ANATOMY - Abdomen p2 Flashcards
1
Q
Role of cecum
A
Reservoir for chyme
2
Q
Where is the cecum in the abdomen
A
RIF
3
Q
is the cecum intra or retroperitoneal
A
intraperitoneal
4
Q
aa supply cecum
A
anterior + posterior cecal aa
5
Q
what are the cecal arteries branches of
A
ileocolic aa
6
Q
what is the ileocolic aa a branch of
A
SMA
7
Q
vv drainage cecum
A
ileocolic vv
8
Q
where do the ileocolic vv drain into
A
SMV
9
Q
inn cecum
A
ileocolic branch of superior mesenteric plexus
10
Q
LN drainage cecum
A
ileocolic LN
11
Q
what % of intestinal volvuli are cecal
A
10%
12
Q
length of colon
A
1.5m
13
Q
what are the 4 parts of the colon
A
ascending
transverse
descending
sigmoid
14
Q
is the ascending colon intra or retroperitoneal
A
retroperitoneal
15
Q
when does the ascending colon becomes the transverse colon
A
at the hepatic flexure
16
Q
where does the transverse colon run between
A
hepatic flexure –> splenic flexure
17
Q
how and where is the transverse colon attached to the diaphragm
A
at splenic flexure
via the phrenicocolic ligament
18
Q
is the transverse mesocolon intra or retroperitoneal
A
intraperitoneal
19
Q
is the descending colon intra or retroperitoneal
A
retroperitoneal
20
Q
what structure is the descending colon anterior to
A
L kidney
21
Q
how long is the sigmoid colon
A
40 cm
22
Q
where does the sigmoid colon run between
A
iliac fossa –> S3
23
Q
how is the sigmoid colon attached to the posterior pelvic wall
A
sigmoid mesocolon
24
Q
4 features of Large intestine that differs it from Small intestine
A
omental appendices
teniae coli
haustra
larger diameter
25
what are the omental appendices
found in LI
small pouches of peritoneum filled with fat
26
what are teniae coli
found in LI
3 strips of MM running longitudinally
27
what are haustra
found in LI
when the teniae coli contract - shorten bowel --> sacculations aka haustra
28
structures anterior to the ascending colon (3)
SI
greater omentum
anterior abdominal wall
29
structures posterior to the ascending colon (5)
iliacus
quadratus lumborum
R kidney
iliohypogastric + ilioinguinal nn
30
structures anterior to the transverse colon (2)
greater omentum
anterior abdominal wall
31
structures posterior to the transverse colon (2)
SI
pancreas head
32
structures anterior to the descending colon (3)
small intestine
greater omentum
anterior abdominal wall
33
structures posterior to the descending colon (5)
L kidney
iliacus
quadratus lumborum
iliohypogastric + ilioinguinal nn
34
structures anterior to the sigmoid colon (3)
bladder
ureters
upper vagina
35
structures posterior to the sigmoid colon (3)
rectum
sacrum
ilium
36
what is the marginal aa of Drummond
an anastomoses of terminal branches of the IMA + SMA which provides collateral blood supply to the colon and from which vasa recta arise
37
middle colic aa, R colic aa and ileocolic aa arise from
SMA
38
l colic aa and sigmoid aa arise from
IMA
39
ileocolic vv and R colic vv drain into
SMV
40
L colic vv and sigmoid vv drain into
IMV
41
innervation of the midgut colon (A + prox 2/3 T colon)
superior mesenteric plexus
42
innervation of the hindgut colon (distal 1/3 T colon, descending + sigmoid)
inferior mesenteric plexus
43
sympathetic component of inferior mesenteric plexus
lumbar splanchnic nn
44
parasympathetic component of inferior mesenteric plexus
pelvic splanchnic nn
45
which LN drain the ascending + transverse colon
superior mesenteric LN
46
which LN drain the descending and sigmoid colon
inferior mesenteric LN
47
journey of Lymphatic drainage from colon to thoracic duct
Sup + inf mesenteric LN --> intestinal lymph trunks --> cisterna chyli --> thoracic duct
48
role of rectum
temporary storage of faeces
49
spinal level at which rectum begins
S3
50
how is the rectum distinctive from the rest of the colon? (3)
no taenia coli
no haustra
no ommental appendices
51
what are the 2 main flexures of the rectum
sacral flexure
anorectal flexure
52
sacral flexure
AP curve with concavity anteriorly
following the curve of the sacrum/coccyx
53
anorectal flexure + role
AP curve with convexity anteriorly
faecal continence
54
which muscle tone forms the anorectal flexure
puborectalis mm
55
what are the 3 lateral flexures of the rectum called
superior
intermediate
inferior
56
what are the 3 lateral flexures of the rectum formed by
transverse folds of the internal rectal wall
57
ampulla of the rectum - where + fct
final segment
relaxes to accommodate faeces
58
peritoneal coverings of rectum - superior 1/3
anterior and lateral aspects covered
59
peritoneal coverings of the rectum - middle 1/3
anterior aspect only covered
60
peritoneal coverings of the rectum - inferior 1/3
no peritoneal covering
61
structures anterior to the rectum in the male (6)
retrovesical pouch
sigmoid colon
ileum
bladder
prostate
seminal vesicles
62
structures anterior to the rectum in females (5)
rectouterine pouch
sigmoid colon
ileum
vagina
cervi x
63
structures posterior to the rectum (5)
sacrum + coccyx
piriformis
coccygeus
levator ani
sacral plexus
64
3 aa supplying the rectum
superior rectal aa
middle rectal aa
inferior rectal aa
65
superior rectal aa is a branch of
IMA
66
middle rectal aa is a branch of
internal iliac aa
67
inferior rectal aa is a branch of
internal pudendal aa
68
which 3 veins drain the rectum
superior rectal vv
middle rectal vv
inferior rectal vv
69
superior rectal vv drains into
portal venous system
70
middle rectal vein drains into
systemic system
71
inferior rectal vein drains into
systemic system
72
how do the rectal veins anastomose
via the portocaval anastomoses between the portal system and systemic system
73
sympathetic inn rectum
lumbar splanchnic nn
superior + inferior hypogastric plexuses
74
parasympathetic inn retum
S2-4 via pelvic splanchnic nn and inferior hypogastric plexus
75
visceral afferent/sensory inn rectum
follows parasymp
76
LN drainage rectum
pararectal LN
also low rectum to internal iliac LN
77
where do the pararectal LN drain into
inferior mesenteric LN
78
role of anal canal
defecation + maintaining faecal continence
79
where is the anal canal
within the anal triangle of the perineum
between the R+L ischioanal fossae
80
how long is the anal canal
4cm
81
where is the internal anal sphincter
surrounding the upper 2/3 of the anal canal
82
what is the internal anal sphincter made of?
involuntary circular SM
83
where is the external anal sphincter
surrounding the lower 2/3 of the anal canal
84
what is the external anal sphincter made of
voluntary SM
85
what muscle does the external anal sphincter blend with
puborectalis muscle
86
what structure lies at the junction of the anal canal and rectum
anorectal ring
mm ring
87
what forms the anorectal ring
fusion of internal anal sphincter, external anal sphincter + puborectalis mm
88
what cell type is the superior aspect of the anal canal
columnar epithelium
89
what are anal columns
mucosaorganised into longitudinal folds
90
what structure joins at the end of the anal columns
anal valves
91
what are anal sinuses
pouches above the anal valves which contain glands which secrete mucus
92
what important landmark do the anal valves form
dentate/pectinate line
93
embryological origin of anal canal above pectinate line
hindgut
94
embryological origin of anal canal below pectinate line
ectoderm of proctodeum
95
cell lining of anal canal below pectinate line
non-keratinised stratified squamous ep
96
when does the cell lining change from the lining below the pectinate line of the anal canal to the skin of the anus
intersphincteric groove
97
structures anterior to the anal canal in males (4)
perineal body
urogenital diaphragm
urethra
bulb of penis
98
structures anterior to the anal canal in females (3)
perineal body
urogenital diaphragm
vagina
99
structures posterior to the anal canal (2)
sacrum/coccyx
anococcygeal ligament
100
structures lateral to the anal canal (1)
ischioanal fossae
101
aa supply to the anal canal ABOVE the dentate line
superior rectal aa (which anastomose w/ middle rectal aa branches)
102
aa supply to the anal canal BELOW the dentate line
inferior rectal aa (which anastomose w/ middle rectal aa branches)
103
vv supply to anal canal ABOVE the dentate line
superior rectal vv
104
vv supply to the anal canal BELOW dentate line
inferior rectal vv
105
nn supply to the anal canal ABOVE dentate line
inferior hypogastric plexus (visceral)
only sensitive to stretch
106
nn supply to the anal canal BELOW dentate line
inferior rectal nn - somatic
sensitive to pain, temp, touch, pressure
107
LN drainage anal canal ABOVE dentate line
internal iliac LN
108
LN drainage anal canal BELOW dentate line
superficial inguinal LN
109
what is the largest gland in the human body
liver
110
function of liver
synthesis bile
glycogen storage
clotting factor production
detoxification
111
which region of the abdomen is the liver in
predominantly R hypogastrium
also epigastric
extends in L hypogastrium
112
what are the 2 surfaces of the liver
diaphragmatic (anterosuperior surface)
visceral (posteroinferior surface)
113
which part of the diaphragmatic surface of the liver is not covered in peritoneum
bare area
hence is in direct contact with the diaphragm
114
which parts of the visceral surface of the liver are not covered in peritoneum
gall bladder fossa
porta hepatis
115
which organs lie in contact with the visceral surface of the liver (8)
R kidney
R adrenal
R colonic flexure
T colon
D1
GB
oesophagus
stomach
116
4 types of ligaments attached to the liver
falciform ligament
triangular ligaments
coronary ligaments
lesser omentum
117
where does falciform ligament run between
anterior surface liver --> anterior abdominal wall
118
what does the free edge of the falciform ligament contain and what is this a remnant of?
ligamentum teres - remnant of umbilical vein
119
where do the triangular ligaments run between
from liver to diaphragm
120
where do the coronary ligaments run between
superior surface of liver to inferior surface of diaphragm
121
what does the lesser omentum attach the liver to
stomach (lesser curvature) + D1 via hepatoduodenal ligament + hepatogastric ligament
122
how is the posterior surface of the liver secured to the IVC?
via hepatic vv + fibrous tissue
123
what are the 3 recesses associated with the liver?
subphrenic
subhepatic
Morisons pouch
124
where is the subphrenic recess
between diaphragm and ant/post liver
125
where is the subhepatic recess
between inferior surface of liver and transverse colon
126
where is Morisons pouch
between liver and right kidney
127
significance of Morisons pouch
deepest part of the peritoneal cavity when supine
fluid collects here in bed ridden patients
128
name of the fibrous layer covering the liver
Glissons capsule
129
what are the 4 lobes of the liver
right
left
caudate
quadrate
130
which lobe of the liver is the largest
right
131
where is the caudate liver lobe
on the upper visceral surface
between IVC + ligamentum venosum
132
where is the quadrate liver lobe
lower visceral surface
between the gall bladder + ligmentum teres fossa
133
what stricture separates the caudate and quadrate liver lobes
porta hepatis
134
role of porta hepatis
transmits all the vv/aa/nn/ducts except the hepatic vv
135
shape of liver lobules
hexagonal
136
what central structure drains the liver lobules
central vein
137
what are the 3 structures at the periphery of the liver lobules (aka the 'portal traid')
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
where does 25% of the blood supply to the liver come from
hepatic aa proper
139
hepatic aa proper is a branch of
coeliac trunk
140
where does the remaining 75% of the blood supply to the liver come from
hepatic portal vv
141
venous drainage liver
hepatic vv --> IVC
142
inn liver
hepatic plexus
143
sympathetic component of the hepatic plexus
coeliac plexus
144
parasympathetic component of the hepatic plexus
CN X
145
inn Glissons capsule liver
lower intercostal nn
146
anterior liver LN drainage
hepatic LN --> coeliac LN --> cisterna chyli
147
posterior liver LN drainage
phrenic + post mediastinal LN --> R lymphatic + thoracic ducts
148
is the gallbladder intra or retroperitoneal
intraperitoneal
149
where is the gallbladder
in fossa between inferior aspects of the R and quadrate lobes of the liver
150
structures anterior + superior to the GB (2)
inferior border of the liver
anterior abdominal wall
151
structures posterior to the GB (2)
transverse colon
proximal duodenum
152
structures inferior to the GB (2)
biliary tree
remainder of duodenum
153
name of fold in the neck of the gallbladder + significance
Hartmans pouch
common place for gallstones to get lodged
154
what are the 3 parts of the gallbladder
fundus
body
neck
155
what structure is the neck of the gallbladder continuous with
cystic duct
156
which is the largest part of the gallbladder
the body
157
what structures is the body of the gallbladder adjacent to?
liver
transverse colon
superior duodenum
158
movement of bile to the hepatic ducts
bile secreted from hepatocytes
--> canaliculi
--> intralobular ducts
--> collecting ducts
--> hepatic ducts
159
what vessel does the hepatic duct run along side
hepatic vv
160
which 2 ducts join together to make the common bile duct
cystic duct + common hepatic duct
161
which 2 ducts join together to make the ampulla of vater
pancreatic duct + common bile duct
162
what regulates the ampulla of vater
sphincter of Oddi
163
via what does the bile empty into the duodenum from the Ampulla of vater
major duodenal papilla
164
aa supply gallbladder
cystic aa
165
cystic aa is a branch of
R hepatic aa
166
vv supply to the neck of the GB
cystic vv
167
cystic vein empties into
portal vein
168
vv drainage body/fundus of the GB
hepatic sinusoids
169
symp inn gall bladder
coeliac plexus
170
parasymp inn gall bladder
CNX
171
LN drainage gallbladder
cystic LN (at GB neck) --> hepatic LN --> coeliac LN
172
where is Calot's traingle
at porta hepatis
173
superior border Calot's triangle
inferior surface of the liver
174
medial border Calot's triangle
common hepatic duct
175
inferior border Calot's triangle
cystic duct
176
contents Callots triangle (4)
R hepatic aa
cystic aa
LN of Lund
lymphatics
177
what is the LN of Lund
1st lymph node of the gallbladder
178
importance of Calot's triangle in lap chole's
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
what is mesentary
double fold of peritoneal tissue which suspends the SI + LI from the posterior abdominal wall
180
what is the mesentary root?
where the mesentary olbiquely attaches to the posterior abdominal wall
181
how many flexures of note along the mesentary?
6
182
what are the 6 flexures of note along the mesentary?
duodenojejunal, ileocaecal, hepatic, splenic, betw descending + sigmoid , sigmoid + rectum
183
mesentary of SI - mobile or flattened again posterior abdo wall
mobile
184
R mesocolon - mobile or flattened again posterior abdo wall
flattened
185
T mesocolon - mobile or flattened again posterior abdo wall
mobile
186
L mesocolon - mobile or flattened again posterior abdo wall
flattened
187
mesosigmoid - mobile or flattened again posterior abdo wall
medial portion flattened
rest mobile
188
mesorectum - role
anchors rectum through pelvis
189
what are the functions of mesentary? (2)
1 - anchor intestines in place whilst still allowing movement
2- conduit for vessels
190
what is Toldt's fascia
additional connective tissue layer attaching the mesentary to the posterior abdominal wall
191
what does Toldt's fascia contain
lymphatic channels
192
where do the superior mesenteric LN drain into
pre-aortic LN
193
what does the gubernaculum become in males?
small scrotal ligament
194
what does the gubernaculum become in females?
ovarian ligament
round ligament uterus
195
mid-inguinal point
1/2 way between PS +AS IS
196
significance of mid-inguinal point
femoral pulse can be palp'd here
197
midpoint inguinal ligament
1/2 between ASIS + PT
198
what is just above the midpoint of the inguinal ligament
opening to the inguinal canal
199
roof inguinal canal
transversalis fascia
IO
TA
200
floor inguinal canal
inguinal ligament
lacunar ligament
201
anterior border inguinal canal
aponeurosis external oblique
202
posterior border inguinal canal
transversalis fascia
203
what forms the deep ring of the inguinal canal
transversalis fascia
204
where is the superficial ring of the inguinal canal
just sup to the PT
205
what forms the superficial ring of the inguinal canal
invagination of EO + intercrural fibres
206
contents inguinal canal (3)
spermatic cord/round ligament
ilioinguinal nn
genital branch GF nn
207
which inguinal ring does the ilioinguinal nn NOT pass through
deep inguinal ring
208
which structure is most at risk during inguinal hernia repair
ilioinguinal nn
209
indirect inguinal hernia - medial or lateral to epigastric vessels
lateral
210
direct inguinal hernia - medial or lateral to epigastric vessels
medial
211
indirect vs direct hernia - which is more common
indirect
212
medial border inguinal triangle/Hasslebach's
lateral border rectus abdominis
213
lateral border inguinal traingle/Hasslebachs
inferior epigastric vessels
214
inferior border inguinal triangle/Hasslebach's
inguinal ligament
215
what are the inferior epigastric vessels a branch of
external iliac aa/vv
