Beruflich Dokumente
Kultur Dokumente
Adrenal medulla -inner layer -10-20% of gland -neural crest migration :para-aortic, paravertebral area :medial aspect of cortex -extra-adrenal neural tissue :organ of Zuckerkandl (lt of aortic bifurcate near IMA) :neck,bladder,pra-aortic -epi+norepi Anatomy -sup-medial to KN -11 th rib -5*3*1 cm -4-5 gm Artery -sup adrenal<--inf phrenic a -mid adrenal<--aorta -inf adrenal<--renal a Vein -single,major adrenal v -rt adrenal-->IVC -lt adrenal (+inf phrenic v)-->lt renal v
Open/lap.assist adrenalectomy -Adrenocortical ca -malignant phaeochromocytoma 1.Ant approach -exam abdo.cavity -bilat sx -midline/bilat subcostal incision 2.Post approach -avoid adhesion -comorbid pt -unsuit >6cm -prone position -hocky sitick/curvilinear incision -extend to latissimus dorsi -excised 12 rib 3.Lateral approach -best for obesed -large tumor -lateral position 4.Thoracoabdo.approach -en bloc resection (>10 cm)
Nelson synd -30% of bilat adrenalectomy -progress growth of pre exist pitu T -inc ACTH -hyperpigment -visual field loss