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ACEM Part 1 > Anatomy - Abdomen > Flashcards

Anatomy - Abdomen Flashcards

1
Q

CT abdomen image: name the structures on this CT

A

stomach = 1
liver = 2
gallbladder = 3
pancreas = 4
abdominal aorta = 5
right kidney = 6
vertebral body = 7
spleen = 8
bowel = 9
rib = 10
ivc = 11

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2
Q

What structures are retroperitoneal/intraperitoneal

A

-retroperitoneal:
kidney, ureter, bladder, pancreas, 2nd part of duodenum, ascending and descending colon, aorta, IVC

-intraperitoneal:
stomach, spleen, cap of duodenum, jejenum, ileum, transverse/sigmoid colon

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3
Q

Describe arterial blood supply of the small and large intestine

A

-small intestine:
celiac trunk supplies upper duodenum
sma supplies the rest

-large intestine:
sma supplies ascending colon to 2/3 of the transverse colon
ima supplies rest of colon

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4
Q

Describe the course of the ureters

A
  • retroperitoneal structures
  • originate at renal hilum at level of L1/L2 and tip of 9th costal cartilage
  • run inferior across psoas muscle medial to tips of L3-L4 transverse processes
  • cross over pelvic brim and anterior to bifurcation of common iliac artery and under the gonadal vessels and vas deferens
  • travel medially to bladder
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5
Q

What are the 3 points of constriction of the ureters (also most likely site for a stone to lodge)

A

1) junction of ureter at renal pelvis (PUJ = pelviureteric junction)
2) where they cross the brim of the pelvic inlet
3) during passage through the wall of the bladder (VUJ = vesicoureteric junction)

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6
Q

What is the arterial supply of the ureters

A
  • upper part: branches from the renal artery
  • middle part: branches from aorta
  • lower part: branches from internal iliac artery (vesical, middle rectal or uterine artery)
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7
Q

Describe the relationships of the spleen

A
  • anterior: stomach
  • posterior: left diaphragm, ribs 9-11
  • superiorly: diaphragm
  • inferior: splenic flexure of the colon
  • medial: left kidney
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8
Q

What is the blood supply of the liver

A
  • hepatic artery brings 20-25% of blood
  • hepatic portal vein brings 75-80% of blood
  • 3 hepatic veins drain blood from liver into central veins
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9
Q

What level does the superior mesenteric artery arise from

A

L1

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10
Q

What are the relations of the pancreas

A
  • posterior: portal vein, right renal artery/vein, bile duct, SMA, L2 vertebrae
  • medial: duodenum
  • lateral: hilum of spleen
  • anterior: stomach, peritoneum, lesser omentum
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11
Q

Xray abdomen image: please demonstrate the transpyloric plane on this xray

A

-transpyloric plane runs through L1 level
-midway between xiphisternum and umbilicus
-cuts costal margin of tip of 9th costal cartilage
-transects:
pylorus, gb fundus, neck of pancreas,
sma, splenic vein, 2nd part of duodenum, hila of kidney

Please Feed Him Some Naughty Doritos

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12
Q

Outline the course of the abdominal aorta on the above abdominal xray

A
  • enters abdomen at T12, left of midline, bifurcates at L4
  • just above the transpyloric plane to a point just below and to the left of the umbilicus
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13
Q

Describe the relations of the right kidney

A
  • surrounded by perinephric fat
  • superior: right adrenal gland, right lobe of liver, portal vein
  • anterior: gallbladder, duodenum, ascending colon
  • posterior: diaphragm, psoas major
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14
Q

What are the branches of the abdominal aorta

A
  • coeliac artery comes off T12
  • superior mesenteric artery comes off L1
  • renal arteries come off L2
  • inferior mesenteric artery comes off L3
  • lumbar arteries come off L1-L4 (4 paired)
  • bifurcation at L4
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15
Q

What are the branches of the celiac trunk

A
  • splenic artery
  • left gastric artery
  • common hepatic artery
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16
Q

What is the relation of the IVC to the aorta

A

IVC lies posterolateral and to the right

17
Q

Describe the arterial supply and venous drainage of the gut

A

arterial: anastomosis between SMA and IMA via marginal artery at splenic flexure
- celiac = esophagus, stomach, upper duodenum, spleen, pancreas, liver, gall bladder
- sma = lower duodenum and rest of small intestine, pancreas, large intestine (right colic and middle colic)
- ima = rest of large intestine (left colic, sigmoid and superior rectal)

venous:
- superior mesenteric vein, inferior mesenteric vein, gastric vein and splenic veins drain into hepatic portal vein, drains to liver
- 3 hepatic veins from liver drain into inferior vena cava

18
Q

What are the branches of the celiac trunk and what do they supply

A
  • splenic artery: pancreas, stomach, spleen
  • left gastric artery: lower esophagus, stomach
  • common hepatic artery: liver, pylorus, upper duodenum, gallbladder, pancreas
19
Q

Where does fluid collect in the supine position

A
  • hepatorenal space
  • splenorenal space
20
Q

Describe the anatomy of the biliary tree

A
  • right and left hepatic ducts join to form the common hepatic duct
  • cystic duct branches off the common hepatic duct to supply bile to the gallbladder
  • common hepatic duct becomes bile duct, join main pancreatic duct, form hepatopancreatic ampulla, empties into duodenum
21
Q

Xray abdomen image: what does this xray demonstrate

A
  • dilated loops of small bowel with multiple air fluid levels
  • minimal large bowel loops, indicating a proximal large bowel obstruction
  • small bowel identified by valvulae conniventes = cross full width
  • more than 5 air fluid levels are diagnostic of SBO
  • dilation of small bowel >3cm is abnormal
22
Q

Describe porto-systemic anatomoses

A
  • when there is a connection between the veins of the portal circulation and systemic veins
  • blood flows in retrograde manner and there are no valves
  • sites:
    1) inferior end of esophagus - blood drains into left gastric vein that empties into portal vein, results in esophageal varices
    2) superior rectum - blood drains into inferior mesenteric vein that empties into portal vein, results in haemorrhoids
    3) umbilicus - result in caput medusae
23
Q

Describe the arterial supply of the stomach

A

Coeliac Trunk:
Most blood supply is from anastomoses
1) along the lesser curvature by the Right and Left Gastric Arteries
2) along the greater curvature by the Right and Left Gastro-Epiploic Arteries

Fundus and Upper Body - Short and Posterior Gastric Artery

ACEM Part 1 (38 decks)

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