Gray’s p298-303; p306-336; 373-385 (Abdomen A&P)
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Questions and Answers

What is the primary function of the mesenteries in the peritoneal cavity?

  • They protect the abdominal wall from infection.
  • They provide a framework for retroperitoneal organs.
  • They suspend abdominal organs within the peritoneal cavity. (correct)
  • They serve as a barrier to restrict movement of the viscera.

    • Which layer of the peritoneum lines the abdominal cavity walls?

  • Parietal peritoneum (correct)
  • Peritoneal cavity
  • Mesentery
  • Visceral peritoneum

    • What distinguishes retroperitoneal organs from intraperitoneal organs?

  • Retroperitoneal organs have greater mobility than intraperitoneal organs.
  • Retroperitoneal organs are suspended by mesenteries.
  • Retroperitoneal organs are located outside the peritoneal cavity. (correct)
  • Retroperitoneal organs are completely covered by peritoneum.

    • What is the major component of the greater sac within the peritoneal cavity?

    <p>It is the largest part of the peritoneal cavity.</p> Signup and view all the answers

    Which of the following structures is found surrounding the omental foramen?

    <p>Inferior vena cava</p> Signup and view all the answers

    How is the visceral peritoneum innervated compared to the parietal peritoneum?

    <p>Visceral peritoneum is innervated by autonomic nerves.</p> Signup and view all the answers

    Which statement best describes the omental bursa?

    <p>It is a continuous space with the greater sac.</p> Signup and view all the answers

    Which type of pain is the parietal peritoneum particularly sensitive to?

    <p>Well-localized pain</p> Signup and view all the answers

    What is the primary function of the peritoneal fluid within the peritoneal cavity?

    <p>It lubricates movement of the viscera.</p> Signup and view all the answers

    What condition is characterized by an increased volume of peritoneal fluid?

    <p>Ascites</p> Signup and view all the answers

    What anatomical structure provides a pathway for cerebrospinal fluid drainage into the peritoneal cavity?

    <p>Ventriculoperitoneal shunt</p> Signup and view all the answers

    What is a significant risk when malignant cells enter the peritoneal cavity?

    <p>Rapid spread of malignant disease</p> Signup and view all the answers

    What type of peritoneal structure helps maintain the proper positioning of the viscera?

    <p>Mesentery</p> Signup and view all the answers

    How does the peritoneal cavity facilitate the spread of disease?

    <p>It allows for rapid communication and exchange.</p> Signup and view all the answers

    What is the role of the greater omentum in the peritoneal cavity?

    <p>It covers and protects abdominal organs.</p> Signup and view all the answers

    What technique is utilized for dialysis in individuals with renal failure that leverages the peritoneum?

    <p>Peritoneal dialysis with a cutaneous tube</p> Signup and view all the answers

    What medical imaging technique can visualize the presence of gas from a perforated bowel?

    <p>Erect chest radiograph</p> Signup and view all the answers

    Which part of the peritoneal cavity is most likely affected by perforation leading to peritoneal gas accumulation?

    <p>Greater sac</p> Signup and view all the answers

    What is the embryonic origin of the lesser omentum?

    <p>Ventral mesentery</p> Signup and view all the answers

    What parameter is crucial for the proper functioning of a ventriculoperitoneal shunt?

    <p>Pressure regulation within the peritoneal cavity</p> Signup and view all the answers

    What is the effect of a perforated duodenal ulcer on the peritoneal cavity?

    <p>Release of intestinal contents into the cavity</p> Signup and view all the answers

    What is the structure that drapes over the transverse colon and coils of the jejunum and ileum?

    <p>Greater omentum</p> Signup and view all the answers

    Which arteries are located between the layers of the lesser omentum near the lesser curvature of the stomach?

    <p>Right and left gastric vessels</p> Signup and view all the answers

    Which part of the stomach surrounds the opening of the esophagus?

    <p>Cardia</p> Signup and view all the answers

    What is the distal end of the stomach called that contains the pyloric sphincter?

    <p>Pyloric part</p> Signup and view all the answers

    Which of the following is NOT a feature of the stomach?

    <p>Hepatoduodenal ligament</p> Signup and view all the answers

    What is the anatomical position of the pyloric orifice in relation to the vertebral column?

    <p>To the right of midline</p> Signup and view all the answers

    Which part of the small intestine is approximately 20 to 25 cm long?

    <p>Duodenum</p> Signup and view all the answers

    What connects the liver to the duodenum?

    <p>Hepatoduodenal ligament</p> Signup and view all the answers

    Which ligament of the lesser omentum passes between the stomach and liver?

    <p>Hepatogastric ligament</p> Signup and view all the answers

    Which artery supplies the pyloric region of the stomach?

    <p>Right gastric artery</p> Signup and view all the answers

    Which region of the stomach is the largest?

    <p>Body</p> Signup and view all the answers

    Which structure serves as the anterior border of the omental foramen?

    <p>Hepatoduodenal ligament</p> Signup and view all the answers

    Which of the following is part of the small intestine?

    <p>Ileum</p> Signup and view all the answers

    What is the main artery that supplies the stomach?

    <p>Celiac trunk</p> Signup and view all the answers

    What condition is indicated by the replacement of stratified squamous epithelium in the esophagus?

    <p>Barrett’s esophagus</p> Signup and view all the answers

    What specific type of cancer risk increases due to Barrett’s esophagus?

    <p>Adenocarcinoma</p> Signup and view all the answers

    What is the primary cause of duodenal ulcers?

    <p>Helicobacter pylori infection</p> Signup and view all the answers

    How did the treatment approach for duodenal ulcers change over the years?

    <p>From no treatment to pharmacological therapies and surgery</p> Signup and view all the answers

    What complication can arise from posterior duodenal ulcers?

    <p>Torrential hemorrhage</p> Signup and view all the answers

    Which procedure is highlighted for the assessment of the colon?

    <p>Colonoscopy</p> Signup and view all the answers

    What imaging technique is used to assess bowel motility and wall thickening?

    <p>Magnetic resonance imaging</p> Signup and view all the answers

    What is the role of the greater omentum in relation to duodenal ulcers?

    <p>Seals off perforations</p> Signup and view all the answers

    What is the purpose of using carbon dioxide–releasing granules during gastrointestinal imaging?

    <p>To visualize bowel lumen more clearly</p> Signup and view all the answers

    What is a potential outcome of anterior duodenal ulcers?

    <p>Peritonitis</p> Signup and view all the answers

    Which type of surgery might be indicated for a patient with a severe duodenal ulcer?

    <p>Extensive upper abdominal surgery</p> Signup and view all the answers

    What is the initial assessment method for patients suspected of gastrointestinal diseases?

    <p>Physical examination and blood tests</p> Signup and view all the answers

    What intervention can be performed using additional instruments during a colonoscopy?

    <p>Stent placement</p> Signup and view all the answers

    Which imaging modality is less invasive and helps monitor bowel diseases?

    <p>Magnetic resonance imaging</p> Signup and view all the answers

    What distinguishes the major duodenal papilla from the minor duodenal papilla?

    <p>Common entrance for both bile and pancreatic ducts</p> Signup and view all the answers

    Which part of the duodenum is longest and crosses the inferior vena cava?

    <p>Inferior part</p> Signup and view all the answers

    What is the primary arterial supply to the jejunum?

    <p>Jejunal arteries from the superior mesenteric artery</p> Signup and view all the answers

    Which structure surrounds the duodenojejunal flexure?

    <p>Suspensory muscle of duodenum</p> Signup and view all the answers

    In which part of the small intestine are the arterial arcades more prominent?

    <p>Ileum</p> Signup and view all the answers

    What is the function of the ileocecal fold?

    <p>Preventing reflux from the cecum to the ileum</p> Signup and view all the answers

    What characterizes the mucosal lining of the jejunum?

    <p>Numerous prominent circular folds</p> Signup and view all the answers

    Which artery is primarily associated with the arterial supply to the ileum?

    <p>Superior mesenteric artery</p> Signup and view all the answers

    Where is the gastroesophageal junction primarily marked?

    <p>Transition from nonkeratinized stratified squamous epithelium to columnar epithelium</p> Signup and view all the answers

    What is true of the descending part of the duodenum?

    <p>It is located posterior to the gallbladder</p> Signup and view all the answers

    What is the location of the ileocecal junction?

    <p>At the termination of the ileum into the large intestine</p> Signup and view all the answers

    What characterizes the location of the ascending part of the duodenum?

    <p>Passes upward to the left of the aorta</p> Signup and view all the answers

    Which of the following arteries contributes to the arterial supply of the duodenum?

    <p>Gastroduodenal artery</p> Signup and view all the answers

    What risk is associated with a displacement of the histological junction in some individuals?

    <p>Increased risk of adenocarcinoma</p> Signup and view all the answers

    What is the primary imaging technique used in CT colonography to visualize the colon?

    <p>Spiral CT</p> Signup and view all the answers

    What complication is NOT commonly associated with Meckel's diverticulum?

    <p>Acute pancreatitis</p> Signup and view all the answers

    What is the primary purpose of bowel preparation before a CT colonography?

    <p>Clear the bowels for better visualization</p> Signup and view all the answers

    Which condition is a known predisposing factor for gastric carcinoma?

    <p>Chronic gastritis</p> Signup and view all the answers

    What does thickening of the bowel wall typically indicate?

    <p>Inflammatory change or tumor presence</p> Signup and view all the answers

    How does endoscopic ultrasound (EUS) improve tumor assessment?

    <p>By allowing direct visualization of submucosal layers</p> Signup and view all the answers

    What is the typical length of the large intestine in adults?

    <p>1.5 meters</p> Signup and view all the answers

    Which imaging method is particularly useful for assessing regional disease and lymph nodes?

    <p>CT or MRI</p> Signup and view all the answers

    Which of the following symptoms is NOT typically associated with carcinoma of the stomach?

    <p>Sudden weight gain</p> Signup and view all the answers

    What is one of the main symptoms that may indicate an issue with Meckel’s diverticulum?

    <p>Abdominal pain</p> Signup and view all the answers

    What portion of the large intestine does the appendix attach to?

    <p>Cecum</p> Signup and view all the answers

    What is the typical survival rate for patients diagnosed with advanced gastric carcinoma within five years?

    <p>5% to 20%</p> Signup and view all the answers

    What should be done if a tumor is detected during imaging studies of the bowel?

    <p>Assess locoregional spread and metastases</p> Signup and view all the answers

    Which of the following segments of the large intestine continues on into the pelvic cavity?

    <p>Rectum</p> Signup and view all the answers

    Which feature is primarily observed in the cecum and colon but is less visible in the rectum?

    <p>Taeniae coli</p> Signup and view all the answers

    What is the primary blood supply to the appendix?

    <p>Anterior cecal artery</p> Signup and view all the answers

    Which position may the appendix occupy relative to the cecum?

    <p>Posterior, subcecal or pre-ileal</p> Signup and view all the answers

    What is the characteristic shape of the colon due to its segmented structure?

    <p>Sacculated structure</p> Signup and view all the answers

    What term describes the free taenia leading directly to the appendiceal base?

    <p>Cecal taenia</p> Signup and view all the answers

    Which segment of the colon is classified as intraperitoneal?

    <p>Sigmoid colon</p> Signup and view all the answers

    What initial symptom is commonly associated with acute appendicitis?

    <p>Central, periumbilical pain</p> Signup and view all the answers

    What is the anatomical significance of McBurney’s point?

    <p>Surface projection of the appendix base</p> Signup and view all the answers

    How does the position of the ascending colon relate to the peritoneal cavity?

    <p>Secondarily retroperitoneal</p> Signup and view all the answers

    Which condition is related to a fecalith obstruction in the appendix?

    <p>Acute appendicitis</p> Signup and view all the answers

    What is the most common location for tenderness in appendicitis?

    <p>Right groin</p> Signup and view all the answers

    At which level does the sigmoid colon become continuous with the rectum?

    <p>Sacral vertebra SIII</p> Signup and view all the answers

    Which of the following features is NOT a characteristic of the large intestine?

    <p>Presence of villi</p> Signup and view all the answers

    What is the primary symptom of bowel obstruction?

    <p>Central abdominal, intermittent, colicky pain</p> Signup and view all the answers

    Which of the following factors can lead to dehydration in bowel obstruction?

    <p>Failure of fluid and electrolytes to be reabsorbed</p> Signup and view all the answers

    Which procedure may be required for large bowel obstruction due to a tumor?

    <p>Surgical resection or temporary bypass</p> Signup and view all the answers

    What is a common cause of small bowel obstruction?

    <p>Adhesions following previous surgery</p> Signup and view all the answers

    What can occur if the diverticulum becomes obstructed by feces?

    <p>Development of abdominal pain and fever</p> Signup and view all the answers

    Which dietary factor is associated with diverticular disease?

    <p>Low dietary fiber intake</p> Signup and view all the answers

    What anatomical part is primarily affected by diverticular disease?

    <p>Sigmoid colon</p> Signup and view all the answers

    What is a potential complication of diverticulitis?

    <p>Formation of abscess in the pelvis</p> Signup and view all the answers

    Which of the following describes the appropriate management for patients with uncomplicated diverticulitis?

    <p>Antibiotic therapy</p> Signup and view all the answers

    What is an indication for performing an ileostomy?

    <p>To divert small bowel contents from the distal bowel</p> Signup and view all the answers

    What technique is used for performing a gastrostomy?

    <p>Puncturing the stomach wall under sedation</p> Signup and view all the answers

    Which of the following statements is true regarding bowel obstruction?

    <p>The cause can be as benign as a simple adhesion.</p> Signup and view all the answers

    What imaging technique is commonly used to diagnose diverticulitis?

    <p>CT scanning</p> Signup and view all the answers

    What is the main purpose of performing a colostomy in the context of bowel obstruction?

    <p>To allow for bowel decompression</p> Signup and view all the answers

    Where is urine directed after passing through an ileal conduit?

    <p>Through the anterior abdominal wall</p> Signup and view all the answers

    Which structures are associated with the visceral surface of the liver?

    <p>Gallbladder and right kidney</p> Signup and view all the answers

    What forms the boundary of the bare area of the liver?

    <p>Anterior and posterior coronary ligaments</p> Signup and view all the answers

    How is the liver primarily anchored within the abdominal cavity?

    <p>Via the coronary ligaments and peritoneal folds</p> Signup and view all the answers

    Which lobe of the liver is considered the largest?

    <p>Right lobe</p> Signup and view all the answers

    What is the primary function of the sigmoid mesocolon?

    <p>To suspend the sigmoid colon in the abdominal cavity</p> Signup and view all the answers

    What is the correct sequence for the path of urine through an ileal conduit after ureter anastomosis?

    <p>Urine flows from kidneys -&gt; ureters -&gt; anterior abdominal wall</p> Signup and view all the answers

    What is necessary for patients with an ileostomy, colostomy, or ileal conduit?

    <p>Use of a collecting bag attached to the abdominal wall</p> Signup and view all the answers

    Which artery primarily supplies the descending colon?

    <p>Left colic artery</p> Signup and view all the answers

    Which ligament divides the liver's right and left lobes?

    <p>Falciform ligament</p> Signup and view all the answers

    What can result from malrotation of the midgut?

    <p>Volvulus of the small bowel</p> Signup and view all the answers

    What is the primary structure that enters the liver at the porta hepatis?

    <p>Hepatic arteries</p> Signup and view all the answers

    Which artery is NOT associated with the arterial supply to the rectum?

    <p>Right colic artery</p> Signup and view all the answers

    How is the subphrenic recess defined?

    <p>Area above the diaphragm and below the liver</p> Signup and view all the answers

    Which statement about the sigmoid colon is accurate?

    <p>The sigmoid colon is highly mobile except at its ends.</p> Signup and view all the answers

    What is the significance of the ligament of Treitz in relation to the small bowel?

    <p>It marks the termination of the mesentery of the small bowel.</p> Signup and view all the answers

    What significance does the hepatorenal recess hold?

    <p>It is continuous with the subphrenic recess</p> Signup and view all the answers

    Which of the following correctly describes the blood supply to the transverse colon?

    <p>Includes the right colic, middle colic, and left colic arteries</p> Signup and view all the answers

    What is required for an end colostomy?

    <p>Surgical resection of the rectum and anus</p> Signup and view all the answers

    What condition arises from an inability of the bowel to peristalse?

    <p>Bowel obstruction</p> Signup and view all the answers

    How does the arterial supply to the rectum differ from that of the sigmoid colon?

    <p>The superior rectal artery supplies the rectum, while the sigmoid arteries supply the sigmoid colon.</p> Signup and view all the answers

    What is the risk associated with a small bowel volvulus?

    <p>Reduced blood flow and possible infarction</p> Signup and view all the answers

    What is the typical consequence of congenital disorders of the gastrointestinal tract?

    <p>They may manifest as surgical emergencies.</p> Signup and view all the answers

    Which of these arteries does NOT provide blood flow to the colon?

    <p>Inferior phrenic artery</p> Signup and view all the answers

    What characterizes the rectosigmoid junction in terms of anatomical location?

    <p>Usually at the level of vertebra SIII</p> Signup and view all the answers

    Which functional obstruction cause is most frequently associated with surgical history?

    <p>Postsurgical state caused by bowel handling</p> Signup and view all the answers

    Which artery branches from the internal iliac artery to supply the anal canal?

    <p>Middle rectal artery</p> Signup and view all the answers

    Which of the following anatomical features separates the caudate lobe from the left lobe of the liver?

    <p>Fissure for the ligamentum venosum</p> Signup and view all the answers

    What supplies the arterial blood to the gallbladder?

    <p>Cystic artery</p> Signup and view all the answers

    Which structure forms the principal duct system connecting the pancreas to the duodenum?

    <p>Main pancreatic duct</p> Signup and view all the answers

    Where does the head of the pancreas lie in relation to the duodenum?

    <p>Within the concavity of the duodenum</p> Signup and view all the answers

    What major anatomical feature is formed by the junction of the main pancreatic duct and the bile duct?

    <p>Hepatopancreatic ampulla</p> Signup and view all the answers

    What embryological origin does the pancreas most closely relate to regarding its duct system?

    <p>Ventral and dorsal buds from the foregut</p> Signup and view all the answers

    Which part of the gallbladder is located against the transverse colon?

    <p>Body</p> Signup and view all the answers

    The neck of the gallbladder contains which anatomical feature?

    <p>Mucosal folds forming the spiral fold</p> Signup and view all the answers

    How many lobes does the pancreas have, and what are they called?

    <p>Four: head, neck, body, tail</p> Signup and view all the answers

    The portal vein is formed by the confluence of which veins?

    <p>Superior mesenteric and splenic veins</p> Signup and view all the answers

    Which ligament helps to anchor the tail of the pancreas?

    <p>Splenorenal ligament</p> Signup and view all the answers

    What is the primary function of the gallbladder?

    <p>To concentrate and store bile</p> Signup and view all the answers

    Which structure lies posterior to the neck of the pancreas?

    <p>Portal vein</p> Signup and view all the answers

    Which artery provides a connection between the gastroduodenal artery and the pancreatic duodenum?

    <p>Posterior superior pancreaticoduodenal artery</p> Signup and view all the answers

    What is a common developmental issue associated with an annular pancreas?

    <p>Bifid ventral bud</p> Signup and view all the answers

    Which symptom is NOT typically associated with pancreatic cancer?

    <p>Increased appetite</p> Signup and view all the answers

    What structure surrounds the kidney and contains the renal sinus?

    <p>Perinephric fat</p> Signup and view all the answers

    Which artery primarily supplies the dorsal aspect of the pancreas?

    <p>Splenic artery</p> Signup and view all the answers

    What anatomical structure does the pancreas develop from?

    <p>Ventral and dorsal buds</p> Signup and view all the answers

    Which artery supplies the kidneys and typically arises inferior to the superior mesenteric artery?

    <p>Renal artery</p> Signup and view all the answers

    What is the primary function of the renal cortex?

    <p>Surrounding the renal medulla</p> Signup and view all the answers

    What is the role of the common hepatic duct in the biliary system?

    <p>Combines right and left hepatic ducts</p> Signup and view all the answers

    What type of veins contribute to the formation of the left renal vein, which crosses the midline posterior to the superior mesenteric artery?

    <p>Interlobar veins</p> Signup and view all the answers

    Which condition occurs due to the obstruction of the bile duct?

    <p>Obstructive jaundice</p> Signup and view all the answers

    What anatomical feature does the hilum of the kidney represent?

    <p>Deep vertical slit for vascular entry</p> Signup and view all the answers

    In the context of pancreatic ducts, where does the bile duct join the pancreatic duct?

    <p>At the major duodenal papilla</p> Signup and view all the answers

    What separates the renal cortex from the renal medulla?

    <p>Renal pyramids</p> Signup and view all the answers

    What vascular structure connects the spleen to the stomach?

    <p>Gastrosplenic ligament</p> Signup and view all the answers

    Which structure forms the funnel-shaped superior end of the ureters?

    <p>Renal pelvis</p> Signup and view all the answers

    Which of the following arteries is a branch of the superior mesenteric artery?

    <p>Inferior pancreaticoduodenal artery</p> Signup and view all the answers

    What muscle lies inferior to the renal fascia?

    <p>Quadratus lumborum</p> Signup and view all the answers

    What is not a common characteristic of pancreatic cancer?

    <p>High rate of cervical metastasis</p> Signup and view all the answers

    Where is the spleen located in the human body?

    <p>Left upper quadrant</p> Signup and view all the answers

    What drains urine from the papillary ducts in the renal papilla?

    <p>Minor calyx</p> Signup and view all the answers

    What is the typical position of the right renal artery in relation to the inferior vena cava?

    <p>Passes posterior to the vena cava</p> Signup and view all the answers

    What complication can result from a pancreatic tumor invading surrounding structures?

    <p>Portal vein obstruction</p> Signup and view all the answers

    Which ligament connects the left kidney to the spleen?

    <p>Splenorenal ligament</p> Signup and view all the answers

    What is the structure called that is formed by the junction of several minor calices?

    <p>Major calyx</p> Signup and view all the answers

    What significant sign might indicate an annular pancreas in a fetus?

    <p>Increased amniotic fluid volume</p> Signup and view all the answers

    What type of fat surrounds the kidneys within the abdominal cavity?

    <p>Perinephric fat</p> Signup and view all the answers

    What happens when the left renal vein is compressed by an aneurysm in surrounding vessels?

    <p>Possible renal dysfunction</p> Signup and view all the answers

    What primarily supplies blood to the spleen?

    <p>Splenic artery</p> Signup and view all the answers

    Which structure is associated with the inferior pole of the left kidney on its lateral side?

    <p>Left colic flexure</p> Signup and view all the answers

    What separates the liver from the anterior surface of the right kidney?

    <p>Peritoneum</p> Signup and view all the answers

    Which is the relationship between the anterior surface of the left kidney and the stomach?

    <p>Stomach covers part of the superior pole</p> Signup and view all the answers

    How must the renal fascia be handled in a surgical approach to the kidney?

    <p>It must be incised</p> Signup and view all the answers

    Which muscle lies posterior to the kidneys?

    <p>Psoas major</p> Signup and view all the answers

    Which type of fat surrounds the kidney directly?

    <p>Perinephric fat</p> Signup and view all the answers

    What structure is covered by the posterior layer of the renal fascia?

    <p>Psoas major muscle</p> Signup and view all the answers

    Which organ is predominantly retroperitoneal and contacts the middle part of the left kidney?

    <p>Pancreas</p> Signup and view all the answers

    What characterizes the structure at the splenic hilum?

    <p>Entry point for splenic vessels</p> Signup and view all the answers

    What anatomical feature may occasionally reach the splenic hilum?

    <p>Tail of the pancreas</p> Signup and view all the answers

    Which layer of fat accumulates posteriorly and posterolaterally to each kidney?

    <p>Paranephric fat</p> Signup and view all the answers

    What forms the anterior layer of renal fascia over the hilum vessels?

    <p>Fibrous connective tissue</p> Signup and view all the answers

    Which anatomical structures are located above each suprarenal gland?

    <p>Diaphragm</p> Signup and view all the answers

    What anatomical feature marks the junction between the renal pelvis and the ureter?

    <p>Ureteropelvic junction</p> Signup and view all the answers

    Which vessels contribute to the blood supply of the middle portion of the ureters?

    <p>Testicular or ovarian arteries</p> Signup and view all the answers

    Where does lymph from the upper part of each ureter drain to?

    <p>Lateral aortic (lumbar) nodes</p> Signup and view all the answers

    What type of fibers are responsible for visceral afferent pathways in the ureters?

    <p>T11 to L2 spinal cord fibers</p> Signup and view all the answers

    What is the primary artery that typically gives rise to the middle suprarenal artery?

    <p>Abdominal aorta</p> Signup and view all the answers

    What are urinary tract stones primarily composed of?

    <p>Soluble salts within an organic matrix</p> Signup and view all the answers

    Which statement correctly describes the venous drainage of the suprarenal glands?

    <p>Each gland usually has one vein exiting from its hilum.</p> Signup and view all the answers

    Which imaging method is preferred for detecting urinary tract stones in pregnant women?

    <p>Ultrasound scanning</p> Signup and view all the answers

    What is the anatomical significance of the three constricted points along the ureters?

    <p>They are sites of potential obstruction for kidney stones</p> Signup and view all the answers

    What is the primary source of innervation to the adrenal medulla?

    <p>Preganglionic sympathetic fibers from spinal levels T8-L1</p> Signup and view all the answers

    Which anatomical feature primarily distinguishes the placement of the right kidney from the left kidney?

    <p>The positioning of the liver affecting the right kidney's location</p> Signup and view all the answers

    What is the most common complication associated with urinary tract stones?

    <p>Renal failure</p> Signup and view all the answers

    What distinguishes the left suprarenal vein from the right suprarenal vein?

    <p>It passes inferiorly to enter the renal vein.</p> Signup and view all the answers

    Which spinal nerve levels are associated with referred pain from ureteric distention?

    <p>T11 to L2</p> Signup and view all the answers

    What demographic is most commonly affected by urinary tract stones?

    <p>Men aged 20-60 years with sedentary lifestyles</p> Signup and view all the answers

    Which arteries contribute to the blood supply of the suprarenal glands?

    <p>Inferior phrenic arteries, abdominal aorta, and renal arteries</p> Signup and view all the answers

    Which anatomical structure directly surrounds the renal papilla?

    <p>Minor calices</p> Signup and view all the answers

    Which of the following features accurately describes the orientation of the kidneys in relation to the vertebral column?

    <p>The left kidney is generally higher than the right due to organ positioning.</p> Signup and view all the answers

    What is commonly used to plan procedures for stone removals based on size and location?

    <p>Low-dose CT of the urinary tract</p> Signup and view all the answers

    How do the superior suprarenal arteries reach the suprarenal glands?

    <p>They arise from the inferior phrenic arteries that supply the diaphragm.</p> Signup and view all the answers

    What is the anatomical pathway that ureters follow after crossing the pelvic brim?

    <p>They descend retroperitoneally to the bladder</p> Signup and view all the answers

    Which renal tumor is most commonly associated with the kidney?

    <p>Renal cell carcinoma</p> Signup and view all the answers

    What common initial symptom is associated with renal cell tumors?

    <p>Blood in the urine</p> Signup and view all the answers

    What is a key characteristic of renal cell carcinoma compared to other tumors?

    <p>It can invade the renal vein</p> Signup and view all the answers

    Which procedure is performed to drain urine from the renal pelvis?

    <p>Nephrostomy</p> Signup and view all the answers

    What imaging technique is utilized to investigate for transitional cell carcinomas in the urinary tract?

    <p>CT urogram</p> Signup and view all the answers

    What is the preferred surgical location for a kidney transplant?

    <p>Left or right iliac fossa</p> Signup and view all the answers

    What does tumors arising from the urothelium primarily indicate?

    <p>The presence of transitional cell carcinoma</p> Signup and view all the answers

    What is a potential complication of a distal ureteric obstruction?

    <p>Renal failure</p> Signup and view all the answers

    What must be considered when assessing living kidney donors?

    <p>The risk of harvesting surgery</p> Signup and view all the answers

    In which condition would you NOT expect transitional cell carcinoma to be present?

    <p>Prostate cancer</p> Signup and view all the answers

    What common treatment approach is generally taken for renal cancers?

    <p>Surgical removal</p> Signup and view all the answers

    What can transitional cell carcinoma potentially cause if not diagnosed early?

    <p>Ureteric obstruction</p> Signup and view all the answers

    What anatomical structure does the nephrostomy tube lie within?

    <p>Renal pelvis</p> Signup and view all the answers

    What unique feature distinguishes the growth of renal cell carcinoma?

    <p>It can grow into surrounding organs</p> Signup and view all the answers

    What type of tissue is primarily harvested for kidney transplantation?

    <p>Aortic and venous tissue</p> Signup and view all the answers

    Which statement accurately describes the advantage of the left and right iliac fossae for a kidney transplant?

    <p>They provide a new space without compromising surrounding structures.</p> Signup and view all the answers

    What is one of the primary functions of cystoscopy?

    <p>To visualize the urinary bladder and urethra</p> Signup and view all the answers

    How does the use of iodinated contrast medium in an IVU help in medical imaging?

    <p>It enhances visualization by increasing the radiation beam attenuation.</p> Signup and view all the answers

    Which characteristic is true of the kidneys' anatomical relationship with the suprarenal glands?

    <p>The right suprarenal gland has a triangular shape.</p> Signup and view all the answers

    What is a unique capability of nuclear medicine in urinary tract investigations?

    <p>It estimates renal cell mass and function using radioisotopes.</p> Signup and view all the answers

    Which imaging technique is particularly useful for assessing kidney size and possible obstruction?

    <p>Ultrasound</p> Signup and view all the answers

    How is the ureter positioned during a kidney transplant?

    <p>It is tunneled obliquely through the bladder wall.</p> Signup and view all the answers

    What is the primary use of a cystoscope during a procedure?

    <p>For visualizing and performing interventions in the bladder</p> Signup and view all the answers

    In which context is a digital rectal examination typically performed?

    <p>To evaluate prostatic health in men</p> Signup and view all the answers

    What distinguishes the two suprarenal glands in terms of shape?

    <p>The left is shaped like a semilunar and larger than the right.</p> Signup and view all the answers

    What does the extraperitoneal approach in kidney transplantation allow for?

    <p>A swift recovery for patients.</p> Signup and view all the answers

    What anatomical feature aids in the identification of the donor artery during kidney transplantation?

    <p>Presence of a large aortic cuff</p> Signup and view all the answers

    Which imaging method is commonly used to visualize the collecting system and ureters?

    <p>CT scan with contrast</p> Signup and view all the answers

    Why is the use of renal fascia important for surrounding the suprarenal glands?

    <p>It provides structural support and separation.</p> Signup and view all the answers

    Study Notes

    Peritoneum

    • The peritoneum is a thin membrane that lines the walls of the abdominal cavity and covers the viscera.
    • The parietal peritoneum lines the walls of the cavity and the visceral peritoneum covers the viscera.
    • Between the parietal and visceral layers of peritoneum is a potential space, the peritoneal cavity.
    • Abdominal viscera are either suspended in the peritoneal cavity by folds of peritoneum (mesenteries) or are outside the peritoneal cavity.
    • Organs suspended in the cavity are referred to as intraperitoneal, while those outside are retroperitoneal.
    • The parietal peritoneum is innervated by somatic afferents carried in branches of the associated spinal nerves and is therefore sensitive to well-localized pain.
    • The visceral peritoneum is innervated by visceral afferents that accompany autonomic nerves (sympathetic and parasympathetic) back to the central nervous system, leading to referred and poorly localized sensations of discomfort, and to reflex visceral motor activity.

    Peritoneal Cavity

    • The peritoneal cavity is subdivided into the greater sac and the omental bursa (lesser sac).
    • The greater sac accounts for most of the space in the peritoneal cavity, beginning superiorly at the diaphragm and continuing inferiorly into the pelvic cavity, it is entered once the parietal peritoneum has been penetrated.
    • The omental bursa is a smaller subdivision of the peritoneal cavity posterior to the stomach and liver and is continuous with the greater sac through an opening, the omental (epiploic) foramen.

    Peritoneum in the Clinic

    • A small volume of peritoneal fluid within the peritoneal cavity lubricates movement of the viscera suspended in the abdominal cavity.
    • In various pathological conditions (e.g., in liver cirrhosis, acute pancreatitis, or heart failure) the volume of peritoneal fluid can increase, known as ascites, resulting in marked abdominal distention.
    • The peritoneal space has a large surface area, allowing the spread of disease through the peritoneal cavity and over the bowel and visceral surfaces.
    • This large surface area can be used for administering certain types of treatment and a number of procedures.

    Ventriculoperitoneal Shunts

    • Patients with obstructive hydrocephalus require continuous drainage of cerebrospinal fluid.
    • A catheter is placed through the skull into the cerebral ventricles and then through the abdominal wall into the peritoneal cavity where cerebrospinal fluid drains and is absorbed.

    Dialysis and Peritoneal Dialysis

    • People with renal failure require dialysis to live.
    • Hemodialysis uses an artificial membrane to dialyse blood taken from the circulation and then returned to the body.
    • Peritoneal dialysis uses the peritoneum as the dialysis membrane.
    • Dialysis fluid is injected into the peritoneal cavity and electrolytes and molecules are exchanged across the peritoneum between the fluid and blood. Once dialysis is completed, the fluid is drained.

    Peritoneal Spread of Disease

    • The large surface area of the peritoneal cavity allows infection and malignant disease to spread easily throughout the abdomen.
    • Malignant cells entering the peritoneal cavity by direct invasion (e.g., from colon or ovarian cancer) can spread rapidly.
    • A surgeon excising a malignant tumor and releasing malignant cells into the peritoneal cavity may worsen the patient’s prognosis.
    • Infection can also spread across the large surface area.
    • The peritoneal cavity can also act as a barrier to, and container of, disease, so intraabdominal infection tends to remain below the diaphragm rather than spread into other body cavities.
    • A perforated bowel (e.g., caused by a perforated duodenal ulcer) often leads to the release of gas into the peritoneal cavity.
    • This peritoneal gas can be visualized on an erect chest radiograph.
    • A patient with severe abdominal pain and subdiaphragmatic gas needs a laparotomy.

    Omenta, Mesenteries, and Ligaments

    • Throughout the peritoneal cavity, numerous peritoneal folds connect organs to each other or to the abdominal wall.
    • These folds (omenta, mesenteries, and ligaments) develop from the original dorsal and ventral mesenteries, which suspend the developing gastrointestinal tract in the embryonic coelomic cavity.
    • Some contain vessels and nerves supplying the viscera, whereas others help maintain the proper positioning of the viscera.

    Omenta

    • The omenta consist of two layers of peritoneum, which pass from the stomach and the first part of the duodenum to other viscera.
    • There are two: the greater omentum, derived from the dorsal mesentery, and the lesser omentum, derived from the ventral mesentery.

    Greater Omentum

    • The greater omentum is a large, apron-like, peritoneal fold that attaches to the greater curvature of the stomach and the first part of the duodenum.
    • It drapes inferiorly over the transverse colon and the coils of the jejunum and ileum.
    • Turning posteriorly, it ascends to associate with, and become adherent to, the peritoneum on the superior surface of the transverse colon and the anterior layer of the transverse mesocolon before arriving at the posterior abdominal wall.
    • Usually a thin membrane, the greater omentum contains an accumulation of fat, which may become substantial in some individuals.
    • Additionally, there are two arteries and accompanying veins, the right and left gastro-omental vessels, between this double-layered peritoneal apron just inferior to the greater curvature of the stomach.

    Lesser Omentum

    • The lesser omentum extends from the lesser curvature of the stomach and the first part of the duodenum to the inferior surface of the liver.
    • A thin membrane continuous with the peritoneal coverings of the anterior and posterior surfaces of the stomach and the first part of the duodenum, the lesser omentum is divided into a medial hepatogastric ligament, which passes between the stomach and liver, and a lateral hepatoduodenal ligament, which passes between the duodenum and liver.
    • The hepatoduodenal ligament ends laterally as a free margin and serves as the anterior border of the omental foramen.
    • Enclosed in this free edge are the hepatic artery proper, the bile duct, and the portal vein.
    • Additionally, the right and left gastric vessels are between the layers of the lesser omentum near the lesser curvature of the stomach.

    Stomach

    • The stomach is the most dilated part of the gastrointestinal tract and has a J-like shape.
    • Positioned between the abdominal esophagus and the small intestine, the stomach is in the epigastric, umbilical, and left hypochondrium regions of the abdomen.
    • The stomach is divided into four regions: the cardia, the fundus of the stomach, the body of the stomach, and the pyloric part.
    • Other features of the stomach include the greater curvature, the lesser curvature, the cardial notch, and the angular incisure.

    Arterial Supply to the Stomach

    • The arterial supply to the stomach includes the left gastric artery from the celiac trunk, the right gastric artery, often from the hepatic artery proper, the right gastro-omental artery from the gastroduodenal artery, the left gastro-omental artery from the splenic artery, and the posterior gastric artery from the splenic artery (variant and not always present).

    Small Intestine

    • The small intestine is the longest part of the gastrointestinal tract and extends from the pyloric orifice of the stomach to the ileocecal fold.
    • This hollow tube, which is approximately 6 to 7 m long with a narrowing diameter from beginning to end, consists of the duodenum, the jejunum, and the ileum.

    Duodenum

    • The duodenum is the first part of the small intestine, a C-shaped structure, adjacent to the head of the pancreas, 20 to 25 cm long, above the level of the umbilicus.
    • Its lumen is the widest of the small intestine.
    • It is retroperitoneal except for its beginning, which is connected to the liver by the hepatoduodenal ligament, a part of the lesser omentum.
    • The duodenum is divided into four parts: the superior part, the descending part, the inferior part, and the ascending part.

    Arterial Supply to the Duodenum

    • The arterial supply to the duodenum includes branches from the gastroduodenal artery, the supraduodenal artery from the gastroduodenal artery, duodenal branches from the anterior superior pancreaticoduodenal artery (from the gastroduodenal artery), duodenal branches from the posterior superior pancreaticoduodenal artery (from the gastroduodenal artery), duodenal branches from the anterior inferior pancreaticoduodenal artery (from the inferior pancreaticoduodenal artery—a branch of the superior mesenteric artery), duodenal branches from the posterior inferior pancreaticoduodenal artery (from the inferior pancreaticoduodenal artery—a branch of the superior mesenteric artery), and the first jejunal branch from the superior mesenteric artery.

    Jejunum

    • The jejunum and ileum make up the last two sections of the small intestine.
    • The jejunum represents the proximal two-fifths.
    • It is mostly in the left upper quadrant of the abdomen and is larger in diameter and has a thicker wall than the ileum.
    • The inner mucosal lining of the jejunum is characterized by numerous prominent folds that circle the lumen (plicae circulares).
    • Less prominent arterial arcades and longer vasa recta (straight arteries) compared to those of the ileum are a unique characteristic of the jejunum.

    Arterial Supply to the Jejunum

    • The arterial supply to the jejunum includes jejunal arteries from the superior mesenteric artery.

    Ileum

    • The ileum makes up the distal three-fifths of the small intestine and is mostly in the right lower quadrant.
    • Compared to the jejunum, the ileum has thinner walls, fewer and less prominent mucosal folds (plicae circulares), shorter vasa recta, more mesenteric fat, and more arterial arcades.
    • The ileum opens into the large intestine, where the cecum and ascending colon join together.
    • Two flaps projecting into the lumen of the large intestine (the ileocecal fold) surround the opening.
    • The flaps of the ileocecal fold come together at their end, forming ridges.
    • Musculature from the ileum continues into each flap, forming a sphincter.
    • Possible functions of the ileocecal fold include preventing reflux from the cecum to the ileum, and regulating the passage of contents from the ileum to the cecum.

    Arterial Supply to the Ileum

    • The arterial supply to the ileum includes ileal arteries from the superior mesenteric artery, and an ileal branch from the ileocolic artery (from the superior mesenteric artery).

    In the Clinic: Epithelial transition between the abdominal esophagus and stomach

    • The gastroesophageal junction is demarcated by a transition from one epithelial type (nonkeratinized stratified squamous epithelium) to another epithelial type (columnar epithelium). ### Esophageal Ulceration

    • Esophageal ulceration occurs when the histological junction is located more proximally in the esophagus.

    • This increased risk of ulceration is associated with a higher risk of adenocarcinoma.

    • Barrett's esophagus, a condition where the stratified squamous epithelium is replaced by columnar epithelium, is also associated with risk of esophageal malignancy (adenocarcinoma).

    ### Duodenal ulceration

    • Duodenal ulcers are usually located in the superior part of the duodenum and are less common than they were 50 years ago.
    • They are treated by histamine H2-receptor antagonists and proton pump inhibitors.
    • Duodenal ulcers can erode into the gastroduodenal artery or posterior superior pancreaticoduodenal artery causing significant hemorrhage and potentially death.
    • Treatment may include surgery involving ligation of vessels or endovascular coiling to stem the blood flow.
    • Anterior duodenal ulcers erode into the peritoneal cavity, causing peritonitis.
    • Surgical treatment is usually required to fix a perforation due to a duodenal ulcer.

    ### Upper and Lower Gastrointestinal Tract Examination

    • Examination of the upper and lower gastrointestinal tract is often necessary to look for disease.
    • The lumen, the wall, and masses extrinsic to the bowel are assessed to investigate the cause of symptoms.
    • Barium sulfate solutions can be swallowed by the patient and visualized using an X-ray fluoroscopy unit.
    • Carbon dioxide-releasing granules can be used to fill the stomach allowing for detailed mucosal visualization.
    • Barium enemas are used to image the large bowel.
    • Colonoscopy and CT colonography are also used to assess the large bowel.
    • Endoscopy, a minimally invasive procedure, is used to assess the interior surfaces of the esophagus, stomach, duodenum, and proximal small bowel.
    • Colonoscopy is performed by passage of the long flexible tube through the anus and into the rectum, reaching the cecum and sometimes the terminal ileum.
    • Bowel preparation is necessary for both endoscopy and colonoscopy to allow clear visualization.
    • Computed tomography (CT) or magnetic resonance imaging (MRI) can also be used to assess the bowel lumen and wall.
    • MRI is especially ideal for assessing the small bowel due to its dynamic assessment of bowel distention and motility.
    • CT Colonography (virtual colonoscopy) is an alternative to traditional colonoscopy that produces high-resolution 3D views of the large bowel using spiral CT.
    • CT and MRI are used to assess regional disease, abnormal lymph nodes, and distant metastases.

    ### Meckel's Diverticulum

    • Meckel's diverticulum is a remnant of the vitelline duct that appears as a blind-ended tubular outgrowth of bowel.
    • It can contain gastric mucosa and therefore cause ulceration and hemorrhage.
    • It may cause intussusception, diverticulitis, and obstruction.

    ### Computed Tomography (CT) and Magnetic Resonance Imaging (MRI)

    • These imaging techniques can provide information about the bowel wall that is not obtainable from barium or endoscopic studies.
    • Thickening of the bowel wall may indicate inflammatory change or tumor.
    • They help assess locoregional spread, lymphadenopathy, and metastatic spread.

    ### Endoscopic Ultrasound (EUS)

    • EUS uses a small ultrasound device on the end of the endoscope to assess the upper gastrointestinal tract.
    • It provides high-power views of the mucosa and submucosa.
    • It helps determine if a tumor is resectable and guides the clinician during biopsy.

    ### Carcinoma of the Stomach

    • Carcinoma of the stomach is a common gastrointestinal malignancy.
    • Chronic gastric inflammation (gastritis), pernicious anemia, and polyps predispose to the development of this cancer.
    • Symptoms include:
      • vague epigastric pain
      • early fullness with eating
      • bleeding leading to chronic anemia
      • obstruction
    • Diagnosis is made using barium, radiology, or endoscopy.
    • Ultrasound and CT scanning are used to check for metastatic spread and assess resectability.
    • Early diagnosis allows for curative surgical resection, but the overall 5-year survival rate is between 5% and 20%.

    ### Large Intestine

    • The large intestine extends from the distal end of the ileum to the anus.
    • It absorbs fluids and salts from the gut contents to form feces.
    • It consists of the cecum, appendix, colon, rectum, and anal canal.
    • The cecum is the first part of the large intestine and is inferior to the ileocecal opening in the right iliac fossa.
    • The appendix is attached to the posteromedial wall of the cecum.
    • Its point of attachment is consistent with the free taeniae leading directly to the base of the appendix.
    • The arterial supply to the cecum and appendix includes:
      • anterior cecal artery
      • posterior cecal artery
      • appendicular artery
      • all originating from the ileocolic artery, which is a branch of the superior mesenteric artery.

    ### Appendicitis

    • Acute appendicitis is an abdominal emergency.
    • Obstruction of the appendix by a fecalith or lymphoid nodules can cause bacteria to proliferate and invade the appendix wall.
    • Inflammation may resolve spontaneously, but in other cases, perforation ensues, which may lead to localized or generalized peritonitis.
    • Most patients with acute appendicitis have localized tenderness in the right groin.
    • Pain begins as a central, periumbilical, colicky type of pain that tends to come and go; after 6 to 10 hours, it localizes in the right iliac fossa.
    • Patients may develop a fever, nausea, and vomiting.
    • Treatment for appendicitis is an appendectomy.

    ### Colon

    • The colon extends superiorly from the cecum and consists of the ascending, transverse, descending, and sigmoid colon.
    • The ascending and descending segments are retroperitoneal, and the transverse and sigmoid segments are intraperitoneal.
    • The right colic flexure is located just inferior to the right lobe of the liver.
    • The left colic flexure is located just inferior to the spleen.
    • The right and left paracolic gutters are formed between the lateral margins of the ascending and descending colon and the posterolateral abdominal wall.
    • The sigmoid colon begins above the pelvic inlet and extends to the level of vertebra SIII.
    • The arterial supply to the ascending colon includes:
      • colic branch
      • anterior cecal artery
      • posterior cecal artery
      • right colic artery
      • all originating from the ileocolic artery, which is a branch of the superior mesenteric artery.
    • The arterial supply to the transverse colon includes:
      • right colic artery
      • middle colic artery
      • left colic artery
      • The right and middle colic arteries are branches of the superior mesenteric artery, and the left colic artery is a branch of the inferior mesenteric artery.
    • The arterial supply to the descending colon includes the left colic artery from the inferior mesenteric artery.
    • The arterial supply to the sigmoid colon includes sigmoidal arteries from the inferior mesenteric artery.
    • Anastomotic connections between arteries supplying the colon result in a marginal artery that courses along the ascending, transverse, and descending parts of the large bowel.

    ### Rectum and anal canal

    • The rectum extends from the sigmoid colon.
    • It terminates as the anal canal.
    • The rectum is generally 12-15cm long and is lined by columnar epithelium, which transitions to stratified squamous epithelium at the anal verge, the junction between the rectum and anus.
    • It has a distinct vascular supply, receiving blood from the superior, middle, and inferior rectal arteries, which are branches of the inferior mesenteric and internal iliac arteries.
    • There are three folds of mucosa in the rectum, called the transverse rectal folds (of Houston).
    • The anal anal canal is the final 2–4 cm of the large intestine and is lined by stratified squamous epithelium.
    • The anal canal is divided into two zones:
      • The upper anal canal: receives blood from the superior rectal artery, which is a branch of the inferior mesenteric artery.
      • The lower anal canal: receives blood from the inferior rectal artery (a branch of the internal pudendal artery), which is a branch of the internal iliac artery.
    • The anal canal also has a complex innervation, with both sympathetic and parasympathetic fibers.
    • The anal sphincter comprises two muscles:
      • Internal anal sphincter: a smooth muscle that is under involuntary control.
      • External anal sphincter: a skeletal muscle that is under voluntary control.
    • Both sphincters work together to control the passage of feces and regulate bowel continence.
    • The rectum and anal canal are important for the final stage of digestion and for the elimination of feces.
    • Abnormalities in the rectum and anal canal can cause a variety of symptoms including constipation, diarrhea, fecal incontinence, rectal prolapse, and anorectal pain.

    Arterial Supply to the Rectum and Anal Canal

    • The superior rectal artery originates from the inferior mesenteric artery.
    • The middle rectal artery originates from the internal iliac artery.
    • The inferior rectal artery originates from the internal pudendal artery, which is a branch of the internal iliac artery.

    Malrotation and Midgut Volvulus

    • Malrotation refers to incomplete rotation and fixation of the midgut during embryonic development.
    • The suspensory muscle of duodenum (ligament of Treitz) determines the position of the duodenojejunal junction.
    • If the duodenojejunal flexure or cecum doesn't reach its usual location, the small bowel mesentery shortens, increasing the risk of twisting (volvulus).
    • Volvulus around the superior mesenteric artery can lead to reduced blood flow and potential infarction.
    • Duodenal obstruction can occur in some cases due to peritoneal folds that compress the duodenum.
    • Emergency surgery may be necessary to divide these folds.

    Bowel Obstruction

    • A bowel obstruction can be mechanical or functional.
    • Mechanical obstruction results from a physical blockage, caused by factors such as foreign bodies, tumors, adhesions, or embryological bands.
    • Functional obstruction occurs when the bowel can't peristalse due to factors like electrolyte imbalances or post-surgical manipulation.
    • Symptoms depend on the location of the obstruction.
    • High obstructions (proximal small bowel) may not cause abdominal distention.
    • Low obstructions (distal) lead to abdominal distention as fluid accumulates.
    • Vomiting and absolute constipation are common symptoms.
    • Early diagnosis is critical to prevent dehydration, electrolyte abnormalities, bowel ischemia, and potential perforation.
    • Adhesions after surgery are the most frequent cause of small bowel obstruction.
    • Examination of hernial orifices is essential in patients with bowel obstruction.
    • Tumors are a common cause of large bowel obstruction.

    Diverticular Disease

    • Diverticular disease involves the development of multiple outpouchings (diverticula) primarily in the sigmoid colon.
    • The sigmoid colon's narrow diameter makes it prone to high intraluminal pressure, contributing to diverticula formation.
    • Poor dietary fiber intake and obesity are associated with diverticular disease.
    • Diverticula may remain asymptomatic.
    • Symptoms can arise when the neck of a diverticulum becomes obstructed by feces, leading to infection and inflammation.
    • Complications include abscess formation, ureter obstruction, and fistula formation between the sigmoid colon and bladder.

    Ostomies

    • Ostomies involve surgically externalizing a portion of the bowel to the anterior abdominal wall.
    • Gastrostomy involves attaching the stomach to the anterior abdominal wall for feeding purposes.
    • Jejunostomy involves attaching the jejunum for feeding tube placement.
    • Ileostomy involves diverting small bowel contents from the distal bowel, often used to protect surgical anastomoses.
    • Colostomy is performed for various reasons, including protecting the distal large bowel after surgery, relieving bowel obstruction, or as a temporary bypass procedure.
    • Ileal conduit is an extraanatomical procedure used to reroute urine after bladder resection.

    Liver

    • The liver is the largest visceral organ, located primarily in the right hypochondrium and epigastric region.
    • It has a diaphragmatic surface and a visceral surface, separated by the falciform ligament.
    • The diaphragmatic surface is smooth and lies against the diaphragm.
    • The visceral surface is largely covered by visceral peritoneum.
    • The porta hepatis serves as the entry point for hepatic arteries and portal vein and the exit point for hepatic ducts.
    • The liver is attached to the anterior abdominal wall by the falciform ligament.
    • The bare area of the liver lacks intervening peritoneum between the liver and diaphragm.
    • The liver is divided into right and left lobes by the falciform ligament and fissures.
    • The quadrate and caudate lobes are functionally distinct from the right and left lobes.
    • Arterial supply to the liver includes the right and left hepatic arteries, branches of the hepatic artery proper.

    Gallbladder

    • The gallbladder is a pear-shaped sac located in a fossa on the visceral surface of the liver.
    • It has a fundus, body, and neck.
    • The cystic artery, a branch of the right hepatic artery, supplies the gallbladder.
    • The gallbladder stores and concentrates bile from the liver.

    Pancreas

    • The pancreas lies posterior to the stomach.
    • It consists of a head, uncinate process, neck, body, and tail.
    • The head lies within the concavity of the duodenum.
    • The uncinate process projects from the lower head, passing behind the superior mesenteric vessels.
    • The neck lies anterior to the superior mesenteric vessels.
    • The body extends from the neck to the tail.
    • The tail passes between layers of the splenorenal ligament.
    • The pancreatic duct originates in the tail of the pancreas.

    Pancreatic Duct System

    • The pancreatic duct travels through the pancreas and joins the bile duct to form the hepatopancreatic ampulla, which enters the duodenum at the major duodenal papilla.
    • The sphincter of ampulla, a collection of smooth muscles, surrounds the ampulla.
    • The accessory pancreatic duct empties into the duodenum at the minor duodenal papilla.
    • The accessory duct branches: one branch connects with the pancreatic duct, and the other descends into the uncinate process.
    • The presence of these two ducts reflects the embryological origin of the pancreas from dorsal and ventral foregut buds.

    Arterial Supply to the Pancreas

    • The pancreas receives blood from the gastroduodenal artery, splenic artery, and superior mesenteric artery.

    Annular Pancreas

    • The pancreas develops from ventral and dorsal foregut buds.
    • A bifid ventral bud can encircle the duodenum, constricting it and potentially leading to atresia.
    • Infants with annular pancreas may exhibit failure to thrive and vomiting due to poor gastric emptying.
    • Annular pancreas can be diagnosed in utero through ultrasound scanning.

    Pancreatic Cancer

    • Pancreatic cancer is a significant cause of death often referred to as the “silent killer.”
    • Malignant tumors are most frequent in the head and neck of the pancreas.
    • Symptoms include upper abdominal pain, loss of appetite, and weight loss.
    • Obstruction of the bile duct can cause obstructive jaundice.
    • Pancreatic cancer often spreads locally, making surgical resection complex and requiring a complex bypass procedure.

    Bile Drainage

    • The bile duct system originates in the liver, connects to the gallbladder, and empties into the duodenum.
    • The right and left hepatic ducts drain the respective lobes of the liver and merge to form the common hepatic duct.
    • The common hepatic duct joins the cystic duct from the gallbladder, forming the bile duct.
    • The bile duct descends, joining the pancreatic duct to enter the duodenum at the major duodenal papilla.

    Spleen

    • The spleen develops from the dorsal mesentery of the stomach.
    • It lies against the diaphragm in the left upper quadrant of the abdomen.
    • The spleen is connected to the stomach via the gastrosplenic ligament and to the kidney by the splenorenal ligament.
    • The splenic hilum is the entry point for the splenic vessels, and occasionally the tail of the pancreas is located here.
    • The splenic artery, a branch of the celiac trunk, supplies blood to the spleen.
    • The anterior surface of the right kidney is related to the right suprarenal gland, liver, descending duodenum, right colic flexure, and small intestine.
    • The anterior surface of the left kidney is associated with the left suprarenal gland, stomach, spleen, pancreas, left colic flexure, and jejunum.
    • Posteriorly, both kidneys are in contact with the diaphragm, psoas major, quadratus lumborum, and transversus abdominis muscles.

    Renal Fat and Fascia

    • Perinephric fat completely surrounds the kidney, enclosed by the renal fascia.
    • The suprarenal glands are also within this fascial compartment.
    • The renal fascia must be incised for surgical access to the kidney.
    • Paranephric fat accumulates posterior and posterolateral to each kidney.

    Kidney Structure

    • The kidney is covered by a fibrous capsule and has a hilum for vessels, lymphatics, and nerves.
    • Internally, the kidney contains a renal cortex and renal medulla.
    • The renal pyramids in the medulla project inward towards the renal sinus.
    • The renal papilla of the pyramid is surrounded by a minor calyx.
    • Minor calices join to form major calices, which merge to form the renal pelvis, the superior end of the ureters.

    Renal Vasculature and Lymphatics

    • Each kidney is supplied by a single renal artery, a branch of the abdominal aorta.
    • The left renal artery typically arises higher than the right.
    • The left renal vein crosses the midline anterior to the aorta and posterior to the superior mesenteric artery.
    • The lymphatic drainage of each kidney is to the lateral aortic (lumbar) nodes.

    Ureters

    • Ureters are muscular tubes transporting urine from the kidneys to the bladder.
    • They originate from the renal pelvis, formed from major and minor calices.
    • The ureteropelvic junction marks the transition from the renal pelvis to the ureter.
    • Ureters descend retroperitoneally along the psoas major muscle.

    Ureters

    • The ureters are tubular structures that transport urine from the kidneys to the bladder.
    • At the pelvic brim, the ureters cross either the end of the common iliac artery or the beginning of the external iliac artery.
    • The ureters have three constricted points: the ureteropelvic junction, where they cross the common iliac vessels, and where they enter the bladder wall.
    • Kidney stones can become lodged at these constrictions.
    • The ureters receive arterial branches from adjacent vessels, with the renal arteries supplying the upper end.
    • The middle part of the ureters may receive branches from the abdominal aorta, testicular or ovarian arteries, and common iliac arteries.
    • Lymphatic drainage of the ureters follows a pattern similar to their arterial supply.
    • The ureters are innervated by the renal, aortic, superior hypogastric, and inferior hypogastric plexuses.

    Urinary Tract Stones

    • Urinary tract stones are more common in men than women and typically occur in people aged 20 to 60 years.
    • They are often associated with sedentary lifestyles.
    • Stones are polycrystalline aggregates of calcium, phosphate, oxalate, urate, and other soluble salts within an organic matrix.
    • They often cause radiating pain from the loin into the groin, scrotum, or labia majora.
    • Blood in the urine (hematuria) is a common symptom.
    • Complications include infection, urinary obstruction, and renal failure.
    • Diagnosis is based on history, examination, and radiological investigations.
    • Ultrasound scanning and low-dose CT of the urinary tract (CT KUB) are common diagnostic tools.

    Urinary Tract Cancer

    • Most tumors that arise in the kidney are renal cell carcinomas, developing from the proximal tubular epithelium.
    • Approximately 5% of kidney tumors are transitional cell tumors, arising from the urothelium of the renal pelvis.
    • Patients with urinary tract cancer typically present with hematuria, loin pain, and a mass.
    • Renal cell tumors can grow outward from the kidney, invading fat, fascia, and spreading into the renal vein.
    • In rare cases, tumors can extend into the inferior vena cava, right atrium, or pulmonary artery.
    • Treatment for most renal cancers is surgical removal.
    • Transitional cell carcinoma can arise from the urothelium, which lines the collecting system from the calices to the urethra.
    • In patients with bladder cancer, the entire urinary tract must be investigated to rule out other tumors.

    Nephrostomy

    • A nephrostomy is a procedure where a tube is placed through the abdominal wall into the renal pelvis for drainage of urine.
    • It is indicated in patients with distal ureteric obstruction, preventing backup of urine and renal failure.

    Kidney Transplant

    • Kidney transplantation is a common procedure for patients with end-stage renal failure.
    • Kidneys are obtained from living or deceased donors.
    • The ideal location for a transplanted kidney is in the left or right iliac fossa.
    • The donor artery is typically anastomosed to the recipient's external iliac artery, and the donor vein to the recipient's external iliac vein.
    • The ureter is tunneled through the bladder wall for anastomosis.

    Investigation of the Urinary Tract

    • Cystoscopy allows visualization of the urinary bladder and urethra using an optical system on a flexible or rigid tube.
    • It can be used to diagnose hematuria, assess diverticula and fistulas, and investigate voiding problems.
    • IVU (intravenous urogram), where iodinated contrast medium is injected intravenously, allows visualization of the collecting system, ureters, and bladder.
    • Ultrasound can assess kidney size and calices, and visualize the full bladder for volume measurements.
    • Nuclear medicine uses radioisotope compounds to assess renal cell mass and function and detect renal scarring.

    Suprarenal glands

    • The suprarenal glands are located at the superior pole of each kidney.
    • They are comprised of an outer cortex and an inner medulla.
    • The right gland is pyramidal, while the left is semilunar and larger.
    • The arterial supply to the suprarenal glands is from three sources: superior suprarenal arteries (from inferior phrenic arteries), middle suprarenal artery (directly from abdominal aorta), and inferior suprarenal arteries (from renal arteries).
    • Venous drainage is typically through a single vein from each gland, with the right suprarenal vein entering the inferior vena cava and the left suprarenal vein entering the left renal vein.

    Kidneys

    • The bean-shaped kidneys are retroperitoneal, located in the posterior abdominal region, lateral to the vertebral column.
    • They extend from approximately vertebra TXII to LIII.
    • The right kidney is slightly lower than the left due to its proximity to the liver.
    • The left kidney is longer and slender than the right kidney, and closer to the midline.

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