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MRCS Anatomy > Abdomen > Flashcards

Abdomen Flashcards

1
Q

Where does the oesophagus originate?

A

C6 - the inferior border of the cricoid cartilage

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2
Q

Where does the oesophaguse lie in relation to the trachea?

A

Posterior to the trachea

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3
Q

Where does the oesophagus enter the stomach?

A

T11 (card oesophageal junction)

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4
Q

Where does the oesophagus enter the abdomen via the hiatus?

A

T10

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5
Q

What mucosa lines the oesophagus?

A

Non keratinised stratified squamous epithelium

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6
Q

What muscle produces the upper oesophageal sphincter?

A

Cricopharyngeus muscle

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7
Q

Where is the lower oesophageal sphincter?

A

At the gastro-oesophageal junction - just left to the T11 vertebra

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8
Q

What aids the occlusion of the lumen at the gastro-oesophageal junction?

A

Mucosal folds

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9
Q

List the relations to the left of the oesophagus:

A

Subclavian artery
Aortic arch
Thoracic duct
Pleura

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10
Q

List the relations to the right of the oesophagus:

A

Pleura
Terminal part of azygous vein

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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

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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

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13
Q

What is the arterial supply to the thoracic part of the oesophagus:

A

The thoracic aorta and inferior thyroid artery

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14
Q

What is the arterial supply of the abdominal part of the oesophagus:

A

The left gastric artery
Left inferior phrenic artery

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15
Q

What is the venous drainage of the thoracic oesophagus?

A

Branches of the azygous veins and inferior thyroid veins

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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

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17
Q

What innervates the oesphagus?

A

The oesophageal plexus

Combined with parasympathetic vagal trunks and sympathetic trunks from the cervical and thoracics.

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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

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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.

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20
Q

Where does the superior third of the oesophagus drain its lymph?

A

Deep cervical lymph nodes

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21
Q

Where does the middle third of the oesophagus drain its lymph?

A

Superior and posterior mediastinal nodes

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22
Q

Where does the posterior third of the oesophagus drain its lymph?

A

Left gastric and coeliac nodes

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23
Q

What cellular change is seen in Barrett’s oesophagus?

A

Metaplasia
Becomes gastric columnar epithelium

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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

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25
Q

Which type of cancer is mostly associated Barret’s oesophagus?

A

Adenocarcinoma

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26
Q

What is the approximate length of the oesophagus?

A

25cm

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27
Q

At what portion of the oesophagus is there both voluntary striated muscle and smooth muscle in the external longitudinal layer?

A

The middle third

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28
Q

What are the 4 regions of the stomach?

A

Cardia
Fundus
Body
Pylorus

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29
Q

What is the transpyloric plane level?

A

T1

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30
Q

What is the most superior aspect of the stomach>

A

The fundus

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31
Q

Where does the greater curvature lie?

A

Lateral border of the stomach

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32
Q

What arteries supply the greater curvature?

A

The short gastric arteries
Right and left gastro-omental arteries

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33
Q

Where is the lesser curvature of the stomach?

A

The medial concave surface of the stomach.

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34
Q

What ligament attaches to the lesser curvature of the stomach?

A

The hepatogastric ligmanent

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35
Q

What point of the lesser curvature indicates the junction of the body and pyloric regions

A

The angular notch

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36
Q

What vessels supply the lesser curvature of the stomach?

A

The left gastric and right gastric branch of the hepatic arteries

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37
Q

What lies anterior to the stomach?

A

Diaphragm
Greater omentum
L lobe of liver
Gallbladder
Anterior abdominal wall

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38
Q

What lies posterior to the stomach?

A

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

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39
Q

What does the pyloric sphincter control?

A

The passage of chyme

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40
Q

What is the name of the folds of peritoneum that attach to the stomach

A

Omentum - greater and lesser

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41
Q

Where does the greater omentum attach on the stomach?

A

It hangs from the greater curvature of the stomach

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42
Q

What other organ does the greater omentum attach to?

A

The Transverse colon

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43
Q

What is the main function of the greater omentum?

A

Contains many lymph nodes
Plays key role in gastrointestinal immunity and can minimise infection spread

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44
Q

Where in the stomach does the lesser omentum attach

A

The lesser curvature

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45
Q

What other organ(s) does the lesser omentum attach to?

A

The liver and duodenum

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46
Q

What is the main function of the lesser omentum?

A

To attach the stomahc and duodenum to the liver

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47
Q

How does the omentum play a role anatomically

A

It divides the abdominal cavity into the greater and lesser sac

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48
Q

Where does the stomach lie in relation to the lesser sac?

A

Anterior to the lesser sac

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49
Q

What is the name for the communication between the greater and lesser sacs?

A

Epiploic foramen

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50
Q

Where does the left gastric artery arise from

A

Directly from the coeliac trunk

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51
Q

Where does the right gastric artery arise from

A

A branch of the proper hepatic - which arises from the common hepatic

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52
Q

The right gastro-omental artery is a branch of what?

A

Terminal branch of the gastroduodenal artery

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53
Q

WHat does the gastroduodenal artery arise from

A

The common hepatic

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54
Q

Where does the left gastro-omental artery arise from?

A

The splenic artery.

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55
Q

Where does the splenic artery arise from?

A

The coeliac trunk

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56
Q

Where does the right and left gastric veins empty into?

A

The hepatic portal vein

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57
Q

Where do the short gastric , left and right gastro-omental veins drain?

A

The superior mesenteric vein

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58
Q

What segments supply the sympathetic nerves to the stomach and how does this occur?

A

T6-T9 spinal cord -
Passes to the coeliac plexus via the greater splanchnic nerve

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59
Q

What is responsible for the parasympathetic stimulation of the stomach?

A

The vagus nerve via the anterior and posterior vagal trunks

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60
Q

Where does the lymph drainage go in the stomach?

A

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

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61
Q

Where are the coaliac lymph nodes located

A

The posterior abdominal wall

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62
Q

How does vagal stimulation impact the stomach?

A

It relaxes the pyloric sphincter
Increases peristalsis
Inhibits somatostatin secretion
Stimulates acid secretion

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63
Q

What arteries are most associated with supplying the greater curvature of the sotmach?

A

The short gastric arteries

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64
Q

What is the approximate length of the small intestine?

A

6.5m

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65
Q

What level is the 1st part of the duodenum (superior part)

A

L1

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66
Q

What connects the superior part of the duodenum to the liver

A

The hepatoduodenal ligament

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67
Q

Where is the most common site of duodenal ulceration?

A

Superior part - notably at the hepatoduodenal ligament

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68
Q

What part of the duodenum is peritoneal

A

The first 3cm of the superior part of the duodenum

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69
Q

Where does the descending duodenum lie anatomically (2nd part)

A

L1 - L3

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70
Q

What organ does the descending duodenum curve around

A

The pancreas

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71
Q

What organ does the descending duodenum lie anterior to?

A

The right kidney

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72
Q

What organ does the descending duodenum lie posteriorly to

A

Transverse colon

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73
Q

What part of the duodenum contains the ampulla of Vater?

A

The descending

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74
Q

At what anatomical level does the inferior duodenum lie?

A

L3

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75
Q

What major vessel does the inferior duodenum cross over?

A

THe inferior vena cava and the aorta

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76
Q

What vessel does the inferior duodenum lie posteriorly to?

A

The superior mesenteric artery and vein

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77
Q

At what level does the ascending duodenum lie? (4th part)

A

L3-L2

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78
Q

Where does the duodenum become the jejunum?

A

At the duoedenojejunal flexture

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79
Q

What assists with movement of intestinal contents into the jejunum

A

The suspensory muscle of the duodenum

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80
Q

How does the suspensory muscle of the duodenum encourage movement of the intestinal contents into the jejunum?

A

Contracts to widen the angle of the flexture

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81
Q

What vessel is at risk in duodenal ulcers?

A

The gastroduodenal artery

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82
Q

Is the jejunum and ileum intraperitoneal or retroperitonea

A

Intraperitoneal

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83
Q

What connects the jejunum and ileum to the abdominal wall

A

The mesentery

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84
Q

What are the two main arterial supplies to the duodenum?

A

Gastro-duodenal artery - Proximal to the major duodenal papilla

Inferior pancreaticoduodenal artery - Distal to the major duodenal papilla

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85
Q

At what point does the duodenum move from the embryological foregut to the midgut?

A

At the major duodenal papilla

86
Q

What is the lymphatic drainage of the duodenum?

A

The pancreatoduodenal and superior mesenteric nodes

87
Q

What is the arterial supply of the jejunoileum?

A

The superior mesenteric artery

88
Q

Where does the SMA leave the aorta?

A

L1, immediately inferior to the coeliac trunk

89
Q

What is the vasa recta?

A

It is a combination of long straight arteries, which come from arcades of the SMA

90
Q

Where does the jejunum and ileum drain lymph?

A

Into the superior mesenteric nodes

91
Q

What is the venous drainahe of the jejunoileum?

A

Superior mesenteric vein

92
Q

What does the superior mesenteric vein unit with and where do they drain

A

The splenic vein
Combine to drain into the hepatic portal vein

93
Q

The caecum is _____peritoneal

A

Intraperitoneal

94
Q

What embryological area is the caecum derived from?

A

The midgut

95
Q

What provides arterial supply to the caecum?

A

The ileocolic artery -

a branch of the superior mesenteric artery which further divides into the anterior and posterior caecal arteries

96
Q

What provides arterial supply to the caecum?

A

The superior mesenteric artery which divides into the anterior and posterior caecal arteries

97
Q

What provides venous drainage to the caecum?

A

The ileocolic vein

98
Q

How is the caecum innervated

A

By rhe superior mesenteric plexus

99
Q

What provides lymph drainage to the caecum?

A

The ileocolic lymph nodes

100
Q

What is the most common site for an intestinal volvulus?

A

Sigmoid colon

101
Q

Where does the appendix originate?

A

The posterior medial end of the caecum

102
Q

What supports the appendix/

A

The mseoappendix - a fold of mesentry which suspends the appendix from the ileum

103
Q

What supports the appendix?

A

The mesoappendix - a fold of mesentery which suspends the appendix from the ileum

104
Q

What is the most common position for the appendix?

A

Retrocecal

105
Q

What is the embryologic origin of the appendix?>

A

The midgut

106
Q

What is the arterial supply of the appendix?

A

The appendicular artery

107
Q

What does the appendicular artery derive off?

A

The ileocolic artery

108
Q

What is the name for the clinical finding in appendicitis?

A

Tenderness of McBurney’s point

109
Q

How long is the large intestine on average

A

1.5m

110
Q

How does the transverse colon attach to the diaphragm?

A

The phrenicocolic ligmanent

111
Q

What parts of the colon are retroperitoneal?

A

The ascending colon, descending colon and part of the sigmoid colon

112
Q

What parts of the colon are intraperitoneal ?

A

Transverse colon and part of the sigmoid

113
Q

Where is the desvending colon in respect to the left kidney?

A

anterior to the left kidney

114
Q

Where is the sigmoid colon located anatomically?

A

LLQ
From left iliac fossa to the level of the S3 vertebra

115
Q

How is the sigmoid attached to the posterior wall?

A

Via the sigmoid mesocolon, very mobile mesentery

116
Q

Where are the paracolic gutters?

A

Two spaces between the ascending / descending colon and the posterolateral abdominal wall

117
Q

What is the name given to the 3 strips of muscle longitudinally along the bowel wall?

A

Teniae coli

118
Q

What is the role of the teniae coli?

A

Create haustra by shortening the wall of the bowel with contractions

119
Q

Where does the teniae coli end?

A

The rectosigmoid junction

120
Q

What lies anterior to the ascending colon?

A

Small intestine
Greater omentum
Anterior abdominal wall

121
Q

What lies anterior to the transverse colon

A

Greater omentum
Anterior abdominal wall

122
Q

What loes anterior to the descending colon?

A

Small intestine
Greater omentum
Anterior abdominal wall

123
Q

What lies anterior to the sigmoid colon>

A

Urinary bladder
Uterus and upper vagina

124
Q

What lies posterior to the ascending colon

A

Iliacis and quadratus lumborum
Right kidney
Iliohypogastric and ilioinguinal nerves

125
Q

What lies posterior to the transverse colon?

A

Duodenum
Head of pancreas
Jejunum
Ileum

126
Q

What lies posterior to the descending colon?

A

Iliacis and quadratus lumborum
Left kidney
Iliohypogastric and ilioinguinal nerves

127
Q

What lies posterior to the sigmoid colon?

A

Rectum
Sacrum
Ileum

128
Q

What parts of the colon are originated from the midgut?

A

Ascending colon
Proximal 2/3rds of the transverse colon

129
Q

What parts of the colon originate from the hindgut?

A

Distal 1/3rd transverse colon
DEscending colon
Sigmoid colon

130
Q

What supplies arterial blood to the midgut parts of the colon?

A

Superior mesenteric artery

131
Q

What supplies arterial blood to the hindgut parts of the colon?

A

Inferior mesenteric artery

132
Q

What are the two branches of the SMA that supply the ascending colon?

A

Ileocolic
Right colic

133
Q

What vessel gives off the middle colic artery?

A

The SMA

134
Q

What vessel gives off the left colic artery?

A

The Inferior mesenteric artery

135
Q

What provides the arterial supply to the desvending colon?

A

The left colic (branch of the IMA)

136
Q

What is the name of the vessel which provides collateral blood supply to the coon?

A

Marginal artery of Drummond

137
Q

What arises from the marginal artery of drummond?

A

Vasa recta

138
Q

Which veins empty into the superior mesenteric vein?

A

Ileocolic
Right colic
Middle colic

139
Q

List the veins which empty into the inferior mesenteric vein?

A

Left colic
Sigmoid veins

140
Q

Where does the superior and inferior mesenteric vein drain?

A

The hepatic portal vein

141
Q

What provides nerve innervation to the midgut posrtiot of the colon?

A

Superior mesenteric plexus

142
Q

What provides nerve innervation to the hindgut position of the colon?

A

Sympathetic: Lumbar splanchnic nerves
Parasympathetic: Pelvic splanchnic nerves

143
Q

The ascending and trasnverse colon have their lymph draining into __________

A

The superior mesenteric nodes

144
Q

The descending and sigmoid colon drain lymh into the __________

A

Inferior mesenteric nodes

145
Q

Where does the lymph from the SMA and IMA drain>

A

Into intestinal lymph trunks to the cisterna chyli. Ultimately drains into the thoracic duct.

146
Q

Which part of the colon is enveloped by visceral peritoneum?

A

Transverse colon

147
Q

Where does the rectum begin?

A

S3

148
Q

Name the two major flexures of the rectum:

A

Sacral flexure
Anorectal flexure

149
Q

What is the final segment of the rectum called?

A

The Ampulla

150
Q

What is the role of the ampulla

A

It relaxes to temporarily store faeces until defacation

151
Q

What parts of the rectum are covered in peritoneum?

A

Superior 1/3rd - Anterior surface and Lateral sides
Middle 1/3rd - ANterior surface only
Inferior 1/3rd - none

152
Q

Where is the rectum located?

A

The Pelvic cavity

153
Q

What lies posterior to the rectum (noth males and females)

A

Sacrum
Coccyx
Piriformis
Coccygeus
Levator Ani
Sacral Plexus

154
Q

List the 3 main arteries supplying the rectum:

A

Superior rectal artery
Middle rectal artery
Inferior rectal artery

155
Q

What is the superior rectal artery a branch of?

A

The IMA

156
Q

What is the middle rectal artery a branch of

A

THe internal iliac artery

157
Q

What is the inferior rectal artery a branch of?

A

The internal pudendal artery

158
Q

How does the rectum drian lymph?

A

Pararectal lymph nodes (superior 1/3rd drains into the inferior mesenteric lymph nodes)

159
Q

Where do the pararectal lymph nodes drain?

A

The interal iliac lymph nodes

160
Q

What type of cells line the rectum and superior anal canal?

A

Columnar epithelium

161
Q

What is the divide known as in the anus?

A

The pectinate / dentate line

162
Q

What cell type lines the anus below to the pectinate / dentate line?

A

Non keratinised stratified squamous epithelium

163
Q

What is the name of the fascia anterior to the rectum?

A

Fascia of Denonvilliers

164
Q

What is the name of the fascia posterior to the rectum?

A

Waldeyers fascia

165
Q

What is the processus vaginalis?

A

An out-pocketing of the peritoneum that occurs in the embryological stage

166
Q

Failure of the processus vaginalis to degenerate can lead to what?

A

An indirect inguinal hernia
Hydrocele

167
Q

What does the gabernaculum become?

A

A small scrotal ligament which tethers the teste to the scortum

168
Q

What does the gabernaculum become?

A

A small scrotal ligament which tethers the teste to the scortum (in men)
The ovarian ligament and round ligament of the uterus (females)

169
Q

Where is the mid inguinal point?

A

Halfway between the pubic symphysis and the anterior superior iliac spine

170
Q

What can be palpated at the mid inguinal point?

A

The femoral artery / pulse

171
Q

Where is the midpoint of the inguinal ligament?

A

Halfway between the pubic tubercle and the anterior superior iliac spine

172
Q

What is the anatomical relevance of the inguinal ligament?

A

If is where the inguinal canal opening is located

173
Q

What forms the anterior wall of the inguinal canal?

A

Aponeurosis of the external oblique

174
Q

What forms the posterior wall of the inguinal canal?

A

Transversalis fascia

175
Q

What forms the roof of the inguinal canal?

A

Transversalis fascia
Internal oblique
Transversus abdominus

176
Q

What forms the floor of the inguinal canal?

A

Inguinal ligament
Thickened medially by the lacunar ligament

177
Q

Waht does the deep inguinal ring mark?

A

The opening of the inguinal canal

178
Q

The deep inguianl ring is just lateral to what vessels?

A

The epigastric vessels

179
Q

What does the superficial inguinal ring mark?

A

The end of the inguinal canal

180
Q

Where does the superficial ring lie anatomically?

A

superior to the pubic tubercle

181
Q

What muscle forms the superifical ring?

A

The external oblique invaginates

182
Q

What forms the deep ingiunal ring?

A

Invagination of the transversalis fascia

183
Q

List the contents of the inguinal canal:

A

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

184
Q

Define an indirect ingiuinal hernia:

A

Peritoneal sac enters the inguinal canal through the deep inguinal ring

185
Q

Define an direct inguinal canal:

A

Peritoneal sac enters the inguinal canal through the posterior wall of the inguinal canal

186
Q

What type of inguinal hernia is more common?

A

Indirect

187
Q

Where do testes originate from?

A

The posterior abdominal wall

188
Q

What is another name for the inguinal triangle?

A

Hasselbach’s triangle

189
Q

What forms the medial border of the inguinal triangle?

A

Lateral border of the rectus abdominis muscle

190
Q

What does the lateral border of the inguinal triangle?

A

Inferior epigastric vessels

191
Q

What forms the inferior border of the inguinal triangle?

A

Inguinal ligament

192
Q

What is contained in the inguinal triangle

A

Muscles of the abdominal wall
Nil other significance

193
Q

What does the inguinal triangle indicate?

A

An area of weakness which can lead to abdominal herniation

194
Q

What type of inguinal hernia occurs in the inguinal triangle?

A

A direct inguinal hernia

195
Q

Which artery does the inferior epigastric originate from>

A

The external iliac artery

196
Q

Where is calot’s triangle located?

A

The porta hepatis

197
Q

What occurs at the porta hepatis?

A

Hepatic ducts and neurovascular structures enter and exit the liver

198
Q

WHat forms the medial border of calot’s triangle?

A

The common heptaic duct

199
Q

What forms the inferior border of Calot’s triangle?

A

Cystic duct

200
Q

What forms the superior border of calot’s triangle?

A

The inferior surface of the liver

201
Q

List the contents of Calot’s triangle:

A

Right hepatic artery
Cystic artery
Lymph node of Lund
Lymphatics

202
Q

What is contained in the supracolic compartment of the greater sac?

A

Stomach
Liver
spleen

203
Q

What is contained within the infracolic compartment of the lesser sac?

A

Small intestine
Ascending and Descending colon

204
Q

What connects the supra and infracolic compartments?

A

Paracolic gutters

205
Q

What separates the right and left subphrenic spaces?

A

The falciform ligament of the liver

206
Q

Where is the lesser sac located?

A

Posterior t the stomach and lesser omentum

207
Q

What connects the greater adn lesser sac?

A

The epiploic foramen (of Winslow )

208
Q

Where is the epiploic foramen located?

A

Posterior to the free edge of the lesser omentum
(The hepatoduodenal ligament)

209
Q

What feature strengthens the lumbosacral joint (L5-S1)

A

Iliolumbar ligaments

210
Q

What is a characteristic feature of the lumbar vertebrae:

A

Triangular vertebral foramen

211
Q

What type of joint sits between the vertebral bodies?

A

Cartilaginous

212
Q

At what vertebral level does the spinal cord terminate:

A

L1

MRCS Anatomy (8 decks)

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