Anatomy of the Individual - Surface Anatomy Flashcards
Where does the clavicle articulate?
Acromion process of scapula and manubrium of sternum
Where is the jugular notch?
At the top of the manubrium between the two clavicles
Which bones articulate at the sternal angle and by which type of joint?
Manubrium and body of sternum articulate in a synarthrosis joint (secondary cartilaginous). Second pair of costal cartilages also attach
Which soft tissue structures underlie the manubrium and which mediastinum do they lie in?
Soft tissue structures of the superior mediastinum, including: oesophagus, trachea, thymus, phrenic, vagus and left recurrent pharyngeal nerves, SVC, brachiocephalic veins aortic arch and thoracic duct
How many true ribs are there?
6 pairs
How many false ribs are there?
4 pairs (ribs 7-10)
How many floating ribs are there?
2 pairs
Can you palpate rib 1?
Difficult to palpate as behind clavicle, but can be felt superior to upper trapezius on inspiration
Describe the pleural cavity (parietal pleura) on the left side
Extends 2-3cm above middle of medial 1/3rd clavicle. Reaches midline at sternal angle. Moves away from midline at 4th costal cartilage to accommodate the heart. Crosses midclavicular line at 8th cc, midaxillary line at 10th rib and follows 12th rib to posterior body wall
Describe the pleural cavity (parietal pleura) on the right side
Extends 2-3cm above middle of medial 1/3rd of clavicle. Reaches midline at sternal angle. Moves away from midline at 6th cc. Crosses midclavicular line at 8th cc, midaxillary line at rib 10 and follows rib 12 to posterior body wall
How high does the dome of diaphragm reach?
On left side 5th intercostal space and on right side 4th intercostal space
How does the pattern of the visceral pleura differ from the parietal pleura?
Visceral pleura does not pass into costodiaphragmatic recesses and is 2 rib spaces higher in midclavicular and midaxillary lines, then follows the line of the 10th rib to posterior body wall
Which lung has three lobes?
Right lung
Describe the route of the oblique fissure
The oblique fissure divides both lungs into an upper and lower lobe. It runs from the 3rd thoracic vertebrae posteriorly to the 6th costochondral junction anteriorly.
Describe the route of the horizontal fissure
Divides right lobe into upper and middle lobes. Runs horizontally from the oblique fissure (posteriorly) to the 4th cc (anteriorly).
Where does the apex of the heart normally lie?
left midclavicular line 5th intercostal space
Where does the inferior border of the heart run?
in a horizontal line from the apex to the right border of the heart
Where does the right border of the heart run?
In a vertical line 1-2cm beyond the right border of the sternum
Where does the left border of the heart run?
From the apex it travels superiorly and medially to the sternal end of the 2nd intercostal space
How do the borders of the heart correspond to its chambers?
The right border is formed by the right atrium, the left border is formed by the left ventricle and the left atrial appendage, the anterior border is the right ventricle and the posterior border is the left atrium superiorly, left ventricle and inferior vena cava
Which valves are the atrioventricular valves? Which chambers do they connect?
Tricuspid and Mitral valves. Tricuspid is between right atrium and ventricle, mitral is between left atrium and ventricle
Which valves are the semilunar valves? Which structures do they connect?
Aortic valve connects left ventricle to ascending aorta
Pulmonary valve connects right ventricle to pulmonary trunk
Where are chest drains most commonly inserted?
The “safe triangle” a region in the 5th intercostal space, midaxillary line which is bordered by latissimus dorsi, pectoralis major, a line from the nipple and an apex in the axilla
Where is a drain inserted for an apical pneumothorax?
2nd intercostal space
Which structures can be found in the right upper quadrant of the abdomen?
Liver, gallbladder, colon (hepatic flexure and transverse colon), right kidney, suprarenal gland, duodenum, head of pancreas, small intestine
Which structures can be found in the left upper quadrant of the abdomen?
Left kidney, suprarenal gland, spleen, stomach, body and tail of pancreas, jejunum, colon (splenic flexure and transverse colon)
Which structures an be found in the right lower quadrant of the abdomen?
ascending colon, caecum, appendix, small intestine
Which structures can be found in the left lower quadrant of the abdomen?
descending colon, sigmoid colon, small intestine
How is the abdomen divided into quadrants (using which lines)?
A vertical line and a horizontal line through the umbilicus
Which lines divide the abdomen into its 9 regions?
Two Horizontal lines: one through the transpyloric plane and one through the transtubercular plane
Two vertical lines through the midpoint of each clavicle to the midpoint of each inguinal ligament
What is the transpyloric plane?
A horizontal line across the abdomen level with the tip of the 9th costal cartilage
What is the transtubercular plane?
A horizontal line across between the tubercles of the iliac crest/along the upper portion of the body of L5 vertebrae
Which structures are found in the right hypochondrium of the abdomen?
liver, gallbladder, (kidney) suprarenal gland, hepatic flexure of colon
Which structures are found in the epigastrium of the abdomen?
liver, transverse colon, abdominal aorta, inferior vena cava
Which structures can be found in the left hyochondrium of the abdomen?
stomach, spleen, (kidney) suprarenal gland, splenic flexure of colon
Which structures can be found in the right lumbar region of the abdomen?
kidney, ascending colon and small intestine
Which structures can be found in the umbilical region of the abdomen?
Duodenum, pancreas, small intestine, aorta, IVC, iliac vessels (transverse colon)
Which structures can be found in the left lumbar region of the abdomen?
kidney, descending colon, pancreas, small intestine
Which structures can be found in the right iliac region of the abdomen?
caecum, appendix, small intestine
Which structures can be found in the hypogastric/suprapubic region of the abdomen?
bladder, rectum, small intestine iliac vessels, spermatic cords
Which structures can be found in the left iliac region of the abdomen?
sigmoid colon and small intestine
What is the jugular line?
A vertical line down the centre of the sternum from the jugular notch
What is the sternal line?
A vertical line down the lateral aspect of the sternum
What is the midclavicular line?
A vertical line from the midpoint of the clavicle to the midpoint of the inguinal ligament
What is the parasternal line?
A vertical line halfway between the sternal and midclavicular lines
What is the anterior axillary line?
A vertical line marking the anterior axillary fold formed by the pectoralis major muscle
What is the posterior axillary line?
A vertical line marking the posterior axillary fold formed by the teres major muscle
What is the midaxillary line?
A vertical line in the midpoint between anterior and posterior axillary lines
What is the subcostal plane?
A horizontal line marking the lowest level of the thoracic cage, level with the 10th costal cartilage
What is the supra-crestal plane?
A horizontal plane connecting the top of the iliac crests
What is the interspinal plane?
A horizontal line connecting the anterior superior iliac crests
Which vertebral level is vertebrae prominens?
C7
Which vertebral level is level with the medial edge of the spines of the scapula?
T3
Which vertebral level is level with the inferior angle of the scapula?
T7
Which vertebral level is level with the lower limit of the thoracic cavity?
T12
Which vertebral level is level with the iliac crests?
L4
Which vertebral level is level with the posterior superior iliac spines?
S2
What are the semi-lunar lines?
bilateral vertical curved lines where layers of rectus sheath fuse in anterior abdominal wall
What are the boundaries of the abdomen?
Diaphragm, xiphoid process and costal cartilages superiorly, pelvic brim and pelvic floor inferiorly, lumbar vertebrae posteriorly. Walls formed by rectus abdominis, external and internal obliques, quadratus lumborum and erector spinae muscles
Describe the location of the aorta within the abdomen?
- Left of midline
- 2.5cm above transpyloric plan to 2.5cm below supracrestal plane, where it bifuractes into common iliac arteries around the level of L4
- Passes through diaphragm via aortic hiatus at T12
Describe the location of the IVC within the abdomen?
Right of the midline
Formed from the union of common iliac veins around L4/5
Runs from 2.5cm below supracrestal plane to just above 6th cc
Passes through diaphragm at caval opening at T8
Describe the location of the liver within the abdomen
Upper border - LHS passes 7cm past xiphisternal joint, RHS continues around right side
Lower border - LHS runs an oblique line from 7cm past midline to the left of 8th cc
RHS follows border of costal cartilage from left to right
Describe the location of the gallbladder within the abdomen
small, sac-like structure around 3cm diameter
difficult to palpate as lies behind the liver on the midclavicular line around the right 9th costal cartilage
Describe the location of the spleen within the abdomen
Posterior to ribs 9-11 on left side near midaxillary line
Roughly 10cm long, 7cm wide and 3-4 cm thick
Describe the location of the stomach within the abdomen
Oesophageal junction is at cardiac oriface along 7th costal cartilage, 2.5cm left of midline and level with xiphoid process
Pyloric origace is transpyloric plane, 1.5cm right of the midline (9th cc)
Remainder is variable: fundus may be as high as 5th ic space 7cm left of midline or as low as 10th cc
greater and lesser curvatures just run between the cardiac and pyloric regions
Describe the location of the duodenum in the abdomen
Approx 25cm in length to connect pyloric valve of stomach to jejunum
4 parts:
part 1 runs 5cm right of the pylorus to costal margin
part 2 runs 7.5cm down and left to 10th cc
part 3 runs 10 cm left across the body of L3
part 4 ascends 2.5cm to jejunum at level of L2, 2cm left of midline
Where does the jejunum begin?
Level of L2, 2cm left of midline
Describe the location of the appendix within the abdomen
lies in midclavicular line, 1.5cm medial to ASIS
Where is pain from the appendix referred to?
Initially to umbilical region as general visceral pain, then over McBurney’s point in right iliac fossa
Describe the location of the pancreas in the abdomen
crosses from right to left anterior to L1
Head surrounded by duodenum
Body lies on transpyloric plane
Tail abuts onto hilum of spleen
Where does the splenic vein run?
Posterior to pancreas before joining superior mesenteric vein posterior to neck of pancreas to form hepatic portal vein
Where does splenic artery run?
Superior to pancreas, giving off pancreatic arteries to supply pancreas body and tail
Describe the location of the right kidney in the abdomen
protected by rib 12, upper margin around T12, lower margin around L3
Hilum approx 3cm from midline, lateral border approx 6.5cm from midline
Describe the location of the left kidney within the abdomen
protected by rib 11 and 12, superior margin around T12, inferior margin around L3
Hilum approx 3cm from midline, lateral border approx 6.5cm from midline
Where are the trunks of the brachial plexus with respect to the clavicle?
Supraclavicular notch posterior to the middle 1/3rd of the clavicle
True or False: The lateral 1/3rd of the clavicle is convex?
FALSE - the medial 1/3rd of the clavicle is convex, the lateral 1/3rd of the clavicle is concave
What attaches to the coracoid process?
Biceps muscle
Where is the medial border of the scapula located? What prevents it being palpated easily?
5cm lateral to the spines of T2-8, covered by attachments of the rhomboid muscles
Which ribs does the inferior angle of the scapula normally cover?
Posterolateral aspect of ribs 7 and 8
Why must the scapula move during movement of the upper limb above the head?
If the scapula did not move when the limb is raised, the head of humerus would come into contact with the acromion process and prevent movement above shoulder level
Why must the scapula move during anterior movement of the upper limb?
Scapula must protract/abduct to allow arm to move anteriorly
Which structure lies within the intertubercular groove near the head of humerus?
tendon of long head of biceps brachii (between tendons of pectoralis major and teres major)
Anterior circumflex humeral artery also runs through here, and latissimus dorsi inserts into the floor of the groove
Which muscle group originates from the lateral epicondyle of the humerus?
Extensor muscles including the supinator, anconeus, extensor carpi radialis brevis, extensor digitorum, extensor carpi minimi and extensor carpi ulnaris
Which large muscle inserts onto the olecranon process of the ulna?
Tendon of triceps brachii
Which muscle group originates from the medial epicondyle of the humerus?
Flexor muscles of the forearm, including flexor carpi radialis, flexor carpi ulnaris and flexor digitorum superficialis
Which cord-like structure is protected in a bony groove posterior to the medial epicondyle?
ulnar nerve
Which carpal bone is found immediately distal to the ulna?
Triquetral
Which carpal bone sits on the anterior surface of the triquetral bone?
Pisiform
Which type of joint exists between the carpal bones? Why?
plane synovial joints - the small gliding motion they allow contributes to greater freedom of movement of the wrist