Anatomy (Abdomen And Pelvis) Flashcards
Structure divided during approach to juxtarenal aortic aneurysm
Left renal vein
First branch of abdominal aorta
Inferior phrenic artery
Tone limit for abdominal aortic clamp
10-15 minutes
Supply of median sacral artery
Lumbar
Sacral
Coccyx
Anorectal junction of posterior
Location of superior and inferior epigastric vessels
Within rectus sheath
Level of placement of mesh in hernial surgery
Below the cord
Below the external oblique(overlay) or below fascia traversalis (sublay)
Which anal is associated without incontinence
External
Drug used as a trial before lateral sphincterotomy
Local diltiazem
Valves in IVC
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.
Median arcuate ligament compression syndrome
Compression of Coeliac trunk
Symptoms of median arcuate ligament syndrome
ABDOMINAL pain
Unintentional weight loss
ABDOMINAL bruits
Confirmatory investigation and treatment of median arcuate ligament syndrome
Vascular imaging
Surgically releasing ligament band
What is Dunbar syndrome
Celiac axis syndrome
Median arcuate ligament compression syndrome MALS also known as
Harjola-Marable syndrome
Consequence of Harjola-Marable syndrome
Mesenteric ischemia
Origin of main pancreatic duct
Duct of ventral rudiment
Origin of annular pancreas
Ventral bud may split and enclose the duodenum
Symptoms of annular pancreas
Fullness after eating
Nausea
Vomiting
Depending on degree of compression
Associated anomaly with annular pancreas
Down syndrome
Poly hydramnios
Normal site of gastrinoma
Duodenum
Type of pancreatic gastrinoma
Highly malignant are solitary
Triad of zollinger Ellison syndrome
Non beta cell tumor of pancreas
Hyper gastrinemia
Severe ulcer disease
Diagnosis criteria of peptic ulcers disease
Fasting hypergaetrinemia
Increased basal acid output
Secretin stimulating test positive
Continuation of external oblique fascia in scrotum
External spermatic fascia
Continuation of internal oblique muscle in scrotum
Cremasteric muscle and fascia
Continuation of scarpas fascia in scrotum
Dartos fascia and smooth muscle
Continuation of transversalis muscle
Cremasteric muscle and fascia
Continuation of fascia transversalis
Internal spermatic fascia
Continuation of peritontium in scrotum
Tunica vaginalis
Anterior and posterior fascia of rectum
Posteriorly Waldeyer
Anteriorly denovillers
Anterior and posterior fascia of kidney
Anterior Gerota
Posterior Zuckerkandl
Location of bucks fascia
Penis
Ribs related to kidney
11
12
And
10 in case of left kidney
Structures of renal pelvis
From anterior to posterior
VAP
Origin level of SMA
L1
Origin level of IMA
L3
Origin level is renal artery
L2
Relation of creatinine with age
It declines with age
Most accurate substance for measuring GFR
Inulin
Origin and termination of greater splanchnic nerve
T5-T9
After piercing the diaphragm they synapse with ciliary ganglion
Level of origin of portal vein
L1
Level of head of pancreas
L2
Vascular structure behind head of pancreas
Renal veins so L2 level
Vertebral level of CBD
L2
Posterior relation of femoral artery
Psoas tendon
Surface anatomy of deep inguinal ring
Midpoint of inguinal ligament
Point of palpation of femoral artery
Midinguinal point
Between ASIS and pubic symphysis
Gut related superiorly to urinary bladder
Small intestine
Sigmoid colon
Muscles related lateral to urinary bladder
Levator ani
Obturator internus
On which muscle does abdominal portion of ureter lie
Psoas major
Vertebral relation of abdominal portion of other
Transverse processes of L2-5
Point of ureter becoming pelvic from abdomen
Anterior to sacroiliac joint
Relation of ureter with common iliac artery
Ureter passes ANTERIOR to bifurcation of common iliac artery
Reason of ischial some with ureter
It passes anterior to spine
Areas to notice for ureteric stone with vertebral level
Pelvis (lateral to L2)
Pelvic brim (level of sacral promontory)
Vesicoureteric junction (ischial spine)
Vertebral level of kidney
T12-L3
Arterial supply of gall bladder
Cystic artery
Origin of cystic artery
Right hepatic artery
Ligament related to cystic artery
The artery is formed within Hepatoduodenal ligament
Branches of Coeliac trunk
Hepatic artery
LEFT gastric artery
Splenic artery
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
Boundary of Calot’s triangle
Superiorly Lower border of liver
Right lateral Cystic duct
Left lateral Common hepatic duct
Vertebral level of Coeliac trunk
T12
What structure is to be damaged for urine to collect in superficial perineal pouch and in scrotum
Spongy urethra
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
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)
Other name of exomphalos
Omphalocele
Cele, so containing sac
Main difference between Gastroschisis and omphalocele
G - apart from umbilical cord
O - within umbilical cord
Pathology in imperforated anus
Rectum
Most common hernia irrespective of gender
Indirect
Most common hernia in female
Femoral
4 time more than male
Relation of kidney and pancreas
Body of pancreas is in direct contact with anterior surface with left kidney
Relation of colon and kidney
They are in direct contact
Posterior relation of 1st part of duodenum
Portal vein
CBD
Gastroduodenal artery
IVC
Vascular relation of 3rd part of duodenum
ABDOMINAL aorta posteriorly
Coeliac trunk anteriorly
Relation of duodenum with colon
Transverse colon passing anteriorly to 2nd part of duodenum
Superior border of epiploic foramen
Caudate lobe
Which part of foramen of Winslow is composed during Pringles maneuver
Anterior wall
Gastric relation with spleen
Located between gastric fundus and left hemidiaphragm
Axis of spleen related to rib
Along left 10th rib
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
Proper time of transfusion platelet during splenectomy
During applying vascular clamp
Origin of longitudinal muscle layer of appendix
Taenia coli
Origin of appendicular artery
From iliocolic artery
Iliocolic artery arises from SMA
*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
*Location of puborectalis
Surrounding around anorectal junction
*Attachment of pubococcygeus
To anococcygeus ligament
*Muscular attachment of perineal body
External anal sphincter
Levator ani
Bulbospongiosus
Superficial and deep transverse perineal
Formation of internal rectal plexus
Submucosal veins
Formation of external rectal plexus
Subserosal veins
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
Cause of formation of deep inguinal ring
Defect in fascia transversalis
Cause of formation of superficial inguinal ring
Defect in external oblique aponurosis
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.
Process of herniotomy
Cut the sac & retract it Back
Reason may cause direct hernia in children
Collagen disease like
Ehlers-Danlos syndrome (EDS)
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
Relation of LEFT phrenic nerve with left common carotid and left subclavian artery
Nerve descends between these arteries
Relation of L.phrenic nerve with aortic arch
Nerve crosses the left surface of arch
Sensory supply of left phrenic nerve
Pleura
Pericardium
Small part of peritoneum
Relation of Phrenic nerve with IJV
The nerve descends parallel to the vein
Important relation of phrenic nerve in the neck
Anterior to anterior scalenes lateral border
Posterior to Prevertebral fascia, transverse cervical artery and subscapular artery
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
Anterior relation of left ureter
Left colic vessels
Sigmoid colon with its mesentery near superior aperture of pelvis
Relation of IVC with ureter
Right ureter lies right side of IVC
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
Origin of urinary bladder
Cloaca
Mesonephric duct
Division of cloaca
By urorectal septum into urogenital sinus and rectum
Function of mesonephric/wolffian duct in urinary bladder
They expand to form bladder trigone
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
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.
Relation of levator ani with bladder
It lies inferolateral to bladder and prostate
Main pathology of Femoral hernia
Weakness of femoral RING
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)
Painful scrotum without skin discoloration indicates what
Not surgical emergency at that time
What to do with a child with hydrocele
Observe until 6 months
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.
Most common site of gall stone ileus
Narrowest part ileum (that’s why ileus)
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
Signs of gallstone ileus
Features of intestinal obstruction
Pneumobilia
Splenic artery to pancreatic supply
Neck,body and tail
Blood supply of pancreatic head
*Superior pancreaticoduodenal from gastroduodenal from common hepatic from Coeliac trunk
*Inferior pancreaticoduodenal artery from superior mesenteric artery
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)
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
