Anatomy Flashcards
Where is the origin of the abdominal aorta?
T12
Passes through the aortic opening of the diaphragm beneath the median arcuate ligament between the crura of the diaphragm
Where does the abdominal aorta terminate?
L4
What are the posterior relations of the abdominal aorta?
L1-L4 vertebral bodies
What are the anterior relations of the abdominal aorta?
3 L’s, 3 P’s, IT
Lesser omentum
Liver
Left renal vein
Inferior mesenteric vein
Third part of duodenum
Pancreas
Parietal peritoneum
Peritoneal cavity
What are the right lateral relations of the abdominal aorta?
Right crus of the diaphragm
Cisterna chyli (abdominal origin of thoracic duct)
IVC (becomes posterior distally)
What are the left lateral relations of the abdominal aorta?
4th part of duodenum
Duodenal-jejunal flexure
Left sympathetic trunk
What are the 10 branches of the abdominal aorta?
Inferior phrenic
Coeliac
Superior mesenteric
Middle suprarenal
Renal
Gonadal
Lumbar
Inferior mesenteric
Median sacral
Common iliac
At what level does the phrenic artery branch from the abdominal aorta?
T12
(paired - give rise to superior suprarenal arteries)
At what level does the coeliac artery branch from the abdominal aorta?
T12
At what level does the superior mesenteric artery branch from the abdominal aorta?
L1
At what level does the middle suprarenal artery branch from the abdominal aorta?
L1
(paired)
At what level does the renal artery arise from the abdominal aorta?
L1-L2
(paired)
At what level does the gonadal artery arise from the abdominal aorta?
L2
(paired)
At what level does the lumbar artery arise from the abdominal artery?
L1-L4
(paired - one artery bilaterally at each vertebral level)
At what level does the inferior mesenteric artery branch from the abdominal aorta?
L3
At what level does the median sacral artery branch from the abdominal aorta?
L4
(where the aorta divides into the common iliac arteries)
At what level does the common iliac artery divide from the abdominal aorta?
L4
(paired - these are a continuation of the aorta and mark it’s end point)
What layers are divided in a midline abdominal incision?
Skin
Subcutaneous fat and fascia
Linea alba
Transversalis fascia
Extraperitoneal fat
Peritoneum
What layers are divided in a paramedian incision?
Skin
Subcutaneous fat and fascia
Anterior rectus sheath
Rectus abdominis
Posterior rectus sheath
Transversalis fascia
Extraperitoneal fat
Peritoneum
When is a Kocher incision used?
Open cholecystectomy
Incision under right subcostal margin
When is a Lanz incision used?
Open appendicectomy
Incision in the right iliac fossa
When is a gridiron incision used?
Open appendicectomy
Oblique incision over McBurney’s point which is less commonly used than Lanz incision as it is less cosmetically acceptable
Describe the Gable incision
Rooftop incision
Used in liver transplantation, adrenalectomy, duodenal surgery
What structures will be divided in lateral abdominal wall incisions?
Skin
Subcutaneous fat and fascia
External oblique (runs towards midline inferiorly)
Internal oblique (runs away from midline inferiorly)
Transversus abdominis
Transversalis fascia
Extraperitoneal fat
Parietal peritoneum
When is a Pfannenstiel incision used?
To gain access to the pelvic organs
It is a transverse suprapubic incision.
When is the Rutherford-Morrison incision used?
To gain extraperitoneal access to the abdomen
It is the incision used for first-time renal transplantation, and gives access to iliac vessels
Which muscle forms the posterior abdominal wall?
Quadratus lumborum
What is the origin of the external oblique muscle?
Ribs 5-12 laterally
What is the insertion of the external oblique muscle?
Iliac crest
Linea alba
Pubic tubercle
What does the lower border of the external oblique form?
The inguinal ligament
What is the origin of the internal oblique muscle?
Thoracolumbar fascia
Anterior 2/3 of the iliac crest
Lateral 2/3 of the inguinal ligament
What is the insertion of the internal oblique muscle?
Cartilages of the inferior 3 ribs
What is the origin of the transversus abdominis muscle?
Inner aspect of the costal cartilages of the inferior 6 ribs
Anterior 2/3 of the iliac crest
Lateral 1/3 of the inguinal ligament
What is the origin of the rectus abdominis?
Pubic crest
What is the insertion of the rectus abdominis muscle?
Xiphoid process
5th, 6th, 7th costal cartilages
What is the nerve supply to the transversus abdominis?
Anterior primary rami of T7-T12
What is the origin of the abductor pollicis brevis?
Fleshy fibres from the flexor retinaculum, scaphoid and trapezium
What is the insertion of the abductor pollicis brevis?
Via a short tendon into the radial side of the proximal phalanx of the thumb
What is the nervous supply to the abductor pollicis brevis?
Recurrent branch of median nerve in the palm
What is the action of the abductor pollicis brevis?
Abducts the thumb at the carpometacarpal and metacarpophalangeal joints, resulting in both radial and palmar abduction
What is the origin of the cranial portion of the accessory nerve?
Arises from the caudal two thirds of the nucleus ambiguus and the caudal four fifths of the dorsal nucleus of the vagus.
Emerges as four rootlets from the dorsolateral surface of the medulla oblongata below those of the vagus.
Describe the path of the cranial portion of the accessory nerve.
Arises from the medulla oblongata, then exits the skull via the jugular foramen.
Combines with the vagus nerve at the inferior ganglion of the vagus nerve, and it’s fibres are then distributed throughout the vagus nerve
What does the cranial portion of the accessory nerve supply?
Palatal muscles (with CN X)
Describe the path of the spinal portion of the accessory nerve.
Arises from C1-5/6, which traverse superiorly and enter the skull via the foramen magnum. Traverses the posterior cranial fossa and exits the skull via the jugular foramen.
Descends alongside the internal carotid artery to the sternoicleidomastoid which it innervates. Moves across the posterior triangle of the neck along the levator scapulae to innervate the trapezius.
Describe the location of the adductor canal
Immediately distal to the apex of the femoral triangle, lying in the middle third of the thigh
Where does the adductor canal terminate?
The adductor hiatus
What is the lateral border of the adductor canal?
Vastus medialis
What are the contents of the adductor canal?
Saphenous nerve
Superficial femoral artery
Superficial femoral vein
What is the posterior border of the adductor canal?
Adductor longus, adductor magnus
What structure forms the anterior/medial aspect of the adductor canal?
Sartorius
What is the origin of the adductor longus?
Anterior body of the pubis
What is the insertion of the adductor longus?
Middle third of the linea aspera
What is the function of the adductor longus?
Adducts and flexes the thigh, medially rotates the hip.
What is the innervation of the adductor longus?
Anterior division of the obturator nerve (L 2, 3, 4)
What is the origin of the adductor pollicis?
Tendon sheath of flexor carpi radialis
Oblique head comes from bases of second, third and fourth metacarpals
Transverse head comes from the third metacarpal
Anterior aspect of the trapezoid and capitate bones
What is the insertion of the adductor pollicis?
Fibres converge into the ulnar aspect of the base of the proximal phalanx of the thumb
What is the nervous supply to the adductor pollicis?
Deep branch of the ulnar nerve (C8, T1)
What is the action of the adductor pollicis?
Draws the thumb towards the midline in the palmar plane of the hand
What is the location of the adrenal glands?
Superomedially to the upper pole of the kidney
Describe the posterior relations of the right adrenal gland
Diaphragm
Describe the inferior relations of the right adrenal gland
Kidney
Describe the medial relations of the right adrenal gland
Inferior vena cava
Describe the anterior relations of the right adrenal gland
Hepato-renal pouch and bare area of the liver
Describe the postero-medial relations of the left adrenal gland
Crus of the diaphragm
Describe the inferior relations of the left adrenal gland
Pancreas and splenic vessels
Describe the anterior relations of the left adrenal gland
Lesser sac and stomach
Describe the arterial supply to the adrenal glands
Superior adrenal arteries (branch of inferior phrenic arteries)
Middle suprarenal arteries (AKA middle adrenal arteries - arise from aorta)
Inferior adrenal arteries (branch of renal arteries)
Describe the venous drainage of the right adrenal gland
One central vein directly into the IVC
Describe the venous drainage of the left adrenal gland
One central artery into the left renal vein
What is the embryological origin of the adrenal cortex?
Mesoderm of the posterior abdominal wall
When is the adrenal gland first embryologically evident?
6 weeks gestation
When does steroid secretion from the adrenal cortex begin?
Shortly after embryological development at 6 weeks
What is the embryological origin of the adrenal medulla?
Ectoderm, arising from neural crest cells that migrate to the medial aspect of the developing cortex
Describe the size of the fetal adrenal gland
At 4 months’ gestation, it is 4 times the size of the kidney; however, at birth, it is a third of the size of the kidney.
This is because of the rapid regression of the fetal cortex at birth. It disappears almost completely by age 1 year; by age 4-5 years, the permanent adult-type adrenal cortex has fully developed.
Describe the embryological association between the adrenal gland and the kidney
Develop with close association.
If there is adrenal agenesis there is also ipsilateral renal agenesis.
If there is adrenal fusion across the midline there is also renal fusion.
Describe the 2 forms of adrenal hypoplasia
(1) hypoplasia or absence of the fetal cortex with a poorly formed medulla
(2) disorganised fetal cortex and medulla with no permanent cortex present
Describe adrenal heterotropia
Normal adrenal gland in an abnormal location (i.e. within renal or hepatic capsule)
What is the most common location of accessory adrenal tissue?
Broad ligament or spermatic cord but can be found anywhere within the abdomen
Describe the histological structure of the internal anal sphincter
Smooth muscle continuous with the circular muscle of the rectum
Describe the location of the internal anal sphincter
Upper 2/3 of the anal canal
Describe the histology of the external anal sphincter
Striated muscle which surrounds the internal sphincter but extends more distally.
Describe the nerve supply to the external anal sphincter.
Inferior rectal branch of the pudendal nerve (S2 and S3) and the perineal branch of the S4 nerve roots
Define the posterior border of the anatomical snuffbox
Tendon of extensor pollicis longus
Define the anterior border of the anatomical snuffbox
Tendons of extensor pollicis brevis and abductor pollicis longus
Define the proximal border of the anatomical snuffbox
Styloid process of the radius
Define the distal border of the anatomical snuffbox
Apex of the snuffbox triangle
What structures form the floor of the anatomical snuffbox?
Trapezium and scaphoid
What structure lies within the anatomical snuffbox?
Radial artery
Which muscles lie within the superficial anterior compartment of the forearm?
Brachioradialis
Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris
Which muscle lies within the middle anterior compartment of the forearm?
Flexor digitorum superficialis
Which muscles lie within the deep anterior compartment of the forearm?
Flexor digitorum profundus
Pronator quadratus
What structure is labelled 1?
Flexor carpi radialis
What structure is labelled 2?
Palmaris longus
What structure is labelled 3?
Flexor carpi ulnaris
What structure is labelled 4?
Pronator teres
What structure is labelled 5?
Brachioradialis
What structure is labelled 1?
Flexor pollicis longus
What structure is labelled 2?
Pronator quadratus
What structure is labelled 3?
Flexor digitorum profundus
What is the origin of flexor carpi radialis?
Common flexor origin and surrounding fascia
What is the origin of palmaris longus?
Common flexor origin
What is the origin of flexor carpi ulnaris?
Small humeral head arises from the common flexor origin and adjacent fascia.
Ulnar head comes from medial border of olecranon and posterior border of ulna.
What is the origin of flexor digitorum superficialis?
Common flexor tendon, adjacent fascia and septa and medial border of the coronoid process
Describe the origin of the flexor digitorum profundus
Upper two thirds of the medial and anterior surface of the ulna, medial side of the olecranon, medial half of the interosseous membrane
Describe the insertion of the flexor carpi radialis
Front of bases of second and third metacarpals
Describe the insertion of the palmaris longus muscle
Apex of the palmar aponeurosis
Describe the insertion of the flexor carpi ulnaris
Pisiform and base of the fifth metacarpal
Describe the insertion of the flexor digitorum superficialis
Via tendons in the fibrous flexor sheath. At the level of the metacarpophalangeal joint each tendon split into two, these bands pass distally to their insertions
Describe the insertion of the flexor digitorum profundus
Via tendons that lie deep to those of flexor digitorum superficialis to insert into the distal phalanx
What is the nerve supply to flexor carpi radialis?
Median
What is the nerve supply to palmaris longus?
Median
What is the nerve supply to flexor carpi ulnaris?
Ulnar
What is the nerve supply to flexor digitorum superficialis?
Median
What is the nerve supply to flexor digitorum profundus?
Medial part= ulnar
Lateral part=anterior interosseous nerve
What is the action of flexor carpi radialis?
Flexes and abducts the carpus, part flexes the elbow and part pronates forearm
What is the action of palmaris longus?
Wrist flexor
What is the action of flexor carpi ulnaris?
Flexes and adducts the carpus
What is the action of flexor digitorum superficialis?
Flexor of metacarpophalangeal joint and proximal interphalangeal joint
What is the action of flexor digitorum profundus?
Flexes the distal interphalangeal joints and the wrist
What are the 8 carpal bones?
Lateral to medial (in two layers of 4):
Scaphoid
Lunate
Triquetrium
Pisiform
Trapezium
Trapezoid
Capitate
Hamate
What is the nerve supply to the interosseous bones of the hand?
Ulnar
How many interosseous bones of the hand are there?
8
4 dorsal (abduct fingers)
4 palmar (adduct fingers)
Describe the function of the lumbrical muscles of the hand
Flex MCPJ and extend IPJ
Describe the origin of the lumbrical muscles of the hand
Flexor digitorum profundus tendons in the hand
Describe the insertion of the lumbrical muscles of the hand
Dorsal extensor hood mechanism
Describe the innervation of the lumbrical muscles of the hand
1st and 2nd- median nerve
3rd and 4th- deep branch of the ulnar nerve.
Which muscles form the thenar eminence?
Abductor pollicis brevis
Opponens pollicis
Flexor pollicis brevis
What structure is labelled 1?
Flexor pollicis brevis
What structure is labelled 2?
Abductor pollicis brevis
What structure is labelled 3?
Opponens pollicis
Which muscles form the hypothenar eminence?
Opponens digiti minimi
Flexor digiti minimi brevis
Abductor digiti minimi
What structure is labelled 1?
Flexor digiti minimi brevis
What structure is labelled 2?
Abductor digiti minimi
What structure is labelled 3?
Opponens digiti minimi
Which structures is the fascia of the palm continuous with?
Antebrachial fascia and the fascia of the dorsum of the hand
Which structures is the palmar aponeurosis continuous with?
Flexor retinaculum and the palmaris longus tendon
What lies between the thenar and hypothenar eminences of the hand, and what does it contain?
The central compartment of the hand
Contains the flexor tendons and their sheaths, the lumbricals, the superficial palmar arterial arch and the digital vessels and nerves.
What is the deepest muscular plane of the forearm?
The adductor compartment, containing the adductor pollicis.
What is contained within the fibrous digital sheath?
Flexor tendons and their synovial sheaths
Where does the fibrous digital sheath lie?
Extend from the heads of the metacarpals to the base of the distal phalanges
What structures are supplied by the superior gluteal nerve?
Gluteus medius
Gluteus minimis
Tensor fascia lata
What symptom will develop from damage to the superior gluteal nerve?
Trendelenburg gait
What structure does the inferior gluteal nerve supply?
Gluteus maximus
Name the 4 deep lateral hip rotators
Piriformis
Gemelli
Obturator internus
Quadratus femoris
Which structures run in the antecubital fossa?
Cephalic vein
Cubital vein
Brachial artery
Median nerve
Describe the action of the gluteal muscles
Extend and abduct the hip.
Which bones form the ankle joint?
Tibia and fibula proximally, talus distally.
Which ligaments form the ankle joint?
Deltoid ligament (medially)
Lateral collateral ligament
Talo-fibular ligaments (anteriorly and posteriorly)
What are the components of the syndesmosis of the ankle?
Antero-inferior tibiofibular ligament
Postero-inferior tibiofibular ligament
Inferior transverse tibiofibular ligament
Interosseous ligament
What is the range of plantarflexion of the ankle joint?
55 degrees
What is the range of dorsiflexion of the ankle joint?
35 degrees
What is the inferior root of the ansa cervicalis?
C2, C3 - passes posterolateral to the internal jugular vein, lying either deep or superficial to it
At which level do inversion and eversion movements of the ankle ovvur?
The subtalar joint
What is the nerve supply to the ankle joint?
Branches of the deep peroneal and tibial nerves
What is the superior root of the ansa cervicalis?
C1 - branch anterolateral to the carotid sheath
What structures does the ansa cervicalis supply?
Sternohyoid
Sternothyroid
Omohyoid
Where does the nerve supply to the inferior strap muscles enter and what is it’s clinical significance?
Their inferior aspect.
When dividing these muscles to expose a large goitre, the muscles should be divided in their upper half.
What is the nerve supply to the inferior strap muscles?
Ansa cervicalis
Which nerve root is tested by the ankle reflex?
S1 and S2
Which pathology will typically cause a delayed ankle jerk reflex?
Disc prolapse at L5/S1
Which structures run in the antecubital fossa?
Cephalic vein
Cubital vein
Brachial artery
Median nerve
What structure is labelled 1?
Median antecubital vein
What structure is labelled 2?
Basilic vein
What structure is labelled 3?
Cephalic vein
What are the sub-triangles of the anterior triangle of the neck?
Muscular triangle
Carotid triangle
Digastric triangle (submandibular triangle)
Which structures form the anterior triangle of the neck?
Anterior border of sternocleidomastoid
Lower border of the mandible
Anterior midline
What are the contents of the muscular triangle of the neck?
Strap muscles
External jugular vein
What are the contents of the carotid triangle of the neck?
Carotid sheath
What are the contents of the digastric triangle of the neck?
Submandibular gland
Submandibular nodes
Facial vessels
Hypoglossal nerve
What is the nerve supply to the digastric muscle?
Anterior: Mylohyoid nerve
Posterior: Facial nerve
What does the external jugular vein drain?
Superficial aspect of scalp and neck
Where does the external jugular vein commence?
Near the angle of the mandible either below or within the parotid.
Formed from posterior divisions of the retromandibular and posterior auricular veins.
Where does the anterior jugular vein commence?
Near the hyoid bone by the confluence of the superficial mandibular veins
Describe the path of the anterior jugular vein
It descends between the midline and the anterior border of the sternocleidomastoid. It eventually descends deep to this muscle to join either the external jugular or the subclavian vein.
Describe the origin of the internal jugular vein
The cranial base in the posterior compartment of the jugular foramen and is continuous with the sigmoid sinus
Describe the path of the internal jugular vein
The vein is contained within the carotid sheath and eventually unites with the subclavian vein posterior to the sternal end of the clavicle.
Describe the surface markings of the internal jugular vein
This is from the ear lobe to the medial end of the clavicle.
The inferior bulb lies in a depression between the sternal and clavicular heads of the sternocleidomastoid, the lesser clavicular fossa.
What is the origin of the external carotid artery?
Immediately lateral to the pharyngeal side wall