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MRCS A > ANATOMY - Abdomen p3 > Flashcards

ANATOMY - Abdomen p3 Flashcards

1
Q

at what vertebral level is the pancreas

A

L1 (transpyloric)

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2
Q

is the pancreas intra or retroperitoneal

A

retroperionteal
apart from the tail = intraperitoneal

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3
Q

where in the abdomen is the pancreas

A

L hypochondrium + epigastric region

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4
Q

relation of stomach to pancreas

A

stomach is anterior the pancreas
stomach is separated from pancreas by lesser sac

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5
Q

relation of D1 to the pancreas

A

D1 is anterior to the pancreas

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6
Q

relation of D2 to the pancreas

A

D2 is lateral to the pancreas, on the right of the head

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7
Q

relation of transverse mesocolon to the pancreas

A

attaches to the anterior surface of the pancreas

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8
Q

relation of the common bile duct to the pancreas

A

CBD descends behind the head of the pancreas, opening into D2

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9
Q

relation of the spleen to the pancreas

A

spleen is located posterolaterally in relation to the pancreas

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10
Q

position of aorta and IVC in relation to the pancreas

A

posterior to the pancreas head

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11
Q

position of SMA/V in relation to the pancreas

A

SMA behind the neck of the pancreas
anterior to the uncinate process

SMV is behind neck of pancreas

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12
Q

position of splenic aa in relation to the pancreas

A

traverses the superior border of the pancreas

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13
Q

name of the 5 parts of the pancreas

A

head
neck
uncinate process
body
tail

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14
Q

what connects the head of the pancreas to the duodenum

A

connective tissue

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15
Q

which part of the pancreas do the SMA+V form a groove on the posterior aspect?

A

neck

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16
Q

what structure is the tail of the pancreas contained within?

A

splenorenal ligament (alongside splenic vessels)

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17
Q

route of enzyme precursors from acini cells to ampulla of Vater

A

acini cells clusters make up lobular serous gland which prod enzymes
cells = connected by intercalated ducts
ducts unite –> intralobular connecting duct system
–> pancreatic duct
+ CBD = Ampulla of Vater

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18
Q

aa supply pancreas

A

splenic aa branches

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19
Q

aa supply pancreas head

A

superior + inferior pancreaticoduodenal aa

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20
Q

superior pancreaticduodenal aa is a branch of

A

gastroduodenal aa

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21
Q

inferior pancreaticduodenal aa is a branch of

A

SMA

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22
Q

venous drainage pancreatic head

A

SMV branches (ultimately into portal vein)

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23
Q

venous drainage rest of pancreas

A

splenic vein

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24
Q

LN drainage pancreas

A

pancreaticosplenal LN + pyloric LN –> SM LN + coeliac LN

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25
Q

where is the spleen in the abdomen

A

ULQ under the diahpragm/ribcage

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26
Q

is the spleen intra or retroperitoneal

A

intraperitoneal

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27
Q

what connects the spleen to the kidney and stomach

A

greater omentum as the gastrosplenic and splenorenal ligaments

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28
Q

what is between the splenorenal and the gastrosplenic ligaments

A

lesser sac

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29
Q

what covers the spleen

A

a weak capsule

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30
Q

what are the 2 surfaces of the spleen

A

diaphragmatic
visceral

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31
Q

what are the 4 borders of the spleen

A

anterior
superior
posteromedial
inferior

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32
Q

which border of the spleen can be palpated in splenomegaly as it moves inferiorly?

A

superior

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33
Q

structure anterior to the spleen (1)

A

stomach

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34
Q

structures posterior to the spleen (3)

A

diaphragm
left lung
ribs 9-11

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35
Q

structures inferior to the spleen (1)

A

left colic flexure

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36
Q

structures medial to the spleen (2)

A

left kidney
tail of pancreas

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37
Q

aa supply spleen

A

splenic aa

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38
Q

how many branches of splenic aa to the spleen

A

5

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39
Q

significance of splenic aa branches not anastomosing in the spleen

A

separate vascular segments of the spleen
meaning that you can do a subtotal splenectomy in trauma cases

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40
Q

venous drainage of the spleen

A

splenic v

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41
Q

innervation of the spleen

A

coeliac plexus

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42
Q

LN drainage of the spleen

A

pancreaticsplenic LN –> coeliac LN

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43
Q

are kidneys intra or retroperitoneal

A

retroperitoneal

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44
Q

spinal level kidneys

A

T12-L3

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45
Q

which kidney is lower and why

A

right
due to presence of liver

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46
Q

layers of fascia/fat on kidney from deep to superficial

A

renal capsule
pre-renal fat
renal fascia/Gerota’s fascia
pararenal fat (posterolateral aspect of kidney only)

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47
Q

cortex/medulla kidney - which is outer/inner

A

outer cortex
inner medulla

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48
Q

structures anterior to the left kidney (6)

A

suprarenal gland
spleen
stomach
pancreas
L colic flexure
jejunum

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49
Q

structures posterior to the left kidney (8)

A

diaphragm
11/12th rib
psoas major
transversus abdominis
quadratus lumborum
subcostal nn
iliohypogastric nn
ilioinguinal nn

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50
Q

structures anterior to the right kidney (4)

A

adrenal gland
liver
duodenum
R colic flexure

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51
Q

structures posterior to the right kidney (8)

A

diaphragm
12th rib
psoas major
transversus abdominis
quadratus lumborum
subcostal nn
iliohypogastric nn
ilioinguinal nn

52
Q

what is the renal aa a branch of

A

abdominal aorta

53
Q

L vs R renal aa - which is longer

A

right

54
Q

position of right renal aa to IVC

A

crosses IVC posteriorly

55
Q

how does renal aa branch

A

renal aa –> anterior + posterior aa –> 5x segmental aa –> interlobar aa –> arcuate aa –> interlobular aa –> afferent arterioles –> capillary network –> efferent arterioles –> peritubular network + vasa recta

56
Q

what are the 5 segments of the kidney

A

upper
apical
middle
posterior
lower

57
Q

what % of people have accessory aa to the kidney

A

25%

58
Q

do the segmental aa of the kidney anastomose?

A

no

59
Q

what is the Avascular plane of the kidney called?

A

Brodels line

60
Q

venous drainage of the kidneys

A

R+L renal vv –> IVC

61
Q

relation of L renal vv to abdominal aorta

A

travels anterior to aa below the origin of the SMA

62
Q

relation of R renal vv to IVC

A

posterior to IVC

63
Q

LN drainage to the kidney

A

para-aortic LN

64
Q

what is a pelvic kidney?

A

kidney fails to ascend, remains in pelvis at the level of the common iliac aa

65
Q

what is a horseshoe kidney?

A

2 kidneys fuse
become stuck under IMA
still drained by 2 ureters

66
Q

PS horseshoe kidney

A

asymptomatic unless obstructed

67
Q

are the adrenal glands intra or retroperitoneal

A

retroperitoneal

68
Q

which fascia encloses the kidneys and adrenal glands?

A

renal fascia

69
Q

what separates the kidneys from the adrenal glands?

A

peri-renal fat

70
Q

structures anterior to right adrenal (2)

A

IVC
R lobe of the liver

71
Q

structures posterior to right adrenal (1)

A

R crus diaphragm

72
Q

structures anterior to the Left adrenal (3)

A

stomach
pancreas
spleen

73
Q

structures posterior to the left adrenal (1)

A

L crus diaphragm

74
Q

layers of the adrenal gland from superficial to deep

A

capsule
zona glomerulosa
zona fasciculata
zona reticularis
medulla

75
Q

embryological origin cortex

A

embryonic mesoderm

76
Q

embryological origin medulla

A

ectodermal neural crest cells

77
Q

colour of adrenal cortex vs medulla

A

cortex = yellowish
medulla = brown

78
Q

what does the zona glomerulosa produce/secrete

A

mineralcorticoids e.g. aldosterone

79
Q

what does the zona fasciculata producte/secrete

A

corticosteroids e.g cortisol

80
Q

what does the zona reticularis produce/secrete

A

androgens e/g/ DHES

81
Q

what cells does the medulla comprise of and what do they secrete

A

chromaffin cells
catecholamines

82
Q

superior adrenal aa is a branch of

A

inferior phrenic aa

83
Q

middle adrenal aa is a branch of

A

abdominal aorta

84
Q

inferior adrenal aa is a branch of

A

renal aa

85
Q

vv drainage adrenals

A

L + R adrenal aa
L –> renal aa –> IVC
R –> IVC

86
Q

innervation adrenals

A

coeliac plexus + greater splanchnic nn

87
Q

LN drainage adrenals

A

lumbar LN

88
Q

level coeliac trunk arises from abdominal aorta

A

T12

89
Q

3 major branches of the coeliac trunk

A

L gastric aa
Splenic aa
common hepatic aa

90
Q

branches of the L gastric a a

A

oesophageal branches

91
Q

what does the L gastric aa ananstomose with and where

A

R gastric aa on the lesser curvature of the stomach

92
Q

what are the 3 branches of the splenic aa (apart from the 5 terminal branches to the spleen)

A

L gastroepiploic aa
short gastrics
pancreatic branches

93
Q

l gastroepiploic aa supplies

A

greater curvature stomach

94
Q

short gastrics supply

A

fundus stomach

95
Q

pancreatic branches of splenic aa supply

A

body and tail of pancreas

96
Q

what are the 2 terminal branches of the common hepatic aa

A

proper hepatic aa
gastroduodenal aa

97
Q

what are the 3 branches of the proper hepatic aa

A

R gastric aa
R/L hepatic aa
cystic aa (branch of R hepatic aa )

98
Q

R gastric aa supplies

A

pylorus + lesser curvature stomach

99
Q

R + L gastric aa supply

A

R + L lobes liver

100
Q

cystic aa supplies

A

GB

101
Q

what are the 2 branches of the gastroduodenal aa

A

R gastroepiploic aa
superior pancreaticoduodenal aa

102
Q

R gastroepiplpoic aa supplies

A

greater curvature sstomach
greater omentum

103
Q

superior pancreaticoduodenal aa supplies

A

head of pancreas

104
Q

what comprises the pancreaticoduodenal arcade

A

superior and inferior pancreaticoduodenal aa
surround head of pancreas

105
Q

what is coeliac trunk compression syndrome

A

median arcuate ligament sometimes lies anterior to the coeliac trunk –> compression –> ischaemia, pain
T

106
Q

Tx coeliac trunk compression syndrome

A

surgical divison of median arcuate ligament

107
Q

structures anterior to the SMA (3)

A

pyloric part of stomach
splenic vv
neck of pancreas

108
Q

structures posterior to the SMA (3)

A

left renal vein
uncinate process pancreas
inferior part of the duodenum

109
Q

major branches of the SMA (5)

A

inferior pancreaticoduodenal aa
middle colic aa
ileal/jejunal aa
r colic aa
ileocolic aa

110
Q

what spinal level does the IMA arise from the AA

A

L3

111
Q

pathway of IMA

A

arises at L3
near inferior border duodenum
3-4cm above where aorta bifurcates into common iliac
initially descends anterior to the AA, then moves left

112
Q

is the IMA intra or retroperitoneal?

A

retroperitoneal

113
Q

what are the 3 major branches of the IMA

A

L colic aa
sigmoid aa
superior rectal aa

114
Q

what are the 2 anastomoeses involving the IMA

A

marginal aa of Drummond
Arc of Riolan (betw L colic branch IMA + middle colic branch SMA)

115
Q

what are the 2 venous drainage systems of the abdomen

A

portal vein
systemic vein

116
Q

location of IVC

A

posterior abdominal wall, anterior to the vertebral column, to the right of abdo aorta

117
Q

what veins unite to form the IVC and at what level

A

common iliac veins
L5

118
Q

what does the IVC drain into

A

RA

119
Q

what are the tributaries of the IVC (7)

A

common iliac vv
lumbar bb
renal vv
R testicular/ovarian vv
R suprarenal vv
inferior phrenic vv
hepatic vv

120
Q

what is the major vessel of the portal venous system?

A

portal vein

121
Q

which veins unite to form the portal vein and where

A

SMV + splenic vv
L2 posterior to the neck of the pancreas

122
Q

tributaries of the portal vein (3)

A

R + L gastric vv
cystic vv
para-umbilical vv

123
Q

tributaries of the splenic vv (4)

A

short gastric vv
L gastro-omental vv
pancreatic vv
inferior mesenteric vv

124
Q

which vv drain into the inferior mesenteric vv (3)

A

superior rectal
sigmoid
L colic vv

125
Q

which vv drain into the SMV? (7)

A

R gastro-omental vv
anterior/posterior inferior pancreaticoduodenal vv
jejunal vv
ileal vv
ileocolic vv
R colic vv
mid colic vv

126
Q

what are the 4 main porto-systemic anastomoses points?

A

oesophageal (oesophageal branch L gastric + oesophageal tributaries to azygous)
rectal (superior rectal vv + inferior rectal vv)
retroperitoneal vv - (portal tributaries of mesenteric vv + retroperitoneal vv)
paraumbilical vv - betw portal vv liver + vv anterior abdominal wall

127
Q

def portal HTN

A

> 20mmHg

MRCS A (36 decks)

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