Anatomy Flashcards
Which veins shunt from the portal to the systemic system in caput medusae.
Para umbilical to superior/inferior epi gastric below the umbilicus and superior epi gastric and lateral thoracic above the umbilicus
Which veins shunt from the portal to the systemic system in esophageal varices?
Left gastric to esophageal
Which veins shunt from the portal to the systemic system in internal hemorrhoids?
Superior rectal to middle/inferior rectal veins
What is TIPS?
Transjugular intrahepatic portosystemic shunt between the portal and hepatic vein
Where is the CTZ zone located?
On the dorsal aspect of the medulla at the caudal end of the 4th ventricle (area postrema)
Where is the inferior thyroid artery?
Arises from subclavian.
Behind the carotid artery and jugular vein
Supplies the inferior pole of the thyroid gland
Where is the ansacervicalis?
Arises from C1-3 and innervates muscles in anterior neck
Where would penetrating trauma be to injure ansa cervicalis.
To the neck superior to cricoid cartilage
What nerve is injured with a positive Trendelenburg sign?
Superior gluteal
What would injury to the obturator nerve cause?
Loss of adduction
Loss of medial thigh sense
What would injury to the inferior gluteal nerve cause?
Glut max problems - can’t climb stairs or get up from a chair
Extension and external rotation
What is lost in an injury to the femoral nerve?
Loss of knee reflex and anterior thigh sensory
What courses through the cribiform plate?
CN I
What goes through the optic canal?
CN II
Ophthalmic artery
Central retinal vein
What goes through the superior orbital fissure?
CN III, IV, V1, VI, ophthalmic vein, sympathetic fibers
What goes through foramen rotundum?
V2
What goes through foramen ovale?
V3
What goes through foramen spinosum?
Middle meningeal artery and vein
What are is the middle meningeal artery from?
Maxillary
What goes thru the internal acoustic meatus?
CN VII, VIII
What goes thru the jugular foramen?
CN IX, X, XI
Jugular vein
What goes thru the hypoglossal canal?
CN XII
What goes thru foramen magnum?
Spinal roots of CNXI, brain stem, vertebral arteries
What would injury to the middle frontal gyrus cause?
Deviation of eyes to the ipsilateral side (FEF lesion)
What is the area injured in Wernicke’s aphasia?
Superior temporal gyrus (Brodmann 22)
From injury to posterior branch of middle cerebral artery
At what level does the facial nerve arise in the brain stem?
Dorsolateral aspect of the pontomedullary jxn
Where does oculomotor nerve arise in the brainstem?
The level of superior colliculus (mesencephalon)
Where does the trochlear nerve arise?
At level of inferior colliculus (crosses before exiting brainstem)
What nerve courses with the inferior thyroid artery?
Recurrent laryngeal nerve
Where does the recurrent laryngeal branch loop on the right?
Below the subclavian
Where does the recurrent laryngeal nerve loop on the left?
Around the aortic arch
What does the recurrent laryngeal nerve supply?
All muscles of the larynx except cricothyroid
What does injury to the recurrent laryngeal nerve cause?
Unilateral = hoarseness Bilateral = respiratory difficulty
Which ribs overlie the spleen?
Ribs 9-11
Where do T cells become double positive?
In the cortex of the thymus
Where do T cells undergo negative selection?
In the medulla
What leads have Q waves with an anterior wall MI?
V1-V4
LAD
Where is the infarction if leads II, III, aVF have q waves?
Inferior wall
RCA
Where is the infarction if q waves are seen in leads V4-V6?
Anterolateral - lateral and posterior walls of left ventricle
LCX
Where is the infarction if you can see q waves in leads I and aVL?
Lateral wall of LV
LCX
Where is the infarction if q waves are in V1-V2
Anteroseptal
LAD
What structure does RCA provide?
SA and AV nodes
Papillary muscles
Posterior 1/3 of the inter ventricular septum and posterior walls of the ventricles
Right ventricle
What does the LCX provide?
Supplies lateral and posterior walls of the left ventricle
What does the LAD supply?
The anterior 2/3 of the septum
Anterior papillary muscle
Anterior surface of the left ventricle
Where is the left atrium?
Posterior
Base of the heart
What can enlargement of the left atrium cause?
Dysphagia and hoarseness due to compression of the left recurrent laryngeal nerve
Where are gastric glands located?
Laminate propria
Which areas of the colon are most susceptible to ischemia?
Splenic flexors (watershed area from SMA and IMA) Sigmoid colon (btween IMA and hypo gastric arteries
What is contraindicated in a patient suspects of toxic mega colon?
Colonoscopy and barium enema - perforation
What does the falciform ligament do?
Connects the liver to the anterior abdominal wall
Which ligament connects the greater and lesser sacs?
Hepatoduodenal
Which ligament holds the gastric arteries?
Gastrohepatic
Which ligament separates the greater and lesser sacs on the right? The left?
Gastrohepatic
Gastrosplenic
What are the layers of the gut wall?
Mucosa = laminate propria, muscularis mucosa, epithelium
Submucosa = regulates BF, secretions, absorptions, meissner’s
Muscularis externa = inner circular, myenteric nerve plexus (auerbach’s), outer longitudinal
Serosa
What is the histo of the duodenum?
Villi, microvilli,
brunner’s glands (secrete alkaline fluid)
Crypts of lieberkuhn (have gi stem cells)
Tubular glands in submucosl layer
What is the histo of the jejunum?
Heavy lymphocytic infiltrate in the laminate propria
Plicae circularis
Crypts of lieberkuhn
What is the histo of the ileum?
Peyer’s patches (laminate propria, submucosa)
Crypts
Most goblet cells in small intestine
What is the histo of the Colon?
No villi
Crypts
Lots of goblet cells
Ulcers in the lesser curvature of the stomach cause bleeding from what artery?
Left gastric
Obstruction of the splenic artery causes ischemia thru which bvs?
Short gastric because left gastroepiploic has good anastomoses
Which part of the duodenum is close to the head of the pancreas?
2nd part
Contains ampulla
Which part of the duodenum is close to the aorta, IVC, and SMA?
The 3rd part (transverse)
May get caught between aorta and SMA
Where do internal hemorrhoids drain?
Superior rectal vein –> inferior mesenteric vein –> portal
To deep nodes
Where do external hemorrhoids drain?
Inferior rectal vein –> internal pudendal vein –> internal iliac vein –> IVC
To superficial inguinal nodes
What is the centrilobular portion influenced by?
Ischemia
Toxins (alcohol)
Contains the p450 system and is furthest away from the portal triad
What are the features of an indirect inguinal hernia?
Lateral to the inferior epigastric vessels
Goes into the scrotum
Occurs due to failure of processes vaginalis to close
Covered by all 3 spermatic layers
Goes through transversalis
What are the features of a direct inguinal hernia?
Medial to the inferior epigastric arteries
Lateral to rectus abdominis
Covered by external spermatic fascia
Older men
Where is a femoral hernia?
Below the inguinal ligament
Lateral to pubic tubercle
More common in women and right side
Where are the G cells?
In the Antrum of the stomach
Where are the I cells in the GI tract?
Duodenum
Jejunum
Secrete CCK - delay gastric emptying, gall bladder contraction, relax sphincter of Oddi
Where are the S cells?
Duodenum
Secretin - cause pancreatic bicarbonate secretion and bile secretion
Where are the D cells?
Pancreatic islets
GI mucosa
Somatostatin
Where are the K cells in the GI tract?
Duodenum
Jejunum
Glucose dependent insulinotropic peptide - increases insulin release and decreases gastric acid secretion
Causes oral glucose to be used more rapidly than IV glucose
Where is VIP secreted from?
Parasympathetic ganglia in sphincters, gallbladder, small intestine
Increases intestinal water and electrolyte secretion
Increases relaxation of sphincters
What secretes bicarbonate in the GI tract?
Mucosal cells of stomach, duodenum, salivary glands, brunner’s glands, pancreas
Where are the peyer’s patches?
In laminate propria and submucosa of ileum
What artery bleeds from a ruptured ulcer in the posterior wall of the duodenum?
Gastroduodenal artery
Where does perforation of the duodenum often occur?
In the anterior part of the duodenum,
Where are ulcers in the stomach most often located?
In the lesser curvature of the stomach at the junction of the
Where is zenker’s diverticulum
Between the thyropharyngeal and cricopharyngeal parts of the inferior pharyngeal constrictor
Due to cricopharyngeal muscle dysfunction
What is the in the mucosal layer of the gut wall?
Epithelium for absorption
Laminate propria for support
Muscularis mucosa for motility
What is in the submucosa layer of the gut wall?
Meissner’s plexus - regulates blood flow, secretions, absorption
What is in the muscularis externa?
Auerbach’s - myenteric plexus for contractility
Inner circular
Outer longitudinal
What is the most common location for diverticulum?
Sigmoid colon
Where do volvulus occur?
Cecum (young adult) Sigmoid colon (elderly)
Where are angiodysplasia located?
In the cecum, terminal ileum and ascending colon
Where does the recurrent laryngeal nerve loop on the right?
Below the right subclavian at the jxn of brachiocephalic artery
Where does the recurrent laryngeal nerve on left?
Under the aortic arch
What lymph nodes does the distal 1/3 of the vagina, vulva, scrotum drain to?
Superficial inguinal
What lymph nodes does the proximal 2/3 of vagina/uterus?
Obturator, external iliac and hypo gastric nodes
What lymph nodes do the glans penis and clitoris drain to?
Deep inguinal nodes
Where do the superficial and deep inguinal nodes drain?
External iliac nodes to the common iliac nodes
What ligament holds the ovarian vessels?
Suspensory ligament of the ovaries
What ligament holds the uterine vessels?
Cardinal ligament
What is contained in the broad ligament?
Uterus
Fallopian tubes
Ovaries
What nerve mediates ejaculation?
Hypo gastric nerve
What nerve mediates erection?
Pudendal nerve
Where are the Sertoli cells? What do they do?
In seminiferous tubules
Secrete inhibit, Mif, androgen-binding protein to maintain local levels of testosterone
Form blood-testis barrier
What cell makes hCG?
Synctiotrohphoblast
What is the outermost layer of the spermatic cord?
External spermatic fascia (from external oblique)
Originates from proximal tubule cells Polygonal clear cells Most common in men 50-70 yo Ass. With gene deletion in ch.3 Invades renal vein - can present with varicocele Resistant to chemo and radiation
RCC
Palpable flank mass with hematuria in a 2-4 yo
HTN
Small blue cells
Associate with beckwith Weismann and WAGR complex
Wilms tumor
Associated with exposure to phenacetin, rubbers, aniline dyes, cyclophosphamide, leather, textiles, plastics
Papillary growth with pleomorphism
Flat growth = high grade from p53 mutations
Presents with painless hematuria
Transitional cell carcinoma
Can be in calyces, pelvis, ureters, or bladder
Arises from urachal remnant at the dome of bladder
Adenocarcinoma
Lipidized astrocytes
Reticulin deposits
Chronic inflammatory infiltrate
Pleomorphic xanthoastrocytoma
Located As cystic and solid mass in Posterior fossa
GFAP positive
Rosenthal fibers -Eosinophilic corkscrew
Pilocytic astrocytoma
Midline cerebellum tumor of blue cells Increased MYC Homer wright rosettes Radio sensitive Associated with Turcot's Drop mets to spinal cord
Medulloblastoma
Perivascular pseudorosettes
Rod-shaped blepharoplasts found near nucleus
Found in 4th ventricle
Ependymoma
Foamy cells
High vascularity
Cerebellum
Can secrete EPO
Hemangioblastoma
Cystic spaces with brown fluid and cholesterol
Calcification
Keratin pearls lined by stratified squamous
May cause bitemporal hemianopsia
Craniopharyngioma
Precocious puberty
Impaired upward gaze
Obstructive hydrocephalus
Germinoma in dorsal midbrain
Stains for GFAP
Serpentine necrosis
Pseudopalisading pleomorphic tumor cells
Central areas of necrosis and hemorrhage
May cross midline
Infiltrative
Mutations in PDGF, p53, EGFR
Glioblastoma multiforme
Spindle cells with whorled pattern Psammoma bodies Near parasagittal brain and surfaces From arachnoid villi cells May have dural attachment Due to loss of Merlin in ch.22
Meningioma
Chicken-wire capillary pattern Round nuclei with clear cytoplasm Calcification GFAP positive Due to loss of heterozygosity Only in white matter Most often in frontal lobes
Oligodendroglioma
S100 positive
Present with facial numbness/weakness, tinnitus, hearing loss
Regular, oval nuclei with areas of dense, loose growth
Schwannoma
Grows in epiphysis of long bones Soap bubble or double bubble on X-ray Spindle cells with multinucleated cells (grow in synctium) Large red/brown cystic degeneration 20-40 yo
Giant cell osteoclastoma
Bony stalk near growth plate of long bones
Mature bone with cartilaginous cap
From metaphysis
Osteochondroma
In metaphysis of long bones
Codman’s triangle
Makes new bone - mixed lytic/blastic lesion in X-ray
Mutations in RB
Rf: Paget’s disease! Radiation, bone infarcts
Osteosarcoma
In boys under 15 Arises in diaphysis Anaplastic blue cell tumor Responsive to chemo Onion skin appearing in bone Associated with t(11;22) translocation Homer wright rosettes, necrosis/hemorrhage May have systemic systems: fever, increased ESR, anemia, increased WBCs
Ewing sarcoma
Usually located in pelvis, spine, scapula, humerus, tibia or femur
Expansive glistening mass within medullary cavity
Chondrosarcoma
Pink pearly nodules with telangectasias
Palisading nuclei
Upper lip
BCC
S100 positive
Driven by activating mutation in BRAF kinase
Nodular form is the worst
Melanoma
Psammoma bodies
Orphan-Annie nuclei, nuclear grooves
Most common type
Papillary thyroid carcinoma
Uniform cells in capsule that are invading
Spreads hematogenous lay
Follicular carcinoma of thyroid
Sheets of cells in amyloid stroma
Associated with RET mutation
Can present with hypocalcemia
From para follicular cells (neuroectoderm)
Medullary carcinoid of the thyroid
MEN2
Where do the ureters course?
On top of psoas
Under the uterine artery and ductus deferens
Crosses over external iliac artery and vein
Medial to gonadal veins and lateral to the internal iliac
What is the blood supply to the ureter?
Upper = renal artery Distal = branches of aorta, iliac, gonadal
Where is the SVC in relation to the other vessels?
The SVC is to the right of the aorta
The aorta is in the middle of the SVC and pulmonary trunk
What are the retroperitoneal structures?
SADPUCKER
Supra renal gland Aorta and IVC Duodenum (2nd and 3rd parts) Pancreas Ureters Colon Kidneys Esophagus (lower 2/3) Rectum Bladder
What ligament holds the portal triad?
Hepatoduodenal ligament
What ligament holds the derivative of the umbilical vein?
Ligamentum teres hepatis in the falciform ligament
