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m1: anatomy and embryology lecture bw > Block 2: Gray's Redo Clarifications > Flashcards

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

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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

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3
Q

Where can you find the remnant of the urachus?

A

median umbilical ligament

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4
Q

What are the main congenital abnormalities of kidney formation?

A 
obstructive uropathy 
renal agenesis 
renal hypoplasia 
multicystic dysplastic kidney 
double collecting system
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5
Q

Renal Hypoplasia

A

small kidneys are produced with a decreased number of nephrons

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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

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7
Q

Potter’s Sequence

A

biateral renal hypoplasia that leads to oligohdyramnios, fetal compression and lung hypoplasia

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8
Q

The kidney originates from the

A

intermediate mesoderm

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9
Q

What are the stages of kidney development?

A

Pronephros
Mesonephros
Metanephrogenic Mesenchyme

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10
Q

What becomes the definitive kidney?

A

metanephros

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11
Q

Ureteric bud originates from

A

the mesonephric duct

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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)

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13
Q

What is derived from the metanephric blastema?

A

excretory system (tubules, the nephrons)

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14
Q

Initial function of the ureteric bud

A

to communicate with the metanephros to initiate and form the metanephric (permanent) kidneys

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15
Q

What would cause renal agenesis?

A

no ureteric bud
no mesenchyme
no interaction

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16
Q

In the urinary system, the cloaca gives rise to the

A

bladder and urethra

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17
Q

Cloaca

A

a hindgut s(x) that’s a common chamber for GI and urinary waste

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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

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19
Q

What divides the cloaca in 2?

A

uro-rectal septum

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20
Q

What do the mesonephric ducts develop into?

A

men: ejaculatory ducts
women: degenerate due to lack of testicular androgens

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21
Q

Foregut contents

A

esophagus to 2nd part of duodenum; also liver and pancreas

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22
Q

Midgut contents

A

distal 1/3 duodenum to proximal 2/3 large intestine

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23
Q

Hindgut contents

A

distal 1/3 of transverse colon, descending colon, sigmoid colon

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24
Q

Stomach rotation

A

moves caudally and rotates 90 degrees clockwise

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25
Q

What is the result of stomach rotation?

A

left wall becomes the anterior wall, right side becomes the posterior wall

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26
Q

Describe midgut lengthening

A

happens with rotation or twisting of the gut tube (90 degree rotation) around the SMA

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27
Q

Midgut reduction

When does this happen? What happens?
Why?

A

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

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28
Q

What is the result of midgut rotation?

A

cephalic limb on the L side of abdominal cavity; caudal limb on R lower portion of abdominal cavity

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29
Q

Cloaca is formed when

A

hindgut joins w/ allantois

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30
Q

Cloaca eventually divides into

A

urogenital sinus (ventral) and the rectum and anal canal (dorsal)

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31
Q

Mesentary derived from

A

splanchnic mesoderm

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32
Q

Ventral mesentary in development eventually forms

A

lesser sac and falciform ligament

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33
Q

Foregut blood supply

A

celiac artery

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34
Q

Midgut blood supply

A

SMA

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35
Q

hindgut blood supply

A

IMA

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36
Q

Pancreas develops from

A

dorsal and ventral pancreatic bud

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37
Q

Fusion of pancreatic buds

A

dorsal bud forms the body; ventral bud forms the head & ucinate process

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38
Q

What parts of the GI tract are retroperitoneal?

A

duodenum (except 1st part); ascending and descending colon

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39
Q

Omphalocele

A

intestinal loops fail to return from the umbilical cord into the abdominal cavity

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40
Q

Result of omphalocele

A

herniated loops cause large swelling in umbilical cord

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41
Q

Congenital umbilical hernia

A

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

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42
Q

Total primitive midgut rotation degrees

A

270 degrees

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43
Q

Left sided colon

A

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

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44
Q

Reversed rotation

A

midgut rotates clockwise instead of counterclockwise

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45
Q

Stenosis and Atresia of Intestines

A

due to incompletion or failure of intestinal recanalization

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46
Q

Meckel’s Diverticulum

A

finger like pouch that develops near the ileocecal junction

represents remaining part of ompalocele (yolk sac)

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47
Q

How is the perineum formed?

A

urorectal septum fuses w/ cloacal membrane

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48
Q

Hirchsprung’s Disease

what is it?
what causes it?

A

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

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49
Q

Anal Agenesis (without a fistula)

A

anal canal ends blindly or ha an ectopic opening

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50
Q

Anal agenesis (w/ a fistula)

A

anal canal may end in a fistula, which opens into the perineum

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51
Q

Anal Stenosis

A

anal canal constricted and narrowed

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52
Q

What causes anal stenosis?

A

urorectal septum grows too far dorsally

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53
Q

Imperforate Anus

what is it?
what causes it?

A

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

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54
Q

Anorectal Agenesis

A

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)

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55
Q

Rectal Atresia

A

rectum and anus separated by a wedge of tissue

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56
Q

Hepatoduodenal Ligament

where:
significance

A

where: b/w duodenum and liver
significance: supports the portal triad

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57
Q

Portal Triad

A

hepartic artery
hepatic vein
bile duct

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58
Q

Caudate lobe location

A

b/w IVC and fossa of ligamentum venosum

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59
Q

Quadrate Lobe location

A

lower aspect of visceal surface, b/w gallbladder and a fossa produced by ligamentum teres

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60
Q

Ligamentum Teres

A

a remnant of the fetal umbilical vein (L)

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61
Q

What separates the caudate and quadrate lobes?

A

porta hepatis

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62
Q

Clinical significance of the hepatoduodenal ligament

A

can be clamped to stop profuse bleeding from the liver

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63
Q

Congenital Hydrocele

A

fluid accumulation in the scrotum

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64
Q

Malrotation

A

incomplete rotation & fixation of the midgut after passing from umbilical sac and returning to abdominal coelom

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65
Q

Describe how volvulus happens

A

if the duodenojefjunal flexure doesn’t end up in the right place the small bowel can twist around the axis of the SMA

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66
Q

Describe how volvulus happens

A

if the duodenojefjunal flexure doesn’t end up in the right place the small bowel can twist around the axis of the SMA

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67
Q

Congenital hydrocele

what is it?
what causes it?

A

what: collection of serous fluid within the tunica vaginalis
cause: failure of the processus vaginalis to close

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68
Q

Inguinal Hernia

A

abdominal cavity contents protrude into the scrotum

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69
Q

Hematocele

A

collection of blood in the tunica vaginalis

70
Q

How to distinguish b/w hematocele and hydrocele?

A

shining a light on the testicles

71
Q

Variocele

A

dilation of the veins draining the penis

72
Q

Portocaval Anastamoses sites

A
  1. gastric & esophageal
  2. umbilical and paraumbilical
  3. superior and middle or inferior rectal
73
Q

Eventration of the Diaphragm

what is it?
cause

A

what: abnormal elevation of 1 leaf of the diaphragm

caused by: paralysis, aplasia, or atrophy of muscle to varying degrees

74
Q

Pouch of Morrison

A

hepatorenal pouch

75
Q

Medial Arcuate ligament

A

cross muscles of abdominal wall to attach to vertebrae

76
Q

Median Arcuate Ligament

A

crosses aorta and is continuous w/ the crus on each side

77
Q

Semilunar Line

A

curved, tendinous intersection on either side of the rectus abdominis

78
Q

Pectineal Line

A

ridge on the superior ramus of the pubic bone

79
Q

Arcuate Line

what is it?
significance?

A

denotes lower limit of the posterior rectus sheath

also where the inferior epigastric vessels perforate the rectus abdominis

80
Q

Minor duodenal papilla f(x)

A

entrance for the accessory pancreatic duct

81
Q

Superior duodenum location (in relation to surroundings)

A

anterior to bile duct, gastroduodenal artery, portal vein, and IVC

82
Q

Descending duodenum location (in relation to surroundings)

A

anterior surface crossed by transverse colon, posterior is right kidney, medial is head of pancreas

83
Q

Inferior duodenum location (in relation to surroundings)

A

crosses IVC & aorta

crossed anteriorly by SMA and SMV

84
Q

Suspensory Ligament of Trietz

A

suspends to duodenojejunal flexure

85
Q

Duodenal Compression

A

3rd part of the duodenum is posterior to the SMA so it can be compressed

86
Q

Compare and contrast jejunum and ileum

A

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
Q

Foregut

afferent pathway
spinal cord level
referral area

A

pathway: greater splanchnic nerve
level: T5 to T9 (or T10)
referral: lower thorax and epigastric

88
Q

Midgut

afferent pathway
spinal cord level
referral area

A

pathway: lesser splanchnic nerve
level: T9, T10 (or T11, T12)
referral: umbilical region

89
Q

Kidneys and Upper Ureter

afferent pathway
spinal cord level
referral area

A

pathway: least splanchnic
level: T12
referral: flanks (lateral regions)

90
Q

Hindgut

afferent pathway
spinal cord level
referral area

A

pathway: lumbar splanchnic
levecl: L1, L2
referral: pubic region, lateral & anterior thighs, groin

91
Q

Chromaffin Cells

A

cells of suprarenal (adrenal) glands; main source of norepinephrine and epinephrine

92
Q

Branches of the celiac trunk

A

splenic
left gastric
common hepatic

93
Q

L gastric gives rise to

A

oesophageal branches

94
Q

L gastric anastamoses w/

A

R gastric

95
Q

Splenic gives rise to

A

L gastroomental
Short Gastrics
Pancreatic Branches

96
Q

Splenorenal Ligament

A

contains the splenic artery

97
Q

Common Hepatic Branches

A

proper hepatic

gastroduodenal

98
Q

Proper Hepatic Branches

A

right gastric
R and L hepatic
cystic

99
Q

Gastroduodenal Branches

A 
R gastroomental 
Superior Panreaticoduodenals (anterior and posterior)
100
Q

Anterior to the SMA

A

pyloric part of stomach, splenic vein, neck of pancras

101
Q

Posterior to SMA

A

L renal vein, uncinate process of pancreas, inferior part of duodenum

102
Q

Branches of the SMA

A

inferior pancreaticoduodenal artery
jejunal & ileal arteries
middle and right colic arteries
ileocolic artery

103
Q

Ileocolic Artery Branches

A

ileal branches
colic branches
cecal arteries
appendicular artery

104
Q

IMA Branches

A

left colic
sigmoid
superior rectal

105
Q

Arc of Riolan

A

anastamosis b/w middle colic branch of SMA and L colic branch of IMA

106
Q

Omental Foramen Border

A

posterior to the hepatoduodenal ligament

107
Q

What passes through the diaphragm hiatuses?

A

Aortic: azygos vein & thoracic duct
Esophageal: vagus nerve
IVC: R phrenic

108
Q

What happens if a gallstone perforates the fundus?

A

the gallbladder lies close to the transverse colon so it’ll perforate the bowel

109
Q

Round ligament of the liver

A

remnant of the L umbilical vein

110
Q

Purpose of portal caval shunting

A

treatment for hypertension

combine portal circulation w/ caval circulation to take the load off the portal system

111
Q

Usual portacaval shunt

A

connection made b/w portal vein and IVC (want to go with the biggest veins to make the biggest impact)

112
Q

Suprarenal arteries supply

A

superior: inferior phrenic
middle: abdominal aorta
inferior: renal artery

113
Q

Gastrosplenic Ligament

A

connects the spleen to the greater curvature of the stomach

114
Q

McBurney’s Point
location
significance

A

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
Q

List the retroperitoneal structures

A 
Suprarenal/adrenal glands
Aorta/IVC
Duodenum (except the 1st part)
Pancreas (except the tail) 
Ureters
Colon (ascending and descending)
Kidneys
Esophagus
Rectum
116
Q

pancreas, IVC, aorta orienttaion

A

paneas is anterior to those

117
Q

SMA and pancreas

A

SMA behind neck of pancreas, anterior to uncinate process

118
Q

Posterior to the neck of the pancreas

A

splenic and SMV unite to form hepatic portal vein

119
Q

Hepatic Portal vein formedby

A

splenic vein

SMV

120
Q

Borders of Hesselbach’s Triangle

significance

A

medial: rectus abdominis
lateral; inferior epigastric vessels
inferior: inguinal ligament

denotes an area of potential weakness in the abdominal wall

121
Q

Direct Inguinal Hernia

A

enters the inguinal canal medial to the inferior epigastric vessels
goes directly through posterior border of the canal

122
Q

Indirect inguinal hernia

A

enter through deep inguinal ring

lateral to interior epigastric vessels

123
Q

Liver Innervation

A

hepatic plexus (sympathetic and parasympathetic nerve fibers)

124
Q

Inguinal Ligament

A

forms the base of the inguinal canal

inferior border of hesselbach’ triangle

125
Q

L testicular/ Ovarian Vein

A

drains into the L renal vein

126
Q

R testicular/ovarian vein

A

drains into the IVC

127
Q

conjoint tendon

A

site of insertion for the transversus abdominis

128
Q

Perinephric Fascia

A

encloses the adrenal glands and the kidneys

129
Q

Perirenal Fat

A

b/w renal fascia and renal capsule

130
Q

Pararenal Fat

A

superficial to renal fascia

131
Q

Arcuate Line aka

A

linea semicirculares

132
Q

Portal vein additional tributaries

A

L and R gastric
cystic
para-umbilical

133
Q

Splenic Vein different than Splenic Artery

A

straight; maintains contact w/ body of pancreas

134
Q

Tributaries to splenic vein

A

short gastric veins
left gastro-omental vein
pancreatic veins
IMV

135
Q

SMV tributaties

A 
R gastroomental 
A & P inferior PD veins 
Jejunal Vein 
Ileal Vein 
Ileocolic Vein 
R colic vein 
Middle Colic Vein
136
Q

Hypospadias

A

external urethral opening on the ventral side of the penis

137
Q

Cause of hypospadias

A

failure of urethral folds to fuse

138
Q

Perineal Hypospadias

A

external urethral orifice is b/w unfused haves of the scrotum

139
Q

Cause of Perienal Hypospadias

A

failure of fusion of the labioscrotal folds

140
Q

Epispadias

A

external urethral opening on the dorsal side of the penis

141
Q

Genital Tubercle formes

A

primordial phallus

142
Q

What happens if the genital tubercle develops too dorsally?

A

external urethral opening on the dorsal side of the penis (epispadias)

143
Q

Extrophy of Bladder

what is it?
cause?

A

what: urinary bladder mucosa is open to the outside fetus or newborn
cause: failure of primitive streak mesoderm to migrate around cloacal membrane

144
Q

Ureteric Buds are derived from

A

mesonephric duct

145
Q

Ureteric Bud is the primordium of

A

ureter, renal pelvis, calyces, and collecting tubules

146
Q

Incomplete division of ureteric bud

A

divided kidney w/ bifid ureter

147
Q

Complete division of ureteric bud

A

double kidney w/ bifid ureter or separate ureter

148
Q

What do paramesonephric duct failures lead to?

A

double uterus or bicornate uterus

149
Q

Double uterus

A

failure of the inferior portions of the paramesonephric duct the fuse

150
Q

Bicornate Uterus

A

failure of the superior portions of the mesonephric duct to fuse

151
Q

Hydrocele

A

accumulation of fluid within the tunica vaginalis

152
Q

How to test for hydrocele

A

visualize by putting an otoscope up to the scrotum, and you’ll see the scrotum contains mostly a clear fluid

153
Q

Variocele

A

enlargement of the veins of the scrotum, usually due to blocked drainage

154
Q

Variocele associated w/

A

“bag of worms”

enarged varicosity of the pampiniform venous plexus

155
Q

What lobe of the prostate is most likely to be enlarged to due an internal urethral orifice obstruction?

A

middle lobe

156
Q

What ligaments serve to support the uterus?

How?

A

cardinal ligament
uterosacral ligament

they prevent uterine prolapse

157
Q

Retropubis Space of Retzius

what is it?
significance?

A

what: extraperitoneal space b/w the pubic symphysis and the bladder
significance: placing a needle here will enter a full bladder

158
Q

Hematocolpos

what is it?
cause:

A

what: filling of the vagina with menstrual blood

occurs due to an imperforate hymen

159
Q

Enterocele

what is it?
cause

A

what: herniation of the small intestine into the posterior wall of the vagina
cause:

160
Q

Enterocele

what is it?
cause

A

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
Q

Garner cysts are remnants of

A

mesonephric ducts

162
Q

Suspensory Ligament of Treitz

What is it?
Importance?

A

ligament between the r crus of the diaphragm and the duodenum @ the duodenojejunal junction

good palpable landmark for surgeries

163
Q

What causes diaphragmatic hernias?

A

failure of fusion of the various parts of the diaphragm

164
Q

Bochdalek’s Hernia

what is it?
what causes it?

A

failure of fusion of the pleuropericardial folds

causes herniation of abdominal contents into the abdomen

165
Q

Hiatal Hernias

where do they happen?
what happens?

A

where: at the level of the esophageal hiatus
what: allows the fundus of the stomach to herniate into the posterior mediastinum

166
Q

What is clamped during a cholecystectomy?

A

cystic duct and cystic artery are clamped and the gallbladder is removed

167
Q

What are the tissues in McBurney’s point

A 
external oblique aponeurosis 
internal oblique muscle
tranversus abdominis muscle 
transversalis fascia 
peritoneum
168
Q

What will fluid accumulate in a standing woman?

A

pouch of douglas

169
Q

Where will fluid accumulate in a standing man?

A

rectovesicle pouch

170
Q

Where will fluid accumulate in a supine patient?

A

hepatorenal pouch of morrison

m1: anatomy and embryology lecture bw (37 decks)

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