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MRCS A > ANATOMY - Abdomen p2 > Flashcards

ANATOMY - Abdomen p2 Flashcards

1
Q

Role of cecum

A

Reservoir for chyme

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2
Q

Where is the cecum in the abdomen

A

RIF

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3
Q

is the cecum intra or retroperitoneal

A

intraperitoneal

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4
Q

aa supply cecum

A

anterior + posterior cecal aa

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5
Q

what are the cecal arteries branches of

A

ileocolic aa

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6
Q

what is the ileocolic aa a branch of

A

SMA

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7
Q

vv drainage cecum

A

ileocolic vv

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8
Q

where do the ileocolic vv drain into

A

SMV

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9
Q

inn cecum

A

ileocolic branch of superior mesenteric plexus

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10
Q

LN drainage cecum

A

ileocolic LN

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11
Q

what % of intestinal volvuli are cecal

A

10%

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12
Q

length of colon

A

1.5m

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13
Q

what are the 4 parts of the colon

A

ascending
transverse
descending
sigmoid

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14
Q

is the ascending colon intra or retroperitoneal

A

retroperitoneal

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15
Q

when does the ascending colon becomes the transverse colon

A

at the hepatic flexure

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16
Q

where does the transverse colon run between

A

hepatic flexure –> splenic flexure

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17
Q

how and where is the transverse colon attached to the diaphragm

A

at splenic flexure
via the phrenicocolic ligament

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18
Q

is the transverse mesocolon intra or retroperitoneal

A

intraperitoneal

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19
Q

is the descending colon intra or retroperitoneal

A

retroperitoneal

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20
Q

what structure is the descending colon anterior to

A

L kidney

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21
Q

how long is the sigmoid colon

A

40 cm

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22
Q

where does the sigmoid colon run between

A

iliac fossa –> S3

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23
Q

how is the sigmoid colon attached to the posterior pelvic wall

A

sigmoid mesocolon

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24
Q

4 features of Large intestine that differs it from Small intestine

A

omental appendices
teniae coli
haustra
larger diameter

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25
Q

what are the omental appendices

A

found in LI
small pouches of peritoneum filled with fat

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26
Q

what are teniae coli

A

found in LI
3 strips of MM running longitudinally

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27
Q

what are haustra

A

found in LI
when the teniae coli contract - shorten bowel –> sacculations aka haustra

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28
Q

structures anterior to the ascending colon (3)

A

SI
greater omentum
anterior abdominal wall

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29
Q

structures posterior to the ascending colon (5)

A

iliacus
quadratus lumborum
R kidney
iliohypogastric + ilioinguinal nn

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30
Q

structures anterior to the transverse colon (2)

A

greater omentum
anterior abdominal wall

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31
Q

structures posterior to the transverse colon (2)

A

SI
pancreas head

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32
Q

structures anterior to the descending colon (3)

A

small intestine
greater omentum
anterior abdominal wall

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33
Q

structures posterior to the descending colon (5)

A

L kidney
iliacus
quadratus lumborum
iliohypogastric + ilioinguinal nn

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34
Q

structures anterior to the sigmoid colon (3)

A

bladder
ureters
upper vagina

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35
Q

structures posterior to the sigmoid colon (3)

A

rectum
sacrum
ilium

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36
Q

what is the marginal aa of Drummond

A

an anastomoses of terminal branches of the IMA + SMA which provides collateral blood supply to the colon and from which vasa recta arise

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37
Q

middle colic aa, R colic aa and ileocolic aa arise from

A

SMA

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38
Q

l colic aa and sigmoid aa arise from

A

IMA

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39
Q

ileocolic vv and R colic vv drain into

A

SMV

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40
Q

L colic vv and sigmoid vv drain into

A

IMV

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41
Q

innervation of the midgut colon (A + prox 2/3 T colon)

A

superior mesenteric plexus

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42
Q

innervation of the hindgut colon (distal 1/3 T colon, descending + sigmoid)

A

inferior mesenteric plexus

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43
Q

sympathetic component of inferior mesenteric plexus

A

lumbar splanchnic nn

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44
Q

parasympathetic component of inferior mesenteric plexus

A

pelvic splanchnic nn

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45
Q

which LN drain the ascending + transverse colon

A

superior mesenteric LN

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46
Q

which LN drain the descending and sigmoid colon

A

inferior mesenteric LN

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47
Q

journey of Lymphatic drainage from colon to thoracic duct

A

Sup + inf mesenteric LN –> intestinal lymph trunks –> cisterna chyli –> thoracic duct

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48
Q

role of rectum

A

temporary storage of faeces

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49
Q

spinal level at which rectum begins

A

S3

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50
Q

how is the rectum distinctive from the rest of the colon? (3)

A

no taenia coli
no haustra
no ommental appendices

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51
Q

what are the 2 main flexures of the rectum

A

sacral flexure
anorectal flexure

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52
Q

sacral flexure

A

AP curve with concavity anteriorly
following the curve of the sacrum/coccyx

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53
Q

anorectal flexure + role

A

AP curve with convexity anteriorly
faecal continence

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54
Q

which muscle tone forms the anorectal flexure

A

puborectalis mm

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55
Q

what are the 3 lateral flexures of the rectum called

A

superior
intermediate
inferior

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56
Q

what are the 3 lateral flexures of the rectum formed by

A

transverse folds of the internal rectal wall

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57
Q

ampulla of the rectum - where + fct

A

final segment
relaxes to accommodate faeces

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58
Q

peritoneal coverings of rectum - superior 1/3

A

anterior and lateral aspects covered

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59
Q

peritoneal coverings of the rectum - middle 1/3

A

anterior aspect only covered

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60
Q

peritoneal coverings of the rectum - inferior 1/3

A

no peritoneal covering

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61
Q

structures anterior to the rectum in the male (6)

A

retrovesical pouch
sigmoid colon
ileum
bladder
prostate
seminal vesicles

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62
Q

structures anterior to the rectum in females (5)

A

rectouterine pouch
sigmoid colon
ileum
vagina
cervi x

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63
Q

structures posterior to the rectum (5)

A

sacrum + coccyx
piriformis
coccygeus
levator ani
sacral plexus

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64
Q

3 aa supplying the rectum

A

superior rectal aa
middle rectal aa
inferior rectal aa

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65
Q

superior rectal aa is a branch of

A

IMA

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66
Q

middle rectal aa is a branch of

A

internal iliac aa

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67
Q

inferior rectal aa is a branch of

A

internal pudendal aa

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68
Q

which 3 veins drain the rectum

A

superior rectal vv
middle rectal vv
inferior rectal vv

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69
Q

superior rectal vv drains into

A

portal venous system

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70
Q

middle rectal vein drains into

A

systemic system

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71
Q

inferior rectal vein drains into

A

systemic system

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72
Q

how do the rectal veins anastomose

A

via the portocaval anastomoses between the portal system and systemic system

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73
Q

sympathetic inn rectum

A

lumbar splanchnic nn
superior + inferior hypogastric plexuses

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74
Q

parasympathetic inn retum

A

S2-4 via pelvic splanchnic nn and inferior hypogastric plexus

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75
Q

visceral afferent/sensory inn rectum

A

follows parasymp

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76
Q

LN drainage rectum

A

pararectal LN
also low rectum to internal iliac LN

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77
Q

where do the pararectal LN drain into

A

inferior mesenteric LN

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78
Q

role of anal canal

A

defecation + maintaining faecal continence

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79
Q

where is the anal canal

A

within the anal triangle of the perineum
between the R+L ischioanal fossae

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80
Q

how long is the anal canal

A

4cm

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81
Q

where is the internal anal sphincter

A

surrounding the upper 2/3 of the anal canal

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82
Q

what is the internal anal sphincter made of?

A

involuntary circular SM

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83
Q

where is the external anal sphincter

A

surrounding the lower 2/3 of the anal canal

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84
Q

what is the external anal sphincter made of

A

voluntary SM

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85
Q

what muscle does the external anal sphincter blend with

A

puborectalis muscle

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86
Q

what structure lies at the junction of the anal canal and rectum

A

anorectal ring
mm ring

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87
Q

what forms the anorectal ring

A

fusion of internal anal sphincter, external anal sphincter + puborectalis mm

88
Q

what cell type is the superior aspect of the anal canal

A

columnar epithelium

89
Q

what are anal columns

A

mucosaorganised into longitudinal folds

90
Q

what structure joins at the end of the anal columns

A

anal valves

91
Q

what are anal sinuses

A

pouches above the anal valves which contain glands which secrete mucus

92
Q

what important landmark do the anal valves form

A

dentate/pectinate line

93
Q

embryological origin of anal canal above pectinate line

A

hindgut

94
Q

embryological origin of anal canal below pectinate line

A

ectoderm of proctodeum

95
Q

cell lining of anal canal below pectinate line

A

non-keratinised stratified squamous ep

96
Q

when does the cell lining change from the lining below the pectinate line of the anal canal to the skin of the anus

A

intersphincteric groove

97
Q

structures anterior to the anal canal in males (4)

A

perineal body
urogenital diaphragm
urethra
bulb of penis

98
Q

structures anterior to the anal canal in females (3)

A

perineal body
urogenital diaphragm
vagina

99
Q

structures posterior to the anal canal (2)

A

sacrum/coccyx
anococcygeal ligament

100
Q

structures lateral to the anal canal (1)

A

ischioanal fossae

101
Q

aa supply to the anal canal ABOVE the dentate line

A

superior rectal aa (which anastomose w/ middle rectal aa branches)

102
Q

aa supply to the anal canal BELOW the dentate line

A

inferior rectal aa (which anastomose w/ middle rectal aa branches)

103
Q

vv supply to anal canal ABOVE the dentate line

A

superior rectal vv

104
Q

vv supply to the anal canal BELOW dentate line

A

inferior rectal vv

105
Q

nn supply to the anal canal ABOVE dentate line

A

inferior hypogastric plexus (visceral)
only sensitive to stretch

106
Q

nn supply to the anal canal BELOW dentate line

A

inferior rectal nn - somatic
sensitive to pain, temp, touch, pressure

107
Q

LN drainage anal canal ABOVE dentate line

A

internal iliac LN

108
Q

LN drainage anal canal BELOW dentate line

A

superficial inguinal LN

109
Q

what is the largest gland in the human body

A

liver

110
Q

function of liver

A

synthesis bile
glycogen storage
clotting factor production
detoxification

111
Q

which region of the abdomen is the liver in

A

predominantly R hypogastrium
also epigastric
extends in L hypogastrium

112
Q

what are the 2 surfaces of the liver

A

diaphragmatic (anterosuperior surface)
visceral (posteroinferior surface)

113
Q

which part of the diaphragmatic surface of the liver is not covered in peritoneum

A

bare area
hence is in direct contact with the diaphragm

114
Q

which parts of the visceral surface of the liver are not covered in peritoneum

A

gall bladder fossa
porta hepatis

115
Q

which organs lie in contact with the visceral surface of the liver (8)

A

R kidney
R adrenal
R colonic flexure
T colon
D1
GB
oesophagus
stomach

116
Q

4 types of ligaments attached to the liver

A

falciform ligament
triangular ligaments
coronary ligaments
lesser omentum

117
Q

where does falciform ligament run between

A

anterior surface liver –> anterior abdominal wall

118
Q

what does the free edge of the falciform ligament contain and what is this a remnant of?

A

ligamentum teres - remnant of umbilical vein

119
Q

where do the triangular ligaments run between

A

from liver to diaphragm

120
Q

where do the coronary ligaments run between

A

superior surface of liver to inferior surface of diaphragm

121
Q

what does the lesser omentum attach the liver to

A

stomach (lesser curvature) + D1 via hepatoduodenal ligament + hepatogastric ligament

122
Q

how is the posterior surface of the liver secured to the IVC?

A

via hepatic vv + fibrous tissue

123
Q

what are the 3 recesses associated with the liver?

A

subphrenic
subhepatic
Morisons pouch

124
Q

where is the subphrenic recess

A

between diaphragm and ant/post liver

125
Q

where is the subhepatic recess

A

between inferior surface of liver and transverse colon

126
Q

where is Morisons pouch

A

between liver and right kidney

127
Q

significance of Morisons pouch

A

deepest part of the peritoneal cavity when supine
fluid collects here in bed ridden patients

128
Q

name of the fibrous layer covering the liver

A

Glissons capsule

129
Q

what are the 4 lobes of the liver

A

right
left
caudate
quadrate

130
Q

which lobe of the liver is the largest

A

right

131
Q

where is the caudate liver lobe

A

on the upper visceral surface
between IVC + ligamentum venosum

132
Q

where is the quadrate liver lobe

A

lower visceral surface
between the gall bladder + ligmentum teres fossa

133
Q

what stricture separates the caudate and quadrate liver lobes

A

porta hepatis

134
Q

role of porta hepatis

A

transmits all the vv/aa/nn/ducts except the hepatic vv

135
Q

shape of liver lobules

A

hexagonal

136
Q

what central structure drains the liver lobules

A

central vein

137
Q

what are the 3 structures at the periphery of the liver lobules (aka the ‘portal traid’)

A

arterioles branching from the hepatic aa
venules draining to the hepatic portal vv
bile ducts draining into the hepatic ducts

also lymphatic vessels + CNX fibres

138
Q

where does 25% of the blood supply to the liver come from

A

hepatic aa proper

139
Q

hepatic aa proper is a branch of

A

coeliac trunk

140
Q

where does the remaining 75% of the blood supply to the liver come from

A

hepatic portal vv

141
Q

venous drainage liver

A

hepatic vv –> IVC

142
Q

inn liver

A

hepatic plexus

143
Q

sympathetic component of the hepatic plexus

A

coeliac plexus

144
Q

parasympathetic component of the hepatic plexus

A

CN X

145
Q

inn Glissons capsule liver

A

lower intercostal nn

146
Q

anterior liver LN drainage

A

hepatic LN –> coeliac LN –> cisterna chyli

147
Q

posterior liver LN drainage

A

phrenic + post mediastinal LN –> R lymphatic + thoracic ducts

148
Q

is the gallbladder intra or retroperitoneal

A

intraperitoneal

149
Q

where is the gallbladder

A

in fossa between inferior aspects of the R and quadrate lobes of the liver

150
Q

structures anterior + superior to the GB (2)

A

inferior border of the liver
anterior abdominal wall

151
Q

structures posterior to the GB (2)

A

transverse colon
proximal duodenum

152
Q

structures inferior to the GB (2)

A

biliary tree
remainder of duodenum

153
Q

name of fold in the neck of the gallbladder + significance

A

Hartmans pouch
common place for gallstones to get lodged

154
Q

what are the 3 parts of the gallbladder

A

fundus
body
neck

155
Q

what structure is the neck of the gallbladder continuous with

A

cystic duct

156
Q

which is the largest part of the gallbladder

A

the body

157
Q

what structures is the body of the gallbladder adjacent to?

A

liver
transverse colon
superior duodenum

158
Q

movement of bile to the hepatic ducts

A

bile secreted from hepatocytes
–> canaliculi
–> intralobular ducts
–> collecting ducts
–> hepatic ducts

159
Q

what vessel does the hepatic duct run along side

A

hepatic vv

160
Q

which 2 ducts join together to make the common bile duct

A

cystic duct + common hepatic duct

161
Q

which 2 ducts join together to make the ampulla of vater

A

pancreatic duct + common bile duct

162
Q

what regulates the ampulla of vater

A

sphincter of Oddi

163
Q

via what does the bile empty into the duodenum from the Ampulla of vater

A

major duodenal papilla

164
Q

aa supply gallbladder

A

cystic aa

165
Q

cystic aa is a branch of

A

R hepatic aa

166
Q

vv supply to the neck of the GB

A

cystic vv

167
Q

cystic vein empties into

A

portal vein

168
Q

vv drainage body/fundus of the GB

A

hepatic sinusoids

169
Q

symp inn gall bladder

A

coeliac plexus

170
Q

parasymp inn gall bladder

A

CNX

171
Q

LN drainage gallbladder

A

cystic LN (at GB neck) –> hepatic LN –> coeliac LN

172
Q

where is Calot’s traingle

A

at porta hepatis

173
Q

superior border Calot’s triangle

A

inferior surface of the liver

174
Q

medial border Calot’s triangle

A

common hepatic duct

175
Q

inferior border Calot’s triangle

A

cystic duct

176
Q

contents Callots triangle (4)

A

R hepatic aa
cystic aa
LN of Lund
lymphatics

177
Q

what is the LN of Lund

A

1st lymph node of the gallbladder

178
Q

importance of Calot’s triangle in lap chole’s

A

permits safe ligation of cystic aa + duct
and R hepatic aa ID’d
if not delineated - may have to do subtotal cholecystectomy or open cholecystectomy

179
Q

what is mesentary

A

double fold of peritoneal tissue which suspends the SI + LI from the posterior abdominal wall

180
Q

what is the mesentary root?

A

where the mesentary olbiquely attaches to the posterior abdominal wall

181
Q

how many flexures of note along the mesentary?

A

6

182
Q

what are the 6 flexures of note along the mesentary?

A

duodenojejunal, ileocaecal, hepatic, splenic, betw descending + sigmoid , sigmoid + rectum

183
Q

mesentary of SI - mobile or flattened again posterior abdo wall

A

mobile

184
Q

R mesocolon - mobile or flattened again posterior abdo wall

A

flattened

185
Q

T mesocolon - mobile or flattened again posterior abdo wall

A

mobile

186
Q

L mesocolon - mobile or flattened again posterior abdo wall

A

flattened

187
Q

mesosigmoid - mobile or flattened again posterior abdo wall

A

medial portion flattened
rest mobile

188
Q

mesorectum - role

A

anchors rectum through pelvis

189
Q

what are the functions of mesentary? (2)

A

1 - anchor intestines in place whilst still allowing movement
2- conduit for vessels

190
Q

what is Toldt’s fascia

A

additional connective tissue layer attaching the mesentary to the posterior abdominal wall

191
Q

what does Toldt’s fascia contain

A

lymphatic channels

192
Q

where do the superior mesenteric LN drain into

A

pre-aortic LN

193
Q

what does the gubernaculum become in males?

A

small scrotal ligament

194
Q

what does the gubernaculum become in females?

A

ovarian ligament
round ligament uterus

195
Q

mid-inguinal point

A

1/2 way between PS +AS IS

196
Q

significance of mid-inguinal point

A

femoral pulse can be palp’d here

197
Q

midpoint inguinal ligament

A

1/2 between ASIS + PT

198
Q

what is just above the midpoint of the inguinal ligament

A

opening to the inguinal canal

199
Q

roof inguinal canal

A

transversalis fascia
IO
TA

200
Q

floor inguinal canal

A

inguinal ligament
lacunar ligament

201
Q

anterior border inguinal canal

A

aponeurosis external oblique

202
Q

posterior border inguinal canal

A

transversalis fascia

203
Q

what forms the deep ring of the inguinal canal

A

transversalis fascia

204
Q

where is the superficial ring of the inguinal canal

A

just sup to the PT

205
Q

what forms the superficial ring of the inguinal canal

A

invagination of EO + intercrural fibres

206
Q

contents inguinal canal (3)

A

spermatic cord/round ligament
ilioinguinal nn
genital branch GF nn

207
Q

which inguinal ring does the ilioinguinal nn NOT pass through

A

deep inguinal ring

208
Q

which structure is most at risk during inguinal hernia repair

A

ilioinguinal nn

209
Q

indirect inguinal hernia - medial or lateral to epigastric vessels

A

lateral

210
Q

direct inguinal hernia - medial or lateral to epigastric vessels

A

medial

211
Q

indirect vs direct hernia - which is more common

A

indirect

212
Q

medial border inguinal triangle/Hasslebach’s

A

lateral border rectus abdominis

213
Q

lateral border inguinal traingle/Hasslebachs

A

inferior epigastric vessels

214
Q

inferior border inguinal triangle/Hasslebach’s

A

inguinal ligament

215
Q

what are the inferior epigastric vessels a branch of

A

external iliac aa/vv

MRCS A (36 decks)

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