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13. Gastrointestinal > Anatomy 1. Surgical Anatomy > Flashcards

Anatomy 1. Surgical Anatomy Flashcards

1
Q

What is the anterolateral abdominal wall bounded by?

A

Superiorly - the cartilages of the 7th-10th ribs, and the xiphoid process of the sternum.
Inferiorly - the inguinal ligament and superior margins of the anterolateral aspects of the pelvic girdle.

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2
Q

What does the anterolateral abdominal wall consist of?

A

Skin, subcutaneous tissue, muscles and their aponeuroses, deep fascia, extraperitoneal fat, and parietal peritoneum.

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3
Q

What is the major landmark of the abdominal wall at spinal level L3?

A

The umbilicus.

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4
Q

What is the epigastric fossa?

A

Pit of the stomach, a slight depression in the epigastric region, just inferior to the xiphoid process.

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5
Q

Which site of the abdominal wall where heartburn is felt?

A

At the epigastric fossa.

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6
Q

What is the linea alba?

A

The aponeuoses of abdominal muscles visible in lean individuals due to the vertical skin groove superficial to it.

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7
Q

What is divarication of the recti?

A

The linea alba is lax so when the rectus abdominis contracts, the muscles spread apart.

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8
Q

What unites the pubic crest and symphysis?

A

Upper margins of the pubic bones and the cartilaginous joint.

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9
Q

Where can the pubic crest and symphysis be felt?

A

At the inferior end of the linea alba.

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10
Q

What is the inguinal groove?

A

A skin crease parallel and just inferior to the inguinal ligament.

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11
Q

What does the inguinal groove mark?

A

The division between the abdominal wall and the thigh.

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12
Q

What are the semilunar lines?

A

The slightly curved, tendinous line on either side of the rectus abdominis.

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13
Q

What is the arcuate/ Douglas’ line?

A

Where the rectus fibrous sheath stops 1/3 of the way from the umbilicus to the pubic crest.

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14
Q

How many muscles are in the anterolateral abdominal wall?

A

Five - three flat and two vertical muscles.

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15
Q

What are the flat muscles in the anterolateral abdominal wall?

A

External oblique, internal oblique, and transversus abdominis.

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16
Q

What are the vertical muscles in the anterolateral abdominal wall?

A

Rectus abdominis and pyramidalis.

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17
Q

What are the orientations of the flat muscle fibres in the anterolateral abdominal wall?

A

The fibres of the obliques run diagonally and perpendicular to each other. The fibres of the transversus muscle run transversely.

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18
Q

What is the origin and insertion of the external oblique muscle?

A

Origin - external surfaces of the 5th-12th ribs.

Insertion - linea alba, pubic tubercle, and anterior half of iliac crest.

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19
Q

What is the origin and insertion of the internal oblique muscle?

A

Origin - thoracolumbar fascia, anterior two thirds of iliac crest, and connective tissue deep to lateral third of inguinal ligament.
Insertion - inferior borders of the 10th-12th , linea alba, and pectin pubis via conjoint tendon.

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20
Q

What is the origin and insertion of the transversus abdominis muscle?

A

Origin - internal surface of 7th-12th costal cartilages, thoraculumbar fascia, iliac crest, and connective tissue deep to lateral third of inguinal ligament.
Insertion - linea alba with aponeuroses of internal oblique, pubic crest, and pectin pubis via conjoint tendon.

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21
Q

What makes up the rectus sheath?

A

The three flat muscles as they continue anteriorly and medially as aponeuroses. Between the mid-clavicular line and the midline.

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22
Q

Which two vertical muscles does the rectus sheath enclose?

A

The rectus abdominis and the small pyramidalis.

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23
Q

What forms the linea alba?

A

The aponeuroses interweaving with their fellows of the opposite side.

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24
Q

What does the linea alba extend between?

A

The xiphoid process to the pubic symphysis.

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25
Q

What is an important consideration when designing an incision?

A

It should be able to close and provide long-lasting strength to minimise the incidence of incisional herniae.

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26
Q

Why is a midline incision a good design for an incision?

A

Surgeons suture the linea alba together and this provides strong closure.

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27
Q

Why is a transverse incision a good design for an incision?

A

Surgeons suture the external oblique aponeuroses together which provides strong closure.

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28
Q

What is the incision point of an appendicectomy?

A

McBurney’s point.

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29
Q

Where is McBurney’s point?

A

2/3rds of the distance between the umbilicus and ASIS.

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30
Q

What type of incision is used in appendicectomies?

A

Gridiron muscle-splitting incision at McBurney’s point.

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31
Q

What is meant by gridiron incision?

A

Put scissors in and open and close them to separate out the muscle fibres. In appendicectomy, this has to be done for the external oblique, then internal oblique, then transversalis abdominis muscles in turn.

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32
Q

What is patent urachus?

A

An opening in the urachus leading to the bladder.

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33
Q

When does a patent urachus present?

A

At birth or later in life in men when they develop bladder outflow obstruction due to benign prostatic hypertrophy.

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34
Q

What is Meckel’s diverticulum?

A

The most common GI abnormality, it is a ‘cul-de-sac’ in the ileum.

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35
Q

What is meant by Meckel’s diverticulum following a rule of 2’s?

A

2% of the population are affected, 2 feet from the ileocecal valve, 2 inches long, detected in under 2’s, 2:1 male:female.

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36
Q

What may Meckel’s diverticulum contain?

A

Ectopic gastric or pancreatic tissue.

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37
Q

What is a complication of Meckel’s diverticulum?

A

The ectopic tissue may secrete eznymes and acids into tissues, causing ulceration.

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38
Q

What is a vitelline cyst?

A

When the vitelline duct forms fibrous strands at either end.

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39
Q

What is a vitelline fistula?

A

Direct communication between the umbilicus and intestinal tract.

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40
Q

What is the result of vitelline fistulae?

A

Faecal matter coming out of the umbilicus.

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41
Q

What is omphalocoele?

A

Persistence of physiological herniation. Part of the gut tube fails to return to the abdominal cavity following its normal herniation into the umbilical cord.

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42
Q

Why does an epithelial layer cover the defect in omphalocoele?

A

The umbilical cord is covered by a reflection of the amnion.

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43
Q

What is gastroschisis?

A

The failure of closure of the abdominal wall during folding of the embryo so the gut tube and its derivative are outside the body cavity.

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44
Q

Why does the gut die in gastroschisis?

A

There is no covering over the gut tube and its derivatives as they herniate through the abdominal wall directly into the amniotic cavity.

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45
Q

What is somatic referred pain?

A

Pain caused by noxious stimulus to the proximal part of the somatic nerve that is perceived in the distal dermatome of the nerve.

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46
Q

What is visceral referred pain?

A

In the thorax and abdomen, visceral afferent pain fibres follow sympathetic fibres back to the same spinal cord segments that gave rise to the preganglionic sympathetic fibres. The CNS perceives visceral pain as coming from the somatic portion of the body supplied by the relevant spinal cord segments.

47
Q

What is visceral pain caused by?

A

Ischaemia, abnormally strong muscle contraction, inflammation, and stretch.

48
Q

What does not cause visceral pain?

A

Touch, burning, cutting, and crushing.

49
Q

Where will visceral pain be felt from foregut structures?

A

Epigastric region.

50
Q

Where will visceral pain be felt from midgut structures?

A

Periumbilical region.

51
Q

Where will visceral pain be felt from hindgut structures?

A

Suprapubic region.

52
Q

Where do retroperitoneal structures cause pain?

A

Central back.

53
Q

Explain how pain changes over acute appendicitis.

A

Early - pain begins at the umbilicus as the innervation of the appendix enters the spine at T10.
Later - appendix is more inflamed so irritates surrounding bowel wall and localises pain to the right lower quadrant.

54
Q

What are the qualities of pain caused by small bowel colic?

A

Doubled over in pain, periumbilical pain (midgut).

55
Q

What are the qualities of pain caused by large bowel colic?

A

Doubled over in pain, suprapubic pain (hindgut).

56
Q

What are the qualities of pain caused by renal or ureteric colic?

A

Patient rolls around on the floor, pain is said to be worse than child birth.

57
Q

What can cause referred diaphragmatic irritation?

A

Ruptured spleen, ectopic pregnancy, or perforated ulcers.

58
Q

How is referred diaphragmatic irritation caused?

A

Blood pools in the pelvis and gives pain. The patient feels faint from loss of blood so lies down, causing blood to rush up to diaphragm - C3/4/5. This causes referred pain to the left shoulder.

59
Q

What is the peritoneal cavity?

A

A potential space between the parietal and visceral layers of peritoneum.

60
Q

What does the peritoneal cavity contain?

A

Small amounts of peritoneal fluid.

61
Q

How does the peritoneal cavity differ in males and females?

A

In males, it is completely closed. In females, there is communication to the exterior through uterine tubes, cavity, and vagina.

62
Q

Why are females more at risk for infection of the peritoneal cavity?

A

It is open to the exterior via uterine tubes, cavity and vagina so there is a potential pathway of infection.

63
Q

What do the layers of the peritoneum consist of?

A

Mesothelium - a layer of simple squamous epithelial cells.

64
Q

What separates the parietal peritoneum from the muscular layers of the abdominal wall?

A

Extraperitoneal connective tissue.

65
Q

Why is pain from the parietal peritoneum well localised?

A

It is served by the same blood, lymphatic and somatic nerve supply as the region of wall it lines.

66
Q

Why is pain from the visceral peritoneum poorly localised?

A

It is stimulated by stretching and chemical irritation and is supplied by visceral nerves so poorly localised to dermatomes of the spinal ganglia providing the sensory fibres.

67
Q

What is the mesentery?

A

A double layer of peritoneum connecting an intraperitoneal organ to the body wall.

68
Q

What does mesentery occur as a result of?

A

The invagination of the peritoneum by an organ, it consitutes a continuity of the visceral and parietal peritoneum.

69
Q

What is the omentum?

A

A double layered extension or fold of peritoneum that passes from the stomach and proximal part of the duodenum to adjacent organs in the abdominal cavity.

70
Q

What is the greater omentum?

A

A prominent, four-layered peritoneal fold that hands down like an apron from the greater curve of the stomach. If folds back after descending and attaches to the anterior surface of the transverse colon and its mesentery.

71
Q

What is the lesser omentum?

A

A smaller, double-layered peritoneal fold that connects the lesser curvature of the stomach and the proximal part of the duodenum to the liver and the stomach to the portal triad.

72
Q

What is the peritoneal ligament?

A

A double layer of peritoneum that connects an organ with another organ or to the abdominal wall.

73
Q

What do the peritoneal ligaments connect the liver to?

A

The anterior abdominal wall - falciform ligament. The stomach - hepatogastric ligament. The duodenum - hepatoguedenal ligament.

74
Q

What do the peritoneal ligaments connect the stomach to?

A

The inferior surface of the diaphragm - gastrophrenic ligament. The spleen - gastrophrenic ligament. The transverse colon - gastrocolic ligament.

75
Q

Why do organ have bare areas?

A

To allow the entrance and exit of neuro-vascular structures.

76
Q

What are the two classifications of structures of the peritoneum?

A

Intraperitoneal and retroperitoneal.

77
Q

What are intraperitoneal structures?

A

Structures completely covered by peritoneum but not completely enclosed due to the mesentery.

78
Q

What are retroperitoneal structures?

A

Structures that are outside the peritoneal cavity and so are only partially covered by the parietal peritoneum.

79
Q

What are the retroperitoneal structures?

A

Kidneys, ureters, and the bladder. The aorta and the inferior vena cava. The oesophagus. The duodenum (except the proximal part). Most of the pancreas. The ascending and descending colon, and the colon.

80
Q

What does the transverse mesocolon divide the abdominal cavity into?

A

A supracolic compartment and infracolic compartment.

81
Q

What does the supracolic compartment contain?

A

The stomach, liver, and spleen.

82
Q

What does the infracolic compartment contain?

A

The small intestine, ascending and descending colon.

83
Q

Where does the infracolic compartment lie?

A

Posterior to the greater omentum.

84
Q

What is the infracolic compartment divided into and by what?

A

Right and left infracolic spaces by the mesentery of the small intestine.

85
Q

How do the supracolic and infracolic compartments freely communicate?

A

Through the paracolic gutters.

86
Q

What are the paracolic gutters?

A

Grooves between the lateral aspect of the ascending or descending colon and the posterolateral abdominal wall.

87
Q

What is the greater sac made up of?

A

The supracolic and infracolic compartments.

88
Q

What is the lesser sac?

A

An extensive sac-like cavity that lies posterior to the stomach, lesser omentum, and adjacent structures.

89
Q

What is the superior recess of the lesser sac limited by?

A

Superiorly by the diaphragm and posterior layers of the coronary ligament of the liver.

90
Q

Where is the inferior recess of the lesser sac?

A

Between the superior parts of the layers of the greater omentum.

91
Q

When does the inferior recess become sealed off from the main part of the lesser sac?

A

After adhesion of the anterior and posterior layers of the greater omentum.

92
Q

How does the lesser sac allow free movement of the stomach?

A

It’s anterior and posterior walls slide smoothly over one another.

93
Q

How do the greater and lesser sacs communicate?

A

Through the omental foramen.

94
Q

What is the omental foramen?

A

An opening situated posterior to the free edge of the lesser omentum.

95
Q

How can the omental foramen by located?

A

By running a finger along the gall bladder to free the edge of the lesser omentum.

96
Q

Where does the right subphrenic space lie?

A

Between the diaphragm and the anterior, superior, and right lateral surfaces of the right lobe of the liver.

97
Q

What is the right subphrenic space bound by?

A

On the left side by the falciform ligament, and behind by the upper layer of the coronary ligament.

98
Q

What is a common site for collections of fluid after right-sided abdominal inflammation?

A

The right subphrenic space.

99
Q

Where does the left subphrenic space lie?

A

Between the diaphragm, the anterior and superior surfaces of the left love of the liver, the anterosuperior surface of the stomach, and the diaphragmatic surface of the spleen.

100
Q

What is the left subphrenic space bounded by?

A

On the right by the falciform ligament and behind by the anterior layer of the left triangular ligament.

101
Q

When is the left subphrenic space enlarged?

A

In the absence of the spleen.

102
Q

Which subphrenic space is larger than the other?

A

The left is larger than the right.

103
Q

What forms the recto-uterine pouch?

A

When the peritoneum passes from the rectum to the posterior vaginal fornix and then back to the uterine cervix and body as the recto-uterine fold, which descends.

104
Q

What forms the shallow vesico-uterine pouch?

A

The peritoneum spreads over the uterine fundus to its anterior surface as far as the junction of the bodt and cervix, it is reflected forward to the upper surface of the bladder.

105
Q

What forms the rectovesical pouch in males?

A

Peritoneum leaves the junction of the middle and lower thirds of the rectum and passes forwards to the upper poles of the seminal vesicles and superior aspect of the bladder. Then moves between the rectum and bladder.

106
Q

What lies between the two sheets of peritoneum in the mesentery of the small intestine?

A

Blood vessels, lymph vessels, and nerves.

107
Q

How can the small intestine move relatively freely in the abdominal cavity?

A

Because of the mesentery.

108
Q

Where is the root of the mesentery of the small intestine?

A

15cm from the duodenojejunal flexture at the level of left side L2, obliquely to the ileocaecal junction.

109
Q

Where does the root of the mesentery of the small intestine cross?

A

The second and third parts of the duedenum, abdominal aorta, inferior vena cava, right ureter, right psoas major muscle and right gonadal artery.

110
Q

What is the sigmoid mesocolon?

A

The peritoneal fold attaching the sigmoid colon to the pelvic wall.

111
Q

What is the attachment of the sigmoid colon to the pelvic wall?

A

The sigmoid mesocolon which is an inverted V shape with the apex near the division of the left common iliac artery.

112
Q

Where does the left limb of the sigmoid mesocolon descend?

A

Medial to the left psoas major muscle.

113
Q

Where does the right limb of the sigmoid pass?

A

Into the pelvis to end in the midline at the level of the third sacral vertebra.

114
Q

What runs between the layers of the sigmoid mesocolon?

A

Sigmoid and superior rectal vessels, the left ureter descends into the pelvis behind its apex.

13. Gastrointestinal (17 decks)

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