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MRCS > Abdomen > Flashcards

Abdomen Flashcards

1
Q

What are the 2 main divisions of the peritoneal cavity

A

Greater sac
Lesser sac

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2
Q

What divides the greater sac of the abdomen into 2

A

The mesentery of the transverse colon

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3
Q

What are the 2 compartments of the greater sac of the abdomen and what do they contain

A

Supracolic (above transverse mesocolon) - contains stomach, liver and spleen
Infracolic (below transverse mesocolon) - contains small intestine, ascending and descending colon

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4
Q

What divides the infra colic compartment of the greater sac

A

Root of the mesentery of the small intestine - divides it into left and right infra colic compartments

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5
Q

What connects the supracolic and infracolic compartments of the greater sac

A

Paracolic gutters
Lie between the posterolateral abdominal wall and the lateral aspect of the ascending/ descending colon

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6
Q

Where is the subphrenic recess found

A

Between the diaphragm and the liver
Left and right subphrenic recesses which are separated by the falciform ligament

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7
Q

On which side is a subphrenic abscess more common

A

Right sided
Due to increased frequency of appendicitis and ruptured duodenal ulcers

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8
Q

Where is the lesser sac found

A

Posterior to the stomach and the lesser omentum

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9
Q

What is the other name for the lesser sac

A

Omental bursa

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10
Q

What connects the omental bursa to the greater sac

A

The epiploic foramen

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11
Q

Where is the epiploic foramen found

A

Posterior to the free edge of the lesser omentum

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12
Q

In which sex is the peritoneal cavity not completely closed and why

A

Females
The uterine tubes open into the peritoneal cavity, providing a potential pathway between the female genital tract and the abdominal cavity.

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13
Q

Where is the rectovesical pouch found and what is it

A

In males
Between the rectum and bladder
It is a double fold of peritoneum

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14
Q

What is the equivalent of the rectovesical pouch in females

A

Rectouterine pouch (of Douglas) - double folding of peritoneum between the rectum and the posterior wall of the uterus
Vesicouterine pouch - Double folding of peritoneum between the anterior surface of the uterus and bladder

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15
Q

Where is Calot’s triangle found

A

At the aorta hepatis of the liver

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16
Q

What are the borders of Calot’s triangle

A

Medial - common hepatic duct
Inferior - cystic duct
Superior - inferior surface of the liver

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17
Q

What is the contents of Calot’s triangle

A

Right hepatic artery
Cystic artery
Lymph node of Lund
Lymphatics

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18
Q

What forms the right hepatic artery

A

Bifurcation of the proper hepatic artery into the right and left branches

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19
Q

What is parietal mesoderm derived from

A

Somatic mesoderm

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20
Q

What is visceral mesoderm derived from

A

Splanchnic mesoderm

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21
Q

Which abdominal organs are retroperitoneal

A

Suprarenal glands
Aorta/IVC
Duodenum
Pancreas
Ureters
Ascending and descending colon
Kidneys
Oesophagus
Rectum

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22
Q

Which part of the pancreas is intraperitoneal

A

Tail of pancreas

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23
Q

What are the attachments of the greater omentum

A

Descends from the greater curvature of the stomach and proximal part of the duodenum
Folds back up and attaches to the anterior surface of the transverse colon

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24
Q

How many layers of visceral peritoneum make up the greater omentum

A

4

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25
Q

Where does the lesser omentum attach

A

Lesser curvature of the stomach and proximal duodenum
to the Liver

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26
Q

What are the 2 parts of the lesser omentum

A

Hepatogastric ligament
Hepatoduodenal ligament

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27
Q

What is contained in the free edge of the hepatoduodenal ligament

A

Portal triad

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28
Q

What is the inguinal canal

A

A short passage extending inferiorly and medially through the inferior part of the abdominal wall, above the inguinal ligament

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29
Q

Is the inguinal canal above or below the inguinal ligament

A

Above

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30
Q

What is the opening of the inguinal canal known as

A

The deep inguinal ring

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31
Q

What is the exit of the inguinal canal known as

A

The superficial inguinal ring

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32
Q

What are the boundaries of the inguinal canal

A

Anterior - Aponeurosis of the external oblique, reinforced by the internal oblique laterally
Posterior wall - transversalis fasciae
Roof - Transversalis fascia, internal oblique, transversus abdominis
Floor - inguinal ligament, thickened medially by the lacunar ligament

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33
Q

What forms the deep inguinal ring

A

Transversalis fascia

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34
Q

What forms the superficial inguinal ring

A

Invagination of the external oblique

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35
Q

What is contained within the inguinal canal

A

Spermatic cord (males)
Round ligament (females)
Ilioinguinal nerve
Genital branch of the genitofemoral nerve

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36
Q

What is the mid inguinal point and what can be palpated here

A

Halfway between the pubic symphysis and the anterior iliac spine
Femoral pulse can be palpated

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37
Q

What is the mid point of the inguinal ligament and what is found here

A

Halfway between the pubic tubercle and the anterior iliac spine
Opening to inguinal canal just above this point

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38
Q

What is Hesselbachs Triangle

A

Also known as the inguinal triangle, is a region in the medial abdominal wall

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39
Q

What are the borders of Hesselbachs triangle

A

Medial - Lateral border of rectum abdomens
Lateral - inferior epigastric muscles
Inferior - inguinal ligament

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40
Q

What is the clinical importance of Hesselbachs triangle

A

An area of potential weakness
Site of direct inguinal hernia

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41
Q

Describe the arrangement of the superficial fascia of the anterior abdominal wall

A

Above the umbilicus - a single sheet of CT
Below the umbilicus - divided into two layers

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42
Q

What are the two layers of superficial fascia of the anterior abdominal wall below the umbilicus

A

Fatty superficial layer - Camper’s fascia
Membranous deep layer - Scarpa’s fascia

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43
Q

What are the 3 flat muscles of the abdominal wall

A

External oblique
Internal oblique
Trasnversus abdominis

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44
Q

The aponeurosis of the 3 flat muscles of the abdominal wall combine to form what

A

Linea Alba

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45
Q

Where does the Linea Alba extend to

A

From the Xiphoid process of the sternum to the pubic symphysis

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46
Q

Which is the largest flat muscle of the abdominal wall

A

External oblique

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47
Q

Where does external oblique attach

A

Ribs 5 -12
Iliac crest and pubic tubercle

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48
Q

What lies directly deep to external oblique

A

Internal oblique

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49
Q

Where does internal oblique attach

A

Inguinal ligament, iliac crest and lumbodorsal fascia Inserts onto ribs 10-12.

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50
Q

Where does transversus abdominis attach

A

Inguinal ligament, costal cartilages 7-12, iliac crest and thoracolumbar fascia
Inserts onto the conjoint tendon, xiphoid process, linea alba and pubic crest

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51
Q

What innervates the flat muscles of the anterior abdominal wall

A

Thoracoabdominal nerve (T7-T11)
Subcostal nerve

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52
Q

What additional nervous innervation does internal oblique and transversus abdominis have

A

Branches of the lumbar plexus

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53
Q

What are the two vertical muscles of the anterior abdominal wall

A

Rectus abdominis
Pyramidalis

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54
Q

Describe rectus abdominis

A

Long, paired muscle, found either side of the midline
Separated by the linea alba

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55
Q

Where does rectus abdominis attach

A

Crest of pubis bone
Inserts onto the xiphoid process of sternum, and costal cartilages of ribs 5-7

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56
Q

What innervates rectus abdominis

A

Thoracoabdominal nerve

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57
Q

Where is pyramidalis found and what is its action

A

Found superficially to the rectus abdominis
Tenses the linea Alba

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58
Q

Describe the rectus sheath

A

Formed by the aponeurosis of the three flat muscles (transversus abdominis, internal and external oblique) and encloses the rectus sheath and pyramidalis

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59
Q

What is the arcuate line and what occurs here

A

The line at which the posterior layer of the rectus sheath is deficient
The rectus abdominis is in direct contact with the transversalis fascia

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60
Q

What are the 5 muscles in the posterior abdominal wall

A

Iliacus
Psoas Major
Psoas minor
Quadratus lumborum
Diaphragm

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61
Q

What is the action of quadratus lumborum

A

Extension and lateral flexion of the vertebral column

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62
Q

Which muscle is found most superiorly in the posterior abdominal wall

A

Quadratus lumborum

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63
Q

What is the action of quadratus lumborum

A

Flexion at the thigh and hip
Lateral flexion of the vertebral column

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64
Q

Which posterior abdominal wall muscle is only present in 60% of the population

A

Psoas Minor

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65
Q

What is the action of iliacus

A

Flexion and lateral rotation of the thigh

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66
Q

What is a positive psoas sign

A

Pain elicited by flexion at the hip

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67
Q

What are the two layers of fascia in the posterior abdominal wall

A

Psoas fascia
Thoracolumbar fascia

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68
Q

At what level does the aorta bifurcate into its terminal branches

A

L4

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69
Q

WHat is the first branch of the abdominal aorta

A

Inferior phrenic arteries

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70
Q

At what level do the gonadal arteries branch from the aorta

A

L2

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71
Q

At what level does the aortic arch end

A

T4

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72
Q

What are the 3 main branches of the aortic arch (proximal to distal)

A

Brachiocephalic trunk
Left common carotid
Left subclavian

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73
Q

What are the branches of the descending aorta (in order)

A

Bronchial arteries - left form aorta, right from intercostals
Mediastinal arteries
Oesophageal arteries
Pericardial arteries
Superior phrenic arteries
Intercostal and subcostal

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74
Q

How many intercostal arteries branch from the aorta

A

9

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75
Q

What are the branches of the abdominal aorta

A

Inferior phrenic
Coeliac axis
Superior mesenteric artery
Middle suprarenal
Renal arteries
Gonadal arteries
Inferior mesenteric artery
Median sacral artery
Lumbar arteries

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76
Q

At what level does the coeliac axis branch from the aorta

A

T12

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77
Q

At what level does the SMA branch from the aorta

A

L1

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78
Q

At what level does the IMA branch from the aorta

A

L3

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79
Q

What is the last branch of the aorta and where does it branch

A

Median sacral artery
L4

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80
Q

How many pairs of lumbar arteries branch from the aorta

A

4

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81
Q

What are the 3 major branches of the coeliac axis

A

Left gastric
Splenic
Common hepatic

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82
Q

Describe the left gastric

A

Smallest of the 3 arteries
Ascends across the diaphragm, gives oesophageal branches, and continues along the lesser curvature of the stomach

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83
Q

Which artery does the left gastric anastomose with

A

Right gastric

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84
Q

In which structure is the splenic artery found

A

Splenorenal ligament

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85
Q

What are the 3 important branches of the splenic artery

A

Left gastroepiploic
Short gastrics
Pancreatic branches

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86
Q

What does the left gastroepiploic artery supply and what does it anastomose with

A

Greater curvature of the stomach
Anastamoses with the right gastroepiploic

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87
Q

What do the short gastric arteries supply

A

The fundus of the stomach

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88
Q

Which branch of the coeilac axis is the only one to go to the right

A

Common hepatic artery

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89
Q

What are the two branches of the common hepatic artery and where does it bifurcate

A

Proper hepatic
Gastroduodenal
Bifurcates at the superior aspect of the duodenum

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90
Q

What are the branches of the proper hepatic artery

A

Right gastric artery
Right and left hepatic
Cystic

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91
Q

What does the right gastric artery supply

A

Pylorus and lesser curvature of the stomach

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92
Q

What are the two branches of the gastroduodenal artey

A

Right gastroepiploic
Superior pancreaticoduodenal

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93
Q

Which is the only organ to receive blood supply from all 3 branches of the coeliac axis

A

Stomach

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94
Q

What are the two main branches of the pancreaticoduodenal arcade

A

Superior pancreaticoduodenal artery - a branch of the gastroduodenal artery
Inferior pancreaticoduodenal artery - branch of SMA

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95
Q

Which artery do posterior duodenal ulcers erode into

A

Gastroduodenal artery

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96
Q

What is coeliac trunk compression syndrome

A

Compression of the coeliac axis by the median arcuate ligament

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97
Q

What are the risk factors for a splenic arteyr aneurysm

A

Female sex
Multiple pregnancies
Portal HTN
Pancreatitis /Pseudocyst formation

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98
Q

What does the SMA supply

A

The Midgut
From the major papillae of the duodenum to the proximal 2/3 of the transverse colon

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99
Q

What is anterior to the SMA at its origin

A

Pyloric part of stomach
Splenic vein
Neck of pancreas

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100
Q

What is posterior to the SMA at its origin

A

Left renal vein
Ucinate process of the pancreas
Inferior part of the duodenum

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101
Q

What is the relationship between the SMA and the ucinate process of the pancreas

A

Ucinate process hooks itself around the back of SMA

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102
Q

What are the branches of the SMA

A

Inferior pancreaticoduodenal artery
Jejunal and ileal arteries
Middle colic artery
Right colic artery
Ileocolic artery

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103
Q

The appendicular artery is a branch of what atery

A

Ileocolic

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104
Q

What does the right colic artery supply

A

Ascending colon

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105
Q

What does the middle colic artery supply

A

Transverse colon

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106
Q

What are the vasa recta and how do they differ between the ileum and jejunum

A

Vasa recta - anastomotic arcades
Jejunal arteries - smaller number of arterial arcades, but they are longer
Ileal arteries - higher number of arterial arcades, they are shorter

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107
Q

Is the IMA intraperitoneal or an retroperitoneal structure ?

A

Retroperitoneal

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108
Q

What are the 3 major branches of the IMA

A

Left colic artery
Sigmoid artery
Superior rectal artery

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109
Q

What are the 2 branches of the left colic artery

A

Ascending
Descending

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110
Q

What does the descending left colic artery anastomose with

A

Superior sigmoid artery

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111
Q

In a left hemicolectomy what artery will they want a high resection of

A

IMA

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112
Q

What is the marginal artery of drummond

A

A continuous arterial circle long the inner border of the colon

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113
Q

What forms the marginal artery of drummond

A

branches from the ileocolic, right colic and middle colic of the SMA and left colic and sigmoid branches of the IMA.

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114
Q

What forms the Arch of Riolan

A

Anastamosis between the middle colic branch of SMA and left colic branch of IMA

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115
Q

What is meant by the splenic flexure being a watershed area

A

Has dual supply from two large arteries

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116
Q

What is the IVC formed by and at what level

A

Common iliac veins at L5

117
Q

What are the tributaries of the IVC

A

Common iliac veins
Lumbar veins
Renal veins
Right testicular or ovarian veins
Right suprarenal veins
Inferior phrenic veins
Hepatic veins

118
Q

Which structures do not have tributaries to the IVC and why

A

No tributaries from the spleen, pancreas, gallbladder or abdominal portion of GI tract
Drained by the portal system

119
Q

What forms the portal vein and where

A

Union of the splenic vein and the SMV, posterior to the neck of the pancreas at level of L2

120
Q

What are the tributaries to the portal vein

A

Right and left gastric veins
Cystic veins
Para-umbical veins

121
Q

Which veins are tributaries to the splenic vein

A

Short gastric veins
Left gastro-omental veins
Pancreatic veins
IMV

122
Q

Where does the IMV drain blood from

A

Rectum
Sigmoid colon
Descending colon
Splenic flexure

123
Q

Where does the IMV pass in relation to the pancreas

A

Posterior to the body of the pancreas

124
Q

Where does the SMV drain blood from

A

Small intestine, caecum, ascending colon and transverse colon

125
Q

Where does the SMV pass in relation to the pancreas

A

Posterior to the neck of pancreas

126
Q

What are the tributaries of the SMV

A

Right gastro-omental vein
Anterior and posterior inferior pancreaticoduodenal veins
Jejunal vein
Ileal vein
Ileocolic vein
Middle colic vein

127
Q

Where is the origin of the SMV

A

RIF
Forms as a convergence of the veins draining the terminal ileum, caecum and appendix

128
Q

Where are the sites of porto-systemic anastomosis

A

Oesophageal
Rectal
Retroperitoneal
Paraumbilical

129
Q

Which veins from the oesophageal portosystemic anastomosis

A

Left gastric vein
Oesophageal tributaries of the azygous system

130
Q

Which veins form the rectal portosystemic anastamosis

A

Superior and inferior rectal veins

131
Q

Which veins form the retroperitoneal portosystemic anastamosis

A

Portal tributaries of the mesenteric veins and retroperitoneal veins

132
Q

Which veins form the paraumbilical portosystemic anastamosis

A

Portal veins of the the liver and veins of the anterior abdominal wal

133
Q

Which surface of the liver is its diaphragmatic surface

A

The anterosuperior aspect

134
Q

Which surface of the liver is its visceral surface

A

Posteroinferior aspect

135
Q

What organs are in direct contact with the liver

A

Right kidney
Right adrenal gland
Right colic flexure
Transverse colon
First part of the duodenum
Gallbladder
Oesophagus
Stomach

136
Q

What does the falciform ligament attach to and what does it contain

A

Anterior abdominal wall
Contains ligamentum teres

137
Q

What is the ligamentum teres a remnant of

A

Umbilical vein

138
Q

What does the coronary ligament attach to and what does it demarcate

A

Attaches the superior surface of the liver to the inferior aspect of the diaphragm
Demarcates the bare area of the Liver

139
Q

What are the coronary ligaments also known as

A

Anterior and posterior fold

140
Q

What do the anterior and posterior folds (coronary ligaments) unite to form

A

The triangular ligaments of the liver
Right and left triangular ligament

141
Q

What ligament surrounds the portal triad

A

Hepatoduodenal ligament

142
Q

What are the ligaments of the liver

A

Falciform ligament
Coronary ligament (right and left folds)
Triangular ligaments (right and left)
Lesser omentum

143
Q

Where is the subhepatic space found

A

Subdivision of the supra colic compartment, located between the liver and the transverse colon

144
Q

What is Morrisons pouch

A

Potential space between the visceral surface of the liver and the right kidney

145
Q

What is the fibrous layer of the liver known as

A

Glissons capsule

146
Q

What are the two ‘accessory lobes’ of the liver and where do they arise from

A

Caudate lobe
Quadrate lobe
Arise from the right lobe of the liver

147
Q

Where is the caudate lobe found

A

It lies between the IVC and a fossa produced by the ligamentum venous

148
Q

Where is the quadrate lobe found

A

Between the gallbladder and a fossa produced by the ligamentum teres

149
Q

What does the porta hepatis separate

A

The caudate and quadrate lobes

150
Q

What are the 2 vessels supplying the liver and what do they proportionally supply

A

Hepatic artery proper - 25% of blood supply
Hepatic portal vein - 75% of blood supply

151
Q

What is the nervous innervation of the Liver

A

Parenchyma of the liver innervated by the hepatic plexus
Glissons capsule - innervated by lower intercostal nerves

152
Q

How is the lymphatic drainage of the liver split

A

Anterior
Posterior

153
Q

What is the lymphatic drainage of the anterior liver

A

Hepatic lymph node s

154
Q

What is the lymphatic drainage of the posterior liver

A

Phrenic
Posterior mediastinal nodes

155
Q

What are the anterior and superior relations of the gallbladder

A

Inferior border of the liver
Anterior abdominal wall

156
Q

What are the posterior and inferior relations of the gallbladder

A

Posterior - Transverse colon and proximal duodenum
Inferior - Biliary tree and remaining parts of duofenum

157
Q

What are the 3 parts of the gallbladder

A

Fundus
Body
Neck

158
Q

which is the largest part of the gallbladder

A

Body

159
Q

The neck of the gallbladder tapers to become continuous with which structure

A

Cystic duct

160
Q

Where is Hartmann’s pouch and what can get stuck there

A

A mucosal fold in the neck of the gallbladder
Gallstones can become lodged here

161
Q

The cystic duct combines with what to form the common bile duct

A

Common hepatic duct

162
Q

The common hepatic duct combines with which structure, where, to form the hepatopancreatico ampulla

A

Combines with the pancreatic duct
Enters the duodenum on the medial aspect of the 2nd part of the duodenum

163
Q

What is the blood supply of the gallbladder

A

Cystic atery

164
Q

What is the cystic artery a branch of

A

Hepatic artery

165
Q

What is the venous drainage of the gallbladder

A

Cystic veins
Drain directly into the portal vein

166
Q

Which organs is the pancreas in direct contact with

A

Stomach
Duodenum
Transverse mesocolon
Common bile duct
Spleen

167
Q

What is the relation of the pancreas and the duodenum

A

The first part of the duodenum lies anteriorly
whereas the second part of the duodenum including the ampulla of Vater lies laterally to the right of the pancreatic head

168
Q

The linorenal ligament connects which 2 organs

A

The spleen and the left kidney

169
Q

Which vessels are related to the pancreas

A

Aorta and IVC
SMA
Hepatic portal vein - and the SMV and splenic vein prior to combining

170
Q

What are the 5 parts of the pancreas

A

Head
Ucinate process
Neck
Body
Tail

171
Q

Which part of the pancreas is intraperitoneal

A

Tail

172
Q

What is the blood supply of the pancreas

A

Pancreatic branches of the splenic artery
Additional supply to the head - superior and inferior pancreaticoduodenal arteries which are branches of the gastroduodenal (from coeliac trunk) and superior mesenteric arteries, respectively

173
Q

What is the venous drainage of the pancreas

A

Head - Superior mesenteric branches of the portal vein
Rest - pancreatic and splenic veins

174
Q

What is the lymphatic drainage of the pancreas

A

Pancreaticosplenal nodes

175
Q

What are the 2 ligaments which connect the spleen to the stomach and kidneys

A

Gastrosplenic ligament
Splenorenal ligament

176
Q

Which borders of the spleen contain notches

A

Anterior and superior borders

177
Q

What is found anterior to the spleen

A

Stomach

178
Q

What is found posterior to the spleen

A

Diaphragm
Left lung
Ribs 9-11

179
Q

What is found inferior to the spleen

A

Left colic flexure

180
Q

What is found medial to the spleen

A

Left kidney
Tail of pancreas

181
Q

What is the arterial supply of the spleen

A

Splenic artery
Branches into 5 separate branches

182
Q

What is the venous drainage of the spleen and what does this eventually form

A

Splenic vein
Combines with SMV to form portal vein

183
Q

What are the relations of the right adrenal gland

A

Anterior - IVC, Right lobe of liver
Posterior -Right crus of diaphragm

184
Q

What are the relations of the left adrenal gland

A

Anterior - stomach, pancreas, spleen
Posterior - Left crus of diaphragm

185
Q

What is the embryological origin of the adrenal gland

A

Cortex -mesoderm
Medulla - ectodermal neural crest cells

186
Q

What are the 3 zones of the adrenal cortex and what do they secrete

A

Zona glomerulosa - mineralocorticoids
Zona fasciularis - corticosteroids
Zona reticularis - androgens

187
Q

What is the blood supply of the adrenal glands

A

Superior, middle and inferior adrenal arteries

188
Q

What is the origin of the superior adrenal artery

A

Inferior phrenic artery

189
Q

What is the origin of the middle adrenal artery

A

Abdominal aorta

190
Q

What is the origin of the inferior adrenal artery

A

Renal arteries

191
Q

What does the right adrenal vein drain into

A

IVC

192
Q

What does the left adrenal vein drain into

A

Left renal vein

193
Q

What layers enclose the kidney

A

Deep to superficial
Renal capsule
Perirenal fat
Renal fascia
Pararenal fat

194
Q

What is the renal fascia also known as

A

Gerotas fascia

195
Q

Which muscles lie posterior to the kidneys

A

Psoas major
Quadratus lumborum
Transversus abdominis

196
Q

What is the line of brodel in the kidney

A

The avascular plane of the kidney, delineating the section of the kidney supplied by the anterior and posterior divisions
Found along the lateral and posterior border of the kidney

197
Q

The renal artery branches are anatomical end arteries - why is this important

A

There is no communication between vessels - therefore damage to a vessel will lead to necrosis of the renal parenchyma

198
Q

The arterial supply to the kidneys divide it into what 5 segments

A

Apical
Upper
Middle
Lower
Posterior

199
Q

What structure does the left renal vein lie over

A

The abdominal aorta

200
Q

Where does lymph from the kidneys drain

A

Para-aortic lymph nodes

201
Q

What is the function of the abdominal mesentery

A

Suspends the small and large intestines from the posterior abdominal wall
Provides conduit for blood vessels

202
Q

Which part of the mesentery is flattened against the posterior abdominal wall

A

Right mesocolon
Left mesocolon
Medial mesosigmoid

203
Q

The parts of the mesentery that are flattened against the posterior abdominal wall are attached to this by what

A

Toldt’s fascia

204
Q

Which major blood vessels are found in the mesentery

A

SMA and SMV
IMA and IMV

205
Q

Where does the inferior mesenteric lymph nodes receive lymph from

A

Hindgut organs

206
Q

Where do the inferior mesenteric lymph nodes drain into

A

Superior mesenteric lymph nodes

207
Q

Where does the superior mesenteric lymph nodes receive lymph from

A

Midgut
Inferior mesenteric lymph nodes

208
Q

Where do the superior mesenteric lymph nodes drain into

A

Para aortic nodes

209
Q

How long is the oeosphagus, where does it start and end

A

25 cm
Starts at C6
Ends at T11

210
Q

Describe the muscualr layer of the oesophagus and how it differs in different thirds

A

External layer of longitudinal muscle - differs - superior third is voluntary striated, middle third - voluntary striated and smooth, lower third - smooth muscle
Internal layer of circular muscle

211
Q

WHat is the mucosa of the oesphagus

A

non-keratinised stratified squamous epithelium (contiguous with columnar epithelium of the stomach).

212
Q

Which of the two oesophageal sphincters are anatomical

A

Upper

213
Q

How could you describe the lower oesophageal sphincter and what maintains it

A

Physiological sphincter
Maintained by:
1. Oesophagus enters stomach at an acute angle
2. Walls of the intra-abdominal section of the oesophagus are compressed when there is a positive intra-abdominal pressure.
3.Prominent mucosal folds at the gastro-oesophageal junction aid in occluding the lumen.
4. Right crus of the diaphragm has a “pinch-cock” effect.

214
Q

Where are the 4 phsyiological constrictions of the oesophagus

A

Arch of aorta
Bronchus
Cricoid cartilage
Diaphragmatic hiatus

215
Q

What nerve is closely related to the oesophagus in the abdomen

A

Right and left vagus nerves

216
Q

What is the arterial supply of the thoracic oesophagus

A

Thoracic aorta
Inferior thyroid artery

217
Q

What is the arterial supply of the abdominal oesophagus

A

Left gastric artery

218
Q

What is the venous drainage of the thoracic oesophagus

A

Azygous veins
Inferior thyroid vein

219
Q

What is the venous drainage of the abdominal aorta

A

Portal circulation - via left gastric vein
Systemic circulation - via azygos vein

220
Q

Nerve fibres from which nucleus supply the upper oesophageal sphincter

A

Nucelus ambiguus

221
Q

Nerve fibres from which nucleus supply the lower oesophageal sphincter

A

Dorsal motor nucleus

222
Q

The superior third of the oesophagus drains to which nodes

A

Deep cervical nodes

223
Q

The middle third of the oesophagus drains to which nodes

A

Superior and posterior mediastinal nodes

224
Q

The inferior third of the oesophagus drains to which nodes

A

Left gastric and coeliac nodes

225
Q

What are the 4 main divisions of the stomach

A

Cardia
Fundus
Body
Pylorus

226
Q

The transpyloric plane is at what level

A

L1

227
Q

Which arteries supply the greater curvature of the stomach

A

Short gastric arteries
Right and left gastro-omental arteries

228
Q

Which arteries supply the lesser curvature of the stomach

A

Left gastric artery
Right gastric branch of the hepatic artery

229
Q

Which structures are found anterior to the stomach

A

Diaphragm
Greater omentum
Anterior abdominal wall
Left lobe of liver
Gall bladder

230
Q

Which structures are found posterior to the stomach

A

Lesser sac
Pancreas
Left kidney
Left adrenal gland
Spleen
Splenic artery
Transverse mesocolon

231
Q

The hepatogastric ligament attaches to which surface of the stomach

A

Lesser curvature

232
Q

The pyloric sphincter is what kind of sphincter

A

Anatomical sphincter

233
Q

The right gastric artery is a branch of which artery

A

Proper hepatic artery (branch of common hepatic)

234
Q

right gastro-omental artery is a branch of which artery

A

Terminal branch of gastroduodenal artery (common hepatic)

235
Q

Left gastro-omental artery is a branch of which artery

A

Splenic artery

236
Q

The right and left gastric veins drain into

A

Portal vein

237
Q

The short gastric vein, left and right gastro-omental veins drain into

A

SMV

238
Q

Lymph drainage of the stomach is to

A

Gastric and gastro-omental lymph nodes
Which drain to coeliac lymph nodes

239
Q

What are the 3 parts of the small intestine

A

Duodenum
Ileum
Jejunum

240
Q

How long is the duodenum and what are its 4 parts

A

approx 25 cm
Superior, descending, inferior, ascending

241
Q

Which part of the duodenum is at the level of L1

A

Superior

242
Q

Which part of the duodenum is connected to the liver by the hepatoduodenal ligament

A

Superior duodenum

243
Q

Which part of the duodenum is intraperitoneal

A

Superior

244
Q

Which part of the duodenum is related to the IVC and aorta

A

Inferior

245
Q

Where is the suspensory muscle of the duodenum found and what is its function

A

Found at the duodenojejunal junction
Contraction of the muscle widens the duodenojejunalflexure, aiding in movement of intestinal contents into the jejunum

246
Q

What is a complication of duodenal ulcers

A

Erosion of the gastroduodenal artery - subsequent haemorrhage

247
Q

Which parts of the small intestine are intraperitoneal

A

Jejunum
Ileum

248
Q

Summarise the jejunum

A

Located in left upper quadrant
Thick intestinal walls
Long, straight vasa recta with less arcades
Red in colour

249
Q

Summarise the ileum

A

Located in right upper quadrant
Thin intestinal walls
Short vasa recta, with more arcades
Pink in colour

250
Q

What are the 2 arterial supplies to the duodenum and what landmarks marks the change

A

Gastroduodenal artery (common of right hepatic - coeliac trunk)
Inferior pancreaticoduodenal artery (branch of SMA)
Changes at major duodenal papilla (in 2nd part of duodenum)

251
Q

The appendicular artery arises from which main artery

A

Ileocolic artery
Branch of the SMA

252
Q

Where is McBurneys point

A

Situated one third of the distance from the right anterior superior iliac spine to the umbilicus

253
Q

Where does lymph from the appendix drain

A

Ileocolic lymph nodes

254
Q

What is the function of the ileocolic valvce

A

prevents reflux of large bowel contents into the ileum during peristalsis and is thought to function passively

255
Q

What is the lymphatic drainage of the caecum

A

Ileocolic lymph nodes

256
Q

How long is the colon

A

150cm

257
Q

what does the phrenicocolic ligament attach to

A

The transverse colon
The diaphragm

258
Q

Where is the sigmoid colon found

A

Left lower quadrant
From the left iliac fossa to the level of the S3 vertebra

259
Q

What are the tenia coli

A

3 strips of muscle running longitudinally along the colon
Mesocolic, free and omental coli

260
Q

What is the arterial supply of the ascending colon

A

Ileocolic artery
Right colic artery

261
Q

What is the arterial supply of the transverse colon

A

Right colic artery
Middle colic artery
Left colic artery - branch of IMA

262
Q

What is the arterial supply of the descending colon

A

Left colic artery

263
Q

Why is the marginal artery of Drummond important

A

Provides collateral blood supply to the colon

264
Q

Where does the superior mesenteric and inferior mesenteric veins drain into

A

Portal vein

265
Q

What is the nervous innervation of midgut structures

A

Sympathetic, parasympathetic and sensory supply via nerves from the superior mesenteric plexus

266
Q

What is the nervous innervation of hindgut structures

A

From the inferior mesenteric plexus
Parasympathetic innervation via the pelvic splanchnic nerves
Sympathetic innervation via the lumbar splanchnic nerves

267
Q

What is the lymphatic drainage of the colon

A

Ascending and transverse colon - superior mesenteric nodes
Descending and sigmoid colon - inferior mesenteric nodes

268
Q

What are the 2 major flexures of the rectum

A

Sacral flexure – anteroposterior curve with concavity anteriorly
Anorectal flexure – anteroposterior curve with convexity anteriorly.

269
Q

What forms the sacral flexure of the rectum

A

The curve of the sacrum and coccyx

270
Q

What forms the anorectal flexure of the rectum

A

The tone of puborectalis muscle

271
Q

What is the final segment of the rectum called and what is its function

A

Ampulla
relaxes to accumulate and temporarily store faeces until defecation occurs

272
Q

Describe the peritoneal coverings of the rectum

A

Superior third - anterior and middle sides are covered with peritoneum
Middle third - anterior peritoneal covering
Lower third - no peritoneum associated with it

273
Q

What is the arterial supply of the rectum

A

Superior, middle and inferior rectal artery

274
Q

What is the origin of the superior rectal artery

A

IMA

275
Q

What is the origin of the middle rectal artery

A

Internal iliac artery

276
Q

What is the origin of the inferior rectal artery

A

Internal pudendal artery

277
Q

Which rectal veins drains into portal circulation and which into systemic circulation

A

Superior rectal vein - portal circulation
Middle and inferior rectal vein - systemic circulation

278
Q

What is the sympathetic innervation of the rectum

A

Lumbar splanchnic nerves
Superior and inferior hypogastric plexuses.

279
Q

What is the parasympathetic innervation of the rectum

A

S2-4 via the pelvic splanchnic nerves and inferior hypogastric plexuses

280
Q

What is the lymphatic drainage of the rectum

A

Pararectal nodes
Lower rectum - drains directly into internal iliac nodes

281
Q

Describe the internal anal sphincter

A

Surrounds the upper 2/3 of the anal canal
It is formed from a thickening of the involuntary circular smooth muscle in the bowel wal

282
Q

Describe the external anal sphincter

A

Voluntary muscle that surrounds the lower 2/3 of the anal canal (and so overlaps with the internal sphincter). It blends superiorly with the puborectalis muscle of the pelvic floor.

283
Q

What form the anorectal ring

A

Fusion of the Internal and external anal sphincter and puborectalis muscle

284
Q

What is the pectinate line

A

The line in which the anal valves are found
Delineates the different embryological origins of the anal canal

285
Q

What is the anal canal lined with superior to the pectinate line

A

Columnar epithelium

286
Q

What is the anal canal lined with inferior to the pectinate line

A

Non keratinised stratified squamous epithelium

287
Q

What is the arterial supply of the anal canal

A

Above the pectinate line - superior rectal, + anastomosis with middle rectal
Below pectinate line - inferior rectal + anastomosis with middle rectal

288
Q

What is the venous drainage of the anal canal

A

Above the pectinate line - superior rectal vein draining into portal system
Below pectinate line - inferior rectal into the pudendal into systemic

289
Q

What is the lymphatic drainage of the anal canal

A

above pectinate line - Internal iliac nodes
Below pectinate line - superficial inguinal nodes

MRCS (17 decks)

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