Anatomy spotter: GI and reproduction

1.

a. Identify structures A and B (above).

b. From which branch of the descending aorta does A originate?
c. Which vessel does B drain into?

A = Splenic artery from Coeliac trunk

B = SMV drains into portal vein

2. The following image applies to questions 2 and 3

2.
a. Identify the structure labelled X (above)

Caecum

b. In which region of the abdomen would a mass in this area present?

RIF/Right lower quadrant

3.

a. Identify the areas of the stomach labelled A, B and C (above)

A= Fundus, B= Pyloric region, C= Cardia

b. Describe 2 types of hiatal hernia

Sliding Hiatal Hernia: Failure of the phrenico-oesophageal ligament,  gastro-oesophageal junction slides up
into the thoracic cavity (85-95% of cases).Symptoms: Heartburn, dysphagia

Rolling (Para-oesophageal) gastro-oesophageal junction remains in place but a part of the stomach (or
colon, spleen, pancreas or small intestine) herniates into the chest next to the oesophagus (5-15% of
cases). Medical emergency, fundus of stomach can become necrotic , diffuse pain

4. The following image applies to questions 4 and 5

4.

a. Identify the branch of the descending aorta marked X (above)

SMA

b. Which part of the embryological gut does it supply?

midgut

c. Describe the cause and effect of the Nutcracker syndrome.

Compression of Left Renal Vein by SMA → obstruction of left testicular vein → varicocele (dilated tortuous
veins around left testis.)

5.

a. Identify the structure marked A (above)

Oesophagus

b. Describe the venous drainage of the lower third of this structure.

Dual venous drainage:

Azygos vein → SVC →heart (SYSTEMIC)

AND Left gastric vein → portal vein → liver (PORTAL)

Portal Systemic anastomosis – connection between 2 venous systems

c. Why is this particularly significant in chronic liver disease?

Portal Hypertension (chronic liver disease)→ Oesophageal varices → Enlarged, tortuous veins → bleeding

d. What other structures pierce the diaphragm?

Descending aorta and IVC

 6. The following image applies to questions 6 and 7

6.
a. Identify the duct marked X. (above)

Main pancreatic duct

b. What duct does it join with and where does it enter the duodenum?

Common bile duct at hepatopancreatic ampulla of Vater; drains into the second part of duodenum at the
major duodenal papilla

c. Name 2 common causes of acute inflammation of this gland.

Alcohol and gallstones

7.

a. Identify A and B (above)

A transverse colon

B small bowel/ ileum

b. A surgeon is performing a laparoscopy and wants to distinguish between the large and small bowel.
Name 3 gross anatomical differences between the appearance of structures A and B (in life)

Large bowel is larger, has haustra, appendices epiploicae, teniae coli

8.

a. Identify the area labelled X (above)

Recto-uterine pouch (Pouch of Douglas)

b. What is its clinical significance?

Lowest point in the peritoneal cavity; may be accessed through posterior fornix of the vagina (deliberately
(Culdocentesis: intraabdominal peritoneal fluid is aspirated) or inadvertently in unsafe abortion); fistula
may develop following difficult labour & breach of vaginal wall
9.

a. Identify the structure labelled X (above).

Bulbourethral (Cowper’s) gland

b. What is its function?

Secretes an alkaline fluid to the urethra for acid neutralisation (particularly neutralisation of acid in the
vagina), and a mucous that lubricates the end of the penis and urethral lining. These glands contribute a
very small amount to the ejaculate.

c. Which gland/s contribute/s the largest volume of fluid to the ejaculate?

Seminal vesicles (60%)

d. Which examination can be performed to detected benign prostatic hypertrophy (BPH)/enlarged

prostate? What might the clinician feel which would support this diagnosis?

Digital rectal examination (DRE) usually reveals an enlarged smooth prostate with loss/flattening of
central furrow. May be unable to palpate upper pole.
10.

a. Identify the muscle labelled X

Pubococcygeus (part of levator ani)

b. Outline 4 causes of pelvic floor dysfunction

Childbirth, Age, menopause (atrophy of tissues after oestrogen withdrawal), obesity (Increases load upon
pelvic musculature), chronic cough or straining, obstetric trauma
11.

a. Identify the structure labelled X

Corpus cavernosum

b. What is its function in an erection?

Smooth muscle in helicine arteries relaxes & straightens→ Blood flows into corpus cavernosum→
Bulbospongiosus & ischiocavernosus muscles compress venous plexus (retain blood in penis)

Tunica albuginea and fascial sheaths resist expansion, such that internal pressure rises and occludes
venous drainage

c. Identify three common causes of erectile dysfunction.

Psychological problems, tears in fibrous capsule of corpora cavernosa, obstruction of blood flow to corpora
cavernosa, pharmacological
12.

a. Identify the structure labelled X

Round ligament of uterus

b. Describe its course and the consequences for lymphatic drainage

It originates at the uterine horns (the points at which the fallopian tubes enter the uterus), and attaches to
the labia majora, passing through the inguinal canal.

Cancer present in the inguinal nodes can be indicative of cancer of the uterus at the level of the round
ligaments. Uterine cancer must be especially suspected if the tissues of the lower limb, vulva, and anal
canal appear normal.
13.

a. Identify the structure labelled X

Greater vestibular glands (Bartholin’s gland)

b. Name the sexually transmitted infection that may cause infection of this structure.

Gonorrhoea, chlamydia
14.

Is this pelvis most likely to belong to a male or female? Give 4 reasons for your answer

Female has: A wider pubic arch, less inward-pointing (shorter) ischial spines, wider pelvic inlet and outlet,
relatively thinner bone, the pelvic inlet is heart-shaped in the male and oval in the female, sacral
promontory is less pronounced in female
15.

a. Describe the arterial supply and venous drainage of structure X. (ovary)

Right and left ovarian arteries arise directly from descending aorta below renal arteries

Venous drainage – paired ovarian veins. Left ovarian vein drains into left renal vein. Right ovarian artery
drains into IVC

b. Which biomarker is often used in the diagnosis of ovarian cancer?

CA125