Activities

Question 1

What are the names of the 2 lines that make up the 4 quadrants

Answer 1

Median plane
Transumbilical plane

Question 2

2 vertical lines that make up the nine quadrants

Answer 2

Midclavicular lines

Question 3

2 horizontal lines that make up the nine quadrants

Answer 3

Subcostal line
Intertubercular line

Question 4

In which of the nine regions does McBurney’s point lie?

Answer 4

Right iliac fossa

Question 5

In which region(s) are the liver and gallbladder located?

Answer 5

Right hypochondrium
Epigastrium

Question 6

In which region is the majority of the small intestine located?

Answer 6

Umbilical region

Question 7

What imaging techniques might be better at showing abdominal pathology?

Answer 7

CT scans are much better than x-rays

Question 8

Which muscle(s) have:
○ diagonally orientated fibres?

Answer 8

External oblique
Internal oblique

Question 9

Which muscle(s) have:
○ horizontally orientated fibres?

Answer 9

Transversus abdominis

Question 10

Which muscle(s) have:
○ vertically orientated fibres?

Answer 10

Rectus abdominis

Question 11

Which muscle is commonly referred to as the ‘six-pack’? What causes the divisions in the individual sections of this muscle?

Answer 11

Rectus abdominis
- the tendinous bands cause the muscle to bulge either side when muscle segments hypertrophy with exercise

Question 12

Which muscle(s) are responsible for twisting the torso?

Answer 12

External and internal oblique

Question 13

What is the effect on the pressure inside the abdomen if these muscles contract without moving the torso?
○ When do you use this function on a regular basis?

Answer 13

Increase intra-abdominal pressure
- going to the toilet

Question 14

Which aponeuroses pass in front of the rectus abdominis muscle

Answer 14

External oblique aponeuroses
Anterior aspect of internal oblique aponeuroses

Question 15

Which aponeuroses pass behind the rectus abdominis muscle

Answer 15

Posterior layer of internal oblique aponeuroses
Transversus abdominis aponeuroses

Question 16

What is the name of the fibrous vertical line in the centre of the rectus abdominis muscles that separates left from right?

Answer 16

Linea alba

Question 17

What layers of tissue are found deep to the anterior abdominal wall muscles and separate them from the abdominal organs?

Answer 17

Transversalis fascia
Parietal peritoneum
Visceral peritoneum

Question 18

Which structures form the roof of the inguinal canal?

Answer 18

Transversalis fascia
Arching fibres of the internal oblique and transversus abdominis

Question 19

Which structures form the floor of the inguinal canal?

Answer 19

Inguinal ligament

Question 20

Which structures form the posterior border of the inguinal canal?

Answer 20

Transversalis fascia
Medial fibres of the internal oblique and transversus abdominis aponeuroses

Question 21

What is the purpose of rugae in the stomach

Answer 21

ridges that increase the surface area of the stomach and stretch out to increase stomach volume when the stomach is full.

Question 22

Are rugae evenly distributed throughout the internal stomach? If not, where are there most, and where are there least?

Answer 22

Most prominent on greater curvature of stomach

Question 23

What is the pyloric sphincter composed of

Answer 23

Thick circular layer of smooth muscle

Question 24

Function of pyloric sphincter

Answer 24

Opens and closes to control the passage of chyme into the duodenal

Question 25

What problems may be caused if the pyloric sphincter is unable to relax fully?

Answer 25

Pyloric stenosis- food stays in the stomach, and symptoms such as bloating, nausea, vomiting, reflux can occur. Eventually, if food can not get absorbed, weight loss occurs.

Question 26

What artery supplies the cardiac

Answer 26

Left gastric artery

Question 27

Which artery supplies the pyloric antrum

Answer 27

Gastroduodenal artery (branch of splenic artery)

Question 28

Which artery is located behind the stomach

Answer 28

Abdominal aorta

Question 29

Where is the division between the foregut and midgut?

Answer 29

1/2 way along the duodenum

Question 30

Where is the division between the midgut and hindgut?

Answer 30

2/3 way along transverse colon

Question 31

What does the pyloric canal contain

Answer 31

the distal portion connecting to the duodenum. At the end of the pyloric canal is the pyloric orifice, marking the junction between the stomach and duodenum.

Question 32

At which vertebral level does the oesophagus penetrate the diaphragm?

Answer 32

T10

Question 33

What is the name of the region located behind the stomach? What are the boundaries of this region?

Answer 33

Lesser sac Anteriorly- stomach and lesser omentum Posteriorly- transverse mesocolon

Question 34

Which organ is located behind the stomach?

Answer 34

Pancreas

Question 35

Is the stomach intra- or extra-peritoneal?

Answer 35

Intraperitoneal

Question 36

Role of greater omentum

Answer 36

prevents the parietal and visceral peritoneum of the abdominal cavity from adhering to each other. For example, it prevents the parietal peritoneum lining the anterior abdominal wall from sticking to the visceral peritoneum of the ileum.

Question 37

Which parts of the large intestine are retroperitoneal, and which are intraperitoneal?

Answer 37

Retroperitoneal = ascending and descending colon Intraperitoneal - transverse and sigmoid colon

Question 38

Where is the marginal artery? Why is this anastomosis clinically important?

Answer 38

Formed by branches of the superior and inferior mesenteric arteries serves as a collateral supply to the colon when there is a blockage in one of the mesenteric vessels

Question 39

If a patient needs a total colectomy (removal of the large intestine), which arteries would need to be ligated?

Answer 39

Ileocolic artery - SMA Right colic artery - SMA Middle colic artery- SMA Left colic artery -IMA Sigmoid branches - IMA

Question 40

Dull pain in the middle of her abdomen suggests pathology of which parts of the GI tract

Answer 40

Umbilical region —> midgut —> 1/2 along duodenum to proximal 2/3 transverse colon

Question 41

The patient’s pain has now moved to the lower-right part of her abdomen - what is the medical term for this region of the abdomen?

Answer 41

Right iliac fossa

Question 42

A 39 year old woman presents to the Emergency Department with abdominal pain and nausea. The pain is constant. It started as a dull ache roughly in the middle of her abdomen but this morning seemed to move to the lower-right part of her abdomen and has become sharp and severe. The patient has tenderness on examination in this region. ● What is your differential diagnosis?

Answer 42

Appendicitis

Question 43

Appendicitis ● Explain why the pain has ‘moved’ and changed in character.

Answer 43

Initially, the visceral afferent nerve fibers at T8 through T10 are stimulated, leading to vague centralized pain. As the appendix becomes more inflamed and the adjacent parietal peritoneum is irritated, the pain becomes more localized to the right lower quadrant.

Question 44

Volvulus

Answer 44

occurs when a loop of intestine twists around itself and the mesentery that supports it, causing bowel obstruction

Question 45

Volvulus symptoms

Answer 45

abdominal distension, pain, vomiting, constipation, and bloody stools. The onset of symptoms may be insidious or sudden.

Question 46

Internal difference between the Jejunum and ileum

Answer 46

plicae circulares are more pronounced in the jejunum

Question 47

Venous drainage of foregut

Answer 47

Celiac vein

Question 48

Venous drainage of midgut

Answer 48

Superior mesenteric vein

Question 49

Venous drainage of Hindgut

Answer 49

Inferior mesenteric vein

Question 50

Why is it called the bare area of the liver

Answer 50

Not covered by visceral peritoneum

Question 51

The Ligamentum teres is the remnant of which fetal structure

Answer 51

Umbilical vein

Question 52

Which structures enter and exit the liver at the porta hepatis

Answer 52

Hepatic portal vein Common bile duct Hepatic artery proper

Question 53

Where do the left and right hepatic arteries originate from

Answer 53

Coeliac trunk —> common hepatic artery —> hepatic artery proper (after branch of Gastroduodenal artery) —> left and right hepatic arteries

Question 54

Which vessels unite to form the hepatic portal vein

Answer 54

Splenic vein Superior mesenteric vein

Question 55

Biliary tree

Answer 55

Left and right hepatic ducts converge to form common hepatic duct Cystic duct from gall bladder joins hepatic duct forming the common bile duct

Question 56

Route of pain fibres from cholecystitis for Epigastric pain

Answer 56

T5-T9

Question 57

Route of pain fibres from cholecystitis for right shoulder pain

Answer 57

Inflammation of diaphragm- C3-C5

Question 58

Route of pain fibres from cholecystitis for right hypochondrium pain

Answer 58

Inflammation of parietal peritoneum

Question 59

First half of duodenum arises from which embryological part of the gut

Answer 59

Foregut

Question 60

Second half of duodenum arises from which embryological part of the gut

Answer 60

Midgut

Question 61

Veins from the duodenum ultimately drain towards which large vein

Answer 61

Hepatic portal vein

Question 62

What is the Hepatopancreatic ampulla and what surrounds it

Answer 62

The union of the common bile duct and the major pancreatic duct Surrounded by sphincter of Oddi

Question 63

Function of Hepatopancreatic ampulla

Answer 63

connection between areas of your digestive system. It acts as a reservoir for pancreatic juices and bile, enabling the release of these substances that help your body break down and absorb food.

Question 64

What surrounds the Hepatopancreatic ampulla

Answer 64

Sphincter of Oddi

Question 65

The tail of the pancreas reaches which structure

Answer 65

Spleen

Question 66

Which artery lies embedded in the upper border of the pancreas

Answer 66

Splenic artery

Question 67

What structures compose the portal triad

Answer 67

Hepatic portal vein Common bile duct Hepatic artery proper

Question 68

3 branches of coeliac trunk

Answer 68

Left gastric artery Splenic artery Common hepatic artery

Question 69

Parts of the pancreas

Answer 69

Uncinate process Head Neck Body Tail

Question 70

What type of cancer commonly metastasises to the liver

Answer 70

Colon or rectum cancer as blood supply connected by hepatic portal vein

Question 71

Where would pain from the pancreas be referred to

Answer 71

Epigastrum

Question 72

What precautions must be taken following removal of the spleen

Answer 72

Antibiotics for life Up-to-date vaccinations

Question 73

Retroperitoneal organs - SAD PUCKER

Answer 73

Suprarenal (adrenal) glands Aorta Duodenum Pancreas Ureters Colon Kidneys Esophagus Rectum