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Anatomy > Abdominal Organs > Flashcards

Abdominal Organs Flashcards

1
Q

Lesser omentum

A

Originates on lesser curvature of stomach

Extends up to the underside of the diaphragn

Extensds and inserts on posterior aspect of liver

Extends down onto duodenum where it has a free lower border

Behind lesser omentum is the lesser lac (oomental bursa)

Arises from vertral mesentery

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2
Q

Greater omentum

A

Arises greater curvature of the stomach

Free lower border

Posterior aspect is attached to the transverse colon to form the gastro-colic ligament

Extends to form the gastro-splenic ligament

Arrives at posterior wall of abdomen

Arises from dorsal mesentery

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3
Q

Ventral mesogastrium

A

Liver develops here

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4
Q

Dorsal mesogastrium

A

Spleen develops here

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5
Q

Epiploeic foramen

A

Entrance to the lesser sac

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6
Q

Ligaments of the liver

A

Falciform ligament

Ligamentum teres: runs in free border of falciform

Coronary ligament

Right and left triangular ligaments

Lesser omentum: inseting at porta hepatis

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7
Q

Runs through hepatic notch

A

Ligamentum teres

Remnants of umbilical vein

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8
Q

Porta hepatis

A

Site of hepatic artery and portal vein entrance

Exit of hepatic ducts

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9
Q

Foregut attachments

A

Ventral mesogastrium

Dorsal mesogastrium

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10
Q

Ligaments of the spleen

A

Anteriorly: Gastro-splenic ligament (extension of greater omentum)

Posteriorly: Lieno-renal ligament (to L kidney)

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11
Q

Surface marking of spleen

A

Ribs 9-11

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12
Q

Branches of the ceoliac trunk

A

Left gastric artery

Common hepatic –> Hepatic and Gastroduodenal
Hepatic –> R gastric

Spelnic

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13
Q

Posterior relations of the pancreas

A

Body of L1

IVC

Aorta and SMA

Left Kidney

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14
Q

Entrance of the lesser sac

A

Epiploic foramen of Winslow

Posterior free edge of lesser omentum
hepatoduodenal ligament

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15
Q

Borders of Callot’s triangle

A

Medial: Common hepatic duct

Inferior: Cystic duct

Superior: Inferior surface of the liver

Clinical point: during laparoscopic cholecystectomy it used to permits safe ligation and division of the cystic duct and cystic artery

If one can’t delineate Callot’s triangle you are at risk of ligating the right hepatic artery–> convert to open or do a subtotal

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16
Q

Contents of Callot’s Triangle

A

Right hepatic artery

Cystic artery: crosses Callot’s

Lympoh node of Lund

Lymphatics

BORDERS:
Medial: Common hepatic duct
Inferior: Cystic duct
Superior: Inferior surface of the liver

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17
Q

Pringle manoeuvre

A

Haemostatic clamp placed across the hepatoduodenal ligament during haemorrhage

Stops blood flow in hepatic artery and portal vein

If bleeding persists: think IVC trauma

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18
Q

Cell type of the peritoneum

A

Mesothelium: simple squamous epithelial cells

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19
Q

Retroperitoneal organs

SAD PUCKER

A

Supra-renal (Adrenal)

Aorta + IVC

Duodenum (with exception of duodenal cap - first proximal 2cm)

Pancreas (except tail)

Ureters

Colon: ascending and descending

Kidneys

Esophagus (oesophagus)

Rectum

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20
Q

Development of visceral and parietal peritoneum

A

Parietal peritoneum: Somatic mesoderm

Visceral perineum: Splanchnic mesoderm

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21
Q

Mid-inguinal point

A

Mid-point between ASIS and pubic symphysis

= Femoral pulse

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22
Q

Mid-point of the inguinal ligament

A

Mid-point between ASIS and PT

= Deep inguinal ring in transversalis fascia

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23
Q

Borders of the inguinal canal

A

Anterior border
=Aponeurosis of external oblique

Posterior border
=Transversalis fascia

Roof
=Internal oblique
Rectus abdominis
Transversalis fascia

Floor
=Inguinal ligament and lacunar ligament medially (both thickenings of external oblique aponeurosis)

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24
Q

Contents of the inguinal canal

A

1) Spermatic cord OR round ligament

2) Ilioinguinal nerve - commonly damaged during hernia repair
- Does not pass through deep ring, only superficial ring

3) Genital branch of genitofemoral nerve
-Supplies cremaster muscle + anterior scrotum
/ mons pubis + labia majora

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25
Q

Position of the superficial inguinal ring

A

Superior and lateral to PT

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26
Q

Borders of Hesselbach’s triangle

A

Medial: Lateral border of rectus andominis muscle

Lateral: Inferior epigastric artery

Inferior: Inguinal ligament

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27
Q

Borders of Hesselbach’s triangle

A

Medial: Lateral border of rectus abdominis muscle

Lateral: Inferior epigastric artery

Inferior: Inguinal ligament

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28
Q

Ligament unique to the lumbar spine

A

Iliolumbar ligament

Tip of the transverse process of the L5 –> posterior part of the inner lip of the iliac crest

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29
Q

Definition of foregut

A

Extends up to the entry of the bile duct at the duodenum

Supplied by coeliac trunk

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30
Q

Definition of midgut

A

From entry of bile duct in duodenum –> distal transverse colon

Supplied by superior mesenteric artery

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31
Q

Hindgut

A

From distal transverse colon to ectodermal part of anal canal

Supplied by inferior mesenteric artery

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32
Q

Complications of Malrotation

A

Occurs when the midgut fails to undergo 270 counterclockwise spin

Duodenojejunal flexure may not become fixed retroperitoneally and hangs freely from the foregut, lying to the right of the abdomen

Caecum may also be free and may obstruct the second part of the duodenum because of peritoneal bands (of Ladd) passing across it

Base of the mesentery is then very narrow as it is
not fixed at either end, and the whole of the midgut
may twist around its own blood supply, i.e. volvulus
neonatorum.

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33
Q

Exomphalos

A

Persistence of midgut herniation after birth

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34
Q

Separation of structures within cloaca

A

Rectum, anus and genitourinary tracts develop at the end of the 9th week

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35
Q

Development of anal canal

A

Anal canal develops from the end of the hindgut
(endoderm)

And an invagination of ectoderm, the proctodeum

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36
Q

Imperforate anus

A

The anal membrane separates the hindgut (endoderm) from the proctodeum (anal pit) (ectoderm)

Eventually the anal membrane breaks down and
continuity is established between the anal pit and
the hindgut.

Failure of the anal membrane to rupture or anal pit
to develop results in imperforate anus

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37
Q

Attachment of diaphragmatic crus

A

Right crus: L3 vertebral body

Left crus: L2 vertebral body

These attachments are below the remainder of the attachment of the diaphragm at the inferior thoracic aperture

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38
Q

Medial arcuate ligament

A

Arises from transverse process of L1

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39
Q

Lateral arcuate ligament

A

Arises from rib XII

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40
Q

Gubernaculum

A

Connects to primordia of scrotum in males

Connects to the labia majora in females

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41
Q

Coeliac trunk arises

A

Upper border of L1

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42
Q

Superior mesenteric artery arises

A

Lower border of L1

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43
Q

Inferior mesenteric artery arises

A

L3

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44
Q

Formation of IVC

A

Left iliac vein crosses midline at L5 to join right iliac vein

= IVC

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45
Q

Prevertebral plexus

A

Sympathetic components: T5- L2

Parasympathetic components: Vagus nerve, S2-S4

Visceral sensoru fibres

Lies on anterior and lateral surface of aorta –> Innervates the abdominal viscera

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46
Q

Arcuate line

A

Midway point between umbilicus and pubic symphysis

~1/3 way down rectus abdominis
-Inferior to it, the rectus abdomens lies directly on top of transversalis fascia

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47
Q

Innervation of external oblique

A

Innervated by anterior rami of T7 - T12
Lower 6 thoracic nerve

O: muscular slips from outer surface of lower eight ribs
Ribs V - VII

I: lateral lips of iliac crest
Aponeurosis ending as line alba

F:

  • compress abdominal contents
  • flex trunk
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48
Q

Innervation of internal oblique

A

Innervated by anterior rami of T7-12 and L1

O: thoracolumbar fascia, iliac crest between origins of external oblique and transversus abdominis

I: Inferior border of lower three ribs, lines alba, pubic crest and pectineal line

F:

  • compress abdominal contents
  • flex trunk
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49
Q

Innervation of transversus abdominis

A

Innervated by anterior rami of T7-12 and L1

O: thoracolumbar fascia, medial lip of iliac crest,
lateral 1/3 of inguinal ligament costal cartilages of lower 6 ribs VII - XII

I: lines alba, pubic crest and pectineal line

F:
-compress abdominal contents

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50
Q

Innervation of rectus abdominis

A

Innervated by anterior rami T7-12

O: pubic crest, pubic tubercle and pubic symphysis

I: costal cartilages of ribs V - XII
xiphoid process

F:

  • compress abdominal contents
  • flex trunk
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51
Q

Innervation of pyramidalis

A

Innervated by anterior ramus T12

O: Front of pubis and pubis sympthysis

I: linea alba

F: tenses linea alba

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52
Q

Arterial supply to superior anterior abdominal wall

A

Musculophrenic artery

-Terminal branch of the internal thoracic artery

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53
Q

Arterial supply to inferior anterior abdominal wall

A

Medially: superficial epigastric artery (not superior)

Lateral: Superficial circumflex iliac artery

Both branches of femoral artery

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54
Q

Arterial supply to the deep structures in the anterior abdominal wall

A

Superior: superior epigastric artery (branch of internal thoracic artery)

Lateral: 10th, 11th intercostal and subcostal artery

Inferior: inferior epigastric artery and deep circumflex iliac artery
-both branches of external iliac artery

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55
Q

Depth of superior and inferior epigastric arteries

A

Both enter rectus sheath and lie deep to rectus abdominis

Superior and epigastric arteries anastomose with one another under the rectus abdominis

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56
Q

Lymphatic drainage of the abdominal wall

A

Above umbilicus –> axillary nodes

Below umbilicus –> superficial inguinal nodes

Deep –> parasternal nodes

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57
Q

Deep inguinal ring

A

Mid-inguinal point

Evagination of transversalis fascia

Continues as internal spermatic facia

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58
Q

Superficial inguinal ring

A

Superior and lateral to PT

Evagination of external oblique

Reinforced with medial and lateral crus

  • medial crus inserting on pubic symphysis
  • lateral crus inserting onto PT

Continues as external spermatic fascia

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59
Q

Conjoint tendon

A

Reinforces posterior wall of inguinal canal at medial third

Formed by insertion of transverses abdominis and internal oblique –> pubic crest and pectineal line

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60
Q

Ilio-inguinal nerve in the inguinal canal

A

Does not pass through the deep inguinal ring

L1
Branch of the lumbar plexus
Enters abdominal wall from posterior by piercing transversus abdominis and internal oblique

Passes into inguinal canal and exits through superficial ring

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61
Q

Contents of the spermatic cord

A

Ductus deferens

Artery to ductus deferens (branch of inferior vesicle artery)
Testicular artery (branch of abdominal artery)
Cremasteric artery and vein (branch of inferior epigastric veins)

Pampiniform plexus of veins (testicular veins)

Genital branch of the genitofemoral nerve
–> cremasteric muscle

Sympathetic and visceral afferent nerve fibres

Lymphatics

Remnants of processus vaginalis

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62
Q

Layers of the spermatic cord

A

External spermatic facia = external oblique

Cremasteric fascia = internal oblique

Internal oblique = transversus abdominal

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63
Q

Round ligament

A

Passes through inguinal canal and has same coverings as spermatic cord

Inserts into connective tissue of labia majora

From connection at uterus the round ligament continues as the ligament to the ovary

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64
Q

Cremasteric reflex

A

Cremaster innervated by genital branch of genitofemoral nerve L1/L2

Stimulation to upper medial thigh sensed by olio-inguinal nerve –> L1

Reflex arc to genitofemoral –> L1/L2 –> cremaster

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65
Q

Borders of Hesselbach’s Triangle

A

Inferior: inguinal canal

Medial: lateral border of rectus abdominis

Lateral: inferior epigastric artery

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66
Q

Arterial supply to greater omentum

A

Right and left gastro-omental arteries

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67
Q

Arises from ventral mesentery

A

Lesser omentum

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68
Q

Arsies from dorsal mesentery

A

Greater omentum

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69
Q

Borders of lesser omentum

A

Lesser curvature of stomach

First part of duodenum

Inferior surface of liver

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70
Q

Ligaments of the lesser omentum

A

Hepatigastric ligament: stomach and liver

Hepatoduodenal ligament: dudodenum to liver

  • Ends as a free border = omental foramen
  • contains hepatic artery proper, portal vein and bile duct
  • right and left gastric vessels lie in between layers of lesser omentum near lesser curvature of stomach
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71
Q

The “Mesentery”

A

Double layered fold of peritoneum

Connects jejunum and ileum to the posterior abdominal wall

Superior attachment: duodenojejunal junction

Passes right and inferiorly

Inferior attachment: ileocaecal junction near upper border of right sacro-iliac joint

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72
Q

Mesentry x 3

A

The mesentry - jejunum and ileum

Transverse mesocolon - transverse colon
-anterior aspect of transverse mesocolon adherent to posterior aspect of greater omentum

Sigmoid mesocolon - sigmoid colon

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73
Q

Oesophageal hiatus

A

Right crus of the diaphragm

T10

Anterior vagal trunk

Posterior vagal trunk

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74
Q

Arerial supply to the abdominal oesophagus

A

Oesophageal branches from left gastric artery (from coeliac trunk)

Oesophageal branches from left inferior phrenic artery (from abdominal aorta)

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75
Q

Arterial supply to the stomach

A

Left gastric artery from coeliac trunk

Right gastric artery from hepatic artery proper

Right gastro-omental artery from gastroduodenal artery

Left gastro-omental artery from splenic artery

Posterior gastric artery from splenic artery (variant)

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76
Q

Length of small bowel

A

6 - 7m

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77
Q

Length of dueodenum

A

20 - 25cm

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78
Q

Sections of the duodenum

A

1: superior
- intraperitoneal
- L1

2: descending
- retroperioneal
- extends to L3
- duodenal papilla

3: inferior
-retroperitoneal
-longest section
-crosses IVC, aorta, vertebral column
R–> L

4: ascending
- passes upwards to left of aorta
- L2
- duodenojejunal flexure

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79
Q

Superior part of duodenum

A

1st part - intraperitoneal

Extends from pyloric orifice –> neck of gallbladder

Lies just right of L1

Passes anteriorly to bile duct, gastroduodenal artery, portal vein and IVC

Most ulcers occur here

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80
Q

Descending part of duodenum

A

2nd part - retroperitoneal

Extends form neck of gallbladder to lower border of L3

Anterior surface is crossed by transverse colon

Lies in front of right kidney

On its medial side is head of pancreas

Contains:
Major duodenal papilla
Minor duodenal papilla

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81
Q

Inferior part of duodenum

A

3rd part - retroperitoneal

Longest section

Passes Right –> Left

Crosses IVC, aorta, vetrebral column

The superior mesenteric artery + vein pass anteriorly in front

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82
Q

Ascening part of duodenum

A

4th part - retroperitoneal

Passes upwards to left of aorta

Upper border of L2
–> terminates as duodenojejunal flexure

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83
Q

Ligament of Trietz

A

Fold of peritoneum containing muscle fibres

= suspensory ligament of duodenojejunal flexure

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84
Q

Arterial supply to duodenum

A

Gastroduodenal artery
–>Supraduodenal artery

Pancreaticoduodenal artery

First jejunal branch of SMA

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85
Q

Characteristics of jejunum

A

Right upper quadrant

Larger diameter

Thicker walled

More plicae circularis

Less arterial arcades

Longer vasa recta

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86
Q

Arterial supply to jejunum

A

Jejunal arteries from superior mesenteric artery

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87
Q

Characteristics of the ileum

A

Right lower quadrant

Thinner walls

Fewer plicae circularis

Shorter vasa recta

More mesenteric fat

More arterial arcades

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88
Q

Arterial supply to ileum

A

Ileal arteries from superior mesenteric artery

Ileal branch from ileocolic artery which is in turn a branch of the superior mesenteric artery

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89
Q

Mesoappendix

A

Supplies appendix

Suspended from terminal ileum

Supplied by appendicular artery, branch of ileocolic artery which is a branch of SMA

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90
Q

Arterial supply to the caecum

A

Anterior cecal artery, a branch of the ileocolic artery

Posterior cecal artery, a branch of the ileocolic artery

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91
Q

Phrenicocolic ligament

A

Ligament attaching left colic flexure to the diaphragm

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92
Q

Blood-less mobilisation of colon

A

Supply to ascending and descending colon tends to be on inner wall

If divided down lateral parabolic gutters the main vessels are avoided

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93
Q

Sigmoid colon position

A

Begins just above pelvic brim

Extends to S3 –> rectum

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94
Q

Artery supply to ascending colon

A

Colic branch of the iliocolic artery

Anterior cecal branch of the iliocolic artery

Posterior cecal branch of the iliocolic artery

Right colic artery of the SMA

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95
Q

Arterial supply to transverse colon

A

Right colic artery form SMA

Middle colic artery from SMA

Left colic artery from INFERIOR mesenteric artery

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96
Q

Arterial supply to descending colon

A

Left colic artery of the IMA

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97
Q

Arterial supply to sigmoid

A

Sigmoidal arteries of the IMA

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98
Q

Rectosigmoid junction level

A

S3

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99
Q

Arterial supply to the rectum

A

Superior rectal artery from IMA

Middle rectal artery from INTERNAL ILIAC artery

Inferior rectal artery from INTERNAL PUDENDAL artery

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100
Q

Ladd’s bands

A

Pathological connection between caecum and undersurface of liver
–> Small bowel volvulus and duodenal obstruction

Occurs on malrotation of the bowel

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101
Q

Recesses around the liver

A

Subphrenic recess
-Divided by the falciform ligament

Hepatorenal recess

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102
Q

Ligaments of the liver

A

Falciform ligament: attaches anterior aspect to anterior abdominal wall

Hepatogastric ligament: liver to stomach

Hepatodudodenal ligament: liver to duodenum

Attachment of liver to the diaphragm:

  • Right triangular ligament
  • Left triangular ligament
  • Anterior coronary ligament
  • Posterior coronary ligaments
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103
Q

Attachments of the liver to the diaphragm

A

Right triangular ligament
Left triangular ligament

Anterior coronary ligament
Posterior coronary ligaments

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104
Q

Coronary ligaments of the liver

A

Anterior coronary ligament marked by reflection of peritoneum
-start of bare area superior surface

Posterior coronary ligament also marked by reflection of peritoneum
-end of bare area

Where the coronary ligaments join on the sides they form the right and left triangular ligaments

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105
Q

Quadrate lobe

A

Visible from anterior view of liver

Bound on the left by the ligament teres
Bound on the right by the gallbladder fossa

Functionally related to left liver

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106
Q

Caudate lobe

A

Visible from posterior view of the liver

Bound on the left by fissure for the ligament venosum
Bound on the right by the groove for the IVC

Functionally distinct

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107
Q

Ligamentum teres

A

Extension of falciform ligament

Remnant of umbilical vein

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108
Q

Position of the gallbladder

A

Lying in visceral surface of right lobe of liver in fossa between right love and quadrate lobe

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109
Q

Arterial supply to the gallbladder

A

Cystic artery, branch of the right hepatic artery

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110
Q

Peritoneal part of the pancreas

A

Nearly all of the pancreas is secondary retroperitoneal apart from small part of the tail

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111
Q

Uncinate process of pancreas

A

Passes posterior to superior mesenteric vessels

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112
Q

Neck of the pancreas

A

Anterior to superior mesenteric vessels

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113
Q

Tail of the pancreas

A

Passes between layers of the splenorenal ligament

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114
Q

Arterial supply to the pancreas

A

Gastroduodenal artery, branch of common hepatic artery

Pancreaticoduodenal artery, branch of gastroduodenal artery

Dorsal pancreatic artery. branch of inferior pancreatic artery, branch of splenic artery

Greater pancreatic artery, branch of splenic artery

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115
Q

Dorsal bud of pancreas

A

Forms main head, body and tail

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116
Q

Ventral bud of pancreas

A

Part of the head and uncinate process

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117
Q

Bifid ventral bud of pancreas

A

Causes bifid uncinate process which encircles duodenum

Undergoes atresia during development –> may cause polyhydramnios

May cause recurrent vomiting as a neonate

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118
Q

At formation of bile duct: orientation

A

Bile duct lies to the right of hepatic artery proper

Usually lies to the right of and anterior to portal vein

Omental forman lies posterior to the structures at this point

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119
Q

Orientation of bile duct to superior duodenum

A

Bile duct passes POSTERIOLY to first part of the duodenum

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120
Q

Surface anatomy of the spleen

A

Rib IX - X

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121
Q

Spleen development

A

Develops in dorsal mesentery

122
Q

Ligaments of the spleen

A

Connected to the greater curvature of the stomach = gastrosplenic ligament
-Contains short gastric and gastro-omental vessels

Connected to the left kidney = splenorenal ligament
-Contains splenic vessels

123
Q

Left liver segments

A

I
II
III
IV

124
Q

Right liver segments

A

V
VI
VII
VIII

125
Q

Liver segment I

A

Caudate lobe

126
Q

Attachment of scarpa’s fascia

A

Extends down to deep fascia of thigh 2.5cm below inguinal ligament

Extends into perineum as Colle’s fascia

127
Q

Attachment of Camper’s fascia

A

=superficial fatty fascia

Extends down to penis and scrotum

128
Q

Colle’s fascia

A

Extension of scarpa’s fascia

Attached to the perineal body, perineal membrane and laterally to the rami of the pubis and ischium

129
Q

Migration of testis not possible below Scarpa’s

A

An ectopic testis in the groin cannot descend any lower into the thigh because of the attachment of Scarpa’s fascia to the deep fascia of the thigh

130
Q

Nerve supply of abdominal muscles

A

Lower 6 thoracic spinal nerve supply

  • rectus abdominis
  • external oblique

Lower 6 thoracic spinal nerves + iliohypogastric + ilioinguinal nerves supply

  • internalonblique
  • transversus abdominis
131
Q

Nerve damaged in kocher’s incision

A

9th intercostal nerve lies at lateral point of incision

Results in weakness of upper rectus –> incisional hernia

132
Q

Contents of spermatic cord `

A

Three arteries:

1) testicular artery
2) cremasteric artery
3) artery to the vas

Three nerves:

1) genital branch of the genitofemoral to cremaster
2) sympathetic nerves
3) ilioinguinal nerve (actually lies on the cord and not within it)

Three other structures:

1) vas deferens
2) pampiniform plexus of veins
3) lymphatics

133
Q

Femoral sheath

A

Prolongation of transversalis fascia anteriorly and iliacus fascia posteriorly prolonged over the:

  • Femoral artery
  • Femoral vein
  • Femoral canal

(but not the nerve)

134
Q

Boundaries of the femoral ring

A

Superior entrance to the femoral canal

Anterior: inguinal ligament

Posterior: pectinal ligament

Laterally: femoral vein

Medially: lacunar liagment

Clinical point: abnormal obturator artery can run close to lacunar ligament and is at risk during femoral hernia repair

135
Q

Contents of femoral canal

A

Fat

Lymphatics

Lymph node (Cloquet’s node)

136
Q

Umbilical folds of peritoneum

A

Median umbilical fold: obliterated urachus

Medial umbilicla fold: obliterated umbilical artery

Lateral umbilical fold: inferior epigastric artery

137
Q

Obliterated urachus

A

Median umbilical fold: obliterated urachus

138
Q

Obliterated umbilical artery

A

Medial umbilicla fold: obliterated umbilical artery

139
Q

Lateral umbilical fold

A

Inferior epigastric artery

140
Q

Epiploic foramen free edge

A

Free edge of lesser omentum containing

bile duct to the right

hepatic artery to the left

portal vein behind

Portal vein is POSTERIOR

141
Q

Borders of epiploic foramen

A

Anteriorly: free edge of lesser omentum containing
bile duct to the right, hepatic artery to the left and
portal vein behind

Posteriorly: inferior vena cava (IVC).

Inferiorly: first part of duodenum.

Superiorly: caudate process of the liver.

142
Q

Boundaries of right subhepatic space

A

Renal well of Rutherford Morrison

Above: liver with gallbladder attached

Behind: posterior abdominal wall and kidney

Below: duodenum

143
Q

Boundaires of left subhepatic space

A

= lesser sac

144
Q

Posterior abscess drainage

A

Usually USS or CT guides percutaneous

If not possible –> posterior abscesses can be
accessed by an incision below or through the bed
of the 12th rib

145
Q

Origin and insertion of quadratus lumborum

A

O: iliolumbar ligament and adjacent iliac crest

I: Medial 1/2 lower border of 12th rib
+ 4 tendons to L1-L4 transverse process

146
Q

Structures anterior on quadratus lumborum

A

Colon

Kidney

Subcostal nerve

Iliohypogastric nerve

Ilioinguinal nerve

Subcostal nerve

147
Q

Bifurcation of common iliac artery

A

Level of sacroiliac joint

148
Q

Differences between right vs left common iliac artery

A

Right common iliac artery is the longer, the aorta being on the left side of the spine

Left common iliac vein crosses behind right
common iliac artery

Left common iliac artery is crossed anteriorly by inferior mesenteric artery

149
Q

Lumbar sympathectomy

A

e.g. for plantar hyperhidrosis

Usually the second, third and fourth ganglia are excised with the intermediate chain

150
Q

Parts of the oesophagus

A

Cervical

Thoracic

Abdominal

151
Q

Thoracic oesophagus

A

Passes downwards through superior and posterior mediastinum

Two vagus nerves form plexus on oesophagus within posterior mediastinum

  • left anteriorly
  • right posteriorly

Passes right to meet the midline at T5

Passes forwards and left to meet diaphragm at T10

Anterior relations:
Left common carotid
Left main bronchus - constricts it

Posterior relations:
Thoracic duct
Hemiazygous vein
Descending aorta below

152
Q

Abdominal oesophagus

A

Passes through diaphragm at T10

Lies in a groove on the posterior surface of the LEFT lobe liver with left crus behind it

153
Q

Blood supply to the oesophagus

A

Cervical: inferior thyroid artery

Thoracic: aortic branches

Abdominal: left gastric and inferior phrenic arteries

154
Q

Venous drainage of the oesophagus

A

Cervical: inferior thyroid veins

Thoracic: azygous vein

Abdominal

  • portal: left gastric
  • systemic: azygous vein
155
Q

Nerve supply to the oesophagus

A

Upper 1/3

  • parasympathetic via recurrent laryngeal nerves
  • sympathetic from middle cervical ganglion carried via the inferior thyroid artery

Lower (below root of lung)
-vagus nerve and sympathetic nerves form oesophageal plexus

156
Q

Three narrowing of oesophagus

A

Commencement of oesophagus
-17cm from incisors

Point at which it crosses left main bronchus
-28cm from incisors

Termination into cardia of stomach
-43cm from incisors

157
Q

Oesophageal porto-systemic anastomoses

A

Lower oesophagus

Azygous vein of systemic venous circulation anastomoses with left gastric vein of portal circulation

= varices

158
Q

Left atrium pathology on a barium swallow

A

Left atrial enlargement causing oesophageal posterior displacement may be noted on a barium swallow

Left atrial enlargement = mitral stenosis

159
Q

Incisuria angularis

A

Notch on lesser curve that indicates transition from body to pyrloric antrum of the stomach

160
Q

Prepryloric vein of Mayo

A

Junction of pylorus with duodenum marked by a constant vein = prepyloric vein of Mayo

-crosses vertically

161
Q

Blood supply to the stomach

A

Lesser curve

  • Left gastric artery, branch coeliac trunk, runs along lesser curve
  • -> anastomoses with right gastric artery, branch of hepatic artery

Greater curve

  • Right gastroepiploic artery, arises from gastroduodenbal artery of hepatic artery
  • -> anastomoses with left gastroepiploic artery

Splenic artery

  • left gastroepiploic artery
  • short gastric arteries

Rich blood supply, can ligate three of four arteries and it still be adequately perfused

162
Q

Gastric cancer presenting with jaundice

A

Nodal infiltration through the hepatic nodes –> porta hepatis

Increase in size here –> compression of bile duct. = jaundice

163
Q

Lymphatic drainage of stomach

A

Splenic area –> splenic lymph nodes –> pancreatic –> coeliac nodes

Cardia –> left gastric –> coeliac nodes

Hepatic artery branches –> coeliac nodes

Right gastroepiploeic branches –> coeliac nodes

Retrograde spread to hepatic lymph nodes –> porta hepatis –> jaundice

164
Q

Innervation of pyloric sphincter

A

Anterior vagus nerve

165
Q

Vagal innervation coeliac plexus

A

Posterior vagus nerve

166
Q

Vagus supply to liver

A

Anterior vagus nerve –> hepatic branch

167
Q

Anterior and posterior nerves of Latarjet

A

= vagus anterior and posterior branches to cardia of stomach

168
Q

Posterior stomach ulcer

A

–> erodes into pancreas

–> radiated back pain

169
Q

Lesser curvature stomach ulcer

A

Likely to erode into left and right gastric arteries

–> Haematemsis and melaena

170
Q

Area that contains G cells and mucin secreting cells

A

Pyloric antrum + distal 30%

171
Q

Blood supply to duodenum

A

Superior pancreaticoduodenal artery, arising from gastroduodenal artery

Inferior pancreaticoduodenal artery, arising from SMA

These two also supply head of pancreas

172
Q

Posterior duodenal ulcers

A

Erode into gastroduodenal artery passing behind it

173
Q

Small bowel mesentery

A

Commences left of L2 at DJ flexure

Extends to right sacroiliac joint

15cm

174
Q

Posterior relations of small bowel mesentery

A

As the small bowel mesentery descends to right sacroiliac joint it pass anteriorly to:

  • 3rd part of duodenum
  • aorta
  • IVC
  • right poses major muscle
  • right ureter
  • right gonadal vessel
  • right iliacus muscle
175
Q

Location of appendix

A

Posteromedial caecum

2.5 cm below ileocaecal valve

176
Q

Posterior relations of ascending colon

A

Iliacus

Quadrates lumborum

Perirenal fascia over lateral right kidney

177
Q

Posterior relations to transverse colon

A

Right kidney

Second part of duodenum

Pancreas

Small bowel

Left kidney

178
Q

Phrenicocolic ligament

A

Fold of peritoneum from

Diaphragm –> splenic flexure

179
Q

Posterior relations of sigmoid colon

A

External iliac vessels

Left ureter

Rests on the bladder

180
Q

Appendices epiploicae

A

Fat-filled scattered over surface of colon

Most numerous: sigmoid

Absent on caecum, appendix, rectum

181
Q

Blood supply to appendix

A

Appendicular artery, branch of ileocolic artery

Has its own mesentery - descends from ileum as a triangular fold

182
Q

Thrombosis of appendicular artery

A

=End artery

Hence, gangrene of appendix develops rapidly

Thrombosis may occur with inflammation of appendix

183
Q

Lumen off appendix

A

Very wide at brith

Very narrow in elderly

Hence obstruction tends to occur in early adulthood as narrowing reaches critical point

Appendicitis is rare at extremes of age

184
Q

Peritoneal covering of rectum

A

Posterior edge: always EXTRAperitoneal

Upper third: anterior and sides covered in peritoneum

Middle third: anterior aspect only covered in peritoneum

Lower third: all extraperitoneal

185
Q

Valves of Houston

A

Three lateral inflections in rectum

Left –> right –> left

186
Q

Anterior relation of rectum

A 
Males: rectovesical pouch
-base of bladder
-seminal vesicles
-prostate
Denovilliers fascia lies in front of rectum separating it from prostate

Female: rectourterine pouch (of Douglas)
-posterior vaginal wall

187
Q

Marginal artery of Drummond

A

Each artery from SMA and IMA branches with its neighbour for length of colon forming the marginal artery

188
Q

Superior rectal artery

A

Branch of IMA

Supplies rectum and upper 1/2 anal canal

Middle rectal artery supplies muscular coat of rectum

189
Q

Inferior rectal artery

A

Branch of internal Iliac artery

Supplies lower 1/2 of anal canal

190
Q

Position of haemorrhoids

A

Superior rectal artery reaches rectum

  • -> divides into two branches
  • run either side of rectum
  • ->right branch divides into two further branches

Three branches descend to level of anal valves and anastomose with branches of inferior rectal artery
-accompanied by tributaries of the superior rectal vein draining into portal system

Final position: one on the leftism two on the right
3, 7, and 11

191
Q

Columns of Morgagni

A

Vertical columns in the mucosa in the middle of the anal canal

192
Q

Anal valves of Ball

A

At distal end of columns of morgagni there are some valve-like folds

= anal valves

Behind the anal valves are the anal sinuses which are the opening of the anal glands

193
Q

Lining of upper half of anal canal

A

Columnar epithelium

Derives from endoderm

194
Q

Lining of lower half of anal canal

A

Stratified squamous epithelium

Derived from ectoderm

195
Q

Cancer of upper 1/2 of anal canal

A

= columnar epithelium –> adenocarcinoma

196
Q

Cancer of lower 1/2 of anal canal

A

= stratified squamous epithelium = squamous cell carcinoma

197
Q

Nerve supply to upper 1/2 anal canal

A

Parasympathetic supply

Insensate

Injecting haemorrhoids here will be painless

198
Q

Nerve supply to lower 1/2 anal canal

A

Somatic innervation from inferior rectal nerve

Sensitive to pain

199
Q

Venous drainage of anal canal

A

Upper 1/2 –> porta drainage

Lower 1/2 –> systemic drainage

200
Q

Lymphatic drainage of upper 1/2 anal canal

A

Along superior rectal vessels –> abdominal nodes

201
Q

Lymphatic drainage of lower 1/2 anal canal

A

Inguinal nodes

Rectal cancer invading lower anal canal may spread to inguinal lymph nodes

202
Q

Branches of celiac trunk

A

T12

Left gastric artery

Splenic artery

Common hepatic artery

203
Q

Left gastric artery

A

Smallest of branches from celiac trunk

–> Oesophageal branches that ascend up to oesophageal junction

Left gastric artery then turns to the right and descends along lesser curvature of stomach

  • -> anastomoses with right gastric artery
  • -> supplies both surfaces of stomach
204
Q

Splenic artery

A

Largest branch of celiac trunk

Courses to left on superior border of pancreas

Travels in splenorenal ligaments

Supplies neck, body an dtail of pancreas

Enters hilum of spleen

Branches

  • short gastric arteries –> gastrosplenic ligament –> supply fundus of stomach
  • left gastro-omental branch –> right, along greater curvature of stomach
  • –> anastomoses with right gastro-omental artery
205
Q

Common hepatic artery

A

Branch of celiac trunk

Runs to the right

Divides into two terminal branches

  • hepatic artery proper
  • gastroduodenal artery
206
Q

Hepatic artery proper

A

One of two terminal branches of the common hepatic artery, which branches from the celiac trunk

Ascends towards liver in free edge of lesser omentum (anterior to portal vein)
Runs left to bile duct

Divides into right and left hepatic arteries
- right hepatic artery branches –> cystic artery to gallbladder

207
Q

Cystic artery

A

Branch of right hepatic artery close to the liver

Right hepatic artery is a branch of hepatic artery porper, which in turn is a branch of the common hepatic artery of the celiac trunk

–> gallbladder

208
Q

Gastroduondeal artery

A

One of two terminal branches of the common hepatic artery

At upper border of superior duodenum gives of:

  • posterior superior pancreaticoduodenal artery
  • supraduodenal artery

Gastroduodenal artery then continues descending posterior to superior duodenum –> reaches lower border of superior duodenum
Divides into terminal branches
-right gastro-omental artery
-anterior superior pancreaticoduodenal artery

209
Q

Right gastro-omental artery

A

Terminal branch of gastroduodneal artery, which is a branch of the common hepatic artery of the celiac trunk

Branches from gastroduodenal artery at lower limit of superior part of duodenum

From here, the right gastro-omental artery passes along greater curvature of stomach

  • branches to stomach and greater omentum
  • anastomoses with left gastro-omental artery (from splenic artery)
210
Q

Anterior superior pancreaticoduodenal artery

A

Terminal branch of gastroduondeal artery of common hepatic artery of celiac trunk

Branches at lower limit of superior duodenum

Anterior superior pancreaticoduodenal artery descends along with posterior superior pancreaticoduodenal artery to supply head of pancreas and duodenum

Both of these vessels then anastomose with corrosponding anterior and posterior inferior pancreaticoduodenal arteries (branch of SMA)

211
Q

Superior mesentaric artery

A

L1 - lower part

Crossed anteriorly by splenic vein and neck of panceas

Posteriorly:

  • left renal vein
  • unicnate process
  • inferior part of duodenum

Branches

  • first: inferior pancreaticoduodenal artery
  • jejnunal branches
  • ileal branches
  • middle colic
  • right colic
  • ileocolic
212
Q

Inferior pancreaticoduodenal artery

A

First branch of SMA (right hand side)

Divies immediately into anterior and posterior inferior pancreaticoduodenal arteries

Anastomose superiorly with anterior and posterior superior pancreaticoduodenal arteries of gastroduodenal artery

Supplies

  • uncinate process of pancreas
  • duodenum
213
Q

Narrow windows in mesentry

A

Long narrow-spaced vasa recta

= jejunum

214
Q

Broad windows in mesentry

A

Spaced-out short vasa recta

= ileum

215
Q

Middle colic artery

A

First of the big three right-side branches from SMA

Emerges from beneath pancreas

Enters transverse mesocolon

Divides into right and left branches

  • right branch anastomoses with right colic
  • left branch anastomoses with left colic (branch of IMA)
216
Q

Right colic artery

A

Second of the big three right-side branches from SMA

Passes to righ tin a retroperitoneal position –> ascending colon

Nearing colon it divides:
Descending branch - anastomoses with iliocolic
Ascending branch - anastomoses with middle colic

217
Q

Iliocolic artery

A

Final / third of the big three right-side branches from SMA

Passes to right iliac fossa

Divides into:
Superior branch: passes upwards to anastomose with right colic artery

Inferior branch:

  • colic artery
  • cecal artery –> anterior and posterior cecal
  • appendicular artery
  • ileal branches
218
Q

Inferior mesenteric artery

A

L3

Passes anteriorly to aorta intially

Passes to left side as it descends

Branches:

  • left colic artery
  • several sigmoid branches
  • superior rectal artery
219
Q

Left colic artery

A

First branch of IMA

Ascends retroperitoneally, divides into:

  • ascending branch
  • descending branch

Ascending branch

  • passes anteriorly to left kidney –> enters transverse mesocolon –> passes superiorly to supply upper part of descending colon + distal transverse colon
  • anastomoses with branch of middle colic artery

Descending branch

  • lower descending colon
  • -> anastomoses with 1st sigmoid artery
220
Q

Sigmoid arteries

A

Two - four branches of IMA

Within sigmoid mesocolon

Supply lowest part of descending colon and sigmoid colon

First branch anastomoses superiorly with descending branch of left colic artery

221
Q

Superior rectal artery

A

Terminal branch of IMA

Descends into pelvic cavity in the sigmoid mesocolon

Cross left common iliac vessels

SIII: divides into two terminal branches

  • descend on either side of the rectum
  • continue inferiorly to level of internal spinchter
  • -> anstomosing with branches of middle rectal artery (from internal iliac artery) AND inferior rectal arteries
222
Q

Atherosclerosis of inferior mesenteric artery

A

Watershed area between SMA and IMA the most clinically significant

–> between middle colic and left colic arteries = splenic flexure vulnerable

IMA atherosclerosis disease means that the marginal artery is relied upon for hindgut perfusion

As celiac and SMA vessels narrow this reaches a critical ischaemia point –> mesenteric angina post meals

If acute occlusion –> ischaemia splenic flexure –> mucous sloughing, risk of perforation

223
Q

Formation of portal vein

A

L2
Posterior to neck of pancreas

Superior mesenteric vein joins with splenic vein Tr

224
Q

Tributaries to the portal vein

A

Rigth and left gastric veins

Cystic veins

Para-umbilical veins

Superior mesenteric vein
Splenic vein (+inferior mesenteric vein)
225
Q

Branches of portal vein

A

Approaching the liver it divides into right and left branches

226
Q

Porto-systematic anastomoses

A

Portal: left gastric vein
AND
Systemic: azygous system

Portal: superior rectal vein
AND
Systemic: middle and inferior rectal veins

Portal: para-umbilical veins
AND
Systemic: anterior abdominal wall veins

227
Q

Prota hepatis

A

Entry-point to liver

  • Common-hepatic duct anteriorly
  • Hepatic artery in middle
  • Portal vein posteriorly

Lymph nodes which, when enlarged by malignancy, may compress the bile ducts and cause obstructive jaundice
-gastric malignancy –> jaundice

228
Q

Left triangular ligament of liver

A

Continuous with part of falciform ligament

When traced to the right and posteriorly, joins the lesser omentum in the fissure for the ligamentum venosum

Contains no blood veseels
- can be divided so left lobe of liver can be re-tracted to visualise oesophagus

229
Q

Liver origin of lesser omentum

A

Arise from ligamentum venosum and porta hepatis

230
Q

Right hemihepatectomy

A

Segments

V, VI, VII and VIII

231
Q

Left hemihepatectomy

A

Segments

II, III and IV.

232
Q

Hepatic veins

A

Three
Right
Central
Left

Caudate - own indepdendent hepatic vein

233
Q

Calot’s triangle

A

Medial – common hepatic duct.
Inferior – cystic duct.
Superior – inferior surface of the liver

Contents:
Right hepatic artery – formed by the bifurcation of the common hepatic artery into right and left branches.
Cystic artery – typically arises from the right hepatic artery and traverses the triangle to supply the gall bladder
Lymph node of Lund – the first lymph node of the gallbladder

234
Q

Path of cystic artery

A

Cystic artery passes behind the common hepatic

duct and cystic duct

235
Q

Blood supply to pancreas

A

Splenic artery via arteria pancreatica magna.

Supply to head and uncinate process

  • superior pancreaticoduodenal artery, branch of gastroduodenal artery
  • inferior pancreaticoduodenal artery, branch of superior mesenteric artery.
236
Q

Contents of gastrosplenic ligament

A

Short gastric and left gastroepiploic vessels

237
Q

Contents of lienorenal ligament

A

Splenic artery and vein, lymph nodes

AND

Pancreatic tail

238
Q

Ribs overlying spleen

A

9th, 10th and 11th

239
Q

Splenunculi

A

Commonly: hilum, tail of pancreas, ometum, small bowel mesentery

May hypertrophy post splenectomy and cause recurrence of exacerbation of condition e.g. thrombocytopenic purpura

240
Q

Renal hilum, anterior –> posterior

A

Renal vein

Renal artery

Pelvis of the ureter

VAP

241
Q

Tributaries to left renal vein

A

Adrenal vein

Gonadal vein

Longer vs right

Passes anteriorly to aorta

242
Q

Lymphastic drainage of kidney s

A

Para-aortic lymph nodes

243
Q

Floatign kidney

A

Hypermobility of kidney in fascial compartment

Can be moved up and down
BUT NOT side-to-side

244
Q

Major calyces

A

Two per kidney

+ 12 minor

245
Q

Pelvic cource of ureter

A

Each ureter enters the pelvis by crossing the bifurcation of the common iliac artery

Runs down to ischial spine, crossing the obturator nerve
Crosses anterior branches of the internal iliac artery

Turns medial to reach the bladder and passes below the vas deferens just before entering the bladder

246
Q

Blood supply to ureter

A

Renal arteries (may receive a considerable contribution from a lower polar artery)

Testicular or ovarian artery

Internal iliac artery

Inferior vesical arteries

247
Q

Pyramidal adrenal

A

RIGHT

Superior pole of kidney

248
Q

Cresenteric adrenal

A

LEFT

Medial border of kidney

249
Q

Venous drainage right adrenal

A

RIght into IVC

Short adrenal vein –> IVC

250
Q

Venous drainage left adrenal

A

Drains via longer vein into the left renal vein, then into IVC

251
Q

Sympathetic innervation of medulla of adrenal

A

Greater splanchnic pre-ganglionic neurons

252
Q

Blood supply to bladder

A

Superior and inferior vesical arteries

Branches of the anterior division of the internal iliac artery

253
Q

Lymphatic drainage of the bladder

A

–> internal iliac nodes –> para-aortic nodes

254
Q

Interureteric ridge

A

Raised fold of mucosa between entry of two ureters into bladder

255
Q

Anterior and posterior relations to prostate

A

Anteriorly:
-pubic symphysis separated by the extraperitoneal fat of the retropubic space
(cave of Retzius)

Posteriorly:
-rectum separated by the fascia of Denonvilliers

256
Q

Lobes of the prostate

A

Posterior lobe: lies posterior to the urethra and
inferior to the plane defined by the course of the ejaculatory ducts

Single median lobe: lies between the ejaculatory ducts
and posterior to the urethra

Two lateral lobes (right and left lobes): separated
by a shallow posterior median groove, which can
be felt on rectal examination

Anterior to the urethra there is a narrow isthmus
only, consisting of mainly fibromuscular tissue

257
Q

Capsules of the prostate

A

True capsule: a thin, fibrous sheath surrounding the
prostate

False capsule: condensed extraperitoneal fascia
continuous with the fascia surrounding the bladder
and with the fascia of Denonvilliers posteriorly

–> prostatic venous plexus lies between the true and
false capsules

Pathological capsule: benign prostatic hypertrophy compresses normal peripheral part of the gland, creating a capsule

Enucleation of the prostate for benign prostatic
hypertrophy, enters plane between the adenomatous
mass and the pathological capsule

258
Q

Blood supply to prostate

A

Inferior vesicular artery

-branch of internal iliac artery

259
Q

Venous drainage of prostate

A

Prostatic venous plexus (between true and false capsule)

–> drains into the internal iliac vein on each side

Some venous blood drains posteriorly around the rectum to the valveless vertebral veins of Batson

–>this may explain why prostatic carcinoma metastasizes early to the bones of the lumbar spine
and pelvis

260
Q

Vertebral veins of Batson

A

Some venous blood from prostate drains posteriorly around the rectum to the valveless vertebral veins of Batson

–>this may explain why prostatic carcinoma metastasizes early to the bones of the lumbar spine
and pelvis

261
Q

Location of seminal vesicles

A

Lie one on each side in the interval between the base of the bladder anteriorly and the rectum posteriorly

Lie lateral to the termination of vas deferens.

Each seminal vesicle has a common drainage with its neighbouring vas via the common ejaculatory duct

The normal vesicles are usually impalpable on
rectal examination; however, if they are enlarged
by infection, e.g. tuberculosis, they become
palpable.

262
Q

Blood supply to uterus

A

Uterine artery. branch from internal iliac artery

Runs in base of broad ligament

2cm lateral to cervix –> passes anterior and superior to URETER

Reaches uterus at level of internal os, divies into ascending and descending branches

Then ascends up the lateral side of the body of the uterus –> laterally and inferiorly to the uterine tube

Terminates by anastomosing with the terminal branches of the ovarian artery

263
Q

Lymphatic drainage of the uterus

A

Fundus:
-ovarian vessels -> para- aortic lymph nodes
-some drains via ound ligament to the inguinal nodes
Metastases from the fundus of the uterus therefore may occur in the inguinal nodes

Body
-drains via lymphatics in the broad ligament to the iliac lymph nodes

Cervix drains in three directions:

  • laterally via the broad ligament to the external iliac nodes
  • posteriorly in the uterosacral fold to the sacral lymph nodes
  • posterolaterally along the uterine vessels to the internal iliac nodes
264
Q

Part of fallopian tube not covered in peritoneum

A

Intramural part

265
Q

Broad ligament of uterus

A

Fold of peritoneum: connects uterus to pelvic sidewalls

Contains or attaches to:

  • fallopian tube in its free edge
  • round ligament
  • ovarian ligament
  • uterine vessels and branches of the ovarianvessels
  • mesovarium attaching the ovary to its posterior aspect
  • lymphatics.

In base of the broad ligament, ureter passes forwards to the bladder lateral to and then immediately above the lateral fornix of the vagina

266
Q

Lymphatic drainage of the vagina

A

Upper and middle 1/3 –> external iliac nodes

Lower 1/3 –> superficial inguinal nodes

267
Q

Ganglion impar

A

Communication between two sides of sympathetic chain over lower end of coccyx

268
Q

Splanchnic Nerves

A

Thoracic, lumbar and sacral:
-carry preganglionic sympathetic fibres from sympathetic trunk –> ganglia in prevertebral plexus

Pelvic splanchnic nerve (parasympathetic root)

  • carry preganglionic PARAsympathetic nerve fibres from anterior rami of S2, S3 and S4
  • -> extension of of prevertebral plexus = inferior hypogastric plexus
269
Q

Greater splanchnic nerve

A

5th - 9th thoracic ganglia

–> travels to ceoliac ganglia in abdomen (prevertebral plexus)

270
Q

Lesser splanchnic nerve

A

9th - 10th / 11th thoracic ganglion

–> travls to aorticorenal ganglion

271
Q

Least splanchnic nerve

A

12th throacic ganglia

–> travels to renal plexus

272
Q

Thoracic splanchnic nerves

A

Greater –> celiac ganglion
-5th - 9th thoracic ganglia

Lesser –>aorticorenal ganglion
-9th - 10th thoracic ganglia

Least –> renal plexus
-12th throacica ganglia

273
Q

Lumbar splanchnic nerve

A

Sympathetic outfllow from lumbar region

–> prevertebral plexus

274
Q

Sacral splanchnic nerve

A

Sympathetic outflow from sacral region

–> inferior hypogastric plexus

275
Q

Pelvic splanchnic nerve

A

PARAsympathetic outflow

Originate form S2 - S4

Preganglionic parasympathetic fibres pass to inferior hypogastric plexus

  • -> supply parasympathetic input from transverse colon onwards
  • -> ascending branches supply hindgut
276
Q

Celiac plexus

A

Two celiac ganglion

Single SMA ganglion

Two aorticorenal ganglion

277
Q

Aortic plexus

A

IMA ganglion

278
Q

Innervation of psoas major

A

Innervated by anterior rami L1 - L3

O:

  • lateral surfaces of bodies of T12 - L5 vertebrae
  • transverse process of L1 - L5
  • intervertebral discs between T12 - L5

I: lesser trochanter of femur

F: hip flexion and flexion of trunk against gravity

279
Q

Innervation of psoas minor

A

Innervated by anterior rami of L1

O: lateral surfaces of vertebral bodies T12 - L1

I: pectineal line of the pelvic brim and iliopubic eminemce

F: flexion of lumbar column

280
Q

Innervation of quadratus lumborum

A

Innervated by aterior rami T12 - L4

O:

  • transverse process L5
  • iliolumbar ligament
  • iliac crest

I:

  • transverse process L1 - L4
  • inferior border of rib 12

F: depresses and stabilises rib 12, lateral bending of trunk

281
Q

Innervation of iliacus

A

Innervated be femoral nerve (L2 - L4)

O:

  • upper 2/3rds iliac fossa
  • anterior sacroiliac ligament
  • iliolumbar ligament
  • upper lateral surface of sacrum

I: lesser trochanter of femur

F: hip flexion and flexion of trunk against gravity

282
Q

Origin of right crus

A

L 1 - L3

283
Q

Origin of left crus

A

L2

284
Q

MedIAN arcuate ligament

A

Connects crura together across midline

Passes anterior to aorta

285
Q

MedIAL acruate ligament

A

Tendinous arch lateral to crura

Formed by fascia over psoas major

  • Medial attachment to L1-2 vertebral body
  • Lateral attachment to transverse process L1
286
Q

Lateral arcuate ligament

A

Situation just lateral to medIAL arcuate ligament

Formed by fascia passing over quadratus lumborum

  • Medial attachment T12 -L1 transverse process
  • Lateral attachment at 12th rib
287
Q

Passes through musculature of right crus

A

Oesophagus at T10

anterior branch of vagus
posterior branch of vagus
left gastric artery
left gastric vein
lymph
288
Q

Structures passing through medIAL arcuate liagment

A

Sympathetic trunk

Least splanchnic nerves

289
Q

Structures passing through left crus

A

Hemiazygous vein

290
Q

Coverigns of the kindye

A

Surrounded by peripnephric fat

Enclosed in renal fasica (including adrenals) = Gerotas fascia

Then covered in peritoneum on anterior seurface (retroperitoneal structures)

Then covered by paranephric fat

291
Q

Right renal artery

A

Longer vs left renal artery

Passes posterior to IVC

292
Q

Renal arteries

A

As each renal artery approaches the hilum it divides:

  • anterior branch
  • posterior branch
293
Q

Order of renal hilum

A

VAP

Anterior: Renal vein
Middle: Renal artery
Posterior: Ureter (pee)

294
Q

Left venal vein

A

Larger vs rigth renal vein

Corsses to right anterior to abominal aorta
BUT posterior to SMA
-can be compressed by an aneursym of either vessel

295
Q

Lymphatic drainage of kidney

A

Lateal aortic lumbar nodes

296
Q

Number of major calices

A

2 - 3 major calices –> renal pelvis

297
Q

Constiction point of ureter

A

First: uretopelvic junction

Second: ureter passes common iliac or external iliac vessels at pelvic brom

Third: uretes enter bladder

298
Q

Blood supply to ureters

A

Upper end: renal arteries

Middle: abomdinal aorta, testicular / ovairan arteries, common iliac arteries

Pelvic: internal iliac arteries

299
Q

Visceral innervation of ureters

A

Afferent fibres –> T11 - L2 spinal roots

Referred loin - groin pain

300
Q

Innervation oesophagus

A

Oesophageal plexus

Vagus nerve

  • upper sphincter: fibres from nucleus ambiguus
  • lower sphincter: dorsal motor nucleus
301
Q

Lymphatic drainage of oesophagus

A

Superior 1/3: deep cervical nodes

Middle 1/3: superior and posterior mediastinal nodes

Lower 1/3: left gastric and celiac nodes

Anatomy (22 decks)

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