Anat Ta's Sup Colic Vis Artery Unpaired GI Org
- 1.
A sickle cell patient needs to have his spleen removed. You are the surgeon and you want to clamp the splenic artery as close to the spleen as possible so as not to occlude blood flow thru arteries which supply which structure?
- A.
Transverse colon
- B.
Tail of Pancreas
- C.
Lesser Greater curvature of stomach
- D.
1st part of duodenum
- E.
Fundus of stomach
Correct Answer
E. Fundus of stomachExplanation
The short gastric arteries branch distally off the splenic artery. The short gastrics supply the fundus of the stomach. If you clamp the splenic artery proximal to the short gastrics, you obstruct blood flow to the fundus of the stomach. Rate this question:
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- 2.
During exploratory surgery, the physician places his hand through a foramen connecting greater and lesser sacs of the abdominal viscera. He pinches off tissue directly anterior to his hand. Which is true of this maneuver?
- A.
Cuts off bile traveling from digestive system to liver
- B.
Cuts off major blood supply to duodenum
- C.
Cuts off portion caval venous system
- D.
Cuts off major blood supply to liver
Correct Answer
D. Cuts off major blood supply to liverExplanation
The tissue being constricted by the surgeon contains hepatic artery, portal vein and common bile duct. The liver's main blood supply (2/3) is by the portal vein and the rest from the hepatic artery (both of which are being constricted in this case). (A) Bile flows from liver and gallbladder to intestine via the common bile duct. (B) The major blood supply of the duodenum is the gastroduodenal artery, which is not located in the hepatoduodenal ligament. (C) The portal vein is part of the portal venous system and there is no caval venous drainage in the hepatoduodenal ligament.Rate this question:
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- 3.
You are observing an open laparotomy surgery and the surgeon asks you to identify all the organs, which originate in the ventral mesentary. You reply,
- A.
Liver, Pancreas, 1st part of duodenum
- B.
Gallbladder, Tail of pancreas, Liver
- C.
Head of Pancreas, Gallbladder and Liver
- D.
Liver, Faliciform ligament and lesser omentum
Correct Answer
D. Liver, Faliciform ligament and lesser omentumExplanation
the liver and falciform ligament are derivatives of the ventral mesentary, which comes from the septum transversium. The others are all developed from the endoderm of the foregut.Rate this question:
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- 4.
A 45-year-old female with chronic cholelithiasis (gall stones) is slated to have her gall bladder removed (cholecystectomy) via laparoscoptic methods. Which of the following structures should be occluded to reduce blood loss during the operation?
- A.
Right hepatic artery
- B.
Cystic vein
- C.
Cystic artery
- D.
Left hepatic artery
Correct Answer
C. Cystic arteryExplanation
The cystic artery supplies arterial blood to the gall bladder and should be occluded during the surgery to reduce blood loss during the procedure.Rate this question:
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- 5.
A 65-year-old male presents to the emergency room complaining of dark tarry stools. What is the anatomical landmark that demarcates the cut off for this type of gastrointestinal bleeding?
- A.
Lienorenal ligament, Upper GI Bleed
- B.
Ligament of Treitz, Upper GI Bleed
- C.
Ligament of Treitz, Lower GI Bleed
- D.
Lienorenal ligament, Lower GI Bleed
Correct Answer
B. Ligament of Treitz, Upper GI BleedExplanation
A lower GI bleed would present with bright red blood in the stool. The ligament of Treitz suspends the fourth part of the duodenum to the stomach.Rate this question:
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- 6.
When the left lesser curvature of the stomach is found to have less blood supply. What is most likely the artery that is damaged?
- A.
Right gastric artery
- B.
Right gastro-omental artery
- C.
Left gastric artery
- D.
Left gastro-omental artery
- E.
Short gastric artery
Correct Answer
C. Left gastric arteryExplanation
The lesser curvature is supply by the left gastric and right gastric arteries. If the left side is found to have less blood supply, the left gastric artery is most likely involved. The left and right gastro-omental arteries supply the greater curvature of the stomach. The short gastric artery supplies the fundus of the stomachRate this question:
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- 7.
Which are the important anastomoses between the superior mesenteric artery and celiac trunk in the abdomen?
- A.
Superior and Inferior Pancreaticoduodenal Arteries
- B.
Ileocolic and Right Colic Arteries
- C.
Left and Right Gastro-omental Arteries
- D.
Right Colic Artery and Marginal Artery of Drummond
Correct Answer
A. Superior and Inferior Pancreaticoduodenal ArteriesExplanation
Superior (anterior and posterior) pancreaticoduodenal arteries originate off of the gastroduodenal artery, a sub-branch of the celiac trunk. Inferior (anterior and posterior) pancreaticoduodenal arteries originate off of the superior mesenteric artery. These four branches will anastomose with each other to "connect" the celiac trunk to the superior mesenteric artery. (B) Ileocolic and right colic arteries are both branches of the superior mesenteric artery. (C) Left and right gastro-omental arteries are both sub-branches of the celiac trunk. (D) The right colic artery and marginal artery of Drummond are both involved in the anastomoses between the superior mesenteric artery and the inferior mesenteric artery.Rate this question:
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- 8.
An 80-year-old woman is found to be anemic by her doctor. Iron studies show an iron deficiency anemia. A colonoscopy reveals a 2 cm mass in her rectum, which bleeds intermittently. Prior to surgical resection, the surgeon would like to gain hemodynamic control by reducing blood flow to the lesion. Given the location of the lesion, the major artery supplying this area arises immediately posterior to which of the following organs?
- A.
First part of the duodenum
- B.
Second part of the duodenum
- C.
Third part of the duodenum
- D.
Head of the pancreas
- E.
Neck of the pancreas
Correct Answer
C. Third part of the duodenumExplanation
The inferior mesenteric artery arises from the anterior surface of the aorta at the level of the third lumbar vertebra. The third part of the duodenum crosses the midline at the level of the L3 vertebra and passes anterior to the aorta at the origin of the inferior mesenteric artery. The first part of the duodenum lies horizontally to the right of the midline at the L1 vertebra. The second part of the duodenum lies vertically to the right of the midline and extends from the level of the L1 to L3 vertebra. The head of the pancreas lies to the right of the midline and extends from the level of the L1 to L3 vertebra. The neck of the pancreas lies in the midline at the level of the L1 vertebra. It lies on the anterior surface of the descending aorta at the origin of the superior mesenteric artery.Rate this question:
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- 9.
A 45-year-old man presents with left-sided testicular swelling. Upon examination, the physician notes that part of the scrotum on the left feels like a "bag of worms." Which of the following underlying conditions might this patient have?
- A.
Systemic hypertension
- B.
Hepatic cirrhosis
- C.
Left-side heart failure
- D.
Dementia
- E.
Abdominal aortic aneurysm
Correct Answer
E. Abdominal aortic aneurysmExplanation
The patient's symptoms are suggestive of a dilated left pampiniform plexus, which drains into the left renal vein. The left renal vein may be compressed between the SMA and abdominal aorta in a condition called the Nutcracker syndrome. Thus, an abdominal aortic aneurysm is the most likely of these choices to cause this patient's presenting complaints.Rate this question:
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- 10.
An ulcer in the posterior part of the duodenal papilla is most likely to cause damage to which artery?
- A.
Gastoduodenal artery
- B.
Superior anterior pancreaticoduodenal artery
- C.
Superior posterior pancreaticoduodenal artery
- D.
Inferior anterior pancreaticoduodenal artery
- E.
Inferior posterior pancreaticoduodenal artery
Correct Answer
A. Gastoduodenal arteryExplanation
The duodenal papilla refers to the proximal 2cm covered in peritoneum (intraperitoneal). The gastroduodenal artery's position to the proximal duodenum puts it at highest risk of damage during an ulcer. See slide 6 of Dr. Barremkala's lecture. Recommendation: spend some time to learn the relationships of arteries to major GI structures (especially in relation to the parts of the stomach for ulcers and pancreas for tumors).Rate this question:
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- 11.
Which of the following pairs of arteries provides an important anastomosis between the Superior Mesenteric artery & the Inferior Mesenteric artery, and what is the name of the artery?
- A.
Left Colic artery & Marginal Artery; Inferior Pancreaticoduodenal Artery
- B.
Middle Colic artery & Left Colic artery; Marginal Artery of Drummond
- C.
Right Colic artery & Left Colic artery; Marginal Artery of Drummond
- D.
Right Colic artery & Middle Colic artery; Marginal Artery of Drummond
- E.
Ileocolic artery & Left Colic artery; Appendicular Artery
Correct Answer
B. Middle Colic artery & Left Colic artery; Marginal Artery of DrummondExplanation
The Middle Colic artery off the SMA and the Left Colic artery off the IMA anastomose to form the Marginal Artery of Drummond.Rate this question:
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- 12.
Your patient had to undergo emergency surgery for a ruptured spleen after falling from his ladder, the surgeon had to ligate the splenic artery to attempt and salvage what was left of the spleen. What other organ could be jeopardized?
- A.
Lower 1/3rd of the Esophagus
- B.
Fundus of the stomach
- C.
Pancreas
- D.
Greater Omentum
Correct Answer
B. Fundus of the stomachExplanation
Remember a common problem with Splenectomy is ligation of the splenic artery occurs to far proximally which causes the Short Gastric artery to lose its blood supply. The Short Gastric artery supplies the fundus of the stomach.Rate this question:
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- 13.
During a liver transplant it may be necessary to clamp the Hepatoduodenal ligament to prevent hemorrhage. When clamping the ligament, what structure is lying most anterior and lateral within the ligament?
- A.
Cystic duct
- B.
Portal vein
- C.
Common bile duct
- D.
Hepatic vein
- E.
Hepatic artery
Correct Answer
C. Common bile ductExplanation
the common bile duct lies anterior and lateral to the hepatic artery, while the portal vein lies posteriorly to both common bile duct and hepatic artery.Rate this question:
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- 14.
Which veins meet to form the portal vein? What structure do they join behind?
- A.
Inferior mesenteric vein, Superior mesenteric vein:Duodenum
- B.
Inferior mesenteric vein, Superior mesenteric vein: Neck of Pancreas
- C.
Splenic vein, Inferior mesenteric vein: Body of pancreas
- D.
Superior mesenteric vein, Splenic vein: Neck of Pancreas
Correct Answer
D. Superior mesenteric vein, Splenic vein: Neck of PancreasExplanation
The Inferior mesenteric vein joins with the Splenic vein. Then the Splenic vein meets with the Superior mesenteric vein behind the neck of the pancreas to continue on as the portal vein.Rate this question:
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- 15.
Which of the following is NOT found in the mesoappendix?
- A.
Appendicular artery
- B.
Appendicular vein
- C.
Lymph vessels
- D.
Ileocecal valve
Correct Answer
D. Ileocecal valveExplanation
The Ileocecal valve is found at the junction of the Cecum and the Ileum. The mesoappendix is the mesentery unique to the appendix structures.Rate this question:
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- 16.
A 55 yo, female, with a history of alcoholism is referred to your clinic. On inspection, the abdomen appears distended with evidence of caput medusa. Fluid wave tests are negative for ascites, but percussion of the abdomen reveals a right-sided enlarged mass extending beyond the thoracic cage. You confirm a diagnosis and determine that your patient may need to undergo surgery in order to relieve her condition. The consult-surgeon recommended a Warren shunt. Which of the following vasculature structures are involved in this particular procedure?
- A.
Inferior Vena Cava/ Superior Mesenteric Vein
- B.
Portal Vein/ Inferior Vena Cava
- C.
Inferior Vena Cava/ Splenic Vein
- D.
Splenic Vein/ Left Renal Vein
- E.
Superior Mesenteric Vein/ Portal Vein
Correct Answer
D. Splenic Vein/ Left Renal VeinExplanation
The patient's findings are highly suggestive of portal hypertension. A past medical history of alcoholism as well as an enlarged liver mass further support our differential diagnosis. Another name for the "Warren Shunt" is the splenorenal shunt. This is one (1) of the extrahepatic shunts specifically involving the splenic vein and the left renal vein. The remaining two (2) extrahepatic shunts include the side-to-side portacaval shunt (between the portal vein and IVC) and the mesocaval shunt (between the IVC and the superior mesenteric vein). The transjugular intrahepatic portosystemic shunt (TIPS) is an intraheptaic shunt that also exists between the hepatic vein and a branch of the portal vein.Rate this question:
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- 17.
A newbie surgeon destroys the mesoappendix accidentally. The mesoappendix contains vessels supplying the appendix. The artery supplying the appendix is a branch from which larger abdominal artery?
- A.
Celiac Trunk
- B.
Superior Mesenteric Artery
- C.
Inferior Mesenteric Artery
- D.
Splenic Artery
- E.
Right Colic Artery
Correct Answer
B. Superior Mesenteric ArteryExplanation
The artery supplying the appendix is called the appendicular artery. It is a branch off the ileocolic artery, which is a branch off the superior mesenteric artery.Rate this question:
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- 18.
What is true about the Blood Supply to the Colon?
- A.
Right Colic Artery gives blood supply to the appendix via the appendicular artery.
- B.
The Left Colic and Right Colic arteries provide anastamoses for the blood supply between midgut and hindgut
- C.
The Left Colic artery supplies the left 1/3 of the transverse colon and the splenic flexure
- D.
The Middle Colic artery supplies the ascending colon
Correct Answer
C. The Left Colic artery supplies the left 1/3 of the transverse colon and the splenic flexureExplanation
The iliocecal artery supplies the appendix via the appendicular artery. The middle colic and right colic arteries anastamose for the blood supply between midgut and hindgut as the marginal artery of Drummond. The middle colic artery mainly supplies the transverse colon.Rate this question:
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- 19.
Upon reviewing an abdominal arteriogram, the attending physician asks the medical student to identify and characterize the artery supplying the proximal portion of the descending colon. Which of the following statements would be correct for the medical student to make?
- A.
This artery anastamoses with the celiac trunk via the pancreaticoduodenal arteries
- B.
This artery may trap the left renal vein and third part of the duodenum if enlarged
- C.
An occlusion of this artery would cause ischemia to the vasa recta
- D.
This artery anastamoses via the marginal artery of Drummond
- E.
This artery supplies the midgut
Correct Answer
D. This artery anastamoses via the marginal artery of DrummondExplanation
This is the inferior mesenteric artery, which anastamoses with the SMA by the marginal artery of Drummond. Options a, b, c, and e all refer to the superior mesenteric arteryRate this question:
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- 20.
What is the ligament of Treitz?
- A.
A ligament that suspends the duodenum at its junction with the pylorus
- B.
A ligament that suspends the duodenum at its junction with the jejunum
- C.
A remnant of the umbilical vein
- D.
A structure that prevents backflow from the colon into the small intestine
- E.
A remnant of the vitelline duct
Correct Answer
B. A ligament that suspends the duodenum at its junction with the jejunumExplanation
The ligament of Treitz suspends the duodenum-jejunum junction from the right crus of the diaphragm. It is also a landmark for the transition to the lower gastrointestinal tract, which is useful, for example, when describing bleeds. The remant of the umbilical vein is the round ligament of the liver (aka ligamentum teres). A remnant of the vitelline duct would be a meckel's diverticulum (remember: rule of 2's)Rate this question:
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- 21.
An 18 year old female who was recently been experiencing loss of sensation to her hips presented to her physician. While taking the history, the patient reported that she was a big fan of Calvin Klein, especially her tight ultra-low rise hip-hugger jeans. What is a correct association with the affected nerve causing the patients presenting symptoms?
- A.
The nerve generally plays a role in the 'Creamasteric Reflex'
- B.
The nerve roots comprising the affected nerve are L1 - L2 and can be found emerging from the medial border of the psoas muscle
- C.
The patient would also likely present with a mass protruding from Hesselbach's triangle due to the nerve being affected
- D.
The affected nerve normally travel towards the ASIS (anterior superior iliac spine) after emerging on the lateral border of the psoas muscle
Correct Answer
D. The affected nerve normally travel towards the ASIS (anterior superior iliac spine) after emerging on the lateral border of the psoas muscleExplanation
To answer the question correctly, first determine what the likely cause of the patient’s chief complaint is: if you are thinking being a fashion afficionado, you are partially correct. Calvin Klein syndrome (compression of the lateral femoral cutaneous nerve at the ASIS) is the likely diagnosis here. The next step would be to think about where the nerve travels. Since the cause of the parasthesia is from tight jeans, the ASIS involvement makes sense. The last thing to realize is the lateral femoral cutaneous nerve emerges on the lateral border of the psoas muscle (it is important to differentiate where the different nerves of the posterior abdominal wall are found in respect to different muscles).
The incorrect answer choices describe: (a) the ilioinguinal [L1] as well as the femoral and genital portions of the genitofemoral nerve [L1-L2] are associated with the creamasteric reflex, (b) L1-L2 is associated with the genitofemoral nerve and the lateral femoral cutaneous nerve can be found emerging from the lateral border of the psoas m. (c) this distractor was only included to remind you to think about herniations and also consider the important relationships and orientations (as far as lateral vs. medial) that can also complicate questions of that nature.Rate this question:
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- 22.
Which of the following is found in the small intestines?
- A.
Plicae circularis
- B.
Valves of Kerckring
- C.
Circular folds
- D.
Rugae
- E.
A, B, C
Correct Answer
E. A, B, CExplanation
Rugae is only found in the stomach.Rate this question:
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- 23.
Which of the following is the correct association?
- A.
Jejunum - Deep red, thick wall, short vasa recta, few large loops, small amount of mesenteric fat and few lymphoid nodules
- B.
Jejunum - Pale pink, thick wall, short vasa recta, few large loops, abundant mesenteric fat and few lymphoid nodules
- C.
Ileum - Pale pink, thin wall, long vasa recta, many short arcades, abundant mesenteric fat and many lymphoid nodules
- D.
Ileum - Pale pink, thin wall, short vasa recta, many short arcades, abundant mesenteric fat and many lymphoid nodules
Correct Answer
D. Ileum - Pale pink, thin wall, short vasa recta, many short arcades, abundant mesenteric fat and many lymphoid nodulesExplanation
The ileum is classically characterized by the features outlined in answer choice D.Rate this question:
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- 24.
Damage to which of the following arteries of the diaphragm may also cause partial reduction of blood flow to the adrenal (suprarenal) glands?
- A.
Damage to the musculophrenic artery, leading to decreased flow to the superior suprarenal artery
- B.
Damage to the musculophrenic artery, leading to decreased flow to the inferior suprarenal artery
- C.
Damage to the pericardiacophrenic artery, leading to decreased flow to the superior suprarenal artery
- D.
Damage to the pericardiacophrenic artery, leading to decreased flow to the superior suprarenal artery
- E.
Damage to the inferior phrenic artery, leading to decreased flow to the superior suprarenal artery
- F.
Damage to the inferior phrenic artery, leading to decreased flow to the middle suprarenal artery
Correct Answer
E. Damage to the inferior phrenic artery, leading to decreased flow to the superior suprarenal arteryExplanation
The diaphragm mostly receives blood supply from the musculophrenic and pericardioacophrenic on the superior surface and inferior phrenic on the inferior surface. For the adrenal gland, it receives blood supply from the inferior phrenic via the superior suprarenal, aorta via the middle suprarenal and renal via the inferior suprarenal. Therefore the answer is the inferior phrenic artery since it is shared by both the diaphragm and adrenal glandRate this question:
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Mar 14, 2023Quiz Edited by
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Apr 09, 2012Quiz Created by
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