Anatomical Study of Variations of Cystic Artery and Contents of Calot’s Triangle in South Kerala - A Cross Sectional Study

2021 ◽  
Vol 8 (27) ◽  
pp. 2363-2367
Author(s):  
Leena Ammini Bhaskaran
Keyword(s):  
Hepatic Artery ◽  
Hepatic Duct ◽  
Cross Sectional Study ◽  
Cystic Artery ◽  
Sectional Study ◽  
Cross Sectional ◽  
Surgical Interventions ◽  
Right Hepatic Artery ◽  
Calot’S Triangle ◽  
Coeliac Trunk

BACKGROUND Cystic artery originates from right hepatic artery which is a branch of hepatic artery proper of coeliac trunk from abdominal aorta. Variations in the origin and course of cystic artery were observed in this study. Contents of Calot’s triangle were also studied. Knowledge of normal anatomy, variations of the biliary apparatus and the arterial supply to the gallbladder is important for surgeon. METHODS Descriptive cross-sectional study was done from April 2008 to January 2010 in 180 adult specimens and 50 foetal specimens in the Departments of Anatomy, Forensic Medicine and Pathology in Government Medical College, Thiruvananthapuram. The abdominal wall was incised and hepatobiliary region was identified and dissected. The gallbladder and coeliac trunk were identified. Cystic artery and Calot’s triangle were studied. RESULTS More than 90 percent of the cystic artery originates from the right hepatic artery in both sexes. Cystic artery originated from left hepatic artery in 4 cases, common hepatic artery in 5 cases and from middle hepatic artery in 1 case. The cystic artery within Calot’s triangle was observed in 41 %. Right hepatic artery was content in 29.9 %. Both the arteries were content in 19 %. Cystic artery and accessory hepatic duct were content of Calot’s triangle in 2.2 %. Double cystic artery was content of the triangle in 1 cadaver. Artery or duct was seen outside the Calot’s triangle in 16 cadavers. CONCLUSIONS It is important for surgeons to know the variations of cystic artery and Calot’s triangle during surgical interventions of the hepato biliary region. “Cystic artery syndrome” is a condition where cystic artery is seen winding around cystic duct although it originates from right hepatic artery. Knowledge of these variations is important for surgeons and helps in better surgical outcome. KEYWORDS Cystic Artery, Calot’s Triangle, Right Hepatic, Gall Bladder, Coeliac Trunk

scholarly journals Caterpillar hump of right hepatic artery: incidence and surgical significance

2012 ◽  
Vol 01 (03) ◽  
pp. 121-124 ◽  
Author(s):  
Devi Jansirani ◽  
N Mugunthan ◽  
Vijisha Phalgunan ◽  
Shiva deep S.
Keyword(s):  
Hepatic Artery ◽  
Undergraduate Students ◽  
Surgical Procedures ◽  
Hepatic Duct ◽  
Cystic Artery ◽  
Common Hepatic Duct ◽  
Right Hepatic Artery ◽  
Calot’S Triangle ◽  
Coeliac Trunk ◽  
The Right

Abstract Background and aims : The right hepatic artery occasionally forms a sinuous tortuousity called as caterpillar hump or Moynihan's hump, which occupies the major portion of Calot's triangle. Due to this variation, inadvertent injury to right hepatic artery may occur during surgical procedures. The aim of the study is to find out the incidence of Caterpillar hump of right hepatic artery in cadavers and to correlate with surgical significance. Materials and methods : Sixty cadavers allotted for the purpose of teaching undergraduate students from the period of 2006 to 2011 were used for this study. Branches of coeliac trunk were traced and right hepatic artery was observed for the presence of caterpillar hump. Results : Caterpillar hump was noted in three out of 60 cadavers (5%). Out of three specimens with caterpillar hump, right hepatic artery passed posterior to common hepatic duct in two specimens and anterior to it in one specimen. The presence of dual loops of right hepatic artery was noted in two specimens and single loop was observed in one specimen. Conclusion: The presence of this variant course of right hepatic artery may lead to the formation of short cystic artery. Thereby, right hepatic artery can be mistaken for cystic artery and may be injured during surgical procedures. The knowledge of caterpillar hump of right hepatic artery is essential for the surgeons to avoid the risk of ischemic necrosis of right lobe of liver.

scholarly journals CYSTIC ARTERY VARIATIONS IN LAPAROSCOPIC CHOLECYSTECTOMY

1969 ◽  
Vol 6 (1) ◽  
pp. 714-717
Author(s):  
MUHAMMAD HUSSAIN ◽  
ADNAN BADAR ◽  
MANZOOR ALI ◽  
SHAHID ALAM ◽  
NAIK ZADA ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
General Anesthesia ◽  
Hepatic Artery ◽  
Cystic Duct ◽  
Gold Standard ◽  
Cystic Artery ◽  
Common Hepatic Artery ◽  
Hepatic Parenchyma ◽  
Right Hepatic Artery ◽  
Calot’S Triangle

BACKGROUND: Lap cholecystectomy is gold standard for cholelithiasis. Earlier the incidence ofmorbidity and mortality was higher. Later on with the understanding of anatomy and fine techniquesboth morbidity and mortality decreased. Understanding of the anatomy of calot’s triangle reduces thecomplications of the procedure.OBJECTIVE: To study the pattern of variations in cystic artery and comparison with Caucasians.MATERIAL AND METHODS: All laparoscopic cholecystectomies performed in Shah MedicalCentre,over a period of 1 year from January 2013 to December 2013,in whom detailed anatomy ofcalot’s triangle was clearly displayed were included in the study. Those laparoscopic cholecystectomiesin whom the detailed anatomy was not clear were excluded from the study.Laparoscopic cholecystectomies were performed under general anesthesia. The anatomy of cystic arteryand its branches were identified, and it was also correlated in relation to cystic duct and common hepaticduct.We performed 240 lap cholecystectomies over a period of 1 year from January 2013 to December 2013.RESULTS: The pattern of cystic artery was studied in 240 laparoscopic procedures. Origin of cysticartery from right hepatic artery was observed in 82% cases. Double cystic arteries were observed in 8%cases. Common hepatic artery gave rise to 6% cystic arteries. Cystic arteries originated fromgastroduodenal artery in 3% cases. Hepatic parenchyma gave rise to 2% cases.CONCLUSION: Percentage of variations in cystic artery as compared to Caucasians are not different inour study.These variations should be kept in mind to reduce complications.KEYWORDS: laparoscopic cholecystectomy, calot’s triangle, hepatic artery, cystic artery.

scholarly journals Extra coeliac axis origin of cystic artery: a cadaveric study

2017 ◽  
Vol 06 (03) ◽  
pp. 184-187
Author(s):  
◽  
Keyword(s):  
Superior Mesenteric Artery ◽  
Hepatic Artery ◽  
Mesenteric Artery ◽  
Arterial Embolization ◽  
Cystic Artery ◽  
Medical College ◽  
Right Hepatic Artery ◽  
Coeliac Trunk ◽  
Upper Abdominal ◽  
Formalin Fixed

Abstract Background: A thorough knowledge of extra hepatic biliary system vasculature is very important for surgeons to avoid iatrogenic bleeding during upper abdominal surgeries. Aim: Cystic artery usually a branch of right hepatic artery rarely has anomalous origin from coeliac trunk or from its branches. Very rarely it has an extracoeliac origin. The aim is to study the incidence of origin of cystic artery other than coeliac trunk. Material and method: The study was done on 50 formalin fixed cadavers [32male, 18 female] in the department of anatomy, Bangalore medical college and research institute during 2014-17. During routine dissection of coeliac trunk, cystic artery was traced and observed for its origin. Results: Cystic artery took its origin from right hepatic artery in 37 [74%], left hepatic artery in 9[18%], hepatic artery in 3[6%] and superior mesenteric artery ini [2%] cadaver. Conclusion: The incidence of extra coeliac axis origin of cystic artery is 2% which arose from superior mesenteric artery. Prior knowledge of these variations is important for surgeons and interventional radiologists during pancreatobiliary surgeries, angiogram and arterial embolization.

scholarly journals Origin and Position of Cystic Artery in Bangladeshi Corpse

1970 ◽  
Vol 3 ◽  
pp. 66-70 ◽  
Author(s):  
Mohsin Khalil ◽  
Zinat Rezina Sultana ◽  
Habibur Rahman Rahman ◽  
Seheli Zannat Sultana ◽  
Sabina Mannan ◽  
...  
Keyword(s):  
Hepatic Artery ◽  
Saline Solution ◽  
Age Groups ◽  
Cystic Artery ◽  
Left Hepatic Artery ◽  
Cross Sectional ◽  
Medical College ◽  
Right Hepatic Artery ◽  
Adjacent Structures ◽  
Different Origin

This cross sectional descriptive morphological study was done to see the site of origin of cystic artery supplying the gallbladder in Bangladeshi people to increase the knowledge regarding variation anatomy in our population. Sixty post mortem tissue blocks containing liver and gallbladder along with surrounding structures were collected from 40 male and 20 female cadavers of different age groups and fixed in 10% formal saline solution. This study was carried out in the Department of Anatomy in Mymensingh Medical College, Mymensingh , from July 2007 to June 2008. Gross and fine dissections were carried out to study the different origin of cystic artery and its topographic relationship with adjacent structures. In the present study, findings were compared with the findings of Western researchers. In the present study, the so-called typical origin of the cystic artery from right hepatic artery was 90% and in 10% cases it was found to arise from other sources. Out of 10%, 3% arise from left hepatic artery, 3% from junction between right and left hepatic artery, 2% from hepatic artery proper and 2% from gastro duodenal artery. Key Words: Cystic artery, Origin, Location.   doi: 10.3329/jbsp.v3i0.1801 J Bangladesh Soc Physiol.2008 Dec;(3):66-70.

scholarly journals Late hepatic artery thrombosis after pediatric liver transplantation: A cross-sectional study of 34 patients

2014 ◽  
Vol 20 (5) ◽  
pp. 591-600 ◽  
Author(s):  
Jesper M. Kivelä ◽  
Silja Kosola ◽  
Teija Kalajoki-Helmiö ◽  
Heikki Mäkisalo ◽  
Hannu Jalanko ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Hepatic Artery ◽  
Cross Sectional Study ◽  
Hepatic Artery Thrombosis ◽  
Pediatric Liver Transplantation ◽  
Sectional Study ◽  
Cross Sectional ◽  
Artery Thrombosis ◽  
Pediatric Liver

scholarly journals Who are the ostomy patients and caregivers attending Portuguese community pharmacies? A cross-sectional study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Mariana Romão ◽  
Débora Figueira ◽  
Heloísa Galante ◽  
José Guerreiro ◽  
Sónia Romano
Keyword(s):  
Cross Sectional Study ◽  
Self Report ◽  
Community Pharmacies ◽  
Sectional Study ◽  
Cross Sectional ◽  
Daily Lives ◽  
Surgical Interventions ◽  
Specialized Nurse ◽  
Low Coverage

Abstract Background In 2017, ostomy patients gained access to ostomy products in community pharmacies that are fully reimbursed by the Portuguese National Health Service. This impacted the daily lives of people with ostomy and opened a new market of products and services for pharmacies. However, little is known about the sociodemographic and clinical profile of ostomy patients. This study aims to characterize people with ostomy and their caregivers, evaluate access and satisfaction with the pharmacy and explore participants’ expectations regarding services and counselling. Methods This was an observational, cross-sectional, multicentre study involving pharmacy users who acquired ostomy products in Portuguese community pharmacies. Data were collected through a confidential self-report questionnaire between June and August 2019. Results Approximately 56% of the participants were ostomy patients, of whom 65.9% were men. The average age of participating ostomy patients was 65.5 years old (SD = 12.9), and near 80% were retired/pensioners. Caregivers were mostly women (81.7%). More than half of the caregivers were employed and acquired products for a direct family member. Three in every four surgical interventions were consequences of cancer. Intestinal ostomy was the most common intervention (78.3%). More than 93% were satisfied with the acquisition of ostomy products at the pharmacy. Approximately 48.2% of ostomy patients received care from a specialized nurse. Conclusion This study describes the profile of people with ostomy and their caregivers who attend community pharmacies in Portugal. Participants’ perceptions of the utility of different proposed services and pharmacist knowledge, as well as the low coverage of ostomy nursing care, highlight the opportunity for an extended role of pharmacists among this group.

scholarly journals Anatomical variations in the extra hepatic biliary system: a cross sectional study

2018 ◽  
Vol 6 (4) ◽  
pp. 1342 ◽  
Author(s):  
P. G. Anandhi ◽  
V. N. Alagavenkatesan
Keyword(s):  
Hepatic Duct ◽  
Indian Subcontinent ◽  
Anatomical Variations ◽  
Cystic Artery ◽  
Biliary System ◽  
Common Hepatic Duct ◽  
Post Mortem ◽  
Cross Sectional ◽  
Calot’S Triangle ◽  
The Common

Background: The anatomy of the biliary system has been the subject of extended research for many years. Largely because of their surgical importance in cholecystectomies and the ease with which they may be studied. Though, interest has been focused on the extrahepatic bile ducts very few studies have been carried out in the Indian subcontinent. Objectives was to study the anatomical variations in extrahepatic biliary system in sample of Indian cadaveric specimens.Methods: The study material consisted of 20 adult dissection room cadavers and 30 enbloc post-mortem specimens. Cadaver specimens were studied from dissection room. Post-mortem enbloc specimens were collected from the Department of Forensic Medicine, Madurai Medical College, Madurai. They were studied by conventional dissection method.Results: The key abnormalities found in all bladder were Hartman's pouch shape and neck in 2 (4%) subjects each. Gallstones were present in 2 (4%) subject. The length of the common Bile duct was ranging from as short as 6.5 cm in 24% of the subjects to 9cm in 4% of the subjects. High level of the cystic duct union with the common hepatic duct was noted in16% of specimens and in remaining 2% it was low union. Abnormal arrangement of structures in hepatoduodenal duct was normal in 98% but was abnormal in 2% of subjects. A total of 14% of the specimens had accessory ducts. Double and accessory cystic artery was found in 2% of the subjects each.  In 8% of the subjects, cystic artery had abnormal course and division. The right hepatic artery was had shown abnormal course and division in 4% of the subjects. Abnormal boundaries of Calot’s triangle was found in 2% of the subjects. Abnormal contents of Calot’s triangle include Accessory hepatic ducts in 10% of subjects.Conclusions: Anatomical variations of the extrahepatic biliary system are very common and a through an understanding of them is essential for surgeons to avoid damage to vital structures during surgical procedures and better surgical outcomes.

scholarly journals Cystic Artery: Morphological Study and Surgical Significance

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Usha Dandekar ◽  
Kundankumar Dandekar
Keyword(s):  
Morphological Study ◽  
Hepatic Duct ◽  
Descriptive Study ◽  
Cystic Artery ◽  
Common Hepatic Duct ◽  
Surgical Safety ◽  
Right Hepatic Artery ◽  
Calot’S Triangle ◽  
Biliary Ducts ◽  
The Common

The cystic artery is the key structure sought to be clipped or ligated during laparoscopic or conventional cholecystectomy. The possible complications like hemorrhage or hepatobiliary injury are always centered on the search, dissection, and clipping or ligation of the cystic artery, many a time because of possibility of variations in its course and relations to the biliary ducts. This descriptive study was carried out to document the normal anatomy and different variations of the cystic artery to contribute to improve surgical safety. This study conducted on 82 cadavers revealed cystic artery with mean length of 16.9 mm (ranged between 2 mm and 55 mm) and mean diameter of 1.6 mm (range between 1 mm and 5 mm). The origin of cystic artery from celiac right hepatic artery was found in 79.3% and in the remaining 20.7% it was replaced. Single cystic artery was present in 72% and double cystic artery in 28%. Considering the site of origin of the cystic artery with reference to Calot’s triangle, it was observed within the triangle in 62.2% and outside it in 37.8%. All the cystic arteries passed through Calot’s triangle except for 3.6%. The cystic artery crossed the common hepatic duct anteriorly in 26.8% and posteriorly in 6.1%. It crossed common bile duct anteriorly in 1.2% and posteriorly in 3.7%. The knowledge of such variations and its awareness will decrease morbidity and help to keep away from a number of surgical complications during cholecystectomy.

scholarly journals The possibility of using tiletamine-zolazepam for sedation during oral administration in dogs and cats: literature review

2021 ◽  
Vol 2021 (1) ◽  
pp. 10-18
Author(s):  
Evgeniy Kornyushenkov ◽  
Aleksandr Shimshirt
Keyword(s):  
Oral Administration ◽  
Cross Sectional Study ◽  
Time Interval ◽  
Sectional Study ◽  
Liquid Form ◽  
Canned Food ◽  
Cross Sectional ◽  
Stray Dogs ◽  
Surgical Interventions

The review presents the results of three studies of the use of tiletamine-zolazepam for sedation during oral administration in dogs and cats. Study 1. Objective: to study the sedative effect of the combination of tiletamine-zolazepam-acepromazine (TZA) or ketamine-flunitrazepam (CF) in dogs with oral administration, as well as to evaluate the effectiveness of the capsule form of TZA in stray dogs. In a pilot study, 6 dogs were administered a liquid form of TZA (20 mg/kg tiletamine-zolazepam and 2 mg/kg acepromazine) or a liquid form of CF (50 mg/kg ketamine and 2 mg/kg flunitrazepam) orally. Sedation was evaluated in points. On average, the time interval from the introduction of MAL to the adoption of the animal side position was: protocol 1 (infusion of the drug into the mouth) — 47.5 (35...80) minutes (67 % of dogs); protocol 2 (addition of the capsule form to the canned food) — 30 (15...65) minutes (83 %), protocol 3 (addition of the liquid form of the drug in gravy) — 75 (45...110) minutes (100 %). None of the dogs in the CF group in protocols 2 and 3 took a side position. Based on these results, 20 stray dogs received encapsulated MAL: TZ (20 mg/kg) and acepromazine (2 mg/kg). Overall, 63 % of the stray dogs in the experiment were caught after eating a double dose of MAL. Oral administration of encapsulated MAL added to the canned food allows you to catch stray dogs, but it may require the use of additional drugs. The time from the introduction of TZA to the development of sedation in animals and the taste of the drug affect the percentage of capture. Study 2. The purpose of the study is to study the possibility of oral administration of the drug «Zoletil» to cats. 8 healthy cats, females and males, aged from 2 to 4 years, were selected. «Zoletil-50» was used in the form of a sterile lyophilizate prepared in the form of a solution with water for injection in doses from 15 to 25 mg/kg. After administration of the drug, hemodynamic parameters, sedation, and the possibility of endotrachial intubation were evaluated. After oral administration, the effect of sedation developed quite quickly. When administered at a dose of 25 mg/kg, intubation and minor surgical interventions were possible. A dose of 15 mg / kg caused only sedation. It is advisable to use «Zoletil» in the form of a powder with a pleasant taste. Study 3. Objective: to assess the quality of sedation, changes in SAD, heart rate and BH in TB administration of TK to healthy cats. Healthy, sterilized European shorthair cats (n=7; 3 males, 4 females) were included in a randomized, blind, cross-sectional study. Each cat received two doses of tiletamine-diazepam TB: 5 mg / kg (LD) and 7.5 mg/kg (HD) of each drug. TB administration of tiletamine-zolazepam in the studied doses is a simple and effective method of pharmacological fixation of cats, while LD has less effect on SAD and BH than HD.

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