Abdomen Flashcards
At what level does the gonadal artery branch from the aorta?
L2
What level does the suprarenal artery branch?
L1
Name 4 anteior relations of aorta
- Lesser omentum
- liver
- left renal vein
inferior mesenteric vein - pancreas
- third part of duodenum
What are the levels of the origin and termination of the aorta
- T12 and L4
At what level does the azygous vein originate and terminate
- Originated at T12-L2 from the inferior vena cava
- Joins superior vena cava at T4-5
Which veins join to make the azygous vein?
- Right ascending lumbar vein
- Right subcostal veins
- Around T12
3 left lateral relations of the aorta
- 4th part of duodenum
duodenojejunal flexure
left sympathetic trunk
Describe SMA syndrome (Wilkie’s syndrome)
Third part of Duodenum becomes compressed by SMA and aorta causes small intestine obstruction
What is median arcuate ligament syndrome (dunbar syndrome)?
- Compression of coeliac artery by median arcuate ligament of diaphragm resulting in post prandial abdo pain, nausea, vomiting and exercise intolerance
- Unintentional weight loss
- Diagnosis of exclusion
Which structure is behind the superior mesenteric artery
- Left renal vein
How many unpaired branches of the aorta are there that supply abdominal viscera
3 - coeliac; SMA; IMA
- Median sacral doesn’t supply abdominal viscera
At what levels will you find the ureteric stones
- L2-L5
- Level of the ureter
What is the blood supply to proximal ureter
Branches of Renal artery
What is the blood supply of the middle ureter?
Gonadal artery + common iliac
What is the blood supply of the lower ureter?
Superior vesical artery + internal iliac
Which lymph nodes drain the ureter?
- Lateral aortic nodes
- Iliac nodes
How long is the ureter
25-35cm long
transitional epithelial
3 muscular layers
retro peroneal structure
Where is the uterine artery in relation to ureters?
Anterior
Where does the ureter enter the bladder
- Posteriorly
- Or base (in MRCS question options)
Which structure provides the main structural support to the uterus?
- Central peroneal tendon
What are the layers of the scrotum
skin => dartos fascia => ext. spermatic fascia => crmasteric mucle => int. spermatic fascia => parietal tunica vaginalis => visceral tunica vaginalis
WHat is the scrotal lymphatic drainage
- Inguinal lymph nodes
What is the tiseticular lymph drainage?
- aortic nodes
=> testicle is not biopsied for tumour due to potential to seed (excisional biopsy from inguinal region instead)
What is the difference in hydrocele management in children vs adults
- Inchildren managed via inguinal incision
- In adults managed through scrotal incision
What is the scrotal blood supply
- Anterior and posterior scrotal arteries (external and internal pudenal arteries (internal iliac))
through which structure does the testes enter the scrotum in embryology?
Gubernaculum pulls it down through tunica vaginalis (vaginalis means bag)
what is the testicles initial location before descent
L2 in abdominal cavity
Name two structures which are posterior to main lung root
vagus nerve and posterior pulmonary plexus
Name two structures which lie anterior to main lung root
Phrenic nerve
Pericardiacophrenic artery
Anterior pulmonary plexus
What are the content of the pulmonary root
Bronchus
Pulmonary arteries
Pulmonary veins
Lymphatic vessels
Bronchial vessels
Autonomic innervation
What is the costal and vertebral level of the hilum
- 4-5 costal cartilage
- T5-T7
Name the structures of the left lung hilum
- Bronchus
- Pulmonary arteries
- Pulmonary veins
- Pulmonary ligament
Name the structures of the right lung hilum
- Eparterial bronchus
- Hyparterial bronchus
- Veins
- Artery
- Pulmonary ligament
Which 3 veins drain oeseophagus
- Upper third: Inferior thyroid
- Middle third: Azygous
- Lower third: Gastric
Which artery supplies the middle third of the oesophagus
- Aortic branches
Describe the borders of the femoral triangle
SUperior: Inguional ligament
- Lateral: Satorius
- Medial Adductor magnus
- FLoor: Iliopsoas, adductur longus + pectineus
- Roof Fasca lata, long saphenous vein
Name 3 freatures of Klippel-Trenaunay syndrome
Name 2 structures superior to the hilum of the lungs
- Azygous vein
- Superior vena cava
WHat are the borders of the urogenital triangle
Pubic symphysis, ischiopubic rami and theoretical between the two ishial tuberosities
What are the contents of the deep perineal pouch?
Space between deep fascia of pelvic floor and perineal membrane:
- Urethra
- External urethral sphincter
- Vagina
- Bulbourethral glands
- Deep transverse perineal membranes
What are the contents of the superficial perineal pouch?
Space between the perineal membrane and superficial perineal fascia:
- Erectile tissues: penis + clitoris
- 3 muscles: ischiocavernosus, bulbospongiosis, superficial transverse perineal muscles
- Bartholins glands
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Which nerve is at risk of damage during anterior resection of the rectum?
Hypogastric autonomic nerves
Name 2 nerves commonly affected by varicose vein surgery
- Sural + Saphenous
Name 3 nerves at risk during Axillary node clearance
- Long thoracic nerve
- Thoracodorsal nerve
- Intercostobrachial
What are the branches of the internal iliac artery?
I Love Going Places In My Very Own Underwear
- Iliolumbar
- Lateral sacral
- Gluteal (inf. + sup.)
- Pudendal
- Inferior vesical
- Middle rectal
- Vaginal
- Obturator
- Umbilical
- Uterine
What are the 3 branches of the external iliac artery?
- Inferior epigastric
- Deep circumflex
- Femoral
What dermatome level is the nipples found at
T4
what dermatome level is the xiphoid found at?
T6
What dermatome level is the umbilicus found at?
T10
What dermatome level is the pubis found at?
T12
what is the most likely cause of bleeding during an LP?
Vertebral venous plexus
Which structures travel through the aortic hiatus
- Aorta
- Thoracic duct
- Azygous vein
WHat level are the adrenal glands
- Left: T11/12
- Right T12
Which ligament ligament contains the portal triad
- Hepatoduodenal ligament contains hepatic artery, prtal vein and common bile duct
Surface anatomy for LP
- Highest point of the iliac crests = L4
- Aiming for L3-L4 interspace or L4-L5 interspace
sWhich sign indicates pneumoperitoneum commonly seen in bowel perf
- Rigler’s sign: Both sides of bowel wall are visible to to gas in peritoneal cavity
- Lateral intermuscular septumisually: Dark gas on either side of the bowel wall
Which structures are drained by the (para) aortic lymph nodes
- Walls and viscera of the pelvis
- Efferent vessels of the lower limb
- Gonads
- Kidney + suprarenal glands
- Deep lymph nodes of greater abdominal wall
Which structures are drained by the superficial inguinal lymph nodes
Found horizontally at the inguinal ligament + vertically at femoral triangle
Horixzontal:
- External genitalia (Vagina inferior to hymen)
- Lower anal canal
- uterine vessels, coursing with round ligament
Vertical
- Superficial vessels of lower limb
Which structures are drained by the superficial inguinal lymph nodes
- Clitoris + glans penis
- Deep lymph nodes of femoral vessels
Which structures are drained by the Internal iliac lymph nodes
- Deep parts of perineum
- gluteal muscles
- Posterior thigh
Which structures are drained by the external iliac lymph nodes
- Glans penis/clitoris
- membranous urethra
- Prostate
- Bladder
- Cervix
- Uteri
- Vagina
- Adductor region of thigh
- Inguinal lymph nodes
Which structures are drained by the sacral lymph nodes
- Uterus, vagina and posterior perineum
Describe the contents of Calcot’s triangle
- Right hepatic artery
- Cystic artery
- Lymph node of lund
- Lymphatics
What are the borders of Calcot’s triangle
- Medial: Common hepatic duct
- Inferior: Cystic duct
- Superior: Inferior aspect of liver
Which lymph nodes does the cervix drain into?
Internal iliac
What are the boundaries of the quadrangular space
- Medial: Long head of triceps brachii
- Inferior: Teres major
- Superior: Teres minor
- Lateral surgical neck of humerus
What are the contents of the quadrangular space
- Axillary artery
- Posterior circumflex artery
Describe the blood supply to the rectum
Superior rectal artery – terminal continuation of the inferior mesenteric artery.
Middle rectal artery – branch of the internal iliac artery.
Inferior rectal artery – branch of the internal pudendal artery.
Describe the lymphatic drainage of the rectum
Mesorectal lymph nodes (superior to dentate line)
Inguinal nodes (inferior to dentate line)
What is the most likely site of adulation of fluid after cholecystectomy (in supine position)?
Morison’s pouch (hepatorenal recess/subhepatic recess)
Which nerve controls detrusor muscle
- Pelvic splanchnic nerves S2,3,4,
- Also control internal urethral sphincter
Which line on an X-ray of the pelvis is most appropriate for the diagnosis of pelvic organ prolapse?
The pubococcygeal line is used to detect and grade pelvic organ prolapse on imaging X-rays of the pelvis. This line is drawn between the inferior margin of the pubic symphysis and the last coccygeal joint. It helps to assess the descent of pelvic organs and is an important reference in evaluating pelvic floor prolapse.
Which artery supplies the fundus of the stomach
- Short gastric arteries
Which arteries supplies the greater curvature of the stomach?
- Right gastroepiploic (brach of gastroduodenal branch of common hepatic)
- Left gastroepiploic (branch of splenic)
Which artery supplies the body of the stomach?
- Left Gastric
- Right gastric
Which blood vessels supplies the lesser curvature of the stomach
Left gastric: upper portion
Right gastric: lower portion
Which blood vessel supplies the pylorus of the stomach
Right gastric artery
gastroduodenal artery
Describe the causes of medial and lateral winging of the scapula
Long thoracic nerve palsy results in medial winging: serratus interior
Spinal accessory winging results in lateral winging: trapezius
Where is Palmer’s point and what is its significance?
- Located on the anterior abdominal wall 3 cm below left costal margin along the mid clavicular line
- Point of entry for insufflation of pneumoperitoneum if umbilicus can’t be used due to prior midline surgery
What is the landmark for safe injection of spinal anaesthetic
- Supracrestal line
- Transverse line joining the highest points of the iliac crest at the level of L4
What lies laterally to 2nd part of duodenum
Hepatic flexure
What lies medially to 2nd part of duodenum
- head of pancreas
Which nerve is most likely to be affected by ablation of accessory heart pathways?
Right phrenic
Which tumour marker is specific to seminoma?
b-HCG
- LDH can be raised in seminomas and non-seminomatous germ cell tumours
Which nerve roots is associated with nerve pain to the left shoulder
C3,4,5: irritation of phrenic nerve
- Can be caused by irrigation of diagphragm due to carbon diaxide gas used for bowel insufflation
What sign is seen on X-Ray for duodenal atresia?
double-bubble sign
What is contained by the pudendal canal
- Internal pudendal artery
- Internal pudendal vein
- Pudendal nerve
What are the branches of the subclavian artery?
- Vertebral
- Internal thoracic
- Thyrocervical
- Costocervical trunk
- Dorsal scapular
VIT C and D
What are the branches of the axillary artery
- Superior thoracic
- Thoraco-acromial
- Lateral thoracic
- Subscapular
- Anterior circumflex humeral
- Posterior circumflex humeral
SAL SAP/Screw The Lawyer Save A Patient
What layers are breeched in LP
- Skin => sib cut => supraspinous ligament => interspinous ligament => ligamentum flavum => epidoural space => dura => arachnoid
What is the pathophysiology thoracic outlet syndrome?
- Trapping of brachial plexus, subclavian artery and subclavian vein between collarbone and 1st rib
