Anatomy PTMRCS 2 Flashcards
What arteries supply the transverse colon?
Middle colic artery to 2/3
Left colic artery distally
What is the major anastomotic artery between the SMA and IMA?
Marginal artery of Drummond - in mesentery
What arteries are most commonly implicated in diverticular bleeds?
Sigmoid branches of IMA
Where does the inferior mesenteric vein drain?
Splenic vein
What forms the portal vein?
SMV and splenic vein
What positions can the appendix lie in?
Retrocaecal
Pelvic
Subcaecal
Anterior or posterior to terminal ileum
Blood supply to rectum?
Superior rectal artery from IMA
Middle rectal artery from internal iliac
Inferior rectal artery from internal pudendal
Describe nerve supply to rectum?
PNS = S2 3 4, causes bowel contraction and relaxation of internal sphincter
Symp from superior hypogastric plexus and lumbar splanchnic nerves = painful stimuli, contract internal sphincter
Is rectum retroperitoneal?
Yes - upper 1/3 has peritoneum over front and sides, middle 1/3 just over front and bottom 1/3 below peritoneal reflection
What are the 5 branches of the SMA?
Inferior pancreaticoduodenal artery Jejunal and ileal arteries Ileocolic artery Right colic artery Middle colic artery
What are the bones of the orbit?
Frontal bone Lacrimal bone Ethmoidal bone Zygoma Maxillary bone Sphenoid Palatine
Structures passing through superior orbital fissure?
CN 3, 4, 6
Superior ophthalmic vein
Ophthalmic nerve - lacrimal, frontal and nasociliary branches (branch of CN5)
Structures passing through inferior orbital fissure?
Inferior ophthalmic vein
Maxillary nerve infraorbital and zygomatic branches
Branches of pterygopalatine ganglion
Structures passing through the optic canal?
Optic nerve
Ophthalmic artery and associated sympathetic fibres
Nerve supply to lacrimal gland?
PNS - pterygopalatine ganglion
SNS - superior cervical plexus and deep petrosal nerve
Sensation - lacrimal branch of ophthalmic nerve
7 extrinsic muscles of the eyeball?
Superior and inferior, medial and lateral rectus
Inferior oblique and superior oblique
Levator palpebrae superioris
Innervation of superior and inferior oblique muscles?
Sup oblique = trochlear
Inf oblique = oculomotor
Nerve supply to levator palpebrae superioris?
Dual innervation from CN3 and sympathetic ganglion
What are the features of Horner’s syndrome?
Miosis
Ipsilateral anhidrosis
Ptosis
Enophthalmos
Where do the ophthalmic veins drain?
Cavernous sinus
4 clinical features of orbital blowout fractures?
Enophthalmos
Diplopia
Infraorbital numbness due to infraorbital nerve compression
Orbital emphysema
3 signs of inferior orbital blowout fracture on XR?
Orbital emphysema
Tear drop sign - fat into sinus
Blood in sinus
Layers go through in lumbar puncture?
Skin Subcutaenous tissue Supraspinous ligament Interspinous ligament Ligamentum flavum Epidural space w venous plexus Dura Subdural space Arachnoid
Blood supply to spinal cord?
1 anterior and 2 posterior spinal arteries
Anterior from vertebrals
Posteriors from PICAs
Segmental supply from radicular arteries at each level - Artery of Adamkiewicz is largest
What is the Artery of Adamkiewicz and where does it arise?
Largest segemental radicular artery, arises from left T8-L1 area
Fascial layers of neck for an ACDF? What do they contain?
Superficial fascia - platysma, fat
Investing deep fascia - trapezius and SCM
Carotid sheaths - common carotid, IJV, vagus
Pretracheal fascia - thyroid gland, trachea, oesophagus, strap/infrahyoid muscles
Prevertebral fascia - vertebral column and associated muscles
Within which fascial layer does post-op haematoma occur in ACDF, thyroidectomy etc.?
Pretracheal
What are the surface markings for the liver anteriorly?
Superior - 5th ICS right, 4th ICS left
Lateral - 5th ICS right, 8-10th rib
Oblique - line between the 2
Which lobe do the quadrate and caudate arise from?
Right
What is the surface marking for the gallbladder?
Angle between 9th costal cartilage and lateral border of rectus
What are the 3 functions of the gallbladder?
Storage of bile
Concentrating bile
Addition of mucus to bile
How much bile does the gallbladder hold?
50ml
Blood supply to the gallbladder?
Cystic artery, from right hepatic artery from hepatic artery proper
Also collaterals from liver bed
What are the branches of the biliary tree?
Intralobular ducts Intrahepatic ducts Right and left hepatic ducts Common hepatic duct Cystic duct CBD
What is Calot’s triangle? What is it’s clinical significance?
Cystic duct
Inferior border of liver
Common hepatic duct
Contains cystic artery and LNs, important to isolate and ligate cystic artery during lap chole
What is Courvoisier’s Law? Why is it true?
Palpable gallbladder and painless obstructive jaundice unlikely to be gallstones - ?Cancer
Because chronic gallstones cause fibrosed, contracted gallbladder rather than enlargement, or CBD stone causes pain
What are Kehr’s and Boas’ sign?
Kehrs - shoulder tip pain in acute cholecystitis
Boas - area of hyperaesthesia just below right scapula in acute cholecystitis
3 signs associated with acute cholecystitis?
Murphys
Kehrs
Boas
Surface anatomy of breast?
2nd to 6th rib
Sternum to mid axillary line
Deep muscular relations of the breast?
Pectoralis major (2/3) Serratus anterior (1/3)
3 major constituents of breast tissue?
Fat
Glandular tissue
Fibrous tissue
How many lobules are there within the breast?
15-20, each drained by a lactiferous duct
What are Cooper’s ligaments? Clinical signifiance?
Suspensory ligaments of breast
Fibrous tissue from pectoral fascia to subcutaneous tissue separating lobules of the breast
Malignant infiltration causes puckering/induration - p’eau d’orange
Arterial blood supply to breast?
Internal thoracic/mammary artery - from SCA
Lateral thoracic - from axillary 2
Thoraco-acromial - from axillary 2
Intercostal arteries
Lymph drainage of breast?
Axillary lymph nodes - 3 levels with respect to pectoralis minor
Parasternal LNs - along internal thoracics
Posterior intercostal LNs
Sensory nerve supply to breast?
Anterior and lateral cutaneous branches of 4th-6th intercostal nerves