Block 2: Gray's Redo Clarifications Flashcards
1
Q
Processus Vaginalis
what is it?
what happens to it?
A
parietal peritoneum that precedes the testes (or labia majora in women) as it migrates from a position in the upper wall to outside the abdomen
usually obliterates, leaving a distal portion that surrounds the testes as tunica vaginalis
2
Q
Explain the relationship b/w the allontois, urachus, and urinary bladder
A
the urinary bladder is initially drained by the allantois.
this, however, is obliterated during fetal development and becomes a fibrous cord–the urachus.
remnants of the urachus can be found in adults
3
Q
Where can you find the remnant of the urachus?
A
median umbilical ligament
4
Q
What are the main congenital abnormalities of kidney formation?
A
obstructive uropathy renal agenesis renal hypoplasia multicystic dysplastic kidney double collecting system
5
Q
Renal Hypoplasia
A
small kidneys are produced with a decreased number of nephrons
6
Q
Describe the life outcomes for renal hypoplasia
A
unilatral: compatible with normal life if the other kidney is normal
bilateral: Potter’s Sequence
7
Q
Potter’s Sequence
A
biateral renal hypoplasia that leads to oligohdyramnios, fetal compression and lung hypoplasia
8
Q
The kidney originates from the
A
intermediate mesoderm
9
Q
What are the stages of kidney development?
A
Pronephros
Mesonephros
Metanephrogenic Mesenchyme
10
Q
What becomes the definitive kidney?
A
metanephros
11
Q
Ureteric bud originates from
A
the mesonephric duct
12
Q
What is derived from the ureteric bud (besides the definitive kidney)
A
collecting system (ureter, renal pelvis, major and minor calyces and collecting tubules)
13
Q
What is derived from the metanephric blastema?
A
excretory system (tubules, the nephrons)
14
Q
Initial function of the ureteric bud
A
to communicate with the metanephros to initiate and form the metanephric (permanent) kidneys
15
Q
What would cause renal agenesis?
A
no ureteric bud
no mesenchyme
no interaction
16
Q
In the urinary system, the cloaca gives rise to the
A
bladder and urethra
17
Q
Cloaca
A
a hindgut s(x) that’s a common chamber for GI and urinary waste
18
Q
Urogenital sinus division
A
upper part: forms the bladder
pelvic part: forms the urethra, some of the reprodutive tract in females and prostatic &* membranous urethra in males
phallic/caudal part: female reproductive tract; spongy urethra in males
19
Q
What divides the cloaca in 2?
A
uro-rectal septum
20
Q
What do the mesonephric ducts develop into?
A
men: ejaculatory ducts
women: degenerate due to lack of testicular androgens
21
Q
Foregut contents
A
esophagus to 2nd part of duodenum; also liver and pancreas
22
Q
Midgut contents
A
distal 1/3 duodenum to proximal 2/3 large intestine
23
Q
Hindgut contents
A
distal 1/3 of transverse colon, descending colon, sigmoid colon
24
Q
Stomach rotation
A
moves caudally and rotates 90 degrees clockwise
25
What is the result of stomach rotation?
left wall becomes the anterior wall, right side becomes the posterior wall
26
Describe midgut lengthening
happens with rotation or twisting of the gut tube (90 degree rotation) around the SMA
27
Midgut reduction
When does this happen? What happens?
Why?
when: Week 10
what: entire midgut length (loop) can be accommodated, so the gut reduces into the abdomen and continues its rotation by 180 degrees
Abdomen is large enough that
28
What is the result of midgut rotation?
cephalic limb on the L side of abdominal cavity; caudal limb on R lower portion of abdominal cavity
29
Cloaca is formed when
hindgut joins w/ allantois
30
Cloaca eventually divides into
urogenital sinus (ventral) and the rectum and anal canal (dorsal)
31
Mesentary derived from
splanchnic mesoderm
32
Ventral mesentary in development eventually forms
lesser sac and falciform ligament
33
Foregut blood supply
celiac artery
34
Midgut blood supply
SMA
35
hindgut blood supply
IMA
36
Pancreas develops from
dorsal and ventral pancreatic bud
37
Fusion of pancreatic buds
dorsal bud forms the body; ventral bud forms the head & ucinate process
38
What parts of the GI tract are retroperitoneal?
duodenum (except 1st part); ascending and descending colon
39
Omphalocele
intestinal loops fail to return from the umbilical cord into the abdominal cavity
40
Result of omphalocele
herniated loops cause large swelling in umbilical cord
41
Congenital umbilical hernia
layers of muscle or skin around umbilicus are absent or fail to close properly
some viscera can leave the abdominal cavity and enter the umbilical cored
42
Total primitive midgut rotation degrees
270 degrees
43
Left sided colon
rotation only completes to 90 degrees so the colon and cecum will be on L side of abdomen and later parts on the R side
44
Reversed rotation
midgut rotates clockwise instead of counterclockwise
45
Stenosis and Atresia of Intestines
due to incompletion or failure of intestinal recanalization
46
Meckel's Diverticulum
finger like pouch that develops near the ileocecal junction
represents remaining part of ompalocele (yolk sac)
47
How is the perineum formed?
urorectal septum fuses w/ cloacal membrane
48
Hirchsprung's Disease
what is it?
what causes it?
what: colon dilation (megacolon)
caused by: absence of autonomic innervation in that portion of the colon caused by failure of neural crest cells to properly migrate
49
Anal Agenesis (without a fistula)
anal canal ends blindly or ha an ectopic opening
50
Anal agenesis (w/ a fistula)
anal canal may end in a fistula, which opens into the perineum
51
Anal Stenosis
anal canal constricted and narrowed
52
What causes anal stenosis?
urorectal septum grows too far dorsally
53
Imperforate Anus
what is it?
what causes it?
what is it: anus exists in normal location but is covered by a thin layer of tissue
what causes it: failure of the anal membrane to rupture
54
Anorectal Agenesis
rectum ends blindly but ends in a fistula associated w/ bladder (rectovesicle fistula), urethra in males (rectourethral fistula) or the vagina in females (rectovaginal fistula)
55
Rectal Atresia
rectum and anus separated by a wedge of tissue
56
Hepatoduodenal Ligament
where:
significance
where: b/w duodenum and liver
significance: supports the portal triad
57
Portal Triad
hepartic artery
hepatic vein
bile duct
58
Caudate lobe location
b/w IVC and fossa of ligamentum venosum
59
Quadrate Lobe location
lower aspect of visceal surface, b/w gallbladder and a fossa produced by ligamentum teres
60
Ligamentum Teres
a remnant of the fetal umbilical vein (L)
61
What separates the caudate and quadrate lobes?
porta hepatis
62
Clinical significance of the hepatoduodenal ligament
can be clamped to stop profuse bleeding from the liver
63
Congenital Hydrocele
fluid accumulation in the scrotum
64
Malrotation
incomplete rotation & fixation of the midgut after passing from umbilical sac and returning to abdominal coelom
65
Describe how volvulus happens
if the duodenojefjunal flexure doesn't end up in the right place the small bowel can twist around the axis of the SMA
66
Describe how volvulus happens
if the duodenojefjunal flexure doesn't end up in the right place the small bowel can twist around the axis of the SMA
67
Congenital hydrocele
what is it?
what causes it?
what: collection of serous fluid within the tunica vaginalis
cause: failure of the processus vaginalis to close
68
Inguinal Hernia
abdominal cavity contents protrude into the scrotum
69
Hematocele
collection of blood in the tunica vaginalis
70
How to distinguish b/w hematocele and hydrocele?
shining a light on the testicles
71
Variocele
dilation of the veins draining the penis
72
Portocaval Anastamoses sites
1. gastric & esophageal
2. umbilical and paraumbilical
3. superior and middle or inferior rectal
73
Eventration of the Diaphragm
what is it?
cause
what: abnormal elevation of 1 leaf of the diaphragm
caused by: paralysis, aplasia, or atrophy of muscle to varying degrees
74
Pouch of Morrison
hepatorenal pouch
75
Medial Arcuate ligament
cross muscles of abdominal wall to attach to vertebrae
76
Median Arcuate Ligament
crosses aorta and is continuous w/ the crus on each side
77
Semilunar Line
curved, tendinous intersection on either side of the rectus abdominis
78
Pectineal Line
ridge on the superior ramus of the pubic bone
79
Arcuate Line
what is it?
significance?
denotes lower limit of the posterior rectus sheath
also where the inferior epigastric vessels perforate the rectus abdominis
80
Minor duodenal papilla f(x)
entrance for the accessory pancreatic duct
81
Superior duodenum location (in relation to surroundings)
anterior to bile duct, gastroduodenal artery, portal vein, and IVC
82
Descending duodenum location (in relation to surroundings)
anterior surface crossed by transverse colon, posterior is right kidney, medial is head of pancreas
83
Inferior duodenum location (in relation to surroundings)
crosses IVC & aorta
| crossed anteriorly by SMA and SMV
84
Suspensory Ligament of Trietz
suspends to duodenojejunal flexure
85
Duodenal Compression
3rd part of the duodenum is posterior to the SMA so it can be compressed
86
Compare and contrast jejunum and ileum
Jejunum: longer vasa recta, more plicae circulares, less arterial arcades, thicker wall
Ileum: shorter vasa recta, no plicae circulares, more arterial arcades, thinner wall
87
Foregut
afferent pathway
spinal cord level
referral area
pathway: greater splanchnic nerve
level: T5 to T9 (or T10)
referral: lower thorax and epigastric
88
Midgut
afferent pathway
spinal cord level
referral area
pathway: lesser splanchnic nerve
level: T9, T10 (or T11, T12)
referral: umbilical region
89
Kidneys and Upper Ureter
afferent pathway
spinal cord level
referral area
pathway: least splanchnic
level: T12
referral: flanks (lateral regions)
90
Hindgut
afferent pathway
spinal cord level
referral area
pathway: lumbar splanchnic
levecl: L1, L2
referral: pubic region, lateral & anterior thighs, groin
91
Chromaffin Cells
cells of suprarenal (adrenal) glands; main source of norepinephrine and epinephrine
92
Branches of the celiac trunk
splenic
left gastric
common hepatic
93
L gastric gives rise to
oesophageal branches
94
L gastric anastamoses w/
R gastric
95
Splenic gives rise to
L gastroomental
Short Gastrics
Pancreatic Branches
96
Splenorenal Ligament
contains the splenic artery
97
Common Hepatic Branches
proper hepatic
| gastroduodenal
98
Proper Hepatic Branches
right gastric
R and L hepatic
cystic
99
Gastroduodenal Branches
```
R gastroomental
Superior Panreaticoduodenals (anterior and posterior)
```
100
Anterior to the SMA
pyloric part of stomach, splenic vein, neck of pancras
101
Posterior to SMA
L renal vein, uncinate process of pancreas, inferior part of duodenum
102
Branches of the SMA
inferior pancreaticoduodenal artery
jejunal & ileal arteries
middle and right colic arteries
ileocolic artery
103
Ileocolic Artery Branches
ileal branches
colic branches
cecal arteries
appendicular artery
104
IMA Branches
left colic
sigmoid
superior rectal
105
Arc of Riolan
anastamosis b/w middle colic branch of SMA and L colic branch of IMA
106
Omental Foramen Border
posterior to the hepatoduodenal ligament
107
What passes through the diaphragm hiatuses?
Aortic: azygos vein & thoracic duct
Esophageal: vagus nerve
IVC: R phrenic
108
What happens if a gallstone perforates the fundus?
the gallbladder lies close to the transverse colon so it'll perforate the bowel
109
Round ligament of the liver
remnant of the L umbilical vein
110
Purpose of portal caval shunting
treatment for hypertension
combine portal circulation w/ caval circulation to take the load off the portal system
111
Usual portacaval shunt
connection made b/w portal vein and IVC (want to go with the biggest veins to make the biggest impact)
112
Suprarenal arteries supply
superior: inferior phrenic
middle: abdominal aorta
inferior: renal artery
113
Gastrosplenic Ligament
connects the spleen to the greater curvature of the stomach
114
McBurney's Point
location
significance
location: right side of abdomen, 1/3 distance from ASIS to umbilicus
significance: most common location of the appendix where it is attached to the cecum
115
List the retroperitoneal structures
```
Suprarenal/adrenal glands
Aorta/IVC
Duodenum (except the 1st part)
Pancreas (except the tail)
Ureters
Colon (ascending and descending)
Kidneys
Esophagus
Rectum
```
116
pancreas, IVC, aorta orienttaion
paneas is anterior to those
117
SMA and pancreas
SMA behind neck of pancreas, anterior to uncinate process
118
Posterior to the neck of the pancreas
splenic and SMV unite to form hepatic portal vein
119
Hepatic Portal vein formedby
splenic vein
| SMV
120
Borders of Hesselbach's Triangle
significance
medial: rectus abdominis
lateral; inferior epigastric vessels
inferior: inguinal ligament
denotes an area of potential weakness in the abdominal wall
121
Direct Inguinal Hernia
enters the inguinal canal medial to the inferior epigastric vessels
goes directly through posterior border of the canal
122
Indirect inguinal hernia
enter through deep inguinal ring
| lateral to interior epigastric vessels
123
Liver Innervation
hepatic plexus (sympathetic and parasympathetic nerve fibers)
124
Inguinal Ligament
forms the base of the inguinal canal
inferior border of hesselbach' triangle
125
L testicular/ Ovarian Vein
drains into the L renal vein
126
R testicular/ovarian vein
drains into the IVC
127
conjoint tendon
site of insertion for the transversus abdominis
128
Perinephric Fascia
encloses the adrenal glands and the kidneys
129
Perirenal Fat
b/w renal fascia and renal capsule
130
Pararenal Fat
superficial to renal fascia
131
Arcuate Line aka
linea semicirculares
132
Portal vein additional tributaries
L and R gastric
cystic
para-umbilical
133
Splenic Vein different than Splenic Artery
straight; maintains contact w/ body of pancreas
134
Tributaries to splenic vein
short gastric veins
left gastro-omental vein
pancreatic veins
IMV
135
SMV tributaties
```
R gastroomental
A & P inferior PD veins
Jejunal Vein
Ileal Vein
Ileocolic Vein
R colic vein
Middle Colic Vein
```
136
Hypospadias
external urethral opening on the ventral side of the penis
137
Cause of hypospadias
failure of urethral folds to fuse
138
Perineal Hypospadias
external urethral orifice is b/w unfused haves of the scrotum
139
Cause of Perienal Hypospadias
failure of fusion of the labioscrotal folds
140
Epispadias
external urethral opening on the dorsal side of the penis
141
Genital Tubercle formes
primordial phallus
142
What happens if the genital tubercle develops too dorsally?
external urethral opening on the dorsal side of the penis (epispadias)
143
Extrophy of Bladder
what is it?
cause?
what: urinary bladder mucosa is open to the outside fetus or newborn
cause: failure of primitive streak mesoderm to migrate around cloacal membrane
144
Ureteric Buds are derived from
mesonephric duct
145
Ureteric Bud is the primordium of
ureter, renal pelvis, calyces, and collecting tubules
146
Incomplete division of ureteric bud
divided kidney w/ bifid ureter
147
Complete division of ureteric bud
double kidney w/ bifid ureter or separate ureter
148
What do paramesonephric duct failures lead to?
double uterus or bicornate uterus
149
Double uterus
failure of the inferior portions of the paramesonephric duct the fuse
150
Bicornate Uterus
failure of the superior portions of the mesonephric duct to fuse
151
Hydrocele
accumulation of fluid within the tunica vaginalis
152
How to test for hydrocele
visualize by putting an otoscope up to the scrotum, and you'll see the scrotum contains mostly a clear fluid
153
Variocele
enlargement of the veins of the scrotum, usually due to blocked drainage
154
Variocele associated w/
"bag of worms"
| enarged varicosity of the pampiniform venous plexus
155
What lobe of the prostate is most likely to be enlarged to due an internal urethral orifice obstruction?
middle lobe
156
What ligaments serve to support the uterus?
How?
cardinal ligament
uterosacral ligament
they prevent uterine prolapse
157
Retropubis Space of Retzius
what is it?
significance?
what: extraperitoneal space b/w the pubic symphysis and the bladder
significance: placing a needle here will enter a full bladder
158
Hematocolpos
what is it?
cause:
what: filling of the vagina with menstrual blood
occurs due to an imperforate hymen
159
Enterocele
what is it?
cause
what: herniation of the small intestine into the posterior wall of the vagina
cause:
160
Enterocele
what is it?
cause
what: herniation of the small intestine into the posterior wall of the vagina
cause: tear in the rectovaginal septum, which weakens the pelvic floor
161
Garner cysts are remnants of
mesonephric ducts
162
Suspensory Ligament of Treitz
What is it?
Importance?
ligament between the r crus of the diaphragm and the duodenum @ the duodenojejunal junction
good palpable landmark for surgeries
163
What causes diaphragmatic hernias?
failure of fusion of the various parts of the diaphragm
164
Bochdalek's Hernia
what is it?
what causes it?
failure of fusion of the pleuropericardial folds
causes herniation of abdominal contents into the abdomen
165
Hiatal Hernias
where do they happen?
what happens?
where: at the level of the esophageal hiatus
what: allows the fundus of the stomach to herniate into the posterior mediastinum
166
What is clamped during a cholecystectomy?
cystic duct and cystic artery are clamped and the gallbladder is removed
167
What are the tissues in McBurney's point
```
external oblique aponeurosis
internal oblique muscle
tranversus abdominis muscle
transversalis fascia
peritoneum
```
168
What will fluid accumulate in a standing woman?
pouch of douglas
169
Where will fluid accumulate in a standing man?
rectovesicle pouch
170
Where will fluid accumulate in a supine patient?
hepatorenal pouch of morrison
