Abdomen Flashcards
(289 cards)
1
Q
What are the 2 main divisions of the peritoneal cavity
A
Greater sac
Lesser sac
2
Q
What divides the greater sac of the abdomen into 2
A
The mesentery of the transverse colon
3
Q
What are the 2 compartments of the greater sac of the abdomen and what do they contain
A
Supracolic (above transverse mesocolon) - contains stomach, liver and spleen
Infracolic (below transverse mesocolon) - contains small intestine, ascending and descending colon
4
Q
What divides the infra colic compartment of the greater sac
A
Root of the mesentery of the small intestine - divides it into left and right infra colic compartments
5
Q
What connects the supracolic and infracolic compartments of the greater sac
A
Paracolic gutters
Lie between the posterolateral abdominal wall and the lateral aspect of the ascending/ descending colon
6
Q
Where is the subphrenic recess found
A
Between the diaphragm and the liver
Left and right subphrenic recesses which are separated by the falciform ligament
7
Q
On which side is a subphrenic abscess more common
A
Right sided
Due to increased frequency of appendicitis and ruptured duodenal ulcers
8
Q
Where is the lesser sac found
A
Posterior to the stomach and the lesser omentum
9
Q
What is the other name for the lesser sac
A
Omental bursa
10
Q
What connects the omental bursa to the greater sac
A
The epiploic foramen
11
Q
Where is the epiploic foramen found
A
Posterior to the free edge of the lesser omentum
12
Q
In which sex is the peritoneal cavity not completely closed and why
A
Females
The uterine tubes open into the peritoneal cavity, providing a potential pathway between the female genital tract and the abdominal cavity.
13
Q
Where is the rectovesical pouch found and what is it
A
In males
Between the rectum and bladder
It is a double fold of peritoneum
14
Q
What is the equivalent of the rectovesical pouch in females
A
Rectouterine pouch (of Douglas) - double folding of peritoneum between the rectum and the posterior wall of the uterus
Vesicouterine pouch - Double folding of peritoneum between the anterior surface of the uterus and bladder
15
Q
Where is Calot’s triangle found
A
At the aorta hepatis of the liver
16
Q
What are the borders of Calot’s triangle
A
Medial - common hepatic duct
Inferior - cystic duct
Superior - inferior surface of the liver
17
Q
What is the contents of Calot’s triangle
A
Right hepatic artery
Cystic artery
Lymph node of Lund
Lymphatics
18
Q
What forms the right hepatic artery
A
Bifurcation of the proper hepatic artery into the right and left branches
19
Q
What is parietal mesoderm derived from
A
Somatic mesoderm
20
Q
What is visceral mesoderm derived from
A
Splanchnic mesoderm
21
Q
Which abdominal organs are retroperitoneal
A
Suprarenal glands
Aorta/IVC
Duodenum
Pancreas
Ureters
Ascending and descending colon
Kidneys
Oesophagus
Rectum
22
Q
Which part of the pancreas is intraperitoneal
A
Tail of pancreas
23
Q
What are the attachments of the greater omentum
A
Descends from the greater curvature of the stomach and proximal part of the duodenum
Folds back up and attaches to the anterior surface of the transverse colon
24
Q
How many layers of visceral peritoneum make up the greater omentum
A
4
25
Where does the lesser omentum attach
Lesser curvature of the stomach and proximal duodenum
to the Liver
26
What are the 2 parts of the lesser omentum
Hepatogastric ligament
Hepatoduodenal ligament
27
What is contained in the free edge of the hepatoduodenal ligament
Portal triad
28
What is the inguinal canal
A short passage extending inferiorly and medially through the inferior part of the abdominal wall, above the inguinal ligament
29
Is the inguinal canal above or below the inguinal ligament
Above
30
What is the opening of the inguinal canal known as
The deep inguinal ring
31
What is the exit of the inguinal canal known as
The superficial inguinal ring
32
What are the boundaries of the inguinal canal
Anterior - Aponeurosis of the external oblique, reinforced by the internal oblique laterally
Posterior wall - transversalis fasciae
Roof - Transversalis fascia, internal oblique, transversus abdominis
Floor - inguinal ligament, thickened medially by the lacunar ligament
33
What forms the deep inguinal ring
Transversalis fascia
34
What forms the superficial inguinal ring
Invagination of the external oblique
35
What is contained within the inguinal canal
Spermatic cord (males)
Round ligament (females)
Ilioinguinal nerve
Genital branch of the genitofemoral nerve
36
What is the mid inguinal point and what can be palpated here
Halfway between the pubic symphysis and the anterior iliac spine
Femoral pulse can be palpated
37
What is the mid point of the inguinal ligament and what is found here
Halfway between the pubic tubercle and the anterior iliac spine
Opening to inguinal canal just above this point
38
What is Hesselbachs Triangle
Also known as the inguinal triangle, is a region in the medial abdominal wall
39
What are the borders of Hesselbachs triangle
Medial - Lateral border of rectum abdomens
Lateral - inferior epigastric muscles
Inferior - inguinal ligament
40
What is the clinical importance of Hesselbachs triangle
An area of potential weakness
Site of direct inguinal hernia
41
Describe the arrangement of the superficial fascia of the anterior abdominal wall
Above the umbilicus - a single sheet of CT
Below the umbilicus - divided into two layers
42
What are the two layers of superficial fascia of the anterior abdominal wall below the umbilicus
Fatty superficial layer - Camper's fascia
Membranous deep layer - Scarpa's fascia
43
What are the 3 flat muscles of the abdominal wall
External oblique
Internal oblique
Trasnversus abdominis
44
The aponeurosis of the 3 flat muscles of the abdominal wall combine to form what
Linea Alba
45
Where does the Linea Alba extend to
From the Xiphoid process of the sternum to the pubic symphysis
46
Which is the largest flat muscle of the abdominal wall
External oblique
47
Where does external oblique attach
Ribs 5 -12
Iliac crest and pubic tubercle
48
What lies directly deep to external oblique
Internal oblique
49
Where does internal oblique attach
Inguinal ligament, iliac crest and lumbodorsal fascia Inserts onto ribs 10-12.
50
Where does transversus abdominis attach
Inguinal ligament, costal cartilages 7-12, iliac crest and thoracolumbar fascia
Inserts onto the conjoint tendon, xiphoid process, linea alba and pubic crest
51
What innervates the flat muscles of the anterior abdominal wall
Thoracoabdominal nerve (T7-T11)
Subcostal nerve
52
What additional nervous innervation does internal oblique and transversus abdominis have
Branches of the lumbar plexus
53
What are the two vertical muscles of the anterior abdominal wall
Rectus abdominis
Pyramidalis
54
Describe rectus abdominis
Long, paired muscle, found either side of the midline
Separated by the linea alba
55
Where does rectus abdominis attach
Crest of pubis bone
Inserts onto the xiphoid process of sternum, and costal cartilages of ribs 5-7
56
What innervates rectus abdominis
Thoracoabdominal nerve
57
Where is pyramidalis found and what is its action
Found superficially to the rectus abdominis
Tenses the linea Alba
58
Describe the rectus sheath
Formed by the aponeurosis of the three flat muscles (transversus abdominis, internal and external oblique) and encloses the rectus sheath and pyramidalis
59
What is the arcuate line and what occurs here
The line at which the posterior layer of the rectus sheath is deficient
The rectus abdominis is in direct contact with the transversalis fascia
60
What are the 5 muscles in the posterior abdominal wall
Iliacus
Psoas Major
Psoas minor
Quadratus lumborum
Diaphragm
61
What is the action of quadratus lumborum
Extension and lateral flexion of the vertebral column
62
Which muscle is found most superiorly in the posterior abdominal wall
Quadratus lumborum
63
What is the action of quadratus lumborum
Flexion at the thigh and hip
Lateral flexion of the vertebral column
64
Which posterior abdominal wall muscle is only present in 60% of the population
Psoas Minor
65
What is the action of iliacus
Flexion and lateral rotation of the thigh
66
What is a positive psoas sign
Pain elicited by flexion at the hip
67
What are the two layers of fascia in the posterior abdominal wall
Psoas fascia
Thoracolumbar fascia
68
At what level does the aorta bifurcate into its terminal branches
L4
69
WHat is the first branch of the abdominal aorta
Inferior phrenic arteries
70
At what level do the gonadal arteries branch from the aorta
L2
71
At what level does the aortic arch end
T4
72
What are the 3 main branches of the aortic arch (proximal to distal)
Brachiocephalic trunk
Left common carotid
Left subclavian
73
What are the branches of the descending aorta (in order)
Bronchial arteries - left form aorta, right from intercostals
Mediastinal arteries
Oesophageal arteries
Pericardial arteries
Superior phrenic arteries
Intercostal and subcostal
74
How many intercostal arteries branch from the aorta
9
75
What are the branches of the abdominal aorta
Inferior phrenic
Coeliac axis
Superior mesenteric artery
Middle suprarenal
Renal arteries
Gonadal arteries
Inferior mesenteric artery
Median sacral artery
Lumbar arteries
76
At what level does the coeliac axis branch from the aorta
T12
77
At what level does the SMA branch from the aorta
L1
78
At what level does the IMA branch from the aorta
L3
79
What is the last branch of the aorta and where does it branch
Median sacral artery
L4
80
How many pairs of lumbar arteries branch from the aorta
4
81
What are the 3 major branches of the coeliac axis
Left gastric
Splenic
Common hepatic
82
Describe the left gastric
Smallest of the 3 arteries
Ascends across the diaphragm, gives oesophageal branches, and continues along the lesser curvature of the stomach
83
Which artery does the left gastric anastomose with
Right gastric
84
In which structure is the splenic artery found
Splenorenal ligament
85
What are the 3 important branches of the splenic artery
Left gastroepiploic
Short gastrics
Pancreatic branches
86
What does the left gastroepiploic artery supply and what does it anastomose with
Greater curvature of the stomach
Anastamoses with the right gastroepiploic
87
What do the short gastric arteries supply
The fundus of the stomach
88
Which branch of the coeilac axis is the only one to go to the right
Common hepatic artery
89
What are the two branches of the common hepatic artery and where does it bifurcate
Proper hepatic
Gastroduodenal
Bifurcates at the superior aspect of the duodenum
90
What are the branches of the proper hepatic artery
Right gastric artery
Right and left hepatic
Cystic
91
What does the right gastric artery supply
Pylorus and lesser curvature of the stomach
92
What are the two branches of the gastroduodenal artey
Right gastroepiploic
Superior pancreaticoduodenal
93
Which is the only organ to receive blood supply from all 3 branches of the coeliac axis
Stomach
94
What are the two main branches of the pancreaticoduodenal arcade
Superior pancreaticoduodenal artery - a branch of the gastroduodenal artery
Inferior pancreaticoduodenal artery - branch of SMA
95
Which artery do posterior duodenal ulcers erode into
Gastroduodenal artery
96
What is coeliac trunk compression syndrome
Compression of the coeliac axis by the median arcuate ligament
97
What are the risk factors for a splenic arteyr aneurysm
Female sex
Multiple pregnancies
Portal HTN
Pancreatitis /Pseudocyst formation
98
What does the SMA supply
The Midgut
From the major papillae of the duodenum to the proximal 2/3 of the transverse colon
99
What is anterior to the SMA at its origin
Pyloric part of stomach
Splenic vein
Neck of pancreas
100
What is posterior to the SMA at its origin
Left renal vein
Ucinate process of the pancreas
Inferior part of the duodenum
101
What is the relationship between the SMA and the ucinate process of the pancreas
Ucinate process hooks itself around the back of SMA
102
What are the branches of the SMA
Inferior pancreaticoduodenal artery
Jejunal and ileal arteries
Middle colic artery
Right colic artery
Ileocolic artery
103
The appendicular artery is a branch of what atery
Ileocolic
104
What does the right colic artery supply
Ascending colon
105
What does the middle colic artery supply
Transverse colon
106
What are the vasa recta and how do they differ between the ileum and jejunum
Vasa recta - anastomotic arcades
Jejunal arteries - smaller number of arterial arcades, but they are longer
Ileal arteries - higher number of arterial arcades, they are shorter
107
Is the IMA intraperitoneal or an retroperitoneal structure ?
Retroperitoneal
108
What are the 3 major branches of the IMA
Left colic artery
Sigmoid artery
Superior rectal artery
109
What are the 2 branches of the left colic artery
Ascending
Descending
110
What does the descending left colic artery anastomose with
Superior sigmoid artery
111
In a left hemicolectomy what artery will they want a high resection of
IMA
112
What is the marginal artery of drummond
A continuous arterial circle long the inner border of the colon
113
What forms the marginal artery of drummond
branches from the ileocolic, right colic and middle colic of the SMA and left colic and sigmoid branches of the IMA.
114
What forms the Arch of Riolan
Anastamosis between the middle colic branch of SMA and left colic branch of IMA
115
What is meant by the splenic flexure being a watershed area
Has dual supply from two large arteries
116
What is the IVC formed by and at what level
Common iliac veins at L5
117
What are the tributaries of the IVC
Common iliac veins
Lumbar veins
Renal veins
Right testicular or ovarian veins
Right suprarenal veins
Inferior phrenic veins
Hepatic veins
118
Which structures do not have tributaries to the IVC and why
No tributaries from the spleen, pancreas, gallbladder or abdominal portion of GI tract
Drained by the portal system
119
What forms the portal vein and where
Union of the splenic vein and the SMV, posterior to the neck of the pancreas at level of L2
120
What are the tributaries to the portal vein
Right and left gastric veins
Cystic veins
Para-umbical veins
121
Which veins are tributaries to the splenic vein
Short gastric veins
Left gastro-omental veins
Pancreatic veins
IMV
122
Where does the IMV drain blood from
Rectum
Sigmoid colon
Descending colon
Splenic flexure
123
Where does the IMV pass in relation to the pancreas
Posterior to the body of the pancreas
124
Where does the SMV drain blood from
Small intestine, caecum, ascending colon and transverse colon
125
Where does the SMV pass in relation to the pancreas
Posterior to the neck of pancreas
126
What are the tributaries of the SMV
Right gastro-omental vein
Anterior and posterior inferior pancreaticoduodenal veins
Jejunal vein
Ileal vein
Ileocolic vein
Middle colic vein
127
Where is the origin of the SMV
RIF
Forms as a convergence of the veins draining the terminal ileum, caecum and appendix
128
Where are the sites of porto-systemic anastomosis
Oesophageal
Rectal
Retroperitoneal
Paraumbilical
129
Which veins from the oesophageal portosystemic anastomosis
Left gastric vein
Oesophageal tributaries of the azygous system
130
Which veins form the rectal portosystemic anastamosis
Superior and inferior rectal veins
131
Which veins form the retroperitoneal portosystemic anastamosis
Portal tributaries of the mesenteric veins and retroperitoneal veins
132
Which veins form the paraumbilical portosystemic anastamosis
Portal veins of the the liver and veins of the anterior abdominal wal
133
Which surface of the liver is its diaphragmatic surface
The anterosuperior aspect
134
Which surface of the liver is its visceral surface
Posteroinferior aspect
135
What organs are in direct contact with the liver
Right kidney
Right adrenal gland
Right colic flexure
Transverse colon
First part of the duodenum
Gallbladder
Oesophagus
Stomach
136
What does the falciform ligament attach to and what does it contain
Anterior abdominal wall
Contains ligamentum teres
137
What is the ligamentum teres a remnant of
Umbilical vein
138
What does the coronary ligament attach to and what does it demarcate
Attaches the superior surface of the liver to the inferior aspect of the diaphragm
Demarcates the bare area of the Liver
139
What are the coronary ligaments also known as
Anterior and posterior fold
140
What do the anterior and posterior folds (coronary ligaments) unite to form
The triangular ligaments of the liver
Right and left triangular ligament
141
What ligament surrounds the portal triad
Hepatoduodenal ligament
142
What are the ligaments of the liver
Falciform ligament
Coronary ligament (right and left folds)
Triangular ligaments (right and left)
Lesser omentum
143
Where is the subhepatic space found
Subdivision of the supra colic compartment, located between the liver and the transverse colon
144
What is Morrisons pouch
Potential space between the visceral surface of the liver and the right kidney
145
What is the fibrous layer of the liver known as
Glissons capsule
146
What are the two 'accessory lobes' of the liver and where do they arise from
Caudate lobe
Quadrate lobe
Arise from the right lobe of the liver
147
Where is the caudate lobe found
It lies between the IVC and a fossa produced by the ligamentum venous
148
Where is the quadrate lobe found
Between the gallbladder and a fossa produced by the ligamentum teres
149
What does the porta hepatis separate
The caudate and quadrate lobes
150
What are the 2 vessels supplying the liver and what do they proportionally supply
Hepatic artery proper - 25% of blood supply
Hepatic portal vein - 75% of blood supply
151
What is the nervous innervation of the Liver
Parenchyma of the liver innervated by the hepatic plexus
Glissons capsule - innervated by lower intercostal nerves
152
How is the lymphatic drainage of the liver split
Anterior
Posterior
153
What is the lymphatic drainage of the anterior liver
Hepatic lymph node s
154
What is the lymphatic drainage of the posterior liver
Phrenic
Posterior mediastinal nodes
155
What are the anterior and superior relations of the gallbladder
Inferior border of the liver
Anterior abdominal wall
156
What are the posterior and inferior relations of the gallbladder
Posterior - Transverse colon and proximal duodenum
Inferior - Biliary tree and remaining parts of duofenum
157
What are the 3 parts of the gallbladder
Fundus
Body
Neck
158
which is the largest part of the gallbladder
Body
159
The neck of the gallbladder tapers to become continuous with which structure
Cystic duct
160
Where is Hartmann's pouch and what can get stuck there
A mucosal fold in the neck of the gallbladder
Gallstones can become lodged here
161
The cystic duct combines with what to form the common bile duct
Common hepatic duct
162
The common hepatic duct combines with which structure, where, to form the hepatopancreatico ampulla
Combines with the pancreatic duct
Enters the duodenum on the medial aspect of the 2nd part of the duodenum
163
What is the blood supply of the gallbladder
Cystic atery
164
What is the cystic artery a branch of
Hepatic artery
165
What is the venous drainage of the gallbladder
Cystic veins
Drain directly into the portal vein
166
Which organs is the pancreas in direct contact with
Stomach
Duodenum
Transverse mesocolon
Common bile duct
Spleen
167
What is the relation of the pancreas and the duodenum
The first part of the duodenum lies anteriorly
whereas the second part of the duodenum including the ampulla of Vater lies laterally to the right of the pancreatic head
168
The linorenal ligament connects which 2 organs
The spleen and the left kidney
169
Which vessels are related to the pancreas
Aorta and IVC
SMA
Hepatic portal vein - and the SMV and splenic vein prior to combining
170
What are the 5 parts of the pancreas
Head
Ucinate process
Neck
Body
Tail
171
Which part of the pancreas is intraperitoneal
Tail
172
What is the blood supply of the pancreas
Pancreatic branches of the splenic artery
Additional supply to the head - superior and inferior pancreaticoduodenal arteries which are branches of the gastroduodenal (from coeliac trunk) and superior mesenteric arteries, respectively
173
What is the venous drainage of the pancreas
Head - Superior mesenteric branches of the portal vein
Rest - pancreatic and splenic veins
174
What is the lymphatic drainage of the pancreas
Pancreaticosplenal nodes
175
What are the 2 ligaments which connect the spleen to the stomach and kidneys
Gastrosplenic ligament
Splenorenal ligament
176
Which borders of the spleen contain notches
Anterior and superior borders
177
What is found anterior to the spleen
Stomach
178
What is found posterior to the spleen
Diaphragm
Left lung
Ribs 9-11
179
What is found inferior to the spleen
Left colic flexure
180
What is found medial to the spleen
Left kidney
Tail of pancreas
181
What is the arterial supply of the spleen
Splenic artery
Branches into 5 separate branches
182
What is the venous drainage of the spleen and what does this eventually form
Splenic vein
Combines with SMV to form portal vein
183
What are the relations of the right adrenal gland
Anterior - IVC, Right lobe of liver
Posterior -Right crus of diaphragm
184
What are the relations of the left adrenal gland
Anterior - stomach, pancreas, spleen
Posterior - Left crus of diaphragm
185
What is the embryological origin of the adrenal gland
Cortex -mesoderm
Medulla - ectodermal neural crest cells
186
What are the 3 zones of the adrenal cortex and what do they secrete
Zona glomerulosa - mineralocorticoids
Zona fasciularis - corticosteroids
Zona reticularis - androgens
187
What is the blood supply of the adrenal glands
Superior, middle and inferior adrenal arteries
188
What is the origin of the superior adrenal artery
Inferior phrenic artery
189
What is the origin of the middle adrenal artery
Abdominal aorta
190
What is the origin of the inferior adrenal artery
Renal arteries
191
What does the right adrenal vein drain into
IVC
192
What does the left adrenal vein drain into
Left renal vein
193
What layers enclose the kidney
Deep to superficial
Renal capsule
Perirenal fat
Renal fascia
Pararenal fat
194
What is the renal fascia also known as
Gerotas fascia
195
Which muscles lie posterior to the kidneys
Psoas major
Quadratus lumborum
Transversus abdominis
196
What is the line of brodel in the kidney
The avascular plane of the kidney, delineating the section of the kidney supplied by the anterior and posterior divisions
Found along the lateral and posterior border of the kidney
197
The renal artery branches are anatomical end arteries - why is this important
There is no communication between vessels - therefore damage to a vessel will lead to necrosis of the renal parenchyma
198
The arterial supply to the kidneys divide it into what 5 segments
Apical
Upper
Middle
Lower
Posterior
199
What structure does the left renal vein lie over
The abdominal aorta
200
Where does lymph from the kidneys drain
Para-aortic lymph nodes
201
What is the function of the abdominal mesentery
Suspends the small and large intestines from the posterior abdominal wall
Provides conduit for blood vessels
202
Which part of the mesentery is flattened against the posterior abdominal wall
Right mesocolon
Left mesocolon
Medial mesosigmoid
203
The parts of the mesentery that are flattened against the posterior abdominal wall are attached to this by what
Toldt's fascia
204
Which major blood vessels are found in the mesentery
SMA and SMV
IMA and IMV
205
Where does the inferior mesenteric lymph nodes receive lymph from
Hindgut organs
206
Where do the inferior mesenteric lymph nodes drain into
Superior mesenteric lymph nodes
207
Where does the superior mesenteric lymph nodes receive lymph from
Midgut
Inferior mesenteric lymph nodes
208
Where do the superior mesenteric lymph nodes drain into
Para aortic nodes
209
How long is the oeosphagus, where does it start and end
25 cm
Starts at C6
Ends at T11
210
Describe the muscualr layer of the oesophagus and how it differs in different thirds
External layer of longitudinal muscle - differs - superior third is voluntary striated, middle third - voluntary striated and smooth, lower third - smooth muscle
Internal layer of circular muscle
211
WHat is the mucosa of the oesphagus
non-keratinised stratified squamous epithelium (contiguous with columnar epithelium of the stomach).
212
Which of the two oesophageal sphincters are anatomical
Upper
213
How could you describe the lower oesophageal sphincter and what maintains it
Physiological sphincter
Maintained by:
1. Oesophagus enters stomach at an acute angle
2. Walls of the intra-abdominal section of the oesophagus are compressed when there is a positive intra-abdominal pressure.
3.Prominent mucosal folds at the gastro-oesophageal junction aid in occluding the lumen.
4. Right crus of the diaphragm has a “pinch-cock” effect.
214
Where are the 4 phsyiological constrictions of the oesophagus
Arch of aorta
Bronchus
Cricoid cartilage
Diaphragmatic hiatus
215
What nerve is closely related to the oesophagus in the abdomen
Right and left vagus nerves
216
What is the arterial supply of the thoracic oesophagus
Thoracic aorta
Inferior thyroid artery
217
What is the arterial supply of the abdominal oesophagus
Left gastric artery
218
What is the venous drainage of the thoracic oesophagus
Azygous veins
Inferior thyroid vein
219
What is the venous drainage of the abdominal aorta
Portal circulation - via left gastric vein
Systemic circulation - via azygos vein
220
Nerve fibres from which nucleus supply the upper oesophageal sphincter
Nucelus ambiguus
221
Nerve fibres from which nucleus supply the lower oesophageal sphincter
Dorsal motor nucleus
222
The superior third of the oesophagus drains to which nodes
Deep cervical nodes
223
The middle third of the oesophagus drains to which nodes
Superior and posterior mediastinal nodes
224
The inferior third of the oesophagus drains to which nodes
Left gastric and coeliac nodes
225
What are the 4 main divisions of the stomach
Cardia
Fundus
Body
Pylorus
226
The transpyloric plane is at what level
L1
227
Which arteries supply the greater curvature of the stomach
Short gastric arteries
Right and left gastro-omental arteries
228
Which arteries supply the lesser curvature of the stomach
Left gastric artery
Right gastric branch of the hepatic artery
229
Which structures are found anterior to the stomach
Diaphragm
Greater omentum
Anterior abdominal wall
Left lobe of liver
Gall bladder
230
Which structures are found posterior to the stomach
Lesser sac
Pancreas
Left kidney
Left adrenal gland
Spleen
Splenic artery
Transverse mesocolon
231
The hepatogastric ligament attaches to which surface of the stomach
Lesser curvature
232
The pyloric sphincter is what kind of sphincter
Anatomical sphincter
233
The right gastric artery is a branch of which artery
Proper hepatic artery (branch of common hepatic)
234
right gastro-omental artery is a branch of which artery
Terminal branch of gastroduodenal artery (common hepatic)
235
Left gastro-omental artery is a branch of which artery
Splenic artery
236
The right and left gastric veins drain into
Portal vein
237
The short gastric vein, left and right gastro-omental veins drain into
SMV
238
Lymph drainage of the stomach is to
Gastric and gastro-omental lymph nodes
Which drain to coeliac lymph nodes
239
What are the 3 parts of the small intestine
Duodenum
Ileum
Jejunum
240
How long is the duodenum and what are its 4 parts
approx 25 cm
Superior, descending, inferior, ascending
241
Which part of the duodenum is at the level of L1
Superior
242
Which part of the duodenum is connected to the liver by the hepatoduodenal ligament
Superior duodenum
243
Which part of the duodenum is intraperitoneal
Superior
244
Which part of the duodenum is related to the IVC and aorta
Inferior
245
Where is the suspensory muscle of the duodenum found and what is its function
Found at the duodenojejunal junction
Contraction of the muscle widens the duodenojejunalflexure, aiding in movement of intestinal contents into the jejunum
246
What is a complication of duodenal ulcers
Erosion of the gastroduodenal artery - subsequent haemorrhage
247
Which parts of the small intestine are intraperitoneal
Jejunum
Ileum
248
Summarise the jejunum
Located in left upper quadrant
Thick intestinal walls
Long, straight vasa recta with less arcades
Red in colour
249
Summarise the ileum
Located in right upper quadrant
Thin intestinal walls
Short vasa recta, with more arcades
Pink in colour
250
What are the 2 arterial supplies to the duodenum and what landmarks marks the change
Gastroduodenal artery (common of right hepatic - coeliac trunk)
Inferior pancreaticoduodenal artery (branch of SMA)
Changes at major duodenal papilla (in 2nd part of duodenum)
251
The appendicular artery arises from which main artery
Ileocolic artery
Branch of the SMA
252
Where is McBurneys point
Situated one third of the distance from the right anterior superior iliac spine to the umbilicus
253
Where does lymph from the appendix drain
Ileocolic lymph nodes
254
What is the function of the ileocolic valvce
prevents reflux of large bowel contents into the ileum during peristalsis and is thought to function passively
255
What is the lymphatic drainage of the caecum
Ileocolic lymph nodes
256
How long is the colon
150cm
257
what does the phrenicocolic ligament attach to
The transverse colon
The diaphragm
258
Where is the sigmoid colon found
Left lower quadrant
From the left iliac fossa to the level of the S3 vertebra
259
What are the tenia coli
3 strips of muscle running longitudinally along the colon
Mesocolic, free and omental coli
260
What is the arterial supply of the ascending colon
Ileocolic artery
Right colic artery
261
What is the arterial supply of the transverse colon
Right colic artery
Middle colic artery
Left colic artery - branch of IMA
262
What is the arterial supply of the descending colon
Left colic artery
263
Why is the marginal artery of Drummond important
Provides collateral blood supply to the colon
264
Where does the superior mesenteric and inferior mesenteric veins drain into
Portal vein
265
What is the nervous innervation of midgut structures
Sympathetic, parasympathetic and sensory supply via nerves from the superior mesenteric plexus
266
What is the nervous innervation of hindgut structures
From the inferior mesenteric plexus
Parasympathetic innervation via the pelvic splanchnic nerves
Sympathetic innervation via the lumbar splanchnic nerves
267
What is the lymphatic drainage of the colon
Ascending and transverse colon - superior mesenteric nodes
Descending and sigmoid colon - inferior mesenteric nodes
268
What are the 2 major flexures of the rectum
Sacral flexure – anteroposterior curve with concavity anteriorly
Anorectal flexure – anteroposterior curve with convexity anteriorly.
269
What forms the sacral flexure of the rectum
The curve of the sacrum and coccyx
270
What forms the anorectal flexure of the rectum
The tone of puborectalis muscle
271
What is the final segment of the rectum called and what is its function
Ampulla
relaxes to accumulate and temporarily store faeces until defecation occurs
272
Describe the peritoneal coverings of the rectum
Superior third - anterior and middle sides are covered with peritoneum
Middle third - anterior peritoneal covering
Lower third - no peritoneum associated with it
273
What is the arterial supply of the rectum
Superior, middle and inferior rectal artery
274
What is the origin of the superior rectal artery
IMA
275
What is the origin of the middle rectal artery
Internal iliac artery
276
What is the origin of the inferior rectal artery
Internal pudendal artery
277
Which rectal veins drains into portal circulation and which into systemic circulation
Superior rectal vein - portal circulation
Middle and inferior rectal vein - systemic circulation
278
What is the sympathetic innervation of the rectum
Lumbar splanchnic nerves
Superior and inferior hypogastric plexuses.
279
What is the parasympathetic innervation of the rectum
S2-4 via the pelvic splanchnic nerves and inferior hypogastric plexuses
280
What is the lymphatic drainage of the rectum
Pararectal nodes
Lower rectum - drains directly into internal iliac nodes
281
Describe the internal anal sphincter
Surrounds the upper 2/3 of the anal canal
It is formed from a thickening of the involuntary circular smooth muscle in the bowel wal
282
Describe the external anal sphincter
Voluntary muscle that surrounds the lower 2/3 of the anal canal (and so overlaps with the internal sphincter). It blends superiorly with the puborectalis muscle of the pelvic floor.
283
What form the anorectal ring
Fusion of the Internal and external anal sphincter and puborectalis muscle
284
What is the pectinate line
The line in which the anal valves are found
Delineates the different embryological origins of the anal canal
285
What is the anal canal lined with superior to the pectinate line
Columnar epithelium
286
What is the anal canal lined with inferior to the pectinate line
Non keratinised stratified squamous epithelium
287
What is the arterial supply of the anal canal
Above the pectinate line - superior rectal, + anastomosis with middle rectal
Below pectinate line - inferior rectal + anastomosis with middle rectal
288
What is the venous drainage of the anal canal
Above the pectinate line - superior rectal vein draining into portal system
Below pectinate line - inferior rectal into the pudendal into systemic
289
What is the lymphatic drainage of the anal canal
above pectinate line - Internal iliac nodes
Below pectinate line - superficial inguinal nodes
