a 50 year old woman was admitted to hospital for surgical resection of the uterus .The surgeon was also going to resects all pelvic lymph node and carry out bilateral salpingiooopherectomy.The patient was prepared for prepared for this procedure and went through routine sugery.25 hour after the surgery it was noted that the patient had passed no urine and her abdomen wasexpanding.Ana US scan demonstrated an considerable amount fluid with is the abdomen. Fluid withdrawn from the abdomen was found to be urine.
A 20 old man visited his family doctor because he has a cough. Chest radiographs demonstrated translucent notches along ribs 3 to 6 .He was referred to a cardiologist and a diagnosis of coractation of the aorta as made. The rib notching was caused by dilated collateral intercostals arteries.
An elderly woman admitted to the emergency room with severe cardiac failure, she had a left side pacemaker box which had been inserted for a cardiac rhythm disorder. Fatal artrial fibrillations many years. Chest radiographs showed that the pacemaker had broken.
Explain anatomically why it broke
Solution to this anatomy Question
It is postulated that this woman ureters were damaged. The pelvic part of the ureter causes posterinferioly and external to the parietal peritoneum and the right wall of the pelvis anterior to the internal iliac artery. It continues its course approximately 2 cm to the ischial spine and passes anterior medially and superior the lavetors ani muscles .Importantly the ureter closely adheres to the peritoneum. The ureter continues close to lateral phoenix of the vagina especially o n the left and enters the poster superior angles of the bladder. It was at this point that the ureter was advent damaged.
Coaction of the aorta is the narrowing of the aorta distal to he left subclaaviamn artery this narrowing can markly reduce blood flow to the lower body. Many of the vessels enlarge so that blood can reach the aorta below the level of the barowing,commonly The internal thoracic, superior epigastriic,and musculophrenic arteries enlarge anetiroly,.This arteries supply the anterior intercostals arteries which anastomose with posterior intericocoatel arteries that allow blood to flow retrograde to the aoprta.The first and second intercostals vessels are supplied fro the ecostocervical trunk which arises from the cervical arteries proximal to the coarctian so do not enlarge
Many patients have cardiac pace maker, a wire rises from the pace maker which lies within the subcutaneous tissue of pectoralis, major muscles and pierce the axxilary vein just beneath he clavicle lateral to the suclavious muscle the wire then passes through he subclain vein, brochiocephalic vein and superior vena cava the right atrium and lies on the wails of the right ventricle. IF the wire pierces the axillary vein directly adjacent to the suclaius muscle it it’s possible that after many years of shoulder the subclaius muscles stress and breaks the wire causing the pacemaker to fail.