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308 Cards in this Set
- Front
- Back
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What separates the morphological lobes of the liver into right and left? |
portal trinity (portal vein, hepatic artery, bile duct) which sits in the gallbladder bed |
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Segments of the right and left sides of liver |
Right side - four segments (anteriorly - segment 5 and 8, posteriorly - segment 6 and 7) Left side - three segments (anteriorly - segment 3 and 4, posteriorly - 2) Segment 1 receives branches from both sides |
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Segment 1 of liver is otherwise known as |
caudate lobe |
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The right hepatic artery supplies the caudate and quadrate lobes - true or false? |
false |
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The quadrate lobe of the liver is bound by |
the fissure for the ligamentum teres |
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The falciform ligament has ______ in its free border |
ligamentum teres |
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Falciform ligament passes from the ________________ to the liver |
anterior abdominal wall |
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The liver develops from |
a foregut diverticulum in the septum transversum |
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Nerve supply of the liver |
Right vagus via the celiac ganglion Left vagus directly to porta hepatis Sympathetic innervation on the vessels |
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The bare area of the liver is in direct contact with |
IVC right suprarenal gland Posterior cupola of diaphragm |
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Describe the course of ligamentum teres |
Runs in the free edge of the falciform ligament from the umbilicus to the anterior surface of liver. Here it lies in a deep groove on the under surface of the liver and extends as afar as the LEFT end of the porta hepatis |
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What is the ligamentum teres |
Rounded fibrous cord in the free lower edge of the falciform ligament Remnant of the obliterated left umbilical vein of the liver |
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Porta hepatis - anterior to posterior |
Bile duct Hepatic artery Portal vein (D --> A --> V) |
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quadrate and caudate lobes belong to the right lobe - T or F |
Functionally, caudate lobe (segment 1) and most of quadrate lobe (segment 4) belong to the left half of liver as they receive blood supply from left hepatic arterial and left portal vein branches. They drain bile into the left hepatic duct |
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Needle biopsy of the liver should be performed through |
the right eighth or ninth intercostal space in the mid axillary line because this level is below the level of the lung |
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the common hepatic artery is intra or retro peritoneal? |
entirely retroperitoneal |
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Arterial supply of the liver |
Coeliac axis --> common hepatic artery which runs in the lesser omentum to the porta hepatis --> right and left branches of hepatic proper artery. |
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Course of the right hepatic artery |
Right hepatic artery passes behind the CHD --> intrahepatic divisions into anterior and posterior segmental branches --> supply 5 and 8 anteriorly, 6 and 7 posteriorly |
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Most common anomaly of the hepatic arteries |
either the common or its left and bright branches can arise from the SMA rather than the coeliac trunk |
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The portal vein runs _________ the epiploic foramen |
anterior to
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Portal vein is formed by |
superior mesenteric vein splenic vein |
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Portal vein is formed at the level of |
L1 vertebra behind neck of pancreas |
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Tributaries of portal vein |
Pancreaticoduodenal veins Right and left gastric veins (including oesophagel venous drainage) Cystic veins Periumbilical veins Remains of the embryonic umbilical veins |
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Portal veins and its tributaries have valves |
No. They are valveless. |
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Course of portal vein |
Formed by superior mesenteric vein and splenic vein at level of L1 behind the neck of pancreas. Runs vertically upwards behind neck of pancreas and first part of duodenum. In front of the IVC. It then enters between the two layers of the lesser omentum where it lies behind the hepatic artery and the bile duct. It then splits into T shape at the porta hepatis into right and left branches to supply the respective liver halves. |
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The liver is supported by the hepatic veins because |
the hepatic veins attach the liver firmly to the adjacent IVC |
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CBD opens into the ampulla _______ from the pylorus |
10cm |
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Course of bile duct in relation to the duodenum |
Separated into three parts 1. Supraduodenal - Upper 1/3 in the free edge of the lesser omentum. the bile duct is to the RIGHT of the hepatic artery. It is in front of the portal vein 2. Retroduodenal - middle 1/3 posterior to first part of duodenum. Bile duct is to the RIGHT of the portal vein. In front of the IVC. (bile duct --> portal vein --> GDA) 3. Paraduodenal - lower 1/3 between the head of pancreas and the 2nd part of duodenum. In front of IVC and right renal vein. |
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Cystic duct variations |
1. Absent cystic duct - gallbladder opening into the CHD 2. Long cystic duct entering main duct system so low - effectively no CBD just CHD and a cystic duct. 3. Cystic duct draining into the RHD 4. Cystic duct into aberrant or accessory RHD |
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Normal size of bile duct |
8cm long 8mm wide |
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Type of epithelial cell lining the bile duct |
tall columnar epithelium that is mucus secreting |
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Size of cystic duct |
3cm long 3mm wide |
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Gallbladder epithelium |
simple columnar cell, non mucus secreting |
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Variations in cystic artery |
75% - from the right hepatic artery. Posterior to the CHD. 25% - anterior to the CHD. From 1. Right hepatic artery; 2. left hepatic artery; 3. GDA; 4. proper hepatic artery |
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Islet of Langerhan cells vs acinar cells - H+E staining |
Islet of Langerhan cells are paler staining in H+E as acinar cells have higher content of RNA and presence of nuclei |
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Acinar cells of the pancreas have lots of rough endoplastic reticulum - T/F |
true |
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Alpha islet of langerhan cells contain |
glucagon |
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Beta islet of langerhan cells contain |
insulin |
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Delta islet of langerhan cells contain |
somatostatin |
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The tail of the pancreas lies within which ligament |
splenorenal ligament |
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Main pancreatic duct drains |
all the pancreas except for the uncinate process and lower part of the head. This is drained by the accessory duct. |
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Which is more proximal? main pancreatic duct or accessory pancreatic duct |
accessory pancreatic duct |
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Communication between the main and accessory pancreatic ducts is common - T/F |
True |
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Blood supply of the pancreas |
Main supply - Artery pancreatic magna from the splenic artery from the celiac trunk Much of head is supplied by - pancreaticoduodenal arteries arising from both coeliac (GDA) and SMA |
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Venous return of pancreas |
Pancreaticoduodenal veins Superior ones drain into portal Inferior ones drain into SMV |
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Spleen develops from the |
dorsal mesogastrium |
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Spleen projects into the lesser sac - T/F |
False. |
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Splenic vein is valveless - T/F |
True |
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Two types of tissue in the spleen |
White pulp - lymphoid aggregates and macrophages arranged around arteries Red pulp - vascular with venus sinuses, arterioles and splenic cords of Billroth |
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How is the oesophagus related to the thoracic aorta above the diaphragm |
Oesophagus is anterior to the thoracic aorta above the diaphragm |
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How does the oesophagus stop air from entering during inspiration? |
The tonic contraction of the cricopharyngeus muscle is maintained through its innervation by the external and/or recurrent laryngeal nerves |
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A surgeon is panning to mobilise the stomach into the chest to form a conduit after an oesophagectomy. Which blood vessel will she preserve to maintain vascularity? |
Gastro omental arcade will maintain the stomach up to the fundus if the other vessels are divided |
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What structure indicates the gastroduodenal junction? |
Prepyloric vein |
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Anterior relation of stomach |
Anterior abdominal wall Left lobe of liver Diaphragm Left costal margin |
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Superior relation of stomach |
Left dome of diaphragm |
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Posterior relation of stomach |
Lesser sac Pancreas Transverse mesocolon Transverse colon Left kidney/adrenal gland Spleen + splenic artery |
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Stomach and spleen are separated by the |
Greater peritoneal sac |
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Blood supply of the stomach |
Coeliac axis via the left and right gastric and gastroepiploic, gastroduodenal and short gastric vessels |
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Lymphatic drainage of the lesser curvature of stomach |
Gastric nodes adjacent to the left and right gastric arteries |
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The anterior surface of the stomach is innervated by |
the left vagus nerve |
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Transpyloric plane is at the lower limit of the spinal cord - T/F |
True |
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Transpyloric plane is just above the level of the gallbladder fundus - T/F |
True |
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Transpyloric plane is at the level of the origin of celiac artery - T/F |
False - at the level of origin of SMA |
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Transpyloric plane is where the linea semilunaris meets the 8th costal cartilage - T/F |
False - Tip of the 9th costal cartilage; lateral border of rectus abdominis |
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The first part of the duodenum has no villi - T/F |
False |
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Length of each part of the duodenum |
1st - 5 cm 2nd - 8 cm 3rd - 10cm 4th - 2.5cm |
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jejunum vs ileum - characteristics |
Jejunum is redder, wider, thicker than ileum. It has taller villi. Wall of jejunum feels double layered. Wall of ileum feels single layered. Lower ileum has presence of lymphoid peyer's patches on the antimesenteric border |
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What is a meckel's diverticulum Characteristics |
remnant of the vitellointestinal tract 2% of population 2 feet (60cm) from caecum 2 inches long |
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Arcades of mesenteric vessels in jejunum vs ileum |
Jejunum - arcades are long and narrow like Gothic cathedral windows Ileum - aracades are shorter stubbier and less transparent (more obscured by fat) - like norman church windows |
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The jejunum has greater absorptive area than the ileum - T/F Why? |
True The jejunum has more circular folds and longer villi than the ileum |
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Course of the small bowel mesentery |
Starts at the DJ junction, to left of L2 vertebra Extends down, to the right to reach the right sacro iliac joint at S2 level |
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posterior relation of the root of the mesentery |
Crosses the 3rd part of the duodenum Across the aorta, IVC, right psoas muscle, right gonadal vessels, right ureter |
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SMA embolism usually results in midgut gangrene because |
SMA is functionally an end artery |
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Termination of the SMA is at |
the terminal ileum at the embryological apex of the midgut loop |
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The mesentery of the transverse colon is attached transversely.... |
to the anterior border of the pancreas |
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Describe the taenia coli |
three separate bands of longitudinal smooth muscle converging on the appendix base at the caecum and again at the sigmoid colon Unique to large bowel |
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Intra/retroperitoneal Ascending colon |
Retroperitoneal |
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Intra/retroperitoneal Descending colon |
20% has mesentery but otherwise retroperitoneal |
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describe sigmoid mesentery |
- attached in the shape of an upside down V - Upper limb runs along the pelvic brim - the apex is over the bifurcation of the common iliac artery |
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Mucosa of the large bowel contains large crypts and villi - T/F |
False contains large cryps and goblet cells, no villi |
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Left colic flexure lies lower than the right colic flexure - T/F |
False |
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Left colic flexure receives parasympathetic vagal supply |
False Parasympathetic vagal supply ends 2/3 of transverse colon At this point parasympathetic sacral supply (S2,3,4) takes over |
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Left colic flexure lies directly anterior to the left adrenal gland - T/F |
False, left colic flexure is too low |
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left colic flexure is attached to the diaphragm via |
phrenicocolic ligament |
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the cecum is retroperitoneal - T/F |
False |
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The cecum has more appendices epiploicae than sigmoid colon - T/F |
False |
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the cecum is supplied by the right colic vessels T/F |
false |
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the cecum has a continuous coat of longitudinal muscles |
false Consist of three bands of longitudinal muscles (taenia coli) between which there are circular muscles |
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the vermiform appendix arises from the ___________ aspect of the cecum |
posteriomedial |
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The vermiform appendix is ________ the ileocecal valve |
2cm below |
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the vermiform appendix has numerous lymphoid follicles - t/f |
true |
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the vermiform appendix has a complete longitudinal muscle coat - t/f |
true |
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the mesoappendix is |
a triangular fold of peritoneum and is a prolongation of the left layer of the mesentery of the terminal ileum |
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the appendicular artery arises from |
the posterior cecal artery |
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Parasympathetic supply of the sigmoid colon is the |
pelvic splanchnic nerve |
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the middle colic artery is a branch of the |
superior mesenteric artery |
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Main branches of the SMA are |
inferior pancreaticoduodenal arteries jejunal arteries ileal arteries ileocolic arteries right colic arteries middle colic arteries |
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Territory of the SMA |
Artery of the midgut Supplies from the middle of the 2nd part of duodenum to the region of the transverse colon near the splenic flexure |
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the peritoneum has a firm attachment to the pancreas - T/F |
True |
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The peritoneum has an opening into the omental bursa, lying behind the pyloric antrum T/F |
False the epiploic foramen is bounded anteriorly by the right free margin of the lesser omentum |
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the peritoneum has a diaphragmatic part innervated completely by the phrenic nerve - T/F |
false the diaphragmatic peritoneum is supplied centrally by the phrenic nerve and peripherally by the intercostal nerve |
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the lesser omentum is attached to the greater curvature of the stomach - T/F |
False |
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the lesser omentum is attached to the margin of the caudate lobe of the liver - T/F |
True |
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the lesser omentum is attached to the quadrate lobe - T/F |
False |
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the lesser omentum is attached to the porta hepatis - T/F |
True |
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The lesser omentum contains the left gastric artery T/F |
True |
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The lesser omentum contains the hepatic branches of the anterior vagal trunk - T/F |
True |
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The lesser omentum has a L shaped attachment to the lower surface of the liver - T/F |
True |
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the lesser omentum has an anterior layer which is continuous with the posterior layer of the left triangular ligament - T/F |
True |
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the lesser omentum develops from the dorsal mesogastrium - T/F |
False Ventral mesogastrium |
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Does the greater omentum attach to the oesophagus? |
Yes The greater omentum has a continuous curved attachment from the abdominal oesophagus to the duodenum |
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Does the greater omentum attach to the stomach? |
Yes |
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Does the greater omentum attach to the kidney? |
Yes Lienorenal ligament |
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Does the greater omentum attach to the colon? |
yes |
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Why is the surgical removal of the right adrenal gland dangerous? |
The right suprarenal gland is drained by a short vein that connects directly into the IVC |
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The right suprarenal gland lacks a peritoneal cover over the inferior half of its anterior surface - T/F |
False Only the lower half of the right suprarenal gland has peritoneal cover |
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The right suprarenal gland is drained by |
a short vein draining directly into the IVC |
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The right suprarenal gland is crescentic in shape - T/F |
False It is pyramidal Left is crescentic in shape |
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The right suprarenal gland lies between |
Posteriorly - right crus of diaphragm Anteriorly - IVC, right lobe of liver |
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The left suprarenal gland is pyramidal in shape |
False It is crescentic in shape the right one is pyramidal |
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The left suprarenal gland is separated from the kidney by the renal fascia - T/F |
True |
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The left suprarenal gland is separated by peritoneum from the pancreas - T/F |
False |
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The left suprarenal gland produces |
mineralcorticoids, mainly in the zona glomerulosa |
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The left suprarenal gland surmounts the upper pole of the left kidney - T/F |
False It drapes over the medial border of the left kidney above the hilum |
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The left suprarenal gland is partially covered by peritoneum of the lesser sac - T/F |
True |
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The left suprarenal gland lies lateral to the left crus of the diaphragm - T/F |
False Lies on top of the left crus of the diaphragm |
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The left suprarenal gland is crossed by the splenic artery - T/F |
True |
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The adrenal medulla contains cells equivalent to.... |
post-ganglionic neurones because the adrenal medulla is of neuroectodermal origin |
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the right kidney has a long axis sloping... |
downwards and laterally |
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the right kidney in the erect position lies... |
opposite the first three lumbar vertebrae |
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The suprarenal gland is in direct contact with the capsule of the right kidney - T/F |
False |
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The right kidney is separated from the duodenum from peritoneum - T/F |
False |
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Name 4 muscles lying posterior to the kidney |
quadratum lumborum psoas muscle diaphragm transversus abdominis |
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Which structure makes contact with the left kidney - left suprarenal gland - the 4th part of the duodenum - the left lumbar sympathetic trunk - the pancreas - the DJ flexure |
Only the pancreas makes direct contact with the left kidney |
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Pneumothorax can occur during the operations on the kidney because.... |
the pleura is a posterior relation of the kidney |
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The left ureter in the female crosses the genitofemoral nerve - T/F |
True The genitofemoral nerve is posterior to the ureter when crossed |
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The left ureter in the female crosses the uterine artery - T/F |
True The uterine artery is anterior to the ureter when crossed |
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The left ureter in the female crosses anterior to the inferior mesenteric vessels - T/F |
False The left ureter is lateral to the inferior mesenteric arteries |
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The left ureter in the female is lateral to the obturator nerve in the pelvis - T/F |
False the ureter crosses the obturator nerve in the pelvis |
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What is the structure superficial to the ureter in the pelvis? |
Female - uterine artery Male - ductus dferens |
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The right ureter crosses posterior to the right colic artery - T/F |
True |
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The right ureter crosses anterior to the right common iliac artery - T/F |
True |
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The right ureter crosses anterior to the right gonadal vessels - T/F |
False The right gonadal vessels are anterior to the right ureter when crossed |
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The right ureter runs along the lateral margin of the right psoas major muscle - T/F |
False It is very much on top of the psoas muscle for most of its course It leaves the psoas muscle at the bifurcation of the common iliac artery |
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Name 4 structures that mark the normal course of the ureter in an intravenous pyelogram |
1. Tips of lumbar transverse processes 2. Sacro-iliac joints 3. Ischial spines 4. Pubic tubercles |
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How long is the ureter? |
25cm |
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What sort of epithelium does the ureter possess? |
transitional epithelium |
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Arterial supply of the ureter |
Upper end - ureteric branch of the RENAL artery Middle - branches from the GONADAL artery, branches from COMMON ILIAC artery Lower - branches fro the INFERIOR and SUPERIOR VESICAL and MIDDLE RECTAL arteries; UTERINE arteries in females |
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The ureter has sole arterial supply from the renal artery - T/F |
False |
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The right renal artery arises at the level of L1 |
False The renal arteries arise from the aorta at level of L2 |
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The right renal artery crosses the right crus and right psoas muscle - T/F |
True |
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The right renal artery runs posterior to the IVC |
True |
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Which one is longer - the right renal artery or the left renal artery? |
Right |
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What separates the right renal artery from the head of pancreas? |
IVC Short right renal vein |
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The right renal vein joins IVC at what level? |
L2 |
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Does the right renal vein receive the right suprarenal vein? |
No. The right suprarenal vein connects directly to the IVC which makes removal of the right suprarenal gland tricky. |
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Which one is more anterior?
right renal vein or right renal artery? |
Right renal vein |
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The right renal vein sometimes receives the right gonadal vein - T/F |
True On the right, the paired gonadal veins usually join the IVC just below the renal vein but may join the renal vein instead. On the left however, the left gonadal veins join the left renal vein. |
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Which one is longer - left or right renal vein? |
The left renal vein is THREE times as long as the right renal vein. It has to cross in front of the aorta to get to the IVC. |
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Is the renal artery anterior or posterior to the pancreas? |
The renal artery is posterior to the pancreas. |
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The renal artery lies ______ to the renal vein. |
posterior |
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The renal artery has no branches except to the kidney. T/F |
False Each renal artery gives off small suprenal and ureteric branches. |
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The renal artery is the only paired branch of the aorta. T/F |
False |
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The left renal vein connects with the azygos and the vertebral venous system. T/F |
True |
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The left renal vein receives the left adrenal vein from above - T/F |
True |
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The left renal vein receives the left gonadal vein from ______ |
below |
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When does the thoracic aorta become the abdominal aorta? |
Level of T12 vertebra When it passes behind the median arcuate ligament and between the crura of the diaphragm |
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When dos the abdominal aorta divide into the two common iliac arteries? |
L4 |
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Between the origin of the coeliac trunk and the SMA, the aorta is crossed by the.... |
splenic vein and body of pancreas |
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Between the origins of the SMA and IMA, the aorta is crossed by... |
left renal vein, uncinate process of the pancreas, third part of the duodenum |
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The aortic arch is crossed on the left by |
Left phrenic nerve running superficially Left vagus nerve running deep Left superior thoracic intercostal vein running across the arch of aorta between the left phrenic/vagus nerve to drain into the left brachiocephalic vein Branches from the cervical ganglia of the sympathetic trunk (Last - pg258) |
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The SMA is ______ to the 3rd part of duodenum |
Anterior |
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The SMA is _________ to the left renal vein |
Anterior |
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The SMA is anterior to a part of the pancreas - T/F |
True |
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The SMA gives branches to the duodenum T/F |
True It gives the inferior pancreaticoduodenal artery which supplies the duodenum below the entrance of bile duct |
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At the level of T12, does the aorta lie to the right or left of the median plane? |
To the left |
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At the level of T12, the aorta lies to the right of the thoracic duct - T/F |
False The aorta is to the left of the thoracic duct |
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Describe the commencement of thoracic duct |
The thoracic duct commences at the upper end of cisterna chyli on a level of T12 body between the aorta and the azygos veins. From behind the right crus it passes upwards to to the RIGHT of the aorta and comes to lie against the right side of the oesophagus |
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At which level does the abdominal aorta give off the coeliac trunk? |
T12 |
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How many pairs of lumbar arteries are there? |
4 pairs |
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The lumbar arteries on the right side are separated by the psoas major from the lumbar vertebrae - T/F |
False Lumbar arteries leave the abdominal aorta opposite the bodies of the upper four vertebrae. They HUG the bone and pass BENEATH the psoas. |
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The lumbar arteries on the right side pass behind the IVC - T/F |
True |
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The lumbar arteries on the right side pass posterior to the lumbar sympathetic trunk - T/F |
True |
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The IVC receives blood from the five paired lumbar veins - T/F |
False There are four paired lumbar veins. The third and fourth paired veins drain into the vena cava The first and second join the ascending lumbar vein which unites common iliac and iliolumbar vein |
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The IVC is formed behind the right common iliac artery - T/F |
True It begins opposite L5 vertebra (lower than the bifurcation of the aorta) by the confluence of the two common iliac veins BEHIND the right common iliac artery |
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The IVC receives both gonadal veins directly - T/F |
False Usually receives the right directly. The left gonadal veins usually join the left renal vein!! |
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The IVC is anterior to the right lumbar sympathetic trunk - T/F |
True The IVC lies on the bodies of the lumbar vertebrae, overlapping the right sympathetic trunk. |
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At which point does the IVC pierce the diaphragm? |
At T8, it lies on the right crus behind the bare area of liver and pierces the central tendon of the diphragm |
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The IVC runs in a deep groove on the bare area of the liver to the _______ of the caudate lobe |
RIGHT |
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The IVC is _________ to the medial part of the right suprarenal gland |
anterior |
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The IVC enters the right atrium to the right of the fossa ovalis - T/F |
True |
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The sympathetic trunk enters the abdomen by |
passing behind the medial arcuate ligament on the front of the psoas major |
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The sympathetic trunk is usually crossed anteriorly by the lumbar vessels - T/F |
False The sympathetic trunk lies in front of the segmental vessels - the lumbar arteries and veins are expected to pass behind the trunk. However some veins can be tricksy and cross in front. |
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The sympathetic trunk passes anterior to the common iliac arteries - T/F |
True The common illiac vessels lie in front of the sympathetic trunk at the pelvic brim |
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The sympathetic trunk ends... |
in front of the coccyx as the ganglion impar |
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Injury to the superior hypogastric plexus can reduce male fertility - T/F |
True Because loss of contraction of internal urethral muscle may result in retrograde ejaculation |
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The coeliac ganglion gives postganglionic fibres to the foregut T/F |
True The fibres from the celiac ganglia supply all the abdominal viscera |
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The coeliac ganglion supplies the postganglionic fibres to the hindgut T/F |
True The fibres from the celiac ganglia supply all the abdominal viscera |
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The coeliac ganglion contains the ganglion cells of visceral afferent neurons - T/F |
False They contain sympathetic fibres that are EFFERENT (they give commands) - vasomotor, motor to sphincters, inhibit peristalsis. They carry sensory fibres TO all the viscera supplied. |
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The celiac ganglion is mainly concerned with the parasympathetic innervation of the gut - T/F |
False Sympathetic |
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The celiac plexus can stimulate production of |
bradykinin and prostacyclin |
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The greater splanchnic nerve contains mainly |
preganglionic sympathetic fibres |
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The posterior vagus gives rise to hepatic branches which enter the liver via the lesser omentum and the porta hepatis - T/F |
False the ANTERIOR vagus gives rise to hepatic branches in the upper part of the lesser omentum. |
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The main terminal branch of the anterior vagus nerve crosses the stomach distal to the incisura angularis about 5-6cm from the pylorus - T/F |
True The main terminal branch of the anterior vagus runs down the lesser curvature and crosses onto the anterior wall of the stomach about 5-6cm from the pylorus |
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Which nerve fibre is preserved in highly selective vagotomy? |
main terminal branch of the anterior vagus |
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Vagal branches to the stomach run parallel with the branches of the left and right arteries - T/F |
False Vagal nerve fibres to the stomach do not accompany blood vessels They run obliquely downwards whereas the vessels tend to run transversely |
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Some vagal fibres travelling to the parietal cell mass may sink into the muscular wall at the oeseophagus some distance above the cardia - T/F |
True To denervate the upper stomach, it is necessary to clear the lowermost 5cm or so of the oesophagus of all vessels and nerves This suggests that some vagal fibres travelling to the parietal cell mass may sink into the muscle wall WELL above the cardia |
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What corresponds to the surface anatomy of the fundus of the gallbladder |
Junction of the lateral rectus edge with the costal margin at the tip of the ninth costal cartilage |
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The umbilicus lies at the level of which disc |
Between L3 and L4 |
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Surface anatomy of the bifurcation of the aorta |
Below and to the left of the umbilicus |
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The aorta bifurcates at the level between |
L4 and L5 |
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Which nerve is invariably cut in a Kocher's subcostal incision? |
The ninth intercostal nerve - this runs obliquely across the incision at the lateral edge of the rectus sheath |
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At the site of a McBurney's incision, the ilioinguinal nerve may be seen running superficial to the internal oblique - T/F |
False the ilioinguinal nerve runs between the internal oblique and the TA to enter the inguinal canal |
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At the site of a McBurney's incision, the external oblique is entirely aponeurotic - T/F |
False The External oblique is mostly aponeurotic but is fleshy laterally |
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At the site of a McBurney's incision for appendicectomy, the TA is almost entirely fleshy - T/F |
False The TA has an aponeurosis that extends more laterally than the IO Where the McBurney's incision is - it is half fleshy half aponeurotic |
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At the site of a McBurney's incision for appendicectomy, the IO is almost entirely fleshy |
True - the IO only becomes aponeurotic just lateral to the rectus abdominis muscle |
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Accidental damage to the ilioinguinal nerve may occur during appendicectomy because the this nerve runs obliquely over the iliacus muscle in the RIF - T/F |
False Accidental damage of ilioinguinal nerve can occur during appendicectomy However, this is because it runs between IE and TA which needs to be split |
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The obturator artery normally arises from... |
the internal iliac artery |
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An abnormal obturator artery can arise from the......... This is dangerous during............ in operative treatment of strangulated femoral hernia via low approach |
It can arise from the inferior epigastric artery instead - this runs along the edge of the lacunar ligament to reach the obturator foramen. This is dangerous during blind incision of the lacunar ligament |
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Division of lacunar ligament during repair of a femoral hernia can result in haemorrage because an abnormal obturator artery may run ________ to the femoral canal |
MEDIAL |
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Lateral to the rectus sheath, a __________ incision can minimise postoperative pain |
transverse Because the direction of pull and maximal tension of lateral abdominal muscles is transverse |
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How is the TA muscle split during lumbar sympathectomy? |
The TA muscle is split in the line of its fibres starting preferably to the extreme lateral aspect of the wound where the fibres are muscles rather than medially where the fibres are aponeurotic and more closely adherent to the underlying peritoneum |
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The medial umbilical fold contains |
the obliterated umbilical artery |
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Median umbilical fold contains |
the obliterated urachus |
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The lateral umbilical fold contains |
the inferior epigastric artery |
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The rectus abdominis muscle is completely enclosed within the internal oblique aponeurosis - T/F |
False Only below the costal margin and above the arcuate line is it completely enclosed within the IO aponeurosis |
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The rectus abdominis muscle forms part of the anterior wall of the inguinal canal - T/F |
False |
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The rectus abdominis muscle is supplied by T7-12 ventral rami - T/F |
True |
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The rectus abdominis muscle extends above the costal margin - T/F |
True Bulk of muscle passes in front of costal cartilages and is attached to the 5th --> 7th cartilage |
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The rectus abdominis muscle is attached below to the ilio-pectineal line - T/F |
False RA has two heads Medially - in front of pubic symphysis Laterally - upper border of pubic crest |
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The rectus abdominis muscle is attached by tendinous intersections to the posterior wall of the rectus sheath - T/F |
False These tendinous intersections are superficial only and do not penetrate to the posterior surface of the muscle |
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The rectus abdominis muscle has a sheath formed entirely from the aponeuroses of eternal and internal oblique muscles - T/F |
False Above costal margin - EO above Between costal margin and arcuate line - enclosed by IO, EO above, TA below Between arcuate line and just above pubis - EO/IO/TA above |
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The rectus abdominis muscle is attached above to the 4th cartilage - T/F |
False Highest level of costal cartilage is to the 5th cartilage |
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The rectus abdominis muscle fibres may atrophy in part following a paramedian muscle splitting incision - T/F |
True |
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The rectus abdominis muscle fibres must be carefully sutured after division to prevent incision hernia - T/F |
False Need not be sutured |
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The RA muscle fibres are divided in a Kocher's sub costal incision - T/F |
True |
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The RA muscle fibres are attached superiorly to the 7th, 8th and 9th costal cartilages - T/F |
False Attached to the 5th-7th cartilages |
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The rectus abdominis muscle is made more powerful by presence of transverse intersections attached to both the anterior and posterior wall of its sheath - T/F |
False Transverse intersections are superficial only |
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The power of a muscle is dependent on |
the number of muscle fibres it contains, not on their length |
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The semicircular fold of Douglas to the rectus sheath is anterior to the rectus abdominis muscle - T/F |
False |
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The semicircular fold of Douglas to the rectus sheath is at the level of the umbilicus |
False 2.5cm below the umbilicus |
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The semicircular fold of Douglas is the line below which the transversus aponeurosis, which include transversus, passes anterior to the RA muscle - T/F |
True |
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The semicircular fold of Douglas is lateral to the rectus abdominis muscle - T/F |
True |
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The surface landmark which is a guide to the position of the gastro-oesophageal orifice is the |
seventh left costal cartilage A thumb breadth away from the side of the sternum |
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The left nipple is the surface landmark indicating |
the fourth left intercostal space |
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Surface marking of level of L1 |
left linea semilunaris crossing the costal margin at tip of the ninth costal margin |
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Which level marks IVC entering dome of diaphragm |
T8 |
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Lymph drainage from the anterior abdominal wall is separated into.... |
quadrants - Superficial vs deep above umbilicus vs below umbilicus |
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Lymph drainage from the anterior abdominal wall - superficial - above umbilicus |
pectoral group of axillary nodes |
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lymph drainage from the anterior abdominal wall - superficial - below umbilicus |
superficial inguinal nodes |
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Lymph drainage from the anterior abdominal wall - deep - above umbilicus |
pierces diaphragm to drain into mediastinal nodes |
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Lymph drainage from the anterior abdominal wall - deep - below umbilicus |
external iliac and para-aortic nodes |
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Lymphatic channels in the abdominal wall may follow subcutaneous veins - T/F |
True |
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Inferior epigastric artery runs between TA and IO muscles - T/F |
False Enters the sheath behind RA |
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Inferior epigastric artery runs anterior to the RA - T/F |
False Enters sheath behind RA |
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Inferior epigastric artery gives rise to the artery of the ductus deferens - T/F |
False |
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Inferior epigastric artery lies medial to the deep inguinal ring - T/F |
True |
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The umbilicus lies nearer to the xiphoid than to the pubis - T/F |
False Lies approximately halfway between xiphoid and pubis |
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The umbilicus is suplied with cutaneous innervation by T11 nerve - T/F |
False Supplied by T10 |
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The umbilicus transmits, during development the umbilical cord containing two arteries and two veins - T/F |
False Contains two arteries and one vein |
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The umbilicus usually lies at about ht level of the disc between third and fourth lumbar vertebrae - T/F |
True |
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In relation to the diaphragm, the IVC passes through in the midline - T/F |
False IVC passes through the diaphragm to the right of midline |
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In relation to the diaphragm, the thoracic duct passes through the aortic opening - T/F |
True |
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In relation to the diaphragm, the right crus has more extensive attachments than the left - T/F |
True |
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In relation to the diaphragm the sympathetic trunk passes posterior to the median arcuate ligament - T/F |
False Passes anterior to the median arcuate ligament |
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The internal oblique muscle is attached to the lateral 2/3 of the inguinal ligament - T/F |
True |
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The internal oblique muscle becomes aponeurotic in the lumbar region - T/F |
False |
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The internal oblique muscle forms the posterior rectus sheath immediately above the inguinal ligament - T/F |
False |
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The IO muscle has a free upper muscular border - T/F |
False Has a free lower border |
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The IO muscle is innervated by 7th-12th intercostal nerves exclusively - T/F |
False Also by the iliohypogastric and ilioinguinal nerves |
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The IO muscle of the abdomen has partial origin from the inguinal ligament - T/F |
True |
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The IO muscle corresponds to the internal intercostal muscle layer in the thorax - T/F |
True |
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The EO muscle of the abdomen arises from the costal cartilages of the lowest eight ribs - T/F |
False From the anterior angles of the lowest 8 ribs |
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The EO muscles attach to the lumbar fascia posteriorly - T/F |
False that is true of the IO |
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The EO muscle interdigitates with the serratus anterior muscles - T/F |
True The upper four interdigitate with the serratus anterior |
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The EO muscle has an aponeurotic attachment to the iliac crest - T/F |
False The only attachment of the EO to the iliac crest is fleshy fibres from the 12th rib. Inserts onto the anterior half of the outer lip of iliac crest |
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The EO muscle is innervated by the ilioinguinal nerve - T/F |
False Exclusively by 7th-12th intercostal nerves |
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the pelvic inlet or brim lies in an oblique plane at 30 degrees to the horizontal - T/F |
False Lies at 60 degrees to the horizontal |
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The pelvic inlet or brim is bounded laterally by the iliac crest - T/F |
False Bounded laterally by the pectineal line of pubis and arcuate line of lilium |
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The pelvic inlet or brim is proportionately larger in the female than in the male - T/F |
True |
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The pelvic inlet or brim is bounded posteriorly by the sacral promontory - T/F |
True |
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The pubic crest gives attachment to part of the rectus abdominis - T/F |
True |
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The pubic crest gives attachment to the interfoveolar ligament - T/F |
False The interfoveolar ligament is derived from the lower border of the transversus abdominis around the vas to attach to the inguinal ligament |
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The pubic crest gives attachment to the external oblique - T/F |
True |
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The pubic crest gives attachment to the lacunar ligament - T/F |
False Lacunar ligament is the medial end of the inguinal ligament extending backwards to the pectinea line. |
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The ilium gives attachment to the rectus femoris muscle - T/F |
True |
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The ilium gives attachment to the quadratus lumborum - T/F |
True |
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The ilium gives attachment to the lattisimus dorsi muscle - T/F |
True |
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The ilium forms 2/3 of the acetabulum |
False Acetabulum is formed by the union of the ilium, ischium and the pubic bones Most of the acetabulum is contributed by the pubic bone |
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The greater sciatic foramen transmits the piriformis muscle - T/F |
True |
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The greater sciatic foramen transmits the inferior gluteal vessels - T/F |
True |
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The greater sciatic foramen transmits the superior gluteal vessels - T/F |
True |
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The greater sciatic foramen transmits the posterior cutaneous nerve of the thigh - T/F |
True The posterior cutaneous nerve of the thigh belongs to the sacral plexus. It passes through the greater sciatic foramen. |
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The greater sciatic foramen contains ______ nerves, ______ vessel sets, ______ muscle |
7 nerves 3 vessel sets 1 muscle |
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Name the nerves that run through the greater sciatic foramen |
sciatic nerve superior gluteal nerve inferior gluteal nerve Pudendal nerve Posterior cutaneous nerve of thigh Nerve to obturator internus Nerve to quadratus femoris |
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Name the vessels sets that run through the greater sciatic foramen |
superior gluteal A+V inferior gluteal A+V Internal pudendal A+V |
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Name the muscle that runs through the greater sciatic foramen |
piriformis |
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What leaves the pelvis through the greater sciatic notch above the piriformis muscle |
superior gluteal A/V/N |
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Structures passing through the lesser sciatic foramen are |
Tendon of the obturator internus Internal pudendal vessels Pudendal nerve Nerve to the obutrator internus |
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The nerve to obturator internus crosses the back of the ischial spine - T/F |
True It is formed from L5-S2 division of sacral plexus Leaves the pelvis through the greater sciatic foramen Crosses the ischial spine Re-enters pelvis through the lesser sciatic foramen |
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The pudendal nerve crosses the back of the ischial spine - T/F |
False It crosses over the lateral part of the sacrospinous ligament |
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The inferior gluteal nerve crosses the back of the ischial spine - T/F |
False |
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The nerve to quadratus femoris crosses the back of the ischial spine - T/F |
False |
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Ischial spine gives rise to coccygeus - T/F |
True |
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Ischial spine gives rise to piriformis - T/F |
False Piriformis arises from the sacrum |
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Ischial spine is crossed by the pudendal nerve - T/F |
False |
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Ischial spine gives rise to gemellus inferior - T/F |
False Gemellus inferior arises from the ischial tuberosity below the ischial spine |
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Ischial spine gives rise to the falciform ligament - T/F |
False |
