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MRCS B > Anatomy - Abdomen > Flashcards

Anatomy - Abdomen Flashcards

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1
Q

Level of branching of unpaired (4) arteries from aorta

A

Coeliac- T12
SMA- L1
IMA -L3

Median sacral - L4

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2
Q

Level of branching of paired (6) arteries from aorta

A

Inferior phrenic - T12
Middle suprarenal - L1
Renal - L1-2
Gonadal - L2
Lumbar L1-4
C. iliac - L4

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3
Q

What are the surface markings/ level of trans pyloric plane

A

Surface markings: 1/2 way between jugular notch and pubic symphysis
Through 9th costal cartilages
L1 level

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4
Q

What GI/GU tract structures pass through trans pyloric plane

A

Pylorus
D1/3??
Renal hilum (L>R)
Neck of pancreas
Fundus of GB
SMA origin
Portal vein formation (from SMV/ splenic)

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5
Q

True vs false aneurysm

A

True - involves bulging of all 3 layers

False/ pseudo - rupture of layers and formation of haematoma contained by external connective tissue

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6
Q

Pathogenesis/ causes of true vs false aneurysm

A

True - median cystic necrosis

False - trauma/ infection

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7
Q

Risk factors for AAA

A

Marfans/ CTD
Bicuspid aortic valve
HTN
Syphilis (chronic aortitis)

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8
Q

Definition of aortic dissection

A

Separation of layers of arterial wall due to intimal tear

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9
Q

What are the branches of the coeliac trunk (3)?

A

Left gastric
Common Hepatic
Splenic

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10
Q

Branches of common hepatic artery

A

Right gastric

Hepatic artery proper
-> R+L hepatic

Gastroduodenal
-> R gastroepiploic
+ Superior pancreaticoduodenal

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11
Q

Branches of splenic artery

A

Short gastric
Right gastroepiploic
Pancreatic

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12
Q

What level does the hepatic vein join the IVC

A

T8

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13
Q

What level do theses veins join the IVC?
1) renal and suprarenal
2) gonadal
3) lumbar
4) Common iliac

A

1) renal and suprarenal - L1
2) gonadal - L2
3) lumbar - L1-5
4) Common iliac L5

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14
Q

What is the bare area of the liver in contact with/ where is it?

What ligaments surround it?

A

Right lobe, superiorly/ posterior

Related to diaphragm, IVC/ R kidney/adrenal

Bound by coronary ligaments

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15
Q

What liver lobes does the left hepatic artery supply?

A

Left, caudate, quadrate

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16
Q

What are the ligaments teres + ligaments venosum remnants of?

Where do they lie?

A

Teres - umbilical vein
- ant inf liver (between left + quadrate)

Venosum - ductus venosus
- post inf liver (between left + quadrate)

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17
Q

What is the blood supply to the liver?

A

Hepatic artery proper -> L+R
- 25% total blood, oxygenated from aorta

Portal vein (splenic + SMV)
-75%
- deoxy, nutrient rich blood from GIT

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18
Q

Venous drainage of liver

A

Hepatic veins -> IVC

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19
Q

What does the porta hepatis contain (Ant -> post)?

A

Ant -> Post = DAV:

R+L Hepatic duct
Hepatic artery proper
Portal vein

Also: lymph - hepatic nodes

*hepatic veins not in porta hepatis

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20
Q

What are the first 2 organs to be injured in a stab to epigastrium?

A

Left lobe liver
Stomach

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21
Q

What demarcates the right and left liver lobes?

A

Falciform ligament (anteriorly)
Fissure for ligamentum teres/ venosum (posteroinferior)

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22
Q

What are the supporting ligaments of the liver?

A

Falciform - to diaphragm and ant abdo wall

Lesser omentum - to stomach/ D1

Coronary - to diaphragm

Triangular - to diaphragm

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23
Q

Surface marking of GB

A

Angle between 9th costal cartilage and lateral rectus sheath

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24
Q

Why is there shoulder pain in cholecystitis

A

Irritation of diaphragm

C3/4 also supply supraclavicular nerve

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25
Describe the ductal drainage system of the pancreas
Main pancreatic duct: - drains head/ body / tail - into major duodenal papilla Accessory duct: - drains uncinate process - into minor papilla
26
Arterial supply of pancreas
1) superior pancreaticoduodenal (gastroduodenal - common hepatic - coeliac) 2) Inferior pancreaticoduodenal (SMA) 3) Pancreatic branches (splenic)
27
What is a Whipples procedure?
Pancreaticoduodenotomy Removal of: Head of pancreas Duodenum GB and cystic duct Distal stomach (usually) Proximal jej (sometimes)
28
What are the 2 ligaments attached to the spleen
Lienorenal/ splenorenal - to kidney Gastrosplenic - to stomach Both are folds of greater omentum
29
What vessel lies behind the body of pancreas?
Portal vein
30
Peritoneal relation of the pancreas?
All retro except for tail which is intra
31
What buds does the pancreas arise from embryologically?
Ventral bud - from hepatic diverticulum - lower head/ uncinate - rotates round duodenum posteriorly Dorsal - from dorsal duodenum - upper head/ neck/ body/ tail
32
Spleen surface relations
9-11th left ribs
33
What structure may be damaged during a splenectomy
Tail of pancreas
34
Describe course of splenic artery
From coeliac trunk -> along upper border of pancreas -> behind stomach ->splenorenal ligament -> spleen
35
What is the splenorenal/ lienorenal ligament?
Double fold of peritoneum connecting spleen to left kidney/ post abdominal wall
36
Contents of the splenorenal/ lienorenal ligament?
Splenic artery + vein Lymphatics Nerves Tail of spleen (hence intraperitoneal)
37
What is the lesser momentum?
Double fold of peritoneum connecting lesser curve or stomach/ duodenum with liver
38
What lies in the hepatoduodenal ligament of lesser omentum?
Contents of porta hepatis: Hepatic artery proper Portal vein CBD
39
Where does the greater momentum attach?
Greater curve of stomach -> TV colon
40
Blood supply to oesophagus
Upper - inf thyroid Middle - oesophageal branches of aorta Lower - left gastric
41
Venous drainage of oesophagus
Upper - inf thyroid Middle - azygous Lower - left gastric
42
Lymph drainage of oesophagus
Upper - deep cervical Middle - mediastinal Lower - gastric
43
Oesophageal cell lining normally + in Barretts
Normal - stratified squamous Barrets - columnar metaplasia
44
What is achalasia
Motility disorder of smooth muscle layer/ lower oesophageal sphincter Incomplete LES relaxation Increased LES tone Lack of peristalsis
45
Microscopic findings of achalasia
Hypertrophy of musculature + absence of myenteric plexus
46
Constrictions/ indentations of oesophagus
A- arch of aorta B- left bronchus C - left atrium D - diaphragmatic hiatus Left atrium - indent
47
Peritoneal relations of duodenum
1st part - intra 2-4th - retro
48
Blood supply to duodenum
Superior pancreaticoduodenal (gastroduodenal - c hepatic - coeliac) Inferior pancreaticoduodenal (SMA) +other branches - hepatic, R gastric, R gastroepiploid - supraduodenal
49
Where is the epiploid foramen
Joins greater and lesser sac (omental bursa) Behind free edge of hepatoduodenal ligament
50
What opens into the major duodenal papilla/ ampulla of vater? Where is it?
Junction of CBD + major pancreatic duct 2nd part duodenum (810cm from pylorus)
51
Appendix blood supply (A+V)
appendicular artery + vein a: Ileocolic (SMA) v: SMV
52
why is appendicitis pain initially central?
Appendix sensation supplied by nerve fibres at T10 level T10 dermatome = level of umbilicus Later localisation is when parietal peritoneum is involved
53
Potential positions of the appendix
retrocecal (most common) Subcecal Pre-ileal Post-ileal Pelvic
54
What passes through diaphragm at T8 and where
IVC Right phrenic nerve At central tendon
55
What passes through diaphragm at T10 and where
Oesophagus Vagus nerves At right crus
56
What passes through diaphragm at T12 and where
Aorta Thoracic duct Azygous vein Behind median arcuate ligament
57
Where do the right and left crura of diaphragm attach to verebra
Right L1-3 Left L1-2
58
Where is the median arcuate ligament boundaries
Between 2 crura or diaphragm
59
mediaL arcuate ligament boundaries
L1 vertebral body -> L2 TP
60
lateral arcuate ligament boundaries
TP L1 -> lower 12th rib
61
What makes up the conjoint tendon? Where does it lie
Aponeurosis of internal oblique + transverse abdominis Lies behind superficial ring
62
Nerve supply to abdominal muscles: EO IO TA RA
All T7-12 IO+TA = also L1 via hypogastric nerve (to conjoint tendon)
63
Injury to what nerve can predispose to inguinal hernia?
Hypogastric nerve (L1) May weaken conjoint tendon which supports superficial ring
64
What muscle forms the inguinal ligament?
Lower border of external oblique
65
Which of the abdominal wall muscles has a free posterior edge (not joined to thoracolumbar fascia)?
External oblique
66
At what level is the arcuate line and what does this deliniate?
Level of ASIS, approx L3-4 Area of posterior abdominal wall marking the lower limit of rectus sheath posteriorly
67
What is the rectus sheath/ what is it made of?
Encloses rectus abdomens muscles (front and back, until arcuate line then only front) Made of aponeurosis of TA/IO/EO (internal oblique splits . Ant/post fuse at line alba.
68
What ribs/CCs do the abdominal muscles originate from?
EO - lower 8 ribs IO - lower 3 ribs TA - lower 6 ribs RA - 5-7
69
Where is the deep inguinal ring?
Opening in transversalis fascia
70
Surface markings of deep inguinal ring
1cm above middle of inguinal ligament
71
What layer of the abdominal wall makes the superficial inguinal ring?
Rolled edge of external oblique/ inguinal ligament
72
Superior Boundaries of inguinal canal
2 Muscles: IO + TA muscles
73
Anterior Boundaries of inguinal canal
2 Aponeuroses: EO aponeurosis IO aponeurosis
74
Inferior Boundaries of inguinal canal
2 Ligaments: Inguinal ligament / EO aponeurosis Lacunar ligament
75
Posterior Boundaries of inguinal canal
2Ts: Transversalis fascia Conjoint Tendon
76
Nerve supply to detrusor muscle
Symp - store, relax muscle (L1/2) P'symp - contract (S2-4)
77
Blood supply to detrusor
Arterial: Int iliac -> superior and inferior vesical arteries Venous: Vesical venous plexus -> internal iliac vein
78
What part of the bladder is intraperitoneal?
Superior and upper posterior part
79
Layer's passed when inserting a suprapubic catheter
Skin Subcut tissue/ Camper's Scarpas fascia Linea alba (or whatever muscles) Transversalis fascia Preperitoneal fat
80
Posterior relations of bladder - male
vas deferens rectovesical pouch distal ureters
81
Posterior relations of bladder - female
vesicouterine pouch distal ureters
82
Bladder blood supply
Superior and inferior vesical arteries (
83
Bladder venous drainage
Vesical venous plexus -> int iliac vein
84
Branches of the internal iliac artery ANTERIOR trunk (7)
1) Obturator (accompanied by nerve/ vein > adductor/ glutes) 2) Umbilical (> sup vesical) - in utero - deoxy blood from foetus-placenta 3)Inf vesical 4) Vaginal 5) Uterine 6) Middle rectal (distal rectum) 7) Inf gluteal
85
Branches of the internal iliac artery POSTERIOR trunk (3)
1) Iliolumbar 2) Lateral sacral 3) Superior gluteal
86
Where does the internal iliac artery divide into ant + post?
Greater sciatic foramen
87
Detrusor nerve supply
Symp = L1/2 (hypogastric n) P'Symp = S2-4 (pelvic splanchnic nerve)
88
Most common bladder cancer type
TCC Adenocarcinoma SCC
89
Bladder cancer risk factors
Schistosomiasis Smoking Chronic inflammation Aniline dyes Beta - naphthylamine (dye rubber chemicals)
90
Bladder peritoneal relations
Covers superior + upper posterior parts
91
Where does ureter enter bladder
At corner of trigone at base
92
Layers encountered in suprapubic catheter insertion
Skin Subcut tissue/fat aka Campers fascia Scarpa's membranous fascia Linea alba Transversalis fascia Preperitoneal fat Bladder wall
93
Posterior relations of bladder
2 ureters Male: 2 vas deferens Rectovesical pouch Female: Vesicouterine pouch + vagina
94
Inferior relations of bladder
Urethra Male: Prostate Puboprostatic ligament Female: Pubovesical ligament

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