Surgical Anatomy Pearls, Chapter17 P103-107

Question 1

What is the drainage of the left testicular vein?

P103

Answer 1

Left renal vein

Question 2

What is the drainage of the right testicular vein?

P103

Answer 2

IVC

Question 3

What is Gerota’s fascia?

P103

Answer 3

Fascia surrounding the kidney

Question 4

What are the prominent collateral circulations seen in portal hypertension?
P103

Answer 4

Esophageal varices, hemorrhoids (inferior hemorrhoidal vein to internal iliac vein), patent umbilical vein (caput medusa),
and retroperitoneal vein via lumbar tributaries

Question 5

What parts of the GI tract are retroperitoneal?

P103

Answer 5

Most of the duodenum, the ascending colon, the descending colon, and the pancreas

Question 6

What is the gubernaculum?

P103

Answer 6

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

Question 7

Which artery bleeds in bleeding duodenal ulcers?

P104

Answer 7

Gastroduodenal artery

Question 8

What is the name of the lymph nodes between the
pectoralis minor and major muscles?
P104

Answer 8

Rotter’s lymph nodes

Question 9

Is the left vagus nerve anterior or posterior?

P104

Answer 9

Anterior; remember that the esophagus rotates during development

Question 10

What is Morrison’s pouch?

P104

Answer 10

Hepatorenal recess; the most posterior cavity within the peritoneal cavity

Question 11

Give the locations of thefollowing structures:
1. Foregut
P104

Answer 11

Mouth to ampulla of Vater

Question 12

2. Midgut

P104

Answer 12

Ampulla of Vater to distal third of transverse colon

Question 13

3. Hindgut

P104

Answer 13

Distal third of transverse colon to the anus

Question 14

Where are the blood vessels on a rib?

P104

Answer 14

Vein, Artery, and Nerve (VAN) are underneath the rib (thus, place chest tubes and thoracentesis needles above the rib!)

Question 15

What is the order of the femoral vessels?

P104

Answer 15

Femoral vein is medial to the femoral artery (Think: “NAVEL” for the order of the right femoral vessels—Nerve, Artery, Vein, Empty space, Lymphatics)

Question 16

What is Hesselbach’s triangle?

P104

Answer 16

The area bordered by:

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

Question 17

What nerve is located on top of the spermatic cord?

P104

Answer 17

Ilioinguinal nerve

Question 18

What is Calot’s triangle?

P104

Answer 18

The area bordered by:
1. Cystic duct
2. Common hepatic duct
3. Cystic artery
(Pronounced “kal-ohs”)

Question 19

What is Calot’s node?

P105

Answer 19

Lymph node found in Calot’s triangle

Question 20

What separates the right and left lobes of the liver?

P105

Answer 20

Cantle’s line—a line drawn from the IVC to just left of the gallbladder fossa

Question 21

What is the gastrinoma triangle?

P105

Answer 21

Triangle where 90% of gastrinomas are located, bordered by:

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

Question 22

Which artery is responsible for anterior spinal syndrome?

P105

Answer 22

Artery of Adamkiewicz

Question 23

Where is McBurney’s point?

P105

Answer 23

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

Question 24

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

P105

Answer 24

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

Question 25

Where is the space of Retzius? | P105

Answer 25

Preperitoneal space anterior to the bladder

Question 26

What are the white lines of Toldt? | P105

Answer 26

Lateral peritoneal reflections of the ascending and descending colon

Question 27

What is the strongest layer of the small bowel? | P105

Answer 27

Submucosa (not the serosa, think: | SUbmucosa = SUperior)

Question 28

Which parts of the GI tract do not have a serosa? | P105

Answer 28

- Esophagus | - Middle and distal rectum

Question 29

What is the vein that overlies the pylorus? | P105

Answer 29

Vein of Mayo

Question 30

What is the pouch of Douglas? | P105

Answer 30

Pouch between the rectum and bladder or uterus

Question 31

What does the thoracic duct empty into? | P105

Answer 31

Left subclavian vein; left internal jugular vein junction

Question 32

What is the coronary vein? | P106

Answer 32

Left gastric vein

Question 33

What is the hypogastric artery? | P106

Answer 33

Internal iliac artery

Question 34

Which is longer, the left or right renal vein? | P106

Answer 34

Left

Question 35

What are the layers of the abdominal wall? | P106

Answer 35

1. Skin, then fat 2. Scarpa’s fascia, then more fat 3. External oblique 4. Internal oblique 5. Transversus abdominis 6. Transversalis fascia 7. Preperitoneal fat 8. Peritoneum

Question 36

What are the plicae circulares? | P106

Answer 36

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

Question 37

What is another name for the plicae circulares? | P106

Answer 37

Valvulae conniventes

Question 38

What are the major structural differences between the jejunum and ileum? P106

Answer 38

- 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 39

What are the major anatomic differences between the colon and the small bowel? P106

Answer 39

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

Question 40

How far up does the diaphragm extend? | P106

Answer 40

To the nipples in men (fourth intercostal space; thus, the abdomen extends to the level of the nipples)

Question 41

What dermatome is at the umbilicus? | P106

Answer 41

T10

Question 42

What are the major layers of an artery? | P107 (picture)

Answer 42

(see picture)