Gravy Sheet Final

Question 0

What forms the anterior wall of the lesser sac?

Answer 0

Gastrocolic ligament

Question 1

What are the attachments of the greater omentum (2)?

Answer 1

1. ) Greater curvature of the stomach

2. ) Transverse colon

Question 2

What two ligaments are associated with the greater omentum, where are they, what do they attach, and what do they contain?

Answer 2

1. ) Gastrosplenic ligament: Left side of greater omentum. Attaches hilum of spleen to greater curvature. Contains short gastric and left gastroepiploic arteries.
2. ) Gastrophrenic ligament: Left side of greater omentum. Connects fundus to inferior diaphragm.

Question 3

1. ) What are the attachments of the lesser omentum (3)

2. ) What are its ligaments called and what do they contain (2)?

Answer 3

1. ) Lesser curvature of stomach to liver and proximal duodenum
2. )
   a. ) Hepatogastric ligament: Stomach to liver (membranous part of LO)
   b. ) Hepatoduodenal ligament: Free thickened edge. Attaches liver to proximal dudenum. Contains portal triad (Hepatic artery, portal vein, bile passages)

Question 4

What is the splenorenal ligament and what does it contain?

Answer 4

It is where the peritoneum come in contact with the lesser sac (between L kidney and spleen).

Contains tail of pancreas, splenic vein and artery.

Question 5

Where is the lesser sac?

Answer 5

Between left kidney and spleen.

Question 6

What are the borders of the lesser sac (aka ______)

Anterior (4), posterior (1), left (2) and right (2) borders.

Answer 6

aka OMENTAL BURSA –> p.313 and p.298 Rohen
Anterior: Liver (quadrate lobe), stomach, lesser omentum, gastrocolic ligament.
Posterior: Pancreas
Left border: Kidney and suprarenal
Right border: Lesser omentum and epiploic foramen

Question 7

What are the borders of the epiploic foramen?

Superior, inferior, anterior, posterior.

Answer 7

Superior: Peritoneum of caudate lobe of liver
Inferior: Peritoneum of 1st part of duodenum
Anterior: Free edge of lesser omentum (hepatoduodenal ligament).
Posterior: Peritoneum of IVC

Question 8

List the 3 openings of the diaphragm (and vertebral level) and what passes through them

Answer 8

1. ) Caval (T8): Conducts IVC and some branches of phrenic nerve. Passes through central tendon
2. ) Esophageal (T10): Conducts esophagus and vagal trunks. Passes though posterior and left of central tendon.
3. ) Aortic (T12): Conducts aorta, azygos and hemiazygos veins, and the thoracic duct. Passes through

Question 9

Where is pain referred from the following structures:

1. ) Duodenum and head of pancreas
2. ) Gallbladder
3. ) Liver
4. ) Appendix
5. ) Cecum and ascending colon
6. ) Kidney and ureter
7. ) Sigmoid colon
8. ) Small intestine
9. ) Spleen
10. ) Stomach
11. ) Liver, gallbladder, and duodenum (resulting from irritated diaphragm)
12. ) Diaphragm

Answer 9

1. ) Epigastric
2. ) RUQ and R flank
3. ) Anterior RUQ to posterior RLQ
4. ) Umbilical to RLQ
5. ) Pubic region
6. ) L flank and inguinal/groin
7. ) L and R inguinal pubic
8. ) Umbilical
9. ) Lateral LUQ, wrapping around to inferior flank
10. ) Epigastric, LUQ, and between scapulae
11. ) Right shoulder
12. ) Left shoulder

Question 10

Which lymph nodes do the following structures drain into:

1. ) External genitalia
2. ) Anal canal above pectinate
3. ) Anal canal below pectinate
4. ) Testes
5. ) Ovaries
6. ) Superior rectum
7. ) Inferior rectum
8. ) Uterus
9. ) Vagina (lower 1/4, and upper 3/4)
10. ) Cervix
11. ) Scrotum

Answer 10

1.) Superficial inguinal
2.) Internal iliac
3.) Superficial inguinal
4.) Lumbar
5.) Lumbar
6.) Pararectal
7.) Sacral
8.) Internal and external iliac
9.) Lower 1/4 (below hymen): superficial inguinal
Upper 3/4: Internal iliac
10.) Internal and external iliac
11.) Superficial inguinal

Question 11

What is the blood supply for the anal canal:

1. ) Above pectinate
2. ) Below pectinate

Answer 11

1. ) Superior rectal

2. ) Inferior rectal

Question 12

What is venous drainage for anal canal:

1. ) Above pectinate
2. ) Below pectinate

Answer 12

1. ) Internal venous plexus –> superior rectal vein –> Portal system
2. ) Internal venous plexus –> inferior rectal vein –> caval system

Question 13

What supplies pain sensation for anal canal below pectinate?

Answer 13

Pudendal (somatic)

Question 14

Kehr’s sign in the _______ is considered a classical symptom of ________.

Answer 14

• Left shoulder

- Ruptured spleen

Question 15

Why is the pelvic outlet larger in females?

Answer 15

Due to EVERTED ISCHIAL TUBEROSITIES

Question 16

1. ) When is a culdocentesis indicated?

2. ) Where is a culdocentesis performed? (i.e. behind and between what structures?)

Answer 16

1. ) LQ and pelvic pain, and ectopic pregnancy or ovarian cyst.
2. ) Posterior to the vaginal fornix, and near the midline between the uterosacral ligaments.

Question 17

Describe the shapes of male and female pelvic inlets

Answer 17

Male = Heart-shaped
Female = Oval

Question 18

Describe the shape of the obturator foramen in males and females

Answer 18

Males = round
Females = oval or triangular

Question 19

1. ) Females typically have what type of pelvic girdle?

2. ) Compare it anthropoid and platypoid in terms of AP and lateral landmarks and shape

Answer 19

1.) Gynecoid: Oval-shaped.
2.) Anthropoid: longer sacrum to pubic symphysis. Narrow heart shaped.
Platypelloid: Longer distance between ischial spines. Wide heart shaped.

Question 20

What three landmarks are wider in a female pelvis?

Answer 20

Sacrum, subpubic angle or pubic arch, greater sciatic arch.

Question 21

What is the blood supply for the superior and inferior vagina?

Answer 21

Superior: Uterine
Inferior: Vaginal

Question 22

1.) What is the blood supply to the rectum in males (proximal, middle, inferior). Anal canal and anorectal junction?

Answer 22

1.) Proximal = Superior rectal. Middle and inferior = Middle rectal arteries. Anal canal and junction = Inferior rectal arteries.

Question 23

1.) What supplies blood to the anterosuperior parts of the bladder?
2.) Fundus and neck?
3.) Posteroinferior
Give answers for both male and female

Answer 23

1.) Males and females: Superior vesical
2.) Males: Inferior vesical
Females: Vaginal arteries
3.) Same as #2

Question 24

What is the location and contents (5 male, 1 female) of the superficial perineal pouch? Male and female

Answer 24

Location: Between Colles’ fascia and the inferior fascia of UG diaphragm.

Contents: Mnemonic –> Great Vest BITCh = Greater vestibular glands (females), Bulb of penis and bulbospongiosus, Ischiocavernosus muscle, superficial Transverse perineal muscle, Cowper’s gland (males)

Question 25

1. ) What are the superior and inferior borders of the deep perineal pouch?
2. ) Contents – male (5) and female (4)

Answer 25

1.) Inferior: Perineal membrane (aka inferior fascia of UG diaphragm)
Superior: Superior fascia of UG diaphragm

2.) Males: Intermediate/membranous part of urethra (narrowest part, MALES only), deep transverse perineal muscle, sphincter urethrae (inferior to prostate), bulbourethral glands, branches of internal pudendal vessels and nerves.

Females: Mass of smooth muscle (instead of deep transverse perineal, FEMALES ONLY), sphincter urethrae (distal inferior end in females), branches of pudendal vessels and nerves. UG diaphragm (FEMALES ONLY).

Question 26

What are the narrowest and widest part of the male urethra?

Answer 26

Narrowest: Intermediate/membranous part (distal to prostatic, proximal to spongy) except for the EXTERNAL URETHRAL ORIFICE

Widest: Prostatic urethra

Question 27

Pudendal nerve block: Where to inject and how to find? Caudal anesthesia?

Answer 27

Palpate ischial spine –> insert needle in direction of tip of finger through the POSTEROLATERAL VAGINAL WALL, just BENEATH the PELVIC DIAPHRAGM and toward the ischial spine – thus, locating the PUDENDAL NERVE. Can be done sub-q through buttock, on medial on medial side of ischial tuberosity

-CAUDAL is done slightly higher (sacral canal) and anesthetizes SUBPERITONEUM plus somatic pudendal distribution (popular for childbirth) <– S2-S4 spinal nerves. Must be done BEFORE actual delivery.