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Flashcards in GI anatomy Deck (221):
1

Where do the lowermost fibres of internal oblique muscle take origin from?

lateral 2/3 of inguinal ligament

2

Which artery perfuses the pancreas?

Splenic artery

2

At what vertebral levels are preganglionic sympathetic fibres for the hindgut derived from?

T12-L2

3

In which quadrant is the jejunum?

LUQ

4

Which kidney is slightly more superior?

Left

4

Which is brighter on CT: fat or soft tissue?

Soft tissue

4

Which organ is just below the celiac trunk?

Pancreas

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5

What is the surface marking for the fundus of the gall bladder?

Intersection of linea semilunaris with costal margin on right side

5

What do we call the aponeurotic envelope that contains the rectus abdominus on each side of the midline?

Rectus sheath

5

Where is the deep inguinal ring?

Exactly half way between ASIS (ant sup iliac spine) and the pubic tubercle and a fingers breadth above the inguinal ligament

5

What are the 4 muscles in the paravertebral gutter?

Psoas major. Psoas minor. Quadratus lumborum. Iliacus

5

What contributes to the major duodenal papilla?

Bile duct and pancreatic duct

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5

Is the pancreas intraperitoneal or retroperitoneal?

Retroperitoneal

5

Where do the unpaired intraperitoneal structures have venous drainage to?

Portal venous system

5

How is the transpyloric plane identified on surface anatomy?

The intersection of the lines semilunaris with costal margin

5

What does the proper hepatic artery divide into?

The right and left hepatic arteries

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6

Where do the lower most fibres of the transverse abdominus originate?

Lateral 1/2 of ingiunal ligament

6

What is the ligamentum teres a remnant of?

Umbilical vein

7

Which aspect of the rectus sheath is present all the way from superior to inferior?

Anterior

7

What defines the limits of the fundus of the stomach?

Cardiac notch (incisure) and angular notch

7

Is the horizontal part of the duodenum intraperitoneal or retroperitoneal?

Retroperitoneal

7

Which part of the duodenum is intraperitoneal?

The first inch of the duodenal cap

8

Is the cecum intra- or retro-peritoneal?

Intraperitoneal

8

What does the aorta bifurcate into?

Common iliac arteries

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9

Between which muscles is the neurovascular bundle of the anterior abdominal wall?

Between internal oblique and abdominis transversus muscles

9

How many segmental arteries are there from the renal artery?

5

11

Which muscles arch up and over to insert into the pubic crest via conjoined tendon

Inner oblique and transverse abdominus

11

What is the rectus sheath?

An aponeurotic envelope that contains the rectus abdominus on each side of the midline

11

Which arteries supply the greater curvature of the stomach?

Left and right gastro-epiploic arteries

12

How long are the ureters?

20-30cm

12

Which has more numerous mucosal folds: jejunum or ileum?

Jejunum

13

Where are the 3 tendinous intersections of the rectus abdominis?

At level of umbilicus At level of xiphisternum At level half way between these two

14

What is the esophageal opening part of the stomach called?

The cardiac orrifice

15

If there is an inflamed gall bladder, where will tenderness be noted?

Junction of right costal margin with linea semilunaris

17

Which muscle does the kidney overlie?

Quadratus lumborum

19

What is the inferior epigastric artery a branch of?

External iliac artery

20

What surrounds the head of the pancreas?

Duodenum

21

What does the 'C' shape of the duodenum curl around?

Head of the pancreas

22

Where is pain from the hindgut referred to?

Suprapubic region

23

What lies just lateral to the duodenal cap?

Right kidney

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23

Which is darker on CT: fat or soft tissue?

Fat

24

Define aponeuroses

Layer of flat, broad tendon

25

What are the 3 free edges of the external oblique?

Superior aponeurotic edge (which pec major takes origin from) Free posterior muscular edge Free inferior edge (between ASIS and pubic tubercle)

25

What do we call the clear lateral border of rectus abdominis?

Linea semilunaris

25

What is the surface landmark for the base of the appendix

McBurney's point

26

What do the left and right hepatic ducts unite to form?

Common hepatic duct

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26

Which hormones does the pancreas release?

Glucagon. Insulin. Somatostatin.

27

Where does the internal oblique muscle take its origin from inferiorly?

anterior 2/3 of iliac crest

27

How long is the esophagus?

25cm

27

What is the anatomical border separating the right and left halves of the liver?

Falciform ligament

28

How can you identify a piece of small intestine is jejunum and not ileum?

Thicker wall with more numerous mucosal folds. Less fat is mesentery so it's easier to see vessels in the mesentery. Mesentery has long vessels (vasa recta) instead of the many arterial arcades seen in the ileum

29

At what vertebral level is the transpyloric plane?

L1

31

Where is the junction of the midgut and hindgut?

2/3 of the way along the transverse colon, towards the splenic flexure

32

What does the common hepatic artery branch into?

Proper hepatic artery and gastroduodenal artery

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34

What does the gastroduodenal artery divide into?

Anterior superior pancreaticduodenal artery. Right gastroepiploic artery

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34

What does the portal vein pass behind?

First part of the duodenum

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35

Under which ribs does the spleen lie?

9, 10 and 11

36

Where can the cystic artery branch off? Which is more common?

Right hepatic artery most commonly, but also can branch from proper hepatic artery

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37

Which passes to the right of the other: hepatic ducts or hepatic artery?

Hepatic ducts

38

What structures does the left gastric artery supply?

Abdominal esophagus. Lesser curvature of stomach.

40

What is the lesser curvature of the stomach attached to? And via what?

To liver via lesser omentum

41

Where is the junction of the foregut and midgut?

Major duodenal papilla

42

What are the 2 components of the dual venous system of the abdomen?

Inferior vena cava (caval system) Portal vein (portal venous system)

42

What vascular structures are behind the pancreas?

Splenic artery and vein

43

Where will irritation of the mid-sigmoid colon to rectum be referred?

Peri-anal

44

Where is the junction between foregut and midgut?

The major duodenal papilla

45

What is a landmark for the dermatome of L1?

Groin

46

What is the first part of the large intestine called?

Cecum

47

What are the 2 surfaces of the liver?

Diaphragmatic and visceral surface

48

Which aspect of the rectus sheath is only present superiorly?

Posterior

49

What is posterior to the head and neck of the pancreas?

IVC and aorta

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51

What does the right renal artery pass behind?

IVC

52

What are the 3 layers that surround the testicular neurovascular bundle?

Internal spermatic fascia Cremasteric fascia External spermatic fascia

53

Where does the left renal vein pass with relation to the aorta?

Anterior

53

What attaches the liver to the anterior abdominal wall?

Falciform ligament

54

What is behind the foramen of Winslow?

IVC

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55

What is the superior epigastric artery a branch of?

internal thoracic aa

55

What forms the superficial inguinal ring?

The triangular opening in external oblique between its attachment between the pubic tubercle and the pubic crest

57

Which artery supplies the abdominal oesophagus?

Left gastric artery

58

Which muscles do external obliques iie edge to edge with?

Pec major and serratus anterior

58

Where does psoas major lie?

In the paravertebral gutter between bodies and transverse processes of lumbar vertebrae

59

Where is the appendix is 65% of people?

Retrocecal

61

Where does the portal vein empty into?

Hepatic sinusoids

62

In what does the portal triad run?

Between two layers of lesser omentum

63

Where do the paired retroperitoneal structures have venous drainage to?

Systemic caval system

64

What do we call the point of junction from esophagus to stomach?

Z line

65

Where should a vein always pass relative to an artery?

Anterior to the artery

67

What is the orientation of internal oblique muscles?

Postero-inferior (back pockets)

67

What is the linea semilunaris?

Clear lateral border of rectus abdominis.

68

Where does external oblique meet with the contralateral external oblique?

In a strong vertical line of insertion (linea alba = white line)

70

From which artery does the hepatic artery arise?

Celiac trunk

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71

At what vertebral levels are preganglionic sympathetic fibres for the foregut derived from?

T6-T9

72

How is the superior margin of the liver identified on surface anatomy?

Plane between the nipples

73

Where is pain from the midgut referred to?

Periumbilical region

73

Where is McBurney's point?

1/3 of the way from the right ASIS to the umbilicus

74

How many free edges does the external oblique have?

3

75

In which quadrant is the ileum?

RLQ

77

Where is the junction between hindgut and midgut?

2/3 the way along the transverse colon, towards the splenic fleexure

79

What do we call the line at the inferior end of the posterior segment of the rectus sheath?

Arcuate line

81

Is the jejunum intraperitoneal or retroperitoneal?

Intraperitoneal

82

What are the ridges of the stomach called?

Rugae

83

Haematemesis due to eroded duodenal ulcer is likely to involve which artery?

Gastroduodenal artery

84

While looking at the posterior surface of the liver, what are the 4 lobes starting at 12 o'clock and moving clockwise?

Caudate. Right. Quadrate. Left

86

Where does the internal oblique muscle take its origin from posteriorly?

Thoracolumbar fascia

88

How many free edges does the internal oblique have?

None

89

What is the greater curvature of the stomach attached to? And via what?

Spleen via greater omentum

91

Is the duodenal cap intraperitoneal or retroperitoneal?

First inch is intraperitoneal. Second inch is retroperitoneal

91

What are the 3 branches off the celiac trunk?

Splenic artery. Left gastric artery. Common hepatic artery

92

Through what do the greater and lesser sacs communicate?

The epiploic foramen of Winslow

93

At what level does the esophagus pass through the diaphragm?

T10

94

At what dermatome level is the umbilicus?

T10

96

Where does the minor duodenal papilla enter the duodenum?

Just proximal to the major duodenal papilla

97

How long is the small intestine from the point of the D-J flexure?

4-6 meters

99

What forms the common bile duct?

Common hepatic duct and cystic duct

100

What is the most posterior structure at the renal hilum?

Renal pelvis

102

Is the stomach intraperitoneal or retroperitoneal?

Intraperitoneal

103

What forms the opening of the common bile duct?

Sphincter of Oddi

104

What forms the minor duodenal papilla?

Accessory pancreatic duct

104

Where does the tail of the pancreas lead?

The hilum of the spleen

105

Where does the foregut begin?

Abdominal esophagus

106

Where does rectus abdominis attach inferiorly?

To body and crest of pubis

106

How big is the spleen?

Clenched fist

107

What forms the common hepatic duct?

Left and right hepatic ducts

109

What is the most superior part of the stomach called?

The fundus

111

Never put an artery in front of a ______

Vein

112

What vertebral levels do the kidneys span?

T12 to L3

113

Which muscles from the roof of the inguinal canal?

Internal oblique and transversus abdominis

114

Is the ascending colon intraperitoneal or retroperitoneal?

Retroperitoneal

115

Which organs does the splenic artery perfuse?

Spleen, pancreas and stomach

116

At what level does the inferior mesenteric artery branch off the aorta?

L3

117

What is the blind end of the gall bladder called?

Fundus

119

What is the most distal part of the stomach?

Pyloric sphincter

120

How long is the appendix?

7-10 cm

122

In which quadrant is the spleen?

LUQ

123

What is a landmark for T10 dermatome?

Umbilicus

124

What gives the liver its visceral peritoneum?

The lesser omentum

126

At what level does the aorta end?

L4

127

What are the 4 parts of the duodenum?

Duodenal cap. Descending. Horizontal. Ascending.

128

Is the ilieum intraperitoneal or retroperitoneal?

Intraperitoneal

130

What part of the stomach is most likely to show as a gas bubble on X ray?

Fundus

131

Never put a ________ in front of a ______

An artery in front of a vein

133

Where does blood from the rectum drain to?

Caval system or hepatic portal system

134

Which part of the duodenum is retroperitoneal?

All but the first inch of the duodenal cap

136

What is the only dead-straight horizontal branch of the lateral aspect of the aorta?

Renal artery

137

At what vertebral levels are preganglionic sympathetic fibres for the midgut derived from?

T8-T12

138

What organ is just behind the pancreas?

Left kidney

139

Is the ascending part of the duodenum intraperitoneal or retroperitoneal?

Retroperitoneal

140

Where does the ileum end?

At the ileo-cecal junciton

141

What is the free inferior edge of the liver called?

Ligamentum teres

142

Which arteries supply the lesser curvature of the stomach?

Left and right gastric arteries

143

Which muscle of the anterior abdominal wall underlaps the costal margin?

Transverse abdominus

144

What is formed by an opening in the transversalis fascia?

Deep inguinal ring or internal inguinal ring

145

Behind which organ does the portal vein form?

Neck of the pancreas

146

What are the structures in the renal hilum from anterior to posterior?

Renal vein. Renal artery. Renal pelvis

147

At what level does the superior mesenteric artery branch off the aorta?

L1

149

Where does the testis exit the inguinal canal during development?

Superficial (or external) inguinal ring

151

What does the duodenal cap lie on?

Right psoas major

152

In which quadrant is the liver?

RUQ

153

What does the sphincter of Oddi envelope?

Common bile duct and pancreatic duct

155

What loops over the left renal vein as it passes the aorta?

Superior mesenteric artery

157

At what vertebral level does the portal vein form?

L2

158

Where is visceral pain from the foregut referred to?

Epigastric region

159

Where is visceral pain from the midgut referred to?

Peri umbilical region

160

Where is visceral pain from the hindegut referred to?

Supra pubic region

161

Where is the junction between foregut and midgut?

Major duodenal papilla

162

Where is the junction between midgut and hindgut?

2/3 the way along the transverse colon, towards the splenic flexure

164

What are the 3 most common locations of kidney stones?

Uretopelvic junction. Crossing of iliac artery. Uretovesicle junction.

165

At what vertebral level does the esophagus begin?

C6

166

How long is the duodenum?

10cm

167

What passes through the porta hepatis?

Portal vein. Proper hepatic artery. Hepatic ducts. Nerves. Lymphatics

168

Which gland sits on the kidney?

Adrenal gland

169

In which quadrant is the gall bladder?

RUQ

170

At what vertebral level is the celiac trunk?

T12

171

What is in front of the foramen of Winslow?

Portal triad

172

Is the transverse colon intraperitoneal or retroperitoneal?

Intraperitoneal

173

What is the common site of opening of the bile duct and pancreatic duct called?

Major duodenal papilla

174

What are the 3 muscular layers of the anterolateral abdominal wall from superficial to deep?

External oblique Internal oblique Transversus abdominus

175

What is the z line?

Esophogeal-gastic junction

176

In which quadrant is the stomach?

LUQ

178

Where is pain from the foregut referred to?

Epigastric region

179

What landmark defines the boundary between the body and fundus of the stomach?

The cardiac notch or incisure

180

Where linea semilunaris intersects with costal margin on the right side is the surface marking for what?

Fundus of gall bladder

181

What overlies the neck of the pancreas?

Pylorus

182

What artery supplies the head of the pancreas?

Anterior superior pancreaticduodenal artery

183

What is above the foramen of Winslow?

Quadrate lobe of liver

184

Where does the iliac crest end?

At the ASIS (anterior superior iliac spine)

186

What is the most posterior structure in the porta hepatis?

Portal vein

187

Where is the rectus abdominis wider?

Superiorly

188

From which artery does the splenic artery arise?

Celiac trunk

189

Where does the major duodenal papilla enter the duodenum?

Half way down the posteromedial wall of the descending segment of the duodenum

190

At what vertebral levels are preganglionic sympathetic fibres derived from?

T6-L2

191

What is the dermatome of the loins?

L1

192

In what direction does abdominus transversus run?

Horizontal

193

What is the part of the stomach distal to the body?

Antrum

194

Which lobes of the liver is the gall bladder between?

Quadrate and right.

195

Which lobes of the liver is the IVC between?

Caudate and right.

196

Is the sigmoid colon intra- or retro-peritoneal?

Intraperitoneal

197

What is the part of the stomach between the pyloric sphincter and the antrum?

Pyloric canal

198

What does THE mesentery connect?

Posterior abdominal wall to jejunum and ileum

199

What is the largest part of the stomach called?

Corpus or body

200

Where do superior and inferior epigastric arteries anastamose with each other?

Behind rectus abdominis in posterior rectus sheath

202

Where is visceral pain from the foregut referred to?

Epigastric region in the midline

203

Is the horizontal part of the duodenum intraperitoneal or retroperitoneal?

Retroperitoneal

204

What forms the inguinal ligament?

The free inferior edge of the external oblique extending from the anterior superior iliac spine to the pubic tubercle

205

What is the orientation of external oblique muscles?

Antero-inferior (front pockets)

206

What demarcates the lateral edge of the pubic crest?

Pubic tubercle

207

What forms the floor of the inguinal canal?

Inguinal ligament

208

What is an approximate radiological landmark for the descent of the ureters?

Tips of lumbar transverse processes

209

Which artery does the left gastroepiploic artery branch from?

Splenic artery

210

What are the 3 parts of the esophagus?

Cervical, thoracic, abdominal

211

Is the descending part of the duodenum intraperitoneal or retroperitoneal?

Retroperitoneal

212

The rami of which spinal nerves contribute to the lumbar plexus?

L1-L4

213

Which artery does the superior rectal artery come from?

Inferior mesenteric artery

214

How long does the esophagus extend in the abdomen before it enters the stomach?

1.25 cm

215

What sits directly above the fundus of the stomach?

Left hemidoaphragm

216

Where do the unpaired retroperitoneal structures have venous drainage to?

Portal venous system

217

Which arteries supply derivatives of the fore-, mid- and hind-gut?

Celiac trunk, superior mesenteric artery, inferior mesenteric artery

218

What are the 6 layers of the antero-lateral abdominal wall from superficial to deep?

1 skin 2 superficial fascia 3 abdominal muscles 4 fascia transversalis 5 extraperitoneal fat 6 parietal peritoneum

219

How long is the large intestine?

1.5 meters

220

Is the descending colon intraperitoneal or retroperitoneal?

Retroperitoneal

221

To which organs does the greater omentum attach?

Greater curvature of the stomach and transverse colon