GROSS ANATOMY

SELF-EVALUATION EXAM - ABDOMEN

by O.W. Henson, Jr., Ph.D.

University of North Carolina, Chapel Hill

Answer True (T) or False (F)

The gallbladder:

______ 1. is a sac in which bile is produced.

______ 2. lies in a fossa between the caudate and quadrate lobes of the liver.

______ 3. is supplied by the cystic a. which usually arises from the right hepatic artery.

______ 4. has a rounded, blind end -- the fundus -- which usually lies at the level of the distal end of the ninth costal cartilage on the right.

The liver:

______ 5. is in close relation to the diaphragm over a major part of its upper surface.

______ 6. has a bare area through which the inferior vena cava passes.

______ 7. has a bare area which could be exposed by incising the coronary ligament.

______ 8. usually has a gallbladder placed at the junction of the right and left anatomic lobes.

The skin and tela subcutanea of the anterior abdominal wall

______ 9. have lymphatic vessels which drain to axillary and inguinal lymph nodes.

______ 10. have veins which have potential communications with the portal system and which might become enlarged after portal obstruction.

______ 11. are innervated primarily by anterior divisions of the lumbar spinal nerves.

______ l2. contain sweat glands innervated by sympathetic nerve fibers.

An incision through the anterior abdominal wall, along the length of the supraumbilical portion of the linea alba, might be expected to:

______ 13. denervate the upper portion of the rectus abdominis m.

______ 14. transect remnants of the umbilical arteries.

______ 15. risk damage to the xiphoid process which is embedded in the upper part of the linea alba.

______ 16. be confined to the linea alba, since the supra-umbilical portion is relatively wide.

An incision through the anterior abdominal wall, along the length of the infraumbilical portion of the linea alba, might:

______ 17. enter one or both rectus sheaths since the infraumbilical portion of the linea alba is narrow.

______ 18. transect the medial umbilical ligament which represents the urachus.

______ 19. transect the inferior epigastric vessels.

______ 20. transect the inguinal ligament.

An incision into the peritoneal cavity along the entire right costal margin (arch) to the axillary line would be expected to:

______ 2l. denervate a major part of the right rectus abdominis muscle.

______ 22. cut into the right rectus abdominis m.

______ 23. transect the right superior epigastric vessels.

______ 24. pass close to the tips of the costal cartilages of ribs 7, 8, 9, and l0.

An incision along the entire length of the right semilunar line and completely through the anterior abdominal wall would be expected to:

______ 25. transect the inferior epigastric artery and nerve.

______ 26. denervate the entire infraumbilical portion of the rectus abdominis muscle.

______ 27. denervate the external abdominal oblique muscle.

______ 28. come close to the distal end of the 9th costal cartilage, and to the gallbladder.

The spleen:

______ 29. could be injected with a radiocontrast material by inserting a needle into the

left 10th intercostal space posteriorly because the bulk of the spleen lies deep to the posterior part of the 10th rib.

______ 30. if injected with contrast material should provide a radiographic image of the portal vein because its venous blood flows into the portal system.

______ 3l. is in contact with the diaphragm and should move downward when the diaphragm contracts.

______ 32. could be damaged by a surgeon trying to free the left colic flexure because the spleen lies near this flexure.

Structures bounding the epiploic foramen include:

______ 33. falciform ligament.

______ 34. inferior vena cava.
______ 35. hepatoduodenal ligament.
______ 36. duodenum.

The blood vessels of the suprarenal glands include:

______ 37. one or more arteries from the ipsilateral renal artery.

______ 38. a main vein which on the left side joins branches which enter the portal

system.

______ 39. a multiplicity of arteries entering practically all surfaces of the gland.

______ 40. three principal arteries which converge on the hilus of each gland.

The right and left suprarenal glands are:

______ 4l. positioned anteriorly to the diaphragm.

______ 42. composed of a cortex and a medulla.

______ 43. recipients of preganglionic sympathetic fibers which end up on the cells of the medulla.

______ 44. approximately at the level of the third lumbar vertebra.

The abdominal part of the left ureter:

______ 45. is entirely retroperitonea1.

______ 46. lies on the anterior surface of the psoas major muscle.

______ 47. transports urine through peristaltic action.

______ 48. lies against the inferior vena cava.

The renal sinus:

______ 49. is open at the hilus of the kidney.

______ 50. contains fat.
______ 51. contains all of the minor calices.
______ 52. contains branches of the renal vessels.

Regarding the renal vessels,

______ 53. the right renal artery typically divides into an anterior and a posterior branch.

______ 54. the normal left renal vein is crossed anteriorly by the superior mesenteric

vessels.

______ 55. the left renal vein, when occluded, could produce varicosities visible through the wall of the scrotum.

______ 56. there may be more than one renal artery on each side.

The pancreas:

______ 57. is supplied by branches of both the superior and inferior mesenteric arteries.

______ 58. has venous blood which drains mostly into the splenic vein.

______ 59. if enlarged would be expected to displace the posterior wall of the omental

bursa since most of the pancreas lies behind this wall.

______ 60. could be readily damaged during surgical removal of the spleen because its head lies against the hilus of the spleen.

The transverse colon:

______ 61. is situated behind and attached to the greater omentum.

______ 62. is the only part of the colon that is not secondarily retroperitoneal.

______ 63. receives blood by way of branches of both the superior and inferior mesenteric arteries.

______ 64. if involved with a malignant tumor would be expected to give rise to metastases to the liver because all of its venous blood passes through the sinuses of the liver.

The diaphragm:

______ 65. receives through the phrenic nerve sensory fibers which account for referred

pain in the neck and shoulder when the diaphragm is diseased.

______ 66. receives some of its sensory innervation by way of the intercostal nerves.

______ 67. has a right half (hemidiaphragm) which would be paralyzed if the right phrenic nerve were sectioned.

______ 68. undergoes a rapid downward movement during a sniff.

Potentially weak areas where diaphragmatic hernias might occur are:

______ 69. the esophageal hiatus in the central tendon.

______ 70. on the left side, where the pleural and peritoneal cavities communicated in the embryo.

______ 71. the muscular hiatus associated with the inferior vena cava.

______ 72. the point where the aorta penetrates the central tendon.

The celiac plexus contains:

______ 73. sympathetic preganglionic nerve fibers.

______ 74. sympathetic postganglionic fibers that provoke vasoconstriction and peristalsis.

______ 75. visceral afferent nerves which conduct pain sensations via the vagus nerve.

______ 76. postganglionic parasympathetic nerve fibers from the vagus nerve.

The duodenum:

______ 77. is completely retroperitoneal.

______ 78. is in contact with the head of the pancreas.

______ 79. has the superior mesenteric vessels crossing its third portion anteriorly.

______ 80. has a descending portion which receives the common bile duct.

With the injection of a contrast material into the aorta at the level of the celiac trunk one could, in a PA radiograph, expect to identify the:

______ 8l. splenic artery coursing to the left and showing a characteristic tortuous course.

______ 82. left gastric artery outlining the left part of the greater curvature of the stomach.

______ 83. common hepatic artery coursing to the right and dividing into a proper hepatic (coursing toward the liver) and gastroduodenal (coursing downward).

______ 84. the approximate position of the aortic hiatus of the diaphragm since the celiac trunk typically leaves the aorta just below this.

True or False:

______ 85. Interruption of the arterial blood flow to the liver is sometimes fatal; accordingly, ligation of the common hepatic artery would pose an immediate threat.

______ 86 If the right hepatic duct were obstructed one would expect an engorgement of the biliary ducts of only the right lobe because there are usually no communications between the right and left hepatic ducts within the liver.

______ 87. If the gallbladder were inflamed one would expect that adhesions might form between the gallbladder and the duodenum and/or the right colic flexure since these normally lie against the gallbladder.

______ 88. The main trunks of the renal vessels are situated anterior to the renal pelvis. Thus, posterior surgical approaches would be expected to not only avoid the peritoneal cavity but also to facilitate operations on the renal pelvis.

______ 89. The hepatic and splenic flexures of the colon are at least partially extraperitoneal and in contact with the kidneys. The degree of contact would be expected to be dependent on the amount of perirenal fat.

______ 90. Duodenal obstruction might be expected to be associated with abdominal aortic aneurysms since the second part of the duodenum passes behind the aorta.

______ 91. An increase in systemic venous pressure (e.g., as in right-sided heart failure) would be expected to result in impairment of venous outflow from the liver.

______ 92. If a catheter were introduced into a patent ligamentum teres of the liver it could be advanced into the portal vein.

______ 93. Since the common bile duct and the pancreatic duct have a common termination in the duodenum, a calculus (stone) could obstruct the outflow of both ducts.

______ 94. The vagus n. fibers to the stomach promote gastric motility and the secretion of hydrochloric acid.

______ 95. Branches of both the portal vein and the hepatic artery end in the sinusoids of the liver.

______ 96. The transversalis fascia is reflected onto the inferior surface of the diaphragm where it becomes the inferior diaphragmatic fascia.

______ 97. The posterior wall of the rectus sheath below the arcuate line is composed only of the aponeurosis of the transversus abdominis m.

______ 98. The short gastric arteries traverse the gastrosplenic ligament.

______ 99. The fourth and fifth lumbar spinal nerves have white rami communicantes associated with them.

______ 100. The pedicles, transverse processes, spinous processes and vertebral bodies can be easily identified in PA radiographs of the mid-lumbar vertebrae.

SELF-EVALUATION EXAM - ABDOMEN

KEY

THE FOLLOWING NUMBERED STATEMENTS ARE TRUE (T) :

3. 39 73
4. 41. 78.
5. 42 79.
6. 43. 80.
7. 45. 81.
9. 46. 83.
l0. 47. 84
12. 49. 86.
15. 50. 87.
l6. 51. 88.
17. 52. 89.
21. 53. 91.
22. 54. 92.
23. 55. 93.
24. 56. 94.
26. 58. 95.
28. 59. 96.
29. 61. 98.
30. 63. 100.
31. 64.
32. 65.
34. 66.
35. 67.
36. 68.
37. 70.