GI Anatomy 4

Question 1

What is the normal arrangement of the blood supply to the gall bladder?

Answer 1

Cystic artery from the right hepatic artery (branch of hepatic artery proper)

Question 2

What is the blood supply to the pancreas?

Answer 2

1) Have an anterior and posterior superior pancreaticodudoenal artery, both from the gastroduodenal (from the common hepatic artery)
2) Have an anterior and posterior inferior pancreaticoduodenal artery which come straight off the superior mesenteric artery
3) Have a dorsal pancreatic artery (which comes off the splenic artery)
4) Have a great pancreatic artery (which comes off the splenic lateral to the dorsal pancreatic artery)
NB. The superior and inferior pancreaticoduodenal arteries anastamoses as do the dorsal and great pancreatic arteries

Question 3

Why does a carcinoma of the head of the pancreas metastasise early?

Answer 3

Because the lymph nodes of the pancreas cant drain to the lymph nodes they normally would - these have become inaccessible
So the lymph drains to the liver via the portal vein - so cancer metastasises to the liver early

Question 4

Which kidney lies at a higher level?

Answer 4

Left kidney (due to the liver on the right)

Question 5

What is perinephric and paranephric fat?

Answer 5

Perinephric fat = completely surrounds the kidney, extraperitoneal fat immediately outside the renal capsule
Paranephric fat = accumulates posterior and posteriolateral to each kidney behind a layer of fascia

Question 6

On which ribs do the left and right kidneys lie?

Answer 6

Left = 11 and 12
Right = 12

Question 7

Which organs lie in contact with the anterior surface of the left kidney?

Answer 7

Suprarenal gland
Intraperitoneal stomach and spleen
Retroperitoneal pancreas
Splenic flexure and beginning of descending colon
Intraperitoneal jejunum

Question 8

Which organs lie in contact with the anterior surface of the right kidney?>

Answer 8

Suprarenal gland
Liver
Descending part of duodenum
Hepatic flexure
Intraperitoneal small intestine

Question 9

What are the posterior relations of each kidney?

Answer 9

Psoas major, Quadratus lumborum, Transversus abdominis

Question 10

Which structures unite to form the ureteric pelvis?

Answer 10

2 or 3 major calices

Question 11

On average at what vertebral level is the renal artery given off?

Answer 11

L2

Question 12

What is the renal sinus?

Answer 12

Main cavity of the kidney, expansion behind the hilum containing the renal pelvis, calices and major renal vessels

Question 13

What is the lymphatic drainage of the kidney?

Answer 13

To the lateral aortic (lumbar) nodes around the origin of the renal artery

Question 14

What is an accessory renal artery?

Answer 14

Arises from the lateral aspect of the abdominal aorta either above or below the primary renal arteries

Question 15

What is the clinical importance of the arrangement of the renal arteries?

Answer 15

Left renal vein crosses the midline anterior to the abdominal aorta and posterior to the superior mesenteric artery and can therefore be compressed in an aneurysm of either

Question 16

What is the difference between the shapes of the 2 suprarenal glands?

Answer 16

Right = shaped like a pyramid
Left = semilunar shape and larger

Question 17

How many arteries supply each suprarenal gland and what are they?

Answer 17

3

1) Superior suprarenal arteries (from the inferior phrenic arteries)
2) Middle suprarenal arteries (from the abdominal aorta)
3) Inferior suprarenal arteries (from the renal arteries)

Question 18

Why do the adrenal glands have such a rich blood supply?

Answer 18

Secrete endocrine hormones

Question 19

What is the venous drainage of the suprarenal glands?

Answer 19

Right suprarenal vein - into the IVC

Left suprarenal vein - into the left renal vein (because of the crossing over the abdominal aorta)

Question 20

What is the endothelial lining of the ureter?

Answer 20

Transitional epithelium

Question 21

The bifurcation of the common iliac arteries lies over what joint?

Answer 21

The sacro-iliac joint

Question 22

What is the course of the ureters?

Answer 22

From the renal pelvis runs down onto the psoas muscle, leaves the psoas at the bifurcation of the common iliacs (over the sacro-iliac joint)
Passes into the pelvis where it turns anteriorly and medially to enter the bladder

Question 23

What structures cross the ureters just before they enter the bladder in males and females?

Answer 23

Males - ductus deferans

Females - Uterine arteries

Question 24

What is the blood supply to the ureters?

Answer 24

Upper end = renal arteries
Middle = branches from aorta, gonadal arteries and common iliacs
In the pelvic cavity = Branches of internal iliacs

Question 25

What is the innervation of the ureters and what dermatomes is pain referred to?

Answer 25

Innervation through renal, aortic, superior and inferior hypogastric plexuses by nerves that follow blood vessels.
Visceral afferents return to T11-L2 so pain is referred to these dermatomes

Question 26

What are the 3 narrowest parts of the ureter where obstruction can commonly occur?

Answer 26

1) Uteropelvic junction (where renal pelvis becomes ureter)
2) Pelvic inlet (where ureters cross the pelvic brim)
3) Uterovesical junction (where the ureters enter the wall of the bladder)

Question 27

Between which vertebral levels does the abdominal aorta extend?

Answer 27

Lower level T12 - Lower level L4

Question 28

From the top to the bottom which veins come off the IVC?

Answer 28

1) Hepatic veins
2) Right suprarenal (left suprarenal drains into left renal)
3) Left and right renal
4) Right gonadal (left gonadal drains into left renal)
5) IVC splits into right and left common iliac veins
6) Median sacral drains into the left common iliac vein
7) Common iliac veins then split into internal and external iliac veins

Question 29

From the top to the bottom what branches come off the abdominal aorta?

Answer 29

1) Right and left inferior phrenic arteries
2) Coeliac trunk
3) Superior mesenteric
4) Right and left middle suprarenal
5) Right and left renal
6) Left and right gonadal arteries
7) Series of left and right lumbar arteries
8) Inferior mesenteric
9) Median sacral artery comes off where the abdominal aorta splits into the left and right common iliacs

Question 30

What is the peritoneum arrangement over the pelvic organs?

Answer 30

Peritoneum drapes over the superior surfaces of the pelvic organs that project upwards into the lower abdomen
This draping creates peritoneal pouches

Question 31

What are the peritoneal pouches in males and females?

Answer 31

Males = rectovesical pouch (between bladder and rectum)
Females = rectouterine and vesicouterine pouches

Question 32

What is the significance of the rectouterine (pouch of douglas) in females?

Answer 32

Lowest portion of abdominal cavity, can collect free fluid and pus

Question 33

Where does the bladder and the apex of the bladder lie in the pelvic cavity?

Answer 33

Lies directly posterior to the pubic symphysis, apex lies superior to pubic symphysis

Question 34

What is the function of rugae in the bladder wall, in which region aren’t they present and why?

Answer 34

Allow the bladder to distend
Not in the trigone, this region needs no contracting fibres, it needs to remain relaxed otherwise urine wont be able to escape

Question 35

What are the 3 parts of the uterus?

Answer 35

1) Cervix - extends into upper portion of vagina
2) Body
3) Fundus

Question 36

What is the shape of the cervix and what is the internal and external os?

Answer 36

Donut shaped
External opening into vagina = external os
Internal opening into body of uterus = internal os

Question 37

What is the cervical fornyx?

Answer 37

Gutter surrounding the cervix in the upper vagina
4 parts
1) Anterior fornyx
2) Posterior fornyx
3) Lateral fornices

Question 38

What is the clinical significance of the posterior fornyx?

Answer 38

Lies close to recto uterine pouch - transvaginal approach can be used to drain pus from the rectouterine pouch

Question 39

What is the broad ligament?

Answer 39

Extension of the peritoneum which drapes laterally either side of the uterus - has important structures running through it

Question 40

What structures run through the broad ligament?

Answer 40

Superior margin broad ligament = uterine tube
3 ligaments within the broad ligament
1) Ovarian ligament (between ovary and uterus)
2) Round ligament of uterus (thickening of broad ligament extends from lateral surface of the uterus through the broad ligament destined from the anterior abdominal wall)
3) Suspensory ligament (continuation of ovarian ligament, from ovary to lateral pelvic wall - contains the ovarian artery and vein)

Question 41

What is the structure of the uterine tube?

Answer 41

1) Dilated distal end with finger like projections called fimbriae
2) Dilation by fimbriae = infundibulum
3) Then have ampulla of uterine tube
4) Then as tube tapers away towards uterus have the ischthmus

Question 42

What lies posterior to the prostate in the male?

Answer 42

Vas deferans and seminal vesicle

Question 43

What is the function of the vas deferens?

Answer 43

takes sperm from the testes through prostate to enter prostatic urethra

Question 44

What do the seminal vesicle and ductus deferans unite to form?

Answer 44

Ejaculatory duct

Question 45

What is the function of the seminal vesicles?

Answer 45

Produce semen

Question 46

At what vertebral level does the rectum begin?

Answer 46

S3

Question 47

Where does the rectum end?

Answer 47

At the ano rectal junction at the level of the plevic floor

Question 48

What are rectal folds/valves and what is their function?

Answer 48

Rectum is not a straight tube, running into tube have rectal folds/valves - 2 rectal folds on left, 1 on right
Shelf like structures which prevent faeces from just passing out the rectum