1: Anatomy - Bleeding

Question 1

What does varicosed mean?

Answer 1

Dilation of a venous structure

Question 2

Which parts of the large intestine are retroperitoneal?

Answer 2

Ascending colon

Descending colon

Question 3

Which parts of the large intestine are intraperitoneal?

Answer 3

Caecum

Transverse colon

Sigmoid colon

Question 4

What are the spaces between the lateral walls of the colon and the abdominal wall?

Answer 4

Paracolic gutters

Question 5

What may collect in the paracolic gutters of supine patients with infection?

Answer 5

Pus

Question 6

What spaces allow pus to travel from the lower abdominal cavity to higher parts?

Answer 6

Paracolic gutters

Question 7

Which space is found lateral to the wall of the ascending colon?

Answer 7

Right paracolic gutter

Question 8

What space is found lateral to the wall of the descending colon?

Answer 8

Left paracolic gutter

Question 9

What are the small, fatty projections which come off the colon?

Answer 9

Omental appendices

Question 10

What are the three longitudinal bands of muscle which run in the muscularis externa of the colon?

Answer 10

Teniae coli

Question 11

What are the pouches formed by tonic contractions of the teniae coli, which serve to increase the surface area for absorption by the colon?

Answer 11

Haustra

Question 12

1. Three bands of longitudinal muscle found in the colon
2. Pouches found in the colon which increase surface area for absorption
3. Fatty projections from the walls of the colon

Name 1-3.

Answer 12

1. Teniae coli

2. Haustra

3. Omental appendices

Question 13

Haustra are formed by the contractions of the ___ ___.

Answer 13

teniae coli

Question 14

Where in the abdomen are the caecum and appendix found?

Answer 14

Right iliac fossa

Question 15

The appendix projects from which part of the colon?

Answer 15

Caecum

Question 16

The position of the appendix can ___.

Answer 16

vary

Question 17

The appendix is usually (anterior / posterior) to the caecum.

Answer 17

posterior

Question 18

What is the passage between the distal ileum and the caecum?

Answer 18

Ileocaecal orifice

Question 19

What is the passage between the caecum and the appendix?

Answer 19

Appendiceal orifice

Question 20

Which point on the abdominal wall corresponds to the appendiceal orifice?

Where exactly is this?

Answer 20

McBurney’s point

1/3rd of the distance between the ASIS and the umbilicus

Question 21

Where, theoretically, is the majority of pain associated with appendicitis felt?

Answer 21

McBurney’s point

1/3rd of the distance between the right ASIS and the umbilicus

Question 22

Where in the abdomen is the sigmoid colon found?

Answer 22

Left iliac fossa

Question 23

What is the long mesentery attached to the sigmoid colon?

Answer 23

Sigmoid mesocolon

Question 24

What name is given to the twisting of the sigmoid colon around itself?

Answer 24

Sigmoid volvulus

Question 25

What are the consequences of **sigmoid volvulus**?

Answer 25

**Bowel obstruction** **Ischaemia ⇒ Infarction**

Question 26

Where does the **abdominal aorta** pierce the diaphragm?

Answer 26

**T12**

Question 27

Name the **midline abdominal aortic branches** found at **T12, L1** and **L3**.

Answer 27

**T12** - coeliac trunk **L1** - superior mesenteric artery **L3** - inferior mesenteric artery

Question 28

Name the **lateral abdominal aortic branches** found at **L1**, **L2** and those found between **L1-L4**.

Answer 28

**L1** - renal artery **L2** - gonadal artery **L1-L4** - lumbar arteries

Question 29

Where does the **abdominal aorta** bifurcate? What does it bifurcate into?

Answer 29

**L4** **Right** and **left common iliac arteries**

Question 30

The **superior mesenteric artery** arises (anterior / posterior) to the neck of the pancreas.

Answer 30

**posterior**

Question 31

Which branch of the **SMA** anastomoses with the coeliac trunk to supply the pancreas and duodenum?

Answer 31

**Inferior pancreaticoduodenal artery**

Question 32

Which branch of the **SMA** supplies parts of the **ascending AND** **transverse colon**?

Answer 32

**Middle colic artery**

Question 33

Which branch of the **SMA** supplies mainly the ascending colon?

Answer 33

**Right colic artery**

Question 34

Which arteries, supplying the **jejunum** and **ileum**, come from the **SMA**?

Answer 34

**Jejunal** **arteries** ## Footnote **Ileal arteries**

Question 35

What are the two components of **jejunal** and **ileal arteries?**

Answer 35

**Vasa rectae** **Arcades**

Question 36

Compare the **jejunum** and **ileum** in terms of their vasa rectae and arcades.

Answer 36

**Jejunum** is **MORE VASCULAR** so it has **longer vasa rectae** and **few, LARGE arcades** **Ileum** is **LESS VASCULAR** so it has **shorter vasa rectae** and **MANY small arcades**

Question 37

At which level does the **IMA** branch off the abdominal aorta?

Answer 37

**L3**

Question 38

Which branch of the **IMA** supplies mainly the **descending colon**?

Answer 38

**Left colic artery**

Question 39

Which arteries supply the **sigmoid colon**?

Answer 39

**Sigmoid arteries**

Question 40

Which branch of the **IMA** supplies the **superior** aspect of the rectum?

Answer 40

**Superior rectal artery**

Question 41

The **SMA** and **IMA** **anastomose** via which artery?

Answer 41

**Marginal artery of Drummond**

Question 42

In the event of obstruction, the **marginal artery of Drummond** helps to prevent **intestinal** \_\_\_. How?

Answer 42

**ischaemia** Provides **collateral route** for blood flow

Question 43

Which branch of the **IMA** supplies up to the proximal half of the anal canal

Answer 43

**Superior rectal artery**

Question 44

Which **artery** supplies the remainder of the anal canal not supplied by the **superior rectal artery**?

Answer 44

**Internal iliac artery**

Question 45

Which vein drains blood to the liver from the **foregut, midgut** and **hindgut**?

Answer 45

**Hepatic portal vein**

Question 46

Which vein drains blood from the **foregut**?

Answer 46

**Splenic vein**

Question 47

Which vein drains blood from the **midgut**?

Answer 47

**Superior mesenteric vein**

Question 48

Which vein drains blood from the **hindgut**?

Answer 48

**Inferior mesenteric vein**

Question 49

Which vein does the **inferior mesenteric vein** drain into?

Answer 49

**Splenic vein**

Question 50

Which vein does the **superior mesenteric** and **splenic** **vein** drain into?

Answer 50

**Hepatic portal vein**

Question 51

Where are three sites of **portal-systemic vein anastomosis**?

Answer 51

**Oesophagus** **Umbilicus** **Rectum**

Question 52

Which venous systems are joined at these anastomoses?

Answer 52

**Portal venous system** **Systemic venous system**

Question 53

Do veins in **portal-systemic anastomoses** have **valves**?

Answer 53

**No**

Question 54

Where does the **superior rectal vein** drain?

Answer 54

**Inferior mesenteric vein**

Question 55

Where do the **middle** and **inferior rectal veins** drain?

Answer 55

**Internal iliac vein**

Question 56

What is **portal hypertension**?

Answer 56

**Elevation of blood pressure in the portal system**

Question 57

Elevation of blood pressure within the portal system is called portal \_\_\_.

Answer 57

**hypertension**

Question 58

What are two causes of **portal hypertension**?

Answer 58

**Cirrhosis** **Tumour compressing hepatic portal vein**

Question 59

**Portal hypertension** causes a reversal in blood flow. Where does the blood go?

Answer 59

Areas of **portal-systemic anastomosis**, i.e: ## Footnote **Distal oesophagus** **Umbilicus** **Rectum / Anal canal**

Question 60

What are **three** clinical signs of **portal hypertension**?

Answer 60

**Oesophageal varices** **Caput medusae** **Rectal varices**