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332 Cards in this Set
- Front
- Back
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What are the three primary muscles of respiration?
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Diaphragm (specialized skeletal muscles), Intercostals (external in inspiration, internal in expiration), Elastic recoil of the lungs
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What constitutes the bony thorax?
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Sternum, ribs, clavicle, vertebrae
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What are the contents inside the bony throax?
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Nerves, arteries and veins of thoracic cage, lungs, mediastinum
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What are the three hiatus through the diaphragm?
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Inferior vena cava hiatus, esophageal hiatus, aortic hiatus
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What is the level of the inferior vena cava hiatus?
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T8. Adheres to diaphragm, stretched open in inspiration
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What is the level of the esophageal hiatus?
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T10. Location of a hiatal hernia
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What is the level of the aortic hiatus?
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T12. Thoracic duct and azygous vein also goes through the aortic hiatus.
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What is the function of the diaphragm?
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Increase diameter of thoracic cage during inspiration
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What innervates the diaphragm?
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Phrenic nerve (C3-5), under ANS control
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What way do the fibers run in the external intercostals? What is their function?
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Fibers run hand in pocket. Elevate ribs in INSPIRATION
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What is the function of the internal intercostals?
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Depress ribs in expiration (much more passive than inspiration)
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What innervates the external and internal intercostals?
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Intercostal nerves
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What happens during inspiration?
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Diaphragm contracts to flat position and descends. Rib cage elevates and expands. Intrathoracic volume increases and pressure decreases. Active process.
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What happens during expiration?
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Diaphragm relaxes (raises). Rib cage lowers and centers itself by action of internal intercostals. Intrathoracic volume decreases and pressure increases. High pressure flow to low pressure. Mostly passive.
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What are the accessory muscles of respiration?
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Scalene muscles (neck), sternocleidomastoid, pec major and minor, serratus posterior superior and inferior, external and internal oblique, rectus abdominis
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What level does the jugular notch of the manubrium coincide with?
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T2
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What level does the sternal angle coincide with?
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T4-5, 2nd rib space.
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What level does the xiphoid process coincide with?
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T9
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What are the three types of ribs?
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True, False, Floating
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Which ribs are true ribs?
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1-7
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Which ribs are false ribs?
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8-10
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Which ribs are floating ribs?
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11-12
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What are three characteristics of the costochondral joints?
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Primarily cartilaginous joint, very little movement, joint may become inflamed very easily.
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What is costochondritis?
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Inflammation of the costochondral joints. Causes chest wall pain.
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What is the posterior border of the thorax?
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Thoracic spine
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What is the thoracic inlet?
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Region where structures from neck enter the thorax and structures of the thorax enter the neck
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What is the root of the neck?
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Thoracic inlet. 1st rib and upper part of manubrium. T1
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What is thoracic outlet syndrome?
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Compression of 1 or more of the structures entering or exiting the thorax inlet. Can happen with repetitive overhead throwing. Misnomer in that the thoracic inlet is the anatomic region where thoracic outlet syndrome occurs.
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What is the thoracic outlet?
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The region of the lower portion of the thorax. T12, Ribs 11 & 12, Costal margins, xiphoid process, contains: diaphragm
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What is a thoracentesis?
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Removal of fluid from pleural cavity
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How would you do a thoracentesis?
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Angle upward, superior to rib, but avoid collaterals! Insert in midde of intercostal space between 7th and 9th intercostal space at mid axillary line
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What is herpes zoster?
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Shingles. Vesicular rash in dermatomal distribution. May occur anywhere, but frequently on the trunk.
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What lines the pulmonary cavity?
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Pleural membranes
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What is the visceral pleura?
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Serous membrane on lungs (autonomic nervous system). Adherent to lungs, outside smooth and slippery, allows for movement, no pain/sensation
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What is the parietal pleura?
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Serous membrane lining thoracic wall (sensitive). Adheres to pleural cavity walls; costal, mediastinal, diaphragmatic, cervical (apical)
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What is the cavity between the visceral and parietal pleura?
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Pleural cavity
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What are two main recesses in the pleural cavity and what is their significance?
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Costodiaphragmatic recess, costomediastinal recess. Pleura lined gutters. Potential region of fluid accumulation.
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What is the term for air in the pleural space?
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pneumothorax. Can be caused by a puncture to the pleura.
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What is done to treat a pneumorthorax?
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Chest tube (can be used to remove air, blood, or pus from pleural space). Generally placed by incision in 5th or 6th (nipple line) intercostal space in mid axillary line. Tube is connected to underwater suction unit.
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What is pleurisy?
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Inflammation of pleura. Can be of visceral and parietal (sharp pain from parietal), can be caused by viral, bacterial, connective tissue disease, pleural rib
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What is a problem with right main bronchus being straight and short?
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It is a direct route for aspirated foreign bodies to lodge into and may also be inadvertantly intubated during attempted endotrachial intubation.
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What part of the tracheobronchial tree is surgically resectable? Why might this be done?
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The repiratory unit - coming off of a tertiary bronchus. Can be resected in cancer.
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What is segmental atelectasis?
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Collapse of a segment of the lung. Common in hospitalized patients.
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What are the three segments of the respiratory unit?
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Bronchiole, Alveolar duct, Alveoli
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What do pulmonary arteries do and at what level are they located?
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Carry deoxigenated blood from body to the lungs. Located at sternal angle.
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What is a pulmonary embolism?
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Blood clot in pulmonary artery. Results in loss of blood flow to lung and acute resp distress. Commonly from leg vein (popliteal). Can cause death. Most commonly after surgery or sitting long periods.
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What do pulmonary veins do?
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Carry oxygenated blood from lungs to body.
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Where do the bronchial arteries go to/from? What are their functions?
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To and from parenchyma of lung. Arteries bring nutrition to lungs. Directly off of aorta. Veins drain hilum of lungs into azygous vein.
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What are four characteristics of bronchogenic cancer?
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Mass arising mostly from mucosa, Cigarette smoking, Mets to hilar nodes, Supraclavicular nodes
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What do the parasympathetic fibers of the vagus nerve do?
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Bronchoconstriction, vasodilation, increased mucosal secretions
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What do the sympathetic plexus (T1-T5) nerves do?
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Bronchodilation, vasoconstriction, decreased mucosal secretion
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What do the intercostal/phrenic nerves do?
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Touch and pain from parietal pleura, Referred pain - for lungs, often arms, for diaphragm, often shoulder
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How does the oxygenation of blood get sent to the brain?
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Chemical and sensory signals to pons/medulla via autonomic and spinal afferent nerves
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What do the spinal nerves activate?
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Diaphragm, Intercostals, Accessory muscles as needed
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Where is the mediastina and what is contained within it?
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Between right and left pleural cavities. Contains heart and thyroid. Very mobile...allows for pressure and movement changes.
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What are the 4 subdivisions of the mediastina?
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Superior, anterior, middle, posterior
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What is located within the anterior mediastinum?
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Connective tissue (ligaments, fat), internal thoracic vessels, transversus throacis muscle, thymus in child. (smallest mediastinum division)
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What is located within the middle mediastinum?
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Pericardium, pericardial cavity (sac), heart, roots of great vessels, other structures "just passing through"
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What is a pericardial effusion?
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A result of trauma where fluid accumulates in the pericardial sac. Fluid accumulation is so great that it impedes pumping of the chambers - called pericardial tamponade - requires immediate pericardiacentesis
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What is a Cardiac tamponade?
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Excessive pericardial effusion. Non-elastic fibrous pericardium. Pressure on myocardium limits volume of blood pumped.
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What are the three layers of the heart?
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Endocardium (endothelial lining), Myocardium (muscle), Epicardium (inner visceral layer of pericardial sac)
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What is the transverse sinus?
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Space between arteries and veins of the heart. Place of ligation of great vessels during CABG surgery.
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What is the first heart sound you hear? (LUB)
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Closure of mitral and tricuspid valves(AV) as blood goes from atria into ventricles
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What is the second heart sound you hear? (DUB)
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Closure of pulmonary and aortic (semilunar) valves as blood is expelled from heart out of ventricles
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What forms the apex of the heart?
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Left ventricle
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What forms the base of the heart?
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Left atrium
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What is the function of the crista terminalis?
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It is a crest that prevents blood from coming up and hitting the pectinate muscles, which would cause turbulence in the right atrium.
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What is Atrial Septal Defect?
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One type is patent fossa ovale where the atrial septum doesn't close completely. Causes left oxygenated and right nonoxygenated shunt of blood. Overloads the pulmonary vasculature and causes right atrial and ventricular hypertrophy
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What can happen to the heart walls due to an atrial septal defect?
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Can cause right atrial and ventricular hypertrophy
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What are three components to the tricuspid valve?
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Chordae tendinae, papillary muscles, three valve cusps
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What do the papillary muscles do?
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They contract to close valve and stay closed during ventricular contraction to prevent backflow into the atria
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What is the left auricle?
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It is an embryonic remnant that can be a source of thrombus, particularly in atrial fibrillation
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What is different about the trabeculae carneae on the left compared to the right?
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It is 2-3 times thicker
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What are three possible types of valvular disease?
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Infection, calcification (stenosis), regurgitation (prolapse, insufficiency)
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What are the three branches off of the right coronary artery?
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SA nodal branch, marginal branch, posterior descending
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What does the right coronary artery supply?
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Mos of the right atrium, SA node (60%), AV node (80%), Right ventricle, Some of left atrium, IV septum (partial)
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What are the branches off of the left coronary artery?
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Circumflex artery (left marginal), left anterior descending, post descending arterial vessel (40% of people)
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What does the left coronary artery supply?
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Left atrium, left ventricle, IV septum (bundle of HIS and branches), SA node (40%), AV node (20%)
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What does dominance of coronary arteries mean?
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Defined by which artery gives rise to the posterior descending artery. It is different in different people. Most people are right heart dominant, but some people are left or co-dominant.
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What is the venous drainage of the heart muscle?
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Great and small cardiac veins into coronary sinus.
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What are the conduction system of the heart?
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1. Sinoatrial node begins signal. 2. Stimulates atria to contract. 3. Impulse travels to the AV node. 4. After delay, impulse is conducted through bundle of HIS to purkinje fibers and endocardium at apex of heart to ventricle causing contraction.
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What are the components of the sympathetic portion of the cardiac plexus? What are the functions?
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Pre: T 1-5, Post: splanchnic to SA and AV nodes.
Functions: increase heart rate, impulse conduction, force of contraction, coronary artery blood flow |
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What are the components of the parasympathetic portion of the cardiac plexus? What are the functions?
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Pre: Vagus nerves to SA and AV nodes. Decreases heart rate, impulse conduction (ACh), force of contraction, coronary arter blood flow (constriction)
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What are the contents of the superior mediastinum?
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Roots of great vessels (aortic arch, SVC), Thymus, Things "just passing through"
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What constitutes the roots of great vessels that are in the superior mediastinum?
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Aortic Arch: Brachiocephalic trunk (right common carotid artery and right subclavian artery), left common carotid and left subclavian arteries. SVC: brachiocephalic vein and jugulars
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What is the primary lymphoid organ?
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Thymus. Houses T-lymphs. Shrinks and becomes fatty tissue in adults unless there is a thymoma.
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What are the four main structures that "just pass through" the superior mediastinum?
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Phrenic and vagus nerves, upper portion of thoracic duct, esophagus and trachea (upper portion) and ligamentum arteriosum
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What are the four things that constitute the phrenic and vagus nerves that run through the superior mediastinum?
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Left recurrent laryngeal nerve, right vagus nerve, right recurrent laryngeal nerve, right phrenic nerve
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What are three characteristics of the upper portion of the thoracic duct - passing through the superior mediastinum?
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Originates at the cysterna chyli, travels behind the esophagus, terminates at union of left internal jugular and subclavian veins
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What is the ligamentum arteriosum?
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Remnant of fetal ductus arteriosum. It lies between arch of aorta and pulmonary trunk. The left recurrent laryngeal nerve passes under it.
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What kind of symptoms would you see in a patient with a superior mediastinum mass?
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If pressure is on the SVC = facial edema
If pressure is on the esophagus and trachea = cough If pressure is on the RLN = hoarseness |
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What are the six main structures in the posterior mediastinum?
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Thoracic aorta, esophagus, thoracic duct, azygous vein, sympathetic trunks, nerves "passing through"
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What are the branches off of the thoracic aorta that you would see in the posterior mediastinum?
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Posterior intercostal arteries, esophageal arteries
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What are three structures that might normally compress the esophagus?
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Arch of aorta, left main bronchus, diaphragm at hiatus
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What are four characteristics of the thoracic duct in the posterior mediastinum?
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Originates at the cysterna chyli, travels behind the esophagus, is just medial to the azygous vein, terminates at the union of left internal jugular and subclavian veins
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What part of the sympathetic trunks would you see in the posterior mediastinum?
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Splanchnic nerves of thoracic cavity
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What happens with the presynaptic fibers in the sympathetic trunk?
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They may ascend the sympathetic trunk to synapse w/ higher post synaptic neuron, they may descend the sympathetic trunk to synapse with lower post synaptic neuron, may enter and synapse at same level or pass through without synapsing (w/ splanchnic nerves)
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What structures are located in the RUQ?
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Small bowel, liver, gallbladder, pylorus, duodenum, head of pancreas, hepatic flexure of colon, portions of ascending and transverse colon, right adrenal gland, portion of right kidney
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What structures are located in the LUQ?
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Small bowel, left lobe of liver, spleen, stomach, body of pancreas, splenic flexure of colon, portions of transverse and descending colon, left adrenal gland, portion of left kidney
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What structures are located in the RLQ?
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Small bowel, cecum and appendix, portion of ascending colon, lower pole of right kidney, right ureter
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What structures are located in the LLQ?
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Small bowel, sigmoid colon, portion of descending colon, lower pole of left kidney, left ureter
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What are the nine regions of the abdomen?
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Right hypochondriac, Epigastric, Left hypochondriac, Right lumbar, umbilical, left lumbar, right iliac, hypogastric/pubic, left iliac
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What structures are in the right hypochondriac region?
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Right lobe of liver, gallbladder, part of duodenum, hepatic flexure of colon, part of right kidney, suprarenal gland
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What structures are in the epigastric region?
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Pyloric end of stomach, duodenum, pancreas, aorta, portion of liver
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What structures are in the left hypochondriac region?
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Stomach, spleen, tail of pancreas, splenic flexure of colon, upper pole of left kidney, suprarenal gland
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What structures are in the right lumbar region?
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Ascending colon, lower half of right kidney, part of duodenum and jejunum
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What structures are located in the umbilical region?
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Omentum, mesentery, transverse colon, lower part of duodenum, jejunum and ilium
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What structures are located in the left lumbar region?
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Descending colon, lower half of left kidney, part of jejunum and ilium
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What structures are in the right iliac region?
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Cecum, appendix, lower end of ileum, right ureter, right ovary in female
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What structures are in the hypogastric or pubic region?
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Ileum, bladder
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What structures are in the left iliac region?
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Sigmoid colon, left ureter, left ovary in female
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What is McBurney's point?
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Surface anatomy that corresponds with the approximate location of the appendix. Used to help determine if acute appendicitis is present.
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What is linea alba?
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Fibrous structure that runs down the midline of the abdomen
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What is the clinical relevance of the linea semilunaris?
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It is a location of potential herniation
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What is the function and innervation of the external oblique, internal oblique and transversus abdominus?
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Action: compression and support of abdominal viscera, flex and rotate trunk.
Innervation: thoracic nerves |
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What is the action and innervation of rectus abdominus?
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Action: flexes trunk
Innervation: thoracic nerves |
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What is the rectus sheath?
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Formed by aponeuroses of EO, IO and TA, encloses rectus abdominis
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What is the arcuate line?
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Part of the rectus sheath. Change in make-up of layers of sheath: transversalis fascia stays posterior, site of entry of the inferior epigastric artery into the rectus sheath, site of potential weakness
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What problems can occur due to the area of potential weakness at the linea alba?
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Umbilical hernia, epigastric hernia, incisional hernia
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What is a spigelian hernia?
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At semilunar line below arcuate line as region of weakness. May see herniation of intrabdominal contents. Rare.
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Where does lymph drainage go to above umbilicus?
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Pectoral and internal thoracic nodes
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Where does lymph drainage go do below umbilicus?
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Inguinal nodes
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Where is the inguinal region? And what are 3 characteristics of it?
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Location: from ASIS to pubic tubercle. Characteristics: Structures enter and exit abdomen, region of potential herniation, descent of testes
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What are 4 characteristics of the inguinal canal?
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Formed when gubernaculum leads testes or round ligament drags layers from abdomen to pelvic region. Thick fascial band forms inguinal ligament. Canal is made by inferior rim of EO fascia. Things enter at deep ring and exit at superficial ring.
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What happens at the inguinal canal in females?
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Ovaries descend from abdomen, gubernaculum connects ovaries to labia majora. Gubernaculum = ovarian ligament and round ligament.
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What is the inguinal region derived from?
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External oblique fascia = inguinal ligament, superficial inguinal ring and external spermatic fascia. Internal oblique fascia = cremasteric muscle and conjoint tendon (together w/ transversalis fascia). Transversalis fascia = deep inguinal ring, internal spermatic fascia and conjoing tendon (together w/ IO fascia)
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What are the two main contents of the inguinal canal?
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Spermatic cord in males/found ligament in females and Ilioinguinal nerve
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What is a vasectomy?
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Ductus deferens are electively ligated in order to prevent pregnancy
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What is a varicocele?
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Enlargement of pampiniform plexus of veins related to failure of the valves. Physical exam reveals a "bag of worms" enlargement, most prominent when patient is standing
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What would you see in a cross section of the spermatic cord?
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External spermatic fascia, cremasteric muscle and fascia, genitofemoral nerve, internal spermatic fascia, ductus deferens, lymph vessels, pampiniform plexus of veins, testicular artery
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What lines the scrotum?
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Dartos fascia. Muscular fibers form rugae
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What is the function of the scrotum?
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Holds testes outside of abdominal cavity because sperm are better in outside temp
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What is the cremasteric reflex and what two nerves are involved?
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Elevation of testes by cremasteric muscles for thermoregulation. Nerves to the area: sensory = ilioinguinal nerve. Motor = genitofemoral nerve. This reflex useful test of spinal cord injury
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What is testicular torsion?
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Twisting of testicle on spermatic cord
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What is cryptorchidism?
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Undescended testicles
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Where does spermatogenesis take place?
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The initial stages occur within the testes and progress to the epididymis where the developing gametes mature and are stored until ejaculation.
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What could cause a ductus deferens mass?
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Sperm granuloma (post vasectomy acuumulation of sperm or following vas deferens strictures. Also, vasitis nodosa), adenoma, metastatic disease
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What is the life and path of sperm?
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Acronym: steve. Spermatogenesis in siminiferous tubules, enter Epidiymis for further maturation, through Vas deferens, passes seminal vesicles (Ejaculatory ducts), exits urethra
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Where are prostaglandins produced in the male genetalia?
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Seminal vesicles
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What is "sperm food?"
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Fructose - found in seminal vesicles
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What is a direct inguinal hernia?
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Acquired (by doing things or being shaped in a way that increases abdominal pressure). Weakness in inguinal region. Originates medially to inferior epigastric artery.
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What is an indirect inguinal hernia?
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More common. Results from patent procesus vaginalis, originates lateral to the inferior epigastric artery. Follows path of inguinal canal. Mass may pass into scrotum or labia
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What is a femoral hernia?
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Originates from inferior to inguinal ligament. May present as thigh pain or a mass.
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What is a hydrocele?
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Fluid passes through patent processus vaginalis. Commonly assoc w/ an indirect inguinal hernia. In female: fluid filled mass in canal of Nuck (inguinal canal)
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What is cryptorchidism?
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Maldescent of testes. 3-30% of men. Usually unilateral. Lands anywhere in path of descent. Increased chance of infertility and malignancy.
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How would you detect cancer of the testes?
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Palpable mass of testicle. Would not be able to tell by lymph nodes because the lymph nodes affected are intra-abdominal (aortic and preaortic)
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What are the components oft he peritoneum?
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Parietal peritoneum: lines cavity. On tranversalis fascia, diaphragm, lumbar vertebra/paravertebral muscles and retroperitoneal structures. Visceral peritoneum: lines organs
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What is the peritoneal cavity?
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Potential space. Small amt of fluid allows for friction, free movement of organs. Fluid contains WBCs and antibodies
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What is peritonitis?
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Infection and inflammation of the peritoneum which occurs usually due to a perforated viscus and leakage of intraluminal GI contents into the peritoneal sac (ex. perforated duodenal ulcer, perforated diverticulitis)
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What are the four main regions of the peritoneum?
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Mesentery, Ligaments, Omentum, Gutters
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Describe mesentery
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Double layer of peritoneum. Encases intra peritoneal organs (i.e. intestines) and attaches them to abdominal wall. Transmission of NAV to intra peritoneal organs
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Describe ligaments of peritoneum
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Double layer of peritoneum. Connects organs to each other. Named for organs of attachment
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Describe omentum
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Double layer peritoneum connecting stomach to other intra peritoneal organs. Allows for movement of viscera. Migrates toward inflamed organs such as appendix to protect peritoneum. Cushions viscera
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Where does the greater omentum run?
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Runs from greater curvature of stomach to transverse colon. Forms a bursa.
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What is the omental foramen (foramen of winslow, epiploic foramen)
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Passage of communication between greater and lesser omentum. Free edge of hepatoduodenal ligament. Portal triad passes posterior (portal vein, hepatic artery, bile ducts)
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What are the gutters of the peritoneum?
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Parietal-peritoneal covered ridges on lateral posterior abdominal wall. Contain colon. May be regions of collection for intraperitoneal fluid.
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What is peritoneal dialysis?
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Use of the peritoneum as a filter for soluble waste products in renal failure. Catheter is placed into the peritoneal cavity, dialysis solution is pumped into cavity and drained out. This may be used only temporarily.
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What is ascites?
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Excess fluid in peritoneal cavity from total-body sodium and water excess.
Might be seen in cirrhosis (portal hypertension), intra-abdominal cancer or peritonitis |
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What are three fluidser that can occur due to peritonitis?
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Ascites, pancreatic pseudocyst, fluid in omental bursa from inflamed pancreas
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What does intraperitoneal refer to?
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Organs with a mesentery such as the stomach, small intestine (jejunum and ileum), transverse colon, liver and gallbladder. They aren't firmly fixed to the wall and may twist and turn w/in the abdomen
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What does retroperitoneal refer to?
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Organs w/out a mesentery and assoc w/ posterior body wall such as aorta, inferior vena cava, kidneys, ureters and suprarenal glands
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What does secondarily retroperitoneal refer to?
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Organs which had a mesentey once and lost it during development, such as pancreas, duodenum, ascending and descending colons
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What is the best way to identify vessels?
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Follow where they go to because there isn't always a "normal" location
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At what level does the esophagus go through the diaphragm?
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T10
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What are 3 locational characteristics of the esophagus? What is its blood supply and what innervates it?
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Mainly located in the mediastinum (only 1-1.5 cm intrabdominal). Through diaphragm at T10. Esophagogastric junction in abdomen T11, left side.
Blood supply: left gastric a (off celiac) and left inferior phrenic. Nerve: vagus, sympathetics from thoracic trunk |
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What is the blood supply to the stomach?
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Arterial supply: left gastric a, short gastric aa, left and right gastroepiploic aa, right gastric a
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What is a partial gastrectomy?
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For treatment of gastric ulceer, carcinoma, or obesity. May remove part of stomach w/out disrupting blood supply. Lymph drainage to preaortic nodes.
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Would the stomach ever suffer from ischemic damage? Why or why not?
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Rarely, if ever. The stomach receives blood supply from multiple sources.
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What are 3 locational characteristics of the duodenum?
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1st part is intraperitoneal. Last parts are secondarily retroperitoneal. It is relatively fixed.
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What is the blood supply to the duodenum?
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Celiac trunk - gastroduodenal a - superior pancreaticoduodenal a
Superior mesenteric a - inferior pancreaticoduodenal a |
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What lymph drainage comes from duodenum?
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Bile duct and pancreatic duct at ampulla. Lymph drainage follows venous drainage to celiac nodes.
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How would a mass in any of the head of the pancreas, duodenum, gallbladder/common bile duct affect the others?
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The duodenum has close anatomical relationship with the other structure. A mass in one structure, often compresses the other two.
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What affects on other structures might a duodenal ulcer have?
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If it perforates, it may inflame nearby structures (pancreas) and may ulcerate into gastroduodenal artery causing bleeding into peritoneal cavity. Duodenum has relationship w/ liver, gallbladder and head of pancreas.
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What is the function of the portal venous system?
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Deliver all digested substances from intestines for filtration through liver prior to distribution of nutrition to the body
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What is the largest gland?
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Liver
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What are functions of the liver?
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Storage of glycogen and production of bile, production of plasma proteins, production of clotting factors, production of immune factors, processing of hb for iron removal
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What is the surface anatomy of the liver?
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Right lobe: 4/5th ICS to 10th ICS (10cm).
Left lobe: across midline 5th ICS |
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What is the movement (fixed, moveable) and palpability of liver?
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Moves with respiration, not normally palpable below costal margin - if it is, it's enlarged.
**Rib fractures that are anterior or lateral in inferior ribs could cause liver rupture - bad! - peritoneal bleeding |
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Describe the peritoneum of the liver
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Falciform Ligament - broad ligament separates right/left lobes, attaches to abdominal wall.
Ligamentum teres (used to be umbilical vein) aka round ligament. Bare area - posterior part of liver not covered by periotneum. |
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What constitutes the porta hepatis?
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Liver entrance and exit of: portal vein, hepatic artery, lymph vessels, hepatic nerves, and hepatic ducts
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What is the arterial supply of the liver?
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Celiac trunk to common hepatic artery to hepatic proper to right and left hepatic aa
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What is the venous drainage of the liver?
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Hepatic veins to IVC
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What is the portal vein?
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Delivers venous blood from intestines for filtration by liver. Formed by SMV and SV
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What causes portal hypertension?
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Obstruction of the portal vein causes a back up of blood flow through the liver. Venous connections of the system dilate causing vericosities in the abdominal wall vessels (paraumbilical), esophageal veins or hemorrhoidal veins. Esophageal and hemmorrhoidal vericosities especially prone to bleeding in pts w/ portal hypertension
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What is the function of the gallbladder?
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Bile storage and concentration
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What is the function of the extrahepatic biliary tree?
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Delivers bile to the gallbladder for storage and to the duodenum for digestion
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What structures make up the extrahepatic biliary tree?
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Right and left hepatic ducts, common hepatic duct, cystic duct, common bile duct
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What is the arterial supply of the gallbladder and ducts?
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Celiac trunk - common hepatic a - hepatic proper (or right hepatic) - cystic a
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What is cholecystitis?
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Condition of inflammation of gallbladder. Most cases this is assoc w/ presence of gallstones
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What is cholelithiasis?
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Presence of gallstones w/in the gallbladder. May occur w/out inflammation or symptoms
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What is choledocholithiasis?
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Presence of gallstones w/in common bile duct. Almost always accompanied by symptoms of crampy abdominal pain & constitutes surgical emergency as the complete obstruction of CBD can cause irriversable liver damage
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What is gallstone Ileus?
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infrequent cause of mechanical bowel obstruction. Caused by an impaction of a gallstone in the terminal ileum by passing through a billiary-enteric fistula (often from duodenum). It occurs more frequently in women with average age of 70 years.
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What is the function of the pancreas?
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Production of pancreatic enzymes (exocrine) and production and regulation of Glucagon and insulin (endocrine)
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What are the locational characteristics of the pancreas?
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Mostly retroperitoneal. Main pancreatic duct joins CBD at ampulla. Duodenal C is located around head of pancreas. Spenic artery runs posteriorly on superior rim of pancreas.
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How might the spleen be affected by a resection of the pancreas?
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Because of the anatomical relationship btwn the splenic artery and the pancreas, in resection of the pancreas for cancer or pancreatitis, spleen is often also resected.
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What is the arterial supply of the pancreas?
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Celiac trunk - gastroduodenal a - superior pancreaticoduodenal a - splenic artery branches
Superior mesenteric a - inferior pancreaticoduodenal a |
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Where is the spleen located?
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On the left between ribs 9-11
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What is the function of the spleen?
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Blood reservoir and removal of expended cells
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What is the movement and palpability of the spleen?
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Moves w/ respiration. Nonpalpable in normal adults. Vulnerable to injury especially w/ rib fracture.
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What is the arterial supply and venous drainage of the spleen?
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Arterial supply: celiac trunk - splenic a
Venous drainiage: splenic vein |
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What are the locational characteristics of the jejunum and ileum?
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Distal to ligament of Treitz. Duodenum becomes jejunum after ligament of Treitz (duodenal jejunal junction). Held in place by mesentery
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What is the main function of the jejunum and ileum?
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Nutrient absorption
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What is the purpose of the iliocecal valve?
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To allow passage of contents from small bowel to colon
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What is the arterial supply of the jejunum and ileum?
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Superior mesenteric artery - jejunal and ileal aa, iliocolic a
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What is mesenteric ischemia?
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Occlusion of superior mesenteric artery may cause various levels of small and large bowel ischemia depending on the location and amt of occlusion. Often leads to sepsis.
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What is Meckel's Diverticulum?
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Congenital true diverticulum (involving all layers of the intestinal wall) which occurs in small intestine. Embryonic remnant. If lumen becomes obstructed, presents like appendicitis.
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What are the rules of twos in regards to Meckel's Diverticulum?
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2% of the population affected, 2 feet from ileocecal valve, 2 inches in length, 2% are symptomatic, 2 types of common ectopic tissue (gastric and pancreatic), commonly presents at 2 years of age, males are 2 times as likely to be affected
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What is the main function of the large intestines?
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Water absorption and waste elimination
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What are some locational characteristics of the transverse colon?
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Intra peritoneal, mobile, transverse mesocolin (fold of peritoneum) attaches transverse colon to posterior wall.
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What is the arterial supply of the transverse colon?
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SMA - iliocolic, right colic a, middle colic a, some left colic a
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What is the arterial supply of the anal canal?
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IMA - left colic a, sigmoid aa, superior rectal a
Middle rectal (internal iliac a) Inferior rectal (internal pudendal a) |
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Describe appendicitis
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IF the lumen of the appendix becomes obstructed, the organ becomes inflamed (appendicitis). Pain may begin periumbilically and then becomes localized at McBurney's point, a point 1/3 of the distance from the ASIS to the umbilicus. Appendix usually retrocecal, pelvic. Referred pain T10.
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What is diverticular disease?
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Colonic diverticuli are acquired "false" diverticuli. Inflammation of a colonic diverticulum = diverticulitis. Don't confuse w/ diverticulosis which is merely the presence of multiple diverticuli in the colon. Both cond prevalent in sigmoid colon. Might bleed. Inflamed = diverticulitis
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What is sigmoid volvulus?
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Sigmoid can be prone to twisting about the mesentery. Causes signs and symptoms of colonic obstruction. Common in the elderly.
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What are three broad characteristics of the kidney?
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They are surrounded by perinephric fat, the function as organs of fluid and electrolyte management, the right is slightly more inferior than the left because of the liver
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What is the arterial supply and venous drainage of the kidney?
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Arterial supply: renal artery and accessory renal arteries
Venous drainage: renal vein |
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What kind of glands are the suprarenal glands?
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Endocrine glands
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What is secreted by the cortex and the medulla of the suprarenal glands?
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Cortex: corticosteroid and androgens.
Medulla: SNS: epi and norepi |
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What is the arterial supply of the suprarenal glands?
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Suprarenal a (off renal a, inferior phrenic a and aorta)
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What are 5 locational characteristics of the ureters?
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Retroperitoneal, in abdomen: colonic vessels anterior to left ureter, in pelvis: run along lateral walls of pelvis. In male: crossed by vas deferens, in female: crossed by ovarian artery
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What are renal/ureteral calculi?
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stones formed by kidney may travel down the ureter, getting "stuck" in regions of natural narrowing along the way. These areas are: at junction of ureter and renal pelvis, at pelvic brim and at entrance to bladder. May cause hydronephrosis
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At what location does the abdominal aorta bifurcate?
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L4
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What are the unpaired visceral branches of the abdominal aorta?
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Celiac artery, SMA, IMA
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What are the paired visceral branches of the abdominal aorta?
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Renal arteries, suprarenal arteries (often come off of renal arteries), gonadal arteries
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What is an abdominal aortic aneurysm?
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Irregular enlargement of the aorta which can result in a tear (dissection). Will be palpated just left of midline as a pulsating mass. Degenerative process.
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What is the pathway of the inferior vena cava?
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Begins at union of common iliac vv, ascends on right side of posterior abdomen, rcv's de-ox blood from lower body and portal blood from digestive system via hepatic veins
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What are the unpaired visceral branches of the inferior vena cava?
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Celiac v, SMV, IMV
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What are the paired visceral branches of the inferior vena cava?
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Renal vv, suprarenal vv, gonadal vv (right off of IVC, left off of renal v)
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What are the 4 muscles of the posterior abdominal wall?
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Diaphragm (T8 IVC, T10 LES, T12 aorta), psoas major/iliacus, quadratus lumborum, transversus abdominis
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What is the function of the psoas major/iliacus? What is the innervation?
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Major hip flexors, hip stabilizer.
Innervation: anterior rami L1-3 - if both iliopsoas contract at same time = flexion at waist |
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What is the function and innervation of the quadratus lumborum?
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Lateral flexion of the trunk, extension of lumbar spine. Innervation: subcostal and lumbar nerves
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What is the function of the transversus abdominis?
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Support abdominal viscera
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What does T12 subcostal nv innervate?
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Anterior lateral abdominal wall mm and skin
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What does L1 iliohypogastric nv and ilioinguinal nv innervate?
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Anterior abdominal wall, skin of inguinal region, inner thigh
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What does L1-2 genitofemoral nv innervate?
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Skin of femoral triangle, scrotum, labia
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What does L2-3 Lateral femoral cutaneous nv innervate?
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Later thigh skin
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What does L2-4 femoral nv innervate?
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Anterior thigh mm and skin
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What does L2-4 obturator nv innervate?
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Adductors of thigh and skin
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Why might you see referred pain in a quadratus strain?
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Lumbar plexus overlays the muscle, spasm will irritate the nerves
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What three fused bones make up the pelvic girdle and formt he os coxae bilaterally?
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Right and left ilium, ischium and pubis
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Where do the right and left sides of the pelvis join?
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Symphysis pubis and connected to sacrum at sacroiliac joints
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What are the three functions of the pelvic girdle?
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Bear weight in sitting and standing, site of attachment for muscles of ambulation, protect pelvic and lower abdominal viscera
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Where is the false/greater pelvis? And what does it contain?
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Superior to pelvic inlet, think of this as "lower abdomen," and it is bounded by iliac alae.
Contains ileum and sigmoid colon |
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What are the two main parts of the true / lesser pelvis (obstetric pelvis)?
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Pelvic inlet (entrance at superior pelvic aperature) and Pelvic outlet (exit at inferior pelvic aperature)
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What is contained in the pelvic inlet?
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Rectum, bladder, reproductive organs
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What is the significance of the pelvic outlet?
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Exit of infant's head in a vertex vaginal birth. Closed by pelvic diaphragm. Bounded by pubic arch, ischial tuberocity and coccyx. Contains perineum
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What makes up the lateral walls of the true pelvis?
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Obturator internus muscle
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What muscles make up the pelvic diaphragm (aka pelvic floor)?
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Levator Ani (3 regions) and coccygeus muscles
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What are the functions of the pelvic diaphragm (aka pelvic floor)?
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Support pelvic viscera, maintain urinary continence, assist in defecation, support fetus head during delivery, separate pelvic cavity from perineum
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What can a dysfunction of the pelvic diaphragm (aka pelvic floor) cause?
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Prolapse, incontinence
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What can cause damage to the levator ani and what can that result in?
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May tear during childbirth or be cut during childbirth. Often involves pubococcygeus. May result in partial loss of function of pelvic diaphragm.
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What can help prevent loss of function of the pelvic diaphragm if the levator ani is torn or cut during childbirth?
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Keigel exercises
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What are two major ligaments of the pelvis?
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Sacrotuberus ligament: from sciatic notch to sciatic foramen.
Sacrospinous ligament: divides sciatic foramen into greater and lesser foramina |
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What does the parietal peritoneum do?
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Lines pelvic cavity above pelvic floor. Pelvic organs are not covered on both sides of peritoneum except for ovaries and uterine tubes
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What can happen in folds of the peritoneum? What are the three folds?
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These areas can accumulate fluid (i.e. in an infection like appendicitis)
Rectouterine pouch in female (aka pouch of douglas, cul-de-sac), Vesicouterine pouch in female (between bladder and uterus), Rectovesical pouch in male or female s/p hysterectom) |
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What forms the peritoneal reflections in a female and what are the three sections?
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Broad ligament from uterus to pelvic wall and floor.
Mesosalpinx - folds over uterine tube. Mesovarium - sheet that hangs over ovary Mesometrium - big portion that hangs over uterus |
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What are the three main nerves that supply the pelvis (broad)?
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Sacral plexus (L4-S4), Pelvic ANS, Obturator nerve (L2-4 anterior rami)
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What is the path of the pudendal nerve and what does it innervate?
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S2-S4 anterior rami of sacral plexus. Leaves pelvis through greater sciatic foramen and enters perineum through lesser sciatic foramen. Innervates perineum and external genitalia
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What is the path of the sciatic nerve?
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L4-S3 anterior rami of sacral plexus. Leaves pelvis through greater sciatic foramen into gluteal region. Branches into tibial nerve and common peroneal nerve.
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What is the path of the superior and inferior gluteal nerves?
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L4-S1 anterior rami of sacral plexus. Superior goes to gluteus medius, minimus and tensor fascia lata. Inferior goes to gluteus maximus
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What is the path of the obturator nerve? What does it supply?
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From L2-4 anterior rami of lumbar plexus. Leaves true pelvis through obturator foramen (with artery) and supplies adductors of thigh
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Where might referred pain from the ureters be seen?
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Ipsilateral lower abdomen and groin
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What are 3 places the ureters narrow and might be a location of a stone obstruction?
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Pelvis of kidney, pelvic brim as it goes over iliac vessels and junction as it enters into the bladder
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What holds the bladder in place?
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Neck is held firmly in place by pelvic fascia, but otherwise the bladder is able to expand
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What is the function of the detrusor muscle?
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Relaxes to fill the bladder and contracts to empty the bladder
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What is the function of the internal urethral sphincter (smooth m) (ANS)?
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Prevents retrograde ejaculation in men and assists in opening the orifice
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What are the trigone and ureteric orifices?
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The trigone is a smooth triangular region of bladder formed by two ureteric orifices and the internal urethral orifice. This area is sensitive to bladder filling and signals to empty bladder. In a UTI, this area is often irritated
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What is the blood supply of the bladder?
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Superior vesical aa, inferior vesicle aa (in male) and vaginal aa (in female)
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What causes a bladder obstruction and what can result from it?
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Common in older men with benign prostatic hypertrophy (usually only cause). Will cause difficult urinating and eventual bladder wall hypertrophy
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What are the regions of the male urethra?
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Prosthetic - portion that goes through prostate, membranous - base of penis, spongy - distance of penile shaft, goes through spongiosum m
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What is the ductus deferens?
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THICK walled, SMALL lumen that conveys sperm. From epididymis - joins duct of seminal vesicle to form ejaculatory duct, then joins urethra
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What is a vasectomy?
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Surgical male sterilization by clipping ductus bilaterally in scrotum
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What are the seminal vesicles?
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Glands which secrete fructose (food for sperm). Superior to prostate
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What composes the prostate?
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2/3 of it is glandular (exocrine, antigens, sugars, alkaline fluids) and 1/3 of it is fibromuscular (doesn't do much).
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How many lobes does the prostate have? What are they?
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4 lobes. Inferoposterior (palpable during digital rectal, most common site of cancer), lateral lobes (right and left) and median lobe
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What is the prostate homologous to in the female?
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Paraurethral glands (Skene's glands, lesser vestibular glands)
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What are the bulbourethral glands?
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"Cowper's gland" Emits pre-ejaculate during sexual arousal to assist in lubrication
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What is the bulbourethral gland homologous to in females?
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Bartholin's (greater vestibular) glands
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What are the fornices of the vagina?
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Deepest portions of the vagina - recesses around the cervix. Posterior, anterior and lateral recesses
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What are the layers of the uterus?
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Perimetrium - outer serous layer, Myometrium - contraction during childbirth stimulated by prostaglandins,
Endometrium - internal layer that is shed during menstrual cycle |
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What are the congenital variations of uterine positions?
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Anteverted - anteflexed, lies on urinary bladder.
Retroverted - retroflexed, backward facing toward sacrum |
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What are the female uterine tubes?
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Tube for transmission of ovum to uterine cavity. Covered by broad ligament attached to mesosalpinx.
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What is an ectopic pregnancy?
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Anatomically most common site is in ampulla of uterine tube. As fetus grows, causes acute abdominal pain and may rupture uterine tube -> peritonitis. Managed by removal of effected portion of uterine tube.
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What are 4 size/locational characteristics of the ovary?
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Almond-sized.
Covered in broad ligament & attached to mesovarium. Nerve/art/vein conveyed via suspensory ligament of ovary. Attached to uterus via ovarian ligament. |
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What do the ovarian ligament and round ligament start out as?
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Gubernaculum
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What are the 2 arterial supplies to the ovary and why is it important that there is double blood supply?
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Internal iliac artery via uterine aa, and abdominal aorta via gonadal aa. Important because dbl supply allows for viable ovaries after hysterectomy.
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What 4 things form the rectum?
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Teniae coli, levator ani, anorectal flexure and anorectal junction (line)
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In the rectum, what is the teniae coli?
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Converge to form smooth wall
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In the rectum, what does the levator ani do?
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Causes the formation of the anorectal flexure which marks end of rectum and beginning of anal canal.
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What is important about the anorectal flexure?
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Helps to maintain fecal continence
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What is the anorectal junction (line)?
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Superior line across upper limit of anal columns. It is the juncture of the rectum and anus
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What are the two anal sphincters?
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Internal (involuntary) and external (voluntary, S4)
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What is the pectinate line?
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Inferior border of anal columns
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What is the lymphatic drainage of the anal canal?
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Above pectinate line: to preaortic, internal iliac nodes.
Below pectinate line: to inguinal nodes |
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What is the innervation of the anal canal?
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Above pectinate line: visceral (insensitive).
Below pectinate line: somatic (sensitive) |
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What are internal hemorrhoids?
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Venous dilation of internal rectal plexus that causes out pouching of rectal mucosa above the pectinate line. These are insensate unless incarcerated.
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What are external hemorrhoids?
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Thrombosis of external rectal venous plexus below pectinate line. Sensate.
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What is the perineum?
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Diamond shaped region inferior to pelvic diaphragm, between legs. Diamond is formed by two traingles: urogenital triangle and anal triangle.
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What are the three broad components of the urogenital triangle?
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Superficial perineal space, deep perineal space and perineal body
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What is the superficial perineal space and what is contained in it?
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Continuation of abdominal fascia (Scarpa's). From subcutaneus tissue to perineal membrane.
Contains: crura of clitoris, bulbs of vestibule, greater vestibular glands. Root and crura of penis, spongy uretra. Superficial transverse perineal muscles and assoc nerves and vessels. |
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What is the deep perineal space and what is contained in it?
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Space from pelvic diaphragm to perineal membrane.
Contains: membranous portion of urethra, part of vagina, bulbourethral glands (Cowper's, male), vessels and nerves, ischioanal fossa |
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What is the perineal body?
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Central point of perineum. Between bulb of penis or vagina and anus. Location of episiotomy and/or tearing during childbirth
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What is a median episiotomy?
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Incision through perineal body - allows for delivery during childbirth
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What are the three components of the anal triangle?
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Ischioanal fossa, anal canal, pudendal nerves/vessels
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What is the ischioanal fossa?
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Fat filled region which support distal colon. Fat is easily compressed to permit evacuation.
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What is the erectile tissue made of? (3 vascular mm)
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Corpora cavernosum (2), Corpus spongiosum, Ischiocavernosus mm (2)
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What is the corpora cavernosum (2) of the erectile tissue of the penis?
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Think of this as the "hotdog bun" - crura of penis
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What is the corpus spongiosum of the erectile tissue of the penis?
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Think of this as the "hotdog" Contains urethra, bulb (root) of penis covered in bulbospongiosus and glans
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What is the ischiocavernosus mm (2) of the erectile tissue of the penis?
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Surrounds crura of penis, helps to maintain erection and complete urination. Pudendal nerve supplies
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What is the function of the bulbospongiosus and what nerve supplies it?
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Assists in erection maintenance by compressing the dorsal vein. Supplied by the pudendal nerve.
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What is hypospadias?
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When the external urethral orifice is ventrally placed instead of in the middle of the glans. Can cause difficulty with urination (dribbling). Often corrected surgically at a young age.
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What is the vulva and what does it include?
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External female genitalia and it includes: mons pubis, labia majora and minora, clitoris and ischiocavernosus muscle (overlies vulva)
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What is the labia majora and minora?
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Majora is the Posterior labial commisure.
Minora forms together at prepuce of clitoris |
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What is the clitoris and what are the 3 components?
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Erectile tissue analogous w/ male penis.
Includes: glans, crura (corpora cavernosa), and prepuce (formed by labia minora) |
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What is the vestibule of the external female genitalia?
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Entrance to the vagina. Accepts penis during intercourse. It is the space between the labia minora and contains the orifices of the urethra and vagina.
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What is the bulbs of the vestibule of the external female genitalia?
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Erectile tissue, covered by bulbospongiosum. Holds penis in vagina during intercourse.
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What are the vestibular glands of the external female genitalia?
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Greater vestibular gland (AKA bartholin's gland): secretes mucous for lubrication.
Lesser vestibular gland (AKA Skene's glands): secretes mucous for lubrication. |
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What is a bartholin's gland cyst?
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A mucinous accumulation in the Barthonlins glands due to occlusion of duct. May form a cyst and is at risk for infection. Would be painful during intercourse and urination. May require incision and drainage and abx.
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What is the labia majora homologous with in the male?
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Scrotum
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What is the clitoris homologous with in the male?
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Penis
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What is the bulb of the vestibule homologous with in the male?
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Bulb of penis
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What is the glans clitoris homologous with in the male?
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Glans penis
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What is the clitoral hood homologous with in the male?
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Foreskin
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What are the Bartholin's glands homologous with in the male?
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Bulbourethral glands
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What are the Skene's glands homologous with in the male?
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Prostate
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What is the scrotum homologous with in the female?
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Labia majora
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What is the penis homologous with in the female?
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Clitoris
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What is the bulb of the penis homologous with in the female?
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Bulb of the vestibule
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What is the glans of the penis homologous with in the female?
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Glans clitoris
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What is the foreskin homologous with in the female?
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Clitoral hood
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What is the bulbourethral gland homologous wiht in the female?
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Bartholin's glands
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What is the prostate homologous with in the female?
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Skene's glands
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