Anatomy Flashcards
1
Q
What makes up the small intestine?
A
- Duodenum 2. Jejunum 3. ileum
2
Q
What makes up the large intestine?
A
- Caecum
- ascending colon
- transverse colon
- descending colon
- sigmoid colon
- rectum
- anal canal
- appendix
3
Q
What is the longitudinal layer which is concentrated into three bands in the large intestine called?
A
Taeniae coli
4
Q
What is the difference between the mucosa of the large and small intestines?
A
- Large intestine contain no villi but do have microvilli and crypts
- Tighter tight junctions in the large intestine- prevents back diffusion of ions into the lumen
5
Q
What does the parasympathetic branches of the vagus innervate in the large intestine?
A
Caecum, ascending and tranverse colon
6
Q
What does the parasympathetic branches of the pelvic from the sacral spinal cord innervate in the large intestine?
A
Descending and sigmoid, rectum and anal canal
7
Q
What supplies the sympathetic fibres to the large intestine?
A
superior mesenteric plexus
inferior mesenteric plexus
superior hypogastric plexus
8
Q
What supplies the sympathetic fibres to the anal canal and rectum?
A
inferior hypogastric plexus
9
Q
What is the difference between the external and internal sphincters’ structures?
A
Internal sphincter- circular
External sphincter- striated
10
Q
What are the accessory structures?
A
i. Salivary glands
ii Pancreas
iii. Liver and gall bladder
11
Q
What are the layers of the tract wall from deep to superficial?
A
Mucosa
Submucosa
Muscularis externa
Serosa
12
Q
What makes up the mucosa layer?
A
Mucous membrane
Lamina propria
Muscularis mucosae
13
Q
What makes up the submucosa layer?
A
Connective tissue
larger blood and lymph vessels glands
submucous plexus
14
Q
What makes up the muscularis externa?
A
Circular muscle layer
Myenteric plexus
Longitudinal muscle layer
15
Q
What makes up the serosa?
A
Connective tissue
16
Q
What three pairs of muscles are involved in closing of the jaw?
A
- Tempeoralis
- Masseter
- Medial pterygoid
17
Q
Which pair of muscles are involved in the opening of the jaw?
A
Lateral Pterygoid.
18
Q
Where does the jaw open?
A
TMJ (temperomandibular joint)
19
Q
Which nerve supplies these muscles related to the Jaw?
A
CN V3- mandibular division of the trigeminal
20
Q
Describe the course of the CN V3
A
- Starts in the pons goes through the formaen ovale then to muscles of mastication and sensory area
21
Q
What are the bottom layer of the teeth referred to as?
A
Mandibular teeth
22
Q
What are the top layer of teeth referred to as?
A
Maxillary teeth
23
Q
Which arteries and supply the maxillary teeth?
A
Superior alveolar arteries/vein
24
Q
Which arteries and veins supply the mandibular teeth?
A
inferior alveolar arteries/vein
25
Where do the lymph vessels of the teeth and gingivae mainly drain to?
Submandibular lymph node
26
what nerves supply the mandibular teeth?
inferior alveolar nerve ( CN V3)
27
What nerves supply the maxillary nerves?
superior alveolar nerve (CN V2)
28
What are the main sections of the tongue?
1. apex (tip)
2. Anterior part (body)
3. Posterior part (root)
29
What are the two surfaces of the tongue?
1. Dorsum of the tongue ( superior)
| 2. Inferior surface of the tongue ( underside0
30
What are the gingivae?
gums
31
What separates the posterior and anterior part of the tongue on the dorsum surface?
terminal sulcus and foramen cecum
32
where are the lingiual papillae found?
Anterior part of the tongue
33
Name the different types of lingual papillae.
From anterior to posterior
1. Fungiform
2. filiform
3. vallate
4. Foliate
34
What divides the anterior of the tongue into left and right?
midline groove
35
What are the groups of lymphoid nodules called on the tongue?
Lingual tonsil
36
Where is the lingual tonsil found?
Mucosa of the posterior part of the tongue.
37
What connects the inferior surface of the tongue to the floor of the mouth?
Frenulum of the tongue
38
What are the three pairs of salivary glands?
1. Parotid
2. sublingual
3. submandibular
39
What does the superior half of the oral cavity consist of in regards to sensation areas?
Gingiva of oral cavity and palate
40
What does the inferior half of the oral cavity consist of in regards to sensation areas?
gingiva of oral cavity and floor of mouth
41
Where does the anterior part of the tongue lie in the mouth?
oral cavity proper
42
Where does the posterior part of the tongue lie in the mouth?
oropharynx
43
Which nerve overall supplies the superior half of the oral cavity?
CN V2
44
Which nerve overall supplies the inferior half of the oral cavity?
CN V3
45
What is the name of the CN V2?
Maxillary division of the trigeminal nerve
46
What is the name of the CN V1?
Opthalmic division of the trigeminal nerve
47
How many divisions of the trigemnial nerve are there?
3
48
What is the course of the CNV2 sensory fibres?
Starts at pons
through Foramen rotundum
to Sensory area (midface)
49
What type of reflex is the gag reflex?
Protective reflex
50
Which nerves carry the sensory part of the gag reflex?
CN IX
51
Which nerves carry the motor part of the gag reflex?
CN IX and CN X
52
What occurs during the gag reflex?
Causes constriction of the pharynx
53
What is the general function of the extrinsic muscles of the tongue?
alter the position of the tongue
54
What is the general function of the intrinsic muscles of the tongue?
alter shape of the tongue
55
Name all the extrinsic muscles.
1. Genioglossus
2. Hyoglossus
3. styloglossus
4. palatoglossus
56
Name all the intrinsic muscles
1. Superior longitudinal- make tongue short and thick
2. Inferior longitudinal- make tongue short and thick
3. transverse- make tongue long and narrow
4. vertical- make tongue long and narrow
57
Which nerves are responsible for the motor innervation of the muscles of the tongue?
All muscles CN XII- hypoglossal nerve
except for
Palatoglossus- palatine muscle which is supplied by pharyneal plexus
58
Which nerves supply the mucosa of the anterior two thirds of the tongue for sensation?
General- Lingual nerve (branch of CN V3)
special - Chorda tympani ( branch of CN VII)
59
WHich nerves supply the mucosa of the anterior 1/3rd of the tongue for sensation?
General and special - Glossopharyngeal nerve ( CN IX)
60
What is the general course of CN VII?
1. starts at Pontomedullary junction
2. Travels through temporal via internal acoustic meatus then stylomastoid foramen
3. supplies: Taste for anterior 2/3 of tongue
muscles of facial expression
glands in floor of mouth
61
What is the general course of CN IX?
Starts in medulla
through jugular foramen
Supplies:
Posterior wall of oropharynx (sensory)
Parotid gland (secretomotor)
Posterior 1/3rt of tongue (sensation and taste)
62
Where do the arteries of the tongue derive from?
lingual artery
63
Where does the lingual artery derive from?
External carotid artery
64
Which artery supplies the root of the tongue?
dorsal lingual arteries
65
Which artery supplies the body of the tongue?
deep lingual veins
66
What separates both the intrinsic and extrinsic muscles in each half of the tongue?
lingual septum
67
Which veins supply the tongue?
dorsal and deep lingual veins- accompany their artery siblings
68
discuss how the both lingual veins drain?
form a lingual vein which then drains into Internal jugular vein or drain directly into the IJV
69
Discuss the lymphatic drainage of the tongue.
1. Lymph from root of tongue drain bilaterally into superior deep cervical lymph nodes
2. Lymph from the medial part of the body drain bilaterally to inferior deep cervical lymph nodes
3. lymph from the right and left lateral parts of body drain to submandibular lymph nodes on the ipsilateral side
4. Apex and frenulum drain to submental lymph nodes - medial poriton drains bilaterally
70
Where do all lymph from the tongue ultimately end up?
deep cervical nodes
71
where are the parotid glands located?
lateral and posterior to the rami of the mandible and masseter muscles
WIthin unyielding fibrous sheaths
72
Where are the submandibular glands found?
along the body of the mandible
73
Where are the sublingual glands found?
in the floor of the mouth between the mandible and the genioglossus muscle
74
What is the motor course of CN XII?
From medulla
through the hypoglossal canal
to extrinsic and intrinsic muscle of the tongue (except for the palatoglossus)
75
where does the pharynx start and end?
extends from the cranial base to the inferior border of the cricoid cartilage anteriorly and the inferior border of the C6 vertebra posteriorly
76
What are the three parts of the pharynx?
1. Nasopharynx
2. oropharynx
3. laryngopharynx
77
What is the pharyngeal tonsil commonly referred to as when it is enlarged?
Adenoid
78
Discuss the muscular layer of the pharynx
1. Entirely voluntary
external layer- circular muscle (constrictors)
internal layer - longitudinal
79
What are the three pharyngeal constrictors found in the external layer of the pharyngeal muscles
1. Superior
2. middle
3. inferior
80
What are the muscles of the longitudinal layer?
1. Palatopharyngeus
2. stylopharyngeus
3. salpingopharyngeus
81
Where do all the circular muscles insert on to?
midline raphe
82
What is the main action of the external layer of the pharynx muscles?
constrict walls of pharynx during swallowing
83
What is the main action of the internal layer of the pharynx muscles?
elevate pharynx and larynx ( shortens and widens them) during swallowing and speaking
84
Which nerves innervate the external layer of the pharynx?
Pharyngeal branch of the Vagus ( CN X) and pharyngeal plexus
85
Which nerves innervate the internal layer of the pharynx?
Palatopharyngeus and salpingopharyngeus- CN X
Stylopharyngeus- CN IX
86
What do the overlapping of the pharyngeal constrictor muscles allow for?
leaves four gaps for structures to enter or leave the pharynx
87
Which vessels supply the pharynx muscles?
tonsillar branch and external palatine vein
88
What is the destination of the tonsillar branch?
palatine tonsils
89
Where does the tonsillar branch derive from?
facial artery
90
Where does the oesophagus begin?
In the neck - inferior continuation of laryngopharynx at the pharyngo oesophageal junction
91
Discuss the muscular layer of the oesophagus.
first 1/3- striated (voluntary)
mid 1/3- mixture of smooth and striated
bottom 1/3 - smooth (involuntary)
92
What is the first part of the oesophagus called?
cervical oesophagus
93
What veterbral level does the oesophagus start at?
C6
94
What is the upper oesophageal sphincter called?
cricopharyngeal
95
Where is the pharyngo-oesophageal junction in relation to the cricopharyngeal muscle?
It begins at the inferior edge of the muscle
96
Where does the oesophagus end?
cardia of the stomach
97
What are the three interior sections of the oesophagus called?
cervical
thoracic
abdominal
98
When does the cervical oesophaggus become the thoracic oesophagus?
when the oesophagus enters the superior mediastinum via the superior thoracic aperature
99
Which arteries/veins supply the cervical oesophagus?
branches of the inferior thyroid arteries/ veins
100
Where do lymphatic vessels of the cervical oesophagus drain into?
paratracheal lymph nodes and inferior deep cervical lymph nodes
101
Describe the nerve supply to the oesophagus
oesophageal plexus run on surface to supply smooth muscle within its walls- contains parasympathetic nerve fibres ( vagal trunks) and sympathetic nerve fibres
102
What three constrictions occur in the oesophagus?
1. cervical constrictions
2. thoracic constriction
3. diaphragmatic constriction
103
what causes cervical constriction? (U.O.S)
cricopharyngeus muscle contraction
104
what causes thoracic constriction?
compressions of aortic arch
and left main bronchus
105
what causes diaphragmatic contractions?
Lower osesophageal sphincter
106
what vertebral level is the oesophageal hiatus?
T 10
107
what vertebral and costal cartilage level is the cardial orifice of the stomach?
7th left costal cartilage and T 11 vertebra
108
what joins the oesophagus to the margins of the oesophagus hiatus in the diaphragm?
phrenico-oesophageal ligament
109
when does the thoracic oesophagus become the abdominal oesophagus?
oesophageal hiatus
110
what is the posterior surface of the abdominal part of the oesophagus covered by?
peritoneum of the omental bursa
111
what separates the left border of the oesophagus to the fundus of the stomach?
cardinal notch
112
what vertebral level is the gastro-oesophageal junction?
left of T 11
113
where is the L.O.S in relation to the gastro-oesophageal junction?
sphincter is immediately superior to the junction
114
What is the Z line?
jagged line where mucosa drastically changes from oesophageal mucosa to gastric mucosa
115
what are the main arteries which supply the abdominal oesophagus?
left gastric and inferior phrenic arteries
116
what are the main veins which supply the oesophagus?
left gastric vein- portal system
oesophagus vein to azygos vein- systemic venous system
117
what are the four main parts of the stomach from superior to inferior?
1. fundus
2. cardia
3. body
4. pyloric part
118
what are the main parts of the pyloric part of the stomach starting from the body to the duodenum?
1. pyloric antrum
2. pyloric canal
3. pylorus ( pyloric sphincter)- contains the pylroric orifice
119
what is the pylorus made out of?
circular layer of smooth muscle
120
when in the supine, what region is the stomach mainly found in?
left hypochondrium,epigastric and umbilical regions
121
what is the shorter concave right border of the stomach called?
lesser curvature
122
what is the most ifnerior part of the lesser curvature called?
incisura angularis ( angular incisure)
123
what is the name given to the longitudinal ridges which form when the gastric mucosa is contracted?
gastric rugae ( folds)
124
what is stomach mainly covered by except where the blood vessels run along its curvatures?
visceral peritoneum
125
what is the longer convex left border of the stomach called?
greater curvature
126
what is the name given to the visceral peritoneum layers which cover the greater curvature?
greater omentum
127
what is the name given to the visceral peritoneum layers which cover the lesser curvature?
lesser omentum
128
what is anterior to the stomach?
diaphragm
left lobe of liver
anterior abdominal wall
129
where is the transverse colon in relation to the stomach?
it is inferiorly lateral to the stomach
130
What is the bed of the stomach?
area on which the stomach rests in the supine position- caused by the organs which the stomach lies upon
131
what makes up the bed of the stomach?
1. posterior wall of the omental bursa
Organs therefore are;
left dome of diaphragm
spleen
left kidney
suprarenal gland
splenic artery
pancreas
132
what are the main arteries which supply the stomach?
left and right gastric arteries
left and right gastro-omental arteries
133
what doe the gastric arteries supply in the stomach?
lesser curvature
134
what do the gastro-omental arteries supply?
greater curvature
135
what branch is the right gastric artery from?
hepatic
136
what branch is the left gastric artery from?
celiac trunk ( directly)
137
what branch is the left gastro-omental from?
splenic artery in hilum of spleen
138
what branch is the right gastro-omental from?
gastroduodenal which is apart of hepatic
139
the gastric lymphatic vessels drain into which main lymph nodes?
1. lymph from superior two thirds of stomach drain to gastric lymph nodes
2. lymph from right 2/3 of inferior third of stomach drain to pyloric lymph node
3. lymph from 1/3 of greater curvature drain to prancreatic duodenal lymph
140
which nerve give the parasympathetic nerve supply of the stomach?
left vagus nerve to the anterior vagal trunk
right vagus nerve to posterior vagal trunk
141
where does the sympathetic nerve supply for stomach originate from?
T6 to T9 segments of the spinal cord- passes to celiac plexus through the greater splanchnic nerve
142
name the abdominal organs
1. liver
2. stomach
3. distal part of oesophagus
4. gallbladder
5. pancreas
6. both intestines
7. rectum
8. anus
143
Describe the foregut.
Oesophagus to mid - duodenum
WHi , gallbladder, spleen and 1/2 of pancreas
144
Describe the midgut.
Mid-duodenum to proximal 2/3rd of transverse colon
1/2 of pancreas
145
Describe the hindgut.
distal 1/3rd of the transverse colon to proximal colon
1/2 of anal canal
146
Name the 9 regions of the abdominal cavity
1. Right hypochondrium
2. Epigastric
3. Left hypochondrium
4. Right Lumbar
5. Umbilical
6. Left Lumbar
7. RIght Lingual
8. Pubic
9. Left Lingual
147
Name the four quadrants of the abdominal cavity.
1. Right/left upper quadrants
| 2. Right/left lower quadrants
148
What plane divides the right quadrants from the left quadrants?
Median planes
149
What plane divides the upper from the lower quadrants
trans-umbilical planes
150
What planes are responsible for dividing the 9 regions?
Midclavicular ( vertical)
Subcostal ( superior horizontal)
Transtubercular Plane ( inferior horizontal)
151
What are the main organs found in the RUQ?
1. Liver (right lobe)
2. Gallbladder
3. head of pancreas
4. stomach's pylorus
Duodenum
5. right kidney
6. right suprarenal gland
7. superior ascending colon
8. right part of transverse colon
152
What are the main organs found in the LUQ?
1. Liver (left lobe)
2. spleen
3. stomach
4. jejunum and proximal ileum
5. Left Kidney
6. Left suprarenal gland
153
What are the main organs found in the RLQ?
1. cecum
2. appendix
3. distal ileum
4. ascending colon
5. Right ovary/right spermatic cord ( abdominal part for cord)
154
What are the main organs found in the LLQ?
1. sigmoid colon
2. descending colon
3. Left ovary
4. left ovary/right spermatic cord ( abdominal part for cord)
155
What are the abdominal vsicera?
Internal organs covered in peritoneum found in the abdominal cavity
156
What is the periotneum?
thin,transparent, semi-permeable serous membrane which lines the walls of the abdominopelvic cavity and organs.
157
what are the two layers of the peritoneum called?
Visceral and parietal - note that they are continuous with each other
158
Which layer of the peritoneum is in contact with the body wall?
parietal
159
Which layer of the peritoneum is in contact with the organs?
visceral
160
What is the gap between the layers of the peritoneum?
peritoneal cavity
161
What type of cells do both layers contain?
mesothelium cells
162
what is the difference in regards to sensation between the two layers of peritoneum
1. Visceral- insensitive to heat,touch,cold and laceration
Pain is poorly localised
2. Parietal - sensitive to heat,touch,cold and lacerations
Pain is well localised
163
What is secreted inside the peritoneal cavity?
ii what is the purpose of this?
peritoneal fluid
ii. To allow organs to slide past each other without friction
164
What is the difference between the peritoneal cavity in men and women?
men- fully closed
women- communication pathway to exterior of the body though uterine tubes, uterine cavity and vagina
165
What are three types of relationships the viscera has with the periotoneum?
1. intraperitoneal- almost completely covered in visceral peritoneum- minimally mobile
2. retroperitoneal- only has visceral peritoneum on its anterior surface
3. organs with a mesentery- visceral peritoneum wraps around viscera to form a double layer - very mobile
166
What is the mesentery?
double layer of peritoneum wrapped around organs
It provides a means for neurovascular communications between the organ and body wall
Connects an intraperitoneal organ to the body wall- usually the posterior body wall
167
What type of organ is the liver?
Intraperitoneal
168
What type of organs are the kidneys and pancreas?
Retroperitoneal
169
Which organs have a mesentery?
small intestine
transverse and sigmoid mesocolon
Mesoesophagus
mesoappendix
170
What is an omentum?
double layered extensions or fold of the peritoneum that passes from the stomach and proximal part of duodenum to adjacent organs in the abdominal cavity
171
What are the differences between the greater and lesser omentums
1. Greater omentum is bigger
| 2. Greater omentum is four layered lesser is double layered
172
What are bare areas?
non peritoneal areas of organs to allow for entrance and exit of neurovasculature
173
what do the omenta do?
divide the peritoneal cavity into greater/lesser sac
174
What is the lesser sac also called?
omenta bursa
175
What does the transverse mesocolon divide the abdominal cavity into?
Supracolic compartment- stomach,liver and spleen
Infracolic compartment-small Intestine, ascending and descending colon
176
How do the supracolic and infracolic compartments communicate?
paracolic gutters
177
How does the omenta bura communicate with the greater sac?
via omental foramen
178
What lies in the free edge of the lesser omentum?
the portal triad
179
What is the name given to excess fluid which can collect in the peritoneal cavity as a result of pathology?
ascitic fluid- patient has ascites
180
Where does the inferior epigastric artery ascend ?
anterior abdominal wall
181
Where does the inferior epigastric artery arise from?
external iliac artery
182
Where do the sympathetic fibres arise from in the spinal cord which innervate the abdominal organs?
Between T5-L2
183
Discuss the course of the sympathetic fibres which innervate the abdominal organs.
1. leave spinal cord
2. enter sympathetic chain bilaterally but do not synapse
3. Leave chain within the abdominopelvic splanchnic nerves
4. Synapse at the prevertebral ganglia which are located anterior to the aorta at the exit points of the major branches of the abdominal aorta
5. postsynaptic sympathetic fibres pass from the prevertebral ganglia via the peri-arterial plexus which the fibres then go on the surface of the arteries and their branches towards the abdominal viscera ( organ's smooth muscle and glands to be exact)
184
Where do the sympathetic fibres which innervate the adrenal gland originate from on the spinal cord?
T10-L1
185
Discuss the course of the sympathetic nerves which innervate the adrenal gland
1. originate from T10-L1
2. Enter the abdominopelvic splanchnic nerves
3. Do not synapse at prevertebral ganglia
4. Carried with periarterial plexuses to the adrenal gland
5. synapse directly onto cells
186
Pelvic splanchnic nerves are what kind of nerves?
presynaptic parasympathetic nerve fibres
187
Vagus nerve supplies which abdominal organs?
oesophagus to distal end of the transverse colon
188
where do the presynaptic parasympathetic nerve enter the abdominal cavity?
surface of the oesophagus
189
Pelvic splanchnic nerves originate where on the spinal cord?
S2,3,4
190
The pelvic splanchnic nerves supply which abdominal organs?
descending colon to anal canal
191
Pain fibres from the majority of the abdominal organs run alongside sympathetic fibres back to the spinal cord true or false?
true
192
visceral afferent fibres of the foregut enter the vertebra at what levels?
T6-T9
193
Visceral afferent fibres of the midgut enter the vertebra at what level?
T8-T12
194
Visceral afferent of the hindgut enter the vertebra what levels?
T10-L2
195
Where is visceral pain usually felt?
in the dermatomes of the levels of which they enter the spinal cord
196
what does the iliohypogastric nerve supply?
some body wall areas of the ileum and the hypochondrium
197
what does the ilioinguinal nerve supply?
some ileal and inguinal body wall
198
what are thoracoabdominal nerves?
somatic motor, somatic sensory and sympathetic nerve fibres that supply the abdominal body wall.
199
What does the portal triad consist of ?
1. hepatic artery
2. Hepatic portal vein
3. common bile duct
200
Where is the portal triad found?
Free edge of the lesser omentum
201
What type of organ is the spleen?
intraperitoneal organ
202
name the midline branches does the abdominal aorta.
1. Celiac trunk
2. inferior mesenteric
3. superior mesenteric
203
what level of the vertebrae does the celiac trunk form?
T12
204
What are the three branches of the celiac trunk
1. splenic
2. Hepatic
3. Left gastric
205
Name the branches of the hepatic artery.
Proper hepatic cystic
Right gastric
Gastroduodenal : (right gastroepiploic superior pancreaticoduodenal supraduodenal)
206
What is the only part of the spleen that is not covered in peritoneum?
splenic hilum
207
What region is the spleen found in?
left hypochondrium
208
What are the three borders of the spleen?
1. Anterior extremity (colic area)
2. Inferior border (renal area)
3. superior border ( Gastric area)
209
Discuss the organs anatomically related to the spleen
Anteriorly is the stomach
Posteriorly is the diaphragm
Inferiorly is the splenic flexure
Medially is the left kidney
210
Which ribs protect the spleen?
ii what are the potential risks?
9-11
ii could puncture spleen
211
spleen is a vital organ true or false?
false
212
what is the neurovasculature of the spleen
artery/vein- splenic artery/vein
lymph fluid drains into pancreaticosplenic lymph nodes
nerves- derive from celiac plexus
213
Which blood vessels supply the liver?
Right and left hepatic arteries which are branches of the common hepatic artery
and the hepatic portal vein
214
Which region is the liver found?
right upper quadrant
mainly right hypochondrium and upper epigastrium
215
What are the surfaces of the liver called?
1. diaphragmatic
| 2. visceral
216
what parts of the liver are not covered in visceral peritoneum?
diaphragmatic surface- bare area of liver
visceral surface- fossa for the gallbladder and porta hepatis
217
What is the porta hepatis?
Transverse fissures where the vessels ( hepatic artery, portal vein and lymphatics), hepatic nerve plexus and ducts enter and leave the liver
Also links the right and left sagittal fissures
218
Discuss the position of the liver to other organs.
superior, anterior and posterior is the stomach
inferior and posterior is the gallbladder
219
Which ribs protect the liver?
7-11
220
How many anatomical segments are there in the liver?
2 anatomical lobes ( right and left)- left much smaller)
2 Accessory lobes ( quadrate and caudal)- quadrate is inferior
Can only see anatomical lobes on anterior surface.
Therefore 4 in total
221
How many functional segments are there in the liver?
ii why are they classed as functional?
8
ii Have there own blood supply
222
How many functional lobes are found in the right liver? Not right anatomical lobe
4- ( V,VI,VII,VIII)
223
How many functional lobes are found in the left liver?
3- (II,III,IV)
224
How many functional lobes found in the caudate lobe?
1-(I)
225
IVC and hepatic veins have valves true or false?
false
226
What happens if central venous pressure rises?
ii what does this cause?
1. IVC and hepatic vein transmit blood to liver
ii causes hepatomegaly
227
Discuss the anatomy of the liver lobule.
Central vein in the middle
interlobular portal triad at each corner (6)
228
What carries blood from the hepatic portal vein to the central vein in the lobule?
sinusoid
229
what carries bile from hepatocytes to the biliary ducts in the lobule?
bile canaliculi
230
what are the three main hepatic veins?
right,left and intermediate
231
What are the two recesses relates to the liver?
Hepatorenal recess (morison's pouch)
Sub-phrenic recess
232
Where are these recesses found?
the greater sac
Hepatorenal - between the right kidney and liver
Sub-phrenic- liver and the diaphragm
233
When supine, which recess is considered one of the lowest parts of the peritoneal cavity?
Hepatorenal
234
The IVC is what type of structure?
Retroperitoneal
235
Where does the hepatic portal vein drain to and from?
From foregut, midgut and hindgut to the liver
236
Where does the splenic vein drain to and from ?
from foregut to the portal vein
237
Where does the superior mesenteric vein drain to and from?
from midgut to the portal vein
238
Where does the inferior mesenteric vein drain to and from?
from hindgut to the splenic vein
239
Where does the IVC drain to and from?
from hepatic vein to right atrium
240
Which ligaments attach the liver to the diaphragm?
coronary ligaments
241
Which ligaments attach the liver to the anterior abdominal wall?
falciform ligament
242
What is the ligamentum teres a remnant of ?
embryological umbilical vein
243
Where do the nerve fibres which innervate the liver come from?
hepatic plexus - consists of sympathetic fibres from the celiac plexus and parasympathetic fibres from the anterior and posterior vagal trunks
244
What are the parts of the gall bladder?
1. Fundus- wide blunt end
2. body
3. neck
245
what connects the gallbladders neck to the common hepatic duct?
cystic duct
246
How does the gallbladder bind to the liver?
via fibrous capsule of the liver
247
What artery/veins supply/drain the gallbladder?
cystsic artery/vein
248
in 75% of people what is the cystic artery a branch of?
right hepatic artery
249
Where do visceral afferents enter the vertebra which supply the gallbladder?
T6 and T9
250
Where do the parasympathetic and sympathetic fibres which supply the gallbladder and cystic duct come from?
para- vagal trunk
sympathetic- celiac trunk
251
What is the splenic pulp?
substance of the spleen
252
Where does the bile duct descend to?
descends posteriorly to the first part of duodenum
253
What does the bile duct join and then form?
Joins with the main pancreatic duct to form the ampulla of vater
254
Where does the ampulla of vater drain into and through what?
Drains into second part of the duodenum
via the major duodenal papilla- papilla means nipple lol
255
Name the smooth muscle sphincters involved in pancreatic and bile duct secretion
1. Bile duct sphincter
2. pancreatic duct sphincter
3. hepatopancreatic sphincter ( Sphincter of oddi)
256
What are the main role of the these smooth muscle sphincters?
prevent reflux of duodenal contents and digestive secretions
257
What is the difference between the bile duct sphincter in comparison to the other two sphincters?
It has an active role in the control of bile secretion (digestive secretion)
258
Where is the sphincter of oddi found?
In the ampulla of vater
259
what type of organ is the pancreas?
elongated accessory digestive gland
retroperitoneal
260
What are the four parts of the pancreas?
1. head - c shaped due to being surrounded by duodenum
2. neck- anterior surface is adjacent to the pylorus of the stomach
3. body- lies to the left of the superior mesenteric vessels. Lies over the aorta and L2 vertebra
4. tail- lies anterior to the left kidney . It is relatively mobile
261
Describe the anatomical relationships of the pancreas.
posterior to the stomach
anterior to the right and left kidney
anterior to the right and left Adrenal gland
anterior to the IVC
anterior to the abdominal aorta
anterior to the superior mesenteric vessels
inferoanterior to the splenic vessels
Duodenum on the right ( head of pancreas)
262
What level of the vertebra is the majority of the pancreas found at?
L1-L2 (transpyloric plane)
263
WHat is the ucinate process?
projection from the inferior part of the pancreatic head
264
Where do the sympathetic and parasympathetic fibres which innervate the pancreas come from?
sympathetic- abdominopelvic splanchnic nerves
parasympathetic- vagus nerves
Both pass through the diaphragm and reach the pancreas by passing along the arteries from the celiac plexus and superior mesenteric plexus
265
What are the main arterial blood supply for the pancreas?
1. pancreatic branches (that come from the splenic artery)
2. superior pancreaticoduodenal (comes from the gastroduodenal)
3. inferior pancreaticoduodenal (comes from the SMA)
2 and 3 form anteriorly and posteriorly placed arcades which supply the head of the pancreas
266
What are the main veins which take part in the venous drainage of the pancreas?
1. Pancreatic veins - drain into splenic vein
| 2. tributaries of the splenic and superior mesenteric parts of the hepatic portal vein
267
State the four parts of the duodenum and what type of structures they are
1. Superior- intraperitoneal
2. Descending- retro
3. Horizontal- retro
4. Ascending- retro
268
where is the duodenal cap found?
superior part of the duodenum
269
What vertebra levels are the four parts of the duodenum found at?
superior- L1 vertebra
descending- L1-L3 vertebra
horizontal- L3
ascending- Begins at L3 and rises to superior border of L2
270
What are the main arteries/veins which supply the duodenum?
1. Superior pancreaticoduodenal artery/vein- branch of Gastroduodenal artery
2. Inferior pancreaticoduodenal artery/vein- branch of superior mesenteric artery
271
What marks the beginning and end of the duodenum?
Begins at pyloric sphincter
ends at duodenaljejunal flexure
272
Which nerves supply the duodenum?
Sympathetic- greater and lesser abdominopelvic splanchnic nerves
parasympathetic- vagal nerves
273
Which muscle supports the duodenaljejunal flexure?
suspensory muscle of the duodenum (ligament of treitz)
274
Where does the jejunum begin and ileum end?
begins at duodenaljejunal flexure
ends at ileocecal junction
No clear demarcation between jejunum and ileum only that mucosa is different
275
State the differences between the ileum and jejunum.
1. Mucosa of distal ileum are much smoother
2. mucosa of jejunum is highly folded.
3. colour of jejunum is overall more deeper red
4. Wall of jejunum is thicker and heavy
5. vascularity is greater in the jejunum
6. few large loops in jejunal arteries vs many short loops in ileal arteries
276
What are the folds in the mucosa of the jejunum called?
plicae circularis
277
what is the purpose of the mesentery?
1. Connects ileum and jejunum to posterior abdominal wall.
| 2. between the two layers nerves, veins and arteries which supply the two parts of the small intestine are found.
278
What is it called when arteries unite to form loops and arches?
arterial arcade
279
Which arteries/veins supply the jejunum and ileum?
jejunal and ileal arteries which are branches of the SMA
SMV drains both jejunum and ileum via the jejunal and ileal branches
Also drain to hepatic portal vein
280
What are the three lymph nodes which lacteal lymph passes through sequentially in the mesentery?
1. juxta-intestinal
2. mesenteric
3. superior central
281
Where do these mesenteric lymph nodes eventually drain into?
the venous system at the left venous angle
282
Compare the vasa recta between ileum and jejunum.
vasa recta are much longer in the jejunal arteries
283
lymph tends to lie where?
alongside arteries
284
what are the 4 main groups of lymph nodes draining the abdominal organs?
1. celiac (foregut)
2. superior mesenteric (midgut)
3. inferior mesenteric (hindgut)
4. lumbar (kidney, posterior abdo wall, pelvis and lower limbs)
285
superficial lymph vessels drain into what?
deep lymph vessels
286
What are the two ducts which lymph ultimately drain into?
ii. What are the two angles in which lymph fluid is recycled into the venous system?
1. Right lymphatic duct (1/4 of body)
Thoracic duct (3/4 of body)
2. Right venous angle- RLD
Left venous angle- TD
287
What are the macroscopic differences between the small and large intestine?
1. Large intestine contain omental appendices
2. Large intestine contain Taeniae coli
3. Large intestine contain haustra
4. Large intestine has a much greater calibre ( internal diameter)
288
What is an omental appendices?
small, fatty Omentum-like projection
289
What type of organ is the cecum?
intraperitoneal
290
what type of organ is the appendix?
Retroperitoneal
291
Where is the appendix and caecum found?
right iliac fossa
292
Where does the appendix join to the caecum?
appendicieal orifice- on the posteromedial wall of the caecum
293
What is the usual position of the appendix to the caecum?
retrocaecal
294
Where is McBurney's point?
It is 1/3 of the way between the right ASIS to umbilicus
on the anterior abdominal wall side
ASIS- anterior superior iliac spine
295
What is McBurney's point?
Corresponds to the where the base of the appendix is usually found?
296
What usually binds the caecum to the lateral abdominal wall?
Caecal folds of the peritoneum
297
What is the relation of the ileocaecal orifice ( and valve) is to the appendiceal orifice?
The ileocaecal orifice is superior
298
Which arteries supply the caecum?
ileocolic artery- terminal branch of SMA
299
Which arteries supply the appendix?
appendicular artery- branch of the ileocolic artery
300
Which veins drain both the appendix and caecum?
Ilecolic vein
301
Where do the nerves which innervate the caecum and appendix derive from?
the superior mesenteric plexus
302
What type of structure is the ascending colon?
retorperitoneal
303
what are the spaces that are part of the greater sac of the peritoneal cavity and sit between the lateral edge of the ascending/ descending colon and the abdominal wall?
paracolic gutters
304
What may form in the paracolic gutters?
pus
305
What are the 3 bands of taenia coli?
1. mesocolic tenia
2. omental tenia
3. Free tenia
306
Where does the ascending colon rise to?
from the caecum to the right lobe of the liver.
307
What is the point called where the ascending colon turns to the left leading into the transverse colon?
Right colic flexure ( hepatic flexure)
308
What type of structure is the transverse colon?
intraperitoneal
309
the transverse colon has a mesentery true of false?
true
310
What is the usual vertebral level of the transverse colon?
L3
311
What is the point called where the transverse colon turns inferiorly leading into the descending colon?
Left colic flexure ( splenic flexure)
312
what is the transverse mesocolon joined to?
posterior wall of the omental bursa
313
What are the two flexures inferior to?
ii what is the difference between the flexures apart from the fact they are in different areas?
right colic flexure is inferior to the liver
Left colic flexure is inferior to the spleen
ii Left colic flexure is slightly more superior, acute and less mobile
314
What type of structure is the descending colon?
Retroperitoneal
315
Where is the point where the descending colon leads into the sigmoid colon?
left iliac fossa
316
What is volvulus of the colon?
twisting of the colon
317
What type of structure is the sigmoid colon?
intraperitoneal
318
What is the the name of the sigmoid's mesenetery?
sigmoid mesocolon
319
Why does the sigmoid mesocolon length matter?
As it is long, it gives the sigmoid colon a lot of mobility
This is increases risk of sigmoid volvulus especially in the middle
320
State the arteries and veins which supply the different sections of the colon
1. ascending- ileocolic and right colic arteries/veins
2. transverse- - middle colic artery/vein
3. descending- left colic and sigmoid artery/vein
4. sigmoid- sigmoid artery/vein
321
What are the 4 main arteries that come off the SMA?
1. inferior pancreaticoduodenal artery
2. middle colic artery
3. right colic artery
4. ileocolic artery
322
what arteries come off the ileocolic artery?
appendicular artery, jejunal arteries, ileal arteries
323
what are the 3 main arteries that come off the IMA?
left colic artery, sigmoidcolic artery, superior rectal artery
324
What is the main arterial anastomoses between the branches of the SMA and IMA?
Marginal artery of drummond
325
What are the name of alternative routes for blood to travel?
collateral vessels
326
What does the hindgut extend to?
Proximal half of the anal canal
327
What separates the proximal part (2/3) and distal part (1/3) of the anal canal?
pectinate line
328
which artery supplies the remains part of the large intestine? ( after the pectinate line).
Internal iliac artery
329
What are the two main branches of the internal iliac artery which supplies the distal part of the anal canal and the rectum?
middle rectal artery
inferior rectal artery
330
what are the three important parts of the portal-systemic anastomses?
1. distal end of the oesophagus
2. Skin around umbilicus
3. rectum/anal canal
331
where does the abdominopelvic cavity extend from?
extends superiorly into the thoracic cage and inferiorly into the pelvis.
332
What is the pelvic cavity found?
1. It is continuous with the abdomino cavity at the pelvic inlet
2. continues to the pelvic floor
333
What is the pelvic cavity surrounded by?
The pelvic girdle ( boney pelvis)
334
What is the pelvic girdle and what does it consist of?
Basin-shaped ring of bones that connects the vertebral column to the two femurs
2. In mature people it consists of 3 bones
Right and left hip bones
Sacrum
335
What bones make up the hip bones?
From superior to inferior
1. ilium
2. ischium
3. pubis
336
What is the pelvis subdivided into?
Greater and lesser pelvis
337
What is the greater pelvis surrounded by?
Superior pelvic girdle ( iliac alae posterolaterally and the antero-superiro aspect of the S1 vertebra posteriorly)
338
What is the lesser pelvis surrounded by?
inferior pelvic girdle ( pelvic surfaces of the hip bones, sacrum and coccyx)
339
What is the greater pelvis occupied by?
abdominal viscera
340
What is the lesser pelvis occupied by?
True pelvic cavity and perineum
341
What separates the pelvic cavity and perineum?
musculofascial pelvic diaphragm
342
what separates the greater and lesser pelvis?
the pelvic inlet ( Pelvic brim is the border of this)
343
What joins the right and left hip bone anteriorly and posteriorly?
Anteriorly- pubic symphysis
Posteriorly- join with the sacrum at the sacro-iliac joints
344
What is the pelvic brim formed by?
1. Promonotry and ala of the sacrum
2. Right and left linea terminalis - form a continuous oblique ridge which consists of :
i Arcuate line
ii. pecten pubis and pubic crest
345
What signifies the end of the lesser pelvis?
Pelvic outlet
346
What are the borders of the pelvic outlet?
1. Pubic arch anteriorly
2. ischial tuberosities laterally
3. Inferior margin of the sacrotuberous ligament posterolaterally
4. tip of the coccyx posteriorly
347
What is the pubic arch formed by?
right and left ischiopubic rami- compound structure consisting of the following two structures:
from the pubis bone , the inferior pubic ramus
from the ischium bone, the inferior ramus
They meet at the pubic symphysis
348
What determines the width of the subpubic angle?
Distance between the right and left ischial tuberosities
349
What does the ilium consist of ?
1. ala ( wing) of the ilium ( superior to the body at a lateral view). Look like the body of an old fan
2. body - Looks like a handle to an old fan
Parts of the ala
1. iliac crest- curve of the ala. Follows to the ASIS and PSIS
2. Iliac fossa- anteromedial part of the ala just superior to the body at a lateral view
350
What does the ischium consist of ?
1. Body
2. Ramus
ischial tuberosity-Large postero-inferior protuberance of the ischium
Ischial spine- small posteromedial projection near the junction of the ramus and body
351
What does the pubis consist of?
1. superior ramus
| 2. inferior ramus
352
What is the perineum?
area of the surface of the trunk between the thighs and buttocks extending from the coccyx to the pubic symphysis. It is inferior to the pelvic diaphragm
353
What is the perineum split into?
Urogenital and anal triangles
354
What organs are found in the perineum?
anal canal , anus and external genitalia ( scrotum for male and vulva for female)
355
What organs are found in the pelvic cavity?
1. Terminal parts of the ureters
2. urinary bladder
3. rectum
4. pelvic genital organs
5. blood vessels, lymphatic vessels and nerves
356
What makes up the walls and floor of the pelvic cavity?
antero-lateral walls- bodies and rami of the pubic bones and the pubic symphysis
Lateral pelvic walls- right and left hip bones - both include an obturator foramen
Posterior wall ( posterolateral wall and roof)- bony wall, roof in the midline ( formed by sacrum and coccyx) and musculoligamentous posterolateral walls.
pelvic floor- pelvic diaphragm
357
What makes up the pelvic diaphragm
Levator ani (main muscles involved) - forms the sheet
coccygeus muscles
Fascial coverings
358
When does the sigmoid become the rectum?
ii What level of the vertebra is this?
Rectosigmoid junction
ii S3
359
Due to the curvature of the sacrum and the coccyx what are the main flexures in the rectum and anal canal?
sacral flexure of the rectum
anorectal flexure of the anal canal
360
What are the lateral flexures of the rectum which can be seen anteriorly?
1. superior ( left side)
2. inferior ( left side)
3. intermediate ( right side)
361
When does the rectum become the anal canal?
anorectal junction- Just on the anterior inferior tip of the coccyx - before the anorectal flexure of the canal
I.e just before passing through the levator ani muscle
362
What is the dilated terminal part of the rectum called?
the ampulla of the rectum
363
What are the two different pouches formed between men and women based on the peritoneum of the rectum reflecting on different organ?
1. Recto-uterine pouch ( pouch of douglas)- male
| 2. rectovesical pouch- female
364
Which arteries/vein supply the rectum?
proximal part - superior rectal artery/vein
distal part ( middle and inferior)- middle rectal artery/vein
365
What are the anatomical relationships to the rectum?
1. peritoneum covers superior rectum
2. recto-uterine/vesicle pouch lies anterior to the superior rectum
3. in Males prostate gland lies anterior to the inferior rectum
4. in females vagina and cervix lie anterior to inferior/middle rectum
366
What muscles make up the levator ani?
1. iliococcygeus
2. pubococcygeus
3. Puborectalis
367
What nerves innervate the levator ani?
"nerve to levator ani"- branch of the sacral plexus which is the pudendal nerve ( S2,3 and 4 ) only S3 and S4 supply levator ani
368
what shape is the puborectalis?
U Shaped
369
What type of muscle is the levator ani?
skeletal
370
What is the part of the levator ani muscle that is particularly important for maintaining faecal continence?
puborectalis muscle
371
what surrounds the anal canal?
internal and external anal sphincters
372
States the difference between internal and external sphincter?
1. Internal is smooth muscle ( involuntary) external is skeletal ( voluntary)
2. Internal surrounds superior two thirds of anal canal. external surrounds inferior 2/3s of anal canal
3. contraction inhibited by parasympathetic fibres in internal sphincter ( extrinsically by pelvic splanchnic nerve, intrinsically ENS). N/A for external
4. contraction stimulated by sympathetic fibres in internal. Pudendal nerve stimulates external
373
The superior part of the external anal sphincter is continuous with what muscle?
the puborectalis muscle of the levator ani muscle
374
sympathetic nerve supply of the rectum and anal canal comes from what vertebra levels?
T12- L2
375
What is the course of the sympathetic nerve supply of the rectum and anal canal?
1. Travel from vertebrae to inferior mesenteric ganglia and synapse
2. Travel the periarterial plexuses of the IMA
376
From what vertebra level do pudendal (somatic motor) and nerve to levator ani come from ?
ii what do they innervate?
S2-4 anterior rami
ii. pudendal muscle- causes contraction of the external anal sphincter
puborectalis contraction
377
What vertebral level do visceral afferents of the rectum and anal canal go back to?
S2-4
378
What vertebral level do parasympathetic fibres synapse in the walls of the rectum?
ii. What nerve do they follow
S2-4
Pelvic splanchnic nerve
379
What foramen does the pudendal nerve exits the pelvis via?
Greater sciatic foramen
380
What foramen does the pudendal nerve enter the perineum by?
Lesser sciatic foramen
381
What is the superior half of the anal canal mucous membrane characterised by?
II. what do they contain?
anal columns
ii. terminal branches of the superior rectal artery/vein
382
What is at the superior and inferior ends of the anal columns?
Superior- anorectal canal
inferior end are joined by anal valves.
383
What does the inferior edges of anal valves form?
pectinate line (dentate line)
384
Discuss the neurovasculature differences between anal canal above and below the pectinate line.
1. Nerve supply
Above: autonomic ( visceral motor) and sensory innervation
Below: Somatic motor and sensory innervation
2. Arterial supply
Above: IMA
Below: Internal Iliac
3. venous drainage
Above: to portal
Below : internal iliac
4. Lymph
Above: Internal iliac nodes
Below: Superficial inguinal nodes
385
What are the 4 main groups of lymph nodes in the pelvis and what do they drain?
1. Internal iliac - drains inferior pelvic structures
2. External iliac- drains lower limb and more superior pelvic structures
3. Common iliac - drains lymph from external and internal iliac nodes
4. Lumbar nodes- drains lymph from common iliac
386
Where are the ischioanal fossae found?
Each side of the anal canal ( right and left)
387
What are ischioanal fossae filled with?
Fat and loose connective tissue
388
Most superficial structure on the parotid gland?
facial nerve
389
what is the space of disse?
Location in the liver between a hepatocyte and a sinusoid. It contains the blood plasma. Microvilli of hepatocytes extend into this space, allowing proteins and other plasma components from the sinusoids to be absorbed by the hepatocytes
390
what artery supplies the omentum?
gastroepiploic
