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NME > Anatomy of NME > Flashcards

Anatomy of NME Flashcards

1
Q

What are the folds of peritoneum called?

A

Mesentery

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2
Q

What does the mesentery do?

A

Allows organs to expand and slide/move against each other without friction.

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3
Q

What does the pharynx do?

A

Directs food to the oesophagus - blocks entry to trachea with epiglottis.

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4
Q

What does the soft palate do?

A

Blocks the nasal cavity entrance during swallowing.

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5
Q

What are the three embryological divisions of the gut?

A

Foregut, midgut & hindgut

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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
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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
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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
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9
Q

What is the line of division between the midgut and foregut?

A

Major duodenal papilla.

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10
Q

Where do the pancreatic duct and gall bladder drain into the duodenum?

A

At the major duodenal papilla.

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11
Q

Where is the division between midgut and hindgut?

A

2/3 way along the transverse colon.

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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.

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13
Q

What is the difference between abdominal cavity and peritoneal cavity?

A

Abdominal cavity = whole region

Peritoneal cavity = organs & structures within peritoneum

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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.

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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

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16
Q

What are the 9 regions and 4 quadrants of the abdomen?

A
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17
Q

What is the landmark for the subcostal plane?

A

Under 10th costal cartilage

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18
Q

What is the landmark for the transtubercular plane?

A

Iliac Tubercules + L5 body

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19
Q

What are the lines of demarcation that divide the abdomen into regions?

A 
Subcostal and transtubercular 
Mid clavicular (both sides)
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20
Q

What are the lines of demarcation that divide the abdomen into quadrants?

A

The umbilical plane & the median (mid-line) plane

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21
Q

What level of the spine is the umbilicus?

A

L3-4

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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
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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
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24
Q

What organs are found in the right lower quadrant?

A

Caecum
Appendix
Ascending colon
Small intestine

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25
Q

What organs are found in the left lower quadrant?

A

Small intestine
Descending colon
Sigmoid colon

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26
Q

Which artery descends into the abdomen to supply all the arteries within?

A

Abdominal aorta

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27
Q

What are the tree main branches of the AA?

A

Coeliac artery
Superior mesenteric artery
Inferior mesenteric artery

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28
Q

Which vertebral level is the coeliac trunk found at and which division of the abdomen does it supply with blood?

A

T12 - foregut

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29
Q

Which vertebral level is the superior mesenteric artery found at and which division of the abdomen does it supply with blood?

A

L1 - Midgut

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30
Q

Which vertebral level is the inferior mesenteric artery found at and which division of the abdomen does it supply with blood?

A

L3 - Hindgut

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31
Q

What are the three main branches of the coeliac artery?

A

Left gastric (stomach)
Splenic
Common hepatic

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32
Q

Which organs does the coeliac artery supply?

A

Stomach, spleen, liver, duodenum & pancreas.

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33
Q

What does the superior mesenteric artery supply?

A

Distal duodenum to proximal 2/3 of transverse colon.

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34
Q

What are the branches of the superior mesenteric artery?

A 
Jejunal 
Ileal
Middle colic (proximal 2/3rds transverse colon)
Right colic (ascending colon)
Ileocolic (caecum & appendix)
Renal arteries (L1)
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35
Q

What does the inferior mesenteric artery supply?

A

Distal 1/3 of transverse colon to upper half of anal canal

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36
Q

What are the branches of the inferior mesenteric artery?

A

Left colic (descending colon)
Sigmoid
Superior rectal
Marginal artery

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37
Q

What is the function of the marginal artery?

A

Forms anastomosis between left and middle colic - ensures we have a collateral supply if one of the vessels are blocked.

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38
Q

At what vertebral level is the bifurcation of the aorta?

A

L4

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39
Q

What are local lymph nodes named after?

A

The part of the gut they are in.

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40
Q

What are regional lymph nodes named after?

A

The branch of artery that supplies them.

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41
Q

What are terminal lymph nodes named after?

A

Parent artery

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42
Q

What do the abdominal nodes feed into?

A

Thoracic duct

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43
Q

What is the hierarchical order of lymph nodes?

A

Local –> regional –> terminal –> main lymphatic ducts

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44
Q

Where do splanchnic nerves relay?

A

In the ganglia related to the three main arteries of the gut - the coeliac ganglion, the superior mesenteric ganglion & the inferior mesenteric ganglion.

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45
Q

What is a ganglion?

A

A collection of nerve cell bodies (not axons) in the peripheral nervous system.

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46
Q

Which nerves supply sympathetic innervation to the gut?

A

The splanchnic nerves

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47
Q

What does the greater splanchnic nerve innervate? Where is its plexus? What vertebral level does it supply?

A

Supplies the foregut.
Plexus is around the coeliac artery
T5-9

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48
Q

What does the lesser splanchnic nerve innervate? Where is its plexus? What vertebral level does it supply?

A

Midgut
Superior mesenteric artery
T10-11

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49
Q

What does the least splanchnic nerve innervate? Where is its plexus? What vertebral level does it supply?

A

Hindgut
Inferior mesenteric artery
T12

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50
Q

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?

A

Lumbar splanchnic nerves - L1-2

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51
Q

Which nerve provides parasympathetic innervation to the gut?

A

Vagus nerve - CNX - supplies foregut and midgut

Pelvic splanchnic nerves - S2-4 - supply hindgut (superior hypogastric plexus)

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52
Q

What are the boundaries of the abdominal wall?

A

Thoracic cage superiorly

Inguinal ligament and hip bones inferiorly

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53
Q

What are the 5 main layers of the abdominal wall?

A 
Skin
Superficial fascia (Camper's & Scarpa's)
Rectal sheath (muscles and aponeuroses)
Deep fascia (transversals fascia)
Extraperitoneal fat & peritoneum
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54
Q

At which point of the abdominal wall is the skin attached firmly?

A

The umbilicus

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55
Q

What is the fatty layer of fascia in the abdominal wall called?

A

Camper’s fascia

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56
Q

What is the membranous layer of fascia in the abdominal wall called?

A

Scarper’s fascia

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57
Q

What is the fascia that covers the muscles of the abdominal wall called?

A

Epimysium

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58
Q

What are the types of fascia in the abdominal wall?

A

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.

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59
Q

What muscles are found in the abdominal wall?

A

External oblique
Internal obliques
Transversus abdominus
Rectus abdominus

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60
Q

What happens to the abdominal muscles as they approach the rectus abdominus?

A

They become aponeurotic.

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61
Q

What is the function of the external obliques? What direction do they run in?

A 
Inferomedial direction (hands in pockets)
Function = torsional movement
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62
Q

What is the function of the internal obliques? Which direction do they run in?

A

Superomedial direction

Allow movement of trunk & compress organs

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63
Q

What is the function of the transverses abdominus muscles?

A

Compress & support organs

Flexion of the trunk

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64
Q

What is the central tendinous intersection between rectus abdominus muscles called?

A

Linea alba

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65
Q

What happens at the arcuate line?

A

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.

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66
Q

What are the functions of the anterolateral abdominal muscles?

A 
Support
Protection
Compression
Force for defecation & urination, vomiting, childbirth
Produce flexion and rotation of trunk
Maintain posture
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67
Q

What happens to the inferior epigastric artery and vein at the arcuate line?

A

They ascend inferiorly to the rectus sheath to the arcuate line - at which point they enters the rectus sheath.

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68
Q

What provides blood supply to the abdominal wall?

A

Inferior epigastric artery and superior epigastric artery - the anastomose to supply musculature of abdominal wall.

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69
Q

What forms the inguinal canal?

A

Herniation when the testes and ovaries descend from embryonic position.

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70
Q

What are the borders of the inguinal canal?

A

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

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71
Q

What is the inguinal ligament?

A

A thickening of the external oblique aponeurosis.

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72
Q
A
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73
Q

Where does the oesophagus meet the stomach?

A

Esophagogastric junction (cardiac orifice).

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74
Q

What is the change of mucosa at the esophagogastric junction termed?

A

Z line - changes from squamous to columnar epithelium.

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75
Q

What controls the passage of food from the oesphagus into the stomach?

A

Lower oesophageal sphincter

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76
Q

What is the landmark for the fundus of the stomach?

A

5th intercostal space

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77
Q

How does the pylorus differ from the body of the stomach?

A

Is a distinct sphincteric region of smooth muscle.

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78
Q

What controls discharge of food into the duodenum?

A

Pyloric sphincter

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79
Q

What marks the junction of the body and pyloric part of the stomach?

A

Angular incisure

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80
Q

What is the lesser curvature of the stomach connected to?

A

Lesser omentum - which is connected to the liver.

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81
Q

Wha is the greater curvature of the stomach connected to?

A

Greater omentum

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82
Q

What are the divisions of the small intestine?

A

Duodenum (20-25cm)
Jejunum (left upper)
Ileum (bottom right)

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83
Q

What are the landmarks of the small intestine

A

From pyloric sphincter to ileocaecal junction.

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84
Q

Is the duodenum intraperitoneal or retroperitoneal?

A

First 2 cm = intra

Remainder = retroperitoneal

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85
Q

What are the 4 parts of the duodenum?

A

Superior
Descending
Horizontal
Ascending

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86
Q

What do the main pancreatic duct + CBD form?

A

Hepatopancreatic ampulla (Ampulla of Vater)

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87
Q

Where does the hepatopancreatic ampulla drain?

A

Via the major duodenal papilla into the duodenum.

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88
Q

Where does the duodenum terminate?

A

The duodenojejunal junction.

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89
Q

What are the four parts of the large intestine?

A

Ascending
Transverse
Descending
Sigmoid

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90
Q

What are the change in directions of the transverse colon known as?

A

The hepatic and splenic flexures

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91
Q

What are the four histological layers of the GIT?

A

Serosa / Adventitia
Muscularis propria
Submucosa
Mucosa

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92
Q

What is the serosa / adventitia?

A

Outer layer of the GIT - visceral peritoneum - lubricates to prevent friction against other organs.

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93
Q

How much does the liver weigh?

A

1.5kg

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94
Q

Which is the largest organ of the body?

A

The liver

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95
Q

When is the liver palpable?

A

When it is diseased

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96
Q

In which regions is the liver found?

A

Right hypochondrium & epigastric, small amount in upper left hypochondrium.

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97
Q

How many surfaces does the liver have and what are they called?

A

Two - diaphragmatic and visceral

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98
Q

How main lobes does the liver have?

A

Two main lobes (right and left) AND two accessory lobes (quadrate and caudate).

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99
Q

What is the blood supply to the right and left lobes of the liver?

A

Each lobe has an hepatic artery (R&L), portal vein (R&L), venous and biliary drainage.

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100
Q

How many segments is the liver divided into?

A

8

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101
Q

What passes between the segments?

A

Intersegmental hepatic veins - take blood to IVC.

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102
Q
A
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103
Q
A
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104
Q
A
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105
Q

What is found between the caudate and quadrate lobes of the liver?

A

Porta hepatis (hilum of liver)

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106
Q

What are the right and left lobes of the liver divided by?

A

Falciform ligament and left sagittal fissure (anteriorly = ligament tires hepatic, posteriorly = ligamentum venosum).

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107
Q

What is the ligamentum venosum?

A

Remnant of foetal ductus venosus - shunted blood from umbilical vein to IVC bypassing liver)

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108
Q

What is the ligamentum teres hepatis?

A

Remnant of the umbilical vein

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109
Q

Which side of the liver are the caudate and quadrate lobe a part of (a) anatomically and (b) functionally?

A

Anatomically - Right

Functionally - left

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110
Q

What is the liver capsule called?

A

The Glisson capsule

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111
Q

Which part of the liver is not surrounded by peritoneum?

A

The bare area - where it lies in direct contact with the diaphragm

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112
Q

What do peritoneal folds on the liver do?

A

Anchor the liver to surrounding abdominal walls and structures - eg falciform ligament & lesser omentum.

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113
Q

What does the falciform ligament enclose?

A

The ligamentum teres

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114
Q

What does the inferior fold of the falciform ligament anchor the liver to?

A

The stomach

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115
Q

What does the lesser omentum anchor?

A

Liver to stomach

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116
Q

What two ligaments is the lesser omentum made of?

A

Hepatogastric and hepatoduodenal

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117
Q

What encloses the structures that pass through the porta hepatis?

A

The hepatoduodenal ligament

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118
Q

What does the coronary ligament to? Where does it run - and what are the corners of it called?

A

Anchors the superior surface of the liver to the diaphragm. Runs along top of liver anteriorly. Corners = triangular ligaments.

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119
Q

What do the right and left triangular ligaments do? What are they formed by?

A

Anchor the right and left lobes of the liver to the diaphragm.

Formed by meeting of anterior and posterior layers of the coronary ligament.

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120
Q

What is contained in the portal triad?

A

Portal vein, hepatic artery & bile passages.

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121
Q

What percentage of cardiac output does the liver receive?

A

25%

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122
Q

Which artery originally supplies the liver?

A

Coeliac artery - which divides into gastric, splenic and hepatic/.

Common hepatic artery (after branching to gastroduodenal) becomes hepatic artery proper which supplies the liver

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123
Q

What does the hepatic artery split into?

A

Right and left hepatic artery.

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124
Q

What is the gallbladder arterial supply?

A

From right hepatic artery - arises small artery which supplies the gallbladder.

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125
Q

What is the dual blood supply of the liver?

A

Supplied by both hepatic artery (25%) - oxygenated, clean blood and portal vein (75% - no valves - blood from gut for metabolism and detoxification).

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126
Q

What is the portal vein formed by?

A

Union of superior mesenteric, inferior mesenteric (joins splenic), splenic, gastric and paraumbilical veins.

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127
Q

What helps hold the liver in position?

A

Attachment of right, left and intermediate hepatic veins to the IVC

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128
Q

How are portal vein branches distributed within the liver?

A

In segmental pattern - end in non-contractile capillaries called venous sinusoids.

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129
Q

What is portosystemtic anastomosis?

A

Communication between tributaries of the portal veins and systemic veins.

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130
Q

Can clinical presentation can portal hypertension cause?

A

Varicose veins
Oesophageal varices
Caput medusa
Haemarrhoids

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131
Q

Name 4 areas of porto-systemic anastomosis

A

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).

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132
Q

What are hepatocytes

A

Liver cells that produce bile.

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133
Q

What are liver lobules?

A

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.

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134
Q

What are Couinaud segments in the liver?

A

Liver divided into 8 segments

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135
Q

What are hepatic sinusoids?

A

Venous channels in the liver

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136
Q

How does venous drainage occur in the liver?

A

Arterial and portal blood mix in hepatic sinusoids –> interlobular veins –> central veins –> collecting veins –> hepatic veins –> IVC

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137
Q

How many hepatic veins are there in the liver?

A

2-3

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138
Q

Why is trauma to the lower ribs serious?

A

Can damage the liver if fractured - cause penetrating wounds. As the liver is so vascularised - can cause severe haemorrhage.

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139
Q

How common are hepatic artery variations?

A

Very common - approx 40-45% of Ps.

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140
Q

How does lymphatic drainage of the liver occur?

A

Superficial and deep lymph nodes converse –> portal hepatis node (regional) –> coeliac nodes (terminal) –> cisterns chyli.

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141
Q

How much lymph does the liver produce?

A

About 1/4 to 1/2 of the lymph received by thoracic duct is produced by the liver.

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142
Q

Where do superficial lymphatics occur in the liver?

A

In the capsule of the liver - drain towards bare area - join deep lymphatics on hepatic vein -> IVC.

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143
Q

How is the liver innervated?

A

SS - coeliac plexus

PSS - anterior and posterior vagal trunks

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144
Q

Where does the mid-sagittal / median line run?

A

From midpoint of manubrium to midpoint of pubic symphysis

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145
Q

Where does the transpyloric plane run?

A

Anterior abdominal wall at 9th costal cartilage

Posterior AW at L1

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146
Q

Where does the trans-tubercular plane run?

A

Tubercles of iliac crests OR on posterior wall at L5

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147
Q

What are the surface landmarks for the liver?

A

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

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148
Q

Where is the landmark for the fundus of the gallbladder?

A

9th costal cartilage MCL

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149
Q

What is the landmark for the spleen?

A

Left side, ribs 9-11 (follows curve of rib 10)

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150
Q

What are the surface landmarks for the stomach?

A

Cardia - 7th costal cartilage, 2cm left of midline
Fundus - 5th ICS MCL
Pylorus = transpyloric plane 1cm right of midline

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151
Q

What are the surface anatomy for the right kidney?

A

Posterior trunk - RHS - superior rib 12/T12
Inferior - L3
Hilum - L1

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152
Q

What is the surface anatomy for the left kidney?

A

Posterior trunk, LHS
Superior - T1 1 / rib 11
Inferior - L3
Hilum - L1

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153
Q

What is the surface anatomy of the pancreas?

A

Head - L2, 1cm right midline
Unicate process - L3
Tail - 10th rib

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154
Q

What is the surface anatomy of the appendix?

A

Lateral 1/3 from right ASIS to umbilicus

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155
Q

What is the surface anatomy of the inguinal ligament?

A

From ASIS to pubic tubercle

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156
Q

What are the attachments of the EO?

A

Ribs 5-12
Lateral iliac crest
Linea albaWhat

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157
Q

What are the actions of the EO?

A

Movement and support of organs

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158
Q

What demarcates the lateral border of the rectus abdominus muscles and the aponeuroses of other muscles?

A

Linea semilunaris

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159
Q

Which structures exit the superficial inguinal ring?

A 
Spermatic cord (male)
Round ligament (female)
Ilioinguinal nerve (M&F)
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160
Q

What are the attachments for the IO muscle?

A 
Thorocolumbar fascia
Mid iliac crest
Lateral 2/3 inguinal ligament
Ribs 8-12 
Linea alba
Pecten pubis
Pubic crest
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161
Q

Which nerves run over the superficial surface of the IO muscle?

A

Iliohypogastric & Ilioinguinal

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162
Q

What are the attachments of the TA muscle?

A 
Thoracolumbar fascia
Medial iliac crest
Lateral 1/3 inguinal ligament
Costal cartilage ribs 7-12
Linea alba
Pubic crest 
Pecten pubis
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163
Q

What does the transversals abdominus muscle do?

A

Supports viscera

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164
Q

What is the innervation of the muscles of the AAW?

A

Anterior rami spinal nerves T7-12, L1 (for TA & IO).

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165
Q

What is the blood supply to the muscles of the AAW?

A

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

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166
Q

Which layers of the AAW becomes layers of spermatic fascia?

A

EO neurosis = external spermatic fascia
IO muscle = cremaster muscle
Transversalis fascia = internal spermatic fascia
Parietal peritoneum = tunica vaginalis

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167
Q

What lies between the rectus abdominus muscles?

A

Tendinous intersections

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168
Q

What are the attachments of the RA muscle?

A

Pubic crest, pubic tubercle, pubic symphysis, costal cartilage ribs 7-12, xiphoid process

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169
Q

What are the actions of the RA muscles?

A

Flexing trunk
Support abdominal viscera
Tense abdominal wall

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170
Q

What are the attachments of the pyramidalis muscle?

A

Pubis, pubic symphysis & linea alba

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171
Q

What is the function of the pyramidalis muscle?

A

Tense linea alba

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172
Q

What is the surface landmark used to identify the deep inguinal ring?

A

Midpoint of the inguinal ligament, lateral to inferior epigastric arteries

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173
Q

What is the clinical significance of Hesselbach’s triangle?

A

Inguinal triangle - is a site of weakness in AAW - likely site of direct inguinal hernia

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174
Q

Which spinal nerves innervate the skin above the umbilicus?

A

T7-9

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175
Q

Which spinal nerves innervate the skin around the umbilicus?

A

T10

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176
Q

Which spinal nerves innervate the skin beneath the umbilicus?

A

T11

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177
Q

What does the spinal nerve at L1 divide into?

A

Iliohypogastric and ilioinguinal nerves

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178
Q

Where is the pancreas found?

A

Behind the lesser curve of the stomach.

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179
Q

What is the embryological origin of the gallbladder, pancreas & spleen?

A

Arise from the foregut.

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180
Q

Where are clinical symptoms from the foregut felt?

A

In the upper 1/3 of the abdomen.

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181
Q

What is bile and what is it produced by?

A

Digestive fluid that emulsifies fats. Is produced by hepatocytes.

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182
Q

What are the functions of the gallbladder?

A
  • Store and conc bile
  • Selectively absorb bile salts
  • Excretes cholesterol and mucus
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183
Q

When is the gallbladder stimulated to secrete bile?

A

When food enters the second part of the duodenum.

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184
Q

What does bile contain?

A

Cholesterol, mucus + bile salts - forms micelles.

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185
Q

What causes gallstones?

A

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.

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186
Q

Where does gallbladder blood supply come from?

A

Cystic artery - which is a branch of the right hepatic artery.

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187
Q

How does bile get from hepatocytes to the gallbladder?

A

Secreted by hepatocytes into canaliculi -> bile ducts -> join to form R&L hepatic duct -> common hepatic duct –> cystic duct -> gallbladder.

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188
Q

What are the three components of the gallbladder?

A

Fundus
Body
Hartman’s pouch

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189
Q
A
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190
Q
A
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191
Q

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?

A

Duodenal papilla - ampulla of Vater.

Controlled by Sphincter of Oddi.

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192
Q

How many pancreatic ducts does the pancreas have?

A

Two - main and accessory. Accessory drains into the duodenum higher than the main.

193
Q

What are the anterior relationships of the gallbladder?

A
  • Visceral surface of the liver

- Fundus - anterior abdominal wall at tip of 9th costal cartilage.

194
Q

Can you normally feel the fundus of the gallbladder?

A

No normally unless tense and inflamed - then may feel it beneath the costal margin.

195
Q

What are the posterior relationships of the gallbladder?

A

Neck - meets lesser omentum posteriorly.

Body - meets 1st & 2nd parts of duodenum posteriorly.

196
Q

What is the inferior relationship of the gallbladder?

A

Fundus & body - inferiorly relate to the transverse colon.

197
Q

What is the arterial blood supply to the gallbladder?

A

Blood from the cystic artery, arises from the right hepatic artery.

198
Q

What is the venous drainage of the gallbladder?

A

Contains lots of veins that go directly into the liver.

199
Q
A
200
Q

What are the bile ducts of the right liver called?

A

Sectoral ducts

201
Q

What are the bile ducts of the left liver called?

A

Segmental ducts

202
Q

What do sectoral ducts drain into?

A

Right hepatic duct

203
Q

What do segmental ducts drain into?

A

Left hepatic duct

204
Q

What do the right and left hepatic bile duct drain into?

A

Common hepatic duct

205
Q

What joins the common hepatic duct to make the common bile duct?

A

Cystic duct

206
Q

What do the common hepatic and cystic duct form?

A

Common bile duct

207
Q

What drains into the duodenum?

A

Common bile duct + pancreatic duct + accessory pancreatic duct (higher up)

208
Q

Where is the upper 1/3 of the common bile duct found?

A

In the free edge of the lesser omentum

209
Q

What is behind & to the side of the upper 1/3 of the common bile duct?

A

Behind - portal vein

Left - common hepatic artery

PART OF THE PORTAL TRIAD

210
Q

Where is the middle third of the common bile duct found?

A

Behind the first part of the duodenum

211
Q

Where is the lower third of the common bile duct found?

A

At posterior aspect of the head of the pancreas.

212
Q

What is ERCP?

A

Endoscopic Retrograde Cholangio Pancreatography

213
Q

Where do the exocrine secretions from the pancreas go?

What are the exocrine secretions?

A

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
Q

Where do the endocrine secretions from the pancreas go?

A

Directly into the blood stream

215
Q

Which direction does pancreatic secretions travel in the pancreas?

A

From tail to body

216
Q

What is the duct called that drains the head of the pancreas?

A

Segmental duct of Santorini - drains head of pancreas.

217
Q

Is the pancreas interperitoneal or retroperitoneal?

A

Retroperitoneal

218
Q

Where is the pancreas located?

A

In the concave part of the duodenum.

219
Q

What is posterior to the pancreas?

A

IVC & renal veins

220
Q

What is the head of the pancreas indented by?

A

The Common bile duct

221
Q

What is the uncinate part of the pancreas?

A

The hooked part of the head

222
Q

Which artery runs along the top of the pancreas?

A

The splenic artery (branched from the coeliac trunk).

223
Q

Which vessel runs along the back of the pancreas?

A

The splenic vein - joins the superior mesenteric vein - then the portal vein.

224
Q

What is the pancreas indented by?

A

The common bile duct?

225
Q

What do the neck and body of the pancreas overlie?

A

The vertebral column

226
Q

What are the neck and body of the pancreas anterior to?

A

IVC & AA - also crosses the origin of the SMA

227
Q

Why is the pancreas not suitable for surgery?

A

Because it is close to major arteries such as the SMA, IVC & AA - makes it hard to remove.

228
Q

What does the tail of the pancreas overlie?

A

The left kidney & the tip of the tail touches the splenic hilum

229
Q

What is the tail of the pancreas attached by?

A

The gastrosplenic ligament

230
Q

What are the arteries that supply the pancreas?

A

Splenic artery

Pancreatico-duodenal artery (branch of the hepatic artery) - supplies the head

231
Q

What are the veins of the pancreas?

A

The pancreatic vein - drains into the portal vein.

232
Q

What are the nerves of the pancreas?

A

The coeliac ganglia (SS) and vagus (PSS)

233
Q

What is the spleen covered by?

A

Capsule

234
Q

What is the red pulp and white pulp of the spleen?

A

Red pulp = blood filled sinuses

White pulp = lymphatic tissue

235
Q

Where is the spleen found?

A

Between 9th & 11th rib - LHS

236
Q

What are the functions of the spleen?

A
  • Immune role - protects against encapsulated bacteria
  • Removes old RBCs
  • Stores platelets
  • Produces RBCs in foetal life
237
Q

What do you need to do if you remove a P’s spleen

A

Vaccinate against certain encapsulated bacteria.

238
Q

What does the spleen sit in front of?

A

Left kidney

239
Q

What is behind the spleen?

A
  • Splenic flexure

- Fundus of stomach (medially)

240
Q

What is the blood supply of the spleen?

A
  • 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
Q

What is the venous drainage of the spleen?

A

Splenic Vein - Runs along posterior surface of pancreas - drains into superior mesenteric vein –> portal vein.

242
Q

What can gallstones cause?

A

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
Q

P has dilated pancreatic duct, gross distension of CBD & jaundice. Possible cause?

A

Pancreatic cancer - jaundice caused by blockage of CBD - can try and stent biliary tube to allow jaundice to settle.

244
Q

Which part of the spleen is notched?

A

The Superior border

245
Q

What is visceral pain described as?

A

Dull aching, pressure pain - not acute or stabbing.

246
Q

What is referred pain?

A

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
Q

Where is gallbladder pain felt?

A

Normally right hypochondrium region, but can be felt in epigastrium.

248
Q
A
249
Q

What is the peritoneum comprised of?

A

Serous membrane - made of connective tissue & squamous epithelium.

250
Q

What are the two types of peritoneum?

A

Parietal peritoneum

Visceral peritoneum

251
Q

Which nerves supply the parietal peritoneum?

A

Segmental spinal nerves - intercostal, diaphragmatic & lumbar

252
Q

What is parietal peritoneum that splits around an organ called?

A

Mesentery

253
Q

Which nerves supply the visceral peritoneum?

A

Visceral nerves

254
Q

What are the divisions of the gut from foetal development?

A

Foregut - Oesophagus -> proximal duodenum + liver + pancreas

Midgut - Distal duodenum - 3/4 of transverse colon

Hindgut - Distal 1/4 transverse colon -> rectum.

255
Q

What is peritoneum made from (i.e. embryological origin?)

A

Mesoderm

256
Q

What is the embryological origin that organs are made from?

A

Endoderm

257
Q

How is the mesentery divided compared to the GIT?

A

Dorsal and ventral divisions. Ventral in front of gut tube, dorsal posterior to it.

258
Q

What does dorsal mesentery do?

A

Attaches gut organs to posterior abdominal wall.

(e.g. gastrosplenic ligament, lienorenal ligament, greater omentum, mesentery of small and large bowel).

259
Q

What does ventral mesentery give rise to?

A

Ligaments around the liver - e.g. falciform ligament & lesser omentum.

260
Q

Why is gut rotation during foetal development important clinically?

A

Can give rise to disorders of rotation (malrotation) - can cause obstruction - and can cause incomplete formation of some structures.

261
Q

What are the two spaces of the peritoneal cavity?

A

Greater sac - majority

Lesser sac - outpouching that lies behind the stomach.

262
Q

What does the ileum absorb?

A

Bile salts
B12
Any water that has not been absorbed

263
Q

What does the jejunum absorb?

A

Water and nutrients

264
Q

Which arteries supply the transverse colon?

What is the venous drainage of the transverse colon?

A

Right, middle & left colic arteries

Middle colic vein

265
Q

How is the transverse colon attached to the posterior abdominal wall?

A

By the transverse mesocolon.

266
Q

Where is the supracolic compartment of the greater sac?

What does it contain?

A

Above the transverse mesocolon.

Liver, biliary tree, stomach, pancreas & spleen.

267
Q

What is the entry between greater and lesser sac called?

A

Epiploic foramen

268
Q

How many layers of peritoneum does the greater omentum have?

A

Four - is a double fold of 2 layers.

269
Q

Which compartment does the greater omentum cover?

A

The infracolic compartment (below the transverse colon)

270
Q

What are the anatomical borders of the lesser omentum?

A

Right border of oesophagus
Lesser curve of stomach to 1st part duodenum
Left lobe of liver

271
Q

What does the free edge of the lesser omentum contain?

A

The portal triad

272
Q

What is the main blood supply of the greater omentum?

A

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
Q

What is the clinical importance of the lesser sac?

A

Pancreas problems - fluid can accumulate in lesser sac - push stomach forward creating mass in epigastrium (pseudocyst).

274
Q

What are the anatomical boundaries of the epiploic foramen?

A

Anterior - hepatoduodenal ligament
Posterior - IVC and right crus of diaphragm
Superior - caudate lobe liver
Inferior - superior duodenum

275
Q

What is found between the sides of the large colon and the abdominal wall?

A

Para-colic gutters (right and left).

276
Q

What is the infra colic divided into by small bowel mesentery?

A

Right and left sides

277
Q

What are the boundaries of the right para-colic gutter?

A

Upper pole of the right kidney
Right lobe of liver (hepato-renal pouch)
Lateral to ascending colon, caecum
Superior to pelvic cavity

278
Q

What are the boundaries of the left para-colic gutter?

A

Left side of transverse mesocolon
Lateral to descending colon & base of sigmoid mesocolon
Superior to pelvic cavity

Bounded superiorly by the phrenicolic ligament.

279
Q

Where does the small bowel mesentery start?

A

At duodenal-jejunal flexure - attachment of small bowel mesentery to PAW

280
Q

What are the boundaries of the right infra-colic compartment?

A

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
Q

Which is bigger - RH or LH infracolic compartment?

A

LH Infracolic

282
Q

What are the boundaries of the left infra-colic compartment?

A

Lateral to left descending colon
Medial to small bowel mesentery
Upper - LHS 1/2 transverse colon
Inferior - pelvic cavity

283
Q

What are the three reflections of the peritoneum?

Why are they important clinically?

A

Vesicle-uterine pouch

Recto-uterine pouch

Recto-vesical pouch

Clinically important as fluid can accumulate in these pouches (infection, abscess etc).

284
Q

What is the vesico-uterine pouch?

A

The fold of peritoneum between the bladder and uterus

285
Q

What is the recto-uterine fold?

A

Fold of peritoneum between rectum and uterus

286
Q

What is the recto-vesicle fold?

A

Fold of peritoneum between the bladder and the rectum

287
Q

Does the parietal peritoneum experience somatic or autonomic nerve innervation?

A

Somatic - is pain sensitive

288
Q

Is the visceral peritoneum innervated by somatic or autonomic nerves?

A

Is innervated by autonomic nerves

289
Q

Why is the peritoneum important in fluid exchange?

A

Big SA - allows a lot of fluid exchange between tissue lymphatics and venues - can be used for peritoneal dialysis.

290
Q

Why is the peritoneum important for infection?

A
  • 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
Q

In which division of the bowel is the appendix located?

A

Midgut

292
Q

What is the spread of cancer through the peritoneum called?

A

Trans-coleomic spread

293
Q

What is the latin word for peritoneum?

A

Coelo

294
Q

Why is cancer in the peritoneum bad?

A

Can get seedlings of cancer deposits on the peritoneal lining.

Can also cause leakage of excess fluid containing cancer cells = malignant ascites.

295
Q

What is malignant ascites?

A

Leakage of fluid containing cancer cells in the abdomen.

296
Q

What are the sites of attachment of the greater omentum?

A

Greater curvature of stomach to diaphragm, spleen & transverse colon

297
Q

What are the three different ligaments of the greater omentum?

A
  • Gastrocolic
  • Gastrosplenic
  • Gastrophrenic
298
Q

What are the two ligaments of the lesser omentum?

A

Hepatogastric

Hetaptoduodenal

299
Q

What does the lesser omentum connect?

A

The porta hepatis to lesser curvature of stomach and duodenum

300
Q

What does the anterior sheet of the greater omentum attach to?

A

Greater curvature of stomach

301
Q

What does the posterior sheet of greater omentum attach to?

A

Duodenum

302
Q

The ligamentum teres is a remnant of which embryological structure?

A

The umbilical vein

303
Q

What do the anterior and posterior lamina of the coronary ligaments fuse to form?

A

The triangular ligaments

304
Q

What is the communicating foramen between the greater and lesser sacs?

A

The omental foramen

305
Q

What are the boundaries of the omental foramen?

What is its clinical significance?

A

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
Q

Which veins unite to form the portal vein?

A 
Splenic vein (+ inferior mesenteric)
Superior mesenteric (+ gastric veins, para-umbilical veins & cystic veins)
307
Q

What is the ligament on the posterior of the liver called that divides it into right and left lobes?

A

The ligamentum venosum

308
Q

What is the surface landmark of the gallbladder?

A

9th costal cartilage, MCL

309
Q

What is the value at the neck of the gallbladder called?

What is its function?

A

Spiral valve

Ensures unidirectional flow of bile

310
Q

What structure does the common bile duct join with and what is the name of the conjoint structure?

A

Joins main pancreatic duct

Forms the hepatopancreatic duct (Ampulla of Vater - opening controlled by sphincter of Oddi).

311
Q

Where does the hepatopancreatic ampulla drain?

A

Drains into the 2nd part of the duodenum at major papilla.

Above = minor papilla (drainage of accessory pancreatic duct).

312
Q

Which border of the spleen is notched?

A

The superior border

313
Q

What direct branch of the AA does the splenic artery arise from? What is the vertebral level of this?

A

Arises from coeliac trunk - T12

314
Q

Which ligament attaches the spleen to

  • the abdominal wall anterior to left kidney
  • the greater curvature of the stomach?
A
  • Splenorenal ligament

- Gastrosplenic ligament

315
Q

Which organ is found in the hilum of the spleen?

A

The tail of the pancreas

316
Q

What is the function of the red and white pulp of the spleen?

A

Red
- Haemolysis, phagocytosis & sequestration of platelets

White - T & B lymphocytes and macrophages

317
Q

What are the names of the internal folds of the gastric mucosa?

A

Rugae

318
Q

What is the function of the pyloric sphincter?

A

To control outflow of stomach contents to duodenum,

319
Q

What is a paediatric development malformation of the stomach and its clinical significance?

A

Pyloric stenosis - presents with failure to thrive and projective vomiting, can cause death.

320
Q

Is the duodenum intra or retro peritoneal?

A

Retroperitoneal - except for first 2cm which are intra peritoneal.

321
Q

Is the pancreas intra or retroperitoneal?

A

Retroperitoneal

322
Q

Is the ascending colon intra or retroperitoneal?

A

Retroperitoneal

323
Q

Is the transverse colon intra or retroperitoneal?

A

Intraperitoneal

324
Q

Is the descending colon intra or retroperitoneal?

A

Retroperitoneal

325
Q

Is the sigmoid colon intra or retroperitoneal?

A

Intraperitoneal

326
Q

How is the sigmoid colon attached to the PAW?

A

Attached by sigmoid mesocolon

327
Q

Which artery supplies the small intestine? Which arteries arise from it?

A

Superior mesenteric artery

Gives rise to:

  • Ileocolic artery
  • Right colic artery
  • Middle colic artery
328
Q

What does the ileocolic artery supply?

A

Caecum, terminal ileum & appendicular artery (supplying appendix)

329
Q

What does the right colic artery supply?

A

Ascending colon

330
Q

What does the middle colic artery supply?

A

The transverse colon - proximal 2/3rds

331
Q

Which vein drains the small intestine and proximal colon (midgut)?

A

Superior mesenteric vein

332
Q

Which vessel does the superior mesenteric merge with and what do they form?

A

Merges with splenic vein

Forms the portal vein

333
Q

How can you determine the jejunum from ileum by looking at arterial arcades?

A

Are only a few arcades in the jejunum and are many arcades in the ileum.

334
Q

How can you differentiate the jejunum from the ileum by looking at vasa recta?

A

Vasa recta are long in the jejunum and short in the ileum.

335
Q

What is the name of mucosal folds in the small intestines?

A

Plicae circulares or valvulae conniventes

336
Q

In which part of the small intestine are the plicae circulares most prominent?

A

In the jejunum

337
Q

Which arteries arise from the inferior mesenteric artery?

A

Left colic artery
Sigmoid arteries
Superior rectal artery
Marginal artery

338
Q

Which artery supplies the descending colon?

A

The left colic artery

339
Q

Which artery supplies the proximal rectum?

A

The superior rectal artery

340
Q

Which artery supplies the distal 1/3 of transverse colon?

A

The marginal artery

341
Q

Which artery supplies the sigmoid colon?

A

Sigmoid arteries

342
Q

Which vein drains the distal colon (hindgut)? Which vein does this drain into?

A

Inferior mesenteric vein - drains into splenic vein.

343
Q

What is the normal position of the appendix?

A

Retrocaecal

344
Q

What are the bands of longitudinal muscle in the large intestines called?

A

Taeniae coli

345
Q

What are the outpouchings of colon wall called? What are the formed by?

A

Haustra - occur from contraction of inner circular muscle

346
Q

What are fatty omental appendices of the peritoneum called?

A

Epiploic appendages

347
Q

Which organs are found in the retroperitoneum?

A

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
Q

What structures are found in the hilum of the kidney?

A

Vein (anteriorly), arteries, renal pelvis & ureter

349
Q

What are the top, middle and bottom of the kidney called?

A 
Top = Upper pole
Middle = Interpolar region
Bottom = Lower pole
350
Q

What are the functions of the kidney?

A

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
Q
A
352
Q

Where are the nephrons of the kidney found?

A

In the columns between the pyramids of the medulla

353
Q

What do the pyramids of the kidney contain?

A

The collecting ducts - they drain into minor calyces.

354
Q

How many major calyces does the average kidney have?

A

4-6

355
Q

What are the surface markings of the transpyloric plane?

Where does the transpyloric plane pass on the kidneys?

A

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
Q

What lies in front of the right kidney?

What lies medially to the right kidney?

A

Ascending colon & hepatic flexure.

Over hilum = second part of duodenum

Medially = IVC

357
Q

What lies in front of the left kidney?

What is medial to the left kidney and what is superior to the left kidney?

A

Anteriorly = transverse colon to splenic flexure + part of descending colon,

Medially = tail of pancreas

Superiorly = adrenal gland + spleen

358
Q

Which muscles lie posteriorly to the kidneys?

A

Psoas major + quadratus lumborum

359
Q

What function does the fascia covering the kidney have?

A

Protection and holds the kidney in place

360
Q

What is the fascia surrounding the kidney called? What does it contain?

A

Perirenal fascia = contains perirenal fat

361
Q

Which arteries supply the kidneys? Which is longer?

Where do they arise from?

A

Left and right renal arteries - right is longer.

Arise from AA laterally.

362
Q

Which vessel does the renal vein run under?

A

The SMA

363
Q

Describe the organisation of blood supply to the kidney.

A 
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
Q

What type of arteries are kidney arteries? Why is this clinically important?

A

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
Q

Which renal vein is longer and why?

A

Left vein longer - IVC lies closer to the right.

366
Q

Which veins drain into left renal vein?

A

Gonadal veins + adrenal vein

367
Q

Does the right adrenal vein drain directly to IVC or into right renal vein?

A

Directly into IVC.

368
Q

Name 4 nerve plexi in the retroperitoneum and their locations.

A

Coeliac plexus (around coeliac trunk)
Aortic plexus (body of aorta)
Superior hypogastric plexus (found on bifurcation of aorta)
Inferior hypogastric plexus (pelvis)

369
Q

Is the nerve supply in the retroperitoneum autonomic, somatic or both?

A

Essentially autonomic only.

370
Q

Which nerves supply the PSS of the retroperitoneum?

A

Top - Vagus
Bottom - S2,3 &4 (pelvic splanchnic)

Both form prevertebral plexi

371
Q

Which dermatome is the kidneys?

A

T10 - L2 - lower hypochondrium

372
Q

Which dermatome is the umbilicus?

A

T10

373
Q

Where does kidney pain tend to be felt?

A

Loin, testicles & inner thigh.

374
Q

Name the three narrowing points of the ureter.,

What is their clinical significance?

A

Ureteropelvic junction
Crossing of iliac artery
Ureterovesical junction

Is where stones get stuck

375
Q

What dermatome is the ureter?

A

T11 - L2

376
Q

What are the lymphatics of the retroperitoneum?

A

Follow the great vessels, drain into cisterns chyli which drains into thoracic duct

377
Q

What is agenesis of the kidney?

A

A kidney is missing - can be unilateral or bilateral.

378
Q

What is a horseshoe kidney?

A

Kidneys are joined across the midline?

379
Q

What is the ureter lined by?

A

Transitional cell epithelium - waterproofing.

380
Q

Where is the ureter located?

A

In the transverse processes of the lumbar vertebrae - cross into the pelvis over the common iliac artery.

381
Q

Where does the top of the ureter obtain blood from?

A

The renal artery & gonadal artery

382
Q

Where does the bottom of the ureter obtain blood from?

A

A variety of arteries inc internal iliac, superior vesicle, uterine artery, middle rectal, vaginal & inferior vesical.

Has good blood supply.

383
Q

Where does the middle of the ureter obtain blood from?

What is the clinical significance of this?

A

Aorta - but not a good supply - means that is harder to recover from trauma / surgery.

384
Q

What muscle is the bladder made of?

A

Detrusor muscle

385
Q

What are the folds of bladder lining called?

A

Rugae

386
Q

Where does urine enter the bladder?

A

Through the ureteric orifice - each side located at top of trigone area

387
Q

How is the trigone area different to the rest of the bladder? What does it contained?

A

It has a different embryological origin.

Trigone = endoderm
Rest of bladder = ectoderm

Contains sensory afferent nerves - tells brain when it needs to pee.

388
Q

What is the top of the bladder lined by?

A

Peritoneum

389
Q

When are bladder perforations problematic and when are they not?

A

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
Q

What type of cell lines the bladder?

A

Transitional cell epithelium

391
Q

Why do F Ps get more UTIs than M Ps?

A

Shorter urethra than men

392
Q

What are the PSS effects on the lower urinary tract?

A

Contract detrusor muscle (bladder)
Vasodilation
Penile erection
Relaxation of urethral and anal sphincters

393
Q

What are the SS effects on the lower urinary tract?

A 
Relax detrusor muscle
Vasoconstriction 
Ejaculation 
Contract internal anal and urethral sphincters
Increase sweating
394
Q

What are the following vertebral levels for the following?

  • Superior duodenum
  • Descending duodenum
  • Horizontal duodenum
  • Ascending duodenum
A

L1
L2
L3
L2

395
Q

Which is the only intraperitoneal part of the pancreas?

A

The tail

396
Q

Where does the endocrine secretions drain into from the pancreas?

A

Into the vasculature of the pancreas (splenic arteries and pancreaticoduodenal arteries)

397
Q

What are the arteries of the pancreas?

A

Pancreatic arteries -from the Splenic artery

Pancreaticoduodenal (x4 of these - anterior superior, posterior superior, anterior inferior and posterior inferior)

398
Q

What are the 4 pancreaticoduodenal arteries?

A

Anterior & Posterior Superior Pancreaticoduodenal (from gastroduodenal artery)

Anterior & Posterior Inferior Pancreaticoduodenal arteries (from SMA)

399
Q

What does the splenic vein join to form the portal vein?

A

Superior mesenteric vein

400
Q

Which vein drains into the splenic vein?

A

Inferior mesenteric vein

401
Q

What are the layers surrounding the kidney?

A 
Parietal peritoneum
Paranephric fat
Renal fascia (anterior and posterior)
Perinephric fat
Renal capsule
402
Q

Between which vertebral levels do the kidneys lie?

A

Between T11 (left) and T12 (right) - to L3

403
Q

What shape are the adrenal glands?

A

Right - triangular

Left - semilunar

404
Q

What is the arterial supply of the adrenal glands?

A

Superior adrenal artery
Middle adrenal artery
Inferior adrenal artery

405
Q

Where does the superior adrenal artery arise form?

A

Inferior phrenic artery

406
Q

Where does the middle adrenal artery arise from?

A

Abdominal aorta

407
Q

Where does the inferior adrenal artery arise from?

A

The renal artery

408
Q

What is the venous drainage of the adrenal glands?

A

Left adrenal - into renal vein then IVC

Right adrenal - directly into IVC

409
Q

Which muscle does the ureter pass over anteriorly?

A

The psoas major muscle

410
Q

What is the level of origin of the IVC?

A

L5

411
Q

Which vessels unite to form the IVC?

A

Common iliac veins

412
Q

At what vertebral level does the AA begin?

A

T12

413
Q

At which vertebral level does the AA bifurcate?

A

L4

414
Q

Name three unpaired visceral arteries from the AA

A

Coeliac trunk
SMA
IMA

415
Q

Name three paired visceral arteries arising from the AA.

A

Middle suprarenal arteries
Renal arteries
Gonadal arteries

416
Q

Name two paired somatic arteries from the AA.

A

Inferior phrenic arteries

Lumbar arteries

417
Q

What are the sympathetic trunks?

A

Sympathetic nerves running from base of skull down the vertebral column.

418
Q

What is the name of the nerve that connects the superior and inferior hypogastric plexuses?

A

Hypogastric nerve

419
Q

What nerve fibre type is in the hypogastric plexus?

A

Autonomic nerve fibres - SS and PSS

420
Q

What type of nerves are the lumbar splanchnic nerves?

A

Autonomic fibres - from sympathetic trunk to preaortic ganglia and aortic plexuses

421
Q

What are the attachments of posts major?

A

Lateral aspects of lumbar vertebrae
Pass under inguinal ligament
Attaches to femur

422
Q

What are the attachments of posts minor?

A

Not always present - arises from lumbar vertebrae & attaches to anterior surface of posts major

423
Q

What are the attachments of the iliacus muscle?

A

Arises from iliac fossae - passes under inguinal ligament to insert with posts major onto the femur

424
Q

What is the attachment of quadratus lumborum muscle?

A

Arises from ilia crests and attaches to lumbar vertebrae and rib 12.

425
Q

What are the muscle actions of psoas major?

A

Hip flexion (uses conjoint tendon with iliacus for this)

+ flexion of trunk

426
Q

What are the muscle actions of iliacus?

A

Conjoint tendon with psoas major - causes hip flexion.

427
Q

What is the action of psoas minor?

A

Flexion of trunk but minimal impact

428
Q

What is the action of quadratus lumborum?

A

Extends trunk if pelvis is fixed, unilaterally laterally flexes trunk

429
Q

What does the iliohypogastric nerve innervate?

A

Abdominal wall muscles

Inguinal region cutaneous

430
Q

What does the ilioinguinal nerve innervate?

A

Abdominal wall muscles
Proximal medial thigh
Mons pubis cutaneous

431
Q

What does the lateral cutaneous nerve of the thigh innervate?

A

Lateral thigh cutaneously

432
Q

What does the femoral nerve innervate?

A

Anterior thigh musculature

Anterior thigh + medial leg cutaneous

433
Q

What does the obturator nerve innervate?

A

Medial thigh muscles + skin

434
Q

Name 5 muscles of PAW

A 
Psoas major
Psoas minor (not always present)
Quadratus lumborum
Diaphragm
Iliacus
435
Q

Which two muscles of the PAW form a conjoint tendon?

What is the clinical significance of this conjoint tendon?

A

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
Q

What herniates the diaphragm at T8?

A

IVC

Right phrenic nerve (innervates the diaphragm)

437
Q

What herniates the diaphragm at T10?

A

Oesophagus & vagal trunks

438
Q

What herniates the diaphragm at T12

A

Aorta
Thoracic duct
Azygos vein

439
Q

Where do the splanchnic nerves arise?

A

Thorax - run down to pelvis in vertebral column.

440
Q

What is psoas major innervated by?

A

Anterior rami L1 - L3

441
Q

What is psoas minor innervated by?

A

Anterior rami L1

442
Q

What is the quadratus lumborum innervated by?

A

Anterior rami of T12 & L1 - L4

443
Q

What is the iliacus muscle innervated by?

A

Femoral nerve - L2-4

444
Q

What is the diaphragm innervated by?

A

C3,4 & 5 (Phrenic nerve) and Intercostal nerves - T5-12.

445
Q

Name 3 types of fascia found in the PAW

A

Psoas fascia
Iliac fascia
Thoracolumbar fascia

446
Q

What do psoas and iliac fascia overlie?

A

The respective muscles

447
Q

What does the top of psoas fascia form?

A

Thickens to form medial arcuate ligaments

448
Q

What are the three layers of thoracolumbar fascia?

A

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
Q

What muscle does the ureters travel over anteriorly?

A

Psoas major

450
Q

Name one unpaired somatic artery in the abdomen.

A

Median sacral artery

451
Q

Where do the common iliac arteries branch?

A

L4

452
Q

What do the lumbar arteries do?

A

Are 8 of them - supply blood to muscles of PAW

453
Q

What do the middle suprarenal arteries supply & where are they found?

A

Immediately superior to renal arteries on AA - supply the suprarenal (adrenal) glands.

454
Q

Where are the renal arteries found?

A

Immediately inferior to the SMA. Are lateral arteries on the AA.

455
Q

Where are the gonadal arteries found?

A

Immediately inferior to the renal arteries - are paired anterior arteries.

456
Q

Where are the inferior phrenic arteries found?

A

Immediately inferior to the aortic hiatus - innervates the diaphragm.

457
Q

Where are the lumbar arteries found? What do they supply blood to?

A

Laterally on AA - 4 pairs - underneath renal arteries - on the posterior of the AA.

Muscles of PAW & spinal cord.

458
Q

Where is the median sacral artery found?

A

Just superior to the aortic bifurcation posteriorly.

459
Q

What does the AA bifurcate into?

A

The common iliac arteries (L4)

460
Q

What is the IVC formed by?

A

The union of common iliac veins at L5

461
Q

What are the tributaries of the IVC?

A
  • 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
Q

What do somatic nerves control?

A

Motor and (usually) / or sensory - very few purely motor nerves.

463
Q

Which nerves innovate the abdominal wall?

A

Iliohypogastric (L1)

Ilioinguinal (L1)

464
Q

What are the vertebrae levels of the following nerves:

  • Iliohypogastric
  • Ilioinguinal
  • Genitofemoral
  • Lateral cutaneous nerve of the thigh
  • Obturator
  • Femoral
A
  • Iliohypogastric = L1
  • Ilioinguinal = L1
  • Genitofemoral = L1-2
  • Lateral cutaneous nerve of the thigh = L2-3
  • Obturator = L2-3
  • Femoral = L2-3
465
Q

All the nerves of the abdomen arise laterally to psoas major except which one?

A

Genitofemoral nerve

466
Q

Autonomic innervation of abdominal viscera are carried out by which nerves?

A

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
Q

Somatic pain = What does sharp, localised pain indicate?

How can you determine what is causing the pain?

A

Skeletal muscle, bone or CT pain - follows dermatome or cutaneous mapping.

468
Q

What does dull, poorly localised pain indicate?

A

Visceral pain = Pain from viscera and vessels - usually due to stretch, ischaemia or irritation.

469
Q

What is the dermatome for the inguinal region?

A

L1

470
Q

What is the dermatome for the xiphoid process?

A

T6

471
Q

Why do we get referred pain?

A

The brain cannot distinguish between visceral and cutaneous pain.

472
Q

Where is visceral pain from the following referred to:

  • Foregut
  • Midgut
  • Kidneys and Upper Ureter
  • Hindgut
A
  • Lower thorax & epigastric region
  • Umbilical region
  • Flanks (lateral regions)
  • Pubic region, thighs and groin
473
Q

What is the difference between direct and indirect inguinal hernia?

A

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
Q

What are the following of the inguinal canal:

  • Anterior boundaries
  • Posterior boundaries
  • Roof
  • Floor
A

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
Q

What is the inguinal ligament and what is its attachments?

A

Thickening of the EO aponeurosis

From ASIS to pubic tubercle

476
Q

What are the branches of the SMA?

A
  • Jejunal and ileal branches
  • Middle colic
  • Right colic
  • Ileocolic
477
Q

Which nerves innervate the pelvic organs for sympathetic innervation?

A 
Lumbar splanchnic (L1-2)
Sacral splanchnic (S2-4)
478
Q
A

NME (2 decks)

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