Abdomen

Question 1

What are the following incisions?
Kocher's
Lanz
Gridiron
Pfannestie
Battle's?

Answer 1

diagram

Question 2

Composition of the anterior and posterior rectus sheath above and below the arcuate line?

Answer 2

above- ant- eo and io. post- io and transverse, and transversalis fascia
below- ant- eo, io, transversus post- transversalis fascia

Question 3

How can you find the appendix?

Answer 3

where the tinae coli coalesce

Question 4

Surface landmark for appendix?

Answer 4

mcburney’s point- third of the way between ASIS and umbilicus

Question 5

Appendicitis pain?

Answer 5

Generalised midgut pain, when peritoneum becomes inflammed pain localises to mcburney point

Question 6

Psoas sign?

Answer 6

one leg flexed to relax psoas msucle

Question 7

Is meckel’s a true diverticulum?

Answer 7

yes outpouching of mucosa muscle and serosa

Question 8

Rule of 2 for meckels

Answer 8

2% of pop
<2 feet from ileoceacal junction
2 inches in length
commonly presents less than 2 years old
2:1 male:females

Question 9

boundaries between fore, mid and hind gut?

Answer 9

fore and mid- ligament of treitz just above DJ flexure

mid and hind- 2/3 along transverse colon

Question 10

how can you differentiate the jejunal and ileal arteries

Answer 10

Jejunum- arterial arcades short, vasa recta long

Ileum- arterial arcades long, vasa recta short

Question 11

Definition of a hernia?

Answer 11

when part of an organ is displace and protrudes through the cavity containing it

Question 12

divisions of coeliac trunk?

Answer 12

Common hepatic- proper hepatic, left hepatic, right hepatic, cystic,,, right gastric, gastrduodenal, supraduodenal, superior pancreatoduodenal, right gastroeipoleic
Left gastric- oesophageal
Splenic- short gastric and left gastroepiploeic

Question 13

what ligamen do the short gastric, portal triad run in?

Answer 13

gastrolineal lig

hepatoduodenal

Question 14

Divisions of the SMA?

Answer 14

Inferior pancreatoduodenal
Middle
Right colic
Ileocolic- colic, caecal- ant, post- appendicular,,,ileal
ileal
jejunal

Question 15

What artery anastamosises the SMA and IMA?

Answer 15

Marginal artery of Drummond

Question 16

IMA divisions?

Answer 16

Left colic- ascending and descending
Sigmoidal
Superior rectal

Question 17

What is toldt’s plane?

Answer 17

way of accessing the retroperitoneum
between mesocolon and retroperitoneum
formed by fusing of viseral and parietal peritoneum

Question 18

What is kocherisation?

Answer 18

mobilisation and medialising of duodenal to expose retroperitoneal structures. perforated duodenal ulcer etc.

Question 19

Open Cholecysectomy set up and incision?

Answer 19

GA, supine, kochers

Question 20

Retrograde cholecysectomy procedure

Answer 20

Remove gall bladder from bed
identify calot’s triangle
clip and ligate cystic duct and artery

Question 21

What is callot’s triangle?

Answer 21

Common hepatic duct
Cystic duct
Inferior surface of the liver
contains cystic artery

Question 22

Liver ligs?

Answer 22

coronary, triangular, falciform

Question 23

How can you access the lesser sack?

Answer 23

Epiploeic foramen of winslow in lesser omentum

Question 24

What is pringle’s manouver?

Answer 24

compression of portal triad by pressing on hepatoduodenal lig

Question 25

What ligament is the splenic flexture?

Answer 25

Phrenicolineal lig??

Question 26

How can determine if a structure is an ureter or not?

Answer 26

Vermiculation

Question 27

Where does the ureter cross on entering the pelvis?

Answer 27

Bifurcation of common iliac- SI joint

Question 28

Retropubic space?

Answer 28

Cave of Retzius

Question 29

Retroinguinal space?

Answer 29

Cave of Bogros

Question 30

Superficial blood supply to the abdominal wall?

Answer 30

Superior- musculophrenic | Inferiorly- medially- superficial epigastric artery. Lat- superficial circumflex iliac artery. Both off femoral artery

Question 31

Deep blood supply of abdominal wall

Answer 31

Superior- medially- Superior epigastric artery. Laterally- 10th/11th IC artery Inferiorly- Medially- inferior epigastric artery. Laterally- Deep circumflex iliac artery. Both off external iliac.

Question 32

What is component separation in abdominal wall reconstruction?

Answer 32

Cutting of EO ApoN, pararectal | Allows midline closure, weakens wall laterally

Question 33

Posterior component separation?

Answer 33

Take posterior rectus sheath of rectus muscle | create a pocket to protect bowel from mesh

Question 34

What neurovascular structure must be identified in Posterior component separation?

Answer 34

inferior epigastric artery

Question 35

Retroperitoneal organs?

Answer 35

``` RAPID SUCK Rectum Abdominal aorta Pancreas Inferior Vena Cava Duodenum 2/3 Supraadrenal glands Ureters Colon- ascending and descending Kidneys ```

Question 36

Divisions of the internal iliac artery?

Answer 36

Anterior- Iliolumbar, lateral sacral, superior gleuteal Posterior- Inferior gleuteal- obturator- foveal, Middle rectal, internal pudendal- inferior rectal, Inferior vesicular/vaginal, Uterine, Superior vesicular, obliterated umbilical artery

Question 37

Periotoneal reflections?

Answer 37

Greater and lesser omentum Mesentry Transverse mesocolon sigmoid mesocolon