Abdomen 2015

Question 1

Which intercostal space marks the superior border of the abdominal cavity?

Answer 1

4th intercostal space

p.184 Moore

Question 2

At what vertebral and CC level does the transpyloric plane exist?

Answer 2

Posterior lower border of L1, and anteriorly to the tip of the 9th CC.

Question 3

Which structures does the transpyloric plane transect (7)?

Answer 3

1.) the fundus of the gallbladder
2.) neck of the pancreas
3-4.) origins of the superior mesenteric artery (SMA) and hepatic portal vein
5.) root of the transverse mesocolon
6.) duodenojejunal junction
7.) hila of the kidneys.

Question 4

What other pelvic/spinal landmark lies at the same level as the ASIS?

Answer 4

Sacral promontory
#6

Question 5

Describe the location of the renal angle in terms of ribs. What does it overlie?

Answer 5

6

• Renal angle lies between 12th rib and lateral margin of erector spinae.
• It overlies the lower part of the kidney.

“Renal angle: ‎An area located on either side of the human back between the lateral borders of the erector spinae muscles and inferior borders of the twelfth rib, so called because the kidney can be felt at this location.” -Wiki

Question 6

Between which two vertebral levels does the umbilicus lie?

What is this demarcation called and what does it demarcate?

Answer 6

-L3 and L4
-Transumbilical line; divides abdomen into upper and lower halves.
#6, p.184 Moore

Question 7

Superior to the costal margin, the rectus abdominis lies directly on ____________.

Answer 7

the thoracic wall

p.193 Moore

Question 8

All layers of the anterolateral abdominal wall fuse at the ________.

Answer 8

umbilicus

p.193 Moore

Question 9

Between which muscle layers does the abdominal neurovascular plane lie?

Answer 9

between the internal oblique and the transversus abdominis muscles

Question 10

Describe the pattern of innervation for the anterior abdominal branches of thoraco-abdominal nerves T7-L1

Answer 10

• T7–T9 supply the skin superior to the umbilicus.
• T10 supplies the skin around the umbilicus.
• T11, plus the cutaneous branches of the subcostal (T12),
iliohypogastric, and ilio-inguinal (L1), supply the skin inferior to the umbilicus (1 in above the superior inguinal ring).
p.195 Moore

Question 11

Where, and from what does the inferior epigastric artery arise?

Answer 11

Arises from the external iliac artery just superior to the inguinal ligament.
p.195 Moore

Question 12

The inguinal ligament is a dense band constituting the inferior-most part of the _____________.

Answer 12

external oblique aponeurosis

p.203 Moore

Question 13

Give the boundaries of the inguinal canal – Anterior wall, posterior wall, roof (lateral, central, and medial), and floor (lateral, central, and medial).

Answer 13

• Anterior wall: External oblique aponeurosis; its lateral part is reinforced by internal oblique.
• Posterior wall: Transversalis fascia; reinforced by the inguinal falx (conjoint tendon).
• Roof: Formed laterally by the transversalis fascia, centrally by the internal obliques and transversus abdominis, and medially by the medial crus of the externl oblique aponeurosis.
• Floor: Formed laterally by the iliopubic tract, centrally by the gutter formed from the infolded inguinal ligament, and medially by the lacunar ligament.
p.203 Moore

Question 14

What structures lie anterior (3) and posterior (4) to the first part of the duodenum?

Answer 14

Anterior: Peritoneum, gallbladder, and quadrate lobe.
Posterior: Portal vein, bile duct, gastroduodenal artery and IVC.

Question 15

What are the three layers of covering for the spermatic cord?

Answer 15

The coverings of the spermatic cord include the following:
• Internal spermatic fascia: derived from the transversalis fascia.
• Cremasteric fascia: derived from the investing fascia of both the superficial and deep surfaces of the internal oblique muscle.
• External spermatic fascia: derived from the external oblique aponeurosis and its investing fascia.
p.206 Moore

Question 16

What is the innervation for the cremaster muscle?

Answer 16

The cremaster muscle is innervated by the genital branch of the genitofemoral nerve (L1, L2), a derivative of the lumbar plexus.
p.207

Question 17

What are the four tissue layers of the spermatic cord and where are they from?

Answer 17

1.) External spermatic fascia –Extension of the external oblique aponeurosis.
2.) Cremasteric muscle and fascia –Continuation of the internal oblique muscle and fascia.
3.) Internal spermatic fascia –Continuation of the transversalis fascia.
#44

Question 18

What is the nerve supply of the scrotum? –Anterior 1/3 (2), Posterior 2/3 (2).

Answer 18

48

1. ) Anterior 1/3 by ilioinguinal, genital branch of genitofemoral (L1).
2. ) Posterior 2/3 by posterior scrotal branch of pudendal nerve(S3) and posterior cutaneous nerve of thigh.

• Branches of lumbar plexus to the anterolateral surface.
• Branches of sacral plexus to posterior and inferior surfaces.

Question 19

What is the blood supply of the scrotum (4)?

Answer 19

Supplied by superficial and deep external pudendal artery, scrotal branch of internal pudendal artery and cremasteric branch of inferior epigastric artery

Question 20

List the five characteristics of an INDIRECT inguinal hernia.

Answer 20

1. ) Occurs through deep inguinal ring
2. ) Descends into scrotum
3. ) Lies lateral to inferior epigastric vessels
4. ) Congenital and is associated with process vaginalis
5. ) Younger age

Question 21

List the five characteristics of a DIRECT inguinal hernia.

Answer 21

1. ) Occurs through posterior wall of inguinal canal
2. ) Not descends into scrotum
3. ) Lies medial to inferior epigastric vessels
4. ) Acquired and is associated with weakness of posterior wall of inguinal canal
5. ) Older age

Question 22

Give the medial, lateral, and inferior borders of Hesselbach’s Triangle.

Answer 22

Medially
Rectus abdominis

Laterally
Inferior epigastric artery

Inferiorly
Inguinal ligament

Direct inguinal hernia occur through this

Question 23

At which vertebral and visceral landmark does the esophagus end?

Answer 23

Ends at cardiac orifice of stomach, opposite T11.

p.229

Question 24

1. ) What is the arterial supply for the abdominal part of the esophagus (2)?
2. ) Thoracic?

Answer 24

1. ) The arterial supply of the abdominal part of the esophagus is from the left gastric artery, a branch of the celiac trunk, and the left inferior phrenic artery.
2. ) Inferior thyroid branch of the thyrocervical trunk.
   p. 230 Moore, #63

Question 25

What supplies innervation to the esophagus?

Answer 25

``` Dervied from VAGI nerves (esophageal plexus, formed by the VAGAL trunks) and thoracic sympathetic trunks. #63 ```

Question 26

The pyloric orifice is approximately _____ cm to the _____ of the midline.

Answer 26

approximately 1.25 cm to the right of the midline. | p.232

Question 27

1. ) Anteriorly, the stomach is related to what three structures? 2. ) Posteriorly, the stomach is related to which two structures? 3. ) The posterior surface of the stomach forms most of the anterior wall of the _______.

Answer 27

1. ) the diaphragm, left lobe of liver, and anterior abdominal wall. 2. ) the omental bursa and pancreas 3. ) omental bursa p. 232

Question 28

The transverse colon is related ______ and ______ to the stomach as it courses along the ________ of the stomach to the ________.

Answer 28

- inferiorly and laterally - as it courses along the greater curvature - to the left colic flexure. p. 232, see iPad Rohen bookmark

Question 29

What structures form the bed of the stomach (6)?

Answer 29

* The structures that form the posterior wall of the omental bursa* - the left dome of the diaphragm, spleen, left kidney and suprarenal gland, splenic artery, pancreas, and transverse mesocolon. p. 234

Question 30

1. ) What supplies sympathetic supply to the stomach? | 2. ) Para?

Answer 30

1.) T6-T9 via great splanchnic nerve to celiac plexus. 2.) Anterior and posterior vagal trunks. #90

Question 31

IMA arises in front of which vertebral level(s)?

Answer 31

``` L2-3 #22 ```

Question 32

What supplies SNS innervation to the large intestine?

Answer 32

``` T10-L2 #31 ```

Question 33

The liver is covered by peritoneum except at the _________ and _________.

Answer 33

``` hepatic portal and the bed of the gall bladder. #45 ```

Question 34

What are the five relations to the liver?

Answer 34

1. ) R side of anterior stomach 2. ) 1st part of duod. 3. ) Gall bladder 4. ) R colic flexure and transv. colon 5. ) R kidney and suprarenal glands

Question 35

The hepatic fissures are formed by what four structures?

Answer 35

1. ) Round ligament 2. ) Fissure of ligamentum venosum 3. ) Fossa for the gall bladder 4. ) Fissure for IVC.

Question 36

Describe the hepatorenal space, aka ? – A _______ extension of the _______ space, lying between the ____ part of the visceral surface of the liver and the ______ and ________.

Answer 36

aka Morison pouch: A posterosuperior extension of the subhepatic space, lying between the right part of the visceral surface of the liver and the right kidney and suprarenal gland. p.269

Question 37

What separates the liver into left and right lobes?

Answer 37

The falciform ligament and the left sagittal fissure separates a large right lobe from a much smaller left lobe. p.271

Question 38

What enters and leaves the porta hepatis?

Answer 38

``` Hepatic portal vein, hepatic artery, and lymphatic vessels, the hepatic nerve plexus, and hepatic ducts (L and R converge to form the common hepatic duct). #55 ```

Question 39

The functional "left" liver includes which anatomic lobes?

Answer 39

LEFT LOBE, CAUDATE and QUADRATE LOBES.

Question 40

1. ) The hepatic portal vein, a short, wide vein, is formed by the ________ and ________ veins posterior to the ___________. 2. ) It ascends anterior to the ________ as part of the __________ in the _________.

Answer 40

1.) superior mesenteric and splenic veins posterior to the neck of the pancreas. 2. ) anterior to the IVC as part of the portal triad in the hepatoduodenal ligament. p. 272

Question 41

Blood from the SMV, rich in absorbed nutrients from the intestines, passes mostly to the _____ liver.

Answer 41

right liver | p.280

Question 42

What anatomical feature makes the porto-systemic anastomoses possible?

Answer 42

Hepatic portal vein and its tributaries have no valves. | p.281

Question 43

1. ) Where does the gall bladder lie on the liver? | 2. ) What are the relations of the body, neck, and cystic duct of the gallbladder to the superior part of the duodenum?

Answer 43

1. ) At the junction between the right and left lobes. 2. ) the body of the gallbladder lies anterior to the superior part of the duodenum, and its neck and cystic duct are immediately superior to the duodenum p. 278

Question 44

At which CC is the fundus of the gallbladder located?

Answer 44

``` tip of 9th CC in the MCL. #75, p.278 ```

Question 45

What forms the common bile duct?

Answer 45

``` Cystic duct connects to common hepatic duct to form the common bile duct. #75 ```

Question 46

1. ) What are the three contents of Calots triangle (laterally, medially, superiorly)? 2. ) What are the boundaries of the cystohepatic triangle (lateral, medial, superior)?

Answer 46

1. ) Cystic duct laterally, common hepatic medially, cystic artery superiorly. 2. ) Cystic duct laterally, common hepatic medially, inferior border of the liver superiorly. p. 279

Question 47

On which 3-4 structures does the head of the pancreas rest on posteriorly?

Answer 47

Rests posteriorly on the IVC, right renal artery and vein, and left renal vein. p.266

Question 48

What is the relationship of the bile duct to the head of the pancreas?

Answer 48

The bile duct lies in a groove on the posterosuperior surface of the head or is embedded in its substance. p.266

Question 49

What is the relationship of the hepatic portal vein to the neck of the pancreas?

Answer 49

The SMV joins the splenic vein posterior to the neck to form the hepatic portal vein.

Question 50

1. ) Which two structures does the body of the pancreas cross? 2. ) It lies in the floor of what, helping to form what structure?

Answer 50

1.) Crosses over the aorta and L2 vertebra. 2.) Lies in the floor of the omental bursa (helping form part of the stomach bed). #97, p.266

Question 51

The posterior surface of the body of the pancreas is in contact with which 5 structures?

Answer 51

Is in contact with the aorta, SMA, left suprarenal gland, left kidney, and renal vessels. p.267

Question 52

The tail of the pancreas lies anterior to the ________, where it is closely related to the ________ and the _________.

Answer 52

- lies anterior to the left kidney. - splenic hilum and the left colic flexure. p. 267

Question 53

Give the relationships of the spleen (anteriorly, posteriorly, inferiorly, medially)

Answer 53

The relations of the spleen are: • Anteriorly, the stomach. * Posteriorly, the left part of the diaphragm, which separates it from the pleura, lung, and ribs 9–11. * Inferiorly, the left colic (splenic) flexure. • Medially, the left kidney. p.263

Question 54

List the three ligaments of the spleen and where they attach on both the spleen and other organs.

Answer 54

*First two attach at hilum* Gastrosplenic ligament: To greater curvature of the stomach. Splenorenal ligament: To left kidney. ``` Phrenocolic ligament: Spleen sits on the phrenocolic ligament. #110, p.264 ```

Question 55

The splenic hilum is often in contact with the _____________ and constitutes the left boundary of the _________.

Answer 55

- tail of the pancreas - omental bursa p. 264

Question 56

Describe the domes of the diaphragm – i.e. which is higher, and which levels do each rise to during expiration?

Answer 56

``` Two domes: Right higher than left – Ascends to 5th rib on RIGHT, and 5th ICS on LEFT during expiration. #7 ```

Question 57

Give the origins of the diaphragm (sternal, costal, lumbar, crura)

Answer 57

Sternal: Inner surface of xiphoid process. Costal: CC and lower six ribs. Lumbar: Medial and lateral arcuate ligaments. Crura: Musculotendinous bundles from bodies of L1-L3; right and left. #8

Question 58

At which vertebral levels/landmarks does the abdominal aorta begin and end?

Answer 58

Begins anterior to T12 body and ends (bifurcates) at L4. | p.313, #29

Question 59

At which vertebral levels do the following structures arise: 1. ) Celiac trunk 2. ) SMA 3. ) IMA 4. ) Gonadal (testicular or ovarian) arteries

Answer 59

1. ) T12 2. ) L1 3. ) L3 4. ) L2 p. 314

Question 60

At which vertebral levels do the following veins arise: 1. ) Hepatic veins 2. ) Inferior phrenic vein 3. ) Suprarenal vein 4. ) Renal veins 5. ) Gonadal veins 6. ) Lumbar veins 7. ) Common iliac veins

Answer 60

1.) T8 2.) T8 3.) L1 4.) L1 5.) L2 6.) L1-L5 7.) L5 #38

Question 61

What does ilioinguinal nerve (root?) supply, and what are its terminal branches?

Answer 61

``` Ilioinguinal n. (L1): Innervates internal oblique and transversus abdominus – Gives off femoral cutaneous branches to upper medial thigh, and anterior scrotal or labial branches. #45 ```