LE 3 Abdomen (2021)

Question 1

12. True about spleen
    A. White pulp contains blood
    B. Capsule and splenic trabeculate contain smooth muscle
    C. Spleen is gut derivative
    D. AOTA
    E. NOTA

Answer 1

B. Capsule and splenic trabeculate contain smooth muscle

Spleen – Located at the Left Upper Quadrant (LUQ) of the Abdomen; 12 X 7 X3 cm; Dense CT Capsule; Trabeculae penetrate parenchyma or Splenic Pulp; No Cortex & Medulla; 2 Regions: White Pulp & Red Pulp.

Functions: Defense Against Blood-Borne Antigens; Main Site of Old Erythrocyte Destruction; Production Site of Antibodies & Activated Lymphocytes.

Splenic capsules and trabeculae with a low percentage of smooth muscle and elastic fibers cannot expand and contract and are designated as defense spleens.

Question 2

13. All require mesenteric support except
    A. Stomach
    B. Spleen
    C. Liver
    D. Head and body of pancreas
    E. 1st part of peritoneum

Answer 2

D. Head and body of pancreas

A. Stomach (Intra)
B. Spleen (Intra)
C. Liver (Intra)
D. Head and body of pancreas (Retro : Secondary)
E. 1st part of peritoneum (Intraperitoneal: Covering Anterolaterally)

Question 3

14. When the pancreas forms a complete ring surrounding the duodenum???

Answer 3

Annular pancreas

Rare Congentital Anomaly (Clinical Notes)

Annular Pancreas is an abnormal ring or collar of pancreatic tissue that encircles the duodenum (the part of the small intestine that connects to stomach).
This portion of pancreas can constrict the duodenum and block or impair the flow of food to the rest of the intestines.

Question 4

15. A man was thrown off his motorcycle and his left side of the body was hit against a metal railing. What organ is affected?
    A. Stomach
    B. Spleen
    C. Liver
    D. Intestines

Answer 4

B. Spleen

Question 5

16. Main pancreatic duct aka
    A. Dochus cholesduchos
    B. Ducts of wirsung
    C. Ducts of Santorini
    D. Sphincter of oddi
    E. Major duodenal papilla

Answer 5

B. Ducts of wirsung

A. Dochus cholesduchos : ???
B. Ducts of wirsung: Major Pancreatic Duct
C. Ducts of Santorini: Accessory/Minor Pancreatic Duct
D. Sphincter of oddi: w/ Major Duodenal Papilla
E. Major duodenal papilla

Notes:
Ampulla – Dilated portion of a canal or duct;
Papilla – Small nipple-like process (Projection, Protuberance);
Sphincter – Circular band of muscle that encircles an orifice.

Question 6

17. Branches of celiac artery/trunk, EXCEPT
    A. Right gastric
    B. Splenic
    C. Left Gastric
    D. Common hepatic
    E. NOTA

Answer 6

A. Right gastric

Branches of Celiac Trunk:

Left Gastric, Splenic, Common Hepatic;

Splenic → Short Gastric, Left Gastroepiploic.

Common Hepatic → Gastroduodenal, Right Gastric, Proper Hepatic.
* Gastroduodenal → Right Gastro-epiploic, Superior Pancreatico-Duodenal.

Question 7

18. Which of the following is a midgut derivative?
    A. Upper duodenum
    B. Lower duodenum
    C. Pancreas
    D. Bile ducts

Answer 7

B. Lower duodenum

Midgut Derivatives:
o Small Intestine (Lower Half of the Descending part of the Duodenum).
o Cecum, Vermiform Appendix, Ascending Colon, & the Right Half (2/3) of the Transverse Colon.

Question 8

19. True statement regarding the gut tube derivatives
    A. Divided according to lymph flow
    B. Foregut derivatives are supplied by the inferior mesenteric
    C. Midgut is supplied by the superior mesenteric
    D. Hindgut is supplied by the celiac artery

Answer 8

C. Midgut is supplied by the superior mesenteric

Foregut : Celiac Trunk (Common hepatic, Splenic, Left Gastric)

Midgut: Superior Mesenteric Artery (SMA).
▪ Branches of SMA: Inferior Pancreatico-Duodenal, Jejunal-Ileal, Ileo-Colic, Right Colic & Middle Colic.

Hindgut: Inferior Mesenteric Artery (IMA).
▪ Branches of IMA: Left Colic, Sigmoid, Superior Rectal.

*Note:

▪ Part of Foregut & Midgut: Descending (2nd) Part of the Duodenum – Supplied by Superior & Inferior Pancreatico-Duodenal Artery.

▪ Part of Midgut & Hindgut: Transverse Colon – Supplied by Right, Middle, & Left Colic Arteries.

Question 9

20. Which of the following organs becomes secondary retroperitoneal due to the development of gut mesenteries
    A. Ascending colon
    B. Thoracic esophagus
    C. Rectum
    D. Sigmoid colon

Answer 9

A. Ascending colon

A. Ascending colon (Retro : Secondary)
B. Thoracic esophagus (Intra)
C. Rectum (Depending on location)
D. Sigmoid colon (Intra)

Question 10

21. Level of esophageal hiatus
    A. T8 B. T10 C. T12 D. T6

Answer 10

B. T10

I8 10 EGGS AT12

Caval Foramen (Inferior Vena Cava) = T8

Esophageal Hiatus (Ant/Post. Vagal Trunk, Esophagus, Esophageal branch of the Left Gastric vessels) = T10

Aortic Hiatus (Descending Aorta, Azygos Vein, Thoracic Duct, Intercostal Lymph Trunks) = T12

Question 11

22. A musculous fibrous band of smooth muscle from 3rd and 4th parts of duodenum
    A. Falciform ligaments
    B. Hepatoduodenal ligament
    D. Ligament of treitz

Answer 11

D. Ligament of treitz

Ascending Part (4th) of the Duodenum:

• Suspensory Muscle of Duodenum; Ligament of Treitz;
• With Plicae Circulares (Valvulae Conniventes);
• Duodenojejunal Flexure.

Question 12

23. Longitudinal folds found at the internal surface of the duodenum
    A. Haustra
    B. Plicae Circularis
    C. Appendicis Epiploicae
    D. Taenia

Answer 12

B. Plicae Circularis

A. Haustra (Large Intestine)
B. Plicae Circularis
C. Appendicis Epiploicae (Large Intestine)
D. Taenia (Large Intestine)

Question 13

24. Portion of duodenum that secretes hormone from pancreas and gallbladder

Answer 13

Second portion

Plicae Circulares (Valvulae Conniventes) – Produces Cholecystokinin.
* Cholecystokinin – Produced when eating; Detected by gallbladder; Signals it to release bile; With Pancreatic enzymes from Wirsung, results to Digestion.
* Found in D2-D4

Question 14

25. Common Bile duct and Major Pancreatic Duct join to form?
    A. Cisterna Chyli
    B. Hepatic duct
    C. Ampulla of Vater
    D. Cystic duct

Answer 14

C. Ampulla of Vater

Hepatopancreatic Ampulla of Vater – Upon meeting of CBD & Major Pancreatic Duct of Wirsung;
o Opens at 2nd part of duodenum (Major Duodenal Papilla).

*Note:
Ampulla – Dilated portion of a canal or duct;
Papilla – Small nipple-like process (Projection, Protuberance);
Sphincter – Circular band of muscle that encircles an orifice.

Question 15

26. Which of the following is NOT a distinguishable factor of large intestine?
    A. Plicae circulares
    B. Taenia
    C. Haustra
    D. Appendices epiploicae

Answer 15

A. Plicae circulares

Question 16

27. The most common position of appendix
    A. Anterior to terminal ileum
    B. Posterior to terminal ileum
    C. Pelvic
    D. Retrocecal

Answer 16

D. Retrocecal

Vermiform Appendix (Positions)

• Retrocecal (Most Common),
• Pelvic,
• Pre-Ileal (Anterior to Ileum),
• Post-Ileal (Posterior to Ileum),
• Subsecal (Inferior to Cecum).

Question 17

28. The base of the appendix usually lies at the junction medial 1/3 of the line joining the asis and umbilicus called the.
    C. Mc Burney’s
    D. Boa’s

Answer 17

C. Mc Burney’s

The base of the appendix is constant and usually lies deep at the
junction of the lateral and middle 1/3 of the line joining the ASIS
and the umbilicus (McBurney’s point) – point of reference used
for uncomplicated appendicitis

Question 18

29. Part of colon which is associated with the greater omentum and inferior border of pancreas
    A. Ascending colon
    B. Transverse colon
    C. Descending colon
    D. Sigmoid colon

Answer 18

B. Transverse colon

Question 19

30. Demarcates opening of ileum to cecum
    A. Ileocecal valve
    B. Ligament of treitz

Answer 19

A. Ileocecal valve

IIeocecal Juncture –
The ileum terminates by entering the cecum posteromedially with some variations:
Ileal Papilla & Ileocecal Valve.

Question 20

31. Which of the following is a branch of superior mesenteric artery?
    A. Ileocolic artery
    B. Left colic artery
    C. Sigmoid artery

Answer 20

A. Ileocolic artery

Branches of the SMA:
* Pancreaticoduodenal Artery,
* Jejunal & Ileal Branches (Arterial Arcades),
* Ileocolic Artery,
* Right Colic Artery,
* Middle Colic Artery.

Branches of the IMA:
* Left Colic Artery,
* Sigmoidal Arteries,
* Rectosigmoid Arteries,
* Superior Hemorrhoidal (Rectal) Artery.

Question 21

32. Hepatomegaly or liver enlargement
    A. Magenblase is displaced to the right
    B. Hepatic flexure is pushed inferiorly
    C. Right hemidiaphragm becomes much higher than usual, as compared to the left
    D. Stomach is deflected to the left

Answer 21

C. Right hemidiaphragm becomes much higher than usual, as compared to the left

An enlarged liver is one that’s bigger than normal.

Question 22

33. This surface landmark forms the **lateral border of the rectus abdominis muscle **
    A. Lina alba
    B. Linea semilunaris
    C.Transverse groove
    D. None of the above

Answer 22

B. Linea semilunaris

Hesselbach’s Inguinal Triangle:
* Lateral Border: Inferior Epigastric Vessels.
* Medial Border: Lateral Border of Rectus Abdominis (Spingelian Line, Linea Semilunaris).
* Inferior Border: Inguinal Ligament of Poupart.

Question 23

35. Triangular and smallest of the anterior abdominal muscle
    A. External oblique
    B. Internal oblique
    C. Transverse abdominis
    D. Rectus abdominis
    E. Pyramidalis

Answer 23

E. Pyramidalis

Question 24

36. Spermatic cord contains the ff Except.
    a. testicular artery
    b. ductus deferens
    c. cremasteric artery
    d. pampiniform plexus
    e. none of the choices are an exception

Answer 24

e. none of the choices are an exception

Contents of Spermatic Cord:

• Vas Deferens/ Ductus Deferens
• Pampiniform venous plexus
• Testicular Vessels
• Autonomic sensory nerve plexus around testicular artery
• Cremasteric Muscle/ Artery
• Ilioinguinal Nerve (L1)
• Genitofemoral Nerve (L2)
• Deferential artery from inferior vesical artery

Question 25

37. The porta hepatis contains the following except: A. Hepatic vein B. Hepatic artery C. Portal vein D. Hepatic duct

Answer 25

A. Hepatic vein ## Footnote Hepatoduodenal Ligament – Portal Triad: CBD, Hepatic Artery, Portal Vein.

Question 26

38. Portal vein is formed by the union of A. Imv & smv B. Smv & splenic vein C. Splenic vein & imv D. Smv & left gastric E. Imv & right gastric

Answer 26

B. Smv & splenic vein ## Footnote Portal System Small intestines → Intestinal Veins → Superior Mesenteric Veins → Joins the Splenic Vein to Form Portal Vein → Liver.

Question 27

39. The common bile duct and major pancreatic duct open through duodenum in what hole?

Answer 27

major duodenal papilla ## Footnote Ampulla of Vater – Dilation; Meeting point of CBD & Main Pancreatic Duct of Wirsung. * Major Duodenal Papilla – Nipple-like projection of Vater to medial wall of 2nd part of duodenum; With Sphincter (Sphincter of Oddi).

Question 28

40. Functional division of liver in which both sides have its own supply of artery, veins and biliary duct. The left side has A. Left lobe B. Left lobe and caudate lobe C. Left lobe and quadrate lobe D. Left lobe, caudate and quadrate lobe E. Caudate and quadrate lobe

Answer 28

D. Left lobe, caudate and quadrate lobe ## Footnote * Right Portal Fissure – 7 & 6 from the rest of the liver. * Mid (Main) Portal Fissure – Functional Right & Left. * Left Portal Fissure – 1 (Caudate lobe), 2, 3, 4

Question 29

41. The right kidney is lower than the left kidney because of right hemidiaphragm. | True or False

Answer 29

FALSE (liver) ## Footnote The kidneys are located between the transverse processes of T12-L3 vertebrae, with the **left kidney typically positioned slightly more superiorly than the right. **This is because the** liver and the stomach offset **the symmetry of the abdomen, with the liver forcing the right kidney a bit down, and the stomach forcing the left kidney a bit up.

Question 30

42. From anterior to posterior, the arrangement of structure the renal sinus is renal artery, renal veins then renal pelvis | True or False

Answer 30

FALSE (VEIN, ARTERY, PELVIS) | VAD ## Footnote Renal Vein, Renal Artery, Duct (Renal Pelvis)

Question 31

43. The posterior relations of the left and right kidney are mainly muscular. | True or False

Answer 31

TRUE (NAMELY PSOAS) ## Footnote Psoas Major (Medial) -> Quadratus Lumborum (Middle) -> Transversus Abdominis (Lateral)

Question 32

44. The inferior pole of the right kidney is just one fingerbreadth superior to the anterior superior iliac spine

Answer 32

TRUE ## Footnote One fingerbreadth = 2-2.5 cm The transpyloric plane passes through the superior pole of the right kidney, which is approximately 2.5 cm lower than the left pole, probably due to the presence of the liver

Question 33

45. The left kidney is in the stomach bed | True or False

Answer 33

TRUE ## Footnote RIGHT KIDNEY ● Superior Pole: Inferior Surface of Liver ● Inferiorly: Descending Part of Duodenum passes Hilum ● Right Colic Flexure: Lateral Border and Inferior Pole LEFT KIDNEY ● Suprarenal Gland (located at the top of superior pole of both left and right kidney ) ● Stomach ● Spleen ● Pancreas ● Jejunum ● Descending Colon ● Lies in Stomach Bed

Question 34

46. The left suprarenal is semi lunar in shape | True or False

Answer 34

TRUE ## Footnote Shapes: Left suprarenal gland: Semilunar / Cresentric Right suprarenal gland: Pyramidal

Question 35

47. Right suprarenal is pyramidal in shape. | True or False

Answer 35

TRUE ## Footnote Shapes: Left suprarenal gland: Semilunar / Cresentric Right suprarenal gland: Pyramidal

Question 36

48. A person can still function normally even if only one kidney. | True or False

Answer 36

TRUE

Question 37

49. What organ is Anteriorly related to both kidneys A. Duodenum B. Jejunum C. Colon D. Liver E. Pancreas

Answer 37

C. Colon ## Footnote Duodenum: N/A Jejunum: Medial (Anterior Surface) Colon: Lateral (Anterior Surface) : Hepatic and Splenic Flexure Liver: N/A Pancreas: Center (Anterior Surface)

Question 38

50. Afferents from biliary tree, stomach, gallbladder, and upper duodenum travel along the **greater splanchnic nerve** at what spinal level? A. C3-C5 B. L1-L2 C.T5-T9 D.T10-T11

Answer 38

C.T5-T9 ## Footnote Thoracic Sympathetic Trunks – Continuous with Cervical & Lumbar Sympathetic Trunks. Gives off paired thoracic splanchnic nerves: o Great Splanchnic: From T5-T9 Vertebral Levels. o Lesser Splanchnic: From T10-T11 Vertebral Levels. o Least Splanchnic: From T12 Vertebral Level.

Question 39

1. This surface landmark forms the lateral border of the rectus abdominis muscle: a. linea alba b. linea semilunaris c. transverse grooves d. inguinal groove

Answer 39

b. linea semilunaris ## Footnote Hesselbach’s Inguinal Triangle: Lateral Border: Inferior Epigastric Vessels. Medial Border: Lateral Border of Rectus Abdominis (Spingelian Line, Linea Semilunaris). Inferior Border: Inguinal Ligament of Poupart.

Question 40

2. Upon opening the abdomen inferior to the umbilicus, the first layer of superficial fascia encountered is: a. Colle's fascia b. Camper’s fascia c. Scarpa's fascia d. fascia latae

Answer 40

b. Camper’s fascia ## Footnote Skin -> Superficial Fascia -> Deep Fascia -> Muscles -> Transversalis Fascia > Extraperitoneal Fascia -> Parietal Peritoneum Superficial Fascia (2 Layers); o Camper’s Fascia – *Fatty Layer; o Scarpa’s Fascia – Membranous layer after Camper’s fascia. o Anterior Cutaneous Nerves (Dermatome) *Referred Pain – Pain received at a location other than the site of the painful stimulus or origin.

Question 41

3. This flat muscle forms the inguinal ligament inferiorly. a. external oblique b. internal oblique c. transversus abdominis d. rectus abdominis e. pyramidalis

Answer 41

a. external oblique ## Footnote Inguinal Ligament of Poupart: * The rolled-under inferior margin of the aponeurosis of the External Oblique Muscle * Attached laterally to the ASIS and curves downward and medially, to be attached to the pubic tubercle

Question 42

4. This muscle becomes aponeurotic distally and “splits” to form a sheath for the rectus abdominis. a. external oblique b. internal oblique c. transversus abdominis d. rectus abdominis e. pyramidalis

Answer 42

b. internal oblique ## Footnote Rectus Sheath: Formed by the aponeurosis of the 3 Flat Abdominal Muscles: EO, IO, TA. Anterior Rectus Sheath – Made up of entire **External Oblique Aponeurosis + Anterior ½ of Internal Oblique Aponeurosis**; Covers the anterior surface of rectus abdominis. Posterior Rectus Sheath – Made up of **Posterior ½ of Internal Oblique Aponeurosis + Transversus Abdominis Aponeurosis**

Question 43

5. Formed by the lateral and medial crura of the external oblique aponeurosis:. a. superficial inguinal ring b. pectineal ligament c. inguinal ligament d. conjoint tendon e. lacunar ligament

Answer 43

a. superficial inguinal ring ## Footnote Superficial inguinal ring (External Oblique Aponeurosis) Aponeurotic crura of external oblique * Lateral Crus = attaches to pubic tubercle * Medial Crus = inserts at pubic crest * ->occurs within the Hesselbach's Triangle Femoral Sheath – Funnel shape extension of transversalis fascia; Opens in the abdomen but closes upon the vessels. Compartments: o Lateral: Femoral Artery & Genitofemoral Nerve. o Intermediate: Femoral Vein. o Medial: Femoral Canal (Femoral Ring) – Lymphatics & LN – Nodes of Cloquet. Boundaries: o Anterior: Inguinal Ligament of Poupart. o Posterior: Pectineal Ligament of Cooper. o Medial: Lacunar Ligament of Gibernant - Continuation of inguinal ligament posterior. o Lateral: Femoral Vein.

Question 44

6. Remnant of the embryonic urachus. a. falciform ligament b. ligamentum teres c. lateral umbilical fold d. medial umbilical fold e. median umbilical fold

Answer 44

e. median umbilical fold ## Footnote ✓ Median Umbilical Ligament (Obliterated Urachus) – Covered internally by median umbilical fold; False Ligament. ✓ Medial Umbilical Ligament (Obliterated Umbilical Artery) – Covered by medial umbilical fold. ✓ Lateral Umbilical Fold – Contains the inferior epigastric vessels. o Umbilical Folds – Peritoneal folds overlying the umbilical ligaments & inferior epigastric vessels; Parietal Peritoneum; Median Umbilical Fold, Medial Umbilical Fold, Lateral Umbilical Fold.

Question 45

7. The spermatic cord contains the following structures, EXCEPT: a. testicular artery b. ductus deferens c. cremasteric artery d. pampiniform plexus e. none of the choices are an exception

Answer 45

e. none of the choices are an exception ## Footnote Contents of Spermatic Cord: * Vas Deferens/ Ductus Deferens * Pampiniform venous plexus * Testicular Vessels * Autonomic sensory nerve plexus around testicular artery * Cremasteric Muscle/ Artery * Ilioinguinal Nerve (L1) * Genitofemoral Nerve (L2) * Deferential artery from inferior vesical artery

Question 46

8. The esophageal hiatus transmits the following structures, EXCEPT. a. anterior vagal trunk b. esophagus c. posterior vagal trunk d. esophageal branch of the left gastric vessels e. none of the choices are exceptions

Answer 46

e. none of the choices are exceptions ## Footnote Caval Foramen (Inferior Vena Cava) = T8 Esophageal Hiatus (Ant/Post. Vagal Trunk, Esophagus, Esophageal branch of the Left Gastric vessels) = T10 Aortic Hiatus (Descending Aorta, Azygos Vein, Thoracic Duct, Intercostal Lymph Trunks) = T12

Question 47

9. To which organ is the greater omentum attached? a. Liver b. transverse colon c. spleen d. pancreas e. gallbladder

Answer 47

b. transverse colon ## Footnote Omentum – Always attached to the stomach; Stomach to other viscera. Lesser Omentum – 2 layers; Attached to the lesser curvature of the stomach, Duodenum & Esophagus to the Liver. Greater Omentum – 4 Layers; Attached to the greater curvature of the stomach; Also attached to the Taena Coli of the Transverse Colon.

Question 48

10. This opening connects the omental bursa to the peritoneal cavity:. a. paracolic gutters b. gallbladder fossa c. subphrenic recess d. foramen of Winslow e. foramen of Morgagni

Answer 48

d. foramen of Winslow ## Footnote Divisions of the Peritoneal Cavity: * Greater Peritoneal Cavity (Greater Sac), * Lesser Peritoneal Cavity (Lesser Sac, Omental Bursa). Greater Peritoneal Cavity (Greater Sac) – Large portion of the peritoneal cavity; Divided into: Supracolic (Stomach, Liver, Spleen) & Infracolic (SI & LI). Lesser Peritoneal Cavity (Lesser Sac, Omental Bursa) – Posterior to the stomach & lesser omentum; Connected to the greater cavity by: Epiploic Foramen of Winslow. Boundaries of the Foramen of Winslow: ▪ Anterior: Hepatoduodenal Ligament – Portal Triad: CBD, Portal Vein, Hepatic Artery. ▪ Posterior: Inferior Vena Cava (IVC). ▪ Superior: Caudate Lobe of the Liver. ▪ Inferior: Duodenal Bulb (1st Part of the Duodenum).

Question 49

11. The porta hepatis contains the following, EXCEPT:. a. hepatic vein b. heaptic artery c. bile duct d. portal vein

Answer 49

a. hepatic vein ## Footnote Hepatoduodenal Ligament – Portal Triad: CBD, Portal Vein, Hepatic Artery.

Question 50

12. This structure ‘grossly’ divides the liver into two lobes:. a. triangular ligament b. falciform ligament c. gallbladder fossa d. coronary ligament

Answer 50

b. falciform ligament ## Footnote Anatomical Divisions: ▪ Formed by the Falciform Ligament & Ligamentum Venosum (Where they bisect the liver). **Ligaments of the LIVER ▪ Falciform Ligament – True ligament. ▪ Right & Left Coronary Ligament – Medially located; Both connected to the liver to the diaphragm. ▪ Right & Left Triangular Ligament – Laterally located; Both connected to the liver to the diaphragm. ▪ Ligamentum Teres – False ligament; Adult Fate of the Umbilical Vein.

Question 51

13. Provides the majority of blood supply to the liver:. a. hepatic artery b. hepatic vein c. portal vein d. cystic artery

Answer 51

c. portal vein ## Footnote Blood Supply: Hepatic Artery, Portal Vein. * Hepatic Artery (30%) – Oxygenated Blood (Nutrient Poor); Metabolic Function. * Portal Vein (70%) – Less Oxygenated Blood (Nutrient Rich); Venous blood; From union of SMV & Splenic Vein (At the level of L2); Ascends superiorly with hepatic artery & CBD towards liver fissure and divides into Right and left portal veins; Can be utilized in the absence of the hepatic artery.

Question 52

14. After giving off the gastroduodenal artery, the common hepatic artery now becomes the: a. right and left hepatic artery b. cystic artery c. superior pancreaticoduodenal artery d. hepatic artery proper

Answer 52

d. hepatic artery proper ## Footnote Branches of Celiac Trunk: Left Gastric, Splenic, Common Hepatic; Splenic → Short Gastric, Left Gastroepiploic. Common Hepatic → Gastroduodenal, Right Gastric, Proper Hepatic. o Gastroduodenal → Right Gastro-epiploic, Superior Pancreatico-Duodenal

Question 53

15. The portal vein is formed by the union of the: a. inferior and superior mesenteric veins b. superior mesenteric and splenic veins c. splenic and inferior mesenteric veins d. superior mesenteric and left gastric veins e. inferior mesenteric and right gastric veins

Answer 53

b. superior mesenteric and splenic veins ## Footnote Portal System: Small intestines → Intestinal Veins → Superior Mesenteric Veins → Joins the Splenic Vein to Form Portal Vein → Liver.

Question 54

16. The ‘triangle of Calot’ is a good surgical landmark in locating this structure: a. common bile duct b. portal vein c. gallbladder d. cystic artery e. portal triad

Answer 54

d. cystic artery ## Footnote Triangle of Calot (Cystohepatic/Hepatobillary Triangle): o Boundaries: ▪ Inferior/ Lateral: Cystic Duct. ▪ Medial: Common Hepatic Duct (CHD). ▪ Superior: Inferior Surface of the Liver. Contains the following vessels: Cystic Artery, Cystic LN, Lymph from Gallbladder, 1-2 Small Cystic Veins, Autonomic Nerves to the Gallbladder, Loose Adipose Tissues.

Question 55

17. The common bile duct and major pancreatic duct opens into the duodenum through the: a. hepatopancreatic ampulla b. sphincter of Oddi c. major duodenal papilla d. minor duodenal papilla

Answer 55

c. major duodenal papilla ## Footnote Major Duodenal Papilla – Nipple-like projection of Vater to medial wall of 2nd part of duodenum; With Sphincter (Sphincter of Oddi).

Question 56

18. This structure attaches the liver to the diaphragm along the **lateral edges:.** a. falciform ligament b. coronary ligament c. triangular ligament d. hepatogastric ligament e. hepatoduodenal ligament

Answer 56

c. triangular ligament ## Footnote Ligaments of the LIVER ▪ Falciform Ligament – True ligament. ▪ Right & Left Coronary Ligament – Medially located; Both connected to the liver to the diaphragm. ▪ Right & Left Triangular Ligament – Laterally located; Both connected to the liver to the diaphragm. ▪ Ligamentum Teres – False ligament; Adult Fate of the Umbilical Vein.

Question 57

19. Union of the common bile duct with the pancreatic duct forms the:. a. choledochal sphincter b. major duodenal papilla c. accessory pancreatic duct d. hepatopancreatic ampulla e. minor duodenal papilla

Answer 57

d. hepatopancreatic ampulla ## Footnote Ampulla of Vater – Dilation; Meeting point of Common Bile Duct & Main Pancreatic Duct of Wirsung.

Question 58

20. If you were to divide the liver “functionally”, each lobe would have its own blood supply, venous and biliary drainage. In this set-up the left side would include the following lobe/s: a. left lobe only b. left and caudate lobes c. left and quadrate lobes d. left, caudate, quadrate lobes e. caudate and quadrate lobes

Answer 58

d. left, caudate, quadrate lobes ## Footnote * Right Portal Fissure – 7 & 6 from the rest of the liver. * Mid (Main) Portal Fissure – Functional Right & Left. * Left Portal Fissure – 1 (Caudate lobe), 2, 3, 4

Question 59

21. Which statement about the stomach is CORRECT? a. Acid secretion occurs in response to secretion of the hormone, carbonic anhydrase b. Glands called Peyer's patches are responsible for acid secretion c. The vagus nerve inhibits acid secretion after a meal has been consumed d. Pepsinogen and gastric lipase are 2 enzymes secreted into the lumen of the stomach

Answer 59

d. Pepsinogen and gastric lipase are 2 enzymes secreted into the lumen of the stomach

Question 60

22. Which of the following functions is most important for survival immediately after a meal?. a. Absorption and retention of water and electrolytes b. Elimination of toxins c. Maintenance of barrier function d. Extraction of maximum value from nutrients

Answer 60

a. Absorption and retention of water and electrolytes

Question 61

23. Water transport can occur from the intestinal lumen to the blood stream or the reverse. Which statement about this is CORRECT? a. A "flip-flop" mechanism efficiently transports water directly across the enterocyte membrane b. Water flows into the gut from the mucosa, during digestion of starch and protein, in order to reduce luminal osmolality c. Water is mostly absorbed by movement between the cells lining the guy via tight junctions d. Dietary intake of water is always greater than water movement in the small intestine

Answer 61

b. Water flows into the gut from the mucosa, during digestion of starch and protein, in order to reduce luminal osmolality

Question 62

24. What does the celiac trunk supply? a. STOMACH b. ILEUM c. JEJUNUM d. APPENDIX

Answer 62

a. STOMACH ## Footnote Foregut Derivatives: (Supplied by Celiac Trunk) o Esophagus & Stomach. o Duodenum (Proximal to the Opening of the Bile Duct). o Liver, Biliary Apparatus (Hepatic Ducts, Gallbladder, & Bile Duct), & Pancreas. o *Note: Spleen – Organ Supplied by Celiac Artery but not a Foregut Derivative; Hematopoietic & Lymphoid Organ → Mesoderm in Origin. Midgut Derivatives: (Supplied by SMA) o Small Intestine (Including Most of the Duodenum). o Cecum, Vermiform Appendix, Ascending Colon, & the Right Half (2/3) of the Transverse Colon. Hindgut Derivatives: (Supplied by IMA) o Left Half (1/3 to ½) of the Transverse Colon. o Descending Colon & Sigmoid Colon. o Rectum & Superior Part of the Anal Canal. ▪ Part of Foregut & Midgut: Descending (2nd) Part of the Duodenum – Supplied by Superior & Inferior Pancreatico-Duodenal Artery. ▪ Part of Midgut & Hindgut: Transverse Colon – Supplied by Right, Middle, & Left Colic Arteries.

Question 63

25. What level is referred pain of the hindgut derivatives felt? a. T4 b. T7 c. T10 d. L1

Answer 63

d. L1 ## Footnote Skin -> Superficial Fascia -> Deep Fascia -> Muscles -> Transversalis Fascia > Extraperitoneal Fascia -> Parietal Peritoneum Superficial Fascia (2 Layers); o Camper’s Fascia – *Fatty Layer; o Scarpa’s Fascia – Membranous layer after Camper’s fascia. o Anterior Cutaneous Nerves (Dermatome) *Referred Pain – Pain received at a location other than the site of the painful stimulus or origin. Pain originating within the** descending colon** is referred to the L1-L2 dermatomes of the inguinal region and thigh. Hindgut Derivatives: (Supplied by IMA) o Left Half (1/3 to ½) of the Transverse Colon. **o Descending Colon & Sigmoid Colon. ** o Rectum & Superior Part of the Anal Canal.

Question 64

26. What does the angular incisure (notch) of the stomach indicate? a. The junction between the distal esophagus and stomach b. The junction of the body and pyloric part of the stomach c. The area closest to the esophageal hiatus d. The area defined by the pyloric sphincter

Answer 64

b. The junction of the body and pyloric part of the stomach ## Footnote Parts of the Stomach: Fundus, Body, Pylorus, Rugae. o Fundus – Dome-shaped, left to the cardiac notch & cardiac orifice. **o Body – Start from the Cardiac Notch up to the (Ends) Incisura Angularis (Angular Notch). ** o Pylorus – Most tubular part of the stomach. ▪ Pyloric Antrum – Dilated triangular area directly below the Angular Notch. ▪ Pyloric Canal – Narrow portion. ▪ Pyloric Sphincter – Controls outflow of chime. o Rugae – Mucous membrane, Stomach folds; Flattens when stomach is distended (Full)

Question 65

27. What is true regarding gastric canals? a. they are ridges formed by rugae b. The junction of the body and pyloric part of the stomach c. Form temporarily during swallowing between gastric folds along the lesser curvature d. The area where the esophageal veins are found

Answer 65

c. Form temporarily during swallowing between gastric folds along the lesser curvature ## Footnote Gastric Rugae – Mucous membrane, Stomach folds; Flattens when stomach is distended (Full). - gastric canal (furrow) forms temporarily during swallowing between longitudinal gastric folds of the mucosa along the lesser curvature. Muscular Layers of the Stomach (3): Innermost Oblique, Middle Circular – Thickest in sphincter, Outermost Longitudinal.

Question 66

28. What forms when the splenic vein unites with the superior mesenteric vein? a. portal vein b. gastroepiploic vein c. short gastric d. left gastric

Answer 66

a. portal vein ## Footnote Portal System Small intestines → Intestinal Veins → Superior Mesenteric Veins → Joins the Splenic Vein to Form Portal Vein → Liver.

Question 67

29. What is responsible for supporting the duodenal junction? a. mesoduodenum b. ligament of Treitz c. mesentery d. retroperitoneal position

Answer 67

b. ligament of Treitz ## Footnote Ascending Part (4th) of the Duodenum: * Suspensory Muscle of Duodenum; Ligament of Treitz; * With Plicae Circulares (Valvulae Conniventes); * Duodenojejunal Flexure.

Question 68

30. Fibrous median structure between two rectus abdominis muscles. a. arcuate line b. external oblique aponeurosis c. linea alba d. linea semilunaris

Answer 68

c. linea alba ## Footnote Aponeurosis: wide sheath of fibrous tissue Linea Alba – Fusion of the aponeurosis of the right and left flat abdominal muscles. Semilunar Line: * At the side of the rectus abdominis; The union of the aponeuroses of the 3 lateral flat muscles; From the semilunar line, the aponeurosis will form: o Anterior Rectus Sheath – Made up of entire External Oblique Aponeurosis + Anterior ½ of Internal Oblique Aponeurosis; Covers the anterior surface of rectus abdominis. o Tendinous Intersection – Attaches firmly the anterior wall of the rectus sheath to the anterior surface of rectus muscle. o Posterior Rectus Sheath – Made up of Posterior ½ of Internal Oblique Aponeurosis + Transversus Abdominis Aponeurosis. Arcuate Line: * Located midway between the pubic symphysis and the umbilicus; The inferior limit of the posterior rectus sheath; Where the inferior epigastric vessels enter the rectus sheat

Question 69

31. At what vertebral level is the trans-umbilical plane located? a. T7-T8 b. T9-T10 c. L1-L2 d. L3-L4

Answer 69

d. L3-L4 ## Footnote Subcostal Plane : L3 Transpyloric Plane : L1 Transumbilical Plane: L3-L4 Transtubercular Plane: L5 Midclavicular/ Midinguinal Line: Midpoint between ASIS and Pubic Tubercle

Question 70

32. Which of the following is FALSE regarding the blood supply of the pancreas?. a. Pancreas receives blood supply from coeliac trunk and superior mesenteric artery b. Body and tail of pancreas is supplied by splenic artery c. Posterior superior pancreaticoduodenal artery is a branch of the superior mesenteric artery d. All major pancreatic arteries lie posterior to pancreatic ducts

Answer 70

c. Posterior superior pancreaticoduodenal artery is a branch of the superior mesenteric artery ## Footnote * Blood Supply of the Duodenum: o Superior Pancreaticoduodenal Artery (Branch of Gastroduodenal Artery) – Upper Half. o Inferior Pancreaticoduodenal Artery (Branch of SMA) – Lower half. o *Supraduodenal Artery & Retroduodenal Artery (Branch of Gastroduodenal Artery). * Venous Drainage of the Duodenum (2): o Superior Pancreaticoduodenal Vein – Drains into Portal Vein. o Inferior Pancreaticoduodenal Vein – Drains into SMV. o *Note: SMV + Splenic Vein → Portal Vein

Question 71

33. Which statement is TRUE about pancreatic embryonic malformations?. a. Pancreas divisum can be a cause of gastrointestinal bleeding b. Heterotopic pancreatic tissue predisposes to pancreatic adenocarcinoma c. Annular pancreas may cause GIT obstruction d. Relative obstruction to the flow of pancreatic juice through the minor papilla is not a cause of pancreatitis in patients with pancreas divisum

Answer 71

c. Annular pancreas may cause GIT obstruction ## Footnote Annular Pancreas – * Probably results from the growth of a bifid ventral pancreatic bud around the duodenum, parts then fuse with the dorsal bud forming a pancreatic ring * Anomaly produces complete obstruction (Atresia) or partial obstruction (Stenosis) of the duodenum.

Question 72

34. Radiation of the pain to the mid or lower back region in pancreatic cancer may indicate spread to? a. SPLANCHNIC NERVE PLEXUS b. LIVER c. COLON d. ABDOMINAL CAVITY

Answer 72

a. SPLANCHNIC NERVE PLEXUS ## Footnote Cancer of the Head of the Pancreas – Can compress the CBD, causing Jaundice Innervation: vagus nerve (parasympathetic), greater and lesser splanchnic nerves (sympathetic).

Question 73

35. As the functional anatomy of the spleen is divided into red pulp, white pulp, and marginal zone, what function is incorporated into the anatomy of the cortical zone that relates to infection control? a. Filtration of red cells, encapsulated bacteria, and other foreign material b. Red pulp for formation of red cells c. White pulp for its role in formation of granulocytes d. Gray areas, so formed because of the production of platelets

Answer 73

a. Filtration of red cells, encapsulated bacteria, and other foreign material ## Footnote Functions: * To remove particulates (Opsonized bacteria, Antibody-coated cells) from the bloodstream * Serves as quality control mechanism for RBC's (Removing senecent and Poorly deformed cells from the circulation) * Immunity * Splenic Macrophage (Graveyard of RBCs) * Prevents sepsis Red Pulp – Filters blood; Removes affected erythrocytes; Recycles hemoglobin iron. White pulp - B-Lymphocytes

Question 74

36. Hemolytic anemia is indication for splenectomy in this disease. a. Felty’s syndrome b. Warm-antibody autoimmune hemolytic anemia c. G6PD deficiency d. Hereditary spherocytosis

Answer 74

d. Hereditary spherocytosis ## Footnote Hemolytic anemia (Hereditary): Membrane Abnormalities * Spherocytosis * G6PD Deficiency Hemoglobin Disorders (Hgb S -> Sickle Cell Anemia )

Question 75

37. Haustra is characteristic of. a. duodenum b. ileum c. jejunum d. colon

Answer 75

d. colon

Question 76

38. Which is a midgut derivative?. a. ascending colon b. distal 1/3 of the transverse colon c. urogenital sinus d. sigmoid colon

Answer 76

a. ascending colon ## Footnote Midgut Derivatives: o Small Intestine (Lower Half of the Descending part of the Duodenum). o Cecum, Vermiform Appendix, Ascending Colon, & the Right Half (2/3) of the Transverse Colon.

Question 77

39. Which of the following is considered secondarily retroperitoneal?. a. Cecum b. descending colon c. appendix d. sigmoid colon

Answer 77

b. descending colon

Question 78

40. Which statement regarding the suprarenal glands is correct? a. its entire arterial supply is directly from the abdominal aorta b. veins from both glands drain directly into the inferior vena cava c. the glands are located in the pararenal space d. cells that secrete epinephrine and norepinephrine are innervated by preganglionic fibers from the greater splanchnic nerve

Answer 78

d. cells that secrete epinephrine and norepinephrine are innervated by preganglionic fibers from the greater splanchnic nerve ## Footnote Zona Glomerulosa/Fasciculata/Reticularis

Question 79

41. The inferior pole of the left kidney is covered by what structure? a. Ileum b. jejunum c. spleen d. stomach

Answer 79

b. jejunum

Question 80

42. Which statement about the kidneys is true? A. The inferior suprarenal artery is supplied by the renal artery B. The left suprarenal gland is pyramidal in shape C. The left suprarenal vein drains directly into the IVC

Answer 80

A. The inferior suprarenal artery is supplied by the renal artery ## Footnote Arterial Supply * Inferior phrenic artery -> Superior suprarenal artery * Abdominal Aorta -> Middle suprarenal artery * Renal Artery -> Inferior suprarenal artery Venous Supply * L/R adrenal glands -> L/R suprarenal veins * Left suprarenal vein -> Renal vein -> IVC * Right suprarenal vein -> IVC

Question 81

43. The superior half of the anterolateral surface of the left kidney is covered by. a. The descending colon b. The left colic flexure c. The retroperitoneal pancreas d. the spleen

Answer 81

d. the spleen

Question 82

44. Which is the correct renal artery pathway? a. Arcuate to interlobar to Efferent arterioles b. Arcuate to Interlobular to segmental arterioles c. Interlobar to Arcuate to Interlobular d. Segmental to Interlobular to Arcuate

Answer 82

d. Segmental to Interlobular to Arcuate

Question 83

45. The superior suprarenal artery arises from which artery? a. abdominal aorta b. iliohypogastric artery c. inferior phrenic artery d. renal artery

Answer 83

c. inferior phrenic artery ## Footnote Arterial Supply * Inferior phrenic artery -> Superior suprarenal artery * Abdominal Aorta -> Middle suprarenal artery * Renal Artery -> Inferior suprarenal artery Venous Supply * L/R adrenal glands -> L/R suprarenal veins * Left suprarenal vein -> Renal vein -> IVC * Right suprarenal vein -> IVC

Question 84

46. Psoas major is in contact with which aspect of the kidneys? a. anterior b. lateral c. medial d. posterior

Answer 84

d. posterior ## Footnote Posterior Surface of Kidneys -Diaphragm -Psoas Major -Quadratus Lumborum -Transversus Abdominis

Question 85

47.A renal papilla will drain urine into which structure? a. major calyx b. minor calyx c. pyramid d. renal pelvis

Answer 85

b. minor calyx ## Footnote Renal Papilla -> Minor Calyces -> Major Calyces -> Renal Pelvis -> Ureter

Question 86

48. What is the most anterior structure at the renal hilum? a. renal artery b. renal pelvis c. renal vein d. renal pyramid

Answer 86

c. renal vein | VAD

Question 87

49. Which statement regarding the kidneys is true? a. In the supine position, the kidneys are found between T10 to L2 vertebral levels b. The anterolateral surface of the left kidney is in contact with the left colic flexure superiorly c. The inferior anteromedial surface of the right kidney is associated with the right colic flexure d. The left kidney is more superior, longer, broader and closer to the midline than the right kidney

Answer 87

d. The left kidney is more superior, longer, broader and closer to the midline than the right kidney

Question 88

50. What is the most common position of the tip of the appendix? a. Pelvic b. retrocecal c. paracecal d. pre-ileal

Answer 88

b. retrocecal

Question 89

1. A 35-year old executive was sent to the emergency room due to vomiting of bright red blood. His vital signs are as follows: BP 100/60, heart rate 98 RR 24. He has a history of peptic ulcer disease. He had an **esophagogastroduodenoscopy showing bleeding duodenal ulcer**. The vessel involved in this condition belongs to which type of artery? A. Superior mesenteric artery B. Left gastric artery C.Common hepatic artery

Answer 89

B. Left gastric artery

Question 90

2. What type of hernia lies lateral to the inferior epigastric A. Direct Hernia B. Indirect Hernia C.Pantaloon Hernia D.Richter's Hernia

Answer 90

B. Indirect Hernia ## Footnote Pantaloon hernia (or "Saddlebag" hernia) is defined as any combination of two adjacent hernia sacs of the femoral or inguinal region (direct or indirect inguinal hernias (alternative plural: herniae)) on the same side. Richter hernia occurs when the anti-mesenteric wall of the intestine protrudes, causing strangulation without obstruction Direct Hernia – Inside the Hesselbach’s Triangle; Medial to inferior epigastric vessels. Indirect Hernia – Outside Hesselbach’s Triangle, with Spermatic cord; Lateral to inferior epigastric vessels. Femoral Hernia – In the femoral canal wherein lymphatics are located; More common in females.

Question 91

3. The superficial or external inguinal ring is an opening of layer: A. Skin B. External oblique C.Transversalis fascia D.Internal oblique

Answer 91

B. External oblique ## Footnote **Structures Related to External Oblique (2):** Inguinal Ligament of Poupart: The rolled-under inferior margin of the aponeurosis of the External Oblique Muscle Attached laterally to the ASIS and curves downward and medially, to be attached to the pubic tubercle External/ Superficial Inguinal Ligament – A triangular- shaped defect in the external oblique aponeurosis lies immediately above and medial to the pubic tubercle; The Spermatic Cord (In Men)/ Round Ligament of the Uterus (In Women) passes through this opening.

Question 92

4. True of jejunum A. Short plicae curcularis B. Thinner walls C. Mesentery has less fat D. Abundance of peyer's patches

Answer 92

C. Mesentery has less fat

Question 93

5. Esophageal hiatus is found at what vertebral level A. T5 B.T8 C.T10 D.T12

Answer 93

C.T10 | I 8 10 EGGS AT 12 ## Footnote Caval Foramen (Inferior Vena Cava) = T8 Esophageal Hiatus (Ant/Post. Vagal Trunk, Esophagus, Esophageal branch of the Left Gastric vessels) = T10 Aortic Hiatus (Descending Aorta, Azygos Vein, Thoracic Duct, Intercostal Lymph Trunks) = T12

Question 94

6. The ligament that extend from the anterior superior iliac spine to the pubic tubercle and forms the lower lateral border of the abdomen is the A. Lacunar B. Pectineal C. Ilioinguinal D. Inguinal

Answer 94

D. Inguinal ## Footnote **Structures Related to External Oblique (2):** Inguinal Ligament of Poupart: The rolled-under inferior margin of the aponeurosis of the External Oblique Muscle Attached laterally to the** ASIS** and curves downward and medially, to be attached to the** pubic tubercle** External/ Superficial Inguinal Ligament – A triangular- shaped defect in the external oblique aponeurosis lies immediately above and medial to the pubic tubercle; The Spermatic Cord (In Men)/ Round Ligament of the Uterus (In Women) passes through this opening. Boundaries of the FEMORAL SHEATH o Anterior: Inguinal Ligament of Poupart. o Posterior: Pectineal Ligament of Cooper. o Medial: Lacunar Ligament of Gibernant - Continuation of inguinal ligament posterior. o Lateral: Femoral Vein.

Question 95

7. Which of the following is retroperitoneal A. Spleen B.Transverse colon C. Descending colon D. Sigmoid colon

Answer 95

C. Descending colon ## Footnote A. Spleen (Intra) B.Transverse colon (Intra) C. Descending colon (Retro : Secondary) D. Sigmoid colon (Intra)

Question 96

8. The porta hepatis transmits all of the following EXCEPT: A. Hepatic Duct B.Hepatic Artery C.Portal vein D.Hepatic Vein

Answer 96

D.Hepatic Vein ## Footnote Hepatoduodenal Ligament – Portal Triad: CBD, Hepatic Artery, Portal Vein.

Question 97

9. The blood vessel that supplies most of the small intestine A. Celiac artery B.Gastroduodenal artery C.Superior mesenteric artery D.Inferior mesenteric artery

Answer 97

C.Superior mesenteric artery ## Footnote Branches of the SMA: * Pancreaticoduodenal Artery, * Jejunal & Ileal Branches (Arterial Arcades), * Ileocolic Artery, * Right Colic Artery, * Middle Colic Artery. o Pancreaticoduodenal Artery – Divides into the anterior & posterior branches of the superior pancreaticoduodenal artery; Supply the Descending & Inferior Portion of the Duodenum as well as the Head of the Pancreas. o Jejunal & Ileal Branches – Provide abundant collateral circulation to the peritoneal portion of the pancreas. o Ileocolic Artery – Termina lbranch of the SMA; Its branches include the Anterior & Posterior Cecal Artery, Appendicular Artery, Ascending Colic Artery, & the Ileal Branches. o Right Colic Artery – Frequently missing; Supplies the Ascending Colon with great variation. o Middle Colic Artery – Supplies the Transverse Colon.

Question 98

10. Umbilical folds are created peritoneum A. Falciform ligament B. Inferior epigastric artery C. Obliterated umbilical artery D.Urachus

Answer 98

C. Obliterated umbilical artery ## Footnote Anterior Abdominal Wall Internal View: * Transversalis Fascia; * Preperitoneal Fat; * Parietal Peritoneum – Shiny portion. ✓ Median Umbilical Ligament (Obliterated Urachus) – Covered internally by median umbilical fold; False Ligament. ✓ Medial Umbilical Ligament (Obliterated Umbilical Artery) – Covered by medial umbilical fold. ✓ Lateral Umbilical Fold – Contains the inferior epigastric vessels. o Umbilical Folds – Peritoneal folds overlying the umbilical ligaments & inferior epigastric vessels; Parietal Peritoneum; Median Umbilical Fold, Medial Umbilical Fold, Lateral Umbilical Fold.

Question 99

11. True of embryology of the stomach A. At 28 days, the gut tube dilates into a fusiform structure B. Ventral border grows faster that dorsal C. Rotation at 56 days causes the stomach to curve around causing the cranial region to move to the right and superiorly. D. All of the above E. None of the above

Answer 99

A. At 28 days, the gut tube dilates into a fusiform structure

Question 100

34. What is the primary organ of respiration?

Answer 100

Diaphragm