MET2 Revision 8 Flashcards
What is the difference in abdominal wall anatomy above and below the arcuate line?
Below arcuate line the abdo wall is weaker
Which arteries supply the abdomen wall and which arteries are they derived from?
Internal thoracic artery becomes superior epigastric artery
External iliac artery runs superiorly and becomes inferior epigastric artery: Most substantial & clinically relevant
Lower intercostal and lumbar arteries run laterally across the abdominal wall
Which two points does the inguinal ligament run between? [2]
ASIS to pubic tubercle
Label A-G
Which of the following is located outside of the external spermatic fascia
Vas deferens
Cremaster muscle
Genitofemoral nerve
Testicular vessels
Ilioinguinal nerve
Which of the following is located outside of the external spermatic fascia
Vas deferens
Cremaster muscle
Genitofemoral nerve
Testicular vessels
Ilioinguinal nerve
At which point in the abdominal wall is the:
- Deep inguinal ring
- Superfical inguinal ring
- Deep inguinal ring: point at which the contents of the spermatic cord enter the abdominal wall.
- Superfical inguinal ring: point at which the spermatic cord emerges from the abdominal wall.
Describe how the external oblique, internal oblique and transvesus abdominis surround the spermatic cord [3]
External oblique: : aponeurosis surrounds spermatic cord
Internal oblique: muscle fibres cover spermatic cord
Transversus abdominis: absent to spermatic cord structure
Explain the journey of the testes through the inguinal canal [2]
What is the origin of each of the following? (They’re not in order)
- external spermatic fascia
- internal spermatic fascia
- cremaster muscle
- tunica vaginalis
- The testes develop on the **posterior abdominal wall **and descend through the inguinal canal to reach the scrotum, guided by the gubernaculum
- As they descend, take venous and arterial supply, nerve supply and lymphatic drainage
- The peritoneum sticks to the testes and creates the processus vaginalis
- Goes through the transervalis fascia, which becomes the internal spermatic fascia
- Takes muscular covering from internal oblique, which becomes the cremaster muscle
- The external oblique becomes the external spermatic fascia
- The processus vaginalis gets longer and longer until the top pinches off: get sac of peritoneum called tunica vaginalis
Which structure is found at the mid point of inguinal ligament? [1]
Deep inguinal ring
Label A-C [3]
A: Internal spermatic fascia
B: cremaster muscle
C: external spermatic fascia
Label A-D [4]
A: transversalis fascia
B: transversalis abdominis
C: internal oblique
D: external oblique
How does the round ligament of uterus develop?
Ovaries descent also guided by gubernaculum into pelvis.
Gubernaculum structure continues onto labia majoria. After maturation is called the round ligament of the uterus
Which structure does a direct inguinal hernia pass through? [1]
Where does a direct hernia emerge? [1]
Which population is it common in? [1]
Which structure does a direct hernia pass through? [1]
Hesselbach’s triangle
Where does a direct hernia emerge? [1]
Superficial inguinal ring
Which population is it common in? [1]
Males over 40
Where does a direct inguinal herniation occur in relation to the inferior epigastric vessels?
Medial to the inferior epigastric vessels
Which structure does an indirect inguinal hernia pass through? [1]
Where does an indirect hernia emerge? [1]
Which population is it common in? [1]
Which structure does an indirect inguinal hernia pass through? [1]
Pass all the way along the inguinal canal
Where does an indirect hernia emerge? [1]
In the scrotum
Which population is it common in? [1]
Children
Which structures make the border of Hasselbach’s trianglge? [3]
Name 3 other types of hernias that exist other than inguinal hernias
Incisional: Following surgery to the abdomen the scar creates a weakness in the abdominal wall
Umbilical: Usually in babies, when the rectus abdominis is not fully joined in the midline
Femoral: Herniation into the femoral canal (beneath the inguinal ligament so below and lateral to pubic tubercle) most common in females
Which two molecules can activate the adenylyl cyclase pathway, which causes glycogenlysis, GNG? [2]
Glucagon
Adrenaline
Where is a common area for objects, for example, fish bones to lodge in the pharynx? [1]
Piriform fossa
Label A-E
A : Right inferior nasal concha
B : Right piriform fossa
C : Spinous process of T1
D : Left epiglottic vallecula
E : Left body of mandible
Which of the following elevates during swallowing?
1
2
3
4
5
6
1
2
3
4
5
6
Which of the following is found at the level of larynx?
1
2
3
4
5
6
1
2
3
4
5
6
The MRI image below shows parotid adenocarcinoma. Which of the following cranial nerve signs would you expect to see in this patient?
Unilateral facial paralysis
Uvular deviation
Reduced facial sensation
Bitemporal heminaopia
The MRI image below shows parotid adenocarcinoma. Which of the following cranial nerve signs would you expect to see in this patient?
Unilateral facial paralysis
Uvular deviation
Reduced facial sensation
Bitemporal heminaopia
Despite not innervating the Partoid glad the Facial nerve runs through the gland. This relationship is important as swelling or surgery on the parotid gland can compress facial nerve branches
As the food bolus is pushed into the pharynx the epiglottis of the larynx is pulled inferiorly to prevent food being aspirated.
Which nerve is responsible for closure of the larynx?
Superior laryngeal nerve
Recurrent laryngeal nerve
Glossopharnygeal nerve
Vagus nerve
As the food bolus is pushed into the pharynx the epiglottis of the larynx is pulled inferiorly to prevent food being aspirated.
Which nerve is responsible for closure of the larynx?
Superior laryngeal nerve
Recurrent laryngeal nerve
Glossopharnygeal nerve
Vagus nerve
As the recurrent laryngeal nerve innervates all muscles of the larynx (except cricothyroid) it is responsible for the closure during swallowing.
Which nerve provides motor supply to the oesophagus? [1]
Acceptable responses: Vagus, Vagus nerve, CN X, X, cranial nerve 10
The openings at each end of the inguinal canal are the [] ring and the [] ring.
The openings at each end of the inguinal canal are the deep (internal) ring and the superficial (external) ring.
What structure is this arrow pointing at? [1]
Inferior epigastric vessels [1]
What does this arrow point to? [1]
Linea alba
What structure is found at the mid point of the inguinal ligament?
Femoral artery
Femoral vein
Deep inguinal ring
Superficial inguinal ring
What structure is found at the mid point of the inguinal ligament?
Femoral artery
Femoral vein
Deep inguinal ring
Superficial inguinal ring
Visceral afferent fibres carry information in autonomic fibres retrogradely. Pain perceived in an organ corresponds to its embryological development.
Name the vert levels where pain would be felt for the following:
A: Foregut (Liver, Gall Bladder, Pancreas, Spleen, Proximal Duodenum)
B: Midgut (Distal Duodenum, Jejunum, Ileum, Caecum, Appendix, Ascending Colon, 2/3rd Transverse Colon)
C: Hindgut (1/3rd Transverse Colon, Descending Colon, Sigmoid Colon, Rectum)
Visceral afferent fibres carry information in autonomic fibres retrogradely. Pain perceived in an organ corresponds to its embryological development.
Name the vert levels where pain would be felt for the following:
A: Foregut (Liver, Gall Bladder, Pancreas, Spleen, Proximal Duodenum): T6-T9 EPIGASTRIC
B: Midgut (Distal Duodenum, Jejunum, Ileum, Caecum, Appendix, Ascending Colon, 2/3rd Transverse Colon): T8-T12 UMBILICAL
C: Hindgut (1/3rd Transverse Colon, Descending Colon, Sigmoid Colon, Rectum): T12-L2 SUPRAPUBIC
Where would you expect pain from appendicitis to present?
Acceptable responses: umbilical, umbilical region
If appendicitis progresses and inflames the parietal peritoneum where would the pain be perceived? [1]
Acceptable responses: Answer 1, right iliac fossa, lower right quadrant
Which of the following is the jejunum and ileum?
Left: J
Right: Ileum
What is a volvulus?
Because of its mobility, the sigmoid colon can rotate around its mesentery. This may correct itself spontaneously, or the rotation may continue until the blood supply to the sigmoid colon is completely shut off. The rotation commonly occurs clockwise and is referred to as a volvulus.
The structures in the upper part of the anal canal follow the pattern of the [] (blood supply, nerve supply, venous and lymphatic drainage).
Whilst the lower part of the anal canal follows the pattern of [].
The structures in the upper part of the anal canal follow the pattern of the hindgut (blood supply, nerve supply, venous and lymphatic drainage).
Whilst the lower part of the anal canal follows the pattern of skin.
THINK ABOUT EMBRYOLOGICAL ORIGINS
Which CNs supply the following salivary glands:
Parotid
Submandibular
Sublingual
Which CNs supply the following salivary glands:
Parotid: CN IX
Submandibular: CNVII
Sublingual: CNVII
Which nerve is sensory in the oropharynx? [1]
The soft palate is tense and elevated to close the nasopharynx. Which nerve is repsonsible for this? [1]
Which nerve is sensory in the oropharynx? [1]
CN IX
The soft palate is tense and elevated to close the nasopharynx. Which nerve is repsonsible for this? [1]
CN X
What is a hiatus hernia?
What is a common cause?
when part of the stomach squeezes up into the chest through an opening (“hiatus”) in the diaphragm.
The most common cause of a hiatal hernia is an increase in pressure in the abdominal cavity. Your abdominal cavity is the space in the middle of your body that holds several organs, including the:
Lower part of the esophagus and stomach.
Small intestine, colon and rectum.
Liver.
Gallbladder, pancreas and spleen.
Kidneys.
Bladder.
What are the 3 boundaries of Hesselbachs triangle?
inguinal ligament, inferior epigastric vessel, and rectus abdominis muscle.
What structure would emerge from the superficial inguinal ring in a female OR male? [2]
F: Round ligament
M: Spermatic cord
desribe the pathway of the left gastric artery, splenic artery and common hepatic artery
left gastric -> supplies the lesser curvature of the stomach, gives off oesphogeal branhces
splenic artery --> short gastric arteries (supplies the fundus), left gastric epiploic (runs around greater curvature of stomach), terminates at spleen
- *common hepatic artery** –> gastroduodenal artery, which branches to give right gastroepiploic artery - which anastamoses with left gastroepiploic artery.
- -> right gastric artery (goes to less curvature of stomach). anastamoes with left gastric artery
- –> after these two have gone, becomes the hepatic artery proper
describe pathway of common hepatic artery –> hepatic artery proper —> ?? :)
common hepatic artery: branches into
- gastroduodenal artery, which branches to give right gastroepiploic artery - which anastamoses with left gastroepiploic artery.
- right gastric artery (goes to less curvature of stomach). anastamoes with left gastric artery
after these two: becomes the hepatic artery proper; branches into:
- **right hepatic artery –> cystic artery (gall bladder)
- left hepatic artery**
what is the name of the artery outlined in green?
cysteic artery
A-D?
A: coeliac trunk
B: splenic artery
C: hepatic artery proper
D: gastroduodenal
describe the branches of the SMA (6)
- inferior pancreaticoduedenal artery
- jejnunal and ileal branches
3 middle colic artery
- right colic artery
- ileocolic artery -> appendicular artery
MRI !
A: jenunal
B: superior mesentric
C ileocolic
This 50-year-old man presents with abdominal pain. Abdominal x-ray shows small bowel dilatation. Contrast-enhanced CT is performed with selected images shown. What is the most likely diagnosis?
Amyand hernia
De Garengeot hernia
femoral hernia
direct inguinal hernia
indirect inguinal hernia
obturator hernia
This 50-year-old man presents with abdominal pain. Abdominal x-ray shows small bowel dilatation. Contrast-enhanced CT is performed with selected images shown. What is the most likely diagnosis?
Amyand hernia
De Garengeot hernia
femoral hernia
direct inguinal hernia
indirect inguinal hernia
obturator hernia
Contrast-enhanced CT is performed with selected images shown. What is the most likely diagnosis?
Amyand hernia
De Garengeot hernia
femoral hernia
direct inguinal hernia
indirect inguinal hernia
obturator hernia
This 50-year-old man presents with abdominal pain. Abdominal x-ray shows small bowel dilatation. Contrast-enhanced CT is performed with selected images shown. What is the most likely diagnosis?
Amyand hernia
De Garengeot hernia
femoral hernia
direct inguinal hernia
indirect inguinal hernia
obturator hernia
Contrast-enhanced CT is performed with selected images shown. The arrow suggests a hernia. What is the most likely diagnosis? Inferior epigastric vessels are shown by the arrowhead
De Garengeot hernia
femoral hernia
direct inguinal hernia
indirect inguinal hernia
obturator hernia
Contrast-enhanced CT is performed with selected images shown. The arrow suggests a hernia. What is the most likely diagnosis?
De Garengeot hernia
femoral hernia
direct inguinal hernia
indirect inguinal hernia Inferior epigastric vessels medial to hernial neck (arrowhead) are visible
obturator hernia
Contrast-enhanced CT is performed with selected images shown. The arrow suggests a hernia. What is the most likely diagnosis?
De Garengeot hernia
femoral hernia
direct inguinal hernia
indirect inguinal hernia
obturator hernia
Contrast-enhanced CT is performed with selected images shown. The arrow suggests a hernia. What is the most likely diagnosis?
De Garengeot hernia
femoral hernia
direct inguinal hernia
anguinal hernia (arrow), which passes medially to inferior epigastric ar tery and vein (arrowhead)
indirect inguinal herni
obturator hernia
Contrast-enhanced CT is performed with selected images shown. The arrow suggests a hernia. What is the most likely diagnosis?
De Garengeot hernia
femoral hernia
direct inguinal hernia
indirect inguinal hernia
obturator hernia
Contrast-enhanced CT is performed with selected images shown. The arrow suggests a hernia. What is the most likely diagnosis?
De Garengeot hernia
femoral hernia
direct inguinal hernia
T image shows par t of bladder (arrow) is contained within direct lef t inguinal hernia medial to inferior epigastric neurovascular bundle (arrowhead)
indirect inguinal hernia
obturator hernia
What type of hernia would it be if came out at the *?
De Garengeot hernia
femoral hernia
direct inguinal hernia
indirect inguinal hernia
obturator hernia
What type of hernia would it be if came out at the *?
De Garengeot hernia
femoral hernia
direct inguinal hernia
indirect inguinal hernia
obturator hernia
What type of hernia is A? [1]
A: direct hernia
What of the following depicts the inferior epigastric arteries
Solids arrows
Open arrows
Curved arrows
Arrowheads
What of the following depicts the inferior epigastric arteries
Solids arrows
Open arrows
Curved arrows
Arrowheads
What of the following depicts the deep inguinal ring
Solids arrows
Open arrows
Curved arrows
Arrowheads
What of the following depicts the deep inguinal ring
Solids arrows
Open arrows
Curved arrows
Arrowheads
What of the following depicts the deep inguinal ring
Solids arrows
Open arrows
Curved arrows
Arrowheads
What of the following depicts the deep inguinal ring
Solids arrows
Open arrows
Curved arrows
Arrowheads
What of the following depicts the inguinal ligament
Solids arrows
Open arrows
Curved arrows
Arrowheads
What of the following depicts the inguinal ligament
Solids arrows
Open arrows
Curved arrows
Arrowheads
FYI
