Abdomen Flashcards
1
Q
What forms the roof of the inguinal canal?
A
Lateral half- internal oblique and transversus abdominis
Medial half- external oblique aponeurosis
2
Q
What forms the anterior wall of the inguinal canal?
A
External oblique aponeurosis with some reinforcement laterally from internal oblique fibres
3
Q
What forms the floor of the inguinal canal?
A
The inguinal ligament
4
Q
What forms the posterior wall and deep inguinal ring of the inguinal canal?
A
Medially the conjoint tendon, laterally transversalis fascia
5
Q
What stops bowel from herniating into the inguinal canal during increased abdominal pressure?
A
Contraction of internal oblique and transversalis fascia (supplied by L1 ilioinguinal and iliohypogastric nerves) this pulls the roof down and effectively shuts the canal
6
Q
What is the interfoveolar ligament?
A
Fibres from transversus abdominis that arch down and strengthen the posterior wall of the inguinal canal and make up the medial portion of the deep inguinal ring
7
Q
What is the course of the ilioinguinal nerve in the inguinal canal?
A
Comes in from the side and not through the deep ring. Runs in front of the spermatic cord, leaves through the superficial ring
8
Q
What is an indirect inguinal hernia?
A
One that passes through the deep inguinal ring and into the inguinal canal?
9
Q
What is a direct inguinal hernia?
A
One that passes medial to the inguinal triangle and enters the canal i.e. passes through a weak spot in the wall rather than through the deep inguinal ring
10
Q
What passes deep to the posterior wall of the inguinal canal?
A
The inferior epigastric artery from the external iliac which lies just proximal to the inguinal ligament. The medial umbilical artery passes medially to the IEA obliquely across the posterior wall
11
Q
What are the three coverings of the spermatic cord?
A
Internal spermatic fascia from the transversalis fascia
Cremasteric fascia and cremasteric muscle, from the internal oblique and transversus abdominis
External spermatic fascia from the external oblique aponeurosis (superficial ring)
12
Q
What are the 6 contents of the spermatic cord?
A
- Ductus deferens (usually posterior)
- Arteries- testicular, artery to ductus, cremasteric
- Veins- pampiniform plexus
- Lymphatics
- Nerves- genital branch of genitofemoral nerve
- Processus vaginalis
13
Q
What is the processus vaginalis
A
The obliterated remains of the peritoneal connection with the tunica vaginalis of the testis. When patent it forms the sac of an indirect inguinal hernia
14
Q
What separates right and left sides of the scrotum?
A
The median scrotal septum
15
Q
What is the gastrocolic ligament?
A
A sheet of peritoneum that connects the stomach to the transverse mesocolon
16
Q
What lies over the stomach in the abdomen?
A
The left lobe of the liver
17
Q
Where does the greater omentum attach to the stomach?
A
Along the whole of the greater curve of the stomach
18
Q
Where does the lesser omentum attach to the stomach?
A
Along the lesser curve, the attachment is quite wide at the gastro-oesophageal junction.
It then attaches to the liver and the diaphragm.
19
Q
Where else does the greater omentum attach?
A
The transverse mesocolon
20
Q
What is the transpyloric plane?
A
Bisects the body between the jugular notch and pubic symphisis
21
Q
Where is the transpyloric plane?
A
A point midway between the xiphisternum and umbilicus or about a handsbreadth below the xiphisternal joint
22
Q
What does the transpyloric plane cut?
A
The ninth costal cartilage which is at the lateral border of the rectus abdominis (semilunar line)
23
Q
What lies beneath the transpyloric plane?
A
On the right, the fundus of the gallbladder, on the left the body of the stomach
24
Q
At which vertebral level is the transpyloric plane?
A
Between the lower body of L1 and upper border of L2
25
What structure does the transpyloric plane pass through?
It passes throught the pylorus, but note that this is free on a mesentery and therefore mobile.
The SMA leaves the aorta at this level and the splenic vein runs transversely behind the pancreas, the hilum of each kidney lies in this plane (left just above, right just below)
26
What does the peritoneum consist of?
A single layer of mesothelium
27
What is the mesentery supporting the transverse colon?
The transverse mesocolon
28
What is the mesentery supporting the appendix?
The mesoappendix
29
What is the mesentery supporting the sigmoid colon?
The sigmoid mesoappendix
30
what is the ligamentum teres?
obliterated remains of the umbilical vein
31
Where is the ligamentum teres?
In the falciform ligament
32
What is the course of the falciform ligament?
Goes upwards from the umbilicus behind the linea alba towards the xiphisternum, delivers ligamentum teres to liver and then continues up and to the right of midline
33
What does the median umbilical fold contain?
The median umbilical ligament
34
What is the median umbilical ligament?
The obliterated remains of the urachus
35
What does the medial umbilical fold contain?
The medial umbilical ligament
36
What is the medial umbilical ligament?
The obliterated remains of the umbilical artery
37
What does the lateral umbilical fold contain?
The inferior epigastric vessels that enter the rectus sheath by passing beneath the arcuate line
38
What is the purpose of the lesser sac?
Provides a slippery surface for the necessary mobility of the posterior surface of the stomach
39
What is the anterior wall of the lesser sac?
The lesser omentum and stomach
40
What is the left of the lesser sac?
The hilum of the spleen where the peritoneum forms the lienorenal and gastrosplenic ligaments
41
What is to the right of the lesser sac?
The epiploic foramen
42
What is the roof of the lesser sac?
Peritoneum covering the caudate lobe of the liver
43
What is the posterior wall of the lesser sac?
Peritoneum which overlies part of the diaphragm, pancreas and left kidney and suprarenal gland
44
What is the lowest part of the posterior wall of the lesser sac?
Transvers mesocolon attached to the lowest part of the pancreas
45
What can be palpated when placing fingers into the lesser sac through the epiploic foramen?
```
Aorta- giving off coeliac trunk
Common hepatic artery
Pancreaticoduodenal fold
Left gastric artery
Pancreaticogastric fold
```
46
Which part of the greater omentum forms the investment for the spleen?
The anterior (outer) layer
47
What forms the gastrosplenic ligament?
2 layers of peritoneum one from the lesser and one from the greater sac. These fuse and connect the stomach and spleen
48
What forms the lienorenal ligament?
2 layers of peritoneum one from the lesser and one from the greater sac. These fuse and connect the left kidney and the spleen
49
What forms the gastrophrenic ligament?
The greater omentum- passes from the stomach to diaphragm above the kidney
50
What are the gastrosplenic, lienorenal and gastrophrenic ligaments derived from?
They are derivatives of the dorsal mesogastrium
51
What is the attachment of the greater omentum?
Continuous attachment from the abdominal oesophagus to duodenum, along the left and lower border of the stomach (greater curvature)
52
What is the attachment of the lesser omentum to the stomach?
From the right side of the abdominal oesophagus and along the lesser curvature to the first inch of the duodenum
53
What is the attachment of the lesser omentum to the liver?
L-shaped to the fissure for the ligamentum venosum and the porta hepatis
54
What is special about the lesser omentum between the duodenum and the liver?
It has a right free margin, where the peritoneum of the greater and lesser sacs become continuous
55
What is contained within the free right margin of the lesser omentum
Portal vein at the BACK
Hepatic artery in FRONT and LEFT of vein
Bile duct to the FRONT and RIGHT of vein
56
What forms the anterior boundary of the epiploic foramen?
The portal vein in the free margin of the lesser omentum
57
What is the epiploic foramen (of Winslow)?
Vertical slit, 2.5cm high that is the entry into the lesser sac
58
What is the upper boundary of the epiploic foramen?
The caudate process of the liver
59
What is the lower boundary of the epiploic foramen?
The first (ascending) part of the duodenum
60
What is the posterior boundary of the epiploic foramen?
The inferior vena cava
61
What does the lesser omentum do after attaching to the liver?
It splits the two layers and encloses the liver, then spreads onto the diaphragm and posterior wall where they form the coronary, triangular and falciform ligaments
62
What is the dividing line between the supracolic and infracolic compartments?
The transverse mesocolon
63
What is the porta hepatis?
Hilum of liver- transverse fissure in the visceral surface of the liver through which right and left branches of the hepatic artery, portal vein and right and left hepatic ducts enter or leave the liver.
64
What is the order of structures in the porta hepatis?
Vein-artery- duct (VAD) with the hepatic ducts in front
65
Where does the IVC begin?
L5, under the right common iliac
66
Where does the IVC run in relation to the aorta?
To the right, it is also longer than the aorta in the abdomen
67
Near its origin what does the IVC cross?
It overlaps the right sympathetic trunk and crosses the right renal artery
68
What is the IVC crossed by in the infracolic compartment?
The root of the mesentery and the 3rd part of the duodenum
69
What is related to the IVC in the supracolic compartment?
The IVC is behind the portal vein, head of the pancreas and bile duct and is then behind the peritoneum of the posterior wall of the epiploic foramen
70
Where is the IVC in relation to the liver?
Behind the bare area on the right crus
| Makes a big groove on the bare area of the liver
71
What are the tributaries of the IVC in ascending order? I Like To Rise So High
```
Common Iliacs
R) + L) 3rd and 4th Lumbar veins
R) gonadal vein (Testicular)
R) + L) Renal veins
R) lumbar azygous vein
R) Suprarenal vein
R) +L) phrenic veins
Hepatic vein
```
72
Where are the common iliac veins formed?
In front of the SI joints by the internal iliac from the pelvis and the external iliac which is a continuation of the femoral vein
73
Which common iliac vein is longer?
The left cos the IVC is right of the midline
74
What are the tributaries of the common iliac veins?
Internal and external iliac veins
Iliolumbar veins
Lateral sacral veins
Left usually receives median sacral vein
75
What separates the right and left lobes of the liver?
Previously falciform ligament.
| Now: divided by the portal trinity which goes through the inferior GALLBLADDER BED
76
How many segments are there in R vs L lobes of the liver?
```
4 on right (5,8,6,7) 3 on Left (2,3,4)
Segment 1 (caudate lobe) has blood supply from both right and left sides
```
77
What are the branches of the descending aorta?
```
Canned Soup Really Good In Cans
Coeliac trunk
SMA
Renal
Gonadal
Inferior Mesenteric
Common Iliac
```
78
Is the bare area of the liver in contact with the IVC?
Yes
79
Which is the only part of the liver that is in the lesser sac?
The caudate lobe
80
What is the porta hepatis?
The hilum of the liver and it is enclosed between two layers of the lesser omentum
Transverse slit perforated by the right and left heaptic ducts and the right and left branches of the hepatic artery and portal vein
81
What is at the front in the porta hepatis
The hepatic ducts which make them more accessible for surgery
82
What supports the liver?
The hepatic veins and inferior vena cava
83
Where does the caudate lobe lie?
Between the IVC and fissure for the ligamentum venosum
84
How is the caudate lobe connected to the right lobe of the liver?
By an isthmus of liver substance, the caudate process
85
Where does the quadrate lobe lie?
Between the gallbladder fossa and the fissure for ligamentum teres
86
To which lobe do the caudate and quadrate lobes functionally belong?
The left lobe- blood supply comes from the left and they deliver their bile to the left
87
What is segment I of the liver?
The caudate lobe at the back
88
What is segment II of the liver?
Left lateral sector
89
What are segments III and IV of the liver?
The lateral and medial parts of the left medial sector
90
What are segments V and VIII of the liver?
Lower and upper parts of the right anterior sector
91
What are segments VI and VII of the liver?
The lower and upper parts of the right posterior sector
92
Where does the hepatic artery divide into right and left branches?
Y-shaped division in the porta hepatis
93
What is the shape of the division of the portal vein?
T-shaped
94
Where does the right branch of the hepatic artery normally pass after division?
Behind the common hepatic duct
95
Where can the common hepatic artery arise from instead of from the coeliac trunk?
The SMA or aorta
| If coming from either of these it usually runs behind the portal vein
96
Where can the right and left hepatic branches come from instead of the common hepatic artery?
The SMA or left gastric arteries respectively. If so they are called "aberrant hepatic arteries
97
What is the most common aberrant hepatic artery?
Left hepatic artery arising from the left gastric artery 20%
98
Where does the portal vein divide?
The porta hepatis
99
Is there any communication between the right and left lobes of the liver?
No- the arteries within each half are end arteries (hence infarction of the liver)
100
How many main hepatic veins are there and where do they drain?
3- right, middle, left
| IVC
101
Do the main hepatic veins have any extrahepatic course?
No
102
Where does the lymph of the liver drain
To 3-4 nodes in the porta hepatis. Gallbladder also drains here
103
Where do the hepatic nodes drain to?
Retropyloric nodes and then to the coeliac nodes
104
What is the first step in development of the liver?
Proliferation of cells from the blind ends of a Y-shaped diverticulum which grows from the septum transversum
105
What is the result of the original diverticulum from the endoderm of the foregut?
It becomes the bile duct.
| A blind diverticulum from the bile duct becomes the cystic duct and gall bladder
106
Where do you insert a needle for liver biopsy?
Through the 8th or 9th intercostal space in the midaxillary line. This ensures the needle is below the level of the lung.
The needle must not penetrate more than 6cm to avoid perforating the IVC.
107
What is the function of the gallbladder?
Stores and concentrates bile secreted by the liver
108
What is the capacity of the gallbladder?
50mL
109
Where does the gallbladder lie in relation to the liver?
It lies on the visceral surface of the right lobe and its fundus projects a little beyond the shapr lower border
110
Where does the gallbladder touch the parietal peritoneum of the anterior abdominal wall?
At the tip of the ninth costal cartilage where the transpyloric plane crosses the right costal margin
111
What is the relation of the gallbladder fundus to the colon?
It lies on the commencement of the transverse colon, just to the left of the hepatic flexure
112
What is the body of the gallbladder in contact with?
The first part of the duodenum
113
What is the neck of the gallbladder in contact with?
The free edge of the lesser omentum
114
What is the length and width of the cystic duct?
2-3cm long, 2-3mm in diameter
115
Where does the cystic duct merge with the common hepatic duct?
1cm above the duodenum and usually in front of the right hepatic artery and its cystic branch
116
What is the arterial supply of the gallbladder?
Many small vessels from the hepatic bed
| Cystic artery- usually a branch from the right hepatic
117
What is the normal course of the cystic artery?
Passes behind the cystic duct to reach the neck of the gallbladder
118
What are the tributaries of the portal vein?
```
Formed by SMV and splenic veins
Right and left gastric veins
Superior pancreaticoduodenal vein
Cystic vein
Periumbilical vein
```
119
Where does the portal vein lie in relation to the pancreas and the first part of the duodenum?
It lies behind both
120
What is the mid-inguingal point??
Halfway between the anterior superior iliac spine and the pubic symphisis. This corresponds to the femoral artery pulse.
121
What is the midpoint of the inguinal ligament?
It is halfway between the ASIS and the pubic tubercle, corresponds to deep inguinal ligament.
122
Where does the appendix open?
The appendix opens at the posteromedial wall of the cecum, 2 cm below the ileocecal valve.
123
Where is the base of the appendix?
The base of the appendix is located on the posteromedial wall of the cecum, where the three taeniae coli converge.
124
What are the attachments of the greater omentum?
The greater omentum attaches to the greater curve of the stomach and hangs down into the abdomen, covering the small bowel. It has attachments to oesophagus, left kidney and transverse colon.
125
What are the borders of the caudate lobe?
The caudate lobe is bordered inferiorly by porta hepatis, superiorly by a fold of peritoneum, and on either side by lesser omentum and inferior vena cava
126
Where is the opening of the hepatopancreatic ampulla of Vater located in the duodenal wall?
posteromedial wall of the second part of duodenum at the major duodenal papilla, situated 10 cm from the pylorus.
127
What indicates the junction of stomach and duodenum?
The prepyloric vein
128
Which parts of the duodenum are intraperitoneal?
First part only
129
Where is the ligament of Treitz?
At the duodenaljejunal flexure
130
What is the ligament of treitz?
Skeletal muscle from the diaphragm that comes down and meets smooth muscle from the duodenum
It then continues through and meets with connective tissue from the SMA, coeliac trunk
Helps to support and also when it contracts can move the flexure and help things pass
131
What's the difference between jejunum and ileum?
Jejunum is thicker, has more folds, simple arterial arcades and longer vasa recta
Also has larger circular folds
