from this general area and this is called?
- The inferior duodenal recess.
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