Clonical Anatkmy Boom Flashcards
Superior angle of scapula level
T2
The suprasternal notch level
T2/3
The spine of scapula level
T3
Angle of Louis level
T4/5
Inferior angle of the scapula level
T8 (overlies 7th rib)
Xiphisternal joint level
T9
The trachea levels
C6 - T4/5
Tracheal bifurcation level
T6
Pleura inferior markings
8th rib in midclavicular line
10th rib in midaxillary line
12th rib in lateral border of erector spinae muscle
Lung inferior markings
6th rib midclavicular line
8th rib midaxillary line
10th posteriorly (adjacent to vertebral column)
Oblique fissure anteriorly
6th costal cartilage anteriorly
The ribs
1-7 connect to the sternum by costal cartilages
8-10 connect with cartilage of the rib above
11-12 floating ribs
Horizontal fissure
4th costal cartilage anteriorly
Costal cartilage - type of cartilage
Hyaline cartilage
At what muscle layer does neurovascular bundle of the ribs lie?
Between internal and innermost intercostal
Ribs neurovascular bundle
VAN
Superior:
Vein
Artery
Nerve
Posterior intercostal arteries are branches of:
Superior intercostal branch of costocervical trunk: 1-2
Descending aorta: 3-11
Intercostal veins are tributaries of:
Azygos and hemiazygos vein
Emergency chest drain:
5th intercostal space, midaxillary line
Medial arcuate ligament
Covers psoas major
Lateral arcuate ligament
Covers quadratum lumborum
Median arcuate ligament
forms the anterior wall of the aortic hiatus (opening in the diaphragm to allow passage of aorta)
Why the referred pain from diaphragm?
Phrenic nerve contains sensory fibres from the central diaphragm. Irritation of diaphragm will cause referred pain to corresponding cutaneous area.
Diaphragm openings
T8 IVC
T10 oesophagus
T12 aorta
T8 diaphragm opening
Aorta, thoracic duct, azygous vein
Lies in the midline
T10 diaphragm opening
Oesophagus, left gastric artery, vein, and both vagus nerves
Lies left of midline
T12 diaphragm opening
IVC, right phrenic nerve
Lies right of midline
Bochdalek hernia
Posterior; through the diaphragm
Morgagni hernia
Anteriorly (between xiphoid and costal origins??)
Sliding vs rolling hiatus hernia:
Sliding- the upper stomach and lower oesophagus slide up (competence of cardia disturbed; regurg, heartburn;bleeding)
Rolling - cardia is in normal position, but fundus rolls up through the hiatus (para-oesophageal hernia)
What is empyema
Pus between two pleural layers
Carotid sheath
Common carotid A
Internal jugular vein
Vagus nerve
Where do bronchial veins drain
Azygos system
Lung innervation
Sympathetic T2-T5 (bronchiodilator; hence use of sympathominetics in asthma)
Parasympathetic (Vagus)-mucus secretion
Oblique sinus of the heart
Between IVC and 4 pulmonary veins
Heart dominance
Depends on which artery gives off posterior descending artery
Transverse sinus of the heart
Between SVC, left atrium, pulmonary truck and aorta (when you put a finger behind aorta and pulmonary trunk)
Blood from placenta to mother
Via umbilical vein (then becomes Ligamentum Teres)
Tetralogy of Fallout
Pulmonary stenosis
Overriding aorta
Ventricular septal defect
Right ventricular hyper trophy
Dysphagia lusoria
swallowing difficulty due to abnormal right subclavian artery passing behind oesophagus
Superior mediastinum
Great vessels (aorta and pulmonary a), trachea, oesophagus, thymus, thoracic duct, vagus, left recurrent laryngeal n, phrenic nerves
L and R vagus relations to oesophagus
Left anteriorly and right posteriorly
Oesophagus layers from outside in
Connective tissue sheath
Muscular layer
Submucosa (containing glands)
Mucosa (stratified epithelium)
Oesophagus lining
stratified squamous epithelium
Stomach lining
Simple columnar epithelium
Muscles of oesophagus
External longitudinal
Internal circular
⁃ Striated in upper 2/3
⁃ Smooth in lower 1-3
Parts of oesophagus:
Superior to inferior
Cervical
Thoracic
Abdominal
Blood supply to oesophagus:
Superior to inferior
Inferior thyroid artery (cervical part)
Descending thoracic aorta (thoracic part)
Left gastric a (abdominal part)
Venous drainage of oesophagus:
Superior to inferior
Inferior thyroid veins (cervical part)
Azygos v (thoracic part)
Left gastric veins (abdominal part)
Oesophagoscopy (points from upper incisor teeth)
7in beginning of oesophagus
11in oesophagus crossed by left bronchus
17in end of oesophagus
Oesophageal stenosis/atresia
Upper oesophagus ends blindly. Lower oesophagus communicates with trachea at T4 level
Carina level
T4/5
Thoracic sympathetic trunk Ganglion
Receives white ramus with preganglionic fibres and gives off grey ramus with postganglionic
Greater splanchnic nerve
T5-T10
Lesser splanchnic nerve
T10-11
Least splanchnic nerve
T13
Sympathetic action on vessels
Vasoconstriction
Inguinal ligament boarders
ASIS and public tubercle
Xiphoid level
T9
Transpyloric plane (of Addison)
L1
Half way bEtween suprasternal notch and top of publis OR hand’s BREADTH below the xiphoid
What passes through transpyloric plane?
(L1)
Pylorus
Pancreatic neck
Duodenojejunal flexure
Gall bladder fundus
Hila of the kidneys
+ spinal cord terminates
Subcostal plane
L3 (inferior margin of 10th rib)
What lies at subcostal plane?
Origin of IMA
Supracristal plane
L4 - summits of iliac crests
What lies at L4 level?
Aortic bifurcation
Liver surface markings
Right 10th rib midaxillary
Right 5th intercostal midaxillary
Left 5th intercostal midclavicular
Spleen surface markings
Left 9th, 10th, 11th rib posteriorly
Which kidney is lower?
R kidney is about 2,5cm lower
Upper pole of the kidney level
Posteriorly, deep to 12th rib
Lower abdominal fasciae
superficial fatty later (of Camper
deep fibrous layer (of Scarpa)
Perineal fascia
Colles’ fascia (from deep fibrous Scarpa’s fascia)
McBurney’s point
2/3rd of a way laterally from umbilicus to ASIS
inguinal canal
Passes between internal and external inguinal rings;
it lies parallel and directly above inguinal ligament
inguinal canal relations
-anterior (external oblique covers fully + internal oblique covers lateral 1/3)
-posterior (conjoint tendon medially, transversalis fascia laterally)
-above (internal oblique and transversus abdominis
- below (lies inguinal ligament)
what is conjoint tendon
fused common insertion of internal oblique and transversus muscles into pubic crest
what does inguinal canal transmit?
male: spermatic cord, ilioinguinal nerve
female: round ligament of uterus, ilioinguinal nerve
layers of the scrotum
some damn enligshman called it the testes:
skin, dartos fascia/muscle, external spermatic f, cremasteric f, internal spermatic f, tunica vaginalis, tunica albuginea
where does external spermatic fascia arise from?
external oblique m
where does cremasteric fascia arise from?
internal oblique m
where does internal spermatic fascia arise from?
transversalis fascia
what does spermatic cord comprises of?
3a (testicular, cremasteric, artery to the vas)
3x (pampiniform plexus, cremasteric v, testicular v)
3n (cremaster n, sympathetic nerves, ilioinguinal n ON the cord, not IN)
3 others (lymphatics, vas deferens, patent processus vaginalis if pathology)
What does patent processus vaginalis signify?
indirect inguinal hernia
indirect inguinal hernia
Passes through internal and external rings, INTO THE SCROTUM (can be reduced + fingertip on internal ring)
direct inguinal hernia
medial to internal ring, pushes directly through posterior wall of inguinal canal
indirect vs femoral hernia
indirect: superior and medial to pubic tubercle
femoral: inferior and lateral to pubic tubercle
hernia’s relation to epigastric vessels
direct hernia is medial to epigastric vessels
indirect hernia is lateral
where is femoral pulse felt?
mid inguinal point (halfway asis and pubic symphysis)
falciform ligament
fold of peritoneum that attaches liver to anterior wall (near umbilicus) - divides liver into right and left lobes
ligamentum teres
obliterated fetal umbilical vein - lies in the free border of falciform ligament
total body water distribution
total body water 70kg x 0.6 = 42L
42L= 1/3 (extracellular fluid) 14L + 2/3 (intracellular fluid) 28L
extracellular fluid 14L = 1/4 (Plasma) 3.5L + 3/4 (interstitial fluid)10.5L
what is lienorenal ligament?
connects kidney and spleen
what is portal triad?
portal vein, hepatic artery, common bile duct
where does the lesser sac open?
into the main peritoneal cavity via the epiploic foramen
Pringle’s manouvre
Squeezing the hepatic artery to reduce bleeding (hepatoduodenal ligament is clamped)
vein of Mayo
marks the junction of pylorus with the duodenum
Duodenal papilla
Guarded by the sphincter of Oddi
Opening of the common bile duct and main pancreatic duct
how to identify duodenojejunal junction?
inferior mesenteric vein descends immediately to the left from duodenojejunal junction
suspensory ligament of Treitz (connects right diaphragm and duodenal termination)
superior pancreaticoduodenal artery arises from?
the gastroduodenal artery
inferior pancreaticoduodenal artery arises from?
superior mesenteric artery
gallstone ileus
small bowel obstruction due to gallstones
posterior duodenal ulcer
might erode gastroduodenal artery posteriorly
+ close relation to pancreas
anatomical relation between duodenum and common bile duct
CBD is immediately posterior to 1st part of duodenum
notch on the lesser curve of the stomnach
incisura angularis
jejunum vs ileum
jejunum: less arcades and longer vessels + valvulae conniventes - circular folds
ileum: more arcades, shorter
how to discern colon from caecum or rectum?
colon has fat filled peritoneal tags - appendices epiploicae
how to discern colon and caecum from rectum?
taniae coli (3 longitudinal smooth muscle ribbons)
what’s the most common position of the appendix?
retrocolic or retrocaecal - 75%
What artery supplies the appendix?
Appendicular artery, branch of ileocolic artery
Valves of Houston
lateral inlfexions in the rectum
imperforate anus
failure of breakdown of the separating membrane between endoderm of hindgut and ectoderm of cutaneous invagination
lining of rectum
upper half: columnar epithelium (adenocarcinoma)
lower half: squamous epithelium (squamous tumour)
Rectum blood supply
upper half: superior rectal artery (from IMA) + superior rectal vein (IMV-> splenic vein -> portal vein)
lower half: inferior rectal artery (internal pudental artery -> internal iliac artery) + inferior rectal vein (internal pudental v -> interna iliac artery)
lymphatics of rectum
upper part of rectum (above mucocutaneous junction) drains to superior rectal vessels to lumbar nodes
lower part: drains to inguinal nodes (groin nodes)
Nerve supply of the rectum
upper anal canal: autonomic plexus
lower anal canal: somatic inferior rectal nerve (branch of pudendal nerve)
internal anal sphincter
involuntary muscle
external anal sphincter
voluntary muscle
haemorrhoids
pathological engogrements of submucosal arterovenous cushions
haemorrhoids grades
grade 1 - contained to the anal canal
grade 2 - come out during defecation but spontaneously reduce
grade 3 - need to be reduced manually
grade 4 - cannot be manually reduced
most common type of anal fistula?
low level (passing through the lower part of external sphincter)
origin level of Coeliac axis
T12
foregut blood supply
coeliac axis
midgut blood supply
Superior mesenteric artery
hindgut blood supply
inferior mesenteric artery
origin of SMA
L1
origin of IMA
L3
portal venous system
Inferior mesenteric vein joins splenic vein
then splenic vein joins superior mesenteric vein behind the NECK of the pancreas
how can portal system be blocked (portal hypertension)?
Prehepatic: thrombosis of portal vein
Hepatic: cirrhosis
Posthepatic: congenital stenosis of hepatic veins
What are the possible communications between portal and systemic circulations?
oesophageal varices
rectal
liver - caput medusae
oesophageal varices
oesophageal branch of left gastric vein and oesophageal veins of the azygous system
rectal communication of portal and systemic circulation
superior rectal branch of IMA and inferior rectal veins (draining into internal iliac vein)
caput medusae
connection between portal branches in the liver and veins of abdominal wall (along the falciform ligament of umbilicus)
oesophageal mucosa and lower anal canal lining
stratified squamous epithelium
alimentary tract lining
columnar epithelium
pyloric antrum
secretes alkaline juice and gastrin
body of the stomach secretions
pepsin and HCl (oxyntic cells)
Brunner’s glands
submucosal glands of the duodenum
Meissner autonomic nerve plexus
lies in submucosal layer
Auerbach autonomic nerve plexus
lies between circular and longitudinal muscle coats
the alimentary tract boundaries
foregut - up to entry of bile duct into the duodenum
midgut - up to the distal transverse colon
hindgut - up to ectodermal part of anal canal
Meckels’s diverticulum
remains embryonic vitellointestinal duct (communication between primitive midgut and yolk sac)
Examphalos
midgut herniation at the umbilicus after birth
ligamentum teres
obliterated remains of left umbilical vein
ligamentum venosum
Fibrous remnant of the foetal ductus venosus (shunts oxygenated blood from left umbilical vein to IVC)
Porta hepatis (anatomy)
the common hepatic duct–anteriorly and to the right;
the hepatic artery–anteriorly and to the left;
the portal vein–posteriorly
falciform ligament
from umbilicus to the liver; bears ligamentum teres in its free border
