Anatomy (Abdomen And Pelvis) Flashcards
1
Q
Structure divided during approach to juxtarenal aortic aneurysm
A
Left renal vein
2
Q
First branch of abdominal aorta
A
Inferior phrenic artery
3
Q
Tone limit for abdominal aortic clamp
A
10-15 minutes
4
Q
Supply of median sacral artery
A
Lumbar
Sacral
Coccyx
Anorectal junction of posterior
5
Q
Location of superior and inferior epigastric vessels
A
Within rectus sheath
6
Q
Level of placement of mesh in hernial surgery
A
Below the cord
Below the external oblique(overlay) or below fascia traversalis (sublay)
7
Q
Which anal is associated without incontinence
A
External
8
Q
Drug used as a trial before lateral sphincterotomy
A
Local diltiazem
9
Q
Valves in IVC
A
The inferior vena cava (IVC) does not have one-way valves. Instead, the IVC’s forward flow of blood to the heart is driven by the pressure difference created by respiration.
10
Q
Median arcuate ligament compression syndrome
A
Compression of Coeliac trunk
11
Q
Symptoms of median arcuate ligament syndrome
A
ABDOMINAL pain
Unintentional weight loss
ABDOMINAL bruits
12
Q
Confirmatory investigation and treatment of median arcuate ligament syndrome
A
Vascular imaging
Surgically releasing ligament band
13
Q
What is Dunbar syndrome
A
Celiac axis syndrome
Median arcuate ligament compression syndrome MALS also known as
Harjola-Marable syndrome
14
Q
Consequence of Harjola-Marable syndrome
A
Mesenteric ischemia
15
Q
Origin of main pancreatic duct
A
Duct of ventral rudiment
16
Q
Origin of annular pancreas
A
Ventral bud may split and enclose the duodenum
17
Q
Symptoms of annular pancreas
A
Fullness after eating
Nausea
Vomiting
Depending on degree of compression
18
Q
Associated anomaly with annular pancreas
A
Down syndrome
Poly hydramnios
19
Q
Normal site of gastrinoma
A
Duodenum
20
Q
Type of pancreatic gastrinoma
A
Highly malignant are solitary
21
Q
Triad of zollinger Ellison syndrome
A
Non beta cell tumor of pancreas
Hyper gastrinemia
Severe ulcer disease
22
Q
Diagnosis criteria of peptic ulcers disease
A
Fasting hypergaetrinemia
Increased basal acid output
Secretin stimulating test positive
23
Q
Continuation of external oblique fascia in scrotum
A
External spermatic fascia
24
Q
Continuation of internal oblique muscle in scrotum
A
Cremasteric muscle and fascia
25
Continuation of scarpas fascia in scrotum
Dartos fascia and smooth muscle
26
Continuation of transversalis muscle
Cremasteric muscle and fascia
27
Continuation of fascia transversalis
Internal spermatic fascia
28
Continuation of peritontium in scrotum
Tunica vaginalis
29
Anterior and posterior fascia of rectum
Posteriorly Waldeyer
Anteriorly denovillers
30
Anterior and posterior fascia of kidney
Anterior Gerota
Posterior Zuckerkandl
31
Location of bucks fascia
Penis
32
Ribs related to kidney
11
12
And
10 in case of left kidney
33
Structures of renal pelvis
From anterior to posterior
VAP
34
Origin level of SMA
L1
35
Origin level of IMA
L3
36
Origin level is renal artery
L2
37
Relation of creatinine with age
It declines with age
38
Most accurate substance for measuring GFR
Inulin
39
Origin and termination of greater splanchnic nerve
T5-T9
After piercing the diaphragm they synapse with ciliary ganglion
40
Level of origin of portal vein
L1
41
Level of head of pancreas
L2
42
Vascular structure behind head of pancreas
Renal veins so L2 level
43
Vertebral level of CBD
L2
44
Posterior relation of femoral artery
Psoas tendon
45
Surface anatomy of deep inguinal ring
Midpoint of inguinal ligament
46
Point of palpation of femoral artery
Midinguinal point
Between ASIS and pubic symphysis
47
Gut related superiorly to urinary bladder
Small intestine
Sigmoid colon
48
Muscles related lateral to urinary bladder
Levator ani
Obturator internus
49
On which muscle does abdominal portion of ureter lie
Psoas major
50
Vertebral relation of abdominal portion of other
Transverse processes of L2-5
51
Point of ureter becoming pelvic from abdomen
Anterior to sacroiliac joint
52
Relation of ureter with common iliac artery
Ureter passes ANTERIOR to bifurcation of common iliac artery
53
Reason of ischial some with ureter
It passes anterior to spine
54
Areas to notice for ureteric stone with vertebral level
Pelvis (lateral to L2)
Pelvic brim (level of sacral promontory)
Vesicoureteric junction (ischial spine)
55
Vertebral level of kidney
T12-L3
56
Arterial supply of gall bladder
Cystic artery
57
Origin of cystic artery
Right hepatic artery
58
Ligament related to cystic artery
The artery is formed within Hepatoduodenal ligament
59
Branches of Coeliac trunk
Hepatic artery
LEFT gastric artery
Splenic artery
60
Overview on Coeliac trunk
#Coeliac trunk—
*Left gastric (connects with R. Gastric)
proper H.—Left & Right-cystic
*C.Hepatic-
Gast.duo.-su.pan.duo & R.ga.epi
Short gastric
*Splenic -
Left gastroepiploic
61
Boundary of Calot's triangle
Superiorly Lower border of liver
Right lateral Cystic duct
Left lateral Common hepatic duct
62
Vertebral level of Coeliac trunk
T12
63
What structure is to be damaged for urine to collect in superficial perineal pouch and in scrotum
Spongy urethra
64
Goodsall's rule
a rule that helps determine the internal opening of an anal fistula based on the location of its external opening
Anterior external opening: The internal opening is in the same radial position.
Posterior external opening: The internal opening is in the midline posteriorly, sometimes taking a curvilinear course
65
Surgical classification of
The Parks classification has become the most widely used surgical classification for distinguishing four types of fistula. The course of the fistula and its relationship to the anal sphincters is described in the coronal plane 1,5,6:
intersphincteric (~70%): fistula crosses the intersphincteric space and does not cross the external sphincter
transsphincteric (25%): fistula crosses from the intersphincteric space, through the external sphincter, and into the ischiorectal fossa
suprasphincteric (5%): fistula passes superiorly into the intersphincteric space, and over the top of the puborectalis muscle then descending through the iliococcygeus muscle into the ischiorectal fossa and then skin
extrasphincteric (1%): fistula crosses from the perineal skin through the ischiorectal fossa and levator ani muscle complex into the rectum (i.e. it is outside the external anal sphincter)
66
Other name of exomphalos
Omphalocele
Cele, so containing sac
67
Main difference between Gastroschisis and omphalocele
G - apart from umbilical cord
O - within umbilical cord
68
Pathology in imperforated anus
Rectum
69
Most common hernia irrespective of gender
Indirect
70
Most common hernia in female
Femoral
4 time more than male
71
Relation of kidney and pancreas
Body of pancreas is in direct contact with anterior surface with left kidney
72
Relation of colon and kidney
They are in direct contact
73
Posterior relation of 1st part of duodenum
Portal vein
CBD
Gastroduodenal artery
IVC
74
Vascular relation of 3rd part of duodenum
ABDOMINAL aorta posteriorly
Coeliac trunk anteriorly
75
Relation of duodenum with colon
Transverse colon passing anteriorly to 2nd part of duodenum
76
Superior border of epiploic foramen
Caudate lobe
77
Which part of foramen of Winslow is composed during Pringles maneuver
Anterior wall
78
Gastric relation with spleen
Located between gastric fundus and left hemidiaphragm
79
Axis of spleen related to rib
Along left 10th rib
80
Importance of lower pole of spleen extended to mid clavicular line
It has become 3 times of normal size
And it is only palpable then
81
Proper time of transfusion platelet during splenectomy
During applying vascular clamp
82
Origin of longitudinal muscle layer of appendix
Taenia coli
83
Origin of appendicular artery
From iliocolic artery
Iliocolic artery arises from SMA
84
*Blood supply of rectum
Superior from IMA- just after entering sigmoid mesocolon it turns into SRA on crossing the pelvic brim
Middle R.A. small or absent
Inferior R.A. from internal pudendal artery
Median sacral from abdominal aorta
85
*Location of puborectalis
Surrounding around anorectal junction
86
*Attachment of pubococcygeus
To anococcygeus ligament
87
*Muscular attachment of perineal body
External anal sphincter
Levator ani
Bulbospongiosus
Superficial and deep transverse perineal
88
Formation of internal rectal plexus
Submucosal veins
89
Formation of external rectal plexus
Subserosal veins
90
Blood draining of rectum
Internal and external rectal plexuses drain into portal vein via superior rectal vein
And to internal iliac vein via middle and inferior rectal vein
91
Cause of formation of deep inguinal ring
Defect in fascia transversalis
92
Cause of formation of superficial inguinal ring
Defect in external oblique aponurosis
93
Why not hernioplasty in children
Plasty is used to reinforce the posterior wall of inguinal canal
But in children pathology is not in wall, rather due to patent proceous vaginalis
ALSO the superficial and deep rings will be apart from each other during growth.
94
Process of herniotomy
Cut the sac & retract it Back
95
Reason may cause direct hernia in children
Collagen disease like
Ehlers-Danlos syndrome (EDS)
96
Symptoms of EDS
Skin: Loose, velvety skin that bruises easily and can lead to wound healing problems
Joints: Joints that are excessively flexible and can dislocate
Blood vessels: Fragile blood vessels that can cause easy bruising and bleeding
Internal organs: Organs that can split open and lead to life-threatening bleeding
97
Relation of LEFT phrenic nerve with left common carotid and left subclavian artery
Nerve descends between these arteries
98
Relation of L.phrenic nerve with aortic arch
Nerve crosses the left surface of arch
99
Sensory supply of left phrenic nerve
Pleura
Pericardium
Small part of peritoneum
100
Relation of Phrenic nerve with IJV
The nerve descends parallel to the vein
101
Important relation of phrenic nerve in the neck
Anterior to anterior scalenes lateral border
Posterior to Prevertebral fascia, transverse cervical artery and subscapular artery
102
Anterior relation of right pelvis and ureter
Origin of right ureter is covered by descending duodenum
Right colic vessels
Iliocolic vessels
Lower part of mesentery & terminal part of ileum near superior aperture of pelvis
103
Anterior relation of left ureter
Left colic vessels
Sigmoid colon with its mesentery near superior aperture of pelvis
104
Relation of IVC with ureter
Right ureter lies right side of IVC
105
Ureteric relation in female
Lies in ovarian fossa
Lateral part of lower uterus accompanied by uterine artery fir 2.5cm (water under bridge)
Upper part of vagina
106
Origin of urinary bladder
Cloaca
Mesonephric duct
107
Division of cloaca
By urorectal septum into urogenital sinus and rectum
108
Function of mesonephric/wolffian duct in urinary bladder
They expand to form bladder trigone
109
Origins of The epithelial tissue in the urinary bladder
The epithelial tissue in the urinary bladder has different origins depending on its location:
Urothelium in the bladder and proximal urethra: This tissue comes from the endoderm, the inner germ cell layer that develops during gastrulation.
Urothelium in the ureters and renal pelvis: This tissue comes from the mesoderm.
Trigone: Some studies suggest that the trigone comes from the endoderm, while others suggest it comes from the Wolffian ducts, which are derived from the mesoderm.
MESOderm from MESOnephric duct
110
Structure of urothelium
The urothelium starts as a single layer of immature cells that divide and differentiate into three layers: basal, intermediate, and umbrella cells. The transitional epithelium tissue in the bladder is elastic, allowing the bladder to stretch and hold urine.
111
Relation of levator ani with bladder
It lies inferolateral to bladder and prostate
112
Main pathology of Femoral hernia
Weakness of femoral RING
113
Difference between sliding hiatal hernia and paraoesophageal hernia
Content
H-whole stomach
P-portion of stomach (more risk of strangulation-(so then may require surgery)
114
Painful scrotum without skin discoloration indicates what
Not surgical emergency at that time
115
What to do with a child with hydrocele
Observe until 6 months
116
Location of Spigelian hernia hernia
At the level of arcuate line between interval and external oblique like a mushroom
A spigelian hernia is a rare, abnormal protrusion of abdominal contents or peritoneum through a defect (spigelian fascia), which is comprised of the transversus abdominis and the internal oblique aponeuroses.
The borders of the Spigelian aponeurosis are the rectus muscle medially and the linea semilunaris laterally.
117
Most common site of gall stone ileus
Narrowest part ileum (that's why ileus)
118
What to do with gall bladder in case of gall stone ileus
Nothing
Let the patient recover from acute condition after removing stone from lodgement site
119
Signs of gallstone ileus
Features of intestinal obstruction
Pneumobilia
120
Splenic artery to pancreatic supply
Neck,body and tail
121
Blood supply of pancreatic head
*Superior pancreaticoduodenal from gastroduodenal from common hepatic from Coeliac trunk
*Inferior pancreaticoduodenal artery from superior mesenteric artery
122
Type of gall stones
Pigments -dark/black (high bilirubin due to hemolysis, sickle cell, hemolytic anaemia, Crohn's disease)
Cholesterol -green(imbalance of composition & improper emptying gall bladder)most common 80%
Mixed -brown(cholesterol+Ca+bilirubin)
123
PBF features of post splenectomy
3H
High platelets -Following splenectomy, reactive thrombocytosis is an anticipated
Howell jolly bodies - Nuclear remnants that remain in red blood cells after they've matured in the bone marrowHowell-Jolly bodies are not normal, and they usually indicate a damaged or absent spleen
Heinz bodies -spleen is not there to remove Heinz bodies from the blood.
Heinz bodies are a late sign of oxidative damage and are caused by the degradation of hemoglobin
