Flashcards in Abdomen3 Deck (67):
Occlusion of the inferior mesenteric artery is seldom symptomatic because its territory may be supplied by branches of the:
The presence of which feature (also obvious on a radiograph with barium contrast) distinguishes small from large bowel?
Circular folds of the mucosa
Circular smooth muscle layer in the wall
Longitudinal smooth muscle layer in the wall
Circular Folds of the mucosa
Which of the following veins does not run a course parallel to the artery of the same name?
superficial circumflex iliac
During development of the gut:
the sigmoid colon is retroperitoneal
the inferior mesenteric artery is the axis for rotation of the midgut loop
the stomach rotates around its longitudinal axis causing the ventral border to become the greater curvature
the liver is non-functional
none of the above
None of the above
None of the statements about development are correct. During development, structures that are peritonealized become retroperitoneal when they are pressed against the body wall and stay there. Structures do not start out retroperitoneal and become peritonealized later. Since the sigmoid colon is peritonealized in the adult, it has not and will not ever be retroperitoneal. The superior mesenteric artery is the axis for rotation of the midgut loop. This should make sense, since the SMA supplies the midgut. When the stomach rotates, the ventral border becomes the lesser curvature. Finally, the liver is functional in the fetus - it is an early site for the formation of erythrocytes.
surgical maneuver which takes advantage of the avascular plane of fusion fascia can be applied to mobilize all of the organs below, except the:
The spleen normally does not descend below the costal margin. However, it pushes downward and medially when pathologically enlarged. What structure limits the straight vertical downward movement?
Left colic flexure
Left suprarenal gland
Ligament of Treitz
Left Colic Flexure
In the diaphragm, which copular is raised higher? Why?
- due to the Liver
What is the central region of the diaphragm called? What inserts here?
Central Tendon of the diaphragm
- the opening for the IVC
What nerves supply the diaphragm?
What 3 areas does the diaphragm originate from?
1. Sternal Part: XIPHOID PROCESS
2. 6 lower costal cartilages
3. Vertebral & Lumbar part: 2 crura & 5 ligaments
Which crus is longer, left or right? Where do they attach?
RIGHT is larger, longer and stronger
- RIGHT = body of L3
Left = body of L2
Which ligament forms the aortic hiatus? Which ligament is formed by the Psoas major? By the Quadrates Lumborum?
1. Aortic Hiatus = Median Arcuate Ligament
2. Psoas Major = MediaL Arcuate Ligament
3. Quad L. = Lateral Arcuate Lig.
What are the 3 structures that travel through the openings of the diaphragm? What Thoracic level do they pierce the diaphragm at?
1. IVC = T8 --> central tendon
2. Esophagus = T10 --> muscular part of diaphragm (right crus)
3. Abdominal Aorta = T12 --> between the two crura
What is the only structure to travel through the muscular part of the Diaphragm?
Esophogus --> through Esophageal Opening
What ligament forms the Aortic Hiatus?
Median Arcuate Ligament
The Lumbar plexus is formed inside which muscle of the posterior abdomen? It is the union of what?
1. PSOAS MAJOR MUSCLE
2. Union of upper 3 lumbar nerves and part of 4th lumbar
What 3 nerves run in FRONT of quadratus lumborum? What lumbar nerves do they originate from? Which of these 3 nerves runs through the superficial inguinal ring?
1. Subcostal = T12
2. Iliohypogastric = L1
3. Ilioinguinal = L1
ILIONGUINAL! - accompanies spermatic cord/round ligament
Which nerve emerges on the front of PSOAS MAJOR muscle? What Lumber nerve is it?
The genital branch of Genitofemoral Nerve (L1,L2) supplies which muscle? Is it in the deep or superficial inguinal ring?
CREMASTER muscle (of internal oblique)
What nerve is on the lateral border of Psoas Major? Medial border? What branch of the Lumbar Plexus are they?
1. Lateral = Femoral Nerve --> L2,L3, L4
2. Medial = Obturator Nerve --> L2,L3,L4
What nerve travels on top of Iliacus muscle?
Lateral Femoral Cutaneous
What branch of the lumbar plexus are the following nerves
5. Lateral Femoral Cutaneous
1. Subcostal --> T12
2. Iliohypogastric --> L1
3. Ilioinguinal -->L1
4. Genitofemoral --> L1,L2
5. Lateral Femoral Cutaneous --> L2, L3
6. Femoral --> L2,L3, L4
7. Obturator --> L2, L3, L4
What two nerves supply internal oblique & transverses abdominus?
Ilioinguinal & Iliohypogastric
What nerve innervates the ADDUCTOR compartment of the thigh?
What nerve innervates Iliacus Muscle?
What are the layers of the posterior abdominal wall?
1. Bony Layer --> iliac bone, lumbar vertebrae, last 2 ribs
2. Muscles (Psoas Major/Minor, Iliacus, Quad Lumborum)
3. Fascia (Psoas fascia, Iliac, & Thoracolumbar Fascia )
4. Visceral Layer (kidneys, ureters, suprarenal glands)
5. Partial peritoneal Layer
1. Iliac Fossa
2. Lesser Trochanter of FEMUR
3. FLEXION OF THE HIP (along with Psoas Major)
4. FEMORAL NERVE**
1. Transverse process of L1-L5
2. LESSER TROCHANTER (w/ iliacus)
3. FLEXES HIP w/ Iliacus
4. Anterior primary rami of L1,2
1. Bodies of T12 and L1
2. Fascia over psoas major and iliacus
3. Weak flexor of trunk (flex pelvis)
4. Anterior primary rami of L1
1. Inferior border of 12th rib
2. ILIOLUMBAR ligament
3. Extend/ FLex VERTEBRAL COLUMN
4. Anterior primary rami (T12-L3)
What retroperitoneal organ lies opposite T12 - L3?
Which kidney is lower? Which rib is the left & right kidney related to?
RIGHT kidney is lower
Right = rib 12
Left = rib 11 & 12
What is the arrangement of the hilum of the kidney from anterior to posterior?
1. Renal Vein
2. Renal Artery (behind)
3. Pelvic Ureter*
What are the major structures of the Kidney?
2. Medulla - 8-12 renal pyramids
- base = papilla --> opens into MINOR CALYX
3. Minor Calyces - receive ruin from collecting tubules
4. Major Calyces
5. Renal Pelvis of the Ureter
What lumbar level do the renal arteries arise from to supply blood to the kidney?
Which renal artery is longer and passes posteriorly to IVC?
Right Renal artery*
Which renal VEIN is longer?
The left renal vein receives what 3 veins? How is the right side different?
1. Left Suprarenal Vein
2. Left Gonadal Vein
3. Hemi-Azygos vein
Right Suprarenal & Gonadal Veins = directly off IVC***
What organ is crossed anteriorly by the Gonadal Vessels & crosses the bifurcation of the Common Iliac Artery?
- retroperitoneal organ
- muscular tube
- from renal pelvis to urinary bladder
What are the 3 common sites of constriction of the urinary bladder?
1. Uretero-pelvic Junction (joins renal pelvis)
2. Pelvic Inlet (over common iliac artery)
3. Ureterovesicular Junction (enters wall of the urinary bladder)
What retroperitoneal gland secretes epinephrine & noreinephrine, and 3 types of steroid hormones & medulla?
- RIGHT = pyramidal
LEFT = Semilunar
Where does the suprarenal gland lie?
Superomedial Pole of the Kidney
What 3 arteries supply the suprarenal glands? What are they branches of?
1. Superior Suprarenal = INFERIOR PHRENIC
2. Middle Suprarenal = off Abdominal AORTA**
3. Inferior Superarenal = RENAL ARTERY
What level does the abdominal aorta bifurcate into the left and right common Iliac Arteries?
What are the 3 unpaired, VISCERAL branches that originate from the anterior midline of the AORTA?
1. Celiac - T12 (foregut)
2. SMA - L1 (midgut)
3. IMA - L3 (Hindgut)
What are the 3 PAIRED, VISCERAL branches that originate from the lateral aspect of the AORTA?
1. Suprarenal (L1)
2. Renal (L1)
3. Gonadal (L2)
What are the 3 PAIRED, PARIETAL branches that originate from the postero-lateral aspect of the AORTA?
1. Subcostal (T12)
2. Inferior Phrenic (T12)
3. Lumbar (L1-L4)
What is Cisterna Chyli?
Where does the thoracic duct drain into?
lower dilated lymphatic sac at the end of the thoracic duct
- right & posteror to the AORTA
* DRAINS INTO THE JUNCTION OF LEFT SUBCLAVIAN & INTERNAL JUGULAR VEINS
The Splanchnic Symphatics are pre-vertebral or para-vertebral?
Greater - T5-T9
Lesser - T10-T11
Least - T12
What nerve is found under Transverses Abdominus?
What two muscles both insert onto the lesser trochanter of the femur but have different nerve supply?
& Psoas Major
Which muscle attaches to the subcostal rib & assists in respiration?
What separates the thorax & abdomen?
What s the only opening in the muscular part of the diaphragm?
- rest are protected by tendons
What is the only nerve to touch the ASIS
Where does the left gonadal vein drain from?
Which artery becomes the Femoral Artery once it crosses the inguinal Ligament?
At the pelvic inlet (2nd constriction), the ureter is crossing what structure?
Common Iliac of Aorta
A football player presented to the ER with a tear in the psoas major muscle. Which nerve emerges from the anterior surface of the muscle is most likely will be injured?
A) Femoral nerve
B) Genitofemoral nerve
C) Obturator nerve
D) Iliohypogastric nerve
E) Ilioinguinal nerve
A 43 year old woman with known kidney disease presents to the hospital because her pain has become more severe. A physician performing kidney surgery must remember that:
A) Left kidney lies a bit lower than the right one.
B) Renal fascia doesn’t surround the suprarenal gland.
C) Left renal vein runs anterior to aorta & Lt. renal A.
D) Left gonadal vein drains in IVC.
E) Perirenal fat lies external to the renal fascia
C) Left renal Vein runs anterior to aorta & Left Renal Artery**
A 55 year old man admitted to the ER complaining of adrenal ischemia which is due to occlusion of its blood supply. Which of the following arteries supplies the adrenal gland?
A) Lumbar arteries
B) Renal arteries
C) Inferior mesenteric arteries
D) Gonadal arteries
E) Inferior epigastric arteries
B) Renal Arteries
The inferior vena cava & the right phrenic nerve pass through the diaphragm at which of the following levels?
The lateral arcuate ligaments are formed from thickenings from which of the following muscle fasciae?
A) Psoas major
B) Rectus abdominis
C) Transversus abdominis
D) Internal oblique
E) Quadratus Lumborum
E) Quadratus Lumborum
What are the structures found within the EpiploiC Foramen?
1. Hepatic Artery
2. Bile Duct
3. Portal Vein (posterior)
Ligamentum Teres is the obliterated _____
Left Umbilical Vein
What gives Vasa Recta?
Right & Middle Colic
Which part of the pancreas is intra-peritoneal?
the END --> splenorenal lit.