Anatomy Flashcards
What are the boundaries of the popliteal fossa
Boundaries of the popliteal fossa
Region Structure
Laterally Biceps femoris above, lateral head of gastrocnemius and plantaris below
Medially Semimembranosus and semitendinosus above, medial head of gastrocnemius below
Floor Popliteal surface of the femur, posterior ligament of knee joint and popliteus muscle
Roof Superficial and deep fascia
Contents
Popliteal artery and vein
Small saphenous vein
Common peroneal nerve
Tibial nerve
Posterior cutaneous nerve of the thigh
Genicular branch of the obturator nerve
Lymph nodes
What structure is the urete derived from
Mesonephric ducts
Which vessel provides the greatest contribution of arterial supply to the breast
Internal mammary artery (60%)
External memory and lateral thoracic make up significant but lesser contributions
What are the contents of the adductor canal
Saphenous Nerve
Superficial branch of the femoral artery and vein
Boards of the adductor canal
Borders
Laterally Vastus medialis muscle
Posteriorly Adductor longis and Magnus
Roof Sartorius
Structure at hilum of kidney
Anterior to posterior
Vein, artery, ureter
What structure can be palpated for Sally and to the right of the CBD in thr hepatoduodenal ligament
Replaced Righth hepatic artery - arises for SMA. Travels dorsal to Panc head and portal vein
Replaced left hepatic may arise for left gastric and lie within gastrohrpatic ligament
Boarders of hasslebacks triangle
Superiorlateral - Epigastric Vessels
Medially -Lateral edge of rectus
Inferiorly -Inguinal ligament
Which scan can be used to identify Oxyphil Cells
Sestamibi scan
Boarders of the femoral canal
Roof – fascia lata.
Floor – pectineus, iliopsoas, and adductor longus muscles.
Superior border – inguinal ligament (a ligament that runs from the anterior superior iliac spine to the pubic tubercle).
Lateral border – medial border of the sartorius muscle.
Medial border – medial border of the adductor longus muscle. The rest of this muscle forms part of the floor of the triangle.
Contents of the femoral triangle
Which liver segments has a dual blood supply from right and left hepatic arteries
caudate lobe has dual arterial and venous supply
Muscles of the anorectal ring
Puborectalis
Superior aspects of the internal and external sphincters
Pubococcygeus
How many hepatic veins enter the IVC directly
2
Middle and left hepatic veins fuse prior to entering IVC
Caudate love has own drainage and is not drained by the main hepatic veins
Course of the median nerve in relation to brachial artery in the upper arm
Lateral to anterior to medial
Passes deep to bicipital aponeurosis and the median cubical vein at elbow
Enters forearm between two heads of pronator teres
Cantlies Line
Functionally the liver is divided into a right and left hemi-liver by the principal plane (Cantlie line). This is a plane passing through the gallbladder bed towards the vena cava and passes through the right axis of the caudate lobe. The middle hepatic vein lies in this plane
Origin of inferior epigastric
arise from external iliac artery immediately above the inguinal ligament.
Then passes along the medial margin of the deep inguinal ring
Continues superiorly to lie behind the rectus abdominis muscle
Thoracic duct relations to oesophagus
The thoracic duct lies posterior to the oesophagus and passes to the left at the level of the Angle of Louis. It enters the thorax at T12 together with the aorta.
Course of the tibial nerve in the popliteal fossa
The tibial nerve lies superior to the vessels in the inferior aspect of the popliteal fossa. In the upper part of the fossa the tibial nerve lies lateral to the vessels, it then passes superficial to them to lie medially. The popliteal artery is the deepest structure in the popliteal fossa
How many bronchopulmonary segments are their in the right lung
There are 10 bronchopulmonary segments in the right lung. Each is supplied by a segmental bronchus, artery and vein. There is no communication between segments.
Nerve first affected by raised ICP
The abducens nerve (CN VI) has the longest intra cranial course and is thus the most susceptible to raised intra cranial pressure. It also passes over the petrous temporal bone and 6th nerve palsies are also seen in mastoiditis.
Opening of stensons duct
Stensens duct conveys secretions from the parotid gland and these enter the oral cavity at the level of the second molar tooth.
Adrenal Arteries origin -upper, middle and lower
The superior arrive from the inferior phrenic. The middle adrenal artery is usually a branch of the aorta, the lower adrenal artery typically arises from the renal vessels.
Venous draining of the adrenal glands
The right - one central vein directly into the IVC
The Left - one central vein to the left renal vein
Most comman location for accessory spleen
Accessory spleen is a common anomaly and compromise the outcome of splenectomy performed for haemolytic anaemia. They occur in up to 20% of patients. 80% of accessory spleens are located at the hilum.
In order to gain access to level 1 axilla Ru nodes which structure needs to be divided
In order to access the axillary contents it is necessary to formally divide the clavipectoral fascia. Once this has been achieved the level one contents can be accessed. Retraction of pectoralis major and minor allows access to the level II and III nodes.
Level of septic bifurcation
L4
Lymphatic drainage of the uterus
Tumours of the cervix/ lower uterine body will tend to spread to the iliac nodes initially. Lesions of the upper part of the uterus will spread to the lumbar lymph nodes of the para-aortic chain. When the tumour is expanding to cross different nodal margins this is of considerable clinical significance if nodal clearance is performed during a Wertheims type hysterectomy
Branches of the abdominal aorta
Inferior phrenic T12 (Upper border) Yes Parietal
Coeliac T12 No Visceral
Superior mesenteric L1 No Visceral
Middle suprarenal L1 Yes Visceral
Renal L1-L2 Yes Visceral
Gonadal L2 Yes Visceral
Lumbar L1-L4 Yes Parietal
Inferior mesenteric L3 No Visceral
Median sacral L4 No Parietal
Common iliac L4 Yes Terminal
Branches of the IVC
T8 Hepatic vein, inferior phrenic vein, pierces diaphragm
L1 Suprarenal veins, renal vein
L2 Gonadal vein
L1-5 Lumbar veins
L5 Common iliac vein, formation of IVC
What have the longest extra hepatic course
left Hepatic Duct
What structure is at risk of injury during mobilisation of thr short saphrnous vein at its origin
Sural nerve
Structures in the parotid gland
Superficial to deep
The facial nerve is the most superficial structure in the parotid gland. Slightly deeper to this lies the retromandibular vein, with the arterial layer lying most deeply.
Venous drainage of oesophageal varices
Hemiazygous vein
Remember that with impairment of flow through the portal system. The feeding vessels will be the gastric veins and drainage superiorly to the azygos system (i.e. reverse flow).
Contents of the femoral canal
Lymphatic vessel
cloquets lymph node
The external laryngeal runs adjacent to the superior thyroid artery- what does it supply
Damage to the superior laryngeal nerve will impair the function of the cricothyroid muscle. As a result it may be difficult for people such as professional singers, to reach high pitched notes.
What structure is the central tendon of the diaphragm derived
Septum transversum
Location of parathyroid glands - abnormalities
The lower a superior parathyroid travels the more posterior it becomes
The lower an inferior travels the more anterior it becomes
Up to 25% of inferior glands will be located along the thyrothymic ligament
Blood supply of the abdominal wall
The direction of arterial blood flow is towards, and the direction of venous blood away from, the umbilicus. The blood supply of the anterior abdominal wall can be divided into both superficial and deep components. It can be further subdivided into vertical and horizontal components. The horizontal superficial vessels are, in fact, superficial branches of the deep horizontal vessels given off in the mid axillary line. The superficial vessels, including the vertically placed lateral thoracic vessels (from the axillary vessels) and the superficial epigastric vessels (from the femoral vessels), run in the superficial fascia. The lumbar veins drain posteriorly into the IC. There is, however, a connection with the ascending lumbar veins through which blood may bypass to the azygos and hemiazygos systems.
Sensation loss lateral aspect of foot post surgery
The sural nerve supplies the lateral aspect of the foot. It runs alongside the short gaphenous vein and may be injured in short saphenous vein surgery.
Surface marking of deep ring
Mid point of inguinal ligament
Foramen at end of adductor canal
The foramen marking the distal limit of the adductor canal is contained within adductor magnus. The vessel passes through this region to enter the popliteal fossa.
Contents of the posterior triangle of the neck
Nerves
• Accessory nerve
• Phrenic nerve
• Three trunks of the brachial plexus
• Branches of the cervical plexus: Supraclavicular nerve, transverse cervical nerve, great auricular nerve, lesser occipital nerve
Vessels
• External jugular vein
• Subclavian artery
Muscles
Inferior belly of omohyoid
• Scalene
Lymph nodes
• Supraclavicular
• Occipital
Contents of the carotid sheath
Internal jugular vein
Internal carotid artery
Vagus nerve
Common carotid artery
Hepatic structure not directly related to fibrous connective tissues
Left hepatic duct
The left hepatic duct is extrahepatic and this makes it an attractive site for surgical reconstruction. The other structures are all intimately related to the fibrous plates and sheaths that support the liver parenchyma.
Original of thyroid blood supply
Superior thyroid artery (1st branch of external carotid)
• Inferior thyroid artery (from thyrocervical trunk)
• Thyroidea ima (in 10% of population -from brachiocephalic artery or aorta)
Venous drainage of the thyroid
• Superior and middle thyroid veins - into the IV
• Inferior thyroid vein - into the brachiocephalic veins
Renal hilum
The renal veins lie most anteriorly, then artery and ureter lies posteriorly.
Aorta
T12-L4
Contents of the anterior triangle
Digastric triangle
Submandibular gland
Submandibular nodes
Facial vessels
Hypoglossal nerve
Muscle triangle
Strap muscles
External jugular vein
Carotid triangle
Carotid sheath (Common carotid, vagus and internal jugular
Anas cervicalis
Nerve supply of biceps femora’s
Short head - common perineal component of existence nerve
Long head - tibial nerve
Hypoglossal nerve
The hypoglossal nerve runs anterior to the external carotid, above the lingual arterial branch. If damaged then ipsilateral paralysis of the genioglossus, hyoglossus and styloglossus muscles will occur. If the patient is asked to protrude their tongue then it will tend to point to the affected side.
Common hepatic arterial anomalies
Common hepatic arterial anomalies:
• RHA from SMA
• LHA from LGA
Index and thumb pinch injury
The anterior interosseous nerve is a motor branch of the median nerve just below the elbow. When damaged it classically causes:
• Pain in the forearm
• Loss of pincer movement of the thumb and index finger (innervates the long flexor muscles of flexor pollicis longs & flexor digitorum profundus of the index and middle finger)
• Minimal loss of sensation due to lack of a cutaneous branch
Blood supply of thr bile duct
The bile duct has an axial blood supply which is derived from the hepatic artery from retroduodenal branches of the gastroduodenal artery. Unlike the liver there contribution by the portal vein to the blood supply of the bile duct. Damage to the hepatic artery during a difficult cholecystectomy is a recognised cause of bile du‹ strictures.
Venous collateral systems in SVC obstruction
• Azygos venous system
• Internal mammary venous pathway
• Long thoracic venous system with connections to the femoral and vertebral veins (2 pathways)
