MIDTERM Flashcards
1
Q
A football player receives a blow to the side wall of chest, what complications could happen?
A
The long thoracic nerve can be caused which will put the serratus anterior out of business and cause winged scapula since serrates anterior can no longe hold shoulder
2
Q
What structures are found in the axilla?
A
Brachial plexus
Axillary artery and vein
3
Q
What are the branches of the Axillary artery?
A
Screw the lawyer, save the patient
Superior thoracic artery
Thoracoacromial artery
Lateral Thoracic artery
Subscapular artery
Anterior humeral circumflex artery
Posterior humeral circumflex artery
4
Q
Where does axillary artery become brachial artery?
A
distal border of teres major
5
Q
What are the terminal branches of the brachial plexus?
A
Median
Radial
Ulnar
Musculocutaneous
Axillary
6
Q
What is the function of the axillary sheath?
A
acts as a conduit from vertebral column to arm, forearm. hand
7
Q
What is contained in the axillary sheath?
A
Axillary artery and its branches
Axillary vein
Brachial Plexus
8
Q
______ becomes axillary artery at the lateral border of the first rib
A
Subclavian
9
Q
What are branches of the Thoracoacromial artery?
A
Cadavers are dead people
Clavicular
Acromial
Deltoid
Pectoral
10
Q
What does the Lateral Thoracic artery supply?
A
Serratus anterior
Lateral Breast
11
Q
Fracture of surgical neck of humerus can cause ?
A
Damage to axillary nerve and posterior humeral circumflex artery
12
Q
If the axillary artery is cut and ligated, blood flow will reverse in what artery?
A
Blood flow will reverse in the subscapular artery
Ligation should be performed proximal to the subscapular artery
13
Q
BRACHIAL PLEXUS IS A NETWORK OF NERVES DERIVED FROM ______ SPINAL NERVES THAT SUPPLY THE UPPER EXTREMITY
A
C5-T1
14
Q
If you fracture the clavicle, you must worry about damage to?
A
Axillary vessels
Brachial plexus
15
Q
_________ and _________ cords of the brachial plexus are anterior to the axillary artery
A
Lateral and medial cords are anterior to axillary artery
16
Q
What part of the brachial plexus is supraclavicular?
A
Roots
Trunks
Divisions
17
Q
What part of the brachial plexus in infraclavicular?
A
Cords
Branches
18
Q
What brachial plexus cord does the Thoracodorsal nerve (middle subscapular nerve) come from?
A
Posterior cord
19
Q
Thoracodorsal nerve (middle subscapular nerve) innervates which muscle?
A
Latissimus dorsi
20
Q
The big M of the brachial plexus is which cords?
A
The big M is comprised of the lateral and medial cords and their branches
21
Q
Which terminal branches of the brachial plexus come from the lateral cord?
A
Musculocutaneous nerve
Median nerve
22
Q
Which terminal branches of the brachial plexus come from the posterior cord?
A
Axillary nerve
Radial nerve
23
Q
Which terminal branches of the brachial plexus come from the medial cord?
A
Median nerve
Ulnar nerve
24
Q
What does the Musculocutaneous nerve innervate?
A
Flexor compartment of arm
Biceps brachii
Coracobrachialis
Brachialis
Musculocutaneous nerve continues as Lateral Cutaneous Nerve of forearm for sensory innervationof lateral forearm
25
Damage to musculocutaneous nerve results in?
Sensory loss to the lateral forearm
Great weakness of forearm and arm flexion
26
What does the axillary nerve innervate?
Deltoid
Teres minor
Skin over deltoid
27
What structures run through the quadrangular space?
Axillary nerve
Posterior humoral circumflex artery
28
Damage to axillary nerve results in?
Weakness in abduction, flexion, extension, and lateral rotation of arm
Sensory loss over the lateral shoulder
29
What does the radial nerve innervate?
Extensor compartment of arm and forearm
Triceps brachii
Skin of the posterior forearm
30
Where is the radial nerve found?
Radial (spiral) groove of the shaft of the posterior humerus
Triangular interval
31
What structures are found in the triangular interval?
Radial nerve
Profunda brachii artery
32
If deep branch of radial nerve is damaged, what happens?
Wrist drop
33
If superficial branch of radial nerve is damaged, what happens?
Lose sensation over the skin of posterior forearm
34
What does median nerve innervate?
Muscles of anterior forearm (except for flexor carpi ulnaris and ulnar half of flexor digitorum profundus)
35
What artery does the median nerve run with?
Brachial artery
36
What does the ulnar nerve innervate?
Flexor carpi ulnaris
Ulnar half of flexor digitorum profundus in the forearm
37
Ulnar nerve runs along_____
medial epicondyle
38
Which compartment of the arm are the flexors found in and what nerve are they innervated by?
Anterior
Musculocutaneous nerve
39
Biceps brachii action
Flexion of forearm at elbow
Supination
40
Brachialis action
flexes forearm
41
Coracobrachialis action
flexes arm
helps biceps brachii
42
What compartment of the arm are the extensors found in and what's it innervated by?
Posterior
Radial nerve
43
What does the hinge joint of elbow consist of and its action?
trochlea and trochlear notch
flexion/extension
44
What does the gliding joint of elbow consist of and its action?
Capitulum and radial head
pronation/supination
45
What are the 3 ligaments of the elbow joint?
Annular ligament
Medial (ulnar) collateral ligament
Lateral (radial) collateral ligament
46
What are 2 functions of the annular ligament of elbow?
Hold radial head in place
Allows for pronation and supination
47
What nerve does a surgeon need to be careful of when performing surgery in the axilla region?
Thoracodorsal nerve
48
IS the radius and ulna crossed in pronation or supination?
The distal radius rolls over the ulna and proximal radius turns in pronation
49
DAMAGE TO WHAT NERVE AND AT WHAT SPINAL LEVEL WILL RESULT IN WINGED SCAPULA?
LONG THORACIC NERVE
C5, C6, C7
50
WHAT HAPPENS TO FUNCTION IN A PATIENT WITH WINGED SCAPULA ?
LOSS OF LONG THORACIC NERVE WILL MAKE THE PATIENT UNABLE TO ABDUCT ARM ABOVE 90 DEGREES BECAUSE OF LOSS OF THE SERRATUS ANTERIOR
51
WHAT STRUCTURES CAN GET DAMAGED IN A FRACTURE OF SURGICAL NECK OF HUMERUS?
AXILLARY NERVE
POSTERIOR HUMORAL CIRCUMFLEX ARTERY
52
WHAT HAPPENS TO FUNCTION IN A PATIENT WITH AXILLARY NERVE DAMAGE?
WEAKNESS IN ABDUCTION, FLEXION, EXTENSION, AND LATERAL ROTATION OF ARM
SENSORY LOSS OVER THE LATERAL SHOULDER
53
HOW MAY A PATIENT PRESENT WHEN THEY HAVE AXILLARY NERVE DAMAGE?
FLATTENED DELTOID
INABILITY TO ABDUCT SHOULDER PAST 15 DEGREES
REDUCED OR LOSS OF SENSATION OVER DELTOID AND LATERL ARM
54
WHAT CAUSES ERB'S PALSY?
DAMAGE TO UPPER ROOTS (C5 AND C6) OF BRACHIAL PLEXUS
INCREASED ANGLE BETWEEN NECK AND SHOULDER
FALLING ON HEAD AND SHOULDER OR IF INFANT'S HEAD PULLED ON FORCEFULLY
55
HOW DOES ERB'S PALSY PRESENT?
UPPER EXTREMITY IS MEDIALLY ROTATED AND PARALYZED EXCEPT FOR FINGERS
LOSS OF SENSATION ON LATERAL ASPECT OF UPPER LIMB
WAITERS TIP POSITION
56
WHAT IS KLUMPKES PALSY CAUSED FROM?
DAMAGE TO LOWER ROOTS (C8 AND T1) OF BRACHIAL PLEXUS
EXCESSIVE UPWARD PULL OF UPPER LIMBS
GRABBING A TREE BRANCH TO BREAK A FALL OR PULLING ON INFANTS ARM DURING DELIVERY
57
HOW DOES KLUMPKES PALSY PRESENT?
SHORT INTRINSIC HAND MUSCLES ARE PARALYZED
CLAW HAND
58
WHAT CAUSES SATURDAY NIGHT PALSY?
DAMAGE TO RADIAL NERVE
CAN HAPPEN THROUGH EXCESSIVE PRESSURE ON AXILLA (CRUTCHES OR SLEEPING WITH ARM OVER CHAIR)
WRIST DROP
59
WHAT NERVE MAY GET DAMAGED IN BREAST SURGERY?
THORACODORSAL NERVE
60
A PATIENT WITH THORACODORSAL NERVE DAMAGE MAY HAVE DEFICITS IN FUNCTION IN WHAT AREAS?
A PATIENT WITH THORACODORSAL NERVE DAMAGE MAY HAVE WEAKNESS IN EXTENSION, MEDIAL ROTATION, AND ADDUCTION OF ARM
61
A PATIENT THAT CAN NOT WIPE THEMSELVES IS EXAMPLE OF WHAT TYPE OF DAMAGE?
THORACODORSAL NERVE DAMAGE
62
what does hypesthesia mean?
reduced sensation
63
What does the interosseous membrane that is between the radius and ulna divide?
Anterior (flexor) and posterior (extensor) compartments
64
What nerves are found in the flexor compartment (anterior forearm) ?
Median and Ulnar nerves
65
What nerves are found in the extensor compartment (posterior forearm)?
Radial nerve
66
Radius articulates with the ________ of the humerus and the _______ of the ulna
Capitulum of humerus
Radial notch of the ulna
67
What inserts on the radial tuberosity of the radius?
Tendon of the biceps brachii
68
What part of radius is prone to fracture?
Styloid process on the distal end of radius
69
What part of the ulna is prone to fracture?
Styloid process of the ulna on distal end
70
What can cause a fracture of the styloid process of the ulna?
Falling on outstretched hand
71
Why is it necessary to have collateral circulation at elbow?
Because when you flex the elbow, you kink brachial artery
72
What does brachial artery split into?
Ulnar and radial arteries
73
During supination, the radius and ulna are _______
parallel
74
What nerve separates the superficial and deep layers of the anterior forearm (flexor compartment)?
Median
75
What muscles are found in the flexor compartment (anterior forearm)
Any muscle starting with flexor or pronator
Palmaris longus
Brachioradialis *** located in extensor compartment but is a flexor muscle
76
All of the flexor muscles of the forearm are innervated by the Median nerve except which muscles?
Flexor carpi ulnaris (Ulnar nerve)
Brachioradialis (Radial nerve)
The portion of the Flexor Digitorum Profundus that controls the medial 2 digits (Ulnar nerve)
Lateral 2 digits controlled by median nerve
77
Pronator teres action
pronates and flexes forearm
78
Flexor carpi radialis action
flexes and abducts wrist (radial deviation)
79
Palmaris longus action
flexes wrist
80
Flexor carpi ulnaris action
flexes and adducts wrist (ulnar deviation)
81
Brachioradialis action
flexes elbow
82
Flexor digitorum superficialis action
flexes wrist, PIP and MP joints of median 4 digits
83
Flexor digitorum profundus action
flexes wrist, DIP,PIP, and MP
84
Flexor pollicus longus action
flexes thumb
85
Pronator quadratus action
pronates forearm
86
what nerve runs through the carpal tunnel?
Median nerve
87
Median nerve enters forearm alongside ________ artery
Brachial artery
88
How does patient with median nerve injury at elbow present?
Hand of Benediction (Ape hand)
cannot oppose thumb
loss of pronation
sensory loss
89
What is Hand of Benediction?
Attempted formation of a fist results in 4th and 5th flexed (intact ulnar nerve) but first 3 fingers remain extended
90
What is ape hand
inability to abduct the thumb
91
What can result from median nerve injury at the wrist (in carpal tunnel)
Ape hand due to damage of the recurrent branch of the median nerve resulting in sensory loss, thenar eminence wasting and inability to abduct the thumb
92
Ulnar nerve runs along the medial edge of the forearm along with the _______
ulnar artery
93
Ulnar nerve innervates which muscles of the anterior compartment of forearm?
Flexor carpi ulnaris
Portion of the flexor digitorum profundus that controls medial 2 digits
94
How does patient with ulnar nerve damage at elbow present?
Claw hand (can't abduct and adduct fingers)
Claw hand develops over time
Hypeextension of MP joint
Flexion of PIP joint
Static Sign unlike Hand of Benediction
can't flex DIP joints, ring and little fingers
95
What artery runs through snuffbox?
Radial artery
96
The radial artery becomes the __________ arch?
Deep palmar arch
97
Ulnar artery becomes the ________ arch
superficial palmar arch
98
What is the Allen's test?
Allen's test allows testing of circulatory status of radial and ulnar arteries. Occlude both arteries by pressure and then ask patient to make a fist until palmar surface is white. Releasing pressure on either radial or ulnar artery will reveal whether the opposite artery is providing adequate circulation to hand
99
All extensor muscles of forearm are innervated by?
any muscle that starts with extensor, supinator, and the abductor pollicis longus
Radial nerve
100
Extensor carpi radialis longus action
extend abduct wrist (radial deviation)
101
Extensor carpi radialis brevis action
extend and abduct wrist (radial deviation)
102
Extensor digitorum action
partially extend all but thumb
final extension of fingers by lumbrical and interosseous muscles
103
Extensor carpi ulnaris action
extend and adduct wrist (ulnar deviation)
104
extensor digiti minimi action
extend little finger
105
Extensor indicis action
extend index finger (along with extensor digitorum)
106
Extensor pollicis longus action
extend thumb (IP joint)
107
Extensor pollicis brevis action
extend thumb
108
Abductor pollicis longus action
abduct thumb
109
Supinator
supinates forearm
110
which are stronger? Supinator or pronator
Supinators are stronger than pronators
111
The superficial branch of radial nerve innervates?
skin of posterior forearm and parts of dorsum of hand
112
The deep branch of the radial nerve innervates ?
muscles in the posterior compartment of forearm (extensors)
113
What are signs of radial nerve injury?
wrist drop
cannot extend elbow
loss of sensation on posterior forearm and dorsum of hand
114
What structure in dorsum of hand holds all tendons in position as they pull on insertions?
extensor retinaculum
115
What is compartment syndrome?
Muscles of forearm are grouped into tight fascial compartments and if there is swelling the compartment blood supply can be cut off
116
What type of fractures are scaphoid bones prone to ?
avascular fractures
117
Identify the bones of wrist on xray
118
Which bones of the wrist transmit force from the hand?
scaphoid and lunate
119
Where is interphalangeal joint (IP) found?
thumb
120
What is the function of the palmar aponeurosis?
Lies right under skin and protects all underneath structures from crushing injuries
Prevents long tendon from bowing out when constricted strongly
121
Carpal tunnel is formed by ______
flexor retinaculum
122
What nerve is found in the carpal tunnel?
Median nerve which breaks into branches called the recurrent nerve
123
Sensory branches of the median nerve innervate?
thumb second digit, third digit and half of fourth digit
124
What is carpal tunnel syndrome?
Inflammation of the flexor retinaculum sheath due to repeated movement in the carpal tunnel, fluid retention, fractures, infection or trauma to wrist
this results in decrease in size of tunnel and compression of the median nerve leading to tingling, lack of sensation (except for palm),
wasting of thenar muscles and lack of opposition
125
If the recurrent median branch of median nerve is affected in carpal tunnel syndrome, what happens?
Ape hand
126
How do you test for carpal tunnel syndrome?
Phalen's maneuver
test for median nerve compression
raise arms to shoulder level and bring dorsum of hand together and hold wrist forced flexion 30-60 seconds. Positive phalens get tingling and numbness
127
What is tendonitis/synovitis?
sterile inflammation of the tendon or synovial sheath that is a result of overuse
128
What is Tenosynovitis
infection of both the digital synovial sheath and the tendon causing inflammation
usually confined to one digit
129
Which muscle is the only muscle to flex DIP joint
Flexor digitorum profundus
130
Flexor digitorum profundus action
flexes DIP, PIP, MP joint and wrist
131
What is special about how the Flexor Digitorum Superficialis attaches ?
Flexor Digitorum Superficialis splits and inserts on each side of the middle phalanx
132
Flexor digitorum superficialis action
flexes PIP, MP joint and wrist
133
What are the three long flexor tendons?
Flexor Digitorum Profundus
Flexor Digitorum Superficialis
Lumbricals
134
Where do Lumbricals insert?
Lumbricals insert on the radial side of profundus tendon (no direct bone attachment)
135
what are vincula
synovial folds containing small blood vessels to long flexor tendons
136
What is the function of the lumbricals?
fine finger movements
137
The lateral two lumbricals are innervated by?
Median nerve
138
The medial two lumbricals are innervated by?
ulnar nerve
139
Interosseus muscles of hand (located between metacarpals) are innervated by?
ulnar nerve
140
What is the function of the palmar interossei muscles of hand?
Palmar Interossei muscles adduct 2, 4, 5 digits (toward middle finger) PAD
141
What is function of Dorsal Interossei muscles of hand?
Dorsal interossei muscles abduct 2, 4, 5 digits (away from middle finger) DAB
142
The intrinsic muscles (aka THENAR muscles) of the deep thumb are innervated by?
recurrent branch of the median nerve
143
Damage to recurrent branch of median nerve causes?
loss of opposition (APE HAND)
144
What are the three muscles of thumb?
Abductor Pollicis Brevis
Flexor Pollicis Brevis
Opponens Pollici
145
What muscle is the ONLY muscle that opposes thumb?
Opponens Pollicis
146
Adductor pollicus action and innervation
Adduct and flex the thumb
Ulnar nerve
147
Hypothenar muscles are innervated by?
Ulnar nerve
148
IF THE UPPER LIMB HAS SUSTAINED TRAUMA, HOW DO TEST FOR SENSATION OF THE
MEDIAN NERVE
ULNAR NERVE
RADIAL NERVE
MEDIAN NERVE-PALMAR SURFACE OF INDEX FINGER
ULNAR NERVE-DORSAL SURFACE OF PINKY
RADIAL NERVE-DORSUM OVER THE FIRST INTEROSSEOUS
149
CUTANEOUS INNERVATIONS OF THE HAND
150
Claw hand is caused by what type of nerve damage?
Ulnar nerve damage
151
Benediction hand is from what type of nerve damage
median nerve damage at elbow
152
Ape hand caused by what type of nerve damage?
median nerve damage at wrist
thenar muscle paralysis
can be due to carpal tunnel
153
The superficial palmar arch (ulnar) and the deep palmar arch (radial) anastomose and provide collateral circulation. Allen's test can be performed by occluding both radial and ulnar nerves. What constitutes a positive Allens test?
Positive Allen's test-color of hand doesn't return to normal within 5 seconds
Negative Allens test-color of hand returns to normal after 5 seconds
154
What is a Colles' fracture?
Fracture of the ulnar styloid process and distal radius (DINNER FORK DEFORMITY)
common in women aged 50+
155
What can cause a scaphoid fracture?
Common in young adults usually with a fall onto an abducted and outstretched hand
Degeneration of bone may occur due to cut off blood supply from branch of radial artery
156
What ligaments are involved in shoulder separation?
acromioclavicular ligament
coracoclavicular ligament
157
muscles of the rotator cuff
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
158
What is the sequence of muscle activation in abduction of the arm at the shoulder?
Supraspinatus initiates abduction
Deltoid brings arm to 90 degrees
Serratus anterior and Trapezius brings arm over 90 degrees
159
What type of action can cause shoulder dislocation?
Forced abduction and lateral rotation
160
What direction do shoulder dislocations most often occur?
Anterior dislocation
161
What is the function of the annular ligament in the elbow?
allows for pronation/supination as radius rotates in ligament
Holds the head of radius against ulna
162
Describe elbow dislocation
Head of radius slips out of the annular ligament (subluxation)
163
What type of nerve damage may occur with olecranon fracture?
Ulnar nerve damaged
164
Winged scapula and difficulty abducting arm above 90 degrees and pushing
No sensory loss
What nerve damaged?
Long thoracic nerve
Serratus anterior
165
Patient undergoes breast surgery and afterwards shows weakness in extension, medial rotation, and arm adduction
no sensory loss
What nerve damaged?
Thoracodorsal nerve
Latissimus dorsi
166
A patient presents with weakness in abduction of arm, weakness in flexion, extension, and lateral rotation of arm plus sensory loss over lateral shoulder
What nerve damage?
Axillary nerve
deltoid, teres minor, and skin over deltoid (lateral shoulder)
167
Axillary nerve comes from ________ cord and runs through _____________
Axillary nerve comes from posterior cord and runs through quadrangular space (surgical neck)
168
A patient presents with weakness in the flexion of the forearm, weakness in the flexion of arm and loss of sensation over the lateral forearm
What nerve damaged?
Musculocutaneous nerve
flexor muscles of the arm and skin of lateral forearm
Biceps brachii
Coracobrachialis
Brachialis
169
Musculocutaneous nerve comes from ______ cord and runs through __________
Musculocutaneous nerve comes from lateral cord and runs through coracobrachialis
170
If a patient present with:
cannot flex the distal IP joint of the ring and little fingers
cannot abduct and adduct fingers
cannot adduct thumb and has CLAW HAND
What nerve damaged?
Ulnar nerve
flexor carpi ulnaris
1/2 of flexor digitorum profundus
171
Ulnar nerve comes from_______ cord and runs behind _______
Ulnar nerve comes from medial cord and runs behind medial epicondyle of humerus
172
The deep branch of the ulnar nerve innervates?
hypothenar muscles
adductor pollicis
ulnar (medial) two lumbricals
all interosseous muscles
173
The superficial branch of ulnar nerve innervates?
skin
174
The median nerve innervates?
flexors of forearm
pronators of forearm
palmaris longus
thenar muscles
radial (lateral) two lumbricals
skin
175
what are the thenar muscles?
flexor polllicis brevis
abductor pollicis brevis
opponens pollici
176
How does the median nerve reach the thenar muscles?
through carpal tunnel
177
Median nerve comes from____ cord
Median nerve comes from medial and lateral cords
178
What happens if the recurrent branch of the median nerve is damaged?
cannot oppose thumb (APE hand)
179
What happens if median nerve is damaged in carpal tunnel?
Patient cannot oppose thumb and has median nerve sensory changes
180
What happens if median nerve damaged higher up than the recurrent median nerve and the carpal tunnel?
Ape hand
cannot pronate
cannot flex distal IP joints of index and middle fingers
weak flexion of the thumb and wrist
Hand of Benediction
181
If radial nerve is damaged up high, what signs?
cannot extend forearm (triceps)
loss of sensation over posterior arm and forearm (I THINK DORSUM OF HAND BUT CHECK
wrist drop
loss of extension of thumb and MP joints
182
Radial nerve comes from _______ cord and travel in _______
Radial nerve comes from posterior cord and runs in the radial groove along shaft of humerus
183
Superficial branch of the radial nerve runs through ________ and supplies
snuff box
sensation to hand
184
Deep branch of the radial nerve runs through _________ to innervate_________
Deep branch of the radial nerve runs through supinator to innervate extensor muscles of forearm
185
Damage to the deep branch of the radial nerve results in ?
wrist drop
unable extend thumb
unable extend MP joints
186
Umbilicus part of _______ dermatome
T10 dermatome
187
What vertebral level is the iliac crest found?
L4
188
HOW DOES APPENDICITIS PRESENT
PERIUMBILICAL/EPIGASTRIC PAIN WHICH GRADUALLY MIGRATES TO RLQ (TO MCBURNEY'S POINT WHERE THE APPENDIX IS FOUND)
189
Name the layers of oblique abdominal wall
skin
Camper fascia
Scarpa fascia
external oblique
internal oblique
transversus abdominis
transversals fascia
exztraperitoneal fat
parietal peritoneum
190
What is the largest and most superficial muscle of abdominal cavity?
External oblique muscle
191
External Oblique muscle is innervated by?
T7-T12
192
Muscle fibres of the external oblique muscle run in what direction?
hands in pocket
193
External oblique muscle becomes __________ at iliac crest
External oblique muscle becomes inguinal ligament at iliac crest
194
A hernia above inguinal ligament is termed ________ and a hernia below inguinal ligament is _______
Hernia above inguinal ligament-inguinal hernia
Hernia below inguinal ligament-femoral hernia
195
Rectus sheath is a combination of aponeurotic fibers of what muscles?
external oblique
internal oblique
transversus abdomonis (POSTERIOR LAYER)
196
Internal Oblique innervated?
T7-L1
197
What muscle originates from the internal oblique muscle?
Cremaster muscle
198
external oblique and internal oblique function ?
flex, rotate, compress
199
Innervation of Transversus Abdomens?
T7-L1
200
Transversus abdominis function
compress and support trunk
201
Innervation of Rectus Abdominis
you can find 6 packs at 7/11
T7-T11
202
What is rectus diastasis?
linea alba becomes stretched causing a weak point and intestines begin to bulge anteriorly
can happen during pregnancy or to infants
203
Pyramidalis innervation?
T12 (subcostal nerve)
204
Pyramidalis function?
tenses linea alba
205
What structures travel upwards and pierce the rectus sheath at the arcuate line?
Inferior epigastric vessels travel upwards and pierce the rectus sheath at the arcuate line
206
What vessels supply the rectus abdominis?
Superior and inferior epigastric artery/vein supply rectus abdominis
207
Superior epigastric artery branches from ___________ artery
Superior epigastric artery branches from internal thoracic artery
208
Inferior epigastric artery branches from __________artery
Inferior epigastric artery branches from external iliac artery
209
A hernia which is found INSIDE Hesselbach's triangle?
Direct inguinal hernia
210
What veins are involved in Caput Medusae?
paraumbilical veins
211
How do you treat Caput Medusae?
paracentesis
212
What are signs of Portal Hypertension?
Caput Medusae
Hemorrhoids
Esophageal varices
Splenomegaly
Intra-abdominal bleed
Retropancreatic rupture
213
Iliohypogastric and Ilioinguinal nerves are found vertebral level?
L1
214
Iliohypogastric and Ilioinguinal nerves traverse between which muscles?
Internal oblique
Transversus abdominis
215
What is patent urachus?
open connection from bladder to umbilicus which urine can be eliminated from after birth
216
The urachus becomes ? after birth
Median umbilical ligament
217
Where is the inguinal canal found?
The inguinal canal lies JUST ABOVE INGUINAL LIGAMENT
(inguinal ligament does not go through inguinal canal)
218
What is function of the inguinal canal?
Transmit spermatic cord
Transmit round ligament of uterus
219
What structures are found in the spermatic cord?
Testicular arteries and veins
Cremasteric artery
Artery of Ductus Deferens
Genital branch of genitofemoral nerve
Pampiniform plexus (veins that act as cooling device)
Ductus (vas) deferens to/from testes
220
What artery lies medial to the deep inguinal ring?
Inferior epigastric artery lies medial to the deep inguinal ring
221
Inguinal ligament is formed by?
External oblique aponeurosis
222
What is lacunar ligament?
part of external oblique aponeurosis that connects inguinal ligament to pectineal ligament and together attach to pubic tubercle
223
What is function of ductus (vas) deferens?
transmits sperm from epididymis
224
225
What structure is cut in vasectomy?
Vas deferens
226
What is function of cremaster muscle and where located?
elevates testes reflexively and for thermoregulation
promotes pubescent descent of testicles
Derived from internal oblique
Cremaster muscles surround the spermatic cord all the way to testes
227
WHAT IS CREMASTER REFLEX AND WHY USED?
CREMASTER REFLEX CAN MEASURE LUMBAR NERVE CONDUCTION IN INJURY
WHEN INNER THIGH IS STROKED, SENSORY
FIBERS ALONG FEMORAL BRANCH OF GENITOFEMORAL NERVE (NERVE ROOTS L1/L2)
AND ILIOINGUINAL NERVE (T12/L1) ARE STIMULATED
THESE SYNAPSE IN SPINAL CORD TO ACTIVATE MOTOR FIBERS OF GENITAL BRANCH (L1/L2) OF GENITOFEMORAL NERVE
CREMASTER THEN CONTRACTS AND ELEVATES THE TESTES
228
_________artery>>>>>________artery>>>>>>anterior scrotal arteries
Common femoral artery>>>deep external pudendal artery>>>anterior scrotal arteries
229
______artery >>>_____artery>>>posterior scrotal arteries
Internal pudendal artery>>>Perineal artery>>>posterior scrotal arteries
230
What is function of panpiniform plexus?
cool blood and keep testicles right temperature
231
Right testicular vein drains to____
IVC
232
Left testicular vein drains to?
left renal vein and then IVC
233
What is testicular varicocele?
Dilation of panpiniform plexus
Can cause fertility issues due to loss of thermoregulation
Caused by malfunction of venous valves, renal problems, nutcracker syndrome
234
Why does testicular varicocele occur more often the left side?
Because Superior Mesenteric Artery can clamp down on left renal vein
Nutcracker syndrome
235
Layers of scrotum
Skin
Dartos fascia
external spermatic fascia
cremaster muscle
internal spermatic fascia
tunica vaginalis
tunica albuginea
236
Tunica vaginalis encloses
epididymis and testis
237
What is Patent Processus Vaginalis?
normally the tunica vaginalis of testis forms with closure of peritoneal sac. If the peritoneum sac never closes this leaves a clear opening in the abdominal cavity where intestines or fluid can enter scrotum
238
WHAT IS A TESTICULAR HYDROCELE?
ACCUMULATION OF SEROUS, CLEAR FLUID BETWEEN PARIETAL AND VISCERAL LAYERS OF TUNICA VAGINALIS CAUSED BY DRAINAGE OR KIDNEY PROBLEM
239
HOW DO YOU DIAGNOSE TESTICULAR HYDROCELE?
SHINE A LIGHT THROUGH TESTICLES IN DARK ROOM TO SEE IF THEY LIGHT UP>>> RED GLOW/TRANSLUCENT COLOR INDICATES PRESENCE OF FLUID
240
IF TESTING FOR A HYDROCELE AND TESTICLES DO NOT LIGHT UP (SO APPEAR OPAQUE), WHAT ARE POSSIBLE DIAGNOSES?
TESTICULAR CANCER
HEMATOCELE
HERNIA
INFECTION
241
What is function of the epididymis?
site of sperm maturation and storage
242
The seminiferous tubules are divided into lobules of the testis and have ducts running to the head of the epididymis. What is function of the seminiferous tubules?
Sperm production
243
WHAT LYMPH NODES DO THE TESTES DRAIN DIRECTLY INTO?
LATERAL LUMBAR AORTIC NODES (AKA PARAAORTIC)
244
What is gubernaculum?
strong ligament between the tunica vaginalis and tunica albuginea which aids in pulling testicles from abdominal cavity through superficial ring into scrotal sac during development
245
A patient with cryptorchidism is at increased risk of?
testicular cancer
246
Testicular cancer is most common in what demographic ?
males aged 15-35
247
What is femoral hernia?
hernia below the inguinal ligament into femoral canal
248
What is the most common hernia?
Inguinal hernia (90%)
249
What is inguinal hernia?
hernia of small intestine or fat enters inguinal canal and occurs ABOVE inguinal ligament
250
WHAT IS RELATIONSHIP OF A DIRECT INGUINAL HERNIA TO THE INFERIOR EPIGASTRIC ARTERY?
A DIRECT INGUINAL HERNIA RUNS MEDIAL TO THE INFERIOR EPIGASTRIC ARTERY
251
WHERE IS PATH OF DIRECT INGUINAL HERNIA?
IN HESSELBACH'S TRIANGLE
GOES ONLY THROUGH THE SUPERFICIAL RING AND DOES NOT GO INTO THE SPERMATIC CORD
252
WHAT ARE CAUSES OF DIRECT INGUINAL HERNIA?
USUALLY DEVELOPS IN ADULTS/ELDERLY
MAY BE DUE TO HEAVY LIFTING AND WEAK ABDOMINAL WALL
253
WHAT IS INDIRECT INGUINAL HERNIA RELATIONSHIP TO INFERIOR EPIGASTRIC ARTERY?
INDIRECT INGUINAL HERNIA RUNS LATERAL TO INFERIOR EPIGASTRIC ARTERY
254
WHAT IS PATH OF INDIRECT INGUINAL HERNIA?
GOES THROUGH THE DEEP AND SUPERFICIAL RINGS INOT SPERMATIC CORD AND SCROTUM
255
WHAT ARE CAUSES OF INDIRECT INGUINAL HERNIA?
USUALLY CONGENITAL
ANY AGE, COMMON IN YOUNG CHILDREN/BABIES
MAY BE DUE TO PATENT OR REOPENED PROCESSUS VAGINALIS
256
Rectus abdominis function
main flexor of trunk
257
Rectus abdominis is supplied by what artery?
Inferior epigastric artery
258
Pyramidalis is supplied by what artery ?
Inferior epigastric artery
259
What is McBurney's point?
McBurney's point is in the RLQ and is the point of maximal tenderness in appendicitis
260
What is the specific location of McBurney's point?
1/3 of the way from anterior superior iliac spine to umbilicus
261
GI tract from mouth to anus
Mouth
Pharynx
Esophagus
Stomach
Duodenum
Jejunum
Ileum
Cecum and appendix
Ascending colon
Hepatic (right) flexure
Transverse colon
Splenic (left) flexure
Descending colon
Sigmoid colon
Rectum
Anus
262
How is pain felt in Parietal peritoneum?
Parietal peritoneum is sensitive to pain, pressure, heat, and cold
Pain is well-localised/acute to exactly where it is coming from (somatic nerves)
263
How is pain felt in visceral peritoneum?
Visceral peritoneum is insensitive to touch, heat, cold, and laceration
Pain is NOT localised and is referred to the dermatomes of the spinal ganglion providing the sensory fibers (visceral afferent nerves)
264
Where is pain first felt in appendicitis?
Vague, dull periumbilical (T10) visceral pain
265
What is the Epiploic foramen of Winslow?
The epiploic foramen, also called the foramen of Winslow, is a small vertical passage between the greater sac (peritoneal cavity proper) and the lesser sac (omental bursa), allowing communication between these two spaces.
266
What structure forms the anterior wall of the epiploic foramen of Winslow?
Hepatoduodenal ligament
267
What are intraperitoneal organs and list them?
Intraperitoneal organs have a mesentery suspending them from the abdominal wall
Liver and gallbladder
Spleen
Stomach
Duodenum (1st part)
Jejunum
Ileum
Transverse colon
Sigmoid colon
Tail of pancreas
268
What are secondarily retroperitoneal organs and list?
Secondarily retroperitoneal organs are ones whose mesentery fuses to posterior abdominal wall
Duodenum (besides 1st part)
Ascending colon
Descending colon
Upper rectum
Pancreas (except tail)
269
What are retroperitoneal organs and list?
Retroperitoneal organs are not covered by visceral peritoneum and not connected by mesentery
Esophagus (thoracic portion)
Anal canal
kidneys
Adrenal glands
ureters
IVC
aorta
270
What are sub peritoneal organs and list?
Subperitoneal organs lie inferior to the peritoneal cavity
Lower rectum
bladder
271
What is the Kocher Maneuver?
Kocher maneuver is a dissection of the avascular lateral peritoneal attachments of the duodenum in order to visualise the posterior duodenum, pancreas, and retroperitoneal structures
272
What is mesentery?
Mesentery is double layered extensions of visceral peritoneum that results from invagination of organs into peritoneum
273
What is omentum?
omentum is an extension of mesentery from the stomach that hangs down from stomach and divides into the greater and lesser momentum
274
Mnemonic to remember retroperitoneal abdominal organs
SAD PUCKER
Suprarenal (adrenal) glands
Aorta and IVC
Duodenum (except first part)
Pancreas (head and body)
Ureters
Colon (ascending and descending)
Kidneys
Esophagus
Rectum (mid-distal)
275
What are three parts of Greater omentum?
Gastrosplenic ligament
Gastrophrenic ligament
Gastrocolic ligament (stomach to transverse colon)
276
What is lesser omentum?
Visceral peritoneum that extend superiorly from lesser curvature of stomach to the porta hepatis of liver
277
Lesser omentum contains what two ligaments?
Hepatogastric ligament
Hepatoduodenal ligament
278
What is Foramen of Winslow (aka epiploic foramen)?
formed by right border of lesser omentum and opens into the lesser sac (omental bursa)
279
What is Pringle manurer?
When the hepatoduodenal ligament (and portal triad) is clamped surgically to slow blood flow to the liver
280
What structures are contained in the portal triad?
Portal Vein
Hepatic artery
Bile duct
281
What is a peritoneal recess?
a pouch that formed by a peritoneal fold
282
Where is subphrenic space located?
between diaphragm and liver
283
What divides the right and left subphrenic spaces?
Falciform ligament
284
What allows communication between the greater and lesser sacs?
Epiploic foramen of Winslow
285
What is another name for lesser sac?
omental bursa
286
What is special about the hepatorenal recess?
rich in lymphatics
Fluid accumulates here when supine
Infections spread easily through here because of contact with peritoneal fluid and lymphatic system
287
What are paracolic gutters?
found on either side of ascending and descending colon
moves fluid superiorly, especially when laying down
288
What is the function of the Right Lateral Paracolic gutter?
Directly connects pelvic cavity to hepatorenal recess and thus transmits things between these two areas easily
-spread of infection or disease
-if appendix/diverticulum is ruptured or there is an absence in pelvis, spreads very fast throughout body via lymph
Reabsorpiton of peritoneal fluids
289
How is liver connected to anterior abdominal wall?
Falciform ligament
290
Where does the esophagus enter the abdomen?
Esophagus enters the abdomen at the esophageal hiatus at T10
291
What sphincter prevent food from refluxing into airways?
Upper esophageal sphincter
292
Stomach produces ______ and releases into duodenum
chyme
293
What two chemicals are produced in stomach and by what cells?
Parietal cells-HCL
Chief cells-Pepsinogen
294
What's the part of the stomach that contacts esophagus called?
Cardia
295
What's the part of the stomach that the dilated superior part of stomach beneath left diaphragmatic dome and above the cardiac notch ?
Fundus
296
How does fundus of stomach tend to appear on radiograph?
Fundus appears black due to ingested air while standing
297
What part of stomach accumulates food (starts digestion)?
Pyloric antrum
298
Which part of the stomach ends in thick muscular layer (pyloric sphincter)?
Pyloric canal
299
Unlike the rest of GI tract (which have 2 layers), the stomach has 3 muscle layers. Name them
Outer longitudinal layer
Middle circular layer
Innermost oblique layerWh
300
Which layer of the stomach is unique to the stomach and what is its function?
Innermost oblique layer churns up contents
301
What sits in the C-shaped part of duodenum?
head of pancreas
302
What type of glands found in duodenum?
Brunner's glands secrete mucus and protect against acidic chyme
303
Function of duodenum?
receive and neutralize acidified chyme with bicarbonate produced from pancreas
304
Which part of the duodenum is most susceptible to ulceration and why?
1st part (superior) because lack of Brunner's glands
305
What is one of the few things absorbed by duodenum?
iron
306
What structures are found in the 2nd part (descending/vertical) duodeum?
Major and minor duodenal papillae
307
What does the major duodenal papilla contain?
Ampulla of Vater (hepatopancreatic) and the surrounding Sphincter of Oddi
308
What is the ampulla of Vater
junction of common bile duct and pancreatic duct
309
What anatomical features do the 2nd-4th part of duodenum have that the 1st doesn't?
Plicae circulares which are permanent circular transverse mucosal membrane folds that don't expand (increase surface area)
310
What is the ligament of Treitz?
triangular suspensory ligament of peritoneum that marks the division between duodenum and jejunum and maintains the bent angle of duodenaljejunal junction
311
How does jejunum appear on X-ray?
feathery due to taller plicae circulares
312
How does ileum appear on X-ray?
sausage appearance because fewer and shorter place circulares
313
Jejunum has _______________ than ileum
Jejunum has less encroaching mesentery/fat than ileum
Jejunum has more vascular, pinker or deeper red collar than ileum
314
Where are Peyers patches found?
Ileum
315
WHAT IS MECKEL'S DIVERTICULUM?
OUTPOUCHING OF ILEUM AND REMNANT OF YOLK STALK
316
WHERE IS MECKEL'S DIVERTICULUM FOUND AND WHAT IS RULE OF 2'S?
FOUND ON THE ANTIMESENTERIC BORDER OF ILEUM
2 INCHES LONG
2 FEET FROM ILEOCECAL JUNCTION
2X MORE COMMON IN MALES
FOUND IN 2% POPULATION
2 TYPES ECTOPIC MUCOSA (GASTRIC AND PANCREATIC)
317
WHAT ARE POSSIBLE COMPLICATIONS OF MECKEL'S DIVERTICULUM?
GASTRIC MUCOSA CAN FORM ULCERS
CAN BECOME INFLAMED AND CAUSE DIVERTICULITIS WITH SYMPTOMS SIMILAR TO APPENDICITIS
318
Watery, nutrient poor material from ileum empty into?
cecum via ileocecal valve
319
WHAT IS DIFFERENCE IN ARCADES BETWEEN JEJUNUM AND ILEUM
JEJUNUM HAS SIMPLER ARCADES
ILEUM HAS MULTIPLE COMPLEX ARCADES
320
WHICH HAS A LARGER DIAMETER, JEJUNUM OR ILEUM?
JEJUNUM HAS LARGER DIAMETER
ILEUM HAS SMALLER DIAMETER
321
WHAT IS DIFFERENCE IN PLICA CIRCULARES BETWEEN JEJUNUM AND ILEUM?
JEJUNUM HAS DENSE AND TALL PLICA CIRCULARES
ILEUM HAS FEW AND SHORT PLICA CIRCULARES
322
WHAT IS DIFFERENCE IN VASA RECTA BETWEEN JEJUNUM AND ILEUM
JEJUNUM HAS LONG VASA RECTA
JEJUNUM HAS SHORT VASA RECTA
323
WHAT IS DIFFERENCE IN ENCROACHING MESENTERY/FAT BETWEEN JEJUNUM AND ILEUM?
JEJUNUM HAS LESS ENCROACHING MESENTERY/FAT
ILEUM HAS MORE ENCROACHING MESENTERY/FAT
324
WHAT IS DIFFERENCE BETWEEN VASCULARIZATION OF JEJUNUM VS ILEUM?
JEJUNUM IS MORE VASCULAR (PINKER)
ILEUM IS LESS VASCULAR (BROWNER)
325
What is function of large intestine?
absorb water and salt (Na, Cl, K)
2L of water from ileum >>>200 mL of water content in feces
secrete mucus
produce and store compact stool
326
What part of the large intestine forms the top two corners of the frame of small intestine?
Left Colic Flexure
Right Colic flexure
327
What is another name for Left Colic Flexure?
Splenic flexure
328
What is another name for Right Colic flexure?
Hepatic flexure
329
Splenic flexure can be used as a reference point for what?
Point at which parasympathetic innervation switches from vagus to pelvic splanchnic
330
what is a watershed region?
A watershed zone lies on the edges of two different areas of blood circulation each supplied by a main artery on the opposite side of where the watershed zone sits. The tiny overlap between the two areas is the watershed zone. Because that zone is the farthest away from each of the main arteries that feeds it, the zone has the weakest blood flow in both directions.
“A watershed zone is very vulnerable. It relies heavily on both those areas to function well, and if something goes wrong and the blood supply is diminished, then it’s very vulnerable to infarction or damage from loss of blood flow,” says Scott. The eye and the brain are not the only organs with watershed zones; they exist in the kidneys and in the intestines as well.
331
What part of the GI tract is a watershed region and what consequences can this have?
Splenic Flexure is a watershed region and is therefore prone to ischemia
332
Where is location of ascending colon?
The ascending colon lies on the right side of the abdominal cavity,
333
WHERE IS MCBURNEYS POINT AND WHAT CAN BE PALPATED THERE?
APPENDIX CAN BE PALPATED HERE
1/3 OF WAY FROM ANTERIOR SUPERIOR ILIAC SPINE (ASIS) TO UMBILICUS
334
WHAT IS THE MOST COMMON POSITION OF THE APPENDIX IN RELATION TO CECUM?
RETROCECAL
335
What part of the colon is most likely to develop volvulus if too long?
Sigmoid colon because it is fairly mobile and therefore can twist on itself if too long
336
What structures in the rectum help support weight of fecal material?
3 semicircular rectal folds/valves of Houston
337
What muscles pull the anus up over the exiting feces?
Levator ani muscles
338
WHAT IS PSOAS SIGN?
PHYSICAL EXAM TEST IN WHICH PATIENT FLEXES THEIR LEG AT THE HIP AGAINST THE RESISTANCE OF THE EXAMINER'S HAND OR THE PATIENT LIES ON LEFT SIDE AND RIGHT LEG IS EXTENDED AT HIP
THIS ACTION TENSES THE RIGHT ILIOPSOAS WHICH MAY BE IRRITATED DUE TO INFLAMED RETROCECAL APPENDIX
339
WHATS A POSITIVE PSOAS SIGN AND WHAT IS THIS INDICATIVE OF?
IF PATIENT HAS ANY PAIN IN THE RLQ WITH FORCED HIP FLEXION OR PASSIVE HIP EXTENSION
ACUTE APPENDICITIS
340
What are two causes of peptic ulcer disease in duodenum?
Helicobacter pylori
NSAID use
341
What happens with Perforating ulcers in duodenum and where do they occur?
Perforating ulcers occur in the anterior wall and cause peritonitis due to food and digestive enzymes entering the peritoneal cavity
342
What happens with Penetrating ulcers and where do they occur?
Penetrating ulcers occur in the posterior wall and cause erosion of gastroduodenal artery which can cause upper GI bleeding
343
Damage to the gastroduodenal artery causes?
Damage to gastroduodenal artery causes upper GI bleeding
344
Duodenal ulcer relieved by ?
eating
345
Gastric ulcer relieved by?
lying down, vomiting
346
How long does a duodenal ulcer take to heal?
1-2 months
347
How long does a gastric ulcer take to heal?
few weeks
348
Does vomiting occur in duodenal ulcer?
uncommon
349
does vomiting occur in gastric ulcer?
common (relieves pain)
350
How is appetite with duodenal ulcer?
Good, no weight loss
351
How is appetite with gastric ulcer?
Poor, weight loss
352
What should patients with gastric ulcer avoid?
fried food
353
Stenonis means?
narrowing
354
What is intestinal atresia?
complete obstruction of the lumen due to congenital malformation
355
What is SMA syndrome?
SMA syndrome is when the superior mesenteric artery passes over the transverse segment of the duodenum and compresses it leading to compression and lack of normal Gi movement
356
What group of patients are more likely to present with SMA syndrome?
Patients with anorexia nervosa or persons with low body fat
Mesenteric fat pads that support the SMA are consumed which shortens the angle between the SMA and aorta
357
What is volvulus?
rotation of gut on its mesentery
Sigmoid mesocolon is long and can twist on itself
358
Diverticulitis vs diverticulosis
Diverticulitis is inflammation of diverticula
Diverticulosis is presence of multiple small bulging pockets in the GI tract without evidence of infection/inflammation
359
How does diverticulitis present, where does it occur, and how is it prevented?
Diverticulitis usually occurs in sigmoid colon
Presents with LLQ abdominal pain
Prevented by consuming fibre
360
WHICH SIDE OF THE BODY IS SIGMOID COLON FOUND?
LEFT
361
What region is the foregut?
epigastric region
362
Where is visceral pain from the liver and gallbladder referred to?
right shoulder and upper back
363
Where is visceral pain from the spleen referred to?
left shoulder
364
What region is the midgut?
periumbilical region
365
ON PE, PATIENT IS GUARDING ABDOMEN? (VOLUNTARILY TENSING ABDOMEN IN ANTICIPATION OF PALPATION)
PERITONITIS
366
WHAT IS REBOUND TENDERNESS?
PAIN UPON REMOVAL RATHER THAN APPLICATION OF PRESSURE (OFTEN SIGN OF PERITONITIS)
367
WHAT IS ROVSING'S SIGN?
Rovsing's sign is a clinical finding that is indicative of acute appendicitis (the inflammation and possible infection of the appendix). A positive Rovsing's sign is characterized by right lower abdominal pain upon palpation of the left side of the lower abdomen.J
368
MURPHY'S SIGN IS INDICATIVE OF ?
CHOLECYSTITIS
369
HOW TO PERFORM TEST FOR MURPHY'S SIGN?
Murphy's sign is elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area. If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examiner's hand, Murphy's sign is positive.
370
What is function of phrenicocolic ligament?
Connects Left Colic Flexure to diaphragm and blocks peritoneal fluid from reaching subphrenic space
371
What ligament contains the portal triad?
Hepatoduodenal ligament
372
What does the falciform ligament do?
divides right and left lobes of liver
attaches liver to anterior abdominal wall
373
What does round ligament do?
Its the obliterated left umbilical vein
374
Name 3 abdominal arteries that are end arteries
Most vasa recta of Gi tract
Splenic artery
Short gastric arteries
375
Name the Great Vessels that come anteriorly off of the aorta
Celiac
Superior Mesenteric Artery
Inferior Mesenteric Artery
376
What vertebral level is the Celiac trunk found?
T12/L1
377
What structures does the celiac trunk supply?
Embryonic foregut
Esophagus
Stomach
First part of duodenum
378
What are the three main branches of the celiac trunk?
Left Gastric artery
Splenic artery
Common hepatic
379
What is the esophageal hiatus?
the esophageal hiatus is an opening in the diaphragm through which the esophagus and the vagus nerve pass.
380
Left gastric artery runs along what path and anastomoses with what?
Left gastric artery runs along superior portion of lesser curvature of stomach and anastomoses inferiorly with right gastric artery
381
Left gastric artery goes up to the _________ and gives rise to _________
Left gastric artery goes up to the esophageal hiatus and gives rise to esophageal branches
382
On xray, which of the celiac branches appears the most curvy?
Splenic artery
383
What ligament does the splenic artery travel within ?
Splenorenal ligament
384
Short gastric arteries supply?
Fundus of stomach
385
What are the branches of the Splenic artery?
Short gastric arteries
Left Gastroepiploic
Pancreatic branches
386
Left Gastroepiploic artery supplies?
Superior portion of greater curvature of stomach and greater omentum
387
Left gastroepiploic anastamoses with what inferiorly?
Right Gastroepiploic
388
Common Hepatic artery runs to patient's right then splits into?
Hepatic Artery Proper
Gastroduodenal artery
389
Hepatic Artery Proper gives off what branch at the same time splits into right and left hepatic arteries?
Right gastric artery
390
Damage to Hepatic Artery Proper can cause?
damage to biliary tree
391
What are branches of the Gastroduodenal artery?
Right Gastroepiploic artery
Superior Pancreaticoduodenal artery
392
Superior Mesenteric Artery is found at what vertebral level?
L1
393
Superior Mesenteric Artery supplies what structures?
Midgut
Duodenum (except first part)
Small intestine
Cecum
Ascending colon and first 2/3 of transverse coon
394
SMA SYNDROME
SMA constricts duodenum which causes intestinal obstruction
395
Name 5 branches of the Superior Mesenteric Artery
Inferior Pancreaticoduodenal artery
Jejunal and Ileal branches
Right Colic Artery
Middle Colic Artery
Ileocolic Artery
396
Inferior pancreaticoduodenal artery anastomoses with __________ which branches from ________
Inferior pancreaticoduodenal artery anastomoses with Superior Pancreaticoduodenal artery which branches from the Gastroduodenal Artery
397
Right Colic artery supplies?
Supplies ascending colon
398
Middle Colic artery supplies?
Supplies mesentery of transverse colon (and in some people the splenic flexure)
399
Middle Colic Artery anastomoses with ____________ to prevent ischemia
Middle Colic Artery anastomoses with Left Colic artery
400
What are branches of the Ileocolic artery ?
Anterior cecal artery
Posterior cecal artery
Appendicular artery
Colic (ascending branch) artery
Iliac (descending branch) artery
401
Inferior Mesenteric Artery is found at what vertebral level?
L3
402
What structures does the Inferior Mesenteric Artery supply?
Embryonic hindgut
Last 1/3 of transverse colon
Descending colon
sigmoid colon
Rectum
upper 1/2 of anus
403
What are the three main branches of the Inferior Mesenteric Artery?
Left Colic Artery
Sigmoid Artery
Superior Rectal artery
404
Left colic artery anastomoses with _______
Middle colic artery of SMA
405
ALL LYMPHATICS OF THE GREAT VESSELS AND THEIR BRANCHES DRAIN TO
LYMPH NODES OF THEIR GIVEN NAME
406
What is the Marginal Artery (of Drummond)?
Collection of anastomoses of the branches of the mesenteric arteries that runs parallel to the entire length of the inner border of the colon
Provides collateral circulation between middle colic artery (SMA) and left colic artery (IMA)
407
_______ is occluded in 50% of men over 50
IMA
408
WHEN SMA OR IMA IS OCCLUDED IN PATIENTS WITH ATHEROSCLEROSIS, WHAT HAPPENS?
WEAK AREAS OF THE MARGINAL ARTERIES CAN BECOME OCCLUDED LEADING TO ISCHEMIA
409
What happens if the vasa recta of Gi tract damaged?
Ischemia and infarct can happen because vasa recta are end arteries
410
What is function of the Portal venous system?
transport deoxygenated, nutrient rich blood from GI tract to liver where it is processed and dumped in to the IVC
411
What is function of the sinusoids in liver?
Sinusoids are specialised capillaries that filter the blood and then drain the portal vein branches and the hepatic duct branches into hepatic veins
412
What happens if you lose the portal vein?
necrosis of liver
hepatocytes survive from the blood perfused from portal vein
413
What 3 veins come together to form Portal Vein?
Splenic Vein
Superior Mesenteric Vein
Inferior Mesenteric Vein
414
What provides VENOUS return of the foregut?
Splenic vein
415
What provides VENOUS return of the midgut?
Superior Mesenteric vein
416
What provides VENOUS return of the hindgut?
Inferior Mesenteric vein
417
Where is the portal vein located in hepatoduodenal ligament ?
Posterior to hepatic artery and bile duct
418
Does the portal vein have valves?
Portal vein VALVELESS
419
What can you access if you put finger in Foramen of Winslow?
lesser sac
hepatic pedicle (bile duct, hepatic arteries, portal veins)
420
Where is the Triangle of Calot located and why is it important in surgery?
Triangle of Calot is located between the bifurcation of right and left bile ducts and lower edge of liver
It is important in surgery because the cystic artery is located inside the triangle
421
Blood from the Superior Mesenteric VEIN flow to what side of liver?
Right side
422
Blood from Inferior Mesenteric VEIN and Splenic VEIN flow to what side of liver?
Left side
423
Which lobe of liver is larger?
Right love of the liver is larger
424
Right and left lobes of liver are divided by ______ which originates at the level of the _______
Right and left lobes are divided by falciform ligament which originates at level of the round ligament
425
Name the anatomical lobes of liver
Right lobe
Left lobe
Caudate lobe
Quadrate lobe
426
What structures are found in the left sagittal fissure of the liver?
ligmanetum venosum
ROUND LIGAMENT (AKA LIGAMENTUM TERES)
427
THE ROUND LIGAMENT OF THE LIVER
(LIGAMENTUM TERES) IS THE FETAL REMNANT OF ?
LEFT UMBILICAL VEIN
428
What structures are found in the Transverse fissure of the liver?
Structures that run in the hepatoduodenal ligament
Portal triad
Hepatic arteries
Portal vein
Bile duct
429
Caudate lobe of the liver sits against _________
IVC
430
What is Coronary ligament of the liver?
Coronary ligament of the livers is located along superior edge of liver and connects liver to diaphragm
431
Blood comes from the _____ and _____ through the liver _______ to the _______ which empties into ______
Blood comes from the portal vein and hepatic artery through the liver sinusoid to the hepatic veins which empties into IVC
432
What are components of Hepatic/Portal triad?
Bile ducts
Portal Vein
Hepatic artery
433
If a liver lobe is supplied by _______, it is a right FUNCTIONAL lobe
If a lobe is supplied by right hepatic artery, it is a right functional lobe
434
Which lobe of the liver is neither left or right functional lobe?
Caudate because it receives blood from both the right and left hepatic arteries
435
Hepatic arteries, hepatic duct, and portal vein are ____________segmental
Hepatic arteries, hepatic duct, and portal vein are INTRAsegmental
436
Each segment of the liver has its own _____
artery
437
Hepatic veins are _______segmental
hepatic veins are intersegmental
438
Hepatoduodenal ligament connects the liver to the first part of the duodenum in the lesser omentum and contains the portal triad. List the components of the portal triad from anterior to posterior
BIle duct
hepatic artery
portal vein
439
What lies behind the hepatoduodenal ligament ?
Foramen of Winslow
440
What is Pringle Maneuver?
When the hepatoduodenal ligament (and therefore portal triad) is clamped to prevent blood flow from the portal vein and hepatic artery
441
Function of gallbladder?
store, concentrate, and release bile made by liver
442
Why is gallbladder pain well-localised?
The gallbladder contact the anterior abdominal wall and cholecystitis inflames the parietal peritoneum there
443
What sign is positive for cholecystitis?
positive Murphy's sign
444
How perform Murphys sign?
Palpate area of the gallbladder and ask the patient to take a breath. If the patient shows pain upon inspiration (Parietal peritoneum touches the palpation upon inspiration since goes up), positive Murphy sign
445
Gallbladder drapes over what two organs?
duodenum
transverse colon
446
Which lobe of the liver is the gallbladder found?
Quadrate
447
Which arteries responsible for biliary tree?
hepatic arteries
448
What's the course of the common bile duct?
Enters through neck of pancreas
Exits through head of pancreas
Ampulla of Vater
Sphincter of Oddi
Major Duodenal Papilla
Duodenum
449
What is Ampulla of Vater?
dilation distal to the junction of Common bile duct and Pancreatic duct
450
What is function of Sphincter of Odds?
controls opening from ampulla of Vater to major duodenal papilla
451
THE MAJOR DUODENAL PAPILLA OPENS FROM THE SPHINCTER OF ODDI INTO WHAT PART OF DUODENUM?
2ND PART OF DUODENUM
452
What is the spiral valve of Heister?
The spiral valve of Heister is a bidirectional spiral valve that allows the lumen of the cystic duct to remain open for bile to both enter and exit
453
What structure is found within Triangle of Calot?
cystic artery
454
What forms borders of Triangle of Calot?
Common hepatic duct
Cystic duct
Inferior border of the liver
455
What organ can also be damaged if there is duodenal ulcer?
head/neck of pancreas
456
Pancreas lies _____ to stomach
Pancreas lies posterior to stomach
457
Painless jaundice in older adults is a sign of what ? What causes it?
Pancreatic cancer
When cancer is in the head of the pancreas, common bile duct gets obstructed near the ampulla of Vater resulting in jaundice
458
What type of structure is Pancreas (except for tail)?
Secondary retroperitoneal structure
459
Four signs of portal hypertension
caput medusae (umbilical vein)
esphogeal varices- 1st sign cirrhosis
haemorrhoids (IMV)
splenomegaly (splenic vein)
460
WHERE IS SPLEEN LOCATED?
SPLEEN IS LOCATED IN LEFT MIDAXILLARY LINE AT THE LEVEL OF T10
461
Is spleen palpable in healthy individuals?
no, only palpable with spenomegaly
462
Splenorenal ligament connects ?
Splenorenal ligament connects spleen to left kidney
463
WHAT STRUCTURES DOES THE SPLENORENAL LIGAMENT CONTAIN?
TAIL OF PANCREAS
SPLENIC ARTERY
464
WHAT IS THE MOST COMMONLY DAMAGED ORGAN DURING BLUNT TRAUMA LIKE A CARWRECK?
SPLEEN
465
WHAT IS THE MOST COMMON CAUSE OF RUPTURE TO THE SPLEEN?
INJURY TO THE SPLENORENAL LIGAMENT
466
What is Abdominal Aortic Aneurysm ?
Enlargement of abdominal aorta
Can rupture leading to internal bleeding
467
What is Splenic Infarction?
Splenic tissue necrosis due to damage to splenic artery (end artery)
468
What is Ischemic colitis?
Normally effects Left Colic artery/Left Splenic Flexure (aka Left Colic Flexure)
watershed region
also can affect Ileocolic jxn and rectosigmoid jin
469
What does Splenic Infarction look like on CT?
Spleen will be darker overall or in one area compared to rest of spleenI
470
_______NERVE INNERVATION STOPS AT SPLENIC FLEXURE (LEFT COLIC FLEXURE) AND THEN DISTALLY TO THE SPLENIC FLEXURE IS SUPPLIED BY ________ NERVES
VAGUS NERVE INNERVATION STOPS AT SPLENIC FLEXURE (LEFT COLIC FLEXURE)
DISTAL TO SPLENIC FLEXURE IS SUPPLIED BY PELVIC SPLANCHNICS
471
SPLENIC FLEXURE IS PART OF HINDGUT SO DOMINANTLY SUPPLIED BY ______ WITH SOME ANASTOMOSIS FROM _______
LEFT COLIC ARTERY
MIDDLE COLIC ARTERY
472
What is Mesenteric Ischemia and which structures most often affected?
Atherosclerosis can occlude mesenteric arteries leading to ischemia
SMA is most often affected followed by SMV
SMV occlusion causes venous thrombosis leading to necrosis
473
WHAT IS PORTAL HYPERTENSION?
INCREASED PRESSURE IN PORTAL VENOUS SYSTEM
474
ETIOLOGY OF PORTAL HYPERTENSION?
BACKFLOW IN THE PORTAL SYSTMEN LEADS TO SHUNTING OF VENOUS BLOOD TO THE SPLENIC VEINS, SMV, AND IMV WHICH IS POSSIBLE SINCE PORTAL VEINS DON'T HAVE VALVES
475
What are causes of Post-hepatic hypertension?
Obstruction of hepatic vein
thrombosis
compression
Blood cannot pass into IVC
476
What are causes of Intra-hepatic hypertension (most common)
Obstruction of liver sinusoids
Cirrhosis
477
What are causes of Pre-hepatic hypertension?
Obstruction of portal tributaries that lead into the liver (by pancreatic tumour)
Blood cannot enter the liver
478
WHY DO YOU GET HEMATEMESIS WITH PORTAL HYPERTENSION?
INJURY TO SWOLLEN ESOPHAGEAL VEIN
479
WHY DO YOU GET INTERNAL HEMORRHOIDS WITH PORTAL HYPERTENSION?
PAINLESS BLEEDING FROM SWOLLEN SUPERIOR RECTAL VEIN
480
WHAT CAUSES SPLENOMEGALY WITH PORTAL HYPERTENSION?
ENLARGEMENT OF SPLENIC VEIN
481
WHAT ARE TWO TREATMENTS (TREATS SYMPTOMS) FOR PORTAL HYPERTENSION?
PORTACAVAL SHUNT
TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT (TIPS)
