Gray's Notes - Abdomen

Question 1

where is the most common site of ectopic pregnancy?

Answer 1

uterine tubes

Question 2

where do lumbar hernias penetrate?

Answer 2

superior (Grynfeltt) or inferior (Petit) lumbar triangles

Question 3

where does the ilioinguinal n. run?

Answer 3

with spermatic cord to innervate the anterior scrotum and proximal genetals.

Question 4

which nerve could be compressed during an indirect inguinal hernia?

Answer 4

ilioinguinal n.

Question 5

what venous tributaries anastomose with cavil veins to cause varicose?

Answer 5

left gastric v. - carries blood from stomach to portal v.

Question 6

what is the left hepatic v. and where does it drain?

Answer 6

caval v. and drains into the IVC

Question 7

what is the most common site of Meckel diverticulum?

Answer 7

ileum - umbilical hernia

Question 8

which lymph node is involved with malignancy of the stomach?

Answer 8

celiac lymph

Question 9

what artery lies within the heptoduodenal l.?

Answer 9

proper hepatic a.

Question 10

which layer is used to maintain sutures?

Answer 10

scarpas fascia - deep

Question 11

what is the 3rd part of the duodenum sandwiched between?

Answer 11

abdominal aorta and superior mesenteric a.

Question 12

failure of the proper formation of what causes gastroschisis (major defect)?

Answer 12

lateral folds

Question 13

what is a minor defect associated with improper formation of the lateral folds?

Answer 13

umbilical hernia

Question 14

what is the lateral fold responsible for?

Answer 14

forming the muscular portion of the anterior abdominal wall!

Question 15

how much does the proximal foregut (the part that fors the esophagus) rotate?

Answer 15

90 degrees - brings vagus n. anterior!

Question 16

what is midgut volvulus?

Answer 16

possible complication of malrotation of the midgut loop without fixed mesentery - small intestines twist around the vasculature and can cause ichemic necrosis of the intestine

Question 17

what is subhepatic cecum?

Answer 17

due to failure of the descent of the cecal bud and results in the absence of an ascending colon

Question 18

what is duplication of the intestine?

Answer 18

fixed mesentery, no free movement of the intestines

Question 19

what is congenital megacolon (Hirschsprung disease)?

Answer 19

due to failty migration of neural crest cells into the wall of the colon which causes a lack of parasympathetic postganglionic neurons

Question 20

what is Wilms tumor?

Answer 20

kidney malignancy that usually occurs in children. can be caused by mutations in the WTI gene

Question 21

what is oligohydraminos linked to (respiratory)?

Answer 21

hypoplastic lungs

Question 22

what would incomplete separation of the cloaca result in?

Answer 22

anal agensis with or without presence of fistula

Question 23

what is rectal atresia?

Answer 23

failure of recanalization of the colon

Question 24

what nerves carry visceral afferent fibers from abdominal organs and can be involved in the occurrence of referred pain?

Answer 24

the greater splanchnic nerve

Question 25

what carries somatic afferent fibers to abdomen?

Answer 25

dorsal primary rami of intercostal nerves

Question 26

what will supply blood to the pancreas if the gastroduodenal a. is ligated?

Answer 26

the superior mesenteric artery

Question 27

the afferent fibers mediating pain from the head of the pancreas run initially with what?

Answer 27

greater thoracic splanchnic nerves

Question 28

where is lymph drainage of the scrotum?

Answer 28

superficial inguinal nodes

Question 29

what does the internal iliac lymph nodes drain?

Answer 29

pelvis, perineum, gluteal region

Question 30

what do the lumbar nodes drain?

Answer 30

kidneys, adrenal glands, testes/ovaries, uterus, uterine tubes

Question 31

what structures originate from the IAO muscle?

Answer 31

cremaster muscle and fascia

Question 32

what is the external spermatic fascia dervied from?

Answer 32

EAO

Question 33

what is the internal spermatic fascia derived from?

Answer 33

transversalis fascia

Question 34

how is darts tunic made?

Answer 34

blending of adipose campers fascia and membranous scarpas fascia with smoothmuscle fibers

Question 35

how can you tell the jejunum and ileum apart during surgery?

Answer 35

jejunum has less mesenteric fat - does have thicker walls, more villi, more plicae circulars, fewer vascular arcades

Question 36

what is the second part of the duodenum cross anteriorly by?

Answer 36

the transverse mesocolon

Question 37

what are the symptoms of yellow eyes and jaundice created by?

Answer 37

reversal of flow of bile into the bloodstream - common bile duct

Question 38

if there was an obstruction of the cystic duct what would happen?

Answer 38

block gallbladder drainage but allow bile flow from the liver

Question 39

what artery directly supplies the appendix?

Answer 39

ilioceliac

Question 40

where does cholecystitis affect dermatome?

Answer 40

T6 to T8 and hypochondriac region

Question 41

what nerve transmit pain from gallbladder?

Answer 41

sonsory afferents from the viscera carry pain fibers aas they travel with sympthaetic axons in the greater thoracic splanchnic nerves

Question 42

where is McBurney's point?

Answer 42

right side of abdomen about 2/3 of the distance from the umbilicus to the ASIS

Question 43

kidney stone is obstructing utterer, what locations is the stone most likely to lodge?

Answer 43

pelvic brim - the ureter is nroamlly constricted to soem degree as it crosses the pelvic brim from the major to minor pelvis

Question 44

which ligament contains the major branches of the splenic a.?

Answer 44

splenorenal l.

Question 45

what does the gastrocolic l. contain?

Answer 45

gastroomental vessels

Question 46

what results from a failure of esophageal recanalization in the 8th week of development?

Answer 46

esophageal stenosis and esophageal atresia

Question 47

where are webs and strictures found in an examination of teh esophagus?

Answer 47

esophageal stenosis

Question 48

when would vomit contain bile and stomach contents?

Answer 48

when the lcoation of teh occlusion is distal to the ampulla of Vater - where the common bile duct enters the small intestine

Question 49

what would cause projectile vomiting without the presence of bile?

Answer 49

hypertrophied pyloric sphincter

Question 50

why does annular pancreas cause duodenal obstruction?

Answer 50

due to the thck pand of pancreatic tissue taht surrounds and constricts the second part of the duodenum. this obstruction can be found shortly after birth or later. annular pancreas can result from the bifid ventral pancreatic bus wrapping around the duodenum during development and fusiing with the dorsal pancreatic bus therefore forming a ring

Question 51

what casues anal a genesis with perineal fistula?

Answer 51

incomplete separation of the cloaca by the urorectal septum

Question 52

how does a midgut volvulous result?

Answer 52

twitsting of te intestines and obstruction of the small and large intestines

Question 53

what is seen in 50% of obstructive lesions of the intestine?

Answer 53

failure of recanalization of the ileum

Question 54

what results in non rotation of the midgut?

Answer 54

results in the lower portion of the loop returning to the abdomen first so that the small intestine becomes fixed on the right side of the abdomen with the large intestine lying entirely on the left.

Question 55

what does dorsal deviation of hte urorectal septum result in?

Answer 55

anal stenosis

Question 56

what resuts of failure of the anal membrane to perforate?

Answer 56

imperforate anus

Question 57

what is a vitelline fistula? what are the symptoms?

Answer 57

persistance of the vitelline duct | fecal discharge from umbilicus

Question 58

which vessels would contribute to ascities in portal hypertension?

Answer 58

veins of the body wall and veins of the retroperitoneal intestinal organs

Question 59

anastamosis between the epigastric veins and the paraumbilical veins would lead to what?

Answer 59

caput madusae

Question 60

Left gastric veins and esophageal beins anstomose and lead to what in portal hypertension?

Answer 60

esophageal varices

Question 61

what vessels anastomose to contribute to the portal-systemic anastamoses and lead to hemorrhoids?

Answer 61

superior rectal, left gastric, middle rectal veins

Question 62

a defect in what most likely causes direct inguinal hernias?

Answer 62

defective aponeurosis of transversus abdominis muscle

Question 63

what can contribute to a formation of indirect inguinal hernias?

Answer 63

patnets processus vaginialis at deep inguinal ring | or expansion of deep niguinal ring with the stretching of the transversalis fascia

Question 64

what is the lowest recess of the female abdominalpelvic cavity when the women is standing upright?

Answer 64

rectouterine pouch of Douglas

Question 65

what separates the vesicouterine space and the rectouterine pouch of Douglas?

Answer 65

the broad ligament of the uterus - prevents the collection of fluids in teh vesicouterine pouch

Question 66

what structure contain the neuronal cell bodies of the pain fibers coming from the appendix?

Answer 66

DRG of spinal nerves T8 to T10

Question 67

what vein is a frequent cause of DVT of the left lower limb

Answer 67

left common iliac vein - which lies posterior to the right common iliac vein?

Question 68

what is present within the celiac ganglion?

Answer 68

preganglionic and postganglionic sympathetic preganglionic parasympathetics visceral afferent

Question 69

what is commonly used as a palpable landmark during abdominal surgeries to find the duodenaljejunal junction?

Answer 69

the suspensatory ligament of the duodenum (ligament of Trietz)

Question 70

what can cause heriation of the abdominal contents into the thorax (CDH)?

Answer 70

failure of the fusion of the pleuroperitoneal folds

Question 71

what type of hernias are due to defects in the pleuroperitoneal membrane?

Answer 71

Morgagni and Bochdalek hernias

Question 72

where is Morgagni hernia normally found?

Answer 72

retrosternal

Question 73

where is Bochdalek hernia commonly located?

Answer 73

posterolateral herniation

Question 74

when does a congenital hiatal hernia occur?

Answer 74

when part of the stomach herniates into the thoracic cavity - caused by shortened esophagus

Question 75

what is a clinical indication of a ruptured spleen characterized by intense radiating pain to the top of the left shoulder?

Answer 75

Kerh sign

Question 76

what occurs during the middle of a womens menstrual cycle when the graafian follicle ruptures and the ovum is released form the ovary?

Answer 76

Mittelschmerz sign

Question 77

what is a clinical indicator of gallbladder inflammation and pain referred to the right shoulder and diaphragmatic irritation?

Answer 77

Rovsing sing

Question 78

what is the most common variation in the hepatic artery supply to the right lobe of teh liver?

Answer 78

riht hepatic artery originating from the SMA - 18% of cases

Question 79

what could potentially be a point of constriction when trying to access the cystic duct?

Answer 79

spiral valve (of Heister)

Question 80

what structures are ligated in a cholecystectomy?

Answer 80

cystic duct and cystic a.

Question 81

what would result in bile peritonitis assuming the cholcystectomy was performed correctly?

Answer 81

the ducts of Lushka - not present in everyone , surgeon was unaware

Question 82

what is the most common cause of severe rectal bleeding in the pediatric age group?

Answer 82

Ileal (Meckel) diverticulum

Question 83

fusion of the caudal poritions of the kidneys during embryonic development results in what?

Answer 83

horseshoe kidney

Question 84

what is renal angenesis associated with?

Answer 84

oligohydraminos

Question 85

annular pancreas obstructs which part of the duodenum?

Answer 85

2nd

Question 86

what is midgut volvulous a possible complication of?

Answer 86

malrotation of midgut loop without fixed mesentery

Question 87

a tumor in the head of the pancreas may obstructu what?

Answer 87

common bile duct

Question 88

what is consistent with a "buffalo hump"?

Answer 88

suprarenal (adrenal) gland

Question 89

what anastomoses is attempted before liver transplant?

Answer 89

splenic to left renal v.

Question 90

which structure is likely to relase products into the blood stead to procude HTN and other signs?

Answer 90

cells of neural crst origin that migrated to adrenal medulla