10. abdomen

83. Abdomen. Antero-lateral abdominal wall. Regions. Layered topography – fasciae, muscles.

84. Inguinal canal. Rectus abdominis sheath. Linea alba.

85. Abdominal cavity. Walls, regions. Peritoneum - structure, blood and nerve supply. Peritoneal compartment of the abdominal cavity.

86. Upper region of the peritoneal cavity. Organs, peritoneal structures, topographic relations of the organs, vessels and nerves.

87. Omental bursa. Greater omentum – formation, parts.

88. Portal vein. Formation, position. Anastomoses with the superior and inferior venae cavae.

89. Lower region of the peritoneal cavity. Organs, peritoneal structures, topographic relations of the organs, vessels and nerves.

90. The unpaired visceral branches of the abdominal aorta - the coeliac trunk, the superior and inferior mesenteric arteries. Position and branches.

91. The hepatic portal system - constituting veins. Position of the portal vein. Anastomoses between the portal and systematic circulation.

92. The abdominal aorta. Parietal (lateral) and paired visceral branches.

93. The superior and inferior vena cava. Position. Main tributaries. Anastomoses between the two caval veins.

Vagina m. recti abdominis is formed by the aponeuroses of

the anterolateral muscles of the abdominal wall.

a. yes

b. no

a. yes

The spleen is located in the infracolic compartment.

a. yes

b. no

b. no

The fluid in the peritoneal cavity lubricates surfaces and

facilitates the movement of viscera.

a. yes

b. no

a. yes

All of the extraperitoneal viscera are surrounded by

visceral peritoneum.

a. yes

b. no

b. no

The peritoneum forms the largest of the serous sacs in the

body.

a. yes

b. no

a. yes

The peritoneal cavity is a slit-like internal between the

parietal and visceral layers of the peritoneum.

a. yes

b. no

a. yes

there are supracolic and infracolic compartments because of the presence of the transverse colon in the flap

a. yes

b. no

a. yes

epiploic foramen of the omental bursa opens into its left part

a. yes

b. no

b. no

bursa omentalis is a peritoneal space in the supracolic compartment

a. yes

b. no

a. yes

nerve supply of the anterolateral abdominal wall is ensured only by the lower intercostal nerves

a. yes

b. no

b. no

portal vein lies in front of hepatic artery

a. yes

b. no

b. no

common bile duct is posterior to the portal vein

a. yes

b. no

b. no

the portal vein is formed behind the neck of the pancreas

a. yes

b. no

a. yes

the portal vein is formed by the union of splenic and inferior mesenteric veins

a. yes

b. no

b. no

the portal vein ascends in the greater omentum

a. yes

b. no

b. no

the liver lies mainly in the right hypochondrium

a. yes

b. no

a. yes

the lesser omentum is attached to the fissure for ligamentum venosum

a. yes

b. no

a. yes

the liver is divided functionally into 8 segments

a. yes

b. no

a. yes

the left hepatic duct drains the left lobe

a. yes

b. no

a. yes

the right hepatic duct drains the quadrate lobe

a. yes

b. no

b. no

omental bursa (lesser sac):

a. is part of the retroperitoneal compartment

b. is in the infracolic compartment

c. is in the supracolic compartment

d. has no communication with the peritoneal cavity

c

The peritoneum:

A. is a double-layered mucous membrane

B. is a double-layered serous membrane

C. covers entirely all the organs in the abdominal cavity

b

The inferior border of the rectus sheath posteriorly is

called the:

A. Falx inguinalis

B. Inguinal ligament

C. Internal inguinal ring

D. Arcuate line

E. Linea alba

d

An obstetrician decides to do a Caesarean section on a

25-year-old pregnant woman. A transverse suprapubic

incision is chosen for that purpose. All of the following

abdominal wall layers will be encountered during the

incision EXCEPT the:

A. Anterior rectus sheath

B. Posterior rectus sheath

C. Rectus abdominis muscle

D. Skin and subcutaneous tissue

E. Transversalis fascia, extraperitoneal fat, and peritoneum

b

The internal thoracic artery is sometimes surgically cut

near the caudal end of the sternum and used to supply

blood to a region of the heart. In these cases, maintenance

of adequate blood flow to the rectos abdominis may be

dependent on increased flow through which artery?

A. Superficial epigastric

B. Inferior epigastric

C. Umbilical

D. Superficial circumflex iliac

E. Deep circumflex iliac

b

If one were to make an incision parallel to and 5 cm

above the inguinal ligament, one would find the inferior

epigastric vessels between which layers of the abdominal wall?

A. Camper's and Scarpa's fascias

B. External abdominal oblique and internal abdominal

oblique muscles

C. Internal abdominal oblique and transversus abdominis

muscles

D. Skin and deep fascia of the abdominal wall

E. Transversus abdominis muscle and peritoneum

e

A loop of bowel protrudes through the abdominal wall to form a direct inguinal hernia; viewed from the abdominal side, the hernial sac would be found in which region?

A. Deep inguinal ring

B. Lateral inguinal fossa

C. Medial inguinal fossa

D. Superficial inguinal ring

E. Supravesical fossa

c

Which structure passes through the deep inguinal ring?

A. Iliohypogastric nerve

B. Ilioinguinal nerve

C. Inferior epigastric artery

D. Medial umbilical ligament

E. Round ligament of the uterus

e

During your peer presentation of the inguinal region dissection, you would indicate the position of the deep inguinal ring to be:

A. Above the anterior superior iliac spine

B. Above the midpoint of the inguinal ligament

C. Above the pubic tubercle

D. In the supravesical fossa

E. Medial to the inferior epigastric artery

b

The normal pattern of venous and lymphatic drainage

of the superficial tissues of the anterior abdominal wall

is arranged around a horizontal plane.Above that plane,

drainage is in a cranial direction; below the plane drainage is in a caudal direction. This reference plane corresponds to:

A. Transpyloric plane

B. Level of anterior superior iliac spines

C. Transtubercular line

D. Level of arcuate line

E. Level of umbilicus

e

The boundaries of the inguinal triangle include all except:

A. Arcuate line

B. Inferior epigastric vessels

C. Inguinal ligament

D. Lateral border of rectus abdominus muscle

a

The superficial inguinal ring is an opening in which

structure?

A. External abdominal oblique aponeurosis

B. Falx inguinalis

C. Internal abdominal oblique muscle

D. Scarpa's fascia

E. Transversalis fascia

a

If a hernia enters into the scrotum, it is most likely a(n):

A. Direct inguinal hernia

B. Indirect inguinal hernia

C. Femoral hernia

D. Obturator hernia

b

Which nerve passes through the superficial inguinal ring and may therefore be endangered during inguinal hernia repair?

A. Femoral branch of the genitofemoral

B. Ilioinguinal

C. Iliohypogastric

D. Obturator

E. Subcostal

b

Occlusion of the inferior mesenteric artery is seldom

symptomatic because its territory may be supplied by

branches of the:

A. Gastroduodenal

B. Ileocolic

C. Middle colic

D. Right colic

E. Splenic

c

The presence of which feature (also obvious on a radiograph with barium contrast) distinguishes small from large bowel?

A. Circular folds of the mucosa

B. Circular smooth muscle layer in the wall

C. Mucosal glands

D. Longitudinal smooth muscle layer in the wall

E. Serosa

a

Which of the following veins does not run a course parallel to the artery of the same name?

A. superior epigastric

B. superficial circumflex iliac

C. inferior mesenteric

D. superior rectal

E. ileocolic

c

During the development of the gut:

A. the sigmoid colon is retroperitoneal

B. the inferior mesenteric artery is the axis for rotation of the midgut loop

C. the stomach rotates around its longitudinal axis causing the ventral border to become the greater curvature

D. the liver is non-functional

E. none of the above

e

Visceral pain is often referred to a site on the body wall

(where the patient ' feels" it) that is innervated by the same

spinal cord segment that innervates the visceral organ

involved. Pain of appendicitis is often first felt around

the umbilicus, indicating that the appendix receives its

sympathetic (and thus visceral afferents) from which spinal

cord segment?

A. T9

B. T 10

C. T 11

D. T 12

E. L 1

b

The spleen normally does not descend below the costal

margin. However, it pushes downward and medially when

pathologically enlarged. What structure limits the straight

vertical downward movement?

A. Left colic flexure

B. Left suprarenal gland

C. Ligament of Treitz

D. Pancreas

E. Stomach

a

As the bowel is exposed, the surgeon says in amazement, "This is a loop of large bowel!" Which characteristic(s) would identify it specifically as large bowel?

A. A serosa

B. Circular folds

C. Epiploic appendages

D. Tenia

E. C and D

e

The anastomotic artery running along the border of the large intestine is called the:

A. Arcade

B. Arteriae rectae

C. Coronary

D. Ileocolic

E. Marginal

e

The inferior mesenteric artery is often occluded by atherosclerosis without symptoms; its normal area of distribution therefore must be supplied by collateral blood flow between which arteries?

A. lleocolic and right colic

B. Left and middle colic

C. Left colic and sigmoidal

D. Right and middle colic

E. Sigmoidal and superior rectal

b

The artery of the midgut is the:

A. Celiac trunk

B. Inferior mesenteric

C. Proper hepatic

D. Splenic

E. Superior mesenteric

e

During a full workup on a 2-month-old infant with a

history of intermittent gastrointestinal pain and

vomiting, physicians discovered that the cause was lack of emptying of the stomach. They immediately

suspected that the cause was a spasmodic contraction of which of the following parts of the stomach?

A. cardiac notch

B. fundus

C. lesser curvature

D. pylorus

E. rugae

d

In order to do a vagotomy (section of vagal nerve

trunks) to reduce the secretion of acid by cells of the

stomach mucosa in patients with peptic ulcers, one

needs to cut

the gastric branches and retain vagal innervation to

other abdominal organs. Where would a surgeon look

for these branches in relation to the stomach?

A. along the gastroepiploic vessels

B. along the greater curvature

C. along the lesser curvature

D. in the base of the omental apron

E. in the gastrocolic ligament

c

While performing a splenectomy (removal of the

spleen) following an automobile accident, the

surgeons were especially attentive to locate and

preserve the tail of the pancreas which is closely

associated with the spleen. This they found in the:

A. gastrocolic ligament

B. gastrosplenic ligament

C . phrenicocolic ligament

D. splenorenal ligament

E. transverse mesocolon

d

A twenty-year-old woman was broad-sided on the

driver side by an SUV and was taken to the hospital

emergency room. Examination showed low blood

pressure and tenderness on the left mid-axillary line.

Also, a large swelling was felt protruding downward

and medially below the left costal margin. X-rays

revealed that her 9th and 10th ribs were fractured

near their angles on the left side. The abdominal organ

most likely to be injured by the fracture is:

A. Descending colon

B. Left kidney

C. Pancreas

D. Spleen

E. Stomach

d

You are observing an operation to remove the left

suprarenal gland. To expose the gland the surgeon

mobilizes the descending colon by cutting along its

lateral attachment to the body wall and dissecting

the medial ward in the fusion fascia behind it. Suddenly the

operative field is filled with blood. The surgeon realizes

he has failed to cut a mesenteric attachment between the

left colic flexure and another organ. As a result of the traction, the surface of the

organ tore. Which organ was injured?

A. Duodenum

B. Kidney

C. Liver

D. Spleen

E. Suprarenal gland

d

A patient presented with a swollen spleen, which protruded medially toward the umbilicus in the abdomen vertical and downward expansion of the spleen was resisted by the:

A. Tail of the pancreas

B. Left colic flexure

C. Left kidney

D. Left renal artery

E. Stomach

b

The spleen contacts all of the following organs EXCEPT:

A. Jejunum

B. Kidney

C. Left colic flexure

D. Tail of the pancreas

E. Stomach

a

Which is not a boundary of the epiploic (omental)

foramen?

A. Aorta

B. Caudate lobe of the liver

C. First part of the duodenum

D. Hepatoduodenal ligament

a

Which of the following is NOT in contact with the spleen?

A. Colon

B. Diaphragm

C. Duodenum

D. Pancreas

E. Stomach

c

The celiac trunk supplies oxygenated blood to the following

elements:

A. The large intestine

B. The kidneys

C. The liver

D. The entire small intestine

E. The entire duodenum

c

The fundus of the stomach receives its arterial supply from the:

A. Common hepatic

B. Inferior phrenic

C. Left gastroepiploic

D. Right gastric

E. Splenic

e

Which of the following structures does not lie at least partially in the retroperitoneum?

A. adrenal gland

B. duodenum

C. kidney

D. pancreas

E. spleen

e

Which organ becomes retroperitoneal during rotation of

the guttube?

A. Duodenum

B. Kidney

C. Spleen

D. Stomach

E. Transverse Colon

a

Regarding the 2nd portion of the duodenum, all are correct EXCEPT:

A. It is crossed by the transverse colon.

B. It is thin walled and circular folds are absent in its interior.

C. It has the opening for the common bile duct and pancreatic duct on its posteromedial wall.

D. It is secondarily retroperitoneal.

E. It is supplied by both the gastroduodenal and superior mesenteric arteries.

b

A Kocher manoeuvre dissects in the avascular plane behind which organ that becomes retroperitoneal during rotation of the gut?

A. Duodenum

B. Kidney

C. Spleen

D. Suprarenal gland

E. Transverse colon

a

The celiac plexus of nerves may contain fibers derived

from all of the following sources except:

A. posterior vagal trunk

B. greater thoracic splanchnic nerve

C. lesser thoracic splanchnic nerve

D. lumbar splanchnic nerves

c

Which statement regarding the suprarenal glands is

correct?

A. Its entire arterial supply is directly from the abdominal aorta.

B. Veins from both glands drain directly into the inferior vena cava.

C. The glands are localized in the pararenal space.

D. Cells that secrete epinephrine and norepinephrine are innervated by preganglionic fibres from the greater thoracic splanchnic nerve.

d

The nerve that innervates the cells of the suprarenal

medulla consists of fibers of the:

A. Greater thoracic splanchnic nerve

B. Lesser thoracic splanchnic nerve

C. Least thoracic splanchnic nerve

D. Anterior vagal trunk

E. Posterior vagal trunk

a

The nerves that end on the secretory cells of the medulla of

the suprarenal glands are principally:

A. Preganglionic fibers from the greater thoracic splanchnic

nerve

B. Postganglionic fibers from the celiac plexus

C. Postganglionic fibers from the aorticorenal ganglia

D. Preganglionic fibers from the lesser thoracic splanchnic

nerve

E. Postganglionic fibers from the renal plexus

a

With one exception, preganglionic sympathetic axons synapse upon postganglionic sympathetic dendrites or cell bodies. The exception to this general rule occurs within the:

A. Kidney cortex

B. Kidney medulla

C. Suprarenal medulla

D. Suprarenal cortex

c

The pararenal fat in the kidney bed is an elaboration of:

A. Peritoneum

B. Extraperitoneal connective tissue

C. Transversalis fascia

D. Fusion fascia

b

T/F

Which of the following are superficial abdominal regions?

A. Regio umbilicalis

B. Regio infraclavicularis

C. Regio inguinalis

D. Regio lumbalis

E. Regio hypochondriaca

T

F

T

F

T

T/F

The transversus abdominis muscle

A. forms part of the posterior wall of the inguinal canal

B. has an attachment to the outer surface of the lower six ribs

C. forms part of the anterior layer of the rectus sheath above the pubis

D. interdigitates with the fibres of the latissimus dorsi muscle

E. contracts on deep expiration.

F

F

T

F

T

T/F

The external oblique muscle

A. is attached posteriorly to the thoracolumbar (lumbar) fascia

B. has an aponeurosis which splits to enclose the rectus abdominis muscle

C. forms the inguinal ligament

D. takes part in the formation of only the medial half of the anterior wall of the inguinal canal

E. contracts on coughing

F

F

T

F

T

T/F

The inguinal canal

A. is about 1.5 cm long

B. has the fascia transversalis along the whole length of its posterior wall

C. has an internal ring lying 5 cm above the middle of the inguinal ligament

D. has the lacunar ligament in the medial part of its floor

E. has the inferior epigastric artery medial to its deep ring

F

T

F

T

T

T/F

The internal oblique muscle

A. is attached to no more than the lateral third of the inguinal ligament

B. forms part of the posterior wall of the inguinal canal

C. is continuous with the cremasteric fascia

D. on the right side rotates the trunk at the vertebral column to the right

E. forms the posterior rectus sheath immediately above the inguinal ligament

F

T

T

T

F

T/F

The inguinal ligament

A. is inferior to the deep inguinal ring

B. is the lower border of the aponeurosis of the external

oblique muscle

C. forms the floor of the inguinal canal

D. is superior to the ilioinguinal nerve

E. is attached laterally to the anterior inferior iliac spine

T

T

T

F

F

T/F

The muscles of the anterior abdominal wall

A. can increase intra-abdominal pressure

B. are usually contracted during deep inspiration

C. are contracted in deep expiration

D. flex the trunk in the upright position

E. control extension of the trunk in the upright position

T

F

T

F

T

T/F

The superficial inguinal ring

A. is circular in shape

B. is an opening in the external oblique aponeurosis

C. has the ilioinguinal nerve passing through it

D. lies wholly lateral to the pubic tubercle

E. has the inferior epigastric artery passing through it

F

T

T

F

F

T/F

The rectus abdominis muscle

A. is surrounded by the rectus sheath along its whole length

B. is innervated by the lower five intercostal nerves

C. is a flexor of the vertebral column

D. is anterior to the epigastric arteries

E. has as many tendinous intersections below the umbilicus as above

F

T

T

T

F

T/F

The deep inguinal ring

A. is an opening in the fascia transversalis

B. has the ilioinguinal nerve passing through it

C. lies above the middle of the inguinal ligament

D. has the inferior epigastric artery passing through it

E. has the lymphatic vessels from the scrotum passing

through it

T

F

T

F

F

T/F

Muscles of the antero-lateral abdominal wall are:

A. M. serratus anterior

B. M. latissimus dorsi

C. M. transversus abdominis

D. M. obliquus externus abdominis

E. M. rectus abdominis

F

F

T

T

T

T/F

The lesser omentum

A. lies between the liver, and stomach and duodenum

B. forms part of the anterior wall of the lesser sac

C. contains the portal vein

D. contains the gastroduodenal artery

E. extends into the fissure for the ligamentum teres

T

T

T

F

F

T/F

Which of the following doesn't belong to the infracolic

compartment?

A. the gastrocolic ligament

B. the lesser omentum

C. the mesenterium

D. the gastrophrenic ligament

E. the cecum

T

T

F

T

F

T/F

The greater omentum

A. is the most noticeable part of peritoneum.

B. hangs down from the porta hepatis.

C. contains a large amount of fat.

D. covers all the organs in supracolic and infracolic

compartments.

E. has been called "the abdominal policeman" because it

prevents the spread of infection.

T

F

T

F

T

T/F

Vv. paraumbilicales:

A. accompany the remnant of umbilical vein.

B. accompany ligamentum teres hepatis.

C. end in the left portal vein.

D. have no connection with venous drainage of the anterior

abdominal wall.

E. are part of portacaval anastomosis .

T

T

T

F

T

T/F

Which of the following peritoneal structures are found in

the supracolic compartment?

A. A. omentum minus

B. mesocolon sigmoideum

C. lig. falciforme hepatis

D. mesenterium

E. lig. gastrocolicum

T

F

T

F

T

T/F

Omentum majus

A. is in part in the supracolic compartment

B. is in part in the infracolic compartment

C. begins from the great curvature of the stomach

D. is attached to the liver

E. is attached to duodenum

T

T

T

F

F

T/F

The rectos abdominis muscle

A. is flat and broad muscle

B. has multiple bellies

C. has 3 to 4 intersections

D. has intersections fused with the anterior wall of its sheath

E. is located in aponeurotic vagina

F

T

T

T

T

T/F

The descending (second) part of the duodenum

A. is developed entirely from the midgut

B. has the opening of the accessory pancreatic duct, if

present, proximal to the opening of the main pancreatic duct

C. is anterior to the right renal vessels

D. is lateral to the right colic flexure

E. is lateral to the second lumbar vertebra

F

T

T

F

T

T/F

The(common) bile duct

A. opens into the posteromedial wall of the descending

(second) part of the duodenum

B. is anterior to the superior (first) part of the duodenum

C. lies behind the head of the pancreas

D. lies to the right of the hepatic artery

E. is anterior to the epiploic foramen (aditus to the lesser sac)

T

F

T

T

T

T/F

The first (superior) part of the duodenum

A. has a blood supply derived from the coeliac artery

B. is posterior to the bile duct

C. has the lesser omentum attached to it

D. is posterior to the quadrate lobe of the liver

E. has no duodenal (Brunner's) glands

T

F

T

T

F

T/F

The vermiform appendix

A. is retrocausal in about 65% of subjects

B. is pelvic in about 10% of subjects

C. has a continuous layer of longitudinal muscle

D. has a nerve supply from the tenth thoracic spinal segment

E. is supplied by an artery that lies in front of the terminal part of the ileum

T

F

T

T

T

T/F

The liver

A. is in contact with the right kidney without the peritoneum intervening

B. is anterior to the stomach on the left

C. receives a blood supply from the superior mesenteric artery

D. is separated from the subdiaphragmatic part of the inferior vena cava by peritoneum

E. develops from a diverticulum from the midgut

F

T

F

F

F

T/F

The first (superior) part of the duodenum

A. begins to the left of the midline

B. forms the lower boundary of the epiploic foramen (aditus

to the lesser sac)

C. is anterior to the bile duct

D. is posterior to the gall bladder

E. has no villi

F

T

T

T

F

T/F

The cecum

A. has no taeniae coli

B. has a blood supply from the superior mesenteric artery

C. is usually surrounded by peritoneum

D. lies to the left of the right mesenteric sinus

E. lies in the right iliac fossa

F

T

T

F

T

T/F

The portal vein

A. is usually formed by the union of the splenic and superior mesenteric veins

B. runs upwards behind the epiploic foramen (aditus to the lesser sac)

C. lies posterior to the (common) hepatic artery

D. is anterior to the superior (first) part of the duodenum

E. has no tributaries other than the branches forming it

T

F

T

F

F

T/F

The coeliac trunk (artery)

A. supplies the whole of the duodenum

B. arises from the aorta at the level of the second lumbar

vertebra

C. gives off the right gastric artery as a direct branch

D. indirectly supplies the gall bladder

E. indirectly supplies the lower end of the esophagus

F

F

F

T

T

T/F

The common hepatic artery

A. lies anterior to the portal vein in the lesser omentum

B. liesto the right of the bile duct

C. gives branches directly or indirectly to both the lesser and

greater curvatures of the stomach

D. supplies the right colic (hepatic) flexure

E. is the only source of blood going to the liver

T

F

T

F

F

T/F

V. portae

A. anastomoses with the system of superior vena cava

B. lies anteriorly to a.hepatica propria and the bile duct

C. collects blood from unpaired abdominal viscera

D. part of it is in the lesser omentum

E. part of it runs posterior to the head of pancreas

T

F

T

T

T

T/F

The left kidney

A. is lower than the right

B. has a lower lateral part which is posterior to the left colic flexure

C. is crossed anteriorly by the splenic vessels

D. is separated from the body of the pancreas by the lesser sac

E. has a lower pole that lies behind the spleen

F

T

T

F

F

T/F

The inferior vena cava

A. has a valve just above itsformation by the union of the

common iliac veins

B. is anterior to the epiploic foramen (aditus) to the lesser sac

C. lies to the right of the right phrenic nerve in the thorax

D. receives directly the right and left suprarenal veins

E. is posterior to the portal vein

F

F

F

F

T

T/F

The right renal artery

A. lies anterior to the right renal vein

B. is anterior to the inferior vena cava

C. divides into four or five branches before entering the

kidney

D. gives off branches to the ureter

E. is anterior to the right crus of the diaphragm

F

F

T

T

T

T/F

The inferior vena cava

A. leaves the abdominal cavity at the level of the eighth

thoracic vertebra

B. is formed at the level of the fifth lumbar vertebra

C. receives directly the blood from the gonadal veins of both

sides

D. is posterior to the right adrenal gland

E. is posterior to the right common iliac artery

T

T

F

F

T

T/F

The descending (second) part of the duodenum

A. is posterior to the transverse colon

B. is anterior to the right kidney

C. is anterior to the left lobe of the liver

D. has a blood supply from both the coeliac artery and the

superior mesenteric artery

E. has the bile duct opening into its anterolateral wall.

T

T

F

T

F