Anatomy

Front 1

describe the transition points of the alimentary system and the associated organs

Back 1

foregut: oesophagus (C6) to proximal duodenum (ampulla of Vater), liver, most of pancreas, spleen
midgut: distal duodenum to 2/3 Tv colon, remainder of pancreas
hindgut: distal 1/3 Tv colon to upper 1/2 of anal canal (pectinate line)below pelvic diaphragm is the anal canal which exists in the perineum

Front 2

describe the development and course of the oesophaguslocationmuscular layersrelationshipsconstriction pointssupply

Back 2

development:from distal part of primitive foregutlarynx and trachea develop from the floor of the foregut - explains malformationslocation:25cm tube connecting the pharynx → stomachstart - continuous with laryngopharynx - C6 at level of cricoid cartilage - end - GOJ at T11 cervical - median plane in the pretracheal fasciathoracic - sup. (L of midline b/w trachea and spine) then post. mediastinum (R post to AoA, then to R of aorta, then crosses in front and to the L of the aorta) abdominal - passes through the oesophageal opening of the diaphragm (T10)muscular layers: outer longitudinal, inner circularupper third - skeletal musclemiddle - mixedlower - smooth musclerelationships:ant. - trachea and thyroid, LA (MS can cause dysphagia), L lobe of liverpost. - vertebrae and prevertebral fascia, azygous v., descending aorta, L crus of diaphragmlateral - common carotids, RLN, thoracic duct, L subclavianconstriction points:C6 - upper oesophageal sphincterT3 - AoAT6 - L main bronchusT10 - R crus of diaphragmsupply:a - inf. thyroid, thoracic aorta, L gastricv - inf. thyroid, azygos, L gastricl - perioesophageal plexus → post. mediastinal → supraclavicular nodesn - vagus

Front 3

where do the 3 GIT arteries originate?

Back 3

foregut: coeliac trunkAA at T12 - just above the pancreasmidgut: SMAAA at L1 - behind the NoPhindgut: IMAAA at L3 - much smaller, half way b/w renal aa. and aortic bifurcation

Front 4

describe the arterial supply of the foregut

Back 4

COELIAC TRUNK - has 3 main brr. leaves AA as soon as in abdomen at T12 - just above pancreas under median arcuate lig.flanked by coeliac group of preaortic LN and coeliac ganglia L gastric:l. curvature to anastamose with the R gastricsplenic: 4 brr.pancreatic brr. - including the greater pancreaticpost. gastric - post. stomachshort gastric - fundusL gastro-omental - middle of g. curvature (anastamoses with R gastro-omental)common hepatic: 3 brr.proper hepatic - GB (cystic) and the liver (R+L hepatic)R gastric - l. curvature - anastamoses with L gastricgastroduodenal - prox. duodenum, g. curvature (R gastro-omental - anastamoses with L gastro-omental),  and HoP (sup. pancreaticoduodenal)

Front 5

describe the arterial supply of the midgut and hindgut

Back 5

SMA: L1 - arises just behind the NoP and descends behind the neck, above uncinate process to L of SMV and the SV down the post. abdominal wall - 6 main brr.inf. pancreaticoduodenal - branches off at the upper border of D3 - moves b/w the HoP and the D to anastamose with the SPD - supplies these structuresjejunal brr.ileal brr.ileocolic - terminal ileum, caecum and appendixR colic - ascending colonmiddle colic - Tv colonIMA: L3 - arises midway between the renal aa. and the iliac bifurcationL colic - descending colonsigmoid brr. - sigmoidbecomes sup. rectal a. at the pelvic brim - terminal branch - rectum until the pectinate lineSMA and IMA anastamose via the marginal a. (of Drummond)

Front 6

describe the venous drainage of the GIT

Back 6

IMV: ascends to L of IMA and ends when reaches the SV behind the pancreassup. rectal v. runs up in root of sigmoid mesocolon to pelvic brimthen called IMV and receives trib. same as IMA - runs up in peritoneal floor of L infracolic compartment - lies on psoas, gonadal vessels, ureter and gentiofemoral n.just below Tv mesocolon turns R towards DJ flexure, raises peritoneum called paraduodenal recesspasses behind body of pancreas, in front of L renal v. to SV (sometimes joins SMV)splenic vein: travels the sup. pancreatic surface alongside SAdrains from trabecular v of spleen, short gastric, L gastro-omental and pancreatic veins SMV: ascends to the R of the SMA along the post. abdominal wallreceives same trib. as SMAcrosses D3 and uncinate processforms PV with SV behind NoPportal vein:ascends behind the D1 into the ant. wall of the foramen of Winslow into the porta hepatis

Front 7

what is the foramen of Winslow?

Back 7

OMENTAL FORAMENpassage of communication between the g. sac (abdominal cavity) and and l. sacant. - free border of l. omentum (hepatoduodenal lig) and b/w 2 layers contains the portal triadpost. - peritoneum covering the IVCsup. - peritoneum covering the caudate lobeinf. - peritoneum covering the start of the D1

Front 8

describe the portocaval anastamoses

Back 8

portocaval anastamoses:oesophageal - b/w L gastric v. to PV and oesophageal v. to azygos v. - oesophageal varicesperiumbilical - b/w paraumbilical v. to PV and epigastric vv. to EIA - caput medusaeretroperitoneal - b/w colic vv. to IMV and colonic retroperitoneal vv. to IVC - silentrectum - b/w sup. rectal vv. to IMV and inf. rectal v. to IIV - haemorrhoids

Front 9

describe the lymphatic drainage of the GIT

Back 9

unpaired viscera drain to preaortic nodes, paired drain to paraaortic nodestravel parallel to aa. but in opposite directionbowel wall LN → mesentery LN → preaortic LNinf. mesenteric: hindgutsmall glands on bowel wall, L colic and sigmoid aa., in mesocolon and around the rectumsup. mesenteric: midgutmesenteric, ileocolic and mesocolic LN groupscoeliac nodes: foregutgastric, hepatic and pancreaticolienal LN groupsdrain to intestinal lymph trunkpreaortic confluencedrains to cysterna chyleruns to the R of the aorta from above the D3becomes the thoracic duct which ascends on R b/w azygos v. and DA, crosses over to L at Angle of Louis, then drains into the L br.c. v. - b/w where L subclavian and IJV connectfat is absorbed into the lymphatic system, not the portal circulation

Front 10

describe the development of the foregut

Back 10

foregut development:only part of the GIT that has both a dorsal and ventral mesenterytube twists to the R ventral mesentery - liver forms within; falciform lig. and free edge becomes l. omentum (foramen of Winslow) forming the l. sac dorsal mesentery - g. omentum, spleen forms within; forms the gastrosplenic and splenorenal ligg.liver enlarges and shifts to R, spleen to L, stomach rotates 90º → creates a peritoneal recess post. to stomach (l. sac or omental bursa)l. sac acts like a bursa for the stomach, enabling it to glide on post. structures

Front 11

describe the development of the midgut

Back 11

midgut development:5/40 - elongates and herniates into the umbilicus, rotates 90º counter-clockwise around the axis of the SMA and vitelline duct10/40 - returns to the abdominal cavity - rotates another 180ºcranial limb of loop - becomes the jejunum and most of the ileumcaudal limb of loop - becomes the ascending and Tv colonMeckel's diverticulum is remnant of where midgut loop joined the yolk sacD2-4 - moves dorsally and the dorsal mesentary is lost - becomes secondarily retroperitoneal and fixedileum/jejunum - dorsal mesentery maintained and gut is mobileascending colon - likewise the mesentery is lost and becomes retroperitoneal and fixedTv colon - likewise mesentery maintained and mobile

Front 12

describe the development of the hindgut

Back 12

hindgut development:descending colon - moves dorsally and the dorsal mesentary is lost - becomes secondarily retroperitoneal and fixedsigmoid colon - dorsal mesentery maintained and mobile

Front 13

describe the development and anatomy of the lesser omentum

Back 13

l. omentum:develops from the ventral mesentery of the stomach, connecting it to the liver2 parts - hepatogastric and hepatoduodenal lighepatoduodenal lig - has free edge - foramen of Winslow - communicates l. sac with g. sacant. wall - contains portal triad

Front 14

describe the development of the positioning of the adult GIT

Back 14

1. elongation of gut tube: 5/40gut tube elongates (especially midgut) so structures will lie either on the L or Rliver enlargesphysiological herniation of midgut loop into umbilical cord2. rotation of gut tube: 6-10/40270° counterclockwise around the axis of the SMA and the vitelline duct - with distal loop lying over proximal loop10/40 - gut tube returns to abdominal cavitycaecum startes high and normally moves down (sometimes may not making the appendix in a high position)3. fusion of certain mesenteries: stabilises rotationmesentery, transverse and sigmoid mesocolon are maintaineddorsal mesentery of duodenum, ascending and descending colon fuses and organs become secondarily retroperitoneal

Front 15

describe the development of a Meckel's diverticulum

Back 15

Meckel's diverticulum:remnant ileal outpouching of the vitelline duct - connecting the ileum to the umbilical cordrule of 2's - 2% individuals, 2x as common in males, 2 feet from ileocolic junction, 2 inches longmay develop gastric mucosa and cause pain like appendicitisif fibrous connection remains can lead to obstruction via volvulus or intussusception

Front 16

describe the development and anatomy of the greater omentum

Back 16

g. omentum:develops from the dorsal mesenteryballoons out and drapes over the Tv colon like an apron (4 peritoneal layers)fuses with the ant. Tv colon and mesocolon

Front 17

describe the different areas of the peritoneum

Back 17

l. omentumstomachvisceral peritoneumparietal peritoneumg. omentumcoronary ligg.pancreasduodenumTv mesocolonTv colonmesenteryjejunum/ileumpouch of Douglasperitoneal cavity areas:A. l. sac (omental bursa)B. g. sacC. epiploic (omental) foramen (of Winslow - the communication b/w them)

Front 18

describe the embryological origin of the GIT

Back 18

embryonic folding:amnion expands right round the foetus to form the amniotic sacembryo grows much faster than the yolk sac resulting in the formation of a head fold and tail fold in the sagittal plane and lat. folds in the Tv planeresults in the formation of a foregut and hindgut and incorporation of part of the yolk sac to form the midgut - still connects via the vitilline ductthe lat. folding results in the formation of the lat. body wall and an enclosed cavity - the coelom or future peritoneal cavitythe mesoderm lining the body wall becomes the parietal peritoneal layer while the mesoderm covering the viscera becomes the visceral peritoneum

Front 19

describe the embryological origin of the GIT blood vessels

Back 19

GIT blood vessels:develops from the descending aortapharynx/oesophagus - 5 main aortic brr. supply the thoracic foregutremainder - CSI develops from the vitelline plexus

Front 20

describe the development and anatomy of the stomachlocationpartsmuscular layersrelationshipssupply

Back 20

development:visible at 4/40 - suspended by ventral and dorsal mesentery4/40 get differential growth - dorsal wall grows faster than the ventral wall 7-8/40 - shape created with added 90º rotation to the R → g. curvature to the L, l. to the Ras the liver expands it is shifted to the Lanatomy:location - upper abdomen - peritonealparts - cardia, fundus, body, pylorislayers - oblique (deepest/unique) → circular (thickens to form pyloris) → longitudinal (only part that has 3 layers)relationships - ant. - abd wall, L costal margin, diaphragm, L lobe of liver - post. - l. sac separates from pancreas and splenic a., Tv mesocolon, L kidney and L adrenal - sup. - L dome of diaphragm - inf. - g. omentum, Tv colon - L lateral - spleensupply: a. - L gastric (cardia), R gastric (lower l. curvature, pyloris), L+R gastro-omental a. (g. curvature), short gastric (fundus)v - correspondingn - ant. and post. vagus (named in relation to original orientation) - travel down either side of the l. omentums - ventral - l. omentum (hepato-gastric and hepato-duodenal ligg.) - dorsal - g. omentum (gastro-phrenic, gastro-leinal and gastrocolic ligg.)

Front 21

describe the development and anatomy of the liverlocationrelationships 

Back 21

development: 4-6/40develops in the ventral mesentery of the stomach from the duodenal endoderm - taking the portal triad with itenlarges and moves to the R shifting the stomach to the Ll. omentum - develops from the connection of the mesentery between the liver and stomachfalciform lig - develops from the remaining ventral mesentery to the ant. abdominal wallcardiac lig - sup. lat. leaf of the falciform lig to the abdo wall - passes the IVCL triangular lig. - sup. medial leaf of falciform lig which reflects back to become the l. omentumanatomy:location - R hypochondrium, epigastrium and into L hypochondriumrelations - sup. diaphragm, pleural cavities, mediastinum - ant. diaphragm - visceral - stomach, oesophagus, duodenum, Tv colon, R colic flexure, R kidney and adrenalsupply: a - hepatic artery proper, portal veinv - hepatic veinsl - PH then coeliac nodesductus venosus - becomes lig. venosum - connects to IVCL umbilical vein - becomes lig. teres (round lig.)l. omentum - joins along fissure for lig venosum and PH - hepatogastric and hepatoduodenal ligg.peritoneum - covers except bare areas at attachment of l. omentum and b/w the attachments of the sup. and inf. coronary ligg.Morrison's pouch - hepatorenal recess - communicates with R subphrenic space, lesser sac and R paracolic gutter

Front 22

describe the development and anatomy of the spleenlocationsurfacessupply

Back 22

development: 6/40develops in the dorsal mesentery of the stomachanatomy:location - sits at the L margin of the l. sac - L hypochondrium ribs 9-11 - post. to midaxillary line - long axis runs parallel to rib 10diaphragmatic surface - related to diaphragm, pleura and ribsvisceral surface - hilum, stomach, splenic flexure, L kidney - all make impressionssupply: a - SA, short gastricv - SVl - hilum to coeliac nodess - leinorenal and gastrosplenic ligg.

Front 23

describe the development, anatomy and supply of the duodenum

Back 23

development:proximal shifted to the R with the curvature/rotation of the stomach creating a C-shapepushed dorsally against the post. abdominal wall → loses dorsal mesentery and becomes secondarily retroperitonealanatomy:location - L1-3, peritoneal to begin with, wraps around HoPD1 (sup.) - peritoneal - ant. - liver and GB - sup. - l. omentum + portal triad, foramen of Winslow - post. - portal vein, CBD, gastroduodenal a., IVC D2 (descending) - retroperitoneal - contains major and minor duodenal papilla - ant. - Tv colon/mesocolon - post. - CBD, pancreatic duct, IVC, R kidney hila - R - R kidney, ureter - L - HoP   D3 (horizontal) - ant. - root of mesentery, SMA, SMV - post. - IVC, AA, L3 - sup. - HoP, SMA, SMVD4 (ascending) - post. - AA, IMV - sup. - Lig of Trietz (from R crus)supply: a - sup. (CA) and inf. (SMA) gastroduodenal aa. v - splenic vein or SMVs - hepatoduodenal lig. (D1), Lig. of Trietz (D4)

Front 24

describe the development and anatomy of the gall bladderlocationpartsrelationshipssupply

Back 24

development: 4-6/40develops from the duodenal endoderm (cystic diverticulum) and expands into the ventral mesenterythe cells at the junction of the hepatic and cystic diverticulum become the CBDCBD dragged dorsally by the rotation of the ventral pancreas, where the pancreatic duct enters it - forms AoV and SoOanatomy:location - GB fossa on the visceral surface of the R lobe of liver b/w segments IV and V under the liver peritoneum, lies on commencement of Tv colonfundus - projects slightly below the sharp lower border of the liver (transpyloric plane) - Murphy's signbody - passes up to R edge of PH - running over duodenumneck - lies against free edge of l. omentum cystic duct - runs b/w 2 layers of l. omentum - forms CBD 1cm above the duodenum just in front of RHA which runs down behind or through the NoP - has spiral then smooth partrelations - ant. - liver, abdo wall - inf. - duodenum, Tv colon - post. - biliary treehistology - columnar mucosa which absorbs Na+ and water (concentrates)supply: a - cystic a. branches off RHA in Calot's triangle - small vessels from hepatic bedv - into hepatic bedl - PH into coeliac node

Front 25

describe the anatomy of the pancreaslocationpartssupply

Back 25

anatomy:location - lies immediately behind the peritoneum of the post. abdominal wall in the supracolic compartment - neck and body curve around the IVC and AA in front of L1head - moulded to cavity of duodenum - ant. - Tv colon and its mesocolon (attaches along inf. border - divides relation to g. and l. sac), g. sac - post. - bile duct, IVC, AA, L1 - uncinate process - sup. mesenteric vessels pass ant.neck - sits above where the sup. mesenteric vessels cross the uncinate process in the l. sac - pass in front of the 'nutcracker' space (where L renal vein passes b/w SMA and AA) and where the PV formsbody - crosses AA (sup. border at coeliac trunk), L crus, L psoas, hilum of L kidney in the stomach bed - SA runs along sup. surface - SV runs post. where joined by IMVtail - passes ant. from the L renal hilum into the leinorenal lig.supply: a - SA, sup. (C) and inf. (SMA) pancreaticoduodenal aa.v - SV, sup. and inf. pancreaticoduodenal vv.l - L of neck into retropancreatic nodes, upper head to coeliac group, lower lead to SM group

Front 26

describe the development and anatomy of the rectumlocationperitoneumrelationshipssupply

Back 26

development:gut begins continuous with the allantois via the cloaca4-6/40 - urorectal septum grows down, partitioning the rectum from the urogenital sinus - due to Tourneux fold and 2x lateral Rathke foldsforms the urogenital membrane, anal membrane and the perineum8/40 - anal pit ectoderm grows up and fuses with hindgut at the pectinate lineanatomy:location - pelvic cavity rectosigmoid junction (S3) to anorectal junction (pelvic diaphragm - puborectalis)identification - absence of sacculations, appendices, epiploicae or taeniae coliperitoneum - no mesentery (differentiates from sigmoid) - upper 1/3 intra, middle only on front, lower no peritoneum - reflects onto pelvic viscera - rectouterine pouch in females (PoD), rectovesical pouch in malesanterior - small bowel; PoD, cervix/vagina (female); rectovesical pouch, prostate, seminal vesicle, vas deferens, bladder (male)posterior - sacrum, coccyxlateral - pararectal fossa, intestines, pelvic diaphragmsupply: a - sup. rectal a. = IMA once passed pelvic brimv - correspondingl - follow the IMAs - Waldeyer's fascia holds to sacrum + Denonvillier's fascia (males - separates rectum from prostate/bladder)

Front 27

describe the development and anatomy of the bladder

Back 27

development:gut begins continuous with the allantois via the cloaca4-6/40 - urorectal septum grows down, partitioning the rectum from the urogenital sinus - due to Tourneux fold and 2x lateral Rathke foldsforms the urogenital membrane, anal membrane and the perineumprimitive urogenital sinus forms in the allantois → bladdersup. allantois regresses 6-8/40, inf. becomes the urethraanatomy:

Front 28

summarise the embryology of the GIT briefly

Back 28

2 rotations: forgut and midgut/hindgut2 expansions: liver, pancreasseveral fusions: duodenum and ascending/descending colon to post. wall, g. omentum to Tv colon/mesocolon

Front 29

describe how the midgut mesentery changes with the rotation

Back 29

midgut mensentery:rotation occurs b/w the duodenum and the descending colonas it rotates around counter-clockwise the root of the midgut mesentery follows and greatly increases the width of its root - which helps prevent volvulus

Front 30

describe the surface anatomy of the abdomen

Back 30

vertebral levels:T9 - xiphoidL1 - transpyloric plane - hand's breadth below the xiphoid - passes through the pylorus, NoP, duodenojejunal flexure, GB, renal hilaL3 - subcostal plane - lowest point of thoracic cage (10th rib) - passes through the origin of IMAL4 - plane of iliac crests - level of the aortic birfurcationliver: R 5th IC → R base of thoracic cage → L 5th IC mid-clavicular linespleen: underlies post. the L 9-11th ribsGB: lateral border of RA cuts costal margin - tip of 9th costal cartilage - distinct 'step' along costal marginpancreas: neck at transpyloric plane, head to R and down, tail to L and upaorta: terminates L of midline at level of iliac crests (L4)kidneys: hila lies on transplyoric plane 4 fingers from midline

Front 31

describe the anatomy of the jejunum/ileum

Back 31

anatomy:location - peritoneum, framed by the colonmesentery - runs from duodenojejunal junction on the L to the ileocoecal junction (overlies R SIJ)jejunum - wider, pinker, longer vasa recta, fat free windows, fewer arcades, thicker walls, villi longer and more numerousileum - thinner, shorter vr, fat encroaches bowel, more arcades, villi shorter and fewer, Peyer's patch

Front 32

describe the distinguishing features of the of the colon

Back 32

features:taeniae colihaustrations (sacculations)epiploic appendages

Front 33

what are the relations to the different parts of the large bowel?

Back 33

caecum: retroperitonealpost. - psoas major and iliacusant. - abdo wallinf. - appendixascending colon: retroperitonealant. - small intestine, g. omentum, abdo wallpost. - psoas, iliacus, iliolumbar lig., QL, TrA, diaphragm, ilioinguinal, iliohypogastric nn.Tv colon: peritonealhepatic flexure - ant. - liver - post. - R kidney, post. abdominal wallTv colon - ant. - g. omentum, post. - mesocolon, kidneys, duodenum, pancreas, sup. - liver and stomachsplenic flexure - sup. - stomach, spleen, phrenocolic lig., post. - L kidneysigmoid: peritonealant. - small intestine, bladder (male), uterus (female)post. - mesentery crosses common iliac birfurcation, L ureter and L SIJ - L piriformis, L sacral plexus

Front 34

briefly describe the anatomy of the sternum

Back 34

landmarks:sternal angle at 2nd costal cartilageribs 1-5 articulate individuallyribs 6-10 converge

Front 35

describe the different methods of finding the transpyloric planewhat structures lie along it?

Back 35

transpyloric plane: lower border of L1midway b/w suprasternal notch and pubic symphysiscostal margin step at 9th cc in MC linewhere semilunaris meets costal marginhandsbreadth below xiphisternal jointmidway b/w umbilicus and xiphisternumstructures:L1 VB - end of SC9th ccpyloris - if supine and emptyNoP in front of beginning of PV and SMA originR colic flexure slightly below, L slightly abovecysterna chylihila of kidneys - R slightly below, L aboveduodenojejunal flexure

Front 36

describe the vertebral levels of the major blood vessels of the abdomen

Back 36

vertebral levels:T12 - commencement of AA, coeliac trunkL1 - SMA (transpyloric plane)L2 - renal aa. - gonadal aa. just belowL3 - IMA (subcostal plane - level of umbilicus L3/4)L4 - termination of AA (umbilicus)L5 - origin of IVC (transtubercular plane - L4/5)

Front 37

what structures require attention when penetrating the R midaxillary line?

Back 37

pleura: down to rib 10consider chest drain 4-6th IC spacebreathe in and holdlung: down to rib 8liver: rib 7-11consider liver biopsy 10th IC - breathe out and hold

Front 38

describe the anatomy of the portal triad

Back 38

portal triad:runs in ant. wall of l. omentum (hepatoduodenal lig)portal vein - post.proper hepatic a. - ant. and Lbile duct - ant. and R

Front 39

what is Calot's triangle?

Back 39

Calot's triangle:required to identify cystic duct and a. in cholecystectomyL - common hepatic ductR - cystic ductsup - livercystic artery branches off RHA within

Front 40

what are the layers when making a midline abdominal incision?

Back 40

midline:skin - epidermis and dermis (CT)superficial fascia - superficial fatty layer (Camper), deeper fibrous layer (Scarpa)deep fascia - very thinlinea alba - aponeurosis of RA and fusion of ant. and post. rectus sheathtransversalis fascia - continuous with iliac and pelvic fasciaeextraperitoneal fatparietal peritoneum

Front 41

what are the layers when making a lateral abdominal incision?

Back 41

lateral:skinsuperficial fascia - superficial fatty layer (Camper) and deep fibrous (Scarpa)deep fascia (very thin)EOIOTrAtransversalis fascia - continuous with iliac and pelvic fasciaeextraperitoneal fatparietal peritoneum

Front 42

describe the anatomy of the superficial fascia of the anterior abdominal wall

Back 42

Camper's fascia:superficial fatty layer - b/w skin and Scarpa's fasciacontinuous with Dartos fascia and muscle of the scrotumcontinuous with the superficial fat of the rest of the bodyScarpa's fascia:deeper membranous layer - b/w  Camper's fascia and EO aponeurosis or ant. rectus sheathcontinuous with Colles' fascia of the scrotum which attaches along ischiopubic ramus (pouch that can fill with urine if urethra ruptures)continuous with deep fascia (Lata) of the thigh

Front 43

describe the anatomy of the external oblique

Back 43

EO:origin - ext. surface of the ribs 4-12 interdigitating with s. anterior (free edge posteriorly - can herniate between EO and LD)insertion - linea alba, pubic tubercle, ant. 1/2 iliac crest, inguinal ligaponeurosis - begins lateral to RA and forms part of the ant. rectus sheath - lower free edge forms the inguinal lig - medial opening forms the sup. inguinal ringinguinal canal - floor (as inguinal lig), front (as aponeurosis)action - trunk flexion, C/L rotationnerve - T7-12

Front 44

describe the anatomy of the internal oblique

Back 44

IO:origin - thoracolumbar fascia, ant. 2/3 iliac crest, lat. 2/3 inguinal liginsertion - ribs 10-12, linea alba (ant. and post. rectus sheath), conjoint tendoncremaster - continuous, elevates testesinguinal canal - roof and front (lateral 1/3)action - trunk flexion, I/L rotationnerve - T7-L1, inserts more anteriorly than EO

Front 45

describe the anatomy of the transverse abdominis

Back 45

TrA:origin - internal surface of ribs 6-8 interdigitates with diaphragm, thoracolumbar fascia, iliac crest, lat. 1/2 inguinal liginsertion - linea alba (post. rectus sheath above arcuate line, ant. below) conjoint tendoninguinal canal - roof, backaction - compress and support abdominal visceranerve - T7-L1

Front 46

describe the anatomy of the rectus abdominis

Back 46

RA:origin - xiphoid process, cc of ribs 5-7insertion - pubic symphisisrectus sheath - ant. only above costal margin (EO) and below arcuate line, ant. and post. in b/wsemilunaris - line along lateral edgeaction - trunk flexion, antilordosis (stabilises pelvis)nerve - T6-12

Front 47

describe the anatomy of the rectus sheath

Back 47

rectus sheath:retains RAarcuate line - midpoint of umbilicus and pubis - is the lower free edge of the post. sheathabove - ant. - aponeurosis of EO and 1/2 IO - post. - aponeurosis of 1/2 IO and TrA - sup. epigastric passes b/w RA and post. sheath below - ant. - aponeurosis of EO, IO and TrA - inf. epigastric passes between RA and transversalis fascia

Front 48

describe the fascial lining of the abdominal cavity

Back 48

fascial lining:continuous lining - takes name from adjacent structurestransversalis, diaphragmatic, QL, endopelvicblends with peritoneum if extraperitoneal fat not presenttransversalis fascia - forms deep inguinal ring

Front 49

describe the internal surface anatomy of the anterior abdominal wall

Back 49

ant. abdo wall:median umbilical fold - peritoneum covering urachus (fibrous remnant of allantois - connects bladder to umbilicus)supravesical fossamed. umbilical folds - obliterated umbilical a. (connected int. iliac aa. to umbilicus)med. inguinal fossa - location of direct inguinal hernia - push directly through post. wall of inguinal canal (conjoint tendon)lat. umbilical folds - covers inf. epigastric vesselslat. inguinal fossa - location of indirect inguinal hernia, pushes into the deep inguinal ring

Front 50

describe the arterial supply of the anterior abdominal wall

Back 50

sup. epigastric a.:terminal br. of int. thoracic a.enters sheath through foramen on Morgani - b/w sternal and costal fibres of diaphragmanastamoses post. to RA with inf. epigastric a.inf. epigastric: br. of ext. iliac a. at inguinal lig.passes upwards behind conjoint tendon in lat. umbilical fold heading medially passes over arcuate line and enters sheath and runs vertically behind RAdeep circumflex a.: br. of ext. iliac a. behind inguinal lig.runs laterally towards ASIS then along inner lip of iliac crestsuperficial epigastric a.: ant. br. of femoral a. 1cm below inguinal lig.passes back through femoral sheath and in front of inguinal lig. then b/w the 2 layers of the sup. fascia up towards the umbilicus

Front 51

describe the lymphatic drainage of the anterior abdominal wall

Back 51

drainage of skin and superficial fascia:above umbilicus/iliac crest to axillary LNbelow umbilicus/iliac crest to sup. inguinal nodes

Front 52

describe the nerve supply of the anterior abdominal wall

Back 52

abdo wall nerve supply:T7 - xiphoidT10 - umbilicusL1 - inguinal fold, anterior scrotum and labia majora (ilioinguinal) - does not pierce rectus sheathtravel in neurovascular plane b/t TrA and IO 

Front 53

describe the anatomy of the inguinal canal

Back 53

inguinal canal:4cm passage waydeep inguinal ring - 1cm above femoral pulse (midpoint of inguinal lig) - formed by opening in the transversalis fasciasup. inguinal ring - just sup. and med. to pubic tubercle - formed by opening in EO aponeurosisfloor - inguinal ligament (curved free edge of EO)roof - IO + TrAant. wall - aponeurosis of EO + IO, sup. inguinal ring (med. third)post. wall - transversalis fascia (lateral) + conjoint tendon (medial), deep inguinal ring (lat. third)FEMALE CONTENTS female - round lig, ilioinguinal n.MALE CONTENTS 3 aa. - a. to vas deferens, testicular a., cremasteric a.3 fascial layers - ext. spermatic, int. spermatic, cremasteric3 other vessels - pampiniform plexus, vas deferens, lymphatics2 nn. - genital br. of genitofemoral n., ilioinguinal n. (enters roof)

Front 54

describe the anatomy of the femoral ring

Back 54

femoral hernia:anterior - inguinal ligposterior - pectineus m. and fascialateral - femoral veinmedial - lacunar lig

Front 55

describe the various abdominal surgical incisions

Back 55

median/midline:through linea alba - relatively bloodless, no nervesused for exploration, large exposureparamedian:1cm lat. to midline - but retract RAmeans RA will sit over the peritoneal scarsubcostal: Kocher1cm below costal margin - used for biliary or splenic surgerymay need to damage 8th or 9th nervegridion/muscle splitting:McBurney's point - EO aponeurosis, IO and TrA split in line of fibresused for appendectomy, caecostomytransverse:as is small, no problems with nerves or supply (due to anastamoses)sigmoid, caecum

Front 56

describe the columns of the neck

Back 56

neck:sup. fascia - contains platysmus - from fascia over pec. major and deltoid to lower border of mandible, separate below but converge just below the chindeep investing fascia - splits to contain SCM, trapezius and infrahyoid mm - from base of skull to clavicle at root of neck sympathetic trunk - ascends in the prevertebral spacespaces in between allow mobility but infection can also track along these planes and into the superior mediastinumvisceral: contained by pretracheal fasciapharynx → oesophaguslarynx → tracheathyroid and parathyroid glandsvascular: contained by carotid sheathCCA and ICAIJVvagus nervedeep cervical LNsupporting: contained by prevertebral fascia7 cervical vertebrae (and SC)prevertebral mmpostvertebral mmscalene (NR passes out b/w anterior and middle)

Front 57

what are the borders of the anterior triangle of the neck?sub-divisions and contents?

Back 57

borders:midlinemandibleant. border of SCMcarotid triangle:SCM, post. belly of digastric, sup. belly of omohyoidcontents - bifurcation of CCA, brr. of ECA, lingual, facial and sup. thyroid vv., CN XII, int. and ext. LN, sup. root of ansa cervicalis, LNdigastric:  mandible, ant. and post. bellies of digastriccontents - submandibular gland, facial, submental and mylohyoid vessels, CN XII, mylohyoid n.submental:  ant. bellies of digastric, body of hyoid (crosses midline)contents - ant. jugular vv., LNmuscular:  SCM, sup. belly of omohyoid, midline from hyoid bone to jugular notchcontents - larynx, trachea, pharynx, oesophagus, thyroid and PTh glands

Front 58

describe the anatomy of the larynxpartscartilagesvocal foldsmusclesnervesphonation

Back 58

larynx: C3-6laryngeal inlet to inferior border of cricoid cartilage - prevents FB from entering airway and organ of phonationsuspended from hyoid bone in anterior neck by soft tissue attachmentssupraglottis - area above true vocal cords - includes epiglottis, false vocal cords, arytenoidsglottis - true vocal folds and 1cm inferiorlysubglottis - 1cm inferior to vocal folds to inferior border of cricoidcartilages: x9thyroid - largest, protects vocal foldscricoid - lies between thyroid and tracheal inlet - only complete ring of larygeal skeleton, enclosing subglottic region (can stenose with chronic ETT)epiglottis - prevents FB entering airwayarytenoid (paired) - on upper posterior cricoid border - attachment sites for intrinsic mm, framework of true vocal cordminor  - corniculate (tips of arytenoids) and cuneiform (anterior to corniculate) - both pairedvocal folds:bands of muscle, fibrous ligament and mucosaextend from arytenoids posteriorly to the thyroid midline anteriorlyfalse - are superior to true - adduct only with forceful closure (Valsalva) or reflex (noxious stimuli)extrinsic muscles:anterior infrahyoid mm and digastricselevate larynx during swallowingfixate during Valsalvaintrinsic muscles:posterior cricoarytenoidlateral cricoarytenoidinterarytenoidthyroarytenoid - make up bulk of true vocal foldcricothyroid - determines pitch by altering the length and tension of the vocal foldsnerves: RLN - all intrinsic mm except cricothyroid, sensory below vocal foldssuperior laryngeal nerve - cricothyroid, sensory above vocal foldsphonation: due to oscillation of the vocal folds - sopranos oscillate at much higher frequencypitch determined by vocal fold length and tension- by cricothyroid

Front 59

name the vessels of the lung hilum

Back 59

AoAR pulmonary a.R pulmonary v.R pulmonary v.L pulmonary a.L pulmonary v.L pulmonary v.

Front 60

describe the anterior articulation of the ribs

Back 60

true ribs: articulates directly with sternumribs 1-7false ribs: ribs 8-12floating ribs: ribs 11-12

Front 61

describe the anatomy of the intercostal space

Back 61

intercostal muscles:ext. - quiet and forced inhalation - elevate ribs expanding the Tv dimensions of thoracic cavityint. - forced expiration - depress ribs ↓ Tv dimensionsinnermost neurovascular bundle: VAN - run b/w int. and innermost intercostalsveinarterynerve - supply overlying skin, bone, joints, intercostal muscles, parietal pleura

Front 62

describe the boundaries of the mediastinumwhat are subdivisions of the mediastinum and their contents?

Back 62

boundaries:superior - thoracic inletinferior - diaphragmanterior - sternumposterior - T1-12 vertebraelateral - lungs/pleurasubdivisions: take an imaginary horizontal plane through sternal angle and lower margin of T4 (angle of Louis)superior - above plane - AP: thymus, brachiocephalic v. and SVC, AoA, trachea, oesophagus, thoracic duct - phrenic n. in front of hila, vagus behindmiddle - heart, pericardium, roots of great vessels (8 - SVC, IVC, ascending aorta, pulmonary trunk, 4x pulmonary vv), phrenic n on sides of pericardiumanterior - in front of middle - ligaments attaching pericardium to sternum, loose CTposterior - behind middle - descending thoracic aorta, oesophagus, vagus n, azygous v., thoracic duct

Front 63

describe the location of the heart

Back 63

location:middle mediastinumrests on diaphragm posterior to body of sternum1/3 to R and 2/3 to L of midlineapex in 5th IC about midclavicular linegreat vessels above heart are posterior to manubrium

Front 64

describe the great vessels of the heart

Back 64

8 vesselsAoA:course - changes from the ascending aorta at the level of the sternal angle (lower border of 1st IC space) - runs upward, backward (to 2.5cm above the manubrium) and to the L in front of the trachea, then down the L side of it, then at the lower border of the T4 VB becomes the descending aorta - both changes at Angle of Louis3 branches: brachiocephalic trunk - 1st aortic br. - from level of lower border of R 1st IC - ascends upward/backward and to the R of the upper border of the R SCJ where it divides to R CCA and R subclavian a.L common carotid a. - 2nd aortic branch, 3rd archL subclavian a. - 3rd aortic branch, branches to vertebral and internal thoracic aa., thyrocervical trunk, costocervical trunk and dorsal scapular a. - becomes the axillary a. at the lateral border of the 1st ribSVC:formed by L and R brachiocephalic vv. at the upper border of R 1st IC - joined by the azygous v. just before it enters the RAIVC: pierces the diaphragm at T8thoracic - ~2cm covered by pericardium which empties into the RAdotted line indicated plane through sternal angle of Louis

Front 65

what are these features of the cardiovascular shadow?

Back 65

AoA (knuckle)pulmonary trunkL auricleL ventricleIVCR atriumSVC

Front 66

what are the locations for auscultating each of the heart valves?why these locations?

Back 66

MV: mid clavicular line 4th ICTV: L sternal edge 5th ICPV: L sternal edge 2nd ICAV: R sternal edge 2nd IClocation of downstream flow from each valve

Front 67

describe the anatomy of the pericardium

Back 67

fibrous pericardium:thick, inelasticretains heart in position, limits acute oversdistentionfuses with wall of great vessels and diaphragmserous pericardium:deep to fibrous pericardiumfacilitates friction free movement of heart

Front 68

describe the arterial supply of the heart

Back 68

L coronary a.:arises from ascending aorta above the L cusp of the aortic valveafter 1-25mm the L main bifurcates into LAD and LCXLAD: begins behind pulmonary a. and passes forward around it between the L auricle to reach the anterior IV sulcus supplies - anterolateral myocardium, apex and IV septum - normally 45-55% of LV, AV node (20%)ECG - anterior leads - V2-4LCX:follows around the coronary sulcus towards the PDA (supplies in 10%)supplies - LA, posterolateral LV (15-50%), anterolateral papillary muscle, SA node (40%)ECG - lateral leads - I, aVL, V5-6R coronary a.:arises from ascending aorta above the R cusp of the aortic valve and travels down the R AV groove to the form the PDA (90%)conus a. - branches from origin of RCA or individually from aorta, present in 45%, can provide collateral flow to LADR marginal a. - follows the acute angle of the heart, supplies both surfaces of RVsupplies - RA, RV, diaphragmatic surface of LV (25-35%), SA node (60%), AV node (80%)ECG - inferior leads - II, III, aVF

Front 69

describe the venous drainage of the heart

Back 69

great cardiac vein:begins at the apex and travels along the anterior longitudinal sulcus, curves L around the coronary sulcus and opens into the L extremity of the coronary sinusreceives a tributary from the L marginal veinmiddle cardiac vein:begins at the apex and travels along the posterior longitudinal sulcus and opens into the R extremity of the coronary sinussmall cardiac vein:runs in the R coronary sulcus and opens into the R extremity of the coronary sinuscoronary sinus:runs in the posterior coronary sulcus to open into the RA just superior to the septal leaflet of the TV - posteroinferior surface medial to the IVCanterior cardiac veins:drains anterior RV and drains directly into the RA

Front 70

describe the nerve supply to the mediastinum

Back 70

cardiac motor:PS - vagus n. (CNX)S - T1-4/5 via sympathetic trunksensory motor:cardiac reflexes - vagus ..pain - with sympathetic nn - T1-4sensory pericardium:phrenic nerve - C345 - refers to shoulder

Front 71

describe the anatomy of the azygos veins

Back 71

azygos veins:from - IVC/ascending lumbar vvto - SVCdrain the upper lumbar region and the thoracic wallR - single azygos v.L - 2 systems - hemiazygos and accessory hemiazygos which drain across to azygos separately azygos v.:from level of R renal vein (subcostal plane of L2) - as either posterior tributary of IVC or confluence of R ascending lumbar and R subcostal vvpasses diaphragm through aortic opening (T12) under R crus and ascends R of vertebral bodies behind oesophagus, turns anteriorly over R hilum (lateral to oesophagus, trachea and R vagus to enter SVC at T4tributaries - lower 8 R posterior IC vv, R superior IC v. (IC v. 2-4), bronchial and oesophageal vv, 2x hemiazygos vvhemiazygos v.:from confluence of L ascending lumbar v. and tributary of L renal v.through aortic opening to L of vertebrae until T9 when it crosses behind aorta, oseophagus and thoracic duct to enter azygos vein at T8tributaries - 4 lower L posterior IC vv (L 9-12th)accessory hemiazygos:runs inferiorly on L of vertebrae until T8 where crosses to enter azygostributaries - 5-8th posterior IC vv, tributaries of L bronchial and oesophageal vv

Front 72

describe the anatomy of the descending aorta

Back 72

descending aorta:from - AoA to L of T4 vertebral bodyto - AA at T12, through aortic opening behind median arcuate ligamentgrooves L side of T4-6 then moves to midline over T7-12branches - L and R bronchial, oesophageal, mediastinal, posterior IC and subcostal aa

Front 73

describe the anatomy of the phrenic nerve

Back 73

phrenic nerve:from - anterior rami of C3,4,5 deep b/w anterior and middle scalenesto - diaphragm, diaphragmatic peritoneum, diaphragmatic pleura, fibrous + parietal pericardium, mediastinal pleuraruns over lateral border of then along anterior scalenes over anterior dome of pleura entering mediastinum posterior to subclavian v. and anterior to subclavian a. R - spirals forward to lie lateral to R brachiocephalic v. then along lateral surface of SVC, RA and IVC within fibrous pericardium then traverses diaphragm via caval orificeL - descends anterior to L internal thoracic a., then anterior to AoA, L vagus and L hilum then lateral to L auricle and LV within fibrous pericardium to traverse diaphragm in isolation along muscular diaphragm to L of central tendonsupply diaphragm by inferior surfacesensory to central diaphragm (peripheral is via IC's and subcostals)

Front 74

describe the course of the vagus nerve in the neck and the chest?

Back 74

vagus nerve:from - medulla - dorsal motor nucleus (visceral motor), NA (branchial motor), NS (taste and visceral sencory)descends in carotid sheath b/w ICA and IJVbranches (6) - pharyngeal, SLN, int., ext. and recurrent LN, cardiacR RLN - originates in root of neck ant. to L subclavian a. then hooks around it post. running med. to tracheo-oesophageal groove L RLN - originates inferolateral to AoA in sup. mediastinum hooks around it then passes over the L side of the trachea to the groovecardiac nn - R descends ant. to br.c. a. and L over AoA to terminate in cardiac plexusesR vagus - crosses ant. to R subclavian a. to run along trachea post. to SVC and R hilum and then behind the R lung along the oesophagus to enter the abdomen through oesophageal hiatusL vagus - enters b/w L CCA and L subclavian and descends on anterior surface of AoA, kept away from trachea, behind L hilum then down along the oesophagus 

Front 75

describe the anatomy of the thoracic duct

Back 75

thoracic duct:from - cisterna chyli at T12 b/w AA and azygos vein to - junction of L subclavian and L IJV (start of L brachiocephalic)ascends through crura to R of oesphagus then at T5 deviates to the L to be posterior and then L of the oesophagus and arches forward over the L pleura to enter root of neckdrains - lower half of body, L arm/thorax/H&N

Front 76

describe the anatomy of the thymus

Back 76

thymus:site - anterior mediastinum b/w pericardium and sternumorigin - endoderm of 3rd branchial pouch (same as inf. PTh glands),   migrates down from the neckis largest in children and can extend from 4th cc. to lower poles of thyroid glandarterial supply - brr. from inferior thyroid and internal thoracic aa.venous supply - corresponding brr., also thymic v. may drain into L br.c. v.

Front 77

describe the anatomy of the AoA

Back 77

AoA:course - changes from the ascending aorta at the level of the sternal angle (lower border of 1st IC space) - runs upward, backward (to 2.5cm above the manubrium) and to the L in front of the trachea, then down the L side of it, then at the lower border of the T4 vertebral body becomes the descending aorta - 3 branchesbrachiocephalic trunk - 1st aortic branch - from level of lower border of R 1st IC - ascends upward/backward and to the R of the upper border of the R SCJ where it divides to R common carotid and R subclavian aaL common carotid a. - 2nd aortic branch, 3rd archL subclavian a. - 3rd aortic branch, branches to vertebral and internal thoracic aa., thyrocervical trunk, costocervical trunk and dorsal scapular a. - becomes the axillary artery at the lateral border of the 1st rib

Front 78

what is the relationship of the oesophagus to the aorta?constriction points of the oesophagus?

Back 78

aorta:begins R posterior to AoAthen to Rthen passes in frontconstriction points:C6 - upper oesophageal sphincterT3 - AoAT6 - L main bronchusT10 - R crus of diaphragm

Front 79

define:bony pelvistrue pelvisfalse pelvispelvic cavityperineum

Back 79

bony pelvis: hip bones, sacrum, coccyxtrue (lesser) pelvis: pelvic inlet to outletfalse (greater) pelvis: above pelvic inlet to top of iliac crest (part of abdominal cavity)pelvic cavity: pelvic inlet to pelvic diaphragmperineum: region below pelvic diaphragm to skin of lower trunk

Front 80

what are the contents of the pelvic cavity?which are the dependent pouches? significance?

Back 80

pelvic cavity:intestinesbladderrectummales - prostate, seminal vescicles, vas deferens females - ovaries, uterine tubes, uterus, upper vaginapouches: rectovesicalPouch of Douglas (rectouterine)infectious material collects here

Front 81

what are the contents of the perineum?

Back 81

divided into 2 trianglesurogenital triangle:external genetaliaperineal membranes (with skeletal muscles above and below it)anterior horns/recesses of ischioanal fossaanal triangle:anal canalanal sphinctersischioanal fossa

Front 82

describe the anatomy of the true pelviswhat are the differences between male and female?

Back 82

pelvic inlet to pelvic outletpelvic inlet:sacral promontaryarcuate linepectineal linepubic symphisispelvic outlet:coccyxsacrotuberous ligischial tuberosityischiopubic ramuspubic symphysismale:longerbucket shapedfemale:short, widecylinder shaped

Front 83

what is the purpose of the sacrospinous and sacrotuberous ligaments?what are the muscles of the true pelvis?

Back 83

ligaments:tie sacrum to ischium, stabilising the SIJ by preventing upward movement of distal sacrum when body weight passes through proximal sacrumsacrospinous - forms g. sciatic foramensacrotuberous - forms l. sciatic foramenmuscles: piriformis (sidewall) - passes through g. sciatic foramenobturator internus (sidewall) - passes through l. sciatic foramenlevator ani - attaches pubic bone, fascia over obturator internus to ischial spinecoccygeus - inner surface of sacrospinous lig. (functionally unimportant) 

Front 84

what attaches to the ischial spine?

Back 84

int. surface:pelvic fasciacoccygeuslevator aniext. surface: gemellus superiortip: sarcospinous lig.

Front 85

what is the function of the pelvic diaphragm?what are the parts?

Back 85

function:supports abdominopelvic viscera (anterior part) - raises pelvic floorimportant in urinary and faecal continence - relaxes to allow defaecation and urination, contracts with sneezing, coughing or heavy lifting  levator ani:attachments - pubic bone, tendinous arch over obturator internus, ischial spine; medial margins blend with associated viscera and perineal body; coccyx posteriorlypubococcygeus - runs AP, attaches to pubis, coccyx, levator plate and perineal bodypuborectalis - from pubis - forms U-shaped sling and joins behind anorectal junction - relaxes at defaecation to reduce anorectal flexure and allow passageileococcygeus - from posterior tendinous arch and ischial spine to levator platecoccygeus: little role in support - located on deep surface of sacrospinous lig

Front 86

bladder

Back 86

A - peritoneumB - vescical plexus (valveless) and prostatic plexus - difficult to stem bleeding after trauma - drain to internal iliac and some via sacral veins to venous plexus of BatsonC - pubovescical lig, pubocervical lig (female), puboprostatic lig (male)D - visceral pelvic fasciaE - parietal pelvic fasciaF - trigoneendopelvic fascia condense to form ligaments

Front 87

female pelvic x-section

Back 87

A - bladderB - pubocervical ligC - transverse cervical lig (contains vessels)D - uterosacral ligE - rectumF - cervix

Front 88

what are the boundaries and the divisions of the perineum?

Back 88

space beneath the pelvic diaphragmboundaries: same as pelvic outletpubic symphysisischiopubic ramusischial tuberositysacrotuberous ligcoccyxdivisions:urogenital triangleanal triangle

Front 89

what are the contents of the anal triangle of the perineum?how does the anatomy relate to the development of perianal abscesses?

Back 89

anal triangle:anal canalanal sphinctersischioanal fossapudendal canal (Alcock's)perianal abscess: infection spreads from rectum or anal canal through fistulae into ischioanal fossacan then spread contralaterally or into anterior urogenital triangle

Front 90

male perineum

Back 90

A - perineal membrane - spans pubic arch and provides support below urogenital hiatus of levator aniB - perineal bodyC - superficial transverse perineal muscleD - external anal sphincter (deep part)E - urethraF - deep dorsal vein of penisG - bulbourethral glandH - deep transverse perineal muscleI - sphincter urethrae

Front 91

what are the layers of the male urogenital triangle from superficial to deep?

Back 91

skinA - superficial fascia of perineum - continuous with Scarpa's fasciaB - perineum - superficial Tv perineal m, bulbospongiosus, ischiocavernosis (erectile tissue)C - perineal membrane - spans pubic arch and provides support below the urogenital hiatus of levator aniD - deep perineal pouch - deep Tv perineal mm, sphincter urethrae, bulbourethral gland

Front 92

what are the layers of the female urogenital triangle from superficial to deep?

Back 92

skinA - superficial fascia - continuous with Scarpa's fasciaB - perineum with erectile tissue - bulbospongiosus, ischiocavernosusperineal membrane: spans pubic arch and gives support below urogenital hiatus of levator aniC - deep perineal pouch - b/w perineal membrane and pelvic diaphragm - bulb of vestibule, greater vestibular gland, deep Tv perineal m., sphincter urethrovaginalis, compressor urethrae, sphincter urethrae

Front 93

what is the perineal body made of?what attaches to it?

Back 93

perineal body: CT (collagen, elastin), smooth and skeletal mmattachments:levator aniexternal anal sphinctertransverse perinei mm

Front 94

describe the anatomy and the function of puborectalis

Back 94

puborectalis:component of levator anifrom pubis and forms sling around anorectal junctionfunction:tonically contracted to support faecal mass, relaxes at defaecation to reduce anorectal flexureindirectly supports bladder (and uterus)

Front 95

describe the anatomy of the perineal pouches and the gender differences

Back 95

perineal pouches:exist in urogenital triangle - Tv perineal mm, ischial tuberosity, ischiopubic ramus, pubic symphysisdeep - b/w pelvic diaphragm and perineal membranemale - deep Tv perineal m, external urethral sphincterfemale - deep Tv perineal m, external urethral sphincter, compressor urethrae, sphincter urethrovaginalissuperficial - b/w perineal membrane and superficial fascia of perineumblood/urine can collect here with ruptured urethrasuperficial fascia - continuous with Scarpa's fascia, ends posteriorly at perineal membrane 

Front 96

describe the arterial supply to the pelvis and perineum

Back 96

arterial supply:internal iliac artery - supplies pelvic viscera, perineum and gluteal area (brr. to bladder, uterus, vagina, prostate, vas deferens and perineal rectum/anal canalinternal pudendal artery - major supply to perineum including erectile tissue (larger in males), exits out of pelvis through greater sciatic foramen then enters perineum through lesser sciaticother vessels that supply pelvic viscera - sup rectal a to rectum/anal canal (IMA), ovarian/testicular aa to gonadsobliterated umbilical aa forms medial umbilical ligament (low O2 to placenta)

Front 97

describe the venous drainage of the pelvis and perineum and the gender differences

Back 97

venous drainage:most pelvic viscera drain into valveless venous plexus which form a communicating network (difficult haemostasis with trauma) which drain into internal iliac veins (some into internal vertebral venous plexus of Baston)exceptions:rectum - IMV to portal veinerectile tissue - deep dorsal vein of penis/clitoris which passes under pubic symphysis to prostatic/vesical plexusgonads - pampiniform plexus to L testicular/ovarian to L renal vein or R testicular/ovarian to IVC

Front 98

describe the lymphatic drainage of the pelvis and perineum

Back 98

lymphatic drainage:in general drain along supplying vesselsrectum/upper anal canal - inferior mesentericpelvic organs - internal iliac and sacral nodesEXCEPTIONSovaries, uterine tubes and uterine fundus - with ovarian vessels to para (lateral) aorticuterus adjacent to attachment of round lig - drains along round ligament to superficial inguinaltesticles/epididymus - drains along testicular vessels to para (lateral) aorticperineum - skin, lower urethra, vagina, anal canal drain to superficial inguinal

Front 99

describe the lymphatic drainage of skin and superficial fascia

Back 99

lymphatic drainage:cervical nodes - above the claviclesaxillary nodes - b/t clavicles and umbilicusinguinal nodes - below umbilicus

Front 100

describe the innervation of the pelvis and perineum

Back 100

pelvic/perineum innervation:sympathetic (T11-L2) - descends from aortic plexus to superior hypogastric plexusparasympathetic (S2-4) - ascend from inferior hypogastric plexus to reach hindgutpudendal nerve (S2-4) - supplies skin and skeletal mm of perineum - including vol. sphincters - carries sympathetic fibres to perineumsacral plexus (L4-S4) - supplies somatic structures in LL, pelvis and perineum (incl pelvic diaphragm)

Front 101

what is the pelvic pain line?heartmidgutureterprostate

Back 101

pelvic pain line:inferior limit of the peritoneum, except GIT which extends to halfway along the sigmoidabove - travels with sympathetic back to T1-L2 spinal cord - includes thoracic and abdo viscera, gonads, pelvic viscera in contact with peritoneumheart T1-5midgut T10 - periumbilical pain of appendicitisureter T10-L1below - travels with parasympathetic back to S2-4 spinal cord - lower bladder, cervix, upper vagina, prostateprostate S2-4

Front 102

describe the different anaesthetic options in labour and how they related to the anatomy

Back 102

spinal block:anaesthetises from waist down with LL paralysisblocks pain of labourcannot feel uterine contraction from sympathetics T11-L2cannot feel dilatation of cervix from parasympathetics S2-4cannot feel stretch of perineal skin from pudendal nerve S2-4caudal epidural:can feel uterine contractionbut not dilation of cervix or stretch of perineal skinpudendal nerve block: cannot feel stretch of perineal skin but can feel rest

Front 103

describe the structures that the pudendal nerve supplies in the male pelvis

Back 103

pudendal nerve: S2-4sensory - skin of shaft and glans of penis; posterior 2/3 of scrotum (ant 1/3 is ilioinguinal n L1)motor - bulbospongiosus, ischiocavernosus, external anal sphincter, external urethral sphincter

Front 104

what are the borders of the posterior triangle of the neck?contents?

Back 104

borders:post .border of SCMant. border of trapeziusmiddle 1/3 of claviclecontents:spinal accessory nerve - CNXIcut. brr. of cervical plexus (supply skin of neck and scalp) - emerge from half way along post. border of SCMbrachial plexusvessels - subclavian a. (and vein but sits sup. to prevertebral fascia), lower end of EJV LN - lie b/w roof and floorfloor (top to bottom) - splenius capitis, levator scapulae, scalenus medius and anterior - inf. belly of omohyoid crosses

Front 105

what joints are responsible for gesturing yes and no with the head?

Back 105

YES - atlantooccipital (atlas has no vertebral body or spinous process)NO - atlantoaxial

Front 106

what vertebral level in the hyoid bone?what are its attachments?

Back 106

hyoid: C3attachments:supra- and infrahyoid mmtongue mmpharynx and larynx

Front 107

what makes the floor and the roof of the posterior triangle of the neck?which is the landmark muscle and why?

Back 107

floor: prevertebral fascia lying on - splenius capitis (intrinsic back mm)levator scapulaescalenesroof: investing layer of deep cervical fasciascalenus anterior:posterior - subclavian a. and roots of brachial plexusanterior - subclavian v. and phrenic nerve

Front 108

what is a simple way of stemming bleeding from the upper limb?

Back 108

upper limb bleeding:press down just posterior to anterior scalenes at root of neckcompresses subclavian a. against the 1st rib

Front 109

describe the major arteries in the neck

Back 109

common carotid:divides in ant. triangle at upper border of thyroid cartilage (C4)ICA - no brr. in neck, supplies brain, eyes/retina, upper nose and nasal cavity, anterior scalpCCA and ICA course - SC jt to a point half way b/w angle mandible and mastoid processECA - has branches in neck - supplies neck, face, lateral scalpsubclavian a.: R begins from brachiocephalic trunk, L from AoA3 parts:1st - ascends lat. to trachea to med. border of ant. scalene - all brr.(including vertebral aa.) except L costocervical trunk br. from herevertebral a. - supplies post. brain and cervical SC, ascends in Tv processes of C6-1 then through foramen magnum into cranial cavity 2nd - post. to ant. scalene3rd - lat. margin of ant. scalene to lat. border of 1st rib - becomes axillary a. - only part covered in pretracheal fascia which then becomes axillary sheath

Front 110

neck arteries

Back 110

A - ECA (has branches in neck)B - ICA (no branches in neck)C - carotid body (chemoreceptor)D - carotid sinus (baroreceptor)E - CCA - divides in anterior triangle at level of superior edge of thyroid cartilage

Front 111

describe the major veins of the neck

Back 111

IJV:drains brain, face, scalp and neckbase of skull to root of neck, continuation of sigmoid sinus at jugular foramen to brachiocephalic vdecends posterior to ICA and CNX/XI/XI then lateral to ICA/CCA within the carotid sheath with CNX posteriorfrom external acoustic meatus to medial end of clavicle b/w heads of SCMEJV:formed by post. branch of retromandibular and post. auricular vv in the parotid glanddeep to platysma but superficial to SCM as it descends vertically to enter posterior triangledrains to subclavian v immediately lateral to anterior scalenesubclavian v.:enters root of neck arching over rib 1 anterior to scalenus anteriorL & R brachiocephalic veins:formed by subclavian vv and IJV behind sternoclavicular jtL much longer than Rbehind manubrium to form SVC 

Front 112

what is the main difference between the R and L lymphatic drainage of the head and neck?

Back 112

lymphatic drainage:all H&N lymph drains into deep cervical nodes, which run in carotid sheath posterior to IJV into jugular trunkL side drains into thoracic duct then into junction of IJV and L subclavian (start of brachiocephalic v)R drains into R lymphatic duct then into the R subclavian

Front 113

describe the major nerves of the neck

Back 113

cervical plexus:ventral rami C1-4 exits b/w scalenus ant. and med. forms deep to SCM and in front of scalenus med. and l. scapulaeenters post. triangle halfway down post. edge of SCMphrenic n - C345 supplies diaphragm, descends ant. to scalenus ant.brachial plexus:C5-T1 ventral rami (5 roots) form 3 trunks and exit (C5 is lower edge of thyroid cartilage) b/w scalenus ant. and med. into post. triangle at angle of SCM and clavicleforms 3 cords when passes post. to clavicle and subclaviusCNXI:supplies SCM and traps, crosses post. triangle on levator scapulaeCNX:descends in carotid sheath behind IJV and ICA/CCAgives off pharyngeal, sup. and recurrent larygeal nn and cardiac brr. in necksympathetic trunk:ascends on prevertebral mm 3 ganglia, white matter from upper thoracic nervessuperior - largest at C2/3, b/w carotid sheath and longus capitismiddle - smallest at C6 in front of inferior thyroid a. inferior - b/w base of TP of C7 and 1st rib 

Front 114

boundaries of the following:nasal cavityoral cavitypharynxnasopharynxoropharynxlaryngopharynxoesophaguslarynx

Back 114

nasal cavity:narez to choanaeoral cavity:lips to soft palatepharynx:choanae and base of skull to C6 and cricopharyngeus (upper oesophageal sphincter)nasopharynx - choanae to soft palateoropharynx - soft palate to epiglottislaryngopharynx - epiglottis to upper oesophageal sphincter (C6)oesophagus: upper oesophageal sphincter (C6) to COJ (T11)larynx:laryngeal inlet at epiglottis (C3) to lower border of cricoid cartilage (C6)

Front 115

what is the level of the:hard palatemouthmandiblepharynxhyoidthyroid cartilagecricoid cartilagemidpoint of tracheacarina

Back 115

hard palate - C1 - arch of atlasmouth - C1,2mandible - C2,3pharynx - base of skull to C6 - cricoid cartilagehyoid - C3thyroid cartilage - C45cricoid cartilage - C6midpoint - jugular notch or T2/3 disccarina - sternal angle or T5

Front 116

describe the location, shape and relationships of the thyroid gland

Back 116

thyroid gland:site - C5-T1, isthmus ant. to tracheal cartilage 2-4within pretracheal fascia bound to larynx (moves with swallowing)shape - pear-shaped with narrow upper pole and broader lower pole - triangular cross-section (lat., med. and post. surfaces) lat. (superficial) - under sternohyoid and sternothyroid (prevents sup. enlargment)med. - larynx and upper trachea (6th ring) with lower pharynx and upper oesophagus immediately behind, cricothyroid, inf. constrictor, ELN (from above) and RLN (from below)post. - carotid sheath, PTh glands (direct contact b/w it and fascia), inf. thyroid a. brr., thoracic duct 

Front 117

describe the vascular supply of the thyroid gland

Back 117

arterial:superior thyroid a. - from start of ECAinferior thyroid a. - from thyrocervical trunk (branch of subclavian a.)venous: superior thyroid v. - ascends with artery to upper IJVmiddle thyroid v. - drains to lower IJVinferior thyroid v. - forms plexus, L drains to L brachiocephalic v. and R to R brachiocephalic v. just at start of IVC

Front 118

describe the laryngeal nerves and the associated nerve lesions

Back 118

branches of CNXsuperior laryngeal n.:internal laryngeal n. takes sensory above vocal folds - loss of sensation, common by fishbone damage in piriform fossaexternal laryngeal n. supplies cricothyroid which lengthens vocal folds - at risk in thyroid surgeryRLN: R turns around R subclavianL around AoA (longer and extends into thoracic cavity, more vulnerable) supplies all remaining intrinsic mm (abducts/adducts vocal folds) sensation below vocal foldsU/L causes hoarsenss and bovine coughB/L causes stridor as cords near midline

Front 119

what are important landmarks in the neck at C4 and C6?

Back 119

C4:upper border of thyroid cartilageCCA bifurcationfeel carotid pulse or carotid massageC6:can compress CCA against TP of C6laryngotracheal junctionpharyngooesophageal junction

Front 120

what are the locations of emergency and surgical airways?

Back 120

emergency:cricothyrotomy - b/w thyroid and cricoid cartilagessurgical:tracheotomy - b/w tracheal rings 2-3

Front 121

what are the boundaries of the thoracic cavity?

Back 121

thoracic inlet:T11st rib and ccmanubriumthoracic outlet:T1212th ribcostal marginxiphisternumclosed by diaphragm

Front 122

describe the venous drainage of the anterior abdominal wall

Back 122

abdo wall veins:superior epigastric v. - runs with artery to internal thoracic v.inferior epigastric v. - runs with artery in lateral umbilical fold to external iliac v.anastamose with paraumbilical vv which drain to portal vein

Front 123

what forms the conjoint tendon?

Back 123

conjoint tendon:lower fibres of TrA and IOinserts into crest of pubis, pectineal line behind superficial inguinal ring

Front 124

Hasselbach's triangle

Back 124

A - posterior layer of rectus sheath (TrA and IO)B - arcuate lineC - RAD - Hesselbach's triangle of conjoint tendon (site of direct hernia)E - inguinal ligamentF - lacunar ligament - strangulates femoral herniaG - femoral ring (site of femoral hernia)H - accessory obturator a. - present in some, in dange when incising lacunar ligament in femoral hernia repairI - ductus deferensJ - external iliac vesselsK - testicular vesselsL - deep inguinal ring (site of indirect hernia)M - inferior epigastric vessels

Front 125

describe the attachments and openings of the diaphragm

Back 125

attachments:12th rib, costal margin and inner surface of lower 6 ribsback of xiphoid by 2 slipslat. arcuate lig - L1 TP to tip rib 12, over TrA and QL, crosses subcostal VANmed. arcuate lig - L1 TP to L1 VB, over psoas major, crosses sympathetic chainL crura - L1,2median arcuate lig - b/w crura over aortic hiatusR crura - L1-3central tendonopenings:T8 - caval hiatus - in central tendon - IVC, brr. of R phrenic n.T10 - oesophageal hiatus - most commonly formed by R crus - oesophagus, vagal trunks, oesophageal brr. of L gastric a. and v.T12 - aortic hiatus - formed by R and L crura - AA, thoracic duct, azygos v.R crus - 2 l. apertures - R greater and l. splanchnic nn.L crus - 3 l. apertures - L greater and l. splanchnic nn., hemiazygos v. foramen of Morgani - lie b/w sternal and costal attachments of diaphragm - passageway for superior epigastric a. and v. - site of Morgani's hernialumbosacral trigone - area b/w rib 12, costal and lumbar components of diaphragm - site of Bochdalek hernia (most common congenital diaphragmetic hernia and L>R)

Front 126

what makes up the posterior abdominal wall?

Back 126

posterior abdominal wall:lumbar vertebrae and discscrura and arcuate ligaments of diaphragmpsoas major and minorQLiliacusaponeurosis of TrA

Front 127

describe the location of the abdominal aorta and its branches

Back 127

abdominal aorta:from - T12 at aortic hiatusruns along lumbar VBto - L4 where branches to common iliac aa (slightly to L and below level of umbilicus)crossed by splenic vein and body of pancreas b/w CT and SMAcrossed by L renal vein, uncinate process of pancreas and D3 b/w SMA and IMAunpaired brs to viscera - coeliac trunk (T12), SMA (L1), IMA (L3)paired branches to viscera - middle suprarenal, renal (L2), gonadal (L2,3)branches to body wall - inferior phrenic (1st branch, above coeliac), lumbar branches (4 pairs), median sacral

Front 128

describe the location of the IVC and its tributaries

Back 128

IVC:from - R of midline at L5 - union of common iliac vv, behind R common iliac a.forms posterior wall of foramen of Winslow then grooves the bare area of the liverto - caval opening at T8 into RAIVC and tributaries are valveless (except gonadal)tributaries: ascending4th and 3rd lumbar vv (2nd and 1st join ascending lumbar v.)R gonadal v. (L goes to L renal v.)renal vv - L2, infront of aa but behind pancreasR suprarenal v (L goes to L renal v.)inferior phrenic vvhepatic vv. - T8 - R, central and L

Front 129

where is Virchow's node?

Back 129

Virchow's node:L supraclavicular node near termination of thoracic ductcan indicate malignant spread from - L thorax, L H&N, L UL, abdomen, pelvis, LL

Front 130

what are the retroperitoneal structures?

Back 130

retroperitoneal structures:suprarenal glands, kidneys and ureterspancreas (except tail)duodenum (except 1st few cm)ascedning and descending colonAA and IVC

Front 131

decribe the location and supply of the suprarenal glands

Back 131

suprarenal glands:site - retroperitoneal, T12/L1, related to sup. pole of kidneysR is pyramidalL is cresentericposterior - L and R cruraanterior - R - bare area of liver and IVC; L - lesser sac and stomach and pancreasaa. - 3x, sup. (br. inferior phrenic), middle (br. AA) and inf. (br renal a.)vv. - 1x, R to IVC, L to L renal v.

Front 132

describe the location and posterior relationships of the kidneys

Back 132

kidneys:location - retroperitoneal in paravertebral gutters on posterior abdominal wall - T12-L3R lower than Lsuperior pole more medial than inferiorPOSTERIOR4 muscles of posterior abdominal wall - diaphragm, TrA, QL, psoas majoroverlying nn of post. abdo wall - subcostal n. (T12), iliohypogastric n. (L1), ilioinguinal n. (L1) - in danger with posterior surgical approach

Front 133

describe the anatomy of the renal fascia

Back 133

renal fascia:condensation of extraperitoneal tissue than envelops kidney and adrenalsthin fascial septum separates adrenal and kidney - therefore when adrenal or kidney removed won't affect the position of the other attaches superiorly to diaphragm, anterior and posterior leaves loosely connected inferiorlyperinephric fat immediately surrounds each kidneyparanephric fat lies superficial to renal fascia

Front 134

describe the anatomy of the renal hilum

Back 134

renal hilum:1cm long cleft on medial border of kidney where structures enter and exit renal sinuson transpyloric plane - L1A→P: renal v.  → renal a.  → renal pelvisL renal v. longer and passes b/w SMA and AA (nutcracker)renal aa. pass posterior to renal v., R renal a. passes posterior to IVCrenal pelvis turns caudally and ureter runs along psoas major

Front 135

describe the internal features of the kidney

Back 135

kidney:cortex - glomeruli, proximal and distal tubule, peritubular capillaries - extend b/w pyramids as columns (of Bertin)medulla - loop of Henle and collecting tubules that form pyramidspyramids → renal papilla → minor calyx → 2-3 join to form major calyx → renal pelvis   

Front 136

describe the blood supply to the kidneys

Back 136

kidneys:renal aa from AA at L2 post. to renal v., R passes post. to IVC receives 20-25% of COaccessory renal a. present in ~30% of population5 segmental areas of each kidney: sup., ant. sup., ant. inf., post., inf.segmental a. → interlobar a. → arcuate a. → cortical radiate a. → perforating radiate a. → afferent arteriole to glomerulus

Front 137

describe the relationships of the kidney

Back 137

anterior:L - adrenal, splenic flexure, mesocolon, jejunum, stomach, lienorenal lig., spleen, tail of pancreas R - adrenal, hepatic flexure, mesocolon, jejunum/ileum, D1-2, liver edge, GB, portal triadposterior:4 mm - diaphragm, psoas major, QL, aponeurosis of TrA3 nn - subcostal (T12), iliohypogastric (L1), ilioinguinal (L1)subcostal aa and vvpleurabones - ribs 11 and 12 on L, 12 on R, TP of L1

Front 138

describe the features and course of the ureters

Back 138

ureters: 25cm long, 3-5mm wide tube of smooth muscle - outer circular, inner longitudinal (opposite to GIT)from - renal pelvis (PUJ) at TP of L2to - ureteric orifice - just med. to ischial spine on XR, enters obliquely to 5cm apart externally but 2.5cm apart internallyabdominal course: retroperitoneal almost vertical on psoas major, crosses in front of genitofemoral n. then crossed itself ant. by gonadal vesselsright - upper part behind D3, lower crossed by R colic and ileocolic aa. and root of mesenteryleft - lat. to IMA, crossed by R colic a. and at pelvic brim apex of sigmoid mesocolonpelvic course: extraperitoneal  midpoint crosses bifurcation of CIA across the origin of EIA, passes posterolaterally on pelvic wall, then at level of ischial spine turns anteromedially towards the bladderfemale - post. to ovarian vessels at pelvic brim, then ovary then inf. to uterine a.male -  post. to testicular vessels at pelvic brim, then inf. to d. deferens

Front 139

describe the female pelvic relationships of the ureter

Back 139

ureter:posterior to ovarian vessels at pelvic brimposterior to ovary on pelvic wallinferior to uterine a. (water under bridge)~2cm lateral to cervix of uterus and lateral fornix of vagina

Front 140

describe the male pelvic relationships of the ureter

Back 140

ureter:posterior to testicular vessels at pelvic briminferior to ductus deferens (water under bridge) near base of bladder

Front 141

describe the constriction points of the ureter

Back 141

ureteric constriction points:PUJ - TP of L2pelvic brim - as crosses external iliac vesselsureteric orifice - just medial to ischial spine on XR

Front 142

describe the pain distribution of the kidneys, ureter, bladder and urethra

Back 142

pain:travel in sympathetic fibreskidney - renal angle - T10/11ureter - loin to groin - T10-L1bladder - superior part → suprapubic pain - L1travel in parasympathetic fibresrest of bladder and urethra - S2-4

Front 143

describe the development of the kidney

Back 143

kidney:develop from ureteric bud reaching the metanephric capbegin close together in pelvis and ascendscan fuse to form horseshoe kidney whose ascent is blocked by IMApalpated as a mass anterior to lower AA just above umbilicus

Front 144

describe the location and shape of the bladder

Back 144

bladder:when empty entirely in pelvic cavitydesire to void at 250-300ml, normal capacity 500ml - above this palpable suprapubicallyas it fills it rises into the abdominal cavity, stripping peritoneum from the anterior abdominal wallnewborn - even when empty is abdominal (more prone to injury), moves to pelvis by age 6-7

Front 145

describe the structure, external features and blood supply of the bladder

Back 145

structure:lined by transitional epitheliumdetrusor m. - sm. muscle arranged in interlacing bundlesexternal features: superior surface - covered by peritoneum2x inferolateral surfaces - rest on pubic bone ant., levator ani and obturator internus lat.base - faces post.apex - ant. connected to urachus/median umbilical lig (formerly allantois)neck - lowest most fixed part, smooth muscle forms int. urethral sphincterblood supply: arterial - internal iliac aa.venous - internal iliac vv.

Front 146

what is the anterior surface anatomy of the heart?

Back 146

heart surface anatomy:R 3rd CCL 2nd CCL 5th IC midclavicular lineR sternal border at 6th IC

Front 147

what is at the angle of Louis? 

Back 147

angle of Louis: sternal angle → T4/5AA →  AoAAoA →  DAlig. arteriosumL RLN around AoAcarinabifurcation of PAazygos v. enters the SVCjunction of upper and middle 1/3 of oesophagus oesophagus moves from L to R of midlinethoracic duct crosses to the Llower extent of prevertebral fasciaprevertebral fascia joins pericardiumSVC enters RAskin dermatomes C4 → T2splitting of the pleura

Front 148

describe the surface anatomy of the lungs and pleura?

Back 148

lungs:from 6th cc to 8th ribR horizontal fissure 4th icR oblique fissure 5th icL oblique 5th icpleura: 10th rib midclavicular line to T12

Front 149

what atery supplies the lower spinal cord?

Back 149

great radicular artery:from decending aortab/w T9 and L1

Front 150

what is the attachment and function of the cruciate ligaments?

Back 150

ACL:tight in extensionstops femur slipping backwardsPCL:stops femur slipping forwards

Front 151

in general terms, describe the direction of the cranial nerves that eneter the neck

Back 151

cranial nerves:IX and XII pass forward to the oropharynx and tongueXI runs backwards to SCM and trapeziusX runs down the carotid sheath

Front 152

what are the bones and the sutures of the cranium?

Back 152

cranium: 8 bonesfrontalparietal x2temporal x2 - squamous and petrous partsethmoidsphenoidoccipitalsutures: coronal - frontal and 2x parietalsagittal - 2x parietallambdoidal - 2x parietal and occipitalpterion - weakest part of skull, junction of 4 bones - frontal, parietal, greater wing of the sphenoid, squamous part of the temporalfracture can lacerate the middle meningeal artery and cause a extradural haematoma - takes time to develop (initially lucid), biconvex as restricted by sutures, lateral pressure can herniate medial temporal lobe (seizures and limb weakness) compressing the brainstem and CNIII (dilated I/L pupil due to loss of PSNS)

Front 153

name the bones of the face

Back 153

facial bones: 14 bonesmandiblepalatinezygoma x2maxillaryvomerinferior nasal conchae x2perpendicular plate of ethmoidnasal x2lacrimal x2frontal

Front 154

describe the Circle of Willis

Back 154

posterior circulation:vertebral aa - from posterosuperior aspect of 1st part of subclavian a., moves posteriorly to medial border of anterior scalenes at apex of pyramidal space with longus colli, enters Tv foramen of C6posterior spinal aa. - descend to right down spine, can be a branch off PICAPICA - largest branch of VA, course behind medulla b/w origin of CN X and XII, over inferior cerebellar peduncle to inferior surface of cerebellum - lateral medullary syndromeanterior spinal a. - fuse at foramen magnum, continue as onebasilar a. - VA fuse at upper medulla and ascends b/w pons and clivusAICA - 1st br. of BA - lateral pontine syndromelabyrinthine a. - can branch off AICA, enters IAMpontine aa. - long and short brSCA - final br. of BA, passes laterally below CN III (separates from PCA), around cerebral peduncle to superior cerebellumPCA - bifurcation of BA, wraps around cerebral peduncles to run posteriorly above tentorium cerebelli on inferomedial surface of occipital lobeposterior communicating a. - 3rd most common site of aneurysmsposterior perforating aa. - supply choroid and thalamusanterior circulation:ICA - from birfucation of CCA at C4, moves posteriorly, crossed by pharyngeal br. of CN X, CN IX, stylopharyngeus and styloglossus, enters carotid canal and runs anteromedially through petrous temporal bone medial to middle ear, then turns up over foramen lacerum then forwards to enter cavernous sinus then up again medial to anterior clinoid and lateral to pituitary stalk and optic chiasmasuperior and inferior hypophyseal aa - branch off ICA, superior supplies stalk, inferior pituitaryophthalmic a. - branches off ICA medial to anterior clinoid, pierces optic nerve's dural sheath and enters orbit through optic canal to supply everything in the orbithypothalamic a. MCA - runs laterally into then posterolaterally along sylvian fissure to supply lateral cerebrumanterior choroidal a. - can also branch off ICAACA - passes anteriorly over CN II to arch superiorly at genu of corpus callosum, then back through longitudinal fissurerecurrent a. of Heubner - to thalamusanterior perforating aa. anterior communicating a. - most common site of aneurysms

Front 155

what is the course and the branches of the ECA?

Back 155

ECA: 6 branches in neckfrom - birfurcation of CCA w/n carotid sheathto - parotid gland b/w deep and superficial lobes posterior to neck of mandible, splits to maxillary a. and superficial temporal a.first lies anteromedial to ICA but at C2 crosses over it to lie lateralcrossed by (inf → sup) - upper root of ansa cervicalis, CN XII, posterior belly of digastric, stylohyoid, stylohyoid lig, CN VII (w/n parotid)floor - pharyngeal wall, SLN, deep parotid lobesuperior thyroid a. - 1st br. from anterior surface near origin, supplies upper pole of thyroid and gives rise to superior laryngeal a. which pierces thyrohyoid membrane to supply laryngopharynx and larynxascending pharyngeal a. - from posterior aspect to supply pharynx lingual a. - runs over greater horn of hyoid then deep to hypoglossus into tonguefacial a. - runs above hyoid deep to digastric, then up medial to body of mandible near angle, then loops back out around anterior to insertion of masseter then in superficial tissues passes angle of mouth to medial canthus of eyeoccipital a. - crossed by CN XII to supply posterior neck and scalpposterior auricular a. - posterior scalpsuperficial temporal a. - runs b/w deep and superficial lobes of parotid over posterior end of zygomatic process

Front 156

neck

Back 156

A - hypoglossal n. (CN XII)B - accessory n. (CN XI)C - inferior ganglion of vagus n. (CN X)D - posterior auricular a.E - upper sternomastoid branch of occipital a.F - posterior belly of digastricG - occipital a.H - carotid sinusI - lower sternomastoid branch of occipital a.J - vagus n. (CN X)K - IJVL - glossopharyngeal n. (CN IX)M - superficial temporal a.N - maxillary a.O - stylopharyngeusP - pharyngeal br of vagus (CN X)Q - SLNR - ICAS - ECAT - facial a.U - hypoglossal n. (CN XII)V - lingual a. (with superior thyroid a. below unlabelled)W - internal and external laryngeal nn.X - superior and inferior root of ansa cervicalisY - CCA

Front 157

what structures pass through the fork of the birfucation of CCA?

Back 157

CCA bifurcation:glossopharyngeal n. (CN IX)pharyngeal branch of vagus (CN X)stylopharyngeus

Front 158

describe the course and branches of the facial nerve

Back 158

facial nerve (CN VII): nerve of 2nd pharyngeal archFUNCTIONSmotor output to facial musclesPSN to lacrimal, submandibular and sublinguinal glandsafferent fibres for taste from ant. 2/3 of tonguesensory from ext. auditory canal and pinnaCOURSE from - 2 roots nervus intermedius and motor root leave cerebellopontine angle medial to CN VIIIenters IAM forms the geniculate ganglion - synapse of external ear sensory and special sensory fibresthen enters the facial canal and runs medial wall of middle ear3 brr. inside the skull:greater petrosal n. - passes superiorly through petrous bone, exits its named canal to run beneath dura under temporal lobe, enters foramen lacerum (joined by SNS fibres of deep petrosal n. off ICA) then through pterygoid canal to pterygopalatine ganglion then fibres go with brr. of V2 to lacrimal, nasal, palatine and pharyngeal glands, palatine taste budsn. to stapedius chorda tympani - runs through the ossicles of the middle ear through petrous bone out the petrotympanic fissure into infratemporal fossa to join V3 to provide PSN to submandibular and sublingual glands and taste ant. 2/3 of tongue exits stylomastoid foramen branches outside skull:post. auricular n. - to occipitofrontalis, auricularisbr. to post. belly of digastric and stylohyoidpasses through parotid gland dividing its lobes then divides to 5 terminal brrtemporal br. - moves sup. over zygomatic arch to supply mm above eyes zygomatic br. - runs over zygomatic bone to lat. angle of orbit to orbicularis oculibuccal br - mm of expression above mouthmarginal mandibular br - passes beneath platysma to muscles of lower lip and chip - injured in surgerycervical br - runs beneath platysma supplying it

Front 159

names these muscles, their origin/insertion and their innervation

Back 159

1 - middle scalenes:from - posterior tubercles of Tv processes of C2-7to - superior aspect of 1st ribnerve - anterior primary rami C3-82 - levator scapulae:from - posterior tubercles of Tv processes of C1-4to - upper part of medial border of scapulanerve - anterior rami of C3-4 and dorsal scapular n (C5)3 - stylohyoid:from - base of styloid processto - greater horn of hyoidnerve - facial n. before enters parorid - elevates and retracts hyoid bone to elevate larynx in swallowing4 - digastric:from - medial aspect of mastoid process (posterior belly)via - lesser horn of hyoidto - medial aspect of symphysis mentinerve - facial n. before enters parotid (posterior belly), mylohyoid v. (V3 anterior belly)5 - omohyoid:from - suprascapular ligvia - slings around SCMto - inferior body of hyoidnerve - ansa cervicalis (C1-3)6 - anterior scalenes:from - anterior tubercles of Tv processes of C3-6to - scalene tubercle on superior aspect of 1st rib

Front 160

name these muscles of the posterior neck, their origin/insertion, action and innervationwhat muscles have been removed to achieve this view?

Back 160

1 - obliquus capitis inferior:from - spinous process of axis (C2)to - lateral mass of atlas (C1)action - rotates atlantoaxial jointnerve - suboccipital n. (posterior primary maus of C1)2 - rectus capatis posterior major:from - spinous process of axis (C2)to - lateral half of inferior nuchal lineaction - extends and rotates atlantooccipital jointnerve - suboccipital n. (posterior primary ramus C1)3 - rectus capitis posterior minor:from - only mm attached to posterior arch of atlasto - medial inferor nuchal lineaction - weakly extends the headnerve -  suboccipital n. (posterior primary ramus C1)muscle layers: superificial - trapeziusintermediate - splenius capitis, semispinalis capitis, longissimus

Front 161

name these muscle, their origin/insertion, action and innervation

Back 161

1 - masseter:from - anterior 2/3 of zygomatic arch and zygomatic process of maxillato - lateral surface of angle and lower ramus of mandibleaction - elevates mandible - enables forced closure of mouthnerve - anterior division of mandibular nerve (V3)2 - medial pterygoid:from - medial side of pterygoid plate and fossa b/w medial and lateral plates (deep head), tuberosity of maxilla and pyramidal process of palatine to - medial aspect of angle of mandibleaction - elevates, protracts and laterally displaces mandible to opposite side for chewingnerve - n. to medial pterygoid (main branch of V3) 3 - lateral pterygoid:from - infratemporal surface of sphenoid (upper head), lateral surface of lateral pterygoid plate (lower head)to - pterygoid fovea below condylar process of mandible and joint capsuleaction - protrudes mandible and opens mouth by pulling condyle and disc forwardnerve - n. to lateral pterygoid (anterior division of V3) 4 - temporalis:from - temporal fossa b/w inferior temporal line and infratemporal crestto - medial and anterior aspects of coronoid process of mandibleaction - elevates mandible, posterior fibres retractnerve - anterior division of V3

Front 162

describe the anatomy of the L gastric artery

Back 162

L gastric a.:1st br of coeliac trunk at T12passes superolaterally on the posterior wall of the lesser sac to reach cardiooesophageal junction of stomachoesophageal brr supply lower third of oesophagus through the oesophageal hiatusterminal gastric br runs inferiorly along lesser curve to anastamose with R gastric

Front 163

describe the anatomy of the splenic artery

Back 163

splenic a.:course - runs L along the superior surface of pancreas in posterior wall of lesser sac, passed L crus and L psoas major to hilum of L kidney where it runs in front in the lienorenal lig to splenic hilumpancreatic branches - including the greater pancreaticshort gastric - br just before terminal brr br to run in gastrosplenic lig to supply fundusL gastroepiploic - br just before terminal brr to run in greater omentum to supply middle of greater curvature (anastamoses with R gastroepiploic)posterior gastric (variable) - posterior stomach

Front 164

describe the course and branches of the common hepatic artery

Back 164

common hepatic: 3 brr.course - passes over upper border of pancreas, down and to the R in post. wall of lesser sac to D1 where turns forward at epiploic foramen  where it branchesproper hepatic:  named once has turned up b/w the 2 layers of l. omentum to run in L of p. triad along free edge of l. omentum to porta hepatis where divides (R+L hepatic) cystic a. br. off and found in Calot's triangle, but may br. off L hepatic or gastroduodenal gastroduodenal:  1st br. descends behind D1 to L of bile duct and PV and divides into terminal brr at upper border of pancreas R gastroepiploic passes forward b/w D1 and pancreas and turns L to enter g. omentum at head of pancreas (proximal duodenum, greater curvature - anastamoses with L gastro-omental)sup. pancreaticoduodenal - anastamoses with inf. pancreaticoduodenal br of SMA at ampulla of Vater - supplies superior D2 and head of pancreasR gastric:  leaves as turns into l. omentum to supply lesser curvature - anastamoses with L gastric

Front 165

what comprises the walls of the epiploic foramen (of Winslow)?

Back 165

foramen of Winslow:anterior - free edge of the lesser omentum containing the portal triad (portal v., hepatic a. and bile duct)posterior - IVCinferior - D1superior - caudate lobe

Front 166

what comprises the walls of the lesser sac?

Back 166

lesser sac:diverticulum from general peritoneal cavity behind stomach opening via epiploic foramen of Winslowshould theoretically extend down b/w layers of greater omentum, but these fuse limiting it to below the stomachanterior - lesser omentum and stomachleft - splenic hilum where peritoneum forms lienorenal and gastrosplenic liggright - epiploic foramen and portal triadroof - peritoneum covering the caudate lobeposterior - peritoneum overlying the diaphragm, pancreas, L kidney and adrenal, IVC, AA and coeliac trunk and brr. - common hepatic artery forms pancreaticoduodenal fold and L gastric forms pancreaticogastric fold

Front 167

what is Morrison's pouch?

Back 167

Morrison's pouch:potential space b/w R kidney and segments VI and VII of the livernot normally filled with fluidseen on FAST

Front 168

describe the segments of the liver?

Back 168

liver segments of Couinaud:I - caudate lobeII - lateral extreme of L lobeIII - inferior L lobeIV - middle anteriorV - anteroinferior segment of R lobeVI - posteroinferior segment of R lobeVII - posterosuperior segment of R lobeVIII - anterosuperior segment of R lobe

Front 169

describe the blood supply to the midgut

Back 169

SMA:embryology - axis of rotation is around SMA and vitelline duct, 2 caudally directed brr. (end up on L) and 3 cephalad directed brr. (end up on R)course - AA at L1 behind splenic v. and neck of pancreas (nutcracker over L renal v.), with SMV on R and through and ant. to uncinate process, over D3 to enter upper end of root of mesentery of small intestineinf. pancreaticoduodenal a. - 1st br., from post. surface (often off 1st jejunal br.) runs in b/w D2-4 and HoP and anastamoses with sup. pancreaticoduodenal a. (R hepatic a. can occasionally br. here)jejunal and ileal brr. - from L of main trunk, run in mesentery with anastamosing arcades ileocolic a. - from R side low down in base of mesentery, runs to ileocaecal junction where it gives an ileal br. which anasatomoses with terminal br. of SMA and colic br. which anastamoses up with R colic - rest divides into ant. (smaller) and post. caecal aa. (gives off appendicular a. which runs in mesoappendix)R colic a. - br. same spot as ileocolic, runs R across R psoas, gonadal vessels, ureter, genitofemoral n. and QL to divide into ascending and descending brr.middle colic a. - highest br. of R side as emerges below pancreas - divides into L and R br. (to L of middle colic is avascular window in Tv mesocolon which is access site to l. sac and post. wall of stomach)

Front 170

posterior view of uterus

Back 170

A - ovarian ligB - uterine tubeC - mesosalpinx (mesovarium attaches ovary)D - arcade of ovarian and uterine aa.E - suspensory lig with ovarian vesselsF - fimbriaeG - broad ligament

Front 171

describe the attachments, location, relations and supply of the ovaries

Back 171

attachments:attached by mesovarium to posterior surface of broad lig - with mesosalpinx aboveattached to uterus by ovarian lig.attached to uterine tube by one or more fimbriaeattached to pelvic wall by suspensory ligament up over the iliac vesselslocation/relations: nulliparous - in ovarian fossa on lateral pelvic wall b/w external iliac a. and ureterlies over obturator n. - can inflame and refer ovarian pain to medial thighsupply: ovarian a. - from ~L2 descends on psoas and ureter, enters pelvis over external iliac a. into suspensory lig. - L crossed by IMV, L colic a., sigmoid mesentery; R crossed by D3, R colic a., ileal mesenteryovarian v. - travels back path of a., L to L renal v., R to IVCnerves - sympathetic from T10 along artery, parasympathetic join from hypogastric plexus

Front 172

describe the femal remnants of the gubernaculum

Back 172

gubernaculum:as ovaries don't descend completely - round lig. continues anterior to broad lig. along lateral pelvic wall, through inguinal canal to labia majoraovarian lig. connects ovary to uterus on posterior side of broad lig.suspensory lig. connects ovaries to lateral pelvic wall over iliac vessels

Front 173

describe the support of the uterus

Back 173

active support:levator ani - attaches around lower vaginapassive support: broad ligament and remnants of gubernaculumTv cervical lig. (cardinal lig. of Mackenrodt) - base of broad lig with peritoneal deflections covering - connects cervix to lateral pelvic wall and ischial spine - contains uterine a. and v. which cross the ureterpubocervical lig. - attaches cervix to pubis around the bladderuterosacral lig. - attaches cervix to sacrum

Front 174

describe the blood supply of the uterus and vagina

Back 174

blood supply:uterine and vaginal aa. branch off internal iliac a.uterine a. crosses over ureter near cervix in Tv cervical lig. - supplies uterus, medial uterine tube, upper vaginavaginal a. - supplies vaginainternal pudendal a. - supplies external genitalia including erectile tissuevv. mostly follow aa.erectile tissue drains by dorsal v. of clitoris into pelvic cavity

Front 175

describe the location and relationships of the vagina

Back 175

vagina:8x4cm fibromuscular pelvic structure that communicates uterus and vestibulecervix - pierces upper anterior wall forming fornices (ant, lat and post) - posterior is deepest and related to PoDanterior - bladder, lower 2/3 fused with urethraposterior - PoD, rectum, perineal bodylateral - ureter (lat fornix), levator ani, bulb of vestibule

Front 176

what are the muscles and nerve supply of the hypothenar eminence?

Back 176

hypothenar eminence: 3 mmabductor digiti minimi - most ulnar - from pisiform to ulnar side of base of proximal phalanx of 5th fingerflexor digiti minimi - flexor retinaculum and hook of hamate to same insertionopponens digiti minimi - flexor retinaculum and hook of hamate and inserts into ulnar border of 5th MC bone  action - all 3 help cup the palm to assist in grasping large objectsall supplied by deep branch of ulnar nerve (T1)

Front 177

what are the muscles and nerve supply of the thenar eminence?

Back 177

thenar eminence: 3 mmcommon origin at the flexor retinaculumAPB - most radial - also from scaphoid tubercle, inserts onto radial side of base of prox phalanx and tendon of EPLFPB - ulnar to APB - sup head from trapezium, deep head from trapezoid and capitate, inserts onto radial sesamoid of thumb - most variable n. supply in bodyopponens pollicis - lies deep to others - trapezium, inserts to radial border of MC of thumb - usually has double supply all supplied by muscular (recurrent) br. of median n. (T1)

Front 178

what are 1-3 and their nerve supply?what 2 spaces does this picture depict, their borders and contents?

Back 178

1 - teres major - lower subscapular n. from posterior cord (C5-7)2 - teres minor - axillary n. from posterior cord (C5,6)3 - supraspinatus - suprascapular n . from upper trunk (C5,6) quadrangular space:in posterior wall of axillasuperior - subscapularis and teres minorinferior - teres majormedial - long head of tricepslateral - medial shaft of humeruscontents - axillary n., posterior circumflex humeral a. and v.lateral triangular space: in posterior wall of axillasuperior/medial - teres majorinferior/medial - long head of tricepslateral - medial shaft of humeruscontents - radial n., profunda brachii vessels

Front 179

describe the anatomy of the cervical plexus

Back 179

cervical plexus:formed by anterior rami of upper 4 cervical nerves after each has received a grey ramus communicans (post-ganglionic) from superior cervical ganglionlies on scalenus medius behind prevertebral fascia and covered by upper part of SCM - is does not lie in posterior triangleC1-3 have meningeal brr. - C1 ascends with CN XII and C2,3 through foramen magnummuscular brr.: segmental brr. to prevetebral mm - longus capitis, longus colli, scalenesC2,3 brr. to SCMC3,4 brr. to trapezius (both mostly proprioceptive)ansa cervicalis - superior root from C1, inferior C2,3 - omohyoid, sternohyoid, sternothyroidphrenic n. - C3,4,5cutaneous brr.: lesser occipital n. - C2 - hooks around CN XI and runs up posterior border of SCM to supply upper neck and post-auricular scalpgreat auricular n. - C2,3 - large trunk passing vertically over SCM - supplies skin over angle of mandible, parotid gland, mastoid and posterior auricletransverse cervical n. - C2,3 - curves forward around SCM and splits into ascending and descending to supply skin b/w mandible and manubriumsupraclavicular n. - C3,4 - emerges from posterior border of SCM and divides into several brr. - medial gp → skin to sternal angle, intermediate gp → anterior to clavicle to skin down to 2nd rib, lateral gp → skin ½ down deltoid and to spine of scapula  

Front 180

describe the anatomy of the ansa cervicalis

Back 180

ansa cervicalis:embedded in anterior wall of carotid sheathsuperior root - C1 - passes directly to CN XII b/w rectus capitis anterior and lateralis, leaves lateral to occipital a. and runs on the front of the IJV where joins inferior root - supply superior belly of omohyoidinferior root - C2,3 - spirals laterally around IJV to form long root - sometimes passes b/w IJV and ICA - supplies infrahyoid mm - sternohyoid, sternothyroid, inferior belly of omoyhyoid

Front 181

describe the brachial plexus

Back 181

roots: anterior rami C5-T1 - 5 roots b/w scalenes with 3 brr.lie behind scalenus anterior and emerge b/w it and scalenus medius to form trunks - upper and lower 2 join, C7 remains as middle trunkdorsal scapula - C5 - nerve to rhomboids descends behind the roots in front of levator scapulae to rhomboidsnerve to subclavius - C5,6 - passes down in front of roots/trunks and subclavian vessels to posterior surface of subclavius - accesory phrenic n. may connect with phrenic to give alternate pathway to diaphragmlong thoracic - C5,6,7 - nerve to serratus anterior C5,6 fibres fuse in scalenus medius and emerge from lateral border then on medial wall of axilla (on serr. ant.) joined by C7 br. which went anterior to medius - together pass down posterior to midaxillary linetrunks: 3 trunks in posterior triangle with 1 br.upper, middle and lower trunks cross lower part of the posterior trianglebehind clavicle divide into anterior (flexor) and posterior (extensor) divisionssuprascapular - C5,6 - large br. from upper trunk at base of posterior triangle deep to border of trapezius, through suprascapular foramen to supraspinatus, GH/AC jts, then lateral to spine to infraspinatusdivisions: 2 per trunk behind clavicle, A&P - no brr.at lateral border of 1st rib, upper 2 anterior divisions form lateral cord, anterior division from lower trunk continues as medial cordall posterior divisions form posterior cordcords: 3 cords in axillaenter axilla above 1st part axillary a.embrace 2nd partbr. at 3rd partlateral cord: 3 brr.lateral pectoral - C5,6,7 - to pectoralis major - communicates across 1st part of axillary a. with medial pec n.musculocutaneous - C5,6,7 - lateral side of Mlateral root of median -  C5,6,7 - middle of Mmedial cord: 5 brr.medial pectoral - C8, T1 - from behind 1st part of axillary a. to supply pectoralis majormedial root of median - C8, T1medial cutaneous n. of arm - C8, T1 - most medial, runs down axillary v. to skin over anteromedial armmedial cutaneous n. of forearm - C8, T1 - runs b/w a. and v. to skin over medial forearmulnar - C7,8, T1 - L side of Mposterior cord: 5 brr.upper subscapular - C5,6 - to upper subscapularisthoracodorsal - C6,7,8 - n. to lats runs down posterior axillary wall behind subscapular a. across teres major to enter lat. dorsi in front of a.lower subscapular - C5,6 - to lower subscapularis and teres majoraxillary - C5,6radial - C5,6,7,8, T1 

Front 182

describe the anatomy of the musculocutaneous n.

Back 182

musculocutaneous n.:from - C5,6,7 from lat. cord (lat. side of M) - lat. to axillary a.behind pectoralis minor through coracobrachialis then down b/w biceps and brachialis - supplies all of theselateral cutaneous n. of the forearm - terminal fibres emerge lat. to biceps tendon to pierce deep fascia and run down to skin over snuff-box

Front 183

describe the anatomy of the median n.

Back 183

median n.:from - C5,6,7 lat. cord; C8, T1 from med. cord - forms middle of Marm - formed at lower border of axilla, starts lat. to axillary a. then med. to brachial a. in ant. compartment to enter c. fossa med. to biceps tendonc. fossa - leaves b/w heads of pr. teres to run deep to FDS - at elbow supplies these both, FCR and p. longus, elbow jt and prox. RU jtwrist - surfaces b/w tendons of FCR and FDS and gives off p. cutaneous br. which runs sup. to retinaculum for thenar skinhand - rest continues through carpal tunnel and then divides to muscular and digital brr.supplies - thenar mm - LOAF - Lateral 2 lumbricals, OP, AbPB, FPBanterior interosseous n. - br. just below pr. teres to run on interosseous m. deep to FDP to supply FPL, radial FDP and pr. quadratus

Front 184

describe the anatomy of the ulnar n.

Back 184

ulnar n.:from - C8, T1 med. cord - forms med. side of Marm - descends b/w a. and v. on coracobrachialis to m.p. of humerus where passes post. through intermuscular septum to post. compartment beneath med. head of tricepsforearm - passes post. to med. epicondyle in cubital tunnel to enter b/w heads of FCU, med. to coronoid and runs deep to FCU (supplies) on FDP (supplies half), uln. to ulnar a. wrist - surfaces rad. to FCU tendon, sup. to retinaculum to divide to terminal brr. at pisiformdorsal cut. br. - 5cm prox. to wrist crosses uln. under FCU to skin on uln. dorsum of handpalmar cut. br. - to skin hypothenar eminencesup. terminal br. - digital br.deep terminal br. - runs b/w pisiform and HoH in Guyon canal, through hypothenar eminence, deep to flexor tendons to AddP - supplies wrist jt, FDM, AbdDM, OppDM, IO, 2 uln. lumbricals on route

Front 185

describe the anatomy of the axillary n.

Back 185

axillary n.:from - C5,6 - post. cord behind 3rd part of axillary a.runs post. on subscapularis below GH jt through quadrangular space with post. circumflex a. - around surgical neck supplying GH jtant. br. - ant. deltoidpost. br. - to teres minor, post. deltoid and upper lat. cut. n. of arm

Front 186

describe the anatomy of the radial n.

Back 186

radial n.:from - C5,6,7,8, T1 post. cordpost. compartment - descends post. to axillary a., passes inf. to l. dorsi and t. major - runs with profunda brachii a. through lat. triangular space and gives off post. cut. n. to post. upper arm skin - rest moves lat. in spiral groove b/w long and med. heads of triceps and pierces lat intermuscular septum - supplies tricep, aconeus, brachioradiali, ECRLant. compartment - runs deep to brachialis and brachioradialis to enter lat. cubital fossa over lat. epicondyle and brr.post. inteross. n. - b/w heads of supinator below radial head passing to post. compartment b/w deep and sup. muscular layer - supplies supinato, ECR, ED, ED, ECU, AbdPL,  EPB, EPL, EI, inf. RU jt, wrist jtsup. terminal br. - runs down under brachioradialis lat. to radial a., post. to tendon over the snuffbox to cut. brr. of dorsum of hand

Front 187

brachial plexus

Back 187

A - dorsal scapular n.B - to phrenic n.C - to longus colli and scalene mm (C5,6,7,8)D - long thoracic n.E - n. to subclaviusF - suprascapular n.G - lateral pectoral n.H - musculocutaneous n.I - median n.J - ulnar n.K - medial pectoral n.L - medial brachial cutaneous n.M - medial antebrachial cutaneous n.N - upper subscapular n.O - thoracodorsal n.P - lower subscapular n.Q - radial n.R - axillary n.

Front 188

what muscles do the nerves pass through into the forearm?

Back 188

median: pronator teresulnar: FCUradial: supinator

Front 189

describe the investing fascial layer of the neck

Back 189

investing fascia:surrounds the neck like a collarsplits to invest SCM and trapeziusant. - attached to hyoid bonepost. - blends with lig. nuchaesup. - lower border of mandible, splits around parotid (parotid fascia) - superficial part to zygomatic arch - deep part forms stylomandibular lig. then to mastoid process, sup. nuchal line, ext. occipital protuberanceinf. - spine and acromion of scapula and lateral clavicle with trapezius, medial clavicle and manubrium with SCMpierced by EJVforms fascial sling for omohyoid

Front 190

describe the prevertebral fascia of the neck

Back 190

prevertebral fascia:firm tough membrane that lies in front of prevertebral mm.from - base of skull in front of longus capitis and rectus capitis lateralisto - blends with ant. long. lig. on T4 VB below longus collipost. triangle - spreads out over scalenus ant. and med., l. scapulae to fade under trapezius - covering floor over cervical (including phrenic n.) and brachial plexuses, LN and CN XI lie superficialpierced by 4 cut. brr. of cervical plexus - g. auricular, l. occipital, Tv cervical and supraclavicular nn.axillary sheath - covers 3rd part of subclavian a. (lat margin ant. scalenes to lat. border 1st rib) then axillary a. and brachial plexus to form sheath, subclavian/axillary v. stays ant. in areolar tissue so can dilate 

Front 191

describe the pretracheal fascia of the neck

Back 191

pretracheal fascia:thin fascia lies deep to strap mm.sup. - limited by strap mm. at hyoid midline and oblique line of thyroid cartilagemed. - splits to enclose thyroid - adherent only at isthmuslat. - fuses with front of carotid sheath on deep surface of SCMinf. - passes behind brachiocephalic vv. to blend with fibrous pericardium 

Front 192

describe the carotid sheath

Back 192

carotid sheath:feltwork of areolar tissue that surrounds carotid aa., IJV (allows dilation), CN X and deep cervical LNsup. - attached to base of skull at margins of carotid canal and jugular fossa - contains CN IX - XIIinf. - blends with adventitia of AoAalar fascia - connects R and L carotid sheaths behind pretracheal fascia

Front 193

neck cross-section

Back 193

A - levator scapulaeB - longissimus cervicisC - longissimus capitisD - posterior rami of C6E - trapeziusF - spleniusG - semispinalis capitisH - ligamentum nuchaeI - semispinalis cervicisJ - multifidusK - C6 nerve rootsL - C6 vertebraM - longus colliN - prevertebral layerO - oesophagusP - cricoid cartilageQ - pretracheal layerR - investing layerS - sternohyoidT - anterior jugular v.U - omohyoidV - sternohyoidW - SCMX - carotid sheathY - EJVZ - platysma1 - sympathetic trunk2 - anterior ramus of C63 - scalenus anterior and phrenic n.4 - scalenus medius

Front 194

describe the tissue spaces of the neck

Back 194

prevertebral space:closed space behind prevertebral fasciaabscess of cervical vertebra can lift fascia or spread as far down as level of superior mediastinum at T4retropharyngeal space:in front of prevertebral fasciaupper part of space that extends from base of skull to diaphragm through sup. and post. mediastinumcontinuous lat. with parapharyngeal space which extends up into the infratemporal fossasubmandibular space: below mylohyoid and above investing fascia b/w hyoid and mandiblecommunicates with sublingual space above mylohyoid under the mucous membrane of floor of mouth and also parapharyngeal spaceimplicated in Ludwig's angina - can spread into sup. mediastinum via para/retropharyngeal spaces, to post. mediastinum through alar fasciacontains submental LN

Front 195

post. triangle

Back 195

A - splenius capitisB - lesser occipital n.C - great auricular n.D - parotid glandE - masseterF - facial a.G - submandibular glandH - SCMI - Tv cervical n.J - supraclavicular nn.K - C3 and 4 to trapeziusL - omohyoidM - Tv cervical a.N - CN XI

Front 196

describe the origin/insertion, action, relationships and nv supply of SCM

Back 196

SCM:from - 2 heads - rounded tendon from manubrium, flat fleshy mass from med. 1/3 of clavicle - space b/w above SC jt can access lower IJVto - lat. mastoid process and lat. sup. nuchal line via aponeurosisenclosed in investing fasciaaction - neck F, I/L F, C/L rot., assist in forced insp.relationships: CN XI - enters deep clavicular part under ear lobule and emerges 1/3 down post. bordercrossed by - great auricular n., EJV, Tv cervical n. (sup.→inf.)crosses - cervical plexus, carotid sheath, brachial plexussupply: aa. - brr. of occipital and sup. thyroid aa.CN XI - spinal part mostly C2-3cervical plexus C2-3 - carries proprioceptive fibres

Front 197

describe the muscles that make up the floor of the anterior triangle of the neck

Back 197

anterior triangle mm:all supplied by ant. rami of C1-34 mm above and 4 below hyoidSUPRAHYOID GROUP digastric - post. belly from med. mastoid - inter. tendon goes through sling above hyoid - ant. belly attaches inner surface of mandible near midline - elevates hyoid and depresses mandiblestylohyoid - base of styloid to junction of body and greater horn of hyoid - retracts and elevates hyoid in swallowingmylohyoid - ant. body of hyoid to inner aspect of mandible - forms floor of mouth - elevates tongue and hyoidgeniohyoid - inf. mental spine of mandible to sup. body of hyoid - protract and elevate hyoidINFRAHYOID - strap mm all depress the larynx either directly or via hyoid - increases volume of resonating chamberssternohyoid - post. manubrium to inf. body of hyoidomohyoid - sup. scapula and Tv scapular lig to lat. inf. body of  hyoid via facial sling and tendon (over IJV)thyrohyoid - oblique line of thyroid cartilage to greater horn of hyoidsternothyroid - post. manubrium to oblique line of thyroid cartilage

Front 198

what is the relationship of the oesophagus to the aorta?

Back 198

oesophagus vs aorta:R post to AoAthen to R of descending aortathen crosses in front and to the L of the aorta

Front 199

descibe the development and parts of the submandibular glandsupplysurgical approach

Back 199

submandibular gland:from - ectodermal groove on floor of mouth becomes a tunnel, the blind end of which becomes aciniSUPERFICIAL has 3 surfaces - lat., inf. and med.lat. - lies against submandibular fossa of mandible - overlaps med. pterygoid insertion and facial a.inf. - covered by skin, platysma, investing fascia, submandibular LN - crossed by facial v., cervical br. of CN VII and sometimes by marginal br. of CN VIImed. - lies against mylohyoid, hypoglossus, lingual n. and CN XII DEEPcontinuous w/ superficial part around free post. margin of mylohyoidextends forward b/w mylohyoid and hypoglossusbelow lingual n. and above CN XIIsupply:facial a.facial v.sup. salivary nucleus via nervus intermedius, chorda tympani and lingual n. to submandibular ganglion on lingual n.submandibular LNapproach: skin crease incision 4cm below mandible to avoid mandibular br. of CN VII (which may lie on gland)ligate facial v. which lies on surfaceseparate facial a. from groove on post.sup. part of gland, also protect CN XII and lingual n.

Front 200

submandibular gland

Back 200

A - styloid processB - vagas n.C - ICAD - stylopharyngeus and glossopharyngeal n.E - pharyngeal br. of CN XF - SLNG - occipital a.H - hypoglossal n.I - lingual a.J - ECAK - int. laryngeal n.L - ext. laryngeal n.M - sup. thyroid a.N - sup. laryngeal a.O - mylohyoid and submandibular glandP - genioglossusQ - geniohyoidR - sublingual glandS - submandibular ductT - lingual n. and submandibular ganglionU - stylohyoid lig.V - styloglossus

Front 201

submandibular gland

Back 201

A - buccinatorB - vestibuleC - depressor anguli orisD - mandibular canalE - facial a.F - submandibular LNG - platysmaH - submandibular glandI - facial v.J - investing fasciaK - mylohyoidL - digastric tendon and slingM - styloglossusN - sublingual glandO - glossopharyngeal n.P - hypoglossusQ - submandibular ductR - lingual n.S - hypoglossal n.T - lingual a.U - hyoid

Front 202

submandibular gland

Back 202

A - submental LNB - mylohyoid n.C - mylohyoidD - central tendon of digastricE - hyoidF - submandibular LNG - submandibular salivary glandH - hypoglossusI - cervical br. of CN VIIJ - post. belly of digastricK - stylohyoid m.L - facial v.M - facial a.N - marginal mandibular br. of CN VIIO - segmental a.

Front 203

describe the development of the pancreas

Back 203

development: 4-6/40vent. bud - develops from the duodenal endoderm just caudal to the cystic diverticulum out into the vent. mesenterydorsal bud - develops out into the dorsal mesenterythe ventral bud rotates to the R around the duodenum to fuse to the under surface of the dorsal budmain pancreatic duct forms between the buds in the ventral buddorsal bud maintains the accessory pancreatic ductrotation drags the CBD around with it, connecting the pancreatic duct to the CBDannular pancreas - 2x ventral buds which then rotate in both directions - surround the duodenum → obstruction

Front 204

anterior triangle

Back 204

A - facial v.B - facial a.C - submandibular glandD - ant. belly of digastricE - hyoidF - thyrohyoidG - mylohyoidH - parotid glandI - sup. belly of omohyoidJ - sternohyoidK - sup. thyroid a.L - cricothyroidM - middle thyroid a.N - IJVO - Tv cervical a.P - suprascapular n.Q - suprascapular a.R - phrenic n. on scalenus ant.S - lat. lobe of thyroidT - CCAU - RLNV - tracheaW - sternothyroidX - AJVY - inf. thyroid v.Z - SCM1 - thyroid isthmus2 - arch of cricoid3 - EJV4 - laryngeal prominence5 - thyrohyoid membrane6 - stylohyoid