Abdomen Flashcards
Where are the adrenal cortex and the medulla derived from
The adrenal cortex is derived from mesoderm. The medulla is derived from neural crest cells.
The gastroduodenal artery attaches which part of the duodenum to the liver
D1
Which ligament is unique to the lumbar spine
Iliolumbar ligaments
Which vertebrae has a distinctively larger vertebral body and transverse processes?
L5 as it carries the weight of the entire body
The oesophageal porto-systemic shunt
The oesophageal porto-systemic shunt is formed by anastomoses between the oesophageal vein (tributary of the azygos vein) and left gastric venous tributaries in the submucosa of the lower end of the oesophagus.
Where is the visceral peritoneum derived from
The splanchnic mesoderm gives rise to the visceral peritoneum.
The gastrosplenic and splenorenal ligaments are part of which structure?
Greater omentum
Which portion of the duodenum is partially intraperitoneal?
Superior D1
In females, which of the following structures travel through the inguinal canal?
Round ligament
In cases of splenomegaly, which border of the spleen can be palpated?
Superior pole
Which ligament contains the splenic vessels
The splenorenal ligament connects the hilum of the spleen to the left kidney. The splenic vessels and tail of the pancreas lie within this ligament
Retroperitoneal organs
SAD PUCKER
S: suprarenal (adrenal) gland
A: aorta/IVC
D: duodenum (second and third part)
P: pancreas (except tail)
U: ureters
C: colon (ascending and descending)
K: kidneys
E: (o)oesophagus
R: rectum
What is the initial treatment for lumbar lordosis?
Stretching
Muscle layers of the esophagus
the external layer of longitudinal muscle and an inner layer of circular muscle. The external layer is composed of different muscle types in each third:
Superior third – voluntary striated muscle
Middle third – voluntary striated and smooth muscle
Inferior third – smooth muscle
Nerve supply of the quad lumb
The anterior rami of the T12-L4 nerves innervates the quadratus lumborum muscle
What are the tributaries of the splenic vein
Short gastric veins – drain the fundus of the stomach.
Left gastro-omental vein – drains the greater curvature of the stomach.
Pancreatic veins – drain the pancreas.
Inferior mesenteric vein – drains the colon.
What are the tributaries of the portal vein?
Right and left gastric veins – drain the stomach.
Cystic veins – drains the gallbladder.
Para-umbilical veins – drain the skin of the umbilical region.
Which of the following is a characteristic feature of a lumbar vertebra?
Triangular vertebral foramen
What is the clinical significance of ‘vascular segments’ of the spleen?
Allows for a subtotal splenectomy
The bare area of the liver is bounded by which hepatic ligament?
Coronary
Which of the following statements correctly describes the tenia coli of the large intestine?
The tenia coli are three longitudinal strips of muscle – the mescolic, free and omental coli.
What is the most common location for intestinal volvulus?
Sigmoid colon
In the posterior abdominal wall, which muscle is located between the anterior and middle layers of the thoracolumbar fascia?
Quadratus Lumborum
What widens the angle of the duodenojejunal junction to allow passage of intestinal contents?
Located at the duodenojejunal junction is a slip of muscle called the suspensory muscle of the duodenum. Contraction of this muscle widens the angle of the flexure, and aids movement of the intestinal contents into the jejunum.
In females the gubernaculum attaches the ovaries to which structure?
Labia majora
Where do the testes originate from?
Posterior abdominal wall
Which structureS does the Gerotas fascia enclose
The renal fascia encloses the kidney and adrenal gland. It is also known as Gerota’s fascia or perirenal fascia.
What is the innervation of the psoas minor muscle?
Anterior rami of L1
Which of the following lymph nodes is located within Calot’s triangle?
Lund’s nodes
Which type of epithelium lines the luminal surface of the oesophagus?
The oesophagus is lined by stratified squamous non-keratinised epithelium.
Where does the aorta bifurcate
L4 (at the level of the pelvic brim)
Which part of the pancreas is in the transpyloric plane
Neck of the pancreas lies in the transpyloric plane
What landmarks does a surgeon use to identify the superficial inguinal ring
Intercrural fibers (external oblique aponeurosis)
Which structure lies anterior to the origin of the hepatic portal vein
Neck of the pancreas
What are the contents of the porta hepatis and how are the oriented
Portal vein posteriorly
Anterior is common bile duct (right )and the common hepatic artery (left)
How does the duodenum lie in relation to the IVC
Duodenum lies anterior to it
Where does the tail of the pancreas lie in relation to the left kidney?
Tail lies anterior to it and is not covered by any peritoneum, it lies in direct contact
Between which layers is the epigastric vessels found
Tranver abdominis and peritoneum
Which part of the pancreas is intraperitoneal?
The tail (It lies in the splenorenal ligament and so do the vessels supplying the spleen)
Which fascia is the Colles fascia a continuation of?
Scrapa fascia
Which structure lies in the posterior epiploic foramen
IVC
What is the most common site of ureteric stone impaction
VUJ
What is the cremasteric muscle an extension of
Internal oblique
Which parts of the duodenum are retroperitoneal
Only the first part is covered by the peritoneum and hence only anterior is covered. Rest is retro
What is the relation of the L1 vertebrae and the transpyloric plane
Inferior border of L1 and the NECK of the pancreas is here
H shape on the visceral surface of the Liver
Gallbladder, IVC, Lig teres and veno, porta hepatis
What is incised to increase the upward mobility of the 12th rib
Costovertebral ligament
Which part of the pancreas lies between AA and SMA
Uncinate process
SMA and the 3rd section of the Du
SMA is anterior in relation
FACT
Leniorenal ligament is also known as the splenorenal ligament
Which structure lies anterior to the origin of the portal vein
Neck of the pancreas
Where are the short gastric arteries found?
Gastrosplenic ligaments
Which artery can be eroded in a posterior gastric ulcer
Splenic artery
What is the inguinal ligament also known as
Poupart’s ligament
What is the most common esophageal cancer that is benign
Leiomyoma
Which part of the colon is enveloped by the visceral peritoneum
Transverse
Which part of the rectum relaxes to accommodate faeces?
Ampulla
Which vessel is the first major branch of the superior mesenteric artery?
Inferior pancreaticoduodenal
The gastro-oesophageal junction occurs at which vertebral level?
T11
What is culdocentesis
Culdocentesis involves the extraction of fluid from the rectouterine pouch
The functional purpose of the lesser omentum
Lesser Omentum
The lesser omentum is a double layer of visceral peritoneum, and is considerably smaller than the greater and attaches from the lesser curvature of the stomach and the proximal part of the duodenum to the liver. This needs to be divided to gain access to the coeliac trunk
It consists of two parts: the hepatogastric ligament (the flat, broad sheet) and the hepatoduodenal ligament (the free edge, containing the portal triad).
Where are the physiological constrictor zones of the oesophagus
Contrictions in the following regions
* Arch of aorta
* Bronchus (left main stem)
* Cricoid cartilage
* Diaphragmatic hiatus
What is the purpose of the suspensory ligament of the duodenum
Located at the duodenojejunal junction is a slip of muscle called the suspensory muscle of the duodenum. Contraction of this muscle widens the angle of the flexure, and aids movement of the intestinal contents into the jejunum.
Aid memoire for jej vs ileum
Aide memoire: Jeju is red in colour and does not play around, hence, it has less arcades. long vasa than the ileum as it does more work. Thick wall
Where does the rectum begin
Starts at the level of S3 when sigmoid colon goes in.
Aide memoir for Caudate and quadrate lobes
Caudate is for CAVA and vein related stuff such as IVC and ligamentum venosum
Quadrate is Gallbladder and teres
Which part of the pancreas lies in close relation to the origin of the hepatic portal vein
Neck of the pancreas
What needs to be excised to increase the vertical mobility of the 12th rib
Costovertebral ligament, Strong fascia between L1, L2 and the 12th rib
Where does the common bile duct lie in relation to the hepatic artery in the lesser omentum
To the right
A 32 year old man is undergoing a splenectomy. Division of which of the following will be necessary during the procedure?
During a splenectomy the short gastric vessels which lie within the gastrosplenic ligament will need to be divided. The splenic flexure of the colon may need to be mobilised. However, it will almost never need to be divided, as this is watershed area that would necessitate a formal colonic resection in the event of division.
Distinction between inguinal and femoral hernia?
Inguinal are superior and medial to pubic tubercle and femoral hernias are inferior and lateral
Why are femoral hernias more common in females?
Pelvis is wider and hence the canal is larger
How many folds does the peritoneum contain below the umbilicus
Median: Urachus obliterated
Medial: Remnant of the umbilical vein
Lateral: Inf epigastric vessels
Subphrenic spaces
Right and left subphrenic spaces are separated by the falciform ligament and the left subphrenic space is known as the lesser sac.
How would you identify the DJ flexure in surgery
By the presence of the ligament of treitz. Peritoneal fold descending from the right crus of the diaphragm.
Hepatectomy segments
Left would involve Possibly 1 and 2,3,4
Right would involve 5,6,7,8
Why is gangrene of the gall bladder rare
Even if the cystic artery is obstructed, there is still collateral from the hepatic bed
SMA, Splenic vein HPV and pancreas relation
SMA and splenic vein join to form the portal vein behind the neck of the pancreas, IMA joins the splenic vein behind the body of the pancreas
Where are the sites of anastomosis between portal and systemic circulation
Anal: Sup and inf rectal veins
Oesophagus: Between left gastric vein and azygous
Retroperitoneal varicies
Between abdominal veins and the portal vein
Between the portal vein and diaphragm
Where can accessory spleens be normally found
locations: hilum of the spleen, tail of the pancreas, along the splenic vessels, in the gastrosplenic ligament, the splenorenal ligament, the walls of the stomach or intestines, the greater omentum, the mesentery, the gonads
What are the 2 main tests for intestinal malrotation in children
Two main tests include an abdominal ultrasound scan to determine the relationship between the superior mesenteric artery and vein (normally SMA lies to the left of the SMV). This test is complemented with an upper GI contrast series and this aims to establish that the DJ flexure is correctly sited to the left of the vertebral bodies.
What should patient’s with rectal cancer that present with obstruction undergo
Loop colostomy
