The Inferior mesenteric, artery’s course,
Starts at the aorta, the original source,
Originates at, the level of L3,
At the inferior edge, of the 3rd part of Dueee…;
Supplies splenic flexure, to upper rectum,
Of the three splanchnic vessels, this is the small one,
Keeps hind-gut alive, the proctologist’s chum,
Friend of that strange bunch, who work on the bum;
Left colic then sigmoid, branches supply?
Errr.. Left colon and sigmoid?… don’t be a wise guy!
Superior rectal, the terminal branch,
Over upper rectum, holds perfusion ‘Carte Blanche’;
Finally two rules, to make sure you stay right,
Don’t clip it until, the ureter is in sight,
And when tying it should be taken, flush for perfection,
When doing an oncological, anterior resection;
That’s all three gut vessels, we’ve mentioned in rhyme,
Might head north and attempt, carotid next time… 🙄🙄
‘Twas the night before Christmas, and in the big house,
Not a creature was stiring, not even a mouse,
The surgical team, and anaesthetist too,
Sat quiet in the mess, with the theatre crew.
Foundation Trainees , all snug in their beds,
Core trainees playing pool, yellow V Reds,
Registrar reading, F.R.C.S text,
Consultant at home, can you guess what comes next?
Trauma bleep sounds, breaks the silence with clatter,
Registrar reaches for the phone, what’s the matter?
After listening, she jumps to her feet in a flash,
The big fellas been, involved in a crash!
It’s existence was discovered in 1506,
Given the name, the caecal appendix,
Vermix by others, or vermiform process,
Latin for ‘worm like’, but we’re starting to digress;
It measures on average, 9 centimetres,
Widest at tip, towards it’s neck down it peters;
Mesentery contains appendicular vessel,
Clip, tie or fry it, at appendix base level;
2/3 are retro, in terms of the caecum,
This can cause stress, as it takes time seek em’.
Sub caecal, pre or post ileal and pelvic,
All can cause trouble, none guaranteed angelic;
Angle of Louis, McBurney’s point,
Foramen of Winslow, Charcot’s joint,
Auerbach's plexus, keeps the gut well,
The long thoracic nerve of Bell,
2/7
Meckel’s Diverticulum, Toldt’s Line,
Gerota’s fascia, Murphy’s sign;
Pouch of Douglas and Morrison’s Pouch,
Buerger’s test, the leg raise off the couch,
The makings of a surgeon…
Prize if you can name all four. 👍
What makes a surgeon, as good as they can be,
Technical prowess and dexterity?
A sympathetic smile, and good bedside manner?
Mechanical mind? Being good with a spanner?
1/4
An eagle’s eye, at least at the start,
The hand’s of a lady, a lion’s heart?
Decision making, thoughtful with care,
Acceptance of failure, hopefully rare,
2/4
Ready to cut, to leap into action,
A strong arm, appreciation of traction?
Patience and courage, when hoping for the best,
‘Sitting tight’, can be a real test,
The SMA is the next of the splanchnic vessels,
Leaves aorta at L1, to it’s right SMV nestles,
Drops anteroinferiorly behind the neck of the pancreas,
Occlusion up here makes the whole small bowel gangrenous;
It’s branches are many, we’ll start from the top,
Pancreas gets a branch, acts as coeliac trunk prop,
Inferior pancreatico duodenal artery,
Adds to the pancreas and duodenal symphony;
Then jejunal branches, and ileal next,
And our friend ileocolic, which also supplies appendix;
Right and middle colic, gives Colon its blood and,
The watershed kept alive, by the marginal of Drummond;
Recall of gut anatomy wanes and waxes,
So let’s quickly recap the coeliac axis,
The first of three vessels to supply the intestine,
The content of these vessels normally fluid and sanguine;
Arising from the aorta, at the level of T12,
From beneath the arcuate, into the abdomen it does delve,
Enters lesser sac, then divides into three,
At the upper border of ‘The Queen’, like an inverted tree;
COMMON HEPATIC is first, and heads off to the Right,
Gives off GDA and RIGHT GASTRIC, when liver’s in sight,
‘PROPER HEPATICS’ to the liver blood do serve,
The RIGHT GASTRIC does the same, to the stomachs lesser curve;