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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
Vertebral level - SMA
Lower part of L1
26
Vertebral level - IMA
L3
27
Vertebral level - inferior phrenic arteries
T12
28
Vertebral level - renal arteries
L1-2
29
Vertebral level - gonadal arteries
L2
30
Vertebral level - aortic bifurcation
L4
31
What is the transpyloric plane of Addison?
L1 - halfway between suprasternal notch and pubic symphysis
32
Structures at L1 transpyloric plane in the midline
Spinal cord conus (termination) Aorta SMA Pancreatic neck Pylorus of the stomach
33
Structures at L1 transpyloric plane laterally
Renal hilum Renal vein Splenic hilum First part of duodenum Origin of portal vein Duodenojejunal flexure Fundus of gallbladder
34
What is the epiploic foramen of Winslow?
Communication between greater and lesser sacs of the peritoneal cavity
35
Which structures run in the hepatoduodenal ligament?
Common bile duct Hepatic portal vein Hepatic artery proper
36
Which structure forms the posterior border of the epiploic foramen of Winslow?
IVC
37
What is Pringle’s manoeuvre?
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
Function of the spleen
Filtration of encapsulated organisms and blood cells Immunological function Storage of platelets Haematopoiesis in the foetus Remember FISH
39
Where do the Porto-systemic anastomoses occur?
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
Where is the most common sites for intra-abdominal collections to form?
Hepatorenal pouch of Rutherford-Morrison when supine Other areas include the left and right paracolic gutters and subphrenic spaces
41
Which organs are intraperitoneal?
Stomach First part of the duodenum Jejunoileum Caecum Transverse colon Part of the sigmoid colon Tail of pancreas Liver Uterus and ovaries
42
What forms the border between the foregut and midgut?
Second part of the duodenum where the common bile duct drains
43
What structure regulates flow of bile into the second part of the duodenum?
Sphincter of Oddi
44
Features differentiating large and small bowel on radiographs
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
Function of the pancreas
Exocrine - digestive enzymes Endocrine - via Islets of Langerhans - alpha - glucagon - beta - insulin - delta - somatostatin
46
Blood supply - pancreas
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
Blood supply - lesser curvature of the stomach
Left gastric (from the coeliac axis) Right gastric (from the common hepatic artery)
48
Blood supply - greater curvature of the stomach
Left gastroepiploic - from the splenic Right gastroepiploic - from the gastroduodenal
49
Which vessel can bleed due to erosion by a duodenal ulcer?
Part 1-2: gastroduodenal artery Part 3-4: pancreaticoduodenal artery
50
What is Meckel’s diverticulum?
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
What is a Littre’s hernia?
Herniation of a Meckel’s diverticulum (usually in the inguinal region)
52
What are the posterior relations of the kidneys?
Diaphragm Psoas major Quadratus lumborum Transversus abdominis 12th rib (11th rib on the left) Nerves (subcostal, ilio -hypogastric, ilio-inguinal)
53
What are the layers of the adrenal glands?
Zona glomerulosa - mineralocorticoid (aldosterone) Zona fasciculata - glucocorticoids (cortisol) Zona reticularis - androgens
54
Vertebral level - xiphoid
T9
55
Vertebral level - subcostal plane
L3
56
Vertebral level - supracristal plane
L4 - corresponds to level of the iliac crest Also used for landmarking the site of a lumbar puncture
57
Vertebral level - umbilicus
L 3-4 junction
58
What is the most common site of colorectal cancer?
Rectal, followed by sigmoid
59
Which artery supplies the transverse colon?
Middle colic (SMA) - proximal ⅔ Left colic (IMA) - distal ⅓ Marginal artery of Drummond is the anastamosis between these two
60
What is the most common site for diverticular disease?
Sigmoid colon
61
Where does the IMV drain?
Splenic vein
62
Which veins join forming the hepatic portal vein?
Splenic vein and superior mesenteric vein
63
What positions can the appendix be found?
Retrocaecal Postileal Preileal Pelvic Subcaecal
64
What is the Surface anatomy of the appendix?
McBurney's Point - ⅓ distance between ASIS and umbilicus
65
What is McBurney's Point?
⅓ distance between ASIS and umbilicus
66
What layers are encountered during an open appendicectomy?
Skin Camper's fascia / Subcutaneous tissue Scarpa's fascia External oblique Internal oblique Transversus abdominis and transversalis fascia Extraperitoneal fat Peritoneum
67
How can you identify the base of the appendix?
Position where the three caecal teniae coli converge
68
Blood supply of the rectum
Superior rectal (IMA) Middle rectal (Internal iliac) Inferior rectal (Internal pudendal)
69
Nerve supply of the rectum
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
Relationship between peritoneum and rectum
Superior ⅓ - anterior and sides covered Middle ⅓ - anterior side only Inferior ⅓ - below peritoneal reflection
71
Which vessel gives rise to the cystic artery?
Right hepatic artery
72
How is the hepatic portal vein formed?
Splenic vein joins the SMV, posterior to the pancreatic neck at L1
73
Function of the gallbladder
- Storage of bile (50ml) - Concentrating bile - Adds mucus to bile
74
What is Calot's Triangle?
Superior: inferior edge of the liver Medially: common hepatic duct Laterally: cystic duct Contains cystic artery and lymph node of Lund
75
What is Courvoisier's Law?
Palpable gallbladder and painless jaundice - unlikely gallstone disease and more likely malignancy
76
Kehr's Sign
Shoulder tip pain secondary to peritoneal irritation
77
Boas's sign
Hyperaesthesia below right scapula in acute cholecystitis
78
What is the origin and insertion of the inguinal ligament?
ASIS -> pubic tubercle
79
Which arteries are given off just before the external iliac passes under the inguinal ligament?
Deep circumflex iliac - lateral Inferior epigastric - medial
80

MRCS Part B (7 decks)

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