Abdomen & Pelvis Flashcards
MRCS
List the contents of the spermatic cord (3 arteries, 3 nerves, 3 other structures)
Arteries - testicular, cremasteric, artery to vas
Nerves - genital branch of genitofemoral, sympathetic nerves, ilioinguinal nerve (on it)
Other - vas deferens, pampiform plexus, lymphatics
Where is the deep inguinal ring?
1cm above the midpoint of the inguinal ligament, lateral to inferior epigastric vessels
Where is the superficial ring?
Above and medial to the pubic tubercle
Where do the inferior epigastric vessels enter the abdominal wall?
Arcuate line - halfway between the umbilicus and pubic symphysis
Where does the root of the penis attach proximally?
Perineal membrane, pubic rami via the crura, pubic symphysis via the suspensory ligament
Which testicle lies lower in the scrotum?
Left
Name the tissue layer that encapsulates the testicles
Tunica albuginea
Name the tissue layer that forms a sac around the testicles
Tunica vaginalis (parietal)
Where do the testicular veins drain?
Right - IVC
Left - left renal vein
Name the muscle that encapsulates the testicles
Cremaster muscle
What is the gubernaculum?
A fibrous cord that connects the fetal testis with the bottom of the scrotum
Where are the ejaculatory ducts found?
Lateral aspect of prostate gland
Where do the common ejaculatory ducts open?
Verumontanum either side of the urticle
Name the fascia that surround the corpora in the penis and what is it a continuation of?
Buck’s fascia
Scarpa’s fascia
Name the superficial fasica surrounding the penis
Colles fascia
Which kidney lies lower in the abdomen and why?
Right - displaced by the liver
Name the fascia that surrounds the kidney and adrenal gland
Gerota’s fascia
How long is the ureter?
25-30cm
What spinal level do parasympathetic fibres to the bladder originate?
S2-4
Which nerve supplies the external urethral sphincter?
Pudendal nerve
Describe the mechanism of a direct inguinal hernia
Bowel enters the inguinal canal directly through a weakness in the posterior wall of the canal
Describe the mechanism of an indirect inguinal hernia
Bowel enters the inguinal canal via the deep inguinal ring
Occur due to a patent processus vaginalis
What are the borders of Hesselbach’s triangle?
Medial - lateral border of rectus abdominis
Superior - inferior epigastric vessels
Inferior - inguinal ligament
Where is the femoral artery palpated?
Mid-inguinal point - midpoint between pubic symphysis and ASIS
What type of cancer is associated with Barrett’s oesophagus?
Oesophageal adenocarcinoma
What level is the oesophageal hiatus?
T10
What level is the inferior oesophageal sphincter?
T11
Which arteries anastomose to supply the stomach?
Gastric and gastro-omental
What is a sliding hiatus hernia?
The lower oesophageal sphincter slides superiorly
What is a rolling hiatus hernia?
Part of the stomach herniates into the thorax next to the lower oesophageal sphincter
What is the most common site of duodenal ulceration?
Hepatoduodenal ligament
What is the major duodenal papilla?
The site in the descending duodenum (D2) where the ampulla of Vater opens to secrete bile and pancreatic fluids
Which part of the duodenum transverses the IVC and aorta?
Inferior (D3)
Which artery is at risk of erosion from a duodenal ulcer?
Gastroduodenal
What is the arterial supply to the duodenum?
Gastroduodenal artery - before major duodenal papilla
Pancreaticoduodenal artery - after major duodenal papilla
What artery supplies the caecum?
Ileocolic artery from SMA
What is the name of the ligament which attaches the colon to the diaphragm?
Phrenicocolic ligament
Why the sigmoid colon prone to volvulus?
The sigmoid mesocolon that is attached to the posterior pelvic wall making it a long mesentery
Name 4 features of the colon that distinguishes it from the small intestine
Omental appendices
Teniae coli
Haustra
Wider diameter
Name the 3 teniae coli
Mesocolic
Free
Omental
What is the arterial supply to the ascending colon?
Ileocolic (colic, anterior caecal, posterior caecal branches) and right colic arteries from the SMA
What is the arterial supply to the transverse colon?
Right colic artery (SMA)
Middle colic artery (SMA)
Left colic artery (IMA)
What is the arterial supply to the descending colon?
Left colic artery from the IMA
Name the artery that provides collateral blood supply to the colon
Marginal artery of Drummond
What spinal level does the rectum begin?
S3
How can the rectum be distinguished from the colon?
Absence of taenia colic, haustra and omental appendices
Which main arteries suppy the rectum?
IMA
Internal iliac
Internal pudendal
What does the pectinate/denate line delineate?
Above - hindgut, columnar epithelium
Below - ectoderm, squamous epithelium
What is the blood supply to the anus?
Above pectinate line - IMA
Below pectinate line - internal pudendal
What positions are haemorrhoids found within the rectum?
3, 7, 11 o’clock
What spinal level is the oesophageal hiatus?
T10
Where are the three narrowings in the oesophagus where things get stuck?
At the start
Crossing the left main bronchus
Termination
Which veins anastomose giving rise to oesophageal varices?
Azygos vein
Oesophageal tributary of the left gastric vein
What level does the aorta originate and terminate?
T12
L4
Where is the femoral canal found?
Medial compartment of femoral sheath
What are the boundaries of the femoral ring?
Anterior - inguinal ligament
Posteriorly - pectineal ligament
Laterally - femoral vein
Medially - lacunar ligament +/- obturator artery
List the contents of the femoral canal
Fat
Lymphatics
Lymph node (Cloquet’s node)
Name the anterior branches of the aorta
Coeliac axis
SMA
IMA
Name the lateral paired branches of the aorta
Suprarenal artery
Renal artery
Gonadal artery
Name the paired branches of the aorta to the abdominal cavity
Lumbar arteries (4)
Inferior phrenic arteries
Which artery is the femoral artery a continuation of?
External iliac artery
What level does the IVC form?
L5
Name the connection between the greater and lesser sac
Epiploic foramen (of Winslow)
What the another name for the free edge of the lesser omentum?
Hepatoduodenal ligament
Name the borders of calot’s triangle
Medial - common hepatic duct
Inferior - cystic duct
Superior - inferior surface of the liver
Name the lymph node in Calot’s triangle
Lund’s node
What type of epithelium is the peritoneum comprised of?
Simpe squamous - mesothelium
What spinal level do the kidneys lie?
T12-L3
Name the structure that is the remnant of the umbilical vein
Ligamentum teres - free edge of falciform ligament
Name the ligament that divides the anterior surface of the liver
Falciform ligament
Name the ligaments that attaches the superior surface of the liver to the diaphragm
Coronary ligament
Left and right triangular ligaments
Name the two ligaments within the lesser omentum
Hepatoduodenal ligament
Hepatogastric ligament
What is Morrison’s pouch?
Potential space behind the liver where fluid can accumulate when lyine supine
Name the 4 lobes of the liver
Left
Right
Caudate
Quadrate
Name the structures within a portal triad
Arteriole from hepatic artery
Venule from hepatic portal vein
Bile duct
What structure is found in the centre of a liver lobule?
Central lobular vein
Describe the dual blood supply to the liver
Hepatic artery (25%) from coeliac trunk - supplies the non-parenchymal structures
Hepatic portal vein (75%) from small intestine - supplies the parenchymal structures
What is Hartmann’s pouch?
Mucosal fold in the neck of the gallbladder where gallstones commonly become lodged
What is the ampulla of Vater?
Where the common bile duct and pancreatic duct join to empty into the duodenum via the major duodenal papilla
Name the valve at the major duodenal papilla
Sphincter of Oddi
What spinal level is the pancrease?
L1
Which artery supplies the pancreas?
Splenic artery
What type of epithelium is in the oesophagus?
Stratified squamous non-keratinised epithelium
Which blood vessel do duodenal ulcers typically erode into?
Gastroduodenal
What level do the common iliacs join to form the IVC?
L5
Which artery does the inferior epigastric artery arise from?
External iliac artery
What is the parasympathetic supply to the bowel?
Foregut and midgut - vagus nerve
Hind gut - pelvic splanchnic nerves (S2-4)
What is the order of structures anterior to posterior at the renal hilum?
Vein, artery, ureter
Which artery does the gastroduodenal artery arise from?
Common hepatic artery
Which two vessels form the oesophageal porto-systemic shunt?
Azygos vein and left gastric vein
Which part of the adrenal cortex secretes mineralocorticoids?
Zona glomerulosa
Which hormones are produced by the zona fasiculata of the adrenal cortex?
Corticosteroids
Which part of the adrenal cortex secretes androgens?
Zona reticularis
Which part of the adrenal gland secretes catecholamines?
Chromaffin cells in the medulla
What is psoas sign?
Flexion of the hip causes pain in the lower abdomen indicating irritation of the iliopsoas muscle group
Positive in appendicitis
What structures does the ligamentum flavum connect?
Laminae of the adjacent lumbar vertebrae
Where are the ishioanal fossae located in relation to the anus?
Lateral
Which muscle in important for maintaining faecal continence?
Puborectalis
Name the levator ani muscles
Puborectalis
Pubococcygeus
Iliococcygeus
What is the broad ligament?
Double layer of peritoneum that attaches the lateral aspect of the uterus to the pelvis
What is the round ligament?
Remnant of gubernaculum that extends from the ovaries to the labia majora via the inguinal canal
Maintains the anteverted position of the uterus
Which ligament joins the ovaries to the uterus?
Ovarian ligament
Which blood vessels and transmitted via with cardinal ligament?
Uterine artery and vein
From which artery do the uterine and vaginal arteries arise?
Internal iliac artery
Where in the fallopian tube does fertilisation occur?
Ampulla
Which ligament contains the neurovascular structures to the ovary?
Suspensory ligament of the ovary
Which artery supplies the prostate and seminal vesicles?
Inferior vesical
Which artery is the main blood supply to the perineum?
Internal pudendal
Which blood vessel supplies the posterior abdominal wall?
Iliolumbar artery
Which two veins drain into the external iliac vein?
Inferior epigastric
Deep circumflex iliac
Damage to which structure in childbirth is most likely to lead to prolapse of the vagina?
Perineal body
Which branch of the pudendal nerve supplies the external anal sphincter?
Inferior rectal
Which structure connects the apex of the bladder to the umbillicus?
Medial umbilical ligament which is a remnant of the urachus
Fascia from which muscle forms the pudendal canal?
Obturator internus
Which zone of the prostate does BPH typically occur?
Transitional zone
