Anatomy 2 Flashcards
Gluteal muscles and attachments
Gluteus maximus: inserts to gluteal tuberosity of the femur and iliotibial tract
Gluteus medius: attach to lateral greater trochanter
Gluteus minimis: attach to anterior greater trochanter
All extend and abduct the hip
Deep lateral hip rotators muscles
Deep lateral hip rotators Piriformis Gemelli Obturator internus Quadratus femoris
How does damage to superior gluteal nerve present?
Damage to the superior gluteal nerve will result in the patient developing a Trendelenberg gait. Affected patients are unable to abduct the thigh at the hip joint. During the stance phase, the weakened abductor muscles allow the pelvis to tilt down on the opposite side. To compensate, the trunk lurches to the weakened side to attempt to maintain a level pelvis throughout the gait cycle. The pelvis sags on the opposite side of the lesioned superior gluteal nerve.
Femoral nerve supply
Mnemonic for femoral nerve supply
(don’t) M I S V Q Scan for PE
M edial cutaneous nerve of the thigh
I ntermediate cutaneous nerve of the thigh
S aphenous nerve
V astus
Q uadriceps femoris
S artorius
PE ectineus
Path of femoral nerve
Penetrates psoas major and exits the pelvis by passing under the inguinal ligament to enter the femoral triangle, lateral to the femoral artery and vein.
Iliacus lies posterior to the femoral nerve in the femoral triangle
Position and relations of adrenal glands
Superomedially to the upper pole of each kidney
Relationships of the right adrenal
Diaphragm-Posteriorly,
Kidney-Inferiorly,
Vena Cava-Medially,
Hepato-renal pouch and bare area of the liver-Anteriorly
Relationships of the left adrenal
Crus of the diaphragm-Postero- medially,
Pancreas and splenic vessels-Inferiorly,
Lesser sac and stomach-Anteriorly
Arterial Supply of adrenals
superior adrenal arteries - from inferior phrenic
Middle adrenal arteries - from aorta,
Inferior adrenal arteries - from renal arteries
You are assisting in an open right adrenalectomy for a large adrenal adenoma. The consultant is distracted and you helpfully pull the adrenal into the wound to improve the view. Unfortunately this is followed by brisk bleeding. The vessel responsible for this is most likely to be:
Venous drainage of the right adrenal
Via one central vein directly into the IVC
Venous drainage of the left adrenal
Via one central vein into the left renal vein
Contents of the Axilla
1) Long thoracic nerve (of Bell)
Derived from C5-C7 and passes behind the brachial plexus to enter the axilla. It lies on the medial chest wall and supplies serratus anterior. Its location puts it at risk during axillary surgery and damage will lead to winging of the scapula.
2) Thoracodorsal nerve and thoracodorsal trunk Innervate and vascularise latissimus dorsi.
3)Axillary vein
Lies at the apex of the axilla, it is the continuation of the basilic vein. Becomes the subclavian vein at the outer border of the first rib.
4) Intercostobrachial nerves
Traverse the axillary lymph nodes and are often divided during axillary surgery. They provide cutaneous sensation to the axillary skin.
5) Lymph nodes
The axilla is the main site of lymphatic drainage for the breast.
Anal Lymph drainage
Mesorectal lymph nodes (superior to dentate line) Inguinal nodes (inferior to dentate line)
Spermatic cord Formed by the vas deferens and is covered by the following structures:
Internal Spermatic fascia - tranversalis fascia
Cremasteric fascia - from IO
External Spermatic fascia - From EO
Scrotum
Composed of skin and closely attached dartos fascia.
Arterial supply from the anterior and posterior scrotal arteries
Lymphatic drainage to the inguinal lymph nodes
Parietal layer of the tunica vaginalis is the innermost layer
Testes
Testes
The testes are surrounded by the tunica vaginalis (closed peritoneal sac). The parietal layer of the tunica vaginalis adjacent to the internal spermatic fascia.
The testicular arteries arise from the aorta immediately inferiorly to the renal arteries.
The pampiniform plexus drains into the testicular veins, the left drains into the left renal vein and the right into the inferior vena cava.
Lymphatic drainage is to the para-aortic nodes.
Contents of the spermatic cord
1) Vas deferens
Transmits sperm and accessory gland secretions
2) Testicular artery Branch of abdominal aorta supplies testis and epididymis
3) Artery of vas deferens Arises from inferior vesical artery
4) Cremasteric artery Arises from inferior epigastric artery
5) Pampiniform plexus Venous plexus, drains into right or left testicular vein
6) Sympathetic nerve fibres Lie on arteries, the parasympathetic fibres lie on the vas
7) Genital branch of the genitofemoral nerve Supplies cremaster
8) Lymphatic vessels Drain to lumbar and para-aortic nodes
Phrenic nerve course
The phrenic nerve descends on scalenus anterior posterolateral to the IJV and passing anterior to the cervical pleura and the second part of the subclavian artery, behind the subclavian vein.
The surgeons decide to perform a high ligation of the inferior mesenteric vein. Into which of the following does this structure usually drain?
The inferior mesenteric vein drains into the splenic vein, this point of union lies close to the duodenum and this surgical maneouvre is a recognised cause of ileus.
nodal stations of axilary node clearance?
During an axillary node clearance for breast cancer the clavipectoral fascia is incised and this allows access to the nodal stations. The nodal stations are; level 1 nodes inferior to pectoralis minor, level 2 lie behind it and level 3 above it
Quadratus lumborum
Origin: Medial aspect of iliac crest and iliolumbar ligament
Insertion: 12th rib
Action: Pulls the rib cage inferiorly. Lateral flexion.
Nerve supply: Anterior primary rami of T12 and L1-3
Which muscles insert to Greater Trochanter?
Mnemonic for muscle attachment on greater trochanter is POGO: Piriformis Obturator internus Gemelli Obturator externus
Relations of parathyroid
Relations Laterally Common carotid Medially Recurrent laryngeal nerve, trachea Anterior Thyroid Posterior Pretracheal fascia
Embryology of parathyroid
The parathyroids develop from the extremities of the third and fourth pharyngeal pouches. The parathyroids derived from the fourth pharyngeal pouch are located more superiorly and are associated with the thyroid gland. Those derived from the third pharyngeal pouch lie more inferiorly and may become associated with the thymus.
Path of IVC
Left and right common iliac veins merge to form the IVC at L5 level.
Passes right of midline
Paired segmental lumbar veins drain into the IVC throughout its length
The right gonadal vein empties directly into the cava and the left gonadal vein generally empties into the left renal vein.
The next major veins are the renal veins and the hepatic veins
Pierces the central tendon of diaphragm at T8
Right atrium
vEINS forming IVC
T8 Hepatic vein, inferior phrenic vein, pierces diaphragm L1 Right suprarenal vein, renal vein L2 Gonadal vein L1-5 Lumbar veins L5 Common iliac vein, formation of IVC
structures posterior to the medial malleolus:
Tom Dick And Nervous Harry
T ibialis posterior tendon flexor Digitorum longus A rtery N erve H allucis longus
What does the RCA supply?
Right atrium
Diaphragmatic part of the right ventricle
Usually the posterior third of the interventricular septum
The sino atrial node (60% cases)
The atrio ventricular node (80% cases)
Left coronary artery
The LCA supplies:
Left atrium
Most of left ventricle
Part of the right ventricle
Anterior two thirds of the inter ventricular septum
The sino atrial node (remaining 40% cases)
Femoral triangle contents
Femoral vein (medial to lateral)
Femoral artery-pulse palpated at the mid inguinal point
Femoral nerve
Deep and superficial inguinal lymph nodes
Lateral cutaneous nerve
Great saphenous vein
Femoral branch of the genitofemoral nerve
Femoral triangle boundaries
Superior - Inguinal ligament
Laterally - SARTORIUS
Medially - Adductor longus
Floor - pectinues, ilopsoas, adductor longus
Roof- Fascia lata, superficial fasica, inguinal lymph nodes, long saph vein
Superior orbital fissure
Recurrent meningeal artery* Lacrimal nerve Trochlear nerve Abducens nerve Superior opthalmic vein Superior division of the oculomotor nerve
Inferior orbital fissure
Maxillary nerve
Inferior opthalmic vein
Zygomatic nerve
Transpyloric plane
Transpyloric plane
Level of the body of L1
Pylorus stomach Left kidney hilum (L1- left one!) Fundus of the gallbladder Neck of pancreas Duodenojejunal flexure Superior mesenteric artery Portal vein Left and right colic flexure Root of the transverse mesocolon 2nd part of the duodenum Upper part of conus medullaris Spleen
Cutaneous sensation to the foot
Lateral plantar - sural Dorsum - superficial peroneal 1ST web space - deep peroneal Extremities of toes - Medial and lateral plantar nerves Proximal plantar- tibial Medial plantar - medial planar Lateral plantar - lateral plantar nerve
Lymphatic drainage of the auricle
The lateral surface of the upper half drains to the superficial parotid lymph nodes
The cranial surface of the superior half drains to the mastoid nodes and deep cervical lymph nodes
The lower half and lobule drain into the superficial cervical lymph nodes.
epiploic foramen has the following boundaries:
Anteriorly (in the free edge of the lesser omentum): Bile duct to the right, portal vein behind and hepatic artery to the left.
PosteriorlyInferior vena cava
Inferiorly1st part of the duodenum
SuperiorlyCaudate process of the liver
Superficial layer of flexor muscles of forearm
PT, FCR,PL, FCU
1) PT - Flex + Pronates -> Medial epicondyle + Ulnar olecranon to Mid shaft of radius
2) FCR - Flex + Abduct wrist -> MEC to 2nr/3rd MC base
3) PL - Flex -> MEC to palmar aponeurosis
4) FCU - Flex + Adduct -> 2 heads MEC AND ulnar olecranon, inserts to pisiform which has ligament attachement for 5th MC
Intermediate layer of flexor muscles of forearm
FDS
X4 Tendons from humeroulnar and radial aspect to pass under flexor retinaculum and SPLITS to accomodat profundus tender coming through
MCP +PIP flexion
Deep layer flexor muscles of the forearm
1) FDP - Flexion at DIP
2) FPL (Flexor policis longus) flexes thumb- from anterior radius to distal thumb DIP
3) Pronator quadratus - from distal ulna to distal radius pronates the forearm
Structures passing posterior to medial malleolous
Tibialis posterior tendon Flexor digitorum longus tendon Posterior tibial artery Tibial nerve Tendon of flexor hallucis longus
Structures posterior to the lateral malleolus and superficial to superior peroneal retinaculum
Sural nerve
Short saphenous vein
Structures posterior to the lateral malleolus and
deep to superior peroneal retinaculum
Peroneus longus tendon
Peroneus brevis tendon
Superficial and deep branch of common peroneal supply which compartments in the leg?
Superficial branch -> lateral
Deep branch -> anterior
Where do Peroneus longus attach?
Tendon runs under the groove under cuboid bone
and inserts
Medial cuniform + base of 1st metatarsal
Everts + plantarflexes
Bitemporal hemianopia mechanism and cause
Lesion of optic chiasm
Upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour
Lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma
Homonymous hemianopia
Incongruous defects: lesion of optic tract
Congruous defects: lesion of optic radiation or occipital cortex
Macula sparing: lesion of occipital cortex
Homonymous quadrantanopias
Superior: lesion of temporal lobe
Inferior: lesion of parietal lobe
Mnemonic = PITS (Parietal-Inferior, Temporal-Superior)
Frontal sinuses drainage?
Frontonasal duct
Sensation of frontal sinuses supplied by?
Supraorbital nerve (branch of opthalmic nerve) Anterior ethmoidal artery (Branch of internal carotid)
Sphenoid sinus opens up to
Spheno-ethmoidal recess
Blood supply to sphenoid sinus
Pharyngeal branches of Maxillary arteries
hree ethmoidal sinuses located within the ethmoid bone
Anterior – Opens onto the hiatus middle meatus
Middle – Opens onto the lateral wall of the middle meatus
Posterior – Opens onto the lateral wall of the superior meatus
drain into the nasal cavity at the hiatus semilunaris, underneath the frontal sinus opening. This is a potential pathway for spread of infection
The maxillary nerve supplies both the maxillary sinus and maxillary teeth, and so inflammation of that sinus can present with toothache.
Borders of femoral canal
Medial border – lacunar ligament.
Lateral border – femoral vein.
Anterior border – inguinal ligament.
Posterior border – pectineal ligament, superior ramus of the pubic bone, and the pectineus muscle
