Exam 2 Flashcards
The endothoracic fascia lines what?
*the entire pulmonary cavity
What do the external and innermost intercostals do?
*elevate the rib
What does the internal intercostal do?
*depress the rib
What kind of space is the intercostal space?
*real space
What is the floor and roof of the intercostal space?
- roof- superficial fascia
* floor-endothoracic fascia
Where does the posterior intercostal artery get blood from?
*thoracic aorta
What does the internal thoracic artery supply blood to?
*anterior intercostal artery
What does the musculophrenic artery supply blood to?
*inferior anterior intercostal artery
Where does the subcostal artery get blood from?
*thoracic aorta
How many veins are on each side?
*12 (11 and 1 subcostal)
Where do the veins end?
*venous system (venous blood to sup Vena Cava)
What innervates the intercostal nerves?
*anterior rami of T1-T12 spinal nerves
What does the posterior ramus supply?
*bones, joints, deep back muscles
What innervates a dermatome?
*cutaneous sensory fibers
What innervates myotomes?
*motor fibers
What is the peritoneal cavity?
*potential space that allows the GI track to slip around
What is the pleural line of reflection?
*where visceral and parietal pleura are continuous
What covers the lungs, and adherents it to all its surface?
*visceral pleurae
What lines the pulmonary cavities?
*parietal pleurae
What happens are the costodiaphragmatic recess?
*parietal pleura in contact with parietal pleura (potential space)
What has no pain receptors?
*visceral pleura and lung tissue
What do the visceral and parietal pleura have?
*serous membrane (secretes slippery/ capillary layer fluid to help with movement)
What moves posteriorly during expiration?
*sternum
What happens during passive expiration and what muscles are used?
- no muscles used
* pull thorax wall closed, diaph relaxes
What is an active process?
*inspiration
What muscles are used during inspiration?
*sternocleido mastoid and scalenes
What muscles are used for active expiration?
*rectus abdominus, internal and external obliques
What innervates the diaphragm?
*right and left phrenic nerves (sensory and motor fibers)
What arises from the prechordal mesoderm?
*central tendon of diaphragm
Where do all muscles of the diaphragm insert on?
*central tendon of diaphragm
What is the central tendon of the diaphragm innervated by?
*phrenic nerve (C3, C4, C5)
Where would you feel an infection of the diaphragm?
- referred pain on top of shoulder/side of neck
* somatic innervation
What is the BS to the central tendon of diaphragm?
*left pericardiacophrenic vein and artery
What is the BS to the diaphragm?
- right musculophrenic artery and vein
* inferior phrenic
What is a congenital hernia?
- when the esophageal hiatus doesn’t close and the GI track develop above diaphragm
- lungs don’t develop, because the heart is pushed up and it compressed the lungs
- 50% survive
Where do congential hernias usually happen?
*left-postural lateral
What is longitudinal folding a result of?
*rapid growth of neural tube
What happens during longitudinal folding?
*amniotic folding around embryo (except connecting stalk)
What does the connecting stalk become?
*umbilical cord
What innervates the septum transversium?
*phrenic nerve
What innervates the pleuroperitoneal fold?
- phrenic nerve
* visceral innervation
What does the septum transversum fuse with and form?
*pleuroperitoneal folds (separates thoracic cavity from abdominal wall)
What does the septum transversum become?
*CT of liver, central tendon of diaphragm, heart
What kind of innervation is the peripheral edge of the diaphragm?
*somatic, all other parts are visceral
What does the lateral plate mesoderm split and become?
*body cavity (visceral and parietal layer)
Why can the bronchoplumonary segments be removed?
*they have their own air and blood supply
How many bronchopulmonary segments are there?
*10-12 per lung
What is pleuritis?
*inflammation of the pleurae, loose slipperiness (friction goes away)
What do you hear in pleuritis?
*cloth rubbing together (pleural rub)
What is the treatment for pleuritis?
*antibiotics
What is pleural effusion/ empyema, and what is its diagnosis and treatment?
- fluid in cavity
- lungs compressed (prevent from inflating fully)
- x-ray or percussion (dead sound = fluid)
- drain (thoracentesis)
What does the needle pass through in thoracentesis?
- external, internal, innermost intercostal
- costal parietal pleura
- intercostal space (9th and 10th)
What is tension pneumothorax?
- struggling to breath and pulling air in, inflate empty space
- diaphragm push down even more, no venous return to heart (squished)
What is simple pneumothorax (ataleltasis), how is it treated, and what are the symptoms?
- fail to inflate
- lungs not completely collapsed, small air in cavity
- body takes care of it
- dyspnea (diff breathing)
How is chronic pulmonary collapse treated?
- scaring pleura so visceral and parietal won’t separate again
- pleurodesis (scape pleura or sprinkle irrating powder)
What is pulmonary collapse and what are the symptoms?
- lung won’t inflate on its own, shrinks about 1/3 size of cavity
- acute respiratory distress, cyanosis
- becomes a real space
Why does pulmonary collapse happen?
- spontaneous (tall, thin people)
* traumatic (injury to thoracic wall)
What is a pulmonary embolism and what is it due to?
- blockage in pulmonary artery
* due to blood clot, glob of fat, air bubble
What can a pulmonary embolism cause?
- mild block goes unnoticed
- large block gives dyspenea (diff breathing), acute respiratory distress, chest pain, coughing, sweating, cyanosis
- can knock out entire lobe of lung
What can a lung that has pulmonary embolism do?
*ventilate but not profusing blood
What does pulmonary embolism come from and what are the risks factors?
- deep vein thrombosis (thromboembolism)
* age, varicose veins, immobility, dehydration, recent surgery, poor health (smoking, obesity)
What does the anterior abdominal wall do?
- protects abdominal viscera
* helps in active expiration
What are the abdominal quadrants?
- right/left upper quadrant
* right/left lower quadrant
What are the abdominal regions?
*epigastric, umbilical, hypogastric, left/right inguinal, left/right lumbar, left/right hypochondriac
What are the muscles of the anterolateral abdominal wall?
- 3 flat: external/internal oblique, transverusus abdominis
* 2 verticcle: rectus abdominis, pyramidalis
What is in the rectus sheath?
*deep fascis of rectus abdominus, apernosis
What gives off the anterior intercostal artery?
*musculophrenic artery
What delivers blood to abdominal wall?
*musculophrenic artery
What does the 10th and 11th posterior intercostal arteries deliver blood to?
*lateral wall
What does the inferior epigastric artery deliver blood to?
*post side of rectus abdominus (inferior part)
What does the superficial epigastric artery deliver blood to?
*anterolateral wall
What does the superior epigastric artery delivery blood to?
*superior rectus abdominus
What innervates the thoracoabdominal nerves?
*anterior rami
Where are the thoracoabdominal nerves?
*T7-L1
What happens in the upper trunk of venous drainage?
*end up in thoracoepigastric vein, into axillary vein
What happens in the lower trunk of venous drainage?
*end up in saphenous opening
What happens to lymph superior to the transumbilical plane?
*ends in axillary lymph node
What happens to lymph inferior to the transumbilical plane?
*flows to superficial inguinal lymph node
What is a umbilical fold?
*where peritoneum is draped over something
What does the ductus deferens enter through and what is medial to it?
- deep inguinal ring
* epigastric vessels medial to ring
What is fetal circulation and what happens to it?
- umbilical artery under external iliac artery (blood goes sup and end up in inferior Vena Cava)
- get filled and become ligament
What did the round ligament of the liver use to contain?
*umbilical vein
What does the lateral, medial, and median umbilical fold contain?
- L: inferior epigastric artery and vein
- medial: umbilical artery
- median: reminiscent of development of digestive system (Urachus)
What is in the portal triad?
*fresh arterial blood, blood from GI track (branch of hepatic portal vein) and bilium (bile duct)
What is attached to the greater/lesser curvature of the stomach?
- greater omentum
* L: lesser omentum
What is in the lesser/ greater omentum?
*L: hepatoduodenal/ hepatogastric ligament
G: gastrophrenic/ gastrosplenic/ gastrocolic
What do the external/ internal oblique and transversus abdominis have?
*own anterior and posterior leaflet of deep fascia
What splits the leaflets of the external/ internal oblique and transversus abdominis?
- rectus abdominis
What is the GI tract lined with?
*epithelium derived from endoderm
What are the 2 layers of smooth muscles in the GI tract?
*inner circular layer, and longitudinal layer (mesoderm derived)
What is amylase for?
*break down carbs
What is lipase for?
*break down fat
What is the purpose of the small intestine?
*absorption of nutrients
What is the purpose of the large intestine?
*absorption of water
What happens in the anal canal?
*innervation switches from visceral to somatic
What does the stomach have?
*3 irregular layers
What is the biliary apparatus?
*gallbladder and various tubes leading to duodenum
What is the esophagus made of?
*superior 1/3 mostly skeletal muscles, inferior 1/3 mostly smooth
What gets added in the duodenum?
*acid chyme (duodenum glands secrete alkaline fluid), pancreatic juice (digestive enzymes), and bile (emulsify fat)
Where is bile produced and stored?
- P: liver
* S: gallbladder
What is gastric mucosa?
*lining of stomach, secretes gastric juice (hydrochloric acid)
What is acidchyme?
*gastric juice and food
What kind of input is the Vagus nerve?
*parasympathetic input
What provides sympathetic input to the 2 plexus?
*abdominopelvic splanchnic nerve pathway
What are the 2 plexus in the GI tract?
*submucosal and myenteric plexus
How can you get esophageal cancer?
*if gastric content bubble up through the diaphragm
What is retroperitonum?
*Big portion behind peritoneum
What is the BS of the GI tract?
*celiac trunk, superior/ inferior mesenteric artery
What is it called if the small intestine hangs from it?
*mesentery
What is it called if the large intestine hangs from it?
*transverse mesocolon
What supplies the foregut, midgut, and hindgut?
- F: celiac trunk
- M: sup. mesenteric artery
- H: inf mesenteric artery
What is the foregut?
*distal esophagus to middle of duodenum
What is the midgut?
*distal half of duodenum to splenic flexure (transverse colon- descending colon)
What is the hindgut?
*spenic flexure to anal canal
WHat are the branches of the celiac trunk?
*comon hepatic, left gastric and splenic
What is the BS to the liver and duodenum?
*common hepatic artery
What is the BS to the lesser curvature of the stomach?
*left gastric artery
What supplies blood to the rectum and sigmoid colon and superior half of the anal canal?
*superior rectal artery
Where is there an anastamosis between in the GI tract?
*superior and inferior mesenteric artery
What are the 4 main veins of the hepatic portal system?
*hepatic portal, splenic, superior and inferior mesenteric
What are the minor veins of the hepatic portal system?
*left gastric veins
What is the setup of the hepatic portal system?
*artery, capillary bed in wall of GI, portal veins, capillary bed in liver
What kind of blood is in the first and 2nd capillary bed?
- 1: oxygen rich, nutrient poor blood
* 2: oxygen poor, nutrient rich
What collects bile?
*left/right hepatic duct
WHat are the contents of the hepatoduodenal ligament (portal triad)?
*bile duct, hepatic artery proper, hepatic portal vein
What is serosis of the liver?
- death of hepatocytes and replacement with fat and CT
* blocks branches of hepatic portal vein (can cause collateral circulation)
What is the cause and treatment of serosis of the liver?
- cause: alcoholism
* treatment: liver transplant, portosystemic shunts
What drains the blood to the round ligament of the liver?
*para-umbilical veins
What is esophageal varacies and what are the symptoms and treatment?
- varicose veins in esophagus
- black/ tarry stool
- fatal
- cauterize
What can varacies in the umbilicus cause and what is it also called?
- blue veins around umbilicus
* caput medusae
What divides the anal canal into the visceral and somatic innervation?
*pectinate line
What do varacies in the wall of the rectum or anal canal cause?
*hemorrhoids
What is the symptoms superior and inferior to the pectinate line?
- s: right red blood in stool
* I: hurt/itch
What do neural crest cells make?
*PNS and gut tube (make ganglia)
What can remain in falciform ligament and lesser omentum?
*ventral mesentery
What buds off the foregut?
*trachea, liver, gallbladder, pancreas
What does visceral mesoderm become?
*2 layers of smooth muscle (inner circular and longitudinal )
What is the yolk sac lined with?
*endoderm
What is lateral folding the formation of?
*embryonic body cavity
What does the yolk sac become?
*epithelium that lines GI track and things that bud off
What happens if the dorsal mesentery remains or disappears?
- R: greater omentum, transverse colon
* D: GI tract up again wall (called 2nd retroperitoneal)
What organs are secondary retroperitneal?
*ascending/descending colon and esophagus
What is the vitelline duct incorporated into?
*umbilical cord (proximal part)
What does longitudinal folding cause?
*things to move to more definitive position
What remains in contact with the yolk sac?
*midgut
What is temporary incorporated into the umbilical cord?
*allantois
Where does the allantois form?
*apex of bladder
What happens when allantois remains and disappears?
- R: Urchus,
* D:causes median umbilical fold
What happens at week 4 of embryo development?
*establishment of gut regions, gut BS, foregut derivatives bud off
When the stomach turns 90 degrees the greater/lesser omentum goes which way?
- G: left
* L: Right
Where does most of the rotation happen?
*midgut
What is the gut tube suspended by?
*dorsal mesentery
What happens at week 5?
*midgut loop
Where does the gut rotate around and which way?
*axis of s. mesenteric artery (counterclock wise)
What does the cranial loop and caudal loop become?
- cranial: most of small intestine
* caudal: most of large intestine
What happens at week 6?
- physiological herniation (midgut loop herniates through umbilical cord)
- 90 degree counterclockwise rotation around viteline duct
What happens at weeks 10-11?
- retraction of physiological herniation
- midgut loop returns to abdominalpelvic cavity (turns another 180 degrees)
- vitelline duct disappears
Where is the Vitelline duct attached to?
*proximal to illeocecal junction
What is left sided colon and what can it cause?
- final 180 degree turn doesn’t happen
* GI tract more free than should be, parts of GI tract can wrap around itself (can impede peristalsis (Vovulus)
What is reversed rotation?
*clockwise rotation
What is atresia and stenosis and what is it due to?
- A: part of GI tract doesn’t form due to a twist and blood can’t get there
- S: narrowing
What can stretching of the walls of the GI tract cause?
*visceral pain (very painful)
What does Meckel’s diverticulum contain?
*gastric mucosa
What are some diseases that are caused by failure of closure of the ventral body wall?
- omphalocoele
- gastroschisis
- omphalocoele
What is Omphalocoele and what can it cause?
- failure of midgut loop to return
* high mortality (cause cardiac abnormalities)
What is gastroschisis?
- reherniates back out because of weakness around umbilicus
* high survival rate
What is congenital aganglionic megacolon caused by?
- failure of myenteric plexus to form (can’t perform peristalsis)
- muscles can breakdown
Where does congenital aganglionic megacolon happen at?
*distal GI tract, distal rectum (where plexus didn’t form)
How do you treat congenital aganglionic megacolon?
*remove part that doesn’t work
What can happen if the vitelline duct remains?
*form cyst, vitelline fistula or ileal diverticulum (Meckel diverticulum)
What is vitelline fistula, signs and treatment?
- opening between GI tract and umbilical
- poop comes out of umbilicus
- just tie it off
What is a fistula?
*abnormal connection between organd and outside or organ and organ
What is the floor, roof, anterior, posterior, and lateral borders of the mediastum?
- F: diaphragm
- R: superior thoracic aperture
- A: sternum and costal cartilage
- P: mediastinum pleural
What is the level of the ascending/descending aorta?
*sternal angle
What does the phrenic nerve innervate and what is its position?
- inn area around central tendon of diaphragm
* stuck to fibrous pericardium, ant. to root of lung, sensory fibers
Where does the Vagus nerve fun and what are the inputs?
- runs post to root of lung
* parasymp. inputs
What is fibrous pericardium attached to and surround?
*attach to central tendon of diaphragm and surrounds heart and blend into roots of great vessels
Why can you only have a small amount of fluid in peric. cavity before it kills you?
*fibrous per. cannot stretch
What is hemopericardium?
- heart cannot fill properly
- take care immed. or die
- can cause cardiac tamponade
What is a sign of tension pneumothorax?
*distended jugular veins
What causes hemopericardium?
*leak from trauma to chest, damaged heart from myocardio infarction, pluged drainage tube after heart surgery
What is cardiac tamponade and what are the signs?
- heart compression
- hypotension, cyanosis, pulseless electrical activity (can’t feel pulse), distended jugular veins, rapid weak pulse, diminished heart sounds
What is the treatment for hemopericardium?
*pericardiocentesis
How is pericardiocentesis done?
- go through bare area of pericardium (5th or 6th space between rib) and get blood/pus out
- parasternal approach
What are the 3 circuits of the heart?
- pulmonary (pressure from R side)
- systemic (pressure from L side)
- coronary
What are the pericardial sinuses?
- transverse pericardial sinus
* oblique pericardial sinus
Where can you clamp the pulmonary trunk and aorta during surgery to cut off BS?
*transverse pericardial sinus
What is a different expectation for coronary circulation?
- Left coronary artery gives rise to the posterior interventricular branch
- LCA dominant
What is normal coronary circulation?
*RCA and LCA share equally in BS
What is atherosclerosis and what can it result in?
- starts as fatty deposits, plaque forms over
* myocardial infection
Where do most coronary artery occlusions occur and how do you fix it (describe)?
- proximal part of AIV
- coronary arterial bypass (use artery)
- balloon angioplasty (use stent to hold open)
WHere does the ligamentum arteriosum run?
*between pulmonary trunk and arch or aorta
What is a volvulus?
- twisting of GI tract
- visceral/ dull pain, but intense
- diagnosis with imagining
What is esophageal atresia and what is it caused by, signs?
- failure of recanalization (opens up again)
- caused by too much tissue on trachea side and not enough on esophagus side
- baby can’t feet, vomit, foaming white stuff in mouth/nose, baby swallow air (distended stomach)
How often do esophageal atresia and tracheoesophageal fistula happen?
*1 in 3000 to 1 in 5000 babies
How do you treat esophageal atresia?
*resect, long gap atresia repair (pull and esophagus lengthens)
What is an ulcer and what are the types and what are they caused by?
- eroding in gastric lining
- caused by helicobacter pylori
- peptic, duodenum, and gastric ulcer
What causes ulcers?
*smoking, alcohol, stress
What can gastric ulcers put you at risk for and where is the pain?
- around xiphoid
* hemorrhage
How do you diagnosis an ulcer?
*endoscope, x-ray, breath/blood/stool test
Where is the pain for duodenum ulcers felt?
*in skin over liver
What are the tissues?
- visceral pericardium (epicardium)
- myocardium
- endocardium
What is in the visceral pericardium and what is it continuous with?
- serous layer and underlining fat
* cont. with tunica externa
What is in the myocardium and what is it continuous with?
- cardiac myocytes
* contin with tunica media
What has their own intrinsic rhythm?
*cardiac myocytes
What is the endocardium continuous with?
*tunica intima
What is the Fossa Ovalis?
*remnant of oval foramen (blood from RA to LA, bypass lung)
What is the SA node?
- pacemaker
What is in the RA?
*column of muscle in wall (pectinate part) and smooth part
What does the crista terminalis divide?
*part of smooth muscle and muscles in wall
What is the smooth part and other part from?
- S: vessels
* embryonic heart wall
What is the interventricular septum?
*mostly muscle, sup part is CT (membranous portion)
What is the membranous portion part of?
*fibrous skeleton
What is rheumatic fever?
*strep to heart, can effect valves and heart tissues
What is in the atrialventricular septum?
*fibrous skeleton of heart (support valves)
What are the functions of the fibrous skeleton of the heart?
- forms membranous interatrial septum
- supports opening of valves
- electrically insulates atria and ventricles
- tunnel for electrical signal to go through
- membranous part of IV septum
How are the walls of the heart in diastole, atrial systole, ventricular systole?
- D: relaxed
* A and V: contraction
Where does the conducting system of heart originate and influenced by?
- O: nodes
* I: autonomic nervous system
What is the conducting system of the heart?
*SA node, AV node, AV bundle, R and L bundle branches, purkinje fibers
What are 5 adaptations for bypassing fetal lungs, liver?
*Ductus arteriosus, oval foramen and valve, ductus venosus, umbilical vein, umbilical arteries
What does the lung have?
*high resistance to blood flow (LA blood pressure is low)
What is the former ductus arteriosus?
*ligamentum arteriosum
What is the former oval foramen and valve?
*fossa ovalis
What is the former ductus venosus?
*ligamentum teres
What is the former umbilical vein?
*round ligament of the liver
What is the former umbilical arteries?
*medial umbilical ligaments
