anatomy

Question 1

in males, the peritoneum is a closed cavity, but in females there is communication with the exterior through which structures? and what is the clinical consequence of this?

Answer 1

communication via the uterine tubes, uterus and vagina. this may allow the spread of infection from the exterior to inside the peritoneal cavity

Question 2

what is the name of the passage that communicates the lesser and greater sac?

Answer 2

epiploic foramen

Question 3

Where is Morison’s pouch and why is it clinically important?

Answer 3

On the right, posterior to the liver, between it and the right kidney; it communicates with the lesser sac through the epiploic foramen; pus may collect in this potential space in recumbent patients.

Question 4

the parietal peritoneum is sensitive to temperature, pain, pressure and touch. pain is usually localised in the abdomen as it is innervated by the nerves supplying the overlying skin. what region of peritoneum would cause referred pain to the shoulder tip?

Answer 4

diaphragmatic peritoneum (supplied by phrenic nerve C3,4,5)

Question 5

what is visceral peritoneum sensitive to?

Answer 5

stretch and tearing only

Question 6

at what vertebral level does the oesophagus start? what epithelium lines the oesophagus and what type of muscle is found in its walls?

Answer 6

C6
stratified squamous (think abrasions from food) with submucosal mucous glands (lubrication)
skeletal upper 1/3, smooth muscle lower 1/3, rest mixed

Question 7

in portal hypotension, why would you get oesophageal varices?

Answer 7

the abdominal oesophagus (after it has passed through the right crus of the diaphragm at T10) is supplied by the left gastric artery and is therefore drained by the portal vein!

Question 8

what is the ‘physiological’ cardiac sphincter?

Answer 8

there is no anatomical sphincter of the lower (cardiac) end of the oesophagus. reflux is prevented by:

1. contraction of the right crus
2. tonic contraction of the circular smooth muscle
3. the valvular effect of its oblique entry into the stomach

Question 9

what marks the transition from stratified squamous epithelium in the oesophagus to columnar epithelium in the stomach

Answer 9

z-line

Question 10

on X-ray, what part of the stomach is normally filled with gas?

Answer 10

fundus

Question 11

what is the name of the muscular folds that are found in the body of the stomach?

Answer 11

rugae

Question 12

what nerve supplying the pylorus is preserved highly selectively in vagotomy so that sphincter function is maintained?

Answer 12

nerve of Latarget

Question 13

the major papilla receives a mixture or bile and pancreatic enzymes from the Ampulla of vater and is surrounded by the sphincter of Odi. what section of the duodenum does the major papilla open into?

Answer 13

situated in the 2nd part of the duodenum

Question 14

what structure does the vermiform appendix hang from? where would appendix pain be referred to?

Answer 14

caecum
T10 dermatome (umbilicus)

Question 15

lacteals absorb fat in the small intestine and form chyle. how is the chyle drained?

Answer 15

passes through the lacteals to into mesenteric lymph channels, doesn’t pass through nodes but converges on the cisterna chyli -> thoracic duct

Question 16

what are the aggregates of lymphocytes in the ileum called?

Answer 16

Preyers patches

Question 17

what forms as a remnant of the vitello-intestinal duct and may ulcerate causing signs and symptoms similar to appendicitis?

Answer 17

Meckel’s diverticulum

Question 18

what part of the large intestine is intraperitoneal?

Answer 18

transverse and sigmoid colon