Anatomy 1 Flashcards
What organs are normally palpable in the abdomen?
Aorta +/- lower pole right kidney
What is the surface marking for the neck of the pancreas?
Transpyloric plane - L1 - halfway between jugular notch of manubrium and upper border of symphysis pubis
What is the surface marking for the liver?
Nipple line superiorly, right 10th rib inferiorly, left 5th ICS MCL
What is the surface marking for the gallbladder?
9th c.c, MCL
What is the surface marking for the spleen?
Ribs 9-11 on left side posteriorly
Name the branches of the abdominal aorta descending?
Inferior phrenic arteries - T12 Coeliac trunk - L1 Suprarenal arteries/middle adrenal - L1 SMA - L1 Renal arteries - L1/2 Gonadal arteries - L2 Four paired lumbar arteries from L1-4 IMA - L3 Bifurcates at L4 to common iliacs and median sacral artery at L4
What is the surface marking of the abdominal aorta?
T12 2 finger breadths above transpyloric plane in midline
Runs down to L4 in midline
What is anterior to the aorta at L1?
Neck of pancreas and SMA
What is in the midline of the transpyloric plane? Back to front
L1 vertebra and conus Aorta SMA Neck of pancreas SMV Pylorus
What is laterally at the transpyloric plane?
Kidney hila Spleen hilum Renal vein D2 and DJ flexure Portal vein origin Fundus of GB 9th c.c.
What is the epiploic foramen of Winslow? What are its boundaries? Clinical significance in terms of pathology?
Boundary between greater and lesser sacs of peritoneum
Above is caudate lobe, below is D1
Anterior is lesser omentum with CBD/portal vein/CHA in free edge
Posterior is IVC
Lesser sac is site for potential internal herniation of bowel
What is Pringle’s manoeuvre?
Clamp hepatoduodenal ligament (containing portal vein and CHA) to control major liver bleeding during laparotomy
FISH of functions of the spleen?
Filtration of encapsulated organs and blood cells
Immunological function
Storage of platelets
Haematopoiesis (fetus)
Organs at risk during splenectomy?
Pancreas (tail) - in relation to hilum Left diaphragm Splenic flexure Left kidney/suprarenal gland Stomach
2 ligaments of the spleen? Where do they attach and what do they contain?
Gastrosplenic - short gastrics and left gastro-epiploics
Lienorenal - splenic vessels and tail of pancreas
5 sites of porto-systemic anastamoses?
Oesophagus - lower end Umbilicus Upper anal canal/lower rectum Retroperitoneum Bare area of liver
What is the oesophageal anastomoses between in portosystemic shunts?
Left gastric/portal
Azygous/hemiazygos veins
Common sites of abdominal collections?
Right subhepatic space - hepatorenal pouch of Rutherford Morrison Pelvis Between bowel loops Right and left subphrenic spaces Right and left paracolic gutters
What is the surface marking for the superior pole of the kidney?
12th rib posteriorly
What level do the renal veins join the IVC?
L1
What crosses the ureter anteriorly on each side of the abdomen?
Gonadal vessels
On right - right colic and ileocolic vessels
On left– left colic vessels
What is the blood supply to the ureter?
Upper = renal artery branches Middle = from common iliac and gonadal arteries Lower = common iliac and internal iliac - uterine and superior vesicular arteries
Anterior relations of right kidney?
Right lobe of liver Gallbladder Adrenal D2 Hepatic flexure Small intestine
Where does the IVC originate and from what?
L5 - from common iliac veins
What lies anterior to the IVC at its origin?
Right common iliac artery
Anatomical relationship of IVC to aorta?
Proximally - to right and anterior
Distally - to right and posterior
What are the retroperitoneal structures?
IVC Aorta and para-aortic nodes Kidneys and adrenals Duodenum except 1st part Ureters Splenic and hepatic flexures Ascending and descending colon Rectum, bladder, vagina Pancreas
Name the parts of the stomach?
Cardia Fundus Body Pylorus Antrum Also greater + lesser curvatures with incisura on lesser
Which part of the duodenum does the CBD enter?
D2 - posteromedial wall
Differences between jejunum and ileum?
Jej is slightly wider diameter, thicker walls, longer vasa recta with fewer arcades, also thinner mesentery
Large vs small bowel on radiograph?
Large has haustra, wider, more peipheral
Small has valvulae conniventes, thinner, more central
What are the parts of the pancreas?
Head Neck Body Uncinate process Tail
Blood supply to pancreas?
Pancreatic branches of splenic artery
Superior (coeliac, via gastroduodenal) and inferior (SMA) pancreaticoduodenal arteries to head
What are the 3 main divisions of the coeliac axis?
Splenic artery
Common hepatic
Left gastric
Blood supply to lesser curve of stomach?
Left and right gastric arteries
Blood supply to greater curve of stomach?
Right (from gastroduodenal) and left (from splenic) gastroepiploic arteries
What arteries can be eroded into by ulcers in the duodenum?
Posterior bit of D1/2 = gastroduodenal
D3/4 = pancreaticoduodenal
How may Meckel’s diverticulum present?
Acute inflammation - appendicitis mimic GI bleed Perforation Hernia - Littre's hernia Intussusception Obstruction
Layers of adrenal gland?
Cortex - GFR (glomerulosa - aldosterone, fasciculata - glucocortiocids, reticularis - androgens)
Medulla - catecholamines
What is the surface marking for dorsalis pedis?
Between first 2 metatarsal bones proximally just lateral to tendon of EHL
Dorsalis pedis is a continuation of?
Anterior tibial artery
What passes posteriorly to the malleolus? Tom Dick And Very Naughty Harry
From anterior to posterior Tibialis posterior tendon flexor Digitorum longus tendon Posterior tibial Artery Posterior tibial Vein Tibial nerve flexor Hallucis longus tendon
What muscles make up the achilles tendon? What compartment is this?
Gastrocnemius
Soleus
Plantaris
Superficial posterior compartment
What nerve supplies the muscles of the superficial posterior compartment of the leg?
Tibial nerve
What nerve supplies the muscles of the deep posterior compartment of the leg?
Tibial nerve
What muscles are in the deep posterior compartment of the leg?
Flexor hallucis longus
Flexor digitorum longus
Tibialis posterior
Popliteus
What innervates the muscles of the anterior compartment of the leg?
Deep peroneal nerve
What innervates the muscles of the lateral compartment of the leg?
Superficial peroneal nerve
Which peroneus muscle is not like the others?
Peroneus tertius - in anterior compartment rather than lateral
Where does peroneus longus originate from and insert?
Head of fibula to medial cuneiform/base of first metatarsal
Where does peroneus brevis originate from and insert?
Lower 2/3 of lateral surface of fibula medial to peroneus longus, to base of fifth metatarsal
Where does peroneus tertius originate from and insert?
Lower 1/3 of anterior surface of fibular / lower interosseus membrane to base of fifth metatarsal, under extensor retinaculum
Where would you test sensation for S1?
Lateral aspect of foot
Where would you test sensation for L4?
Medial malleolus
Where would you test sensation for deep peroneal nerve?
First web interspace
Where would you test sensation for superficial peroneal nerve?
Dorsum of foot (not first web interspace)
Where would you test sensation for sural nerve?
Lateral border of foot, similar to S1
What movements does EHL do?
Extension of big toe
Also foot dorsiflexion and inversion of foot
What vessels are deep to EHL in leg? Which nerve?
Anterior tibial artery and vein
Deep peroneal nerve
Nerve roots for knee reflex?
L3/4
Nerve roots for ankle reflex?
S1/2
Nerve roots for biceps reflex?
C5/6
Nerve roots for triceps reflex?
C7/8
Between what bones does ankle dorsiflexion occur?
Tibia/fibula and talus
Muscles that dorsiflex foot?
Anterior compartment: Tibialis anterior EHL EDL Peroneus tertius
Muscles that plantarflex foot?
Gastrocnemius
Soleus
Plantaris
Flexor hallucis longus, flexor digitorum longus and tibialis posterior (whole deep compartment except popliteus)
Why can people with achilles tendon rupture still plantarflex?
Superficial posterior compartment insert into achilles tendon but deep posterior compartment except popliteus also plantarflex
What muscles contracting together cause eversion of ankle?
Peroneus longus and brevis
What muscles contracting together cause inversion of ankle?
Tibialis anterior and posterior
At what joint do ankle inversion and eversion occur?
Subtalar
What sensorimotor loss occurs with damage to superficial peroneal nerve?
Loss of sensation to dorsum of foot except first dorsal webspace
Weak ankle eversion
Outline the ligaments supporting the ankle joint?
Deltoid ligament - medial, with strong deep part and weak superficial part
Anterior and posterior talofibular ligaments, and calcaneofibular ligament - lateral
Syndesmosis - normal alignment of distul tib-fib joint
What forms the syndesmosis of the ankle?
Anterior and posterior tibio-fibular ligaments
Interosseus ligament
Inferior transverse ligament
Where would you test saphenous nerve sensation?
Medial aspect of foot
Where would you test tibial nerve sensation?
Posterior sole of foot
Which way does the patella usually dislocate? Why?
Laterally - as knee normally held in valgus
Which muscles attach onto the linea aspera?
Adductors (magnus, longus, brevis)
Pectineus
Short head of biceps femoris
Vastus medialis and lateralis
Innervation and function of tibialis anterior?
Deep peroneal nerve
Dorsiflexion and inversion
Muscles in anterior compartment of leg?
Tibialis anterior
EHL
EDL
Peroneus tertius
Muscles in lateral compartment of leg?
Peroneus longus and brevis
Muscles in deep posterior compartment of leg?
Popliteus
Tibialis posterior
Flexor hallucis longus
Flexor digitorum longus
Muscles in superficial posterior compartment of leg?
Plantaris
Gastrocnemius
Soleus
What separates the anterior and posterior compartments of leg?
Interosseus membrane
What separates the anterior and lateral compartments of leg?
Anterior fascial septum
What separates the lateral and posterior compartments of leg?
Posterior fascial septum
What separates the deep and superficial posterior compartments of leg?
Deep transverse fascial septum
How would you perform a lower limb fasciotomy?
4 compartment decompression
2cm anterior to fibula anteriolateral incision to decompress ant/lat compartments, from tibial tuberosity to ankle
Posteromedial incision from tuberosity to 5cm above medial malleolus
Divide underlying fascia and debride any necrotic tissue
3 muscles attaching to medial cuneiform bone? Think ankle inversion
Peroneus longus
Tibialis anterior and posterior
Describe arterial supply to lower leg? On angiogram where are they?
Popliteal artery divides into anterior tibial artery and tibioperoneal trunk just under arch of soleus below knee
Anterior tibial is most lateral
Tibioperoneal trunk divides into peroneal and posterior tibial
Peroneal is middle of the 3 arteries on angio and supplies lateral compartment
Posterior tibial is most medial and supplies posterior compartments
What nerve does the small saphenous vein run with up the leg and what does it drain into?
Sural nerve in posterior compartment
Drains into popliteal vein
Where does the vas deferens run and what is its function?
Runs from epididymis in scrotum, up through inguinal canal, down into ejaculatory ducts
Carries sperm which are released under sympathetic stimulation via peristalsis of tube into urethra, mixed with seminiferous fluid and secretions
At what angle do the ureters enter the bladder?
Posterior aspect of bladder through trigone, at an oblique angle
What stops reflux of urine into the ureters from the bladder?
Ureters pass through detrusor in bladder wall
So when detrusor contracts it brings wall down and closes ureters
Where are kidney stones commonly impacted?
Pelviureteric junction
Pelvic brim (near the bifurcation of the common iliac arteries)
Vesicoureteric junction (most common)
What is the most common type of bladder cancer worldwide and in the UK? Why difference?
UK = TCC = related to smoking, dyes etc Worldwide = SCC = schistosoma haematobium causing squamous metaplasia
Initial investigation of visible painless haematuria?
CT urogram and flexible cystoscopy
Initial investigation of invisible painless haematuria (microscopic)?
US renal tract and flexible cystoscopy
If findings on flexible cystoscopy are suspicious for cancer what is undertaken next?
Rigid cystoscopy and biopsy under GA
Or TURBT
Blood supply to bladder?
Branches of the anterior division of the internal iliac artery:
Upper part = superior vesical artery
Lower part = inferior vesical artery in men, vaginal artery in women
Obturator and inferior gluteal arteries contribute small branches
Nerve supply to bladder?
Efferent parasymp from S2-4 (pelvic splanchnic, inferior hypogastric plexus) to bladder wall and inhibitory fibres to internal sphincter - pee
Efferent symp from hypogastric plexus inhibits detrusor and stimulates internal sphincter - no pee
Voluntary control of urination?
Pudendal nerve - S234 - external sphincter
