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MRCS Essentials > Abdomen > Flashcards

Abdomen Flashcards

(94 cards)

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1
Q

At what level does the gonadal artery branch from the aorta?

A

L2

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2
Q

What level does the suprarenal artery branch?

A

L1

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3
Q

Name 4 anteior relations of aorta

A
  • Lesser omentum
  • liver
  • left renal vein
    inferior mesenteric vein
  • pancreas
  • third part of duodenum
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4
Q

What are the levels of the origin and termination of the aorta

A
  • T12 and L4
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5
Q

At what level does the azygous vein originate and terminate

A
  • Originated at T12-L2 from the inferior vena cava
  • Joins superior vena cava at T4-5
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6
Q

Which veins join to make the azygous vein?

A
  • Right ascending lumbar vein
  • Right subcostal veins
  • Around T12
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7
Q

3 left lateral relations of the aorta

A
  • 4th part of duodenum
    duodenojejunal flexure
    left sympathetic trunk
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8
Q

Describe SMA syndrome (Wilkie’s syndrome)

A

Third part of Duodenum becomes compressed by SMA and aorta causes small intestine obstruction

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9
Q

What is median arcuate ligament syndrome (dunbar syndrome)?

A
  • Compression of coeliac artery by median arcuate ligament of diaphragm resulting in post prandial abdo pain, nausea, vomiting and exercise intolerance
  • Unintentional weight loss
  • Diagnosis of exclusion
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10
Q

Which structure is behind the superior mesenteric artery

A
  • Left renal vein
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11
Q

How many unpaired branches of the aorta are there that supply abdominal viscera

A

3 - coeliac; SMA; IMA
- Median sacral doesn’t supply abdominal viscera

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12
Q

At what levels will you find the ureteric stones

A
  • L2-L5
  • Level of the ureter
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13
Q

What is the blood supply to proximal ureter

A

Branches of Renal artery

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14
Q

What is the blood supply of the middle ureter?

A

Gonadal artery + common iliac

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15
Q

What is the blood supply of the lower ureter?

A

Superior vesical artery + internal iliac

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16
Q

Which lymph nodes drain the ureter?

A
  • Lateral aortic nodes
  • Iliac nodes
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17
Q

How long is the ureter

A

25-35cm long
transitional epithelial
3 muscular layers
retro peroneal structure

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18
Q

Where is the uterine artery in relation to ureters?

A

Anterior

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19
Q

Where does the ureter enter the bladder

A
  • Posteriorly
  • Or base (in MRCS question options)
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20
Q

Which structure provides the main structural support to the uterus?

A
  • Central peroneal tendon
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21
Q

What are the layers of the scrotum

A

skin => dartos fascia => ext. spermatic fascia => crmasteric mucle => int. spermatic fascia => parietal tunica vaginalis => visceral tunica vaginalis

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22
Q

WHat is the scrotal lymphatic drainage

A
  • Inguinal lymph nodes
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23
Q

What is the tiseticular lymph drainage?

A
  • aortic nodes
    => testicle is not biopsied for tumour due to potential to seed (excisional biopsy from inguinal region instead)
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24
Q

What is the difference in hydrocele management in children vs adults

A
  • Inchildren managed via inguinal incision
  • In adults managed through scrotal incision
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25
What is the scrotal blood supply
- Anterior and posterior scrotal arteries (external and internal pudenal arteries (internal iliac))
26
through which structure does the testes enter the scrotum in embryology?
Gubernaculum pulls it down through tunica vaginalis (vaginalis means bag)
27
what is the testicles initial location before descent
L2 in abdominal cavity
28
Name two structures which are posterior to main lung root
vagus nerve and posterior pulmonary plexus
29
Name two structures which lie anterior to main lung root
Phrenic nerve Pericardiacophrenic artery Anterior pulmonary plexus
30
What are the content of the pulmonary root
Bronchus Pulmonary arteries Pulmonary veins Lymphatic vessels Bronchial vessels Autonomic innervation
31
What is the costal and vertebral level of the hilum
- 4-5 costal cartilage - T5-T7
32
Name the structures of the left lung hilum
- Bronchus - Pulmonary arteries - Pulmonary veins - Pulmonary ligament
33
Name the structures of the right lung hilum
- Eparterial bronchus - Hyparterial bronchus - Veins - Artery - Pulmonary ligament
34
Which 3 veins drain oeseophagus
- Upper third: Inferior thyroid - Middle third: Azygous - Lower third: Gastric
35
Which artery supplies the middle third of the oesophagus
- Aortic branches
36
Describe the borders of the femoral triangle
SUperior: Inguional ligament - Lateral: Satorius - Medial Adductor magnus - FLoor: Iliopsoas, adductur longus + pectineus - Roof Fasca lata, long saphenous vein
37
Name 3 freatures of Klippel-Trenaunay syndrome
38
Name 2 structures superior to the hilum of the lungs
- Azygous vein - Superior vena cava
39
WHat are the borders of the urogenital triangle
Pubic symphysis, ischiopubic rami and theoretical between the two ishial tuberosities
40
What are the contents of the deep perineal pouch?
Space between deep fascia of pelvic floor and perineal membrane: - Urethra - External urethral sphincter - Vagina - Bulbourethral glands - Deep transverse perineal membranes
41
What are the contents of the superficial perineal pouch?
Space between the perineal membrane and superficial perineal fascia: - Erectile tissues: penis + clitoris - 3 muscles: ischiocavernosus, bulbospongiosis, superficial transverse perineal muscles - Bartholins glands
42
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43
Which nerve is at risk of damage during anterior resection of the rectum?
Hypogastric autonomic nerves
44
Name 2 nerves commonly affected by varicose vein surgery
- Sural + Saphenous
45
Name 3 nerves at risk during Axillary node clearance
- Long thoracic nerve - Thoracodorsal nerve - Intercostobrachial
46
What are the branches of the internal iliac artery?
I Love Going Places In My Very Own Underwear - Iliolumbar - Lateral sacral - Gluteal (inf. + sup.) - Pudendal - Inferior vesical - Middle rectal - Vaginal - Obturator - Umbilical - Uterine
47
What are the 3 branches of the external iliac artery?
- Inferior epigastric - Deep circumflex - Femoral
48
What dermatome level is the nipples found at
T4
49
what dermatome level is the xiphoid found at?
T6
50
What dermatome level is the umbilicus found at?
T10
51
What dermatome level is the pubis found at?
T12
52
what is the most likely cause of bleeding during an LP?
Vertebral venous plexus
53
Which structures travel through the aortic hiatus
- Aorta - Thoracic duct - Azygous vein
54
WHat level are the adrenal glands
- Left: T11/12 - Right T12
55
Which ligament ligament contains the portal triad
- Hepatoduodenal ligament contains hepatic artery, prtal vein and common bile duct
56
Surface anatomy for LP
- Highest point of the iliac crests = L4 - Aiming for L3-L4 interspace or L4-L5 interspace
57
sWhich sign indicates pneumoperitoneum commonly seen in bowel perf
- Rigler's sign: Both sides of bowel wall are visible to to gas in peritoneal cavity - Lateral intermuscular septumisually: Dark gas on either side of the bowel wall
58
Which structures are drained by the (para) aortic lymph nodes
- Walls and viscera of the pelvis - Efferent vessels of the lower limb - Gonads - Kidney + suprarenal glands - Deep lymph nodes of greater abdominal wall
59
Which structures are drained by the superficial inguinal lymph nodes
Found horizontally at the inguinal ligament + vertically at femoral triangle Horixzontal: - External genitalia (Vagina inferior to hymen) - Lower anal canal - uterine vessels, coursing with round ligament Vertical - Superficial vessels of lower limb
60
Which structures are drained by the superficial inguinal lymph nodes
- Clitoris + glans penis - Deep lymph nodes of femoral vessels
61
Which structures are drained by the Internal iliac lymph nodes
- Deep parts of perineum - gluteal muscles - Posterior thigh
62
Which structures are drained by the external iliac lymph nodes
- Glans penis/clitoris - membranous urethra - Prostate - Bladder - Cervix - Uteri - Vagina - Adductor region of thigh - Inguinal lymph nodes
63
Which structures are drained by the sacral lymph nodes
- Uterus, vagina and posterior perineum
64
Describe the contents of Calcot's triangle
- Right hepatic artery - Cystic artery - Lymph node of lund - Lymphatics
65
What are the borders of Calcot's triangle
- Medial: Common hepatic duct - Inferior: Cystic duct - Superior: Inferior aspect of liver
66
Which lymph nodes does the cervix drain into?
Internal iliac
67
What are the boundaries of the quadrangular space
- Medial: Long head of triceps brachii - Inferior: Teres major - Superior: Teres minor - Lateral surgical neck of humerus
68
What are the contents of the quadrangular space
- Axillary artery - Posterior circumflex artery
69
Describe the blood supply to the rectum
Superior rectal artery – terminal continuation of the inferior mesenteric artery. Middle rectal artery – branch of the internal iliac artery. Inferior rectal artery – branch of the internal pudendal artery.
70
Describe the lymphatic drainage of the rectum
Mesorectal lymph nodes (superior to dentate line) Inguinal nodes (inferior to dentate line)
71
What is the most likely site of adulation of fluid after cholecystectomy (in supine position)?
Morison's pouch (hepatorenal recess/subhepatic recess)
72
Which nerve controls detrusor muscle
- Pelvic splanchnic nerves S2,3,4, - Also control internal urethral sphincter
73
Which line on an X-ray of the pelvis is most appropriate for the diagnosis of pelvic organ prolapse?
The pubococcygeal line is used to detect and grade pelvic organ prolapse on imaging X-rays of the pelvis. This line is drawn between the inferior margin of the pubic symphysis and the last coccygeal joint. It helps to assess the descent of pelvic organs and is an important reference in evaluating pelvic floor prolapse.
74
Which artery supplies the fundus of the stomach
- Short gastric arteries
75
Which arteries supplies the greater curvature of the stomach?
- Right gastroepiploic (brach of gastroduodenal branch of common hepatic) - Left gastroepiploic (branch of splenic)
76
Which artery supplies the body of the stomach?
- Left Gastric - Right gastric
77
Which blood vessels supplies the lesser curvature of the stomach
Left gastric: upper portion Right gastric: lower portion
78
Which blood vessel supplies the pylorus of the stomach
Right gastric artery gastroduodenal artery
79
Describe the causes of medial and lateral winging of the scapula
Long thoracic nerve palsy results in medial winging: serratus interior Spinal accessory winging results in lateral winging: trapezius
80
Where is Palmer's point and what is its significance?
- Located on the anterior abdominal wall 3 cm below left costal margin along the mid clavicular line - Point of entry for insufflation of pneumoperitoneum if umbilicus can't be used due to prior midline surgery
81
What is the landmark for safe injection of spinal anaesthetic
- Supracrestal line - Transverse line joining the highest points of the iliac crest at the level of L4
82
What lies laterally to 2nd part of duodenum
Hepatic flexure
83
What lies medially to 2nd part of duodenum
- head of pancreas
84
Which nerve is most likely to be affected by ablation of accessory heart pathways?
Right phrenic
85
Which tumour marker is specific to seminoma?
b-HCG - LDH can be raised in seminomas and non-seminomatous germ cell tumours
86
Which nerve roots is associated with nerve pain to the left shoulder
C3,4,5: irritation of phrenic nerve - Can be caused by irrigation of diagphragm due to carbon diaxide gas used for bowel insufflation
87
What sign is seen on X-Ray for duodenal atresia?
double-bubble sign
88
What is contained by the pudendal canal
- Internal pudendal artery - Internal pudendal vein - Pudendal nerve
89
What are the branches of the subclavian artery?
- Vertebral - Internal thoracic - Thyrocervical - Costocervical trunk - Dorsal scapular VIT C and D
90
What are the branches of the axillary artery
- Superior thoracic - Thoraco-acromial - Lateral thoracic - Subscapular - Anterior circumflex humeral - Posterior circumflex humeral SAL SAP/Screw The Lawyer Save A Patient
91
What layers are breeched in LP
- Skin => sib cut => supraspinous ligament => interspinous ligament => ligamentum flavum => epidoural space => dura => arachnoid
92
What is the pathophysiology thoracic outlet syndrome?
- Trapping of brachial plexus, subclavian artery and subclavian vein between collarbone and 1st rib
93
Which structures make up the cremaster muscle
cremaster muscle - Lateral muscle: Inguinal ligament - Medial muscle: internal oblique
94
What are the branches of the femoral artery
Mnemonic: Do Princesses Sew Sweet Superhero Dresses? - Descending genicular artery - Profunda femoris artery - Superficial epigastric - Superficial circumflex iliac - Superficial external pudendal - Deep external pudendal

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