Test Flashcards

1
Q

If you cut off the common hepatic artery, collateral circulation to the hepatic artery distal to that is available by what artery?

A

Splenic artery:

Left gastroomental > right gastroomental > gastroduodenal>proper hepatic artery

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2
Q

What are the boundaries of the lesser sac

A

Anterior - stomach, gastrocolic ligament
Inferior - transverse colon, transverse mesocolon
Superior - caudate lobe of liver
Posterior - pancreas, IVC, Aorta, Celiac Trunk, Splenic Artery and Vein, Left Kidney, Left Suprarenal gland
RIght - liver and duodenal bulb
Left- gastrosplenic ligament, spleen and splenorenal ligament.

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3
Q

What are the boundaries of the omental foramen?

A

anterior - portal vein, proper heaptic artery and common bile duct
Posterior - inferior vena cava and right crus of the diaphragm
Superior - caudate lobe of liver
Inferior - first part of duodenum

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4
Q

What is in the supracolic compartment?

What is in the infracolic compartment?

A
Supracolic = stomach liver and spleen
Infracolic = small intestine, ascending colon, descending colon

Boundary is the transverse colon and mesocolon.

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5
Q

What do the vestigial remnants of the genital system and males become?

A

Male: cranial to the region of the mesonephric duct which becomes the epididymis and ductus deferens may become the appendix of the epididymis
Paramesonephric duct: caudal ends induce an enlargement of the urogenital sinus which becomes the seminal colliculus (elevation on the wall of the prostatic urethra). Within this elevation is a recess called the prostatic utricle, homologue of the vagina.

Females: eppophoron, paroophoron, Gartner’s duct + cysts

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6
Q

Where are renal calculus usually lodged?

A

Kidney stones are usually found in the in the ureter just past the renal pelvis.

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7
Q

A patient has an inflamed Meckel diverticulum. The inflammation is confined to the diverticulum itself. Which physical findings is most consistent with this?

A

Visceral umbilical pain.

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8
Q

Which organ has its primary lymphatic drainage to lateral aortic lymph nodes and which do not

A

Testes drains into lateral aortic lymph nodes.

Vaginal portion of cervix, scrotum, transitional zone of prostate, anal canal below pectinate line.

Testes becomes its supplied by the testicular artery and that empties into the aorta.

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9
Q

What would occur in these urethral dysfunctions

  1. men, loss of sympathetic innervation of the internal urethral sphincter
  2. Over-stimulation of pelvic splanchnic nerves > bladder
  3. Hypermobility of the urethra due to loss of fascial support
  4. Loss of sympathetic innervation of smooth muscle surrounding prostatic urethra
A
  1. dry (retrograde) ejaculation because it goes in both directions
  2. Voiding bladder excessively
  3. Stress Urinary Incontinence
  4. Voiding bladder excessively
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10
Q

Referred pain from the right ovary would be felt in…

A

Right T10 dermatome because the pain travels through ovarian plexus to thoracic splanchnic nerves.

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11
Q

Which muscles attach to the perineal body?

A

puborectalis, superfiical/deep transverse perineal, external anal sphincter, bulbospongiosus
Not - ischiocavernosus

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12
Q

Where would these be felt?

Cervical pain?

Uterine body and fundus pain?

Ovarian pain?

describe their pathways

A

Cervical - S2 (afferents travel from the cervix > inferior hypogastric plexus>pelvic splanchnics)

Uterine body and fundus pain - T11-L1 (afferents travel from uterus > inferior hypogastric plexus > hypogastric nerve > superior hypogastric plexus>inferior mesenteric plexus> lumbar splanchnics)

Ovarian pain - T10/T11 - afferents go from ovaries>ovarian plexus > superior mesenteric plexus >thoracic splanchnics

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13
Q

Where are the cell bodies for supplying an erection?

A

The intermediate gray matter of spinal cord segments S2 - S4

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14
Q

Which structures enter the pelvis by crossing the pelvic brim?

A

lumbosacral trunk, ureters, internal iliac arteries, hypogastric nerves.

But NOT testicular artery, which doesn’t even enter the pelvis.

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15
Q

4 things about the pelvic diaphragm

A
  1. Comprised in part by pubococcygeus muscles
  2. Will contract in response to intraabdominal pressure
  3. Comprised of skeletal muscle innervated by ventral rami of the S4 spinal nerves
  4. It has an anterior gap called the urogenital hiatus through which the urethra and vagina pass.
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16
Q

How would a failure of the epithelial plug in the pylorus to vacuolize present?

A

It would present as vomiting but lacking bile as bile reaches the food in the second part of the duodenum.

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17
Q

What are the origins of the visceral peritoneum of the liver and spleen.

What are the origins of the parietal peritoneum of the ascending, descending colon, and body of the pancreas.

A

Visceral peritoneum of the liver = embryonic ventral mesentary

Parietal peritoneum of the left colic artery = embryonic visceral peritoneum (mesentary)

Pariteal peritoneum of body of pancreas = embryonic dorsal mesentary

Visceral peritoneum covering spleen = dorsal mesentary

Ascending colon = embryonic visceral peritoneum.

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18
Q

What adult structures are derived from embryonic endoderm cells?

A
Hepatic cells of liver 
Epithelial lining of gallbladder 
Epithelial lining of urinary bladder 
Exocrine glandular cells of pancreas
Epithelial lining of the common bile duct

NOT smooth muscle of common bile duct
NOT visceral peritoneum of the liver

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19
Q

Excessively high presure in the portal venous system would best relieved how?

A

Side to side anastomosis of the splenic vein to the left renal vein.

20
Q

What is directly posterior to the head of the pancreas?

A

The inferior vena cava.

21
Q

If you occluded the origin of the superior mesenteric artery, we know the colon would be well supplied by the Marginal artery from the inferior mesenteric artery, but damn wtf would happen to the intestinal arteries?

A

The gastroduodenal artery takes over. Blood travels from the anterior and posterior superior pancreaticoduodenal arteries to the inferior pancreaticoduodenal arteries to the superior mesenteric artery and then through its branches.

22
Q

Where do the cavernous nerves travel?

A

They carry postganglionic parasympathetic axons and go through the urogenital hiatus to reach the erectile tissue.

23
Q

Someone has ureteric stones and has pain moving from his lower back to his testicle on the right side, his pain is most likely a result of what?

A

Referred pain caused by obstruction of the ureter at the ureteric orifice of the bladder (uterovesicular junction)

24
Q

Where does the genital branch of the genitofemoral nerve enter?

A

It enters the deep inguinal ring.

25
Q

occlusion of the splenic artery to control hemorrhage can be preformed by placing the clamp across the?

A

Splenorenal ligament…

26
Q

A patient has dull suprapubic pain…after 24 hours the pain migrates to the left lower quadrant of the abdomen and has localized tenderness in that area

A

inflammation of the sigmoid colon.

27
Q

Drops or urine are coming out of the umbilicus. Which of the following adult strcutres contains a patent embryological structure in this infant.

A

The median umbillical ligament which contains the collapsed urachus which is the allantois (connecting the fetal urogential sinus to the umbilical tube)

28
Q

If your patient has a ureteric calculus where would you expect reffered pain>

A

From the lumbar region extending to the groin.

29
Q

You try to alleviate pelvic pain by cutting both hypogastric nerves. Cell bodies of these neurons can be found in…

A

lateral horn of the L2 spinal cord segment.

30
Q

What is the innervation of the prostate?

A

Parasympathetics which travel through pelvic splanchnics = secretomotor

Sympathetics: smooth muscle contraction during ejaculation (travel throuh the prostate plexus (a subset of the inferior hypogastric)

31
Q

Whcih artery is in a mesentary in the embryo and remains in a mesentery in the adult?

A

middle colic artery

Right colic and left colic are both originally in embryonic visceral peritoneum (mesentery) and then become retroperitoneal.

32
Q

A man can’t expel drops of urine because of paralysis of the perineal skeletal muscle, this arises from a lesion of what?

A

Pudendal nerves.

33
Q

What else can result in protrusion of the posterior vaginal wall in addition to the rectouterine fascia?

A

The perineal body.

34
Q

You are careful about noting the location of the pudendal nerve because…

A

First of all it doesn’t innervate the obturator internus - its branches could be damaged by a peisiotomy which cuts through the perineal body.

35
Q

What is at the root of the mesentary of the transverse colon?

A

The pancreas.

36
Q

Diverticulitis of the sigmoid colon, where would visceral pain be felt?

A

Well sigmoid is hindgut and hindgut is supplied by the lumbar splanchnics corresponding to L1 and L2. It would also be diffuse pain. Therefore, pain would be felt within the L1 dermatome anteriorly.

37
Q

What can cause the second portion of the duodenum to be compressed?

A

The defective rotation of the ventral pancreatic bud (annular pancreas)

38
Q

Fetus has loops of small intestine that are FREE in the amniotic cavity. What could account for this?

A

Defective fusion of lateral folds.

39
Q

Which arteries and organs undergo retropertionealization to become secondary retroperitoneal?

A

Left colic artery, ascending colon, head of pancreas, right colic artery, superior pancreaticoduodenal artery

40
Q

What can tear through the falx inguinalis

A

A direct hernia

41
Q

Ultrasound of 20 week old fetus reveals oligohydramnios, what is the developmental defect causing this?

A

Bilateral failure of the ureteric buds to form.

42
Q

How do you tell the difference between ileum and jejunum

A

Jejunum - more vasculature

  • longer vasa recta
  • few large arcades
  • thicker
  • circular folds (plicae circulares)
  • few, almost none lymphoid nodules (peyers patches)
  • less fat

Ileum-less vasculature

  • shorter vasa recta
  • numerous small arcades
  • thinner
  • no circular folds
  • lots of lymphoid nodules
43
Q

Describe the neurovasculature of organs in the foregut

A

Arterial supply is from the celiac trunk

Their postganglionic sympathetic nerve supply is from cell bodies in the celiac ganglion.

Their preganglionic parasympathetic nerve supply is from neurons in vagus nerves.

Their preganglionic sympathetic nerve supply is from neurons who se cell bodies are in the middle thoracic spinal cord.

44
Q

A pelvic kidney would receive its blood supply from where?

A

The a renal artery coming off of a common iliac artery

45
Q

What needs to be cut for a left kidney transplant -

A

left renal vein
left renal artery
left gonadal vein
Renal capsule

46
Q

Describe the vasculature of the adrenal glands

A

Right and left adrenal galnds

Superior adrenal artery is from the inferior phrenic artery
Middle adrenal artery is a branch of the aorta
Inferior adrenal artery is a branch of the renal artery
Lymphatic drainage is to the lumbar lymph nodes

Right - adrenal vein is a branch off vena cava
Left- adrenal vein is a branch off left renal vein.