Abdomen

Question 1

What is the embryological origin of the ligamentum teres hepatis?

Answer 1

Remnant of fetal left umbilical vein

Question 2

What is the embryological origin of the ligamentum venosum?

Answer 2

Remnant of the ductus venosus separating the caudate and left lobe

Question 3

What is the embryological origin of the falciform ligament?

Answer 3

Remnant of embryonic ventral mesentry

Question 4

What is the arterial blood supply of the CBD?

Answer 4

1) Cystic artery
2) RIght & Left hepatic artery
3) 3 o’clock artery & 9 o’clock arteries
4) Posterior superior pancreaticoduodenal artery

Question 5

Within the hepaticoduodenal ligament, what is the position of the CBD?

Answer 5

Right anterolateral

Question 6

Within the hepaticoduodenal ligament, what is the position of the common hepatic artery?

Answer 6

Left anterolateral

Question 7

Within the hepaticoduodenal ligament, what is the position of the portal vein?

Answer 7

Posterior to both CBD & common hepatic artery

Question 8

What is the position of the IVC in relation to the porta hepatis?

Answer 8

Posterior

Question 9

What is the porta hepatis?

Answer 9

A deep transverse fissure in the liver surface separatring the caudate and quadrate lobes

Question 10

What structures does the porta hepatis transmit?

Answer 10

1) CBD
2) Hepatic arteries
3) Portal vein

Question 11

Where is the bare area of the liver?

Answer 11

Non-peritoneal liver surface area which is in contact with the diaphragm

Question 12

What is the arterial supply of the lower third of oesophagus?

Answer 12

oesophageal branches of left gastric artery

Question 13

Which vein does the inferior mesenteric vein drain into?

Answer 13

Splenic vein

Question 14

Which vein does the splenic vein drain into?

Answer 14

Portal vein

Question 15

Which vein does the right gastric vein drain into?

Answer 15

Portal vein

Question 16

Name the 5 portosystemic anastomoses

Answer 16

1) Lower end of oesophagus - left gastric & oesophageal azygous & hemiazygous
2) Upper end of anal canal - superior rectal vein & middle & inferior rectal veins
3) Bare area of liver - hepatic portal veins & inferior phrenic systemic veins
4) Peri-umbilical - ligamentum teres is the venous watershed area. Left branch of portal vein & indirectly via axillary & saphenous veins (systemic)
5) Retroperitoneal - left, right colic & splenic veins (portal) & lumbar veins (IVC & azygous veins).

Question 17

What are the structures passing through the aortic opening?

Answer 17

1) Aorta
2) Thoracic duct
3) Azygous vein

Question 18

At what level is the aortic opening situated?

Answer 18

T12

Question 19

What are the structures passing through the oesophageal opening?

Answer 19

1) Oesophagus
2) Left gastric artery
3) Left gastric vein
4) L & R vagus nerves

Question 20

At what level is the oesophageal opening situated?

Answer 20

T10

Question 21

What are the structures passing through the vena caval opening?

Answer 21

1) IVC

2) R phrenic nerve

Question 22

Where does the right testicular vein drain into?

Answer 22

IVC

Question 23

Where does the left testicular vein drain into?

Answer 23

Left renal vein

Question 24

What vertebral level is the hilum of the left kidney found?

Answer 24

L1

Question 25

What vertebral level is the hilum of the right kidney found?

Answer 25

L2

Question 26

What vertebral level does the bifurcation of the aorta occur?

Answer 26

L4

Question 27

What is the nerve supply of the liver?

Answer 27

Coeliac plexus (sympathetic & parasympathetic)

Question 28

Of the structures relating to the left kidney, which of the following is anterior and posterior? - renal artery - renal vein - ureter

Answer 28

``` MOST ANTERIOR - Renal vein - Renal artery - Ureter MOST POSTERIOR ```

Question 29

Which structure is not present inferior to the arcuate line?

Answer 29

posterior rectus sheath

Question 30

In any incision of the abdomen, which 3 layers are always present?

Answer 30

transversalis fascia, pre-peritoneal fat, peritoneum

Question 31

What forms the superficial ring of the inguinal canal?

Answer 31

Aponeurosis of the external oblique muscle

Question 32

What forms the deep ring of the inguinal canal?

Answer 32

Transversalis fascia

Question 33

Which nerve is more likely to be injured in an open appendicectomy?

Answer 33

Iliohypogastric nerve

Question 34

Which nerve is more likely to be injured in a hernia repair?

Answer 34

ilioinguinal nerve

Question 35

Which artery provide arterial supply of the anterior abdominal wall superiorly?

Answer 35

Superior epigastric artery (branch of internal mammary artery).

Question 36

What vertebral level is the Xiphoid process?

Answer 36

T9

Question 37

What vertebral level is the transpyloric plane?

Answer 37

L1

Question 38

What are the 4 layers of the GI tract wall?

Answer 38

1) Mucosa 2) Submucosa 3) Muscularis externa 4) Adventitia

Question 39

What vertebral level is the supracristal plane?

Answer 39

L4

Question 40

What bony structures are found at L4?

Answer 40

Summits of iliac crests

Question 41

What vertebral level is the subcostal plane?

Answer 41

L3

Question 42

What vertebral level is the umbilicus?

Answer 42

L3/L4

Question 43

What are the 3 landmarks that would outline the position of the liver in a healthy adult?

Answer 43

1) 10th Rib midaxillary line 2) 5th R intercostal space midaxillary line 3) 5th L intercostal space midaxillary line

Question 44

Where does the spleen lie?

Answer 44

9th-11th rib posteriorly on left side

Question 45

What vertebral level does the neck of pancreas lie?

Answer 45

L1

Question 46

Above the costal margin, what does the anterior sheath only comprise of?

Answer 46

external oblique aponeurosis

Question 47

What is the purpose of a midline incision?

Answer 47

Provides a rapid bloodless access to the abdomen

Question 48

What constitutes the anterior rectus sheath between the costal margin & arcuate line?

Answer 48

Aponeurosis of muscles: 1) External Oblique 2) Internal Oblique

Question 49

What constitutes the posterior rectus sheath between the costal margin & arcuate line?

Answer 49

Aponeurosis of muscles: 1) Internal Oblique 2) Transverus abdominus

Question 50

Which structure lies posterior to the superior/inferior epigastric arteries & veins between the costal margin & arcuate line?

Answer 50

Posterior rectus sheath

Question 51

Describe a Kocher's incision

Answer 51

From midline & extends parallel to subcostal margin inferiorly by 1 inch

Question 52

Which nerve is most likely to be damaged by a Kocher's incision?

Answer 52

8th intercostal nerve

Question 53

Which incision would you use to gain access to the open extraperitoneal exposure of the prostate?

Answer 53

Pfannenstiel Incision

Question 54

What is the median umbilical fold?

Answer 54

obliterated fetal urachus from bladder to umbilicus

Question 55

What are the medial umbilical folds?

Answer 55

Obliterated umbilical arteries from umbilicus to internal iliac arteries

Question 56

What are the lateral umbilical folds?

Answer 56

peritoneum covering the inferior epigastric vessels

Question 57

Name the 4 intraperitoneal fossae

Answer 57

1) Lesser sac via foramen of Winslow 2) Paraduodenal fossa - between duodenojejunal flexure & inferior mesenteric vessels 3) retrocecal fossa - appendix normally found 4) intersigmoid fossa - inverted V attachment of mesosigmoid

Question 58

What anatomical relation does the supracristal plane at L4 refer to?

Answer 58

Summits of iliac crests

Question 59

What are the boundaries of the epiploic foramen?

Answer 59

1) Caudate lobe 2) Free edge of lesser omentum (bile duct, portal vein, hepatic artery) 3) IVC (peritoneum of vena cava) 4) 1st part of duodenum