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)
Identify the main intra-abdominal branches of the aorta
(McMinn’s kidneys and suprarenal glands)
4 to pass:
- Coeliac trunk T12 (2)
- SMA L1 (52)
- Renal L1 (R 44, L 20)
- Gonadal L2 (R 48, L 23)
- IMA L3 (3)
- Common iliac L4 (R 30, L 6)
- Lumbar arteries at multiple levels (not visible in this photo)
Describe the arterial supply of the kidneys
2 to pass:
- Renal arteries (L1/2)
- Originates from abdominal aorta
- R renal artery longer
- Divides into 5 segmental arteries (each independent)
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
Describe the course of the iliac arteries
- Originate at common iliac arteries from aorta at L3*
- Follows medial border of psoas to pelvic brim
- Bifurcates into external and internal iliac arteries at L5-S1
- Internal iliac artery* enters pelvis
- External iliac artery* follows iliopsoas and ends at the inguinal ligament, becoming the femoral artery at the mid inguinal point*
*need to pass
What is the blood supply of the uterus?
Uterine artery* from anterior division of the internal iliac artery*
Crosses above the ureter on its course to the uterus, and commonly anastomoses with the vaginal and ovarian arteries
*needed to pass
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
What are the contents of the spermatic cord?
- Ductus deferens*
- Artery of ductus deferens
- Testicular artery*
- Testicular vein* with pampiniform plexus
- Lymphatics
- Autonomics nerves (sympathetic and parasympathetic)
*needed to pass
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 main structures of the liver
(picture of liver from below and behind)
- R (24) and L (14) lobes*
- Caudate lobe (2)
- Quadrate lobe (21)
- IVC (13)
- Hepatic artery (11)
- Portal vein (20)*
- Common hepatic duct (5)
- Gallbladder (9)*
- Coronary ligament (12)
- R (25) and L (15) triangular ligaments
- Ligamentum teres (17)
- Diaphragm (6)
- needed to pass
Describe the anatomy of the biliary tree
L and R hepatic ducts* run into common hepatic duct*
Joined by cystic duct* from gallbladder to become the common bile duct* which runs into the duodenum*
*needed to pass
What is the innervation of the urethra?
Intramural, prostatic and membranous:
- Prostate nerve plexus arising from the inferior hypogastric plexus
Spongy:
- Dorsal nerve of penis (from pudendal nerve)
Describe the anatomy of the prostate
- Surrounds prostatic part of the urethra
- Approx the size of a walnut
- Base sits near neck of urinary bladder
- Apex is next to urogenital diaphragm
- Covered in thick fibrous capsule, which houses the prostatic plexuses or nerves and veins
- 5 lobes: anterior, middle, posterior and two lateral
- Arterial supply via inferior vesical, internal pudendal and middle rectal arteries
- Venous drainage via prostatic venous plexus, which is located around the base and sides of the prostate
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
Where might you find a pathological fracture on this model of the hip joint?
1 to pass:
- Pubic rami
- Neck of femur
- Proximal femoral shaft
