Anatomy Pratical 1 Flashcards
1
Q
what are the 3 main salivary glands
A
parotid
submandibular
sublingual
2
Q
what is the largest salivary gland
A
parotid
3
Q
where does the parotid gland enter the mouth
A
2nd molar
4
Q
where does submandibular enter the mouth
A
small prominences on either side of the lingual frenulum
5
Q
where does sublingual enter the mouth
A
they have minor sublingual ducts and major sublingual ducts
a major sublingual duct (of Bartholin) can be present in some people.
6
Q
what is the nerve supply of the parotid duct
A
glossopharyngeal nerve (cranial nerve IX).
- Sensory innervation is supplied by the auriculotemporal nerve (gland) and the great auricular nerve (fascia).
- Sympathetic innervation originates from the superior cervical ganglion, part of the paravertebral chain.
7
Q
what nerve passes through he parotid gland
A
facial nerve
8
Q
which foramen does the facial nerve exit the cranium form
A
stylomastoid foramen.
9
Q
o Which muscle(s) innervated by the facial nerve is involved during chewing (but is not a muscle of mastication)?
A
buccinator
10
Q
what is the nerve supple to the submandibular and sublingual glands
A
facial nerve
11
Q
name the 4 main muscles involved with mastication and what is there nerve supply
A
Masseter
Temporalis
Medial pterygoid
Lateral pterygoid
- innervated by a branch of the trigeminal nerve (CN V), the mandibular nerve.
12
Q
which nerve is the motor supply to the tongue
A
hypoglossal
13
Q
what are the phases of swallowing
A
pharyngeal phase
oesophageal phase
14
Q
what causes the pharyngeal phase
A
Stimuli in the oropharynx (and laryngopharynx) provoke the pharyngeal phase.
15
Q
which nerve is sensory in the oropharynx and forms the afferent limb of the pharyngeal phase
A
glossopharyngeal
- afferent limb is glossopharyngeal phase
16
Q
which nerve forms the efferent limb of the pharyngeal phase
A
vagus nerve
17
Q
what are inhibited in the pharyngeal phases
A
chewing, breathing, coughing and vomiting are inhibited.
18
Q
what contracts when you swallow food
A
- The pharynx widens and shortens to receive the bolus of food as the suprahyoid and longitudinal pharyngeal muscles contract elevating the larynx.
- There is then an INVOLUNTARY sequential contraction of the pharyngeal constrictor muscles creating a peristaltic ridge (involuntary because it is part of a reflex action
19
Q
what type of muscle is pharyngeal muscle
A
skeletal
- therefore it has a somatic supply
20
Q
what prevents aspiration during swallowing
A
It is true vocal fold closure that is the primary laryngopharyngeal protective mechanism to prevent aspiration during swallowing.
- False vocal fold adduction and retroversion of the epiglottis also take place.
21
Q
describe the oesophageal phase of swallowing
A
- involuntary neuromuscular control
- slower than the pharyngeal phase
- bolus enters the oesophagus and is propelled downwards by striated muscle and then by smooth muscle
- The upper oesophageal sphincter relaxes to let food pass, after which various striated constrictor muscles of the pharynx as well as peristalsis and relaxation of the lower oesophageal sphincter sequentially push the bolus of food through the oesophagus into the stomach.
22
Q
what is the somatic nerve supply to the upper oesophagus
A
sympathetic and parasympathetic from the nucleus ambiguus
23
Q
what is the autonomic supply to smooth muscle in the lower oesophagus
A
sympathetic and parasympathetic from the dorsal motor nucleus
24
Q
what is dysphagia
A
difficulty swallowing
25
what are the risk factors of aspirating foreign materials into the lung
- Poor gag reflex in people who are not alert (unconscious or semi-conscious) after a stroke or brain injury
- Drinking large amounts of alcohol
- General anaesthesia
- Old age
- Problems with swallowing
- Coma
- Being less alert due to medicines, illness, or other reasons
26
where does the oesophagus exited from
C6-T1
| - cricoid to the stomach
27
what is the diameter of oesophagus
approximately 2cm in diameter
28
what are the upper half and lower half relations of the oesophagus
The relations of the upper half of the Oesophagus (C6 – T4):
1. Posteriorly: the vertebral column.
2. Anteriorly: the Trachea
3. On both sides: the dome of the Pleura and superior lobe of each lung. In the groove made by the trachea and Oesophagus you will find the Recurrent Laryngeal Nerve.
The relations to the lower half of the Oesophagus (T4 – T10):
1. Posteriorly: the vertebral column.
2. Anteriorly: the heart (left Atrium) (transoesophageal echocardiograms produce some of the most detailed images of the heart, especially those structures difficult to see using transthoracic echocardiography)
3. On the left: descending thoracic aorta.
4. On the right: the azygos vein and inferior lobe of right lung.
29
what are the two sphincters in the oesophagus
upper oesophageal sphincter
| lower oesophageal sphincter
30
describe the two sphincters in the oesophagus
upper oesophageal sphincter
- voluntary
- skeletal muscle mainly comprised of the inferior pharyngeal constrictor/cricopharyngeus
Lower Oesophageal Sphincter (LOS)
- specialized segment of the circular muscle layer of the distal oesophagus.
- It functions as the first antireflux barrier protecting the oesophagus from the acidic gastric content.
31
o Where are foreign objects most likely to lodge in the pharynx and oesophagus? Why?
upper oesophageal spincther - voluntary and anatomical sphincter - first one it comes into contact with
32
what are the three constrictions of the oesopgahus
- upper oesophageal sphincter
- abdominal aorta causes it to pinch
- lower oesophageal sphincter
33
what is a hiatus hernia
A hiatus hernia or hiatal hernia is the protrusion (or herniation) of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm.
34
what can a hiatus hernia result in
Hiatus hernias often result in heartburn but may also cause chest pain or pain with eating.
35
what is the most common cause of a hiatus hernia
obesity
36
what is the most common form of a hiatus hernia
. Sliding hiatal hernias are the most common form.
37
what is the inguinal ligament
• The inguinal ligament is a thickening of the external oblique aponeurosis and spans from the anterior superior ileac spine (ASIS) to the pubic tubercle (PT) of the pelvis.
38
what is the inguinal canal
• The inguinal canal is a space that passes obliquely through abdominal wall in the inguinal region. The inguinal canal is found over the medial half of the inguinal ligament (i.e. the inguinal ligament forms the floor of the canal).
39
what forms the wall of the inguinal canal
• The anterolateral muscles of the abdominal wall (external oblique, internal oblique and transversus abdominis) and their aponeuroses form the walls of the inguinal canal
40
what is the deep ring and where does it open
o Deep (Internal) Ring: is an opening in the transveralis fascia and is located at the midpoint of the inguinal ligament. This is the point halfway between the ASIS and the PT.
41
what is the superficial ring and where does it open
o Superficial (External) ring: is an opening in external oblique aponeurosis. It is located above the PT.
42
what does the inguinal canal contain
o spermatic cord and ilioinguinal nerve in the MALE
| o round ligament of the uterus and ilioinguinal nerve in the FEMALE
43
what is a hernia
A hernia is a protrusion of a tissue, structure or part of an organ through a wall that normally contains it. Areas of the abdominal wall may be inherently weak. These sites are predisposed to abdominal contents protruding through them
44
why are hernias clinically important
They are clinically important as the bowel lumen can become obstructed (obstructed hernia) or the blood supply in its wall can be cut off (strangulated hernia)
- this requires surgical intervention
45
what are the causes of hernia
: (i) anything that raises intra-abdominal pressure (e.g. excessive coughing, lifting heavy weights);
(ii) anything that weakens or stretches the abdominal wall (e.g. old age, incision from an operation, obesity, pregnancy).
46
what are the most comments hernias
• The commonest hernias are inguinal and femoral hernias.
47
what is a direct inguinal hernia
- Direct inguinal hernias protrude through the abdominal wall. (HASSELBACH’S TRIANGLE)
48
what is an indirect inguinal hernia
- Indirect inguinal hernias pass through the deep inguinal ring and can extend through the inguinal canal, out of the superficial inguinal ring and into the scrotum.
49
what is the peritoneum
The peritoneum is a continuous serous membrane that sits in the abdominal cavity and lines the abdominal viscera, either completely or partially
50
name intraperiotneal organs
```
= stomach
= pancreas
= liver
= ileum
= jejenum
```
51
name intraperiotneal organs
= stomach
= liver
= ileum
= jejenum
52
name some retroperiotenal organs
```
= kidneys
= bladder
= ureter
= ascending and descending colon
= distal 3 parts of the duodenum
= aorta and other vessels
= pancreas
= rectum
= oesophagus
```
SAD PUCKER
53
what is mesentery
the mesentery is the name given to the folds of visceral peritoneum that arise from the posterior abdominal wall and extend to the jejunum and ileum
- e.g. mesentery proper - supsends the small intestine, transverse mesocolon - attaches to the transverse colon and the sigmoid mesocolon is attached to the sigmoid colon
54
what are the two omentums
greater and lesser momentum
55
what is the greater omentum
The greater is a large double layer of visceral peritoneum that starts from the greater curvature of the stomach, hangs down in front of the small intestine, then the double layer folds back on itself and attaches back to the transverse colon.
56
what is the lesser omentum
The lesser omentum is a double layer of peritoneum that extends from the liver to the lesser curvature of the stomach (the hepatogastric ligament), and part of the duodenum (the hepatoduodenal ligament).
57
what does the falciform ligament do
- attaches the liver to the anterior abdominal wall
58
what is laparoscopy
Laparoscopy is the process of viewing inside the abdomen using a fibre optic camera, and
- key hole surgery
- air is given to blow the stomach up
59
o What is commonly the first incision site of a laparoscopic procedure?
umbilicus around that area
60
what are adhesions
As part of this scarring process when following abdominal surgery, the two layers of the peritoneum can stick together and limit the movement of internal organs.
61
o Can adhesions cause pain? Explain your answer.
- in many people now but in some people it can lead to chronic pain - they can compress each other and cause pain that way
62
o What is the name of the procedure to remove or divide adhesions?
adhesiolysis
63
what is peritonitis
Peritonitis is the name given to an inflamed peritoneum
64
what is acute abdomen
this is sudden severe abdominal pain with an unclear cause
65
what are 5 causes of periostitis
```
blood
infection
leak
a ruptured appendix.
a stomach ulcer.
a perforated colon.
```
66
what is a duodenal ulcer
A duodenal ulcer is a peptic ulcer that develops in the first part of the small intestine (duodenum)
67
how do people present with an duodenal ulcer
```
Burning stomach pain
Feeling of fullness, bloating or belching
Fatty food intolerance
Heartburn
Nausea
```
68
what are the two types of abdominal pain
visceral pain
| parietal pain
69
describe the two types of abdominal pain
1. Visceral Pain
This layer is sparsely innervated hence produces a dull, poorly localised pain.
2. Parietal Pain
Richly innervated by somatic nerves. This causes a well-localised, sharp pain.
70
where is pain received in the foregut
* Foregut (Liver, Gall Bladder, Pancreas, Spleen, Proximal Duodenum)
* T6-T9 – therefore EPIGASTRIC
71
where is main received in the midgut
* Midgut (Distal Duodenum, Jejunum, Ileum, Caecum, Appendix, Ascending Colon, 2/3rd Transverse Colon)
* T8-T12 – therefore UMBILICAL
72
where is pain received in the handout
* Hindgut (1/3rd Transverse Colon, Descending Colon, Sigmoid Colon, Rectum)
* T12 – L2 – therefore SUPRAPUBIC
73
why does appendicitis first progress from umbilical pain to right iliac fossa pain
changes form visceral pain to parteiral pain as the inflammation gets bigger
74
what is psoas sign
this is hyperexntesion of right hip pain in the right iliac fossa
75
what is obturator sign
this is internal rotation of flexed right pain in the right iliac fossa
76
where might pain be referred to if you suffer from diverticular disease
• T12 – L2 – therefore SUPRAPUBIC
77
what is a sigmoid volvulus
In sigmoid volvulus (SV), the sigmoid colon wraps around itself and its mesentery
78
why are caecal and sigmoid volvuli more common
lack of fixation
79
o How can you recognise a sigmoid volvulus on an x-ray?
plain abdominal X-ray radiographs usually show a dilated sigmoid colon and multiple small or large intestinal air-fluid levels
80
where does the thoracic aorta become the abdominal aorta
when it goes through the diaphragm at T12
81
how many branches does the SMA give of
The SMA gives 15-18 branches to supply the small bowel
82
what does mesenteric ishcaemia result from
Mesenteric ischaemia can occur as a result of blockage of the blood supply to the gut from the IMA or SMA due to thrombus/ embolus formation
83
what are the sings of mesenteric ischemia
This causes
- abdominal pain
- vomiting
- bloody stool
- and can result in a gangrenous bowel and death if the blood supply is not restored within 24/48 hours.
84
where does the sigmoid colon start
The sigmoid colon starts anterior to the pelvic brim.
85
where does the rectum start
- anterior to the 3rd sacral vertebra
86
how long is the sigmoid colon
The sigmoid colon shows a great variation in length and may measure as much as 91cm.
87
what is the sigmoid colon a common sight for
cancer
88
what is removed if there is cancer in the sigmoid colon
The colon is removed from the left colic flexure to the distal end of the sigmoid colon, and the transverse colon is anastomosed with the rectum or a stoma is created.
89
what forms the anorectal angle
The puborectalis portion of the levator ani muscle forms a sling at the junction of the rectum with the anal canal and pulls this part of the bowel forward producing the anorectal angle
90
what is the blood supply of the rectum
The superior rectal artery is a direct continuation of the inferior mesenteric artery.
The middle rectal artery is a small branch from the internal iliac artery.
The inferior rectal artery is a branch of the pudendal artery. It anastomoses with the middle rectal artery at the anorectal junction
91
what is the anal canal divided into
It can be split into two sections, upper and lower, divided by the pectinate (or dentate) line.
92
where does the upper part of the anal canal originate from
The upper part originates from the embryological endoderm (hindgut).
It originates at the anorectal junction and is characterised by anal columns (of Morgagni), which are joined inferiorly by anal valves.
93
what are anal valves
- marker the border between the lower and upper anal canal
| - also secrete mucous on defection
94
what is the nerve supply difference between the upper and lower anal canal
* Above, the nerve supply is visceral, coming from the inferior hypogastric plexus. As is it visceral, this part of the anal canal is only sensitive to stretch.
* Below the pectinate line, the nerve supply is somatic, receiving its supply from the inferior rectal nerves (branches of the pudendal). As it is somatically innervated, it is sensitive to pain, temperature, and touch.
95
what is the lower half of the anal canal divided into and what is its blood supply
is supplied by the inferior rectal artery and is divided into two zones separated by Hilton's white line (anal verge).
96
what is the internal anal sphincter
The internal anal sphincter is an involuntary, smooth muscle sphincter supplied by parasympathetic fibres that pass through the pelvic splanchnic nerves.
- This sphincter relaxes in response to pressure (gas or faeces) distending the rectal ampulla.
97
what is the external anal sphincter and what is it innervated by
The external anal sphincter is a voluntary sphincter innervated primarily by S4 through the inferior rectal nerve
98
where does the lower zone of the anus originate from what embryonic layer
ectoderm
99
what is the difference in mciroanatomy between the upper and lower rectum
upper zone - simple columnar epithelium
| lower zone - stratified squamous epithelium
100
where are the anal cushions
The anal cushions are at the level of the pectinate line.
101
what do anaal cushions do
- this allows a water tight closure of the anal canal
102
what are haemorrhoids
a swollen vein or group of veins in the region of the anus
103
what are the symptoms of haemorrhoids
bright red blood after you poo
an itchy anus
feeling like you still need to poo after going to the toilet
slimy mucus in your underwear or on toilet paper after wiping your bottom
lumps around your anus
pain around your anus
104
what are prolapsed haemorrhoids
Sometimes patients notice a lump around the anus, which may need to be “pushed back”, or may return to the anal canal on their own following a bowel movement. These are known as “prolapsed” haemorrhoids
105
what causes haemorrhoids
constipation
pushing too hard when pooing
pregnancy – read about piles during pregnancy
heavy lifting
106
what muscle help forms the external sphincter
The puborectalis fibres of the levator ani blend with the deep fibres of the external sphincter.
107
what is the anorectal ring
At the junction of the rectum and the anal canal, the internal sphincter, the deep part of the external sphincter and the puborectalis muscles form a distinct ring, called the anorectal ring, which can be felt on rectal examination
