EH

Question 1

The jejunum and ileum are attached to the posterior abdominal wall by this

Answer 1

mesentary

Question 2

The ______ is the suspensory ligament of the duodenum

Answer 2

ligament of Treitz

Question 3

What part (s) of the intestines is (are) responsible for nutrient absorption?

Answer 3

jejunum and ileum

Question 4

A patient is presenting with LUQ abdominal pain – what structures are in this area?

Answer 4

Jejunum, stomach, pancreas, spleen, splenic flexure of colon

Question 5

Same patient comes back but now has RLQ paint – what’s in that area?

Answer 5

ileum, ileo-cecal junction, appendix

Question 6

Where does the blood supply for jejunum and ileum come from?

Answer 6

Superior mesenteric artery

Question 7

What is the main function of the colon?

Answer 7

water absorption

Question 8

A tumor in this part of the colon rarely results in obstruction but rather, iron-deficiency anemia secondary to occult bleeding from ulcerations on tumor surface.

Answer 8

Cecum

Question 9

What three features distinguish the colon?

Answer 9

1) taeniae coli 2) haustra 3) appendices epiploicae

Question 10

These fat-filled pouches on the surface of the colon can become inflamed

Answer 10

epiploic appendages

Question 11

This circular muscle prevents reflux of colon contents into the ileum.

Answer 11

Ileocecal junction/valve/sphinter

Question 12

A positive McBurney’s point and pain with hip extension (psoas sign) likely indicates…

Answer 12

appendicitis

Question 13

Duodenum blood supply?

Answer 13

celiac trunk and SMA

Question 14

The left colic artery of the SMA supplies blood to the?

Answer 14

Descending colon

Question 15

Where in the intestines does diverticulosis occur? Which quadrant is this?

Answer 15

Sigmoid colon. Left lower, to mid lower.

Question 16

The celiac trunk comes off the ____ at level __.

Answer 16

Aorta at T12

Question 17

The ____ comes off the aorta at L1 and supplies blood to the midgut (from mid-duodenum to ~2/3 across transverse colon)

Answer 17

SMA

Question 18

At the level of ___ the IMA supplies blood to the rest of the GI tract, which includes:

Answer 18

L3; last 1/3 transverse colon, descending colon, sigmoid, rectum

Question 19

What is SMA syndrome?

Answer 19

When the angle between the SMA and the aorta drops from 45 to less that 25, compressing the 3rd part of the duodenum between the two vessels and causing intestinal obstruction.

Question 20

Why should a surgeon be extra cautious around the left colic splenic flexure?

Answer 20

the anastomosis between middle colic and left colic arteries is weak, surgeons must be aware when removing sections of descending colon– just FYI, this accounts for high requency of splenic flexure ischemia when arterial supply is compromised

Question 21

What 3 main veins form the hepatic portal vein?

Answer 21

superior mesenteric vein, splenic vein and gastric vein(s)

Question 22

What vein does the inferior mesenteric vein meet up with?

Answer 22

splenic vein

Question 23

the venous blood from the small bowel returns via the ____

Answer 23

Superior mesenteric vein

Question 24

Sympathetic innervation in the foregut comes from?

Answer 24

Greater splanchnic nerve

Question 25

Sympathetic innervation in the midgut comes from?

Answer 25

lesser and least thoracic splanchnic

Question 26

FOREGUT blood supply? sympathetic innervation?parasympathetic innervation?

Answer 26

celiac trunk greater splanchnic nerve vagus

Question 27

MIDGUT blood supply? sympathetic innervation?parasympathetic innervation?

Answer 27

SMA lesser and least splanchnic vagus

Question 28

HINDGUT blood supply? sympathetic innervation?parasympathetic innervation?

Answer 28

IMA lumbar splanchnic pelvic splanchnic

Question 29

What is the name of the confluence of lymphatic trunks? At what level is it?

Answer 29

Cisterna Chyli; T12, same as hilum of kidneys

Question 30

What acronym do we used to remember some of the retroperitoneal organs?

Answer 30

SADPUCKER Suprarenal (adrenal) glands Aorta/IVC Duodenum (2nd and 3rd segments) Pancreas (except the tail) Ureters Colon (ascending and descending) Kidneys Esophagus Rectum (upper 2/3)

Question 31

At what level does the abdominal aorta bifurcate into two common iliac arteries?

Answer 31

L4

Question 32

What are the three unpaired visceral branches of the abdominal aorta and at what levels do they come off?

Answer 32

Celiac trunk (T12) Superior mesenteric (L1) Inferior mesenteric (L3)

Question 33

What are the two paired visceral branches of the abdominal aorta and what levels do they come off?

Answer 33

renal aa. (L1/2) ovarian/testicular aa (L2)

Question 34

What three nerves supply the transversus abdominis?

Answer 34

subcostal nerve, iliohypogastric, ilioinguinal

Question 35

This nerve pierces the psoas major muscle and provides sensory innervation to upper thigh and genital regions

Answer 35

genitofemoral nerve

Question 36

What do we call an opening in the diaphragm?

Answer 36

Hiatus

Question 37

What is and where is the IVC opening through the diaphragm?

Answer 37

Caval hiatous; T8

Question 38

What passes along with the aorta through the aortic hiatus at T12?

Answer 38

thoracic duct

Question 39

From top to bottom, what are the branches of the SMA?

Answer 39

middle colic, right coli, and ileocolic and jejunal arteries

Question 40

This muscle provides a route for a tuberculous abscess from a vertebral body to spread into the thigh.

Answer 40

Psoas major

Question 41

What is the arrow pointing at?

Answer 41

Celiac trunk

Question 42

The liver has dual blood supply from which two sources?

Answer 42

Hepatic artery and portal vein

Question 43

What fraction of the liver's blood supply comes from the hepatic artery?

Answer 43

1/3

Question 44

When a maligant tumor forms in the liver, where does angiogenesis occur? What fraction of liver blood supply is this?

Answer 44

hepatic artery, 1/3

Question 45

Following IV contrast injection for a CT scan, sequential scans of the liver are taken. In the early phase scans _______ blood flow is present. At this point, a _______ tumor will light up; wherease a ________ tumor will not enhance as much, since its blood supply will be coming from the portal circulation.

Answer 45

Following IV contract injection for a CT scan, sequential scans of the liver taken. In the early phase scans, arterial blood flow is present. At this point, a malignant tumor will light up; whereas a benign tumor will not enhance as much, since its blood supply will be coming from the portal circulation.

Question 46

What type of tumor is this? Which blood phase is delayed?

Answer 46

Benign, portal venous phase (2/3 of liver supply)

Question 47

A patient presents with abdominal pain. You find out she has not undergone any recent surgery. Upon radiograph, you image air in the peritoneal space. What are you concerned about?

Answer 47

Bowel rupture!

Question 48

Describe the findings of this CT

Answer 48

ascites, nodular and shrunken liver

Question 49

The stomach and duodenum are connected by the \_\_\_\_\_\_\_\_

Answer 49

pylorus

Question 50

What part of the stomach does the lesser omentum attach to?

Answer 50

the lesser curvature

Question 51

The greater omentum is suspended from the \_\_\_\_\_\_

Answer 51

greater curvature of the stomach

Question 52

What part of the stomach crosses midline?

Answer 52

pylorus

Question 53

The L and R _______ arteries run along the ________ curvature of the stomach, whereas the L and R gastro-omental arteries anastomose on the ________ curvature.

Answer 53

The L and R gastric arteries anastomose on the lesser curvature of the stomach, whereas the L and R gastro-omental arteries anastomose on the greater curvature of the stomach.

Question 54

the four parts of the duodenum wrap around the head of the \_\_\_\_\_\_\_

Answer 54

pancreas

Question 55

The duodenal bulb is the most frequent location of a peptic ulver. Perforation of the antior wall fo the duodenum can result in gut contents spilling into the ___________ causing generalized \_\_\_\_\_\_\_\_.

Answer 55

greater sac; peritonitis

Question 56

the pancreas delivers its enzymes via the pancreatic duct into \_\_\_\_

Answer 56

the second part of the duodenum

Question 57

tell me the position of the pancreas

Answer 57

mostly retroperitoneal; overlies and transversely crosses L1-2; posterio to stomach between duodenum on the right and spleen on the left

Question 58

why may pancreas tumors grow quite large before they are detectable to palpation?

Answer 58

the pancreas is mostly retroperitoneal and lies against the posterios body wall behind several abdominal organs

Question 59

\_\_\_\_\_\_\_\_ + ________ = common bile duct

Answer 59

common hepatic duct and cystic duct

Question 60

Tell me about that lesser sac

Answer 60

bounded posteriorly by the pancreas; anteriorly by the stomach; inferiorly by the transverse colon; left by mesenteric connections; right by liver and epiploic foramen of winslow

Question 61

what is the epiploic foramen of winslow?

Answer 61

the only opening to the lesser sac

Question 62

what are the main structures of the portal triad?

Answer 62

1) hepatic portal vein 2) proper hepatic artery 3) common hepatic duct

Question 63

this structure of the liver is remnant of obliterated umbilical vein

Answer 63

round ligament of the liver

Question 64

The ______________ + ______________ come together as the ampulla of vater, emptying onto the major duodenal papilla of Vater.

Answer 64

main pancreatic duct and common bile duct (cystic duct + common hepatic duct)

Question 65

What are the three branches of the celiac trunk?

Answer 65

left gastric, common hepatic, splenic

Question 66

what are the three branches of the SMA?

Answer 66

ileocolic, right colic, middle colic

Question 67

what are the three branches of the IMA?

Answer 67

left colic, sigmoid, sigmoid rectal