Anatomy of the abdomen and pelvis


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Anatomy of the abdomen and pelvis

  1. 1. Anatomy of the Abdomen and PelvisThe Abdominal Walls1. State the boundaries of the abdomino-pelvic cavity12. What are the surface boundaries of the abdomen?23.What characteristic of the diaphragm helps toprotect the upper abdomen?34.What is the pelvic diaphragm?5.What are the linea alba and the linea semilunaris?46.On the diagram, label the lines A-C and the 9 sub-divisions of the abdomen created by them. 57.Name the pair of vertical muscles on the anteriorabdominal wall68.What are the three layers of muscle which runlaterally across the sides of the anterior wall?79.What are the two muscles of the posteriorabdominal wall?810.What is the name of the double membrane surrounding the abdominal contentsthat lies deep to the transversalis fascia?91 Abdomen is everything from the diaphragm up to the ʻtrueʼ pelvis, so bounded inferiorly by the pelvic inlet.2 The costal margin above and the V-shape of the pelvis (iliac crest and inguinal ligament) below3 It is domed so as to move up into the ribcage meaning upper abdomen is protected by lower ribs4 Linea alba is the line down the middle of the abdomen, crossing the umbilicus. The 2 linea semilunaris areeither side of the rectus abdominus muscles.5 A = mid saggital plane, B = subcostal plane, C = Intertubercular plane, i = right hypocondrium, ii = epigastricregion, iii = left hypochondrium, iv = right flank, v = umbilical region, vi = left flank, vii = right groin, viii = pubicregion, ix = left groin6 Rectus abdominus7 External oblique, internal oblique and transversus abdominis8 Quadratus lumboram and psoas major9 Parietal and visceral peritoneum
  2. 2. 11.Name the three layers of abdominal superficial fascia1012.Where are the attachments of the Scarpa’s fascia?1113.What are the two main superficial veins of the abdomen and where are they?1214.What are the functions and attachments of the psoas major?1315.Where is the iliacus muscle?1416.What are the root values of the subcostal, iliohypogastric and ilioinguinal nerves?1517.What could cause compression of the nerves in (16)?1618.Describe the course and distribution of the genitofemoral nerve?1719.What are the attachments and functions of the external obliques?1820.What are the attachments and functions of the internal obliques and thetransversus abdominus?1910 Outside in = Camperʼs fascia, Scarpaʼs fascia. There is a negligible amount of deep fascia below the11 Bound to the fascia lata of the thigh below the inguinal ligament and to structures in the perineum (regionof the external genetalia). Posteriorly to the throacolumbar fascia and the fascia lata of the buttock.12 Thoraco-epigastric (run through right and left hypochondrium), superficial epigastric (run up to theumbilicus from the pubic region13 Flexes the thigh on the trunk or trunk on thigh. Arises from the lumbar transverse processes and lumbarvertebral bodies, attaches the illiacus muscle (on the iliac fossa) onto the lesser trochanter of the femur.14 Inside the iliac fossa on the interior of the hip bone15 Subcostal nerve = T12, Iliohypogastric = L1, Ilioinguinal = collateral branch of iliohypogastric so also L116 Enlargement of the psoas major muscle, which runs alongside these nerves. This can happen followinginfection of the psoas fascia, or intra-muscular haematomas.17 Derived from L1 and 2 and emerges from the anterior surface of psoas major and runs down deep to thepsoas fascia to supply the cremaster muscle in the male, via its genital branch.18 Pull the trunk downwards and forwards to right, left or if contracted together, forwards. Arises from thelower ribs 5-12, inserts posteriorly to the iliac crest.19 Internal oblique begins at ribs 9-12 and inserts into the the iliac crest, thoracolumbar fascia posteriorly andlinea alba anteriorly. It functions to stabilise the lumbar spine. The transversus abdominus originates from theinternal surfaces of the bones and cartilages forming the thoracic outlet and iliac crest, as well as thethoracolumbar fascia. Its primary role is abdominal compression/breathing, and stabilization.
  3. 3. 21.What are the layers of the rectal sheath?2022.Which dermatomes cover the anterior abdominal wall?2123.Which nerves (spinal segments) innervate the rectus abdominis muscle?22Inguinal Region and Hernias1.Label the locations of hernias A-F232.What is the difference between an inguinalhernia and a femoral hernia?243.What stuctures form the inguinal ring?254.List the boundaries of the inguinal canal265.Most layers of the abdominal wall are broughtdown with the testes as they descend to formthe scotum, but which layers must they passthrough?276.What is a patent processus vaginalis and howwould you test for it?20 Linea alba in the centre, either side are each rectus abdominus muscle, the external oblique passes overthe top of this and the transversus behind. Below the arcuate line, the internal oblique passes infront of therectus, above it straddles it on both sides.21 T7-L122 T7-T1223 A = Epigastric, B = Paraumblical, C = Umbilical, D = Spigelian, E = Inguinal, F = Femoral24 Inguinal is a protrusion through the inguinal canal25 Medial and lateral margins are formed by the split in the aponeurosis (crura/crus), the lateral crus attachedto the pubic tubercle and the medial to the pubic crest. Intercrucal fibres arising from the inguinal ligamentstop the crura from spreading apart.26 It is the lower free edge of the external oblique aponeurosis. Openings either end are the deep andsuperficial inguinal rings. The deep inguinal ring is the beginning of an invagination in the transversalis fasciawhich continues into the canal forming its innermost covering. It passes through all 3 layers of abdominalmuscles, obliquely along the inguinal ligament, the internal oblique gives some slips of muscle coveringknown as the cremaster muscle.27 Under the transversus abdominis tendon and internal oblique. Descended testes leave a trail ofsurrounding layers called the vas deferens which forms the spermatic cord, derived from 3 layers ofabdominal wall.
  4. 4. 7. Describe the path of the spermatic cord288. Describe the coverings of the spermatic cord in relation to the abdominal wall299. What is the nerve supply for the cremaster muscle?3010.What are the boundaries of the inguinal triangle?3111.Which nerve supplies the muscle fibres of the conjoint tendon?3212.What is the difference between a direct and indirect inguinal hernia?3313.What is a hiatus hernia?34Peritoneum1. What is a mesentery?352. What are the ventral and dorsal mesenteries?363. What is mesothelium?3728 Begins at the deep inguinal ring, lateral to the inferior epigastric artery, ends at the posterior border of thetestis. Passing through the inguinal canal and emerging at the superficial inguinal ring. As the cord leavesthe inguinal canal, it acquires its 3rd covering, the external spermatic fascia.29 Internal = fascia transversalis, Middle layer = cremaster layer, Lastly = spermatic fascia derived from theexternal oblique. (transversalis abdominis does not contribute to the sheath)30 Genital branch of the genitofemoral nerve, L1-231 Medial: The lateral margin of the rectus abdominus muscle (linea semilunaris), Lateral: the inferiorepigastric artery, Inferior: the Inguinal Ligament32 Supplied by the L1 nerve, loss of this nerve or muscle can lead to direct inguinal hernia33 A indirect inguinal hernia is where abdominal contents protrude through the deep inguinal ring, directinguinal hernias are where the abdominal contents herniate the wall of the inguinal canal without going downthe canal itself.34 Herniation of stomach up through the hole in the diaphragm through which the oesophagus travels.35 A double folded membrane which separates the abdominal cavity from the peritoneum. The peritonealcavity itself does not contain any organs, rather the gut is trapped within the mesentery in a ʻsandwichʼ.36 The two sides of the mesentery (either side of the gut organs). The front (ventral) mesentery is shorterthan the dorsal one, so there is continuity beneath it, the mesentery is only a partial septum.37 The histological term for mesentery, once is has slung around the organs to form the visceral perironeum.This is a simple squamous columnar epithelium.
  5. 5. 4. What is the meaning of the term ligament in context of the peritoneum and whatis the gastro-hepatic ligament?385. Explain the difference between an intra-peritoneal and retro-peritoneal organ396. Which organs and structures are retro-peritoneal?407. What is the caecal bud?418. What is the vitelline duct?429. What is Meckel’s diverticulum?4310.What is the origin of the greater omentum?4411.What is the relation of the greater omentum to the greater and lesser sacs?4512.What are the functions of the greater omentum?4613.What is the epiploic foramen?4714.Name the 4 peritoneal spaces (between the mesenteries)4838 Ligaments may be formed out of remaining double folds of mesentery, meaning that abdominal organs areconnected to each other in some way. The hepato-gastric ligament is also known as the lesser omentum.39 As the gut twists and turns in development, some organs lost their mesentery, fusing with the parietalperitoneum or posterior abdominal wall instead. These are known as retro-peritoneal organs.40 DUKE CRAPS - Duodenum, Ureters, Kidneys, Espohagus, Colon (ascending and descending), Aorta,Pancreas, Supraneal Glands41 Part of the caecum (gut following the stomach) which protrudes into the umbilicus in embreyologicaldevelopment having been pushed by growth of the liver.During later stages of development, there is anti-clockwise rotation of the midgut and the caecum retracts back from the umbilicus, so the caecal bud remainssuperior to the gut, then as the gut rotates further, it lies inferiorly on the right.42 Communication between midgut and yolk sac in embreyo43 The adult remnant of the vitelline duct44 Expansion of the embryological ʻdorsal mesenteryʼ of the stomach. Greater omentum expands downwardsto cover the small intestine.45 The lesser sac is the area behind the stomach, the greater sac is everywhere else.46 The greater omentum is a fat filled apron which folds down over the small intestines. Its function is tolocalise infection by sticking to any infected region, trapping the infection and preventing it from spreading.47 aka Omental foramen, passage of communication between the lesser sac (behind stomach) and greatersac (everywhere else)48 Left and right paracolic gutters (between the colon and the abdominal wall) and the left and rightparamesenteric gutters (between the colon and the root of the mesentery)
  6. 6. 15.How do the peritoneal folds and spaces differ between male and female?49Stomach and Spleen1. What is the approximate position of the stomach in relation to the abdominaldivisions?502. What are the main sub-divisions/parts of the stomach, what substances do theysecrete?513. What are the main functions of the stomach?524. Name the layers of the gut wall535. Name the two parts of the enteric nervous system546. Name the 3 muscular coats of the stomach in order557. Name the sphincters of the stomach and oesophagus568. What are the right and left crus?579. What are rugae5849 In males, the peritoneum sweeps forward and around the lateral walls and towards the floor of the pelvis(levator ani muscle), before ascending up the anterior wall of the abdomen. The fossa between the posteriorand anterior folds is known as the rectovesical pouch. Females have an additional fold of peritoneumdividing this space into the rectouterine pouch (of Douglas) behind and a vesouterine pouch in front.50 Occupies parts of the epigastric, umbilical and left hypochondriac regions51 Cardia (mucus secretion), fundus (storage/gas), body (mucus, HCl, pepsiongen, intrinsic factor), Pyloris(mixing, gastrin)52 Storage, secretions, breakdown with enzymes/HCl, absorbtion.53 From lumen outwards: Epithelium, lamina propria, muscularis mucosae (internal ring of smooth muscle),submucosa, mucularis externa (1 layer circular, 1 layer longlitudinal), serosa.54 Submucosal plexus and myenteric plexus55 Inner oblique layer, middle circular layer, outer longitudinal layer (for peristalsis/churning)56 Oesophageal sphincter is a layer of muscle but not a true sphincter & pyloric sphincter (exit to duodenum).Control of gastric reflux is done largely by the muscular fibres of the diaphragm.57 Tendonous structures which extend from the diaphragm for a short distance down the vertebral column58 A series of ridges caused by the in-folding of the mucus membrane of the stomach.
  7. 7. 10.Which organs and structures are in contact with the stomach?5911.Which arteries supply the stomach and liver and what are their origins?6012.Where do all the veins of the stomach ultimately drain into?6113.Where does the stomach lymph ultimately drain into?6214.Describe the nerve supply to the stomach6315.Which dermatomes would be sensitive to foregut pain?6416.Where is the spleen located in relation to the ribs?6517.What are the functions of the spleen?6618.Identify the indentations on the surface of the spleen67Liver and Hepatobiliary System1. What is the approximate position of the liver in relation to other abdominalorgans and surface regions?682. What are the main functions of the liver?6959 Superiorly the liver and left diaphragm, laterally the left kidney, supraneal gland and spleen. Splenic artery,hepatic portal vein and coealiac trunk. The lesser omentum and lesser sac separate the stomach fromadjacent organs inferiorly.60 The coeliac artery arises from the aorta. It is split into 3 branches, left gastric, splenic and commonhepatic. The common hepatic artery then splits into the proper hepatic and gastroduodenal artery.61 Hepatic portal vein62 Coeliac (pre-aortic) nodes and the thoracic duct via the cysterna chyli63 The right and left vagi (split in the vagus nerve) split anterior and posterior to the stomach.64 T6-965 Immediately beneath ribs 9-10, with ribs 11 and 12 below it. The spleen is highly vascular so a rupturecaused by broken ribs leads to severe haemorrage.66 Largest lymphoid unit in the body, contains macrophages which destroy old red blood cells, produceswhite and red blood cells (in infant), reservoir for 1/3 of platelets, store of blood can be released in responseto adrenaline.67 The spleen has two surfaces (diaphragmatic and visceral), two borders (one notched and one not). Lowerpole = splenic flexure of the colon, visceral surface = stomach, left kidney and tail of pancreas68 Lower border corresponds to right costal margin,69 Produces bile (stored in the gallbladder), glucose into glycogen, production of cholesterol, regulation offats and amino acids, stores iron, detoxification, immunity, manufacture of plasma proteins.
  8. 8. 3. What are the spaces above and below the liver?704. List the lobes of the liver and the ligaments separating them?715. Which organs lie on the visceral surface of the liver?726. Which structures pass through the porta hepatis/portal triad (on the free edge ofthe lesser omentum)?737. Which veins form the hepatic portal vein (bearing in mind it drains the whole gutto the liver)?748. Describe the passage of venous blood through porto-systemic anastemosis in thecase of portal hypertension in liver disease?759. What clinical symptoms could follow blockage of the portal system?7610.By contrast, if the IVC becomes blocked, what route will blood be diverted to inorder to reach the heart?7711.List the functions of the gallbladder7870 Hepato-renal (inferior/posterior) and sub-phrenic (superior/anterior)71 Anteriorly: Right lobe and left lobe separated by the falciform ligament. Posteriorly the quadrate lobe andsmaller caudate lobe separated by the coronary ligaments and triangular ligaments72 Right kidney, hepatic flexure of the colon, oesophagus, stomach and duodenum73 Portal vein, hepatic artery and the common hepatic duct (into which the bile duct drains from thegallbladder)74 The hepatic portal vein is the product of the entire venous drainage of the gut, which includes the superiorand inferior mesenteric veins, the splenic vein, the gastric veins and the cystic vein from the gallbladder.75 Progressive opening up of pre-existing anastemoses between the systemic and portal venous systems atone of 4 possible sites: lower oesophagus, anal canal, recanalized umbilical vein to the abdominal wall, orthe posterior abdominal wall.76 Could result in haemorrhoids, varicose veins on the abdominal wall, diltated superficial veins arising fromthe umbilicus (Medusaʼs head).77 Effectively the reverse of portal hypertension, veins of the anterior abdominal wall enlarge and shunt bloodaround the obstruction but in the opposite direction to their normal flow, linking the subclavian/axilliarysystem with the iliac/femoral.78 Reservoir of bile produced by the liver, concentrates the bile and adds mucus, absorbing water out of themixture.
  9. 9. 12.Name the different bile ducts7913.What and where is the sphincter of Oddi?8014.What is the hepatopancreatic ampulla ofVater?8115.Name the 4 parts of the pancreas8216.What are the functions of the pancreas8317.What is the arterial supply of the pancreas8418.What are the 2 ducts of the pancreas entering the duodenum85The IntestinesThe Intestines1. Define foregut, midgut and hind gut862. What membranous structure is stretched between the liver/gallbladder andstomach?873. What membranous structure is stretched from just below the stomach across theintestines?8879 Right and left hepatic ducts drain from right and left lobes of the liver, these merge to form the commonhepatic duct and then combine with the cystic duct from the gallbladder to form the bile duct which enters theduodenum.80 Sphincter at the lower end of the common bile duct where it joins the pancreatic duct, controls biliarysecretion81 The route by which the pancreatic duct enters the duodenum82 head, body, tail and uncinate process83 Exocrine gland secreting digestive enzymes, as an endocrine gland producing and secreting insulin andglucagon84 Receives blood from the arteria pancreatica magna (from splenic artery), superior pancreatoduodenalartery (from gastroduodenal), inferior pancreatoduodenal (from superior mesenteric).85 Main pancreatic duct (joint with the common bile duct), enters the duodenum through the ampulla of Vater.The accessory pancreatic duct enters the duodenum superior to the main duct.86 Foregut: ends after entry of common bile duct into duodenum, Midgut: ends 2/3rds of the way along thetransverse colon, Hindgut: Ends halfway down the anal canal.87 Lesser omentum88 Greater omentum
  10. 10. 4. What are the right and left spaces superficial to the colon?895. What are the divisions of the intestine?906. Which artery supplies the midgut?917. Which artery supplies the hindgut?928. What is the suspensory ligament of the duodenum?939. What is the most significant difference in the structure of the epithelium betweenthe small and large intestines?9410.What are the name of the anatomical folds in the membrane of the duodenum?9511.Which surface abdominal region does most of the duodenum lie within?9612.Which organ does the duodenum encircle on three out of four sides?9713.What is the name of the opening into the duodenum where pancreatic juice andbile are secreted from the pancreas and gallbladder?9814.What is the name of the feature between (13) and the hepatopancreatic ampulla?9915.What is the main difference between the epithelium of the ileum andduodenum10089 Right and left paracolic gutters90 Small Intestine (6m) (3-6 hours): Duodenum (5%), Jejunum (roughly 40%) and Ileum (roughly 60%). LargeIntestine (20 hours): Caecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum.91 Superior mesenteric artery92 Inferior mesenteric artery93 Ligament of Treitz94 Small intestine contains villi whereas large intestine does not95 Plicae circularis96 The umbilical (central) region97 Pancreas98 Major and minor duodenal papillae99 Sphincter of Oddi100 The Ileum lacks the plicae circularis of the duodenum
  11. 11. 16.In which surface abdominal regions are the jejunum and ileum located?10117.Which part of the small intestine contains Peyer’s patches?10218.What are vasa recta?10319.What are the three main structural components of the large intestine which arenot found in the small intestine?10420.What is the difference between appendages and diverticula?10521.Which organ does the corner of the ascending and transverse colon turn justbelow (at the right colic flexure)?10622.Which part of the large intestine is the appendix attached to?10723.Which part of the pelvis does the caecum sit within?10824.What and where (surface location) is McBurney’s point?10925.Which parts of the the large intestine and small intestine are retroperitoneal andwhich are intraperitoneal?11026.What are the names for the anastemoses of blood vessels that supply theascending and descending colon?111101 Jejunum mostly located in umbilical region, Ileum located in hypogastric/pubic and right inguinal regions102 Lymph nodules involved in fat absorbtion, found uniquely in ileum103 Arcades off the mesenteric arteries which run straight to the gut wall104 Haustra (sac like divisions), Epiploic/Omental appendages (fatty tags on surface), Teniae coli (strips oflongitudinal muscle which contract to produce the haustra)105 Appendages are normal fatty pouches in the serosa whereas diverticula are pathological pouches of thewhole gut wall and may signify the presence of a blockage or cancer.106 The right lobe of the liver107 The caecum108 The right iliac fossa109 The tip of the appendix, it lies 2/3rds of the way down a line drawn from the umbilicus to the anteriorsuperior iliac spine. It is the point of maximum pain in appendicitis.110 Retroperitoneal: Rectum, ascending and descending portions of the colon, duodenum. Intraperitoneal:transverse colon, sigmoid colon, caecum, jejunum and ileum.111 Right colonic or hepatic flexure and left colonic or splenic flexure
  12. 12. 27.Which parts of the colon are mobile withinthe peritoneum and which are not?11228.Where does the superior mesentericartery arise from?11329.Where does the inferior mesenteric arteryarise from?11430.Label arteries A-H on the diagram115Posterior Abdominal Wall1.Which structures are retroperitoneal andtherefore lie on the posterior abdominalwall1162. Which muscles form the posterior abdominal wall?1173. Which nerve innervates the psoas major muscle1184. What are the root values of the iliohypogastric, ilioinguinal and genitofemoralnerves?1195. Name the 4 parts of the urinary system120112 Transverse and sigmoid colon are mobile because they have mesenteries and are within the peritoneumwhereas the descending colon is not because it has no mesentery and is retroperitoneal. The transversecolon has a mesentery however it is retroperitoneal.113 The abdominal aorta around L1114 The abdominal aorta around L3115 A= Ileocaecal artery, B = right colic artery, C=middle colic artery, D=superior mesenteric artery, E= inferiormesenteric artery, F=left colic artery, G= sigmoid artery, H=superior rectal artery116 DUKE CRAPS Duodenum, ureters, kidneys, esophagus, colon (asc. & desc.)117 Diaphragm, psoas major (longitudinally from lumbar vertebra),118 Anterior rami of L1-4119 Iliohypogastric = L1/T12, Ilioingunal = L1, Genitofemoral = L1/2120 Kidneys (main function to purify blood), ureters, bladder, urethera
  13. 13. 6. Describe the position of the kidneys in relation to the anterior abdominal walland to the ribs1217. Name the layers of fat and fascia surrounding the kidney?1228. Which kidney is higher?1239. List and describe the locations of the calyxes and pelvis of the kidney12410.Which vertebral level do the renal arteries arise from?12511.List the points along the course of the ureter at which it is normally constricted?12612.What are the symptoms of renal and ureteric colic and who might bepredisposed to this condition?12713.Describe the shape and position of each supraneal gland and its main functions12814.Describe the blood supply and venous drainage of the supraneal gland129121 Anteriorly, the kidney is related to the spleen, stomach, pancreas, jejunum and descending colon. Thekidneys themselves are in contact with the psoas muscles and fat pads and ribs 11-12 on the posteriorabdominal wall. The centres of each kindey hila lie about 5cm from the medial plane either side of thetranspyloric plane.122 Surrounded by a thick layer of peri-renal fat and renal fascia, each are contained within a transparent buttough renal capsule. Outside this is retroperitoneal fat.123 The left kidney rests on the 11th and 12th ribs, the right just under the 12th124 The renal pelvis is the flat expansion of the ureter as it passes through the diaphragm. Minor calices arecup shaped branches of the renal pelvis into individual medullary pyramids. The major calices are formed bythe convergence of several minor calices.125 Just below the superior mesenteric artery at L1/2126 1/ The junction with the renal pelvis, 2/ where the ureter crosses the pelvic brim, 3/ where the ureterpasses through the bladder wall127 Ureteric colic is the precipitation of substances in the urine to form kidney stones. Most common inchronic dehydration, renal infections and prolonged immobilization. Symptoms normally include severe painin the renal angle between the back muscles, erector spinae and 12th rib, or anywhere down the course ofthe ureter to the groin.128 Supraneal (adrenal) glands are positioned on top of each kidney, their functions are control of salt andwater balance, regulation of carbohydrate level and secretion of sex hormones.129 Receives blood from a number of branches from the renal and inferior phrenic arteries and from the aorta,the venous drainage is by a large vein into the left renal vein.
  14. 14. 15.Name the cortical zones of the supraneal glands130Abdominal and Pelvic Vasculature1. At which vertebral levels does the abdominal aorta enter the abdomen and atwhich does it end?1312. Name the branches of the abdominal aorta1323. Which vertebral level does the inferior vena cava begin?1334. What are the tributaries of the inferior vena cava?1345. What is the origin of the superior and inferior epigastric arteries?1356. Which arteries supply the anterior and lateral abdominal wall?1367. What are the vertebral levels of the paired visceral and unpaired visceral branchesof the abdominal aorta?1378. Which arteries supply the foregut, midgut and hindgut?1389. Which arteries supply the thoracic foregut and proctodaeum?139130 Zona glomerulosa (salt/water balance), Zona fasciculata (regulates carbohydrates), Zona reticularis (sexhormones)131 Enters at T12 and ends at L4132 1/ Ventral to the gut, 2/ lateral, to the supraneal gland, 3/to the kidneys, 4/ to the gonads (testes orovaries), 5/inferior phrenic, 6/inferior phrenic, 7/4th lumbar, 8/median sacral133 Begins in the body of the 5th lumbar vertebra. It the ascends to the right of the aorta to pierce the centraltendon of the diaphragm134 Follow the same route as the aortic branches except the anterior ones, whose veins drain into the portalsystem135 The superior epigastric artery a continuation of the internal thoracic artery, it crosses the costal margin.The inferior epigastric artery is the same artery but further down where the artery anastemoses with anascending artery from the internal iliac.136 Segmental branches from the lower intercostal arteries.137 Unpaired visceral branches: coeliac (T12), superior mesenteric (L1), inferior mesenteric (L3), Pairedvisceral branches: suprarenal (L1), renal (L1/L2) and testicular/overian (L2)138 Foregut (mouth to 1/3 duodenum) = coeliac trunk, Midgut (duodenum to 2/3 transverse colon) = superiormesenteric artery, Hindgut (2/3 transverse colon to rectum) = inferior mesenteric artery139 The early thoracic part of the foregut is supplied by the external carotid and oesophageal arteries, theproctodaeum (lower anal canal) is supplied by the paired inferior rectal arteries.
  15. 15. 10.Why do the gut and the beginning and end of the alimentary tract have differentblood supplies?14011.Which large vessel does venous blood from the proctodaeum end up in?14112.Where do the splenic, superior mesenteric and inferior mesenteric veins end up?14213.Where does venous drainage from the liver go to?14314.Where do the ascending lumbar veins and the azygos system of veins drain to?14415.What are the tributaries of the inferior vena cava?14516.What is the connection between the SVC and IVC without passing through theheart?14617.What is the cisterna chyli?14718.What are the routes of lymphatic drainage from in the gut, liver and stomach?148140 Because embreyologically the ends of the alimentary tract are derived from the ectoderm (outside layer)and the gut from the endoderm (inside layer)141 The inferior vena cava142 All the venous drainage of the gut comes together to form the hepatic portal vein.143 The hepatic vein drains the liver, the hepatic portal vein is a separate vein which brings nutrient rich bloodto the liver from the gut.144 The azygos veins which are inferior to the ascending lumbar veins drain into them, the ascending lumbarveins drain into the inferior vena cava. Superiorly, the azygos veins also drain into the superior vena cavadirectly.145 The tributaries of the vena cava correspond to the abdominal aorta i.e. coeliac T12, superior mesentericL1 and inferior mesenteric L3 (all paired) and supraneal L1, the difference is that left renal and gonadalvessels join the IVC via the left renal vein.146 The azygos vein drains into the SVC and the ascending lumbar veins connect the azygos vein to theSVC. Should the IVC become blocked then blood can reach the heart via the SVC147 A sac like expansion at the inferior end of the thoracic duct, not present in all individuals. Locatedbetween the origin of the abdominal aorta and azygos vein. Right of L1 and L2.148 lacteals drain into larger lymph nodes around the origin of the gut arteries. Gut lymph is divided into pre-aortic (coeliac, superior and inferior mesenteric nodes (which correspond to arteries of the same name) orpara-aortic (either side of the aorta) and via the neck, which come from the liver and stomach. So enlargedlymph nodes in the neck can indicade cancer or infection in the stomach, whereas enlarged para-aorticnodes can indicate cancer or infection in the gut.
  16. 16. Pelvis and Perineum1. What is the pelvic girdle and pelvic inlet?1492. What are the 3 divisions of the hip bone and the key tuberosities, spines and ramiof each of these bones1503. What is the function of the sacrotuberous and sacrospinous ligaments?1514. What are the boundaries of the false and true pelvis1525. List the muscles of the lateral pelvic wall and pelvic floor/pelvic diaphragm1536. Name the parts of the levator ani muscle1547. What is the functional importance of the puborectalis muscle1558. What nerves innervate the pelvic floor muscle1569. Define the perineum (not peritoneum) and its boundaries and subdivisions157149 The pelvic girdle is the left and right hip bones joined together to (pubic symphysis) and the sacrum(sacroiliac joint). The pelvic inlet is the ring of bone formed in the centre of the pelvic girdle.150 The hip bones are formed by the fusion of the ilium, ischium and pubis (which fuse in adulthood into theinnominate bone). The ilium has the superior and anterior iliac spine. The pubis has the pubic tubercle andsuperior and inferior rami. The ischium has a spine, tuberosity and a ramus which fuses with the pubis calledthe ischiopubic ramus.151 They stabilize the sacrum and prevent tilting152 False pelvis is the upper part of the pelvis, in the pelvic region but above the pelvic brim. The true pelvisis inferior to the pelvic brim and bordered inferiorly by the pelvic diaphragm made up of the levator animuscles.153 Iliac fossae are covered by the iliacus muscles. The ʻtrue pelvisʼ contains the piriformis and obturatorinternus muscle, the foramen between these is closed by the obturator membrane. The pelvic diaphragmmuscle prevents prolapse of the organs from the cavity.154 The levator ani is a transeverse sheet of skeletal muscle which forms a support for the pelvic visceraabove. It is divided into 3 parts: puboerectalis (inner ring around anus), pubococcygeus (fans out anteriorly),iliococcygeus (fans out either side of the pubococcygeus).155 Main muscle of the levator ani and therefore has control over defecation156 Mostly innervated by the pudendal, perineal and inferior rectal nerves157 Diamond shaped region containing the genitals and anus. Divided into perineal pouches (superficial anddeep) and the ischioanal fossa (a fat filled space at the sides of the anal canal.
  17. 17. 10.What are the superficial and deep perineal pouches?15811.How are the fascia of the anterior abdominal wall joined to the fascia of theperitoneum?15912.What is the ischio-anal fossae?16013.Describe the course, origin and main branches of the pudendal nerve16114.Which artery supplies blood to the perineum?16215.Which lymph nodes take almost all the lymphatic drainage of the perineum?16316.Which lymph nodes take the lymphatic drainage from the pelvic viscera?164Rectum and Anal Canal1. Where does the rectum begin and end?1652. Which muscle marks the anorectal junction?1663. What is the name for the lower expansion of the rectum?1674. What are the names of the three semicircular folds in the wall of the rectum thatzigzag across the wall acting to slow the passage of faecal material?168158 Fascia surrounding the inferior boundary of the perineum. In females the superficial layer contains fat, inmales it is called the dartos fascia and contains smooth muscle over the scrotum, giving the scrotum theability to contract. The deep perineal pouch is membranous and known as the urogenital diaphragm.159 The deep, membranous layer of the perineum is continuous with Scarpaʼs fascia of the anteriorabdominal wall.160 A fat filled space at the sides of the anal canal.161 Derives from S2,3 and 4, branches into dorsal nerve under the urogenital diaphragm (penis/clitoris), overthe urogenital diaphragm, perineal nerve (scrotum/labia) and inferior rectal nerve (anus).162 Pudendal artery, a branch of the internal iliac artery.163 Superficial inguinal nodes164 Common iliac nodes (apart from ovaries which drain to the para-aortic nodes)165 Begins at S3 and ends at the pelvic floor166 Puboerectalis muscle, which is also a pelvic floor muscle and forms part of the anal sphincter167 Rectal ampulla168 Valves of Houston/ Rectal Valves/ Plicae Transversalis Recti
  18. 18. 5. What is the name for the non-keratinising squamous epithelial lining forming 6-7ridges along the lower anal canal?1696. What links the lower ends of these columns?1707. Describe the structure of the ‘muscularis externa’ of the rectum?1714. List the parts of the anal sphincters1725. What are the blood supplies and venous drainage vessels of the upper and loweranal canal?1736. What are the 3 main routes of lymphatic spread from the rectum and anal canal?1747. Describe the mechanism and control of the defecation reflex175Bladder, Prostate and Urethra1. What is the location of the external meatus in males and females?1762. Name the 4 parts of the male urethera177169 Anal columns170 Anal valves, together known as the pectinate line. These are above the Anocutaneous ʻwhite lineʼ.171 Similar to the structure elsewhere in the GI tract (apart from the colon), there is a complete internal layerof circular muscle coated in a layer of longitudinal muscle172 The internal anal sphincter is made up of smooth muscle, ends at the white line. The external sphincter ismade up of striated muscle and consists of 3 parts (subcutanous, superficial, deep), going from the outsidein. These are innervated by S2,3 & 4.173 Upper = superior and middle rectal vessels, Lower = inferior rectal vessels. All are linked to the inferiormesenteric.174 Above the pectinate line, lymph drains into the inferior mesenteric pre-aortic nodes and the internal iliacnodes. Below the pectinate line it drains into the superficial inguinal nodes.175 The rectum is a distensible contractile chamber which responds to stretch (S2, 3 & 4) as faecesaccumulates inside it from the sigmoid colon. The defecation reflex is controlled by the internal (smoothmuscle/involuntary) sphincter and external (striated muscle/voluntary). The stretch causes inhibition of thepuboerectalis muscle and anal sphincters. Although the external (voluntary) sphincter remains in a state oftonic contraction until the point of defecation.176 The external meatus is the narrowest portion of spongy urethra and therefore the hardest part tocatheterize. It is simply the opening of the urethral orifice.177 1/ The proximal posterior urethra begins at the interface with the bladder, prostate and urethra, 2/prostatic urethra is entirely contained within the prostate 3/ membranous urethra is located within theurogenital diaphragm 4/ the anterior/spongy urethra is anything beyond this including the penis
  19. 19. 3. Name the parts of the female urethra1784. What is the location of the external urethral sphincter in males and females?1795. How is the female urethra lubricated?1806. What is the purpose of the internal urethral sphincter in males?1817. What glands lubricate the male urethra prior to ejaculation?1828. What is the position and normal size of the prostate gland?1839. What is the coliculus?18410.What are the possible routes of spread of infection and cancer from theprostate?18511.What does ‘vesical’ refer to?18612.What are the main differences between the course of the ureter in females asopposed to males?18713.Describe the shape of the bladder, its surfaces and borders188178 The muscular coat is continuous with that of the bladder, it extends the whole length of the tube andconsists of circular fibres. Surrounded by sphincter urethrae between the superior (entrance to the truepelvis) and inferior urogenital diaphragm.179 Located on the urogenital diaphragm180 Mucous coat continuous with that of the vulva. Mucus glands are called glands of Skene.181 Prevent the reflux of semen into the bladder during ejaculation182 Bulbouretheral glands & mucous glands183 Walnut sized and enclosed around the urethra184 A raised portion of the prostate that contains several openings into the urethra185 Spreads through lymphatics to the nodes around the internal and common iliac arteries and aorta.Venous spread through the internal iliac veins and IVC.186 The bladder, supplied by ʻvesical arteriesʼ, tributaries of the internal iliac187 In females, the course of the ureter crosses the uterine artery, which is absent in males. In males theureter passes under the vas deferens (sperm duct).188 Pyramid shaped - 2 inferolateral surfaces, superior surface and a base. Ureters enter obliquely either sideof the trigone, other point of the trigone is the urethral opening.
  20. 20. 14.What is the median umbilical ligament and where is it derived from?18915.What are the ‘detrusor muscle’ and trigone?19016.Which nerve causes detrusor muscle contraction?19117.Where is the internal urethral sphincter located?19218.Give a simple account of the neuronal process of micturition involving autonomicand somatic neurones19319.How does the position of the bladder change when full?19420.What are the ligaments which anchor the neck of the bladder in place?19521.Which parts of the urethra are most susceptible to rupture?196189 The remnant of the embryonic urachus (which would have drained the bladder to the umbilical cord)which runs between the bladder and the umbilicus190 Trigone is the shape formed by the ureters and urethra entering/exiting the bladder. Detrusor musclecontracts around the bladder when urinating to squeeze the bladder empty.191 Parasympathetic innervation from S2-4192 Prominent in males only, on the junction between the bladder and urethra (above the prostate), preventsreflux of semen and prostate fluid into the bladder.193 Afferent fibres signal distention through CNS. Parasympathetic efferents from S2-4 inhibit the sphincterand motor to the detrusor. When holding on, sympathetics from T11-12 and L1-2 cause constriction ofsphincter and inhibit detrusor.194 When full the bladder becomes an abdominal organ, it can be drained by a suprapubic catheter.195 In both sexes the pubovesical ligament extends from the pubis to the bladder, in males there is apuboprostatic (pubis and prostate) ligament, in females there is a pubourethral ligament (pubis and urethra).196 The urethra above the membranous part can be ruptured by prostatic cancer, in which case the urine willcollect from the membrane upwards. If below it will collect in the superficial pouch. Bulbous (penile) rupturecan be associated with traumatic injury, and in some cases rupture of the membranous urethra can resultfrom pelvic fracture.