Inguinal Canal and Liver

Question 1

Where is the inguinal canal located?

Answer 1

Between deep inguinal ring and superficial inguinal ring, above and parallel to inguinal ligament

Question 2

Where does the inguinal ligament run?

Answer 2

Anterior superior iliac spine to pubic tubercle

Question 3

What 4 things can be found in the inguinal canal?

Answer 3

1. Ilioinguinal nerve
2. Genital branch of genitofemoral nerve
3. Spermatic cord (males)
4. Round ligament of uterus (females)

Question 4

Where is the deep inguinal ring located?

Answer 4

Opening in fascia transversalis located ½ inch above mid-inguinal point

Question 5

What 2 structures pass through deep inguinal ring?

Answer 5

1. Spermatic cord

2. Round ligament of uterus

Question 6

Where is the superficial inguinal ring located?

Answer 6

External oblique aponeurosis above and lateral to pubic tubercle

Question 7

What 3 structures pass through superficial inguinal ligament?

Answer 7

1. Ilioinguinal nerve
2. Spermatic cord (males)
3. Round ligament of uterus (females)

Question 8

Why does the midpoint of inguinal canal and inguinal ligament differ?

Answer 8

Inguinal canal inserts at pubic crest but inguinal ligament inserts at pubic tubercle

Question 9

What is the conjoint tendon?

Answer 9

Lower part of aponeurosis of internal oblique abdominal muscle and transversus abdominis as it inserts into the crest of pubis

Question 10

What forms the anterior wall of the inguinal canal?

Answer 10

External oblique aponeurosis, reinforced laterally by internal oblique

Question 11

What forms the posterior wall of the inguinal canal?

Answer 11

Conjoint tendon medially and fascia transversalis laterally

Question 12

What forms the roof of the inguinal canal?

Answer 12

Arching lowest fibres of internal oblique and transversus abdominis muscles

Question 13

What forms the floor of the inguinal canal?

Answer 13

Inguinal ligament and at the medial end, the lacunar ligament

Question 14

What is the lacunar ligament?

Answer 14

Ligament between inguinal ligament and pubic crest

Question 15

Where is the anterior wall of the inguinal canal strongest?

Answer 15

Opposite the deep inguinal ring

Question 16

Where is the posterior wall of the inguinal canal strongest?

Answer 16

Opposite the superficial inguinal ring

Question 17

What is the inguinal ligament?

Answer 17

Fibrous band formed by lower boarder of aponeurosis of external oblique muscle

Question 18

Where is the inguinal ligament located?

Answer 18

Anterior superior iliac spine to the pubic tubercle

Question 19

Where do gonads develop?

Answer 19

Extraperitoneal layer of abdomen

Question 20

What is gubernaculum?

Answer 20

Fibrous band which links ovaries and labia majora/scrotum and testes

Question 21

What is the order of descent of things to form scrotum?

Answer 21

1. Gubernaculum
2. Processus vaginalis
3. Testes

Question 22

What is the processus vaginalis?

Answer 22

Portion of the peritoneum

Question 23

What is a hernia?

Answer 23

Abnormal weakness in the abdominal wall which allows something inside to protrude

Question 24

What are 2 types of inguinal hernia?

Answer 24

1. Indirect

2. Direct

Question 25

What is an indirect inguinal hernia?

Answer 25

Peritoneal sac transverses the length of the canal and can continue to scrotum

Question 26

What is a direct inguinal hernia?

Answer 26

Protrusion of abdominal viscera through weakness of posterior wall of inguinal canal

Question 27

What is the major difference between a direct and indirect inguinal hernia?

Answer 27

Direct hernia runs parallel to spermatic cord while indirect hernia runs within the spermatic cord

Question 28

What are the 3 hiatuses found in the diaphragm?

Answer 28

1. Vena caval hiatus 2. Oesophageal hiatus 3. Aortic hiatus

Question 29

Where is the vena caval hiatus located?

Answer 29

Central tendon at vertebral level of T8

Question 30

What 2 things pass through vena caval hiatus?

Answer 30

1. Inferior vena cava | 2. Right phrenic nerve

Question 31

Where is the oesophageal hiatus located?

Answer 31

Right crus at the vertebral level of T10

Question 32

What 2 things pass through the oesophageal hiatus?

Answer 32

1. Oesophagus | 2. Anterior and posterior trunks of the vagus nerves

Question 33

Where is the aortic hiatus located?

Answer 33

Between two crura of the diaphragm at vertebral level T12

Question 34

What 3 things pass through the aortic hiatus?

Answer 34

1. Aorta 2. Thoracic duct 3. Azygous vein

Question 35

What separates the two lobes of the liver?

Answer 35

Falciform ligament

Question 36

What is the name of the free edge of the falciform ligament?

Answer 36

Ligamentum teres

Question 37

What are the 2 accessory lobes of the right lobe of the liver?

Answer 37

1. Caudate (Superior) | 2. Quadrate (Inferior)

Question 38

What is the porta hepatis?

Answer 38

Where hepatic arteries and portal vein enter and hepatic ducts leave the liver

Question 39

Give the order of arteries supplying the liver

Answer 39

1. Common hepatic artery 2. Hepatic artery proper 3. Left / Right hepatic artery

Question 40

Where does the common hepatic artery become the hepatic artery proper?

Answer 40

After the origin of the gastroduodenal artery

Question 41

What forms the portal vein?

Answer 41

The union of splenic and superior mesenteric vein

Question 42

What happens in patients with elevated portal vein pressure with regards to blood flow?

Answer 42

Less blood flows to the liver and the rest enters collateral channels which drain into the systemic circulation

Question 43

What are 3 of the largest portosystemic collaterals?

Answer 43

1. Gastroesophageal junction 2. The anus 3. Anterior abdominal wall around umbilicus

Question 44

What is the portosystemic collateral at the gastroesophageal junction?

Answer 44

Left gastric vein of portosystemic system anastomose with tributaries to azygous system of caval system

Question 45

What is the portosystemic collateral at the anus?

Answer 45

The superior rectal vein of portosystemic system anastomoses with middle and inferior rectal veins of systemic venous system

Question 46

What is the portosystemic collateral at the anterior abdominal wall around umbilicus?

Answer 46

Paraumbilical veins of porta system anastomose with veins on anterior abdominal wall of vena cava system

Question 47

What are 3 origins of the diaphragm?

Answer 47

1. Musculotendinous crura 2. Medial and lateral arcuate ligaments 3. Sternocostal origin

Question 48

Where is the sternocostal origin of the diaphragm?

Answer 48

Lower 6 ribs and posterior aspect of xiphoid process

Question 49

Where is the right crus of the diaphragm attached?

Answer 49

L1 - L3 (including associated intervertebral discs)

Question 50

Where is the left crus of the diaphragm attached?

Answer 50

L1 - L2 (including associated intervertebral discs)

Question 51

What connects left and right crura?

Answer 51

Median arcuate ligament

Question 52

What is the name of the second tendinous arch of the diaphragm?

Answer 52

Medial arcuate ligament

Question 53

What forms the medial arcuate ligament?

Answer 53

Fascia which covers the upper part of the psoas major muscle

Question 54

What is the name of the third tendinous arch of the diaphragm?

Answer 54

Lateral arcuate ligament

Question 55

What forms the lateral arcuate ligament?

Answer 55

Thickening of the fascia which covers the quadratus lumborum muscle

Question 56

Where is the insertion of the diaphragm?

Answer 56

Central tendon

Question 57

What are the 3 arteries which provide superior arterial supply of the diaphragm?

Answer 57

1. Musculophrenic 2. Pericardiophrenic (internal thoracic artery) 3. Superior phrenic (thoracic aorta)

Question 58

What artery provides inferior arterial supply to the diagram?

Answer 58

Inferior phrenic arteries (abdominal aorta)

Question 59

What nerves innervate the diaphragm?

Answer 59

C3 - C5