Surgical Anatomy Pearls

Question 1

What is the drainage of the left testicular vein?

Answer 1

Left renal vein

Question 2

What is the drainage of the right testicular vein?

Answer 2

IVC

Question 3

What is Gerota’s fascia?

Answer 3

Fascia surrounding the kidney

Question 4

What are the prominent collateral circulations seen in portal hypertension?

Answer 4

1. ) Esophageal varices
2. ) Hemorrhoids (Inferior hemorrhoidal vein to internal iliac vein)
3. ) Patent umbilical vein (caput medusa)
4. ) Retroperitoneal vein via lumbar tributaries

Question 5

What parts of the GI tract are retroperitoneal?

Answer 5

1. ) most of the Duodenum
2. ) Ascending colon
3. ) Descending colon
4. ) Pancreas

Question 6

The embryologic structure that adheres the testes to the scrotal sac; used to help manipulate the testes during indirect hernia repair.

Answer 6

Gubernaculum

Question 7

Which artery bleeds in bleeding duodenal ulcers?

Answer 7

Gastroduodenal artery

Question 8

What is the name of the lymph nodes between the pectoralis minor and major muscles?

Answer 8

Rotter’s lymph nodes

Question 9

Is the left vagus nerve anterior or posterior?

Answer 9

Anterior; remember that the esophagus rotates clockwise during development

Question 10

What is Morrison’s puch?

Answer 10

Hepatorenal recess; the most posterior cavity within the peritoneal cavity

Question 11

Give the locations of the following structures:
Foregut
Midgut
Hindgut

Answer 11

Foregut - Mouth to ampulla of vater

Midgut - Ampulla of vater to distal third of transverse colon

Hindgut - distal third of transverse colon to anus

Question 12

Where are the blood vessels on a rib?

Answer 12

Vein, Artery, and Nerve (VAN) are UNDERNEATH the rib

Question 13

What is the order of the femoral vessels?

Answer 13

Think: “NAVEL” for the order of the right femoral vessels - Nerve, Artert, Vein, Empty space, Lymphatics

Question 14

What is Hesselbach’s triangle?

Answer 14

The area bordered by:

1. Inguinal ligament
2. Epigastric vessels
3. Lateral border of the rectus sheath

Question 15

What nerve is located on top of the spermatic cord?

Answer 15

Ilioinguinal nerve

Question 16

What is Calot’s triangle?

Answer 16

The area bordered by:

1. Cystic duct
2. Common hepatic duct
3. Liver margin

The cystic artery is seen in this triangle

Question 17

What separates the right and left lobes of the liver?

Answer 17

Cantile’s line - a line drawn from the IVC to just left of the gallbladder fossa

Question 18

1. Junction of the second and third portion of the duodenum
2. Cystic duct
3. Pancreatic neck

Answer 18

Gastrinoma triangle

Triangle where >90% of gastrinomas are located

Question 19

Which artery is responsible for anterior spinal syndrome?

Answer 19

Artery of Adamkiewics

Question 20

Where is McBurney’s point?

Answer 20

One third the distance from the anterior superior iliac spine to the umbilicus (estimate of the position of the appendix)

Question 21

How can you find the appendix after you find the cecum?

Answer 21

Trace the taeniae back as they converge on the origin of the appendix

Question 22

Where is the space of Retzius?

Answer 22

Preperitoneal space anterior to the bladder

Question 23

What are the white lines of Toldt?

Answer 23

Lateral peritoneal reflections of the ascending and descending colon

Question 24

What is the strongest layer of the small bowel?

Answer 24

Submucosa (Think: SUbmucosa = SUperior)

Question 25

Which parts of the GI tract do not have a serosa?

Answer 25

Esophagus | Middle and distal rectum

Question 26

What is the vein that overlies the pylorus?

Answer 26

Vein of Mayo

Question 27

What is the pouch of Douglas?

Answer 27

Pouch between the rectum and bladder or uterus

Question 28

What does the thoracic duct empty into?

Answer 28

Left subclavian vein; Left internal jugular vein junction

Question 29

What is the coronary vein?

Answer 29

Left gastric vein

Question 30

What is the hypogastric artery?

Answer 30

Internal iliac artery

Question 31

Which is longer, the left or right renal vein?

Answer 31

Left

Question 32

What are the layers of the abdominal wall?

Answer 32

1. Skin 2. Camper's fascia 3. Scarpa's fascia 4. External oblique 5. Internal oblique 6. Transversus abdominis 7. Transversalis fascia 8. Preperitoneal fat 9. Peritoneum

Question 33

What are the plicae circulares?

Answer 33

Plicae = folds, circulares = circular; thus, | The circular folds of mucosa of the small bowel

Question 34

What is another name for the plicae circulares?

Answer 34

Valvulae conniventes

Question 35

What are the major structural differences between the jejunum and ileum?

Answer 35

Jejunum - long vasa rectae; large plicae circulares; thicker wall Ileum - Shorter vasa rectae; smaller plicae circulares; thinner wall (Think: Ileum = Inferior vasa rectae, Inferior plicae circulares, and inferior wall)

Question 36

What are the major anatomic differences between the colon and the small bowel?

Answer 36

Colon has taeniae coli, haustra, and appendices epiploicae (fat appendages), whereas the small intestine is smooth

Question 37

How far up does the diaphragm extend?

Answer 37

To the nipples in men (4th ICS)

Question 38

Which dermatome is the umbilicus?

Answer 38

T10

Question 39

What are the major layers of an artery?

Answer 39

Adventitia Media Intima