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The Structural Basis of Medical Practice (SBMP) - Human Gross Anatomy, Radiology, and Embryology

Answer Guide for Abdomen, Pelvis, and Perineum: Written Examination Part IV (52pts) - 2000

The College of Medicine at The Pennsylvania State University


Note: This is an outline of items to discuss -- NOT the "Answer"

Table of Contents
  1. Review the boundaries of Scarpa's fascia. (10 pts)
  2. Review the anatomy of the 3rd (horizontal) segment of the duodenum (10 pts)
  3. Review the anatomy of the testis. (12 pts)
  4. Review the anatomy of the ovary.  (10 pts)
  5. Review the anatomy of the lesser sac.  (10 pts)

1.  Discuss the boundaries of Scarpa's fascia and its derivatives with respect to the containment of urine.  Specify the fascial layers associated with the accumulation of urine.  Discuss whether urine will be in the ischiorectal fossa.  (10 pts)

General comments: Scarpa's fascia is membranous tela subcutanea.  This fascia is capable of holding sutures and defines a potential space between it and deep fascia.  This space can be invaded by infection or the extravasation of urine. The tear in the inferior fascia of the urogenital diaphragm transmits urine from the deep pouch to the superficial perineal pouch.  The intact superior fascia of the urogenital diaphragm prevents urine from entering the ischiorectal fossa.  The accumulation of urine will be restricted by the boundaries of Scarpa's (membranous) fascia.
 

2.  Discuss the anatomy of the 3rd (horizontal) segment of the duodenum and include the relationships (6 directions), boundaries, vertebral levels, structure, surfaces, vasculature, lymphatic drainage, and innervation. (10 pts)

General comments: The horizontal part of the duodenum is 3-4" long.  It is between the descending and ascending parts of duodenum.  Other than plicae circulares there are no distinquishing internal

3.  Review the anatomy of the testis including relationships, structure, coverings, vasculature, lymphatics, and innervation. (12 pts)

General comments:  The embryological descent of the testis accounts for much of the anatomy .  The testis "passed through" the anterior abdominal wall pushing ahead fascias derived from transversalis fascia, internal oblique, and external oblique.  These fascias are known at tunics of the spermatic cord.  The testis passed through the deep ring, the inguinal canal, and the superficial ring.  "Following" the testis were the vas deferens, deferential vessels, deferent autonomic plexus, testicular vessels, and testicular autonomic plexus.  The testis descended from the posterior abdominal wall from near the renal arteries.  This beginning accounts for much of the vascularisation and innervation of the testis.  The vas deferens descended from the pelvic cavity near the posterior aspect of the bladder and prostate.  This beginning accounts for much of the vascularisation and innervation of the epididymis.  The testis, prior to descent, was retroperitoneal having about 3/4 of the surface peritonealized.  Thus, during the descent, the testis pulled along a peritoneal diverticulum.  This diverticulum becomes the tunica vaginalis and the obliterated processes vaginalis.

4.  Review the anatomy of the ovary including relationships (6 directions), structure, surfaces, supports, vasculature, lymphatics, and innervation. (10 pts)


5.  Review the anatomy of the lesser sac including relationships (6 directions), boundaries, structures, surfaces, vasculature, innervation, and lymphatics.  Explain why pain may originally be diffuse but suddenly becomes severe, and why depris from the the stomach may be found in the hepatorenal recess. (10 pts)

General comments: The lesser sac is a diverticulum in the superior region of the peritoneal cavity. Communication with the greater sac is via the epiploic foramen. For the most part, the lesser sac is posterior to the stomach and liver, anterior to the pancreas and diaphragm, superior to the duodenum, pancreas, and transverse mesocolon, inferior to the liver and diaphragm, left of the caudate, and right to the gastroleino and leinorenal ligs.
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The Structural Basis of Medical Practice - Human Gross Anatomy
The College of Medicine of the The Pennsylvania State University
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