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Surgery > Anatomy > Flashcards

Anatomy Flashcards

1
Q

Length of colon

A

150cm

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2
Q

Which part of the colon is retroperitoneal?

A
  • ascending colon
  • descending colon
  • rectum and anal canal
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3
Q

Length of sigmoid colon

A

40cm

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4
Q

Arterial supply of ascending colon

A
  • Ileocolic (from SMA)

- Right colic arteries (from SMA)

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5
Q

Arterial supply of transverse colon

A
  • Right 2/3: right marginal branch from SMA

- Left 1/3: left marginal branch from SMA

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6
Q

Arterial supply of descending colon

A
  • Left colic artery (from IMA)
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7
Q

Arterial supply of sigmoid colon

A
  • Sigmoid arteries (from IMA)
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8
Q

What is Marginal Artery of Drummond?

A

Clinically important vessels that provide collateral supply to colon - maintaining arterial supply in case of occlusion of major vessels. Forms from terminal vessels of SMA and IMA.

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9
Q

Nerve supply of colon

A
  • Midgut-derived (ascending colon and proximal 2/3 of transverse colon) = superior mesenteric plexus
  • Hindgut-derived structures (distal 1/3 of the transverse colon, descending colon and sigmoid colon)
    = Inferior mesenteric plexus (parasympathetic: pelvic splanchnic nerve; sympathetic: lumbar splanchnic nerve)
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10
Q

How long is the oesophagus?

A

25cm

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11
Q

Where does the oesophagus start and end at?

A
  • Start at the cricoid cartilage (C6 vertebra)

- End at the stomach (T10 vertebra)

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12
Q

Upper oesophagal sphincter formed by

A

Cricopharyngeus muscle

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13
Q

Lower oesophageal sphincter formed by

A
  • Increased tone of the muscularis propria
  • Fibres of the right diaphragmatic crus
  • Angle of His
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14
Q

3 narrow points of the oesophagus

A
  • Cricopharyngeus sphincter
  • Aortic arch
  • Where the oesophagus pierces through the diaphragm
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15
Q

Layers of oesophagus

A
  • Mucosa
  • Submucosa [Meissner’s plexus]
  • Muscularis propria (Inner circular, outer longitudinal) [Auerbach Plexus in between]
  • Serosa or adventitia
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16
Q

Retroperitoneal part of duodenum

A

1st inch of the 1st part

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17
Q

Difference between jejunum and ileum

A

> Jejunum

  • Vasa recta longer
  • Arcades less
  • Has valvular conniventes

> Ileum

  • Shorter vasa recta
  • Arcades more
  • Has Peyer’s patches
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18
Q

Arterial supply of small intestine

A

> Duodenum

  • 1st and 2nd: superior pancreatoduodenal artery (branch of gastroduodenal artery)
  • 3rd and 4th: inferior pancreatoduodenal artery (branch of superior mesenteric artery)

> Jejunum & Ileum
- Jejunal and ileal branches of SMA

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19
Q

Inferior mesenteric vein drains blood from

A
  • Rectum
  • Sigmoid colon
  • Descending colon
  • Splenic flexure
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20
Q

Ureter length and diameter

A
  • 25-30cm long

- 3mm in diameter

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21
Q

Relation of inguinal canal

A

> Floor
- Inguinal ligament

> Roof

  • Formed by arching fibers of transversus abdominis and internal oblique
  • Become the conjoint tendon medially

> Anterior wall

  • External oblique aponeurosis
  • Reinforced laterally by internal oblique

> Posterior wall
- Transversalis fascia

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22
Q

Content of spermatic cord

A

> 3 arteries

  • Testicular artery
  • Artery to the Vas Deferens
  • Cremasteric artery

> 3 nerves

  • Autonomic nerve (sympathetic from T10)
  • Ilio-inguinal nerve
  • Nerve to cremaster ( from genito-femoral nerve)

> 3 important structures

  • Vas Deferens
  • Pampiniform Plexus of vein
  • Processus Vaginalis
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23
Q

Anatomy of anal sphincter

A

> Internal anal sphincter

  • Upper 2/3
  • Involuntary smooth muscle

> External anal sphincter

  • Lower 2/3
  • Voluntary muscle
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24
Q

Arterial supply of anal canal

A

> Above pectinate line
- Superior rectal artery (branch of IMA)

> Below pectinate line
- Inferior rectal artery
( branch of internal pudendal artery)

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25
Q

Nerve supply of anal canal

A

> Above pectinate line
- Visceral innervation via inferior hypogastric plexus

> Below pectinate line
- Somatic innervation via inferior rectal nerve (branches of pudendal nerve)

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26
Q

Venous drainage of anal canal

A

> Above pectinate line
- Superior rectal vein -> inferior mesenteric vein (portal venous system)

> Below pectinate line
- Inferior rectal vein -> internal pudendal vein (systemic venous system)

  • Site of varices when portal HPT
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27
Q

Common position of appendix

A
  • Post-ileal (1 or 2 o’clock)
  • Pre-ileal (1 or 2 o’clock)
  • Pelvic (5 o’clock)
  • Sub-cecal (6 o’clock)
  • Retrocecal (11 o’clock) [Most common]
28
Q

Describe branches of portal venous system

A
  • Formed by union of the splenic vein and SMV posterior to neck of pancreas
  • IMV join to splenic vein posterior to body of pancreas
29
Q

Superior mesenteric vein drains blood from

A
  • Small intestine
  • Cecum
  • Ascending colon
  • Transverse colon
30
Q

Anatomy of pancreas

A
  • Head: lie within c-shaped concavity of duodenum, uncinated process extend to left behind the superior mesenteric vessels
  • Neck: lie in front of portal vein
  • Body: run upward and left across the midline
  • Tail: anterior to left adrenal gland contacting hilum of spleen
31
Q

Blood supply of pancreas

A
  • Celiac artery -> splenic artery (tail) and superior pancreaticoduodenal artery (head)
  • Superior mesenteric artery -> inferior pancreaticoduodenal artery (head)
  • Venous drainage via pancreaticoduodenal veins -> portal vein
32
Q

Arterial supply of breast

A

> Medial
- Internal thoracic artery (branch of subclavian artery)

> Lateral

  • Lateral thoracic and thoracoacromial branches (from axillary artery)
  • Lateral mammary branches (from posterior intercostal arteries)
  • Mammary branch (from anterior intercostal artery)
33
Q

Lymphatic drainage of breast

A
  • Axillary nodes (75%) [5 groups]
  • Parasternal nodes (20%)
  • Posterior intercostal nodes (5%)
34
Q

Anatomical division of liver

A
  • Separated by falciform ligament into right and left lobe
  • 2 accessories lobes arise from right lobe, located at visceral surface of liver: caudate (upper) and quadrate (lower) lobe
  • Portal hepatis separate the 2 accessory lobes
35
Q

Arterial supply of liver

A
  • Hepatic artery proper (25%)

- Hepatic portal vein (75%)

36
Q

Functional division of liver

A
  • Divide by 1 transverse plane (main branch of portal vein) and 3 sagittal plane (3 main hepatic veins)
  • Into 8 segments numbered in anti-clockwise manner around porta hepatis
  • Have own vascular inflow, outflow, and biliary drainage
37
Q

Border of anterior triangle

A
  • Lower border of mandible superiorly
  • Midline anteriorly
  • Anterior border of the SCM posteriorly
38
Q

Border of posterior triangle

A
  • Posterior border of the SCM anteriorly
  • Anterior border of the trapezius posteriorly
  • Clavicle inferiorly
39
Q

Blood supply of thyroid glands

A
  • Superior thyroid artery (from external carotid)
  • Inferior thyroid artery (from thyrocervical trunk)
  • Thyroid ima artery - around 10% of people
40
Q

Symptoms of damaged recurrent laryngeal nerve

A
  • Unilateral damage = hoarseness

- Bilateral damage = dyspnea

41
Q

Arteries of lower limb

A
  • External iliac artery continues as femoral artery after crossing the inguinal ligament
  • Superficial femoral enter the adductor canal and pass through the hiatus in the adductor magnus to reach the popliteal fossa, where it changes its name to popliteal artery
  • Popliteal divide at lower border of popliteus into anterior and posterior tibial artery
  • Anterior tibial -> dorsalis pedis
  • Posterior tibial -> peroneal artery + medial and lateral plantar artery
42
Q

Course of the great saphenous vein

A
  • Arise from medial side of dorsal venous arch of foot
  • Ascends immediately in front of medial malleolus (accompanied by saphenous nerve)
  • Ascends obliquely up the medial aspect of thigh
  • Pierces the cribriform fascia at the saphenofemoral junction to drain into the femoral vein
43
Q

Course of small saphenous vein

A
  • Arise from lateral side of the dorsal venous arch of foot
  • Passes posterior to the lateral malleolus
  • Ascends up the midline of calf
  • Pierces the deep fascia over popliteal fossa to drain into popliteal vein
  • Accompanied in course by sural nerve
44
Q

Location of communicating veins

A
  • Saphenofemoral junction
  • Hunterian perforator: mid-thigh
  • Dodd’s perforator: distal thigh
  • Boyd’s perforator: knee
  • Calf perforator: at 5, 10, 15cm above medial malleolus
45
Q

Parts of gallbladder

A
  • Fundus
  • Body
  • Neck
46
Q

Describe the biliary tree

A
  • Right and left hepatic ducts -> common hepatic duct
  • Joined with cystic duct when descend -> common bile duct
  • Joined with main pancreatic duct -> hepatopancreatic ampulla/ ampulla of Vater
47
Q

Artery supply of gallbladder

A
  • Cystic artery (branch of right hepatic artery)
48
Q

Calot’s triangle

A
  • Inferior border of liver superiorly
  • Cystic duct laterally
  • Common hepatic duct medially
49
Q

Content of inguinal canal

A
  • Males: spermatic cord + ilioinguinal nerve

- Females: round ligament of the uterus + ilioinguinal nerve

50
Q

Borders of Hesselbach’s triangle

A
  • Lateral: inferior epigastric artery
  • Medial: lateral border of rectus abdominis
  • Inferior: inguinal ligament
51
Q

Anatomy of inguinal canal

A
  • 4-6cm long oblique passage above inguinal ligament
  • Deep ring: 2cm above the midpoint of the inguinal ligament
  • Superficial ring: above and medial to the pubic tubercle
52
Q

Langer line

A
  • Line of skin tension
  • Associated with the distribution of collagen and elastic fibers in the skin
  • Predominantly horizontal in abdomen
53
Q

Location of appendix

A
  • Pre-ileal (1, 2 o’clock)
  • Post-ileal (1, 2 o’clock)
  • Sub-ileal (3 o’clock)
  • Pelvic (5 o’clock)
  • Subcecal (6 o’clock)
  • Paracecal (10 o’clock)
  • Retrocecal (11 o’clock) [Most Common]
54
Q

Artery supply of appendix

A
  • Appendicular artery (derived from ileocolic artery, a branch of SMA)
55
Q

Major branches of SMA

A

Inferior Pancreaticoduodenal artery

  • Inferior region of head of pancreas
  • Uncinated process
  • Duodenum

Jejunal and Ileal artery

Ileocolic artery

  • Ileum
  • Cecum
  • Appendix
  • Ascending colon

Right colic artery
- Ascending colon

Middle colic artery
- Transverse colon

56
Q

Dependent area for pelvic - Supine position

A
  • Morison’s pouch (hepato-renal fossa)
  • Pouch of Douglas (retro-uterine pouch)
  • Para-colic gutter
57
Q

Cantlie line

A
  • Vertical line extends from inferior vena cava posteriorly to the middle of gallbladder fossa anteriorly
  • Left: segment 2,3,4a,4b
    Right: segment 5,6,7,8
58
Q

Anatomical vs Functional division of liver

A

> Anatomical division
- Demarcated by falciform ligament

> Functional division

  • Demarcated by Cantlie’s line -> more important for reading CT scan and surgery
  • Further divide into 8 functional segment
59
Q

9 layers of abdominal wall

A
  • Skin
  • Subcutaneous tissue
  • Superficial fascia
  • External oblique muscle
  • Internal oblique muscle
  • Transversus abdominis muscle
  • Transversalis fascia
  • Preperitoneal adipose and areolar tissue
  • Peritoneum
60
Q

Midline vs Paramedian incision

A

> Midline
- Cut through skin, subcutaneous tissue, fascia, linea alba, transversalis fascia and peritoneum

> Paramedian

  • Cut through skin, subcutaneous tissue, anterior rectus sheath, posterior rectus sheath, transversalis fascia, and peritoneum
  • Assess lateral viscera - kidney, spleen, and adrenal glands
  • Can damage blood and nerve supply, leading to atrophy of muscle medially
61
Q

Blood supply of stomach

A

> Lesser curvature

  • Right gastric (branches of common hepatic, from coeliac trunk)
  • Left gastric (directly from coeliac trunk)

> Greater curvature

  • Right gastro-omental (branches of gastroduodenal artery, from common hepatic)
  • Left gastro-omental (branches of splenic artery, from coeliac trunk)
62
Q

Direct vs Indirect hernia

A

> Indirect

  • Remnants of patent processus vaginalis
  • Lateral to the inferior epigastric vessels
  • Travelling through the inguinal canal with spermatic cord
  • May continue through the superficial inguinal ring into the scrotum

> Direct

  • Result of weak posterior wall
  • Arise medial to the inferior epigastric vessels
  • Not within the spermatic cord
63
Q

Example of perforator veins

A
  • Saphenofemoral junction
  • Hunter veins (at thigh level)
  • Dodd’s perforators (inferior 1/3 of the thigh, above the knee)
  • Body’s perforator (at or below the knee level)
  • Cockett’s perforator (at the level of calf and inferior 2/3 of the leg) - further subdivided into superior, medium and inferior perforators
64
Q

Mallampati classification

A
  • Class 1: complete visualization of the soft palate
  • Class 2: complete visualization of the uvula
  • Class 3: visualization of only the base of uvula
  • Class 4: soft palate is not visible at all
65
Q

Lymph nodes at inguinal region

A
  • Divide into 2 groups by their position relative to a horizontal line drawn at the level of termination of the great saphenous veins
  • Above line: Superficial inguinal nodes
  • Below line: Sub-inguinal nodes (Superficial and Deep)

Surgery (11 decks)

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