Anatomy Flashcards

1
Q

Epigastric

A

Upper middle ninth

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2
Q

Hypochondrium

A

Left and right upper ninths

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3
Q

Umbilical

A

Middle ninth

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4
Q

Flank

A

Left and right middle ninths

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5
Q

Pubic

A

Lower middle ninth

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6
Q

Groin

A

Left and right lower ninths

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7
Q

9 layers of abdominal wall from skin to abdominal cavity

A
Skin
Campers fascia
Scarpas fascia
External oblique muscle
Internal oblique muscle
Transversus abdominis
Transversalis fascia
Extraperitoneal fascia
Parietal peritoneum
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8
Q

Superior boundary of abdomen

A

Diaphragm and inferior thoracic aperture

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9
Q

Inferior boundary of abdomen

A

Iliac crest, inguinal ligament and pelvic inlet

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10
Q

Posterior boundary of abdomen

A

Lumbar vertebral column, psoas major, quadratum lumborum

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11
Q

Lateral and anterior boundary of abdomen

A

Abdominal wall muscles

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12
Q

Above the bellybutton, the fascia present is:

A

Campers fascia only

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13
Q

Below the bellybutton, the fascia present is:

A

Campers and Scarpas fascia

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14
Q

Campers fascia

A

Thick, fatty superficial layer of the anterior abdominal wall

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15
Q

Scarpas fascia

A

Deep membranous layer of fascia

Deep to Campers fascia, superficial to external oblique muscle

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16
Q

Rectus abdominis origin

A

Pubic tubercle, crest and symphysis

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17
Q

Rectus abdominis insertion

A

Costal cartilage of ribs 5 - 7 and xiphoid process

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18
Q

Rectus abdominis actions

A

Flexes trunk

Supports and compresses abdominal wall

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19
Q

Rectus abdominis innervation

A

Anterior rami of thoracic spinal nerves

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20
Q

Rectus abdominis fibre direction

A

Directly down

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21
Q

External oblique origin

A

Ribs 5 - 12

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22
Q

External oblique insertion

A

Iliac crest and linea alba

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23
Q

Aponeurosis of external oblique muscle

A

From xiphoid process of sternum to pubic symphysis. Lower border forms inguinal ligament.

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24
Q

External oblique actions

A

Flexes trunk
Turns to opposite side
Bends to same side

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25
Q

External oblique innervation

A

Anterior rami of thoracic spinal nerves

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26
Q

External oblique fibre direction

A

Infero-medial

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27
Q

Linea alba

A

Fibrous structure that runs down the midline of the abdomen in humans and other vertebrates

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28
Q

Internal oblique origin

A

Thoracolumbar fascia, inguinal ligament and iliac crest

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29
Q

Internal oblique insertion

A

Ribs 9 - 12, linea alba and pubis

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30
Q

Internal oblique actions

A

Flexes trunk

Bends and turns trunk to the same side

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31
Q

Internal oblique innnervation

A

Anterior rami of thoracic spinal nerves

Some L1

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32
Q

Internal oblique fibre direction

A

Supero-medial

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33
Q

Transversus abdominis origin

A

Thoracolumbar fascia, iliac crest, inguinal ligament and costal cartilage of ribs 7 - 12

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34
Q

Transversus abdominis insertion

A

Linea alba, pubic crest and pectineal line

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35
Q

Transversus abdominis actions

A

Supports abdominal wall

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36
Q

Transversus abdominis innervation

A

Anterior rami of thoracic spinal nerves

Some L1

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37
Q

Transversus abdominis fibre direction

A

Transverse

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38
Q

Below the arcuate line there is no:

A

Posterior rectus sheath behind rectus abdominis

Instead covered posteriorly by transversalis fascia and parietal peritoneum

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39
Q

The superior epigastric artery comes from:

A

The internal thoracic artery

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40
Q

The inferior epigastric artery comes from:

A

The external iliac artery

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41
Q

Position of superior and inferior epigastric arteries

A

Deep longitudinally to rectus abdominis, on top of transversalis fascia and within the rectus sheath
Eventually form an anastamosis

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42
Q

The thoracoepigastric veins drain into:

A

The axillary vein

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43
Q

The superficial epigastric veins drain into:

A

The femoral vein

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44
Q

The axillary vein drains:

A

The superior abdomen

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45
Q

The femoral vein drains:

A

The inferior abdomen

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46
Q

Abdominal nerve position

A

Travel in neurovascular plane between internal oblique and transversus abdominis muscles

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47
Q

Skin, muscles and parietal peritoneum innervation

A

T7 - T12 intercostal and L1 iliohypogastric spinal nerves

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48
Q

Important landmark of the T10 dermatome

A

Umbilicus

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49
Q

Important landmark of the T4 dermatome

A

Nipple

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50
Q

In general, the superior lymphatics follow:

A

Veins

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51
Q

In general, the inferior lymphatics follow:

A

Arteries

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52
Q

Visceral peritoneum covers:

A

Organs (abdominal viscera)

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53
Q

Parietal peritoneum:

A

Lines the body wall

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54
Q

Between the two peritoneum layers you can find:

A

A small amount of serous fluid to prevent friction during movement

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55
Q

Mesentery is formed by:

A

The visceral peritoneum folding back in on itself, forming an anchor to the posterior body wall

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56
Q

Function of mesentery

A

Anchorage

Passage of blood vessels and nerves in and out

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57
Q

Parietal peritoneum sensation

A

Sensitive to pain, touch, temperature and pressure
Thoracic and lumbar somatic nerves supply body wall
Phrenic nerve supplies near diaphragm
Obturator nerve supplies near pelvis

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58
Q

Visceral and mesentery sensation

A

Sensitive to stretch by autonomic nervous system

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59
Q

GI tract is suspended by:

A

Multiple mesenteries

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60
Q

Midgut and hindgut is suspended by:

A

Dorsal mesentery only

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61
Q

Foregut is suspended by:

A

Both ventral and dorsal mesenteries

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62
Q

Greater sac

A

Peritoneal cavity proper

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63
Q

Lesser sac

A

Behind lesser omentum and stomach

Formed by rotation of foregut structures which drags the lesser omentum round to create a pocket

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64
Q

The opening to the lesser sac is called:

A

The foramen of Winslow

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65
Q

Boundaries of the foramen of Winslow

A

Anterior: the free edge of the lesser omentum containing the portal triad
Posterior: the IVC

66
Q

3 intraperitoneal areas suspended by mesenteries

A

Jejunum to terminal ileum - mesentery
Transverse colon - transverse mesentery
Sigmoid colon - sigmoid mesocolon

67
Q

Paracolic gutter

A

Peritoneal sulci lateral to the ascending/descending colons

Create a pathway for fluids to migrate around the abdomen

68
Q

Clinical significance of paracolic gutter

A

Different positions of the body can affect fluid migration which can cause pain to present in different regions distant from the affected organ
A sitting position causes fluid to migrate down towards appendix, a spine position causes fluid to migrate into lesser sac

69
Q

Abdominal aorta branches

A

Celiac trunk at T12/L1 level
Superior mesenteric artery at L1 level
Inferior mesenteric artery at L3 level
Bifurcation at L4 leading to left and right common iliac arteries

70
Q

3 branches from the celiac trunk

A

Left gastric artery
Splenic artery
Common hepatic artery

71
Q

Injury to foregut localises pain at the:

A

Epigastric region

72
Q

Components of the foregut

A
Distal oesophagus
Stomach
Liver
Gall bladder
Proximal 1/3 of duodenum
Pancreas
73
Q

Foregut blood supply

A

Branches of the celiac trunk

74
Q

Foregut venous drainage

A

The portal vein

75
Q

Foregut innervation

A

Celiac plexus at T12

76
Q

Foregut lymphatics

A

Pre-aortic nodes at T12 (celiac nodes)

77
Q

Fundus location

A

Ribs 5/6

78
Q

Oesophagus location

A

Costal cartilage 7/8

79
Q

Pylorus location

A

L1 verterbral level

80
Q

Lesser curvature arterial supply

A

Left gastric - celiac trunk

Right gastric - common hepatic artery

81
Q

Greater curvature arterial supply

A

Left gastro-omental - splenic

Right gastro-omental - gastroduodenal and common hepatic arteries

82
Q

Fundus arterial supply

A

Splenic artery

83
Q

Duodenal structure

A

Originates from pyloric region of stomach and wraps around head of pancreas. Then crosses back over IVC and aorta and ascends to duodenojejunal flexure.
Mostly retroperiotoneal except for the very first part

84
Q

Duodenal blood supply

A

Part celiac trunk, part super mesenteric artery
Superior half = superior pancreaticoduodenal branches from gastroduodenal artery of celiac origin
Inferior half = inferior pancreaticoduodenal branches from superior mesenteric artery

85
Q

Duodenal innervation

A

Superior half: celiac plexus at T12

Inferior half: superior mesenteric plexus at L1

86
Q

Duodenal venous drainage

A

Superior half: direct to portal vein

Inferior half: superior mesenteric vein

87
Q

Duodenal lymphatic drainage

A

Superior half: Pre-aortic celiac nodes at T12

Inferior half: Pre-aortic superior mesenteric nodes at T1

88
Q

Ampulla of Vater

A

Union of common bile duct and main pancreatic duct which drains into descending duodenum

89
Q

Major duodenal papilla

A

Enters through wall of descending duodenum

Controls bile flor from liver and pancreatic juice from pancreas into the duodenum via the Sphincter of Oddi

90
Q

Sphincter of Oddi

A

Clamps off major duodenal papilla to stop bile constantly dripping in

91
Q

Midgut refers to pain in the:

A

Umbilical region

92
Q

Components of midgut

A
Distal 1/2 duodenum
Jejunum
Ileum
Caecum
Appendix
Ascending colon
Proximal 2/3 transverse colon
93
Q

Neurovascular structures of midgut

A

Arterial: branches of SMA
Venous: SMV
Innervation: SM plexus at L1
Lymphatics: Pre-aortic nodes at L1

94
Q

Small intestine anatomy

A

About 6 m long
Suspended from body wall by mesentery, fan shaped folds of peritoneum enclosing the gut tube allowing ingress and egress of vessels, nerves and lymphatics

95
Q

Haustra

A

Sacculations of the large intestine wall

96
Q

Appendices epiplociae

A

Pouches of peritoneum in the large intestine filled with fat that can get inflamed

97
Q

Teniae coli

A

Longitudinal muscles of the large intestine wall collected into 3 bands that can contract, pulling the colon into haustra coli

98
Q

Caecum and appendix region

A

Right groin

99
Q

Large intestine is found in all gut regions except:

A

Umbilical

100
Q

3 flexures of large intestine

A

Hepatic
Splenic
Sigmoid colon

101
Q

Regions that flexures are found in

A

Hepatic - Right hypochondrium
Splenic - Left hypochondrium
Sigmoid colon - Left groin

102
Q

Superior mesenteric arteries supplying the large intestine

A

Caecum/appendix: caecal and appendicualr arteries respectively, both from ileocolic artery
Ascending colon: right colic artery
Proximal 2/3 transverse colon: middle colic and marginal arteries

103
Q

Inferior mesenteric arteries supplying the large intestine

A

Distal 1/3 transverse colon: marginal and left colic arteries
Descending colon: left colic artery
Sigmoid colon: sigmoid artery

104
Q

Marginal artery

A

Anastomotic point between SMA and IMA

105
Q

Neurovascular structures of hindgut

A

Arterial supply: branches of IMA at L3
Innervation: IM plexus at L3
Venous: IMV
Lymphatics: pre-aortic inferior mesenteric nodes at L3

106
Q

Sigmoid colon becomes rectum at:

A

S3 vertebral level

107
Q

Stool is held in the:

A

Transverse folds of the rectum

108
Q

Rectal peritoneum

A

1st 1/3: Covered in visceral peritoneum
2nd 1/3: Peritoneum on anterior surface only
3rd 1/3: Infraperitoneal

109
Q

Arterial supply of rectum

A

Superior rectal branches of IMA at L3
Middle rectal branch of internal iliac artery
Inferior rectal branch of internal pudendal

110
Q

Venous drainage of rectum

A

Superior rectal vein —-> IMV —-> portal vein

Middle and inferior rectal veins —-> internal iliac vein —-> common iliac artery —-> IVC

111
Q

Innervation of rectum

A

Proximal 1/3: IMP at L3

Distal 2/3: Inferior/superior hypogastric plexus

112
Q

Lymphatics of rectum

A

Proximal 1/3: to pre-aortic nodes at L3

Distal 2/3: to internal iliac nodes

113
Q

Parasympathetic nerve supply of the gut

A

Vagus nerve

Pelvic splanchnic nerves S2-4

114
Q

Sympathetic nerve supply of the gut

A

Thoracic, lumbar and sacral splanchnic nerves from T5-L2 sympathetic ganglia

115
Q

Foregut autonomic supply

A

Plexus: Celiac
SNS: Greater splanchnic T5-9
PSNS: Vagus X

116
Q

Midgut autonomic supply

A

Plexus: Superior mesenteric
SNS: Lesser splanchnic T10-11
PSNS: Vagus X

117
Q

Aorticorenal autonomic supply

A

Plexus: Renal
SNS: Least splanchnic T12
PSNS: Vagus X

118
Q

Hindgut autonomic supply

A

Plexus: Inferior mesenteric and superior hypogastric
SNS: Lumbar/sacral splanchnic fibres L1-2
PSNS: Pelvic splanchnic S2-4

119
Q

Pelvic organs autonomic supply

A

Plexus: Inferior and superior hypogastric
SNS: Sacral splanchnic L1-2
PSNS: Pelvic splanchnic S2-4

120
Q

Location of liver

A

Right hypochondrium, extends into epigastric region

121
Q

Superior boundary of liver

A

Ribs 5/6

122
Q

Gall bladder location

A

9th costal cartilage level, affixed to bottom of liver

123
Q

Gross morphology of liver

A

2 lobes on anterior surface separated by falciform ligament
4 lobes on posterior surface: back of left and right lobes, caudate lobe in middle and quadrate lobe below (continuation of right lobe)
Gall bladder between quadrate lobe and right lobe on posterior surface, IVC between caudate lobe and bare area above right lobe

124
Q

Bare area of liver

A

Only part of the liver not intraperitoneal. Functions to anchor liver to diaphragm

125
Q

Quadrate lobe

A

Anatomically part of right lobe but separated from the rest of the lobe by the gall bladder, therefore considered its own area

126
Q

Falciform ligament

A

Separates right and left lobes on anterior surface. Remnant connecting to body wall containing ligamentum teres

127
Q

Ligamentum teres

A

Runs inside and extends out of the falciform ligament. Embryological remnant of umbilical cord.

128
Q

Porta hepatis

A

Doorway to liver
Free edge of lesser omentum attaches here
Portal triad runs through here

129
Q

Portal triad

A

Portal vein
Hepatic artery
Common hepatic duct

130
Q

The liver is covered in visceral peritoneum except for:

A

Bare area and fossa for gall bladder

131
Q

6 peritoneal ligaments

A
Right triangular ligament
Anterior coronary ligament
Left triangular ligament
Falciform ligament
Posterior coronary ligament
Hepatoduodenal ligament
132
Q

Pouch of Morison

A

Space that separates the liver from the right kidney, normally not filled with fluid

133
Q

Blood supply to liver

A

25% hepatic artery proper supplies oxygenated blood

75% portal vein supplies nutrient rich blood

134
Q

Venous drainage of liver

A

Arterial and venous blood conducted to central vein of each liver lobule by sinusoids, then central veins drain to left, right and central hepatic veins, then directly into IVC

135
Q

Liver segments

A

Determined by position of hepatic and portal veins
Caudate lobe is I, rest numbered clockwise from top right corner
Falciform ligament separates lobes II and III from rest of liver
No arterial communications between right and left halves
2 x portal veins
3 x hepatic veins

136
Q

Lymphatic drainage of liver

A

Lymph from liver about 1/3 total body lymph

Nodes at porta hepatis to celiac nodes at T12

137
Q

ANS of liver

A

Visceral supply from celiac plexus

PSNS via vagus nerve, SNS from greater splanchnic nerves T5-9

138
Q

Pain in liver

A

Referred to epigastric region

Small amount via diaphragm to right shoulder/chest (C3-5)

139
Q

Gross morphology of gallbladder

A

Fundus hangs below liver
Body contacts visceral surface of liver
Neck joins cystic duct
Covered in visceral peritoneum

140
Q

Biliary tree

A

Bile secreted by liver, stored by gallbladder
When released, bile flows down cystic duct into common hepatic duct where it is joined by main pancreatic duct
Drained via bile duct which bifurcates past cystic duct into left and right hepatic ducts

141
Q

Hepatopancreatic ampulla of Vater

A

Formed by the union of the pancreatic duct and common bile duct
Opens into duodenum via sphincter of Oddi

142
Q

Neurovascular structures of gallbladder

A

Arterial supply: cystic artery from right hepatic artery
Venous drainage: cystic vein into portal vein
Innveration: ANS via celiac plexus, pain referred to epigastric region
Lymphatics: cystic nodes to hepatic nodes to celiac nodes at T12

143
Q

Gallstones

A

Crystalline bodies made from bile components
Cholesterol = green or yellow/white
Pigment stones = small, dark calcium or bilirubin stones

144
Q

5 areas of pancreas

A
Head - in  concavity of duodenum
Ulcinate process - wraps behind SM vessels
Neck - anterior to SM vessel origins
Body
Tail - passes into splenorenal ligament
145
Q

The tail of the pancreas is in contact with:

A

The hilus of the spleen

146
Q

Main pancreatic duct

A

From tail to Ampulla of Vater
Joined by bile duct
Enters descending duodenum via Sphnicter of Oddi (major duodenal papilla)

147
Q

Accessory pancreatic duct

A

Not always present

Drains into upper part of head then into duodenum (minor duodenal papilla)

148
Q

Arterial supply of pancreas

A

Common hepatic artery and splenic artery (from coeliac trunk origin)
Superior mesenteric artery

149
Q

6 specific arteries that supply pancreas

A

Anterior superior pancreaticoduodenal
Posterior superior pancreticoduodenal

Dorsal pancreatic
Great pancreatic

Anterior inferior pancreaticoduodenal
Posterior inferior pancreaticoduodenal

150
Q

Venous and lymphatic drainage of pancreas

A

Always flows back through splenic or SMV into liver through portal vein then IVC
Lymph drains to coeliac nodes and SM nodes

151
Q

ANS for pancreas

A

Coeliac and SM plexi
Greater and lesser splanchnic nerves
Vagus nerve
Pain referred to epigastric region

152
Q

Spleen position

A

Inferior to ribs 9-11 in left hypochondrium

153
Q

Splenorenal ligament

A

To left kidney

Carries splenic vessels and pancreas tail

154
Q

Spleen vessels

A
Splenic artery from coeliac axis
Splenic vein to portal vein
Lymph drains to coeliac nodes
ANS: coeliac plexus - vagus and greater splanchnic
Pain to epigastric region
155
Q

2 surfaces of spleen

A

Diaphragmatic

Visceral

156
Q

2 poles of spleen

A

Upper

Lower

157
Q

3 areas of spleen

A

Gastric
Colic
Renal

158
Q

2 splenic ligaments

A

Spenorenal: splenic vessels, tail of pancreas
Gastrosplenic: short gastric vessels and gastro-omental vessels

159
Q

Splenic rule of odd numbers

A

1 x 3 x 5 inches
7 ounces
Found under ribs 9-11

160
Q

3 main porto-systemic shunts

A

Bottom 1/3 of oesophagus
Around umbilicus
Anus

161
Q

Trans-pyloric plane

12 key areas

A
L1
Midway between suprasternal notch and pubic symphysis
1st part duodenum
Pylorus
Hila of kidneys
Neck of pancreas
SMA origin
PV origin
Fundus of gallbladder
Tip of 9th costal cartilage
Transverse mesocolon origin
Colic flexures
Spleen
End of spinal cord