Anatomy Flashcards
muscle opening law
lateral pterygoid
muscles closing jaw
masseter, temporalis, medial pteryoid
what innervates the muscles of the jaw
mandibular divison of trigeminal nerve
on what joint is the jaw held and what prevents it from dislocating
temporomandibular joint
articular tubercle
space between teeth and lips
vestibule
where is the parotid gland found and where does it empty
in front of ear
buckle and 2nd molar
where is the sublinqual gland found and where does it empty
under oral cavity
base of mouth
where is the submandibular gland found and where does it empty
base of jaw
frenulum of tongue
what is sensation in upper mouth supplied by
CN V2
what is sensation in lower mouth supplied by
CN V2
state the numbers of the teeth
1,2 - incisor
3 - canine
4,5 - premolar
6,7,8 - molar
what nerves control the gag reflex
sensory - IX
motor- IX, X
what nerves control anterior 2/3 tongue
sensory - CN V3 (mandibular of trigeminal)
Special sensory - VII (facial)
what nerves control the posterior 1/3 tongue
sensory/special sensory - IX (glossopharyngeal)
true/false - the palatoglossus/styloglossus, hyoglossus and genioglossus are all supplied by XII
false - palatoglossus has vagal innervation
what do Palatoglossus Styloglossus Hyoglossus
Genioglossus control
tongue position
what is the cricopharyngeus
C6, upper oesophageal sphincter
constrictor muscles are voluntary but contract ___
sequentially
constrictor muscles have ___ innervation
vagal
what innervation does the longitudinal inner layer pharynx have and what does it do?
elevates pharynx and larynx to close laryngeal inlet
CN X, IX
describe anatomy of swallow
closure of lips
tongue pushes bolus to oropharynx
sequential contraction of constrictor muscles
inner longitudinal pharyngeal muscles contract to prevent aspiration
bolus reaches oesophagus
where does the oesophagus begin
inferior edge of cricopharyngeus
what runs on the surface of the oesophagus
oesophageal plexus
where does the oesophagus pass through diaphragm
T10
the lower oesophageal sphincter is anatomical/physiological and how does it work?
physiological - higher intra-abdominal pressure over intragastric
4 parts of the stomach
cardia
fundus
body
pyloric antrum
where does the stomach lie
below left hemidiaphragm in left hypochondrium, epigastric and umbilical region
the stomach is said to be J shaped due to a ___ curvature on the left and a ____ on the right
greater
lesser
small intestine
duodenum
jejunum
ileum
large intestine
caecum appendix ascending, transverse, descending, sigmoid colon rectum anal canal anus
where does the foregut range from and what is contained in it
oesophagus to mid duodenum
liver, gallbladder, spleen, half of pancreas
where does the midgut range from and what is contained in it
mid duodenum to proximal 2/3 transverse colon
half of pancreas
where does the hindgut range from and what is contained in it
distal 1/3 transverse colon to proximal 1/2 anal canal
divisions of the 9 regions of the abdominal cavity
mid-clavicular
subcostal
trans-tubercular
9 stomach regions
epigastrum pubic umbilical right/left lumbar right/left iliac fossa right/left hypochondriac
4 body quadrants and their divisions
median and trans-umbilical planes
right/left upper/lower quadrants
muscles of anterolateral abdominal wall
rectus abdominis
externa/internal oblique
transversus abdominis
where is the peritoneal cavity located
between the visceral and parietal peritoneum
what is mesentery
double layer peritoneum
what are intraperitoneal organs?
organs completely covered by peritoneum
what are retroperitoneal organs and give examples
organs not fully covered by the peritoneum and so are located in the retroperitoneum
Pancreas and kidneys
what organ is held suspended by mesentery?
small intestine
what is the greater omentum
4 layer structure covering intestine
originates from greater curvature of stomach
where does the lesser omentum span
lesser curvature of stomach from inferior of liver
where do the greater peritoneal sac and lesser peritoneal sac communicate through
omental foramen
pouch formed by peritoneum in men
rectovesicle pouch
pouches formed by peritoneum in women
vesico-uterine pouch
recto-uterine pouch
describe the process of paracentesis
needle insertion lateral to rectus sheath avoiding inferior epigastric artery
nerve innervation modalities to abdominal wall?
somatic sensory
motor
sympathetic
nerve innervation modalities to visceral peritoneum and abdominal cavity organs
visceral afferent
ANS/ENS
where do sympathetic nerves leave the spinal cord for abdomen
T5-L2
describe path of sympathetic nerves from spinal cord to abdomen
enter sympathetic chains and pass through to abdominopelvic splanchnic nerves
synapse at prevertebral ganglia and travel down periarterial plexuses
why is sympathetic innervation unique to the adrenal gland
travels T10-L1
synapses directly onto adrenal cells
describe path of CN X
travel from surface of oesophagus
travels on periarterial plexus to organs
synapse in ganglia on organ
how much of the GI tract is supplied by vagal innervation
GI tract to distal of transverse colon
where do pelvic splanchnic nerves come from, where do they supply
S2-S4
smooth muscle and glands of descending colon to anal canal
foregut pain is often ____
epigastric
midgut pain is often _____
umbilical
hindgut pain is often ____
pubic
where do nerve bundles reach on spinal cord for the gut?
foregut - T6-9
midgut - T8-T12
hundgut - T10-L2
where is liver/gallbladder pain felt
right lumbar/hypochondrium, extending to back, patients shoulder tip
where is stomach pain felt
epigastric, interscapular or umbilical
where is appendix pain felt
umbilical, moving to right iliac fossa
where is splenic pain felt
right lumber or right of back
where is small intestine pain felt
umbilical region, or epigastric if duodenal
what make up the thoracoabdominal intercostal nerves
7-11th intercostal nerves
what makes up the subcostal nerve
T12, anterior ramus
what makes up the iliohypogastric nerve
half of the anterior ramus of L1
what makes up the ilioinguinal nerve
half of the anterior ramus of L1
what is bilirubin?
by product of breakdown of RBC
where does breakdown of RBC occur
spleen
liver
where is bile formed
liver
function of gallbladder
stores and concentrates bile
what is bile essential for
normal fat absorption
what is found in the portal triad
hepatic artery
hepatic portal vein
common bile duct
lymphatics and nerves
what is the celiac trunk and where does it supply
first of three branches of abdominal aorta at T12
supplies foregut organs
the celiac trunk trifurcates to what?
splenic artery
hepatic artery
left gastric artery
what are the anatomical relations of the spleen?
anterior to lower diaphragm
posterior to stomach
superior to splenic fixture
lateral to left kidney
functions of the spleen?
break down RBC to bilirubun
immunological protection
storage of blood
what ribs protect the spleen
9-11
the left and right gastric arteries anastomose together and run on the greater/lesser curvature of the stomach
lesser
the left and right gastro-omental arteries anastomose together and run on the greater/lesser curvature of the stomach
greater
from what vessels does blood flow to the liver
hepatic artery
hepatic portal vein
in what quadrant is the liver located
upper right, extending into upper left
anatomical relationships to the diaphragm
diaphragm, superior, anterior and posterior
anterior stomach is medial
gallbladder posterior and inferior
right kidney, adrenal IVC, abdominal aorta posterior
what ribs offer protection to the liver
7-11
4 anatomical lobes of the liver
right, left, caudate, quadrate
how many functional segments does the liver have?
8
what does each functional segment of the liver have?
hepatic arterial, hepatic portal and bile supply
what is the hepatorenal recess
morisons pouch
one of the lowest points of peritoneal cavity when patient is supine
what are the 2 pouches of the peritoneal cavity
hepatorenal
sub-phrenic
function of the hepatic portal vein
drains blood from foregut, midgut and hindgut for first pass metabolism
function of the splenic vein
drains blood from foregut to hepatic portal vein
function of the inferior mesenteric vein
drains blood from hindgut to splenic vein
function of the superior mesenteric vein
drains midgut blood to hepatic portal vein
function of the IVC in hepatic blood supply
drains blood from 3 hepatic veins to right atrium
anatomical relationships of the gallbladder
posterior of liver, anterior of duodenum
the neck of the gallbladder narrows to become?
the cystic duct
where would gallstones likely impact on a patient
the cystic duct
where does blood supply to the gallbladder come from?
cystic artery, from right hepatic artery (usually)
where would pain in the gallbladder
epigastric as T6-9 but may be in hypochonrium or roght shoulder if there is diaphragmatic irritation
what is jaundice
yellowing of sclera/skin due to blood bilirubin increase
what composes common bile duct and where does it drain to
common hepatic duct (L+R hepatic duct)
Cystic duct
2nd part of duodenum
the common bile duct combines with the main pancreatic duct to form the ___ and drains into duodenum via ____
ampulla of vater
major duodenal papilla
3 sphincters of the biliary tree
bile duct sphincter
pancreatic duct sphincter
sphincter of oddi
What is ERCP and what is it used for
endoscopic retrograde cholangiopancreatography
studies biliary tree and pancreas and may be used to treat certain pathologies
describe how jaundice forms due to biliary obstruction
biliary obstruction causes bile to back up into liver and overspills into blood, with bilirubin
causes of biliary obstruction
gallstones
carcinoma at head of pancreas
what are the 4 parts of the pancreas
head
neck
body
tail
where does the head of the pancreas lie
over superior mesenteric vessels
where does body of pancreas lie
L2
aorta
where is tail of pancreas anterior to
left kidney
anatomical relationships of pancreas
posterior to stomach
duodenum to right, spleen left
anterior to left/ right kidney, IVC, SMA/SMV
splenic vessels superoposteriorly
where does sympathetic and parasympathetic innervation to the pancreas come from
sympathetic - abdominopelvic splanchnic nerves
parasympathetic - vagus nerves
blood supply to pancreas?
gastroduodenal to superior pancreaticoduodenal
SMA to inferior pancreaticoduodenal
causes of pancreatitis
blocked ampulla of vater causing direction of bile to pancreas
where is pancreatic pain felt
epigastric and/or umbilical and may radiate to back
true/false - all of the duodenum is foregut
false - the first 2 parts are but the rest is midgut
4 parts of the duodenum
superior
descending
horizontal
ascending
duodenal ulcer pain presents as ___
epigastric
blood supply to duodenum?
gastroduodenal - superior pancreaticoduodenal
SMA - inferior pancreaticoduodenal
where does jejunum begin
duodenaljejunal flexure
where does ileum end
ileocaecal junction
what are plicae circularis
folds in the mucosa of jejunum
where does blood supply to jejunum and ileum come from
jejunal and ileal arteries, from SMA
describe venous drainage from jejunum and ileum
drains via jejunal and ileal veins, drains to SMVs and onto hepatic portal vein
main abdominal lymph node groups
celiac
superior mesenteric
inferior mesenteric
lumbar
where is fat within chylomicrons absorbed into from enterocytes
lacteals
what parts of the colon are mobile
caecum and appendix
transverse
sigmoid colon
hepatic/spenic flexure - barely
what parts of the colon are not mobile
ascending colon
descendin colon
where are the paracolic gutters found and in what sac of the peritoneum would they be found
lateral edge of ascending and descending colon and abdominal wall
part of greater sac of peritoneal cavity
where is the appendiceal orifice
posteromedial wall of caecum
the sigmoid colon has a long mesentery for good movement, what is the disadvantage of this
sigmoid volvulus
causes obstruction of infarction
3 midline branches of abdominal aorta?
Celiac trunk
SMA
IMA
what anastomosis connects SMA to IMA
marginal artery of drummond
branches of SMA?
inferior pancreaticoduodenal jejunal and ileal arteries ileocolic artery right colic artery middle colic artery appendicular artery
branches of IMA
left colic artery
sigmoid colic artery
superior rectal artery
true/false - IMA supplies all of rectum and anal canal
false - internal ileac supplies below pectinate line
3 anastomoses of portal circulation
distal end of oesophagus
skin around umbilicus
rectal/anal canal
describe distal end of oesophagus anastomosis
inferior systemic to hepatic portal and most superior GI to azygous vein
describe skin around umbilicus anastomosis
blood flows around umbilicus via epigastric arteries before joining IVC
describe rectal/anal canal anastomosis
rectum and superior anal canal to IMV, most inferior of GI tract to internal ileac veins
what is portal hypertension and describe the consequence
increased BP in portal veins
causes blood to be diverted to anastomoses and so dilate and become varicose
function of the rectum
hold faeces until appropriate to defecate
what level does the sigmoid colon become rectum
S3, rectosigmoid junction
when does rectum become anal canal
tip of coccyx and prior passing through levator ani
rectal ampulla is superior/inferior to levator ani
superior
anatomical relationships of the rectum
peritoneum covers superior
rectouterine/rectovesical pouch anterior to superior rectum
prostate anterior to inferior rectum
cervix/vagina anterior to inferior/middle rectum
true/false - levator ani is usually relaxed
false - it is usually tonically contracted
what nerves supply levator ani
nerve to levator ani
pudendal nerve
contraction of the puborectalis causes?
decreased anorectal angle to allow defecation
when does internal anal sphincter relax
rectal distention
when is the external anal sphincter contract and what nerve does this
response to rectal distention and internal sphincter relaxation
pudendal nerve
where do sympathetic fibres to rectum originate from and what do they do
exit T12-L2
contract internal anal sphincter
inhibit peristalsis
where does nerve to levator ani and pudendal exit and what do they supply
nerve to levator ani -S2-S4
pudendal -S3-S4
contract external anal sphincter and puborectalis
describe the path of the pudendal nerve
exits pelvis via greater sciatic foramen
enters lesser sciatic foramen to enter perineum
panches to supply structures
how can labour lead to faecal incontinence or weakened muscle wall
stretch of pudendal nerve or muscle tear during labour
where do visceral afferents and parasympathetics run and what do they stimulate
S2-S4
visceral afferents - sense stretch and ischaemia
parasympathetic - inhibit internal anal sphincter and stimulate peristalsis
lymphatic drainage below pectinate line?
superficial inguinal nodes
internal iliac lymphatics drain?
inferior pelvic structures
external iliac lymphatics drain?
drains lower limb, superior pelvic structures
common iliac lymphatics drain what and drain to what?
drains internal and external iliac nodes to lumbar nodes
blood supply to rectum?
IMA
blood supply to anus?
internal iliac artery
Venous drainage of rectum
IMV to portal system
venous drainage of rectum
internal iliac vein to systemic venous
what is a rectal varice?
dilation of collateral veins between portal/systemic systems
usually related to portal hypertension
what is a haemorrhoid
prolapses of rectal venous plexuses due to raised pressure
not postal hypertension
what are the ischioanal fossae
fat and connective tissue that lie on each side of the anal canal
what is a hernia
structure passing through another and ending in the wrong place
what factors are required usually for herniation
structural weakness
increased pressure ie intraabdominal pressure
sites of herniation
femoral diaphragmatic inguinal incisional spigelian umbilical epigastric
what muscle is most superficial and extends from linea alba to linea semilunaris
rectus abdominis
what is the most superficial muscle running from the linea semilunaris across the lateral abdominal wall and in what direction is its fibres
external oblique muscle
anteroinferior
what muscle lies beneath the external oblique and what direction does its fibres run
internal oblique
anterosuperior
what muscle is deep to internal oblique and in what direction do its fibres run?
transversus abdominis
horizontal
what exactly is the inguinal ligament and where does it attach?
thickening of external oblique muscle
superior iliac spine to pubic tubercle
what is the inguinal canal, how long is it, what direction does it run and what is the entry and exit
oblique passage between abdomen and perineum
4cm
inferomedially
superficial/deep inguinal ring
contents of the inguinal canal?
spermatic cord in males
round ligament of uterus in females
ilioinguinal nerve
blood and lymphatics
anterior border of inguinal canal?
external oblique muscle
internal oblique muscle
posterior border of inguinal canal?
transversalis fascia
conjoint tendon
superior border of inguinal canal?
transversalis fascia
external oblique aponeurosis
arches of internal oblique and transversus abdominis
inferior border of inguinal canal
gutter of infolded inguinal ligament
borders of hesselbachs triangle and significance?
inferior epigastric artery
inguinal ligament
lateral border of rectus abdominis
site of direct inguinal herniation
what is direct inguinal herniation
directly through abdominal wall structures in hesselbachs triangle
what is indirect inguinal herniation
use of inguinal canal to allow abdominal contents to herniate
surface anatomy - deep inguinal ring?
superior to halfway point along inguinal ligament
surface anatomy - superficial inguinal ring
superior and lateral to pubic tubercle
