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555 Cards in this Set
- Front
- Back
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Where is the costal cartilage located?
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Between the ribs and the sternum
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What are the parts of the sternum?
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Manubrium, (sternal angle), body of sternum, xyphoid process
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What is the junction between the body of the sternum and the manubrium called?
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Sternal angle
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What bones comprise the pectoral girdle?
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Clavicle and scapula
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What are the true ribs?
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Vertebrocostal --> #1-7
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What are the false ribs?
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Vertebrochondral --> #8-10
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What are the floating ribs?
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Free --> #11 and 12
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Which vertebra does the 1st rib attach to?
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1st thoracic vertebra
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What is the lowest vertebra to have a rib attached to it?
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12th thoracic vertebra
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What is unique about the costal cartilage of the fals ribs?
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costal cartilage of these ribs articulate with the costal cartilage of the ribs superior to them
--> 7 is last to join sternum |
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What is the space between ribs called?
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The intercostal space
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What is a costovertebral joint?
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B/w ribs and vertebral bodies, ribs and transverse processes of vertebrae
-->Synovial! |
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What is a sternocostal joint?
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B/w costal cartilage of true ribs and sternum
EXCEPT 1ST RIB!!!! --> Synovial! |
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Where is the only sternocostal synchondrosis located?
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The 1st rib articulates with the sternum via the costal cartilage
(Fibrocartilagenous joint) |
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What is a costochondral joint?
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b/w distal ends of ribs and costal cartilage
--> Synchondroses! (fibrocart) |
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Where is the clavicular/jugular notch of the manubrium located?
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Level of T2
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Where is the manubrium located with respect to the vertebrae?
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Level of T3 and T4
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How many costal notches are there on the sternum?
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7
(clavicular notch, sternal angle notch, 3/4/5/6 down body of sternum, xiphosternal joint notch) |
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What is the angle of Louis?
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Sternal angle (manubriosternal joint)
At level of disk b/w T4 and T5 |
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What also happens at the level of the Angle of Louis?
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Bifurcation of the trachea
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At what level is the xyphoid process located?
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Level of T10
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What is the xyphoid process a marker for?
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Midline marker for upper limit of liver, central tendon of diaphragm, inferior border of heart
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What is the costal margin?
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Costal cartilage of false ribs that is inferomedial border of rib cage
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What happens when a rib is dislocated?
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Displaced at sternocostal joint
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What happens when a rib is separated?
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Rib torn from costal cartilage
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What happens when a rib is fractured?
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Break in rib, often at angle of rib
--> not normally reduced or immobilized -->very painful everytime breathe |
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What muscles does breast tissue lay on?
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Pectoralis major
And the axillary tail of the breast lays on the serratus anterior |
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What type of connective tissue surrounds the breast glands?
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Dense irregular CT
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What is the space between the breast tissue and the pec major called?
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The retromammary space (bursa)
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What is the name of the duct in the breast?
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Lactiferous duct
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What is the path of lactation?
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Alveoli-->
--> Intralobular ducts -->Interlobular ducts -->Lactiferous ducts --> Lactiferous sinus |
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What is significant about the histology of an actively lactating breast?
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Enlarged secretory lobules and lots of milk lipids!
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What is the dual mode of secretion of the breasts?
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Merocrine—proteins and carbs secreted by exocytosis of granules
Apocrine—milk fates secreted in large lipid droplets |
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Histologically what does an adult, quiescent mammary gland look like?
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Dark and collapsed
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Histologically what does an adult, active mammary gland look like?
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Light—> lipids!
Open, full, producing, distended lobules |
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What is colostrums?
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“First milk”
Produced at end of preggo - birth to 3-4 days after Very high in protein and antibodies, lower in fat and carbs |
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When is normal breast milk produced and what are its contents?
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~5 days after birth
Lower in protein and Igs High in fat and carbs |
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What controls mammary gland growth?
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Primarily—estrogen
(and various other growth factors) |
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What controls mammary gland secretion DURING pregnancy?
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Prolactin production is suppressed by estrogen and progesterone
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After birth, what happens to stimulate milk production?
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Temporary decrease in estrogen/progesterone
Prolactin INC - milk! |
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What does suckling do?
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Sends impulse to hypothalamus - activates adenohypophysis!
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What is the adenohypophysis?
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Anterior glandular lobe of the pituitary gland that secretes many hormones, including ACTH, prolactin, and somatotropin
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What is oxytocin?
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Mammalian hormone that acts primarily as a neuromodulator in the brain.
after stimulation of the nipples, facilitating breastfeeding. |
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How does oxytocin facilitate breastfeeding?
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Suckling - oxytocin stimulates myoepithelial cells to contract and eject milk
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Where do the arteries and veins of the breast originate/drain?
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Midline!
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Where do the lymphatics of the breast drain?
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Laterally
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What is the general pattern of lymphatic drainage throughout the body?
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Left head (L upper and lower lips), Left thorax, Left upper limb, Left AND Right abdomen and lower limbs
--> Thoracic duct Right head, right thorax, right upper limb ----->Right lymphatic duct |
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Where do lymphatic vessels drain?
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To veins or secondary nodes
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What are the lymphatic nodes of the chest?
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Axillary nodes (Lateral)
Pectoral nodes (lateral) Sternal nodes Parasternal nodes Intercostal nodes Mediastinal nodes Bronchomediastinal nodes |
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What are the axillary lymph nodes?
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Pectoral
Lateral Central Subscapular Apical |
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Where does most of the drainage of the upper limb travel?
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Initially - lateral nodes
Then -apical nodes |
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What are the normal lymph drainage patterns from the breast through the axillary nodes?
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Axillary nodes (pectoral, subscapular, apical)
- infraclavicular and suprclavicular nodes - subclavian nodes -thoracic duct or right lymphatic duct -Junction of brachiocephalic and jugular veins |
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How can breast cancer gain access to the ab cavity?
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Intercostal nodes - cistern chyli- thoracic duct
**Superficial abdominal nodes - external iliac nodes -internal iliac nodes - para-aortic nodes - cistern chyli - thoracic duct |
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What are some clinical signs of breast cancer?
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Skin dimpling
Retracted signs: -peau d’orange (edema of skin) -nipple retraction and deviation -abnormal contours |
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What is the origin of the pectoralis major?
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Clavicle
Anterior sternum Upper 6 costal cartilages (Aponeurosis of external oblique) |
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What is the insertion of the pec major?
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Lateral aspect of the intertubercular groove of the humerus
(bicipital groove) |
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What are the primary actions of the pec major?
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ADDUCTION and medial rotation of the humerus
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What are the secondary actions of the pec major?
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Forced inspiration
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What innervates the pec major?
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Lateral and medial pectoral nerves
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What are the pectoral nerves named for?
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Where they CAME from out of the brachial plexus
(NOT where they innervate) -lat nerves go medial -med nerves go lateral |
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Where is the coracoids process?
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Anterior scapula
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What is the origin of the pectoralis minor?
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3rd-5th ribs
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What is the insertion of the pec minor?
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Coracoid process
(anterior scapula) |
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What are the primary actions of the pec minor?
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Pull scapula inferior
Scapular protrusion |
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What is the secondary action of the pec minor?
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Forced inspiration
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What innervates the pec minor?
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Medial pectoral nerve
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What is the origin of the serratus anterior?
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Ribs 1-8
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What is the insertion of the serratus anterior?
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Anterior surface of medial border of scapula
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What are the primary actions of the serratus anterior?
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Protrusion and inferior rotation of the scapula
***Major muscle of scap protrusion!!! |
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What are the secondary actions of the serratuc anterior?
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Forced inspiration
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What innervates the serratus anterior?
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The long thoracic nerve
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Why do nerves usually run deep to muscle?
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For protection!
Long thoracic nerve runs on top of serratus anterior… |
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What can happen to the long thoracic nerve during a radical mastectomy?
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Damage- can’t protrude scapula - winged scapula!
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What is the superior attachment of the external intercostals muscles?
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Inferior margin of the superior rib
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What is the inferior attachment of the external intercostals muscles?
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Superior surface of the inferior rib
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When are the external intercostals muscles most active?
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Inspiration
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What innervates the external intercostals?
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Segmental branches of the thoracic ventral primary ramii (VPR)
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Where do the internal intercostals muscles run?
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Lateral edge of costal groove of superior rib
-superior surface of inferior rib DEEP to attachment of external intercostals |
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When are the internal intercostals active?
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Respiration
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Where do the innermost intercostals run?
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DEEP to internal intercostals
Medial edge of superior costal groove-internal aspect of the superior surface of the rib below |
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How do the innermost intercostals act?
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With the internal intercostals in respiration
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How do the intercostals run on the body?
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External—“hands in pockets”
Internal—perpendicular to external Innermost—with internal |
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What innervates all of the intercostals?
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Segmental branches of the thoracic VPR
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What are the subcostals?
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Run from internal surface of the lower ribs to the internal surface of the 2nd or 3rd ribs below them
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What is the possible function of the subcostals?
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Depress ribs
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What innervates the subcostals ?
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Segmental branches of the thoracic VPR
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Where does the transversus thoracis run?
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From lower margins and internal surfaces of costal cartilages of 2nd and 6th ribs
-inferior aspect of deep surface of body of sternum, xiphoid process and costal cartilages of 4-7 |
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What is the function of the transversus thoracis?
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Depress costal cartilages
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What is the innervation of the transverses thoracis?
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Segmental branches of the thoracic VPR
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What runs between the inner and innermost intercostals muscles?
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Intercostal arteries
Intercostal veins Intercostal nerves |
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Branches of what arteries supply the intercostals?
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Anteriorly:
--internal thoracic Posteriorly: --descending aorta |
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Branches of what veins drain the intercostals?
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Anteriorly:
--internal thoracic vein Posteriorly: --azygos and hmiazygos |
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What are the 3 apertures of the thoracic cavity?
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Superior thoracic aperture
Inferior thoracic aperture Axillary inlet |
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If a baseball player has weakness in his arm, what could be the problem?
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Arteries of arm are bein constricted!
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What runs through the subclavian triangle?
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Subclavians and brachial plexus
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What are the borders of the superior thoracic aperture?
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Posterior—body of T1 vert
Sides—medial margin of rib 1 Anterior—manubrium |
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What passes through the superior thoracic aperture?
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· trachea
thoracic duct apexes of the lungs nerves phrenic nerve vagus nerve Recurrent laryngeal nerves sympathetic trunks vessels arteries left and right common carotid arteries left and right subclavian arteries veins internal jugular veins brachiocephalic veins subclavian veins lymph nodes and lymphatic vessels |
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What are the borders of the Inferior thoracic aperture?
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Body of T12 (posterior)
rib 12 and distal end of rib 11 (sides) distal cartilaginous ends of ribs 7-10, xyphoid process (anterior) Diaphragm and its ligaments (bottom) |
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What structures pass through the inferior thoracic aperture?
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(from thorax - ab)
Inferior vena cava and esophagus, abdominal aorta and thoracic duct |
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What is the most likely aperture to become restricted?
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Axillary inlet
(triangular inlet on either side of superior thoracic inlet) Ex) baseball player |
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What are the borders of the axillary inlet?
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Posterior—superior margin of scapula
Anterior—clavicle Lateral—medial aspect of 1st rib Apex—medial margin of coracoids process Base—lateral margin of rib 1 |
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What runs through the axillary inlet?
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Brachial plexus, Long thoracic nerve, Axillary artery and vein, Axillary lymphatics (apical nodes)
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What is the parietal pleura innervated by?
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Phrenic and intercostals nerves
Feel somatic pain! |
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What innervates the visceral pleura?
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Autonomic plexi
-feel pressure, but not pain |
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T/F—since the right lung has 3 lobes, it is higher functioning than the left lobe.
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FALSE. They are about the same.
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What are the borders of the lungs?
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Apex—superior portion bulges thru thoracic inlet
Base—rests on diaphragm Mediastinal surface—adjacent to middle mediastinum Costal surface—contacts internal ribs |
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T/F—Both lungs have a middle fissure and an oblique fissure.
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FALSE.
Right lung has both, left lung only has oblique. |
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What does the horizontal fissure separate?
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Right lung:
Superior and middle lobes |
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What does the oblique fissure separate?
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Right and Left lungs:
Superior and inferior lobes |
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What does the left lung have that the right lung doesn’t?
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· Cardiac notch
Lingula |
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What is the hilum?
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Where the blood vessels and brochi enter the lungs
Left—Pulmonary artery is superior Right—Pulmonary artery is lateral |
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What areteries supply the parynchema of the pulmonary artery?
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Bronchial arteries
(branches of aorta and intercostals areteries) |
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Where do the bronchial veins drain?
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To azygous (RIGHT) and hemiazygous (LEFT) veins
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Where does the innervations of the lungs originate?
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Pulmonary plexi found on roots of lungs
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What is the parasympathetic innervation of the lungs?
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Parasymp fibers from X nerve
Ganglion cells are found in pulmonary plexi next to branches of bronchi |
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What is the sympathetic innervations of the lungs?
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From sympathetic trunks
Ganglion cells are in the paravertebral symp chain |
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What do parasympathetic signals cause in the lungs?
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Constriction of bronchial muscles
Vasodilation of pulm vessels Stim secretion in glands of bronchi (visceral afferent) -closes down lungs |
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What do sympathetic signals cause in the lungs?
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Inhib of bronchial muscles
Constriction of pulm vessels Inhibition of alveolar type II cells -Open up lungs |
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What travels with sympathetic fibers in the lungs?
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Nocioceptive impulses from the pleura and bronchi
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Where do pain impulses from the trachea travel?
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With the vagus nerve
(parasymp) |
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What is the lymph drainage of the superficial lung parynchema and visceral pleura?
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Bronchopulmonary nodes
-sup and inf tracheobronchial nodes -bronchomediastinal nodes -bronchomediastinal trunk |
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What is the lymph drainage of the deep lung parynchema and deeper bronchi?
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Pulmonary nodes along larger bronchi
-Bronchopulmonary nodes -sup and inf tracheobronchial nodes -bronchomediastinal nodes -bronchomediastinal trunk |
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What is the lymph drainage of the superficial lung parynchema and trachea?
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Paratracheal nodes
-bronchomediastinal nodes -bronchomediastinal trunk |
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What is the lymph drainage of the parietal pleura?
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Intercostal, parasternal, mediastinal, and phrenic nodes
-bronchomediastinal nodes -bronchomediastinal trunk |
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How does lung cancer easily spread?
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Lung cancer-->Trachea and bronchi nodes--> midline --> spinal column or vascular system
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What is pneumothorax?
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Collapsed lung
-puncture-air rushes in-pressure causes lung to collapse |
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What are the diaphragmatic apertures?
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-Caval
-Esophageal -Aortic |
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What is the caval aperture?
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Between T8 and T9
Contents: Inferior vena cava Right phrenic nerve Lymph vessels |
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What is the esophageal aperture?
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At T10
Contents: Esophagus Symp fibers Esophagus branches of left gastric vessels Ant and post vagal trunks Lymph vessels |
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What is the aortic aperture?
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Posterior to diaphragm at T12
Contents: Aorta Thoracic duct (azygous vein) |
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What is the phrenic nerve?
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--C3, 4,5 keep the diaphragm alive!
(efferent and afferent) --run on pericardium |
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What nerves give visceral pain in the diaphragm?
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Phrenic nerve
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What nerves give somatic pain in the diaphragm?
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Phrenic and intercostals nerves
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What accessory muscles are involved in active breathing?
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Scalenes, Pec major and minor, serratus anterior
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What muscles are involved in active exhalation?
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Abs
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Normally, what type of actions are inspiration and exhalation?
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Inspiration—active
Exhalation—passive |
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What happens during inhalation?
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Transverse diameter is INC by actions of intercostals as they elevate ribs at costovertebral and costosternal joints
Antero-posterior diameter is INC when intercostals raise ribs around costovertebral joints Bucket handle movement Vertical dimension INC as diaphragm contacts inferiorly |
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What muscles are involved in normal inspiration?
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Diaphragm and intercostals
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What muscles are involved in forced inspiration?
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Diaphragm, intercostals, scalene, sternocleidomastoid, pec major and minor, serratus anterior
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What muscles are involved in normal expiration?
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NONE. Passive.
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What muscles are used in forced exhalation?
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External and internal obliques
transverses thoracis and abdominus rectus abdominus |
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What is atelectasis?
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Collapse of part or all of a lung
Caused by bock of air passages or by pressure on the lung Risk factors: -Anesthesia -Prolonged bed rest w/few position changes -shallow breathing -tumors |
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In relation to joints, what must a muscle do to move a bone?
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It must cross a joint
-muscle works at any joint it crosses -what muscle does depends on where it crosses joint |
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What does the power of a muscle across a joint depend on?
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--Mass and size of musc
--Length of musc --where muscle attaches to bone in relationship to joint |
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What are some normal places where muscle attach to bones or redirect the actions of muscles?
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Depressions (fossae)
Elevations (tubercles, processes) |
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What 2 bone groups comprise the skeleton?
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Axial Skeleton—midline (skull, vert column, ribs and sternum)
Appendicular skeleton—rest of bones |
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What affects the flexibility and stability of a joint?
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--Structure of apposing bone
--ligaments that attach bones |
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In anatomical position, which way are the palms facing?
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Palms face anterior
Thumbs are lateral |
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What is flexion?
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Bending or decreasing the angle between body parts.
For the body as a whole, the vast majority of it is flexed when you are in the fetal position. |
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What is extension?
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straightening the body or making an increasing angle between parts of the body.
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What is abduction?
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moving a part of the body away from the median plane, and doing it in the coronal plane. -body is in the anatomical position, the upper limb is taken lateral and superior in an arcing type of motion.
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What is adduction?
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moving a part of the body from a lateral position in the coronal plane, back to the midline position.
-This is the opposite of abduction. |
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What is supination?
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only occurs around the radio-ulnar joint!
- When you are in the anatomical position, with the palm facing forward, your hand and forearm are in a supinated position. |
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What is pronation?
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the act of rotating the radius around the ulna, so that the palm is now facing posteriorly, is called pronation.
-opposite of suppination. |
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What is a joint?
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A place where 2 bones are joined
(usually for movt) |
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How are joints classified?
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According to their mobility
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What is a fibrous joint?
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--Some of least mobile
--Suture and syndesmosis joints |
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What is a suture joint?
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Fibrous joint!
Found between bones of skull Bones are grooved to fit closely- become glued together as single structure Ex) Coronal suture, Sagittal suture, lambdoid suture |
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What is a syndesmosis?
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--Fibrous joint!
--slightly mobile! 2 bones are spread apart and connected by series of CT fibers Ex) Radius and ulna, Tibia and fibia |
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What is the CT between the 2 bone of a syndesmosis called?
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Interosseous membrane
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What is a gomphosis?
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--FIBROUS joint!
--b/w tooth and alveolar bone, held together by PDL |
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What are 2 types of cartilaginous joints?
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(fibrocartilagenous—still relatively immobile)
-Synchondrisis -Symphysis |
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What is a synchondrosis?
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“Cartilagenous joint”
--normally = temporary joints -epiphyseal growth plates Long bone-cartilage-long bone -more bone grows around cartilage -when growth stops, cartilage disappears |
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What is a symphysis?
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“Fibrocartilagenous joint”
--partially moveable --opposing bones covered in articular cartilage w/fibrocartilage in b/w Ex) Pubic symphysis—pubic bones; bodies of vert and intervert disks; b/w 2 halves of mandible in fetus-fuses in 1st year of life |
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What is the most mobile of all joint types?
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Synovial
(most joints are this type) -some are relatively immobile, some are very mobile |
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What characteristics do all synovial joints have?
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1. Articular cartilage: like the symphysis, the two apposing bones are covered by articular cartilage.
2. Joint cavity - a space exists between the two bones. There is a lubricating fluid, synovial fluid, which is normally found in this space. 3. Capsular ligament (capsule) - surrounds the joint and attaches to both bones to enclose the joint cavity. 4. Synovial membrane: loose connective tissue highly supplied with blood and lymphatic vessels that lines the inner portion of the capsular ligament and secretes synovial fluid into the joint cavity. |
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What 2 synovial joints contain a meniscus in the joint cavity?
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(bit of fibrocartilage)
knee joint and TMJ |
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What are the 5 types of synovial joints?
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Plane joint
Ginglymus (hinge) joint Trochoidal (pivot) joint Condyloid joint Ball and socket joint |
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What is a plane joint?
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SYNOVIAL
-apposing surfaces are flat and movement occurs in only one plane (a sliding type of movement). Ex) Intercarpal joint |
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What is a ginglymus joint?
|
SYNOVIAL (hinge joint)
- allows movement around a single axis at right angles to the bones. Ex) Elbow (humero-ulnar) joint |
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What is a Trochoidal joint?
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SYNOVIAL (pivot joint)
- allows radial movement around a single axis. Ex) rotation of the head of the radius which produces pronation and supination at the radio-ulnar joint AND rotation between the 1st and 2nd vertebrae which results in turning the head. |
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What is a condyloid joint?
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SYNOVIAL
- a “ball and socket” type joint but movement can only occur in two planes (biaxial) Ex) metacarpophalangeal joints |
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What is a ball and socket joint?
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SYNOVIAL
- the most mobile of the joints allowing motion in all planes. Ex) Shoulder and hip joints |
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What is a bursa?
|
synovial membrane will form a closed sac-bursa.
-contains synovial fluid And, is located in areas that are liable to experience friction, such as between a muscle and bone, or a muscle and another muscle, or a tendon and bone, or between skin and muscle. Irritation-Bursitis. Typical near large joints such as the shoulder, hip, elbow and knee. |
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What are the actual muscles of the thoracic wall?
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Intercostal muscles
(between ribs) |
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What are the 3 types of intercostal muscles?
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External (hand in pocket)
Internal (perpendicular to external) Innermost (transverse, parallel to internal) -->subcostal -->transversus thoracis |
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What runs transversely between the internal and innermost intercostals?
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The intercostal arteries, veins, and nerves
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What do the anterior intercostal arteries branch from?
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Internal thoracic artery
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What do the posterior intercostal arteries branch from?
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Descending aorta
|
|
|
What veins drain the intercostals?
|
Anterior intercostal veins --> internal thoracic vein
Posterior intercostal veins --> azygos (right) or hemiazygos (left) veins |
|
|
What is the action of the external intercostals?
|
Elevate ribs during inspiration
|
|
|
What is the action of the internal and innermost intercostals?
|
Elevate ribs during inspiration
Depress ribs during expiration |
|
|
What are 3 small back muscles involved in respiration?
|
Levator cosatrum--elevate ribs for inspiration
Serratus posterior superior--elevate ribs for inspiration Serratus posterior inferior--depress ribs for exhale |
|
|
T/F--The lungs fill their respective sides of the thoracic cavity.
|
FALSE.
|
|
|
T/F--The superior aspect of the lungs lie just superior to the 1st rib and clavicle.
|
True!
|
|
|
What might happen if a person received a knife wound just above their clavicle?
|
Can result in direct lung damage and/or collapsed lung due to loss of intrathoracic pressure
|
|
|
What is notable about the primary bronchi?
|
The right comes of more steeply and is wider than the left
|
|
|
How many lobes does each lung have?
|
Right--3, Left--2
|
|
|
What are the 2 layers of lung pleura?
|
Visceral (thin, inner) and
Parietal (thicker) |
|
|
What is the pleural sac?
|
Space between visceral and parietal lung pleura
Filled with pleural fluid --> lubricate linings (stops sticking) -->cushion lungs as expand and contract |
|
|
What is pleuritis?
|
Excess of pleural fluid due to inflammation of the pleura --> can compress lungs and lead to discomfort and pain
|
|
|
What does the external aspect of the parietal pleura contact?
|
The inner aspect of ribs
Thoracic diaphragm |
|
|
T/F--Parietal Pleura does not directly follow visceral pleaura leading to the formation of recesses.
|
True! Excess fluid can accumulate here --> patient distress
|
|
|
Where is the costodiaphragmatic recess located?
|
Between the ribs and the diaphragm
|
|
|
Where is the costomediastinal recess located?
|
Between the ribs and the mediastinum
|
|
|
What do the pleural layers feel?
|
Parietal pleura--sensitive to pain
Visceral pleura--no pain, but sensitive to stretch and pressure |
|
|
T/F--The lungs have both voluntary and involuntary muscles.
|
FALSE! No involuntary!... Only voluntary
|
|
|
What happens to pressure in the pleural cavities during inspiration?
|
Pressure decreases by enlarging volume of cavities
So, high pressure external air rushes in to equalize pressure --> inhale |
|
|
What enlarges the pleral cavity vertically?
|
Diaphragm contracts inferior
|
|
|
What is the "bucket handle" movement?
|
Intercostal muscles raise ribs and swing them somewhat laterally
--> enlarge pleural cavity transversely |
|
|
What causes Anterior-Posterior enlargement of the pleural cavity?
|
When all of the ribs rise as a unit above the costovertebral joint
--> sternum moves ventrally --> enlarge thoracic cavity --> expansion of lungs --> air rushes in |
|
|
What is unforced inspiration?
|
Normal breathing
|
|
|
What is forced inspiration?
|
During exercise/stress, need more air --> use extra muscles
Scalenes raise rib 1 and 2 SCM raises sternum and clavicle In extreme cases: Pec major and minor and serratus anterior also help |
|
|
Is expiration usually active or passive?
|
Passive --> muscles of resp relax --> elastic recoil forces air out
|
|
|
What muscles are used in forced expiration?
|
Abs! (external and internal obliques, transversus and rectus abdominis)
--> contract- Raise press in abdomen And Diaphragm relaxes --> rise in intathoracic pressure --> force air out |
|
|
What innervates the thoracic diaphragm?
|
Phrenic nerve (C3,4,5) and intercostal nerves
--> inspire |
|
|
What innervates the intercostal muscles?
|
Segmental intercostal nerves
--> inspire |
|
|
What innervates the scalene muscles?
|
Ventral Primary rami C3-C8
--> inspire |
|
|
What innervates the SCM?
|
Accessory nerve
--> inspire |
|
|
What innervates the pec major?
|
Lateral and medial pectoral nerves
--> inspire |
|
|
What innervates the pec minor?
|
Medial pectoral nerve
--> inspire |
|
|
What innervates the external oblique, internal oblique, tranversus abdominus, and rectus abdominus?
|
Lower intercostal nerves
|
|
|
What structures are in the superior mediastinum?
(superior thorax-superior heart) |
--arch of the aorta
--ligamentum arteriosum --pulmonary and brachiocephalic trunks --subclavian and carotid arteries --branchiocephalic veins --superior vena cava --Thoracic and right lymphatic ducts --Trachea and bronchi --Vagus and phrenic nerves --sympathetic chain |
|
|
What structures are in the posterior mediastinum?
|
--Descending aorta
--Thoracic duct --Azygos and hemizygous veins --Esophagus --Sympathetic trunk -- splanchnic nerves (symp, pre-gang fibers) --Superior vena cava --Vagus nerve --intercostal vessels and nerves |
|
|
What structures are in the middle mediastinum?
|
--The heart
--Great vessels --Phrenic nerves --Main bronchi (root of lungs) |
|
|
What structures are in the anterior mediastinum?
|
Thymus, fat
|
|
|
What is unusual about the position of the heart?
|
It is suspended from the major vessels
(including aorta and pulm trunk) --> suspension allows it to move/change position |
|
|
Is the heart higher during inspiration or expiration?
|
Higher during expiration
Lower during inspiration |
|
|
What are the 2 types of pericardium?
|
Fibrous and serous
|
|
|
What is the fibrous pericardium?
|
Outter layer, sturdy, durable, can lift body without ripping
Continuous with thoracic diaphragm |
|
|
What is the serous pericardium?
|
Inner pericardium
2 layers with fluid filled space in b/w--pericardial sac |
|
|
What are the 2 layers of the serous pericardium?
|
Outter--parietal pericardium
Inner--visceral pericardium |
|
|
Which layer is very thin and closely applied to the heart?
|
Visceral pericardium
(usually not visible in dissections) |
|
|
How does the fluid in the pericardial sac function normally?
|
--To cushion the heart as it moves
|
|
|
In path (like pericarditis), what happens to the pericardial sac?
|
--Excess fluid is produced --> pressure on heart --> pain resembling heart attack
|
|
|
What are the 1st 2 major branches off the ascending aorta?
|
--Left and right coronary arteries --> supply blood to heart
|
|
|
What does blockage of coronary arteries or their branches result in?
|
--Ischemia and heart attack
|
|
|
What is the 1st major branch from the right coronary artery?
|
--Sinoatrial artery (blood to SA node)
|
|
|
As the right coronary artery travels posteriorly, what does it give off?
|
--right marginal artery (blood to right ventricle)
|
|
|
What is the terminal branch of the right coronary artery?
|
--posterior interventricular artery (travels in posterior interventricular space b/w external walls of R and L vents)
|
|
|
What is the 1st major branch of the left coronary artery?
|
--Anterior interventricular artery
(travels inferiorly in anterior interventricular sulcus) |
|
|
What is the other major branch of the left coronary artery?
|
--Circumflex artery
(travels around posterior heart and as right coronary artery gives of right marginal branch, the circumflex gives off left marginal branch) |
|
|
What are some of the notable anastamoses of the coronary arteries?
|
--anterior and posterior interventricular arteries
--circumflex and right coronary arteries (via margial branches) |
|
|
Where does all venous blood from the heart muscle ultimately drain?
|
--Right atrium
|
|
|
Before draining into the right atrium, where does most of the heart muscle's venous blood drain?
|
--Coronary sinus
|
|
|
What is the exception to this, which veins bypass the coronary sinus and drain directly into the right atrium?
|
--Anterior cardiac veins
(small veins on ant R atrium and R vent) |
|
|
What is the largest vein that drains into the cardiac sinus?
|
--The great cardiac Vein
|
|
|
What runs parallel with the great cardiac vein?
|
--anteriorinterventricular artery
|
|
|
What are the other major veins that drain into the coronary sinus and what areteries do they parallel?
|
--Middle cardiac vein runs with posterior interventricular artery
--small cardiac vein runs with right marginal artery |
|
|
In the right atrium, what separates the smooth and rigid wall areas?
|
--crista terminalis
|
|
|
Where are the smooth portions of the right and left atria from?
|
--Incorporated from surrounding veins
(vena cava) |
|
|
What is the rough part of the right atrium?
|
Musculi pectinati (pectinate musc)
--> dev with heart |
|
|
What structures are visible in the right atrium?
|
--crista terminalis
--opening of coronary sinus --valve of coronary sinus --fossa ovalis --orifice of Sup vena cava --orifice of inf vena cava --pectinate muscles --SA and AV nodes |
|
|
What is the right auricle and where is it located?
|
--external right atrium appendage
--abundance of endocrine cells that produce ANP |
|
|
What is ANP?
|
--Atrial natiuretic peptide
--powerful vasodilator, reduces bp |
|
|
T/F--ANP producing endocrine cells are only found in the right auricle.
|
FALSE! Scattered throughout the heart
|
|
|
Where does the thick interventricular septum thin out?
|
--just prior to atrial-ventricular septa
|
|
|
What is the right a-v valve?
|
--tricuspid valve
|
|
|
How are the cusps of the valves moved?
|
Papillary muscles pull on chordae tendonea (strong CT) that is attached to cusps
|
|
|
What is the left a-v valve?
|
--bicuspid valve, "mitral valve" (bishops miter)
|
|
|
How do the a-v valves function?
|
ventricle walls contract--> INC interventricular press --> push blood out
AND, as vent contract, papillary musc pull chordae tendonae--> tense cusps and pull together--> prevent blood regurgitation back into atrium |
|
|
What can cause a heart murmur?
|
--valve doesn't shut properly
--valvar insufficiency/infection (can lead to valve degen) |
|
|
What is endocarditis?
|
--Inflammation of internal lining of heart
(possibly from infection) --very serious, must tx quickly |
|
|
What is the cardiac plexus?
|
External innervation of heart
Bundle of nerve fibers... --symp (INC heart rate) --parasymp (DEC heart rate) |
|
|
Why is heart muscle considered myogenic?
|
Because it contracts without having to be stimulated by a nerve
|
|
|
What are the 4 layers of the anterior abdominal wall?
|
Superficial fascia, muscles, rectus sheath, deep fascia
|
|
|
What 2 layers make up the superficial fascia of the anterior ab wall?
|
Camper's fascia (fat)
Scarpa's fascia (dense irreg CT) |
|
|
What is scarpa's fascia?
|
Superficial fascia of LOWER ab wall
Dense irreg CT --> membranous backing that fuses laterally with deep fascia of leg Defines potential space that includes perineum and lower abdomen |
|
|
How do the abdominal muscles insert into to the abdominal midline?
|
Via aponeurosis--broad flat tendons
|
|
|
What is the linea alba?
|
The aponeurosis of the ab muscles (except rectus abdominis) insert into midline of abdomen --> these fibers interweave to form the linea alba
Runs from xyphoid process to pubic symphysis |
|
|
What are the 4 ab muscles?
|
External oblique (sup-lat to inf-med)
Internal oblique (inf-lat to sup-med) Transversus abdomisi (transverse) Rectus abdominis (vertical-->6 pack) |
|
|
What is the rectus abdominis?
|
Fibers run vertically from costal margin to pubic bonep
tendenous interuptions--> 6 pack Enclosed in sheath made up of aponeurosis of ab muscles |
|
|
What is the rectus sheath?
|
Sheath made up of aponeurosis of ab muscles that encloses the rectus abdominis
|
|
|
What is the arcuate line?
|
Indicates point in rectus sheath where there is a change in the composition of its layers
Halfway b/w umbilicus and pubic bone |
|
|
What is the composition of the rectus sheath above the arcuate line?
|
Apo of ext oblique--anterior wall
Apo of int oblique--splits to give anterior and posterior walls Apo of trasversus abdominis--posterior wall |
|
|
What is the composition of the rectus sheath below the arcuate line?
|
ALL apo is anterior!!
(posterior wall is transversalis fascia) |
|
|
Where is the abdominal wall weakest?
|
Below the arcuate line
|
|
|
What does the deep fascia of the anterior ab wall consist of?
|
Transversalis fascia
(deep fascia of transversus muscle) Extraperitoneal fat Peritoneum |
|
|
What is the inguinal region?
|
-Inferior portion of anterior ab wall
-Includes inguinal triangle -Important b/c some muscle layers abent --> weakened wall |
|
|
What is the inguinal triangle?
|
-"Hesselbach' triangle"
-In the inguinal region of ant ab wall -Inferior border--inguinal ligament -Medial border--rectus abdominis -Lateral border--inferior epigastric vessels **direct hernia through this** |
|
|
What is the inguinal ligament?
|
Thickened inf apo border of external oblique
|
|
|
What does the inguinal ligament attach to?
|
Anterior superior iliac spine and pubic tubercle
|
|
|
What is the superficial inguinal ring?
|
Medial opening of inguinal canal formed in external oblique muscle
|
|
|
What are the crura?
|
Lateral and medial fibersthat surround superficial ring
|
|
|
What are the intercrural fibers?
|
Fiber arching over the superficial ring between the crura
|
|
|
What is the lacunar ligament?
|
Inguinal ligament fibers that diverge and attach pecten pubis
--> reinforce underside of inguinal ligament |
|
|
What is the reflex of the inguinal ligament?
|
Some inguinal lig fibers travel superomedially too blend with linea alba
|
|
|
What is the conjoint tendon?
|
Fused tendons of internal oblique and transversus abdominis
|
|
|
What is the inguinal canal?
|
Oblique passagway thru ant ab wall
~2.5cm (ducts, vessels, and nerves associates with organs of reprod travel through) |
|
|
Where is the inguinal canal located?
|
Parallel to and immediately superior to the medial half of the inguinal lig
Begins at deep inguinal ring (dimple in transversalis fascia) --> inferomedial to superficial ring |
|
|
How is the inguinal canal formed in utero?
|
With movement of processus vaginalis (an evagination of peritoneum) thru the dif layers of the ab wall
|
|
|
In males, what is significant about the inguinal canal?
|
Testes descend from abdomen into scrotum thru it
|
|
|
T/F--Since women have ovaries, they do not have an inguinal canal.
|
FALSE! Women do have inguinal canal, but ovaries do not pass thru it.
|
|
|
What are the boundaries of the inguinal canal?
|
Floor--inguinal lig
Roof--internal oblique, transversus abdominis Ant wall--internal and external oblique Post wall--Transversalis fascia, conjoint tendon Lat opening--deepinguinal ring Medial opening--superficial inguinal ring |
|
|
What are the contents of the inguinal canal in a MALE?
|
Spermatic cord**
(ductus deferens, defrential artery, pampiniform plexus, testicular artery, genital branch of genitofemoral nerve [L1,L2], lymphatics, ilioinguinal nerve) |
|
|
What are the contents of the inguinal canal in a FEMALE?
|
Round ligament of the uterus**
(ilioinguinal nerve, genital branch of genitofemoral nerve, remnants of ab wall layers) |
|
|
Where do the undifferentiated gonads form?
|
-On posterior ab wall
-gonadal blood vessels enter at superior pole -gubernaculum attaches to inferior pole |
|
|
What is the gubernaculum?
|
-Fibrous cord that attaches to inferior pole of gonad and what will become scrotum or labia majus
-Traverses ab muscle wall |
|
|
In utero, when does the processus vaginalis evaginate and begin to form the deep inguinal ring?
|
During 4th month in utero
(pushes out against transversalis fascia--> defect in wall) |
|
|
What happens with reguard to the processus vaginalis in the 4th month in utero?
|
Pushes out against transversalis fascia creating deep inguinal ring
--> travels inferomedially (following gubernaculum) --> passes thru opening in external oblique musc creating superficial inguinal ring and catching/pulling some internal oblique musc and fascia with it …The passage way formed = inguinal canal |
|
|
Where is the processus vaginalis by the END of 4th month IU?
|
The processus vaginalis (and layers pushed ahead of it) reach bottom of scrotum/labia majora
|
|
|
What happens to the testes between 5 and 9 months in utero then birth?
|
Testes descend
(due to diff growth and testosterone) Gonadal vessels elongate --> usually testes descended into scrotum by brith -->skin muscle and fascial layers derived from ab wall cover the testes and spermatic cord |
|
|
What happens to the ovaries between 5 and 9 months in utero, then birth?
|
Ovaries do not descend entirely, remain in pelvic cavity
--> gubernaculum turns into the round ligament of the uterus by birth -->the layers surround the round lig but fuse together and disappear (usually in inguinal canal) |
|
|
What the round ligment of the uterus?
|
Female gubernaculum --> fibrous CT --> round ligament of uterus
Connects lateral uterus to skin of labia majorum |
|
|
Which type of inguinal hernia is congenital and which is acquired?
|
Indirect inguinal hernia—congenital
Direct inguinal hernia--acquired |
|
|
T/F--Indirect inguinal hernias are more common in MEN.
|
True!
|
|
|
What is an indirect inguinal hernia?
|
Continuity b/w ab cavity and scrotum
-->intestines protrude and herniate into scrotum (hernial sac exits abdomen thru deep inguinal ring lateral to the inferior epigastric vessels) **hernial sac takes same route as testes did during descent |
|
|
What is a direct inguinal hernia?
|
Results from weakness of ant ab wall in inguinal triangle
INC ab press pushes intestines thru peritoneum and transversalis fascia --> exits thru superficial inguinal ring (hernial sac exits abdomen medial to inferior epigastric vessels) **hernial sac rarely descends into scrotum |
|
|
How does a direct inguinal hernia present clinically?
|
Bulge in lower ab wall
|
|
|
Who commonly gets direct inguinal hernias?
|
Men, but women more and more frequently
|
|
|
What is a femoral hernia?
|
ACQUIRED!
Results from weak ab wall and continuity of transversalis fascia w/femoral sheath (surrounds large vessels of thigh) --> loop of gut may protrude below inguinal lig into anterior thigh |
|
|
Who most commonly gets femoral hernias?
|
WOMEN.
|
|
|
What are the main organs of the abdominal cavity?
|
Liver, spleen, stomach, pancreas, small intest, large intest, kidneys, rectum, anus
|
|
|
If the anterior abdominal wall was removed, what structures would be clearly visible?
|
Liver, Stomach, transverse colon, greater omentum.
|
|
|
What lies under the greater omentum?
|
Small and large intestines
(hangs from transverse colon) |
|
|
What is a double layer peritoneum called?
|
A mesentery or a ligament
|
|
|
What are organs found behind the peritoneum called?
|
Retroperitoneal
(vertebrae, kidneys, major vessels) |
|
|
What are organs suspended in the ab cavity via a mesentary or ligament called?
|
Peritoneal
(stomach, liver) |
|
|
What are organs that begin as peritoneal but come to lie against the posterior wall called?
|
Secondarily peritoneal
(ascending colon, descending colon, pancreas, part of duodenum) |
|
|
T/F--Initially, the majority of abdominal structures are bound by both ventral and dorsal mesenteries, but during fetal development, the ventral mesentery stretches and mostly dissolves.
|
True.
(exception--falciform ligament) |
|
|
What is the falciform ligament?
|
Part of ventral messentery that doesn’t dissolve
Liver --> anterior body wall |
|
|
Which way do the stomach and the liver rotate?
|
Clockwise
|
|
|
What grows in the mesentery between the stomach and the posterior body wall?
|
Spleen
|
|
|
At what point are the greater and lesser sacs formed?
|
After liver and stomach rotation and after spleen growth
|
|
|
What are the borders of the lesser sac?
|
Post--posterior body wall
Ant--Stomach, lesser omentum Left—spleen Right—epiploic foramen Sup--liver and thoracic diaphragm Inf—transverse mesocolon |
|
|
What is an omentum?
|
Membrane composed of 4 layers
(2 adjacent mesenteries/ligaments) |
|
|
What is the lesser omentum?
|
4 layer membrane b/w liver and stomach
-Gastrohepatic ligament -Gastroduodenal ligament |
|
|
What ligament connects the stomach and the spleen?
|
Gastrosplenic ligament
|
|
|
What ligament connects the spleen and the kidneys?
|
Lienorenal ligament
|
|
|
What structures travel within the lesser omentum?
|
-Portal vein
-Proper hepatic artery-Common bile duct -lymphatics and ANS nerves |
|
|
What structures form the posterior border of the greater sac?
|
-lesser omentum
-stomach -transverse colon -posterior body wall |
|
|
What is the epiploic foramen of Winslow?
|
Hole that allows access from greater sac into lesser sac
|
|
|
Does the lower abdominal tract rotate during development?
|
YES! Small and large intestines rotate so rapidly they can't be retained in fetal ab cavity.
|
|
|
How does the lower ab tract manage its rapid rotating development?
|
They herniate into umbilical cord
--> as re-enter ab cavity--> rotate |
|
|
What forms the axis around which the small and large intestines rotate as they re-enter the ab cavity?
|
Superior mesenteric artery
(main aortic branch that serves them) |
|
|
What is the rotation of the lower ab tract?
|
270deg counterclockwise
|
|
|
Where does the area that will become the cecum begin?
|
Area just to the hindgut side of the yolk sak begins on the posterior wall
|
|
|
As the process of rotation completes, where should the cecum be located?
|
Inferior aspect of right side of abdomen
|
|
|
What is attached to the cecum?
|
Appendix
|
|
|
What is important about the possibility of mis-rotation of the intestines?
|
Cecum and appendix could be almost anywhere in the ab cavity
(appendicitis) |
|
|
How does the greater omentum develop?
|
A 2 layer memb descends from stomach
--> as it passes transverse colon --> posterior part becomes affixed --> 4 layers --> omentum! |
|
|
What often complicates abdominal dissection with respect to the greater omentum?
|
It is rarely normal!
Trauma, cancer, infection… May be large/small/absent May adhere to structures in abdomen |
|
|
What are the 3 basic primordia that the gut develops from?
|
Foregut, midgut, hindgut
|
|
|
What are the structures of the foregut?
|
Pharynx, esophagus, stomach, liver, gall bladder, 1st third of pancreas (head), duodenum (before bile duct)
|
|
|
What are the structures of the midgut?
|
2/3 of Duodenum, jejunum, ileum, appendix, cecum, ascending colon to midpoint of transverse colon
|
|
|
What are the structure of the hindgut?
|
Distal half of transverse colon, descending colon, sigmoid colon, rectum, anus
|
|
|
What are the 3 major arterial branches that supply the abdomen?
|
Celiac trunk (foregut)
Superior mesenteric artery (midgut) Inferior mesenteric artery (hindgut) |
|
|
What are the 3 main branches of the celiac artery?
|
Left gastric artery
Common hepatic artery Splenic artery |
|
|
What branch does the left gastric artery give off?
|
Esophageal branch
|
|
|
What does the esophageal branch of the left gastric artery anastamose with?
|
Esophageal branches off of the descending aorta
(in inferior thorax) |
|
|
After giving of esoph branch, what does the left gastric artery anastamose with?
|
The right gastric artery!
(of descending aorta) (on superior stomach) |
|
|
What are the branches of the splenic artery?
|
To spleen, to pancreas, to stomach
AND gastroepiploic branch (travels inferiorly) |
|
|
What does the left gastroepiploic artery anastamose with?
|
The right gastroepiploic artery (inferior stomach)
|
|
|
What are the branches of the common hepatic artery?
|
Gastroduodenal
Proper hepatic (right gastric--from common hep art OR proper hep art) |
|
|
What are the branches of the gastroduodenal artery?
|
-Right gastroepiploic artery
-Anterior Superior pancreaticoduodenal artery -Posterior Superior pancreaticoduodenal artery |
|
|
What do the 2 superior pancreaticoduodenal arteries anastamose with?
|
The inferior pancreaticoduodenal arteries
(off superior mesenteric artery) --> ANASTAMOSES b/w CELIAC and SUP MESENTERIC ARTERIES! |
|
|
What do branches of the superior mesenteric artery supply?
|
Small intestine, appendix, cecum, ascending colon, prox half of transverse colon
|
|
|
What are the 3 branches of the superior mesenteric artery that supply the large intestine?
|
Iliocolic artery
Right colic artery Middle colic artery |
|
|
What do branches of the inferior mesenteric artery supply?
|
Distal half of transverse colon, descending colon, sigmoid colon, rectum
|
|
|
What are the main branches of the inferior mesenteric artery?
|
Left colic artery
Sigmoidal artery Superior rectal artery |
|
|
What does the superior rectal artery anastamose with?
|
Branches of middle and inferior rectal arteries
(internal iliac artery branches) --> ANASTAMOSES b/w INF MESENTERIC and INTERNAL ILIAC |
|
|
What is the entire anastomotic network of arteries traveling around the inner aspect of the large intestines called?
|
Marginal Artery of Drummond
|
|
|
What are the 2 ways in which venous blood can drain from the abdomen?
|
Via the portal system (main)
Via the caval system |
|
|
What is the pathway of the portal system?
|
Abdomenal venous blood --> portal vein --> liver --> hepatic veins --> inferior vena cava
|
|
|
What is the pathway of the caval system?
|
Abdomenal venous blood--> systeic veins --> superior or inferior vena cava
|
|
|
What are the 2 major veins that drain into the portal vein?
|
Splenic vein
Superior mesenteric vein (Inferior mesenteric vein--drains into portal or sup mes vein) |
|
|
What is significant about blood that is drained via the portal system?
|
Can be detoxified by liver
|
|
|
What is the porto-caval anastamoses?
|
Capability of blood from abdomen to drain into either portal or caval systems
4 of them to know… |
|
|
What is the porto-caval anastamoses in the esophagus?
|
Blood from esoph can drain into esophageal veins --> portal veins [PORTAL]
OR Blood from esoph--> esoph veins --> azygos vein- superior vena cava [CAVAL] |
|
|
What is the porto-caval anastamoses in the descending colon?
|
Left colic veins- inf mesenteric vein-portal vein [PORTAL]
OR Retroperitoneal veins -inferior vena cava [CAVAL] |
|
|
What is the porto-caval anastamoses in the rectum?
|
Blood from rectum--> superior rectal veins--> inf mesenteric vein --> splenic vein--> portal vein [PORTAL]
OR Blood from rectum--> rectal veins--> internal iliac vein --> common iliac vein [CAVAL] |
|
|
What is the porto-caval anastamoses in the in the umbilicus?
|
Blood from umbilicus--> epigastric branches on ant ab wall --> external iliac vein --> common iliac vein [CAVAL]
OR Blood from umbilicus --> paraumbilical vein --> portal vein [PORTAL] |
|
|
What gives sympathetic innervation to the abdomen?
|
Sympathetic trunk
(descends thru ab cavity, follows anterior border of psoas muscle, runs on vertebrae and intervertebral disks) |
|
|
Where is the right sympathetic trunk located?
|
Posterior to the inferior vena cava
|
|
|
What is the right sympathetic trunk crossed by?
|
The right renal artery
|
|
|
What is the left sympathetic trunk crossed by?
|
Left renal vessels
Left testicular artery Inferior mesenteric artery |
|
|
How does the sympathetic trunk function?
|
Each trunk recieves white ramus from 2 or 3 lumbar nerves
Each trunk send one more gray ramus to each of the 5 lumbar nerves --> send signal to plexi throughout abdomen near organs |
|
|
What are 3 of the main sympathetic plexi in the abdomen?
|
Celiac, mesenteric, hypogastric
(also plexi near bladder and reprod organs) |
|
|
What is the parasympathetic innervation to the abdomen?
|
Both vagus nerves pass thru celiac plexus and distribute throughout abdominal viscera up to midpoint of transverse colon
Fibers from splanchnic nerves ascend to cover rest of ab and pelvic viscera (also, parasymp fibers travel to plexi near bladder and reprod organs) |
|
|
How does lymphatics flow in the abdomen and pelvis?
|
Retrorgrade
(via lymph channels that run on arteries named by which organ they supply) |
|
|
What are the 2 major lymphatic vessels of the abdomen?
|
External iliac vessels (ab wall)
Internal iliac vessels (ab and pelvic contents) |
|
|
What is the lymphatic drainage pattern of the abdomen?
|
External/Internal iliac --> right/left para-ortic or lumbar nodes --> cisterna chyli
|
|
|
What is the cysterna chyli?
|
Dilated sac at lower end of thoracic duct into which lymph from intestinal and 2 lumbar trunks drain
|
|
|
Where does lymph from the ascending colon travel?
|
Right colic nodes --> superior messenteric nodes --> para-aortic nodes
|
|
|
What happens to lymph drainage if an organ is served by branches of more than one artery?
|
Drainage can be by more than one pathway!
Ex) pancreas lymph --> superior mesenteric AND celiac trunk nodes |
|
|
What travels in the fibrous pericardium?
|
Phrenic nerve
|
|
|
Where does the vagus nerve run?
|
Down the arch of the aorta
|
|
|
What branch does the vagus nerve give off posterior to the ligamentum arteriosum?
|
Recurrent laryngeal nerve
(motor and sensory to larynx) Branches level T4/T5 Runs up the esophagus |
|
|
What might a left side cough indicate?
|
Aortic aneurism that is irritating the recurrent laryngeal nerve
|
|
|
What is the relationship between the azygos vein and the right hilum?
|
Azygos vein arches over right hilum
|
|
|
What nerve is medial to the azygos vein?
|
Phrenic nerve
|
|
|
What nerve runs posterior to the azygos vein?
|
Vagus nerve
|
|
|
Where does the right recurrent laryngeal nerve run?
|
Around the right subclavian artery
|
|
|
What runs along the thoracic duct?
|
-Descending thoracic aorta
-Esophagus -Spinal cord …malignant cells leaving the thoracic duct can enter any of these |
|
|
What comes of the sympathetic chain and goes MEDIAL?
|
Splanchnic nerves
|
|
|
What comes by deep to the sympathetic chain then goes LATERAL?
|
Intercostal nerves
|
|
|
Where does the azygos vein drain?
|
Superior vena cava
|
|
|
Where does the hemiazygos vein drain?
|
-Azygos
-Left subclavian …more variable than azygos. |
|
|
What runs just lateral to the thoracic duct?
|
Azygos vein
|
|
|
What is the sternocostal surface of the heart?
|
-Anterior aspect
-almost totally overlapped by lungs |
|
|
What is the diaphragmatic surface of the heart?
|
-Rests on diaphragm, doe NOT adhere to it
|
|
|
What is the base surface of the heart?
|
-Posterior surface composed almost entirely of left atrium and left ventricle
|
|
|
What is the apex surface of the heart?
|
Inferior aspect of heart formed by the left ventricle
|
|
|
What are the layers of the pericardium and heart starting from the most superficial and going deep?
|
-Fibrous pericardium
-Parietal layer of serous pericardium -Pericardial cavity -Visceral layer of serous pericardium (epicardium) -Myocardium (heart) -Endocardium (heart) |
|
|
What innervates the pericardium?
|
-Phrenic nerves
-Vagus nerves -Sympathetic trunks |
|
|
Where is the transverse sinus?
|
Between the aorta and pulm artery (Anterior)
And the right atrium and superior vena cava (POSTERIOR) |
|
|
Where is the oblique sinus?
|
Posterior to heart
Anterior to fibrous pericardium |
|
|
Where do the coronary arteries originate?
|
Behind the aortic semilunar valves
|
|
|
All of the cardic veins drain directly into the coronary sinus accept which one?
|
è Anterior cardiac veins
drain directly into right atrium |
|
|
What is the fossa ovalis?
|
Remnant of foramen ovale,
on smooth part of right atrium |
|
|
Where are the pectinate muscles in the right atrium?
|
Rough part of wall
|
|
|
What are the trabeculae carne?
|
Muscles in ventricle walls
(NOT papillary muscles) |
|
|
What is the septomarginal trabecula?
|
Muscle going from intraventricular wall over to papillary muscles
shortens time for signal to reach anterior cusp |
|
|
How many sets of papillary muscles are in each ventricle?
|
Right—3 (tricuspid valve)
Left—2 (mitral valve) |
|
|
What structures are visible in the right atrium?
|
--crista terminalis
--opening of coronary sinus --valve of coronary sinus --fossa ovalis --orifice of Sup vena cava --orifice of inf vena cava --pectinate muscles --SA and AV nodes |
|
|
What are important structures in the right ventricle?
|
-Trabeculae carnae
-Tricuspid valve -Cusps of valves -papillry muscles -Pulmonary valve -Septomarginal trabecula |
|
|
How does blood flow from the Right atrium to the right ventricle?
|
Passively and/or by gravity
|
|
|
What is the most important structure in te left atrium?
|
Entry of pulm veins
|
|
|
What are some important structures in the left ventricle?
|
-Trabeculae carne
-Mitral valve -Chordae tendinae -Papillary muscles -Cusps of AV valve --Aortic valve |
|
|
What is the pattern of fetal blood circulation?
|
Right atrium- foramen ovale - left atrium - left ventricle - aorta (MOSTLY)
If blood goes to right ventricle - pulmonary trunk - ductus arteriosus- aorta |
|
|
What is the fetal shunt around the liver?
|
Ductus venosus
|
|
|
What do the ductus venosus and ductus arteriosus turn into after birth?
|
Ductus venosus- ligamentum teres hepatus
Ductus arteriosus - ligamentum arteriosum |
|
|
What do the umbilical arteries turn into after birth?
|
--Superior vesical arteries
--Medial umbilical ligament |
|
|
What are the cusps of the pulmonary valve?
|
Aterior, right, and left
|
|
|
What are the cusps of the aortic valve?
|
Posterior, right, and left
|
|
|
What are the cusps of the tricuspid valve?
|
Anterior, Septal/medial, Posterior
|
|
|
What are the cusps of the mitral valve?
|
Anterior (aortic) and posterior
|
|
|
What happens during diastole?
|
Filling—ventricles are relaxed:
Close aortic valve Close Pulm valve Open tricuspid valve Open mitral valve |
|
|
What happens during systole?
|
Emptying—ventricles contract:
Close mitral valve Close tricuspid valve Open pulm valve Open aortic valve |
|
|
What is normal BP?
|
Sys =less than 120mmHg
Dys=less than 80 mmHg |
|
|
What is pre-high BP?
|
120-139 / 80-89
|
|
|
What is stage 1 high BP?
|
140-159 / 90-99
|
|
|
What is stage 2 high BP?
|
160+ / 100+
|
|
|
Where do you ascultate valve sounds?
|
-Atrial—right of sternum under 2nd rib
-Pulm—left of sternum under 2nd rib -Tricuspid—left costosternal joint of rib 5/6 -Mitral—left of sternum under 5th rib (distal and slightly belo tricuspid auscultation point) |
|
|
How many cervical spinal nerves are there?
|
8
|
|
|
How many cervical vertebrae are there?
|
7
|
|
|
What is the extrinsic innervations of the heart?
|
--Cardiac plexus (parasymp and symp)
---Fibers from X (parasymp) --Splanchnic nerves—(C8),T1-T6 (symp and afferent) |
|
|
What is the cardiac plexus?
|
Symp and parasymp fibers
Found on inferior aortic arch border anterior to bifurcation of trachea |
|
|
What are the splanchnic nerves?
|
Carry preganglionic sympathetic fibers from T1-T6
Also carry afferent fibers from T1-T6 and sometimes C8 |
|
|
During a heart attack, why is there sometimes referred pain down the left arm?
|
C-8 and T-1 dermatome
(afferent innervation) |
|
|
What is the intrinsic innervations of the heart?
|
SA node- atrial walls and AV node- bundle of His- septomarginal band and right and left fasiculus - purkinje fibers - contraction
|
|
|
What is the bundle of His?
|
(AV bundle)-- collection of heart muscle cells specialized for electrical conduction that transmits the electrical impulses from the AV node to the point of the apex of the fascicular branches
|
|
|
What are purkinje fibers?
|
Located in the inner ventricular walls of the heart, just beneath the endocardium.
Specialized myocardial fibers that conduct an electrical stimulus or impulse that enables the heart to contract in a coordinated fashion. |
|
|
What is the mitral valve disease?
|
1) Mixture of stenosis and incompetence of valve- regurgitation of blood from L vent to L atrium
Can result in: Left vent hypertrophy INC pulm venous pressure Pulm edema Difficulty breathing Enlargement (dilation) and hypertrophy of left atrium |
|
|
What are the 4 most common congenital heart defects?
|
1) Atrial septal defect
Ventricular septal defect Persistent ductus arteriosus Tetralogy of fallot |
|
|
What is the tetralogy of fallot?
|
- Pulmonay valve stenosis
(narrowing of the pulomnary artery) - Overriding aorta (blood from right and left ventricle can enter the aorta) - Hypertrophic right ventricle (abnormal growth of the right ventricle because more and more blood is being pushed to the lungs since the blood has less oxygen seeen deoxygenated blood is entering the aorta due to overriding aorta.) - Persistent ductus arteriosus (remains open thus blood from right atrium bypasses the lungs.) |
|
|
What are the 9 sections of the abdomen?
|
--Hypochondriac (R and L)
--Latural/Lumbar (R and L) --Inguinal/Groin (R and L) --Epigastric --Umbilical --Pubic/hypogastric |
|
|
What composes the iliac crest?
|
--Inner lip
--Intermediate zone --Tuberculum --Outer lip |
|
|
Where does the inguinal ligament attach?
|
--Anterior superior spine
--Pubic tubercle |
|
|
What is the shape of the pubic arch of the pelvis?
|
Male---U shaped (wider)
Female—V shaped (narrower) |
|
|
What are the layers of the abdominal wall from the outside in?
|
Skin
Superficial fascia Camper’s fascia (Adipose) Scarpa’s fascia (Dese Irreg CT) External oblique Internal oblique Transversus abdominis Transversalis fascia Extraperitoneal fat Peritoneum |
|
|
What is different about the superficial fascia in the face and the abdominal wall?
|
Face—adipose mostly
Ab wall—2 layers, adipose and dense irreg CT |
|
|
What are the 2 layers of the superficial fascia?
|
Camper’s fascia—fatty layer
Scarpa’s fascia—membranous layer -fuses with fascia lata |
|
|
What is the origin of the external oblique?
|
Lower 8 ribs
|
|
|
What is the insertion of the external oblique?
|
--Iliac crest
--Aponeurosis of ant ab wall --Tendinous insertion into iliac crest -Inferior border = inguinal ligament |
|
|
What is the innervations of the external oblique?
|
VPR of T7-T11
Subcostal nerve |
|
|
What is the origin of the internal oblique?
|
--Thoracolumbar fascia
--Iliac crest --inguinal ligament |
|
|
What is the insertion of the internal oblique?
|
--costal margin
--linea alba --conjoint tendon |
|
|
What is the conjoint tendon?
|
Combined insertion of transverses abdominis and internal oblique into the pubic crest and pectineal line
Forms a part of aponeurosis of the rectus sheath |
|
|
What is the innervation of the internal oblique?
|
VPR of lower 6 thoracic nerves and upper lumbar nerves
|
|
|
What is the origin of the transverses abdominis?
|
--Thoracolumbar fascia
--iliac crest --inguinal ligament --lower costal cartilages |
|
|
What is the insertion of the transverses abdominis?
|
--Linea alba
--Part of aponeurosis of the rectus abdominis |
|
|
What is the innervations of the transverses abdominis?
|
VPR of lower 6 Thoracic nerves and upper lumbar nerves
|
|
|
What is the origin of the rectus abdominis?
|
--Costal margin
--Xiphoid process --lower thoracic cage |
|
|
What is the insertion of the rectus abdominis?
|
--Rectus sheath
--Pubis |
|
|
What is the innervation of the rectus abdominis?
|
VPR of lower 6 thoracic spinal nerves
|
|
|
What does the inferior epigastric artery branch from?
|
External iliac artery
|
|
|
What does the inferior epigastric vein drain into?
|
External iliac vein
|
|
|
What arteries anastamose in the anterior ab wall?
|
Internal thoracic art
Intercostal arteries Sup epigastric art Musculophrenic art Inf epigastric artery Deep circumflex iliac art Superficial circumflex iliac art |
|
|
Where does a DIRECT inguinal hernia emerge from the ab cavity relative to the epigastric vessels?
|
Direct hernia—MEDIAL
|
|
|
Where does a INDIRECT inguinal hernia emerge from the ab cavity relative to the epigastric vessels?
|
Indirect hernia—LATERAL
|
|
|
What do the Thoracoabdominal nerves supply?
|
(T7-T11)
--supply muscles of anterior lateral abdominal wall and overlying skin |
|
|
What do the VPR of T7-T9 innervate?
|
Skin of right and left hypochondriac regions
|
|
|
What does the subcostal nerve innervate?
|
(T12)
--muscles of anterolateral ab wall and skin superior to iliac crest and inferior to umbilicus |
|
|
What does the iliohypogastric nerve innervate?
|
(L1)
--Skin overlying iliac crest and upper inguinal and hypogastric regions --internal oblique and transverses abdominis muscles |
|
|
What does the Ilioinguinal nerve innervate?
|
(L1)
--Skin of lower inguinal region, external genitalia, medial thigh --Internal oblique and transverses abdominis muscles |
|
|
What are the boundaries of the inguinal canal?
|
--Medial entrance—superficial ring
--Lateral entrance—deep inguinal ring --Roof—arches of conjoint tendon --Floor—medial half of inguinal ligament --Anterior wall—external oblique --Posterior wall—conjoint tendon and transversalis fascia |
|
|
What often happens to females in their 1st pregnancy with regards to the inguinal canal?
|
Stretches out! May be painful
(similar to appendicitis but no fever or constipation) |
|
|
What is the descent of the testes?
|
--Testes dev on posterior ab wall
--path is determined by gubernaculum --Descent begins in 7 month IU --descent complete at birth |
|
|
When does the processus vaginalis begin to protrude?
|
è (peritoneum evaginates)—2nd-3rd month IU
Fully evaginated by 4th month |
|
|
In the female, what does the gubernaculum attach to?
|
The uterus
Round ligament of the uterus Round ligament of the ovary |
|
|
T/F—Lymph drainage of the testis is the same as that of the scrotum.
|
FALSE!
|
|
|
What is the lymph drainage of the testis?
|
Intitial spread to retroperitoneal lumbar nodes, then to mediastinal and supraclavicular nodes
-can spread throughout body to lungs, liver, brain, boe |
|
|
What is the lymph drainage of the scrotum?
|
Initial spread to superficial inguinal nodes
|
|
|
What is cryptorchidism?
|
Failure of testes to properly descend
--higher rate of testicular cancer (high temp) |
|
|
What is a hydrocele?
|
A collection of watery type fluid around the testis
(fluid accumulation in the cavity of the tunica vaginalis) |
|
|
What happens in an indirect inguinal hernia?
|
Herniated loop of intestine enters scrotac sac via patent processus vaginalis
|
|
|
What is the femoral sheath a continuation of?
|
Transversalis fascia
|
|
|
How does a femoral hernia present?
|
Buldge on lower lateral anterior abdomen
|
|
|
How many costal cartilages are there?
|
10
|
|
|
What protects the upper abdominal viscera?
|
Thoracic cage (ribs 5-10)
|
|
|
What supports and protects the lower abdominal viscera?
|
Greater pelvis
|
|
|
What are the contents of the Right Upper Quadrant of the abdomen?
|
Right lobe of liver
Gallbladder Pylorus of stomach Duodenum Head of pancreas Right suprarenal gland Right kidney Right colic (hepatic) fixture Superior part of ascending colon Right half of transverse colon |
|
|
What are the contents of the Left upper quadrant of the abdomen?
|
Left lobe of liver
Spleen stomach jejunum and prox ileum body and tail of pacreas Left suprarenal gland Left kidney Left colic (splenic) fixture Left half of transverse colon Superior part of descending colon |
|
|
What are the contents of the Right lower quadrant of the abdomen?
|
Cecum
Vermiform appendix Most of ileum Inferior part of ascending colon Right ovary and uterine tube Right ureter (ab part) Right sperm cord (ab part) Uterus (if enlarged) Urinary bladder (if very full) |
|
|
What are the contents of the Left lower quadrant of the abdomen?
|
Sigmoid colon
Inferior part of Descending colon Left ovary and uterine tube Left ureter (ab part) Left sperm cord (ab part) Uterus (if enlarged) Urinary bladder (if very full) |
|
|
What artery runs on the anterior abdominal wall?
|
Epigastric artery
|
|
|
What are the remnants of the ventral mesentery?
|
--Falciform ligament
--Ligamentum teres hepatis --lesser omentum |
|
|
What organs are secondarily retroperitoneal?
|
--Ascending colon
--Descending colon --2nd, 3rd, 4th parts of Duodenum --Head and Body of pancreas (NOT tail) |
|
|
What surrounds the tail of the pancreas?
|
Lienorenal ligament
|
|
|
What is the difference between a peritoneum, a mesentery, and an omentum?
|
-peritoneum = 1 layer
-Mesentery (ligament) = 2 layers -Omentum = 4 layers |
|
|
What makes up the lesser omentum?
|
Hepatoduodenal and hepatogastric ligaments
|
|
|
Where are the greater and lesser sacs located?
|
Greater sac à stomach à lesser sac (omental bursa)
|
|
|
What is the communication between the greater and lesser sacs?
|
The epiploic (omental) formen of Winslow
(omentum=barrier between) |
|
|
What runs in the hepatoduodenal ligament of the lesser omentum?
|
Hepatic artery, bile duct, portal vein
(this is the portal triad) |
|
|
How does the greater omentum form?
|
2 layers off stomach anterior of transverse colonsàreflect back and up to underside of transverse colon
|
|
|
What mesentery derives the greater omentum?
|
The dorsal mesentery
|
|
|
What 2 ligaments are part of the greater omentum?
|
-Gastrosplenic ligament
-Gastrohepatic ligament |
|
|
Why is fat in the abdomen necessary?
|
Protection and vessels run in it!
|
|
|
What is different in the anatomy of the greater omentum in an infant vs and adult?
|
As grow, transverse colon grows superiorly and fuses with the greater omentum
àThe layers of the greater omentum fuse together and lesser sac is shortened |
|
|
What is posterior to the stomach?
|
Pancreas
|
|
|
What is postero inferior to the stomach?
|
Transverse colon
..so pancreas is superior to the transverse colon |
|
|
What is posterior to the pancreas?
|
Superior vena cava
|
|
|
T/F—Because of its location, pancreatic cancer can spread almost anywhere.
|
True.
|
|
|
What does the pancreas secrete?
|
**Proenzymes
(activated by neuroendocrine cells in the gut) |
|
|
Where is the pancreas located?
|
Secondarily retroperitoneal
(except tail—in lienorenal ligament) Head—in C-shaped part of duodenum Neck—anterior to mesenteric vessels |
|
|
What is found inferior to the head of the pancreas?
|
Uncinate process of pancreas, which is posterior to the superior mesenteric artery and vein
|
|
|
What is found posterior to the neck of the pancreas?
|
Mesenteric vessels
Superior mesenteric and splenic veins mergeà portal vein |
|
|
What is the main pancreatic duct of vater?
|
Where the pancreatic and bile ducts meet
Closed by sphincter of Oddi |
|
|
What arteries feed the pancreas?
|
--Superior mesenteric*
àruns thru pancreasàspread cancer! --Celiac trunk (splenic) |
|
|
Which way does the stomach turn during development?
|
Right
(creates lesser sac) |
|
|
How does the cecum rotate during development?
|
270deg to the left
…around superior mesenteric artery (feeds cecum) |
|
|
What happens if the cecum only rotates 90deg?
|
Cecum ends up on right side
àappendix will be on left side |
|
|
What innervates up to the midpoint of the transvers colon?
|
X nerve
|
|
|
What innervates the hindgut after the midpoint of the transverse colon?
|
S2-S4 nerves
|
|
|
What does the portal vein carry?
|
De-oxygenated blood from gutsàto liver to clean out toxins
|
|
|
What is the configuration of the elements of the portal triad as they run in the Hepatoduodenal ligament in the lesser omentum?
|
The hepatic artery and common bile duct rin anterior to the portal vein
|
|
|
What are the main arterial supplies of the 3 parts of the gut?
|
Fore gut—celiac artery
Midgut—superior mesenteric artery Hindgut—inferior mesenteric aartery |
|
|
How far down the abdomen are there anastamoses between blood vessels?
|
From the esophagus all the way to the colon
|
|
|
Where are aneurisms of the abdominal aorta located?
|
Descending aorta à where common iliac arteries branch…BIG!
(inf mesenteric may branch off aneurism) --press palm into abdomen at thelevel of the umbilicus (L4) to palpate |
|
|
As the superior mesenteric artery branches off and heads inferior, what does it branch over (go anterior to)?
|
--Left renal vein
--3rd part of duodenum |
|
|
What is the difference between thigh, leg , and lower limb?
|
Thigh = hipàknee
Leg=kneeàankle Lower limb= hip àankle |
|
|
What inervates the scrotum or labia majorum?
|
Genital branch of the gentio-femoral nerve
|
|
|
What nerves are numbed during labor?
|
Ilioinguinal and genital branch of genitofemoral
|
|
|
What is the lumbar plexus?
|
Composed of VPR of lumbar spinal nerves
(revealed by removing psoas muscle) |
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What does the femoral nerve innervate?
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(L2-L4)
àmuscles of anterior and lateral thigh |
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What does the obturator nerve innervate?
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(L2-L4)
àmuscles of medial thigh |
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What do the ilioinguinal and iliohypogastric nerves innervate?
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(L1)
àmuscles of anterior ab wall and skin of anterior ab wall |
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What does the genitofemoral nerve innervate?
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(L1, L2)
àgenital and femoral cutaneous branches |
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What does the lateral cutaneous nerve of the thigh innervate?
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(L2, L3)
àcutaneous sensation from the skin of thateral thigh |
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What does the lumbar portion of the lumbosacral trunk innervate?
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(L3, L4)
àmotor to muscles of the buttocks and lower limb |
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Where do all parasympathetic fibers from the neck to the midpoint of the transverse colon originate?
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Dorsal motor nucleus of X
(vagus) |
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What is the origin of the psoas major muscle?
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Lateral surface of bodies of vertebrae T12-L5, transverse process of lumbar vertebrae, intervertebral discs between T12 and L5
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What is the insertion of the psoas major?
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Lesser trochanter of the femur
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What is the function of the psoas major?
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Flexion of thigh at hip
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What is the innervation of the psoas major?
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VPR of L1-L3
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What is the origin of the iliacus?
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--Upper 2/3 of iliac fossa
--anterior sacro-iliac and iliolumbar ligaments --upper lateral surface of sacrum |
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What is the insertion of the iliacus?
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Lesser trochanter of femur
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What is the function of the iliacus?
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Flexion of thigh at hip
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What is the innervation of the iliacus?
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Femoral nerve (VPR L2-L4)
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What is the origin of the psoas minor?
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--late surface of bodies of the vertebrae T12-L1 and intervening intervertebral discs
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What is the insertion of the psoas minor?
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Pectineal line
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What is the function of the psoas minor?
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Weak flexion of lumbar vertebral column
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What is the innervations of the psoas minor?
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VPR of L1
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What is the origin of the Quadratus Lumborum?
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--Transverse process of 5th lumbar vert
--iliolumbar ligament --iliac crest |
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What is the insertion of the Quadratus Lumborum?
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--Transverse process of vert L1-L4
--Inferior border of 12th rib |
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What is the innervations of the Quadratus Lumborum?
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VPR T12-L4
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What is the diameter of the portal vein?
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1.09 cm
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What is the diameter of the pancreatic veins?
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0.45cm
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What are the 4 portacaval anastamoses?
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--Esophageal anastamoses
--Paraumbilical anastamoses --Peritoneal-Retroperitoneal anastamoses (intestines) --Rectal anastamoses |
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What is a “Caput medusa”?
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“heads, snake woman”
--occurs because of vein enlargements in umbilicus |
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What happens if the portal system is blocked?
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Blood can drain into the caval system.
àok short term but don’t want unfiltered blood draining directly into vena cava for extended time period |
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What is the sympathetic innervations of the abdomen?
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T5-L2 pregang fibers travel to the:
--celiac plexi --hypogastric plexi --mesenteric plexi --renal plexi |
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What is the parasympathetic innervations to the abdomen?
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Vagus—up to mid transverse colon
Pelvic splanchnic (VPR of sacral nerves)—midpoint of transverse colon down abdomen, pelvic structures |
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What is the innervations of the enteric system?
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Auerbach--ganglion cells between the 2 smooth muscle layers in guts
àsymp and parasymp Meyer's plexus--in submucosal area of gut àparasymp ONLY |
