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Abdomen MCQ’s 4. The caudate process of the liver connecting the caudate lobe and the right Block 2 lobe, extends to the right between the following structures: 1.* Near the apex (the left extremity) of the wedge-shaped liver, the anterior and A. Ligamentum venosum posterior layers of the left part of the coronary ligament meet to form the B. Inferior vena cava following peritoneal formation: C. Gallbladder A. The lesser omentum D. Round ligament B. The round ligament E. Porta hepatis C. The left triangular ligament 5.* The main portal fissure is demarcated on D. The bare area of the liver the visceral surface of the liver by the following feature: E. The greater omentum A. Bare area 2. The portal triad includes the following structures: B. Right sagittal fissure A. The ligamentum venosum C. Porta hepatis B. The hepatic artery (proper) D. Falciform ligament C. The lesser omentum E. Left sagittal fissure D. The bile duct 6.* According to the surgical classification of the segments of the liver, the caudate lobe E. The hepatic portal vein counts as segment number: 3. The impressions on (areas of) the visceral A. V surface of the liver include: B. IV A. Splenic area C. VIII B. Renal and suprarenal areas D. I C. Colic area E. II D. Gastric area E. Duodenal area 1 7. The interlobular portal triads of the liver 10. The lymphatic vessels from the bile duct include: pass to the following lymph nodes: A. Initial branches of the biliary ducts A. Cystic B. Initial branches of the hepatic portal vein B. Inferior mesenteric C. Terminal branches of the hepatic artery C. Superior mesenteric (proper) D. Hepatic D. Terminal branches of the hepatic portal vein E. Lymph node of the omental foramen E. Terminal branches of the biliary ducts 11. The gallbladder has the following parts: 8. The course of the bile duct includes: A. Duct A. Descends posterior to the hilum of the B. Body right kidney C. Head B. Lies in a groove on the posterior surface of the head of the pancreas D. Fundus C. Descends posterior to the superior part of E. Neck the duodenum 12.* The spiral fold is a feature of the D. Unites with the minor duodenal papilla, mucosa of the following structure: forming the hepatopancreatic ampulla A. Major duodenal papilla E. Unites with the major duodenal papilla, forming the hepatopancreatic ampulla B. Neck of pancreas 9. The arterial supply of the bile duct is C. Hepatopancreatic ampulla from the following arteries: D. Neck of gallbladder A. Superior mesenteric E. Cystic duct B. Colic C. Cystic D. Posterior superior pancreaticoduodenal E. Right hepatic 2 13. The cystohepatic triangle (of Calot) is 16. The fat which surrounds the kidneys and bordered by the following structures: their vessels, as it extends into their renal sinuses, is named: A. Common hepatic duct A. Perinephric fat B. Visceral surface of the liver B. Perirenal fat capsule C. Right hepatic artery C. Paranephric fat D. Cystic artery D. Pararenal fat body E. Cystic duct E. Renal fascia 14. The hepatic portal vein is formed at the level of the following structures: 17.* The kidneys lie on each side of the vertebral column at the level of the A. Close to the transpyloric plane following vertebrae: B. Anterior to the inferior vena cava A. T10-T12 C. Posterior to the neck of the gallbladder B. T10-L1 D. Posterior to the neck of the pancreas C. T11-L1 E. Close to the level of the L1 vertebra D. L3-L5 15. Portal-systemic anastomoses are formed E. T12-L3 in the following regions: 18. Each ______ calyx is indented by a A. Submucosa of the anal canal renal papilla, which is the apex of the renal ______. B. Peri-umbilical region A. Pyramid C. Submucosa of the stomach B. Sinus D. Anterior aspect of secondarily retroperitoneal viscera C. Minor E. Submucosa of the esophagus D. Major E. Pelvis 3 19. The surface marking of the ureter is a 22. The left suprarenal gland comes in line joining a point 5 cm lateral to the relation with the following structures: ________ and the ________. A. Inferior vena cava A. T10 spinous process B. Left kidney B. L5 spinous process C. Spleen C. Posterior superior iliac spine D. Pancreas D. Iliac tubercle E. Stomach E. L1 spinous process 23. The area between the medial borders of 20. The ureters normally demonstrate the suprarenal glands features the following relative constrictions in the following places: structures: A. During their passage through the renal A. Superior mesenteric artery sinus B. Left ureter B. During their passage through the wall of the urinary bladder C. Left crus of diaphragm C. Where the ureters cross the brim of the D. Celiac ganglion pelvic inlet E. Inferior vena cava D. At the junction of the ureters and the renal pelves 24. The blood supply of the kidney includes the following segmental arteries: E. During their passage through the renal hilum A. Superior (apical) 21. The right suprarenal gland comes in B. Postero-inferior relation with the following structures: C. Inferior A. Inferior vena cava D. Posterior B. Pancreas E. Antero-superior C. Right crus of diaphragm D. Right kidney E. Spleen 4 25.* The superior suprarenal arteries arise 28.* The right suprarenal vein drains into from the following arteries: the following vein: A. Splenic A. Superior mesenteric vein B. Renal B. Superior vena cava C. Superior mesenteric C. Inferior vena cava D. Abdominal aorta D. Right renal vein E. Inferior phrenic E. Hepatic portal vein 26.* The middle suprarenal arteries arise 29.* The left suprarenal vein drains into the from the following arteries: following vein: A. Abdominal aorta A. Left renal vein B. Superior mesenteric B. Inferior vena cava C. Renal C. Splenic vein D. Inferior phrenic D. Inferior mesenteric vein E. Splenic E. Superior vena cava 27.* The inferior suprarenal arteries arise 30.* The fibers of the abdominopelvic from the following arteries: splanchnic nerves arise from the spinal cord segments: A. Splenic A. C1-C5 B. Inferior phrenic B. T3-T10 C. Renal C. T10-S2 D. Superior mesenteric D. T5-L2 E. Abdominal aorta E. L1-S4 5 31. The lower thoracic splanchnic nerves 34. The parasympathetic part of the include: autonomic innervation of the abdominal viscera consists of the following: A. The least splanchnic nerve A. Abdominal autonomic plexuses B. The lesser splanchnic nerve B. Pelvic splanchnic nerves C. The celiac plexus C. Prevertebral ganglia D. The middle splanchnic nerve D. Anterior and posterior vagal trunks E. The greater splanchnic nerve E. Intrinsic (enteric) ganglia 32. The cell bodies of postsynaptic sympathetic neurons constitute the following 35. The parasympathetic part of the major prevertebral ganglia: autonomic innervation of the abdominal viscera consists of the following: A. Inferior mesenteric A. Abdominal autonomic plexuses B. Superior mesenteric B. Prevertebral ganglia C. Aorticorenal C. Intrinsic (enteric) ganglia D. Intrinsic (enteric) ganglia D. Pelvic splanchnic nerves E. Celiac E. Anterior and posterior vagal trunks 33. The parasympathetic part of the autonomic innervation of the abdominal 36. The level of the domes of the diaphragm viscera consists of the following: varies according to the following: A. Pelvic splanchnic nerves A. Size of abdominal viscera B. Intrinsic (enteric) ganglia B. Posture C. Abdominal autonomic plexuses C. Degree of distension of abdominal viscera D. Anterior and posterior vagal trunks D. Race E. Prevertebral ganglia E. The phase of respiration 6 37. Based on the peripheral attachments, the 40. The large apertures of the diaphragm parts of the diaphragm are: include: A. The costal part A. Piriform aperture B. The lumbar part B. Caval opening C. The sternal part C. Semilunar hiatus D. The scapular part D. Esophageal hiatus E. The clavicular part E. Aortic hiatus 38. The crura of the diaphragm are 41. The elements passing through the caval musculotendinous bands that arise opening of the diaphragm include: (originate) from the following structures: A. Branches of the right phrenic nerve A. Intervertebral discs B. Lymphatic vessels from the liver B. Abdominal aorta C. Thoracic duct C. Inferior vena cava D. Anterior vagal trunk D. Anterior longitudinal ligament E. Inferior vena cava E. Bodies of the superior three lumbar vertebrae 42. The elements passing through the esophageal hiatus of the diaphragm include: 39. The inferior surface of the diaphragm is supplied by the following blood vessels: A. Esophageal branches of the left gastric vessels A. Inferior phrenic arteries from the abdominal aorta B. Branches of the right phrenic nerve B. Left inferior phrenic veins draining into C. Anterior vagal trunk the left renal vein and splenic vein D. Posterior vagal trunk C. Right inferior phrenic vein draining into the hepatic portal vein E. Esophagus D. Left inferior phrenic veins draining into the inferior vena cava and left suprarenal vein E. Right inferior phrenic vein draining into the inferior vena cava 7 43. The elements passing through the aortic 46.* The inferior attachment of the iliopsoas hiatus of the diaphragm include: muscle is at the level of: A. Branches of the right phrenic nerve A. The lower six costal cartilages B. Thoracic duct B. The transverse processes of lumbar vertebrae C. Anterior vagal trunk C. The lesser trochanter of the femur D. Lymphatic vessels from the liver D. The greater trochanter of the femur E. Descending aorta E. The iliac fossa 44. The sternocostal triangle (foramen) of the diaphragm transmits the following 47. The superior attachments of the iliacus elements: muscle include: A. Anterior vagal trunk A. Anterior sacro-iliac ligaments B. Superior epigastric vessels B. Superior two thirds of iliac fossa C.
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  • Laparoscopic Surgical Anatomy of Calot`S Triangle Adnan Al Helli Laparoscopic Surgical Anatomy of Calot`S Triangle

    Laparoscopic Surgical Anatomy of Calot`S Triangle Adnan Al Helli Laparoscopic Surgical Anatomy of Calot`S Triangle

    Laparoscopic Surgical Anatomy of Calot`s Triangle Adnan Al Helli Laparoscopic Surgical Anatomy of Calot`s Triangle Adnan Al Helli; CABS, Mohammad Al Taee**; CABS, Majid Al Khafaji**; CABS * Dept of Surgery, College of Medicine, University of Karbala, **Senior Surgeon in Hilla Teaching Hospital Abstract ntroduction: Calot`s triangle is an anatomical space in the subhepatic region contains the cystic duct and cystic artery. These structures are of normal arrangement and I configuration in about three quarters of people. Laparoscopic cholecystectomy now is the gold standard surgical procedure for the treatment of cholecystolithiasis but is associated with significant incidence of operative injuries. Recognition of the normal and variations of the surgical anatomy in this space is essential in order to reduce the incidence of these events. Aims: to start Iraqi data base, improve anatomy recognition and reduce laparoscopic complication. Method: Through a prospective observational study we identified the cystic artery and cystic duct characters within Calot`s triangle during Laparoscopic Cholecystectomy operations. Results: 200 cases, 96% females. Cystic artery; total single artery; 179, 89%, double cystic arteries; 21, 10.5%, normal configuration; 133, 66%, total artery anomalies; 67.33.5%. Cystic duct; normal ducts; 125/62.5%, total anomalies; 75/37.5% and other details. Discussion: the anatomy of Calot`s triangle is puzzling and surgeons should be aware of this fact. The published studies are of variable ranges, arterial variations are more frequent than ductal anomalies. Studies implementing Laparoscopic methodology sound the most accurate. The current study denotes higher incidences of normal cystic arteries and lower incidence of normal cystic duct compared to global ranges.