Abdomen Flashcards
1
Q
Where does the oesophagus originate?
A
C6 - the inferior border of the cricoid cartilage
2
Q
Where does the oesophaguse lie in relation to the trachea?
A
Posterior to the trachea
3
Q
Where does the oesophagus enter the stomach?
A
T11 (card oesophageal junction)
4
Q
Where does the oesophagus enter the abdomen via the hiatus?
A
T10
5
Q
What mucosa lines the oesophagus?
A
Non keratinised stratified squamous epithelium
6
Q
What muscle produces the upper oesophageal sphincter?
A
Cricopharyngeus muscle
7
Q
Where is the lower oesophageal sphincter?
A
At the gastro-oesophageal junction - just left to the T11 vertebra
8
Q
What aids the occlusion of the lumen at the gastro-oesophageal junction?
A
Mucosal folds
9
Q
List the relations to the left of the oesophagus:
A
Subclavian artery
Aortic arch
Thoracic duct
Pleura
10
Q
List the relations to the right of the oesophagus:
A
Pleura
Terminal part of azygous vein
11
Q
List the structures anterior to the oesophagus:
A
THORAX
Trachea
Left recurrent laryngeal nerve
Pericardium
Abdomen:
Left vagus nerve
Posterior surface of the heart
12
Q
List the structures posterior to the oesophagus:
A
THORAX
Thoracic vertebra
Thoracic duct
Azygous veins
Descending aorta
Abdominal:
Right vagus nerve
The left crus of the diaphragm
13
Q
What is the arterial supply to the thoracic part of the oesophagus:
A
The thoracic aorta and inferior thyroid artery
14
Q
What is the arterial supply of the abdominal part of the oesophagus:
A
The left gastric artery
Left inferior phrenic artery
15
Q
What is the venous drainage of the thoracic oesophagus?
A
Branches of the azygous veins and inferior thyroid veins
16
Q
What is the venous drainage of the abdominal oesophagus?
A
It has two routes:
1) Portal circulation via the left gastric vein
2) systemic circulation via the azygous vein
NOTE: these two routes form a porto-systemic anastomosis
17
Q
What innervates the oesphagus?
A
The oesophageal plexus
Combined with parasympathetic vagal trunks and sympathetic trunks from the cervical and thoracics.
18
Q
What role does the nucleus ambigus have on the oesophagus:
A
Supplies the nerve fibres to the upper oesophageal sphincter and upper striated muscle
19
Q
What role does the dorsal motor nucleus have on the oesophagus?
A
Supplies the nervous innervation to the lower oesophageal sphincter and smooth muscle.
20
Q
Where does the superior third of the oesophagus drain its lymph?
A
Deep cervical lymph nodes
21
Q
Where does the middle third of the oesophagus drain its lymph?
A
Superior and posterior mediastinal nodes
22
Q
Where does the posterior third of the oesophagus drain its lymph?
A
Left gastric and coeliac nodes
23
Q
What cellular change is seen in Barrett’s oesophagus?
A
Metaplasia
Becomes gastric columnar epithelium
24
Q
What are the two most common types of oesophageal carcinomas?
A
Squamous cell - most common
Adenocarcinoma cell - only occurs in the inferior third of the oesphagus
25
Which type of cancer is mostly associated Barret's oesophagus?
Adenocarcinoma
26
What is the approximate length of the oesophagus?
25cm
27
At what portion of the oesophagus is there both voluntary striated muscle and smooth muscle in the external longitudinal layer?
The middle third
28
What are the 4 regions of the stomach?
Cardia
Fundus
Body
Pylorus
29
What is the transpyloric plane level?
T1
30
What is the most superior aspect of the stomach>
The fundus
31
Where does the greater curvature lie?
Lateral border of the stomach
32
What arteries supply the greater curvature?
The short gastric arteries
Right and left gastro-omental arteries
33
Where is the lesser curvature of the stomach?
The medial concave surface of the stomach.
34
What ligament attaches to the lesser curvature of the stomach?
The hepatogastric ligmanent
35
What point of the lesser curvature indicates the junction of the body and pyloric regions
The angular notch
36
What vessels supply the lesser curvature of the stomach?
The left gastric and right gastric branch of the hepatic arteries
37
What lies anterior to the stomach?
Diaphragm
Greater omentum
L lobe of liver
Gallbladder
Anterior abdominal wall
38
What lies posterior to the stomach?
Lesser sac
Pancreas
Left kidney
Left adrenal gland
Spleen
Splenic artery
Transverse mesocolon
39
What does the pyloric sphincter control?
The passage of chyme
40
What is the name of the folds of peritoneum that attach to the stomach
Omentum - greater and lesser
41
Where does the greater omentum attach on the stomach?
It hangs from the greater curvature of the stomach
42
What other organ does the greater omentum attach to?
The Transverse colon
43
What is the main function of the greater omentum?
Contains many lymph nodes
Plays key role in gastrointestinal immunity and can minimise infection spread
44
Where in the stomach does the lesser omentum attach
The lesser curvature
45
What other organ(s) does the lesser omentum attach to?
The liver and duodenum
46
What is the main function of the lesser omentum?
To attach the stomahc and duodenum to the liver
47
How does the omentum play a role anatomically
It divides the abdominal cavity into the greater and lesser sac
48
Where does the stomach lie in relation to the lesser sac?
Anterior to the lesser sac
49
What is the name for the communication between the greater and lesser sacs?
Epiploic foramen
50
Where does the left gastric artery arise from
Directly from the coeliac trunk
51
Where does the right gastric artery arise from
A branch of the proper hepatic - which arises from the common hepatic
52
The right gastro-omental artery is a branch of what?
Terminal branch of the gastroduodenal artery
53
WHat does the gastroduodenal artery arise from
The common hepatic
54
Where does the left gastro-omental artery arise from?
The splenic artery.
55
Where does the splenic artery arise from?
The coeliac trunk
56
Where does the right and left gastric veins empty into?
The hepatic portal vein
57
Where do the short gastric , left and right gastro-omental veins drain?
The superior mesenteric vein
58
What segments supply the sympathetic nerves to the stomach and how does this occur?
T6-T9 spinal cord -
Passes to the coeliac plexus via the greater splanchnic nerve
59
What is responsible for the parasympathetic stimulation of the stomach?
The vagus nerve via the anterior and posterior vagal trunks
60
Where does the lymph drainage go in the stomach?
Travels alongside the greater and lesser stomach arterial supply
Then drains into gastric and gastro-omental lymph nodes at the curvatures
Ultimately drains into coeliac lymph nodes
61
Where are the coaliac lymph nodes located
The posterior abdominal wall
62
How does vagal stimulation impact the stomach?
It relaxes the pyloric sphincter
Increases peristalsis
Inhibits somatostatin secretion
Stimulates acid secretion
63
What arteries are most associated with supplying the greater curvature of the sotmach?
The short gastric arteries
64
What is the approximate length of the small intestine?
6.5m
65
What level is the 1st part of the duodenum (superior part)
L1
66
What connects the superior part of the duodenum to the liver
The hepatoduodenal ligament
67
Where is the most common site of duodenal ulceration?
Superior part - notably at the hepatoduodenal ligament
68
What part of the duodenum is peritoneal
The first 3cm of the superior part of the duodenum
69
Where does the descending duodenum lie anatomically (2nd part)
L1 - L3
70
What organ does the descending duodenum curve around
The pancreas
71
What organ does the descending duodenum lie anterior to?
The right kidney
72
What organ does the descending duodenum lie posteriorly to
Transverse colon
73
What part of the duodenum contains the ampulla of Vater?
The descending
74
At what anatomical level does the inferior duodenum lie?
L3
75
What major vessel does the inferior duodenum cross over?
THe inferior vena cava and the aorta
76
What vessel does the inferior duodenum lie posteriorly to?
The superior mesenteric artery and vein
77
At what level does the ascending duodenum lie? (4th part)
L3-L2
78
Where does the duodenum become the jejunum?
At the duoedenojejunal flexture
79
What assists with movement of intestinal contents into the jejunum
The suspensory muscle of the duodenum
80
How does the suspensory muscle of the duodenum encourage movement of the intestinal contents into the jejunum?
Contracts to widen the angle of the flexture
81
What vessel is at risk in duodenal ulcers?
The gastroduodenal artery
82
Is the jejunum and ileum intraperitoneal or retroperitonea
Intraperitoneal
83
What connects the jejunum and ileum to the abdominal wall
The mesentery
84
What are the two main arterial supplies to the duodenum?
Gastro-duodenal artery - Proximal to the major duodenal papilla
Inferior pancreaticoduodenal artery - Distal to the major duodenal papilla
85
At what point does the duodenum move from the embryological foregut to the midgut?
At the major duodenal papilla
86
What is the lymphatic drainage of the duodenum?
The pancreatoduodenal and superior mesenteric nodes
87
What is the arterial supply of the jejunoileum?
The superior mesenteric artery
88
Where does the SMA leave the aorta?
L1, immediately inferior to the coeliac trunk
89
What is the vasa recta?
It is a combination of long straight arteries, which come from arcades of the SMA
90
Where does the jejunum and ileum drain lymph?
Into the superior mesenteric nodes
91
What is the venous drainahe of the jejunoileum?
Superior mesenteric vein
92
What does the superior mesenteric vein unit with and where do they drain
The splenic vein
Combine to drain into the hepatic portal vein
93
The caecum is _____peritoneal
Intraperitoneal
94
What embryological area is the caecum derived from?
The midgut
95
What provides arterial supply to the caecum?
The ileocolic artery -
a branch of the superior mesenteric artery which further divides into the anterior and posterior caecal arteries
96
What provides arterial supply to the caecum?
The superior mesenteric artery which divides into the anterior and posterior caecal arteries
97
What provides venous drainage to the caecum?
The ileocolic vein
98
How is the caecum innervated
By rhe superior mesenteric plexus
99
What provides lymph drainage to the caecum?
The ileocolic lymph nodes
100
What is the most common site for an intestinal volvulus?
Sigmoid colon
101
Where does the appendix originate?
The posterior medial end of the caecum
102
What supports the appendix/
The mseoappendix - a fold of mesentry which suspends the appendix from the ileum
103
What supports the appendix?
The mesoappendix - a fold of mesentery which suspends the appendix from the ileum
104
What is the most common position for the appendix?
Retrocecal
105
What is the embryologic origin of the appendix?>
The midgut
106
What is the arterial supply of the appendix?
The appendicular artery
107
What does the appendicular artery derive off?
The ileocolic artery
108
What is the name for the clinical finding in appendicitis?
Tenderness of McBurney's point
109
How long is the large intestine on average
1.5m
110
How does the transverse colon attach to the diaphragm?
The phrenicocolic ligmanent
111
What parts of the colon are retroperitoneal?
The ascending colon, descending colon and part of the sigmoid colon
112
What parts of the colon are intraperitoneal ?
Transverse colon and part of the sigmoid
113
Where is the desvending colon in respect to the left kidney?
anterior to the left kidney
114
Where is the sigmoid colon located anatomically?
LLQ
From left iliac fossa to the level of the S3 vertebra
115
How is the sigmoid attached to the posterior wall?
Via the sigmoid mesocolon, very mobile mesentery
116
Where are the paracolic gutters?
Two spaces between the ascending / descending colon and the posterolateral abdominal wall
117
What is the name given to the 3 strips of muscle longitudinally along the bowel wall?
Teniae coli
118
What is the role of the teniae coli?
Create haustra by shortening the wall of the bowel with contractions
119
Where does the teniae coli end?
The rectosigmoid junction
120
What lies anterior to the ascending colon?
Small intestine
Greater omentum
Anterior abdominal wall
121
What lies anterior to the transverse colon
Greater omentum
Anterior abdominal wall
122
What loes anterior to the descending colon?
Small intestine
Greater omentum
Anterior abdominal wall
123
What lies anterior to the sigmoid colon>
Urinary bladder
Uterus and upper vagina
124
What lies posterior to the ascending colon
Iliacis and quadratus lumborum
Right kidney
Iliohypogastric and ilioinguinal nerves
125
What lies posterior to the transverse colon?
Duodenum
Head of pancreas
Jejunum
Ileum
126
What lies posterior to the descending colon?
Iliacis and quadratus lumborum
Left kidney
Iliohypogastric and ilioinguinal nerves
127
What lies posterior to the sigmoid colon?
Rectum
Sacrum
Ileum
128
What parts of the colon are originated from the midgut?
Ascending colon
Proximal 2/3rds of the transverse colon
129
What parts of the colon originate from the hindgut?
Distal 1/3rd transverse colon
DEscending colon
Sigmoid colon
130
What supplies arterial blood to the midgut parts of the colon?
Superior mesenteric artery
131
What supplies arterial blood to the hindgut parts of the colon?
Inferior mesenteric artery
132
What are the two branches of the SMA that supply the ascending colon?
Ileocolic
Right colic
133
What vessel gives off the middle colic artery?
The SMA
134
What vessel gives off the left colic artery?
The Inferior mesenteric artery
135
What provides the arterial supply to the desvending colon?
The left colic (branch of the IMA)
136
What is the name of the vessel which provides collateral blood supply to the coon?
Marginal artery of Drummond
137
What arises from the marginal artery of drummond?
Vasa recta
138
Which veins empty into the superior mesenteric vein?
Ileocolic
Right colic
Middle colic
139
List the veins which empty into the inferior mesenteric vein?
Left colic
Sigmoid veins
140
Where does the superior and inferior mesenteric vein drain?
The hepatic portal vein
141
What provides nerve innervation to the midgut posrtiot of the colon?
Superior mesenteric plexus
142
What provides nerve innervation to the hindgut position of the colon?
Sympathetic: Lumbar splanchnic nerves
Parasympathetic: Pelvic splanchnic nerves
143
The ascending and trasnverse colon have their lymph draining into __________
The superior mesenteric nodes
144
The descending and sigmoid colon drain lymh into the __________
Inferior mesenteric nodes
145
Where does the lymph from the SMA and IMA drain>
Into intestinal lymph trunks to the cisterna chyli. Ultimately drains into the thoracic duct.
146
Which part of the colon is enveloped by visceral peritoneum?
Transverse colon
147
Where does the rectum begin?
S3
148
Name the two major flexures of the rectum:
Sacral flexure
Anorectal flexure
149
What is the final segment of the rectum called?
The Ampulla
150
What is the role of the ampulla
It relaxes to temporarily store faeces until defacation
151
What parts of the rectum are covered in peritoneum?
Superior 1/3rd - Anterior surface and Lateral sides
Middle 1/3rd - ANterior surface only
Inferior 1/3rd - none
152
Where is the rectum located?
The Pelvic cavity
153
What lies posterior to the rectum (noth males and females)
Sacrum
Coccyx
Piriformis
Coccygeus
Levator Ani
Sacral Plexus
154
List the 3 main arteries supplying the rectum:
Superior rectal artery
Middle rectal artery
Inferior rectal artery
155
What is the superior rectal artery a branch of?
The IMA
156
What is the middle rectal artery a branch of
THe internal iliac artery
157
What is the inferior rectal artery a branch of?
The internal pudendal artery
158
How does the rectum drian lymph?
Pararectal lymph nodes (superior 1/3rd drains into the inferior mesenteric lymph nodes)
159
Where do the pararectal lymph nodes drain?
The interal iliac lymph nodes
160
What type of cells line the rectum and superior anal canal?
Columnar epithelium
161
What is the divide known as in the anus?
The pectinate / dentate line
162
What cell type lines the anus below to the pectinate / dentate line?
Non keratinised stratified squamous epithelium
163
What is the name of the fascia anterior to the rectum?
Fascia of Denonvilliers
164
What is the name of the fascia posterior to the rectum?
Waldeyers fascia
165
What is the processus vaginalis?
An out-pocketing of the peritoneum that occurs in the embryological stage
166
Failure of the processus vaginalis to degenerate can lead to what?
An indirect inguinal hernia
Hydrocele
167
What does the gabernaculum become?
A small scrotal ligament which tethers the teste to the scortum
168
What does the gabernaculum become?
A small scrotal ligament which tethers the teste to the scortum (in men)
The ovarian ligament and round ligament of the uterus (females)
169
Where is the mid inguinal point?
Halfway between the pubic symphysis and the anterior superior iliac spine
170
What can be palpated at the mid inguinal point?
The femoral artery / pulse
171
Where is the midpoint of the inguinal ligament?
Halfway between the pubic tubercle and the anterior superior iliac spine
172
What is the anatomical relevance of the inguinal ligament?
If is where the inguinal canal opening is located
173
What forms the anterior wall of the inguinal canal?
Aponeurosis of the external oblique
174
What forms the posterior wall of the inguinal canal?
Transversalis fascia
175
What forms the roof of the inguinal canal?
Transversalis fascia
Internal oblique
Transversus abdominus
176
What forms the floor of the inguinal canal?
Inguinal ligament
Thickened medially by the lacunar ligament
177
Waht does the deep inguinal ring mark?
The opening of the inguinal canal
178
The deep inguianl ring is just lateral to what vessels?
The epigastric vessels
179
What does the superficial inguinal ring mark?
The end of the inguinal canal
180
Where does the superficial ring lie anatomically?
superior to the pubic tubercle
181
What muscle forms the superifical ring?
The external oblique invaginates
182
What forms the deep ingiunal ring?
Invagination of the transversalis fascia
183
List the contents of the inguinal canal:
Spermatic cord (males)
Round ligament (females)
Ilioinguinal nerve
Genital branch of the genitofemoral nerve
184
Define an indirect ingiuinal hernia:
Peritoneal sac enters the inguinal canal through the deep inguinal ring
185
Define an direct inguinal canal:
Peritoneal sac enters the inguinal canal through the posterior wall of the inguinal canal
186
What type of inguinal hernia is more common?
Indirect
187
Where do testes originate from?
The posterior abdominal wall
188
What is another name for the inguinal triangle?
Hasselbach's triangle
189
What forms the medial border of the inguinal triangle?
Lateral border of the rectus abdominis muscle
190
What does the lateral border of the inguinal triangle?
Inferior epigastric vessels
191
What forms the inferior border of the inguinal triangle?
Inguinal ligament
192
What is contained in the inguinal triangle
Muscles of the abdominal wall
Nil other significance
193
What does the inguinal triangle indicate?
An area of weakness which can lead to abdominal herniation
194
What type of inguinal hernia occurs in the inguinal triangle?
A direct inguinal hernia
195
Which artery does the inferior epigastric originate from>
The external iliac artery
196
Where is calot's triangle located?
The porta hepatis
197
What occurs at the porta hepatis?
Hepatic ducts and neurovascular structures enter and exit the liver
198
WHat forms the medial border of calot's triangle?
The common heptaic duct
199
What forms the inferior border of Calot's triangle?
Cystic duct
200
What forms the superior border of calot's triangle?
The inferior surface of the liver
201
List the contents of Calot's triangle:
Right hepatic artery
Cystic artery
Lymph node of Lund
Lymphatics
202
What is contained in the supracolic compartment of the greater sac?
Stomach
Liver
spleen
203
What is contained within the infracolic compartment of the lesser sac?
Small intestine
Ascending and Descending colon
204
What connects the supra and infracolic compartments?
Paracolic gutters
205
What separates the right and left subphrenic spaces?
The falciform ligament of the liver
206
Where is the lesser sac located?
Posterior t the stomach and lesser omentum
207
What connects the greater adn lesser sac?
The epiploic foramen (of Winslow )
208
Where is the epiploic foramen located?
Posterior to the free edge of the lesser omentum
(The hepatoduodenal ligament)
209
What feature strengthens the lumbosacral joint (L5-S1)
Iliolumbar ligaments
210
What is a characteristic feature of the lumbar vertebrae:
Triangular vertebral foramen
211
What type of joint sits between the vertebral bodies?
Cartilaginous
212
At what vertebral level does the spinal cord terminate:
L1
