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104: Theme 1 > Anatomy and Imaging of the Abdomen > Flashcards

Anatomy and Imaging of the Abdomen Flashcards

1
Q

Which layer of an embryo forms the majority of the gut?

A

The Endoderm, and Mesoderm

  • most of the GI originates around week 3
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2
Q

What is found in the Foregut?

A
  • Oesophagus
  • Stomach
  • Proximal half Duodenum
  • Liver
  • Pancreas
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3
Q

What is found in the Midgut?

A
  • Distal half Duedenum
  • Jejunum
  • Ileum
  • Cecum
  • Asc. Colon
  • 3/4 Trans. Colon
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4
Q

What is found in the Hindgut?

A
  • 1/4 Trans. Colon
  • Desc. Colon
  • Sigmoid Colon
  • Rectum
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5
Q

Label the parts of the primitive gut?

A
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6
Q

What is Mesentery?

A
  • A double layer of peritoneum around a specific organ
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7
Q

Label the parts of the primitive gut

A
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8
Q

What is the role of Mesentery?

A
  • Suspends gut organs
  • originates from the mesoderm
  • Provides a pathway for blood, innervation, lymphatics etc to the gut
  • Only the foregut has dorsal and ventral mesentery after development, ventral mesentery degrades
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9
Q

What is the result of abnormal gut rotation during development and what are the symptoms?

A
  • duodenum constrictions
  • midgut volvulus leading to ischaemia, necrosis and death

Symptoms

  • vomiting
  • pain
  • abdominal distention
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10
Q

Label the diagram, what happened to result in this?

A
  • formed as a result of organ rotation
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11
Q

Explain the role of Dorsal Mesentery

A
  • attaches organs to the posterior abdominal wall

Gives rise to

  • Gastrosplenic ligament
  • Lienorenal ligament
  • Greater omentum
  • The mesentery of small & large intestine
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12
Q

Label the diagram, what is it depicting?

A

The Ventral Mesentery which is only found in the foregut

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13
Q

What are the regions of the abdomen?

A
  • Abdomen proper
  • Greater pelvis
  • Lesser pelvis
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14
Q

Label the diagram, what plane is it in?

A
  • Sagittal Plane of the Pelvis
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15
Q

Label the diagram, what does ASIS stand for?

A

Anterior Superior Illiac Spine

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16
Q

What is part of Ventral mesentry?

A
  • The falciform ligament
  • lesser omentum
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17
Q

What is the name of the gap between the greater and lesser sacs?

A
  • the Epifloic foreman
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18
Q

What are the muscles of the anterior abdominal wall?

A
  • External oblique
  • Internal Oblique
  • Transversus abdominis
  • Rectus abdominis
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19
Q

Describe the location of the external oblique

A

From the outer surface of the lower eight ribs

To the linea alba transversely and the iliac crest and pubic tubercle inferiorly

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20
Q

Describe the location of the Internal oblique

A

From the lateral 1/3 of the inguinal ligament to the anterior 2/3 of the iliac crest

To the Linea alba costal margin and crest of the pubic bone

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21
Q

Describe the location of the Transversus Abdominis

A

From the lateral 1/3 inguinal ligament, the interior surface of the lower 6 ribs and the iliac crest

To the linea alba and the crest of the pubic bone

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22
Q

Describe the location of the Rectus Abdominis

A

From the pubic symphysis and pubic crest

To the Xiphoid process and the 5th-7th costal cartilage

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23
Q

What is the blood supply of the muscles of the anterior abdominal wall?

A

Arteries: Sup. and Inf. epigastric, intercostal, circumflex iliac

Veins: thoracoepigastric (between the lat. thoracic and sup. epigastric vein)

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24
Q

What is the innervation of the muscles of the anterior abdominal wall?

A
  • Thoracoabdominal nerves
  • subcostal nerves for the rectus abdominis
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25
Q

What is the function of the muscles of the anterior abdominal wall?

A

Ext Obl: work with Int Obl for torsional movement of the trunk

Int Obl: flex and rotate trunk; compresses the viscera

Transv Abd: compress and supports the viscera

Rectus Abd: flexes trunk; compresses the viscera

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26
Q

What is the difference between the fibre pattern of the internal and external obliques?

A
  • External obliques, fibres travel down towards the pelvis
  • Internal obliques, fibres run mainly upwards
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27
Q

What is the purpose fo the Inguinal canal?

A

Allows passage for

  • the spermatic cord is able to reach the scrotum
  • the round ligament of the uterus is able to reach the labia majora
  • the genital nerve and other blood and lymphatic vessels
  • this passage is limited by the superficial and deep inguinal sings
28
Q

As the spermatic cord passes through the abdominal wall what three layers does it take with it?

A
  • Transversalis fascia => contributes the innermost covering of the spermatic cord – the internal spermatic fascia
  • Internal oblique => contributes the middle covering layer to the cord – the cremasteric fascia
  • External oblique => contributes the outer covering of the cord – the external spermatic fascia
29
Q

What are the 9 anatomical subdivisions of the abdomen? How are they marked out?

A

Right hypochondriac | Epigastric | Left hypochondriac

Right lumbar | Umbilical | Left lumbar

Right inguinal (iliac) | Hypogastric (pubic) | Left Inguinal (Iliac)

  • Right and left regions are measured from the midclavicular lines
  • 1st horizontal demarcation is the subcostal line, 2nd is the Transtubercular line
30
Q

What is the contents of the right upper abdomen?

A

Right lobe of the liver

Gallbladder

Duodenum

Head of Pancreas

Hepatic flexure of the colon

Part of the ascending and transverse colon

31
Q

What is the contents of the Left upper abdomen?

A

Stomach

Spleen

Left lobe of the liver

Body of pancreas

Splenic flexure of the colon

Part of the transverse and descending colon

32
Q

What is the contents of the Right lower Abdomen?

A

Cecum

Appendix

Ascending colon

Small intestine

33
Q

What is the contents of the Left lower abdomen?

A

Small intestine

Descending colon

Sigmoid Colon

34
Q

What is the purpose of the Serous membrane of there peritoneum?

A
  • the outer membrane; encloses several body cavities; secretes a lubricating fluid;
  • the outer epithelial layer (secretory) and the inner layer (connective tissue with vessels
35
Q

What is the purpose of the Muscular membrane of the peritoneum?

A
  • longitudinal or circular;
  • responsible for the movement of the contents of the lumen
36
Q

What is the purpose of the mucosal layers of the peritoneum?

A
  • inner layer; lines internal organs or cavities exposed to external environment;
  • secretes mucus; also involved in absorption
37
Q

What are the three basic membranes of the peritoneum?

A

Serous

Muscular

Mucosal

38
Q

Name the 5 anatomical regions of the stomach ( not including the fundus)

A
  • Cardial orifice – link to the oesophagus
  • Pyloric orifice – link to the small intestine
  • Lesser curvature (superior border)
  • Greater curvature (inferior border)
  • Pyloric and cardial sphincters
39
Q

What are the 3 layered muscle types in the stomach

A
  • longitudinal
  • circular
  • oblique
40
Q

Describe the anatomy of the duodenum

A
  • Retroperitoneal organ (have peritoneum on their anterior side only)
  • 20-25 cm long
  • C-shaped and split into four parts: superior, descending, horizontal ascending
  • the pancreatic and gall bladder ducts open into it
  • ends at the duodenal-jejunal flexure
41
Q

Describe the anatomy of the large intestine

A
  • 1.5 m long
  • M shaped with 4 parts: ascending, transverse, descending, sigmoid
  • the ascending and descending section or retroperitoneal
42
Q

What is the VAN-L of the Foregut?

A

Vein: Portal

Artery: Celiac

Symp Nerve: Celiac ganglia (prevertebral)

Parasymp Nerve: Vagus - CN X

Lymphatics: Celiac nodes

43
Q

What is the VAN-L of the Midgut?

A

Vein: Sup Mesenteric

Artery: Sup Mesenteric

Symp Nerve: Sup Mesenteric ganglia ( prevertebral)

Parasymp Nerve: Vagus - CN X

Lymphatics: Sup Mesenteric nodes

44
Q

What is the VAN-L of the Hindgut?

A

Vein: Inf Mesenteric

Artery: Inf Mesenteric

Symp Nerve: Inf Mesenteric Ganglia (paravertebral)

Parasymp Nerve: Pelvic Splanchnic - S2-4

Lymphatics: Inf Mesenteric Nodes

45
Q

Where do the branches of the Superior Mesenteric Artery supply?

A
  • the Distal part of the duodenum to the proximal 2/3 of the transverse colon
  • the Hehunal and ileal branches
  • Middle Colic branch
  • the Right Colic branch
  • The Ileocaecal branch

(all in the midgut)

46
Q

Where do the branches of the Inferior Mesenteric Artery supply?

A
  • the distal 1/3 of the transverse colon to halfway down the anal canal
  • the Left colic
  • the Sigmoid
  • Superior rectal

( all in the hindgut)

47
Q

What are the 4 main gut-associated glands?

A
  • Liver
  • Spleen
  • Gall bladder
  • Pancreas
48
Q

What are the main two types of imaging sequences for MRI?

A
  • T1 and T2 weighted
  • T1: fluid is black

T2: fluid is white

49
Q

What are the Pros for X-Rays

A
  • Cheap, Quick
  • Easy for patient
  • High spatial resolution (good for bone)
  • Low radiation dose
50
Q

What are cons for X-rays?

A
  • Poor contrast resolution (poor for soft tissue)
  • Planar imaging (superimposes structures)
51
Q

What are pros for CT imaging?

A
  • Quick, widely available
  • Cross-sectional images
  • High Contrast resolution (good for soft tissue)
52
Q

What are cons for CT imaging?

A
  • Radiation dose
  • IV Contrast risks: excreted through the kidney, therefore there is a temporary reduced kidney function
53
Q

What are pros for Ultrasound imaging?

A

● Cheap, Quick, No radiation

● Cross sectional images

● US guided interventions

54
Q

What are cons of ultrasounds?

A

● Saved images are only a snapshot of examination (report operator dependant)

55
Q

What are pros for MRI imaging?

A
  • Contrast resolution
  • Specific applications (e.g. Spine, MSK)
  • No radiation
56
Q

What are cons of MRI imaging?

A
  • Limited availability
  • Patient experience (duration, claustrophobia)
  • Expense
  • Magnet / Contrast risks
57
Q

What paired opposing factors need to be accounted for when carrying out abdominal imaging?

A
  • Solid vs Hollow viscera: bladder vs kidney
  • Intraperitoneal vs Retroperitenal: jejunum vs ascending/descending colon
  • Systemic vs Portal circulation
58
Q

Describe the organisation of the hepatic segments

A

Divided by the portal vein horizontally

Divided by the hepatic vein vertically

  • the middle hepatic vein operates the right and left liver lobes
  • the right hepatic vein separates the anterior and posterior liver
  • the left hepatic vein separates the medial and lateral segments of the left liver lobe
59
Q

What is posterior acoustic shadowing and when would you encounter this?

A
  • seen in ultrasounds of the liver/ gallbladder
  • creates dark shoeing behind a gallstone
  • the gall bladder wall may also appear thickened
60
Q

What radiological interventions are there for gallstones?

A

ERCP: Endoscopic retrograde cholangiopancreatography

PTC: Percutaneous transhepatic cholangiogram

DSA: Digital subtracted angiogram

61
Q

What would be seen in a CT of a shattered spleen?

A
  • there wouldn’t be a clear divide between the stomach and the spleen
  • the gastrosplenic ligament wouldn’t be seen
62
Q

What would be seen on an axial cross looking at the pancreas and the surrounding structures?

A
63
Q

What would be seen in a CT of Pancreatitis?

A
  • a poor gastro-splenic border
64
Q

What is this an image of and when would it be identified?

A
  • free gas in the hemidiaphragm when standing erect
  • seen in an X-ray
  • bowel perforation
65
Q

What modalities are good for imaging the hollow viscera (the bowel)?

A
  • X-ray: good as a first-line
  • CT colonography replaces Ba enema &
  • MRI as they avoid endoscopy
  • Fluoroscopy, barium follow-through, barium meal (double-contrast; difficult for frail patients)

104: Theme 1 (4 decks)

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