Anatomy Flashcards
what are 4 functions of the upper GI tract?
1) mastication (chewing)
2) taste
3) deglutition (swallowing)
4) Salivation
what muscle and feature of the mouth controls mastication?
= temporo-mandibular joint
- muscles of TMJ, face and tongue
- dentition (teeth)
what 4 things are involved in deglutition (swallowing)?
- tongue
- palate
- pharynx
- oesophagus
what 4 glands are involved in salivation?
- parotid gland
- submandibular gland
- sublingual gland
- minor glands
what 3 things are involved in taste?
- mastication
- salivation
- tongue
how is mastication (chewing) conducted?
what does mastication facilitate?
by movement of jaw which occurs at the TMJ and tongue, to breakdown good.
- facilities taste and digestion by mixing food with saliva
how many teeth do adults have?
and how many quadrants do the mouth have?
= 32 teeth
4 quadrants
- upper right
- upper left
- lower right
- lower left
what 3 points does the TMJ articulate?
1) mandibular fossa
2) head of condylar process
3) articular tubercle
what are all the muscles of mastication supplied by?
= mandibular division of tri-geminal nerve
CN V3
how many muscles are there at each TMJ?
4 muscles
- 3 close
- 1 opens
what are 4 muscles involved in mastication?
1) temporlais muscle
2) masseter muscle
3) lateral pterygoid
4) medial pterygoid
describe what the temporalis and masseter muscle are?
TEMPORALIS
- coronoid process of mandible to temporal fossa
MASSETER
- angle of mandible to zygomatic arch
describe what the lateral and medial pterygoid are?
LATERAL PTERYGOID
- condyle of mandible to pterygoid plates of sphenoid bone
MEDIAL PTERYGOID
- angle of mandible (Medial side) two pterygoid plates of sphenoid bone
what are the 2 cavities of TMJ and what do they each allow?
1) superior cavity
= translation
2) inferior cavity
= rotation
what are the 2 cavities in TMJ divided by?
= articular discs
what function do mandibular division of tai-geminal nerves (CNV3) have?
= sensory and motor fibres
describe the course of the mandibular division of tai-geminal nerve (CNV3)?
- from pons
- through foramen oval
- to muscles of mastication and sensory area
see diagram of oral cavity
see diagram of oral cavity
see diagram of surface anatomy of oral cavity
see diagram of surface anatomy of oral cavity.
what things should you be cautious of in the oral cavity?
- any dental work
- loose teeth or loose parts of teeth = choking hazard and an aspiration risk
= aspiration is the inhalation of liquid or solid matter into lungs - potential infection
match the following; Posterior 1/3rd Anterior 2/3rd with Vertical part Horizontal part
Posterior 1/3rd = vertical part
Anterior 2/3rd = horizontal part
where is the posterior 1/3rd and anterior 2/3rd found?
Posterior 1/3rd in oropharynx
Anterior 2/3rd in oral cavity
what are the functions of posterior 1/3rd and anterior 2/3rd of the tongue?
Posterior 1/3rd = taste & general sensation (CNIX)
Anterior 2/3rd = general sensory (CNV3)
what are the different points of the tongue?
TIP = filiform papillae
MID = fungiform papillae
BACK = vallate papillae
BACK EDGE = foliate papillae
what is the course of the facial nerves?
- from ponto-medullary junction
- travels through temporal bone via internal acoustic meatus then stylomastoid foramen
To supply;
- taste ant. 2/3rds tongue
- muscles of facial expression
- glands in floor of mouth
see slide on facial nerve course diagram.
see slide on facial nerve course diagram
describe whats on the superior half of oral cavity?
and what is the general sensation of superior half of oral cavity?
= gingival of oral cavity and palate
- CN V2
what particular area of the oropharynx is extremely sensitive to touch?
= posterior wall
describe whats on the inferior half of oral cavity?
and what is the general sensation of inferior half of oral cavity?
= gingival of oral cavity & floor of mouth
- CN V3
what is the gag reflex?
a protective reflex preventing foreign bodies from entering the pharynx or laryngeal
what is sensory part of the gag reflex carried by?
what is the motor part of the gag reflex carried by?
Sensory
= by nerve fibres within CN IX
Motor
= by nerve fibres within CN IX and CN X
part of the gag reflex involves response to touching posterior wall of oropharynx, why is this?
to constrict pharynx, as patient attempts to close it of as an entry point into node
if you spray a local anaesthetic into the mouth, what sensory action potential will it block?
- CN V2
- CN V3
- CN VII
- CN IX
what is the course of CN V2?
- from pons
- through foramen rotundum
- to sensory area (mid-face)
what is CN IX also known as?
= glossopharyngeal
- special sensory, motor, visceral afferent and parasympathetic
what is the course of CN IX?
- from medulla
- through jugular foreman
- to posterior wall of oropharynx (sensory), parotid gland (secretomotor), and post
1/3rd tongue (sensation and taste)
what are the 3 salivary glands?
1) parotid gland
2) sub-mandibular gland
3) sub-lingual gland
where are the salivary glands located?
Parotid
- parotid duct crosses face secretes into mouth by upper 2nd molar
Sub-Mandibular
- sub-mandibular duct enters floor of mouth secreting via lingual caruncle
Sub-lingual
- lays in floor of mouth secreting via several ducts superiorly
what can duct clotting/blockage cause?
- swelling due to back up of secretions
how is the tongue suspended in oral cavity?
by 4 Paris of skeletal muscle;
- PALATOGLOSSUS
- STYLOGLOSSUS
- GENIOGLOSSUS
- HYYPOGLOSSUS
what are the functions of the extrinsic muscles of the tongue?
- function to change the position of the tongue during mastication, swallowing and speech
where are the 4 pairs of skeletal intrinsic muscles of tongue located and what is their function?
- mainly dorsally/posteriorly
Function = to modify the shape of the tongue during function
what are all the tongue muscles innervated by?
CN XII (hypoglossal nerve)
EXCEPT PALATOGLOSSUS
describe the course of the hypoglossal nerves, CN XII?
- from medulla
- through hyypoglossal canal
- to intrinsic and extrinsic muscles of tongue (except palatoglossus)
how many circular (constrictor) muscles does the pharynx have?
and what layer do they form of the pharynx?
3x circular (constrictor) muscles
= the external layer
what are the circular constrictor muscles in the pharynx like?
= voluntary muscles
what do the external (circular) layers of the pharynx overlap with?
= each other and contract sequentially
what is the pharynx circular muscles innervated by?
CN X (vagus)
where is the CN X inserted in the pharynx?
= onto the midline raphe
how many longitudinal muscles are there in the pharynx?
= 3x longitudinal muscles
what are the longitudinal muscles in the pharynx like?
skeletal (voluntary) muscles
what layer do the longitudinal muscles make up of the pharynx?
= inner layer
what are the longitudinal muscles innervated by?
- CN X and IX (one muscle, stylopharyngess)
what do both the internal and external layers of the pharynx do?
elevate the pharynx and larynx
- attach to laryngeal
- contrat to shorten pharynx
- raise larynx to close over the laryngeal inlet
what is used to view inside the GI tract?
endoscopy
when you insert an endoscopy, what should you ask the patient to do?
swallow
what happens when you ask the patient to swallow?
1) tongue pushes bolus of food towards oropharynx
= voluntary
2) soft palate elevated, larynx elevated
= involuntary
3) circular layer of pharyngeal constrictor mussels contract
= involuntary
4) bolus of food enters oesophagus and travels inferiorly by peristalsis
= involunttary
what is the anatomy of swallowing?
1) Close the lips to prevent drooling (orbicularis oris & cranial nerve VII)
2) The tongue (cranial nerve XII) pushes the bolus posteriorly towards the
oropharynx
3) Sequentially contract the pharyngeal constrictor muscles (cranial nerve X) to
push the bolus inferiorly towards the oesophagus
4) At the same time the inner longitudinal layer of pharyngeal muscles (cranial
nerves IX & X) contracts to raise the larynx, shortening the pharynx and closing off the laryngeal inlet to help prevent aspiration
5) The bolus reaches the oesophagus
what are all the muscles of involved in swallowing?
skeletal muscles
is the initiation of swelling involuntary or voluntary?
voluntary
what are all the muscles of swelling supplied by?
cranial nerves
what is the oesophagus an inferior continuation of?
paryngopharynx
where does then oesophagus begin?
at inferior edge of circopahryngeus muscle (vertebral level C6)
what is the oesophagus?
a muscular tube
= walls site together when no food is present
what does the oesophagus have in terms of sphincter aNd what do they aid ?
- anatomical upper
- physiological lower
which aid in controlling food movement
what does the oesophagus plexus run on and why?
runs on surface to supply smooth muscle within its walls (distally)
- contains parasympathetic nerve fibres (vagal trunks) and sympathetic
- these fibres influence ENS to speed up or slow down peristalsis
where does the oesophagus terminate?
entering the cardia of stomach
where is the oesophagus in the root of the neck, in chest and abdomen?
ROOT OF NECK;
- posterior to trachea
- anterior to vertebral bodies
IN CHEST;
- posterior to heart
- in contract with left atrium
IN ABDOMEN;
- thorough diaphragm at T10 vertebral level
- immediately connects with stomach
describe then oesophagus in cervical, thoracic and diaphragmatic constriction?
Cervical
= circopahryngeus muscle
Thoracic
= arch of aorta
= left main bronchus
Diaphragmatic constrictor
= result of passing through diaphragm
= lower oesophageal sphincter
Is the lower oesophageal sphincter physiological or anatomical?
= PHYSIOLOGICAL
what factors produce the sphincter effect?
- contraction of diaphragm
- intra-abdominal pressure slightly higher than intra-gastric pressure
- oblique angle at which oesophagus enters cardia for stomach
what does the sphincter effect help reduce?
occurrence of reflux
what will reduce the effectiveness of sphincter?
= hiatus hernia
where does the lower oesophageal sphincter lie?
- immediately superior to gastro-oesophageal junction
where does the stomach lie?
leeft hypochodrium, epigastric and umbilical regions when patient is supine
see anatomy of stomach diagram
see anatomy of stomach diagram
see diagram of anatomical relations of stomach
see diagram of anatomical relations of stomach
LECTURE 2 - Where is patients ABDOMINAL PAIN and what is the likely source
LECTURE 2 - Where is patients ABDOMINAL PAIN and what is the likely source
describe what the small intestine is made up of from proximal to distal?
- duodenum (short)
- jejunum (3m)
- ileum (4m)
describe what the large intestine is made up of from proximal to distal?
describe what 6 things are in the colon?
- colon = caecum = appendix = ascending colon = transverse colon = descending colon = sigmoid colon
- rectum
- anal canal
anus
see diagram on slide 2 of GI tract.
see diagram on slide 2 of GI tract
name the abdominal organs.
see slide 3 for diagram
1) liver
2) gall bladder
3) stomach
4) pancreas
5) large intestine
6) small intestine
7) rectum
8) anus
+ spleen
+ Kidney
+ adrenal gland
(see slide 3 for diagram)
how are the abdominal organs describe?
= in 3 parts
1) foregut
2) midgut
3) handout
what does the foregut consist of?
- oesophagus two mid-duodenum
+ liver + gall bladder
+ spleen
+ 1/2 pancreas
what does the midgut consist of?
- mid-duodenum to proximal 2/3rd of transverse colon
+ 1/2 pancreas
what does the hundgut consist of?
- distal 1/3rd of transverse colon to proximal 1/2 of anal canal
describe the arteries/veins, lymphatics and nerves in the abdominal organs.
- arteries and veins = similar names
- lymphatics = share similar path
- nerves = share a common path
what are the 4 quadrants of the abdominal?
1) right upper
2) left upper
3) right lower
4) left lower
what are the 9 regions of the admin?
Right (from top to bottom);
- right hypochondrium
- right lumbar
- right inguinal
Left (from top to bottom);
- left hypochondrium
- left lumbar
- left inguinal
Middle (from top to bottom);
- epigastric
- umbilical
- pubic
what are the 3 planes involved in the abdomen and where are they?
1) mid-clavicular planes
- running from middle of clavicle.
= separating the epigastric r, umbilical and pubic regions from the left and right
2) sub-costal plane
- runs beneath right and left hypochondrium & epigastric BUT above right and left lumber and umbilical
3) trans-tubercular plane
- runs beneath right &left lumber and umbilical
BUT above right and left inguinal & pubic
why do the anterolateral muscles of the abdominal walls contract?
to ‘guard’ off the abdominal organs when injury threatens.
- this guarding occurs in peritonitis.
describe the 5 anterolateral muscles?
1) rectus abdominis
2) external oblique
3) internal oblique
4) transverse abdominus
5) parietal peritoneum
what is the peritoneum?
= a thin, transparent semi-permeabile serous membrane.
- lining the walls of the abdomen/pelvic cavity and organs
True or false?
Peritoneum is a continuous membrane?
what are the 2 components of the peritoneum?
= YES
- parietal (on body wall)
- visceral (engulfing organs)
what forms between the 2 layers?
= peritoneal cavity which contains a small amount of lubricating fluid
what causes severe & painful inflammation of the peritoneum (peritonitis)?
= blood, pus or faeces in peritoneal cavity
how can organs be classed in the peritoneum?
= depends on their relationship with peritoneum
1) intra-peritoneal
2) retro-peritoneal
3) with a mesentery
describe intra-peritoneal organs?
= completely covered in visceral peritoneum
- minimally mobile
describe organs with a mesentery?
= covered in visceral peritoneum
- visceral wraps behind organs to form a double layer = mesentery
- mesentery suspends the organ from posterior abdominal wall
= very mobile
describe retro-peritoneal organs?
= only has visceral peritoneum on its anterior surface
- located in retropertoneum
what 2 ways can abdominal organs be classed?
1) intra-peritoneal organs (A)
2) retro-peritoneal organs (B)
what organs are there in intra-peritoneal and retro-peritoneal?
Intra-peritoneal;
- liver + gall bladder
- stomach
- spleen
- parts of intestine
- transverse colon
Retro-peritoneal;
- kidneys
- adrenal gland
- pancreas
- ascending colon
- descending colon
Yes or No.
does condensation of peritoneum exist?
Yes
what are the 3 types of peritoneal formation?
1) mesentery
2) omentum (greater and lesser)
3) peritoneal ligaments
describe mesentery.
- connects organs to posterior body wall
describe omentum.
- double layer of peritoneum passes from stomach to adjacent organs
describe peritoneal ligaments.
- double layer of peritoneum connecting organs to one another or body wall
see diagram regarding peritoneal formation, slide 13.
see diagram regarding peritoneal formation, slide 13.
describe mesenteries core in peritoneal formation?
= core of connective tissue with blood and lymph vessels, nerve, lymph nodes and fat
Do mesentery provides high levels of mobility?
Yes
in peritoneal formation, describe the greater and lesser omentum?
Greater omentum;
- 4 layers
- hands like an apron
- attaches greater curvature of stomach too transverse colon
Lesser omoentum;
- double layer
- runs between lesser curvature of stomach and durodenum tot liver
= free edge
what divides the peritoneal cavity into a greater and lesser sac?
= omenta
describe the size of the lesser sac compared to greater sac?
lesser sac = much small
how do the 2 sacs communicate?
= omentum foramen (foramen of Winslow)
where does the portal triad lie?
= lies in the free edge of lesser omentum
look at slide 18 for ligaments in peritoneum.
look at slide 18 for ligaments in peritoneum.
describe the appearance of the peritoneum at its inferior aspect?
= peritoneum drapes over superior aspect of pelvic organs
what does the peritoneum form?
= pouches (located in greater sac)
- one pouch in male
- two pouches in female
what is the name off the pouch in males and the 2 pouches in females?
Males
= recto-vescial pouch
females
= vesico-uterine pouch
= recto-uterine pouch
what is the recto-uterine pouch known as?
= pouch of douglas
what are ascites?
= collection of fluid in peritoneal cavity
what most commonly causes ascites?
caused by liver disease;
- cirrhosis
- porttal hypertesnion
describe how ascitic fluid can be drained?
- drained from peritoneal cavity by paracentesis
= ‘abdominocentesis’
during pancreatesis to remove asciitc fluid, where must the needle be placed?
= placed lateral to rectus sheath to avoid inferior epigastric artery
(which ascends in anterior abdominal wall - Deep to recus abdomens)
where does the inferior epigastric arise from?
= external iliac medial to deep inguinal ring
what are the 4 questions to ask someone with abdominal pain?
1) location
- pain localised?
- what anatomy lies there?
2) character
3) timing
- does pain come and go (colicky pain)
4) pain referral pattern
- is pain showing classical distribution
describe the localisation of visceral and stomach pain?
Visceral = hard to localise
Stomach = easier to localise
describe the character of visceral and stomach pain?
Visceral (from organ) = dull, achy and nauseating
Stomach (from body wall) = sharp and stabbing
what is the type of pain that comes and go called?
= colicky pain
what is an example of a condition that pain comes in wave that could indicate GI obstruction?
= peristalsis
what sensory nerves are there in the visceral peritoneum
= visceral afferents
what 2 nervous systems are involved in visceral peritoneum?
1) enteric nervous
2) autonomic motor nerves
- influencing ENS
- parasympathetic (increases peristalsis)
- sympathetic (deceases peristalsis)
what sensory nerves are there from skin through to parietal peritoneum?
= somatic sensory nerves
= somatic motor nerves
what nerve fibre is involved from skin to parietal peritoneum?
= sympathetic nerve fibres
how do sympathetic nerves get from CNS to abdominal organs
- leave spinal cord between T5 and L2
- enter sympathetic chains (bilaterally) but don’t synapse
- leave sympathetic chains within abdominno pelvic splanchnic nerves
- synapse at pre-vertebral ganglia which are located anterior to aorta a exit points of major branches of abdominal aorta
where do post-synaptic sympathetic nerve fibres pass from?
= pre-vertbral ganglia (celiac, superior mesenteric etc) onto the surface of the arterial branches leaving the abdominal aorta
They take part in “periarterial plexuses” with other nerve fibres (parasympathetic and visceral afferent)
As they “hitch a ride” with the arteries, and their branches, towards (or away from if sensory) the smooth muscle and glands of the organs
what gland is important in helping sympathetic nerves getting from CNS to abdominal organs?
= adrenal glands
where do sympathetic nerve fibres for the adrenal land leave the spinal cord and where do they enter?
Leave = T10-L1
Enter = abdomen-pelvic splanchic nerves
Yes or no do sympathetic nerve fibres for the adrenal gland synapse at pre-vertebral ganglia?
= yes
what are the sympathetic fibres carried with to the adrenal gland?
= peri-arterial plexus
- synapse directly onto cells
how do parasympathetic nerves get form CNS to abdominal organs?
1) CNX (vagus nerve)
- presynaptic parasympathetic nerve fibres enter abdominal cavity on surface of the oesophagus (“vagal trunks”)
- travel into the periarterial plexuses around the abdominal aorta
- carried to the walls of the organs where they synapse in ganglia
- supply parasympathetic nerve fibres to the GI tract + abdominal organs up to the distal end of the transverse colon
3) Pelvic Splanchnic Nerves (S2,3,4)
- Presynaptic parasympathetic nerve fibres
- smooth muscle/glands of the descending colon to anal canal
describe abdominal pain in foregut, midgut and hindgut?
Foregut
= epigastric region
Midgut
= umbilical region
Hindgut
= pubic region
how do visceral afferent nerve fibres get from abdominal organs to CNS?
- pain fibres from abdominal organs run along sympathetic fibres back to spinal cord
where do foregut, midgut and handout structures enter the spinal cord?
foregut
= at T6-T9
midgut
= at T8-T12
hindgut
= at T12-L2
where does pain from these organs tend to be perceived by the patient and what is then pain considered to be a type of?
= in dermatoses of the level at which they enter the spinal cord
- referred paint
look at slides 29,30.
look at slides 29,30
what 3 things supply the structure of the abdominal part of body wall?
1) somatic motor
2) somatic sensory
3) sympathetic nerve fibres
what are 4 body wall nerves?
1) thorax-abdominal nerves
2) sub-costal nerves
3) Illiohypogastric nerves
4) illoinguinal nerve
where is the location of these 4 body wall nerves?
1) Thoracoabdominal nerves:
= 7th-11th Intercostal nerves
Travel anteriorly, then leave the intercostal spaces, travel in the plane between the internal oblique and transversus abdominis, as thoracoabdominal nerves
2) Subcostal nerve
= T12 anterior ramus
3) Iliohypogastric nerve
= half of L1 anterior ramus
4) Ilioinguinal nerve
= other half of L1 anterior ramus
describe the initial and later presentation of appendicitis?
= dull, aching pain but then become sharp pain at a point in the right iliac fossa
what type of organ is the appendix?
= midgut organs, locate din right iliac fossa
where does pain in the midgut organs tend to be felt?
= in umbilical region as visceral afferents from these organs enter spinal cord between T8-T10
when appendicitis worsens, what does the appendix start to irritate?
= parietal peritoneum in right iliac fossa which lies anterior to it.
- parietal peritoneum is part of soma
