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MRCS part A > Abdomen Anatomy > Flashcards

Abdomen Anatomy Flashcards

1
Q

What are the boundaries of the Femoral Triangle?

A

Superiorly: - Inguinal ligament
Laterally: - Sartorius
Medially: - Adductor longus

Floor: - Iliopsoas
- Adductor longus
- Pectineus

Roof: - Fascia lata
- Superficial inguinal lymph nodes
- Long Saphenous vein

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2
Q

Where do the Deep and Superficial Circumflex Iliac arteries in relation to the inguinal ligament, arise?

A

Deep circumflex iliac artery: arises above the inguinal ligament

Superficial circumflex iliac artery: arises below the inguinal ligament

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3
Q

What are the contents of the Femoral Triangle ( from medial to lateral)

A
  • Femoral vein
  • Femoral artery (pulse at mid inguinal point)
  • Femoral nerve
  • Deep and Superficial inguinal lymphs
  • Lateral Cutaneous Nerve
  • Great saphenous vein
  • Femoral branch of the Genitofemoral nerve
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4
Q

What makes up the posterior wall of the inguinal canal?

A

Transversalis Fascia

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5
Q

What structure makes up the anterior wall of the inguinal ligament and also the lateral edge of the superficial inguinal ring?

A

External oblique aponeurosis

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6
Q

What makes up the floor and roof of the inguinal canal?

A

Floor: inguinal ligament, thickened medially by the lacunae ligament

Roof: Transversalis fascia, Internal Oblique

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7
Q

What are the contents of the inguinal canal in male and females?

A

Males: Spermatic cord and Ilioinguinal nerve

Females: Round ligament of uterus and ilioinguinal nerve

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8
Q

What are the venous drainages of the left and right adrenal glands?

A

Right: directly into IVC
Left: into left renal vein and then into IVC

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9
Q

What is the arterial supply of the adrenal glands?

A

Superior adrenal: - inferior phrenic artery
Middle adrenal: - aorta
Inferior adrenal: - renal arteries

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10
Q

What are the relationships of the left and right adrenal glands?

A

Right Adrenal:
- Posteriorly: Diaphragm
- Inferiorly: Kidney
- Medially: IVC
- Anteriorly: Hepato-renal pouch

Left Adrenal:
- Posteriorly: Crus of the diaphragm
- Inferiorly: Pancreas and splenic vessels
- Anteriorly: Lesser sac and stomach

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11
Q

What is the arterial supply of the Transverse colon

A

Middle colic artery (branch of SMA)

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12
Q

What is the arterial supply of the Descending and Sigmoid colon?

A

Inferior mesenteric artery (IMA which originates at L3)

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13
Q

What organs are retro peritoneal?

SAD PUCKER

A
  • Suprarenal glands (adrenals)
  • Aorta and IVC
  • Duodenum (2nd and 4th part)
  • Pancreas (except for portion of the tail)
  • Ureters
  • Colon (Descending and Ascending colon)
  • Kidneys
  • Esophagus (lower 2/3rds)
  • Rectum
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14
Q

What is the blood supply of the rectum?

A

Superior rectal artery (from IMA)
Middle rectal artery (from Int. iliac)
Inferior rectal artery (from pudendal vessels)

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15
Q

What marks the transition between the sigmoid colon and the rectum?

A

Marked by the disappearance of the Tenia coli

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16
Q

What is the posterior fascia of the rectum?

A

Waldeyers Fascia

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17
Q

What is contained within the deep perineal pouch?

A
  • Urethral sphincter
  • Transversus perinei
  • Dorsal nerve of penis
  • Deep and Dorsal arteries of the penis
  • Urethral artery
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18
Q

What is the lymphatic drainage of the FEMALE urethra?

A

Internal iliac nodes

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19
Q

What is the name of the narrowest part of the male urethra?

A

Membranous Urethra (surrounded by external sphincter)

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20
Q

What artery is found near the point of entry of the long saphenous vein to the femoral vein?

A

Deep external pudendal artery

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21
Q

What is the nerve roots of the external urethral sphincter and what is the name of the nerve that innervates it?

A

Branches of the pudendal nerve (S2, S3, S4)

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22
Q

What is the most posterior structure at the hilum of the right kidney?

A

Ureter

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23
Q

What structures lie Anteriorly to the right kidney?

A
  • IVC
  • Right renal vein
  • Head of pancreas
  • Descending part of duodenum
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24
Q

What lies Anteriorly to the left kidney?

A
  • left renal vein
  • tail of the pancreas
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25
Q

What is the arterial supply of the prostate gland?

A

Inferior vesical artery (from Int. Iliac)

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26
Q

What is the lymphatic drainage of the prostate?

A

Internal Iliac Nodes

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27
Q

What does the genital branch of the genitofemoral nerve supply?

A

Skin and fascia of the scrotum

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28
Q

What are the borders of the Greater Sciatic Foramen?

A
  • Anterolaterally: Greater sciatic notch of the ilium
  • Posteromedially: Sacrotuberous ligament
  • Inferior: Sacrospinous ligament and ischial spine
  • Superior: Anterior sacroiliac ligament
29
Q

What vessel travels above the piriformis after exiting the sciatic notch?

A

Superior Gluteal vessels (art + vein)

30
Q

What structures travel below the piriformis after exiting the sciatic notch?

A
  • Inferior gluteal vessels (art + vein)
  • Sciatic nerve
  • Posterior cutaneous nerve of the thigh
31
Q

What nerve transmit through the sciatic Foramen?

A
  • Sciatic
  • Superior and Inferior gluteal nerves
  • Pudendal
  • Posterior cutaneous nerve of thigh
  • Nerve to Quadratus femoris
  • Nerve to Obturator internus
32
Q

What are the 3 layers of the spermatic cord and what are their origins?

A
  • Internal spermatic fascia (Transversalis fascia)
  • Cremasteric fascia (internal oblique)
  • External spermatic fascia (External oblique aponeurosis)
33
Q

What is the lymphatic drainage of the spermatic cord?

A

Lumbar and Para-aortic nodes

34
Q

What are the arteries present in the spermatic cord and where do they arise from?

A
  • Testicular artery (arises from AA. Supplies testis and epididymis)
  • Artery of Vas Deferans (arises from Inferior vesical artery)
  • Cremasteric artery (arises from Inferior Epigastric artery)
35
Q

What are the testis surrounded by and from which structure are they derived from?

A

Testes are surrounded by the TUNICA VAGINALIS.

This is derived from the peritoneum

36
Q

What organ lies most superficially at the level of L1?

A

The fundus of the gallbladder

37
Q

What are the borders of the Epiploic Foramen?

A

Anterior: - Bile duct (right)
- Portal vein (behind)
- Hepatic artery (left)

Posteriorly: IVC

Inferiorly: 1st part of duodenum

Superiorly: Caudate process of liver

38
Q

What is the Pringles Manoeuvre and what 3 structures does this occlude?

A

Placing vascular clamp across the anterior aspect of the Epiploic Foramen - done to control bleeding during liver surgery

Occludes:
- CBD
- Hepatic artery
- Portal vein

39
Q

What is the blood supply to the proximal part of the ureter?

A

Branches of the renal artery

40
Q

What forms the lateral edge of the superficial inguinal ring?

A

External oblique aponeurosis

41
Q

Where is the porta hepatis and what does it transmit?

A

Postero-infero surface of liver and separates the caudate lobe behind the quadrate lobe in front

Transmits (anterior to posterior):
- Common hepatic duct
- Hepatic artery
- Portal vein
- Lymph drainage
- Sympa and parasympa fibres

42
Q

What is the supply to the quadrate and caudate lobes and what are their relations?

A

Quadrate lobe:
- right hepatic artery
- gallbladder fossa lies on the right
- fossa for umbilical vein lies on the left

Caudate lobe:
- supplied by right + left hepatic arteries
- anterior and medial to IVC

43
Q

Bleeding in the left paracolic gutter upon traction of the left colon is due to what source?

A

Spleen

44
Q

Which embryological structure is the ureter derived from?

A

Mesonephric duct

45
Q

What ligament provides the main structural support to the uterus?

A

Central perineal tendon

46
Q

During a right adrenalectomy, what is the most likely source of brisk bleeding and how is this injury best managed?

A

Source: IVC

Best managed using a Satinsky clamp and 6/0 prolene suture

47
Q

What is the primary site of venous drainage of the urinary bladder?

A

Vesicoprostatic venous plexus (may be a site of significant bleeding during a cystectomy)

This then drains into the Internal iliac vein

48
Q

What is arterial supply of the urinary bladder?

A

Superior and Inferior VESICAL arteries
(Branches of the internal iliac artery)

49
Q

What is the positioning of the bladder in the body?

A
  • empty bladder is contained within the pelvic cavity
  • usually a 3 sided pyramid
  • apex of the bladder points forwards towards the pubis symphysis
  • base lies anterior to the rectum/vagina
  • inferior aspect is retroperitoneal and superior aspect is covered by peritoneum
50
Q

What are the lymphatic drainage of the Superior and Inferior vagina?

A

Superior vagina: Int and Ext Iliac nodes

Inferior vagina: Superficial inguinal nodes

51
Q

What are the 3 main branches of the Coeliac axis and their sub branches?

A
  • Left gastric
  • Hepatic:
    - Right gastric
    - Gastroduodenal artery
    - Superior Pancreaticoduodenal
    - Cystic
  • Splenic:
    • Pancreatic
    • Short gastric
    • Left gastroepiploic
52
Q

At what level does the coeliac axis branch off the AA?

A

T12

53
Q

What are the relations of the coeliac axis?

A

Anterior: Lesser omentum

Right: right coeliac ganglion and caudate process of liver

Left: Left coeliac ganglion and gastric cardia

Inferiorly: upper border of pancreas and renal vein

54
Q

What is the arterial supply of the rectum?

A

Superior rectal artery
Middle rectal artery (from Int. iliac)
Inferior rectal artery (from Pudendal vessels)

55
Q

What is the lymphatic drainage of the rectum?

A
  • Mesorectal lymph nodes (Superior to dentate line)
  • Inguinal nodes (inferior to dentate line)
56
Q

What are the borders of the Hesselbach’s triangle and what is it’s clinical significance?

A
  • Superolaterally: Epigastric vessels
  • Medially: Lateral edge of Rectus muscle
  • Inferiorly: Inguinal ligament

Direct hernias pass through here

57
Q

What incision would be done for a Whipple’s procedure?

A

Rooftop incision (Gable)

58
Q

What is the lymphatic drainage of the ovaries?

A

Para aortic nodes

59
Q

What does the inferior mesenteric vein usually drain into?

A

Splenic vein

60
Q

What is the best incision for an appendectomy?

A

Lanz incision

61
Q

What structures lie anterior to the rectum?

A

Males:
- Rectovesical pouch
- Bladder
- Prostate
- Seminal vesicles

Females:
- Recto-uterine pouch (pouch of Douglas)
- Cervix
- Vaginal wall

62
Q

At what level does the IVC enter the thorax?

A

T8 - passes through the diaphragm

63
Q

What is the lymphatic drainage of the scrotum?

A

Inguinal nodes

64
Q

What is the arterial and venous supply to the pancreas?

A

Arterial:
- Head: pancreaticoduodenal artery
- Rest: splenic artery

Venous:
- Head: Superior mesenteric vein
- Body and tail: splenic vein

65
Q

What are the posterior relations of the anatomical segments of the pancreas?

A

Head: IVC, CBD, Right and Left Renal veins, SMA and SMV

Neck: SMV, Portal vein

Body:
- Left renal vein
- Psoas muscle
- Adrenal gland
- Kidney
- Aorta

Tail: Left kidney

66
Q

Which lobes is the Quadrate lobe functionally and anatomically part of?

A

Functionally: left lobe of the liver

Anatomically: right lobe of the liver

67
Q

What are the relations of the quadrate lobe?

A
  • Porta hepatis lies behind
  • Gallbladder fossa lies on the right
  • Fossa for the umbilical vein lies on the left
68
Q

What is the name of the fascia that surrounds the kidney?

A

Gerotas fascia

MRCS part A (9 decks)

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