Dry Room 1

Question 1

What is the peritoneum?

Answer 1

The peritoneum is a transparent serous membrane that covers body wall and organs.

Although it is one continuous layer, it is often described differently, depending on whether it lines the body wall or covers the organs.

Question 2

What are the two layers of the peritoneum called?

Answer 2

Parietal = covers the wall
Visceral = covers viscera

Question 3

What structures does the peritoneum form?

Answer 3

It forms folds such as mesenteries and omenta

It also forms ligaments which may be vascular or avascular

Question 4

Define the term peritoneal cavity

Answer 4

The peritoneal cavity is the potential space between the parietal and visceral peritoneum

Question 5

Two major divisions of the peritoneal cavity are termed sacs.
Which are these?

Answer 5

Greater sac
Lesser sac (omental bursa)

Question 6

Through which passage do the two sacs of the peritoneum communicate?

Answer 6

Omental foramen

Question 7

Describe where the omental foramen is located and its relations

Answer 7

Posterior to the free edge of the lesser momentum forming the hepatoduodenal ligament

Question 8

How are organs described depending on how they are peritonised?

Answer 8

Intraperitoneal = organs completely surrounded by visceral peritoneum

Retroperitoneal = organs only covered on their anterior surface and therefore firmly attached to the posterior wall

Question 9

List the intraperitoneal organs

Answer 9

SALTD SPRSS

S=Stomach
A=Appendix
L=Liver
T=Transverse colon
D=Duodenum (only first part)
S=Small intestine
P=Pancreas (only the tail)
R=Rectum (upper 3rd)
S=Sigmoid colon
S=Spleen

Question 10

List the retroperitoneal organs

Answer 10

SADPUCKER

S=Suprarenal glands
A=Aorta and IVC
D=Duodenum (except first part)
P=Pancreas
U=Ureter and Bladder
C=Colon (asending and descending)
K=Kidneys
E=Esophagus
R=Rectum (lower two thirds)

Question 11

What is present inside the peritoneal cavity?

Answer 11

Peritoneal fluid. There are no organs

Question 12

What term is used to describe structures in the abdominopelvic cavity which are not covered in peritoneum

Answer 12

Extraperitoneal

Question 13

Which layer of the peritoneum is more sensitive to pressure, pain, heat and cold?

Answer 13

Parietal layer

You don’t want the visceral layer to feel lots of eating food would cause you pain.

Question 14

What are the attachments of the greater and lesser omentum?

Answer 14

Greater Omentum: Greater curvature of the stomach to proximal part of the duodenum

Lesser Omentum: Lesser curvature of the stomach and proximal part of the duodenum to the liver

Question 15

What parts of the greater omentum are free?

Answer 15

The lower margin and the left and right margins.

It moves about the abdominal cavity in response to peristaltic movements.

Question 16

Why do surgeons refer to the greater omentum as the abdominal policeman?

Answer 16

In infection, especially appendicitis, inflammatory exudate causes the momentum to adhere to the site of infection, and wrap itself around the infected organ.
This localises the infection to a small area of the cavity, protecting against serious diffuse peritonitis.

Question 17

Describe the innervation of the parietal peritoneum

Answer 17

Innervated by the lower 6 thoracic nerves and L1, the pain here is somatic and can be easily localised.

It is extremely sensitive to stretching and this is made use of in clinical diagnosis (rebound tenderness)

Question 18

Describe the innervation of the visceral peritoneum

Answer 18

Innervated by automatic nerves. Pain is often referred, and is dull and poorly localised.

Because the GI tract is a midline structure receiving bilateral nerve supply, pain is often referred to the midline.

Question 19

What are the 3 major openings in the diaphragm and at what vertebral level are they found?

Answer 19

Caval Opening T8
Oesophageal Opening T10
Aortic Hiatus T12

Question 20

What are the 3 main branches of the abdominal aorta which supplies blood to the gut tube within the abdominopelvic cavity

Answer 20

Celiac Trunk
Superior Mesenteric Artery
Inferior Mesenteric Artery

Question 21

At what vertebral level does the abdominal aorta divide into 2 common iliac arteries?

Answer 21

L4

Question 22

How is the inferior vena cava (IVC) formed in the abdomen?

Answer 22

Formed from the left common iliac and right common iliac veins.

Question 23

What vertebral level do the celiac trunk, superior mesenteric and inferior mesenteric arise from the aorta?

Answer 23

Celiac Trunk = T12
Superior Mesenteric = L1
Inferior Mesenteric = L3

Question 24

List the foregut structures

Answer 24

Abdominal part of the oesophagus

Stomach

Question 25

List the midgut structures

Answer 25

Small intestine | Ascending colon and 2/3rds transverse colon

Question 26

List the hindgut structures

Answer 26

Descending colon | Rectum

Question 27

Name the additional foregut and midgut structures not associated with the gut tube

Answer 27

Foregut: Liver, Biliary apparatus, Pancreas, Spleen Midgut: Appendix

Question 28

How does blood from the abdominopelvic gastrointestinal tract drain blood to the liver?

Answer 28

Via the hepatic-portal system

Question 29

The portal vein is formed by the union of which two major veins of the abdominal cavity?

Answer 29

Superior Mesenteric vein | Inferior Mesenteric vein

Question 30

How does blood from the gut tube superior to the diaphragm and inferior to the pelvic floor drain?

Answer 30

Via the systemic venous system This means that an anastomosis is present at these watersheds: porto-systemic (portocaval) anastomoses

Question 31

List the 4 sites of portocaval anastomoses in the body

Answer 31

In the distal oesophagus In the rectal veins Para-umbilical (anterior abdominal wall) In the colic veins

Question 32

What is the clinical significance of portocaval anastomoses?

Answer 32

Cirrhosis of the liver causes portal hypertension. At sites of anastomoses between portal an systemic veins, portal hypertension produces varicose veins. These may rupture (haemorrhage). Bleeding from oesophageal varies at the distal oesophagus is severe and possibly fatal.

Question 33

How does the sympathetic nervous system supply the abdominal viscera?

Answer 33

Abdominopelvic splanchnic nerves (greater, lesser and least) Prevertebral sympathetic ganglia Abdominal aortic plexuses

Question 34

How does the parasympathetic nervous system supply the abdominal viscera?

Answer 34

Anterior and posterior vagal trunks (vagus nerve) | Pelvic splanchnic nerves (S2, S3 and S4)

Question 35

How does parasympathetic innervation affect the GI tract?

Answer 35

Increased GI secretion Increased GI motility or peristalsis Vasodilation of blood vessels

Question 36

How does the sympathetic innervation affect the GI tract?

Answer 36

Decreased GI secretion Decreased GI motility or peristalsis Vasoconstriction of blood vessels

Question 37

What is a vagotomy and what effect does it have on gastric secretion?

Answer 37

Eliminates the parasympathetic supply from the stomach to the left side of the transverse colon. Used to treat peptic ulcer disease. It decreases the production of acid

Question 38

What is the functional difference between the greater, lesser and least splanchnic nerves and the pelvic splanchnic nerves?

Answer 38

ask scott

Question 39

What is the chief difference in the arrangement of ganglia in the sympathetic and parasympathetic nervous system?

Answer 39

Sympathetic ganglia lie outside the target organ | Parasympathetic ganglia lie within the target organ

Question 40

What is the position of the kidneys?

Answer 40

The kidneys lie on the posterior abdominal wall at the level of T12-L3 vertebrae

Question 41

The right kidney lies slightly lower than the left kidney. Why is this?

Answer 41

Presence of the liver

Question 42

What is the anterior to posterior arrangement of the structures entering and leaving the hilum of the kidney?

Answer 42

Renal vein, Renal artery and then renal pelvis

Question 43

How are the kidneys peritonised?

Answer 43

Reteroperitoneum

Question 44

What is the anatomical location of the suprarenal gland, and what type of gland is it?

Answer 44

Between the supermodel aspects of the kidneys and the diaphragmatic crura. These are adrenal glands

Question 45

What are the ureters?

Answer 45

Muscular ducts carry urine from the kidneys to the urinary bladder

Question 46

What is the term used to describe the expanded upper part of the ureter?

Answer 46

The renal pelvis

Question 47

In which three locations is the ureter normally constricted during its course from the kidneys to the urinary bladder?

Answer 47

At the junction of the ureters and renal pelvis (pelviuretic junction) Where the ureters cross the brain of the pelvic inlet During passage through the wall of the urinary bladder

Question 48

Coeliac trunk gives what branches?

Answer 48

Left gastric artery Splenic artery Common hepatic artery

Question 49

Common hepatic artery gives what branches?

Answer 49

Hepatic artery Right gastric artery Gastroduodenal artery

Question 50

Gastroduodenal artery gives what branches?

Answer 50

Superior pancreatoduodenal artery | Right gastro-epiploic artery

Question 51

The splenic artery gives which branches?

Answer 51

Short gastric arteries Splenic branches Left gastro-epiploic artery