Lachmans TEST REVIEW (PERSONAL Abdomen) (Part2)

Question 1

Are the duodenum and pancreas retroperitoneal?

Answer 1

Yes, almost all of the duodenum and pancreas are secondary retroperitoneal.

Question 2

Describe the path of bile from the liver to the duodenum.

Answer 2

Bile from hepatocytes → biliary canaliculi → R & L hepatic ducts → common hepatic duct

Merges with cystic duct (from gallbladder) → common bile duct

Passes behind 1st part of duodenum → through groove in pancreatic head → joins major pancreatic duct → forms ampulla of Vater → opens into 2nd part of duodenum

Question 3

What is the ampulla of Vater, and where does it open?

Answer 3

Hepatopancreatic ampulla (of Vater) is formed by the union of the common bile duct and major pancreatic duct; it opens into the second part of the duodenum.

Question 4

What three structures make up the portal triad?

Answer 4

Common bile duct

Proper hepatic artery

Portal vein

Question 5

Where does the portal triad enter the liver?

Answer 5

Porta hepatis.

Question 6

What are the terminal branches of the common hepatic artery?

Answer 6

Proper hepatic artery

Gastroduodenal artery

Question 7

Where does the portal vein originate? (Behind what part of what organ?)

Answer 7

Union of the superior mesenteric vein (SMV) and the splenic vein

Behind the neck of the pancreas

Question 8

What supplies blood to the body and tail of the pancreas?

Answer 8

Splenic A

Question 9

What arteries supply the head and neck of the pancreas and part of the duodenum?

Answer 9

Superior pancreaticoduodenal artery (from gastroduodenal a)

Inferior pancreaticoduodenal artery (from SMA)

Question 10

How do the pancreaticoduodenal arteries function in terms of collateral circulation?

Answer 10

Form a collateral pathway between the celiac trunk and the SMA.

Question 11

What arteries supply the greater curvature of the stomach?
A:

Right gastroepiploic artery

Left gastroepiploic artery (from splenic artery)
These anastomose along the greater curvature.

Answer 11

Right gastroepiploic artery

Left gastroepiploic artery (from splenic artery)
These anastomose along the greater curvature.

Question 12

What are the four parts of the duodenum?

1st part- What direction, Vertebral Level
2nd What vertebral level, Left or Right side of Vertebral c?
3rd What crosses here
4th ends at..?

Answer 12

First (superior): From pylorus → horizontally to L1

Second (descending): From L1–L3, on right of vertebral column

Third (horizontal/inferior): From right side of L3 to left, crossing IVC & aorta

Fourth (ascending): On left side, from L3 to L2 → ends at duodenojejunal flexure

Question 13

What structure marks the transition from duodenum to jejunum?

Answer 13

Duodenojejunal flexure, supported by the suspensory ligament of Treitz.

Question 14

Where does the suspensory ligament of Treitz attach?

Answer 14

Attaches the duodenojejunal flexure to the right crus of the diaphragm and the posterior abdominal wall.

Question 15

What is contained within the C-shape formed by the duodenum?

Answer 15

Head and neck of the pancreas

Question 16

What anatomical structure divides the duodenum into supracolic and infracolic compartments?

Answer 16

Transverse mesocolon.

Question 17

What is the course of the SMA relative to the pancreas?

Answer 17

Arises from behind the neck of the pancreas, then passes in front of the uncinate process.

Question 18

What artery branches from the SMA at the level of the pancreatic notch to supply the duodenum?

Answer 18

Inferior pancreaticoduodenal artery.

Question 19

What is the arterial anastomosis between the celiac trunk and SMA?

Answer 19

Between:

Inferior pancreaticoduodenal a (from SMA)

Superior pancreaticoduodenal a (from gastroduodenal a, which is from the celiac trunk)

Question 20

Where is the left renal vein vulnerable to compression, and by what structures?

Answer 20

Between the SMA (anterior) and aorta (posterior) – known as the nutcracker phenomenon.

Question 21

Trace the pathway of urine from nephron to ureter.

Answer 21

Nephron → collecting tubules (in pyramids) → minor calyces → major calyces → renal pelvis → ureter (via renal hilum)

Question 22

Where do the collecting tubules open into the calyces?

Answer 22

Apex of the renal pyramid, into a minor calyx.

Question 23

What muscle does the ureter lie on as it leaves the kidney?

Answer 23

Anterior surface of the psoas major muscle

Question 24

Where does the ureter cross the pelvic brim, and what artery does it pass near?

Answer 24

At the bifurcation of the common iliac artery, crossing the most proximal portion of the external iliac artery.

Question 25

What are the three points of narrowing in the ureter?

Answer 25

Ureteropelvic junction Pelvic brim (over iliac artery bifurcation) Ureterovesical junction (entry into bladder wall)

Question 26

Which part of the ureter is the most narrow?

Answer 26

Ureterovesical junction.

Question 27

What is the blood supply to the superior ureter?

Answer 27

The renal artery

Question 28

What arteries supply the inferior ureter?

Answer 28

Gonadal artery Abdominal aorta Common iliac artery Branches of internal iliac artery

Question 29

What provides parasympathetic innervation to the ureter?

Answer 29

Vagus nerve and pelvic splanchnic nerves.

Question 30

What nerves provide sympathetic innervation to the ureter?

Answer 30

Lesser splanchnic nerve (T10–T11) Least splanchnic nerve (T12) Lumbar splanchnic nerve (L1–L2)

Question 31

What spinal levels correspond to ureteric sensory innervation?

Answer 31

T10–L2 – upper levels for upper ureter, lower levels for lower ureter.

Question 32

What are the two venous systems in the abdomen? What do they drain?

Answer 32

IVC system (drains primary retroperitoneal organs & body wall) Portal vein system (drains peritoneal & secondary retroperitoneal organs)

Question 33

Describe the drainage path of the portal system.

Answer 33

Portal vein → porta hepatis → liver sinusoids → central vein → hepatic vein → IVC

Question 34

hat veins form the portal vein and where?

Answer 34

Superior mesenteric vein (SMV) and splenic vein, posterior to the neck of the pancreas.

Question 35

Which veins drain into the portal vein on its way to the liver? Via??

Answer 35

Left and right gastric veins (via the hepatoduodenal ligament)

Question 36

Where does the IMV drain?

Answer 36

Splenic vein.

Question 37

What does the splenic vein drain?

Answer 37

Spleen, pancreas, and stomach.

Question 38

What does the SMV drain? A

Answer 38

Duodenum Head of pancreas Jejunum & ileum Cecum & appendix Ascending colon Proximal 2/3 of transverse colon

Question 39

What does the IMV drain?

Answer 39

Distal 1/3 of transverse colon Descending colon Sigmoid colon Upper rectum

Question 40

What does the left gastric vein drain, and what branch does it give off? (Runs where?)

Answer 40

Drains the lesser curvature of the stomach Gives off esophageal branches that run to the esophageal hiatus

Question 41

What is the portal and systemic drainage of the esophagus?

Answer 41

Portal: Esophageal branches of left gastric vein Systemic: Esophageal veins → azygos vein → SVC

Question 42

Describe the portal and systemic venous drainage of the rectum.

Answer 42

Portal: Superior rectal vein → IMV Systemic: Middle & inferior rectal veins → internal iliac vein → IVC

Question 43

How does the anterior abdominal wall connect to the portal system? within what structure?

Answer 43

Paraumbilical veins (branches of portal vein) running with ligamentum teres in the falciform ligament.

Question 44

What systemic veins does the anterior abdominal wall connect to?

Answer 44

Superficial epigastric veins → external iliac and axillary veins