Anatomy of NME Flashcards
1
Q
What are the folds of peritoneum called?
A
Mesentery
2
Q
What does the mesentery do?
A
Allows organs to expand and slide/move against each other without friction.
3
Q
What does the pharynx do?
A
Directs food to the oesophagus - blocks entry to trachea with epiglottis.
4
Q
What does the soft palate do?
A
Blocks the nasal cavity entrance during swallowing.
5
Q
What are the three embryological divisions of the gut?
A
Foregut, midgut & hindgut
6
Q
What is the
- artery
- vein
- lymphatics
- SS
- PSS
of the foregut?
A
- Coeliac Artery
- Portal vein
- Coeliac nodes
- Greater splanchnic nerve (coeliac ganglia)
- Vagus nerve
7
Q
What is the
- artery
- vein
- lymphatics
- SS
- PSS
of the Midgut?
A
- Superior Mesenteric
- Superior Mesenteric vein
- Superior Mesenteric nodes
- Lesser splanchnic nerves - superior mesenteric ganglia
- Vagus Nerve
8
Q
What is the
- artery
- vein
- lymphatics
- SS
- PSS
of the hindgut?
A
- Inferior mesenteric artery
- Inferior mesenteric vein
- Inferior mesenteric nodes
- Least splanchnic - Inferior mesenteric ganglia
- Pelvic splanchnic nerves
9
Q
What is the line of division between the midgut and foregut?
A
Major duodenal papilla.
10
Q
Where do the pancreatic duct and gall bladder drain into the duodenum?
A
At the major duodenal papilla.
11
Q
Where is the division between midgut and hindgut?
A
2/3 way along the transverse colon.
12
Q
What are the boundaries of the abdomen?
A
Superior - xiphoid process, 7-12th ribs, diaphragm
Anterior - musculoaponeurotic abdominal walls
Distally - hip bones
Inferior - pelvic floor muscles
Posterior - lumbar vertebral column + posterior diaphragm + deep back muscles.
13
Q
What is the difference between abdominal cavity and peritoneal cavity?
A
Abdominal cavity = whole region
Peritoneal cavity = organs & structures within peritoneum
14
Q
What is the pelvic space divided into?
How is this important for the peritoneal viscera?
A
Greater and lesser (aka true and false space).
A lot of peritoneal viscera hang into the false (greater) pelvis.
15
Q
What are the muscular boundaries of the abdominal cavity?
A
Diaphragm superiorly
Pelvic inlet / peritoneal fold inferiorly
Abdominal wall muscles anteriorly
Posterior abdominal wall muscles posteriorly
16
Q
What are the 9 regions and 4 quadrants of the abdomen?
A
17
Q
What is the landmark for the subcostal plane?
A
Under 10th costal cartilage
18
Q
What is the landmark for the transtubercular plane?
A
Iliac Tubercules + L5 body
19
Q
What are the lines of demarcation that divide the abdomen into regions?
A
Subcostal and transtubercular Mid clavicular (both sides)
20
Q
What are the lines of demarcation that divide the abdomen into quadrants?
A
The umbilical plane & the median (mid-line) plane
21
Q
What level of the spine is the umbilicus?
A
L3-4
22
Q
What organs are found in the right upper quadrant?
A
Right lobe of liver Gallbladder Duodenum Head of pancreas Hepatic flexure of colon Part of ascending and transverse colon
23
Q
What organs are found in the left upper quadrant?
A
Stomach Spleen Left lobe of liver Body of pancreas Splenic flexure of colon Part of transverse and descending colon
24
Q
What organs are found in the right lower quadrant?
A
Caecum
Appendix
Ascending colon
Small intestine
25
What organs are found in the left lower quadrant?
Small intestine
Descending colon
Sigmoid colon
26
Which artery descends into the abdomen to supply all the arteries within?
Abdominal aorta
27
What are the tree main branches of the AA?
Coeliac artery
Superior mesenteric artery
Inferior mesenteric artery
28
Which vertebral level is the coeliac trunk found at and which division of the abdomen does it supply with blood?
T12 - foregut
29
Which vertebral level is the superior mesenteric artery found at and which division of the abdomen does it supply with blood?
L1 - Midgut
30
Which vertebral level is the inferior mesenteric artery found at and which division of the abdomen does it supply with blood?
L3 - Hindgut
31
What are the three main branches of the coeliac artery?
Left gastric (stomach)
Splenic
Common hepatic
32
Which organs does the coeliac artery supply?
Stomach, spleen, liver, duodenum & pancreas.
33
What does the superior mesenteric artery supply?
Distal duodenum to proximal 2/3 of transverse colon.
34
What are the branches of the superior mesenteric artery?
```
Jejunal
Ileal
Middle colic (proximal 2/3rds transverse colon)
Right colic (ascending colon)
Ileocolic (caecum & appendix)
Renal arteries (L1)
```
35
What does the inferior mesenteric artery supply?
Distal 1/3 of transverse colon to upper half of anal canal
36
What are the branches of the inferior mesenteric artery?
Left colic (descending colon)
Sigmoid
Superior rectal
Marginal artery
37
What is the function of the marginal artery?
Forms anastomosis between left and middle colic - ensures we have a collateral supply if one of the vessels are blocked.
38
At what vertebral level is the bifurcation of the aorta?
L4
39
What are local lymph nodes named after?
The part of the gut they are in.
40
What are regional lymph nodes named after?
The branch of artery that supplies them.
41
What are terminal lymph nodes named after?
Parent artery
42
What do the abdominal nodes feed into?
Thoracic duct
43
What is the hierarchical order of lymph nodes?
Local --> regional --> terminal --> main lymphatic ducts
44
Where do splanchnic nerves relay?
In the ganglia related to the three main arteries of the gut - the coeliac ganglion, the superior mesenteric ganglion & the inferior mesenteric ganglion.
45
What is a ganglion?
A collection of nerve cell bodies (not axons) in the peripheral nervous system.
46
Which nerves supply sympathetic innervation to the gut?
The splanchnic nerves
47
What does the greater splanchnic nerve innervate? Where is its plexus? What vertebral level does it supply?
Supplies the foregut.
Plexus is around the coeliac artery
T5-9
48
What does the lesser splanchnic nerve innervate? Where is its plexus? What vertebral level does it supply?
Midgut
Superior mesenteric artery
T10-11
49
What does the least splanchnic nerve innervate? Where is its plexus? What vertebral level does it supply?
Hindgut
Inferior mesenteric artery
T12
50
Apart from the least splanchnic nerve, which other nerve supplies sympathetic innervation to part of the hindgut and pelvic viscera? Which vertebral level is this?
Lumbar splanchnic nerves - L1-2
51
Which nerve provides parasympathetic innervation to the gut?
Vagus nerve - CNX - supplies foregut and midgut
| Pelvic splanchnic nerves - S2-4 - supply hindgut (superior hypogastric plexus)
52
What are the boundaries of the abdominal wall?
Thoracic cage superiorly
| Inguinal ligament and hip bones inferiorly
53
What are the 5 main layers of the abdominal wall?
```
Skin
Superficial fascia (Camper's & Scarpa's)
Rectal sheath (muscles and aponeuroses)
Deep fascia (transversals fascia)
Extraperitoneal fat & peritoneum
```
54
At which point of the abdominal wall is the skin attached firmly?
The umbilicus
55
What is the fatty layer of fascia in the abdominal wall called?
Camper's fascia
56
What is the membranous layer of fascia in the abdominal wall called?
Scarper's fascia
57
What is the fascia that covers the muscles of the abdominal wall called?
Epimysium
58
What are the types of fascia in the abdominal wall?
Superficial fascia (subcutaneous - Scarpa's and Camper's)
Investing fascia (epimysium)
Endo-abdominal fascia (lines internal side of abdo muscles - named according to muscle it is lining)
Parietal peritoneum - is separated from endo-abdominal fascia by variable amount of fat.
59
What muscles are found in the abdominal wall?
External oblique
Internal obliques
Transversus abdominus
Rectus abdominus
60
What happens to the abdominal muscles as they approach the rectus abdominus?
They become aponeurotic.
61
What is the function of the external obliques? What direction do they run in?
```
Inferomedial direction (hands in pockets)
Function = torsional movement
```
62
What is the function of the internal obliques? Which direction do they run in?
Superomedial direction
| Allow movement of trunk & compress organs
63
What is the function of the transverses abdominus muscles?
Compress & support organs
| Flexion of the trunk
64
What is the central tendinous intersection between rectus abdominus muscles called?
Linea alba
65
What happens at the arcuate line?
Above the arcuate line - the internal oblique aponeurosis splits into anterior laminar and posterior laminar sheets - enveloping the RA muscles. Very supportive.
Below the arcuate line - the internal oblique aponeurosis does not split - all three pass anterior to the RA and only the transversals fascia & parietal peritoneum pass posteriorly.
66
What are the functions of the anterolateral abdominal muscles?
```
Support
Protection
Compression
Force for defecation & urination, vomiting, childbirth
Produce flexion and rotation of trunk
Maintain posture
```
67
What happens to the inferior epigastric artery and vein at the arcuate line?
They ascend inferiorly to the rectus sheath to the arcuate line - at which point they enters the rectus sheath.
68
What provides blood supply to the abdominal wall?
Inferior epigastric artery and superior epigastric artery - the anastomose to supply musculature of abdominal wall.
69
What forms the inguinal canal?
Herniation when the testes and ovaries descend from embryonic position.
70
What are the borders of the inguinal canal?
Anterior - aponeurosis of external obliques and internal obliques on lateral 1/3
Posterior - transversalis fascia & conjoint tendon
Roof - arching fibres of internal oblique and transversalis abdominus
Floor - inguinal ligament
71
What is the inguinal ligament?
A thickening of the external oblique aponeurosis.
72
73
Where does the oesophagus meet the stomach?
Esophagogastric junction (cardiac orifice).
74
What is the change of mucosa at the esophagogastric junction termed?
Z line - changes from squamous to columnar epithelium.
75
What controls the passage of food from the oesphagus into the stomach?
Lower oesophageal sphincter
76
What is the landmark for the fundus of the stomach?
5th intercostal space
77
How does the pylorus differ from the body of the stomach?
Is a distinct sphincteric region of smooth muscle.
78
What controls discharge of food into the duodenum?
Pyloric sphincter
79
What marks the junction of the body and pyloric part of the stomach?
Angular incisure
80
What is the lesser curvature of the stomach connected to?
Lesser omentum - which is connected to the liver.
81
Wha is the greater curvature of the stomach connected to?
Greater omentum
82
What are the divisions of the small intestine?
Duodenum (20-25cm)
Jejunum (left upper)
Ileum (bottom right)
83
What are the landmarks of the small intestine
From pyloric sphincter to ileocaecal junction.
84
Is the duodenum intraperitoneal or retroperitoneal?
First 2 cm = intra
| Remainder = retroperitoneal
85
What are the 4 parts of the duodenum?
Superior
Descending
Horizontal
Ascending
86
What do the main pancreatic duct + CBD form?
Hepatopancreatic ampulla (Ampulla of Vater)
87
Where does the hepatopancreatic ampulla drain?
Via the major duodenal papilla into the duodenum.
88
Where does the duodenum terminate?
The duodenojejunal junction.
89
What are the four parts of the large intestine?
Ascending
Transverse
Descending
Sigmoid
90
What are the change in directions of the transverse colon known as?
The hepatic and splenic flexures
91
What are the four histological layers of the GIT?
Serosa / Adventitia
Muscularis propria
Submucosa
Mucosa
92
What is the serosa / adventitia?
Outer layer of the GIT - visceral peritoneum - lubricates to prevent friction against other organs.
93
How much does the liver weigh?
1.5kg
94
Which is the largest organ of the body?
The liver
95
When is the liver palpable?
When it is diseased
96
In which regions is the liver found?
Right hypochondrium & epigastric, small amount in upper left hypochondrium.
97
How many surfaces does the liver have and what are they called?
Two - diaphragmatic and visceral
98
How main lobes does the liver have?
Two main lobes (right and left) AND two accessory lobes (quadrate and caudate).
99
What is the blood supply to the right and left lobes of the liver?
Each lobe has an hepatic artery (R&L), portal vein (R&L), venous and biliary drainage.
100
How many segments is the liver divided into?
8
101
What passes between the segments?
Intersegmental hepatic veins - take blood to IVC.
102
103
104
105
What is found between the caudate and quadrate lobes of the liver?
Porta hepatis (hilum of liver)
106
What are the right and left lobes of the liver divided by?
Falciform ligament and left sagittal fissure (anteriorly = ligament tires hepatic, posteriorly = ligamentum venosum).
107
What is the ligamentum venosum?
Remnant of foetal ductus venosus - shunted blood from umbilical vein to IVC bypassing liver)
108
What is the ligamentum teres hepatis?
Remnant of the umbilical vein
109
Which side of the liver are the caudate and quadrate lobe a part of (a) anatomically and (b) functionally?
Anatomically - Right
| Functionally - left
110
What is the liver capsule called?
The Glisson capsule
111
Which part of the liver is not surrounded by peritoneum?
The bare area - where it lies in direct contact with the diaphragm
112
What do peritoneal folds on the liver do?
Anchor the liver to surrounding abdominal walls and structures - eg falciform ligament & lesser omentum.
113
What does the falciform ligament enclose?
The ligamentum teres
114
What does the inferior fold of the falciform ligament anchor the liver to?
The stomach
115
What does the lesser omentum anchor?
Liver to stomach
116
What two ligaments is the lesser omentum made of?
Hepatogastric and hepatoduodenal
117
What encloses the structures that pass through the porta hepatis?
The hepatoduodenal ligament
118
What does the coronary ligament to? Where does it run - and what are the corners of it called?
Anchors the superior surface of the liver to the diaphragm. Runs along top of liver anteriorly. Corners = triangular ligaments.
119
What do the right and left triangular ligaments do? What are they formed by?
Anchor the right and left lobes of the liver to the diaphragm.
Formed by meeting of anterior and posterior layers of the coronary ligament.
120
What is contained in the portal triad?
Portal vein, hepatic artery & bile passages.
121
What percentage of cardiac output does the liver receive?
25%
122
Which artery originally supplies the liver?
Coeliac artery - which divides into gastric, splenic and hepatic/.
Common hepatic artery (after branching to gastroduodenal) becomes hepatic artery proper which supplies the liver
123
What does the hepatic artery split into?
Right and left hepatic artery.
124
What is the gallbladder arterial supply?
From right hepatic artery - arises small artery which supplies the gallbladder.
125
What is the dual blood supply of the liver?
Supplied by both hepatic artery (25%) - oxygenated, clean blood and portal vein (75% - no valves - blood from gut for metabolism and detoxification).
126
What is the portal vein formed by?
Union of superior mesenteric, inferior mesenteric (joins splenic), splenic, gastric and paraumbilical veins.
127
What helps hold the liver in position?
Attachment of right, left and intermediate hepatic veins to the IVC
128
How are portal vein branches distributed within the liver?
In segmental pattern - end in non-contractile capillaries called venous sinusoids.
129
What is portosystemtic anastomosis?
Communication between tributaries of the portal veins and systemic veins.
130
Can clinical presentation can portal hypertension cause?
Varicose veins
Oesophageal varices
Caput medusa
Haemarrhoids
131
Name 4 areas of porto-systemic anastomosis
Abdominal part of oesophagus (left gastric vein - portal meets oesophageal branches of azygos - systemic).
Upper anal canal (superior rectal - portal - anastomoses with middle and inferior rectal - systemic)
Umbilical area (paraumbilical veins - portal - meet epigastric veins - systemic)
Posterior abdominal wall - (retroperitoneal veins of colon, duodenum, pancreas & liver - portal - meet renal, lumbar, phrenic and bare area of liver - systemic).
132
What are hepatocytes
Liver cells that produce bile.
133
What are liver lobules?
Hexagon shaped lobules in liver segments.
Centre of each = central vein (drains blood back to systemic veins).
Each corner = portal triad - hepatic artery, portal vein & small bile duct + lymph and nerves.
134
What are Couinaud segments in the liver?
Liver divided into 8 segments
135
What are hepatic sinusoids?
Venous channels in the liver
136
How does venous drainage occur in the liver?
Arterial and portal blood mix in hepatic sinusoids --> interlobular veins --> central veins --> collecting veins --> hepatic veins --> IVC
137
How many hepatic veins are there in the liver?
2-3
138
Why is trauma to the lower ribs serious?
Can damage the liver if fractured - cause penetrating wounds. As the liver is so vascularised - can cause severe haemorrhage.
139
How common are hepatic artery variations?
Very common - approx 40-45% of Ps.
140
How does lymphatic drainage of the liver occur?
Superficial and deep lymph nodes converse --> portal hepatis node (regional) --> coeliac nodes (terminal) --> cisterns chyli.
141
How much lymph does the liver produce?
About 1/4 to 1/2 of the lymph received by thoracic duct is produced by the liver.
142
Where do superficial lymphatics occur in the liver?
In the capsule of the liver - drain towards bare area - join deep lymphatics on hepatic vein -> IVC.
143
How is the liver innervated?
SS - coeliac plexus
PSS - anterior and posterior vagal trunks
144
Where does the mid-sagittal / median line run?
From midpoint of manubrium to midpoint of pubic symphysis
145
Where does the transpyloric plane run?
Anterior abdominal wall at 9th costal cartilage
| Posterior AW at L1
146
Where does the trans-tubercular plane run?
Tubercles of iliac crests OR on posterior wall at L5
147
What are the surface landmarks for the liver?
Superior border right lobe = 5th MCL - 7th ICS MAL
Inferior border right lobe 7th costal cartilage midline and 11th rib MAL
Superior border left lobe = 5cm left midline. 5th ICS
Inferior border left lobe = 7th costal cartilage midline
148
Where is the landmark for the fundus of the gallbladder?
9th costal cartilage MCL
149
What is the landmark for the spleen?
Left side, ribs 9-11 (follows curve of rib 10)
150
What are the surface landmarks for the stomach?
Cardia - 7th costal cartilage, 2cm left of midline
Fundus - 5th ICS MCL
Pylorus = transpyloric plane 1cm right of midline
151
What are the surface anatomy for the right kidney?
Posterior trunk - RHS - superior rib 12/T12
Inferior - L3
Hilum - L1
152
What is the surface anatomy for the left kidney?
Posterior trunk, LHS
Superior - T1 1 / rib 11
Inferior - L3
Hilum - L1
153
What is the surface anatomy of the pancreas?
Head - L2, 1cm right midline
Unicate process - L3
Tail - 10th rib
154
What is the surface anatomy of the appendix?
Lateral 1/3 from right ASIS to umbilicus
155
What is the surface anatomy of the inguinal ligament?
From ASIS to pubic tubercle
156
What are the attachments of the EO?
Ribs 5-12
Lateral iliac crest
Linea albaWhat
157
What are the actions of the EO?
Movement and support of organs
158
What demarcates the lateral border of the rectus abdominus muscles and the aponeuroses of other muscles?
Linea semilunaris
159
Which structures exit the superficial inguinal ring?
```
Spermatic cord (male)
Round ligament (female)
Ilioinguinal nerve (M&F)
```
160
What are the attachments for the IO muscle?
```
Thorocolumbar fascia
Mid iliac crest
Lateral 2/3 inguinal ligament
Ribs 8-12
Linea alba
Pecten pubis
Pubic crest
```
161
Which nerves run over the superficial surface of the IO muscle?
Iliohypogastric & Ilioinguinal
162
What are the attachments of the TA muscle?
```
Thoracolumbar fascia
Medial iliac crest
Lateral 1/3 inguinal ligament
Costal cartilage ribs 7-12
Linea alba
Pubic crest
Pecten pubis
```
163
What does the transversals abdominus muscle do?
Supports viscera
164
What is the innervation of the muscles of the AAW?
Anterior rami spinal nerves T7-12, L1 (for TA & IO).
165
What is the blood supply to the muscles of the AAW?
Deep - superior & inferior epigastric arteries + deep circumflex iliac artery, intercostal arteries (10th & 11th) and subcostal artery
Superficial - musculophrenic artery, superficial circumflex iliac artery + superficial epigastric artery
166
Which layers of the AAW becomes layers of spermatic fascia?
EO neurosis = external spermatic fascia
IO muscle = cremaster muscle
Transversalis fascia = internal spermatic fascia
Parietal peritoneum = tunica vaginalis
167
What lies between the rectus abdominus muscles?
Tendinous intersections
168
What are the attachments of the RA muscle?
Pubic crest, pubic tubercle, pubic symphysis, costal cartilage ribs 7-12, xiphoid process
169
What are the actions of the RA muscles?
Flexing trunk
Support abdominal viscera
Tense abdominal wall
170
What are the attachments of the pyramidalis muscle?
Pubis, pubic symphysis & linea alba
171
What is the function of the pyramidalis muscle?
Tense linea alba
172
What is the surface landmark used to identify the deep inguinal ring?
Midpoint of the inguinal ligament, lateral to inferior epigastric arteries
173
What is the clinical significance of Hesselbach's triangle?
Inguinal triangle - is a site of weakness in AAW - likely site of direct inguinal hernia
174
Which spinal nerves innervate the skin above the umbilicus?
T7-9
175
Which spinal nerves innervate the skin around the umbilicus?
T10
176
Which spinal nerves innervate the skin beneath the umbilicus?
T11
177
What does the spinal nerve at L1 divide into?
Iliohypogastric and ilioinguinal nerves
178
Where is the pancreas found?
Behind the lesser curve of the stomach.
179
What is the embryological origin of the gallbladder, pancreas & spleen?
Arise from the foregut.
180
Where are clinical symptoms from the foregut felt?
In the upper 1/3 of the abdomen.
181
What is bile and what is it produced by?
Digestive fluid that emulsifies fats. Is produced by hepatocytes.
182
What are the functions of the gallbladder?
- Store and conc bile
- Selectively absorb bile salts
- Excretes cholesterol and mucus
183
When is the gallbladder stimulated to secrete bile?
When food enters the second part of the duodenum.
184
What does bile contain?
Cholesterol, mucus + bile salts - forms micelles.
185
What causes gallstones?
Change in the concentration of either cholesterol, mucus or bile salts - disrupts the micelles and leads to crystallisation of them --> gallstones.
Can also arise from minor infection in the gallbladder.
186
Where does gallbladder blood supply come from?
Cystic artery - which is a branch of the right hepatic artery.
187
How does bile get from hepatocytes to the gallbladder?
Secreted by hepatocytes into canaliculi -> bile ducts -> join to form R&L hepatic duct -> common hepatic duct --> cystic duct -> gallbladder.
188
What are the three components of the gallbladder?
Fundus
Body
Hartman's pouch
189
190
191
Where do the common bile duct & main pancreatic duct drain into the duodenum?
What controls of the amount of bile & pancreatic entering at this point?
Duodenal papilla - ampulla of Vater.
Controlled by Sphincter of Oddi.
192
How many pancreatic ducts does the pancreas have?
Two - main and accessory. Accessory drains into the duodenum higher than the main.
193
What are the anterior relationships of the gallbladder?
- Visceral surface of the liver
| - Fundus - anterior abdominal wall at tip of 9th costal cartilage.
194
Can you normally feel the fundus of the gallbladder?
No normally unless tense and inflamed - then may feel it beneath the costal margin.
195
What are the posterior relationships of the gallbladder?
Neck - meets lesser omentum posteriorly.
Body - meets 1st & 2nd parts of duodenum posteriorly.
196
What is the inferior relationship of the gallbladder?
Fundus & body - inferiorly relate to the transverse colon.
197
What is the arterial blood supply to the gallbladder?
Blood from the cystic artery, arises from the right hepatic artery.
198
What is the venous drainage of the gallbladder?
Contains lots of veins that go directly into the liver.
199
200
What are the bile ducts of the right liver called?
Sectoral ducts
201
What are the bile ducts of the left liver called?
Segmental ducts
202
What do sectoral ducts drain into?
Right hepatic duct
203
What do segmental ducts drain into?
Left hepatic duct
204
What do the right and left hepatic bile duct drain into?
Common hepatic duct
205
What joins the common hepatic duct to make the common bile duct?
Cystic duct
206
What do the common hepatic and cystic duct form?
Common bile duct
207
What drains into the duodenum?
Common bile duct + pancreatic duct + accessory pancreatic duct (higher up)
208
Where is the upper 1/3 of the common bile duct found?
In the free edge of the lesser omentum
209
What is behind & to the side of the upper 1/3 of the common bile duct?
Behind - portal vein
Left - common hepatic artery
PART OF THE PORTAL TRIAD
210
Where is the middle third of the common bile duct found?
Behind the first part of the duodenum
211
Where is the lower third of the common bile duct found?
At posterior aspect of the head of the pancreas.
212
What is ERCP?
Endoscopic Retrograde Cholangio Pancreatography
213
Where do the exocrine secretions from the pancreas go?
What are the exocrine secretions?
Into the duodenum via pancreatic ducts.
Pancreatic secretions collect in small ducts -> main pancreatic duct (Duct of Wirsung) -> ampulla of Vater - empties into the duodenum at major duodenal papilla.
Exocrine secretions from pancreas are digestive enzymes.
214
Where do the endocrine secretions from the pancreas go?
Directly into the blood stream
215
Which direction does pancreatic secretions travel in the pancreas?
From tail to body
216
What is the duct called that drains the head of the pancreas?
Segmental duct of Santorini - drains head of pancreas.
217
Is the pancreas interperitoneal or retroperitoneal?
Retroperitoneal
218
Where is the pancreas located?
In the concave part of the duodenum.
219
What is posterior to the pancreas?
IVC & renal veins
220
What is the head of the pancreas indented by?
The Common bile duct
221
What is the uncinate part of the pancreas?
The hooked part of the head
222
Which artery runs along the top of the pancreas?
The splenic artery (branched from the coeliac trunk).
223
Which vessel runs along the back of the pancreas?
The splenic vein - joins the superior mesenteric vein - then the portal vein.
224
What is the pancreas indented by?
The common bile duct?
225
What do the neck and body of the pancreas overlie?
The vertebral column
226
What are the neck and body of the pancreas anterior to?
IVC & AA - also crosses the origin of the SMA
227
Why is the pancreas not suitable for surgery?
Because it is close to major arteries such as the SMA, IVC & AA - makes it hard to remove.
228
What does the tail of the pancreas overlie?
The left kidney & the tip of the tail touches the splenic hilum
229
What is the tail of the pancreas attached by?
The gastrosplenic ligament
230
What are the arteries that supply the pancreas?
Splenic artery
Pancreatico-duodenal artery (branch of the hepatic artery) - supplies the head
231
What are the veins of the pancreas?
The pancreatic vein - drains into the portal vein.
232
What are the nerves of the pancreas?
The coeliac ganglia (SS) and vagus (PSS)
233
What is the spleen covered by?
Capsule
234
What is the red pulp and white pulp of the spleen?
Red pulp = blood filled sinuses
White pulp = lymphatic tissue
235
Where is the spleen found?
Between 9th & 11th rib - LHS
236
What are the functions of the spleen?
- Immune role - protects against encapsulated bacteria
- Removes old RBCs
- Stores platelets
- Produces RBCs in foetal life
237
What do you need to do if you remove a P's spleen
Vaccinate against certain encapsulated bacteria.
238
What does the spleen sit in front of?
Left kidney
239
What is behind the spleen?
- Splenic flexure
| - Fundus of stomach (medially)
240
What is the blood supply of the spleen?
- Splenic artery - loops so is longer in length than actual distance.
Runs along superior border of pancreas - splits at hilum of spleen into several branches.
241
What is the venous drainage of the spleen?
Splenic Vein - Runs along posterior surface of pancreas - drains into superior mesenteric vein --> portal vein.
242
What can gallstones cause?
Blockage of the CBD (extra-hepatic biliary obstruction) - causes jaundice, build up of bile in bile duct - bile is then absorbed causing jaundice and poss liver infection.
Can show as dilated CBD.
243
P has dilated pancreatic duct, gross distension of CBD & jaundice. Possible cause?
Pancreatic cancer - jaundice caused by blockage of CBD - can try and stent biliary tube to allow jaundice to settle.
244
Which part of the spleen is notched?
The Superior border
245
What is visceral pain described as?
Dull aching, pressure pain - not acute or stabbing.
246
What is referred pain?
Where pain is felt in a different location to where the pathology is occurring - occurs with visceral pain due to innervation of the organs & dermatomes.
247
Where is gallbladder pain felt?
Normally right hypochondrium region, but can be felt in epigastrium.
248
249
What is the peritoneum comprised of?
Serous membrane - made of connective tissue & squamous epithelium.
250
What are the two types of peritoneum?
Parietal peritoneum
| Visceral peritoneum
251
Which nerves supply the parietal peritoneum?
Segmental spinal nerves - intercostal, diaphragmatic & lumbar
252
What is parietal peritoneum that splits around an organ called?
Mesentery
253
Which nerves supply the visceral peritoneum?
Visceral nerves
254
What are the divisions of the gut from foetal development?
Foregut - Oesophagus -> proximal duodenum + liver + pancreas
Midgut - Distal duodenum - 3/4 of transverse colon
Hindgut - Distal 1/4 transverse colon -> rectum.
255
What is peritoneum made from (i.e. embryological origin?)
Mesoderm
256
What is the embryological origin that organs are made from?
Endoderm
257
How is the mesentery divided compared to the GIT?
Dorsal and ventral divisions. Ventral in front of gut tube, dorsal posterior to it.
258
What does dorsal mesentery do?
Attaches gut organs to posterior abdominal wall.
(e.g. gastrosplenic ligament, lienorenal ligament, greater omentum, mesentery of small and large bowel).
259
What does ventral mesentery give rise to?
Ligaments around the liver - e.g. falciform ligament & lesser omentum.
260
Why is gut rotation during foetal development important clinically?
Can give rise to disorders of rotation (malrotation) - can cause obstruction - and can cause incomplete formation of some structures.
261
What are the two spaces of the peritoneal cavity?
Greater sac - majority
Lesser sac - outpouching that lies behind the stomach.
262
What does the ileum absorb?
Bile salts
B12
Any water that has not been absorbed
263
What does the jejunum absorb?
Water and nutrients
264
Which arteries supply the transverse colon?
What is the venous drainage of the transverse colon?
Right, middle & left colic arteries
Middle colic vein
265
How is the transverse colon attached to the posterior abdominal wall?
By the transverse mesocolon.
266
Where is the supracolic compartment of the greater sac?
What does it contain?
Above the transverse mesocolon.
Liver, biliary tree, stomach, pancreas & spleen.
267
What is the entry between greater and lesser sac called?
Epiploic foramen
268
How many layers of peritoneum does the greater omentum have?
Four - is a double fold of 2 layers.
269
Which compartment does the greater omentum cover?
The infracolic compartment (below the transverse colon)
270
What are the anatomical borders of the lesser omentum?
Right border of oesophagus
Lesser curve of stomach to 1st part duodenum
Left lobe of liver
271
What does the free edge of the lesser omentum contain?
The portal triad
272
What is the main blood supply of the greater omentum?
From the gastroepiploic artery - branches oss the gastroduodenal artery and runs along the greater curvature of the stomach.
Gastroepiploic gives off main branches which supply the greater omentum.
Venous supply = gastroepiploic veins
273
What is the clinical importance of the lesser sac?
Pancreas problems - fluid can accumulate in lesser sac - push stomach forward creating mass in epigastrium (pseudocyst).
274
What are the anatomical boundaries of the epiploic foramen?
Anterior - hepatoduodenal ligament
Posterior - IVC and right crus of diaphragm
Superior - caudate lobe liver
Inferior - superior duodenum
275
What is found between the sides of the large colon and the abdominal wall?
Para-colic gutters (right and left).
276
What is the infra colic divided into by small bowel mesentery?
Right and left sides
277
What are the boundaries of the right para-colic gutter?
Upper pole of the right kidney
Right lobe of liver (hepato-renal pouch)
Lateral to ascending colon, caecum
Superior to pelvic cavity
278
What are the boundaries of the left para-colic gutter?
Left side of transverse mesocolon
Lateral to descending colon & base of sigmoid mesocolon
Superior to pelvic cavity
Bounded superiorly by the phrenicolic ligament.
279
Where does the small bowel mesentery start?
At duodenal-jejunal flexure - attachment of small bowel mesentery to PAW
280
What are the boundaries of the right infra-colic compartment?
Laterally right of caecum & ascending colon
Medially - small bowel mesentery
Upper limit - first 1/2 RHS transverse colon
Includes 3rd & 4th part duodenum & lower pole of right kidney
281
Which is bigger - RH or LH infracolic compartment?
LH Infracolic
282
What are the boundaries of the left infra-colic compartment?
Lateral to left descending colon
Medial to small bowel mesentery
Upper - LHS 1/2 transverse colon
Inferior - pelvic cavity
283
What are the three reflections of the peritoneum?
Why are they important clinically?
Vesicle-uterine pouch
Recto-uterine pouch
Recto-vesical pouch
Clinically important as fluid can accumulate in these pouches (infection, abscess etc).
284
What is the vesico-uterine pouch?
The fold of peritoneum between the bladder and uterus
285
What is the recto-uterine fold?
Fold of peritoneum between rectum and uterus
286
What is the recto-vesicle fold?
Fold of peritoneum between the bladder and the rectum
287
Does the parietal peritoneum experience somatic or autonomic nerve innervation?
Somatic - is pain sensitive
288
Is the visceral peritoneum innervated by somatic or autonomic nerves?
Is innervated by autonomic nerves
289
Why is the peritoneum important in fluid exchange?
Big SA - allows a lot of fluid exchange between tissue lymphatics and venues - can be used for peritoneal dialysis.
290
Why is the peritoneum important for infection?
- Contains phagocytes (protects viscera)
- Mesothelial cells can transform to fibroblasts (inc healing)
- Greater omentum can physically protect by walling off areas to prevent infection spreading - can migrate to areas of inflammation and produce abscess - felt as a mass.
291
In which division of the bowel is the appendix located?
Midgut
292
What is the spread of cancer through the peritoneum called?
Trans-coleomic spread
293
What is the latin word for peritoneum?
Coelo
294
Why is cancer in the peritoneum bad?
Can get seedlings of cancer deposits on the peritoneal lining.
Can also cause leakage of excess fluid containing cancer cells = malignant ascites.
295
What is malignant ascites?
Leakage of fluid containing cancer cells in the abdomen.
296
What are the sites of attachment of the greater omentum?
Greater curvature of stomach to diaphragm, spleen & transverse colon
297
What are the three different ligaments of the greater omentum?
- Gastrocolic
- Gastrosplenic
- Gastrophrenic
298
What are the two ligaments of the lesser omentum?
Hepatogastric
| Hetaptoduodenal
299
What does the lesser omentum connect?
The porta hepatis to lesser curvature of stomach and duodenum
300
What does the anterior sheet of the greater omentum attach to?
Greater curvature of stomach
301
What does the posterior sheet of greater omentum attach to?
Duodenum
302
The ligamentum teres is a remnant of which embryological structure?
The umbilical vein
303
What do the anterior and posterior lamina of the coronary ligaments fuse to form?
The triangular ligaments
304
What is the communicating foramen between the greater and lesser sacs?
The omental foramen
305
What are the boundaries of the omental foramen?
What is its clinical significance?
Superior - caudate lobe
Inferior - duodenum and parietal peritoneum
Anterior - hepatoduodenal ligament & portal triad
Posterior - IVC and parietal peritoneum
Clinical significance = herniation of lesser sac contents
306
Which veins unite to form the portal vein?
```
Splenic vein (+ inferior mesenteric)
Superior mesenteric (+ gastric veins, para-umbilical veins & cystic veins)
```
307
What is the ligament on the posterior of the liver called that divides it into right and left lobes?
The ligamentum venosum
308
What is the surface landmark of the gallbladder?
9th costal cartilage, MCL
309
What is the value at the neck of the gallbladder called?
What is its function?
Spiral valve
Ensures unidirectional flow of bile
310
What structure does the common bile duct join with and what is the name of the conjoint structure?
Joins main pancreatic duct
Forms the hepatopancreatic duct (Ampulla of Vater - opening controlled by sphincter of Oddi).
311
Where does the hepatopancreatic ampulla drain?
Drains into the 2nd part of the duodenum at major papilla.
Above = minor papilla (drainage of accessory pancreatic duct).
312
Which border of the spleen is notched?
The superior border
313
What direct branch of the AA does the splenic artery arise from? What is the vertebral level of this?
Arises from coeliac trunk - T12
314
Which ligament attaches the spleen to
- the abdominal wall anterior to left kidney
- the greater curvature of the stomach?
- Splenorenal ligament
| - Gastrosplenic ligament
315
Which organ is found in the hilum of the spleen?
The tail of the pancreas
316
What is the function of the red and white pulp of the spleen?
Red
- Haemolysis, phagocytosis & sequestration of platelets
White - T & B lymphocytes and macrophages
317
What are the names of the internal folds of the gastric mucosa?
Rugae
318
What is the function of the pyloric sphincter?
To control outflow of stomach contents to duodenum,
319
What is a paediatric development malformation of the stomach and its clinical significance?
Pyloric stenosis - presents with failure to thrive and projective vomiting, can cause death.
320
Is the duodenum intra or retro peritoneal?
Retroperitoneal - except for first 2cm which are intra peritoneal.
321
Is the pancreas intra or retroperitoneal?
Retroperitoneal
322
Is the ascending colon intra or retroperitoneal?
Retroperitoneal
323
Is the transverse colon intra or retroperitoneal?
Intraperitoneal
324
Is the descending colon intra or retroperitoneal?
Retroperitoneal
325
Is the sigmoid colon intra or retroperitoneal?
Intraperitoneal
326
How is the sigmoid colon attached to the PAW?
Attached by sigmoid mesocolon
327
Which artery supplies the small intestine? Which arteries arise from it?
Superior mesenteric artery
Gives rise to:
- Ileocolic artery
- Right colic artery
- Middle colic artery
328
What does the ileocolic artery supply?
Caecum, terminal ileum & appendicular artery (supplying appendix)
329
What does the right colic artery supply?
Ascending colon
330
What does the middle colic artery supply?
The transverse colon - proximal 2/3rds
331
Which vein drains the small intestine and proximal colon (midgut)?
Superior mesenteric vein
332
Which vessel does the superior mesenteric merge with and what do they form?
Merges with splenic vein
Forms the portal vein
333
How can you determine the jejunum from ileum by looking at arterial arcades?
Are only a few arcades in the jejunum and are many arcades in the ileum.
334
How can you differentiate the jejunum from the ileum by looking at vasa recta?
Vasa recta are long in the jejunum and short in the ileum.
335
What is the name of mucosal folds in the small intestines?
Plicae circulares or valvulae conniventes
336
In which part of the small intestine are the plicae circulares most prominent?
In the jejunum
337
Which arteries arise from the inferior mesenteric artery?
Left colic artery
Sigmoid arteries
Superior rectal artery
Marginal artery
338
Which artery supplies the descending colon?
The left colic artery
339
Which artery supplies the proximal rectum?
The superior rectal artery
340
Which artery supplies the distal 1/3 of transverse colon?
The marginal artery
341
Which artery supplies the sigmoid colon?
Sigmoid arteries
342
Which vein drains the distal colon (hindgut)? Which vein does this drain into?
Inferior mesenteric vein - drains into splenic vein.
343
What is the normal position of the appendix?
Retrocaecal
344
What are the bands of longitudinal muscle in the large intestines called?
Taeniae coli
345
What are the outpouchings of colon wall called? What are the formed by?
Haustra - occur from contraction of inner circular muscle
346
What are fatty omental appendices of the peritoneum called?
Epiploic appendages
347
Which organs are found in the retroperitoneum?
PEAR DUCKS
Pancreas
Esophagus
Aorta & IVC
Rectum
```
Duodenum (2nd and 3rd parts)
Ureter
Colon (only ascending and descending, transverse and rectum are intraperitoneal)
Kidneys
Suprarenal glands (adrenal glands)
```
348
What structures are found in the hilum of the kidney?
Vein (anteriorly), arteries, renal pelvis & ureter
349
What are the top, middle and bottom of the kidney called?
```
Top = Upper pole
Middle = Interpolar region
Bottom = Lower pole
```
350
What are the functions of the kidney?
A WET BED
```
A - Acid/base balance
W - Water balance
E - Electrolyte balance
T - Toxin & waste product removal
B - BP control
E - Erythropoietin production
D - Vitamin D activation
```
351
352
Where are the nephrons of the kidney found?
In the columns between the pyramids of the medulla
353
What do the pyramids of the kidney contain?
The collecting ducts - they drain into minor calyces.
354
How many major calyces does the average kidney have?
4-6
355
What are the surface markings of the transpyloric plane?
Where does the transpyloric plane pass on the kidneys?
Inferior border of L1 posteriorly
Anteriorly - costal cartilage of rib 9
Passes through upper plane of renal pelvis in right kidney & through middle of renal pelvis in left kidney.
356
What lies in front of the right kidney?
| What lies medially to the right kidney?
Ascending colon & hepatic flexure.
Over hilum = second part of duodenum
Medially = IVC
357
What lies in front of the left kidney?
What is medial to the left kidney and what is superior to the left kidney?
Anteriorly = transverse colon to splenic flexure + part of descending colon,
Medially = tail of pancreas
Superiorly = adrenal gland + spleen
358
Which muscles lie posteriorly to the kidneys?
Psoas major + quadratus lumborum
359
What function does the fascia covering the kidney have?
Protection and holds the kidney in place
360
What is the fascia surrounding the kidney called? What does it contain?
Perirenal fascia = contains perirenal fat
361
Which arteries supply the kidneys? Which is longer?
Where do they arise from?
Left and right renal arteries - right is longer.
Arise from AA laterally.
362
Which vessel does the renal vein run under?
The SMA
363
Describe the organisation of blood supply to the kidney.
```
AA
Renal Arteries
5 Segmental arteries (4 front, 1 posterior)
Interlobar arteries (down pyramid sides)
Arcuate arteries
Interlobular arteries
Afferent arterioles
Efferent arterioles
Vasa recta
```
364
What type of arteries are kidney arteries? Why is this clinically important?
They are end arteries - do not anastomose with each other - therefore if one is damage is no collateral supply and potentially a kidney segment will die.
365
Which renal vein is longer and why?
Left vein longer - IVC lies closer to the right.
366
Which veins drain into left renal vein?
Gonadal veins + adrenal vein
367
Does the right adrenal vein drain directly to IVC or into right renal vein?
Directly into IVC.
368
Name 4 nerve plexi in the retroperitoneum and their locations.
Coeliac plexus (around coeliac trunk)
Aortic plexus (body of aorta)
Superior hypogastric plexus (found on bifurcation of aorta)
Inferior hypogastric plexus (pelvis)
369
Is the nerve supply in the retroperitoneum autonomic, somatic or both?
Essentially autonomic only.
370
Which nerves supply the PSS of the retroperitoneum?
Top - Vagus
Bottom - S2,3 &4 (pelvic splanchnic)
Both form prevertebral plexi
371
Which dermatome is the kidneys?
T10 - L2 - lower hypochondrium
372
Which dermatome is the umbilicus?
T10
373
Where does kidney pain tend to be felt?
Loin, testicles & inner thigh.
374
Name the three narrowing points of the ureter.,
What is their clinical significance?
Ureteropelvic junction
Crossing of iliac artery
Ureterovesical junction
Is where stones get stuck
375
What dermatome is the ureter?
T11 - L2
376
What are the lymphatics of the retroperitoneum?
Follow the great vessels, drain into cisterns chyli which drains into thoracic duct
377
What is agenesis of the kidney?
A kidney is missing - can be unilateral or bilateral.
378
What is a horseshoe kidney?
Kidneys are joined across the midline?
379
What is the ureter lined by?
Transitional cell epithelium - waterproofing.
380
Where is the ureter located?
In the transverse processes of the lumbar vertebrae - cross into the pelvis over the common iliac artery.
381
Where does the top of the ureter obtain blood from?
The renal artery & gonadal artery
382
Where does the bottom of the ureter obtain blood from?
A variety of arteries inc internal iliac, superior vesicle, uterine artery, middle rectal, vaginal & inferior vesical.
Has good blood supply.
383
Where does the middle of the ureter obtain blood from?
What is the clinical significance of this?
Aorta - but not a good supply - means that is harder to recover from trauma / surgery.
384
What muscle is the bladder made of?
Detrusor muscle
385
What are the folds of bladder lining called?
Rugae
386
Where does urine enter the bladder?
Through the ureteric orifice - each side located at top of trigone area
387
How is the trigone area different to the rest of the bladder? What does it contained?
It has a different embryological origin.
Trigone = endoderm
Rest of bladder = ectoderm
Contains sensory afferent nerves - tells brain when it needs to pee.
388
What is the top of the bladder lined by?
Peritoneum
389
When are bladder perforations problematic and when are they not?
If the perforation occurs at the sides (extraperitoneal perforation) - the urine can only leak into limited area containing fat. Usually heals without surgery and catheterisation alone.
If the perforation occurs into the peritoneal cavity - will need surgery to repair to prevent leakage of urine into the peritoneal cavity.
390
What type of cell lines the bladder?
Transitional cell epithelium
391
Why do F Ps get more UTIs than M Ps?
Shorter urethra than men
392
What are the PSS effects on the lower urinary tract?
Contract detrusor muscle (bladder)
Vasodilation
Penile erection
Relaxation of urethral and anal sphincters
393
What are the SS effects on the lower urinary tract?
```
Relax detrusor muscle
Vasoconstriction
Ejaculation
Contract internal anal and urethral sphincters
Increase sweating
```
394
What are the following vertebral levels for the following?
- Superior duodenum
- Descending duodenum
- Horizontal duodenum
- Ascending duodenum
L1
L2
L3
L2
395
Which is the only intraperitoneal part of the pancreas?
The tail
396
Where does the endocrine secretions drain into from the pancreas?
Into the vasculature of the pancreas (splenic arteries and pancreaticoduodenal arteries)
397
What are the arteries of the pancreas?
Pancreatic arteries -from the Splenic artery
Pancreaticoduodenal (x4 of these - anterior superior, posterior superior, anterior inferior and posterior inferior)
398
What are the 4 pancreaticoduodenal arteries?
Anterior & Posterior Superior Pancreaticoduodenal (from gastroduodenal artery)
Anterior & Posterior Inferior Pancreaticoduodenal arteries (from SMA)
399
What does the splenic vein join to form the portal vein?
Superior mesenteric vein
400
Which vein drains into the splenic vein?
Inferior mesenteric vein
401
What are the layers surrounding the kidney?
```
Parietal peritoneum
Paranephric fat
Renal fascia (anterior and posterior)
Perinephric fat
Renal capsule
```
402
Between which vertebral levels do the kidneys lie?
Between T11 (left) and T12 (right) - to L3
403
What shape are the adrenal glands?
Right - triangular
| Left - semilunar
404
What is the arterial supply of the adrenal glands?
Superior adrenal artery
Middle adrenal artery
Inferior adrenal artery
405
Where does the superior adrenal artery arise form?
Inferior phrenic artery
406
Where does the middle adrenal artery arise from?
Abdominal aorta
407
Where does the inferior adrenal artery arise from?
The renal artery
408
What is the venous drainage of the adrenal glands?
Left adrenal - into renal vein then IVC
Right adrenal - directly into IVC
409
Which muscle does the ureter pass over anteriorly?
The psoas major muscle
410
What is the level of origin of the IVC?
L5
411
Which vessels unite to form the IVC?
Common iliac veins
412
At what vertebral level does the AA begin?
T12
413
At which vertebral level does the AA bifurcate?
L4
414
Name three unpaired visceral arteries from the AA
Coeliac trunk
SMA
IMA
415
Name three paired visceral arteries arising from the AA.
Middle suprarenal arteries
Renal arteries
Gonadal arteries
416
Name two paired somatic arteries from the AA.
Inferior phrenic arteries
Lumbar arteries
417
What are the sympathetic trunks?
Sympathetic nerves running from base of skull down the vertebral column.
418
What is the name of the nerve that connects the superior and inferior hypogastric plexuses?
Hypogastric nerve
419
What nerve fibre type is in the hypogastric plexus?
Autonomic nerve fibres - SS and PSS
420
What type of nerves are the lumbar splanchnic nerves?
Autonomic fibres - from sympathetic trunk to preaortic ganglia and aortic plexuses
421
What are the attachments of posts major?
Lateral aspects of lumbar vertebrae
Pass under inguinal ligament
Attaches to femur
422
What are the attachments of posts minor?
Not always present - arises from lumbar vertebrae & attaches to anterior surface of posts major
423
What are the attachments of the iliacus muscle?
Arises from iliac fossae - passes under inguinal ligament to insert with posts major onto the femur
424
What is the attachment of quadratus lumborum muscle?
Arises from ilia crests and attaches to lumbar vertebrae and rib 12.
425
What are the muscle actions of psoas major?
Hip flexion (uses conjoint tendon with iliacus for this)
+ flexion of trunk
426
What are the muscle actions of iliacus?
Conjoint tendon with psoas major - causes hip flexion.
427
What is the action of psoas minor?
Flexion of trunk but minimal impact
428
What is the action of quadratus lumborum?
Extends trunk if pelvis is fixed, unilaterally laterally flexes trunk
429
What does the iliohypogastric nerve innervate?
Abdominal wall muscles
| Inguinal region cutaneous
430
What does the ilioinguinal nerve innervate?
Abdominal wall muscles
Proximal medial thigh
Mons pubis cutaneous
431
What does the lateral cutaneous nerve of the thigh innervate?
Lateral thigh cutaneously
432
What does the femoral nerve innervate?
Anterior thigh musculature
| Anterior thigh + medial leg cutaneous
433
What does the obturator nerve innervate?
Medial thigh muscles + skin
434
Name 5 muscles of PAW
```
Psoas major
Psoas minor (not always present)
Quadratus lumborum
Diaphragm
Iliacus
```
435
Which two muscles of the PAW form a conjoint tendon?
What is the clinical significance of this conjoint tendon?
Iliacus + psoas major - inserts on lesser trochanter
If infection (e.g. TB) in PAW is hard to see - it can sometimes track down and cause swelling in the proximal part of the thigh1
436
What herniates the diaphragm at T8?
IVC
| Right phrenic nerve (innervates the diaphragm)
437
What herniates the diaphragm at T10?
Oesophagus & vagal trunks
438
What herniates the diaphragm at T12
Aorta
Thoracic duct
Azygos vein
439
Where do the splanchnic nerves arise?
Thorax - run down to pelvis in vertebral column.
440
What is psoas major innervated by?
Anterior rami L1 - L3
441
What is psoas minor innervated by?
Anterior rami L1
442
What is the quadratus lumborum innervated by?
Anterior rami of T12 & L1 - L4
443
What is the iliacus muscle innervated by?
Femoral nerve - L2-4
444
What is the diaphragm innervated by?
C3,4 & 5 (Phrenic nerve) and Intercostal nerves - T5-12.
445
Name 3 types of fascia found in the PAW
Psoas fascia
Iliac fascia
Thoracolumbar fascia
446
What do psoas and iliac fascia overlie?
The respective muscles
447
What does the top of psoas fascia form?
Thickens to form medial arcuate ligaments
448
What are the three layers of thoracolumbar fascia?
Anterior - covers quadratus lumborum and forms lateral arcuate ligaments
Middle - Deep covering of the erector spinae muscles
Posterior - superficial covering of the erector spinae muscles
449
What muscle does the ureters travel over anteriorly?
Psoas major
450
Name one unpaired somatic artery in the abdomen.
Median sacral artery
451
Where do the common iliac arteries branch?
L4
452
What do the lumbar arteries do?
Are 8 of them - supply blood to muscles of PAW
453
What do the middle suprarenal arteries supply & where are they found?
Immediately superior to renal arteries on AA - supply the suprarenal (adrenal) glands.
454
Where are the renal arteries found?
Immediately inferior to the SMA. Are lateral arteries on the AA.
455
Where are the gonadal arteries found?
Immediately inferior to the renal arteries - are paired anterior arteries.
456
Where are the inferior phrenic arteries found?
Immediately inferior to the aortic hiatus - innervates the diaphragm.
457
Where are the lumbar arteries found? What do they supply blood to?
Laterally on AA - 4 pairs - underneath renal arteries - on the posterior of the AA.
Muscles of PAW & spinal cord.
458
Where is the median sacral artery found?
Just superior to the aortic bifurcation posteriorly.
459
What does the AA bifurcate into?
The common iliac arteries (L4)
460
What is the IVC formed by?
The union of common iliac veins at L5
461
What are the tributaries of the IVC?
- Suprarenal veins (R direct into IVC, L into L renal vein)
- Renal veins
- Gonadal veins (R direct in to IVC, L into L renal vein)
462
What do somatic nerves control?
Motor and (usually) / or sensory - very few purely motor nerves.
463
Which nerves innovate the abdominal wall?
Iliohypogastric (L1)
| Ilioinguinal (L1)
464
What are the vertebrae levels of the following nerves:
- Iliohypogastric
- Ilioinguinal
- Genitofemoral
- Lateral cutaneous nerve of the thigh
- Obturator
- Femoral
- Iliohypogastric = L1
- Ilioinguinal = L1
- Genitofemoral = L1-2
- Lateral cutaneous nerve of the thigh = L2-3
- Obturator = L2-3
- Femoral = L2-3
465
All the nerves of the abdomen arise laterally to psoas major except which one?
Genitofemoral nerve
466
Autonomic innervation of abdominal viscera are carried out by which nerves?
SS
- Greater splanchnic - T9
- Lesser splanchnic- T10-11
- Least splanchnic - T12
- Lumbar splanchnic nerves (L2-4)
- Sacral splanchnic nerves (S2-4)
PSS
- Vagus - CNX - foregut & midgut
- Pelvic splanchnic - (S2-4) hindgut
And enteric nervous system (intrinsic)
467
Somatic pain = What does sharp, localised pain indicate?
| How can you determine what is causing the pain?
Skeletal muscle, bone or CT pain - follows dermatome or cutaneous mapping.
468
What does dull, poorly localised pain indicate?
Visceral pain = Pain from viscera and vessels - usually due to stretch, ischaemia or irritation.
469
What is the dermatome for the inguinal region?
L1
470
What is the dermatome for the xiphoid process?
T6
471
Why do we get referred pain?
The brain cannot distinguish between visceral and cutaneous pain.
472
Where is visceral pain from the following referred to:
- Foregut
- Midgut
- Kidneys and Upper Ureter
- Hindgut
- Lower thorax & epigastric region
- Umbilical region
- Flanks (lateral regions)
- Pubic region, thighs and groin
473
What is the difference between direct and indirect inguinal hernia?
Direct - protrusion through anterior wall - usually in Hasselbach's triangle - natural weakness - organs herniate through
Indirect - generally congenital - when testes descend - track through layers of inguinal canal - can get herniation through this hole - herniation through deep inguinal ring
474
What are the following of the inguinal canal:
- Anterior boundaries
- Posterior boundaries
- Roof
- Floor
Anterior = aponeurosis of EO, IO on lateral 1/3
Posterior = fascia transversals, cojoint tendon (IO & TA)
Roof = arching fibres of IO & TA
Floor = inguinal ligament & its extensions
475
What is the inguinal ligament and what is its attachments?
Thickening of the EO aponeurosis
From ASIS to pubic tubercle
476
What are the branches of the SMA?
- Jejunal and ileal branches
- Middle colic
- Right colic
- Ileocolic
477
Which nerves innervate the pelvic organs for sympathetic innervation?
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Lumbar splanchnic (L1-2)
Sacral splanchnic (S2-4)
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478
