Exam 1

Question 1

fibrous pericardium

Answer 1

• most superficial layer of the pericardial sac
• made of strong fibrous CT

Question 2

what is tamponade? how does it occur and what are the clinical manifestations/symptoms? when is one at risk?

Answer 2

pressure on the heart muscle

fibrous pericardial sac is non-distensible so effusion of fluid into the pericardial cavity results in tamponade

decreases venous return and cardiac output

manifests as Kussmaul’s sign (distension of neck veins during inspiration)

at risk 24-48 hrs after heart surgery from clots in chest tubes draining blood

can be treated by pericardiocentesis

Question 3

parietal pericardium

Answer 3

• layer of serous pericaridal sac adherent to fibrous pericardium

Question 4

visceral pericardium

Answer 4

• inner layer of the serous pericardial sac

Question 5

epicardium

Answer 5

• visceral pericardium that touches the heart
• produces pericardial fluid

Question 6

where are visceral and parietal pericardium continuous?

Answer 6

pulmonary veins, SVC, IVC, and great arteries

Question 7

what are the two pericardial sinuses and where are they?

Answer 7

recesses of the pericardial cavity situated between vessels of the heart

1. transverse pericardial sinus- posterior to ascending aorta and pulmonary trunk and anterior to SVC
2. oblique sinus- inferior to pulmonary veins and left of the IVC (posterior to heart)
   - neither are continuous

Question 8

where does the right coronary artery course, what does it branch into, and what does it supply?

Answer 8

courses in the coronary sulcus and supplies the right atrium, right ventricle, and part of LBBB

branches into the nodal branch, marginal branch, and if dominant the posterior interventricular artery

Question 9

coronary sulcus

Answer 9

divides the atria and ventricles

Question 10

nodal branches of R coronary artery supplies?

Answer 10

SA and AV nodes

Question 11

marginal branch of R coronary artery supplies?

Answer 11

Right ventricle

Question 12

posterior interventricular artery/posterior descending (PDA) courses where and supplies what?

Answer 12

courses in the posterior interventricular sulcus and supplies the L and R ventricles, 1/3 of the posterior interventricular septum, and a branch to the AV node

Question 13

where does the left coronary artery originate, what does it branch into and what does it supply?

Answer 13

it is a short artery that branches within 1 cm of its origin at the left aortic sinus

branches into the anterior interventricular artery/left anterior decending (LAD) and circumflex (LCX)

supplies L and R ventricles, 2/3 of interventricular septum (including AV bundle), L atrium, RBB and part of LBB

Question 14

where does the LAD course and what does it supply?

Answer 14

courses in the anterior interventricular sulcus

supplies the R and L ventricles and 2/3 of the interventricular septum, including the AV bundle

Question 15

where does the circumflex artery course and what does it supply?

Answer 15

courses in the coronary sulcus

supplies the L atrium and L ventricle

branches into the obtuse marginal artery

Question 16

where do coronary artery anastomoses occur?

Answer 16

a. RCA anatomoses with circumflex of LCA after RCA gives rise to posterior interventricular artery
b. LAD hooks around apex to anastomose with posterior interventricular artery

Question 17

where are common sites of coronary occulsion?

Answer 17

1. proximal part of LAD
2. RCA (proximal)
3. circumflex branch of LCA
4. Left main

Question 18

where is pain referred to from the heart and how?

Answer 18

afferent pain fibers in heart enter at T1-T4 or T5 on the left side resulting in angina pectoris pain on the left side of the best and medial aspect of the upper arm and forearm (T1 dermatome)

Question 19

which vessels enter the right atrium?

Answer 19

SVC and IVC as well as ostium of coronary sinus and openings of anterior cardiac veins

Question 20

sinus venarum

Answer 20

smooth walled part of the R atrium which is remnant of sinus venosus

makes up the SA node and coronary sinus

Question 21

crista terminalis

Answer 21

separates sinus venarum from part with pectinate muscles

looks like a thick portion of heart muscle in a crescent shape at the opening into the right auricle

origin of the pectinate muscles

Question 22

pectinate muscles

Answer 22

parallel ridges in the rough-walled part of the atria of the heart (anterior wall and auricle)

Question 23

fossa ovalis

Answer 23

in the interatrial septum of R atrium

remnant of foramen ovale

Question 24

foramen ovale

Answer 24

in fetal life it permits oxygenated blood to bypass lungs by shunting blood from right to left atrium

Question 25

tricuspid valve

Answer 25

separates the R atrium from the R ventricle in the right AV orifice three leaflets (anterior, posterior, septal with anterior facing closest to you)

Question 26

trabeculae carneae

Answer 26

rounded or irregular muscular columns which project from the inner surface of the right and left ventricles of the heart (rough-walled part)

Question 27

conus arteriosis/infundibulum

Answer 27

conical pouch representing entrance from the right ventricle into the pulmonary artery and pulmonary trunk. wall of the infundibulum is smooth

Question 28

right papillary muscles

Answer 28

anterior/great, posterior, septal when contracted prevents prolapse of tricuspid valve

Question 29

septomarginal trabecula or moderator band

Answer 29

extends base of anterior papillary in R ventricle to interventricular septum and contains RBB of AV bundle

Question 30

which valve separates the RV from the pulmonary trunk?

Answer 30

pulmonic semilunar valves

Question 31

which part of the left atrium has pectinate muscles?

Answer 31

auricle (rough-walled)

Question 32

which vessels empty into the left atrium?

Answer 32

the 4 pulmonary veins (2 to each lung)

Question 33

mitral valve/bicuspid valve

Answer 33

closed by anteriomedial and posteriolateral leaflets separate the L atrium and L ventricle

Question 34

mitral valve stenosis a. where can the heart sound be best heard b. what heart changes occur c. what happens in the lungs d. what is a common complication

Answer 34

a. can be heart at left 5th intercostal space slightly medial to mid-clavicular line b. as result the the left ventricle regurgitates into the left atrium causing its enlargement c. if further progressive narrowing of the orifice occurs, blood builds up in left atrium causing pulmonary congestion in the lungs (pulmonary hypertension) and strain on the right side of the heart--\>R ventricle hypertrophies d. blood clots are common complication and if dislodged from the LV can enter systemic circulation--\>carotid arteries--\>brain--\>stroke

Question 35

aortic vestibule

Answer 35

smooth walled part of L ventricle to ascending aorta through aortic semilunar valve

Question 36

aortic semilunar valve

Answer 36

right, left and posterior cusps

Question 37

left papillary muscles

Answer 37

two: anterior and posterior with chordae tendineae attached to leaflets of mitral valve which contract during ventricular contraction

Question 38

SA node

Answer 38

pacemaker (70 bpm) in sinus venarum of right atrium near entrance of SVC initiates wave of depolarization--\>atria contract

Question 39

AV node

Answer 39

in interatrial septum near right AV orifice stimulated by depolarization of atria muscles delays waveof depolarization from passing to ventricles until atria fully contract rate of 50-60 bpm

Question 40

AV bundle of His

Answer 40

passes into interventricular septum divides into RBB and LBB causes paillary muscles to contract

Question 41

Purkinje fibers

Answer 41

spread depolarization to R and L ventricles (the septomarginal trabecula/moderator band carries purkinje fibers from RBB to base of anterior papillary muscle)

Question 42

what occurs with an AV block?

Answer 42

conduction is slowed through the AV node or is not transmitted complete AV block: contraction of atria and ventricles dissociated and chambers beat independently atria may continue to contract about 70 bpm and pacemaker may develop in the AV bundle distal to site of block so that contraction of ventrcles occurs at rate of 30-40 bpm

Question 43

coronary sinus

Answer 43

largest venous channel of the heart located in the coronary sulcus and passes to the posterior surface of the heart, just below IVC the major veins of the heart empty into the coronary sinus which inturn empties directly into the right atrium

Question 44

great cardiac vein

Answer 44

runs from apex superiorly along anterior interventricular sulcus and veers left to empty into coronary sinus

Question 45

middle cardiac vein

Answer 45

travels with the posterior interventricular artery in the posterior interventricular sulcus

Question 46

small cardiac vein

Answer 46

drains blood from posterior and lateral R ventricle runs along the margin of the heart (coronary sulcus) with the marginal branch of the right coronary artery will meet up posteriorly with great cardiac vein to coronary sinus

Question 47

anterior cardiac veins

Answer 47

drain blood directly from anterior R ventricle to R atrium

Question 48

where does the heart get its parasympathetic innervation?

Answer 48

preganglionic parasympathetic axons from vagus nerve synpase in terminal ganglia then postganglionic parasympathetic axons from terminal ganglia in cardiac plexus synpase in SA node, AV node, and walls of coronary arteries

Question 49

where does the heart get its sympathetic innervation?

Answer 49

postganglionic sympathetic axons from cervical and upper thoracic splanchnic nerves (which have cell bodies in superior, middle, and infervior cervical paravertebral ganglia and in the T1-T5 paravertebral ganglia) synpase in SA and AV nodes and walls of coronary arteries

Question 50

how are the cardiac plexus sensory fibers carried back to the CNS?

Answer 50

a. sensory fibers innervate varoreceptors and chemoreceptors in the heart and aortic arch which course back to CNS with vagus nerve b. pain sensations are carried back with synpathetic nerves and enter CNS from T1-T5 (which is why pain is reffered to T1-T5 dermatomes ex. angina pectoris)

Question 51

what are the heart sounds and what do they correspond to?

Answer 51

cuased by acceleration/deceleration of blood flowing through valve S1: closing of mitral/tricuspid valve (beginning of systole) S2: closing of aortic/pulmonary valve (end of systold and beginning of diastole)

Question 52

where do you put the stethoscope to best hear the heart sounds?

Answer 52

1. Aortic region (between the 2nd and 3rd intercostal spaces at the right sternal border) (RUSB – right upper sternal border) 2. Pulmonic region (between the 2nd and 3rd intercostal spaces at the left sternal border) (LUSB – left upper sternal border) 3. Tricuspid region (between the 3rd, 4th, 5th, and 6th intercostal spaces at the left sternal border) (LLSB – left lower sternal border) 4. Mitral region (near the apex of the heard between the 5th and 6th intercostal spaces in the mid-clavicular line) (apex of the heart)

Question 53

what are the structures of the foregut?

Answer 53

lower esophagus, spleen (mesodermal derivative), liver, gallbladder, biliary ducts, stomach, pancreas, prox 1/2 of duodenum

Question 54

which artery supplies the foregut?

Answer 54

celiac artery

Question 55

where does the celiac artery originate from and branch into?

Answer 55

branches from abdominal aorta just inferior to aortic hiatus of diaphragm in 1 cm it divides into the a. splenic artery b. left gastric artery c. common hepatic artery

Question 56

what does the splenic artery supply? (include branches)

Answer 56

1. spleen 2. neck, body, tail of pandreas 3. left side of greater curvature of stomach (by left gastroepipolic/omental artery) 4. fundus of stomach (by short gastric arteries)

Question 57

what does the left gastric artery supply?

Answer 57

1. most of lesser curvature of stomach 2. abdominal part of esophagus

Question 58

which artery is subject to erosion by ulcer in the lesser curvature of the stomach?

Answer 58

left gastric artery

Question 59

what does the common hepatic artery branch into?

Answer 59

1. proper hepatic artery 2. gastroduodenal artery

Question 60

what does the proper hepatic artery supply? (include branches)

Answer 60

1. lesser curvature of stomach (R gastric artery) 2. liver (R and L hepatic arteries) 3. gallbladder (cystic artery, off of the R hepatic artery)

Question 61

what does the gastroduodenal artery supply? (include branches)

Answer 61

1. foregut part of duodenum 2. superior head of pandreas (by anterior and posterior superior pancreaticoduodenal arteries) 3. right side of greater curvative (R gastroepiploic/omental artery)

Question 62

which artery is subject to erosion by ulcer of duodenum?

Answer 62

gastroduodenal artery from the common hepatic

Question 63

peritoneal

Answer 63

generally mobile, suspended by mesentery

Question 64

which structures are peritoneal?

Answer 64

stomach, first 1/3 of duodenum (1st part), jejunum, ileum, cecum, appendix, transverse colon, sigmoid colon, superior rectum, liver, spleen, tail of pancreas

Question 65

secondarily retroperitoneal

Answer 65

in fetal life suspended by mesentery, but lost in development

Question 66

which structures are secondarily retroperitoneal?

Answer 66

distal duodenum inferior to entrance of bile duct (2nd-4th parts), ascending colon, descending colon, head/neck/body of pancreas "PADD" (pancreas, ascending, descending, duodenum)

Question 67

primarily retroperitoneal

Answer 67

were never suspended by mesentary

Question 68

which structures are primarily retroperitoneal?

Answer 68

kidneys, adrenal glands, ureter, bladder, aorta, IVC, esophagus (thoracic) and rectum

Question 69

which structures are retroperitoneal?

Answer 69

SAD PUCKER supradrenal glands, aorta/IVC, duodenum (second and third segments), pandreas (except tail), ureters, colon (only ascending and descending), kidneys, esophagus, rectum

Question 70

which ligaments suspend the spleen?

Answer 70

gastrosplenic and splenorenal ligaments

Question 71

which arteries and veins supply/drain blood from spleen?

Answer 71

Splenic artery reaches spleen by coursing posterior to stomach and superior to pancreas (very kinked) Drained by splenic vein which is posterior to body and tail of pancreas

Question 72

what are the functions of the liver?

Answer 72

exocrine gland: produces and secretes bile into the biliary duct system endocrine gland: plasma proteins, release of glucose/lipoproteins processes nutrients, regulates glucose, detoxifies drugs/toxins, stores triglycerides and vitamin A

Question 73

which ligaments suspend the liver?

Answer 73

falciform ligament (ends inferiorly at umbilicus), coronary ligament, and lesser omentum (lesser curvature of stomach to liver)

Question 74

round ligament of uterus/ligamentum teres hepatis

Answer 74

at inferior end of falciform ligament remnant of fetal umbilical vein

Question 75

what are the four anatomic lobes of the liver and what separetes?

Answer 75

1. left 2. right 3. quadrate 4. caudate falciform ligament and ligamentum venosum (remnant of fetal ductus venosus) separate anatomic left and right

Question 76

what are the two functional lobes of the liver and what do they include?

Answer 76

1. func left: left lobe, quadrate, and caudate 2. func right: right and part of caudate contain separate arterial blood, venous drainage, and biliary drainage separated by interconnecting gallbladder and IVC

Question 77

what is contained in the porta hepatis and where is it located?

Answer 77

portal triad= hepatic ducts, portain vein (70% of blood) and proper heptic (30%) in the hepatoduodenal ligament

Question 78

what drains the liver and into what?

Answer 78

hepatic veins into IVC

Question 79

what is the function of the gallbladder?

Answer 79

stores and releases bile produced by the liver in response to CCK in presence of fats

Question 80

what artery supplies the gallbladdeR?

Answer 80

cystic artery (branch of R hepatic artery)

Question 81

what is the path of bile from the liver?

Answer 81

R and L common hepatic ducts--\>common hepatic duct+cystic duct--\>bile duct--\>posterior to duodenum and through head of pancreas--\>joins with main pancreatic duct--\>hepatopancreatic ampulla--\>enters second part of duodenal papilla

Question 82

what suspends the stomach?

Answer 82

greater and lesser omentum

Question 83

which ligaments are associated with the lesser omentum?

Answer 83

extends from lesser curvature to liver hepatoduodenal ligament and hepatogastric ligament

Question 84

omental bursa/lesser peritoneal cavity

Answer 84

posterior to lesser omentum and stomach

Question 85

epiploic foramen

Answer 85

bounded anteriorly by hepatoduodenal ligament, posteriorly by IVC, superiorly by caudate lobe of liver, inferiorly by duodenum communicates lesser and greater peritoneal cavity

Question 86

which ligaments are assocaited with greater omentum?

Answer 86

extends from greater curvature to encircle the spleen and reflect back to dorsal wall gastrocolic ligament extends from greater curvature to transvere colon splenorenal ligament extends from spleen to dorsal body wall

Question 87

what are the functions of the pancreas?

Answer 87

endocrine: glucagon, insulin, somatostatin, pancreatic polypeptides

Question 88

what suspends the pancreas?

Answer 88

only tail is peritoneal, located in splenorenal ligament

Question 89

what supplies/drains the pancreas?

Answer 89

head has uncinate process which is enclosed by the duodenum and supplied by pancreatoduodenal branches of the gastroduodenal and SMA splenic vein and SMV join to form portal vein posterior to neck SMV and SMA pass porterior to neck and anterior to uncinate process

Question 90

Innervations of the foregut

Answer 90

1. parasympathetic: vagus nerves, in terminal ganglia 2. sympathetic: pregangiolic sympathetic axons in lower thoracic splanchnic nerves (greater splanchnic nerves)from T5-T9 and celiac ganglia 3. visceral pain fibers back in greater splanchnic nerves 4. sensations that are not pain carried back in vagus nerves

Question 91

what structures are contained in the midgut?

Answer 91

distal duodenum inferior to entrance of bile duct, jejunum, ileum, cecum , appendix, ascending colon, prox 2/3 of transverse colon

Question 92

what main artery supplies the midgut?

Answer 92

superior mesenteric artery leaves aorta 1 inch below celiac artery (can trace middle colic supplying the transverse back to SMA)

Question 93

what are the branches of the SMA and what do they supply?

Answer 93

1. anterior and posterior inferior pancreaticoduodenal branches--\>midgut part of duodenum and inferior head and uncinate process of pancreas 2. intestinal branches--\>jejunum and ileum (arcades and vasa rectas) 3. ileocolic--\>distal ileum, appendix (appendicular artery), cecum, prox ascending colon R colic--\>ascending colon Middle colic--\>prox 2/3 of transverse colon

Question 94

what are the parts of the duodenum? which parts are peritoneal/retroperitoneal? which part are supplied by which arteries?

Answer 94

1. from pylorus to superior duodenal flexure (only part that is peritoneal): foregut, supplied by the celiac trunk 2. descending part: inferiorly to L3 3. horizontal part: R to L anteror to body of L3 and corssed anteriorly by SMA and SMV 4. ascending part: superiorly left of L3 to left of L2 (at duodenojejunal junction) parts 2-4 are midgut, supplied by SMA, and enclose head of pancreas

Question 95

where does the pancreatic duct enter the duodenum?

Answer 95

through the major duodenal papilla (known as Ampulla of Vater) at second part of duodenum represents junction between the embryological foregut and midgut lies just below the major duodenal papilla

Question 96

ligament of Treitz

Answer 96

suspensatory ligament at duodenojejunal junction (contains muscle from R cruz of diaphragm) jejunum begins left of L2

Question 97

how can you tell the difference between the jejunum and ileum?

Answer 97

jejunum has simple arcades and long vasa recta, also thicker walls, larger luminal diameter, more prominent plica circulares, greater vascularity ileum has complex/branched arcades and short vasa cecta, also more fat in mesentary and contains Peyer's patches in wall

Question 98

which parts of the colon are in the midgut?

Answer 98

cecum, ascending colon, proximal 2/3 of transverse colon

Question 99

what are characteristics of the colon?

Answer 99

1. larger luminal diameter than SI 2. taeniae coli 3. haustrations or sacculations 4. omental appendices

Question 100

teniae coli

Answer 100

3 independent longitudinal bands of smooth muscle from appendiz to sigmoid colon/rectal junction

Question 101

haustrations/sacculations

Answer 101

form because teniae coli are shorter than total length of colon

Question 102

omental appendices

Answer 102

globules of fat covered by peritoneum suspended from teniae coli

Question 103

where is the appendix located? what suspends the appendix? what supplies the appendix?

Answer 103

inferior to iliocecal opening peritomeal, suspended by mesoappendix supplied by appendicular artery (branch of ileocolic)

Question 104

what is appendicitis and how/where does it present?

Answer 104

result of obstruction by stool--\>fecalith (adults) or hyperplasia of lymphatic tissue (children) pain is referred by the lower splanchnic to umbilical McBurney's point: 1/3 distance from ASIS to umbilicus in the lower right quad

Question 105

where is the ascenidng colon? what is it fused to? what supplies it?

Answer 105

extends to R colic/hepatic flexure to the transverse colon it is fused to the R posterior abdominal wall supplied by R colic artery and middle colic artery

Question 106

what suspends the transverse colon? what supplies the transverse colon of the mid-gut?

Answer 106

posterior greater omentum middle colic artery

Question 107

where does the mid-gut get its parasympathetic innervation?

Answer 107

from preganglionic presympathetic axons in the vagus and neurons in the terminal ganglia

Question 108

where does the mid-gut get its sympathetic innervation from?

Answer 108

lower thoracic splanchnic nerves (greater, lesser, and least) from T5-T 12 and neurons in celiac and superior mesentery ganglia

Question 109

where is pain in the mid-gut referred (SI versus colon) and how (aka through which spinal nerves)?

Answer 109

visceral pain fibers go through the lower splanchnic back to the CNS from from SI is referred through T5 to 10 dermatomes in the epigastric and umbilical region from cecum, appendix, AC, 2/3 of TC referred through T10-T12 to umbilical, hypogastric, and lumbar region

Question 110

how do visceral sensations other than pain get back to CNs from the mid-gut?

Answer 110

vagus nerves

Question 111

what are the structures of the hind-gut?

Answer 111

distal 1/3 of transverse colon, descending colon, sigmoid colon, rectum, anal canal

Question 112

which structures of the hind-gut are peritoneal or retroperitoneal?

Answer 112

sigmoid and distal 1/3 of transverse colon are peritoneal, descending colon and upper rectum are secondarily retroperitoneal, lower rectum and anal canal are primarily retroperitoneal

Question 113

what artery supplies the hind-gut and where does it originate?

Answer 113

inferior mesenteric artery , which leaves aorta 4 cm above bifurcation into the common iliac arteries

Question 114

why is the splenic flexure a common site for ischemic bowel infarction?

Answer 114

distal parts of the vascular beds of the middle colic branches of the SMA and the left colic branches of the IMA anastomose here

Question 115

what are the branches of the IMA and what do they supply?

Answer 115

1. left colic artery--\>descending colon and dital 1/3 of transvere colon 2. sigmoid arteries--\>sigmoid colon 3. superior rectal artery--\>rectum and anal canal to pectinate line (middle rectal artery of internal iliac--\>rectum and anal canal above pectinate line)

Question 116

where is the descending colon located?

Answer 116

from transverse colon at splenic flexure to the left iliac fossa

Question 117

where is the sigmoid colon located and what suspends it?

Answer 117

iliac fossa to rectum at S3 vertebra suspended by sigmoid mesocolon

Question 118

what is different about rectum from the rest of the colon?

Answer 118

end of teniae coli, haustrations, omental appendices

Question 119

ampulla of rectum

Answer 119

inferior aspect of rectum is dilated to store feces

Question 120

where does the hind-gut get its parasympathetic innervation from?

Answer 120

pregangionic axons in pelvic splanchnic nerves from sacral spinal (S2-S4) and terminal ganglia

Question 121

where does the hind-gut get its sympathetic innervations from?

Answer 121

lower thoracic and lumbar splanchnic from T11-L2 and neurons in the inferior mesenteric ganglia

Question 122

how do pain sensations from the hind-gut reach the CNS and where are they referred to, and how?

Answer 122

visceral pain to the lower thoracic and lumbar splanchnic from T11-L2 and referred to hypogastric and iliac regions

Question 123

how do sensations other than visceral pain get to CNS from hind-gut?

Answer 123

pelvic splanchnic nerves

Question 124

Which nerves are sympathetic, post-ganglionic splanchnics and what is their path of innervation?

Answer 124

cardiopulmonary splanchnics presynaptic fibers from upper thoracic vertebral levels--\>sympathetic paravertebral ganglia via white rami--\>synapse in upper thoracic and lower cervical ganglia--\>immediately exit both ganglia and sympathetic chain directy to thoracic viscera do not re-enter spinal nerve (no grey rami) and don't travel up and down sympathetic chain

Question 125

Which nerves are sympathetic, preganglionic splanchnics and what is their path of innervation?

Answer 125

greater, lesser, and least thoracic splanchnic nerves, lumbar splanchnic nerves, sacral splanchnic nerves fibers originally enter sympathetic chain via white rami but don't synpase in paravertebral ganglia--\>prevertebral ganglia in the abdomen or pelvis where they will synapse

Question 126

what does the greater splanchnic orginate and what is its destination?

Answer 126

T5-T9--\>celiac ganglia

Question 127

what does the lesser splanchnic orginate and what is its destination?

Answer 127

T10-T11--\>superior mesenteric ganglia

Question 128

what does the least splanchnic orginate and what is its destination?

Answer 128

T12--\>aorticorenal ganglia

Question 129

where is the destination of the lumbar splanchnic nerve?

Answer 129

inferior mesenteric ganglia

Question 130

what is the destination of the sacral splanchnic nerve?

Answer 130

hypogastric plexus

Question 131

what are the parasympathetic, preganglionic splanchnic nerves and what is their path of innervation?

Answer 131

S2-S4 directly to intrinisic ganglia of descending colon, sigmoid colon, rectum, pelvic viscera should also include the vagus nerve (brain stem--\>thoracic viscera, foregut, midgut)

Question 132

what is the main venous drainage ssytem of the gastrointestinal structures below the diaphragm?

Answer 132

hepatic portal system (hepatic portal vein)

Question 133

where is the hepatic portal vein formed? what drains into it?

Answer 133

formed posterior to the neck of the pancreas when the SMV unites with the splenic vein normally the IMV drains intot he splenic vein, but can drain into the SMV or all 3 may merge at a single point

Question 134

what drains the foregut?

Answer 134

splenic vein

Question 135

what drains the midgut?

Answer 135

SMV

Question 136

what drains the hind-gut?

Answer 136

IMV, which usually empties into the splenic vein

Question 137

which veins empty directly into the portal vein other than the splenic and SMV (perhaps IMV)?

Answer 137

left and right gastric veins which drain the stomach including the lesser curvature and abdominal part of the esophagus

Question 138

hepatic veins

Answer 138

NOT the same as the hepatic portal vein drain blood from hepatic sinusoids and empty into the IVC just below the diaphragm

Question 139

how do portal-systemic anastomoses occur?

Answer 139

in cirrhosis of the liver, obstruction of the portal vein and hypertension in the portal system occur which causes retrograde flow of portal venous blood from GI strctures entering the liver retrograde flow forces portal venous blood into capillary beds which also drain into tributaries of the superior or inferior vena cava and here portacaval anastomoses are established to bypass the liver

Question 140

what are the sites of portacaval anastomosis?

Answer 140

1. esophageal varices: wall of esophagus at junction of capillary bed draining into the left gastric/coronary vein and esophageal tributaries of azygos vein 2. wall of rectum at junction of internal rectal plexus (drains into rectal veins) and external rectal plexus (middle/inferior rectal veins)--\>internal hemorrhoids 3. anterior abdominal wall at junction of capillary beds draining into para-umbilical veins (course in falciform ligament) and tributaries of superficial epigastric veins (drain anterior abdominal wall)--\>caput medusa: varicose superficial epigastric veins radiating from umbilicus

Question 141

Names the veins

Answer 141

Question 142

what are the parts of the mediastinum and what are the boundaries?

Answer 142

1. Superior (between first thoracic vertebra and first rib and between sternal angle and intervertebral disc between T4 and T5) 2. Middle 3. Posterior (above the sternal angle and between the pericardium, vertebral column, and diaphragm) 4. Anterior

Question 143

what structures does the superior mediastinum include?

Answer 143

trachea, brachiocephalic vein, thymus, aortic arch, esophagus, thoracic duct

Question 144

what structures does the middle mediastinum contain?

Answer 144

heart, ascending aorta, pulmonary trunk, pulmonary veins, phrenic nerve

Question 145

what structures does the posterior mediastinum contain?

Answer 145

esophagus with vagus nerves, descending aorta, thoracic duct, sympathetic trunks

Question 146

what structures does the anterior mediastinum contain?

Answer 146

smaller vessels and nerves, fat and connective tissue, thymus in child or remnant of thymus

Question 147

what are the layers of the superior mediastinum?

Answer 147

endocrine, venous, arterial, respiratory, digestive

Question 148

what is contained in the endocrine layer of the superior mediastinum?

Answer 148

contains thymus in children or remants of thymus in adults (will extend inferiorly into the anterior mediastinum in children)

Question 149

what is contained in the venous layer of the superior mediastinum?

Answer 149

SVC (descends on right side and drains into RA) left and right brachiocephalic veins

Question 150

where are the brachiocephlic veins formed?

Answer 150

- formed posterior to a sternoclavicular joint by union of an internal jugular vein and subclavian vein

Question 151

what is the pathway of the brachiocephalic vein and where does it receive from?

Answer 151

- left brachiocephalic vein crosses the midline behind the thymus or remnants and recieves interior thyroid veins and the left superior intercostal vein

Question 152

what is contained in the arterial layer of the superior mediastinum?

Answer 152

arch of the aorta and its 3 branches

Question 153

what are the 3 branches of the aorta and what do they divide into?

Answer 153

brachiocephalic, left common carotid, left subclavian the brachiocephalic artery divides into the right common carotid and the right subclavian

Question 154

ligamentum arteriosum

Answer 154

remnant of the fetal ductus arteriosus between the left pulmonary artery and arch of the aorta

Question 155

ductus arteriosus

Answer 155

in fetal life, shunts blood from the pulmonary trunk directly into the arch of the aorta to bypass the lungs (oxygenated blood comes from the mother via placenta)

Question 156

what is contained in the respiratory layer of the superior mediastinum?

Answer 156

trachea (bifurcates at sternal angle to L and R main bronchi)

Question 157

which vessels cross over the left and right main bronchi?

Answer 157

arch of aorta passes over left main bronchus and azygos vein passes over the right main bronchus

Question 158

if the trachea is seen in a cross-section image, which area must the cross-section be through? what main structure of the mediastinum will not be present?

Answer 158

the neck of the superior mediastinum the heart will not be seen since it lies in themiddle mediastinum interior to the trachea bifurcation

Question 159

what is contained in the digestive layer of the superior mediastinum?

Answer 159

esophagus, thoracic duct, left and right vagus nerves, left recurrent laryngeal nerve, left and right phrenic nerves

Question 160

what indents/constricts the esophagus?

Answer 160

indented on the left by arch of aorta and indented anteriorly by left main bronchus also, origin of esophagus at neck and at esophageal hiatus of diaphragm

Question 161

what is the course of the thoracic duct?

Answer 161

arises from the cisterna chyli below the diaphragm and courses therough the posterior and superior mediastinum posterior to esophagus terminates in the root of the neck on the left at the origin of the left brachiocephalic vein (at junction of the left subclavian and left internal jugular vein) to drain lymph

Question 162

what are the courses of the left and right vagus nerves and what are the branches?

Answer 162

pass through the superior mediastinum and enter posterior mediastinum to pass posterior to root of lung and form esophageal plexus on the esophagus also left and right recurrent laryngeal nerves pulmonary and cardiac branches to end at cardiac plexus

Question 163

what are the courses of the left and right recurrent laryngeal nerves?

Answer 163

the left vagus nerve crosses the arch of the aorta and gives off the left recurent laryngeal nerve in the superior mediastinum which hooks under arch posterior to the ligamentum arteriosum and courses superiorly to the larynx the right recurent laryngeal nerve branches from the right vagus nerve at the root of the neck, hooks around the right subclavian artery and is NOT in the superior mediastinum

Question 164

what is the course of the left and right phrenic nerves?

Answer 164

pass through superior mediastinum to middle, pass anterior to root of lung and descend to innervate the diaphragm

Question 165

what is the course of the desending aorta in the posterior mediastinum?

Answer 165

begins at the sternal angle, gives rise to posterior intercostal arteries that supply the thoracic wall, bronchial arteries that supply lung tissue, and esophageal arteries

Question 166

what type of muscle does the esophagus have?

Answer 166

skeletal in its upper third smooth muscle in its lower third mix of both in the middle

Question 167

what is the course of the azygos vein?

Answer 167

formed by the union of the ascending lumbar veins and right subcostal veins at the level of T12 ascends in the posterior mediastinum before arching over the right main bronchus posteriorly at the root of the right lung where it joins the SVC "arch of the azygos vein" (arcus venae azygos) is an important anatomic landmark - sternal angle hemiazygos drains into the azygous along with other tributaries such as bronchial veins, pericardial veins, and **posterior right intercostal** veins

Question 168

what is the course of the hemiazygos veins?

Answer 168

similar structure to azygos vein on the opposite side of the vertebral column (left) and drains into the azgous after crossing midlineat T8 drains the left posterior intercostal veins

Question 169

what is the course of the accessory hemiazygos vein?

Answer 169

vein on the left side of the vertebral column that generally drains the fifth through eighth intercostal spaces on the left side of the body

Question 170

are the kidneys peritoneal, secondarily retroperitoneal, or primarily retroperitoneal?

Answer 170

primarily retroperitoneal embedded in perirenal and pararenal fat

Question 171

where are each of the kidneys located? which is higher than the other?

Answer 171

left: anterior to 11th and 12 rib right: anterior to 12th rib left is superior

Question 172

renal hilus (location and contents)

Answer 172

anteromedial border contains renal artery, renal vein, and renal pelvis renal vein is anterior to renal artery which is anterior to renal pelvis

Question 173

what are the two regions of the kidneys and what do they contain?

Answer 173

1. cortex: proximal parts of the uriniferous tubules, renal corpuscles, and proximal and distal convoluted portions of the duct system 2. medulla: renal pyramids, which contain the distal parts of the collecting ducts

Question 174

what is the organization of minor calyces, major calyces, and the renal pelvis?

Answer 174

at apex of each pyramid the collecting ducts open into a minor calyx 2-4 minor calyces form a major calyx 3-4 major calyces unite to form the renal pelvis (expanded upper part of the ureter)

Question 175

what is the course of the renal arteries?

Answer 175

- arise from the abdominal aorta at L2 - give rise to interlobar arteries that branch into arcuate arteries at the juncture between the medulla and the cortex - this gives rise to interlobular arteries which give rise to afferent arterioles of the glomerulus - blood leaves glomerulus via efferent arterioles

Question 176

where do the renal veins drain into?

Answer 176

empty into the IVC at L2

Question 177

Because the aorta is on the left side and the IVC is on the right side, where do the right renal artery and left renal vein cross?

Answer 177

- right renal artery passes posterior to the IVC - left renal vein passes anterior to the aorta just inferior to origin of the SMA

Question 178

what are the innervations of the kidney and what do they control?

Answer 178

- preganglionic sympathetic axons in lower thoracic or lumbar splanchnic nerves (T11-L2) that synpase in aorticorenal ganglia - postganglionic sympathetic axons from aorticorenal ganglia distributed to renal arteries to control blood flow to glomeruli

Question 179

when would one use retroperitoneal approach to removing the kidneys versus transabdominal?

Answer 179

- would use retroperitoneal if contamination of the peritoneal cavity is likely to occur - would use transabdominal approach if renal vessels or ureters are involed

Question 180

what structures (muscles/bones) are in close proximity to the kidneys?

Answer 180

- kidney lies along vertebral column against the psoas major muscles - also related more inferiorly to quadratus lumborum and transvesus abdominis - superior parts of kidney are protected by the thoracic cage - posteriorly, superior pole of each kidney related to the diaphragm which separate it from the pleural cavity and 12th rib

Question 181

if fracture to lower ribs or lumbar transverse processes, which structures should be suspected to also have injury?

Answer 181

kidneys

Question 182

which structures would have to be cut and ligated to remove the kidney?

Answer 182

renal artery, renal vein, ureter potentially accessory renal arteries, which will be omre common on left side and usually inferior to main artery

Question 183

from what does the left renal vein receive blood?

Answer 183

left suprarenal vein and left gonadal vein (testicular/ovarian)

Question 184

during kidney transplant, the renal artery and vein are anastomosed to which vessels?

Answer 184

transplant site is iliac fossa renal artery and vein are anastomosed to external iliac artery and vein

Question 185

what is the path of the ureters?

Answer 185

tubes containing smooth muscle that arise from renal pelvis at L2 and descend inferiorly on anterior surface of psoas major, cross the pelvic brim (at which time it lies between the external and internal iliac arteries), and enter the posterolateral aspect of the bladder

Question 186

what arteries supply the ureters?

Answer 186

1. upper third: renal arteries 2. middle third: common iliac artery 3. distal third: superior vesical artery

Question 187

are adrenal glands peritoneal, secondarily retroperitoneal or primarily retroperitoneal?

Answer 187

primarily retroperitoneal

Question 188

what are the zones of the adrenal gland cortex and what do they produce/secrete?

Answer 188

1. zona glomerulosa: aldosterone 2. zona fasciculata: glucocorticoids 3. zona reticularis: reproductive steroids

Question 189

a. where are chromaffin cells located? b. what is the function of chromaffin cells? c. what are they derived from? d. what are they innervated by?

Answer 189

a. medulla of adrenal gland b. secrete epinephrine mostly and some noreepinephrine c. derived from neural crest cells d. innervated by preganglionic sympathetic axons from lower thoracic splanchnic nerves

Question 190

what supplies blood to/drains blood from the adrenal glands?

Answer 190

supplied by adrenal arteries that branch from renal arteries, aorta, and inferior phrenic arteries each drained by single vein - right adrenal vein drains into IVC - left adrenal vein drains into the left renal vein

Question 191

what is the path of the abdominal aorta?

Answer 191

begins at aortic hiatus (where crosses diaphragm T12) and descends inferiorly to left of the midline and ends by bifurcating into common iliac arteries at L4 (just above this bifurcation is a common site for aneurysm)

Question 192

what arteries branch off of the abdominal aorta and where?

Answer 192

a. **celiac artery** (forefut) at T12 b. **SMA** (midgut) at L1 c. renal arteries at L2 d. gonadal arteries between renal arteries and IMA around L2/L3 e. **IMA** (hindgut) L3 (few cm superior to bifurcation) f. pair of inferior phrenic arteries supply diaphragm g. lumbar arteries supply body wall h. adrenal gland arteries

Question 193

Name the arteries

Answer 193

Question 194

where is the IVC formed and where does it run?

Answer 194

L5 by union of common iliac veins ascends through posterior abdominal wall to right of aorta, passes posterior to liver in deep groove and enters thoracic cavity by piercing central tendom of diaphragm (T8) and related fibrous pericardium to drain into RA

Question 195

Name the tributaries of the IVC

Answer 195

Question 196

how do the renal veins drain into the IVC and what differs on either side?

Answer 196

drain at L1/L2 right side: renal, adrenal, gonadal veins drain directly into IVC left: only left renal vein drains directly into IVC; left gonadal, left suprarenal and left adrenal veins drain into left renal vein - left renal vein crosses anterior aorta just inferior to origin of SMA

Question 197

what three main collateral routes are available for venous blood to pass to heart if IVC is obstructed?

Answer 197

a. various anastomoses in the abdomen and pelvis that enable blood to reach superficial epigastric (connects superiorly to thoraco-epigastric and drains into axillary vein) and inferior epigastric veins (superior epigastric vein, tributary of internal thoracic vein to enter subclavian) b. lateral thoracic which connects circumflex iliac vein to axillary vein c. tributaries of IVC anastomose with epidural venous plexus of veins (within vertebral canal) and azygos/hemiazygos venous system

Question 198

how is the lumbar plexus formed and what does it divide into?

Answer 198

formed by ventral rami of L1-T4 and found on posterior abdominal wall and greater pelvis ventral rami branch into posterior and anterior divisions which form femoral and obturator nerves, respectively

Question 199

what is the path of the femoral nerve?

Answer 199

contains posterior division fibers from L2-L4 ventral rami emerges from lateral border of psoas major in iliac fossa and passes into anterior thigh posterior to inguinal ligament and lateral to femoral artery innervates anterior thigh muscles and skin of anterior/medial thigh gives rise to saphenous nerve

Question 200

what is the path of the obturator nerve?

Answer 200

L2-L4 ventral rami emerges from medial (semi-posterior) side of psoas major, crosses pelvic brim and courses anteriorly and inferiorly in lesser pelvis to obturator foramen, through obturator externus to medial thigh innervates skin of medial thigh and adductor longus, brevis, mangus, gracilis, obturator externus muscles (adduct and flex thigh at hip)

Question 201

what is the path of the subcostal nerve?

Answer 201

passes between psoas major and quadratus lumborum muscles inferior to 12th rib innervates abdominal musculature and overlying skin of lateral and anteror abdominal wall

Question 202

what is the path of the iliohypogastric nerve?

Answer 202

emerges between the psoas major and quadratus lumnorum inferior to the subcostal nerve innervates abdominal musculature and the skin of the inguinal and hypogastric regions of the lateral and anterior wall

Question 203

what is the path of the ilioinguinal nerve?

Answer 203

courses inferior to the iliohypogastric nerve and pierces the inguinal canal to pass through superficial inguinal ring innervates skin of medial thigh, labium majus, and anterior aspect of the scrotum innervates abdominal musculature and skin of inguinal and hypogastric reions of the lateral and anterior abdominal wall

Question 204

wht is the path of the genitofemoral nerve?

Answer 204

courses through and then lies anterior to psoas major muscle divedes into a femoral branch (passes posterior to inguinal ligament to innervate skin of medial thigh) and genital branch (enters inguinal canal through deep inguinal ring and innervates the cremasteric muscle)

Question 205

what is the path of the lateral femoral cutaneous nerve?

Answer 205

emerges lateral to the psoas major muscle and crosses the iliacus to reach the anterior superior iliac spine will descend into the lateral thigh passing posterior to the inguinal ligament

Question 206

Name the nerves of the lumbosacral plexus (take note of the spinal nerves they come from)

Answer 206

Question 207

Name the nerves of the lumbosacral plexus

Answer 207

Question 208

what are the three fetal circulation shunts that help bypass blood flow around liver and lungs? where are they located?

Answer 208

1. ductus venosus: oxygenated blood in umbilical vein to bypass liver into IVC and RA 2. foramen ovale: atrial septum to allow oxygenated blood to bypass pulmonary circulation (R to L atrium) 3. ductus arteriosus: SVC drains deoxygenated blood from upper limbs and head into RA--\>RV--\>pulmonary trunk then shunted to underside of aorta distal to L subclavian, bypasing pulmonary circulation

Question 209

pressure is higher on the right side or left side of the fetal circulation?

Answer 209

right side

Question 210

what is the oxygen saturation of the fetal circulation a. in the umbilical vein b. in the IVC c. post-natally/in mother's arterial blood

Answer 210

a. 80% b. 67% c. 98%

Question 211

what are the remnants of fetal circulation? a. R and L umbilical arteries b. L umbilical vein c. ductus venosus d. foramen ovale e. ductus arteriosus

Answer 211

a. medial umbilical ligaments b. ligamentum teres (round ligament of liver) c. ligamentum venosum d. fossa ovale e. ligamentum arteriosum

Question 212

what are the three major aperatures in the diaphragm and at what levels of the vertebrae are they? (after expiration)

Answer 212

IVC T8 esophagus T10 aorta T12 \*\* I ate 10 eggs at midnight

Question 213

what prevents contents of stomach from reflexing into esophagus?

Answer 213

lower esophageal sphincter (cardiac sphincter)

Question 214

Name the muscles 1-4

Answer 214

1. psoas major 2. iliacus 3. quadratus lumborum 4. transversus abdominus

Question 215

how many pairs of spinal nerves are there and how are they divided?

Answer 215

31 pairs 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal

Question 216

Name the parts of the spinal cord segment

Answer 216

Question 217

why is the dorsal root outside of the spinal cord?

Answer 217

derived from neural crest

Question 218

gray matter has what part of the neuron? white matter?

Answer 218

gray matter: cell bodies white matter: bundles of axons organized in tracts of fasciculi

Question 219

where are the cell bodies of the sensory neurons found? motor neurons?

Answer 219

sensory neuron cell bodies found in dorsal root ganglia... no synapses here (pseudo-unipolar) ventral root cell bodies found in grey matter of ventral horn (only motor axons are found in the ventral root?

Question 220

sensory nerves in skin that are mostly found in the sermis are innervated by specific types of dorsal roots. what are the general functions of the following: a. Pacinian corpuscle b. Meissner's corpuscle c. Merkel's disc d. Ruffini ending e. free nerve ending

Answer 220

a. vibration and pressure ("onion"); deep dermis b. light touch, will be just beneath epidermis between dermal papillae c. pressure, texture; will be near hair follicles and in the superficial dermis with ends surrounding a dermal papillae d. enlarged dentritic endings with elongated capsules; skin stretch e. pain, temperature

Question 221

how many dermatomes are there? how many myotomes?

Answer 221

30 (none for C1) dermatomes 31 myotomes

Question 222

what is the clinical significance of dermatomes?

Answer 222

cutaneous branch of spinal nerve that supplies certain area of skin... can cause referred pain

Question 223

what do the epimeres form? what do the hypomeres form?

Answer 223

epimeres: deep muscles of back (maintain posture) hypomeres: intercostal muscles, abdominal muscles, limb muscles

Question 224

what do the dorsal rami supply?

Answer 224

- supply epimere and skin covering it - also innervate joints between articular processes of vertebra, deep intrinsic muscles that act on vertebral column, medial 2/3 of back from vertex of skull to coccyx (some have name: subocciptal nerve (of C1): greater occipital nerve (of C2), cluneal nerves (cutaneous innervation to gluteal region))

Question 225

what do the ventral rami supply?

Answer 225

- hypomere and skin covering it - skin, muscle, joints in ventrolateral neck, trunk, extremities - intermingle to form plexus (except T2-T11) that innervate extremities and neck - communicate with sympathetic chain of paravertebral ganglia by white and gray communicating rami (generally all have names)

Question 226

what is the difference between dorsal and ventral rami in the trunk versus the limbs?

Answer 226

- in trunk, individual sorsal and ventral rami innervate overlapping dermatomes - in limbs: adjacent ventral rami may join in a plexus to form nerves that supply overlapping dermatomes and myotomes

Question 227

Name the components of a spinal nerve

Answer 227

Question 228

what is a irritative nerve lesion and what does it result in clinically?

Answer 228

nerve fibers compressed and firing of sensory or motor is altered 1. sensory--\>reduced sensation (hypethesia) or altered sensation (paresthesia) 2. motor--\>weakness (paresis)

Question 229

what is a destructive lesion and what does it result in clinically?

Answer 229

nerve fibers severely compressed or severed, resulting in loss of ability to conduct impulses 1. sensory--\>loss in sensory modality (anesthesia) 2. motor--\>paralysis of denervated skeletal muscles, fasciculations (random twitches), atrophy

Question 230

where do the cell bodies of preganglionic neurons lie? post-ganglionic?

Answer 230

pre-ganglionic: in CNS with axons in cranial/spinal nerves post-ganglionic: in autonomic ganglia in PNS

Question 231

Fill in the chart concerning the nervous system chemical transmission

Answer 231

Question 232

which neurons have cholernergic transmission?

Answer 232

- all preganglionic autonomic neurons (sympathetic and parasympathetic) - all parasympathetic post-ganglionic

Question 233

which neurons have adrenergic transmission?

Answer 233

- sympathetic post-ganglionic neurons (NE released) - adrenal medulla (80% epinephrine, 20% NE)

Question 234

what are the basic steps of transmitter release and removal for each neurotransmitter?

Answer 234

Transmitter release: 1. action potential--\>calcium influx--\>exocytosis of neurotransmitter Transmitter removal: a. Ach hydrolyzed by acetylcholinesterase b. NE removed by direct Na-driven reuptake into nerve terminals

Question 235

what are the types of acetylcholine receptors?

Answer 235

Nicotinic and muscarinic

Question 236

where are the two types of nicotinic receptors located? what type of channels are they? are they excitory or inhibitory?

Answer 236

N1: skeletal muscle end-plates (somatic) N2: mediate transmission to all ganglionic synpases (autonomic) ligand-gated channels that depolarize postsynaptic membrane--\>excitory

Question 237

where are the muscarnic receptors located? what type of channels are they? are they excitory or inhibitory?

Answer 237

- on all ANS cells sensitive to Ach (heart muscle, smooth muscle, glands) inlcuding all parasympathetic - GPCR - excitory: increase IP3 and DAG, stimulate opening of Ca or increase cAMP - inhibitory: decrease cAMP and may open K+ channels

Question 238

what types of channels are epinephrine and noreepinephrine (adrenergic) receptors?

Answer 238

GPCR

Question 239

what is the function and mechanism of the following adrenergic receptors? which neurotransmitter is most effective? a. alpha-1 b. alpha-2 c. beta-1 d. beta-2

Answer 239

a. - excitory effect except in the heart by increasing IP3 and DAG and/or closing K channels; both NE and E equally effective b. - presynaptic nerve terminal of adrenergic and certain post-ganglionic cholinergic nerve fibers; inhibitory by decreasing cAMP, inhibiting opening of Ca channels, inhbiting transmitter release (such as inhibiting sympathetic outflow to gut); NE and E equally effective c. - found only in heart and are excitory by increasing cAMP; NE and E qually effective d. - increase cAMP, but responsible for inhibitory adrenergic actions on target cells such as relaxation/dilation of smooth muscles of bronchioles; E more potent

Question 240

how many sympathetic pre-ganglionic segments are there? how many paravertebral ganglia?

Answer 240

14 pre-ganglionic segments which can split into 31 pairs of paravertebral ganglia

Question 241

what do the paravertebral ganglia supply? the prevertebral ganglia?

Answer 241

paravertebral: body wall and thoracic viscera prevertebral ganglia: inferior to diaphragm and supplies abdominopelvic viscera

Question 242

why do the cardiopulmonary splanchnic nerves synapse in paravertebral ganglia, not prevertebral ganglia?

Answer 242

above the diaphragm, there is no prevertebral ganglia

Question 243

what are white rami? what are gray rami?

Answer 243

white rami: preganglionic sympathetic axons that enter and synpase in a paravertebral ganglion (of ventral root) gray rami: post-ganglionic sympathetic axons that leave paravertebral ganglia, rejoin spinal nerve and go to body wall to innervate sweat glands and vascular smooth muscle

Question 244

what is the possible fate of white rami?

Answer 244

a. enter ganglia and synapse at paravertebral ganglia then postganglionic cell leaves through Gray Ramus b. can travel to higher or lower ganglia and synapse there c. pass through chain without synapsing to then synapse at the pre vertebral ganglia aka splanchnic nerves \* also remember that the splanchnic nerves above tge diaphragm will synapse at the paravertebral ganglia

Question 245

splanchnic nerves that synapse inn prevertebral ganglia will arise from which spinal vertebral levels?

Answer 245

T5-L3 greater splanchnic T5-T9 less T10-T11 least T12 lumbar L1-L3

Question 246

where do the parasympathetic preganglionic nerves arise from?

Answer 246

in brainstem and exit with cranial nerves III, VII, IX, X or from sacral cord levels in ventral roots of S2-S4

Question 247

what is the path of the cranial nerves carrying preganglionic parasympathetic axons? vagus? sacral?

Answer 247

4 cranial nervs: parasympathetic ganglia in the head vagus: synpase in terminal ganglia near heart, lungs, walls of GI in foregut and midgut (pharynx to 2/3 of transverse) sacral: pelvic spanchnic to hindgut terminal ganglia--\>transverse colon, descending colon, sigmoid colon, rectum, bladder, erectile tissue, pelvis

Question 248

where do the preganglionic parasympathetic nerves originate?

Answer 248

in brain stem or S2-4 and these will synpase in ganglia in head or neck or in terminal ganglia at viscera

Question 249

what does the vagus nerve innervate? what does the pelvic splanchnic nerves innervate?

Answer 249

vagus: thoracic viscera and 2/3 of abdominalviscera (peristalsis and gland secretion) pelvis splanchnic: distal 1/3 of gut (perstalsis and gland secretion), bladder contract, dilate erectile tissues

Question 250

besides motor function, what do parasympathetic nerves also carry?

Answer 250

visceal sensations other than visceral pain ex. mechanoreceptors, baroreceptors, chemoreceptos\rs

Question 251

what are the two parts of the respiratory system and what are their main functions?

Answer 251

conducting part: warms, moistens, filters inspired air respiratory/histological part: gas exchange

Question 252

what are the 4 areas of the parietal plura and where are they?

Answer 252

1. costal pleura: covers thoracic wall 2. diaphragmatic pleura 3. mediastinum pleura 4. cervical/cupola pleura: extends into root of neck superior to medial 1/3 of clavicle and first rib

Question 253

where are the visceral and parietal pleura continuous?

Answer 253

root of the lung

Question 254

during inspiration, where does the inferior extent of the visceral pleura lie in comparison to the parietal pleura?

Answer 254

approximately two rib levels apart visceral: 6th at midclavicular, 8th at midaxillary, 10th at paravertebral

Question 255

what are the two recesses of the lungs and where are they located?

Answer 255

costodiaphragmatic (inferior and lateral aspect of lung) and costomediastinal (anterior and medial aspect) potential spaces at which the visceral pleura and lungs don't completely fill the pleural cavity during inspiration during maximal inspiration, lingula of superior lobe of left lung fills costomediatinal recess

Question 256

what innervates the different parts of the pleura?

Answer 256

costal parietal pleura: intercostal nerves mediastinal pleura and most of diaphragmatic parietal pleura: phrenic nerve

Question 257

wat is the significant of the potential space? (i.e. function, possible concerns)

Answer 257

- between visercal and parietal pleura is serous fluid which flues the two together and thus when chest wall/parietal pleura move so do the visceral pleura and lungs - air can enter this area and cause a pneumothorax

Question 258

describe the different processes of inspiration and expiration. which one is passive?

Answer 258

inspiration: diaphragm descends and elevates and widens the rib cage. external intercostals also elevate rubs and sternum--\> negative pressure which pulls air in expiration: passive recoil of lungs and rib cage. internal intercostals can actively depress ribs and abdominal muscles can push up the diaphragm

Question 259

what innervates the phrenic nerves? where will pain be referred then if pinching under diaphragm?

Answer 259

phrenic nerves from C3-C5 ... may feel dull referred pain in neck

Question 260

what are the lobes and fissures of the lungs?

Answer 260

right lung: superior and middle, separated by horizontal fissure and inferior separated by oblique fissure left lung: superior and inferior separated by oblique fissure

Question 261

where are the best areas to ausculate breath sounds from each lobe of the lungs?

Answer 261

a. superior lobe: anterior and superior thoracic wall b. inferior lobe: posterior and inferior aspects of the back c. anterior chest near sternum, inferior to right fourth costal cartilage

Question 262

why does the left lung only have two lobes? what aspect of the left lung asks as a middle lobe?

Answer 262

heart is on left side--\>cardiac impression below cardiac notch is the lingula which is a tongue like depression which could have been the middle lobe

Question 263

what structures are in the hilum of the lung and how does the order differ on either lung?

Answer 263

pulmonary artery, pulmonary veins, nerves, lymphatics, primary bronchus right lung: pulmonary artery is anterior to primary bronchi left lung: pulmonary artery is superior to primary bronchi

Question 264

what is the urachus? where is its remnant?

Answer 264

fibrous remnant of the allantois, a canal that drains the urinary bladder of the fetus that joins and runs within the umbilical cord remnant lies in the space of Retzius, between the transversalis fascia anteriorly and the peritoneum posteriorly.

Question 265

what 3 bones make up the hip bone and where do they fuse?

Answer 265

ilium, ishium, pubis fuse at the acetabulum

Question 266

what are the boundaries of the greater (false) pelvis and what does it contain?

Answer 266

bounded by iliac fossae, sacrum above the promontory (superior part of sacrum) and the anterior abdominal wall at upper end it flares out and should be considered part of the abdominal davity contains the iliacus muscle (fills the iliac fossa)

Question 267

what are the boundaries of the lesser (true) pelvis and what does it contain?

Answer 267

formed by the hipbones, the sacrum below the promontory, and the coccyx posterior: sacrum and coccyx anterior: symphysis pubis lateral: hipbone contains the obturator internus and piriformis muscles

Question 268

what are the 3 parts of the true pelvis?

Answer 268

inlet (pelvis brim), outlet, cavity

Question 269

what forms the pelvic inlet/pelvic brim?

Answer 269

separates the greater pelvis and lesser pelvis; formed by superior aspect of the pubic symphysis, the pelvic brim, and the sacral promontory

Question 270

what forms the pelvic outlet?

Answer 270

diamond-shaped opening with borders at the inferior aspect of the pubic symphysis, ischiopubic rami, ischial tubberosities, sacrospinous ligamens, tip of the coccyx

Question 271

what forms the subpubic angle?

Answer 271

ischiopubic rami unite at the pubic symphysis to form the subpubic angle

Question 272

what is the difference in pelvic inlet and subpubic angles between males and females?

Answer 272

females have oval shaped pelvic inlets and males have heart shaped females in general have a shallower, wider pelvis females have a wider pelvic inlet angle (90 degrees) versus males (60 degrees)

Question 273

how is the pelvic outlet divided and by what?

Answer 273

subdivided into urogenital triangle and anal triangle by coronal line extending between ischial tuberosities with a center point of perineum

Question 274

what is the smallest dimension of sacral promontory to medial pubic symphysis in the sagittal view?

Answer 274

true (obstretic) conjugate: sacral promontory to midpont symphysis

Question 275

what is the plane of smallest/narrowest dimension? what is the length?

Answer 275

interspinous distance 10 cm

Question 276

Name the pelvic bone ligaments and foramens

Answer 276

Question 277

Name the bony parts of the pelvis (some repeat)

Answer 277

Question 278

what is the pelvic diaphragm and what are its attachments/boundaries?

Answer 278

boundary between the pelvis and perineum; a funnel shaped structure that consists of skeletal muscle and fascia supports all pelvic viscera plus rectum and anal canal base of pelvic diaphragm attaches to bony/facial walls of lesser pelvis below pelvic brim and apex projects posteriorly and inferiorly into anal triangle

Question 279

what is the urogentital diaphragm and what are its attachments?

Answer 279

separates the perineum below urethra and vagina transverse it

Question 280

what sphincters so the pelvic and urogenital diaphragms have and what are their functions?

Answer 280

pelvic: external anal sphincter--\>anal continence urogenital diaphragm: sphincter urethrae--\>urinary continence

Question 281

what are the muscles of the pelvic diaphragm?

Answer 281

1. levator ani a. pubococcygeus puborectalis b. iliococcygeus 2. "ischio"coccygeus

Question 282

describe location of pubococcygeus muscle

Answer 282

encircles viagina, prostate, and anorectal junction and attaches to the perineal body

Question 283

describe location and function of the puborectalis muscle

Answer 283

founds the urogenital hiatus and forms part of external anal sphincter when it contracts, anorectal junction is pulled anteriorly to contribute to fecal continence

Question 284

describe location of the iliococcygeus muscle. what is different about its attachment?

Answer 284

arises from the tendinous arch, a thickening of the fascia covering the obturator internus muscle and attaches to the anococcygeal raphe between anal canal and coccyx

Question 285

what muscles make up the levator ani?

Answer 285

pubococcygeus, puborectalis, iliococcygeus

Question 286

describe the location of the "ischio"-coccygeus muscle

Answer 286

attaches lateally to ischial spine and sacrospinous ligament and medially to the coccyx and sacrum

Question 287

what/where is the perineal body? (and what converges there?)

Answer 287

perineal body (or central tendon of perineum) is a pyramidal fibromuscular mass in the middle line of the perineum at the junction between the urogenital triangle and the anal triangle. males: between the bulb of penis and the anus females: between the vagina and anus

Question 288

what innervates the muscles of the pelvic diaphragm?

Answer 288

by ventral rami of S2 and S3 spinal nerves and branches of the pudendal nerve

Question 289

ischioanal fossa

Answer 289

distensible fat and connective tissue that is between the pelvic diaphragm and obturator internus muscle/fascia which can distend when fecal matter enters the lower anal canal

Question 290

where do the pudendal nerves arise from and what do they innervate?

Answer 290

ventral rami of S2-S4 innervate skeletal muscles in both urogental and pelvic diaphragms and both external anal and urethral sphincters

Question 291

describe what results in uterine prolapse, cystocele, and rectocele and what happens in each

Answer 291

pelvic diaphragm weakness uterine prolapse: cervix, isthmus, body of uterus protrude into superior vagina--\>bleeding/discharge cystocele: bladder herniates into the upper part of the anterior wall of the vagina--\>urinary problems rectocele: rectum herniates into lower part of the posterior wall of the vagina--\>defecation issues

Question 292

if looking at the pelvic diaphragm in a coronal view and can see the obturator internus and tendinous arch, which muscle of the pelvic diaphragm are you looking at?

Answer 292

iliococcygeal muscle

Question 293

what are the differences in lining, blood supply, venous drainage, lymph drainage, and innervation of the snal canal above and below the pectinate line?

Answer 293

above the pectinate line: - anal canal lined by mucosa - superior rectal artery from IVC - internal rectal venous plexus--\>superior rectal vein--\>inferior mesenteric vein--\>heptaic portal system - lymph to internal iliac nodes - sensory innervation of mucosa by fibers that course w/ autonomic nerves, but insensitve to pain below the pectinate line: - lined with skin - inferior rectal artery, branch of pudental artery - external rectal venous plexus--\>inferior rectal vein--\>internal iniliac bein--\>internal pudental vein--\>of caval system - lymph to supericifial inguinal nodes - sensory innervation of skin by inferior rectal branches of pudendal nerve, sensitive to pain, touch, temperature

Question 294

what is the difference between internal and external hemorrhoids and where can the occur?

Answer 294

internal hemorrhoids: painless protrustion of anal canal covered by mucosa (above the pectinate line) containing dilted veins of internal rectal venous plexus external hemorrhoids: painful enlargements covered by skin (below the pectinate line) that contain dilated veins of the external rectal venous plexus

Question 295

what is the difference between the internal and external sphincters of the anal canal?

Answer 295

internal anal sphincter: smooth muscle derived from inner circular muscle layer of the rectum; under involuntary control, innervated by sympathetic nerves that contract and parasypathetic nerves which relax external anal sphincter: skeletal muscle derived from puborectalis muscle; attaches to skin and perineal body; voluntary control; innervated by inferior rectal branches of pudendal nerve

Question 296

detrusor muscle

Answer 296

smooth muscle surrounding the bladder

Question 297

internal urethral sphincter

Answer 297

sphincter vesicae smooth muscle at the base of the bladder that is more prominent in males and prevents reflux of sperm into bladder (under sympathetic control)

Question 298

external urethral sphincter

Answer 298

sphincter urethrae sksletal muscle encircles urethra in urogenital diaphragm

Question 299

is the bladder peritoneal, primarily retroperitoneal, or secondarily retroperitoneal?

Answer 299

primarily retroperitoneal

Question 300

what are the peritoneum reflection points in the male and female?

Answer 300

in male: rectovesical pouch in female: vesicouterine pouch and rectouterine pouch

Question 301

what is the most inferior part of the peritoneal cavity in the male and femle?

Answer 301

rectouterine pouch for females and the rectovesical pouch in males

Question 302

trigone of the bladder

Answer 302

inner posterior wall of the bladder where at the lateral angles the ureters open and at the inferiorly apex the urethra opens

Question 303

what are the parts of the male urethra and where are they?

Answer 303

1. protatic urethra: arises from the bladder and passes through the prostate and urogenital hiatus of the pelvic diaphragm to reach the urogenital diaphragm 2. membranous urethra: passes through the sphincter urethrae muscle/external sphincter in the urogenital diaphragm 3. penile urethra turns sharply anteriorly inferior to the urogenital diaphragm and trasnverses the bulb and corpus spongiosum of the penis (... obviously, it's in the penis)

Question 304

what is the different between the male and female urethrae?

Answer 304

female urethra is distensible because it contains considerable elastic tissue and smooth muscle (why cathters hurt males more than females...) infections of female urthra more common because shorter and more open to exterior through vestibule of the vagina (why UTIs are like rampant)

Question 305

where is the ductus deferens and what is its function?

Answer 305

arises from the epididymis adjacent to the testis and trasnverses the inguinal canal then descends into the pelvis to reach the posterior aspect of the urinary bladder to meet up with the ejaculatory duct transports sperm made by the seminiferous tubules of the testis

Question 306

where are the seminal vesicles and what is their function?

Answer 306

posterolateral aspect of the bladder lateral to ductus deferens to join the ejaculatory duct secrete a fructose-rich component of the seminal fluid which contribute to metabolism

Question 307

what forms the ejaculatory duct, where is it, and what is its function?

Answer 307

formed when ductus deferens joing with duct of seminal vescile just above the prostate and will open onto the surface of the seminal coliculus in the posterior wall of the prostatic urethra (between periurethral and peripheral zones) function is to (obviously) then transport sperm and seminal fluid through the prostate

Question 308

where is the prostate gland (what does it surround) and what are its parts/zones and their function?

Answer 308

bellocated below the bladder and surrounds the prostatic urethra (duh) a. periurethral zone: surrounds the prostatic urethra and contains mucosal and submucosal glands which lubricate the urethra b. peripheral zone: contains main prostatic glands which secrete a milky component of the seminal fluid that contain prostatic acid phosphatase and prostate-specific antigens which contribute to sperm activation and motility c. ducts of the prostatic glands open into the prostatic sinuses on either side of the seminal colliculus in the prostatic urethra

Question 309

what is benign prostatic hyperplasia and where is a common site for is?

Answer 309

enlargement of the prostate and commonly occurs in the periurethral zone resulting in the obstruction of prostatic urethra and urinary flow

Question 310

what is the common site for adenocarcinoma in the prostate and where can they commonly metastasize? what will be elevated in the blood?

Answer 310

perpheral part of the prostate in the main prostatic glands urine flow may be altered, may pass urine into blood can metastasize into the bones of the pelvis, body of vertebrae, or ribs patients have elevated blood levels of prostatic acid phosphatase and prostate-specific antigen

Question 311

keep mentioning seminal colliculus... wtf is it?

Answer 311

landmark on the prostatic urethranear the entrance of the seminal vesicles The margins of seminal colliculus are the following: the orifices of the prostatic utricle the slit-like openings of the ejaculatory ducts. the openings of the prostatic ducts

Question 312

where is the uterus situated? what muscle type is it made of and what are its parts?

Answer 312

between bladder and rectum 50% anteverted typically at junction of cervix and vagina to lie on the superior aspect of the bladder smooth muscle fundus, body, isthmus, cervix

Question 313

where is the fundus of the uterus?

Answer 313

superior to the opening of the uterine tubes located at the junction of the body and the fundus

Question 314

where does the body of the uterus begin?

Answer 314

below the uterine tubes

Question 315

where does the cervix begin and end?

Answer 315

inferior to the isthmus at the internal os and continues to the external os which opens into the upper ends of the vagina

Question 316

what are the parts of the uterine tube? and where are they located?

Answer 316

intramural part: lies inside uterine wall between fundus and body isthmus: thick muscular wall and extends from uterine wall to ampulla ampulla: dilated and longest segment infundibulum: distal segment that terminates in fimbriae and contains the ostium, which opens into the peritoneal cavity

Question 317

the round ligament of the uterus is a remnant of?

Answer 317

the gubernaculum

Question 318

what is the vestibule?

Answer 318

common chamber of the urethra and vagina

Question 319

what are the two other names for the recto-uterine pouch (one is Dr. White's specifically)? the name that Dr. White prefers is because (has to do with location)?

Answer 319

pouch of Douglas recto-vaginal pouch-- this is because technically the pouch comes in contact with the rectum and the beginning of the vagina or posterior fornix

Question 320

what is special about the uterus, uterine tubes, and ovaries in regards to peritoneal?

Answer 320

secondarily peritoneal (aquared mesentery during development)

Question 321

what is the broad ligament and what are its parts?

Answer 321

fold of peritoneum that forms a mesentery suspending the uterine tubes, ovaries, and most of uterus mesometrium: adjacent to uterus mesoalpinx: suspends the uterine tubes mesovarium: suspends the ovaries

Question 322

where are the transverse cervical ligaments and what courses with them?

Answer 322

base of the borad ligament consist of condensations of CT and support the cervix and vagina uterine artery and vein and ureter course through the trasnver cervical ligaments

Question 323

during a hysterectomy what may be accidentally ligated?

Answer 323

the ureter because of its proximity to the cervix and uterine artery

Question 324

immediately after ovulation, where is the ovum?

Answer 324

in the peritoneal cavity after passesing through the peritoneum covering the ovary

Question 325

where is ectopic implantation most common?

Answer 325

ampulla of the uterine tube

Question 326

what is a episiotomy?

Answer 326

incision of the posterior wall of the vagin that can be performed during labor to make healing more rapid

Question 327

what does the meaning "water under the bridge" mean in the female versus the male?

Answer 327

female: ureter passes under the uterine artery male: ureter passes under ductus deferens

Question 328

what transverses the urogenital diaphragm?

Answer 328

urethra and vagina in females

Question 329

what muscles does the perineum contain?

Answer 329

the deep transversus perineus msucles and spincter urethrae/external urethral sphincter which encircles the urethra

Question 330

what does the deep perineal pouch contain in males and females?

Answer 330

contains sphincter urethrae and deep transversus perineus muscles in both sexes and is between the inferior and superior fasscial layers of the urogenital diaphragm in female contains urethra and vagina in males contains the membranous part of the urethra and bulbourethral/Cowper's glands which open into the penile urethra

Question 331

what does the superficial perineal pouch contain?

Answer 331

crura and bulbs of penis and clitoris, which consist of rectile tissue

Question 332

what are the path of the two crura, what do they continue as, and what muscles cover them?

Answer 332

attached to the ischiopubic rami and perineal membrane and continue as the corpora cavernosa into the penis and clitoris ishiocavernosus muscles cover and will contract to limit venous drainage during erection

Question 333

where are the bulbs in the male and female and what muscles cover them?

Answer 333

in male, bulbs of penis lie in midline, attached to perineal membrane and contains the penile urethra in females, the bulbs of the vestibule are in the wall of the vestible with the greater vestibular/Bartholin's glands. unlike in the male they are split and will join at the base of the clitoris covered by the bulbospongiosus muscles which contract to limit venous drainage during erection

Question 334

in males, when the bulbospongiosus muscles contract what functions do they have in addition to preventing venous drainage?

Answer 334

expel sperm and seminal fluid during ejaculation and urine during micturition

Question 335

what is the Colles' fascia and what is it continuous with?

Answer 335

"fatty layer" forms the superficial fascial boundary of the superficial perineal space continuous with the dartos fascia of the scrotum, superifical penile fascia that covers the penis and clitoris and Scarpa's (membranous) fascia of the abdominal wall

Question 336

what is the deep penile or Buck's fascia?

Answer 336

enclose the 3 erectile bodies, deep dorsal vein, dorsal nerves and arteries (2 corpa cavernosa and corpus spongiosum)

Question 337

in the female, what is analogous to the scrotum?

Answer 337

labia majora

Question 338

what are homologous to the prostate in females?

Answer 338

paraurethral glands of Skene's which lubricate the urethra and vestibule

Question 339

what artery supplies the pelvic viscera and perineal structures as well as the walls of the pelivs, gluteal region, and medial aspect of the thigh?

Answer 339

internal iliac artery

Question 340

umbilical artery

Answer 340

now the medial umbilical ligament but gives off vesical arteries to the bladder

Question 341

uterine artery

Answer 341

only in females branch of umbilical artery to course through broad ligament and supply the cervix, body, and fundus of the uterus and uterine tubes

Question 342

artery to ductus deferens arises from and supplies?

Answer 342

inferior vesical artery supplies the ductus deferens and testis

Question 343

vaginal artery is a branch of and supplies the?

Answer 343

branch of uterine artery suplies under the urtery to the bladder and vagina

Question 344

inferior vesical artery

Answer 344

supplies the inferior aspect of the bladder and prostate

Question 345

middle rectal artery is a branch of and supplies?

Answer 345

branch of internal pudendal artery supplies rectum and anal canal ABOVE the pectinate line and seminal vesicles

Question 346

internal pudendal artery, what does it supply, what is its path and what are its branches

Answer 346

supplies the perineum exits the pelvis through the greater sciatic foramen and lesser sciatic foramen courses through the pudendal canal a. inferior rectal artery: supplies the anal canal below the pelvic diaphragm b. perineal branch supplies muscles in the superificial and deep perineal pouches and skin of the labia, vestibule, and scrotum c. artery to the bulb and deep artery of the penis/clitoris supply erectile tissues, bulbourethral bland and greater vestibular gland d. dorsal artery of the penis and clitoris supplies erectile tissue and skin of penis and clitoris

Question 347

iliolunbar artery

Answer 347

crosses the pelvic brim to supply the iliacus, psosas major and minor and quadratus lumborum muscles

Question 348

lateral sacral artery

Answer 348

supplies structures in wall of lesser pelvis and sends branches to sacral canal

Question 349

what are the pelvic wall branches?

Answer 349

iliolumbar artery and lateral sacral artery

Question 350

pudendal nerve what forms it and what are its branches

Answer 350

ventral rami of S2-S4 passes through greater sciatic foramen and enters pudendal canal after passing through lesser sciatic foramen inferior rectal nerve, perineal nerve, dorsal berve of the penis and clitoris

Question 351

inferior rectal nerve

Answer 351

branches from pudental nerve at entrance of pudendal canal innervtes the external sphincter muscle, skin of anal canal BELOW the pectinate line, and skin covering anal triangle

Question 352

perineal nerve

Answer 352

posterior scrotal nerves: skin of posterior scrotum posterior labial nerves: skin of labia majora and vestibule innervates muscles in superifical and deep perineal pouches (transverse perineus, sphincter urethrae, bulbospongiosus, ischiovacernosus muscles)

Question 353

dorsal nerve of penis/clitoris

Answer 353

innervates skin of penis and clitoris

Question 354

what conveys pain from structures in the perineum?

Answer 354

pudendal nerve

Question 355

what are the motor functions of the pudendal nerve?

Answer 355

maintains voluntary urinary continence (sphincter urethrae) maintains voluntary fecal continence (external anal sphincter) supports pelvic visera and helps prevent proapse of structures (urogenital diaphragm and pelvic diaphragm skeletal muscles) maintain erection (ischiocavernosus and bulbospongiosus) expulsion of erine from penile urethra and sperm and seminal flud (bulbospongiosus)

Question 356

what nerves provide sympathetic innervation to smooth muscle and glands in pelvis and perineum?

Answer 356

T11-L2 lower thoracic and lumbar splanchnic nerves that synpase in inferior mesenteric ganglion or cross pelvic brim to synpase in prevertebral ganglia in inferior hypogastric plexus pain and motor

Question 357

what are the motor funcitons of the lower thoracic and lumbar splachnic nerves?

Answer 357

facilitate contraction of sphincter vesicae which allows bladder to fill and prevents retrograde ejaculation facilitates contraction of ductus deferences, prostate, seminal vesicles for emission of sperm and seminal fluid faciliate emptying of secretory products of bulbourethral and greater vestibular glands (lubricate urethra and vesitbule) facilitate contraction of internal anal sphincter for fetal continence

Question 358

what converys pain from GI in hindgut, pelvic viscera, bladder, rectum anal canal above pectinate line? also the fundus, body, cervis of uterus and upper vagina

Answer 358

lower thoracic and lumbar splanchnic

Question 359

what provides the parasympathetic innervation to smooth muscle and glands in the pelvis and perineum?

Answer 359

pelvic splanchnic nerves S2-S4

Question 360

what are the motor functions of the pelvic splanchnic nerves?

Answer 360

facilitate bladder emptying by contracting detrusor muscles stimulate glandular secretions and peristalsis of hindgut faclitate emptying of rectum by relaxing internal anal sphincter and contraction smooth muscle in ampulla of rectum facilitate erection by dilating helicine arteries in erectile tissue stimulate secretory activity of prostate, seminal vesicles, bulbourethral and greater vestibular glands

Question 361

describe vesical reflex of micturation

Answer 361

filling stage: no urine sensed stretch receptors in wall innervated by pelvic splanchnic--\>CNS--\>sympathetic nerves inhibit detrusor to allow bladdr wall to stretch--\>pain fibers stimulated by bladder fullness innverated by lumar and lower thoracic splanchnic nerves emptying stage: CNS activated--\>sphincter urethrae and sphicter vesicae relax, pelvic splanchnic nerves cause detrusor to contract; also bulbospongiosus muscle in male contracts; throacoabdominal diaphragm and muscles also contract to increase intrapelvic pressure this reflex is faciliated by parasympathetic and sympathetic nerves and pudendal nerves

Question 362

describe process of defecation

Answer 362

visceral afferent fibers mediate distension of rectum and anal canal above the pectinate line to sacral spinal cord via pelvix splanchnic nerves these facilitate peristalsis by stimulating contraction in smooth muscle in ampulla of rectum internal anal sphincter and external anal sphincter inhibited

Question 363

sexual relex steps

Answer 363

1. erection - pelvic splanchinic and posganglionic cavernous nerves - relaxation of vascular smooth muscle, dilation and filling of arteries in erctile tissue of crura and sorpora cavernosa, bulb and corpus spongiosum - contraction of ischiocavernosus and bulbospongiosus (by perineal branches of pudendal nerve) help maintain 2. secretion - pelvic splanchnic nerves - males: stimulae prostate, seminal vesicles, and bulbourethral glands to secrete - females: vaginal glands and greater vestibular glands secrete, vagina elongates, uterus moves from anteverted to retoverted position 3. emission - lower thoracic and lumbar splanchnic nerves - contraction of smooth muscle in ductus deferens, prostate, and seminal vesicles - contraction of sphicter vesicae muscle at base of ladder to prevent retrograde ejaculation 4. ejaculation - pudendal nerve - sphincter urethrae is relaxed - rhythmic contractions of bulbospongiosus muscle propel sperm and seminal fluid

Question 364

sacrospinous ligament

Answer 364

converts the greater sciatic notch to the grater sciatic foramen

Question 365

right ovarian vein drains into the...

Answer 365

IVC

Question 366

perineal membrane

Answer 366

separate deep and superficial pouch roots of enternal male genitalia and roots of clitoris

Question 367

where do the bulb and crus converge?

Answer 367

at around the level of the pubic symphyss in the supericial peritoneal pouch to form the penis proper

Question 368

patient has bilateral ptosis, horizontal diplopia, dysphagia, dysarthria, and weakness in chewing as well as in the muscles of facial expression. weakness increases with use. cardiac and smooth muscle are spared. what may the patient have? what nerves are affected? what else can cause this?

Answer 368

myasthenia gravis antibodies attack Ach receptors--\>defective neuromuscular transmission muscles innrvated by cranial nerves primarily affected, especially ocular muscles many patients may have thymic hyperplasia or thymoma

Question 369

condition that presents as weakness in limbs caused by axons peripheral myelin defects

Answer 369

Guillain Barre

Question 370

what is the mechanism behind botulinum toxin?

Answer 370

it prevents the release of Ach by binding to SNARE proteins at presynaptic membrane

Question 371

what is a ganglion versus a nucleus?

Answer 371

ganglion- collection of neuron cell bodies situated in the PNS nucleus- collection of neuron cell bodies inside the brain or spinal cord

Question 372

what synapses in the sensory ganglia?

Answer 372

nothing... contain cell bodies of either pseudounipolar or bipolar sensory neurons

Question 373

what synpases in autonomic ganglia?

Answer 373

motor cell bodies

Question 374

where are neurons in ganglia derived from embryonically speaking?

Answer 374

neural crest ectoderm

Question 375

what type of neurons are found in the nuclei and where are they derived from embryonically speaking?

Answer 375

skeletal motor neurons and preganglionic autonomic neurons derived from neural tube

Question 376

compare oligodendrocytes to schwann cells

Answer 376

- oligodendrocytes form myelin for parts of multiple axons in the CNA - schwann cells- form myelin for axons or processes in the PNS; only for one segment of a single axon

Question 377

can CNS axons regenerate if cut? can PNS axons?

Answer 377

CNS axons: no PNS: if myelinated then yes at rate of 1-4 mm/day

Question 378

what is affected in multiple sclerosis?

Answer 378

both sensory and motor systems containing axons with myelin formed by oligodendrocytes (thus in CNS) undergo inflammatory reaction that impairs impulse transmission multiple lesions appear over time and deficients in sensory/motor may be seen in all areas of body only nerve affected is the optic nerve because all of the myelin sheath of its axons are formed by oligodendrocytes (other spinal/cranial nerves have myelin formed by schwann cells)

Question 379

patients present with anhydrosis (inability to sweat on certain side of face), ptosis, and miosis (constriction of pupil). what condition is this and what is it caused by?

Answer 379

horner's syndrome caused by lesion in either preganglionic or postganglionic sympathetic neurons that innervate sweat glands and blood vessels in face and scalp and 2 smooth muscles in the orbit which elevate uppereyelid and dilate the pupil (differs from myasthenia gravis which attacks Ach receptors resulting in weakness with use or ocular muscles and muscles of face)

Question 380

patient presents with impotence, urine retention with increased urinary frequency at night, dizziness on standing, blurred vision, and inability to sweat. what condition is this and what is it caused by?

Answer 380

Shy-Drager syndrome results from degeneration of preganglionic sympathetic and parasympathetic neurons and of neurons in most ganglia

Question 381

what causes Hirschsprung's disease and what are the symptoms?

Answer 381

caused by failure of neural crest cells to either migrate into wall of the descending colon, sigmoid colon, or rectum or to differentiate into termial parasympathetic ganglia in these areas will be an absence of peristalsis in the affected segment and distended bowel proximal to that segment (huge colon guy)

Question 382

what is an irritated lesion versus a destructive lesion? what do each of them result in for sensory or motor fibers?

Answer 382

irritated lesion- nerve fibers compressed and firing of the irritated sensory or motor neurons altered - sensory fibers have reduced sensation (hypesthesia) or altered sensation (paresthesia) - motor fibers have weakness (paresis) of skeletal muscle destructive lesion- nerve fiber severely compressed or severed resulting in loss of ability of nerves to conduct impulse - sensory fibers have loss of sensory modality (anesthesia) - motor fibers have paralysis and may exhibit faciculations (random twitches) or undergo atrophy

Question 383

what are examples of anatomic end arteries?

Answer 383

arteries that lack collateral circulation central artery of retina, interlobular arteries of kidney

Question 384

Raynaud's disease is characterized by...

Answer 384

arteriovenous shunts that show hyperactive vasocontriction, resulting in cooling of hands and feet cyanosis may be present in fingers and toes

Question 385

where does the thoracic duct drain into? what drains into the thoracic duct? and what does not? where do those structure then drain into and what vein do they meet up with?

Answer 385

the thoracic duct drains into the venous system at the junction of the left subclavian and left jugular vein (where they become the brachiocephalic vein), below the clavicle (will go up and come back down) the thoracic duct collects from any nodes below the diaphragm and the left head, neck, chest, and arm it does not collect from the right side of the head, neck, right upper extremities, right chest or the LEFT LOWER LOBE OF LUNG these drain into the right lymphatic duct which drain into venous system at junction of R subclavian and R jugular veins

Question 386

if there is an overproduction or lack of absorption of cerebrospinal fluid or a blackage into ventricles of the CNS/subarachnoid space, this can cause...

Answer 386

hydrocephalus

Question 387

parasympathetic or sympathetic? mkaes detrusor muscle contract

Answer 387

parasympathetic

Question 388

parasympathetic or sympathetic? sends preganglionic axons to synpase in prevertebral ganglia

Answer 388

sympathetic

Question 389

parasympathetic or sympathetic? contains preganglionic axons that exit the CNS in ventral roots of spinal nerves

Answer 389

both

Question 390

parasympathetic or sympathetic? has preganglionic neuron cell bodies in the spinal cord

Answer 390

both

Question 391

parasympathetic or sympathetic? sends preganglionic axons to synpase in terminal gangia

Answer 391

parasympathetic

Question 392

parasympathetic or sympathetic? superior cervical ganglion is part of this system

Answer 392

sympathetic

Question 393

parasympathetic or sympathetic? facilitates emission

Answer 393

sympathetic

Question 394

parasympathetic or sympathetic? postganglionic fibers of this system innervate smooth muscle in blood vessels in the upper limb

Answer 394

sympathetic

Question 395

parasympathetic or sympathetic? responsible for innervating a smooth muscle that dilates the pupil

Answer 395

sympathetic

Question 396

parasympathetic or sympathetic? increases secretory activity of glands in the wall of the GI tract

Answer 396

parasympathetic

Question 397

parasympathetic or sympathetic? functions in dilating vascular smooth muscle in erection

Answer 397

parasympathetic

Question 398

parasympathetic or sympathetic? preganglionic axons course in white rami

Answer 398

sympathetic

Question 399

parasympathetic or sympathetic? preganglionic axons exit the CNS in cranial nerves V, VII, IX, X

Answer 399

neither... only III, VII, IX, and X carry preganglionic parasympathetics out of brainstem

Question 400

parasympathetic or sympathetic? postganglionic in gray rami

Answer 400

sympathetic (cardiopulmonary splanchnic)

Question 401

parasympathetic or sympathetic? lesion of this system results in miosis (pupil constriction), ptosis, anhydrosis

Answer 401

sympathetic

Question 402

lambert-eaton syndrome is caused by... and results in...

Answer 402

immunologic disorder of calcium ion channels in nerves at end plate associated with small cell carcinoma of lungs proximal muscles in limbs are primarily affected muscles innervated by cranial nerves paraed repetitive contractions of affected muscle can temporarily increase strength