Abdomen Flashcards

1
Q

which planes divide the abdomen into quadrants

A

median plane

trans umbilical plane

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2
Q

which planes divide the abdomen into regions

A

mid-clavicular lines vertically

subcostal and trans tubercular lines horizontally

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3
Q

what are the abdominal regions

A
right and left hypochondrium
epigastric 
right and left lumbar 
umbilical 
right and left inguinal 
suprapubic
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4
Q

what are the layers of the abdominal wall

A
skin
superficial fascia
muscle
deep fascia 
extraperitoneal fascia 
parietal peritoneum
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5
Q

what are the two layers of superficial fascia below the umbilicus

A

campers fascia

scarpas fascia

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6
Q

what are the characteristics of campers/scarpas fascia

A
campers = fatty 
scarpas = membranous
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7
Q

________ fascia is continuous over inguinal ligament and into fascia of thigh and peritoneum

A

campers fascia

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8
Q

which structure continuous with the fascia of the penis in males and fascia of the labia majora in females

A

campers fascia

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9
Q

describe campers fascia as a structure contributing to the male external genitalia

A

loses the fatty layer and fuses with deeper later of superficial fascia to become the dartos muscle of the scrotum

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10
Q

what are the attachments of scarpas fascia

A

pubic symphysis and linea alba

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11
Q

what does scarpas fascia fuse with below the inguinal ligament

A

fuses with the fascia of the thigh to form fascia late

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12
Q

which male genital structures does the scarpas fascia contribute to

A

fascia of penis
dartos fascia of scrotum
fungiform ligament of penis

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13
Q

which female genital structures does the scarpas fascia contribute to

A

labia majora

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14
Q

where do the fibres of external oblique run from and to

A

from ribs 5-12 to iliac crest and linea alba

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15
Q

which direction to the fibres of external oblique travel

A

inferomedially

hands in pockets

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16
Q

attachments of the aponeurosis of external oblique

A

linea alba from xiphoid to pubic symphysis

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17
Q

which structure is formed by the inferior border of external oblique

A

inguinal ligament

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18
Q

action of external oblique

A

bilateral contraction = flexion of trunk

unilateral contraction = lateral flexion of trunk

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19
Q

external oblique forms which aspect of the rectus sheath

A

anterior wall

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20
Q

innervation of external oblique

A

anterior rami T7-12

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21
Q

where do fibres of internal oblique run from and to

A

from thoracolumbar fascia, inguinal ligament and iliac crest to ribs 9-12

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22
Q

direction of fibres of internal oblique

A

superomedial

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23
Q

action of internal oblique

A

bilateral contraction = flexion of trunk

unilateral contraction = lateral flexion of trunk

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24
Q

innervation of internal oblique

A

T7-12 and L1

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25
Q

direction of fibres of transversus abdominis

A

transverse

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26
Q

attachments of transversus abdomens

A

thoracolumbar fascia, iliac crest, inguinal ligament, costal cartilages of ribs 7-12 to linea alba, pubic crest and pectineal line

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27
Q

innervation of transversus abdominis

A

T7-12, L1

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28
Q

attachments of rectus abdominis

A

pubic tubercle, crest and symphysis to diploid process and costal cartilages of ribs 5-7

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29
Q

action of rectus abdominis

A

flexion of trunk

support/compression of abdominal wall

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30
Q

innervation of rectus abdominis

A

T7-12

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31
Q

which blood vessels travel on posterior of rectus sheath

A

inferior epigastric

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32
Q

which muscle is part of the abdominal wall but is often absent

A

pyramidalis

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33
Q

attachments of pyramidalis

A

pubis to linea alba

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34
Q

action of pyramidalis

A

tenses linea alba

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35
Q

innervation of linea alba

A

anterior rams T12

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36
Q

which structures form the anterior wall of rectus sheath above the umbilicus

A

external oblique aponeurosis

superficial layer of internal oblique aponeurosis

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37
Q

which structures form the posterior wall of rectus sheath above the umbilicus

A

deep later of internal oblique aponeurosis

transversus abdominis fascia

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38
Q

which structures form the anterior wall of the rectus sheath below the umbilicus

A

all of the aponeuroses

internal oblique, and both layers of internal oblique

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39
Q

which structures form the posterior wall of the rectus sheath below the umbilicus

A

transversalis fascia

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40
Q

which structure marks the transition of the structures of the anterior wall of rectus sheath

A

arcuate line

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41
Q

what is the median umbilical ligament

A

urachus remnant

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42
Q

what is the medial umbilical ligament

A

umbilical artery remnant

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43
Q

what is contained in the lateral umbilical fold

A

inferior epigastric vessels

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44
Q

where do superficial epigastric veins drain

A

femoral vein

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45
Q

thoracoepigastric vein drains where

A

axillary vein superiorly and femoral vein inferiorly

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46
Q

the musculophrenic artery is a branch of which artery

A

internal thoracic

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47
Q

the superficial epigastric artery and superficial circumflex iliac artery are branches of which artery

A

femoral artery

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48
Q

which nerves provide innervation to superficial abdominal wall

A

lateral cutaneous branches 6-12 intercostal nerve and iliohypogastric (L1)
anterior cutaneous branches of 6-12 intercostal nerves

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49
Q

where do the lumbar arteries arise from

A

abdominal aorta

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50
Q

where does the deep circumflex iliac artery arise from

A

femoral artery

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51
Q

where does they inferior epigastric artery arise from

A

external iliac artery, just before it turns into femoral artery

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52
Q

which nerves supply the deep aspect of abdominal wall

A

iliohypogastric nerve

ilioinguinal nerve

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53
Q

which areas of abdominal wall drain into superficial inguinal lymph nodes

A

bit of thigh

bit of anterolateral wall below umbilicus

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54
Q

which areas of abdominal wall drain into axillary nodes

A

above umbilicus (superficial)

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55
Q

describe the flow of lymph in the deep aspects of abdominal wall

A

via abdominal aorta to lumbar nodes
or via external iliac artery to external iliac nodes
then via internal thoracic to parasternal nodes

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56
Q

which nerves supply the skin, muscle and parietal peritoneum of the anterolateral abdominal wall

A

T7-11 (intercostal), T12 (subcostal) L1 (iliohypogastric and ilioinguinal)
all anterior rami

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57
Q

which structures are present in the inguinal canal in males

A

spermatic cord

ilioinguinal nerve

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58
Q

which structures are present in the inguinal canal of females

A

round ligament of uterus

ilioinguinal nerve

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59
Q

which structure in the inguinal canal passes through the superficial ring but not the deep ring

A

ilioinguinal nerve

pierces the internal oblique to enter the canal

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60
Q

describe the superficial ring of the inguinal canal

A

triangular shaped defect in the aponeurosis of external oblique

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61
Q

what are the margins of the superficial ring of inguinal canal

A

medial and lateral crura

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62
Q

describe the deep ring of inguinal canal

A

oval opening in the transversalis fascia

halfway between the ASIS and pubic symphysis

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63
Q

which vessels lie medially to deep ring

A

inferior epigastric vessels

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64
Q

which structure gives origin of the internal spermatic fascia

A

deep ring (transversalis fascia)

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65
Q

what forms the anterior wall of inguinal canal

A

aponeurosis of external oblique

internal oblique in lateral third

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66
Q

why does internal oblique contribute to the anterior wall of inguinal in the lateral third

A

to give further protection anterior to the weakening as the opening of the deep ring

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67
Q

what forms the floor of the inguinal canal

A

inferior rolled edge of external oblique aponeurosis and medially the lacunar ligament

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68
Q

what forms the roof of the inguinal canal

A

fibres of internal oblique and transversus abdominis

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69
Q

which nerves pierce through internal oblique to enter the inguinal canal

A

ilioinguinal and iliohypogastric

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70
Q

what forms the posterior wall of the inguinal canal

A

transversalis fascia plus conjoint tendon in medial third

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71
Q

what is the conjoint tendon and what is its function in the posterior wall of the inguinal canal

A

common insertion of internal oblique and transversus abominis to pubic crest and pectineal line
strengthens the canal behind the opening of superficial ring in anterior wall

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72
Q

which ligament extends from the medial end of the inguinal ligament

A

lacunar ligament

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73
Q

describe the lacunar ligament

A

extends superiorly and posteriorly from medial end of inguinal ligament
attaches to pectineal line n superior pubic rams

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74
Q

the free edge of the lacunar ligament forms which structure

A

medial margin of femoral ring

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75
Q

how is the weakness in the abdominal wall created by the inguinal canal protected

A

oblique passage makes it harder of abdominal cavity contents to pass through it
strengthened areas corresponding to deep and superficial rings
increased abdominal pressure causes muscles to contract and flatten the canal
squatting position in defecation closes the canal as thighs press into abdominal wall

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76
Q

indirect vs direct hernia

A
indirect = inguinal canal entered via the deep ring (normally due to congenital weakness)
direct = pushed through weak spot directly out of superficial ring
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77
Q

what are the three layers of spermatic cord fibres and the structures they originate from

A
internal spermatic fascia (transversalis fascia)
cremasteric fascia (internal oblique)
external spermatic fascia (external oblique aponeurosis)
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78
Q

where does the spermatic cord originate

A

deep inguinal ring

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79
Q

what is contained in the sporadic cord

A
vas deferens 
testicular artery 
testicular veins 
lymph vessels 
autonomic nerves 
cremasteric artery 
artery of vas deferens 
genital branch of genitofemoral nerve
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80
Q

at which level do the gonadal arteries branch from the abdominal aorta

A

L2

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81
Q

where do the testicular veins drain

A

Right to IVC

left to left renal vein

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82
Q

where does lymph from the testes drain

A

paraaortic nodes

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83
Q

where does the cremasteric artery arise from

A

inferior epigastric

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84
Q

what does the cremasteric artery supply

A

cremasteric fascia

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85
Q

where does the artery of vas deferens arise

A

inferior vesical artery

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86
Q

what does the genital bench of genitofemoral nerve supply in the spermatic cord

A

cremaster muscle

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87
Q

how does the superficial fascia of the scrotum differ from the abdominal wall

A

fat replaced with dartos muscle

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88
Q

what is scarpas fascia called in the scrotum

A

colles’

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89
Q

what are the attachment of colles’ fascia in the scrotum

A

perineal body and membrane

ischiopubic rami

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90
Q

what is the function o the cremaster muscle

A

raises testes and scrotum to control temperature

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91
Q

what is the tunica vaginalis the remains of

A

processus vaginalis

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92
Q

the seminiferous tubules open into which structure

A

rete testes

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93
Q

how are the retentions testes connected to the epididymis

A

efferent ductules

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94
Q

testes and epididymis drain lymph to

A

para-aortic nodes

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95
Q

scrotal wall and fascia drain lymph to

A

superficial inguinal nodes

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96
Q

what is the mesentery

A

double fold of peritoneum

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97
Q

which modalities is parietal peritoneum sensitive to

A

pain
touch
temperature
pressure

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98
Q

which nerves supply the parietal peritoneum

A

lateral and anterior walls by the lower 6 thoracic nerve
central part by phrenic nerves
pelvic part by obturator

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99
Q

what is the visceral peritoneum sensitive to

A

stretch

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100
Q

which type of nerve fibres are present in the visceral peritoneum

A

ANS afferent fibres

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101
Q

what does intraperitoneal mean

A

organ is totally surrounded by visceral peritoneum and attached to body wall via a mesentery

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102
Q

examples of intraperitoneal organs

A
stomach
gall bladder
small intestine (only 1st part of duodenum)
spleen
liver 
caecum
transverse colon
sigmoid colon
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103
Q

what does retroperitoneal mean

A

partially covered in peritoneum

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104
Q

what is the difference between primary and secondary retro-peritoneal organs

A

primary = no mesentery
ever
secondary = mesentery lost in development

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105
Q

examples of primary retroperitoneal organs

A

kidneys

suprarenal glands

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106
Q

examples of secondary retroperitoneal organs

A

2, 3, 4th parts of duodenum
pancreas
ascending and descending colon
upper 2/3rd rectum

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107
Q

what does infraperitoneal mean

A

below the peritoneum

in the pelvic cavity

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108
Q

what are the attachments of the greater omentum

A

greater curvature of the stomach

anterior surface of transverse colon

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109
Q

describe how the greater omentum functions as the ‘policeman of the abdomen’

A

the omentum is usually spread out across the anterior surface of the intestines by the movement of the intestine underneath
if part of the intestine is unhealthy, it is less motile so the omentum tends to gather over this area, as it is not moved away
if it remains static, over time it will form adhesions, which block off the area from the rest of the cavity, preventing spread of infection etc

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110
Q

how many layers are present in the omentum

A

4 layers

double layer of peritoneum

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111
Q

how is the transverse colon attached to the body wall

A

transverse mesocolon

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112
Q

which two compartments does the transverse mesocolon split the abdominal cavity into

A
supracolic (liver, gall bladder, stomach)
infra colic (intestines)
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113
Q

which vessels are found in the superior border of the greater omentum and which structure do they supply

A

left and right gastro-epiploic arteries (and veins)

supply the greater curvature of the stomach

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114
Q

where do the gastro-epiploic arteries originate

A

right = hepatic artery
left = splenic artery
both branches of coeliac axis

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115
Q

what is the lesser sac also known as

A

omental bursa

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116
Q

what is the lesser sac

A

portion of the peritoneal cavity behind the lesser omentum and stomach

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117
Q

where does the lesser omentum extend from

A

lesser curvature of stomach

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118
Q

how many layers in the lesser omentum

A

2

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119
Q

what is the function of the lesser omentum

A

communication between stomach and porto-hepatic

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120
Q

what is located at the free edge of the lesser omentum

A

omental/epiploic foramen

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121
Q

what structures are contained within the free edge of the lesser omentum

A
hepatic artery (left, anterior)
bile duct (right, anterior)
portal vein (posterior)
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122
Q

what are the boundaries of the epiploic foramen

A
anterior = lesser omentum and its contained structures 
posterior = inferior vena cava 
superior = liver
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123
Q

what is contained in the mesentery

A

blood vessels
autonomic nerve
lymphatics
fat

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124
Q

which blood vessels supply the mesentery proper

A

superior mesenteric artery/vein

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125
Q

what is the function of the mesentery proper

A

allows movement of small intestine required for peristalsis

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126
Q

examples of mesenteries in the abdominal cavities

A

transverse mesocolon
sigmoid colon mesentery
vermiform appendix mesentery

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127
Q

blood supply of transverse colon (within the transverse mesocolon)

A

marginal artery

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128
Q

which structures are included in the foregut

6

A
distal oesophagus
stomach
liver 
spleen 
proximal duodenum
part of pancreas
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129
Q

arterial supply of foregut structures

A

coeliac axis (aorta T12)

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130
Q

venous drainage of foregut structures

A

portal vein

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131
Q

lymphatic drainage of foregut structures

A

pre-aortic nodes at T12 (coeliac nodes)

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132
Q

the stomach is retro-peritoneal/intra-peritoneal

A

intra-peritoneal

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133
Q

which structure extends from the lesser curvature of the stomach

A

lesser omentum

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134
Q

which structure extends from the greater curvature of the stomach

A

greater omentum

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135
Q

what are the layers of the stomach wall

A

serosa
muscularis externa
submucosa
mucosa

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136
Q

what are the layers of the muscularis externa of the stomach

A

outer longitudinal layer
middle circular layer
inner oblique layer

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137
Q

what is the function of the differently orientated muscle fibres of the stomach

A

to allow the stomach to contract in all directions to churn food up with acid n whatnot

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138
Q

what are the main areas of the stomach

A
oesophageal region 
fundus 
body 
pyloric antrum 
pyloric valve
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139
Q

what are the two notches located in the stomach and where are they located

A

cardiac notch
- located between the oesophageal opening and fundus
angular notch
- in the lesser curvature of stomach

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140
Q

what is the name given to the fold on the internal surface of the stomach

A

rugae

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141
Q

how does the shape of the stomach change depending on body type

A

shorter, wider people tend to have a stomach sitting higher in their abdomen that is more rounded
taller, thinner people tend to have a lower hanging stomach that is j-shaped

142
Q

structures anterior to the stomach

A

transverse colon

143
Q

structures posterior to the stomach

A
pancreas 
spleen 
top pole of left kidney 
1st part of duodenum 
left suprarenal gland
144
Q

branches of the coeliac axis

A

left gastric
common hepatic
splenic artery

145
Q

structures supplied by left gastric a.

A

lesser curvature of stomach

146
Q

structures supplied by the common hepatic a.

A

liver, gall bladder, parts of stomach

147
Q

structures supplied by the splenic a.

A

spleen
parts of stomach
pancreas
duodenum

148
Q

arterial supply to the lesser curvature of the stomach

A
right gastric (branch of hepatic artery)
left gastric (branch of coeliac axis)
<>
149
Q

arterial supply to fundus of stomach

A

short gastric artery (branch of splenic)

150
Q

arterial supply to greater curvature of stomach

A
right gastroepiploic (gastroduodenal from common hepatic artery)
left gastroepiploic (from splenic artery)
151
Q

venous drainage of lesser curvature of stomach

A

gastric veins to hepatic portal vein

152
Q

venous drainage of greater curvature of stomach

A

left gastroepiploic into splenic vein, then portal vein

right gastroepiploic vein to superior mesenteric vein, then portal vein

153
Q

venous drainage of fundus of stomach

A

short gastric vein, to splenic vein, to portal ven

154
Q

lymphatic drainage of stomach

A

small nodes:
cardiac ring around entrance to oesophagus, gastro-mental, gastric, pyloric, pancreaticosplenic and pancreaticoduodenal nodes

important nodes:
coeliac nodes (pre-aortic T12)
155
Q

autonomic innervation of the stomach

A

coeliac plexus

156
Q

parasympathetic innervation of stomach

A

anterior and posterior vagal trunks

157
Q

sympathetic innervation of stomach

A

greater splanchnic nerve to coeliac plexus

158
Q

which parts of the duodenum are intra-peritoneal and why

A

the first part
- attaches to the stomach so needs to be able to move with it as it contracts
the last (4th) part
- attaches to the small intestine which is attached to a mesentery so needs more movement

159
Q

describe the 4 parts of the duodenum

A

1st part duodenal cap, intraperitoneal
2nd part descending, retroperitoneal
3rd part, transverse, retroperitoneal
4th part, ascending, intraperitoneal

160
Q

in which part of the duodenum is the entrance of the bile and pancreatic ducts

A

2nd part (descending)

161
Q

what are the folds of the duodenum called

A

plicae circularis

162
Q

what is the name given to the union of the common bile duct and main pancreatic duct

A

hepatopancreatic ampulla (of Vater)

163
Q

what is the name of the structure that controls the flow of pancreatic and bile fluids onto the duodenum

A

sphincter of Oddi

164
Q

at which level is the start of the duodenum located

A

transpyloric plane (L1/2)

165
Q

what is the approximate location of the duodenal jejunal junction

A

3 cm to left of midline

166
Q

structures related to the 1st part of the duodenum

A
liver
gall bladder 
bile duct 
portal vein 
IVC
167
Q

structures related to the 2nd part of the duodenum

A

transverse colon
right kidney and ureter
pancreas

168
Q

structures related to the 3rd part of the duodenum

A
superior mesenteric vessels 
jejunum
right ureter
right poses
IVC
aorta 
pancreas
169
Q

structures related to the 4th part of the duodenum

A

root of mesentery
jejunum
aorta
left psoas

170
Q

arterial supply of duodenum

A

proximal:
superior pancreaticoduodenal artery (branch of gastroduodenal –> common hepatic)
distal:
inferior pancreaticoduodenal artery (branch of SMA)

171
Q

venous drainage of duodenum

A

proximal:
superior pancreaticoduodenal vein to portal vein
distal:
inferior pancreaticoduodenal vein to superior mesenteric vein then portal vein

172
Q

innervation to duodenum

A

sympathetic: greater and lesser splanchnic nerves
parasympathetic: vagal trunks

173
Q

where is pain from the duodenum referred to

A

epigastric region

174
Q

describe lymph drainage from the duodenum

A

proximal:
pre-aortic coeliac axis nodes at T12
distal:
pre-aortic superior mesenteric nodes at L1

175
Q

lobes of the liver

A
anteriorly:
right and left lobe 
posteriorly:
quadrate lobe 
caudate lobe
176
Q

which ligaments are visible anteriorly on the liver

A
falciform ligament (between left and right lobes)
ligamentum teres (remnant of umbilical vein)
177
Q

what is the porta hepatis

A

point where structures enter the liver

178
Q

which structures are present in the porta hepatis

A
right and left hepatic ducts 
hepatic arteries 
portal vein
ANS fibres 
lymph nodes
179
Q

which structures are carried to the porta hepatis in the lesser edge of the lesser omentum

A

common bile duct
hepatic artery
portal vein

180
Q

where are the hepatic veins

A

within the liver

drain into the IVC

181
Q

which structures are associated with the anterior surface of liver

A

ribs and costal cartilages

182
Q

which structures are associated with the posterior surface of the liver

A
oesophagus 
stomach 
duodenum 
right colic flexure 
right kidney 
right suprarenal gland 
gall bladder
183
Q

which structures are associated with the superior surface of the liver

A

diaphragm

184
Q

what are the surface markings of the gall bladder

A

9th costal cartilage, right midclavicular line

185
Q

what are the surface markings of the superior border of the liver

A

between ribs 5-6

186
Q

why is there a bare area on the liver

A

the part of the liver in contact with the diaphragm is not covered in peritoneum

187
Q

what are the falciform, right and left triangular ligaments made of

A

folds of peritoneum

188
Q

arterial blood supply to liver

A

hepatic artery

189
Q

describe blood flow through liver

A

blood supplied to liver by hepatic artery and portal vein
arterial and venous blood conducted to central vein of each liver lobule by sinusoids
central veins drain into right and left hepatic veins (often up to four)
hepatic veins drain into IVC

190
Q

lymph drainage of liver

A

nodes at porta hepatis –> coeliac nodes (T12)

small amount passes through diaphragm to posterior mediastinum

191
Q

autonomic innervation of liver

A

coeliac plexus

sympathetic: greater splanchnic
parasympathetic: vagal trunks

192
Q

where is pain from the liver referred to

A

epigastric region

right shoulder if diaphragmatic irritation

193
Q

what is another name for the sphincter of Oddi

A

major duodenal papilla

194
Q

parts of the gall bladder

A

superior neck (connected to cystic duct)
body (in contact with posterior surface of liver)
fundus (hangs below level of liver)

195
Q

how does bile and the gallbladder aid in digestion

A

fat in the duodenum causes release of cholecystokinin from the small intestine mucosa
causes gall bladder to contract
smooth muscle in distal bile duct and ampulla relaxes to allow bile to enter the duodenum
bile emulsifies fat

196
Q

arterial supply of gall bladder

A

cystic artery (branch of right hepatic artery)

197
Q

venous drainage of gallbladder

A

cystic vein drains to portal vein

198
Q

lymph drainage of gallbladder

A

cystic nodes –> hepatic nodes –> coeliac nodes

199
Q

innervation of gallbladder

A

coeliac plexus

200
Q

where is pain from the gall bladder referred to

A

epigastric region

201
Q

parts of the pancreas

A

head (uncinate process posteriorly)
neck
body
tail

202
Q

where is the head of the pancreas located

A

in the curvature of the duodenum

203
Q

which vessel is posterior to the neck of the pancreas

A

superior mesenteric artery

204
Q

in which ligament is the tail of the pancreas located

A

leinorenal ligament

205
Q

which artery runs along the superior border of the pancreas

A

splenic

206
Q

which structures are anterior to the pancreas

A

transverse colon

stomach

207
Q

which structures are posterior to the pancreas

A
bile duct 
portal vein
splenic vein 
IVC 
aorta 
SMA
left posts
left suprarenal gland 
left kidney
spleen
208
Q

what is the course of the main pancreatic duct

A

from the tail to the ampulla of vater

209
Q

if present, what is the course of the accessory pancreatic duct

A

drains into the upper part of the head and into the duodenum (superior to ampulla of vater)

210
Q

arterial supply of pancreas

A

right side:
superior pancreaticoduodenal artery (common hepatic, CA)
inferior pancreaticoduodenal artery (SMA)
left side:
dorsal pancreatic artery (splenic, CA)

211
Q

venous drainage of pancreas

A

splenic or superior mesenteric veins –> portal system

212
Q

lymphatic drainage of pancreas

A

coeliac (T12) and superior mesenteric (L1) pre-aortic nodes

213
Q

innervation of pancreas

A

coeliac and superior mesenteric plexuses

214
Q

surface markings of spleen

A

deep to ribs 9-11 in left hypochondrium

215
Q

which vessels are carried in the gastrosplenic ligament

A

short gastric

L. gastro-epiploic

216
Q

arterial supply to spleen

A

splenic artery –> CA

217
Q

venous drainage of spleen

A

inferior mesenteric vein –> splenic vein –> superior mesenteric vein –> portal vein

218
Q

innervation of spleen

A

coeliac plexus

219
Q

which structures are classed as midgut

A
distal 1/2 duodenum 
jejunum 
ileum 
caecum 
appendix
ascending colon
proximal 2/3 of transverse colon (not including splenic flexure)
220
Q

what is the arterial supply of midgut structures

A

superior mesenteric artery

221
Q

which structures are classed as hindgut

A
distal 2/3 transverse colon 
descending colon
sigmoid colon
rectum
anal canal
222
Q

what is the arterial supply of hindgut structures

A

inferior mesenteric artery

223
Q

difference in appearance between jejunum and ileum

A
jejunum = upper, red
ileum = lower, pale
224
Q

difference in wall of jejunum and ileum

A
jejunum = thicker, more plicae circularis
ileum = thinner, less plicae
225
Q

difference in bore of jejunum and ileum

A
jejunum = wider 
ileum = narrower
226
Q

difference in mesenteric vessels of jejunum and ileum

A
jejunum = 1 or 2 arcades, long branches to wall
ileum = 3 or 4 arcades, many short branches to wall
227
Q

difference in adipose tissue of jejunum and ileum

A
jejunum = most near root of mesentery 
ileum = all through mesentery
228
Q

difference in lymphoid tissue in jejunum and ileum

A
jejunum = small amount 
ileum = numerous Peter's patches
229
Q

arterial supply of small intestine

A

mostly jejunal and ill branches from SMA

lower parts of ileum by ileocolic arteries

230
Q

venous drainage of small intestine

A

to superior mesenteric veins

231
Q

lymph drainage of small intestine

A

mesenteric nodes –> pre-aortic nodes at superior mesenteric artery (L1)

232
Q

innervation of small intestine

A

superior mesenteric ganglion

233
Q

pain from small intestine is referred where

A

umbilical region

234
Q

features unique to large intestine

A

haustra = sacculation of body wall
appendices epiploicae = fatty tags
teniae coli = longitudinal muscles collected into 3 bands

235
Q

structures related to caecum

A

small intestine
psoas
iliacus

236
Q

arterial supply of caecum

A

caecal arteries from ileocolic artery (SMA)

anterior and posterior caecal arteries

237
Q

venous drainage of caecum

A

SMV

238
Q

lymphatic drainage of caecum

A

mesenteric –> superior mesenteric nodes

239
Q

innervation of caecum

A

superior mesenteric plexus

240
Q

how is the appendix attached to the body wall

A

small mesoappendix mesentery

241
Q

where is MacBurney’s point

A

1/3 along line from ASIS to umbilicus

242
Q

blood supply to appendix

A

appendicular artery (from either caecal artery or directly from ileocolic artery)

243
Q

venous drainage of appendix

A

posterior caecal vein

244
Q

where is pain from appendix referred to

A

umbilicus

until inflammation reaches body wall –> MacBurney’s point

245
Q

the ascending colon is intraperitoneal/retropertioneal

A

retroperitoneal

246
Q

structures related to ascending colon

A
small intestine
greater omentum 
iliacus 
iliac crest 
quadratus lumborum 
right kidney 
ilioinguinal and iliohypogastric nerves
247
Q

blood supply to ascending colon

A

ileocoloc and right colic branches of SMA

248
Q

venous drainage of ascending colon

A

superior mesenteric vein via ileocolic and right colic veins

249
Q

lymph drainage of ascending colon

A

superior mesenteric nodes (L1)

250
Q

nerve supply of ascending colon

A

ANS from superior mesenteric plexus

251
Q

how is transverse colon attached to body wall

A

transverse mesocolon

252
Q

relations of transverse colon

A

greater omentum
pancreas
small intestine

253
Q

blood supply of transverse colon

A

proximal: middle colic artery (SMA)
distal: left colic (IMA)
<>

254
Q

venous drainage of transverse colon

A

proximal: superior mesenteric veins
distal: inferior mesenteric veins

255
Q

lymph drainage of transverse colon

A

proximal: superior mesenteric nodes
distal: inferior mesenteric nodes

256
Q

innervation of transverse colon

A

ANS: superior and inferior mesenteric plexuses
parasympathetic: vagus (proximal) and pelvis (distal)

257
Q

relations of descending colon

A
small intestine 
greater omentum 
left kidney 
Quadratus lumborum 
psoas 
femoral, ilioinguinal and iliohypogastric nerves
258
Q

blood supply of descending colon

A

left colic and sigmoid arteries (IMA)

259
Q

venous drainage of descending colon

A

inferior mesenteric –> splenic vein –> portal vein

260
Q

innervation of descending colon

A
sympathetic = inferior mesenteric plexus 
parasympathetic = pelvis
261
Q

how is sigmoid colon attached to body wall

A

pelvic mesocolon

262
Q

relations of sigmoid colon

A

urinary bladder (M)
uterus/vagina (F)
rectum, sacrum (both)

263
Q

arterial supply to sigmoid colon

A

sigmoidal branches of L colic artery (IMA)

264
Q

innervation of sigmoid colon

A

ANS from inferior hypogastric plexus

265
Q

arterial supply of rectum

A

superior rectal artery (IMA)
middle rectal artery (internal iliac)
inferior rectal artery (internal pudendal)

266
Q

venous drainage of rectum

A

superior to portal system via IMV

middle and inferior veins to internal iliac and internal pudendal veins

267
Q

lymph drainage of rectum

A

upper to inferior mesenteric nodes

lower to nternal iliac nodes

268
Q

innervation of rectum

A

inferior hypogastric plexus

269
Q

define retroperitoneal

A

lies posterior to parietal peritoneum

270
Q

what is the difference between primary and secondary retroperitoneal structures

A

primary: develops behind the peritoneum, has always been attached to body wall
secondary: develops within the body wall totally covered by peritoneum and moves to body wall by end of development

271
Q

primary retroperitoneal structures

4

A

kidneys
suprarenal glands
vessels
nerves

272
Q

secondary retroperitoneal structures

5

A
2nd/3rd parts of duodenum 
pancreas 
ascending colon
descending colon
upper 2/3 rectum
273
Q

which ribs protect the kidneys

A

left kidney: 11/12

right kidney: 12

274
Q

anterior relations of right kidney

4

A

suprarenal gland
liver
2nd part of duodenum
right colic (hepatic) flexure

275
Q

posterior relations of right kidney

6

A
diaphragm
rib 12
psoas
Quadratus lumborum 
transversus abdominis
subcostal nerve
276
Q

anterior relations of left kidney

6

A
suprarenal gland 
spleen
stomach 
pancreas
left colic (splenic) flexure 
jejunum
277
Q

posterior relations of left kidney

6

A
diaphragm
ribs 11/12
psoas
Quadratus lumborum 
transversus abdominis 
subcostal nerve
278
Q

structures in the renal hilum

A
renal vein
renal artery
renal pelvis (and ureter)
lymph 
sympathetic fibres
279
Q

in which renal vein is variation more common and why

A

left renal vein

longer and more communications

280
Q

where do the renal arteries branch from the aorta

A

L1

bilateral

281
Q

how do the renal arteries branch when they reach the kidney

A

anterior and posterior branches, then segmental branches

282
Q

what are the segmental branches of the renal arteries

A

anterior: apical, upper, middle, lower

posterior

283
Q

describe the course of the right renal artery

A

longer than left

passes posterior to IVC

284
Q

describe the course of the right renal vein

A

shorter than left

passes behind the descending duodenum

285
Q

describe the course of the left renal vein

A

longer than right
travels over aorta and under SMA
passes behind splenic vein and body of pancreas

286
Q

which veins drain into the left renal vein

A

left gonadal

left suprarenal

287
Q

where do the kidney receive their nerve supply from

A

renal sympathetic plexus

lesser and least splanchnic nerves

288
Q

where do afferent fibres from the kidney meet the spinal cord

A

T10-12

289
Q

where does lymph from the kidneys drain

A

lateral aortic nodes at origin of renal artery (L1)

290
Q

describe the course of the ureters

A

runs vertically from hilum on surface of psoas
crosses bifurcation of common iliac anterior to SI joint
runs on lateral wall of pelvis towards ischial spine
enters inferior surface of bladder at trigone

291
Q

where are the three natural constrictions of the ureters

A

at junction with renal pelvis
as it crosses pelvis brim
as they enter bladder

292
Q

describe the arterial supply of the ureters

A

superior: renal artery
middle: gonadal artery (l2)
inferior: superior vesical artery (one in pelvis)

293
Q

describe venous drainage of ureters

A

superior: renal veins
middle: gonadal veins
inferior: vesical veins

294
Q

where does lymph from the ureters drain

A
lateral aortic (L1) nodes 
iliac nodes
295
Q

what is the nerve supply of the ureters

A

renal, gonadal and hypogastric plexuses

296
Q

where does pain from the ureters refer

A

groin pain

297
Q

what shapes are the suprarenal glands

A
right = pyramidal 
left = crescentic
298
Q

arterial supply of suprarenal glands

A
superior = suprarenal branch of inferior phrenic artery 
middle = suprarenal artery (branch of aorta) 
inferior = suprarenal branch of renal artery
299
Q

venous drainage of suprarenal glands

A

single vein on each side
right to IVC
left to renal vein

300
Q

how is the fascia of the posterior abdominal wall named

A

after the muscles is covers

eg fascia over Quadratus lumborum

301
Q

the fascia below the arcuate line is called…

A

transversals fascia

302
Q

attachments of Quadratus lumborum

A

iliac crest to 12th rib and L1-4 transverse processes

303
Q

action of quad lumborum

A
unilateral = lateral flexion 
bilateral = pressure, forced expiration, support of 12th rib
304
Q

innervation of quad lumborum

A

anterior rami T12-L4

305
Q

attachments of iliacus

A

iliac fossa (joins with posts to form Iliopsoas) to lesser trochanter

306
Q

action of iliacus

A

hip flexion

307
Q

innervation of iliacus

A

femoral nerve

308
Q

attachments of psoas

A

T12-L4 bodies and IV disc (superficial) and L1-5 (deep) to lesser trochanter (joins iliacus)

309
Q

innervation of psoas

A

lumbar plexus direct branches from L2-4

310
Q

muscles within the abdominal cavity are innervated by anterior/posterior rami

A

anterior rami

posterior rami for muscles of the back

311
Q

what is the lateral accurate ligament

A

thickening of fascia over Quadratus lumborum

312
Q

what are he two divisions of psoas

A

minor (superficial, long tendon)

major (deep)

313
Q

what is the medial arcuate ligament

A

thickening of the fascia over psoas

314
Q

which levels does the right crus attach

A

L1-3

315
Q

which levels does the left crus of diaphragm attach

A

L1-2

316
Q

which branch of the abdominal aorta supplies the diaphragm

A

inferior phrenic

317
Q

at which level does the aorta bifurcate

A

L4

318
Q

what are the anterior branches of the abdominal aorta

A

coeliac axis
SMA
IMA

319
Q

lateral branches of the abdominal aorta

A

real arteries
gonadal arteries
middle suprarenal artery

320
Q

posterior branches of abdominal aorta

A

lumbar arteries

321
Q

which structures drain into the IVC

A

body wall
diaphragm
suprarenal glands
right gonadal vein

322
Q

where do the digestive organs drain blood to

A

portal vein NOT IVC

323
Q

at which level is the IVC formed, and by the union of which vessels

A

L5

union of common iliac veins

324
Q

where do the ascending lumbar veins arise, and what is their course/purpose

A

from external iliac
run upwards to join the azygous system, sometimes communicating with the renal veins
provides collateral venous drainage

325
Q

where do the lumbar veins normally drain

A

L1/2 into ascending lumbar vein (superiorly)
L3/4 into IVC
L5 into iliolumbar vein (then common iliac) or ascending lumbar (inferiorly)

326
Q

what are the main ganglia in the abdomen

A

coeliac
superior mesenteric
inferior mesenteric
superior/inferior hypogastric

327
Q

describe the parasympathetic innervation of the abdominal ganglia

A

posterior vagal trunks to coeliac plexus and superior mesenteric ganglia
pelvic parasympathetic fibres (S2-3/4) to inferior mesenteric and superior/inferior hypogastric ganglia

328
Q

where does lymph from the pelvis drain

A

iliac nodes

329
Q

lymph from which structures drains to para-aortic (lateral) nodes

A

body wall
kidneys
testes/ovaries

330
Q

lymph from which structures drain to pre-aortic nodes

A

digestive tract

includes coeliac, superior mesenteric and inferior mesenteric nodes

331
Q

which level is the cisterns chill at

A

L1/2

332
Q

the cistern chill is the start of which structure

A

thoracic duct

333
Q

the lumbar plexus is made up of which nerve roots

A

L1-4

334
Q

the branches of the lumbar plexus can all be identified in relation to which muscle

A

psoas

335
Q

roots of iliohypogastric nerve

A

L1

336
Q

sensory innervation of iliohypogastric nerve

A

lateral gluteal skin

pubic skin

337
Q

motor innervation of iliohypogastric nerve

A

internal oblique

transversus abdominis

338
Q

nerve roots of ilioinguinal nerve

A

L1

339
Q

sensory innervation of ilioinguinal nerve

A

medial thigh

root of penis/scortum or mons pubis/labium magus

340
Q

nerve roots of genitofemoral nerve

A

L1/2

341
Q

sensory innervation of genitofemoral nerve

A

scrotum or mons pubis

upper anterior thigh

342
Q

motor innervation of genitofemoral nerve

A

cremasteric muscle

343
Q

where does the genitofemoral nerve lie in relation to psoas

A

runs on the surface of psoas

344
Q

roots of lateral cutaneous nerve of thigh

A

L2/3

345
Q

sensory innervation of lateral cutaneous nerve of thigh

A

skin on anterior and lateral thigh

346
Q

roots of femoral nerve

A

L2-4

347
Q

motor innervation of femoral nerve

A

pectineus
iliacus
anterior compartment of thigh

348
Q

which branch of femoral nerve supplies the leg

A

saphenous nerve

349
Q

sensory innervation of femoral nerve

A

skin on anterior thigh and medial leg

350
Q

roots of obturator

A

L2-4

351
Q

sensory innervation of obturator

A

medial thigh

352
Q

motor innervation of obturator nerve

A

obturator externus
medial compartment of thigh
sometimes pectineus