Exam IV Abdomen

Question 1

What are the layers of the anterolateral wall, from superficial to deep, underneath the skin?

Answer 1

1) Camper fascia (superficial fatty layer)
2) Scarpa fascia (epimysium)
3) external oblique m.
4) internal oblique m.
5) transversus abdominus m.
6) transversalis fascia
7 extraperitoneal fat
7) parietal peritoneum

*investing fascia (superficial, intermediate. and deep) overlie each muscle layer

Question 2

The semilunar line is where?

Answer 2

at the respective lateral aspects of the aponeuroses of the internal and external obliques

Question 3

What is the lower boundary of posterior rectus sheath?

Answer 3

arcuate line

Question 4

What makes up the anterior layer of the rectus sheath, ABOVE the arcuate line?

Answer 4

• part of internal oblique m. aponeurosis

- aponeurosis of external oblique m.

Question 5

What makes up the posterior layer of the rectus sheath, ABOVE the arcuate line?

Answer 5

• part of the internal oblique m. aponeurosis

- aponeurosis of transverse abdominal m.

Question 6

The inferior epigastric artery originates from ____ ___ artery to anastomose with superior epigastric artery and ___ ____ artery.

Answer 6

external iliac; internal thoracic

Question 7

From what nerve do the iliohypogastric and iliolingual nerves arise?

Answer 7

anterior ramus of spinal nerve L1

Question 8

From where does the superior epigastric artery orginate?

Answer 8

internal thoracic artery

Question 9

What arteries originate from the femoral artery?

Answer 9

• superficial circumflex iliac

- superficial epigastric

Question 10

From where does the deep circumflex artery arise?

Answer 10

external iliac artery

Question 11

What makes up the anterior layer of the rectus sheath, BELOW the arcuate line?

Answer 11

• part of internal oblique m. aponeurosis
• external oblique m. aponeurosis
• transverse abdominal m. aponeurosis

Question 12

What makes up the posterior layer of the rectus sheath, BELOW the arcuate line?

Answer 12

transversalis fascia only

Question 13

What is the incision for gallbladder removal called?

Answer 13

subcostal

Question 14

What incision is made for hysterectromy?

Answer 14

Pfanenstiel (suprapubic)

Question 15

What incisions are for appendectomy?

Answer 15

• Gridiron

- transverse

Question 16

What incisions are made for exploratory operations?

Answer 16

• median/midline

- left paramedian incision

Question 17

What is the tradeoff with making an incision to the linea alba, and what explains this tradeoff?

Answer 17

• lesser perfusion to this region

- will be less bleeding but takes longer to heal

Question 18

The internal spermatic fascia in the spermatic cord is a continuation of what layer or the anterolateral abdominal wall?

Answer 18

transversalis fascia

Question 19

The INTERNAL oblique muscle becomes what in the spermatic cord?

Answer 19

cremaster muscle

Question 20

The external spermatic fascia is a continuation of what layer of the anterolateral abdominal wall?

Answer 20

external oblique muscle aponeurosis

Question 21

What does the inguinal canal encapsulate in males? Females?

Answer 21

spermatic cord; round ligament of the uterus

Question 22

The internal (deep) inguinal ring is an invagination of what structure?

Answer 22

transversalis fascia

Question 23

The internal (superficial) inguinal ring is a narrow opening made from what structure?

Answer 23

aponeurosis of external oblique m.

Question 24

Where and how do direct hernias occur?

Answer 24

• In Hesselbach’s triangle, which is just medial to deep inguinal ring
• internal organs protrude through deep inguinal ring

Question 25

What structures in the abdominal cavity are retroperitoneal?

Answer 25

- kidneys - pancreas - vertebrae - aorta - IVC

Question 26

Epigastric pain is usually referred from where?

Answer 26

visceral peritoneum of foregut structures

Question 27

Pubic pain is usually referred from where?

Answer 27

visceral peritoneum of hindgut strucures

Question 28

Compare the nerve supply and sensation of the parietal peritoneum to the visceral peritoneum.

Answer 28

- parietal has somatic nerve supply and is sensitive to pressure, pain, and temperature. sensation is well localized - visceral peritoneum has autonomic fibers, no tactile or thermal receptors, and pain is referred

Question 29

What is another name for the LESSER omentum?

Answer 29

hepatogastric ligament

Question 30

What is another name for the GREATER omentum?

Answer 30

gastrocolic ligament

Question 31

What is an adhesionotomy?

Answer 31

separation of peritoneal membranes

Question 32

What can cause peritonitis?

Answer 32

infiltration of bacteria caused by - tissue necrosis - trauma - ulceration - external sources, internal gas, fecal matter

Question 33

Peritonitis can lead to what 2 things?

Answer 33

- adhesions (parietal and visceral membranes converge) | - ascites

Question 34

What artery supplies the foregut?

Answer 34

celiac trunk

Question 35

What artery supplies the midgut?

Answer 35

superior mesenteric artery

Question 36

What artery supplied the hindgut?

Answer 36

inferior mesenteric artery

Question 37

What structures are categorized as MIDGUT?

Answer 37

- stomach - pancreas - liver - proximal duodenum

Question 38

What structures are categorized as HINDGUT?

Answer 38

- left transverse colon - descending colon - sigmoid colon - most of rectum

Question 39

What part of the esophagus is protective against reflux?

Answer 39

lower esophageal sphincter (LES)

Question 40

What and where is the z line?

Answer 40

- transition of epithelia from stratified squamous to columnar - at esophagogastric junction

Question 41

What are the 3 muscle layers of the stomach?

Answer 41

- radial - longitudinal - transverse (oblique)

Question 42

How does the jejunum compare to the ileum?

Answer 42

- shorter and thicker - blood vessels are thicker, mesentery tends to be redder - more packed with adipose tissue and greater abundance of gut-associated lymphatic tissue (GALT) - less extensive arterial arcades

Question 43

What artery supplies the cecum? What does it branch into?

Answer 43

ileocolic artery; appendicular artery

Question 44

What artery supplies the transverse colon?

Answer 44

middle colic artery

Question 45

What arteries supplies the descending colon?

Answer 45

- proximally: superior mesenteric vein | - distally: inferior mesenteric vein

Question 46

What are the functions of the spleen?

Answer 46

- red pulp recycles RBCs, bilirubin, iron - white pulp plays a role in adaptive and innate immune systems - serves as reservoir for blood

Question 47

What is the largest branch of the celiac trunk?

Answer 47

splenic artery

Question 48

What part of the pancreas is adjacent to the hilum of the spleen? What part is adjacent to duodenum?

Answer 48

tail; head

Question 49

What artery provides blood supply to greater curvature of stomach?

Answer 49

pancreticoduodenal artery

Question 50

What part of the peritoneum envelops the liver?

Answer 50

coronary ligament

Question 51

What separates the ANATOMICAL lobes of the liver?

Answer 51

- falciform ligament | - left sagittal fissure

Question 52

What part of the liver contains the caudate and quadrate lobe?

Answer 52

left FUNCTIONAL liver

Question 53

What is the difference between the hepatic vein and the portal vein?

Answer 53

- hepatic vein is draining blood from liver segments to the IVC - portal vein is draining blood from the GI tract to the liver

Question 54

What separates the FUNCTIONAL lobes of the liver?

Answer 54

portal triad

Question 55

What segments constitute the left functional liver?

Answer 55

1-4

Question 56

What is the trajectory of blood through the liver lobules from the hepatic artery and portal vein?

Answer 56

sinusoid>central vein>hepatic vein>IVC

Question 57

The ampulla of Vater is formed by the merging of which 2 ducts?

Answer 57

bile and pancreatic ducts

Question 58

What drains bile into the duodenum?

Answer 58

Ampulla of Vater, via the major duodenal papilla

Question 59

What type of pain does biliary colic produce?

Answer 59

epigastric

Question 60

Where is gallbladder pain referred to?

Answer 60

regions of abdomen, thorax, and shoulder

Question 61

What causes cholecystitis?

Answer 61

blockage of bile cystic duct

Question 62

What kind of epithelium is found in the bladder?

Answer 62

transitional

Question 63

Where does ureteric colic cause pain?

Answer 63

- lumbar region - inguinal region - proximal thigh - external genitalia