Anatomy Flashcards
1
Q
What is mastication?
A
The process of chewing
2
Q
At what joint does movement of opening and closing the jaw come from?
A
The Temporomandibular Joint
3
Q
What are the four muscles of mastication? Do they open or close the mouth?
A
Temporalis muscle (close) Lateral Pterygoid (open) Medial pterygoid (close) Masseter (close)
4
Q
Where do the muscles of facial expression lie?
A
Between superficial fascia and fascial skeleton
5
Q
What muscle prevents drooling? Describe it
A
Orbicularis Oris
Circular muscle surrounding the mouth
Lays within the lips
Prevents dribbling during chewing and swallowing
6
Q
Where does temporalis muscle go from?
A
Coronoid process (bit at front side) of mandible to temporal fossa (bit on temporal bone)
7
Q
Where does the lateral pterygoid muscle go from?
A
Condyle of mandible (bit at back side) to pterygoid plates of sphenoid bone
8
Q
Where does the medial pterygoid muscle go from?
A
Angle of mandible (medial side) to pterygoid plates of sphenoid bone
9
Q
Where does the masseter muscle go from?
A
Angle of mandible to zygomatic arch
10
Q
Describe the two cavities of the temporomandibular joint?
A
Two cavities divided by an articular disc;
- Superior cavity for translation
- Inferior cavity for rotation
11
Q
What nerve are the muscles of mastication innervated by?
A
Mandibular division of trigeminal nerve- CN V3
12
Q
CNV3 is the only nerve that comes from the ___1_____, through ____2_____ to muscles of mastication and sensory area.
A
1) pons
2) foramen ovale
13
Q
The posterior 1/3 of the tongue is supplied by what nerve?
A
Glossopharyngeal CN lV
14
Q
The anterior 2/3 of the tongue taste is supplied by?
A
Facial nerve- Vll
15
Q
Anterior 2/3 of tongue general sensation is supplied by?
A
CN V3
16
Q
Taste buds lie on _________
Only papillae that don’t have taste buds are ________
A
papillae
filiform papillae at the front
17
Q
What does the facial nerve supply?
A
- Taste ant. 2/3rds tongue
- Muscles of facial expression
- Glands in floor of mouth
18
Q
Describe the route of the facial nerve
A
- From Pontomedullary junction
* Travel through temporal bone via internal acoustic meatus then stylomastoid foramen
19
Q
What is the superior half of the gingiva of oral cavity and palate general sensation supplied by?
A
CN V2
20
Q
What is the inferior half of the gingiva of oral cavity and palate general sensation supplied by?
A
CN V3
21
Q
What is the gag reflex?
A
A protective reflex that prevents foreign bodies from entering the pharynx or larynx
22
Q
The sensory part (or “limb”) of the gag reflex is carried by nerve fibres within ___1______
The motor part (or “limb”) is carried by nerve fibres within ______2______
A
1) CN IX
2) CN IX and CN X
23
Q
Spraying a local anaesthetic into the mouth will therefore block sensory action potentials of what nerves?
A
CN V2, CN V3, CN VII and CN IX
24
Q
What is CN V2 and CN V3?
A
CN V3 = the mandibular division of trigeminal nerve
CN V2= the maxillary division of trigeminal nerve
25
The course of CN V2?
* From pons
* Through foramen rotundum
* To sensory area (mid-face)
26
The course of CN lX- glossopharyngeal?
From medulla
Through jugular foramen
To posterior wall of oropharynx (sensory), parotid gland (secretomotor) and post. 1/3rd Tongue (Sensation and Taste)
27
3 pairs of salivary glands? What are they innervated by?
Parotid- lX
Submandibular- Vll
Sublingual- Vll
28
Describe the route of the parotid gland?
Crosses face secretes into mouth by upper 2nd molar
29
Describe the route of the submandibular gland?
Enters floor of mouth and secretes via lingual caruncle
30
Describe the route of the sublingual gland?
Lays in floor of mouth secretes via several ducts superiorly
31
What are the four pairs of skeletal intrinsic muscles of the tongue?
Palatoglossus
Styloglossus
Hyoglossus
Genioglossus
32
All tongue muscles are innervated by what? Except what muscle?
CN Xll hypoglossal
| EXCEPT PALATOGLOSSUS
33
Hypoglossal motor course?
From medulla
Through hypoglossal canal
To extrinsic and intrinsic muscle of tongue (except palatoglossus)
34
Where does the oesophagus begin?
Inferior edge of cricopharyngeus muscle (vertebral level C6)
35
Oesophageal ____1____ runs on surface to supply smooth muscle within its walls (distally)
Contains parasympathetic nerve fibres (vagal trunks) and sympathetic nerve fibres
These fibres influence _________2___________
1) plexus
| 2) the enteric nervous system to speed up (P) or slow down(S) peristalsis
36
What heart chamber is the oesophagus in contact with?
The left atrium
37
What factors produce the physiological sphincter of the lower oesophageal sphincter?
Contraction of diaphragm
Intrabdominal pressure slightly higher than intragastric pressure
Oblique angle at which oesophagus enters the cardia of stomach
38
Just before the stomach at the sphincter what change is there?
abrupt change in mucosa- the Z line- you know in endoscopy that you are about to go into the stomach
39
The oesophagus penetrates the diaphragm at what level?
T10 vertebral level
40
What are the organs of the foregut?
Oesophagus to mid-duodenum
Liver + gall bladder
Spleen
½ of pancreas
41
What are the organs of the midgut?
Mid-duodenum to proximal 2/3rds of Transverse colon
| ½ of pancreas
42
What are the organs of the hindgut?
Distal 1/3rd of Transverse colon to Proximal ½ of Anal canal
43
List the 9 regions and 4 quadrants of the abdomen
```
9 regions
Right hypochondrium
Left hypochonrdrium
Epigastric
Right Lumbar
Left Lumbar
Umbilical
Right Inguinal
Left Inguinal
Pubic
```
4 quadrants
Right and Left Upper
Right and Left Lower
44
Anterolateral abdominal wall muscles __________ the abdominal organs when injury threatens
contract to guard
45
What is the peritoneum?
The peritoneum is a thin, transparent, semi-permeable, serous membrane
It lines the walls of the abdominopelvic cavity and organs
It has visceral and parietal layers and between a peritoneal cavity that contains a small amount of lubricating fluid as the gut moves a lot.
46
If an organ is intraperitoneal what does this mean?
These organs are almost completely covered with visceral peritoneum, they are invaginated into the closed sac.
47
What does it mean if an organ is retroperitoneal?
Only has visceral peritoneum on its anterior surface
| Located in the retroperitoneum
48
What does it mean if an organ has mesentery?
Covered in visceral peritoneum
Visceral peritoneum wraps behind the organ to form a double layer – mesentery
Mesentery suspends the organ from the posterior abdominal wall – very mobile
Have a core of connective tissue with blood and lymph vessels, nerve, lymph nodes and fat
49
Five things that are intraperitoneal?
```
Liver + gall bladder
Stomach
Spleen (not GI Tract- Lymphatic)
Parts of small intestine
Transverse colon
```
50
Five things that are retroperitoneal?
```
Kidneys (not GI Tract - Renal)
Adrenal gland (not GI Tract – Endocrine)
Pancreas
Ascending colon
Descending colon
```
51
What are peritoneal ligaments?
Double layer of peritoneum connect organs to one another or body wall
52
What is omentum?
Double layer of peritoneum that passes from stomach to adjacent organs
53
Name some mesenteries
‘The Mesentery proper’ – of small intestine
Transverse and sigmoid mesocolon
Mesoappendix
54
Describe the greater omentum
Four-layered
Hangs like apron
Attaches the greater curvature of stomach to transverse colon
55
Describe the lesser omentum
Double-layered
Runs between lesser curvature of stomach and duodenum to liver
Has a free edge
56
The omenta divide the peritoneal cavity into________1_______. The lesser sac is much smaller
The two sacs communicate through the ______2_______
The ____3_____ lies in the free edge of the lesser omentum
1) a greater and lesser sac
2) Omental foramen (foramen of Winslow)
3) portal triad (hepatic artery, vein and bile duct)
57
What ligament connects the liver to the anterior abdominal wall?
Falciform ligament
58
What ligament connects the liver to the stomach?
The hepatogastric ligament
59
What ligament connects the liver to the duodenum?
The hepatoduodenal ligament
60
The hepatogastric and hepatoduodenal ligament are
continuous parts of the lesser omentum and are separated only for descriptive convenience
61
The stomach is connected to:
1) the inferior surface of the diaphragm by
2) the spleen by
3) the transverse colon by
ALL THESE HAVE A CONTINUOUS ATTACHMENT ALONG THE GREATER CURVATURE OF THE STOMACH AND ARE ALL PART OF THE GREATER OMENTUM SEPARATED ONLY FOR DESCRIPTIVE PURPOSES
1) gastrophrenic
2) gastrosplenic
3) gastrocolic
62
At its ___1____ aspect the peritoneum “drapes over” the superior aspect of the pelvic organs. This forms ____2____(located in the greater sac). In males there is one called _____3______ In females there is two ____4___ and _____5____
```
1 inferior
2 pouches
3 rectovesical pouch
4 Vesico-uterine pouch
5 Recto-uterine pouch
```
63
What is ascites? How can it be treated?
Fluid in the peritoneal cavity, treated by paracentesis
64
What is colicky pain? What is the significance of it in GI?
Pain that come and go (‘Colicky pain’)?
| Peristalsis comes in waves so may indicate a GI tract obstruction
65
Organs within the abdominal cavity including visceral peritoneum, what nerves are you dealing with?
```
Visceral afferents (sensory nerves)
The enteric nervous system
The autonomic motor nerves
Can influence the enteric nervous system
Parasympathetic (speed up peristalsis)
Sympathetic (slow down peristalsis)
```
66
Abdominal wall of the abdominal cavity, from skin through to parietal peritoneum, what nerves are you dealing with?
Somatic sensory nerves
Somatic motor nerves
Sympathetic nerve fibres
67
How do sympathetic nerve fibres get from the CNS to the abdominal organs?
Leave the spinal cord between levels T5 and L2
Enter the sympathetic chains (bilaterally) but do not synapse
Leave the sympathetic chains within abdominopelvic splanchnic nerves
Synapse at prevertebral ganglia which are located anterior to the aorta at the exit points of the major branches of the abdominal aorta
68
Abdominal sympathetic nerves “hitch a ride” with the ___________ towards (or away from if sensory) the smooth muscle and glands of the organs
arteries, and their branches,
69
Parasympathetic nerves of abdominal organs?
CNX (vagus nerve)
| Pelvic Splanchnic Nerves (S2,3,4)
70
Where does abdominal pain of the foregut tend to be felt?
In the epigastric region
71
Where does abdominal pain of the midgut tend to be felt?
In the umbilical region
72
Where does abdominal pain of the hindgut tend to be felt?
In the pubic region
73
How do visceral afferent nerve fibres get from the abdominal organs in the foregut to the CNS?
Enter spinal cord at approx T6-T9
74
How do visceral afferent nerve fibres get from the abdominal organs in the midgut to the CNS?
Enter spinal cord at approx T8-T12
75
How do visceral afferent nerve fibres get from the abdominal organs in the hindgut to the CNS?
Enter spinal cord at approx T10-L2
76
Why is pain from appendicitis initially felt as a dull, aching pain, but then becomes a sharper pain at a point in the right iliac fossa?
The appendix is a Midgut organ – usually located in the right iliac fossa
Pain from Midgut organs tends to be felt in the Umbilical region because the visceral afferents from these organs enter the spinal cord between levels T8-T10 (appendix is T10 – umbilicus)
As appendicitis worsens, the appendix will start to irritate the parietal peritoneum in the right iliac fossa, which lies anterior to it. The parietal peritoneum is part of the soma hence pain is sharper and well localised.
77
Arterial supply of foregut organs?
Coeliac Trunk
78
Arterial supply of midgut organs?
Superior mesenteric artery
79
Arterial supply of hindgut organs?
Inferior mesenteric artery
80
What is the hepatic portal vein formed by?
Union of superior mesenteric vein and splenic vein
81
What vein drains the foregut?
The splenic vein
82
What vein drains the midgut?
Superior mesenteric vein
83
What vein drains the hindgut?
Inferior mesenteric vein (via the splenic vein)
84
What is jaundice and what is it caused by?
* Yellowing of the sclera (white of eyes) and skin
| * Caused by an increase in the blood levels of bilirubin
85
What is bilirubin, where is it mainly made, what is it used to form?
* Normal by-product of the break-down of red blood cells which mainly occurs in the spleen
* Bilirubin is used to form bile – in the liver which then travels through the ‘biliary tree’. The bile tree is a set of tubes connecting the liver to the 2nd part of the duodenum
86
What does the gall bladder play an important role in?
The storage and concentration of bile- it does not make bile- hepatocytes in the liver make bile.
87
What is bile important for?
Normal absorption of fats from the small intestine
88
Largest abdominal organ in the body is?
Liver
89
Similarity between the liver and the lungs?
They both have a dual blood supply
90
Surface anatomy of the liver?
Mainly located in RUQ (right hypochondrium and epigastric), protected by ribs 7-11, location mainly changes in breathing.
91
Anatomical relations of the liver
It is inferior to the right hemi-diaphragm
gall bladder is posterior and inferior
inferior is the hepatic flexure
it is anterior to right kidney
right adrenal gland, IVC and abdominal aorta
the stomach is posterior at the mid/left side.
92
What is the hepatic flexure?
the sharp bend between the ascending colon and the transverse colon.
93
What are 2 clinically important areas of the peritoneal cavity related to the liver? Where are both recesses located?
• Hepatorenal recess (Morrison’s pouch)
• Sub-phrenic recess
In the greater sac
94
What is the lowest part of the peritoneal cavity when the patient is supine?
Hepatorenal recess
95
How many anatomical and functional lobes?
Four anatomical lobes and 8 functional lobes
96
What does each functional lobe of the liver have?
Branch of a hepatic artery, branch of a hepatic portal vein, bile drainage (to bile duct) and venous drainage (to IVC)
97
Segment one of the liver is strange because?
it gets blood from both parts of the primary split
98
The hepatic veins directing deoxygenated blood from the liver come together as ____ veins before entering ____
3
| IVC
99
Portal triad contains main structures that enter or leave the liver paraenchyma. These structures run within the _____________ ligament (diagram)
hepatoduodenal
100
The coeliac trunk is first of three midline branches of the aorta
It is _____1______
Leaves aorta at __2___ vertebral level
Supplies the organs of the ____3_____
1) retroperitoneal
2) T12
3) foregut
101
The three branches of the coeliac trunk are?
Splenic artery
Left gastric artery
Common Hepatic artery
102
The splenic artery has a very ____1____ course and it runs on the _______ border of the pancreas
1) torturous
| 2) superior
103
Anatomical relations of the spleen
```
Anatomically related to:
Diaphragm is posterior to spleen
Stomach is anterior to the spleen
Splenic fissure is inferior to the spleen Inferiorly
Left kidney is medial to the spleen
```
104
Describe the major blood supply of the stomach?
Right and left gastric arteries
Along junction of lesser curvature and lesser omentum
Anastomose together
Right and left gastro-omental arteries
Along junction of greater curvature and greater omentum
Anastomose together
105
Describe the blood supply to the liver
Right and Left hepatic arteries
Branches of the Hepatic artery proper
Only accounts for around 20-25% of the blood received by the liver
Rest is from hepatic portal vein
Liver has a dual blood supply
106
Hepatic portal vein (HPV) drains blood from__________1___________ to the liver for ______2______
1) foregut, midgut and hindgut
| 2) first pass metabolism (cleaning)
107
Where does the portal triad enter the liver?
Through the portal hepatis
108
Blood supply of the gall bladder is by the .... in most people this is a branch of...
cystic artery
| right hepatic artery
109
Only part of the duodenum that is intraperitoneal?
The superior part
110
The pancreas is a __________ organ
| It has four parts: _________
```
retroperitoneal
The pancreas is described as having a:
Head (with uncinate process)
Neck
Body
Tail
```
111
The Bile Duct descends posteriorly to the ___1___ part of the duodenum. Then travels into a groove on the ___2___ aspect of the pancreas. It then joins with the _____3______ to form the _______4_________
1 superior
2 posterior
3 main pancreatic duct
4 ampulla of Vater / hepatopancreatic ampulla
112
2 most common causes of jaundice?
Obstruction of the biliary tree by:
Gallstones
Carcinoma at head of pancreas
113
Compare the colours of the jejunum and the ileum
Jejunum is deep red
| Ileum is lighter pink
114
Compare the walls of the jejunum and ileum
Jejunum is thicker and heavy
| Ileum is thinner and lighter
115
Compare the vascularity of the jejunum and the ileum
Jejunum is more vascular
| Ileum is less vascular
116
Compare the mesenteric fat of the jejunum and ileum
Jejunum has less
| Ileum has more
117
Is it the jejunum that has plicae circularis or the ileum?
Jejunum
118
Is it the ileum or the jejunum that has peyers patches of lymphoid tissues?
ileum
119
Where does the superior mesenteric artery leave the aorta?
At the level of L1 vertebrae
120
Bile helps in the absorption of fats from the GI tract lumen into the intestinal cells
Fats (within chylomicrons) are then absorbed from intestinal cells into specialised lymphatic vessels of the small intestine called ____1____
They travel via the lymphatic system to eventually drain into the venous system at the ____2______
1) lacteals
| 2) left venous angle
121
In regards to the colon what is intraperitoneal and what is retroperitoneal?
Caecum, transverse and sigmoid intraperitoneal
| Descending and ascending are secondarily retroperitoneal
122
What are paracolic gutters?
Spaces between the colon and the abdominal wall
| There are two- a left and right- these are potential spaces for pus to collect.
123
Describe 3 distinguishing features of the colon?
1. Omental appendices- small fatty projections
2. Teniae coli- longitudinal bands of smooth muscle that run from caecum to sigmoid and come together at the appendix
3. Haustra- saccules
124
The splenic flexure is _______ than the hepatic flexure
higher
125
What is McBurney's point?
The name given to the point over the right side of the abdomen that is one-third of the distance from the anterior superior iliac spine to the umbilicus (navel)= maximal tenderness in appendicitis. Other test is get them to do hip flexion as this will knock the appendix and cause pain.
126
The long _____ of the sigmoid colon gives it a significant degree of movement however this can result in it twisting around its self which is called _______
mesentery
| sigmoid volvulus
127
ABDOMINAL AORTA
```
Bifurcates into common iliacs at ___1___
Coeliac trunk comes off at ___2___
Superior Mesenteric comes off at ___3__
Inferior mesenteric at __4____
Paired lateral branches- Renal artery comes off after SMA between ___5____
Gonadal arteries at __6___
```
1) L4
2) T12
3) L1
4) L3
5) L1 and L2
6) L2
128
Vasa recta are ____1_____ coming off from arcades in the mesentery of the jejunum and ileum
The arcades _____2_____ of jejunal and ileal arteries which are branches of the SMA
The vasa recta of jejunum are ______3_______
In the ileum this is the opposite
1) straight arteries
2) anastomoses
3) longer with fewer arcades
129
What is the marginal artery of drummond? and purpose?
anastomoses between IMA and SMA, even if there is blockage of a big mesenteric artery blood can still make its way there
130
Describe the blood supply to the rectum and anal canal
Superior rectal artery provides blood and this is a branch of the IMA
The hindgut descends to the proximal part of the anal canal
Hence the remainder of the GI tract is provided by internal iliac artery
There is another anastomoses here
131
3 clinically important sites of venous anastomoses between the systemic and portal venous systems
skin around the umbilicus
distal end of the oesophagus
rectum/ anal canal
132
Where does the sigmoid colon become rectum?
Anterior to S3
133
Where does the rectum become the anal canal?
Anterior to the top of the coccyx just prior to passing through the levator ani (pelvic floor muscle)
134
What four parts does the rectum consist of?
Rectal ampulla= dilation at the end. There are then three transverse rectal folds.
135
What does the levator ani mark?
The floor of the pelvic cavity and the roof of the perineum
136
3 different muscle fibres of the levator ani?
pubococcygeus, puborectalis, iliococcygeus
137
What muscle must relax to allow defection and urination to occur?
Levator Ani
138
What 2 nerves is the levator ani supplied by?
nerve to levator ani”: (a branch of the sacral plexus) and pudendal
139
Pudendal nerve is made by coming together of nerves?
S2, 3 and 4
140
What part of the levator ani is particularly important in maintaining faecal continence?
Puborectalis as when the rectal ampulla is relaxed & filled with faeces, voluntary contraction of this muscle will help to maintain continence
141
Internal sphincter is continuation of ____1______
and occupies the _______2__________
Contraction/ closure is stimulated by _____3______
Contraction is inhibited by _______4__________
This sphincter is ____5_____ most of the time but relaxes receptively in response to ________6________
1) GI tract muscle
2) superior two thirds of anal canal
3) sympathetic nerves
4) parasympathetic
5) contracted
6) distension (filling) of the rectal ampulla
142
External anal sphincter is _____1_____ It occupies the _______________2___________
Contraction is stimulated by the _____3_____
Voluntary contraction occurs in response to ________________4___________________
1) skeletal muscle and voluntary
2) Inferior two thirds of anal canal (superior part of the sphincter is continuous with the puborectalis muscle)
3) pudendal nerve
4) rectal ampulla distension and internal sphincter relaxation
143
Sympathetic fibres supplying the anal canal and rectum come from ___1____ travel to inferior mesenteric ganglia – synapse - then travel via periarterial of IMA.
Stimulation results in ____________2___________
1) T12-L2
| 2) Contraction of plexuses around branches internal anal sphincter and inhibition of peristalsis
144
Somatic motor from supply of anal canal and rectum is from _________1__________ and stimulation results in ___________2_______________
1) pudendal nerve (S2-S4) and nerve to levator ani (S3,S4)
| 2) Contraction of external anal sphincter and puborectalis
145
Parasympathetic fibres supplying the anal canal and rectum come from __1___
via ______2______, synapse in walls of rectum
Stimulation results in ________3___________
1) S2-4
2) pelvic splanchnic nerves
3) Inhibition of internal anal sphincter and stimulation of peristalsis
146
What is the pectinate line?
Marks the junction between the part of embryo it is formed from. Above the line is visceral and formed from endoderm, below is somatic and ectoderm
147
```
Above the pectinate line....
Nerve supply?
Arterial Supply?
Venous Drainage?
Lymphatic Drainage?
```
Autonomic
IMA
To hepatic portal system via IMV
Inferior mesenteric nodes
148
```
Below the pectinate line?
Nerve supply?
Arterial Supply?
Venous Drainage?
Lymphatic Drainage?
```
Somatic- pudendal
Internal iliac artery
Systemic Venous System via internal iliac vein
Superficial Inguinal Nodes
149
What are Ischioanal fossae?
They lie on each side of the anal canal and are filled with fat and loose connective tissue
150
Lymph drainage of the small intestine?
Lacteals drain into lymphatic plexuses in the walls of the jejunum and ileum. Then drainage is into lymphatic vessels in the mesentery with 3 nodes- juxta intestinal, mesenteric and superior central. Ultimately all drains into the superior mesenteric nodes. Lymphatics from the terminal ileum follow the ill branches of the ileocolic artery to the ileocolic lymph nodes.
151
What muscle keeps food in the correct position whilst chewing?
The buccinator
