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ACEM Viva > Anatomy - Abdomen > Flashcards

Anatomy - Abdomen Flashcards

1
Q

CT abdomen image: name the structures on this CT

A

stomach = 1
liver = 2
gallbladder = 3
pancreas = 4
abdominal aorta = 5
right kidney = 6
vertebral body = 7
spleen = 8
bowel = 9
rib = 10
ivc = 11

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2
Q

What structures are retroperitoneal/intraperitoneal

A

-retroperitoneal:
kidney, ureter, bladder, pancreas, 2nd part of duodenum, ascending and descending colon, aorta, IVC

-intraperitoneal:
stomach, spleen, cap of duodenum, jejenum, ileum, transverse/sigmoid colon

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3
Q

Describe arterial blood supply of the small and large intestine

A

-small intestine:
celiac trunk supplies upper duodenum
sma supplies the rest

-large intestine:
sma supplies ascending colon to 2/3 of the transverse colon
ima supplies rest of colon (up to the pectinate line in the rectum)

Transition points between fore/mid/hindgut:
- Ampulla of Vater
- Distal third junction of tv colon
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4
Q

Describe the course of the ureters

A
  • retroperitoneal structures
  • originate at renal hilum at level of L1/L2 and tip of 9th costal cartilage
  • run inferior across psoas muscle medial to tips of L3-L4 transverse processes
  • cross over pelvic brim and anterior to bifurcation of common iliac artery and under the gonadal vessels and vas deferens
  • travel medially to bladder
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5
Q

What are the 3 points of constriction of the ureters (also most likely site for a stone to lodge)

A

1) junction of ureter at renal pelvis (PUJ = pelviureteric junction)
2) where they cross the brim of the pelvic inlet
3) during passage through the wall of the bladder (VUJ = vesicoureteric junction)

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6
Q

What is the arterial supply of the ureters

A
  • upper part: branches from the renal artery
  • middle part: branches from aorta
  • lower part: branches from internal iliac artery (vesical, middle rectal or uterine artery)
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7
Q

Describe the relationships of the spleen

A
  • anterior: stomach
  • posterior: left diaphragm, ribs 9-11
  • superiorly: diaphragm
  • inferior: splenic flexure of the colon
  • medial: left kidney
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8
Q

What is the blood supply of the liver

A
  • hepatic artery brings 20-25% of blood
  • hepatic portal vein brings 75-80% of blood
  • 3 hepatic veins drain blood from liver into central veins
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9
Q

What level does the superior mesenteric artery arise from

A

L1

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10
Q

What are the relations of the pancreas

A
  • posterior: portal vein, right renal artery/vein, bile duct, SMA, L2 vertebrae
  • medial: duodenum
  • lateral: hilum of spleen
  • anterior: stomach, peritoneum, lesser omentum
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11
Q

Xray abdomen image: please demonstrate the transpyloric plane on this xray

A

The transpyloric plane, also known as Addison’s plane, is an imaginary axial plane located midway between the jugular notch and superior border of pubic symphysis, at approximately the level of L1 vertebral body.
-cuts costal margin of tip of 9th costal cartilage
-transects:
Pylorus,
gb Fundus
Hila of kidney,
Sma, Splenic vein,
Neck of pancreas
Duodenum 2nd part

Please Feed Him Some Naughty Doritos

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12
Q

Outline the course of the abdominal aorta on the above abdominal xray

A
  • enters abdomen at T12, left of midline, bifurcates at L4
  • just above the transpyloric plane to a point just below and to the left of the umbilicus
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13
Q

Describe the relations of the right kidney

A
  • surrounded by perinephric fat
  • superior: right adrenal gland, right lobe of liver, portal vein
  • anterior: gallbladder, duodenum, ascending colon
  • posterior: diaphragm, psoas major
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14
Q

What are the branches of the abdominal aorta

A
  • coeliac artery comes off T12
  • superior mesenteric artery comes off L1
  • renal arteries come off L2
  • inferior mesenteric artery comes off L3
  • lumbar arteries come off L1-L4 (4 paired)
  • bifurcation at L4
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15
Q

What are the branches of the celiac trunk

A
  • splenic artery
  • left gastric artery
  • common hepatic artery
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16
Q

What is the relation of the IVC to the aorta

A

IVC lies posterolateral and to the right

17
Q

Describe the arterial supply and venous drainage of the gut

A

arterial: anastomosis between SMA and IMA via marginal artery at splenic flexure
- celiac = esophagus, stomach, upper duodenum, spleen, pancreas, liver, gall bladder
- sma = lower duodenum and rest of small intestine, pancreas, large intestine (right colic and middle colic)
- ima = rest of large intestine (left colic, sigmoid and superior rectal)

venous:
- superior mesenteric vein, inferior mesenteric vein, gastric vein and splenic veins drain into hepatic portal vein, drains to liver
- 3 hepatic veins from liver drain into inferior vena cava

18
Q

What are the branches of the celiac trunk and what do they supply

A
  • splenic artery: pancreas, stomach, spleen
  • left gastric artery: lower esophagus, stomach
  • common hepatic artery: liver, gallbladder, pylorus, upper duodenum, pancreas
19
Q

Where does fluid collect in the supine position

A
  • hepatorenal space
  • splenorenal space
20
Q

Describe the anatomy of the biliary tree

A
  • right and left hepatic ducts join to form the common hepatic duct
  • cystic duct branches off the common hepatic duct to supply bile to the gallbladder
  • common hepatic duct becomes bile duct, join main pancreatic duct, form hepatopancreatic ampulla, empties into duodenum
21
Q

Xray abdomen image: what does this xray demonstrate

A
  • dilated loops of small bowel with multiple air fluid levels
  • minimal large bowel loops, indicating a proximal large bowel obstruction
  • small bowel identified by valvulae conniventes = cross full width
  • more than 5 air fluid levels are diagnostic of SBO
  • dilation of small bowel >3cm is abnormal
22
Q

Describe porto-systemic anatomoses

A
  • when there is a connection between the veins of the portal circulation and systemic veins
  • blood flows in retrograde manner and there are no valves
  • sites:
    1) inferior end of esophagus - blood drains into left gastric vein that empties into portal vein, results in esophageal varices
    2) superior rectum - blood drains into inferior mesenteric vein that empties into portal vein, results in haemorrhoids
    3) umbilicus - result in caput medusae
23
Q

Describe the arterial supply of the stomach

A

Coeliac Trunk:

Most blood supply is from anastomoses
1) along the lesser curvature by the Right and Left Gastric Arteries
2) along the greater curvature by the Right and Left Gastro-Epiploic Arteries
3) Fundus and Upper Body - Short and Posterior Gastric Artery

ACEM Viva (39 decks)

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