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MRCS > Anatomy Abdomen > Flashcards

Anatomy Abdomen Flashcards

1
Q

Calot’s triangle borders

A

superior: inferior border of liver
medial: common hepatic duct
lateral: cystic duct

located at the porta hepatis of liver

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2
Q

Calot’s triangle contents

A

cystic artery, right hepatic artery, Lund’s lymph node

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3
Q

inguinal (Hesselbach) triangle borders

A

inferior: inguinal ligament
medial: lateral border of rectus abdominis muscle
lateral: inferior epigastric vessels

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4
Q

inguinal Hesselbach triangle relevance

A

no structures within it

demarcates area of weakness through which direct hernia occurs and enters inguinal canal

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5
Q

difference between direct and indirect inguinal hernias

A

DIRECT: protrudes through inguinal triangle, can exit through superficial inguinal ring, origin medial to inferior epigastric vessels
INDIRECT: protrudes through deep inguinal ring and exits through superficial ring, origin lateral to inferior epigastric vessels
both can reach scrotum

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6
Q

inferior epigastric vessels origin

A

external iliac artery and vein

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7
Q

subdivisions of peritoneal cavity and what divides them

A 
lesser sac (omental bursa): posterior to stomach and lesser omentum --> connected to greater sac via epiploic foramen of Winslow
greater sac: divided into supracolic and infracolic compartments by transverse mesocolon (mesentery of transverse colon)
infracolic : divided into right and left infracolic spaces by mesentery of small intestine
supracolic and infracolic compartments are connected by right and left paracolic gutters (between posterolateral abdominal wall and lateral aspect of ascending or descending colon)
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8
Q

location of epiploic foramen

A

posterior to hepatoduodenal ligament (free edge of lesser omentum)

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9
Q

supracolic compartment contents

A

stomach, liver, spleen

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10
Q

infracolic compartment contents

A

small intestine, ascending and descending colon

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11
Q

subphrenic recesses

A

potential spaces in supracolic compartment, between diaphragm and liver
right and left spaces separated by falciform ligament of liver

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12
Q

subphrenic abscesses

A

accumulation of pus in right or left subphrenic spaces, more common on right due to high frequency of appendicitis or ruptured duodenal ulcers
(pus reaches up to right subphrenic space through right paracolic gutter)

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13
Q

differences between peritoneal cavity in pelvis of males vs females

A

males: rectovesical pouch
females: rectouterine pouch (Douglas) + vesicouterine pouch

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14
Q

characteristic of lumbar vertbebrae

A

triangular vertebral foramen

largest in size to support weight

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15
Q

length of esophagus

A

25 cm

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16
Q

esophagus origin and end levels

A

cricoid cartilage inferior border C6 - cardiac orifice of stomach T11

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17
Q

esophageal hiatus level

A

T10

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18
Q

type of epithelium of esophageal muscosa

A

stratified squamous

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19
Q

upper esophageal sphincter made of

A

cricopharyngeus muscle, constricts to prevent air into esophagus

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20
Q

lower esophageal sphincter made of

A

no muscles, at gastro-esophageal junction to the left of T11, “physiological” sphincter (made of acute angle and compression of walls due to high intra abdominal pressure)

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21
Q

4 physiological constrictions of esophagus

A 
ABCD
Aortic arch
Bronchus (left)
Cricoid cartilage
Diaphragmatic hiatus
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22
Q

esophagus blood supply

A

thoracic: thoracic aorta + inferior thyroid artery
abdominal: left gastric artery + left inferior phrenic arterty

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23
Q

barret’s esophagus

A

long-standing GERD causes metaplasia of lower epithelium - squamous to columnar (like stomach)

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24
Q

esophageal cancer types

A

squamous cell carcinoma, most common
adenocarcinoma, from Barret’s esophagus, only in inferior third of esophagus
present with dysphagia and weight loss

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25
Q

transpyloric plane level

A

L1, demarcated by pyloric sphincter

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26
Q

greater curvature of stomach start to end

A

starts at cardiac notch to reach pyloric antrum - lateral border of stomach

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27
Q

lesser curvature of stomach start to end

A

medial surface, starts at cardia to reach angular notch (junction between body and pylorus)
attached to hepatogastric ligament

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28
Q

Lesser omentum attachments

A

from stomach and duodenum to liver

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29
Q

Greater omentum attachments

A

from stomach to transverse colon

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30
Q

Stomach blood supply

A

anastomoses of right and left gastric arteries along lesser curvature
Anastomoses of right and left gastro omental arteries along greater curvature

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31
Q

sliding vs rolling hiatal hernia

A

sliding: lower esophageal sphincter slides up superiorly with part of cardia
rolling: sphincter stays in place while part of cardia slides up next to it

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32
Q

epiploic foramen contents

A

hepatoduodenal and hepatogastric ligaments

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33
Q

parts of duodenum

A

D1 superior: hepatoduodenal ligament - common for duodenal ulcers
D2 descending: curves around pancreatic head - posterior to transverse colon - major duodenal papilla (opening of ampulla of Vater)
D3 inferior: crosses over aorta and ICV but posterior to SMA and vein - inferior to pancreas
D4 ascending: duodejejunal flexure - at junction, suspensory muscle of duodenum (ligament of Treitz)

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34
Q

duodenal ulcer causes and complications

A

H. pylori, chronic NSAID

perforation can cause peritonitis or erosion of gastroduodenal artery –> hypovolemic shock

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35
Q

differences between jejunum and ileum

A

jejunum has longer vasa recta and less arcades (arterial loops) - red color
ileum - pink color, short vasa recta, more arcades

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36
Q

duodenum blood supply

A

proximal to duodenal papilla D2: gastroduodenal artery
distal to D2: inferior pancreaticoduodenal artery
transition marks change from foregut to midgut

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37
Q

jejunoileum blood supply

A

SMA

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38
Q

ileocecal valve importance in large bowel obstruction

A 
if competent (no backflow into ileum): closed loop obstruction (2 points obstructed) - emergency, perforation
if incompetent (backflow allowed): less emergent, decompresses the cecum
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39
Q

cecum blood supply

A

ileocolic artery (from SMA)

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40
Q

most common position of appendix

A

retrocecal

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41
Q

cecum and appendix embryologic origin

A

midgut

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42
Q

appendix blood supply

A

appendicular artery (from ileocolic or right colic artery)

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43
Q

right colic flexure at which organ

A

liver

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44
Q

left colic flexure at which organ

A

spleen

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45
Q

colon length

A

150 cm

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46
Q

large intestine features to distinguish it from small intestine

A
  • omental appendices (small pouches of peritoneum filled with fat on surface)
  • teniae coli (3 longitudinal strips of muscle)
  • haustra
  • wider diameter
  • -> these features end at rectosigmoid junction
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47
Q

embryological origin of colon

A

midgut: ascending + 2/3 transverse
hindgut: 1/3 transverse + descending + sigmoid

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48
Q

colon blood supply

A

right colic - ascending
middle colic - transverse
left colic - descending
sigmoid arteries - sigmoid (from left colic)

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49
Q

which part of rectum relaxes to accumulate and store feces

A

ampulla - continuous with anal canal

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50
Q

rectum blood supply

A

superior rectal artery - terminal continuation of IMA
middle rectal artery - internal iliac artery
inferior rectal artery - internal pudendal artery

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51
Q

what is palpated with DRE

A

anterior wall of rectum is in direct contact with prostate and seminal vesicles / cervix

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52
Q

anal canal sphincters

A

internal: surrounds upper 2/3, involuntary smooth muscle
external: surrounds lower 2/3, voluntary muscle, continuous with puborectalis muscle

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53
Q

what is anorectal ring

A

fusion of internal and external anal sphincters and puborectalis muscle, at junction of rectum and anal canal

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54
Q

what is pectinate line

A

“dentate line”

divides upper part of anal canal made of columnar epithelium from lower part made of stratified squamous epithelium

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55
Q

anal canal blood supply

A

above pectinate line: superior rectal artery
below pectinate line: inferior rectal artery
–> anastomosing branches from middle rectal artery supply both

56
Q

location of liver

A

right hypochondrium

57
Q

where is the bare area of the liver

A

posterior aspect of diaphragmatic surface, direct contact with diaphragm
not covered in any visceral peritoneum

58
Q

at which level does the aorta bifurcate and into what

A

L4

right and left common iliac arteries

59
Q

level of aortic hiatus in diaphragm

A

T12

60
Q

normal aorta diameter

A

less than 3 cm

61
Q

branches of abdominal aorta

A
  • inferior phrenic arteries
  • celiac trunk at T12
  • SMA at L1
  • middle suprarenal arteries at L1 (adrenals)
  • renal arteries between L1 and L2
  • gonadal arteries at L2
  • IMA at L3
  • lumbar arteries from L1 to L4
  • median sacral artery at L4 (coccyx, sacrum, lumbar vertebrae)
62
Q

branches of celiac trunk

A
  • left gastric
  • splenic
  • common hepatic
63
Q

left gastric artery branches

A

esophageal branches

continues to supply lesser curvature and anastomose with right gastric artery

64
Q

splenic artery pathway + branches

A

posterior to stomach, along superior margin of pancreas, through splenorenal ligament

branches:
- left gastroepiploic (greater curvature, anastomoses with right)
- short gastrics (5-7 small branches supply fundus)
- pancreatic branches (body and tail of pancreas)

terminates into 5 branches that supply spleen
has tortuous appearance

65
Q

common hepatic artery branches

A
  • sole arterial supply of liver*
  • proper hepatic
  • gastroduodenal

proper hepatic:

  • right gastric
  • right and left hepatic (right hepatic give cystic)

gastroduodenal:

  • right gastroepiploic
  • superior pancreaticoduodenal (inferior from SMA)
66
Q

which organ receives blood from the 3 branches of the celiac trunk

A

stomach

67
Q

celiac trunk compression syndrome

A

median arcuate ligament (fibrous anchor of diaphragm that forms aortic hiatus) lies anterior to celiac trunk instead of superior –> compressing it

68
Q

position of SMA related to pancreas

A

neck of pancreas is anterior to it

uncinate process is posterior to it along with inferior duodenum

69
Q

SMA branches

A
  • inferior pancreaticoduodenal (pancreatic head, uncinate process, duodenum)
  • jejunal and ileal
  • right colic
  • middle colic
  • ileocolic (gives appendicular)
70
Q

SMA and IMA supply structures of which embryonic origin

A

SMA: midgut
IMA: hindgut (distal 1/3 transverse till rectum)

71
Q

IMA level and location

A

L3

inferior border of duodenum, 3-4 cm above bifurcation into common iliacs

72
Q

IMA branches

A
  • left colic (distal 1/3 of transverse, descending colon)
  • sigmoid arteries
  • superior rectal

they cross OVER left ureter

73
Q

watershed areas

A

splenic flexure, rectoigmoid junction

–> blood supply from 2 large arteries - more sensitive to systemic hypoperfusion

74
Q

falciform ligament

A

attaches anterior surface of liver to anterior abdominal wall
contains ligamentum teres (remnant of umbilical vein)

75
Q

coronary ligament

A

attaches superior surface of liver to diaphragm
has anterior and posterior folds which unite at each side to make right and left triangular ligaments
demarcates the bare area of liver

76
Q

right and left triangular ligaments

A

made from union of anterior and posterior coronary ligaments at apex of liver, attach it to diaphragm

77
Q

lesser omentum attachment to liver

A

attaches liver to lesser curvature of stomach and D1

consists of hepatoduodenal ligament and hepatogastric ligament

78
Q

what surrounds the portal triad

A

hepatoduodenal ligament

79
Q

what are the hepatic recesses

A
  • subphrenic space: between diaphragm and liver, divided into right and left by falciform ligament
  • subhepatic: between liver and transverse mesocolon
  • morison’s pouch: between liver and right kidney, deepest part of peritoneal cavity when supine (for bedridden patients)
80
Q

anatomical structure of liver

A

left lobe, right (larger) lobe

2 accessory lobes arise from right lobe - on visceral surface: caudate and quadrate

81
Q

where is caudate lobe

A

upper part of visceral surface

between IVC and fossa made by ligamentum venosum (remnant of fetal ductus venosus)

82
Q

where is quadrate lobe

A

lower part of visceral surface

between gallbladder and fossa made by ligamentum teres

83
Q

what is the liver covered with

A

Glisson’s capsule (fibrous layer)

distension of capsule causes sharp pain

84
Q

where is the porta hepatis

contents

A

visceral surface, between caudate and quadrate - it runs in the hepatoduodenal ligament
all vessels, nerves (vagus), ducts except hepatic veins
mainly: hepatic artery, portal vein, common hepatic duct

85
Q

liver blood supply

A

dual supply:
hepatic artery proper 25% - non-parenchymal part
hepatic portal vein 75% - parenchyma, partially deoxygenated blood with nutrients from small intestine, for detoxification
venous drainage through many small hepatic veins which drain into IVC

86
Q

gallbladder storage capacity

A

30-50 mL

87
Q

what is Hartmann’s pouch

A

mucosal fold in neck of gallbladder, most common location for gallstone impaction, causing cholestasis

88
Q

biliary tree pathway

A

bile made in liver, travels through right and left hepatic ducts which combine to make common hepatic duct
CHD joins cystic duct to form common bile duct which travels posterior to D1 and pancreatic head to reach pancreatic duct and form ampulla of Vater (hepatopancreatic ampulla) which opens in D2 via major duodenal papilla and is regulated by sphincter of Oddi

89
Q

what stimulates contraction of gallbladder

A

parasympathetic stimulation causes contraction of GB and relaxation of sphincter of Oddi
+ cholecystokinin (gustatory response)

90
Q

charcot’s triad

A

for cholangitis

fever, jaundice, RUQ pain

91
Q

pancreas level and position in peritoneal cavity

A

transpyloric plane L1

retroperitoneal EXCEPT its tail

92
Q

pancreas and vessels relationship

A
  • aorta and IVC pass posterior to head
  • SMA passes behind neck but anterior to uncinate
  • splenic and superior mesenteric vein unite behind neck of pancreas to form portal vein
  • splenic artery traverses superior border of pancreas
93
Q

pancreatic tail attached to spleen by what

A

splenorenal ligament with the splenic vessels

94
Q

pancreas blood supply

A

pancreatic branches from splenic artery

pancreatic head also from superior and inferior pancreaticoduodenal arteries (from gastroduodenal -celiac- and SMA)

95
Q

pancreatitis causes

A 
GET SMASHED
Gall stones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion sting
HyperCa, hypertriglycerides, hyperparathyroidism
ERCP
Drugs (sodium valproate, azathioprine and sulphonamides)
96
Q

relevance of vascular segments of spleen

A

arterial branches from splenic artery do not anastomose with each other, enabling subtotal splenectomy without affecting other segments

97
Q

splenectomy vaccine

A

Pneumococcal, meningococcal, and Haemophilus influenzae (Hib)
2 weeks before or after surgery

98
Q

shape of adrenal glands

A

right: pyramidal
left: semi lunar

99
Q

adrenal gland layers

A

outer capsule, cortex, medulla

100
Q

adrenal gland cortex function

A

from mesoderm
zona glomerulosa - aldosterone (mineralocorticosteroids)
zona fasciculata - cortisol (corticosteroids)
zona reticularis - DHES (androgens)

101
Q

adrenal gland medulla function

A

from ectodermal neural crest cells

contains chromaffin cells, secrete adrenaline (catecholamines)

102
Q

pheochromocytoma

A

tumor in adrenal medulla
secretes adrenaline and noradrenaline
phenoxybenzamine - adrenaline antagonist

103
Q

what encloses the kidneys and adrenal glands

A

renal fascia “Gerota’s fascia”

104
Q

avascular plane of kidney

A

line of Brodel
along lateral slightly posterior border of kidney, important access for open and endoscopic surgeries, minimizes risk of damage to major arteries

105
Q

lymphatic drainage of kidneys

A

para-aortic nodes

106
Q

segmental vascular supply of kidneys relevance

A

like spleen, branches do not anastomose
can perform partial nephrectomies
NB: if one branch is obstructed, its part of kidney will die because no other supply

107
Q

pelvic kidney location

A

kidney that failed to ascend

level of common iliac artery

108
Q

root of mesentery function and pathway

A

mesentery: anchors small and large intestine to posterior abdominal wall, provides conduit for vessels
root: bare area, attaches mesentery to posterior abdominal wall
oblique orientation: left side of L2 till right sacroiliac junction

109
Q

which part of mesentery is most mobile

A

transverse mesocolon

110
Q

most common area of volvulus

A

sigmoid

111
Q

retroperitoneal organs

A 
SAD PUCKER
Suprarenal glands
Aorta + IVC
Duodenum (except 2cm of D1 "cap")
Pancreas (except tail)
Ureters
Colon (ascending + descending)
Kidneys
Esophagus
Rectum
112
Q

mesentery vs omentum

A

both are double layers of visceral peritoneum
omentum comes from stomach mainly and proximal part of duodenum
mesentery for rest of organs (named according to organ its covering, “the mesentery” for small intestine)

113
Q

lesser omentum consists of

A

hepatogastric ligament and hepatoduodenal ligament

114
Q

embryological origin of organs and referred pain

A

foregut referred to epigastric region:
esophagus, stomach, pancreas, liver, gallbladder, duodenum (proximal to entrance of CBD)
midgut referred to umbilical region:
duodenum to proximal 2/3 of transverse colon
hindgut referred to pubic region:
distal 1/3 of transverse to upper part of anal canal

115
Q

abdominal muscles

A

3 flat: external oblique, internal oblique, transversus abdominis
2 vertical: rectus abdominis, pyramidalis

116
Q

linea alba

A

aponeuroses of all 3 flat muscles join in midline of abdomen

from xiphoid to pubic symphysis

117
Q

rectus abdominis structure

A

split in half by linea alba
lateral borders create linea semilunaris
tendinous intersections are fibrous strips that intersect the muscle horizontally –> intersections + linea alba: 6 pack

118
Q

pyramidalis location

A

anterior to rectus abdominis

triangle shape, base at pubis bone, apex at linea alba

119
Q

rectus sheath

A

aponeuroses of 3 flat muscles covering rectus abdominis
anterior wall: external oblique + 1/2 internal oblique
posterior wall: 1/2 internal oblique + transversus abdominis

120
Q

arcuate line

A

midway between umbilicus and pubic symphysis
below arcuate, rectus sheath has only anterior wall with the 3 aponeuroses of the 3 muscles
no more posterior wall, rectus abdominis in direct contact with transversalis fascia

121
Q

superficial fascia composition based on location

A

above umbilicus: single sheet

below umbilicus: Camper’s fascia and Scarpa’s fascia - superficial vessels and nerves run between them

122
Q

inguinal canal function

A

allows structures to pass from abdominal cavity to external genitalia

123
Q

indirect hernia cause

A

failure of processus vaginalis to regress

sac herniates in canal based on amount of processus vaginalis still present

124
Q

what is gubernaculum

A

fibrous cord which attaches to gonads, guides them in their descent, then attaches them to future scrotum or labia

125
Q

what does gubernaculum become

A

males: scrotal ligament
females: ovarian ligament + round ligament of uterus

126
Q

mid-inguinal point vs midpoint of inguinal ligament

A

mid inguinal: between ASIS and pubic symphysis - femoral pulse
midpoint of inguinal ligament: between ASIS and pubic tubercle - above this point is the opening of inguinal canal

127
Q

inguinal canal walls

A

anterior: external oblique aponeurosis
posterior: transversalis fascia
roof: internal oblique, transversus abdominis, transversalis fascia
floor: inguinal ligament, lacunar ligament

128
Q

inguinal ligament made of

A

external oblique aponeurosis

129
Q

deep/internal inguinal ring made of

A

transversalis fascia

above midpoint of ligament

130
Q

superficial/external inguinal ring made of

A

external oblique aponeurosis

131
Q

inguinal canal contents

A

spermatic cord (male), round ligament (female), ilioinguinal nerve, genital branch of genitofemoral nerve

132
Q

ilioinguinal nerve function

A

sensory innervation of genitalia

133
Q

genital branch of genitofemoral nerve function

A

supplies cremaster muscle + anterior scrotal skin

OR skin of mons pubis + labia majora

134
Q

direct hernia cause

A

weakness in abdominal muscles

135
Q

What ligament attaches to lesser curvature of stomach

A

hepatogastric ligament

MRCS (12 decks)

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