SIMPLIFIED MRCS ANATOMY-ABDOMEN AND PELVIS Flashcards
Enumerate layers of anterior abdominal wall (laterally)
Discuss attachment of external oblique muscle
+Origin—— costal
+Insertion—- lumbar , ilioinguinal , linea alba
+Innervation—- lower 6 thoracic and 1st lumbar(L1)
+Direction of fibres—- downward,forward and medially
Discuss internal oblique muscle
+Origin——lumbar fascia,ilioinguinal(iliac crest and inguinal ligament)
+Insertion—— costal(lower part makes conjoint tendon),linea alba
+Innervation—- lower 6 thoracic+ 1st lumbar(L1)
+Direction of fibres—— upward,forward and medially
Discuss transversus abdominis muscle
+Origin—— costal,lumbar,ilioinguinal
+Insertion—-Linear alba
+Innervation—-lower 6 thoracic+1st lumbar(L1)
+Direction of fibres —- Transverse
Discuss quadratus lumborum
+Origin—- lumbar fascia,iliac crest
+Insertion—-12th rib
+Innervation—— T12,L1-L3
+Action—- (1)Unilateral (alone): laterally flex the vertebral column
(2)Bilateral (together): depression of thoracic cage
Discuss rectus abdominis muscle
+Origin—- (1) At the level of arcuate line
Midway between umbilicus and symphysis pubis
(2) Above arcuate line
+Anterior—External oblique + Anterior lamina of internal oblique
+Posterior—Posterior lamina of internal oblique +Transversus abdominis muscle
+Insertion— Below arcuate line
+Anterior—All muscles
+Posterior—- Transversalis fascia
+Innervation— (1) lower 6 intercostal
(2) Nerve from lateral side
Discuss linea alba
+Definition—- bloodless midline
+Features— (1)Superiorly— wide
(2)Inferiorly—- narrow
(3)Bloodless
Define linea alba
Bloodless midline
What are the features of linea alba?
(1)Superiorly—- wide
(2)Inferiorly—-narrow
(3)Bloodless
What are the dimensions of linea alba?
(1)Superiorly—- wide
(2)Inferiorly—- narrow
Define linea semilunaris
Lateral border of rectus abdominis muscle
What is the blood supply of rectus abdominis muscle?
Superior and inferior epigastric arteries posterior to it
What is the location of superior and inferior epigastric arteries in the anterior abdominal?
Posterior to the rectus abdominis muscle
What is the blood supply to the anterior abdominal wall?
Superior and inferior epigastric arteries behind rectus abdominis muscle
What is the clinical significance of linea alba?
Midline incision through linea alba during exploration
What is the clinical significance of rectus abdominis muscle?
(1)During Pfannenstiel incision the muscle divided is the rectus abdominis
(2)Posteriorly,below arcuate line
+no posterior rectus sheath
+there is only Transversalis fascia behind the muscle
What is the clinical significance of linea semilunaris?
Spigelian hernia— (1)at the level of arcuate line
(2)at lateral border of rectus muscle (i.e., linea semilunaris
What is the location of spigelian hernia?
(1)at level of arcuate line
(2)At lateral border of rectus abdominis muscle(i.e., linea semilunaris)
What is the location of linea semilunaris?
At lateral border of rectus abdominis muscle
What is the origin of cremasteric fascia?
Internal oblique muscle
What is the origin of conjoint tendon?
Internal oblique muscle
What is the length of inguinal canal?
4cm
What is the location of superficial inguinal ring?
(1)At external oblique muscle
(2)Above pubic tubercle
What is the location of deep inguinal ring?
(1)At fascia transversalis
(2)1/2 inch above midpoint of inguinal ligament
(3)lateral to inferior epigastric vessels (site of indirect hernia)
What is the direction of inguinal canal?
Downward ,forward ,medially
Discuss boundaries of inguinal canal
Mnemonic = APSI-AT ML ( 2A+ 2T+ 2M+ 2L)
+Anterior wall (2A)— (1)External oblique (A)poneurosis—you should open it during hernia repair
(2)Internal oblique (A)poneurosis+Transversus abdominis(both laterally)
+Posterior wall (2T)—(1)(T)ransversalis fascia—you put mesh on it during hernia repair
(2)Conjoint (T)endon(medially+from internal oblique muscle)
+Superiorly (roof)(2M)— arched fibres of
(1)Internal oblique (m)uscle
(2)Transversus abdominis (m)uscle
+Inferiorly(floor)(2L)— (1)Inguinal (L)igament (the lower end of external oblique muscle)
(2)(L)acunar ligament
Discuss contents of inguinal canal
Mnemonic;S/3V/3Nerves
(1)Spermatic cord-the most important content
(2)Vas deferns
(3)Vessels(artery of vas,testicular artery,cremasteric artery)
(4)Vestige of processes vaginalis(processes vaginalis derived from peritoneum)
(5)Genital branch of Genito femoral nerve
(6)Ilioinguinal nerve
(7)Sympathetic nerves
What is the most important content of inguinal canal?
Spermatic cord
Discuss covering of inguinal canal
Mnemonic; ICE/TIE or ICE/FIE
(1)Exteranl spermatic fascia—Extarnal oblique muscle
(2)Cremasteric fascia—-Internal oblique muscle
(3)Internal spermatic fascia—-Transversalis fascia
What is the origin of external spermatic fascia?
External oblique muscle
What is the origin of internal spermatic fascia?
Transversalis fascia
Discuss indirect inguinal hernia
+Aetiology
In children (indirect mainly) —- patent or persistent processes vaginalis
+Site of defect
Deep inguinal ring
+Direction of descent
Downward,forward and medially
+Course—through the following
(1)deep ring
(2)inguinal canal
(3)Superficial ring
(4)Scrotum—presented as a groin swelling
What is the cause of indirect inguinal hernia?
In children (indirect mainly) —- patent or persistent processes vaginalis
What is most common inguinal hernia in children?
Indirect inguinal hernia
What is the cause of indirect inguinal hernia in children?
Patent or persistent processes vaginalis
What is the site of defect in indirect inguinal hernia?
Deep inguinal ring
What is the direction of descent of indirect inguinal hernia?
Downward,forward and medially
Discuss course of indirect inguinal hernia
through the following
(1)deep ring
(2)inguinal canal
(3)Superficial ring
(4)Scrotum—presented as a groin swelling
Which inguinal hernia passes lateral to inferior epigastric vessels?
Indirect inguinal hernia
What are the boundaries of Hessel Bach triangle?
+Laterally—inferior epigastric vessels
+Medially—Lateral border of rectus abdominis muscle
+Inferiorly—Inguinal ligament
What is the clinical significance of Hassel Bach triangle?
Site of direct inguinal hernia
What is the site of direct inguinal hernia?
(1)Through Hassel Bach triangle
(2)Medial to inferior epigastric vessels
Which inguinal hernia passes medial to inferior epigastric vessels?
Direct inguinal hernia
Define direct inguinal hernia
(1)Through Hassel Bach triangle
(2)Medial to the inferior epigastric vessels
Define hydrocele
Collection of fluids in tunica vaginalis
What is the nerve root of the ilioinguinal nerve?
L1
What is the course of the ilioinguinal nerve?
(1)Emerges from the lateral border of the psoas major muscle just inferior to the iliohypogastric nerve
(2)Perforates the transversus abdominis muscle near the anterior part of the iliac crest
(3)Passes between the transversus abdominis and internal oblique muscles
(4)Pierces the Inguinal canal to pass through it anterior to spermatic cord but not enter from beginning
(5)Leave the abdominal wall through superficial Inguinal ring
What is the function of the ilioinguinal nerve?
+Motor
No motor function in the lower limb but innervates muscle of the abdominal wall
+Sensory
(1)Skin over anteromedial part of the upper thigh and
(2)Adjacent skin of perineum
(3)Anterior scrotum and labia
What causes ilioinguinal nerve injury?
Entrapped during Inguinal hernia repair causing severe postoperative pain
What is the manifestations of ilioinguinal nerve injury?
Severe postoperative pain
What is the motor function of the ilioinguinal nerve?
No motor function in the lower limb but innervates muscle of the abdominal wall
What is the sensory function of the ilioinguinal nerve?
(1)Skin over anteromedial part of the upper thigh and
(2)Adjacent skin of perineum
(3)Anterior scrotum and labia
What is the nerve root of the genitofemoral nerve?
L1-L2
What is the course of the genitofemoral nerve?
(1)Passes obliquely and anteroinferiorly through psoas major muscle on the posterior abdominal wall
(2)Emerges from the medial border of psoas major opposite the fibrocartilage between L3-L4 vertebrae
(3)It then descends on the anterior surface of psoas major,undercover of the peritoneum
What is the function of the genitofemoral nerve?
+Motor
No motor function in lower limb, but genital branch innervates cremaster muscle in the wall of the spermatic cord in men thence cremastric reflexes
+Sensory
-Genital branch(inguinal canal)
(1)Innervates cremaster muscle in the wall of
spermatic cord in men thence cremastric reflexes
(2)Skin of scrotum
-Femoral branch(post.to ing.lig,lat.to femoral artery)
Skin at femoral triangle,i.e.,skin on anterior central part of upper thigh
What are the components of the genitofemoral nerve?
-Genital branch(inguinal canal)
(1)Innervates cremaster muscle in the wall of
spermatic cord in men thence cremastric reflexes
(2)Skin of scrotum
-Femoral branch(post.to ing.lig,lat.to femoral artery)
Skin at femoral triangle,i.e.,skin on anterior central part of upper thigh
What are locations and functions of the components of the genitofemoral nerve?
-Genital branch(inguinal canal)
(1)Innervates cremaster muscle in the wall of
spermatic cord in men thence cremastric reflexes
(2)Skin of scrotum
-Femoral branch(post.to ing.lig,lat.to femoral artery)
Skin at femoral triangle,i.e.,skin on anterior central part of upper thigh
What are the locations of the genital branch of the genitofemoral femoral nerve?
+Location—Genital branch(inguinal canal)
+Function
(1)Innervates cremaster muscle in the wall of
spermatic cord in men thence cremastric reflexes
(2)Skin of scrotum
What are the functions of the genital branch of the genitofemoral nerve?
+Location—inguinal canal
+Function
(1)Innervates cremaster muscle in the wall of
spermatic cord in men thence cremastric reflexes
(2)Skin of scrotum
What are locations and functions of the femoral branch of the genitofemoral nerve?
+Location—post.to ing.lig,lat.to femoral artery)
+Function
Skin at femoral triangle,i.e.,skin on anterior central part of upper thigh
What are the locations of the femoral branch of the genitofemoral nerve?
+Location—post.to ing.lig,lat.to femoral artery
+Function—Skin at femoral triangle,i.e.,skin on anterior central part of upper thigh
What are the functions of the femoral branch of the genitofemoral nerve?
+Location—post.to ing.lig,lat.to femoral artery)
+Function—Skin at femoral triangle,i.e.,skin on anterior central part of upper thigh
What are the motor functions of the genitofemoral nerve?
No motor function in lower limb, but genital branch innervates cremaster muscle in the wall of the spermatic cord in men thence cremastric reflexes
What are the sensory functions of the genitofemoral nerve?
-Genital branch(inguinal canal)
(1)Innervates cremaster muscle in the wall of
spermatic cord in men thence cremastric reflexes (2)Skin of scrotum
-Femoral branch(post.to ing.lig,lat.to femoral artery)
Skin at femoral triangle,i.e.,skin on anterior central part of upper thigh
What nerve is responsible for cremasteric reflex?
Genital branch of the genitofemoral nerve
Which branch of the genitofemoral nerve is responsible for cremasteric reflex?
Genital branch of the genitofemoral nerve
Discuss blood supply to the testis
What is the arterial supply to the testis?
From aorta
What is the venous drainage of the testis?
What is the site of drainage of the right testicular vein?
IVC
What is the site of drainage of the left testicular vein?
Left renal vein
What is the lymphatic drainage of the testis?
What is the lymphatic drainage of the scrotum?
Inguinal L.N(medial transverse group)
Which group of inguinal lymph nodes is the site lymphatic drainage of the scrotum?
Medial transverse group
Discuss cutaneous Innervation of scrotum?
Which nerve supply the anterior scrotum?
Ilioinguinal nerve
Which nerve supply the posterior scrotum?
Pudendal nerve
Which nerve supply small area of scrotum?
Genital branch of genitofemoral nerve
Enumerate the layers covering the testes?
What guides descend of the testes?
Gubernaculum
What is the course of undescended testes?
(1)Abdomen
(2)Deep inguinal ring
(3)Inguinal canal
(4)Superficial inguinal ring
(5)Upper scrotum
Enumerate sites of ectopic testes
(1)Abdomen
(2)Suprapubic
(3)Base of penis
(4)Superficial inguinal pouch
(5)Inguinal canal
(6)Suprascrotal regions
(7)Contralateral hemiscrotum
(8)Perineal region
(9)Femoral region
Discuss attachment of the diaphragm
+origin
(1)Sternal—Xiphoid
(2)Costal—Lower 6 costal cartilages
(3)Vertebral—by 2 crura and 3 arcuate ligaments
+Insertion
Central tendon
What is the nerve supply of the diaphragm?
(1)Central part—Phrenic nerve(sensory and motor)
(2)Peripheral part—Lower 6 Thoracic nerves
What is the origin of the diaphragm?
(1)Sternal—-Xiphoid
(2)Costal—Lower 6 costal cartilages
(3)Vertebral—by 2 crura and 3 arcuate ligaments
What is the insertion of the diaphragm?
Central tendon
What is the nerve supply of the central part of the diaphragm?
Phrenic (Sensory and motor)
What is the nerve supply of the peripheral part of the diaphragm?
Lower 6 Thoracic nerves
What are the opening in the diaphragm and enumerate the contents of each one?
Mnemonic;Voice Of Arab
(1)Caval opening (T8)–Vena cava+Phrenic nerve
(2)Oesophageal opening (T10)–Oesophagus+vagus nerve
(3)Aortic opening (T12)–Aorta+thoracic duct+azygous
What is the vertebral level of the caval opening in diaphragm?
T8
What is the vertebral level of the caval opening in diaphragm?
T8
What is the vertebral level of the oesophageal opening in diaphragm?
T10
What is the vertebral level of the aortic opening in diaphragm?
T10
What is the vertebral level of the aortic opening in the diaphragm?
T12
What are the contents of the caval opening?
Vena cava+phrenic nerve
What are the contents of the oesophageal opening?
Oesophagus+vagus nerve
What are the contents of the aortic opening?
Aorta+thoracic duct+azygous
Compare between the types of congenital diaphragmatic hernia
What are the arcuate ligaments of the diaphragm?
(1)Median arcuate ligament
(2)Medial arcuate ligament
(3)Lateral arcuate ligament
Discuss blood supply to the stomach
Discuss arterial supply to the stomach
Discuss venous drainage of the stomach
What is the other name for gastroepiploic arteries
Gastro-omental arteries
What are the main branches of the coeliac trunk?
(1)Lt gastric artery
(2)Splenic artery
(3)Hepatic artery
What are the main branches of the splenic artery?
(1)Short gastric—-the fundus
(2)Lt gastroepiploic artery—anastomoses with the Rt gastroepiploic at the greater curvature of the stomach
What are the main branches of the hepatic artery proper?
(1)Rt gastric artery
anastomoses with the Lt gastric artery from the coeliac trunk on the lesser curvature of the stomach
(2)gastroduodenal artery
from the hepatic artery proper and terminates in a bifurcation when it splits into
+right gastroepiploic artery
+anterior superior pancreaticoduodenal artery (superior pancreaticoduodenal artery).
What artery supply the pylorus of the stomach?
Gastrodudenal artery
What artery supply the lesser curvature of the stomach?
Anastomosis of the Rt and Lt gastric arteries
What artery supply the greater curvature of the stomach?
Anastomosis of the Rt and Lt gastroepiploic (gastrointestinal-omental)arteries
What artery supply the fundus of the stomach?
Short gastric arteries
Enumerate ligaments of the stomach
What are the ligaments that are part of the greater omentum?
What is the blood supply to the greater omentum?
Gastro-epiploic vessels
Discuss main causes upper GIT Bleeding
Which type of omentum is supplied by gastroepiploic vessels
Greater omentum
What is the site and source of bleeding from oesophageal varices?
+Site—between oesophageal veins and left gastric vein
+Source of bleeding—from left gastric vein
What is the location of bleeding from oesophageal varices?
Between oesophageal veins and left gastric vein
What is source of bleeding from oesophageal varices?
Left gastric vein
Which blood vessel causes bleeding from oesophageal varices?
Left gastric vein
What is the clinical significance of left gastric vein?
What is the site and source of bleeding from duodenal ulcer?
What is the site of bleeding from duodenal ulcer?
Gastroduodenal artery behind the 1st part of duodenum
From which artery is the bleeding from duodenal ulcer?
Gastroduodenal artery behind the 1st part of duodenum
What is the site and source of bleeding from gastric ulcer?
What is the site and source of bleeding from gastric ulcer between antrum and body of the stomach?
Discuss peritoneal cavity
Discuss greater omentum
What is the other name for the greater omentum?
Apron of the peritoneum
Discuss attachment of the greater omentum
What is the clinical significance of the greater omentum?
Which sac in the abdomen is related to greater omentum?
Is connected to the lesser sac
Discuss lesser omentum
Define lesser omentum
Double layer of peritoneum
What is the extension of the lesser omentum?
From the lesser curvature of the stomach and proximal duodenum to the liver
What is the location of the lesser omentum?
In front of the coeliac trunk
What is the clinical significance of the lesser omentum?
Compare between the greater and lesser omentum
Discuss gastrophrenic ligament
+Source—portion of greater omentum
+Location—Extends from fundus of the stomach to diaphragm
Define gastrophrenic ligament
+portion of greater omentum
+Extends from fundus of the stomach to diaphragm
Discuss attachment of the gastrophrenic ligament
Extends from fundus of the stomach to diaphragm
Discuss gastrosplenic ligament
Source—Left part of greater omentum
Attachment—extends from hilum of spleen to greater curvature of stomach
From which part of the peritoneum is the gastrosplenic ligament?
Greater omentum
What is the location of the gastrosplenic ligament?
Extends from the hilum of the spleen to the greater curvature of the stomach
Discuss gastrocolic ligament
+portion of greater omentum
+extends from the greater curvature of the stomach to the transverse colon
Discuss hepatogastric ligament
+portion of lesser omentum
+extends from liver to lesser curvature of the stomach
Discuss heptoduodenal ligament
+portion of lesser omentum
+extends from the liver to the 1st part of the duodenum
Discuss splenorenal ligament
Connects the spleen to the left kidney
Discuss hepatorenal ligament
Connects the liver to the right kidney
Discuss phrenicocolic ligament
Extends from the left colic flexture to the diaphragm
What are the ligaments that are part of the lesser omentum?
(1)Hepatogastric ligament
(2)Hepatoduodenal ligament
Enumerate ligaments in the abdomen that are stateless(i.e.,not part of the greater or lesser omentum)?
(1)Splenorenal ligament
(2)Phrenico-colic ligament
(3)Hepatorenal ligament
Discuss mesentries
+Definition
Double fold of peritoneum
+Function
(1)Suspending parts of bowel
(2)Conveying vessels,lymphatic,and nerves of bowel
+Examples
(1)Mesoappendix
(2)Transverse mesocolon
(3)Sigmoid mesocolon
Discuss boundaries of the lesser sac(Omental bursa)
+Anteriorly -
(1)quadrate lobe of liver,
(2)gastrocolic ligament,
(3)lesser omentum
+Left
(1)left kidney,
(2)left adrenal gland
+Posteriorly
pancreas
+Right
(1)epiploic foramen,
(2)lesser omentum,
(3)greater sac
Enumerate the most important structures in the anterior free border of the lesser sac?
(1)Hepatic artery
(2)Hepatic duct (Common bile duct,CBD)—Anterior to portal vein
(3)Portal vein
What is the surgical significance of the anterior free border of the lesser sac?
Contains the most important structures for which Pringle manoeuvre to be done:
(1)Heptic artery
(2)Hepatic duct (Common bile duct,CBD)—Anterior to portal vein
(3)Portal vein
What is the location of performing Pringle manoeuvre?
The anterior free border of the lesser sac in which these structures are contained
(1)Hepatic artery
(2)Hepatic duct(Common bile duct,CBD)—Anterior to portal vein
(3)Portal vein
What is the other name for epiploic foramen.
Foramen of Winslow
Enumerate boundaries of epiploic foramen?
What are the measurements of the spleen?
Describe the peritoneal covering of the spleen
Completely covered by Peritoneum
Enumerate the ligaments of the spleen?
Enumerate contents of gastrosplenic ligament
(1)Short gastric arteries
(2)Lt gastroepiploic artery
Enumerate the contents of the leinorenal ligament
(1)Splenic vessels
(2)Tail of pancreas
What is the function of leinorenal ligament?
Attach the spleen to the posterior abdominal wall
What is the function of Phrenicocolic ligament?
Direct large spleen to umbilicus
Discuss blood supply of the spleen
What is location of the splenic artery to the pancreas?
Above pancreas
What is the anatomical significance of the splenic vein?
Join superior mesentric vein to form portal vein
What is the anatomical location of the splenic vein?
Behind pancreas
What are the components of portal vein?
Portal vein = splenic vein + SM vein
What is the incidence of accessory spleen?
10%
What is the size of accessory spleen?
1 cm
What are the possible locations of accessory spleen?
+4 organs
(1)wall of the stomach
(2)tail of the pancreas
(3)hilum of the spleen
(4)gonads—not ureter
+4 coverings
(1)gastrosplenic ligament
(2)leinorenal ligament
(3)mesentry
(4)greater omentum
+1 vessel
Along splenic vessels
What is the most commonly injured structure post splenectomy?
Tail of pancreas
What vessels should be divided or ligated during splenectomy?
Short gastric vessels
What is the most commonly injured structure on division of short gastric vessels?
Greater curvature of the stomach
Discuss structure of the spleen
+Origin
Mesenchyme
+Cells
(1)White pulp(20%)—lymphocyte
—Immune function
(2)Red pulp(80%)—platelets store
—remove aged and defective RBCs
Describe Pringles manoeuvre
Enumerate ligaments supporting the liver
Mnemonic;Full 2 ligaments CT luminous
(1)Falciform ligament: قدام
(2)Ligamentum teres: تحت
(3)Ligamentum venosum: فوق
(4)Coronary ligament: Rt and Lt
(5)Triangular ligament: Rt and Lt
For the last L in luminous ,it could also stands for Ligamentum venosum
Describe attachment of the falciform ligament
قدام(1)
(2)From the liver to the diaphragm and anterior abdominal wall
So—-(1)Liver
(2)Diaphragm
(3)Anterior abdominal wall
Discuss Ligamentum teres
+Definition
Obliterated left umbilical vein
+Location
تحت(1)
(2)In the free margin of the falciform ligament
Define Ligamentum teres
Obliterated left umbilical vein
What is the location of the Ligamentum teres
تحت(1)
(2)In the free margin of the falciform ligament
Discuss coronary ligament
+Definition
Reflections of peritoneum
+Location
From the superior aspect of the liver to the diaphragm
Define coronary ligament
Reflections of peritoneum
What is the location of the coronary ligament?
From the superior aspect of the liver to the diaphragm
What is the location of the triangular ligament?
Rt and Lt to the diaphragm
What is the location of Ligamentum venosom?
فوق
Describe division of the liver by Surgical and anatomical lines
Describe anatomical and surgical liver lobes
Discuss anatomical liver lobes
Discuss surgical liver lobes
What is the size of the anatomical liver lobes?
+Large Rt lobe
+Small Lt lobe
What is the size of the surgical liver lobes?
Nearly equal
What divides lobes of the liver into anatomical lobes?
What divides lobes of the liver into surgical lobes?
Compare caudate lobe and quadrate lobe
What is the location of the caudate lobe?
What is the location of the quadrate lobe?
Discuss blood supply to the liver
which vessel mainly supplies the liver?
Portal vein(70%)
What is the accessory vessel which helps in blood supply of the liver?
Hepatic artery(30%)
What percentage of portal vein supplying blood to the liver?
70%
What percentage of hepatic artery supplying blood to the liver?
30%
What is the other name for porta hepatis?
Hilum of the liver
Describe porta hepatis
What is the location of porta hepatis
Between caudate and quadrate lobes
What are the contents of porta hepatis?
What is the location of portal vein in the porta hepatis?
Most posterior
What is the location of the the hepatic artery in the porta hepatis?
Middle
What is the location of the hepatic duct in the porta hepatis?
(1)Most anterior
(2)Lateral
What is the most posterior structure in porta hepatis?
Portal vein
What is the middle structure in porta hepatis?
Hepatic artery
What is the most anterior structure in porta hepatis?
Rt and Lt hepatic duct
