Breast and Oesophagus (249-261)

Question 1

Desribe the arterial supply to the breast;

Answer 1

Medial breast
- Internal throacic/mammary artery.

Lateral breast
- Lateral thoracic and thoracoacromial branches (originate from axillary artery),
- Lateral mammary branches (branches of intercoastal).

[Venous is same as arterial]

Question 2

Describe the lymphatic drainage of the breast;

Answer 2

Axillary lymph nodes (level 1-3)
[Level 1- below pectoralis minor]
[Level 2- underneath/posterior to pectoralsis minor]
[Level 3- above/medial to pectoralis minor]

Question 3

Describe the musculature of the oesophagus including contriction points;

Answer 3

Upper 1/3rd- straited muscle.
Middle 1/3rd- mixed (straited and smooth muscle).
Lower 1/3rd- smooth muscle.

4 contriction points (ABCD)-
Aortic arch (T4),
Bronchus (T4/5),
Criopharyngeus (C6) and
Diaphragm (T10) (right crus T11).

Question 4

What is the epithelium of the oesophagus?;

Answer 4

Stratified squamous non-keratinised epithelium. (Last lower 1cm is columnar epithelium like stomach)

Question 5

What is the arterial supply to the oesophagus?;

Answer 5

Upper 1/3rd- inferior thyroid artery (branch of thyrocervical trunk [branch of subclavian]).
Middle 1/3rd- oesophageal branches of throacic aorta.
Lower 1/3rd- oesophageal branches of left gastric

Question 6

Describe the venous drainage of the oesophagus;

Answer 6

Upper 1/3rd- inferior thyroid veins (into brachiocephalic vein).
Middle 1/3rd- azygous (into SVC).
Lower 1/3rd- left gastric vein (into portal vein)

Question 7

Describe the lymphatic drainge of the oesophagus;

Answer 7

Upper 1/3rd- deep cervical lymph node.
Middle 1/3rd- posterior mediastinal lymph nodes.
Lower 1/3rd- left gastric and coeliac lymph nodes.

Question 8

What is the arterial supply to the diagphragm?;

Answer 8

Posterior surface (majority)- Inferior phrenic artery and superior phrenic artery (both branches of descending aorta).
Anterior- musclophrenic and pericardiacophrenic (both branches of internal throacic/mammary artery)

Question 9

What is the innervation of the diaphragm?;

Answer 9

Phrenic nerve (C3, 4, 5 keep the diaphragm alive)

Question 10

Name the types of congential diaphragmatic hernias;

Answer 10

Bochdalek hernia (most common 90%)- foramen of bochalalek (left and posterior).
Morgangi (2%)- anterior and right.

Question 11

What structures pass through the caval opening?;

Answer 11

T8- inferior vena cava, phrenic nerve

Question 12

What structures pass through the oesophageal hiatus?;

Answer 12

T10- oesophagus, right and left vagus nerves, oesophageal branches of left gastric artery

Question 13

What structures pass through the aortic hiatus?;

Answer 13

T12- aorta, azygous vein, thoracic duct