Abdomen anatomy

Question 1

Blood supply to ureter

Answer 1

Segmental supply

Abdominal supply
1. Renal arteries
2. Gonadal arteries
3. Ureteric branches from aorta

Pelvic supply
-Superior and inferior vesical arteries (from internal iliac anterior division)

Question 2

Borders of lesser sac

Answer 2

Anterior: quadrate lobe of liver, lesser omentum, stomach, gastrocolic ligament

Posterior: Pancreas, left kidney, left adrenal gland

Superior: Superior recess lesser sac lies behind caudate lobe of liver

Inferior: Inferior recess of lesser sac lies between layers of greater omentum (superior part)

To the left: gastrosplenic, lienorenal ligament

To the right: Epiploic foramen (of wilmslow)

Question 3

Boundaries of epiploic foramen

Answer 3

Superior: caudate lobe of liver
Anterior: common hepatic artery, portal vein and common bile duct in free edge of lesser omentum
Posterior: IVC and crus of right diaphragm
Inferior: 1st part of duodenum

Question 4

What are the differences between the ileum and the jejunum?

Answer 4

jejunum: redder in colour, more prominent vasa recta, located in LUQ, thicker intestinal wall, less arcades
Ileum: pink, more arterial arcades and shorter vasa recta, located in RLQ

Question 5

Borders of inguinal canal

Answer 5

Roof: arching fibres of internal oblique and transversus abdominis
Anterior: aponeurosis of external oblique reinforced in lateral 1/3rd by fibres of internal oblique
Posterior: transversalis fascia, conjoint tendon medial 1/3rd
Floor: inguinal ligament reinforced in medial 1/3rd by lacunar ligament

Question 6

What is the conjoint tendon?

Answer 6

–> sheath of connective tissue
–> formed by lower part of common aponeurosis of internal oblique/transversus abdominis
–> forms posterior wall of inguinal canal medially

The conjoint tendon (previously known as the inguinal aponeurotic falx) is a sheath of connective tissue formed from the lower part of the common aponeurosis of the abdominal internal oblique muscle and the transversus abdominis muscle

Forms posterior wall inguinal canal medially

Question 7

Borders femoral ring

Answer 7

Anterior: inguinal ligament
Medial: lacunar ligament
Lateral: femoral vein
Posterior: pectineal ligament overlying superior ramus of pubis

Question 8

Blood supply to pancreas:

Answer 8

Neck, body and tail:
-Splenic artery- runs along superior margin and supplies neck, body and tail via its pancreatic branches

Head:
-Superior pancreaticoduodenal artery from gastroduodenal
-Inferior pancreaticoduodenal from SMA

Question 9

At what vertebral level does sma arise?

Answer 9

Lower border L1

Question 10

Name branches of SMA

Answer 10

Inferior pancreaticoduodenal
ileal and jejunal branches
middle colic
right colic
ileocolic

Question 11

Name branches of IMA

Answer 11

Left colic
Sigmoidal
Superior rectal

Question 12

Name the boundaries of hasselbach’s triangle

Answer 12

Medial: lateral border rectus abdominis
Lateral: inferior epigastric artery
Inferior: inguinal ligament

Question 13

Describe blood supply of rectum

Answer 13

Superior 1/3rd: superior rectal artery (IMA)
Middle 1/3rd: middle rectal artery (internal iliac anterior division)
Bottom 1/3rd: inferior rectal artery (from internal pudendal from internal iliac)

Question 14

Paired branches abdominal aorta

Answer 14

Inferior phrenic (T12)
Middle suprarenal (T12)
Lumbar arteries (L1-L4)
Renal (L1-L2)
Gonadal (L2)

Question 15

Name some anatomical sites of porto-systemic anastomoses, state the vessels

Answer 15

Rectal
–> Portal: superior rectal vein –> IMV
–> Systemic: Middle and inferior rectal veins

Oesophageal
-Portal: Oesophageal branches left gastric vein –> splenic vein
-Systemic: Oesophageal branches left azygous

Retroperitoneal:
–> Portal: colic veins
–> Systemic: retroperitoneal veins

Paraumbilical
–> Portal: portal veins of liver
–> Systemic: Veins of anterior abdominal wall

Question 16

Branches anterior division of internal iliac

Answer 16

3 urinary (umbilical, superior vesical, inferior vesical)
3 parietal (obturator, internal pudendal, inferior gluteal)
3 visceral (middle rectal, uterine, vaginal)

Question 17

Branches posterior division internal iliac

Answer 17

PILS
-Iliolumbar
-Lateral sacral
-Superior gluteal

Question 18

Where is superficial ring located?

Answer 18

Superior to pubic tubercle. V shaped defect in external oblique

Question 19

Where is deep ring located? What forms it?

Answer 19

-Above mid point of inguinal ligament (lateral to inferior epigastric vessels)
-Formed by transversalis fascia which invaginates to cover contents of inguinal canal.

Question 20

Where is the mid-inguinal point and what is the clinical significance?

Answer 20

Midway between pubic symphysis and asis. Femoral pulse palpated here

Question 21

What are the retroperitoneal organs?

Answer 21

Primarily:
-Kidneys
-Adrenal glands
-Rectum
-IVC
-Aorta
-Oesophagus

Secondarily
-2nd and 3rd parts duodenum
-Ascending and descending colon
-Pancreas (exceept tail)

Question 22

Which muscles form pelvic floor?

Answer 22

2 pubes + the others

Iliococcygeus, pubococcygeus, puborectalis (levator ani)
Coccygeus

Question 23

Innvervation to the pevlic floor

Answer 23

-Levator ani + coccygeus: S3 and S4 nerve roots
-Perianal muscles, external urethral sphincter + external anal sphincter: pudendal nerve
-Anal canal inferior to dentate line: inferior rectal nerves + pudendal nerve

Question 24

Layers abdominal wall midline laparotomy

Answer 24

Skin
Subcut fat
camper’s fascia
Scarpa’s fasica
linea alba
preperitoneal fat
parietal peritoneum

Question 25

Describe arterial supply to anterolateral abdominal wall

Answer 25

1. internal thoracic---> superior epigastric 2. External iliac ---> inferior epigastric, deep circuflex iliac 3. Femoral ---> superficial circumflex iliac ---> superficial epigastric

Question 26

At what vertebral level does abdominal aorta bifurcate?

Answer 26

Lower border L4

Question 27

Name anterior unpaired branches of abdominal aorta

Answer 27

Coeliac trunk sma ima

Question 28

At what vertebral level does coeliac trunk arise?

Answer 28

Lower border T12

Question 29

Name branches of coeliac trunk

Answer 29

Left gastric artery --> oesophageal branches Common hepatic --> Gastroduodenal (right gastroepiploic, superior pancreaticoduodenal) --> Hepatic artery proper (right gastric, right-->cystic and left hepatic) Splenic --> Left gastroepiploic (greater curvature of stomach) --> Short + posterior gastrics (Fundus and posterior stomach) --> Pancreatic branches (body and tail of pancreas)

Question 30

Where to left and right testicular veins drain?

Answer 30

Left: left renal vein right: directly into IVC Therefore left sided varicoceles are more common

Question 31

Constrictions of the ureter

Answer 31

Pelviureteric junction As it crosses iliac vessels at pelvic brim Vesicoureteric junction

Question 32

Describe blood supply to the stomach

Answer 32

Lesser curvature: left (coeliac trunk) and right gastric (hepatic artery proper) Greater curvature: left (splenic) and right (gastroduodenal) gastro-epiploic fundus and posterior: posterior and short gastric

Question 33

Structures at the transpyloric plane

Answer 33

Upper pole right kidney Right and left colic flexures Fundus of gallbladder Head of pancreas Pylorus of stomach 2nd Part of duodenum Formation of portal vein (joining smv and sv) D-J flexure SMA origin from aorta End of spinal cord in adults Hilum of spleen Hilum of kidney

Question 34

What are conents of spermatic cord?

Answer 34

Fascial coverings: External spermatic fascia, internal spermatic fascia, cremasteric fascia Arteries: Testicular artery, artery to vas deferens, cremasteric artery Nerves: Genital branch genitofemoral nerve, sympathetic nerve fibres, ilioinguinal nerve (lies outside spermatic cord) Other structures: pampiniform plexus, ductus deferens, lymphatics

Question 35

Abdominal wall layers: appendicectomy

Answer 35

Skin Subcut fat Campers Scarpas External oblique Internal oblique Transversus abdominis Transversalis fascia Preperitoneal fat Peritoneum

Question 36

Contents of inguinal canal in males and females

Answer 36

Round ligament in females Spermatic cord in males Ilioinguinal nerve both sexes

Question 37

What is the conjoint tendon?

Answer 37

-Formed from aponeurosis of internal oblique and transversus abdominis. -Forms medial part posterior wall inguinal canal The conjoint tendon (previously known as the inguinal aponeurotic falx) is a sheath of connective tissue formed from the lower part of the common aponeurosis of the abdominal internal oblique muscle and the transversus abdominis muscle

Question 38

What do the branches of proper hepatic artery supply??

Answer 38

Right gastric: supplies the pylorus and lesser curvature of the stomach. Right and left hepatic: divide inferior to the porta hepatis and supply their respective lobes of the liver. Cystic: branch of the right hepatic artery – supplies the gall bladder

Question 39

What do branches of gastroduodenal supply?

Answer 39

Right gastroepiploic: supplies the greater curvature of the stomach. Found between the layers of the greater omentum, which it also supplies. Superior pancreaticoduodenal: divides into an anterior and posterior branch, which supplies the head of the pancreas.

Question 40

Describe blood supply to adrenal gland

Answer 40

Superior adrenal artery – arises from the inferior phrenic artery Middle adrenal artery – arises from the abdominal aorta. Inferior adrenal artery – arises from the renal arteries.