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MRCS > Abdomen > Flashcards

Abdomen Flashcards

1
Q

Foregut

A

oesophagus to 1st part of duodenum

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2
Q

Midgut

A

2nd part of duodenum to proximal 2/3rd of transverse colon

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3
Q

Hindgut

A

distal 1/3rd of transverse colon to rectum

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4
Q

Transpyloric plane

A

L1 verterbrae
Midway through jugular notch and pubic symphysis
ninth costal cartilage
pyloric orifice (opening of stomach into duodenum)
Body of pancreas
Hila of kidney - inferior pole of left kidney, superior pole of right kidney

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5
Q

Coeliac artery

A

anterior unpaired branch from abdominal aorta at upper border of L1

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6
Q

Superior mesenteric artery

A

anterior unpaired branch from abdo aorta at lower border of L1

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7
Q

Inferior mesenteric artery

A

anterior unpaired branch from abdo aorta at LIII

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8
Q

left renal vein

A

drains left kidney, suprarenal gland and gonad on left side. Left suprarenal vein, left gonadal vein and left lumbar vein drains into left renal vein. THis then drains into IVC.

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9
Q

Left common iliac vein

A

crosses at midline at approximately L5 to join with partner on right to form IVC.

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10
Q

left lumbar vein

A

drains back and posterior abdominal wall on left side

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11
Q

portocaval anastomoses

A

inferior end of oesophagus
inferior part of rectum
where liver is in direct contact with diaphragm (bare area of liver)
where wall of GI tract in direct contact with posterior abdominal wall (retroperitoneal areas of large and small intestine)
posterior surface of pancreas

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12
Q

rectus sheath contents

A

rectus abdominis
pyramidalis
superior and inferior epigastric vessels
lower 6 thoracic nerves and accompanying branches of the posterior intercostal vessels

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13
Q

transversalis fascia - deep to transversus abdominus

A

Continuous layer of deep fascia that lines abdominal cavity and continues deep into pelvic cavity. Continuous with fascia on inferior surface of diaphragm.
Continuous posteriorly with deep fascia covering muscles of posterior abdo wall and attaches to thoracolumbar fascia.
Attaches to iliac crest.

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14
Q

Ilioinguinal nerve cutaneous supply

A

anterior surface of scrotum/labia majora, small cutaneous branch to thigh

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15
Q

intercostal nerves to abdomen

A

runs in between internal oblique and transversus abdominis muscle, appears lateral to rectus sheath and pass posterior to rectus abdominis. Midline anterior cutaneous branch passes through rectus abdominis to supply skin.

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16
Q

Arterial supply to superficial layer of anterolateral abdominal wall

A

Musculophrenic artery - branch of internal thoracic

Superior epigastric artery and superficial circumflex iliac artery - both branches of femoral artery

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17
Q

Arterial supply to deep layer of abdominal wall

A

Superior epigastric artery
Intercostal arteries T10-T11 and subcostal artery T12
Inferior epigastric artery and deep circumflex iliac artery - both branches of external iliac artery

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18
Q

superior and inferior epigastric arteries

A

passes posteriorly to rectus abdominis throughout their course and anastomose with each other

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19
Q

lymphatic drainage of anteriolateral abdo wall

A

Superficial
superior to umbilicus - axillary nodes
below umbilicus - superficial inguinal nodes
Deep
Parasternal nodes, lumbar nodes and external iliac nodes

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20
Q

layers of processus vaginalis

A

transversalis fascia forms deepest covering
second covering - internal oblique
most superficial -external oblique
transversus abdominis covering not acquired because PV passes under arching fibers of this muscle

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21
Q

processus vaginalis

A

forms basic structure of inguinal canal

anterior to gubernaculum

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22
Q

inguinal canal

A 
4cm long. 
Contents: 
Genital branch of genitofemoral nerve
spermatic cord (men), round ligament (women)
Ilioinguinal nerve
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23
Q

deep inguinal ring

A

mid-inguinal point
lateral to inferior epigastric vessels
continues as internal spermatic fascia of spermatic cord

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24
Q

superficial inguinal ring

A

superior to pubic tubercle
Triangular opening in the aponeurosis of external oblique. Apex pointing superolaterally and base formed by pubic crest. Two side of triangle attached to pubic symphysis and pubic tubercle.
continues as external spermatic fascia.

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25
Q

borders of inguinal canal

A

anterior - aponeurosis of external and internal oblique
posterior - transversalis fascia and conjoint tendon
roof - transversus abdominis and internal oblique muscles
floor - inguinal ligament

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26
Q

Contents of spermatic cord

A 
ductus deferens
artery to ductus deferens (from inferior vesical artery)
testicular artery (from abdominal aorta)
testicular veins
cremasteric artery and veins
genital branch of genitofemoral nerve
sympathetic and visceral afferent fibers
lymphatics
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27
Q

Fascia of spermatic cord

A

internal spermatic fascia - deepest, from transversalis fascia
cremasteric fascia - internal oblique
external spermatic fascia - external oblique

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28
Q

cremasteric muscle

A

supplied by genital branch of genitofemoral nerve.

Sensory fibres enter spinal cord at L1

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29
Q

Hesselbach triangle boundaries

A

inferiorly inguinal ligament
laterally inferior epigastric vessels
medially rectus abdominis

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30
Q

Omental bursa

A

smaller subdivision of peritoneal cavity posterior to stomach and liver, connected to greater sac through epiploic foramen

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31
Q

Epiploic foramen

A

anteriorly - portal vein, hepatic artery proper, bile duct
posteriorly - IVC
superiorly - caudate lobe of liver
inferiorly - first part of duodenum

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32
Q

greater omentum

A

derived from dorsal mesentery from greater curvature of stomach and first part of duodenum draping over transverse colon and coils of jejunum and ileum
contains two arteries and accompanying veins - right and left gastro-omental vessel between this double-layered peritoneal apron

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33
Q

lesser omentum

A

lesser curvature of stomach and first part of duodenum to inferior surface of liver. derived from ventral mesentery
Divided into
medial hepatogastric ligament - between stomach and liver
lateral hepatoduodenal ligament - between duodenum and liver
Right and left gastric vessels are in between the layers of lesser omentum

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34
Q

Oesophagus

A

25cm long, from C6 behind cricoid cartilage to cardia of stomach (around T11)
vagus nerve through T10 of diaphragm - anterior trunk from left vagus, posterior trunk from right vagus

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35
Q

Regions of stomach

A

cardia - opening of oesophagus into stomach
fundus - area above level of cardial orifice
body - largest region
pyloric - pyloric antrum and pyloric canal and is the distal end of stomach

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36
Q

Arterial supply of oesophagus

A

branches from left gastric (from coeliac trunk)

branches from left inferior phrenic artery (from abdo aorta)

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37
Q

arterial supply to stomach

A

lesser curvature:
left gastric artery from celiac trunk
right gastric artery from hepatic artery proper
greater curvature:
right gastro-omental artery from gastroduodenal artery
left gastro-omental artery from splenic artery
posterior gastric artery from splenic artery (not always present)

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38
Q

duodenum

A

20-25cm long
above level of umbilicus, adjacent to head of pancreas
retroperitoneal except for its beginning, which is connected to liver by hepatoduodenal ligament

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39
Q

4 parts of duodenum

A

superior part
descending
inferior
ascending

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40
Q

Superior part of duodenum

A

pyloric orifice of stomach to neck of gallbladder. just right of L1 and passes anteriorly of bile duct, gastroduodenal artery, portal vein and IVC. Most duodenal ulcers occur here.

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41
Q

2nd part (Descending part) of duodenum

A

Right of midline and from neck of gallbladder to lower border of LIII. Anterior surface crossed by transverse colon, posterior to it is right kidney, and medial is head of pancreas. Contains major duodenal papilla (entrance for bile and pancreatic ducts) and minor duodenal papilla (entrance for accessory pancreatic duct).

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42
Q

inferior part (3rd part) of duodenum

A

longest section, crossing IVC, aorta and vertebral column. Crossed anteriorly by SMA and SMV.

43
Q

Ascending part (4th part) of duodenum

A

passes upward and left of aorta to approximately upper border of LII and terminates at duodenojejunal flexure.

44
Q

arterial supply to duodenum

A

branches of gastroduodenal artery

first jejunal branch of SMA

45
Q

Jejunum

A

proximal 2/5ths of small intestine, larger in diameter and thicker wall than ileum.
walls has plicae circulares.
less prominent arterial arcades and longer vasa recta
arterial supply - jejunal arteries from SMA

46
Q

Ileum

A

distal 3/5ths of small intestine.
Thinner walls, fewer and less prominent mucosal folds, shorter vasa recta, more arterial arcades.
arterial supply - ileal arteries from SMA and ileal branch from ileocolic (from SMA)

47
Q

duodenal ulcers

A

posterior - erode into gastroduodenal artery or more commonly onto posterior superior pancreaticoduodenal artery
anterior - peritoneal cavity causing peritonitis

48
Q

appendix

A

arterial supply - anterior cecal artery, posterior caecal artery and appendicular artery. All branches of ileocolic artery from SMA

49
Q

colon structure locations

A

ascending and descending are secondarily retroperitoneal

transverse and sigmoid are intraperitoneal

50
Q

arterial supply to ascending colon

A

colic branch from ileocolic (from SMA)
anterior cecal artery, posterior caecal artery both from ileocolic (from SMA)
right colic artery from SMA

51
Q

arterial supply to transverse colon

A

right colic from SMA
middle colic from SMA
left colic from IMA

52
Q

arterial supply to descending colon

A

left colic from IMA

53
Q

arterial supply to sigmoid

A

sigmoidal artery from IMA

54
Q

Rectosigmoid junction

A

level of vertebra S3, rectum is a retroperitoneal structure

55
Q

Arterial supply to rectum and anal canal

A

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

56
Q

Visceral surface of liver in contact with

A

oesophagus,, right anterior part of stomach, superior part of duodenum, lesser omentum, gallbladder, right colic flexure, right transverse colon, right kidney and right suprarenal gland

57
Q

Ligaments of liver

A

Liver attached to anterior abdominal wall by falciform ligament, except for a small area against diaphragm (bare area of liver).
Hepatoduodenal ligaement
Hepatogastric ligament
Anterior and posterior coronary ligaments - attached to diaphragm.

58
Q

Bare area of liver

A

Anterior boundary - anterior coronary ligament
Posterior boundary - posterior coronary ligament
Where coronary ligaments come together laterally they form right and left triangular ligaments

59
Q

Quadrate lobe of liver

A

Visible on anterior part of visceral surface, bounded on left by fissure for ligamentum teres and right by gallbladder. Functionally related to left lobe of liver

60
Q

Caudate lobe of liver

A

Visible on posterior part of visceral surface. Bounded on left by fissure for ligamentum venosum and right by IVC

61
Q

arterial supply of liver

A

right and left hepatic artery - branch of hepatic artery proper - branch of common hepatic artery from coeliac trunk

62
Q

arterial supply of gallbladder

A

cystic artery from right hepatic artery

63
Q

Pancreas

A

Lies mostly posterior to the stomach. Extends from duodenum (on R) to spleen (on L)
Mostly retroperitoneal except for some parts of its tail.
Develops from ventral and dorsal buds from foregut.
Ventral - head and uncinate
Dorsal - head, neck and body.

64
Q

Parts of pancreas

A

Head, uncinate process, neck, body and tail

65
Q

Head of pancreas

A

C-shaped concavity of duodenum

66
Q

Uncinate process of pancreas

A

passes posterior to superior mesenteric vessels

67
Q

Neck of pancreas

A

anterior to superior mesenteric vessels.

SMV and splenic veins join to form portal vein behind neck of pancreas

68
Q

Tail of pancreas

A

passes between layers of splenorenal ligament

69
Q

arterial supply to pancreas

A

gastroduodenal artery (branch of common hepatic artery)
inferior pancreatic artery (branch of splenic artery)
inferior pancreaticoduodenal artery (branch of SMA)

70
Q

Bile duct relative structure

A

Lies to the right of hepatic artery proper, and usually to the right/anterior of portal vein.
Continues inferiorly and passes posterior to superior part of duodenum

71
Q

Spleen

A

Develops from dorsal mesentery

From rib 9 to 10

72
Q

Spleen connected to

A

greater curvature of stomach by gastrosplenic ligament which contains short gastric and gastro-omental vessels
left kidney by splenorenal ligament which contains splenic vessels

73
Q

arterial supply to spleen

A

splenic artery (a branch of coeliac trunk)

74
Q

Liver

A

8 lobes, Caudate lobe = Segment I and moves clockwise.

Principal plane = parasagittal plane across IVC and gallbladder

75
Q

Coeliac trunk

A

anterior branch of abdominal aorta - anterior to L1.

Divides into left gastric, splenic and common hepatic arteries

76
Q

Left gastric artery

A

Smallest branch of coeliac trunk.
Has oesophageal branches to abdo part of oesophagus.
Descends along lesser curvature of stomach and anastomose with right gastric artery.

77
Q

Splenic artery

A

largest branch of coeliac trunk.
Travels to the left along superior border of pancreas, travels in splenorenal ligament and enters hilum of spleen.
Branches into short gastric arteries (fundus of stomach)
Branches into left gastro-omental artery which runs along greater curvature of stomach and anastomose with right gastro-omental artery

78
Q

Common hepatic artery

A

Divides into 2 terminal branches - hepatic artery proper and gastroduodenal artery

79
Q

Hepatic artery proper

A

runs to left of bile duct and anterior to portal vein, and divides into left and right hepatic artery

80
Q

Gastroduodenal artery

A

Give off posterior superior pancreaticoduodenal artery

Terminates into 2 branches - right gastro-omental artery and anterior superior pancreaticoduodenal artery

81
Q

Superior mesenteric artery

A

anterior branch of abdominal aorta, lower part of LI
Crossed anteriorly by splenic vein and neck of pancreas
Posterior to it - left renal vein, uncinate process and inferior part of duodenum.
First branch - inferior pancreaticoduodenal artery
left branches - jejunal and ileal arteries
right branches - middle colic, right colic and ileocolic.

82
Q

Inferior mesenteric artery

A

anterior branch of abdominal aorta, around LIII.

Branches - left colic, sigmoid and superior rectal artery

83
Q

Portal vein

A

Union of splenic vein and superior mesenteric vein posterior to neck of pancreas at level LII.

84
Q

Tributaries of portal vein

A

right and left gastric veins
cystic veins
paraumbilical veins

85
Q

Tributaries of splenic vein

A

short gastric veins
left-gastro-omental vein
pancreatic vein
inferior mesenteric vein (usually)

86
Q

portosystemic anastomoses

A

gastro-oesophageal junction at stomach - left gastric vein (portal) with azygos system (caval)
anus - superior rectal vein (portal) with middle and inferior rectal veins (systemic)
umbilicus - paraumbilical (portal) with veins of anterior abdominal wall. Causes caput medusae.

87
Q

Sympathetic trunks route

A

As they pass through neck, lie posterior to carotid sheath.
In upper thorax, anterior to necks of ribs.
Lower thorax, lateral aspect of vertebral bodies.
Abdo, anterolateral to lumbar vertebral bodies.
In pelvis, anterior to sacrum.
The two trunks come together anterior to coccyx to form ganglion impar.

88
Q

sympathetic trunk ganglias

A

cervical - 3
thoracic - 11/12
lumbar - 4
sacral - 4/5

89
Q

Splanchnic nerves

A

thoracic, lumbar and sacral - sympathetic

pelvic - parasympathetic

90
Q

thoracic splanchnic nerves

A

greater - T5-T9 - to coeliac ganglion
lesser - T10-11 - to aorticorenal ganglion
least - T12 - to renal plexus

91
Q

lumbar splanchnic nerves

A

usually 2 to 4

passes from lumbar part of trunk to prevertebral plexus

92
Q

sacral splanchnic nerves

A

pass from sacral part of trunk and enter inferior hypogastric plexus, which is an extension of prevertebral plexus into the pelvis.

93
Q

Pelvic splanchnic nerves (parasympathetic)

A

Originate from anterior rami of S2-4 to inferior hypogastric plexus.
Innervates the hindgut.

94
Q

Abdominal prevertebral plexus

A

3 major divisions - coeliac, aortic and superior hypogastric plexus.
Receives:
preganglionic parasympathetic and visceral afferent fibers from vagus nerves
thoracic and lumbar splanchnic nerves
pelvic splanchnic nerves

95
Q

Boundaries of posterior abdominal region (muscle)

A

Medially - psoas major and minor
Laterally - quadratus lumborum
Inferior - Iliacus
Superior - diaphragm

96
Q

Psoas major

A

Attachment - lateral surface of bodies of T12 and L1-5 vertebrae, travels under inguinal ligament to lesser trochanter of femur
Innervation - Anterior rami of L1 to L3
Function - flex thigh at hip joint

97
Q

Psoas minor

A

Attachment - lateral surface of bodies of T12 and Li vertebrae.
Insertion - pectineal line of pelvic brim
Innervation - anterior rami of L1
Function - weak flexion of lumbar vertebral column

98
Q

Quadratus lumborum

A

Origin - transverse process of L5, iliolumbar ligament and iliac crest
Insertion - transverse process of L1 -4 and inferior border of rib 12
innervation - anterior rami of T12 and L1-4
Function - depress and stabilise rib 12 some lateral bending of trunk

99
Q

Iliacus

A

Origin - upper 2/3rd of iliac fossa and upper lateral surface of sacrum
insertion - lesser trochanter of femur
Innervation - femoral nerve (L2-4)
function - flexion of thigh at hip joint

100
Q

Diaphragm phrenic nerve

A

Right phrenic nerve passes through with IVC

Left phrenic nerve passes through muscular part of diaphragm just anterior to central tendon on left side

101
Q

Arterial supply to diaphragm

A

Superiorly, musculophrenic and pericardiocophrenic arteries (branches of internal thoracic) and superior phrenic artery (branch of thoracic aorta)
Inferiorly, inferior phrenic artery (branch of abdo aorta)

102
Q

Transpyloric plane - between jugular notch and pubic symphysis

A 
L1 vertebrae
THrough ends of ninth costal cartilage 
Beginning and upper limit of end of duodenum
Hila of kidneys
Neck of pancreas
Origin of SMA from aorta
103
Q

Surface anatomy of kidneys

A

Left slightly higher than right, up to rib 11 whereas right reaches only rib 12
Lower poles around level of disc between L3-L4

MRCS (28 decks)

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