Abdomen, Pelvis, and Perineum: Lecture Notes and Review Questions

Core Lectures

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Radiology

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Clinical Correlates

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Cummulative Library of Questions for the Abdomen, Pelvis, and Perineum

Questions for the Abdominal Wall

These questions were not submitted by the lecturer.

True/False - August 23, 2011 (selection limited by earthquake)

  1. The paraumbilical veins communicate with lateral thoracic vein and, thus, contribute to a portacaval shunt.
  2. The superficial epigastric vein has a communicating branch to the lateral thoracic vein known as the thoracoepigastric vein.
  3. Scarpa's fascia extends are far inferior as the thigh.
  4. The thoracoepigastic vein resides deep to Scarpa's fascia but superficial to deep fascia.
  5. The umbilicus A/P projection is to the T10 vertebra and the cutaneous innervation is by the L3 spinal nerve.
  6. The transversus abdominis muscle contributes to the same fascial plane as the innermost intercostal muscles.
  7. The arcuate line is a feature of the anterior lamina of the rectus sheath that occurs 3/4 of the way inferior along the sheath.
  8. The aponeurosis of the internal oblique, inferior to the arcuate line, has two lamina that contribute to the anterior and posterior walls of the rectus sheath.
  9. The internal oblique takes origin, in part, from the lateral 2/3 of the linea alba.
  10. The transversus abdominis takes origin, in part, from the later 1/3 of the linea alba.
  11. The inferior epigastric artery enters the rectus sheath at a location inferior to the arcuate line.
  12. Stability of the vertebral column is enhanced by well toned abdominal oblique muscles due to increased intraabdominal pressure.
  13. The transversalis fascia lines the internal surface of the transversus abdominis muscle and is limited by the attachments of transversus abdominis.
  14. The rectus abdominis, inferior to the arcuate line, rests directly on transversalis fascia.
  15. The superficial epigastric artery is a branch of the femoral artery.

True/False

August 24, 2010
  1. The anterior abdominal wall is divided into a 3X3 matrix.
  2. The external oblique muscle defines the same fascial plane as does the innermost intercostal muscles.
  3. The transversus abdominis muscle defines the same fascial plane as does the external intercostal muscles.
  4. The rectus abdominis muscle is within the rectus sheath.
  5. The umbilicus includes the T10 dermatome and has a vertebral projection to the L3 vertebra.
  6. There is a membranous layer of tela subcutanea, inferior to the level of the umbilicus, called Scarpa's fascia.
  7. Scarpa's fascia extends to the anterior thigh.
  8. The fascia lata of the anterior thigh has its superior extent at the inguinal ligament.
  9. The paraumbilical veins normally drain into the portal vein.
  10. The lateral thoracic vein has connections with the paraumbilical veins.
  11. The thoracoepigastric vein provides communicating veins between the superficial epigastric vein and the lateral thoracic vein.
  12. The superficial epigastric vein lies deep to Scarpa's fascia.
  13. The T7 dermatome includes the region of the xiphoid process
  14. The L1 dermatome includes the region of the pubic crest.
  15. The arcuate line is a defect in the anterior lamina of the rectus sheath.
  16. Inferior to the arcuate line the rectus abdominis is separated from the peritoneal cavity by transversalis fascia, extraperitoneal connective tissue, and parietal peritoneum.
  17. The external oblique has attachments to the lower 8 ribs, iliac crest, and pubic tubercle.
  18. The internal oblique is attached to the medial 2/3s of the inguinal ligament.
  19. The transversus abdominis muscle has attachments to the medial 1/3 of the inguinal ligament.
  20. The transversalis fascia defines the abdominal cavity.
  21. The peritoneum defines the peritoneal cavity.
  22. Retroperitoneal structures, by definition, may have a peritonealized surface; but this surface does not disqualify the organ of being retroperitoneal.
  23. Structures having 2/3 or more of their surface covered by visceral peritoneum are said to be intraperitoneal but they are not in the peritoneal cavity.
  24. The xiphisternal junction projects to the T9/10 vertebra and includes the T8 dermatome.
  25. The umbilicus projects to the L4 vertebra and includes the T10 dermatome.
August 2009
  1. The arcuate line is located at the level of the umbilicus.
  2. The umbilicus projects to vertebral level L4 but receives cutaneous innervation from spinal level T10.
  3. Immediately posterior to the rectus abdominis muscle, at a location inferior the to arcuate line, is the transversalis fascia.
  4. Immediately posterior to the rectus abdominis muscle, at a location superior to the arcuate, is the posterior lamina of the rectus sheath.
  5. The superior boundary of Scarpa's fascia is at the level of the umbilicus.
  6. Scarpa's fascia extends onto the thigh.
  7. A penetrating wound through the lateral aspect of rectus sheath and inferior to the umbilicus will compromise Scarpa's fascia.
  8. Caput medusae happens when the paraumbilical veins reverse blood flow and dilate as a consequence of portal hypertension.
  9. The linea semilunaris outlines the lateral margin of the rectus sheath..
  10. Tendinous intersections interrupt the rectus abdominis muscle.
  11. Tendinous intersections are not connected to the rectus sheath.
  12. A penetrating wound inferior to the xiphoid process and superior to the umbilicus will compromise the potential space defined by the boundaries of Scarpa's fascia.
  13. The superior epigastric artery has an anastomosis with the superficial epigastric artery within the rectus abdominis muscle.
  14. The thoracoepigastric vein travels with the artery of the same name.
  15. Inferior to the arcuate line the fibers of the transversus abdominis and fibers from the posterior lamina of the internal oblique turn anterior at the linea semilunaris.
  16. The tela subcutanea of the anterior wall superior to the umbilicus is know as Camper's fascia.
  17. The abdominopelvic cavity is lined by transversalis fascia.
  18. The costal margin projects to L3 where as the umbilicus and the iliac crest project to L4.
  19. Caput Medusae may lead to distension of the superficial circumflex iliac vein.

Definition and Short Answer

  1. First question.

Essay

  1. First question.

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Questions for the Inguinal Canal

These questions were not submitted by the lecturer.

True/False - August 26, 2011

  1. The external oblique contributes fibers to the formation of the linea alba, inguinal ligament, and the posterior wall of the rectus sheath.
  2. The external oblique contributes fibers to the formation of the superficial inguinal ring, the reflected inguinal ligament, and the cremasteric fascia.
  3. The external oblique contributes fibers to the formation of the pectineal ligament, lacunar ligament and the conjoint tendon.
  4. The external oblique contributes fibers to the boundaries of the superficial ring, femoral ring, and the deep ring.
  5. The external oblique contributes fibers that define three of the four boundaries of the femoral ring.
  6. The intercrural fibers secure the aponeuronsis of the external oblique to the conjoint tendon of the internal oblique.
  7. The internal oblique and the transversus abdominis arise, in part, from the external oblique.
  8. The transversus abdominis muscle contributes a layer of transversalis fascia to the layers of the spermatic cord.
  9. The cremasteric muscle/fascia shares an innervation with the internal oblique muscle.
  10. The conjoint tendon has origins partly from the inguinal ligament.
  11. The transversalis fascia refers to the investing fascia of the transversus abdominis muscle.
  12. An extended hip tightens the anterior abdominal wall and may cause strangulation of an inguinal hernia.
  13. The artery of the ductus deferens is of the pelvic cavity.
  14. The testicular artery is of the abdominal cavity.
  15. When residing inside the abdominal cavity, the testis is retroperitoneal, but has a peritonealized surface.
  16. The vascular supply to the non-descended testis is retroperitoneal.
  17. The processes vaginalis is a diverticulum of transversalis fascia.
  18. A patent processes vaginalis invites an indirect inguinal hernia.
  19. The transversus abdominis muscle contributes the layer of internal spermatic fascia to the spermatic cord.
  20. Scarpa's fascia takes on smooth muscle as it transitions into Dartos fascia.
  21. The processes vaginalis of the spermatic cord is deep to the internal spermatic fascia.t
  22. The cremasteric fascia, but not the external spermatic fascia, makes up part of the spermatic cord within the inguinal canal.
  23. The deep ring is located medial to the inferiorepigastic artery.
  24. The obliterated umbilical artery creates a fold of visceral peritoneum named the medial umbilical fold.
  25. The urachus obliterates to form the median abdominal ligament.
  26. The median umbilical folds define the medial inguinal fossa between them.
  27. The cremasteric artery is deep to the internal spermatic fascia and deep to the processes vaginalis.
  28. A patent processes vaginalis may transmit a direct inguinal hernia.
  29. The external spermatic fascia is in contact with Dartos fascia.
  30. Lymphatic drainage from the superior pole of the testis is to the upper lumbar nodes and lymphatic drainage from the inferior pole is to internal iliac nodes.
  31. The parietal layer of the tunica vaginalis is superficial to the internal spermatic fascia.

True/False

August 27, 2010
  1. The linea alba lies lateral to the linea semilunaris.
  2. The medial and lateral crus are stabilized by the transverse fibers of the internal oblique.
  3. The inguinal ligament, but not the reflected inguinal ligament, is derived from the external oblique aponeurosis.
  4. The opening of the superficial ring is medial and superior to the pubic tubercle.
  5. The inguinal ligament gives rise to fibers that extend medial to the pubic tubercle and these fibers contribute to the "floor" of the superficial ring and are named the reflected inguinal ligament.
  6. A medial gap between the inguinal ligament and the pectin line
  7. A medial gap (lacuna) between the inguinal ligament and pectin line partly filled by the lacunar ligament.
  8. Fibers from the lacunar ligament extend onto the pubic pectin as the pectineal ligament.
  9. The internal spermatic fascia, despite its name, lies superficial to the processes vaginalis.
  10. An indirect inguinal hernia passes indirectly out the superficial ring by way of the deep ring.
  11. A direct hernia is often described as pushing the conjoint tendon medially and then slipping past the lateral side; the hernial sac lies deep to the external spermatic fascia and superficial to the cremasteric fascia.
  12. The indirect hernia lies deep to all the tunics of the cord except for the processes vaginalis.
  13. The external oblique, directly or indirectly, gives rise to the inguinal ligament, reflected inguinal ligament, pectineal ligament, lateral, medial, and intercrural fibers, anterior lamina of rectus sheath, linea alba, linea semilunaris, and the conjoint tendon.
  14. The transversus abdominis muscle contributes the processes vaginalis component of the spermatic cord.
  15. The internal oblique, arising from the lateral 1/3 of the inguinal, does not contribute a tunic to the spermatic cord.
  16. The deep ring lies lateral to the medial umbilical fold and medial to the lateral umbilical fold.
  17. The median umbilical fold, caused by a contour of the transversalis fascia, is deep to the obliterated urachus.
August, 2009
  1. The prostate is easier to palpate than is the breast.
  2. Compression of the prostate may effect the delivery of fluids from the vas deferens to the urethra.
  3. The medial and lateral crura together with the intercrural fibers contribute to the anterior wall of the inguinal canal.
  4. The inferior boundary of the superficial ring is superior and medial to the pubic tubercle.
  5. The femoral ring is inferior and lateral to the pubic tubercle.
  6. A derivation of the external oblique aponeurosis applies to the pectin pubis (pectineal line).
  7. A derivation of the internal oblique aponeurosis contributes the lacunar ligament.
  8. The external spermatic begins after the deep ring of the inguinal canal.
  9. An oblique course is advantageous for thwarting herniation.
  10. Arising from the lateral 2/3 of the inguinal ligament is the external oblique muscle whereas arising from the lateral 1/3 is the transversus abdominis.
  11. The cremasteric fascia and muscle is derived from the transversus abdominis muscle.
  12. The transversalis fascia, the epimysium of the transversus abdominis muscle, contributes the external spermatic fascia.
  13. An inferior free edge of the transversus abdominis muscle is superior to the deep ring.
  14. The conjoined tendon is formed by a joining of the of the internal and external oblique muscles.
  15. The testis, at 3 mo fetal has a a peritonealized surface, is retroperitoneal and is located near the kidney,
  16. The peritonealized surface of the testis becomes the parietal layer of tunica vaginalis.
  17. A distal part of the processes vaginalis becomes the visceral layer of tunica vaginalis.
  18. The gubernaculum becomes the scrotal ligament.
  19. An indirect hernia that descends to the tunica vaginalis can be palpated at the anterior margin of the testis.
  20. The obliterated umbilical arteries raise a peritoneal fold know at the medial umbilical fold
  21. A remnant of the urachus raises a peritoneal fold known as the median umbilical fold.
  22. The obliterated inferior epigastric artery raises a peritoneal fold know as the lateral umbilical fold.
  23. Between the median and medial umbilical folds is the paravesical fossa; a part of the medial inguinal fossa.
  24. Between the medial and lateral umbilical folds if the lateral inguinal fossa, typically to site of herniation for the indirect inguinal hernia.
  25. The outermost layer of the spermatic cord is dartos tunic.
  26. The vas deferens, deferential plexus, artery of the vas deferens, tail of the epididymis, testicular artery, pampiniform plexus, and testicular plexus, but not the cremasteric artery and the genitofemoral nerve, are within (deep to) the internal spermatic fascia.
  27. An indirect inguinal hernia proceeds indirectly out the superficial ring by way of the deep ring and the inguinal canal.
  28. The direct inguinal hernia proceeds directly out the superficial ring by compromising the conjoint tendon and the lateral inguinal fossa.
  29. The indirect inguinal hernia proceeds directly down an embryological pathway and, thus, is often a congenital condition.
  30. A hydrocele reflects a built up of fluid in the testicular coelom.
  31. The ovarian ligament, but not the suspensory ligament of the ovary, is derived from the gubernaculum.
  32. The round ligament of the uterus proceeds out the deep ring, into the inguinal canal, out the superficial ring, and then ascends to the level of the umbilicus.

Definition and Short Answer

  1. Derivations of the external oblique aponeurosis
  2. What invaginated fascias form the tunics of the spermatic cord.
  3. Deep inguinal ring

Essay

  1. First question.

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Questions for the Abdominal Cavity and Development

These questions were not submitted by the lecturer.

True/False - August 29, 2011

  1. The lesser omentum is a visceral ligament that connects the greater curvature of the stomach to the spleen.
  2. In the male, under non-pathological conditions, the peritoneal cavity is empty except for a film of serous fluid.
  3. In the female, except under non-pathological conditions, the peritoneal cavity has an episodic content.
  4. Intraperitoneal structures are located inside the peritoneal cavity.
  5. The transverse colon is intraperitoneal.
  6. The lesser sac and the greater sac are partitions of the abdominal cavity defined by the walls of transversalis fascia.
  7. Intraperitoneal structures, by definition, have less than 2/3 of their surface area covered by parietal peritoneum.
  8. The alimentary canal, at its most distal extent, begins with the mouth.
  9. A swelling of the alimentary canal becomes the stomach and a diverticulum of the alimentary canal becomes the spleen.
  10. The axis of rotation of the gut tube during development is around the superior mesenteric artery.
  11. Reflections of peritoneum at the lesser curvature of the stomach are from the ventral mesentery.
  12. The foregut includes the esophagus, stomach, and part of the duodenum.
  13. The artery of the midgut is the inferior mesenteric artery.
  14. The transverse colon marks a transition from foregut to midgut.
  15. The left colic flexure belongs to the hindgut.
  16. The proximal 2/3 of the rectum is derived from the midgut.
  17. The transversalis fascia and the extraperitoneal connective tissue are components of endocavital fascia within the abdominal cavity.
  18. The greater omentum fuses with the transverse mesocolon to form the lesser omentum.
  19. The free edge of the facliform ligament marks the most distal persistence of the ventral mesentery.
  20. The epiploic foramen provides a communication between the abdominal cavity and the peritoneal cavity.
  21. The tail of the pancreas may extend into the gastroleinal ligament.
  22. The hepatogastric ligament plus the hepatoduodenal ligament equals the falciform ligament.
  23. Intraperitoneal structures receive their vascular and neural supply by way of visceral ligaments and mesentery.
  24. Much of the head of the pancreas developed in ventral mesentery.
  25. The pancreatic incisor takes a bite out of the superior mesenteric artery.
  26. The part of the chief pancreatic duct, at the joining with the common bile duct, developed within the dorsal mesentery.
  27. A deficit of parasympathetic ganglia within the gut wall leads to a region incapable of peristalsis.

True/False - August 30, 2010

  1. The greater omentum, derived from the dorsal mesentery, is positioned anteriorly in the abdominal cavity.
  2. The greater omentum lies anterior to the transverse colon.
  3. The duodenum crosses the posterior surface of the colon.
  4. Intraperitoneal structures defined by having 3/4 of their surface peritonealized, are not within the peritoneal cavity.
  5. Intraperitoneal structures defined by having 3/4 of their surface peritonealized, are not within the abdominal cavity.
  6. The celiac, superior mesenteric, and inferior mesenteric arteries form anastomoses at the transition from the foregut to the midgut and from midgut to hindgut.
  7. The right half of the transverse colon is derived from the hindgut.
  8. The ascending colon is derived from the hindgut whereas the descending colon is derived from the hindgut.
  9. The greater, lesser, and least splanchnic nerves synapse on postganglionic cell bodies located, respectively, in the celiac, superior mesenteric, and inferior mesenteric paraaortic ganglia.
  10. At 5 weeks of development there is a 90 degree counterclockwise (AP view) rotation of the alimentary canal around the superior mesenteric artery.
  11. At 10 weeks of fetal development the herniated alimentary canal returns to the abdominal cavity and completes a 270 degree counterclockwise rotation around the inferior mesenteric artery.
  12. The stomach undergoes a 90 degree clockwise rotation so that the original left surface faces anterior.
  13. Vagal fibers of the esophageal plexus that were predominately from the left vagus nerve combine to the form the anterior vagus nerve.
  14. The pancreas, except possibly for the tail, is retroperitoneal.
  15. The greater omentum contributes to the lower recess of the omental bursa.
  16. The greater omentum folds "back on itself" resulting in four layers of peritoneum that define the omental bursa.
  17. The posterior two layers of the greater omentum fuse with the transverse mesocolon.
  18. The lesser curvature of the stomach has reflections of original ventral mesentery.
  19. The greater curvature of the stomach has reflections of original dorsal mesentery.
  20. The falciform ligament is derived from ventral mesentery.
  21. Both the spleen and pancreas develop within ventral mesentery.
  22. The tail of the pancreas together with the splenic artery, may become intraperitoneal within the lienorenal ligament.
  23. The omental bursa (lesser peritoneal sac) contains the lesser omentum.
  24. The epiploic foramen (of Winslow) provides the sole communication between the upper and lower recesses of the omental bursa.
  25. The left paracolic gutter provides a route to the hepatorenal recess.
  26. The epiploic foramen provides a communication between the greater sac and the hepatorenal recess.
  27. The parasympathetic nervous system mediates peristalsis of the alimentary canal.

Definition and Short Answer

  1. First question.

Essay

  1. First question.

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Questions for the Abdominal Vasculature

These questions were not submitted by the lecturer.

True/False

August 31, 2010
  1. There are five lumbar vertebrae and 4 pairs of lumbar arteries.
  2. The celiac arterial distribution has an anastomosis with the inferior mesenteric artery at the duodenum.
  3. Generally, the cystic artery branches from the right hepatic artery.
  4. The right gastric artery is a branch of the common hepatic artery.
  5. The left and right gastric arteries anastomose along the greater curvature of the stomach and within the lesser omentum.
  6. The superior anterior and posterior pancreaticoduodenal arteries anastomose with the second jejunal artery.
  7. The celiac plexus of autonomic fibers distributes as far distally along the alimentary canal as the second or third part of the duodenum.
  8. The dorsal pancreatic, but not the great pancreatic artery, becomes intraperitoneal.
  9. The right and left gastroepiploic arteries anastomose within the greater omentum at the lesser curvature of the stomach.
  10. The free edge of the hepatoduodenal ligament marks the inferior extent of the persistent ventral mesentery.
  11. The superior mesenteric artery is retroperitoneal as it passes through the pancreatic incisor.
  12. The superior mesenteric arterial distribution forms an anastomosis with the celiac arterial distribution along the retroperitoneal duodenum.
  13. Intestinal branches arise from the left side of the superior mesenteric artery.
  14. Colonic branches arise from the right and anterior side of the superior mesenteric artery.
  15. The vasa recta are end arteries and, thus, do not enter anastomotic networks.
  16. The vasa recta are shorter at the ileum and longer at the jejunum.
  17. The distal intestinal arcades are more opaque than the proximal arcades.
  18. The middle colic and sigmoidal arteries have retroperitoneal and intraperitoneal pathways.
  19. The marginal artery (of Drummond) represents and anastomosis of arteries along the margin of the ileum.
  20. The ileocecal artery is entirely retroperitoneal but gives rise to an appendicular artery that becomes intraperitoneal.
  21. During development the ventral pancreas rotates around the inferior mesenteric artery.
  22. The celiac and superior mesenteric arteries arise from the aorta at the upper L1 and lower L1 vertebral levels respectively.
  23. The inferior mesenteric artery arises from the aorta at the L3 vertebral level.
  24. Blood from the portal system normally passes through the liver before draining into the inferior vena cava.
  25. In portal hypertension, portal blood may reverse flow and enter the caval system without passing through the liver.
  26. Portacaval shunts include a pathway from the gastroduodenal vein to the esophageal veins.
  27. Portacaval shunts include a pathway from the superior rectal vein to the middle and inferior rectal veins.
  28. Portacaval shunts include a pathway from the paraumbilical veins to the inferior epigastric veins.

Definition and Short Answer

Essay

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Questions for the Liver Duodenum and Pancreas

These questions may not have been submitted by the lecturer.

True/False

  1. First question.

Definition and Short Answer

  1. First question.

Essay

  1. First question.

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True/False Questions for the Posterior Abdominal Wall

These questions were not submitted by the lecturer.

True/False - September 1, 2011

  1. The psoas major muscle covers the intervertebral foramina of the lumbar region.
  2. The transversalis fascia is derived from endocavital connective tissue of the peritoneal cavity.
  3. The renal fascia is derived from parietal peritoneum as it reflects off the posterior surface of the kidney,
  4. The renal fascia intervenes between the the kidney and the suprarenal gland and does not extend to cover the superior border of the suprarenal gland.
  5. The inferior pole of the kidney is supported by the inferior extent of the renal fascia.
  6. The pararenal fat is between the capsule of the kidney and the renal fascia.
  7. The perirenal fat lies between the peritonealized surface of the kidney and the renal capsule.
  8. The pararenal fat, renal fascia, and perirenal fat are all derivatives of extraperitoneal connective tissue.
  9. The posterior wall of the left kidney, but not the right kidney, is directly related to the left colic flexure.
  10. The posterior wall of the left kidney, but not the right kidney, is directly related to the 11th rib.
  11. The superior poles of the left and right kidneys extend superior to the inferior extent of the costodiaphragmatic recess.
  12. The left renal artery, but not the left, crosses the inferior vena cava.
  13. Inferior mesenteric syndrome leads to a swollen right scrotal sac.
  14. The fibrous capsule of the kidney is derived from Scarpa's fascia.
  15. The renal columns are named parts of the renal cortex.
  16. The renal pyramids were so named for the Greek God - Luther Henry.
  17. Swelling of the renal pelvis is accommodated by pararenal fascia.
  18. The medullary rays converge at a renal papilla.
  19. The renal papillae drain directly into the major calyces.
  20. The renal pelvis is deep to the renal artery.
  21. The renal sinus is occupied by the renal pelvis and the pararenal fascia.
  22. The medullary rays are found in the medulla of the suprarenal gland.
  23. The right suprarenal gland, but not the left, is directly related to the inferior vena cava.
  24. The medial surface of the left suprarenal gland is directly related to the aorta.
  25. The inferior suprarenal artery of the left suprarenal gland is one of a paired artery arising from the aorta.
  26. The central vein of the right suprarenal gland drains into the left renal vein.
  27. Within the "nutcracker," the left renal vein is superior to the horizontal duodenum.
  28. Superior mesenteric syndrome may present with "flank" pain, nausea, and right scrotal swelling.
  29. The superior and inferior anterior and posterior pancreaticoduodenal arteries anastomose along the duodenum.
  30. The most distal extent along the alimentary canal where inhibition of peristalsis is driven by the celiac ganglion is along the second and third part of the duodenum.
  31. The most distal extent along the alimentary canal where inhibition of peristalsis is driven by the superior mesenteric ganglion is along the right transverse colon.
  32. The most distal extent along the alimentary canal where inhibition of peristalsis is driven by the inferior mesenteric ganglion is along the proximal rectum. (True)
  33. The most distal extent along the alimentary canal where peristalsis is driven by the vagus nerve is the left colic flexure.
  34. The most distal extent along the alimentary canal where lymphatic drainage is to the celiac nodes is along the second and third part of the duodenum.
  35. The most distal extent along the alimentary canal where lymphatic drainage is to the superior mesenteric nodes is along the right transverse colon.
  36. The most distal extent along the alimentary canal where lymphatic drainage is to the inferior mesenteric nodes is along the proximal rectum. (True)
  37. The celiac autonomic plexus carries preganglionic sympathetic fibers and postganglionic vagal fibers.
  38. The superior mesenteric autonomic plexus conveys postganglionic sympathetic fibers and postganglionic parasympathetic fibers.
  39. The celiac ganglion hosts postganglionic parasympathetic cell bodies and passes preganglionic sympathetic fibers.
  40. The lumbar splanchnic nerves convey postganglionic sympathetic fibers to the aortic plexus and to the inferior mesenteric ganglion.
  41. Key locations for testing your knowledge of blood supply, lymph supply, and autonomic supply are: the duodenal cap, ascending duodenum, left colic flexure, and the right colic flexure (non-exhaustive).
  42. Primary lymphatic drainage from the superior pole of the testis is to upper lumber nodes.
  43. Primary lymphatic drainage from the inferior pole of the testis is to internal iliac nodes.
  44. Primary lymphatic drainage from the anterior scrotum is to superficial inguinal nodes.
  45. Primary lymphatic drainage from the uncinate process of the pancreas is to celiac nodes.
  46. Primary lymphatic drainage from the inferior left head (non-uncinate) is to the superior mesenteric nodes.
  47. The primary lymphatic drainage from the left colic flexure is to the inferior mesenteric nodes.
  48. The primary parasympathetic supply to the left colic flexure is from the vagus nerve.
  49. The primary parasympathetic supply to the left colic flexure is by the sacral component of the craniosacral division of the autonomic nervous system.
  50. The inferior mesenteric plexus of autonomic fibers conveys postganglionic fibers from the inferior mesenteric ganglia and preganglionic fibers from the vagus nerve.
  51. Visceral afferent fibers, by definition, are not part of the autonomic nervous system.
  52. High threshold (non-homeostatic) visceral receptors send information along sympathetic pathways.
  53. Low threshold (homeostatic) visceral receptors send afferent information along parasympathetic pathways.
  54. Referred pain reflects the activities of high-threshold ("pain") visceral receptors.
  55. Visceral "pain" from the superior pole of the testis or ovary may refer along the T10 dermatome. True.
  56. Visceral "pain" from the kidney may refer along the T12 dermatome.
  57. Preganglionic sympathetic cell bodies that enter the aorticorenal ganglion are from the intermediolateral cell column of the T12 cord level.
  58. Postganglionic sympathetic cell bodies from the superior mesenteric ganglion contribute fibers to the testicular autonomic plexus of the testicular arteries.
  59. Visceral pain from the duodenal cap may refer to the T9 dermatome.
  60. Visceral pain from the ascending duodenum may refer to the T10 dermatome.
  61. Visceral pain from the right colic flexure may refer to the T11 dermatome.
  62. Visceral pain from the left colic flexure may refer to the L1 dermatome.
  63. Most all of the previous questions can be answered based on your knowledge of the vascular anastomoses between the foregut, midgut, and hindgut.

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Questions for the Topography of the Pelvic Viscera

These questions were not submitted by the lecturer.

True/False - September 6, 2011

  1. The ejaculatory duct enters the posterior wall of the membranous urethra.
  2. The urogenital diaphragm lies within the pelvic cavity.
  3. The seminal vesicle lies in pelvic visceral fascia of the rectovesicle pouch in the femaie.
  4. The seminal vesicle lies in pelvic visceral fascia of the rectovesicle space in the male.
  5. The most distal part of the male urethra is the membranous urethra.
  6. The pelvic visceral fascia is peritoneum that extends into the pelvic cavity.
  7. The retropubic space defines a reflection of visceral peritoneum onto the the pelvic wall to become parietal peritoneum.
  8. An incision of the rectus sheath at the superior margin of the pubic crest provides access to the prevesicle space without entering the peritoneal cavity.
  9. The space of Douglas hosts the inferior hypogastric (rectal) plexus of autonomic fibers.
  10. The pouch of Douglas defines a reflection of peritoneum from the anterior margin of the rectum to the posterior wall of the uterus.
  11. The pouch of Douglas defines the lowest extent of the abdominopelvic cavity
  12. The pouch of Douglas defines the lowest extent of the peritoneal cavity.
  13. The pubosacral ligamentous complex is derived from a condensation of transversalis fascia.
  14. Transverse fibers of the pubosacral ligamentous complex constitute the lateral cervical (Cardinal) ligament.
  15. The pubovesicle ligament anchors the male bladder to the pubic bone.
  16. Passing along the superior margin of the lateral cervical ligament is the cervical artery.
  17. The periprostatic fascia is a case of perivisceral fascia derived the peritoneum.
  18. Transversalis fascia is membranous fascia derived from the endoabdominal fascia.
  19. Parietal pelvic fascia is an extension of the transversalis fascia into the pelvic cavity.
  20. Peritoneal reflections define pouches in the pelvic cavity.
  21. Parietal pelvic fascia and perivisceral fascia define, in part, spaces in the pelvic cavity.
  22. The retropubic space has parietal pelvic fascia as an anterior fascial boundary and perivisceral fascia as a posterior fascial boundary.
  23. The rectouterine space has perivisceral fascia for the anterior and posterior fascial boundaries.
  24. The presacral space has perivisceral fascia at the posterior boundary and parietal pelvic fascia at the anterior boundary.
  25. The fimbria sweep the fertilized egg into the uterine tube.
  26. The isthmus of the uterine tube connects the fimbriae to the ampulla of the uterine tube.
  27. The supsensory ligament of the ovary is a fibrous ligament and the ovarian ligament is a visceral ligament.
  28. The ovarian lymphatic drainage for the superior pole is to upper lumbar nodes and the inferior pole is to the superficial inguinal nodes.
  29. The ovarian ligament, from the inferior pole of the ovary, leaves the pelvic cavity at the deep ring and leaves the inguinal at the superficial ring.
  30. The fundus of the uterus has lymphatic drainage to upper lumbar nodes and the cervix has lymphatic drainage to the internal iliac nodes.
  31. The mesovarium and the mesosalpinx are named parts of the pelvic visceral fascia.
  32. Mesometrium is pelvic visceral fascia located between the anterior and posterior lamina of the parametrium.
  33. Antiverted and antiflexed describes the position of the typical uterus.
  34. The anterior vaginal fornix provides hypodermic access to the rectouterine pouch (of Douglas).
  35. The fundus of the uterus is a site of anastomosis between the ovarian arteries.
  36. The lateral margin of the uterus is a site of anastomosis between the ovarian and uterine arteries.
  37. The iliolumbar artery and the deep circumflex iliac artery define an anastomosis between the distributions of the internal and external iliac arteries.
  38. The inferior epigastric artery is the final leg of a descending aortic shunt within the anterior thoracic/abmoninal wall.
  39. There are 4 pairs of lumbar arteries and 5 lumbar vertebrae.
  40. The iliolumbar artery ascends from the pelvic cavity to enter the lumbar region of the 5th lumbar vertebra.
  41. The lateral sacral artery is verified by its branches that enter into the posterior sacral foramina.
  42. The lumbosacral trunk sends splanchnic nerves into the gluteal region by way of the greater sciatic foramen.
  43. The ventral ramus of the 5th lumbar spinal nerve contributes all of its fibers to the sacral plexus.
  44. The superior vesicle arteries can be identified as the final branches before the obliteration of the umbilical artery.
  45. The obturator artery can be identified as the artery that passes into the obturator canal along with the obturator nerve.
  46. Lymphatic drainage from the body of the epididymis is primarily to upper lumbar nodes.
  47. The internal pudendal artery passes between the coccygeus and piriiformis muscles proximal to crossing the posterior surface of the ischial spine/ligament.

True/False - September 2010

  1. With regard to the pelvic floor spaces are superficial to the the peritoneum whereas pouches are deep to the peritoneum.
  2. Peritoneal reflections around the pelvic viscera are named pouches whereas regions of extraperitoneal connective are named spaces.
  3. Posterior to the rectouterine pouch is the presacral space.
  4. Inferior to the pubovesical pouch is the rectopubic space.
  5. Posterior to the rectum is the presacral space.
  6. The pubosacral ligamentous complex includes the lateral cervical ligament, pubovesical ligament, and the suspensory ligament of the ovary.
  7. Perivisceral fascia is a condensation of transversalis fascia.
  8. The pubovesical ligament blends with the perivesical fascia in the female and the periprostatic fascia in the male.
  9. Parietal pelvic fascia refers to transversalis fascia of the pelvis.
  10. Parietal pelvic fascia extends onto the pelvic viscera as the visceral pelvic fascia.
  11. The rectouterine pouch separates the anterior fornix of the vagina from the retrorectal space.
  12. Visceral pelvic fascia refers to the extraperitoneal connective tissue of the pelvis.
  13. Parietal pelvic fascia reflects off the pelvic wall to from the pubovesical ligamentous complex.
  14. Between the os of the uterus and the isthmus of the uterus is the cavity of the uterus.
  15. Between the peritoneal cavity and the ampulla of the uterus is the os of the uterine tube.
  16. The supensory ligament of the ovary is derived from extraperitoneal connective tissue whereas the ovarian ligament is derived from pelvic visceral fascia.
  17. Within the broad ligament and along the lateral margin of the uterus there is an anastomosis between the ovarian and vaginal arteries.
  18. The lateral ligament of the uterus is derived from peritoneum whereas the broad ligament of the uterus is derived from parietal visceral fascia.
  19. The mesosalpinx plus the mesometrum plus the mesovarium equals the broad ligament whereas the broad ligament minus the mesosalpinx equals the parametrium.
  20. The uterus is normally anteverted and retroflexed.
  21. The lumbosacral trunk is formed by part of the L4 and all of the L5 dorsal ramus.
  22. There are five paired lumbar arteries and an unpaired iliolumbar artery.
  23. The superior, middle, and inferior rectal arteries are branches of the posterior division of the internal iliac artery.
  24. The superior vesical arteries are the most distal branches of the patent umbilical artery.
  25. The artery of the vas deferens is a branch of the internal iliac artery whereas the cremesteric artery is a branch (of a branch) of the external iliac artery.
  26. An anastomsis of the internal and external iliac arteries is located in the iiiac fossa.
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-- CourtLucas - 21 Sep 2015

Questions for the Pelvic Musculature and Fascia

These questions were not submitted by the lecturer.

True/False - September 9, 2011

  1. The sacrotuberous ligament is anterior to the sacrospinous ligament.
  2. The urogenital hiatus includes the urethra as an effluent but not anal canal.
  3. The piriformis muscle originates from the posterior surface of the sacrum.
  4. The ischiococcygeus (coccygeus) takes origin from the internal surface of the sacrospinous ligament.
  5. The puborectalis muscle attaches to the anococcygeal raphe and, thus, is tethered to the coccyx.
  6. The inferior fascia of the pelvic diaphragm blends with the superior fascia of the urogenital diaphragm at the urogenital hiatus.
  7. An equation; the pelvic diaphragm minus the ischiococcygeus equals the levator ani.
  8. Contraction of the ischiococcygeus raises the pelvic floor (push upward on the pelvic floor from the ischiorectal fossa in the laboratory).
  9. The iliac crest contributes the superior boundary of the true pelvis.
  10. The sacral promontory contributes to a boundary of the true pelvis.
  11. The arcuate line contributes a boundary of the true pelvis.
  12. The ischial spines in the female are oriented more laterally than in the male.
  13. The fifth lumbar vertebra couples the weight of the upper body to the sacrum.
  14. The topography of the female, pelvis relative to the male pelvis, accounts for the higher incidence of femoral hernias in the female.
  15. The puborectalis muscle is inferior the to the pubococcygeus muscle.
  16. The puborectalis, when contracted, enforces an angle at the anorectal junction that contributes to continence.
  17. The urethral crest is a raised part of the anterior membranous urethra.
  18. The bulbourethral glands drain into the prostatic sinuses.
  19. The bulbourethral glands drain into the membranous urethra.
  20. The arcus tendineus is a specialization of the obturator externus muscle that provides a site of attachment for the iliococcygeus muscle.
  21. The transversalis fascia of the pelvis, know as parietal pelvic fascia, is applied to the superior fascia of the pelvic diaphragm.
  22. The parietal pelvic fascia covers the inferior fascia of the pelvic diaphragm and lines the walls of the ischiorectal fossa.
  23. The prostatic ducts are lateral to the ejaculatory ducts at the urethral crest.
  24. The ejaculatory ducts are lateral to the utricle.
  25. The seminal colliculus of the urethral crest is medial to the prostatic sinuses.
  26. The utricle and and the ejaculatory ducts, but not the prostatic ducts, are topographies of the seminal colliculus.
  27. The fascia of Denonvilliers' is a thickening of parietal visceral fascia.
  28. The perivisceral fascia of the rectum is opposed to the fascia of Dennonvilliers'.
  29. The rectum has a convexity with the outside wall toward the right side.
  30. There is one transverse rectal fold on the right and two transverse rectal folds on the left.
  31. The convexity to the right of the rectum provides a mnemonic for which side has two transverse rectal folds and which side has one rectal fold.
  32. The location of the descending colon on the left provides a mnemonic for knowing that the rectum has a convexity to the right.
  33. The venous drainage of the rectum is partly to the portal system and mostly to the caval system.
  34. The levator ani muscle blends with the internal anal sphincter muscle.
  35. The pectinate line is located at the inferior margin of the anal valves.
  36. Internal hemorrhoids, more so the external hemorrhoids, may develop during portal hypertension.

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Questions for the Pelvic Nerves and Vessels

These questions were not submitted by the lecturer.

True/False - September 12, 2011

  1. Visceral afferent fibers that connect to the cell bodies of pelvic splanchnic nerves are part of the autonomic nervous system.
  2. A transection of the spinal cord superior to the S2 cord level preserves spinal reflexes of micturition.
  3. Spinal cord levels S2-4 elaborate somatic and autonomic nerves that act together to mediate micturition, defecation, and ejaculation.
  4. Like the sympathetic nerves of the coronary arteries, the sympathetic nerves of the perineum dilate the helicine arteries.
  5. Similar to peristalsis along the alimentary canal, parasympathetic nerves of the perineum control peristalsis of the seminal vesicles and ejaculatory ducts.
  6. Lumbar splanchnic nerves and pelvic splanchnic nerves are sources of sympathetic supply to the pelvic plexus.
  7. The right and left hypogastric nerves convey visceral afferent fibers from the uterus and sympathetic supply to the Uterus.
  8. Lesioning of the hypogastric nerves to disrupt visceral afferent fibers as a treatment for intractable pain removes all sympathetic supply to the uterus.
  9. Despite lesioning of the hypogastric nerves, there are at least two other pathways that convey sympathetic fibers to the uterus.
  10. Sacral splanchnic nerves are postganglionic and pelvic splanchnic nerves are preganglionic.
  11. The cavernous nerves are part of the prostatic autonomic plexus.
  12. The cavernous nerves are a continuation of fibers from the sacral splanchnic nerves.
  13. The sympathetic supply to the descending colon is by an arterial plexus and the parasympathetic supply is by a retroperitoneal path along the medial margin of the descending colon.
  14. The external anal sphincter is a somatic muscle innervated by the inferior rectal branches of the pudendal nerve.
  15. Disruption of the pelvic splanchnic nerves is expected to cause impotence.
  16. The pudendal nerve typically elaborates the inferior rectal nerve immediately proximal to the entrance of the pudendal canal.
  17. The falciform edge is on the medial margin of the ischio tuberosity and contributes a bony wall of the pudendal canal.
  18. The distal opening of the pudendal canal is at the inferior edge of the urogenital diaphragm.
  19. The primary lymphatic drainage of the superior pole of the ovary is to upper lumbar nodes and the inferior pole drainage is to internal iliac and superficial inguinal nodes.
  20. An infection of the perianal skin may involve superficial inguinal lymph nodes and somatic pain.

True/False - September2010

  1. Sacral splanchnic nerves and pelvic splanchnic nerves are, in fact, the same nerves.
  2. Parasympathetic preganglionic cell bodies that mediate contraction of the detrusor muscle are located in the intermediolateral cell column at levels L1-2.
  3. Peristalsis of the hindgut is driven by the parasympathetic division of the autonomic nervous system.
  4. Relaxation of the external anal sphincter and the puborectalis is driven by the somatic nervous system.
  5. The helicine arteries dilate in response to parasympathetic activity.
  6. The bulbospongiosus and the ischiocavernosus muscles contract in response to the somatic nervous system.
  7. Peristalsis of the vas deferens is driven by sympathetic nerves from the pelvic plexus.
  8. The cerebral release mechanism for urination is mostly driven by the somatic nervous system.
  9. Both the true urethral sphincter and the function urethral sphincter (uvula) are driven by the somatic nervous system.
  10. Sensation from the glans of the penis/clitoris is mediated by the autonomic nervous system.
  11. The sacral splanchnic nerves contribute to the inferior hypogastric plexus.
  12. The pelvic splanchnic nerves contribute to the inferior hypogastric plexus.
  13. The right and left hypogastric nerves contribute to the inferior hypogastric plexus.
  14. Gray rami from the sacral sympathetic trunk contribute to the inferior hypogastric plexus.
  15. White rami from the sacral sympathetic trunk contribute to the inferior hypogastric plexus.
  16. Nerve fibers derived from the lumbar splanchnic nerves contribute to the inferior hypogastric plexus.
  17. The uterine autonomic plexus receives contributions from the inferior hypogastric plexus.
  18. The uterine autonomic plexus receives contributions from the internal iliac plexus.
  19. The hypogastric nerves contain both preganglionic and postganglionic sympathetic nerves. (this is true)
  20. The cavernous nerves pass through the urogenital diaphragm to arrive in the perineum.
  21. Pelvic splanchnic nerves, by way of the inferior hypogastric plexus, contribute to the cavernous nerves.
  22. Surgical resection of the prostate may damage the cavernous nerves.
  23. Peristalsis at the left colic flexure is indirectly inhibited by lumbar splanchnic nerves.
  24. Peristalsis at the left colic flexure is indirectly activated by sacral splanchnic nerves.

Definition and Short Answer

  1. First question.

Essay

  1. First question.

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-- LorenEvey - 25 Aug 2009

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Topic revision: r1 - 02 Oct 2014, UnknownUser
 
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