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-- MatthewKlocek - 02 Oct 2007

key Access Control: 1. Hepatorenal Recess (Subhepatic recess). (4 pts.) Relations: posterior & inferior – anterior surface of right kidney anterior – inferior surface of right lobe of liver posterior & superior – diaphragm (limited superiorly by posterior layer of right coronary ligament) (0.5 pt will be awarded for mention of each relation) • Deepest point in abdominal cavity when an individual is supine. (0.5 pt) • Immediately superior to the right lateral (paracolic) gutter (0.5 pt) • may conduct fluid from the omental bursa to pelvis. (0.5 pt) • part of greater sac in which epiploic foramen opens (0.5 pt) • superior to right colic flexure (0.5 pt), on right side of body (0.5 pt), intraperitoneal (0.5 pt), mention of hepatorenal ligament (0.5 pt), mention of relation with lesser omentum (0.5 pt), can have communication with subphrenic recess (0.5 pt), mention of anterior abdominal wall laterally (0.5 pt)

2. Anterior rectus sheath (4 pts.) • Aponeurosis contributions: superior to arcuate line – external oblique aponeurosis and anterior lamina of internal oblique aponeurosis inferior to arcuate line - external oblique aponeurosis, internal oblique aponeurosis, and transversus abdominus aponeurosis (1 pt will be awarded for mention of contributions superior and inferior to arcuate line, 0.5 pt will be awarded for mention of only one of the two contribution scenarios) • Runs from sternum to pubic crest (0.5 pt) • Fuses with posterior rectus sheath at linea alba (0.5 pt) and linea semilunaris (0.5 pt) • Tendinous intersections attach to anterior rectus sheath (0.5 pt) • Thoracoabdominal nerves course in between internal oblique and transversus abdominus aponeurosis (0.5 pt) • Internal oblique and transversus abdominus aponeurosis fuse to make conjoint tendon, which inserts on to the pubic crest (0.5 pt) • Mention of direct inguinal hernias and possible layers of anterior rectus sheath that may be compromised (0.5 pt), anterior to rectus abdominus (0.5 pt), mention of approximate location of arcuate line (0.5 pt), inferior epigastric vessels posterior to rectus abdominus (0.5 pt), below arcuate line rectus abdominus muscles are anterior to tranversalis fascia (0.5 pt)

3. Superficial inguinal ring. (4pts) • Boundaries medial/superior – medial crus (external oblique aponeurosis) inferior – lateral crus (inguinal ligament) lateral – incrural fibers medial – reflected inguinal ligament (0.5 pt will be awarded for the mention of each boundary) • Round ligament (female) or spermatic cord (male) pass through superficial inguinal ring (0.5 pt for mention of each) • External spermatic fascia continues from the ring to spermatic cord (0.5 pt) • Mention of indirect of direct inguinal hernia and the relations to superficial inguinal ring (0.5 pt) • Mention of genitofemoral or ilioinguinal nerves (anterior scrotal or labial branches) 0.5 pts • Inferior to deep inguinal ring 0.5 pt • Medial to pubic tubercle 0.5 pt • Inferior aspect of inguinal canal 0.5 pt • Part of external oblique aponeurosis 0.5 pt

Mention of all boundaries, round ligament, and spermatic cord must be present for full credit

4. Superior pancreaticoduodenal artery. (4 pts) • Anterior and posterior branches past ant. and post. to the head of the pancreas, respectively (1 pt mandatory for full credit) • Communication with inferior pancreaticoduodenal artery (0.5 pt) • Branches of gastroduodenal artery via celiac trunk (0.5 pt each, mandatory for full credit) • Posterior to the 1st part of duodenum (1 pt mandatory for full credit) • Creates a portion of pancreatic arcade (0.5 pt) • Supplies blood to 2nd – 4th part of duodenum and head of pancreas (0.5 pt each) • Medial to 2nd part of duodenum

5. Ligamentum venosum (4 pts) • Remanent of ductus venosus (1 pt) • Connection between left portal vein to left hepatic vein in embryonic life (1 pt) • Between caudate lobe and left lobe of liver (1 pt) • Attachment of hepatogastric ligament (1 pt) • Posterior to ligamentum teres 0.5 pt • From ventral mesentery 0.5 pt • Ductus venosus shunted blood from liver to heart 0.5 pt • Fossa of ligamentum venosum 0.5 pt
Topic revision: r1 - 03 Oct 2007, UnknownUser
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