Answer to Where There’s a Will, There Can Be a Wrong and a Right Way!

Correct answer is C. The indicated vessel is the left renal vein. In addition to venous return from the left kidney, two veins drain to this vesselhttps://youtu.be/wnRHtSGQ61o, the left gonadal and the left suprarenal veins. Beginning students often forget that gonadal refers to both the testicular and the ovarian veins, and that the nutcracker effect can exist in both the male and female patients. If venous flow is compromised at the left renal vein, venous return from either of these two veins will back up as well. In women, ovarian vein incompetence can lead to the following: dysuria, urinary frequency and urgency, constant urinary requirements, gross hematuria, renal colic, lower back pain, lower abdominal and pelvic pain, and dysmenorrhea. The nutcracker effect can result from sudden and extreme weight loss. Fortunately, the nutcracker effect is rare.

Question: If the following vessel is constricted by the “nutcracker effect”, back-up of venous return is most likely to occur at which of the following?

A.IVC

B.Inferior mesenteric a.

C.Left ovarian vein

D.Portal vein

E.Superior mesenteric a.

Answer to this question is based on material presented in lectures 9 of the Abdomen Lecture Series.