VIVA: Anatomy - Abdomen and pelvis Flashcards
Describe the course of the iliac arteries
Common iliac origin from aorta at L3
Follows medial border of psoas to pelvic brim
Divides at level of L5-S1
Internal iliac artery enters pelvis
External iliac artery follows iliopsoas ends at the inguinal ligament and becomes femoral artery at mid-inguinal point
What is the blood supply of the uterus?
Uterine artery from the anterior division of the internal iliac artery
Crosses above the ureter on its course to the uterus
Commonly anastamoses with the vaginal and ovarian arteries
Identify structures that can be seen in this axial slice of an abdominal CT scan
6/10 to pass (including one vascular structure):
- Liver
- Intestines
- Pancreas
- Spleen
- Kidneys
- Descending aorta
- Vertebral body
- Rectus muscle
- Diaphragm
- Inferior vena cava
Describe the branches of the abdominal aorta
Inferior phrenic
Coeliac* (T12)
Superior mesenteric* (L1)
Middle suprarenal
Renal* (L1)
Gonadal (L2)
Inferior mesenteric* (L3)
Median sacral
Common iliac (L4)
Lumbar
*2 to pass + 2 others
Describe the arterial supply of the small and large intestine
Duodenum:
- Supplied by branches of coeliac (gastroduodenal from common hepatic, proximal to major duodenal papilla) and superior mesenteric (inferior pancreaticoduodenal) arteries
Jejunum and ileum:
- Supplied by ileal and jejunal arteries arising from superior mesenteric artery*
Large intestine:
- Supplied by branches of the superior mesenteric* (ileocolic, middle colic and right colic to the caecum, ascending and proximal 2/3 of transverse colon) and the inferior mesenteric artery* (left colic, sigmoid and superior rectal)
*needed to pass
Describe the course of the ureters
4 to pass:
- Originate at the renal hilum (PUJ) at L2
- Run inferiorly lying along psoas major, and adjacent to the tips of the transverse processes of L3-4
- Cross over pelvic brim and anterior to bifurcation of the common iliac artery to lie on the lateral wall of the pelvis
- Travel medially to the bladder, with a short intramural path at the vesicoureteric junction
What are the three narrowest points of the ureters?
2/3 to pass:
- PUJ
- VUJ
- Pelvic brim
What structures in this photograph are potential sources of acute abdominal pain?
- Aorta* (aneurysm)
- Coeliac axis and SMA* (mesenteric ischaemia)
- Kidneys and ureters* (stones/infarcts)
- Splenic artery (aneurysm/dissection)
- Lymph nodes (adenitis/pressure)
- Psoas (abscess or bleed)
*needed to pass
Identify the vascular structures in this photograph
4/6 to pass:
- IVC
- L renal vein
- R renal vein
- Aorta
- Coeliac axis (T12)
- Superior mesenteric artery (L1)
Describe the arterial supply and venous drainage of the gut
Foregut (+ hepatobiliary and spleen):
- Coeliac axis: common hepatic (with cystic, hepatic, R gastric and gastroduodenal branches), splenic, L gastric
Midgut (duodenum distal to major ampulla to proximal 2/3 transverse colon):
- Superior mesenteric: inferior pancreaticoduodenal, jejunal/ileal, ileocolic, R and middle colic branches
Hindgut:
- Inferior mesenteric (small calibre with collaterals, therefore rarely blocked): L colic, sigmoid and superior rectal branches
Venous drainage:
- Superior mesenteric vein (joins splenic vein to form portal vein)
- Inferior mesenteric vein
Where in the ureters is a stone likely to lodge, and where else could a stone be present?
Likely to lodge (2/3 to pass):
- PUJ
- Pelvic brim
- VUJ
Elsewhere (1/2 to pass):
- Kidney (intraparenchymal)
- Bladder
Point out on the XR the course of the L ureter
- From hila of kidney at L1-2*
- Passes inferiorly just medial to tips of transverses of lumbar vertebrae*, and on anterior surface of psoas muscles
- Passes over pelvic brim around sacroiliac joint
- Runs along lateral wall of pelvis until ischial spine, then passes medially to enter the bladder
What structures on this CT are retroperitoneal?
3 to pass:
- Pancreas
- Kidneys
- Aorta
- IVC
Demonstrate the potential spaces for fluid collection in the supine position
Hepatorenal space
Splenorenal space
Identify the anatomical structures of the renal tract on this photo
(McMinn’s kidneys and suprarenal glands)
3 to pass:
- R kidney (42)
- L kidney (18)
- R ureter (50)
- L ureter (25)
Using this model, identify the major anatomical structures
5 to pass:
- Pubic symphysis
- Bladder
- Vagina
- Uterus
- Rectum
- Sacrum
- External anal sphincter
- Ovary
- Fallopian tube
- Broad ligaments
- Internal and external iliac vessels
Identify the structures that form the male genitourinary system in this model
- Bladder*
- Ureter
- Prostate gland*
- Prostatic urethra
- Seminal gland
- Spermatic cord
- Testis*
- Tunica albuginea
- Tunica vaginalis
- Epididymis
- Penis
- Corpus cavernosum
- Penile urethra
- Deep dorsal vein of penis
- Ductus deferens
- Coccyx
- Pubic symphysis
- Rectosigmoid junction
- Rectovesical pouch
*needed to pass + 3 others
Indicate on the model the location of the named parts of the male urethra
3/4 to pass:
- Intramural: at base of bladder wall, surrounded by internal urethral sphincter
- Prostatic: length of prostate, widest part, receive prostatic and ejaculatory ducts
- Membranous: short narrow section surrounded by external sphincter, narrowest and least distensible part except for external urethral orifice
- Spongy (penile): length of corpus spongiosum, with intrabulbar fossa proximally and navicular fossa distally
Identify the bony landmarks of the pelvis
- Bones: ilium *, ischium *, pubis *
- Surfaces: iliac crest *, ASIS *, AIIS *, ischial tuberosity , ischial spine, PSIS, PIIS, symphysis pubis
- joints: SIJ *, acetabulum/femur *, symphysis pubis *
- Other: pubic rami *, ala of ilium, greater/lesser sciatic notches, obturator foramen
*needed to pass
Identify on the model the ligaments of the hip joint and their attachments
Iliofemoral: AIIS/acetabular rim to intertrochanteric line*
Pubofemoral: obturator crest to joint capsule and iliofemoral ligament*
Ischiofemoral: acetabular rim to base of greater trochanter
*needed to pass
