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Phase 1b - Revision > Abdomen, Pelvis and Perineum Revision > Flashcards

Abdomen, Pelvis and Perineum Revision Flashcards

1
Q

Name the green part.

A

Central Nervous System

Brain + Spinal Cord

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2
Q

Define the green part.

A

Neurons start and end in brain/ spinal cord

Central Nervous System

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3
Q

Name the pink part.

A

Peripheral Nervous System

Cranial nerves + Spinal nerves

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4
Q

Define the green part.

A

Cell bodies in CNS but axons leave CNS OR Cell bodies outside CNS

Peripheral Nervous System

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5
Q

What is the function of the PNS?

A

Conveying information to and from the CNS

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6
Q

How many pairs of cranial nerves are there?

A

12 pairs

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7
Q

What is the function of the cranial nerves?

A

Innervation of the head and neck (mostly)

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8
Q

What is the composition of the cranial nerves?

A

Motor, sensory or mixed (including parasympathetics)

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9
Q

How many pairs of spinal nerves are there?

A

31 pairs

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10
Q

What is the function of the spinal nerves?

A

Take somatic and visceral information to / from spinal cord

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11
Q

What is the composition of the spinal nerves?

A

Always mixed nerves (motor and sensory info)

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12
Q

What are plexuses?

A

Mixing of fibers to create terminal branches containing fibers from different cranial and spinal nerves

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13
Q

What is the function of plexuses?

A

Compensation and protection

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14
Q

What are the 2 functional divisions of the nervous system?

A
  • Somatic nervous system
  • Visceral nervous system
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15
Q

What is the efferent function of the somatic nervous function?

A
  • Innervates structures derived from the somites namely skeletal muscle and skin
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16
Q

What is the afferent function of the somatic nervous system?

A
  • Responds to information from the external environment
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17
Q

What is the efferent function of the visceral nervous system?

A
  • Innervates the viscera namely smooth muscle, cardiac muscle and glands
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18
Q

What is the afferent function of the visceral nervous system?

A
  • Responds to information from the internal environment
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19
Q

What is the difference between the visceral and autonomic nervous system?

A
  • Autonomic nervous system is a division underneath the visceral nervous system.
    • Autonomic nervous system is purely motor in function (efferent)
    • Visceranl nervous system involves both efferent and afferent neurones (umbrella)
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20
Q

What is the autonomic system divided into?

A
  • Sympathetic
  • Parasympathetic
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21
Q

Where does the sympathetic nervous system (fight or flight) originate?

Also known as thoracolumbar outflow

A

T1 - L2

Forms sympathetic chain to reach cervical and sacral areas of the body

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22
Q

Where does the parasympathetic nervous system originate?

A
  • CNIII
  • CNVII
  • CNIX
  • CNX
  • S2 - S4
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23
Q

How does the structure of the spinal cord differ at the points where the visceral nervous system originates?

A
  • Little lateral horn present, beside the ventral and dorsal horn
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24
Q

What path do the sympatehtic neurones follow in the spinal cord?

A
  • Preganglionic cell bodies are in lateral horn of spinal cord between T1-L2
  • Leave spinal cord via anterior horn and anterior root to enter T1-L2 spinal nerve
  • Enter the sympathetic chain from here via white and grey rami communicantes
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25
Q

Give 5 functions of the sympathetic nervous system (fight or flight) (8).

A
  • Increases heart rate
  • Bronchodilation
  • Vasodilation of skeletal muscle
  • Vasodilation of skin
  • Piloerection of hairs on skin
  • Sweating
  • Dilation of pupils (mydriasis)
  • Ejaculation (shoot)
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26
Q

Give 5 functions of the parasympathetic nervous system (rest & digest) (7).

A
  • Decreases heart rate
  • Bronchoconstriction
  • Increase blood flow to viscera
  • Increase peristalsis of GIT
  • Secretion from accessory glands of GIT
  • Constriction of pupils (miosis)
  • Erection (point)
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27
Q

What are the sympathetic splanchnic nerves?

A

Bundles of sympathetic nerve fibers innervating the viscera

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28
Q

Name the sympathetic splanchnic nerves.

A
  • Greater splanchnic nerves
  • Lesser splanchnic nerves
  • Least splanchnic nerves
  • Lumbar splanchnic nerves
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29
Q

At what level does the greater splanchic nerve originate?

A

T5 - T9

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30
Q

At what level does the lesser splanchic nerve originate?

A

T10 - T11

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31
Q

At what level does the least splanchic nerve originate?

A

T12

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32
Q

At what level does the lumbar splanchic nerve originate?

A

L1 - L2

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33
Q

What is the function of the splanchnic nerves?

A

Travel towards the aorta and mix with parasympathetic neres to form visceral plexuses to supply abdominal and pelvic organs

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34
Q

What is the pelvic splanchnic nerve?

A

The parasympathetic nervous system originating in S2-S4

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35
Q

Name the prevertbral plexuses (4).

A
  • Celiac plexus
  • Aortic plexus
  • Superior hypogastric plexus
  • Inferior hypogastric plexus
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36
Q

What makes up the prevertabral plexuses?

A
  • Greater splanchinc nerve
  • Vagus nerve
  • Pelvic splachnic nerve
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37
Q

Name structure 1.

A

Celiac ganglion

Nerves innervating the foregut originate here.

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38
Q

Name structure 2.

A

Aorticorenal ganglion

Nerves innervating the aorta and the kidneys originate here.

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39
Q

Name structure 3.

A

Superior mesenteric ganglion

Nerves innervating the foregut originate here.

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40
Q

Name structure 4.

A

Inferior mesenteric ganglion

Nerves innervating the hindgut originate here.

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41
Q

What is the hypogastric nerve?

A

The continuation of the prevertebral plexus in the pelvic region.

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42
Q

What are the limits of the foregut?

A
  • From the abdominal oesophagus to the major duodenal papilla
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43
Q

What major structures are found in the foregut (5)?

A
  • Stomach
  • Liver
  • Spleen
  • Pancreas
  • Gallbladder
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44
Q

What is main sympathetic innervation of the foregut?

A
  • Greater splanchnic nerve (T5-T9) via the coeliac ganglion
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45
Q

What is main parasympathetic innervation of the foregut?

A
  • Vagus nerve via the coeliac ganglion
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46
Q

Where does foregut pain refer to?

A

Lower thorax and epigastric region

T5 - T9

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47
Q

What are the limits of the midgut?

A

From the major duodenal papilla to the final 2/3s of the transverse colon

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48
Q

What major structures are found in the midgut (4)?

A
  • Jejunum
  • Ileum
  • Caecum
  • Appendix
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49
Q

What is main sympathetic innervation of the midgut?

A
  • Lesser splanchnic nerve (T10-T11) via the aorticorenal and superior mesenteric ganglia
50
Q

What is main parasympathetic innervation of the midgut?

A
  • Vagus nerve via the aorticorenal and superior mesenteric ganglia
51
Q

Where does midgut pain refer to?

A

Umbilical region

T9 - T10

52
Q

What are the limits of the hindgut?

A
  • From the final 1/3 of the transverse colon to the superior rectum
53
Q

What major structures are found in the hindgut (2)?

A
  • Descending colon
  • Sigmoid colon
54
Q

What is main sympathetic innervation of the hindgut?

A
  • Lumbar splanchnic nerve (L1-L2) via the inferior mesenteric ganglion
55
Q

What is main parasympathetic innervation of the hindgut?

A
  • Pelvic splanchnic nerves (S2-S4) (Fibers travel upwards from the inferior hypogastric plexus to the inferior mesenteric ganglion)
56
Q

Where does hindgut pain refer to?

A
  • Pubic region
  • Lateral & anterior thighs
  • Groin

L1 - L2

57
Q

What nerves innervate the kidneys?

A
  • Sympathetic input from lesser and least splanchnic nerves via the renal plexus which receives input from the coeliac and aorticorenal ganglia

Sympathetic input only.

58
Q

Where does pain in the kidneys refer to?

A

Flanks (lateral region)

T12

59
Q

What nerves innervate the ureters?

A
  • The ureters take their innervation from different locations as they move down the abdomen into the pelvis: renal, aortic, superior and inferior hypogastric plexuses (T11 - L2)
60
Q

What nerves innervate the adrenal gland?

A
  • Presynaptic fibers from the greater splanchnic nerve (T5-T9) travel via the renal plexus to the adrenal medulla

Sympathetic input only.

61
Q

What is the effect of sympathetic innervation of the adrenal medulla?

A
  • Presynaptic fibers synapse on chromaffin cells (modified postganglionic sympathetic neurons)
  • Chromaffin cells release adrenalin and noradrenalin in response to sympathetic input
62
Q

What is the innervation of the parietal peritoneum?

A
  • Innervated by the somatic nervous system
63
Q

What is the effect of the innervation of the parietal peritoneum when it comes to pain referral?

A
  • Pain very well localized and sharp
64
Q

What is the innervation of the visceral peritoneum?

A
  • Innervated by the visceral nervous system
65
Q

What is the effect of the innervation of the visceral peritoneum when it comes to pain referral?

A
  • Pain poorly localized, often referred, and dull
66
Q

The inferior hypogastric plexus gives rise to 4 plexuses that innervate the pelvic organs. Name them.

A
  • Rectal plexus
  • Uterovaginal plexus
  • Prostatic plexus
  • Vesical plexus
67
Q

Where does the cavernous

A
68
Q

Where does the cavernous nerve (supply the erectile tissue) originate?

A

Inferior hypogastric plexus

69
Q

What is the sympathetic function of the inferior hypogastric (pelvic) plexus (3)?

A
  • Constriction of smooth muscle of internal urethral sphincter & internal anal sphincter
  • Smooth muscle contraction of the reproductive organs and accessory organs
  • Moving secretions from epididymis and accessory glands during ejaculation
70
Q

What is the parasympathetic function of the inferior hypogastric (pelvic) plexus (4)?

A
  • Usually vasodilatory (think erection)
  • Contraction of the bladder
  • Stimulate erection
  • Innervation of the hindgut
71
Q

What is the somatic sensory innervation of the perineum?

A
  • S3-S5 spinal levels mostly via the pudendal nerve
72
Q

What is the somatic motor (skeletal muscle) innervation of the perineum?

A
  • S2-S4 spinal levels via the pudendal nerve
73
Q

When incising the anterior abdominal wall (3cm lateral from the midline), what layers do we cut through before reaching the peritoneal cavity? How does this differ above and below the level of the umbilicus? How does this differ if we cut directly at the midline?

A
  • Above umbilicus: Skin -> superficial fascia -> Anterior rectus sheath -> rectus abdominis -> posterior rectus sheath-> transversalis fascia -> parietal peritoneum
  • Below umbilicus: Skin -> superficial fascia -> Anterior rectus sheath -> rectus abdominis -> transversalis fascia -> parietal peritoneum
  • At the midline above umbilicus: Skin -> superficial fascia -> linea alba-> rectus abdominis -> posterior rectus sheath-> transversalis fascia -> parietal peritoneum
  • At the midline below umbilicus: Skin -> superficial fascia -> linea alba-> rectus abdominis -> transversalis fascia -> parietal peritoneum
74
Q

When incising the lateral abdominal wall, what layers do we have to cut through before reaching the peritoneal cavity?

A

Skin -> superficial fascia -> external oblique muscle-> internal oblique muscle-> transversus abdominis muscle-> transversalis fascia -> parietal peritoneum

75
Q

How can you identify between the external oblique, internal oblique and transversus abdominis muscles? What is the difference between their muscle fibre direction?

A

External is most superficial, transversus is most deep of these muscles. External oblique fibres run inferomedially, internal oblique fibres run perpendicular (the same as the intercostal muscles!). Transversus abdominis fibres run horizontally as the name suggests.

76
Q

With your demonstrator discuss the formation of the rectus sheath from the aponeuroses of the lateral sheet muscles. Which layers of aponeuroses form the anterior rectus sheath and posterior rectus sheath? How does this differ above and below the level of the umbilicus?

A

Above the umbilicus the rectus abdominis is covered anteriorly and posteriorly by the rectus sheath. Below the level of the umbilicus the rectus abdominus is only covered on its anterior surface by the rectus sheath. Above the umbilicus the anterior rectus sheath is formed by the external and internal aponeuroses, and the posterior rectus sheath is formed by the internal and transversus aponeuroses. Below the level of the umbilicus the anterior rectus sheath is formed by the aponeuroses of the external, internal and transversus aponeuroses and there is no posterior rectus sheath.

77
Q

What can you see exiting the superficial inguinal ring in the cadaver at your station? How would this differ between sexes?

A

Either a spermatic cord or round ligament depending on male or female sex of the cadaver. The spermatic cord is a much larger structure and so leaves a larger more obvious defect in the superficial inguinal ring.

78
Q

Describe the difference between the mid-inguinal point and midpoint of the inguinal ligament from the diagram below:

A

Mid-inguinal point is midway between the pubic symphysis and the ASIS. Mid-point of the inguinal ligament is midway between the pubic tubercle and the ASIS. The deep inguinal ring is located at mid-inguinal point, whereas the femoral artery can be palpated at the midpoint of the inguinal ligament.

79
Q

What are the main anatomical differences between the small and large intestine?

A

Large intestine has teniae coli, haustra, omental appendices, has a larger lumen and fewer folds in the mucosa. The small intestine has one large mesentery meaning is it not fixed unlike the retroperitoneal ascending and descending colon. The small intestine has permanent folds (plicae circularis) on its internal walls.

80
Q

What is the clinical significance of the teniae coli?

A

Allow for the identification of the colon in certain imaging techniques such as MRI and identification for the beginning of the rectum as the teniae fuse and disappear to form a circular band of muscle around the rectum.

81
Q

What is a hiatus hernia? Why can it predispose patients to oesophageal cancer?

A

The cardiac region of the stomach pushes through the oesophageal hiatus in the diaphragm and into the thorax. This can cause gastro-oesophageal reflux and expose the cells of the oesophagus to stomach acid. Overtime, the cells of the oesophagus may change from squamous to columnar epithelium and predisposes the person to adenocarcinoma.

82
Q

Where would early, visceral pain from sigmoid colon refer to?

A

The sigmoid colon is a hindgut structure therefore early visceral pain would refer to the suprapubic region.

83
Q

Why does pain from appendicitis begin as a dull pain in the umbilical region and migrate to a sharp, searing pain in the right iliac region?

A

In early appendicitis, only the visceral peritoneum covering the appendix is affected, this pain is dull and poorly localised. It refers to the umbilical region because the appendix is a midgut structure. Later, if the disease progresses, the appendix may distend or rupture and irritate the parietal peritoneum in the area. This pain is very sharp and well localised to the part of skin directly overlying the site of the appendix in the right iliac region of the abdomen.

84
Q

Early pain from the structure indicated by the arrow would refer to which region of the anterior abdominal wall?

A

Umbilical region

85
Q

Identify the structure indicated by the arrow.

A

Pylorus of stomach

86
Q

Please select the correct statement:
1. The superior epigastric artery continues from the internal thoracic artery
1. The inferior epigastric artery is a branch from the common iliac artery
1. The superior epigastric artery is a direct branch from the abdominal aorta
1. The superior epigastric artery and inferior epigastric artery do not anastomose with each other

A

The superior epigastric artery continues from the internal thoracic artery

87
Q

Direct inguinal hernias occur in the anterior abdominal wall towards the medial end of the inguinal ligament. In what layer of the anterior abdominal wall is the weakening which allows the bowel to protrude through the anterior abdominal wall?

A

Transversalis fascia

This is the deepest layer before the parietal peritoneum. In the inguinal triangle region, there is very little supporting layers to the anterior abdominal wall, meaning the bowel may protrude through weakened transversalis fascia.

88
Q

Direct inguinal hernias occur in the anterior abdominal wall towards the medial end of the inguinal ligament. In what layer of the anterior abdominal wall is the weakening which allows the bowel to protrude through the anterior abdominal wall?

A

Transversalis fascia

This is the deepest layer before the parietal peritoneum. In the inguinal triangle region, there is very little supporting layers to the anterior abdominal wall, meaning the bowel may protrude through weakened transversalis fascia.

89
Q

What part of the peritoneum is indicated by the arrow?

A

Parietal peritoneum

90
Q

Select the true statement about the following structure:
* It is the tail of the pancreas and is intraperitoneal
* It is the tail of the pancreas and is retroperitoneal
* It is the uncinate process of the pancreas and is intraperitoneal
* It is the uncinate process of the pancreas and is retroperitoneal

A

It is the tail of the pancreas and is intraperitoneal

91
Q

The structure indicated by the arrow is supplied by which major branch of the abdominal aorta?

A

SMA

92
Q

Identify the structure indicated by the arrow.

A

Falciform ligament

93
Q

Pain from the structure indicated refers to which region of the abdomen?

A

Epigastric and right hypochondrium

94
Q

Select the false statement about the structure indicated by the arrow:
1. It is formed by the union of the superior mesenteric vein and the splenic vein
1. It brings blood to the liver from all of the abdominal organs
1. It is the hepatic portal vein
1. It enters the liver at the porta hepatis alongside the hepatic artery proper

A

It brings blood to the liver from all of the abdominal organs

95
Q

The broad ligament is:
1. is the broad ligament attached to and running posterior to the ovaries.
1. the muscular layer within the wall of the uterus.
1. a sheet of peritoneum lying over the uterus and uterine tubes, and posteriorly suspending the ovaries.
1. the large area of broad ligament associated with the uterus.
1. the broad ligament associated with and encasing the uterine tubes.
1. the innermost lining of the uterus.

A

a sheet of peritoneum lying over the uterus and uterine tubes, and posteriorly suspending the ovaries.

96
Q

The endometrium ligament is:
1. is the broad ligament attached to and running posterior to the ovaries.
1. the muscular layer within the wall of the uterus.
1. a sheet of peritoneum lying over the uterus and uterine tubes, and posteriorly suspending the ovaries.
1. the large area of broad ligament associated with the uterus.
1. the broad ligament associated with and encasing the uterine tubes.
1. the innermost lining of the uterus.

A

the innermost lining of the uterus.

97
Q

The mesometrium ligament is:
1. is the broad ligament attached to and running posterior to the ovaries.
1. the muscular layer within the wall of the uterus.
1. a sheet of peritoneum lying over the uterus and uterine tubes, and posteriorly suspending the ovaries.
1. the large area of broad ligament associated with the uterus.
1. the broad ligament associated with and encasing the uterine tubes.
1. the innermost lining of the uterus.

A

the large area of broad ligament associated with the uterus.

98
Q

The myometrium ligament is:
1. is the broad ligament attached to and running posterior to the ovaries.
1. the muscular layer within the wall of the uterus.
1. a sheet of peritoneum lying over the uterus and uterine tubes, and posteriorly suspending the ovaries.
1. the large area of broad ligament associated with the uterus.
1. the broad ligament associated with and encasing the uterine tubes.
1. the innermost lining of the uterus.

A

the muscular layer within the wall of the uterus.

99
Q

The mesovarium ligament is:
1. is the broad ligament attached to and running posterior to the ovaries.
1. the muscular layer within the wall of the uterus.
1. a sheet of peritoneum lying over the uterus and uterine tubes, and posteriorly suspending the ovaries.
1. the large area of broad ligament associated with the uterus.
1. the broad ligament associated with and encasing the uterine tubes.
1. the innermost lining of the uterus.

A

the broad ligament attached to and running posterior to the ovaries.

100
Q

The mesosalpinx ligament is:
1. is the broad ligament attached to and running posterior to the ovaries.
1. the muscular layer within the wall of the uterus.
1. a sheet of peritoneum lying over the uterus and uterine tubes, and posteriorly suspending the ovaries.
1. the large area of broad ligament associated with the uterus.
1. the broad ligament associated with and encasing the uterine tubes.
1. the innermost lining of the uterus.

A

the broad ligament associated with and encasing the uterine tubes.

101
Q

Which artery gives rise to those supplying the region of the stomach indicated by the arrow?

A

Splenic artery

102
Q

Identify precisely the structure indicated by the arrow.

A

Tail of the pancreas

103
Q

Where do postganglionic neurons innervating the structure indicated by the arrow originate?

A

Superior mesenteric plexus

104
Q

Identify the structure indicated by the arrow.

A

Transverse mesocolon

105
Q

The ventral ramus of which spinal nerve is indicated by the arrow?

A

T10

106
Q

From what does the vessel indicated by the arrow originate?

A

Gastroduodenal artery

107
Q

What structure Indicated by the arrow?

A

Left renal pelvis

108
Q

What is the structure indicated by the arrow the expanded distal end of?

A

Corpus spongiosum

109
Q

What precisely does the structure indicated by the arrow surround?

A

Right crus of penis

110
Q

A 23 year old male visited the GP complaining of a painful swelling in their left groin; they had vomited 4 times in the last 3 hours.

Where is the pathology located?

A
111
Q

A 23 year old male visited the GP complaining of a painful swelling in their left groin; they had vomited 4 times in the last 3 hours.

What is the most likely diagnosis from the information we have so far?
* Early appendicitis
* Stomach ulcer
* Inguinal hernia
* Gallstones

A

Inguinal hernia

112
Q

A 23 year old male visited the GP complaining of a painful swelling in their left groin; they had vomited 4 times in the last 3 hours.

What are the 5 steps (in order) of abdominal physical examination?

A
  • Inspection
  • Light palpation
  • Deep palpation
  • Percussion
  • Auscultation
113
Q

A 23 year old male visited the GP complaining of a painful swelling in their left groin; they had vomited 4 times in the last 3 hours.

On examination the patient was dehydrated and the abdomen was moderately distended. A large tense swelling, which was very tender on palpation was present in the left groin and extended down in the scrotum. An attempt to push the contents of the swelling back into the abdomen was impossible.

What is the most likely diagnosis from the information we have so far?
* Early appendicitis
* Direct inguinal hernia
* Ruptured appendix
* Indirect inguinal hernia

A

Indirect inguinal hernia

114
Q

A 23 year old male visited the GP complaining of a painful swelling in their left groin; they had vomited 4 times in the last 3 hours.

On examination the patient was dehydrated and the abdomen was moderately distended. A large tense swelling, which was very tender on palpation was present in the left groin and extended down in the scrotum. An attempt to push the contents of the swelling back into the abdomen was impossible.

Which layer of the abdominal wall is continuous with the creamster muscle of the scrotum?

A

Internal oblique muscle

115
Q

A 23 year old male visited the GP complaining of a painful swelling in their left groin; they had vomited 4 times in the last 3 hours.

On examination the patient was dehydrated and the abdomen was moderately distended. A large tense swelling, which was very tender on palpation was present in the left groin and extended down in the scrotum. An attempt to push the contents of the swelling back into the abdomen was impossible.

Which one of these structures does not travel in the spermatic cord?
* Testicular artery
* Testicular vein
* Genitofemoral nerve
* Ilioinguinal nerve
* Ductus deferens

A

Ilioinguinal nerve

116
Q

A 23 year old male visited the GP complaining of a painful swelling in their left groin; they had vomited 4 times in the last 3 hours.

On examination the patient was dehydrated and the abdomen was moderately distended. A large tense swelling, which was very tender on palpation was present in the left groin and extended down in the scrotum. An attempt to push the contents of the swelling back into the abdomen was impossible.

In which layer of the abdominal wall is the deep inguinal ring located?

A

Transversalis fascia

117
Q

A 39 year old man was referred to Ambulatory Care by his GP with severe and acute onset left sided abdominal pain.

You discover that the patient has left-sided abdominal pain that has started near the inferior angle of the scapula but has now moved to the left groin region.

The pain is constant, with regular waves of increasedintensity.
No fever but sweating.
No change in bowel habit, but reduced appetite, with nausea and vomiting.
Slight dysuria and need to urinate more frequently.

What are the 7 steps (in order) of abdominal physical examination?

A
  • Inspection
  • Light palpation
  • Deep palpation
  • Palpation of the liver edge and spleen
  • Balloting the kidneys
  • Percussion
  • Auscultation
118
Q

A 39 year old man was referred to Ambulatory Care by his GP with severe and acute onset left sided abdominal pain.

You discover that the patient has left-sided abdominal pain that has started near the inferior angle of the scapula but has now moved to the left groin region.

The pain is constant, with regular waves of increasedintensity.
No fever but sweating.
No change in bowel habit, but reduced appetite, with nausea and vomiting.
Slight dysuria and need to urinate more frequently.

What is the most likely diagnosis?

A

Urinary tract stones

119
Q

A 39 year old man was referred to Ambulatory Care by his GP with severe and acute onset left sided abdominal pain.

You discover that the patient has left-sided abdominal pain that has started near the inferior angle of the scapula but has now moved to the left groin region.

The pain is constant, with regular waves of increasedintensity.
No fever but sweating.
No change in bowel habit, but reduced appetite, with nausea and vomiting.
Slight dysuria and need to urinate more frequently.

What would be the gold standard imaging to get the diagnosis?

A

Non contrast computer tomography (NC-CT)

120
Q

A 39 year old man was referred to Ambulatory Care by his GP with severe and acute onset left sided abdominal pain.

You discover that the patient has left-sided abdominal pain that has started near the inferior angle of the scapula but has now moved to the left groin region.

The pain is constant, with regular waves of increasedintensity.
No fever but sweating.
No change in bowel habit, but reduced appetite, with nausea and vomiting.
Slight dysuria and need to urinate more frequently.

What is the most likely site for a urinary tract stone to be stuck?

A
  • Where the renal pelvis narrows to become the ureter (uretopelvic junction UPJ)
  • Where the ureter crosses the pelvic brim and is kinked by the common iliac artery
  • Where the ureter enters the bladder at an oblique angle (vesicouerteric junction VUJ)

Phase 1b - Revision (11 decks)

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