Edissector Notecards

Question 1

The retroperitoneal space contains

Answer 1

Kidneys, ureters, adrenal glands, abdominal aorta, and inferior vena cava

Question 2

The kidneys extend between what levels

Answer 2

T12 and L3 vertebrae

Right is slightly lower than the left because of the position of the liver

Question 3

The right kidney is in contact with
The left kidney is in contact with
Posterior structures to kidneys

Answer 3

Serosal surface of the liver, the second part of the duodenum, the right colic flexure and the jejunum

Stomach, spleen, tail of pancreas, left colic flexure and jejunum

11th and 12th ribs, along with subcostal (T12) and iliohypogastric (L1) nerves. The muscles that form the posterior abdominal wall are directly behind the kidneys: the diaphragm, the psoas major, quadratus lumborum, and aponeurosis of the transversus abdominis muscle

Question 4

Vasculature of the kidneys

Answer 4

Short right renal vein
Right renal artery is posterior to the right renal vein and IVC. Right renal artery is longer than the left renal artery
The renal pelvis lies posteriorly to the right renal artery
The left renal vein crosses anterior to the renal arteries and abdominal aorta and is longer than the right renal artery
Left renal artery lies posterior to the left renal vein
Arteries usually divide before reaching the hilum and accessory arteries are common

Question 5

The renal hilum

Answer 5

Concave medial margin of the kidney containing, from anterior to posterior, the renal vein, the renal artery, and the renal pelvis

Question 6

Nutcracker syndrome

Answer 6

The course of the left renal vein leaves it susceptible to compression between the abdominal aorta and superior mesenteric artery, similar to how a nutcracker operates. This impedes blood flow out through the renal vein and can lead to hematuria and flank pain.

Question 7

course of the ureters

Answer 7

Leave the hilum and pass posterior to the testicular or ovarian vessels and crosses the anterior surface of the psoas major muscle
The pelvic part of the ureter crosses the common or external iliac artery near bifurcation. Remaining deep to the peritoneum, it descends along the lateral wall of the pelvis and curves anteromedially to the base of the bladder

Question 8

Branches to the left renal vein

Branches of the left renal artery

Answer 8

Testicular/ovarian or the left suprarenal veins drain into it

Left renal artery branches to the ureter and suprarenal glands

*note testicular/ovarian vein drain into IVC on the right

Question 9

abdominal aorta has three types of branches

Answer 9

Unpaired arteries to the GI tract- celiac trunk, superior mesenteric artery, inferior mesenteric artery
Paired arteries to the three pairs abdominal organs- suprarenal, renal, testicular/ovarian arteries
Paired arteries to the abdominal wall- inferior phrenic and lumbar arteries

Question 10

lumbar artery

Answer 10

Four pairs of lumbar arteries supply the posterior abdominal wall
From the posterior aspect of the aorta passing deep to the psoas major muscle

Question 11

Where does the abdominal aorta bifurcate

Answer 11

L4

Common iliac arteries arise from this bifurcation- supply blood to the pelvis and lower limbs

Question 12

Ureteric arterial supply in the clinic

Answer 12

Arterial supply top the abdominal portion of the ureters arises from renal arteries, and less commonly from gonadal arteries, abdominal aorta, or common iliac arteries.
The ureteric arteries are small and delicate and may be damaged during surgery when ureters are retracted. Loss of blood supply can result in necrosis and urinary obstruction

Question 13

Suprarenal glands in the clinic

Answer 13

If kidneys fail to ascend to its normal position during development, the suprarenal gland develops in its normal position lateral to the celiac trunk

Question 14

Surface of the bladder covering

The wall consists of

Answer 14

The superior surface is covered by peritoneum; the posterior surface is covered by peritoneum and its superior part and by endopelvic fascia on its inferior part and the two inferolateral surfaces are covered by endopelvic fascia

Bundles of smooth muscle called the detrusor muscle

Question 15

The apex of the bladder
The body
The fundus
The neck
Trigone- definition and covering

Answer 15

Directed toward the anterior abdominal wall and attached to Urachus/median umbilical ligament.
Body is between the apex and fundus
The fundus is called the base of the bladder
The neck is where the urethra exits the bladder. Here the wall thickens to form the internal urethral sphincter
The mucous membrane lining all parts of the bladder is thrown into folds to accommodate expansion except for the mucous membrane over the trigone, which is smooth. The angles of the trigone are the internal urethral orifice and the two orifices of the ureter (making up the floor of the bladder)

Question 16

Three portions of urethra in male

Answer 16

Prostatic urethra, membranous urethra, and spongy/penile urethra
The tip of the urethral orifice is at the tip of the glans penis

Question 17

Parts of the kidney:

Renal capsule, renal cortex, renal medulla, renal sinus, renal papilla, minor calyx, major calyx, renal pelvis, ureter

Answer 17

Capsule- a fibrous capsule that covers kidney surface
Cortex- outer zone of kidney- 1/3 of its depth
Medulla- inner zone of kidney consists of pyramid and columns 2/3rd of its depth
Sinus- space within kidney that occupies renal pelvis, calices, vessels, nerves and fat
Papilla- apex of renal pyramid projects into minor calyx
Minor calyx- cup-like chamber that is beginning of extrarenal duct system. Several combine to form a major calyx.
Major calyx- two or three per kidney that combine to form renal pelvis
Renal pelvis- funnel-like end of ureter that lies within renal sinus
Ureter- muscular duct that carries urine from kidney to bladder

Question 18

Kidney stones

Answer 18

Renal calculus may form in the calyces and renal pelvis. Small kidney stones may spontaneously pass through the ureter into the urinary bladder. Larger ones may lodge at one of three natural constrictions of the ureter: where the renal pelvis joins the ureter, where the ureter crosses the pelvic brim, and at the entrance of the ureter into the urinary bladder

Question 19

Central tendon of diaphragm

Answer 19

Tendon is aponeurotic and shaped like a boomerang into which muscle fibers are inserted from all parts of the circumference of the inner aspects of the body wall. Dense, fibrous and the pericardium is firmly attached to its upper surface

Question 20

Sternal part of diaphragm
Costal part
Lumbar part

Answer 20

Consists of two small Muscular slips arising from posterior surface of xiphoid process
Arises from deep surfaces of lower 6 costal cartilages on each side and inserts into the central tendon. The two costal parts form the right and left domes of the diaphragm
Arises as two crura from anterolateral surfaces of the first three lumbar vertebrae on the right and first two lumbar on the left, including their IV discs. Both crura embrace the aorta as it enters the abdominal cavity at the aortic hiatus and are joined by a tendinous band, the median arcuate ligament.

Question 21

The right crus of the diaphragm

Answer 21

Larger and longer, extending from it L1-L3 and distally to central tendon. The esophageal hiatus is an opening in the right crus of the diaphragm at T10. The right crus muscle fibers decussate and surround the esophageal hiatus

Question 22

The left crus of the diaphragm

Answer 22

Smaller, from L1-L2 and passes to the left of the esophageal hiatus

Question 23

The arcuate ligaments

Answer 23

Thickening of fascia that serve as proximal attachments for some muscle fibers of the diaphragm:

• the paired lateral arcuate ligament bridges the anterior surface of the quadratic lumborum muscle
• the paired medial arcuate ligament bridges the anterior surface of the psoas major muscle
• the unpaired median arcuate ligament bridges the anterior surface of the aorta at the aortic hiatus

Question 24

three openings in the diaphragm

Answer 24

Vena caval foramen passes through the central tendon at T8
Esophageal hiatus passes through the right crus of the diaphragm at T10
Aortic hiatus passes behind the diaphragm at T12

Question 25

Nerve supple to abdominal surface of diaphragm

Answer 25

Right and left phrenic nerves- each phrenic nerve provides motor innervation to one half of the diaphragm (hemidiaphragm). They supply most of the sensory innervation to the parietal peritoneum (abdominal) and parietal pleura (thoracic) surfaces of the diaphragm The pleural and peritoneal coverings of the peripheral part of the diaphragm receive sensory fibers from the lower intercostal nerves T5-T11 and the subcostal nerve.

Question 26

Efferent and afferent fiber levels that make up the phrenic nerve

Answer 26

C3-C5

Question 27

Arteries over the surface of each hemidiaphragm

Answer 27

The superior phrenic arteries arise from the thoracic aorta while the inferior phrenic arteries arise immediately from the abdominal aorta below the diaphragm

Question 28

Diaphragm in the clinic- referred pain and paralysis

Answer 28

Phrenic nerves arise from cervical spinal cord segments C3-C5. Therefore, pain from the diaphragm is referred to the shoulder region (supraclavicular nerve territory). The diaphragm is paralyzed in cases of high cervical (above C3) spinal cord injuries, but it is spared in low cervical spinal cord injuries. A paralyzed hemidiaphragm cannot contract (descend), so it will appear high in the thorax and chest radiograph.

Question 29

Naris

Answer 29

External opening of nose, separated by lower border of nasal septum Nasal cavity begins as naris and extends to choana, the opening of the nasopharynx

Question 30

nasal cavity separation

Answer 30

The nasal septum, composed of cartilage and bone and covered by mucous membrane, separates the two nasal cavities.

Question 31

Lateral wall of nasal cavity projections

Answer 31

Conchae- curved shelves of bone covered by mucous membrane that project from lateral nasal wall and greatly increase the respiratory surface of the nose Inferior concha is the longest, middle concha, and superior concha is the shortest

Question 32

What separates the nasal cavity from the oral cavity

Answer 32

Soft palate

Question 33

The pharynx

Answer 33

Continuation of the digestive system posterior to the nasal and oral cavities, extending inferiorly posterior to the larynx to the beginning of the esophagus. The pharynx extends from base of the skull to the inferior border of the cricoid cartilage anteriorly and inferior border of C6 posteriorly.

Question 34

3 parts of the nasopharynx

Answer 34

Nasopharynx- posterior to the choanae and superior to the soft palate oropharynx- posterior to the tongue between soft palate and epiglottis laryngopharynx- continuous with oropharynx at the upper border of the epiglottis and narrows rapidly below at the level of the cricoid cartilage to become continuous with the esophagus at the border of the cartilage

Question 35

larynx | Laryngeal cavity extends

Answer 35

Extends from epiglottis anterior to laryngopharynx and inferiorly to the lower border of the cricoid cartilage where it becomes continuous with the trachea From the laryngeal inlet (aditus) to the lower border of the cricoid cartilage where it continues with the trachea. Divided into 3 major parts: - vestibule, extends from laryngeal inlet to vestibular folds. The aperture between the vestibular folds is the rima vestibuli. - ventricle, or laryngeal sinus, is the recess between the vestibular and vocal folds. The aperture between the vocal folds is the rima glottidis: it is the narrowest part of the larynx and varies with movement of vocal cords during respiration and phonation. - the infraglottic cavity extends from vocal folds to lower border of cricoid cartilage.

Question 36

The portion of the pleura in direct contact with the lung, completely covering it Transitions into

Answer 36

Visceral pleura As the visceral pleura reflects off the lungs and onto the inner wall of the thoracic cavity, it is called parietal pleura The transition between these two is called the root of the lung,

Question 37

Root of the lung contains

Answer 37

The primary bronchus Pulmonary artery Pulmonary veins

Question 38

Pleural cavity

Answer 38

In living body- Potential space and the visceral pleura touches the parietal pleura Normally only contains a thin film of serous fluid that lubricates the serous surfaces and allows free movement of the lungs within the pleural cavity

Question 39

Subdivisions of the parietal pleura

Answer 39

Costal parietal pleura- lines inner surface of thoracic wall Mediastinal parietal pleura- lines mediastinum Diaphragmatic parietal pleura- lines superior surface of the diaphragm Cervical parietal pleura (cupula)- extends superior to the first rib

Question 40

Lines of pleural reflection Pleural recesses

Answer 40

Sharply folded areas where different divisions of parietal pleura meet. The lines are acute, and the inner surfaces of the parietal pleurae are usually in contact with one another The potential spaces where parietal pleura contacts parietal pleura are called pleural spaces. Two costomediastinal recesses are posterior to sternum between costal parietal pleura and mediastinal parietal pleura. Two costodiaphragmatic recesses are located at the most inferior limits of the parietal pleura between the coastal parietal pleura and the diaphragmatic parietal pleura. *during inspiration, the inferior border of the lungs do not extend into the costodiaphragmatic recesses.

Question 41

The mediastinal pleura is continuous with the visceral pleura at

Answer 41

The root of the lung- attaches to the mediastinum. *All other parts of the lung should slide freely against the parietal pleura. Pleural adhesions may occur between visceral and parietal pleurae. Pleural adhesions are the result of disease processes.

Question 42

Pleural cavity in the clinic

Answer 42

Under pathological conditions, the potential space of the pleural cavity my becomes a real space. If air enters the pleural cavity (pneumothorax), the lung collapses due to the elastic recoil of its tissue. Excess fluid may accumulate in the pleural cavity, compress the lung, and produce breathing difficulties. The fluid can be serous fluid (plural effusion) or blood resulting from trauma (hemothorax)

Question 43

Pleural effusion in the clinic

Answer 43

Only a thin layer of fluid normally separates the two layers of the pleura. Fluid can accumulate in the pleural space as a result of a large number of disorders, including infections, injuries, heart failure, cirrhosis, or liver failure, pneumonia, blood clots in lung blood vessels (pulmonary emboli), cancer and drugs. Symptoms may include difficulty breathing and chest pain, particularly when breathing and coughing. Diagnosis by chest x-ray, lab testing of fluid, CT scans. Large amounts of fluid are drained with a tube inserted into the chest

Question 44

Pleural tap (thoracocentesis)

Answer 44

The aspiration of pathological material from the pleural cavity (serous fluid, fluid mixed with tumor cells, blood, pus, etc) may be done through the intercostal space. The pleural tap is performed in the mid axillary line or slightly posterior to it, usually at spaces 6,7 or 8 to avoid penetrating abdominal viscera. A large-bore needle is inserted low in intercostal space to avoid injury to the intercostal nerve and vessels.

Question 45

What surface of the lung can you see in situ?

Answer 45

The costal surface

Question 46

The oblique fissure lies deep to what rib The horizontal fissure lies deep to what rib

Answer 46

Lies deep to the fifth rib laterally and that is deep to the sixth costal cartilage anteriorly. AKA the major fissure. The horizontal fissure lies deep to the fourth rib and fourth costal cartilage. AKA minor fissure

Question 47

What occupies the cupula of the pleura?

Answer 47

The apex of the lung- both sides rise as high as the neck of the first rib. Therefore, the apex of the lung and the cupula of the pleura lie superior to the plane of the superior thoracic aperture and are actually located in the neck Superior thoracic aperture is bordered by the superior border of the manubrium, first pair of ribs, and superior border of the first thoracic vertebra

Question 48

Course of the phrenic nerve | Course of vagus nerve

Answer 48

Passes inferiorly in connective tissue between the mediastinal parietal pleura and the fibrous pericardium anterior to the root of the lung Vagus nerve passes posterior to the root of the lung in the same connective tissue plane

Question 49

Irritation of the pleura in the clinic

Answer 49

Parietal pleura is innervated with pain fibers that originate from either intercostal or phrenic nerve. Can manifest differently depending on which part is involved. The visceral pleura is innervated by autonomic nerves and has no pain fibers

Question 50

The pulmonary plexus

Answer 50

Autonomic plexus formed from pulmonary branches of the vagus nerve and sympathetic trunk

Question 51

The pleural sleeve

Answer 51

The root of the lung, making up the transition between the mediastinal parietal pleura adhering to the fibrous pericardium and the visceral pleura on the lung surface. Covers the main bronchus, pulmonary artery, and pulmonary veins.

Question 52

Components in the root of the lung positioning

Answer 52

Pulmonary arteries and veins are anterior to the main bronchus, with the pulmonary artery superior to the vein. As these structures approach the lung and divide into their lobar branches, this order becomes mixed.

Question 53

Most of the inferior lobe lies | Most of the superior lobe lies

Answer 53

Posteriorly | Anteriorly

Question 54

Pinholes on the main bronchus at the hilum of the lung are from

Answer 54

The bronchial arteries, supplying lungs with oxygenated blood from the thoracic aorta.

Question 55

Right lung bronchi divisions Left-Main bronchus divides into blank at what position?

Answer 55

Primary/main bronchus- to each lung Secondary/lobar bronchus- to each lobe: right has a superior, middle and inferior lobar bronchi. *the superior lobar bronchus passes superior to the right pulmonary artery, so it is called the eparterial bronchus* Divide into lobar bronchi at the posterior position in the hilum of the left lung. The left pulmonary artery divides into lobar arteries at the superioanterior position. The left pulmonary veins enter the hilum at the interioanterior position.

Question 56

Innervation of the lungs

Answer 56

Anterior and posterior pulmonary plexuses. Sympathetic contributions from right and left sympathetic trunks, while parasympathetic are from right and left vagus nerves.

Question 57

The right vagus nerve lies

Answer 57

Deep (medial) to the mediastinal parietal pleura overlying the trachea Passes posterior to the root of the lung, unlike the phrenic nerve which passes anterior to the root of the lung.

Question 58

Arch of the azygos vein passes | What nerve passes near it?

Answer 58

Superior to the right main bronchus to drain into the superior vena cava. The right vagus nerve passes medial to the arch of the azygos vein.

Question 59

Compare the right and left main bronchus The trachea bifurcates within what plane What is inside the tracheal bifurcation?

Answer 59

The right is larger in diameter, shorter and oriented more vertically than the left main bronchus. *the right lung is shorter, but has greater volume than the left lung* The horizontal plane passing through the sternal angle The carina- specialized piece of tracheal cartilage.

Question 60

Bifurcation of the trachea in the clinic

Answer 60

During bronchoscopy, the carina serves as an important landmark because it lies between the superior ends of the right and left main bronchi. The carina is usually positioned slightly to the left of the median plane of the trachea. When foreign bodies are aspirated, they usually enter the right main bronchus because of leftward position of the carina, and because of the fact that the right main bronchus is wider and more vertically oriented than the left main bronchus.

Question 61

Boundaries of the posterior mediastinum

Answer 61

``` Superior- horizontal plane through the sternal angle (T4-T5) Posterior- bodies of vertebrae T5-T12 Anterior- pericardium Lateral- mediastinal parietal pleura Inferior- diaphragm ```

Question 62

Oblique pericardial sinus

Answer 62

Formed by reflection of serous pericardium onto the pulmonary veins

Question 63

Esophagus | Thoracic aorta orientation

Answer 63

The esophagus sits just to the right of the midline The thoracic aorta is slightly left and posterior to the esophagus The esophagus lies immediately posterior to the left atrium and part of the left ventricle- transesophageal echo*

Question 64

The right vagus nerve is found and makes up Left vagus nerve is found and makes up

Answer 64

In the angle formed by the arch of the azygos and the SVC. Follows posteriorly to the root of the lung on the right. These nerve fibers spread out mostly on the posterior surface of the esophagus. Crosses the left side of the arch of the aorta. Follows posteriorly to the root of the lung on the left and its fibers spread out mostly on the anterior part of the esophageal plexus

Question 65

Near the diaphragm, fibers of the esophageal plexus come together to form

Answer 65

The anterior and posterior vagal trunks. The trunks are found on the inferior part of the esophagus, just before they pass through the diaphragm to innervate a large part of the GI tract.

Question 66

The arch of the azygos arches where Positioning of thoracic duct- course

Answer 66

Superior to the root of the right lung. Follow posteriorly to the azygos vein Retract the esophagus to the left and look at the area between the azygos vein and the thoracic aorta. The duct lies immediately left to the azygos vein, posterior to the esophagus. Thin walled and easily torn and looks like a small vein without blood in it. Passes through the diaphragm with the thoracic aorta. Drains superiorly into the junction of the left internal jugular vein and left subclavian vein.

Question 67

Posterior intercostal vein are tributaries to

Answer 67

Right side- tributaries to the azygos vein Left side- drain into the hemiazygos vein or accessory azygos vein. These veins cross the bodies of the ninth and eighth thoracic vertebae, respectively, and terminate by draining into the azygos vein

Question 68

Posterior intercostal arteries

Answer 68

Branch from the thoracic aorta to their intercostal spaces. The right posterior intercostal arteries cross the midline on the anterior surface of the vertebral bodies

Question 69

The sympathetic trunk crosses Ganglion Communicates

Answer 69

The heads of ribs 2-9. Inferior to rib 9, the trunk lies on the sides of the thoracic vertebral bodies. It has one sympathetic ganglion for each thoracic level. Two rami communicates connect each intercostal nerve with its corresponding thoracic sympathetic ganglion, (more lateral one is white)

Question 70

Greater splanchnic nerve receives contributions from | Lesser splanchnic nerve arises from

Answer 70

The fifth through the ninth thoracic sympathetic ganglia and it is not completely formed until lower thoracic levels. It is found on the sides of the vertebral bodies T5-T9,, while the sympathetic trunk crosses the heads of ribs 5-9 (posterior to the greater splanchnic nerve. The 10th and 11th thoracic sympathetic ganglia. The least splanchnic nerve arises from the 12th ganglia.