Q1

Q1 Abdo-2

What structures in this photograph are potential sources of acute abdominal pain?

  • Aorta (aneurysm)
  • Coeliac axis and SMA (mesenteric ischaemia)
  • Kidneys and ureters (stones/infarcts)
  • Splenic artery (aneurysm/dissection)
  • Lymph nodes (adenitis/pressure)
  • Psoas (abscess or bleed)

Pass Criteria:

  • Bold to pass

Identify the (other) vascular structures in this photograph (if not already).

Q1 Abdo-2

  • IVC
  • Left renal vein
  • Right renal vein
  • Aorta
  • Coeliac axis
  • Superior mesenteric artery

Pass Criteria:

  • 4/6 bold to pass

Describe the arterial supply and venous drainage of the gut.

 

  • Foregut (+ hepatobiliary & spleen) – Coeliac axis
    • Common hepatic (-> cystic, hepatic, right gastric, gastro-duodenal), splenic, left gastric (not shown)
  • Midgut (duodenum to transverse colon) – Superior mesenteric artery
    • Inferior pancreaticoduodenal, jejunal/ileal branches, right and middle colic
  • Hindgut – Inferior mesenteric artery
    • (small calibre + collaterals, therefore rarely blocked)
  • Venous drainage
    • Superior mesenteric vein (joins splenic vein to form portal vein), inferior mesenteric vein

Q3 AbdoVein

 

 

 

 

 

 

Pass Criteria:

  • Bold to pass

Q2

X-ray Abdo TextX-ray Abdo

Please outline the course of ureter.

  • Hilum(~L2)
  • Tips of Transverse processes of lumbar vertebrae
  • Pelvic brim at SI joint or there abouts (bifurcation of common iliac artery)
  • Lateral wall of pelvis toward ischial spine then medially to base of bladder

Pass Criteria:

  • 4 bold to pass

Where is a stone likely to lodge?

  • Narrowings of ureter: Pelviureteric junction; Pelvic brim; Vesicoureteric junction

Pass Criteria:

  • 2/3 to pass

Where would a staghorn calculus form?

  • Hilum: pelvis and calyces

Pass Criteria:

  • Bold to pass

If you have time - please name other structures on this X-ray.

X-ray Abdo


Q3

Q3 Abdo 2

Identify and name the blood vessels in this image.

Q3 Abdo

  • Aorta
  • Common iliac arteries
  • Femoral artery
  • IVC
  • Common iliac veins
  • External iliac arteries
  • External iliac veins
  • Internal iliac arteries
  • IMA
  • Femoral vein
  • Lumbar artery
  • Testicular vessels

Pass Criteria:

  • 4 bold PLUS 3 others to pass

Identify the ureters and describe their course.

Q1 Abdo-2

  • Origin at the renal hilum (PUJ)
  • Run inferiorly lying across the psoas (32)
  • Lie medially to tips of the lumbar transverse processes (on X-ray)
  • Cross over the pelvic brim
  • Cross anteriorly to the bifurcation of the common iliac artery
  • Lie on the lateral wall of pelvis, travels medially to bladder
  • Short intramural path at VUJ

Pass Criteria:

  • Correctly identifies ureters PLUS 3 points

What are the narrowest points of the ureters?

  • Narrowings at the PUJ, VUJ & pelvic brim

Pass Criteria:

  • 2 of 3 points

 


Q4

Q6 Abdomen

Identify the structures visible.

  • Liver
  • Portal vessels
  • Part of gallbladder (not obvious)
  • Right kidney (top)
  • Diaphragms
  • Aorta
  • IVC (not clearly differentiated)
  • Left kidney
  • Spleen
  • Splenic vein (not turtuous)
  • Bowel loops
  • Pancreas
  • Antrum
  • Vertebra
  • Ribs
  • Paravertebral muscles
  • Intercostal and abdominal wall muscles
  • Fat
  • Skin

Abdominal CT with Labels

Pass Criteria:

  • 4 bold + 2 others

Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID: 36677


Q5

X-ray Abdo TextX-ray Abdo

Could you point out on the xray the course of the L ureter?

  • Hila of kidney L1-L2
  • Transverse processess
  • Medial to tips of transverse processes of lumbar vertebrae
  • On anterior surface of psoas muscle
  • Pass over pelvic brim around SI joint
  • Run along lateral wall of pelvis till ischial spine
  • Medially to enter bladder

Pass Criteria:

  • Bold to pass

Where in the ureters is a stone likely to lodge?

  • PUJ
  • Pelvic brim
  • VUJ

Pass Criteria:

  • 2/3

Where else could a stone be present?

  • Kidneys
  • Bladder

Pass Criteria:

  • 1/2

What other structures can you identify on the xray?
(Only if time - not required for pass)

X-ray Abdo

  • Liver
  • Large bowel
  • Lumbar spine
  • Pelvis
  • Femoral head
  • Ribs
  • Psoas

Q6

Q6 Abdomen

Identify the structures on this CT.

  • Liver
  • Portal vessels
  • R kidney (top)
  • Aorta
  • L kidney
  • Spleen
  • Splenic vein (not tortuous)
  • Bowel loops
  • Pancreas
  • IVC
  • Vertebra
  • Ribs
  • Paravertebral muscles
  • Intercostal & abdominal wall muscles
  • Fat
  • Skin

Pass Criteria:

  • 5 Bold + 2 others

Abdominal CT with Labels

Describe the course of the ureters

  • Originate at renal hilum (PUJ) – approx. L2
  • Run inferiorly lying across psoas
  • Near tips of transverse process of lumbar vertebra (L3-L4)
  • Cross over pelvic brim
  • Cross anterior to bifurcation of common iliac artery
  • Lie on lateral wall of pelvis
  • Travel medially to bladder
  • Short intramural path at VUJ

Pass Criteria:

  • 4 of 8 points to pass

What are the 3 narrowest points of the ureters?

  • PUJ
  • VUJ
  • Pelvic brim

Pass Criteria:

  • 2 of 3

Q7

PHOTO: Posterior abdomen wall – major structures and course of ureters

This is a photo of the posterior abdominal wall. Please identify the major structures.

  • Psoas, iliacus (2 of 2 to pass)
  • Aorta, common external & internal iliac arteries (3 of 4 to pass)
  • Inferior vena cava and common/external iliac veins (2 of 3 to pass)
  • Bladder, ureters (2 of 2 to pass)
  • Gonadal vessels (bonus)
  • Genitofemoral nerve (bonus)

Pass Criteria:

  • As above

Describe the course of the ureter from the kidney to the bladder.

  • Retroperitoneal, 25-30 cm long
  • Arise from renal pelvis, ~L1 on left and L2 on right
  • Continue distally parallel to transverse processes of lumbar spine, adherent to parietal peritoneum
  • Pass over pelvic brim at bifurcation of common iliac artery
  • Run on lateral wall of pelvis then at level of ischial spine curve anteromedially to enter base of bladder

Pass Criteria:

  • 3 of 5 to pass

What are the common sites of ureteric narrowing?

  • Pelvoureteric junction
  • Crossing pelvic brim
  • Vesicoureteric junction

Pass Criteria:

  • 2 of 3 to pass

Q8

Describe the branches of the abdominal aorta that supply the gut.

  • Coeliac trunk T12
  • SMA L1
  • IMA L3

Pass Criteria:

  • All 3 to pass

Describe the arterial supply of the stomach.

  • Lesser curvature – left gastric (from coeliac trunk)
  • Lesser curvature – right gastric (from hepatic)
  • Posterior gastric from splenic
  • Short gastric arteries from distal splenic
  • Left gastro-omental (gastro-epiploic) from splenic
  • Greater curvature – right gastro-omental (gastroepiploic) from gastroduodenal (from hepatic)

Pass Criteria:

  • 2 of 3 branches to pass

If extra time: Describe the arterial supply of the colon.

  • Superior mesenteric from aorta
    • Ileocolic, right colic, middle colic
    • Marginal artery
  • Inferior mesenteric artery
    • Left colic, sigmoid arteries
    • Marginal artery
  • Anastamosis between superior and inferior colic arteries

Upper Limb Lower Limb

Thorax Pelvis & Perineum Head & Neck