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MRCS Part B > Anatomy - Abdomen > Flashcards

Anatomy - Abdomen Flashcards

1
Q

Name the opening of the lesser sac

A

Epiploic foramen of Winslow

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2
Q

What are the 5 branches of the SMA?

A

Inferior pancreatoduodenal
Jejunoileal branches
Ileocolic
Middle colic
Right colic

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3
Q

What is the marginal artery of Drummond?

A

Anastomosis between SMA and IMA, supplying the transverse colon

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4
Q

Vertebral level: pyloric sphincter

A

L1

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5
Q

Vertebral level: gastro-oesophageal sphincter

A

T11

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6
Q

What embryological mesogastrium forms the Liver and the Spleen?

A

Dorsal - Spleen
Ventral - Liver

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7
Q

Differences between Jejunum and Ileum

A

Jejunum - larger, thicker walls, more red, longer vasa recta, less arcades

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8
Q

Which structure runs beneath the neck of the pancreas?

A

Portal vein

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9
Q

In which structure can the common bile duct be found

A

Hepatoduodenal ligament (part of the lesser ommentum)

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10
Q

Name the opening of the common bile duct and & pancreatic duct in the duodenum

A

Duodenal papilla

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11
Q

Which ribs offer protection for the spleen?

A

9, 10, 11

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12
Q

Which ligaments help secure the position of the spleen?

A

Lieno-splenic ligament
Gastrosplenic ligament

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13
Q

Divisions of the Coeliac Trunk

A

Left gastric
Common hepatic
Splenic

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14
Q

Divisions of the common hepatic artery

A

Hepatic
Gastroduodenal

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15
Q

Which structure runs over the SMA at its origin?

A

Splenic vein

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16
Q

Which structure runs beneath the SMA at its origin?

A

Left renal vein

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17
Q

What are the branches on the IMA?

A

Left colic (anastomoses with middle colic from SMA)
Branches to the sigmoid colon
Superior rectal

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18
Q

Which structure crosses anteriorly over the aorta inferior to the origin of the SMA?

A

Left renal vein

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19
Q

Which structure runs directly over the ureters?

A

Male - testicular artery
Female - ovarian artery

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20
Q

Surface anatomy - gallbladder

A

9th costal cartilage
Mid-clavicular line

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21
Q

Rib level - kidney superior pole

A

12th rib

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22
Q

Surface anatomy - liver

A

Superior - nipple line
Inferior - right 10th rib
Left - 5th intercostal space, mid-clavicular line

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23
Q

What organs are palpable in the normal abdomen?

A

Aorta if slim
Right kidney

Liver and Spleen only in pathological states

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24
Q

Vertebral level - Coeliac axis

A

T12 or upper L1

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25
Q

Vertebral level - SMA

A

Lower part of L1

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26
Q

Vertebral level - IMA

A

L3

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27
Q

Vertebral level - inferior phrenic arteries

A

T12

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28
Q

Vertebral level - renal arteries

A

L1-2

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29
Q

Vertebral level - gonadal arteries

A

L2

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30
Q

Vertebral level - aortic bifurcation

A

L4

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31
Q

What is the transpyloric plane of Addison?

A

L1 - halfway between suprasternal notch and pubic symphysis

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32
Q

Structures at L1 transpyloric plane in the midline

A

Spinal cord conus (termination)
Aorta
SMA
Pancreatic neck
Pylorus of the stomach

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33
Q

Structures at L1 transpyloric plane laterally

A

Renal hilum
Renal vein
Splenic hilum
First part of duodenum
Origin of portal vein
Duodenojejunal flexure
Fundus of gallbladder

34
Q

What is the epiploic foramen of Winslow?

A

Communication between greater and lesser sacs of the peritoneal cavity

35
Q

Which structures run in the hepatoduodenal ligament?

A

Common bile duct
Hepatic portal vein
Hepatic artery proper

36
Q

Which structure forms the posterior border of the epiploic foramen of Winslow?

A

IVC

37
Q

What is Pringle’s manoeuvre?

A

Compression of hepatic artery and portal vein where they lie in the free edge of the lesser omentum (hepatoduodenal ligament) in order to stop bleeding from the Liver

38
Q

Function of the spleen

A

Filtration of encapsulated organisms and blood cells
Immunological function
Storage of platelets
Haematopoiesis in the foetus

Remember FISH

39
Q

Where do the Porto-systemic anastomoses occur?

A

Points at which the systemic venous circulation meets the portal venous circulation

Retroperitoneum
Upper anal canal
Bare area of the Liver
Lower end of the oesophagus
Periumbilical area of abdominal wall

40
Q

Where is the most common sites for intra-abdominal collections to form?

A

Hepatorenal pouch of Rutherford-Morrison when supine

Other areas include the left and right paracolic gutters and subphrenic spaces

41
Q

Which organs are intraperitoneal?

A

Stomach
First part of the duodenum
Jejunoileum
Caecum
Transverse colon
Part of the sigmoid colon
Tail of pancreas
Liver
Uterus and ovaries

42
Q

What forms the border between the foregut and midgut?

A

Second part of the duodenum where the common bile duct drains

43
Q

What structure regulates flow of bile into the second part of the duodenum?

A

Sphincter of Oddi

44
Q

Features differentiating large and small bowel on radiographs

A

Large bowel - haustra which extend a third of the way across the bowel, larger, more peripheral

Small bowel - valvulae conniventes which transverse the complete distance

45
Q

Function of the pancreas

A

Exocrine - digestive enzymes

Endocrine - via Islets of Langerhans
- alpha - glucagon
- beta - insulin
- delta - somatostatin

46
Q

Blood supply - pancreas

A

Head is supplied by the superior pancreaticoduodenal (which arises from the gastroduodenal and coeliac trunk) and inferior pancreaticoduodenal (from the SMA)

The rest of the pancreas is supplied by direct branches of the splenic artery

47
Q

Blood supply - lesser curvature of the stomach

A

Left gastric (from the coeliac axis)
Right gastric (from the common hepatic artery)

48
Q

Blood supply - greater curvature of the stomach

A

Left gastroepiploic - from the splenic
Right gastroepiploic - from the gastroduodenal

49
Q

Which vessel can bleed due to erosion by a duodenal ulcer?

A

Part 1-2: gastroduodenal artery
Part 3-4: pancreaticoduodenal artery

50
Q

What is Meckel’s diverticulum?

A

Remnant of vitellointestinal duct (connection between midgut and yolk sac)

Rule of 2s - 2% incidence, 2 inches long, 2 feet from the ileocaecal valve, 2 times more common in males

Herniation is termed a Littre’s hernia (most commonly in the inguinal region)

51
Q

What is a Littre’s hernia?

A

Herniation of a Meckel’s diverticulum (usually in the inguinal region)

52
Q

What are the posterior relations of the kidneys?

A

Diaphragm
Psoas major
Quadratus lumborum
Transversus abdominis
12th rib (11th rib on the left)
Nerves (subcostal, ilio -hypogastric, ilio-inguinal)

53
Q

What are the layers of the adrenal glands?

A

Zona glomerulosa - mineralocorticoid (aldosterone)
Zona fasciculata - glucocorticoids (cortisol)
Zona reticularis - androgens

54
Q

Vertebral level - xiphoid

A

T9

55
Q

Vertebral level - subcostal plane

A

L3

56
Q

Vertebral level - supracristal plane

A

L4 - corresponds to level of the iliac crest

Also used for landmarking the site of a lumbar puncture

57
Q

Vertebral level - umbilicus

A

L 3-4 junction

58
Q

What is the most common site of colorectal cancer?

A

Rectal, followed by sigmoid

59
Q

Which artery supplies the transverse colon?

A

Middle colic (SMA) - proximal ⅔
Left colic (IMA) - distal ⅓

Marginal artery of Drummond is the anastamosis between these two

60
Q

What is the most common site for diverticular disease?

A

Sigmoid colon

61
Q

Where does the IMV drain?

A

Splenic vein

62
Q

Which veins join forming the hepatic portal vein?

A

Splenic vein and superior mesenteric vein

63
Q

What positions can the appendix be found?

A

Retrocaecal
Postileal
Preileal
Pelvic
Subcaecal

64
Q

What is the Surface anatomy of the appendix?

A

McBurney’s Point - ⅓ distance between ASIS and umbilicus

65
Q

What is McBurney’s Point?

A

⅓ distance between ASIS and umbilicus

66
Q

What layers are encountered during an open appendicectomy?

A

Skin
Camper’s fascia / Subcutaneous tissue
Scarpa’s fascia
External oblique
Internal oblique
Transversus abdominis and transversalis fascia
Extraperitoneal fat
Peritoneum

67
Q

How can you identify the base of the appendix?

A

Position where the three caecal teniae coli converge

68
Q

Blood supply of the rectum

A

Superior rectal (IMA)
Middle rectal (Internal iliac)
Inferior rectal (Internal pudendal)

69
Q

Nerve supply of the rectum

A

Parasympathetic: nervi erigentes (S2,3,4) - sensation of fullness, causing contraction and relaxation of internal sphincter

Sympathetic: superior hypogastric plexus and lumbar splanchnic nerves - transmit pain and cause internal sphincter contraction

70
Q

Relationship between peritoneum and rectum

A

Superior ⅓ - anterior and sides covered
Middle ⅓ - anterior side only
Inferior ⅓ - below peritoneal reflection

71
Q

Which vessel gives rise to the cystic artery?

A

Right hepatic artery

72
Q

How is the hepatic portal vein formed?

A

Splenic vein joins the SMV, posterior to the pancreatic neck at L1

73
Q

Function of the gallbladder

A
  • Storage of bile (50ml)
  • Concentrating bile
  • Adds mucus to bile
74
Q

What is Calot’s Triangle?

A

Superior: inferior edge of the liver Medially: common hepatic duct Laterally: cystic duct

Contains cystic artery and lymph node of Lund

75
Q

What is Courvoisier’s Law?

A

Palpable gallbladder and painless jaundice - unlikely gallstone disease and more likely malignancy

76
Q

Kehr’s Sign

A

Shoulder tip pain secondary to peritoneal irritation

77
Q

Boas’s sign

A

Hyperaesthesia below right scapula in acute cholecystitis

78
Q

What is the origin and insertion of the inguinal ligament?

A

ASIS -> pubic tubercle

79
Q

Which arteries are given off just before the external iliac passes under the inguinal ligament?

A

Deep circumflex iliac - lateral
Inferior epigastric - medial

80
Q
A

MRCS Part B (7 decks)

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