Anatomy of heart and its vessels Flashcards
what can cause a block in the vertebral artery?
an occlusion in the middle cerebral artery
where is the hilum of the kidney found? and where is the right kidney?
on L1 in the abdomen
right kidney is located posteriorly to the liver
what can be seen to be posterior to the kidney?
Rib 12
what nerves are responsible for causing bladder emptying and relaxation of the internal sphincter?
the parasympathetic nerves
what are the medullary pyramids and what are they made up of?
formed of the Loop of Henle and the collecting duct
where is the kidney placed in relation to the diaphragm ?
kidneys are anterior and inferior to the diaphragm
where is the ureters and the bladder situated in relation to the abdomen?
the bladder is posterior to the pubic symphysis at the pelvic brim
ureters are anterior to the posterior muscular wall
where are the abdominal wall muscles and where are they located?
they are in the quadrates lumborum and located between vertebrae L1-L5 and rib 11 and 12
where is the transplyoric plane?
it is halfway between jugular notch and the pubic symphysis
- site of anatomical relations to the kidneys
what is the greater omentum?
it is a double sheet of peritoneum folds
It has two layers
where is the duodenum?
it is the first part of the small intestine and it helps to digest food that comes from the stomach and absorb any nutrients
how are the small and large intestine connected?
the last part of the small intestine, called the ileum, is connected to the cecum which is the first part of the colon (large intestine)
where is ascending and descending part of the colon?
ascending is on the right side of the abdomen and descending on the left
what is the kidney anterior and posterior to?
kidney is anterior to the diaphragm and posterior to peritoneum
how does the small and large intestine sit in relation to the right kidney?
they sit inferiorly with the large intestine being retroperitoneal and the small intestine being intraperitoneal
where does the duodenum sit in relation to the kidney?
the duodenum sits medially to the right kidney
the beginning part of the duodenum is medial to kidney
the duodenum is retroperitoneal
where does the small intestine sit in relation to the left kidney?
the small intestine sits medially and intraperitoneally to the left kidney
what organs sit superiorly to the left kidney?
the stomach and spleen and they sit intraperitoneally
the suprarenal gland and diaphragm also and they sit retroperitoneally
how does the pancreas sit in relation to the left kidney?
it sits retroperitoneally
it cuts across the anterior surface of the left kidney
what is the jejunum?
the second part of the small intestine
what plane does ureter sit in relation to lumbar vertebrae?
sits in the agitate plane with transverse processes
what plane does the kidney sit in?
the transpyloric plate
what are the gross external features of the kidney?
the hilum - renal pelvis, artery, vein sinus - major/minor calyx - lobes; divided by renal columns - outer; cortex, renal columns - inner; medulla
where do the renal pyramids point towards?
the sinus
what is the apex of the pyramid?
the renal papilla
where does the papilla drain urine into?
- minor calyx
- major calyx
- renal pelvis
how do the renal artery and the renal vein sit with each other?
renal artery us posterior to the renal vein
where does the renal artery emerge?
emerges from the abdominal aorta
level: vertebrae L1 and L2
what does the superior mesenteric artery do?
provides oxygenated blood and nutrients to the intestines
what are the internal arteries of the kidney?
- interlobular; terminal arteries
- arcuate
- interlobular; become the afferent arterioles when entering the glomerulus in the nephron
- has a posterior and anterior artery branch
what does ht phrenic nerve innervate?
it innervates the diaphragm
what nerves innervate the kidney?
- the renal plexus; supplied by sympathetic nerves in the prevertebral plexus
- splanchnic nerve
how are the ureters supplied with blood superiorly, medially and inferiorly?
superior: renal arteries
middle; gonadal arteries/ aorta/ common iliac arteries
inferior: internal iliac arteries
where is the uterine artery and the ductus deferens?
the uterine artery is wrapped around the ureter in the women
the ductus deferens in men cuts straight across the bladder surface; brings sperm from testes to prostate
how do kidney stones work in causing pain?
the stone pushes on the muscular wall and when there is smooth muscle activity pain will occur for the patient
how does the spinal cord and brain sense referred pain?
the spinal cord receives sensory information from:
- viscera; visceral afferent nerves- unconscious monitor of internal systems
- skin and muscle; somatic afferent nerves- conscious sensation
what do dermatomes represent?
represent areas of the skin innervated by a single spinal cord segment
where does sensory innervation of ureters reach?
reaches the spinal cord segments T11-L2
pain is felt in these regions
what are the nine abdominal regions?
- right flank
- left flank
- right groin
- left groin
- right hypochondrium
- left hypochondrium
- pubic region; hindgut referred pain
- umbilical region; midgut referred pain
- epigastric region; foregut referred pain
where is the bladder located and what are its external features?
- posterior to pubic symphysis
- inferior to peritoneum
- immediately anterior to vagina/rectum
- supported by pelvic floor muscles
what is bladders shape when empty? how is this formed?
it has a triangular shape
this is formed superiorly by the two entry points of the uterus
apex is pointed anteriorly
where does the female bladder get its blood supply?
- right internal iliac artery supplies the internal pelvis
- the vaginal artery
- superior vesical artery
where does the male bladder get its blood supply?
- right internal iliac artery
- superior vesical artery
- inferior vesical artery; only in males
where does all venous drainage occur?
through the internal iliac veins
what are the internal features of the bladder?
- trigone
- ruage
- ureter openings
- internal urethral orifice and sphincter
in the female pelvis peritoneum where does fluid accumulate in an infection?
in the recto-uterine pouch and vesicle-uterine pouch; pus and blood can be drained in this pouch
in the male pelvis peritoneum where does fluid accumulate in an infection?
recto-vesical pouch
how long is female urethra? how does this affect its susceptibility?
4cm approx.
susceptible to UTI; bladder inflammation so prescribe oral antibiotics
how long is the male urethra and how is it divided?
approx 20cm has four segments: 1. preprostatic urethra 2. prostatic urethra 3. membranous urethra 4. spongy (penile) urethra
what does the internal urethral sphincter do?
it closes off during ejaculation so sperm and acidic urine dont mix and kill the sperm
- controlled involuntarily by visceral nervous system
is the external urethral sphincter movements voluntarily or involuntarily controlled?
it is voluntarily controlled
what is urge incontinence?
‘overactive bladder’
- involuntary leakage of urine
- sensation/urgency to urinate
- caused by spontaneous detrusor muscle overactivity during the bladder
- can be neurogenic
- exacerbated by caffeine, alcohol consumption
how can stress incontinence occur from pelvis floor muscle trauma
- common in females
- weakened pelvic floor
- triggered by increased intra-abdominal pressure; bladder pressure> urethral pressure
- urethral hyper mobility
how is micturition controlled?
controlled by the autonomic nervous system
- sympathetic nerves relax bladder, contract internal urethral sphincter; bladder is empty
- mechanoreceptors detect stretch
- visceral afferent fibres to CNS
- parasympathetic nerves contract detrusor muscle and relax internal urethral sphincter
what is the pelvic floor?
a sling that contracts around the neck of the bladder
- has the pudendal nerve; somatic nerve
- can squeeze your pelvic floor musculature and control whether to hold urine in
what is the levator ani muscle?
made up of the puborectalis, pubococcygeus and illiococcygeus
what splanchnic nerves are sympathetic and parasympathetic?
sacral splanchnic nerves ( T10- L2) are sympathetic
pelvic splanchnic nerves (S2-S4) are parasympathetic
what is the micturition reflex?
- when empty sympathetic nerves tell muscle to relax and form the wrinkled appearance
- cause contraction of the internal urethral sphincter muscle
- as bladder fills with water, the stretch receptors and parasympathetic nerves kick into action
- the muscle then contracts and creates pressure onto the internal urethral sphincter
- stretch receptors send signals back to parasympathetic nerves
- external sphincter muscles relax so urine is released but stopped if any voluntary restriction
where are the stretch receptors located?
in the wall of the bladder
what are the basic components of CVS?
- the pump (specialised muscle); 2 pumps
- closed system of tubes; carry blood to/from capillary beds
it is actually 2 circulations;
- pulmonary
- systemic
where is the inferior mediastinum?
it is below the plane between the sternal angle and vertebrae T4/T5
and above the diaphragm
where is the middle mediastinum placed?
the fibrous pericardium around the heart separates the inferior mediastinum into three parts
what are the 3 parts of the inferior mediastinum?
the anterior, the middle and posterior
the middle is occupied by the heart
where is the mediastinum positioned in relation to the lungs?
it is centrally located between the lungs and anterior to the vertebrae
posterior to the sternum
what are the types of pericardium are there and what are they made up of?
- Fibrous pericardium; contains heart during contraction/relaxation
- > tough protective sleeve. prevents over distension/enlargement
- > attached to the diaphragm and sternum - Serous pericardium; layers slide over each other to allow movement during heart beat so heart can contract/relax
- > parietal is the outer layer and attached to fibrous
- > visceral is the inner layer and attached to hearts myocardium
what are the layers of the heart muscle?
- epicardium; visceral layer of serous pericardium
- myocardium; allows pump to function
- endocardium; in contact with the blood as it is the internal lining
what are the surfaces of the heart?
- base/posterior
- anterior/ sternocostal
- diaphragmatic
- apex
- left/right pulmonary
what are the external features of the heart?
- the four chambers
- sulci denote the division of these chambers; coronary arteries/veins are found here
what are the great vessels of the heart?
1b. right common carotid artery
1a. right subclavian artery
1. brachiocephalic trunk
braciocephalic veins
2. left common carotid artery
3. left subclavian artery
where does the right and left coronary artery come from?
right- the abdominal aorta
left- branch of the aortic valve
when a blockage occurs with the coronary circulation what can occur?
no blood supply
- cardiac muscle ischaemia
- myocardial infarction and necrosis
where do cardiac veins drain into? where does this drain into?
into the coronary sinus and the coronary sinus drains into the right atrium
what vessels does the right atrium have? where is the sinus node in the RA?
it has SVC, IVC and coronary sinus
the SA node is within the superior part of the crest terminalis
what is right atrium made up of?
pectinate muscle
what does the chordae tendineae do in right ventricle?
stops the reflux of blood to the right atrium
what vessels does the left atrium have? what muscle is it made up of?
- smooth wall and smooth muscle
- has left and right pulmonary veins
- it has mitral valve for blood to enter through its two cusps
which ventricle is thicker?
the left as a larger force is needed to push blood through systemic circulation
so larger papillary muscle and thick myocardium
what is the intrinsic SA node rate?
ntrinsic SA node rate= 100bpm
how does parasympathetic and sympathetic nerves affect heart rate?
- parasympathetic; vagus nerve will decrease heart rate and force. this constricts the coronary arteries
- sympathetic inputs; sympathetic trunk will increase heart rate and force.
what is the cardiac conduction system?
- SA
2. across atrial cardiac muscle wall
