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MRCS Anatomy > Abdomen > Flashcards

Abdomen Flashcards

1
Q

Abdominal wall - anterior layers

A 
Skin
Camper's fascia
Scarpa's fascia
external oblique
internal olblique
transversus abdominis
transversalis fascia
2 layers of peritoneum
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2
Q

External oblique

A

origin: ribs 5-12
insertion: iliac crest and pubic tubercle
innervation: thoracoabdominal nerves

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3
Q

Internal oblique

A

origin: inguinal ligament, iliac crest, lumbodorsal fascia
insertion: ribs 10-12
innervation: thoracoabdominal nerve

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4
Q

Transversus abdominis

A

origin: inguinal ligament, costal cartilage, iliac crest and thoracolumbar fascia
insertion: conjoint tendon, xiphoid process, linea alba and pubic crest
innervation: thoracoabdominal muscles, subcostal

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5
Q

Rectus abdominis

A

origin: Crest of pubis
insertion: xiphoid process and sternum and costal cartilage 5-7
innervation: thoracoabdominal nerves

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6
Q

Pyramidalis

A

origin: pubic crest, pubic symphysis
insertion: linea alba
innervation: subcostal nerves

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7
Q

Rectus sheath

A

Formed by the aponeurosis of three flat muscles
Anterior wall - aponeurosis of external oblique and internal oblique
posterior wall - aponeurosis of internal oblique and transversus abdominis
ARCUATE LINE - midway from umbilicus to pubic symphysis where the posterior wall also lies anterior to the rectus sheath

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8
Q

Posterior abdominal wall

A

Quadratus lumborum
Psoas major
psoas minor

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9
Q

Quadratus lumborum

A

origin: iliac crest and iliolumbar ligament
insertion: transverse process of L1-L4
innervation: T12- L4

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10
Q

Psoas major

A

origin: T12-L5
insertion: Lesser trochanter
innervation: L1-L3

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11
Q

Psoas minor

A

origin: T12, L1
insertion: superior ramus of pubis
innervation: L1
action: flexion fo vertebral column

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12
Q

Fascia of the posterior wall

A

Psoas fascia - encloses psoas major & minor

thoracolumbar fascia - divided into 3 layers, anterior, middle and posterior layer

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13
Q

Peritoneum

A

Continous layer divided into parietal and visceral peritoneum
Squamous epithelial cells from mesothelium

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14
Q

Parietal peritoneum

A

Somatic sensation thus well localised

sensitive pain, laceration, temperature

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15
Q

Visceral peritoneum

A

Splanchnic mesoderm origin
poorly localises, referred to pain in dermatomes
Sensitive to chemical and stretch

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16
Q

Intraperitoneal organ

A

Stomach
Liver
Spleen
GI tract

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17
Q

Retroperitoneal organ

A 
primary vs secondary
Suprarenal glands
Aorta
Duodenum (except 1st part)
Pancreas (except the tail)
Ureters
Colon (ascending & descending)
Kidneys
Oesophagus
Rectum
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18
Q

Peritoneal reflections

A

Mesentery
Greater omentum
Lesser omentum

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19
Q

Mesentery

A 
Double layer of the visceral peritoneum
Connects the organs to the posterior abdominal wall
Small bowel
Transverse colon
Sigmoid mesocolon
mesoappendix
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20
Q

Greater omentum

A

Greater curvature of stomach and proximal part of duodenum to anterior surface of transverse colon
Act as immunological barrier

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21
Q

Lesser omentum

A

Lesser curvature of stomach & proximal part of duodenum to liver
Hepatogastric ligament & hepatoduodenal ligament

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22
Q

Greater sac

A

Divided by transverse mesocolon
Supracolic - stomach, liver and spleen
Infracolic - small intestine, colon

23
Q

Lesser sac

A

posterior to stomach and lesser omentum
connected to greater sac via EPIPLOIC FORAMEN
situated posterior to the free edge of the hepatoduodenal ligament

24
Q

Peritoneum in pelvis

A

Male - rectovesical pouch - CLOSED

female - vesicouterine pouch and rectouterine pouch (pouch of douglas)

25
Q

Inguinal canal - borders

A

Floor - inguinal ligament, lacunar ligament medially
Anterior - internal oblique then external oblique aponeurosis
Posterior - transversalis fascia
roof - transversalis fascia, transverse abdominis and internal oblique

26
Q

Inguinal canal content

A

Spermatic cord

Ilioinguinal nerve

27
Q

Spermatic cord content

A

3 fascia - external spermatic (external oblique aponeurosis), cremaster muscle & fascia (internal oblique aponeurosis) and internal spermatic fascia (transversalis fascia)
3 arteries - testicular, cremaster, vas
2 nerves - autonomic, genital branch of genitofemoral nerve
4 others - pampiliform, lymphatics, vas deferens, tunica vaginalis

28
Q

Formation of inguinal canal

A 
GUBERNACULUM guides the descend of testis from posterior abdominal wall to scrotum
Processus vaginalis (part of peritoneum) degenerates but if not - leads to indirect hernia
29
Q

GI Tract - oesophagus

A

approx 25cm in length
C6 to T11 and pierces diaphragm at T10
attached to the phrenoesophageal ligament
consists of internal circular and external longitudinal muscles
Upper oesophageal sphincter - cricopharyngeus muscle, striated muscle
Lower oesophageal sphincter - PHYSIOLOGICAL (acute angle of entry, gets compressed with raised IAP, folds of mucosa and right crus of diaphragm
Supplied by inferior thyroid, aorta, left gastric artery
Drains into portal circulation via left gastric vein and azygous vein

30
Q

GI tract - Stomach

A

Cardia - fundus - body - pylorus (ANATOMICAL SPHINCTER)
Greater curvature - reaches the pyloric antrums
Lesser curvature: has the angular notch which divives the body and pylorus
Supplied by left gastric (coeliac trunk), right gastric (CHA), right gastro omental (gastroduodenal), left gastro omental (splenic)
Drains to Left and & right gastric - hepatic portal vein
Gastro omental into SMV

31
Q

GI tract - Small interstine

A

Duodenum
Jejunum
Ileum

32
Q

Duodenum

A

4 parts
1st - intraperitoneal, attached to liver by hepatoduodenal ligament, common area for ulcers
2nd - retroperitoneal, major duodenal papilla (posteromedial wall)
3rd - crosses over IVC and aorta, posterior to SMA
4th - duodenojejunal flexure, suspensory muscle of the duodenum
supplied by gastroduodenal artery and inferior pancreaticoduodenal artery (SMA)

33
Q

Jejunum and ileum

A

attached the posterior wall by mesentery
starts at the duodenojejunal flexure and ends at ileocaecal junction
Jejunum - thicker wall, longer vasa recta, less arcadesm red
ileum - thinner wall, shorter vasa recta, more arcades and pink

34
Q

Caecum

A

Start of colon, inferior to IC junction

intraperitoneal

35
Q

Appendix

A 
Vermiform shaped blind end tube located posteromedial to caecum, at the end of tinea
Pre ileal - 1 (anterior)
Post ileal - 2 (posterior)
sub ileal - 3 (alond)
pelvic - 5 
subcaecal - 6 (below caecum)
para caecal - 10 (lateral to caecum)
retro caecal - 11 (posteiror to caecum)
36
Q

Colon

A

It has omentum appendices, teniae coli, haustra
Ascending - retroperitoneal up to hepatic flexure
Transverse - mesocolon up to splenic flexure
Descending - retroperineal up to sigmoid flexure
Sigmoid - intraperitoneal up to rectosigmoid junction
Supplied by SMA (right colic, middle colic) and IMA (left colic, sigmoid)
Watershed area - marginal artery of Drummond

37
Q

Rectum

A

Stores faeces, 15cm long begins at S3
superior third covered by peritoneum from 3 sides and middle third covered on anterior side
Supplied by Superior rectal (IMA), middle rectal (IIA), inferior rectal (pudendal)
Drains into superior/middle/inferior rectal veins where superior one drains into IMV thus postal system
sympathetic - lumbar splanchnic - inferior hypogastric plexus
parasympathetic - S2-S4

38
Q

Anal canal

A

located at the anal triangle, right and left ischioanal fossa
internal sphincter - involuntary
external sphincter - voluntary puborectalis muscles
ABOVE pectinate line - endoderm origin, columnar epithelium, organised into anal column and anal valve; supplied by SRA, SRV
BELOW pectinate line - ectoderm origin, non keratinised stratified squamous epithelium until intersphincteric groove - skin; supplied by IRA/IRV

39
Q

Liver - surface

A

Intraperitoneal organ
4 ligaments - falciform ligament (ligamentunm teres - umbilical vein), coronary ligaments, triangular ligaments, lesser omentunm (hepatoduodenal/hepatogastric)
3 recesses - subphrenic, subhepatic and morison’s pouch
2 supply - hepatic portal and systemic

40
Q

Liver lobal anatomy

A

2 lobes divided by falciform ligament
2 further accessory lobes
caudate - separated by IVC and ligamentum venosum (remnant of ductus venosus)
quadrate - separated by ligamentum teres (umbilical vein) and lies with the gall bladder
anatomically part of right but functionally part of left lobe
Can also be divided in 8 hepatic segments

41
Q

Gall bladder

A

Located at L1
Stores bile, connected through the cystic duct and joins the CBD
Fundus - body - neck - Hartmann’s pouch - cystic duct
Supplied by cystic artery (branch of hepatic artery)
Vagus nerve stimulates as well but main stimulant is Cholecystokinin

42
Q

Biliary tree

A

Right and left hepatic duct
Common hepatic duct (+ cystic duct )
Common biliary duct (+ pancreatic duct)
Ampulla of Vater

43
Q

Pancreas

A

Retroperitoneal
Exocrine and endocrine organ
Head, uncinate process, neck, body and tail (intraperitoneal)
Lies posterior to SMA/SMV
Tail is closely related to spleen via splenic artery and splenorenal ligament
supplied by pancreatic branch of splenic, superior & inferior pancreatoduodenal (gastroduodenal)

44
Q

Spleen

A

Immunological & haematological organ
Intraperitoneal
Ligaments - splenorenal ligament, gastrosplenic ligament
1 x 3 x 5 inches, 7 ounces (200g), ribs 9-11
Splenic artery has segmental supply thus subtotal resection is possible

45
Q

Adrenal glands

A

Retroperitoneal organ, endocrine organ
Cortex - zona glomerulosa (mineralocorticoid), zona fasciculata (glucocorticoid), zona reticularis (sex hormones)
Medulla - chromaffin cells - adrenaline
Supply - 3 arteries
Superior adrenal - inferior phrenic artery
Middle adrenal - aorta
Inferior adrenal - renal artery

46
Q

Kidneys

A

Retroperitoneal organ - T12-L3
Clear toxin from circulation & maintain circulatory homeostasis (volume & electrolyte)
Complex fascia - capsule, perirenal fat, renal fascia, pararenal fat
Cortex & medulla
Medulla - renal pyramids - calyx - pelvis - ureter
Supply - renal artery - interlobar - arcuate
Drains into renal veins (left side drains adrenal & gonadal as well)

47
Q

Aorta

A

Ascending aorta - left and right coronary
Arch - brachiocephalic, CCA, subclavian
Thoracic - bronchial, mediastinal, oesophageal, pericardial, superior phrenic, intercostal arteries
Abdominal - Inferior phrenic, Coeliac(T12), SMA(L1), Middle adrenal, renal, gonadal (L2), IMA(L3), Median sacral (L4), CIA(L4); lumbar arteries

48
Q

Coeliac trunk

A

at T12
Common hepatic artery - hepatic artery proper (right gastric, R&L hepatic, cystic), gastroduodenal (superior pancreaticoduodenal, right gastro omental)
Left gastric artery - oesophageal
Splenic artery - left gastro omental, short gastric, pancreatic branches

49
Q

Superior mesenteric artery

A 
at L1, supplies the midgut
anterior aspect - pyloric part of stomach, splenic vein, NECK of pancreas
posterior aspect - left renal vein, duodenum, uncinate process of pancreas
Major branches:
Inferior pancreaticoduodenal artery
Right & middle colic
Ileocolic 
Jejunal & ileal arteries
50
Q

Inferior mesenteric artery

A

at L3, supplies the hindgut, retroperitoneal
main branches:
Left colic; Sigmoid; Superior rectal
Anastomosis with middle colic - Marginal artery of Drummond

51
Q

Venous drainage

A

IVC

Hepatic portal system

52
Q

Inferior vena cava

A

Formed by CIV at L5

Drains - Lumbar veins, right gonadal, right adrenal, right and left renal, inferior phrenic and hepatic veins

53
Q

Portal venous system

A

Drains the GIT content and supplied to liver
At L2
Formed by SMV & Splenic
Drains R&L gastric, cystic, para-umbilical veins
Splenic - short gastric, left gastroomental, pancreatic, IMV
SMV - right gastroomental, anterior and posterior inferior pancreaticoduodenal, jejunal, ileal, ileocolic, right & middle colic

54
Q

Portosystemic anastomosis

A

Oesophageal - left gastric and azygous
Rectal - superior rectal and inferior rectal
Retroperitoneal - mesenteric to reperitoneal
Paraumbilical - portal vein to anterior abdominal wall

MRCS Anatomy (8 decks)

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