The Abdomen

Question 1

What causes portal hypertension?

Answer 1

Cirrhosis of the liver leads to compression and distortion of the vessels in the liver, increasing the pressure

Question 2

what are two points of anastemosis caused by portal hypertension?

Answer 2

Superior rectal artery/vein (IMA) + Interal illiac vein = Varicies and heamarroids

Left gastric vein/ Oesophageal branches + azygos vein = Oesophageal Varicies

Question 3

What is the diameter of a early AAA ?

Answer 3

> 4cm

surgery required at >5cm

> 6cm then critical ~50% rupture

Question 4

What is teh diameter of a normal AA ?

Answer 4

1-1.5 cm

Question 5

Where does the IVC originate?

Answer 5

When the common illiac merge at L5.

Question 6

What two veins drain into the L renal vein?

Answer 6

Left Gonadal
L suprarenal

Question 7

what are the branches of the abdominal aorta

Answer 7

3 walls
- phrenic
- lumbar (L1-L4)
- median sacral (after teh bifercation)

3 to the Gut
- Coeliac
- SMA
- IMA

3 to Glands
- suprarenal
- renal
- gonadal

Question 8

What are the borders of the foramen of winslow/epiploic foramen?

Answer 8

Anterior = hepato-duodenal ligamnet (portal triard)

Posterior = IVC

Superior = 1st part of Duodenum

Posterior = Left Lobe of the liver

Question 9

What is in the porta hepatis?

Answer 9

The common hepatic Duct (anterior and left)

propper heatic artery (anterior and right)

portal vein (most posterior)

Question 10

What forms the portal vein ?

Answer 10

The confluence of the superior mesenteric and splenic vein at the level of L1

the NECK of the pancrease in anterior

Question 11

where does the inferior mesenteric vein enter the portal system?

Answer 11

Via the splenic vein

Question 12

What is carried in teh splino-renal ligament?

Answer 12

connects the hillum of the spleen to the left kidney

The splenic artery, vein and the pancreatic tail are carried within it

Question 13

Where does the transverse mesocolon attach?

Answer 13

Attaches to The anterior surface of the pancrease

Question 14

Where are the IVC and aorta in relation to the pancreas

Answer 14

They pass posteriorly behind the head of the pancreas

Question 15

where does the SMA lie in relation to the pancreas?

Answer 15

Initially posterior to the neck of the pancrease but passes anteriorly across the uncinate process.

Question 16

what part of the pancrease is intra-peritoneal?

Answer 16

The tail of the pancreas

Question 17

Describe the blood suply of the Pancreas

Answer 17

Pancreatic branches of the splenic artery.

Head is additioanly supplied
- Superior pancreatico-duodenal artery (branch of gastroduodenal)
- Inferior pancreatico-duodenal artery (branch of SMA)

Question 18

Where does the Middle colic artery supply?

Answer 18

Branch of the SMA, it supplies the transverse colon.

branches of the the middle colic artery, form anastomosis when the IMA is occuled, and can supply the desending –> rectum

Question 19

What atery is affected in a posterior duodenal ulcer?

Answer 19

Gastroduodenal artery

Question 20

what artery is affected in a posterior gastric ulcer?

Answer 20

Splenic

Question 21

what structures can be found at the level of L1/Transpyloric plane?

Answer 21

Origin of SMA

The pancreatic neck

The first part of the duodenum

Pylorus

Renal Hilar

The duojejunal flexure

The gall bladder fundus

The origin of the hepatic portal vein

Right and left flexures of the colon

Question 22

What nerves are bloacked when repairing a inguinal hernia ?

Answer 22

Truncular ilioinguinal and iliohypogastric nerve

Question 23

what is the antomical landmark of the femoral nerve?

Answer 23

below the inguinal ligament and 1cm lateral to the pulse of the femoral artery.

Question 24

what is the anatomical landmark of the block for the obturator nerve?

Answer 24

4cm medial to the pubic tubercle and 3cm cephalad to the tendon of the adductor longus muscle

Question 25

at what level does the sigmoid loose its mesentary and become the rectum?

Answer 25

s3

Question 26

complication of a left suded distal colonic resection?

Answer 26

damage to parasympathetic nerves in the pelvis resulting in impared contraction of the detrusor muscels

Question 27

at what level is the cardio oesphageal junction ?

Answer 27

T11