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DIG 209 FINAL > Anatomy > Flashcards

Anatomy Flashcards

1
Q

Problem 1:
A male patient with severe colic in the loin radiating to groin and external genitalia on radiograph shows a stone in the right ureter.

a. Mention two sites for impaction of the stone?
b. Mention where can you locate stone ureter in the X-ray?
c. How does the ureter enter the pelvic cavity?
d. How does the ureter end?
e. How is the ureter related to the broad ligament?

A

a. Pelvi ureteric and intramural parts.

b. At the tips of transverse processes of the lumbar vertebrae and ischial spine.

c. By crossing the bifurcation of the common iliac artery.

d. Intramural part in the posterior superior angle of the urinary bladder.

e. It passes below the root of the broad ligament.

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2
Q

A 20-years- old girl was admitted to the hospital complaining of severe pain which starts around the umbilicus, then settled in the right iliac fossa and vomiting the patient keeps the right hip flexed. Condition was diagnosed as acute appendicitis.

a. Mention two common positions of the appendix.
b. Give the surface anatomy of it base.
c. How does a surgeon identify the base of appendix during surgery?
d. Name its artery and give its origin.
e. Why does the patient flex his night hip?

A

Answer:

a. Pelvic and retroceacal,

b. Mc Burney’s point (At Junction of the medial 2/3 and lateral 1/3 of a line extending between umbilicus and right anterior
superior iliac spine.)

c. By following the teniae coli of the caecum as they converge at base of the appendix.

d. Appendicular artery from ileocolic artery.

e. Due to irritation and spasm of psoas major muscle.

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3
Q

Problem 3:
A 65-years-old man, who had a history of chronic duodenal ulcer, was admitted to hospital with signs of severe internal hemorrhage due to perforated duodenal ulcer.

a. What is the commonest site of duodenal ulcer?
b. What is the cause of internal hemorrhage?
c. Where does the duodenum begin?
d. Name two arteries supplying the duodenum.
e. Give the venous drainage of the duodenum.

A

Answers:

a. Posterior wall of 1st- part of duodenum.

b. Erosion of gastro-duodenal artery.

c. In Transpyloric plane 1/2 inch to the right of middle line.

d. Superior and inferior pancreatico duodenal arteries, supradudenal artery.

e. Portal circulation.

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4
Q

Problem 4:

A 40-years–old fatty female, complained of tenderness in right hypochondrium, which increases after fatty meals and the pain, was referred to right shoulder. A diagnosis of inflammation of the gall bladder was confirmed.

a. Give the surface anatomy of fundus of gall bladder.
b. Why was the pain referred to night shoulder?
c. Give it arterial supply.
d. Give the anterior relation of its fundus.
e. Give the posterior relation of its fundus.

A

Answers:

a. Tip of right 9 th costal cartilage.

b. Due to irritation of the phrenic nerve (C3.4.5), the same segments supply skin of shoulder by supraclavicular nerves.

c. Cystic artery from right branch of hepatic artery

d. Anterior abdominal wall.

e. Transverse colon.

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5
Q

Problem (5)

A 35 years old farmer came to the clinic complaining of a mass in his left hypochondrium. On examination it was found to be an enlarged spleen which descended downwards and medially.

a. Why does the spleen descend directly downwards?
b. Mention its surface anatomy?
c. Name its ligaments?
d. Name its surfaces?
e. Mention its blood supply?

A

Answers:

a. Because the left colic flexure and phrenico-colic ligament prevent its direct downward descent.

b. Opposite 9.10.11 ribs with its long axis on the 10th rib and its lateral end at midaxillary line.

c. Lieno-renal and gastro- splenic ligaments.

d. Diaphragmatic and visceral.

e. Splenic artery from celiac trunk and splenic vein into portal vein.

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6
Q

Describe the relations of the body of pancreas.

A

Anterior surface: stomach, separated by lesser sac

Inferior surface: Duodenojejunal flexure, loops of jejunum, Lt colic flexure.

Posterior surface: Lt renal vein, splenic vein, Abdominal aorta + SMA origin, Lt kidney, Lt suprarenal gland, Lt crus of diaphragm, Lt psoas major muscle, Lt sympathetic chain

Superior border: splenic A, coeliac trunk

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7
Q

What are the related to the posterior surface of right kidney.

A

Area for transversus tendon
Area for quadratus lumborum
Psoas area
12th rib
Diaphragm

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8
Q

Explain the congenital anomalies of the development of the kidney.

A

Renal agenesis: unilateral absence of kidney

Pelvic kidney: one kidney fails to ascend and remains in pelvis

Horse-shoe kidney: sue to fusion of lower poles of 2 kidneys across the midline

Accessory renal arteries: represent the persistence of embryonic vessels

Congenital Polycystic kidney: numerous cyst form

Bifid ureter: resulted from early splitting of the ureteric bud

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9
Q

Mention the anterior relation of both right and left kidney.

A

Rt kidney: rt suprarenal gland, 2nd part of duodenum, lobe of liver, Rt colic fixture, Rt colic A, Loops of jejunum

Lt kidney: Lt suprarenal gland, stomach, spleen,

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10
Q

Write a short note on the covering of the kidney

A

It has true fibrous capsules: closely surrounds the kidney and covers the renal sinus.

Perirenal fat: surrounds the capsule and prolongs into the renal sinus

Renal fascia: is derived from fascia transversalis, consists of two layers

Pararenal fat: condensation of the retroperitoneal fat outside renal fascia.

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11
Q

Enumerate the congenital anomalies of the testis.

A

Cryptorchism

Ectopic testis

Congenital hydrocele

Congenital inguinal hernia

Gonadal dysgenesis

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12
Q

Give an account on the formation of the rectus sheath

A

Above costal margin: Rectus muscles lies directly on 5,6,7 costal cartilages

Mid way between umbilics and symphisis pubis: Anterior wall formed of external oblique and internal oblique aponeurosis. Posterior wall is formed of transverse abdominis

Below arcuate line: Anterior wall formed of aponeurosis of external, internal oblique and transverse abdominis muscle.

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13
Q

Enumerate the content of the rectus sheath

A

Rectus abdominis
Pyramidalis
Superior epigastric vessels
Inferior epigastric vessels
Lower 5 intercostal nerve and vessels
Connective tissue
Lymphatics
Sympathetic fibers

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14
Q

Give the beg and end of the inguinal canal

A

At deep inguinal ring: oval opening in fascia transversalis

At superficial inguinal ring: a triangular opening in the external oblique aponeurosis. Found above and medial to pubic tubercle.

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15
Q

Enumerate the contents of the inguinal canal

A

Spermatic cord or round ligament of uterus

Internal spermatic fascia

Cremasteric muscle and fascia

Ilio-inguinal nerve:

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16
Q

Give an account on the boundaries of the inguinal canal:

A

Anterior wall: external abdominal oblique aponeurosis, internal abdominal oblique aponeurosis

Posterior wall: formed of fascia transversalis (conjoint tendon and inguinal ligament)

Roof: internal abdominal oblique and transverse abdominis muscle

Floor: inguinal ligament along whole length and lacunar ligament

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17
Q

Enumerate the contents of the spermatic cord

A

Testicular artery
Artery of Vas deferens
Cremasteric artery

Cremasteric nerve
Ilio-inguinal nerve
Sympathetic plexus

Vas deferens
Pampiniform plexus of veins
Lymphatics of testis

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18
Q

Enumerate the coverings of the spermatic cord

A

Internal spermatic fascia

Cremasteric fascia and muscle

External spermatic fascia

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19
Q

Give account on the extensions of the Lesser Sac

A

Extends upwards behind caudate lobe forming superior recess

Extends downwards between layers of greater omentum forming inferior recess

It extends left as far as spleen forming splenic recess

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20
Q

Give the boundaries of the Lesser Sac

A

Anterior wall: Peritoneum of caudate lobe, Lesser omentum, peritoneum on posterior surface of stomach, Gastrosplenic ligament

Posterior wall: peritoneal cover of stomach bed, Transverse colon+ mesocolon, layers of greater omentum

Left border: Hilum of spleen, left free margin of greater omentum

Right border: peritoneum at right margin of caudate lobe of liver, opening of lesser sac, right free margin of greater omentum

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21
Q

What is the Epiploic foramen (foramen of Winslow)? Give its boundaries

A

Orifice where lesser sac communicates with greater sac

Anteriorly: Portal vein, Hepatic Artery, Bile duct

Posteriorly: IVC

Superiorly: Caudate lobe

Inferiorly: 1st inch of duodenum, curved part of portal vein

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22
Q

What are the functions of the Greater Omentum (Gastrocolic ligament)? Give its attachments

A

Localizes infection in peritoneum and prevents its spread

2/3 of greater curvature of stomach

1st inch of duodenum

Surround transverse colon and continue as transverse mesocolon

Lower border is free

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23
Q

Enumerate the contents of the Greater Omentum

A

Rt and Lt gastro-epiploic arteries
Lymph nodes and vessels
Autonomic nerve fibers
Extraperitoneal fat

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24
Q

Give the attachments of Lesser Omentum

A

Above and to right: porta hepatis, ligamentum venosum, lower surface of diaphragm

Below and left: lesser curvature of the stomach

On the right side: anterior and posterior layers

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25
Q

Enumerate the contents of the Lesser Omentum

A

Rt and Lt gastric vessels
Portal vein
Hepatic artery
Common bile duct
Lymph vessels and lymph nodes
Sympathetic fibers
Extraperitoneal fatty tissue

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26
Q

Give the anterior and posterior relations of the stomach

A

Anterior: Inferior surface of liver, Diaphragm, anterior abdominal wall

Posterior:

Anterior surface of pancreas and splenic artery above it.

Anterior surface of Lt kidney and Lt suprarenal gland.

Spleen.

LT crus of diaphragm, Transverse colon and transverse mesocolon.

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27
Q

Give the attachments of the mesentery (root of mesentery)

A

3rd part of duodenum
Abdominal Aorta
IVC
Rt psoas major
Rt genitofemoral nerve
Rt gonadal artery
Rt ureter

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28
Q

Enumerate the contents of the mesentery

A

Loops of small intestine
Superior mesenteric vessels
Sympathetic and parasympathetic plexus
Extraperitoneal fat and connective tissue

29
Q

What is the most common position of the appendix? Give its arterial supply

A

Retrocaecal position

Appendicular artery

30
Q

Give the contents of the mesoappendix

A

Vermiform appendix
Appendicular vessels
Sympathetic and parasympathetic fivers
Lymph vessels and lymph nodes

31
Q

Give the surface anatomy of the appendix

A

The base of the appendix is represented by “McBurney’s point”.

Lies at junction of lateral 1/3 and medial 2/3 of a line drawn from the umbilicus to the right anterior superior iliac spine

32
Q

Give relations of the portal vein

A

Before it reaches the lesser omentum: 1st part of duodenum, common bile duct, gastroduodenal artery, IVC

In lesser omentum: common bile duct, proper hepatic artery, IVC

Porta hepatis: hepatic artery, caudate process of caudate lobe of liver

33
Q

Enumerate the tributaries of the portal vein

A

Splenic vein and Superior mesenteric vein

Paraumbilical veins, cystic vein

Rt gastric vein and Lt gastric vein

34
Q

Give an account of Portosystemic Anastomoses

A

Anastomosis at lower end of esophagus: made of Lt gastric vein and azygos vein

Anastomosis at the lower end of rectum: made of superior rectal vein, middle rectal vein and inferior rectal vein.

Anastomosis around of umbilicus: made of paraumbilical veins, superior and inferior epigastric vein

Other areas: bare area of liver and posterior abdominal wall

35
Q

Give the relations of the head of pancreas

A

lies in concavity of duodenum

Anterior: transverse colon, loops of SI, SMA

Posteriorly: common bile duct, IVC, abdominal aorta

Neck: anterior to it is pyloroduodenal junction and posteriorly union of splenic, superior mesenteric veins

36
Q

Give an account on the arterial supply of pancreas

A

Head: superior pancreaticoduodenal A

Neck, body and tail: splenic artery

37
Q

Give the relations of the gall bladder

A

Fundus: anterior abdominal wall and transverse colon (posteriorly)

Body: above-inferior surface of liver, inferior: transverse colon, 1st and 2nd part of duodenum

Neck: superior-cystic artery

38
Q

Give the surface anatomy of the gall bladder

A

The fundus of the gall bladder corresponds to the midclavicular point approximately 9th rib costal margine, at the transpyloric plane

39
Q

Give the beg and end of the IVC. Give its tributaries.

A

Begins at L5

End: pierce diaphragm

Tributaries:

Common iliac veins
3rd and 4th lumbar vein
Rt gonadal vein
Rt and Lt renal veins
Rt and Lt inferior phrenic veins
Rt, Lt and middle hepatic veins
Vena azygos

40
Q

Give the origin, insertion and two important features of the external oblique

A

Origin: Eight fleshy digitations from lower borders of the lower 8 ribs

Insertion: Anterior 1/2 of the outer lip of iliac crest. By aponeurosis into xiphoid process, linea alba, symphysis pubis and pubic crest

It has the opening of the superficial inguinal ring
Below the line between the anterior superior iliac spine, umbilicus and muscles become aponeurotic

41
Q

Give the origin, insertion of Rectus Abdominis

A

Origin: pubic crest and front of symphysis pubis

Insertion: 5,6,7th costal cartilage, xiphoid process

42
Q

Give the coverings, Blood supply & lymphatic drainage Testis

A

Tunica vaginalis, tunica ablunginea and tunica vasculosa

Testicular artery

Para-aortic groups of lymph node

43
Q

Peritoneal covering & Blood supply of Stomach.

A

Greater omentum, lesser omentum, Gastrophrenic ligament, gastrosplenic ligament

Along lesser curvature: Rt gastric, Lt gastric

Along greater curvature: Lt gastro-epiploic, Rt gastro-epiploic, short gastric

44
Q

Give relations of the 3rd part of duodenum

A

Anteriorly: Root of mesentery, coils of jejunum

Posteriorly: Rt psoas major, IVC, abdominal aorta, IMA, right gonadal A

Superiorly: head of pancreas

Inferiorly: coils of jejunum

45
Q

Give the relations of the 2nd part of duodenum

A

Anteriorly: inferior surface of liver, transverse colon, coils of jejunum

Posteriorly: Hilum of Rt kidney, Rt psoas major

Medially: Head of pancreas, ampulla of Vater, superior and inferior pancreatico-duodenal arteries

Laterally: Rt lobe of liver, Ascending colon, Rt colic flexture

46
Q

Give the relations of the FIRST PART of the FIRST INCH

A

Anteriorly: liver, gall bladder

Posteriorly: bile duct, portal vein, gastroduodenal artery, IVC behind all these

47
Q

Give the relations of the Caecum

A

Anteriorly: Anterior abdominal wall, Small intestine, Greater Omentum

Posteriorly: Iliacus, Psoas major, Psoas minor, Femoral nerve, Genitofemoral nerve, Lateral cutaneous nerve of thigh

48
Q

Give the contents of the Transverse mesocolon

A

Transverse colon
Ascending branch of superior Lt colic artery
Branches of middle colic artery
Lymph vessels and lymph nodes
Sympathetic plexus
Extraperitoneal fat and tissue

49
Q

Enumerate the branches of the splenic artery

A

Pancreatic branches
Short gastric arteries
Lt gastro-epiploic artery
Posterior gastric artery
Terminal splenic branches

50
Q

Give the course and the branches of the Hepatic artery

A

Artery ascends in the lesser omentum where it lies in front of portal vein and to the left of the common bile duct.

Rt gastric artery
Gastroduodenal artery
Supraduodenal artery
Rt and Lt terminal branches

51
Q

Give the structures that the superior mesenteric artery passes through in mesentery

A

Abdominal aorta
IVC
Rt psoas major
Rt ureter
Rt gonadal vessels
Rt genitofemoral nerve

52
Q

Give course of SMA and branches of SMA

A

Lies behind the body of pancreas. It then descends in front of the uncinate process of pancreas, then in front of the 3rd part of duodenum to enter mesentery.

Inferior pancreatico-duodenal A
Jejunal and ileal branches
Middle colic artery
Rt colic
Ileocolic artery

53
Q

Enumerate the impressions of the spleen

A

Gastric impression
Renal impression
Colic impression
Pancreatic impression

54
Q

Enumerate the splenic ligaments and give contents of the main one

A

Gastrosplenic ligament: short gastric artery, left gastroepiploic vessels, lymphatics, extraperitoneal fat and autonomic nerve fibers

Lienorenal ligament: Hilum of spleen to left kidney

Phrenocolic ligament: from lt colic to inferior surface of diaphragm

55
Q

Give the surface anatomy of the liver

A

Upper border: line passing through 5th intercostal space at left midclavicular line, Xiphisternal junction, 5th rib in the right midclavicular line and 7th mid axillary line

Right border: between 7th rib in right mid axillary line,

Inferior border: 1 cm below costal margin in the RT mid axillary line. 9th costal cartilage in the midclavicular line. The transpyloric plane, tip of lt 8th costal cartilage and 5th intercostal space

56
Q

Enumerate the posterior relations of the liver

A

Esophageal groove

Fissure for ligamentum venosum

Caudate lobe

Groove for IVC

Bare area proper for liver

57
Q

Enumerate the inferior relations of the liver

A

Gastric impression
Tuber omnetale
Fissure of ligamentum teres
Quadrate lobe
Gall bladder fossa
second part of duodenum
Rt colic flexure
Lower part of suprarenal gland
Porta hepatis

58
Q

Give the contents of porta hepatis

A

Rt and Lt hepatic ducts
Rt and Lt hepatic artery branches
Rt and Lt portal vein branches
Hepatic nerve plexus
Lymph nodes, lymph vessels, extraperitoneal fat

59
Q

Give the attachments and the contents of the Falciform ligament

A

Upper convex border attached to undersurface of the diaphragm and anterior abdominal wall

Lower border which enclose the paraumbilical veins.

Contents: ligamentum teres, para-umbilical veins, Lymph vessels, extra-peritoneal fatty tissue

60
Q

Give the surface anatomy of the kidney

A

Posterior abdominal wall know as Morris parallelogram

Upper and lower horizontal line: drawn opposite 11th thoracic and 3rd lumbar spines

Medial and lateral vertical lines: one inch and three inches from the median plane respectively

Hilum is two inches front he middle line at level of first lumbar spine.

61
Q

Compare the Rt and Lt suprarenal gland

A

Rt suprarenal: triangular in shape, higher, hilum is upwards, related posteriorly to left crus of diaphragm, related anteriorly to IVC

Lt suprarenal: semilunar in shape, lower, hilum is directed downwards, related posteriorly to right crus of diaphragm, related anteriorly to lesser sac.

62
Q

Give the posterior relations of the Rt and Lt ureter

A

Posterior:
Medial border of Psoas major and Psoas minor
Tips of transverse process of L2-L5 vertebrae
Genitofemoral nerve

Anterior: peritoneum of posterior abdominal wall

63
Q

Enumerate the constrictions of the abdominal ureter

A

Pelvi-ureteric junction
Where ureter crosses the bifurcation of CIA
At ischeal spine
Ureteric orifice

64
Q

Enumerate the openings of the diaphragm

A

Aortic opening
Esophageal
IVC opening
Musclophrenic artery
Superior epigastric artery
Lower five intercostal nerves and vessels
Subcostal nerve, subcostal vessels
Hemiazygos vein
Sympathetic chain
psoas major muscle
Lt phrenic nerve

65
Q

Enumerate the arterial supply of diaphragm

A

Superior phrenic artery
Lower intercostal arteries
Inferior phrenic artery
Musculophrenic artery
Pericardiophrenic artery

66
Q

Psoas major muscle anterior and posterior relations

A

Anterior: kidney and renal vessels, ureter, medial arcuate ligament, gonadal vessels, genitofemoral nerve, psoas minor, 3rd and 4ht part of duodenum, end of ileum, inguinal ligament

Posterior: Lumbar vertebra transverse process, lumbar arteries, Lumbar nerve quadratus lumborum

67
Q

Psoas major medial and lateral relations

A

Medial: sympathetic chain, external iliac vessels, obturator nerve, aorta, IVC

Laterally: Quadratus lumborum, iliacus, iliohypogastric nerve, ilio-inguinal, femoral nerve, lateral cutaneous nerve of thigh

68
Q

Give an account on the parts of the common bile duct

A

Supraduodenal part: in front of free border of the lesser omentum

Retroduodenal part: lies behind the first part of the duodenum

Infraduodenal part: lies behind the head of pancreas

Intraduodenal part: unites with main pancreatic duct to form ampulla of Vater

DIG 209 FINAL (4 decks)

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