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Anatomy > Abdomen and Pelvis ( 12.5% ) > Flashcards

Abdomen and Pelvis ( 12.5% ) Flashcards

1
Q

The anterior abdominal wall

  • Is supplied by lower and subcostal nerves.
  • Is divided for clinical purposes into 6 regions.
  • Contains rectus abdominis which is formed by fusion of external oblique, internal oblique and transversus abdominis.
  • Contains transversus abdominis which arises from the medial 1/3 of the inguinal ligament.
  • Contains the rectus sheath which is derived from the aponeurosis of external oblique
A

Contains the rectus sheath which is derived from the aponeurosis of external oblique

I think the above is correct (though it also includes aponeurosis of internal oblique and transversus abdominis). Nick though the below, with the assumption that they meant rectus sheath, rather than rectus abdominis

Contains rectus abdominis which is formed by fusion of external oblique, internal oblique and transversus abdominis.

  • Is supplied by T7-L1
  • Is divided for clinical purposes into either 4 or 9 regions
  • Contains transversus abdominis which arises from connective tissue deep to the lateral 1/3 of the inguinal ligament.
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2
Q

With regard to the cutaneous innervation of the thorax and abdomen

  • Above the 2nd rib, the skin is supplied by the cervical plexus (C4).
  • Loss of a single spinal segment will produce a sensory deficit.
  • It is supplied segmentally by the anterior primary rami of T1 to L1.
  • T8 supplies the skin at the level of the umbilicus.
  • The lower 8 thoracic nerves pass beyond the costal margin to supply the skin of the abdominal wall.
A

Above the 2nd rib, the skin is supplied by the cervical plexus (C4). Supraclavicular nerves (C3-4)

T1 supplies the medial forearm

  • Loss of a single spinal segment will not produce a sensory deficit - adjacent dermatomes have considerable overlap, but they do NOT overlap at axial lines
  • It is supplied segmentally by the anterior primary rami of T2 to L1.
    • T1 supplies medial forearm
  • T10 supplies the skin at the level of the umbilicus. (and T4 the nipple)
  • The lower 8 thoracic nerves pass beyond the costal margin to supply the skin of the abdominal wall.
    • Nick thought: This is also true (see image)
    • T7-T12 are listed as the thoracoabdominal nerves, which would be the lower 6 thoracic nerves
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3
Q

Which is incorrect

  • The inguinal canal of the female contains the round ligament of the uterus
  • The deep inguinal ring is an opening in transversus muscle.
  • The spermatic cord in the male emerges from the deep ring
  • The inguinal canal lies above the medial half of the inguinal lig
  • The roof of the inguinal canal is formed by the lower edges of internal oblique and transversus muscles
A

The deep inguinal ring is an opening in transversalis fascia

Actually an evagination - the fascia is the innermost layer of fascia surrounding the contents of the canal

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4
Q

All of the following structures pass though the deep inguinal ring except

  • Pampiniform plexus
  • Ilioinguinal nerve.
  • Genital branch of the genitofemoral nerve
  • Processus vaginalis
  • External spermatic fascia
A

I think External spermatic fascia as this is derived from external oblique aponeurosis, and hence unlikely to continue past the superficial inguinal ring

As per Nick:

Ilioinguinal nerve.

With iliohypogastric, pierces abdo muscles near the ASIS

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5
Q

Which structure in the inguinal canal is not part of the spermatic cord

  • Testicular artery
  • Genital branch of the genitofemoral n
  • Ilioinguinal n
  • Ductus deferens
  • Cremasteric artery
A

Ilioinguinal n

runs in inguinal canal outside of the spermatic cord

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6
Q

Pick the boundary of the inguinal canal

  • Floor – lacunar ligament.
  • Posterior wall – inguinal ligament.
  • Superficial ring – opening in internal oblique.
  • Anterior wall – conjoint tendon.
  • Roof – external oblique.
A

Floor – lacunar ligament.

Floor of the medial third

  • Floor of middle third – inguinal ligament
    • Posterior wall is transversalis fascia
  • Superficial ring – opening in aponeurosis of external oblique
  • Anterior wall – Aponeurosis of external oblique
  • Roof –Transversalis fascia laterally, centrally by musculo-aponeurotic arches of internal oblique and transversus abdominis, aponeurosis of external oblique medially
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7
Q

With regards to the spleen

  • Innervated by the coeliac plexus with the sympathetic and parasympathetic fibres.
  • Lymphatic drainage is through retro-pancreatic and coeliac nodes.
  • There is a colonic resonance found on percussion over the organ.
  • It is developed from the ventral mesogastrium.
  • Its hilum lies in the angle between the stomach and the right kidney.
A

Innervated by the coeliac plexus with the sympathetic and parasympathetic fibres.

  • Lymphatic drainage is through pancreaticosplenic -> coeliac nodes
  • There is not a colonic resonance found on percussion over the organ, as Colon = air, spleen = fluid
  • It is developed from the mesenchyme, whereas the gut is from endoderm
  • Its hilum lies in the angle between the stomach and the left kidney.
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8
Q

Regarding the spleen, which is false

  • It weighs 7 oz
  • Lymph drains to pancreaticosplenic nodes
  • It lies between the 9th and 11th ribs
  • Its lower pole often extends beyond the MAL.
  • It is supplied by sympathetic fibres only.
A

It is supplied by sympathetic fibres only.

Innervated from coeliac plexus, which has small amounts of para n.s

  • Its lower pole often extends beyond the MAL.
    • Moores does not reference where its lower pole is in relation to the MAL but a picture suggests it is just beyond the MAL
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9
Q

All are true of the spleen except

  • It is related to the 9, 10, 11th ribs
  • its blood supply is from a branch of the coeliac trunk
  • the splenic vessels are contained in the splenorenal ligament.
  • its anterior relation include the head of the pancreas
  • it has a notched anterior border.
A

its anterior relation is the Stomach.

Post = 9th – 11th ribs. Inferior = left colic flexure. Medial = left kidney

  • its blood supply is from a branch of the coeliac trunk
    • The splenic artery, largest branch of coeliac trunk
  • it has a notched anterior border (as well as superior ; inferior is smooth)
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10
Q

The spleen

  • Has a lower pole which normally projects forward to the anterior axillary line.
  • Lies between the 8th and 10th rib.
  • Has a long axis lying in the line of the 9th rib
  • As it enlarges, glides in contact with the anterior abdominal wall in front of the splenic flexure
  • When palpable on abdominal examination is identified by being resonant to percussion.
A

As it enlarges, glides in contact with the anterior abdominal wall in front of the splenic flexure

  • Has a lower pole which normally projects forward to the mid axillary line.
  • Lies between the 9th and 11th ribs
  • Has a long axis lying in the line of the 10th rib
  • When palpable on abdominal examination is identified by being dull to percussion.
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11
Q

Which is true of the spleen

  • Lower pole extends forwards to the anterior axillary line.
  • Long axis lies in the line of the 10th rib
  • Medial border is notched.
  • Kidney lies anterior to the hilum.
  • Gastrosplenic ligament runs from the lower pole to the lesser curvature of stomach.
A

Long axis lies in the line of the 10th rib

  • Lower pole extends forwards to the mid axillary line.
  • Superior and anterior borders is notched.
  • Kidney lies posterior to the hilum.
  • Gastrosplenic ligament runs from the upper pole / hilum to the greater curvature of stomach.
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12
Q

Which is the correct relation of the duodenum

  • 1st part – behind IVC.
  • 2nd part – anterior to the hilum of right kidney.
  • 3rd part – crossed by the IMA.
  • 3rd part – level of L2.
  • all but last 2cm is retroperitoneal.
A

2nd part – anterior to the hilum of right kidney. ​

  • 1st part – Anterior to IVC
  • 3rd part – level of L3 and crossed by SMA
  • all but first 2cm is retroperitoneal.
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13
Q

Directly in front of the right kidney lies

  • 2nd part of duodenum
  • portal vein
  • bile duct
  • splenic flexure of colon
  • IVC
A

2nd part of duodenum

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14
Q

Which is false regarding the duodenum

  • The duodenal cap has plicae circulares which are often evident on Xray.
  • The 3rd part may be compressed by the SMA
  • The 2nd part lies at the level of L2 in cadavers
  • The duodenal cap lies upon the bile duct, hepatic artery and portal vein
  • The accessory pancreatic duct opens into it proximal to the ampulla of Vater
A

The duodenal cap has no plicae circulares which are often evident on Xray.

Cap (aka ampulla) is the first 2cm which is in the peritoneum. Unlike the rest of the small bowel, it does not have the trademark plicae

Not mentioned in Moores - just that it is radiologically distinct

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15
Q

Which of the structures is not retroperitoneal

  • Kidney
  • Adrenal gland
  • Cisterna chyli
  • Spleen
  • Pancreas
A

Spleen

Intraperitoneal, fairly mobile

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16
Q

The duodenum:

  • is a retroperitoneal structure.
  • is 25cm long
  • lies between the levels of L2-L4.
  • in its fourth part lies to the R of the aorta.
  • all of the above
A

is 25cm long

Same as the ureter and the oesophagus

  • is a retroperitoneal structure (except first 2cm)
  • lies between the levels of L1 to 3
  • in its fourth part lies to the left of the aorta.
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17
Q

Appendix

  • Usually lies retrocaecal in health.
  • Drains to inguinal nodes
  • Has no mesentery
  • Has a tip constant in relation to the caecum
  • Opens into the caecum 2 cm below the ileocaecal valve
A

Usually lies retrocaecal in health.

As per Moores

Opens into the caecum 2 cm below the ileocaecal valve

Given as correct (I think an older textbook had A as wrong - Moores just states opens ‘inferior to ileocaecal valve’ without a specific distance)

  • Drains to ileocolic and superior mesenteric nodes
  • Has a small mesentery - the mesoappendix
  • Has a base constant in relation to the caecum.
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18
Q

Which of the following is untrue about the appendix (2 answers)

  • It has a base constant in relation to the caecum
  • It has its own mesentery.
  • It is formed by teneae coli convergence
  • Varies in length from 2 to 25cm.
  • It always lies in retro-ileal position with disease
A

It always lies in retro-ileal position with disease

Seems definitely wrong as appendix can be in different places when inflamed - can cause RUQ pain in some cases

Varies in length from 6-10cm.

Moores says usually 6-10cm - cannot confirm that 2-25cm have never been found but based on Moores this also seems false

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19
Q

Where does the appendix mostly lie in health

  • Retro-ilial.
  • Retrocaecal
A

Retrocaecal

Retroilial given as answer but clearly stated as retrocecal in Moores.

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20
Q

Which is true of colon

  • Ascending is longer than descending.
  • Only part suspended on mesentery is transverse.
  • Marginal artery is weakest at hepatic flexure
  • Lymphatic drainage is via superior and inferior mesenteric LN
A

Lymphatic drainage is via superior and inferior mesenteric LN

  • Ascending is shorter than descending as splenic flexure is higher than hepatic
  • Transverse and sigmoid are suspended by mesentery
  • Marginal artery is weakest at splenic flexure
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21
Q

Concerning the colon

  • Appendices epiploicae are most frequent on the ascending colon
  • The transverse colon is normally shorter than the descending colon
  • The blood supply includes the SMA
  • Parasympathetic supply does not include the X
  • None of the above
A

The blood supply includes the SMA

  • The transverse colon is normally the longest segment, then decending > ascending (splenic flexure is higher)
  • Parasympathetic supply does include the X
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22
Q

Regarding radiology of GIT

  • The terminal ileum can be identified by haustrations.
  • Haustrations represent teniae coli
  • Air fluid levels are diagnostic of large bowel obstruction.
  • Gas should always be visible in the rectum
  • Small bowel is always visible on a normal AXR
A

Haustrations represent teniae coli

  • Haustra are in large bowel, not ileum
  • Air fluid levels are diagnostic of small or large bowel obstruction.
  • Gas should always be visible in the rectum - be wary of always
  • Small bowel is sometimes visible on a normal AXR - be wary of always
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23
Q

Which lymph nodes drain the lower anal canal

  • Superficial inguinal.
  • External iliac
  • Deep inguinal
  • Para-aortic
  • Internal iliac.
A

Superficial inguinal.

Below the pectinate line

Superior to the pectinate line -> Internal iliac -> common iliac -> lumbar nodes

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24
Q

The internal anal sphincter

  • Is skeletal muscle.
  • Has longitudinal fibres.
  • Has no bony attachments
A

Has no bony attachments

  • Is smooth muscle
  • The sphincter is a thickening of the circular muscle layer
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25
Q

With regard to the blood supply of the rectum and anus:

  • It is principally the inferior rectal artery
  • The anal canal is a site of porto-systemic anastomoses
  • The veins do not correspond with the arteries.
  • The IMA changes to the superior rectal artery at L3.
  • The vessels do not supply the full thickness of the anal wall.
A

The anal canal is a site of porto-systemic anastomoses.

Sup rectal vein -> portal, inf and middle -> systemic

  • It is principally the inferior rectal artery
  • The veins do correspond with the arteries
  • The IMA arises from aorta at L3, changes to SRA at pelvic brim
  • The vessels do supply the full thickness of the anal wall.
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26
Q

The rectum

  • Is continuous with sigmoid colon at the level S3
  • Has an incomplete outer layer of longitudinal muscle.
  • Is attached to mesentery.
  • Has a small amount of lymphatic drainage to inguinal LN.
  • Is principally supplied by branches of the internal iliac artery
A

Is continuous with sigmoid colon at the level S3

  • Has an complete outer layer of longitudinal muscle
    • At the rectosigmoid junction, the teniae (3 longitudinal bands) form a continuous outer layer of longitudinal muscle (typically 3 distinct bands)
  • Is not attached to mesentery - Rectum is retro-peritoneal, then sub-peritoneal as it descends
    • Sigmoid is intra-peritoneal, suspended by long mesocolon that can twist.
  • Has no amount of lymphatic drainage to inguinal LN (but the anal verge inferior to the pectinate line -> superficial inguinal nodes)
    • ​Rectum -> internal iliac nodes
  • Mixed arterial supply: Sup rectal is from IMA, middle rectal from internal iliac, inferior rectal from internal pudendal
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27
Q

Which is not true of the stomach

  • Completely invested by peritoneum
  • Cardia at T11
  • Pyloric opening at L1
  • Aorta to the left of the lesser curve
  • Supplied by the branches of the coeliac trunk
A

Aorta to the right of the lesser curve

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28
Q

All of the following are veins which drain the stomach except

  • Gastro-omental
  • Gastroduodenal
  • Right gastric
  • Left gastric
  • Short gastric
A

Gastroduodenal
There is a gastroduodenal artery -> superior pancreaticoduodenal and right gastro-omental arteries (but does not supply stomach itself)

But does not seem to be a corresponding vein

Gastro-omental is a left (-> splenic vein -> SMV -> porta hepatis) and right (-> SMV -> porta) branch

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29
Q

The duodenum

  • Is retroperitoneal except for the 4th part.
  • IVC is behind 2nd part.
  • 2nd part lies alongside the head of the pancreas
  • inferior border of the 4th part lie at the origin of the IMA.
  • ligament of Trietz marks the opening of the bile duct into the duodenum.
A

2nd part lies alongside the head of the pancreas

Curves around it

  • Is retroperitoneal except for f**irst 2cm of the first part
  • IVC is behind 3rd part.
  • inferior border of the 4th part lie inferior to the origin of the IMA.
    • IMA arises at L3 level.
    • 3rd part of duodenum crosses L3, then the 4th part ascends from the left of L3 level to sup border of L2. Therefore, the inferior border of the 4th part would be inferior and to the left of IMA origin (maybe just to the left)
    • 3rd part is crossed by SMA
  • Major duodenal papilla marks the opening of the bile duct into the duodenum
    • Ligament of trietz is the mesenteric suspension of the duodenaljejunal flexure
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30
Q

The first part of the duodenum

  • Lies at the level of L2 in the supine body.
  • Is approximately 10cm long in adults.
  • Partially overlies the right crus of the diaphragm and psoas muscle
  • Is entirely retroperitoneal.
  • Receives the common opening of the bile duct on its posteromedial wall
A

Partially overlies the right crus of the diaphragm and psoas muscle

  • Lies at the level of L1 in the supine body.
  • Is approximately 5cm long in adults.
  • Is 60% retroperitoneal - First 2cm is peritoneal
  • 2nd part of the duodenum receives the common opening of the bile duct on its posteromedial wall.
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31
Q

The main vessel supplying the body of the pancreas is the

  • Superior pancreaticoduodenal a
  • Splenic a
  • Left gastric a
  • Left gastroepiploic
  • Inferior pancreaticoduodenal
A

Splenic a

  • Gives off up to 10 branches to the body*
  • ​(Ant + post) Superior (from gastroduodenal) and inferior (from SMA) pancreaticoduodenal arteries supply the head*
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32
Q

All of the following are relations to the body of the pancreas except

  • L crus of diaphragm
  • L psoas
  • L kidney hilum.
  • Bile duct
  • Lesser sac
A

I am tempted to go with bile duct as this is in contact with the head

As per Moores:

Passes over aorta and L2; is posterior to omental bursa, and in floor of omental bursa and part of bed of stomach. Posterior aspect is in contact with aorta, SMA, left adrenal gland, and left kidney and renal vessels

Nick thought hilum of kidney but this is definitely wrong as above.

Diaphragm and psoas not specifically mentioned but likely given it is retroperitoneal. Lesser sac and hilu, definitely right.

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33
Q

The pancreas

  • Has no anatomical relationship with the spleen
  • Lies over the IVC at L2
  • Receives its blood supply from the SMA.
  • Receives no sympathetic nerve supply
  • Passes anterior to the duodenum
A

Lies over the IVC at L2

Head lies on IVC, body lies on aorta

  • Lies with the spleen on its left (duodenum on the right, stomach anteriorly)
  • Receives its blood supply from the Coeliac trunk primarily (-> splenic -> pancreatic arteries + superior pancreaticoduodenal), but also receives the inferior pancreaticoduodenal arteries from the SMA
  • Receives sympathetic nerve supply from the superior mesenteric plexus
  • Passes superior/inferior/left to the duodenum (lies in the curve of the duodenum so is never in front of it)
34
Q

Which does not pass through the transpyloric plane?

  • Splenic vein
  • Tips of the 9th costal cartilage
  • Lower border of L1
  • Spleen
  • SMA
A

Spleen

  • Part of the 9th ribs do, but unclear if it is the tips of the costal cartilages - the plane is at the level of the 8th CC.*
  • Diagram in Moores clearly shows the splenic vein without the spleen but does not have a written list per se.*
35
Q

Which is not a structure in the transpyloric plane

  • Pancreas
  • SMA origin
  • Fundus of gallbladder
  • Tip of 8th costal cartilage
  • Lower pole of right kidney.
A

Lower pole of right kidney.

Hila of both kidneys in transpyloric plane but right kidney is lower than left due to the liver, hence the lower pole will be well below the transpyloric plane

36
Q

Regarding the liver

  • The porta hepatis is on the posterior surface.
  • at the porta hepatis, the vessels lie in order: vein, duct, artery (posterior to anterior).
  • there is no arterial connection between the left and right halves of the liver.
  • parasympathetic nerves synapse in the coeliac ganglia.
  • the portal triad contains the hepatic artery, central vein and bile ductules.
A

there is no arterial connection between the left and right halves of the liver.

Hence their resectability

  • The porta hepatis is on the Visceral surface, which is postero-inferior
  • at the porta hepatis, the vessels lie in order: Vein, artery, duct (posterior to anterior).
  • Innervation of the liver: symp via celiac plexus, para from ant/post vagal trunks
  • the portal triad contains the hepatic artery, portal vein and bile ductules.
37
Q

Direct tributaries of the portal vein include all except

  • Right gastric vein
  • Short gastric vein.
  • Splenic vein
  • Superior pancreaticoduodenal vein
  • Left gastric vein
A

Short gastric vein.

Drain into the splenic vein (drain the greater curvature of the stomach, and drain towards the hilum of the spleen)

38
Q

Which is not true of the surface markings of the liver

  • Lies below the 7-11th ribs in the right MAL
  • Highest point on the right is the 5th rib
  • Superior surface crosses the xiphisternal joint
  • Inferior margin lies level with the right costal margin in most cases
  • Highest point on left is the 6th IC space.
A

Highest point on left is the 5th rib

39
Q

Which is true of the liver

  • Protected from ischaemia by good anastomosis between R & L lobes.
  • Divided functionally into right and left lobes along the falciform ligament.
  • Drains into 3 hepatic veins which have a long extrahepatic course.
  • Left lobe may be supplied by a branch of the left gastric artery
  • Caudate lobe has no connections with the right lobe.
A

Caudate lobe has no connections with the right lobe.

  • Not the answer Nick got, but I think this is correct - Moores states the Caudate lobe can be considered an independent lobe as it gets its blood supply independent of the bifurcation of portal vessels (from both left and right) and has its own hepatic veins which drain directly into the IVC.*
  • ie it is functionally independent (whilst remaining physically attached)*
  • Each lobe has an independent blood supply
  • Falciform ligament and left sagittal fissure divide into external lobes, but these are not functional divisions, merely external.
  • Drains into 3 hepatic veins (right, middle, left) which have a very short extrahepatic course before draining into the IVC
  • Left lobe may be supplied by a branch of the left gastric artery
    • Nick thought this was correct, though no mention is made in Moores of it.
40
Q

Which is the correct order of the structures in the porta hepatis (ant – post)

  • Right and left hepatic arteries – right and left portal veins – right and left hepatic ducts
  • R/L portal veins, R/L hepatic ducts, R/L hepatic arteries
  • R/L hepatic ducts, cystic duct, R/L hepatic arteries, R/L portal veins
  • R/L hepatic ducts, R/L hepatic arteries, cystic duct, R/L portal veins.
  • R/L hepatic ducts, R/L hepatic arteries, R/L portal veins
A

R/L hepatic ducts, R/L hepatic arteries, R/L portal veins

Ducts-arteries-veins (ant-post)

Cystic duct is not in the portal triad

41
Q

With regard to the blood supply of the liver

  • The right branch of the hepatic artery normally passes in front of the common hepatic duct.
  • The hepatic artery sometimes arises from the SMA of aorta
  • The hepatic artery, portal vein and accompanying tributaries of the hepatic ducts lie together in the sinusoids.
  • There are 2 main hepatic veins
  • Arterial and portal venous blood becomes mixed in the canals
A

The hepatic artery sometimes arises from the SMA of aorta

SMA->common hepatic-> hepatic artery proper

  • The right branch of the hepatic artery normally passes behind the common hepatic duct - duct-artery-vein (ant-post)
  • The hepatic artery, portal vein and accompanying tributaries of the hepatic ducts dont lie together in the sinusoids.
    • Sinusoids are the capillaries -> note in diagram below blood travels in a different path to the bile
  • There are 3 main hepatic veins - right, left, intermediate/central
  • Arterial and portal venous blood becomes mixed in the sinusoids - bile flows in the canals
42
Q

Regarding CBD all are true except

  • Opens into the posteromedial wall of the 3rd part duodenum
  • Is approximately 8cm long
  • Upper 1/3 lies in the free edge of the lesser omentum
  • The middle 1/3 runs behind the 1st part of the duodenum
  • Lower 1/3 grooves the back of the head of the pancreas
A

Opens into the posteromedial wall of the 2nd part duodenum

43
Q

Which is the correct porto-systemic anastomosis

  • Portal – tributary of inferior mesenteric vein, systemic – tributary of the internal iliac vein.
  • Portal – periumbilical vein, systemic – phrenic vein.
  • Portal – intrahepatic portal branches, systemic – azygous vein.
  • Portal – left gastric vein (oesophageal branches of left gastric vein), systemic – IVC via oesophageal veins.
  • Portal – middle rectal vein, systemic – inferior rectal vein.
A

Portal – tributary of inferior mesenteric vein, systemic – tributary of the internal iliac vein.

  • Sup rectal vein -> IMV*
  • inf and middle rectal veins into the internal iliac*
  • Portal – periumbilical vein, systemic – superficial epigastric vein
  • Portal – intrahepatic portal branches, systemic – hepatic artery
  • Portal – left gastric vein (oesophageal branches of left gastric vein), systemic – oesophageal branches of azygous vein
  • Portal – superior rectal vein, systemic – inferior or middle rectal vein.
44
Q

The ureters

  • Widest in diameter at the PUJ.
  • Innervated by sympathetic n T12-L1.
  • Lie lateral to the tips of the lumbar transverse processes.
  • Depend on innervation from the pelvis for peristalsis.
  • None of the above are true
A

None of the above are true

  • Narrowest in diameter at the PUJ
  • Innervated by sympathetic n T11-L2
  • Lie medial to the tips of the lumbar transverse processes
  • Have i**ntrinsic peristalsis
45
Q

Regarding the kidneys

  • Each weigh around 340g
  • The left kidney lies below the transpyloric plane.
  • The iliohypogastric and ilioinguinal nerves lie in front of the posterior surface of the kidney.
  • Each kidney has 6 segments
  • The hilum is separated from the peritoneum on the right side by the 3rd part of duodenum.
A

Each weigh around 340g

  • The left kidney lies at the transpyloric plane - it passes through the hilum (and upper pole of right kidney)
  • The iliohypogastric and ilioinguinal nerves run behind the posterior surface of the kidney.
    • Makes no sense – anterior to the posterior surface is within the kidney.
  • Each kidney has 5 segments
  • The hilum is separated from the peritoneum on the right side by the 2nd part of duodenum
46
Q

The ureters

  • Cross the gonadal vessels.
  • Cross over the vas deferens.
  • Are crossed by the genitofemoral n.
  • Pass under the cover of the psoas.
  • Lie lateral to the lumbar transverse processes.
  • Do not cross the SI joint. Enters pelvis anteriorly to SIJ
A

Do not cross the SI joint.

Enters pelvis anteriorly to SIJ

  • Crossed by the gonadal vessels and vas deferens
  • Cross the genitofemoral n.
  • Pass on top of psoas.
  • Lie medial/at the lumbar transverse processes.
47
Q

Regarding the kidneys

  • The hilum of the left is just below that of the right.
  • The hilum faces medially and somewhat posteriorly
  • The long axis is parallel with the lateral border of the psoas
  • The perinephric fat is surrounded by renal fascia.
  • The renal artery lies in front of the renal vein.
A

The long axis is parallel with the lateral border of the psoas

Given as true by Nick, not mentioned in Moores. Below definitely appears correct.

The perinephric fat is surrounded by renal fascia.

‘This is also true. A possible exception might be the inferior extension of the fascia as peri-ureteric fascia’

  • The hilum of the left is just above that of the right
  • The hilum faces medially and somewhat anteriorly
  • The renal artery lies behind the renal vein.
48
Q

Regarding the left kidney

  • Anterior relations include the spleen.
  • Posteriorly lies the costodiaphragmatic recess
  • The suprarenal gland lie within the renal fascia.
  • The lateral femoral cutaneous nerve lies posteriorly
  • The median arcuate ligament lies posteriorly
A

Anterior relations include the spleen.

The suprarenal gland lie within the renal fascia.

Lie within the fascia but are separated from the kidneys by a thin septum of the fascia. Both these seem to be correct

  • Posteriorly lies the costodiaphragmatic recess
    • Diaphragm is posterior - costodiaphragmatic recess will be either posterior to that, or more likely superior as the spleen sites higher.
  • The subcostal, iliohypogastric, and ilioinguinal nerves lies posteriorly
  • The median arcuate ligament lies posteriorly
    • Probably medially
49
Q

The ureters

  • The lower 1/3 are supplied by gonadal arteries.
  • They are supplied by somatic fibres T11 – L2.
  • They are superficial to uterine arteries in females.
  • The apex of the sigmoid mesocolon is a guide to position of left ureter
  • The pelvic part accounts for a quarter of its length
A

The apex of the sigmoid mesocolon is a guide to position of left ureter

Not mentioned in Moores

  • The lower 1/3 are supplied by Internal iliac arteries
  • They are supplied by visceral afferent fibres T11 – L2.
  • They are deep to uterine arteries in females
  • The pelvic part accounts for a quarter of its length
    • ??
50
Q

Regarding the ureters (2 correct)

  • They exit the hilum behind the renal artery.
  • They are a continuation of the renal pelvis which is formed by the union of 10 major calyces
  • They are each 40cm long.
  • On an XR KUB they run just lateral to the transverse process of the lumbar vertebrae.
  • The lower ends are supplied by the ureteric branch of the renal artery.
  • Derives its sole supply from the ureteric branch of the renal artery.
  • Begins at the level of the tip of the 8th costal cartilage
  • Run posteriorly to the internal iliac artery.
  • Is more superficial than the ductus deferens in males.
A

They exit the hilum behind the renal artery.

Posterior to anterior: pelvis, artery, vein

Begins at the level of the tip of the 8th costal cartilage.

Hila at transpyloric plane, which is at this level

  • They are a continuation of the renal pelvis which is formed by the union of 2-3 major calyces, each with 2-3 minor ones
  • They are each 25cm (same as oesophagus and duodenum)
  • On an XR KUB they run just medial to the transverse process of the lumbar vertebrae
  • The upper ends are supplied by the ureteric branch of the renal artery.
  • Derives its blood supply from the ureteric branch of the renal artery, and Branches from aorta and gonadal arteries
  • Run anteriorly to the internal iliac artery.
  • Is deep to the ductus deferens in males.
51
Q

The ureter

  • On Xray lies lateral to tips of transverse processes of lumbar vertebrae.
  • Runs down on quadratus lumborum
  • Is intraabdominal.
  • Passes over the SIJ to enter pelvis
  • On the right is in front of the duodenum.
A

Passes over the SIJ to enter pelvis

  • On Xray lies medial to tips of transverse processes of lumbar vertebrae.
  • Runs down on Psoas major
  • Is Retroperitoneal
  • On the right is behind the duodenum
52
Q

The ureter (2 correct)

  • Passes anterior to the genitofemoral nerve
  • Develops from the metanephric cap
  • Is represented by the dermatome L2.
  • In the male is crossed anteriorly by the ductus deferens.
  • Passes anterior to the uterine artery in females
A

Passes anterior to the genitofemoral nerve

(and ilioinguinal nerve, both branches of L1 that run on the internal abdominal wall)

In the male is crossed anteriorly by the ductus deferens

  • Is represented by the dermatome L2.
    • Visceral afferents via symp nerves from T10 – L2
  • Passes posterior to the uterine artery in females.
53
Q

Which is true of the relations of the kidneys

  • Left hilum lies just below the transpyloric plane.
  • Middle colic artery crosses the lower pole of the right kidney.
  • The structures in the hilum from front to back are vein, artery, ureter
  • Vertical axis lies in the same axis at the vertebral column
  • Right adrenal gland lies medial to the upper pole.
A

The structures in the hilum from front to back are vein, artery, ureter

  • Right hilum lies just below the transpyloric plane. Left is at the transpyloric level
  • Middle colic artery crosses the lower pole of the right kidney. Unlikely, as the middle colic is an early branch of the SMA that heads superiorly and to the right to supply the transverse colon
  • Vertical axis lies in the same axis at the vertebral column
  • Right adrenal gland lies superior to the upper pole.
    • The left adrenal lies medial to the upper pole. Note that the major attachments for the adrenals are to the crura of the diaphragm
54
Q

Which does not cross the ureter

  • Right colic artery
  • Gonadal vessels
  • Apex of the sigmoid mesocolon
  • Ileocolic artery
  • IMA
A
55
Q

Which is true of the ureter’s blood supply

  • Poor anastomosis makes blood supply easily endangered.
  • Receives supply from the gonadal vessels
  • CIA supplies only the most distal portion
  • Distal portion receives its supply from the posterior division of the IIA
  • Renal artery provides no blood supply.
A

Receives supply from the gonadal vessels

  • Have good anastamoses, but the blood supply is very fragile and easily endangered
  • CIA supplies only the most distal portion
    • IIA and uterine arteries also supply, and these are inferior to the CIA
  • Distal portion receives its supply from the posterior division of the IIA
    • Moores only mentions the internal iliac, not its branches
  • Renal artery Supplies upper part
56
Q

Right adrenal gland

  • Lies on the medial surface of the upper pole of right kidney.
  • Lies on the quadrate lobe of liver
  • Adrenal vein drains into right renal vein.
  • Is supplied by a branch of the renal artery only. Sup branches from the inferior phrenic artery, middle branches from aorta
  • Is separated from the kidney by renal fascia
A

Is separated from the kidney by renal fascia

  • Lies on the superior surface of the upper pole of right kidney, and medial to upper pole of left
  • Lies on the ???caudate lobe of liver
  • Right adrenal vein drains into IVC. Left adrenal vein drains into left renal vein
  • Is supplied by a branch of the renal artery, and also branches from the inferior phrenic artery, middle branches from aorta
57
Q

Referred pain from pancreatitis is at what level

  • T7,8
  • L1,2
  • T3,4
  • T12,L1
A

T7,8

Heart = T1-4 - chest and medial arm

Foregut = T5-9 - Lower chest/epigastric

Midgut = T10-11 - umbilical

Hindgut = L1-2 - Flank, groin, anterior thigh

Kidneys/ureters = T11-12 - flanks and pubic region

58
Q

The lumbar plexus

  • Is immediately medial to IVC.
  • Is formed from the posterior rami.
  • Is derive from the last 3 lumbar nn.
  • The femoral nerve is formed from L2,3 and 4
  • The pudendal nerve is a branch of the lumbar plexus.
A

The femoral nerve is formed from L2,3 and 4

  • ????Is immediately medial to IVC.
  • Is formed from the Anterior rami
  • Is derive from the first 3 lumbar nn (+/- L4)
  • The pudendal nerve is a branch of the Sacral plexus (S2-4)
59
Q

The ilioinguinal nerve

  • Enters the inguinal canal though the deep ring
  • Supplies motor fibres to internal oblique and transversus
  • Has roots from L1 and L2.
  • Supplies sensory fibres to the anterior 2/3 of the scrotum.
  • Has a collateral branch from the iliohypogastric.
A

Supplies motor fibres to internal oblique and transversus

  • Exits the inguinal canal though the superficial ring
    • Enters by piercing internal oblique
  • Has roots from just L1
  • Supplies sensory fibres to the Upper medial thigh and either labia majora / penis root and anterior scrotum
  • Has a collateral branch from the iliohypogastric.
    • According to wikipedia they do communicate
60
Q

With regard to the spinal cord blood supply

  • There are 2 anterior spinal arteries.
  • The anterior spinal artery arises from the vertebral a
  • The posterior spinal artery is singular
  • The posterior spinal artery arises from the posterior superior cerebellar
  • The anterior spinal artery retains a uniform size throughout its length
A

The anterior spinal artery arises from the vertebral a

  • There is 1 anterior spinal artery, and 2 posterior
  • The anterior spinal artery is singular
  • The posterior spinal artery arises from the posterior inferior cerebellar artery
  • The anterior spinal artery becomes much smaller at the filum terminale
61
Q

The highest branch of the abdominal aorta is:

  • R suprarenal a.
  • Coeliac trunk.
  • L renal a.
  • L gonadal a.
  • SMA.
A

Coeliac trunk - T12

(along with inferior phrenic arteries but these were not an option)

  • L1 - SMA, right suprarenal, left renal
  • L2 - left gonadal
62
Q

the abdominal aorta

  • left renal vein lies between the origins of coeliac trunk and SMA.
  • renal arteries arise at L1.
  • body of the pancreas lies in front of the coeliac trunk
  • gives off 5 lumbar aa.
  • gives off the CIA at L3.
A

renal arteries arise at L1. ​

  • middle suprarenal artery lies between the origins of coeliac trunk and SMA (all L1, suprarenal -> SMA -> renal sup-inf)
  • body of the pancreas lies in front of the SMA
  • gives off 4 lumbar aa.
  • gives off the CIA at L4
63
Q

Lymph from the perineal region drains initially to the

  • Paraaortic nodes
  • Rectal nodes
  • Deep inguinal nodes
  • Medial group of superficial inguinal nodes
  • Lateral group of superficial inguinal nodes
A

Medial group of superficial inguinal nodes

64
Q

Superior pancreaticoduodenal vein drains into

  • L gastric vein
  • Portal vein.
  • Splenic vein
  • Superior mesenteric vein.
  • IVC
A

Superior mesenteric vein.

(B) (Portal vein) is stated as the correct answer but Moore’s clearly shows it is the SMV

Portal vein = Formed by the union of splenic vein and SMV

Some images from other sources show the superior PDV draining to the portal vein however Moores doesnt appear to.

65
Q

Regarding the abdominal aorta (2 CORRECT)

  • Renal arteries originate at T12
  • Splenic vein crosses the aorta just below the SMA origin
  • Surface marking from a point just above the transpyloric plane to a point to the left of the umbilicus
  • Lies to the right of the IVC.
  • Enters the abdomen at the level of T10.
  • Gives off renal arteries at L1
  • Is crosses anteriorly by the tail of the pancreas
  • Divides over the sacrum into 2 common iliac aa.
A

Gives off renal arteries at L1

Surface marking from a point just above the transpyloric plane to a point to the left of the umbilicus

  • Splenic vein crosses the aorta just above the SMA origin
  • Lies to the left of the IVC.
  • Enters the abdomen at the level of T12 (T10 = oesophagus)
  • Is crosses anteriorly by the body of the pancreas.
  • Divides over L4 into 2 common iliac aa.
66
Q

Superficial inguinal lymph nodes drain all of the following except

  • Anterior thigh
  • Base of penis
  • Testis
A

Testis

67
Q

With respect to the blood supply of the gut

  • Coeliac trunk supplies the 3rd part of duodenum.
  • The SMA arises at L2.
  • SMA supplies the hepatic flexure
  • IMA supplies the hind gut to anus.
  • IMV drains directly into IVC
A

SMA supplies the hepatic flexure.

Major duodenal papilla to proximal 2/3 transverse colon

  • Coeliac trunk supplies the Abdominal oesophagus to major duodenal papilla (2nd part)
  • The SMA arises at L1 (along with renal arteries and middle suprarenal arteries)
  • IMA supplies the hind gut to anus. IMA ​supplies hindgut, which is distal 1/3 transverse colon to midway through the anal canal (sup rectal artery)
  • IMV drains directly into splenic vein then portal vein
68
Q

The anterior relations of the abdominal aorta include

  • The lateral arcuate ligament
  • The splenic vein inferior to the SMA.
  • The left renal vein inferior to the IMA.
  • The parietal peritoneum inferior to the duodenum
  • The sympathetic trunk
A

The parietal peritoneum inferior to the duodenum

  • The Median arcuate ligament
  • The splenic vein superior to the SMA.
  • The left renal vein Superior to IMA, inferior to SMA
  • The sympathetic trunks Lie next to the vertebral bodies
69
Q

The abdominal aorta is crossed anteriorly by

  • Left renal artery
  • IMA
  • Left renal vein
  • Right gonadal artery
  • Right renal vein
A

Left renal vein

Behind the pancreas and splenic vein, in front of the aorta

70
Q

Which is not a branch of the anterior division of the IIA

  • Internal pudendal
  • Superior gluteal
  • Uterine
  • Obturator
  • Superior vesicle
A

Superior gluteal

Off the posterior divison

71
Q

Which is not true of the abdominal aorta

  • Begins at T12
  • Ends at L5.
  • Inclines to the left
  • Direct continuation is median sacral artery
  • Gives off 4 pairs of lumbar arteries
A

Ends at L4

Lumbar arteries L1-4

72
Q

Which is true of the coeliac trunk and its branches

  • Inferior pancreaticoduodenal artery encircles the head of the pancreas.
  • Left gastric artery supplies the stomach only.
  • Gastroduodenal artery runs in front of the 1st part of the duodenum.
  • Hepatic artery runs in front of the portal vein
  • Right gastro-omental artery runs along the lesser curvature of the stomach.
A

Hepatic artery runs in front of the portal vein

Duct-artery-vein (Ant-post)

  • Superior pancreaticoduodenal artery encircles the head of the pancreas - Inferior PDA comes off SMA
  • Left gastric artery supplies the stomach and Abdominal oesophagus
  • Gastroduodenal artery runs behind the 1st part of the duodenum.
  • Right gastro-omental artery runs along the greater curvature of the stomach.
73
Q

Which is true of the SMA and its branches

  • Right colic artery is the main supply of the caecum.
  • SMA runs anterior to the 1st part of the duodenum.
  • Right colic artery passes behind the right ureter.
  • SMA arises from the aorta at L2.
  • Main trunk of the SMA ends at the level of Meckel’s diverticulum
A

Main trunk of the SMA ends at the level of Meckel’s diverticulum

Apparently, Moores doesnt mention this, but it does mention the others are all wrong.

  • Ileocolic artery is the main supply of the caecum.
  • SMA runs anterior to the 3rd part of the duodenum.
  • Right colic artery passes in front of the right ureter.
    • Right ureter runs on psoas major so colic artery won’t pass behind it
  • SMA arises from the aorta at L1
74
Q

Which is true of the IMA and its branches

  • IMA ends as the superior rectal artery
  • The main trunk crosses the left ureter, but its branches pass behind it.
  • It arises from the aorta at the level of L2.
  • The descending branch of the left colic supplies the sigmoid only.
  • There is very little anastomosis between the branches.
A

IMA ends as the superior rectal artery

  • The main trunk and its branches crosses the left ureter, but its branches pass behind it.
    • Only genitofemoral nerve and iliacs are posterior to the ureters
  • It arises from the aorta at the level of L3
  • The descending branch of the left colic supplies the sigmoid and d**escending colon
  • There is are many anastomosis between the branches - the marginal artery and branches
75
Q

Regarding the innervation of the bladder

  • Parasympathetics are via pelvic splanchnic nn.
  • Sympathetic innervation comes from L3 and L4 segments of the cord.
  • Sympathetic fibres are excitatory to the bladder.
  • Bladder distension sensation travels with the sympathetics.
  • Bladder pain only travels with the superior hypogastric plexus.
A

Parasympathetics are via pelvic splanchnic nn (S2-4)

Sympathetics are from L1-2 via hypogastric plexus

  • Sympathetic innervation comes from lower thoracic and upper lumbar segments of the cord.
  • Sympathetic fibres are excitatory to the Internal sphincter only (prevent retrograde ejaculation, and passing urine cos you’re embarassed at a busy urinal)
    • ​Parasympathetic is excitatory to the detrusor
  • Bladder distension sensation travels with the Parasympathetic fibres
  • Bladder pain only travels with the inferior hypogastric plexus.
76
Q

The bladder

  • Main motor innervation via parasympathetic fibres.
  • In its non-distended state has 1/5 of it volume in the abdominal cavity.
  • Is connected via the pubovesical ligaments to the superior aspect of the pubic bone
  • Has the openings of the urethral orifice 5cm apart in its non-distended state
  • Receives its major blood supply from the obturator artery.
A

Main motor innervation via parasympathetic fibres.

Para – contracts detrusor muscle, relaxes internal urethral sphincter. Symp – contracts internal sphincter.

  • In its non-distended state has is e**ntirely within the pelvis (in adults)
  • Is connected via the pubovesical ligaments to the posterior aspect of the pubic bone
  • Has the openings of the urethral orifice 5cm apart in its non-distended state
    • Externally they enter 5cm apart, internally they are 2.5cm apart due to their oblique course, in its empty state
  • Receives its major blood supply from the Superior and inferior vesicular arteries (branches of internal iliac)
77
Q

Regarding the testicular blood supply

  • Division of the testicular a results in testicular infarction
  • Testicular artery has numerous anastomoses with the cremasteric a
  • Pampiniform plexus is a superficial plexus surrounding the testicular a
A

Pampiniform plexus is a superficial plexus surrounding the testicular a

  • Division of the testicular a results in testicular infarction
    • Anastamoses with the artery to ductus deferens
  • Testicular artery has no anastomoses with the cremasteric a
78
Q

Lymph drainage of testes

  • The deep inguinal nodes
  • The mediastinal nodes
  • The para-aortic nodes
  • The pectoral group of axillary nodes
  • The external iliac nodes
A

The para-aortic nodes

Scrotum = superifical inguinal

79
Q

Lymph drainage of scrotum

  • The superficial inguinal nodes
  • The internal iliac nodes
  • The deep inguinal nodes
  • The external iliac nodes
  • Non of the above
A

The superficial inguinal nodes

Testicular = para-aortic

80
Q

The pelvic floor

  • Consists of ischiococcygeus, iliococcygeus and pubococcygeus.
  • Muscles have significant insertion into the sacrum.
  • Creates a gutter that slopes down and back.
  • Has the anococcygeal raphe as its superficial part.
  • None of the above
A
  • Consists of iliococcygeus and pubococcygeus - No ischiococcygeus muscle, and also includes perineal membrane
  • Muscles have significant insertion into the sacrum.
    • Coccygeus inserts onto coccyx and some of the sacrum, levator ani onto the perineal membrane (anteriorly) and sacrococcygeal ligament (posteriorly)
  • Creates a gutter that slopes down and back.
    • Likely referring to the ischio-anal fossae, which are down and forward
  • Has the anococcygeal raphe as its superficial part.
    • Can see on the diagram below (unlabelled) – likely to be considered a deep part of the pelvic floor, given that a number of structures lie superficial to it
  • None of the above

Anatomy (6 decks)

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