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Anatomy for MRCS > Abdominal anatomy > Flashcards

Abdominal anatomy Flashcards

1
Q

What structures do we pass through in midline incision?

A 
Skin
Campers
Scarpas
Linea alba
Transversalis fascia
Extra-peritoneal fat
Parietal peritoneum
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2
Q

Whats structures do we pass through in a grid-iron incision?

A 
Skin
Campers
Scarpas
EO
IO
TA
Transversalis fascia
Extra-peritoneal fat 
Parietal peritoneum
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3
Q

Transverse incision - what structures do we pass through?

A 
Skin
campers
Scarpas 
±EO depending how lateral
Anterior rectus fascia 
Rectus ± IO depending how lateral 
TA
TF
EP fat
Parietal peritoneum
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4
Q

What level is the transpyloric plane, what is at this level?

Remember the story….

A

L1

Pylorus of the stomach 
Left hilum of kidney
fundus with the gallbladder
Neck of the pancreas
2nd part of the duodenal 
DJ flex him
L +R colic flexure
SMA, portal vein
Spleen
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5
Q

Subcostal plane?

A

Margin of 10th costal cartilage

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6
Q

Intercostal plane?

A

Highest point of iliac crest = L4

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7
Q

Intertubercular plane?

A

L5

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8
Q

Levels of the: IMA, aortic bifurcation, IVC formation from common iliac veins?

A

L3, L4, L5

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9
Q

Difference between superficial fascia above and below umbillicus

A

Above = 1 layer

Below = Campers fascia and Scarpas fascia
Campers = superficial fatty layer
Scarpas = membranous deep layer
- It is the Scarpas fascia that is only really found below umbilicus

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10
Q

How does Campers fascia continue inferiorly in men vs women?

A

Men = continues to penis, after losing fat becomes continuous with scrotum - dartos fascia

Women - retains some fat > labium majora

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11
Q

How does Scarpas fascia continue inferiorly?

A

Continues into thigh and just under inguinal ligament fuses with deep fascia of thigh = fascia lata

Continues into anterior perineum = attaches to ischiopubic rami + posterior perineal membrane = Colle’s fascia

In men = blends with superficial layers as it passes over penis, before continuing to scrotum to become dartos fascia
In men you also have extensions reaching dorsum of penis as fungiform ligament
Women = continues to become labia majora and perineum

In midline it is firmly attached to linea alba and symphysis pubis

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12
Q

External oblique - origin, insertion, innervation?

A

Origin = outer surface of lower 8 ribs (5-12)
Insertion = anterior 2/3rds - outer lip of iliac crest
Aponeurosis in midline with linea alba

Innervation = Ventral rami of lower 6 spinal thoracic nerves

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13
Q

Internal oblique - origin, insertion and innervation?

A 
Origin = From thoracolumbar fascia - anterior 2/3rds of iliac crest and lateral 2/3rds of inguinal ligament 
Insertion = lower 3 ribs

Ventral rami of lower 6 spinal thoracic nerves

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14
Q

Transversus abdominus - origin, insertion and innervation?

A

Origin = inner aspect of costal cartilages of lower 6 ribs, anterior 2/3rds of iliac crest, lateral 1/3rd of inguinal ligament

Insertion = Pubic crest and pectineal line

Ventral rami of lower 6 spinal thoracic nerves

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15
Q

Why is transversalis fascia unique?

A

All flat muscles (EO, IO, TA) are surrounded by fascia

But the deep fascia of the transversalis abdominus is more developed = transversalis fascia

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16
Q

Which abdominal muscle forms the anterior wall of inguinal canal?

A

Aponeurosis of external oblique

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17
Q

Which abdominal muscles lower border forms inguinal ligament?

What other ligaments does inguinal ligament form medially?

A

External oblique

Lacunar ligament attaches to pectin pubis of superior pubic ramus

Coopers ligament extends to pectin pubis of pelvic brim

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18
Q

Rectus abdominus - origin, insertion and innervation?

A 
Origin = pubic symphysis, crest and tubercle
Insertion = costal cartilage of rib 5-7 and xiphoid process

Ventral rami of lower 6 spinal thoracic nerves

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19
Q

Rectus sheath above costal margin vs above arcuate line vs below arcuate line?

A

Above costal margin = anterior sheath is only external oblique

Above arcuate line:
Internal oblique splits to anterior and posterior sheath
Anterior with EO
Posterior with TA

Below arcuate line all muscle go to anterior sheath = no posterior sheath

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20
Q

What is the arcuate line?

A

Where inferior epigastric vessels enter the rectus sheath

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21
Q

How are the greater sac and omental bursa of peritoneal cavity connected?

A

Epiploic foramen

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22
Q

What is boundaries of epiploic foramen?

A

Anterior = portal vein, hepatic artery and bile duct
- These are all enclosed in the hepatoduodenal ligament
Posterior = IVC
Superior = caudate lobe of liver
Inferior = First part of duodenum

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23
Q

Superficial blood supply of abdominal wall?

A

Superior wall = Musculophrenic and internal thoracic

Inferior = Femoral artery via superficial epigastric and superficial circumflex

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24
Q

Deeper blood supply of abdominal wall?

A

Superior = superior epigastric (Terminal branch of internal thoracic)

Inferior = inferior epigastric and deep circumflex of iliac (both branches of external iliac)

Laterally = intercostal and subcostal

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25
Q

Lymphatic drainage of abdominal wall?

A

Above umbilicus = axillary

Below = superficial inguinal

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26
Q

Where does the greater omentum attach?

A

Greater curve of the stomach and 1st part of duodenum

Then passes inferiorly over transverse colon and jejunum

Then turns posteriorly and ascends to join posterior border of transverse colon

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27
Q

What two arteries lie with greater omentum, and where do they originate from?

A

Left and right gastro-epiploic

Left = splenic 
Right = terminal branch of gastroduodenal (from common hepatic artery)
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28
Q

Where does lesser omentum attach?

How can we divide it?

A

Lesser curve of stomach and first part of duodenum
To the inferior surface of liver

Into hepatoduodenal ligament and hepatogastric ligament

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29
Q

What is significant about hepatoduodenal ligament?

A

Is anterior border of epiploic foramen

Houses:
Portal vein
Hepatic artery proper
Bile duct

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30
Q

Which arteries lie between the two layers of the lesser omentum?

A

Left and right gastric

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31
Q

What are the three peritoneal folds which attach organs to posterior abdominal walls?

A
  1. Mesentery - connect jejunum and ileum to posterior wall.
  2. Transverse mesocolon - begins at head + body of pancreas
  3. Sigmoid mesocolon - joins sigmoid colon to posterior abdominal wall. Contains sigmoid and superior rectal vessels.
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32
Q

Where does oesophagus begin and end?

Where does it pierce the diaphragm ?

A

C6 to T11

T10

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33
Q

Narrowings of the oesophagus?

A

ABCD

Arch of aorta
Left main stem bronchus
Cricoid cartilage
Diaphragmatic orifice

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34
Q

Histology of oesophagus?

A

Mucosa = non-keratinised squamous epithelium
Submucosa = glandular tissue
Muscularis externa
Adventitia

NO SEROSAL LAYER

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35
Q

Muscularis externa of oesophagus in upper vs lower?

A 
Upper = striated
Middle = both
Lower = smooth
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36
Q

Upper middle lower oesophagus - artery, vein and lymphatic supply?

A

Artery: Inferior thyroid, aortic branches, left gastric
Veins: Inferior thyroid, azygous system, left gastric
Lymphatics = Deep cervical, mediastinal, gastric

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37
Q

Nerve supply of oesophagus?

A 
Upper = recurrent laryngeal
Lower = oesophageal plexus = vagus
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38
Q

Arterial supply of the stomach?

A

Left gastric from coeliac trunk
Right gastric from common hepatic

Left gastro-epiploic from splenic artery
Right gastro-epiploic from the gastroduodenal

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39
Q

three main branches of coeliac axis, and the some of the main branches of these as well?

A

Left gastric

Common hepatic > right gastric, gastroduodenal and proper artery hepatic, cystic.
- GDA:
right gastro-epiploic + superior pancreaticoduodenal, duodenal branches

Splenic > Left gastro-epiploic, short gastric and pancreatic

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40
Q

What does the right gastro-epiploic pass through?

A

The layers of the greater omentum

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41
Q

Relations to the coeliac axis?

A 
Inferior = pancreatic body and renal vein
Right = coeliac ganglion and liver
Left = Coeliac ganglion and gastric cardia
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42
Q

4 parts of the duodenum and their relations?

A

Superior part = from pyloric orifice to neck of gallbladder at L1
- Passes anterior to bile duct, gastroduodenal artery, IVC and portal vein

Descending part = neck of gallbladder down to L3
- Anterior = transverse colon
- Posterior = right kidney
Medial = head of the pancreas

Inferior part = Crosses IVC, aorta and vertebral bodies
-crossed anteriorly by SMA and SMV

Ascending part = upwards to the left of the aorta to about L2
- terminates at duodojejunal flexure

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43
Q

what ligament surrounds duodenojejunal flexure?

A

Suspensory ligament of duodenum / Ligament of Treitz . This is a fold of the peritoneum.

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44
Q

Where are the two papilla in the duodenum?

A

Both in descending duodenum:

Major papilla = CBD and pancreatic duct

Minor papilla = accessory pancreatic duct and junction of midgut and foregut

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45
Q

Whats the arterial supply of duodenum?

A

Coeliac axis = ant and post. SUPERIOR pancreaticoduodenal, supraduodenal

SMA = ant and post. INFERIOR pancreaticoduodenal, 1st jejunal branch

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46
Q

Jejunal blood supply vs ileal?

Wall structure?

A

Both from SMA

Jejunal has longer vasa recta
Ileum has more dominant double layered arcade, smaller vasa recta

Ileum is thinner walled and has less prominent place circulares

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47
Q

Where does Meckels diverticulum love and what is it?

A

Would be found on the anti-mesenteric border of the ileum

It is a remnant of the vitelline duct

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48
Q

What are the four lobes of liver?

Which Couinaud segments make these up?

Falciform ligament vs cantiles line?

A

L = 1-4

R = 5-8

quadrate = 4
caudate = 1

Cantiles line is a line separating right and left lobe anatomically. Falciform ligament divides left lobe through segments 4a/b on right and 2/3 on left.

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49
Q

Blood supply to each liver lobe?

A 
L = left hepatic 
R = right hepatic

Caudate = both left and right hepatic

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50
Q

What separates the caudate and quadrate?

What does this structure contain?

A

Porta hepatis. Quadrate anterior, caudate posterior

Common hepatic duct, hepatic artery, portal vein, symp. and parasympathetic fibres + lymphatic drainage

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51
Q

What makes up the portal triad, and its relation to each other?

A

Hepatic artery
Portal vein
Bile duct

Artery medial to duct
Vein posterior to both

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52
Q

Ligaments of the liver - Falciform: What it splits up, what it contains, where it runs from and what it splits into itself?

A

Falciform:
Splits left lobe into medial and lateral
2 layer fold of peritoneum from umbilicus to the anterior liver surface
Free edge contains ligamentum teres = remant of umbilical vein.
On superior surface it splits into the coronary and left triangular ligament

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53
Q

Blood supply to the liver?

Venous drainage ?

A

Left and right hepatic artery from hepatic artery proper

Portal vein takes 70% of blood supply to liver, hepatic artery = 30%

Venous drainage:
Blood is dispersed by sinusoids to central veins of liver lobules = drain to hepatic veins = drain to IVC

Caudate lobe drains directly into IVC

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54
Q

Borders of the epiploic foramen?

A

Anterior = free border of lesser omentum = hepatoduodenal ligament
> contains bile duct, portal vein and hepatic artery

Posterior = IVC

Superior = caudate lobe

Inferior = 1st part of the duodenum + hepatic artery

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55
Q

What is the Pringles manoeuvre?

A

When you clamp the epiploic foramen in a difficult cholecystectomy / liver trauma

This will clamp the portal vein and hepatic artery which sit in the anterior border (hepatoduodenal ligament)

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56
Q

Relations of the liver?

A

anterior = diaphragm and xiphoid process

Postero-infeiror:
Oesophagus, stomach and duodenum
Hepatic flexure of colon
Right kidney
Gall bladder 
IVC
57
Q

Cell type of gallbladder?

A

Columnar epithelium

58
Q

Relations of the gallbladder?

A

Anterior = liver
Posterior = peritoneum, transverse colon and 1st part of duodenum
Either side = liver

59
Q

Vascular supply of gallbladder?

A

Cystic artery = branch of right hepatic

Venous = directly to liver

60
Q

Path of the bile in the biliary system?

A

Bile collects in cannaliculi between hepatocytes and drains via collecting ducts in portal triad

(Then stored in gallbladder where it is concentrated)

This drains via left and right hepatic duct which becomes common hepatic duct > at its origin: hepatic artery = medial, portal vein = posterior

Then joined by cystic duct from gallbladder = CBD

This passes down behind duodenum, through the head of pancreas to drain via ampulla of Vater into duodenum.
Pancreatic duct joins it here
Sphincter of Oddi prevents duodenal reflux

61
Q

Boundaries of Calots triangle?

A

Common hepatic duct, cystic duct, inferior lobe of liver

62
Q

Pancreatic relation?

A

Head sits in duodenal curve
Body lies behind the stomach and DJ flexure
Tail close to hilum of spleen

63
Q

Arterial supply to pancreas?

A 
Head = pancreaticoduodenal
Tail = splenic
64
Q

Which parts of the duodenum are retroperitoneal?

A

1st part lies within the peritoneum

Rest is retroperitoneal

65
Q

Which parts of the colon are retroperitoneal?

A

Posterior aspect of ascending and descending colon

66
Q

Embryology of the colon?

A

Midgut = second part of duodenum to 2/3rds along the transverse colon

Hindgut = distal 1/3rd of transverse colon to anus

67
Q

General arterial supply of different parts of the colon?

A

Ascending = ileo-colic and right colic (SMA)
Transverse = Right colic and middle colic (SMA) + left colic (IMA)
Descending colon = IMA + marginal artery from right colon

68
Q

Important colonic relations:
Ascending and descending colon
Splenic flexure
Hepatic flexure

A

Asc. + Desc. colon = ureters and gonadal vessels

Spleen = spleen and tail of pancreas

Hepatic = gall bladder + liver

69
Q

Caecum blood supply and relations?

A

Ileo-colic artery

Anterior = greater omentum 
Posterior = Psoas + iliacus, femoral and genitofemoral nerve, gonadal vessels + ureter
70
Q

Where is appendix located, how can it be identified surgically and what suspends it?

A

Base of caecum

Conversion of taenia coli at base allows identification
- useful as 74% retrocaecal

suspended from terminal ileum by mesoappenidx - which contains appendicular vessels

71
Q

Appendix blood supply?

A

Appendicular + anterior/posterior caceai = SMA via ileocolic

72
Q

Where is McBurneys point?

A

1/3rd way along from ASIS to umbilicus

73
Q

What connects transverse colon to pancreas?

What attaches to superior aspect of transverse colon and what lies within this?

A

Transverse mesocolon

Greater omentum attaches to superior aspect - contains middle colic artery and vein

74
Q

At what level does descending colon become sigmoid?

A

L3/L4

This is the level where it becomes wholly intraperitoneal again

75
Q

Significance of para-colic gutters in surgery?

A

Immediately lateral to ascending and descending colon = para-colic gutter
Medial to colon is lots of vessels, so you must mobilise the colon from the para-colic gutters, dissecting the lateral peritoneum in surgery

76
Q

Which artery requires high ligation during right semi-colectomy?

A

Right colic

77
Q

What levels do your SMA and IMA branch off the abdominal aorta?

Immediate path of each?

A

L1
L3

SMA travels underneath neck of pancreas
IMA travels inferiorly and immediately crosses to the left of the aorta

78
Q

Where does the IMA become the superior rectal artery?

A

At level of left common iliac

79
Q

Branches of SMA?

A

Inferior pancreaticoduodenal (anterior and posterior)
Jejunal and ileal arcades (ileum has extra arcades)
Right colic, middle colic and ileocolic

80
Q

Branches of IMA?

A

Left colic
3 sigmoid arteries
Terminal branch = superior rectal

81
Q

Is spleen intra or extraperitoneal?

A

Intraperitoneal

82
Q

Which two ligaments attach to spleen?

A

Splenorenal attaches posteriorly and links it to left kidney = contains splenic vessels

Splenogastric attaches anteriorly and links it to greater curvature of stomach = short gastric and gastroepiploic

83
Q

What vessels must be ligated in splenectomy and what structure is at risk of damage?

A

Short gastric vessels ligated (within gastrosplenic ligament) and splenic artery and vein

Tail of pancreas may be injured
- leave a drain in = amylase raised

84
Q

Blood film post-splenectomy?

A

Initially reticulocytosis and platelet count raised
Then granulocytosis - mainly neutrophils, then lymphocytes

Blood film = Howell jolly, target cells, pappenheimer + irregularly contracted erythrocytes

85
Q

Blood supply to and from the spleen?

A

Splenic artery from coeliac axis

Splenic vein. Joined by IMV, the goes on to unite with SMV.

86
Q

Level of abdominal aorta?

A

T12 - L4

87
Q

What accompanies aorta through diaphragm?

A

Azygous vein and thoracic duct at T12

88
Q

Location of the IVC, azygous, cisterna chyli?

A

all on the right

89
Q

Branches of the coeliac trunk and their path?

A

Left gastric - ascends to cardioesophageal junction, gives off oesophageal branches then descends along lesser curvature of the stomach

Splenic artery - travels in splenorenal ligament.

  • gives off short gastric prior to spleen and L gastroepiploic
  • L gastroepiploic runs along greater curvature of stomach to anastomose with the right one

Common hepatic:

  • gives off hepatic artery proper and gastrodudoenal
  • hepatic artery proper ascends towards liver, travels in free edge of lesser omentum (Medial to bile duct, anterior to portal vein).
  • gastroduodenal then gives off supraduodenal, superior pancreaticoduodenal (anterior and posterior) and right gastroepiploic
90
Q

Branches of the SMA and what anastomoses with what?

A
  1. Inferior pancreaticoduodenal:
    Divides immediately into anterior and posterior branches which anastomose with the superior equivalents.
  2. Middle colic = transverse colon
    Emerges beneath the pancreas, then enters mesocolon where it gives right and left branches
    - right anastomoses with right colic of SMA
    - Left with left colic of IMA
  3. right colic = ascending colon
    Near colon it divides into ascending and descending branch
    descending = ileocolic anastomoses
    ascending = middle colic anastomoses
  4. Ileocolic = ileum and caecum and appendix etc
    Superior branch = anastomoses with right colic
    Inferior branch divides giving: colic (1st part of ascending), caecal, appendicular, ileal branches
    - ileal branch then anastomoses with SMA
91
Q

What passes anterior and posterior to SMA?

A 
Anterior = neck of pancreas and splenic vein
Posterior = Left renal vein and uncinate process and inferior duodenum
92
Q

What ligament does the splenic artery travel in?

A

Splenorenal

93
Q

Which branches of the SMA and IMA enter the transverse mesocolon?

A

SMA = Only the middle colic, where it then branches into the left and right branches

IMA = Left colic

94
Q

Which branches of IMA enter the sigmoid mesocolon?

A

Sigmoid

Superior rectal

95
Q

Branches of IMA?

A
  1. Left colic:
    -Ascending branch passes anterior to left kidney and enters transverse mesocolon.
    Supplies superior descending colon, and anastomoses with middle colic
    -Descending branch supplies inferior descending colon. and anastomoses with 1st branch of sigmoid
  2. Sigmoid = 2-4 branches, which descend to the left in sigmoid mesocolon.
    Supply lower descending colon
    Anastomoses superiorly with left colic, inferiorly with superior rectal artery
  3. Superior rectal = terminal branch
    At level of S3 forms two terminal branches
    These branches anastomose with the middle and inferior rectal arteries, which come from the internal iliac and pudendal respectively.
96
Q

Arterial supply of the rectum?

A 
Superior = IMA
Middle = internal iliac
Inferior = Pudendal
97
Q

What veins combine to form the portal vein?

Where does this occur?

A

Splenic vein and SMV

occurs posterior to the neck of the pancreas at level of L2

98
Q

What does the splenic vein drain?

A

Short gastric
L gastroepiploic
Pancreatic veins
IMV

99
Q

What does the IMV drain?

A

Rectum, sigmoid and up to splenic flexure

Initially begins as the superior rectal vein
Receives sigmoid and left colic

100
Q

What does the SMV drain?

A 
Inferior pancreaticoduodenal 
Ileo-colic
right and middle colic
Ileal and jejunal
R gastroepiploic
101
Q

When does the IVC form?

A

At L5 when two common iliacs join

102
Q

Tributaries of IVC?

A 
Common iliacs
Lumbar veins
Right gonadal
Renal veins
Right suprarenal
Inferior phrenic 
Hepatic
103
Q

Muscles of the posterior abdominal wall?

A

Psoas major = flexes thigh at hip
Origin = T12-L5 laterally and intervertebral discs + transverse processes
Insertion = lesser trochanter of femur
Anterior rami of L1-L3

Psoas minor = weak flexor lumbar column
Origin = lateral surface of T12 / L1
Insertion = Pectineal line of pelvic brim + iliopubic eminence
Anterior rami of L1

Quadratus lumborum = acts laterally to flex
Origin = Medial aspects of iliac crest and iliolumbar ligament
Insertion = 12th rib
Anterior rami of T12-L3

Iliacus = flexion of thigh at hip joint
Origin = upper 2/3rds of iliac crest + upper/lateral sacrum
Insertion = lesser trochanter of femur
Femoral nerve

104
Q

What makes up the abdominal pre-vertebral plexus?

A

from diaphragm to SMA = coeliac plexus
SMA to aortic bifurcation = Abdominal aortic plexus
Aortic bifurcation to common iliac bifurcation = superior hypogastric plexus

105
Q

Where is processus vaginalis in relation to the gubernaculum?
What is the processus vaginalis?

What does gubernaculum eventually form in men vs women

A

PV is anterior to gubernaculum

It essentially is an extension of the peritoneal cavity. Formed when the gubernaculum guides down the testis.

In men it becomes a ligament tethering the testicles
In women it becomes the round ligament and ovarian ligament

106
Q

Deep ring vs superficial ring location?

A

Deep ring is located at the mid inguinal point. Immediately lateral to inferior epigastric vessels.

Superficial ring is located just superior to pubic tubercle = opening in aponeurosis of external oblique.

107
Q

Mid-inguinal point vs midpoint of inguinal ligament?

A

Mid-inguinal point = ASIS to pubic symphysis = femoral artery !!

Mid point of the inguinal ligament = ASIS to pubic tubercle, deep inguinal ring

108
Q

Borders of the inguinal canal?

A 
Roof = TIT = TF, internal oblique, TA
Floor = inguinal canal (inguinal ligament is aponeurosis of external oblique) 
Anterior = external oblique aponeurosis
Posterior = TF and IE
109
Q

Contents of the spermatic cord?

Contents of inguinal canal in women?

A

MEN: runs from deep inguinal ring down to the testis.

3 layers: External oblique = external cremasteric fascia, IO = cremasteric muscle and fascia, TF = internal spermatic fascia

3 arteries = cremasteric, deferential and testicular
3 nerves = genital branch of genitofemoral, sympathetic chain (+ Ilio-inguinal sits outside the cord)
3 other = venous plexus, vas deferens, lymphatics

Women = round ligament + genital branch of GF and ilio-inguinal

110
Q

Direct vs indirect inguinal?

A

Inguinal hernias = ABOVE and LATERAL to pubic tubercle.

Direct = through hesselbachs triangle, medial to epigastric vessels, old people

Indirect = patent processus vaginalis, will descend into scrotum, via deep ring, young people

111
Q

Borders of Hesselbach’s triangle?

A 
Medially = lateral border anterior rectus muscles
laterally = inferior epigastric vessels 
inferiorly = inguinal ligament
112
Q

Ilioinguinal nerve - nerve roots + path it travels?

A

L1 ventral rami

Passes inferolaterally through the psoas major, on top of quadratus lumborum.
Pierces internal oblique travelling deep to external oblique aponeurosis
Enters inguinal canal and exits via superficial ring to reach skin

113
Q

What does ilioinguinal nerve supply?

A

Abdominal muscles it passes through
Skin to scrotum, femoral triangle and pubic symphysis
Dorsum of penis

114
Q

How can ilioinguinal nerve be injured in hernial repair?

A

In mesh repair can get entrapped = neuroma = severe groin pain

115
Q

Femoral triangle borders?

Roof and floor?

A

Inguinal ligament, sartorius and adductor longus

Roof = fascia lata
Floor = Pectineus, Iliopsoas, iliacus and adductor longus
116
Q

Contents of femoral triangle ?

A 
Femoral canal
Femoral artery, nerve and vein
Inguinal LN's
Femoral branch of GF and lateral cutaneous nerve 
Great saphenous vein
117
Q

What encloses the femoral artery, vein and lymphatics

A

femoral sheath

Each of the three structures in the femoral sheath are enclosed in a compartment

118
Q

Which is the most medial compartment in the femoral sheath?

A

Each of the three structures in the femoral sheath are enclosed in a compartment, most medial is….

Femoral canal

119
Q

Borders of the femoral canal?

Contents?

A 
LMAP - FLIP
Lateral = femoral vein
medial = lacunar ligament
Anterior = inguinal ligament
Posterior = pectineal ligament

Lymphatics and Cloquet’s node

120
Q

Which muscle lies posterior to femoral vein?

A

Illiacus

121
Q

What is the roof and floor of femoral triangle?

A 
Roof = fascia lata
Floor = pectinous, Iliopsoas and adductor longus
122
Q

Where do you find femoral hernias?

A

Below and lateral to pubic tubercle

123
Q

Kidneys in relation to peritoneum?

A

Retroperitoneal

124
Q

Order of structures at renal hilum?

A

Renal vein most anterior
Then renal artery
Then ureter

125
Q

Fascial covering of kidney?

A

Gerota’s fascia - divide into anterior and posterior

They both fuse together on top of the adrenals

Posterior part fuses with psoas major fascia
Anterior part fuses with connective tissue of IVC and aorta

126
Q

What is Gerota’s fascia a continuation of?

A

Transversalis fascia

127
Q

What does left renal vein cross between?

A

Passes anterior to abdominal aorta, but posterior to the SMA

128
Q

What does the right renal artery pass behind?

A

IVC

129
Q

Levels of the right and left renal artery?

Branches?

A

Right = L2, left = L1

Each has branch to the adrenals = suprarenal
Before reaching the organ each renal artery branches into 4/5 segmental branches

130
Q

Adrenal gland embryology:

What cell type is the cortex from vs medulla?

A 
Cortex = mesoderm
Medulla = ectoderm from neural crest cells
131
Q

What are adrenal rests?

A

Small bits of ectopic adrenal tissue
Small yellow round nodules
Common in neonates
Commonly found in broad ligament / spermatic cord

132
Q

what must commonly be mobilised in anterior open adrenal surgery?

A

Hepatic flexure and right colon

133
Q

Arterial supply of the adrenals?

A

Superior adrenal = inferior phrenic branch
middle adrenal = aorta directly
Inferior adrenal = renal artery branch

134
Q

Venous drainage of adrenals?

A

Right is directly into the IVC: this is often avulsed in surgery, requires stinky clamp and 6/0 proline suture

Left goes into left renal vein

135
Q

If you avulsed the right adrenal vein during surgery what would you do?

A

Satinsky clamp + 6/0 prolene suture

136
Q

Which nerves innervate abdominal wall?

A

T7-L1

T7-T11 leave intercostal space and travel between internal oblique and transversus abdominus.

137
Q

Crura and ligaments of the diaphragm?

A

Muscular sheets anchored to lumbar vertebrae via a L+R crura

Crura connected across midline via MEDIAN arcuate ligament

Lateral to crura is MEDIAL arcuate ligament, which attaches to L1 and L3.

LATERAL arcuate ligament = thickening of fascia that covers quadratus lumborum.

138
Q

Arterial supply of diaphragm?

A

Superiorly:
From internal thoracic = musculophrenic and pericardiophrenic
From thoracic aorta = Superior phrenic

Inferiorly:
Directly from abdominal aorta = Inferior phrenic

Anatomy for MRCS (7 decks)

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