Abdomen MRCS part B Flashcards
1
Q
which parts of the duodenum are retroperitoneal?
A
2nd, 3rd, 4th parts
2
Q
the duodenum forms a C shape around what part of the pancreas?
A
Head of pancreas
3
Q
What lies in the free edge of the lesser omentum?
A
Hepatic Artery, portal vein
4
Q
what are the 5 sites of porto-systemic anastomoses?
A
Retroperitoneum Upper anal canal Bare area of liver Oesophagus Periumbilical area
5
Q
what are the 4 functions of the spleen?
A
F - filtration of encapsulated organisms + blood cells
I - immunological function
S - Storage of platelets
H - haematopoiesis in the fetus
6
Q
what is the surface anatomy of the spleen?
A
LUQ 9-12th ribs
7
Q
what is the most common place of intra abdominal fluid collection?
A
Rutherford Morrison pouch (R subhepatic space)
8
Q
which part of the duodenum is related to the head of the pancreas?
A
2nd part
9
Q
peyers patches are present in which part of the intestine?
A
ileum
10
Q
which parts of the pancreas perform the exocrine function of the pancreas?
A
Pancreatic Acini
11
Q
which cells produce insulin?
A
Beta cells of islets of langerhans
12
Q
which cells produce glucagon?
A
Alpha cells of islets of langerhans
13
Q
which cells produce somatostatin?
A
Delta cells of islets of langerhans
14
Q
which arteries supply the head of the pancreas?
A
Superior and inferior pancreaticoduodenal arteries
15
Q
Meckel’s diverticulum is a remnant of which embryological structure?
A
Vitellointestinal duct (connects midgut to yolk sac)
16
Q
what is the blood supply to the upper 1/3 of the oesophagus?
A
Inferior thyroid artery
17
Q
what is the blood supply to the middle 1/3 of the oesophagus?
A
Descending thoracic aorta
18
Q
what is the blood supply to the lower 1/3 of the oesophagus?
A
Left Gastric artery
19
Q
what is the lymphatic drainage of the upper 1/3 of the oesophagus?
A
Deep cervical nodes
20
Q
what is the lymphatic drainage of the middle 1/3 of the oesophagus?
A
Superior and posterior mediastinal nodes
21
Q
what is the lymphatic drainage of the lower 1/3 of the oesophagus?
A
Left gastric + coeliac nodes
22
Q
which veins are involved in oesophageal varices?
A
Portal contribution = oesophageal branch of LEFT GASTRIC Vein
Systemic contribution = oesophageal branch of AZYGOUS vein
23
Q
what are the sites of porto-systemic anastomoses?
A
Oesophagus Rectum Umbilicus Liver Retroperitoneum
24
Q
what veins are involved in rectal varices?
A
Portal contribution = superior rectal vein
Systemic contribution = middle/inferior rectal vein
25
what 3 main mechanisms exist at the lower oesophageal sphincter to prevent gastro-oesophageal reflux?
1. Acute angle of entry at diaphragm- angle of His
2. phreno-oesophageal ligament
3. prominent mucosal folds
26
which is more common - sliding hiatus hernia or rolling hiatus hernia?
Sliding hiatus hernia >80%
27
in barrets oesophagus what histological change occurs?
Metaplasia from stratified squamous epithelium to columnar epithelium
28
is metaplasia reversible?
Yes
29
what are the 3 physiological narrowings of the oesophagus?
1. Cervical Constriction - Cricoid cartilage (C5/6)
2. Thoracic Constriction - Aortic Arch (T4/5)
3. Abdominal Construction - Oesophageal Hiatus (T10)
30
what vertebral levels does the oesophagus lie?
C6 (inferior border of cricoid cartilage) to T11 (cardiac orifice of stomach)
31
what is achalasia?
Oesophageal dysmotility caused by disordered coordination of the peristaltic action of the smooth muscle and non relaxation of the oesophageal sphincter (due to loss of the myenteric plexus)
32
what are the findings for achalasia on manometry?
High pressure/hypertension in the LES at rest + failure to relax the LES on swallowing as well as aperistalsis
33
the ureters are crossed by what structures anteriorly?
Gonadal artery and vein
34
the R ureter is crossed by what structures anteriorly?
Ileocolic vessels
| R colic vessels
35
the L ureter is crossed by what structures anteriorly?
L colic vessels
36
what is the blood supply to the upper ureter?
Renal artery (+gonadal a + aorta)
37
what it the blood supply to the middle ureter?
Gonadal A + common iliac
38
what is the blood supply to the distal ureter?
Common iliac + internal iliac branches - superior vesical + uterine arteries
39
what are the anterior relations of the R kidney?
```
R adrenal
R lobe of liver
Gallbladder
2nd part of duodenum
Hepatic flexure of colon
Small intestine
```
40
at what level does the IVC form?
L5 - common iliac veins converge
41
what structure lies anteriorly to the IVC at its origin?
Right common iliac artery
42
the common iliac veins pass anterior or posterior to the common iliac arteries?
Posterior
| IVC moves posterior to aorta distally
43
does the ureter lie anterior or posterior to the bifurcation of iliac vessels?
anterior
44
does the ureter lie in front of or beneath the uterine artery?
Beneath
45
what are the anterior relations of the left kidney?
Stomach, pancreatic tail
46
what are the superior relations of the left kidney?
Spleen, adrenal gland
47
what are the posterior relations of both kidneys?
Quadratus lumborum, diaphragm, psoas major, transversus abdominis
48
is gerotas fascia surrounding or beneath the perirenal fat?
Surrounds perinephric fat
49
what parts of the colon are retroperitoneal?
Splenic + hepatic flexures
| Ascending + descending colon
50
which part of the duodenum is intraperitoneal?
1st part
51
is the spleen an intraperitoneal or retroperitoneal structure?
intraperitoneal
52
does the SMA travel anterior or posterior to the duodenem?
Anterior to 3rd part
53
which part of the pancreas does the SMA travel anterior to?
Uncinate process
54
what part of the pancreas lies immeadiately anterior to the origin of the SMA?
Body of pancreas
55
the middle colic artery is a branch of what artery?
SMA
56
the SMA and IMA form an anastomoses called what?
Marginal artery of drummond
57
what is the surface markings for the oblique border of the liver?
Diagonal line from 4th IC space MCL on left to 8-10th Rib on right mid-clavicular line
58
what is the surface markings for the superior border of the liver?
5th IC space MCL on Right to 4th IC space MCL on Left
59
what is the surface marking for the lateral border of the liver?
5th IC space MCL on right downwards to between 8-10th ribs
60
which lobe of the liver is anatomically part of the right lobe but functionally a part of the left?
Quadrate lobe
61
the hepatic artery divides into 3 which main branches?
Hepatic artery proper
Gastroduodenal
Right gastric artery
62
which artery gives off the cystic artery which supplies the gallbladder?
Right hepatic artery
63
from what structures is the portal vein formed and where?
SMV + splenic vein
| Posterior to the pancreas neck at L2
64
what is the surface marking for the gallbladder?
Angle between 9th costal cartilage + lateral margin of rectus muscle
65
what are the 3 main functions of the gallbladder?
Storing Bile
Concentrating Bile
Adding mucus to bile produced by the liver
66
how much bile is stored in the gallbladder?
50ml
67
which arteries supply collateral supply to the gallbladder?
Perforating branches from the liver bed (supplies lateral body + fundus)
68
what are the 3 borders of Calot's triange?
Superior - inferior edge of liver
Lateral - cystic duct
Medical - hepatic duct
69
what structures are found in calot's triangle?
Cystic Artery
| Lymph node of Lund
70
what does courvoisiers law state?
Presence of a palpable gallbladder in a patient with painless jaundice is unlikely to be gallstones
71
what does Bsoas sign refer to?
Area of hyperaesthesia of skin just below the right scapula in acute cholecystitis
72
what does Kehr sign refer to?
Referral of abdominal pain to the shoulder tip
73
the superior rectal artery is a branch of what artery?
inferior mesenteric artery
74
into which vein does the inferior mesenteric vein drain?
Splenic vein
75
initially visceral pain from the appendix is conveyed via what spinal nerve roots?
T10
76
which of campers or scarpas fascia is the outer fatty subcutaneous fascia?
Campers fascia
77
where do the 3 taenia coli converge to help identify the appendix?
Caecum
78
the inferior rectal artery is a branch of what artery?
Internal pudendal
79
the middle rectal artery is a branch of what artery?
Middle rectal
80
the upper 1/3 of the rectum has peritoneum over which areas?
Front and sides
81
the middle 1/3 of the rectum has peritoneum over which areas?
Front only
82
the lower 1/3 of the rectum has peritoneum over which areas?
None - lies beneath the peritoneal reflection
83
the ejaculatory duct drains in to what?
The prostatic urethra
84
the seminal vesicles lie between what 2 structures?
Bladder and Rectum
85
where in the bladder wall do the ureters open?
Posteriorly in trigone region
86
what are the 3 constrictions of the ureter?
1. Uretopelvic junction
2. Pelvic brim, at bifurcation of common iliac
3. Vesicoureteric junction
87
what organism causes chronic inflammation predisposing to SCC of the bladder?
Schistosoma haematobium
88
which arteries supply blood to the bladder?
Superior and inferior vesical arteries (branches of internal iliac)
89
what is the venous drainage of the bladder?
External Iliac Nodes
| +internal iliac, obturator nodes
90
which nerves provide parasympathetic supply to the bladder?
Pelvic sphlanchnic nerves
91
what is the nerve supply to the external uretheral sphincter?
Pudendal nerve S2,3,4
92
what supplies sympathetic supply to the bladder?
Hypogastric plexuses
93
what is the nerve supply to external oblique?
T7-T12 thoracoabdominal nerves + Subcostal nerve (T12)
94
what is the roof of the inguinal canal?
Internal oblique
| transversus abdominis
95
what is the floor of the inguinal canal?
inguinal ligament
| lacunar ligament
96
what is the anterior wall of the inguinal canal?
Aponeurosis of external oblique
| Internal oblique
97
what is the posterior wall of the inguinal canal?
Transervaslis fascia
| Conjoint tendon
98
where does the conjoint tendon attach?
Pectineal line
| Pubic crest
99
which ligament of the uterus passes through the inguinal canal?
round ligament of the uterus
100
what are the 3 arteries in the spermatic cord?
Artery to vas
Cremasteric artery
testicular artery
101
what are the 3 nerves in the spermatic cord?
Genital branch genitofemoral n
Autonomic nerves
Ilioingional nerve (not within cord but in canal)
102
what are the 3 'others' in the spermatic cord?
Vas deferens
Lymphatics
Pampinoform plexus
103
what are the 3 coverings of the spermatic cord?
External spermatic fascia
Cremasteric Muscle
Internal spermatic fascia
104
what is the external spermatic fascia derived from?
External oblique
105
what is the cremasteric muscle derived from?
Internal oblique + transervsus abdominis
106
what is the internal spermatic fascia derived from?
transversalis fascia
107
what is the nerve supply to the testes?
T10 sympathetic nerve
108
the superior epigastric artery is a branch of what artery?
INternal thoracic (subclavian)
109
the inferior epigastric artery is a branch of what artery?
External iliac
110
what is the medial border of Hesselbach's triange?
Rectus sheath (lateral border)
111
what is the superolateral border of Hesselbachs triange?
Inferior epigastric vessels
112
what is the inferior border of Hesselbach's triangle?
Inguinal ligament
113
what does the genital branch of the genitofemoral nerve innervate?
Cremaster muscle
| Skin of scrotum (posterior)
114
what does the ilioinguinal nerve supply?
upper and medial parts of thigh
anterior scrotum
base of penis
115
what does the iliohypogastric nerve supply?
Skin above pubis
116
where are femoral hernias found in relation to the pubic tubercle?
Below and lateral to pubic tubercle
117
where are inguinal hernias found in relation to the pubic tubercle?
Above and medial to pubic tubercle
118
what are the contents of the femoral canal?
Fat
| Lymph node of Cloquet
119
what is the function of the femoral canal?
Allows expansion of femoral vessels
| Potential space
120
what is the posterior border of the femoral canal?
Pectineal ligament
121
what is the medial border of the femoral canal?
Lacunar ligament
122
where does hunters canal run?
From base of the femoral triangle to popliteal fossa
123
what are the boundaries of hunters canal?
Anterolaterally - vastus medialis
Anteromedially/Roof - sartorius
Posteriorly - adductor longus + magnus
124
what are the contents of hunters canal?
Femoral artery
Femoral Vein
Saphenous nerve
nerve to vastus medialis
