Exam 3 Flashcards
The thorax is located between the ____ and _____.
neck and abdomen
The thorax provides protection for…
the heart, lungs, and some abdominal organs (liver, spleen, kidneys)
What does the superior thoracic aperture communicate with?
head, neck, and upper limbs
The inferior thoracic aperture is separated from the abdominal cavity by the _____
diaphragm
What forms the thoracic cage?
thoracic vertebrae, ribs, sternum
There are usually ____ ribs on each side of the thorax
12
Typical ribs, ribs # ___-____ have a head, neck, tubercle, and shaft
3-9
The head of a typical rib has two facets for articulation with…
the numerically corresponding vertebra and the vertebrae superior to it
The tubercle of a typical rib articulates with…
the transverse process (TP) of the corresponding vertebra
The shaft (body_ of a typical vertebra has a costal groove for what 3 structures?
vein, artery, and nerve
Ribs 1-7 are considered ___ ____ because they are connected to the sternum
true ribs
Ribs 8-10 are called ____ ____
false ribs
Ribs 11 and 12 are called ____ ____
floating ribs
Which rib is the broadest and most curved of all ribs, as well as the shortest of the true ribs?
1st rib
True or False: The 1st rib only has a single facet on its head because it only articulates with T1.
True
What vein crosses the 1st rib anterior to the scalene tubercle?
subclavian vein
The scalene tubercle of the 1st rib is an attachment point for what muscle?
anterior scalene
The subclavian artery passes _____ to the 1st rib
posterior
What trunk of the brachial plexus passes posterior to the scalene tubercle of the 1st rib.
inferior trunk
The costal cartilages contribute to the _____ of the thoracic wall.
flexibility
The costovertebral joints are individual ____ joints.
synovial
The ___ ____ is the portion of the inferior aperture of the thorax formed by the articulated cartilages of the seventh to tenth ribs
costal margin
The ____ ligament is associated with the head of the rib.
radiate
The superior costotransverse ligament runs from what to what?
neck of the rib to the tip of the TP of the vertebra above
The ___ ____ ligament runs from the tubercle of the rib to the tip of the TP of the same vertebra.
lateral costotransverse ligament
The costotransverse ligament runs from what to what?
rib to TP of same vertebra
The costotransverse ligament is more ____ than the lateral costotransverse ligament
anterior
Name the three parts of the sternum.
manubrium, body, and xiphoid process
What are the sternal notches for on the body of the sternum?
sternocostal articulations
The sternal angle also the site of the ______ joint and is connected by a plate of cartilage making it a ______ joint.
manubosternal; symphysis
What five things occur at the level of the sternal angle?
- the 2nd costal cartilage articulates with the sternum
- the aortic arch begins and ends
- the trachea bifurcates into right and left bronchi
- demarcates the inferior border of the superior mediastinum
- a transverse plane would pass through the intervertebral disc between T4-T5
There are both ___, ____, and _____ intercostal muscles.
external, internal and innermost intercostal muscles
There are ___ pairs of external intercostal muscles.
11 pairs
There are ____ intercostal spaces.
11
External intercostal muscles have fibers running ___ to ___
laterally to medially (hands in pocket)
The external intercostal muscles arise from the inferior margin of one rib and insert on the….
superior margin of the rib below
The intercostal spaces are named…
according to the superior rib
The external intercostal muscles run from the ____ _____ posteriorly to the ____ _____ anteriorly and continues as the….
vertebral column to costochondral junctions;
continues as the external intercostal membrane
The external intercostal muscles are most active in _____ and act to….
inspiration, elevates ribs; stiffen the chest wall
There are ___ pairs of internal intercostals.
11
Internal intercostal muscles have fibers running ___ to ___
medially to laterally (at right angles to the external intecostals)
The internal intercostals arise from the _____ margin of one rib and inserts on the superior margin of the rib below.
inferior
The internal intercostal muscles run from the ____ to the ____ ___ and continues as the…. back to the vertebral column
sternum to midaxillary line; continues as the internal intercostals membrane
The anterior fibers of the internal intercostal muscles are active in ____ and the more posterior fibers are active in ____.
inspiration; expiration
The innermost intercostals are the ___ portions of the internal intercostals.
internal
What separates the internal intercostals from the innermost intercostals?
the intercostal nerves and vessels
The innermost intercostal muscles run ___ to ____ from the angle of the rib to the midaxillary line
medial to lateral
Typically, the male nipple corresponds to what intercostal space?
4th intercostal space
What do all the intercostal muscles act to do?
to keep the intercostal spaced rigid and have a respiratory role as well
The transversus thoracis muscles are attached to the posterior aspect of the sternum and pass to the ___-___ costal cartilages
2nd-5th
What vessels run anterior to the transversus thoracis muscles?
internal thoracic vessels
The subcostal muscles extend from the internal surface if the angle of one rib to the internal surface of the rib….
2-3 ribs below the rib of origin.
True to False: The subcostal muscles are posteriorly placed meaning they are on the posterior thoracic wall.
True
What muscles are referred to as the innermost complex?
tranversus thoracis, innermost intercostals, and subcostal muscles.
The intercostal space houses the intercostal…
Vein, Artery, and Nerve (VAN)
The intercostal (thoracic) nerves are the ____ rami of __-___
ventral rami T1-T11
Name the two branches of the intercostal nerves.
lateral cutaneous branches, and anterior cutaneous branches
T12 is the ____ nerve
subcostal
Name the intercostal arteries.
posterior intercostal artery and anterior intercostal artery
The internal thoracic artery is also known as the…
internal mammary artery
The internal thoracic artery arises from the ____ artery
subclavian
The internal thoracic artery runs on the internal surface of the thorax _____ to the sternum, _____ to the transversus thoracis muscle.
lateral; anterior
Name the terminal branches of the internal thoracic artery.
Superior epigastric artery and musculophrenic artery, also gives rise to anterior intercostal arteries
Name the 3 ways the thoracic cavity changes during respiration.
- inferiorly
- laterally
- anteriorly
Describe how the thoracic cavity changes inferiorly during respiration.
vertical diameter;
contraction and relaxation of the diaphragm
Describe how the thoracic cavity changes laterally during respiration.
transverse diameter; swinging outward of ribs; “bucket handle movement”
Describe how the thoracic cavity changes anteriorly during respiration.
anteroposterior diameter; raising of anterior ends of rib; “pump handle movement”
The 2 internal thoracic veins are ____ ___ and run on either side of the arteries
venae communicantes
The right and left pulmonary cavities contain the ____ and the ____
lungs and pleurae
There are two pleural cavities , which are completely _____ from each other.
separate
The pleural cavities, together with the lungs occupy most of the _____ ____
thoracic cavity
What is pleura?
a thin serous membrane
Describe the visceral pleura of the lungs
moist and shiny
adheres to all surfaces
provides a smooth slippery surface that enables the lungs to move freely
not very well innervated
Describe the parietal pleura of the lungs.
adherent to thoracic wall and diaphragm by connective tissue
well innervated
The parietal pleura is given different names according to what it is associated with. These include…,which are all supplied by….
costal, mediastinal, diaphragmatic, and cervical pleura;
supplied by the thoracic arteries
The cervical pleura is called ___ ___
pleura cupula
The costodiaphragmatic recess allows…. and the costomediastinal recess acts to….
the lung to expand;
make room for the heart on the left side
What is the pleural cavity, what does it contain, and what does it allow?
potential space between the two pleural layers, pleural fluid, allows lungs to expand and contract freely
The lungs are surrounded by the ___ ___ but outside of them
pleural sacs
What is pleuritis?
inflammation of the pleura
What is pneumothorax?
entry of air in the pleural cavity
The lungs are the essential organs of _____
respiration
What is the main function of the lungs?
to oxygenate the venous mixed blood
What is the shape of each lung?
conical
What are the lungs attached to and by what structures are they attached?
attached to the heart and trachea by the structures in the root of the lungs (pulmonary arteries, veins, and main bronchii
The right lung has ___ lobe(s) and ___ fissure(s). Name each.
3 lobes- superior, middle, inferior
2 fissures- horizontal an oblique
The left lung has ___ lobe(s) and ___ fissure(s). Name each.
2 lobes: superior and oblique
1 fissure- oblique
The left lung also has a tongue like area called the ____ and the ___ ___, which is the space where the heart fits.
lingua; cardiac notch
Name the 4 parts of the lung.
Apex, base, root, hilum
The apex is the superior end that extends through the superior thoracic aperture into the roof of the neck. It is in contact with the ____ of the pleura and crosses by the ____ artery.
cupula; subclavian
The base of each lung is a ___ diaphragmatic surface that sits on top of the diaphragm
concave
The root of the lung serves as the attachment of the lung connecting the ___ surface of the lung with the heart and trachea
medial
What ligament is associated with the root of the lung
pulmonary ligament
What is the hilum of the lung?
space where the root is attached
Name the surfaces of the lung.
- costal
- mediastinal
- diaphragmatic
Name the borders of the lung.
- anterior-sharp
2 posterior- more rounded - inferior- around diaphragmatic surface
The _____ bifurcates at the level of the sternal angle into the right and left main bronchi
trachea
The _____ main bronchus is wider, shorter, and more vertical than the ____
right; left
Clinical question! If a person aspirates, it is likely to go into the ____ lung.
right
What are the bronchial walls supported by?
c-shaped rings of cartilage
Each bronchi accompanies the pulmonary artery into the hilus, where it subdivides ti form a ___ ___
bronchial tree
There are secondary bronchi or ____ bronchi for each lung. There are ___ on the left and ____ on the right. They supply the lobe of the lungs
lobar
2; 3
The secondary bronchi further branch into the ____ (____) bronchi
tertiary (segmental)
The tertiary bronchi supply _____ _____, a region also supplied by the segmental (tertiary) artery
brochopulmonary segments
Within bronchopulmonary segments there is further branching of bronchi. These are separated by…
adjacent segments by connective tissue septa
There are ___ segmental bronchi on the right and ___ on the left.
10; 8-10
Conducting bronchioles –> ____ _____ –> respiratory bronchioles –> ___ _____ –> ___ ____
terminal bronchioles
alveolar duct
alveolar sac
What occurs in the alveoli?
exchange of gases with capillary plexus
The pulmonary arteries arise from the _____ _____
pulmonary trunk
The pulmonary arteries distribute ______ blood to the lungs
deoxygenated
There is a branch of the pulmonary artery to each lobe called the ____ arteries and to the brochopulmonary segment called the ____ _____ artery
lobar, tertiary segmental
The terminal branches of the pulmonary arteries divid einto ______ in the walls of the alveoli-gaseous exchange
capillaries
The ____ arteries supply blood to the connective tissue of the bronchial tree
bronchial
There are ___ left bronchial artery(ies) and ___ right bronchial artery(ies)
2; 1
There are ___ pulmonary veins on each side, which carry _____ blood from the lungs to the left atrium.
2 (superior and inferior); oxygenated
The branches of the pulmonary veins drain multiple ____ ______
bronchopulmonary segments
Where do the bronchial veins drain?
near the root of the lungs
The lungs are visceral pleura are innervated by….which contain sympathetic, parasympathetic and GVA fibers
the anterior and posterior pulmonary plexuses
The vagus nerve is cranial nerve ___
ten (CN X) (vagus means wanderer)
The lungs and visceral pleura are relatively _____ to pain
insensitive
For the lungs are visceral pleura, sympathetic fibers are _____ to bronchial muscle (bronchidilator), ____ to the pulmonary vessels (vasoconstrictor) and _______ to alveolar glands
inhibitory, motor, inhibitory
For the lungs and visceral pleura, the parasympathetic fiber are motor to the ___ ____ of the bronchial tree, inhibitory to the ___ _____ (vasodialtor), and secretory to…
smooth muscle; bronchial vessels; the glands of the bronchial tree
The parietal pleura –> costal pleura and part of diaphragmatic pleura are innervated by…
intercostal nerves
The central part of the diaphragmatic pleura and mediastinal are supplied by ____ nerves
phrenic
The parietal pleura is _____ to pain
very sensitive
The superficial lymphatic plexus lies ____ to the visceral pleura
deep
The superficial lymphatic plexus drains into _____ lymph nodes in the hilum to the _____ lymph nodes
bronchopulmonary to tracheobronchial
What does the superficial lymphatic plexus drain?
the lung and visceral pluera
What does the deep lymphatic plexus drain?
structures that from the root of the lung
The deep lymphatic plexus drains into _____ lymph nodes along the lobar bronchi, then into the _____ lymph nodes, then into the _____ lymph nodes
pulmonary, bronchopulmonary, tracheopulmonary
From the tracheobronchial lymph nodes the lymph passes to the right and left ______ ____ ____, which usually terminate at the junction of the subclavian and internal jugular veins.
bronchomediastinal lymph trunks
What are two common sites of metastasis?
brain and bones
When we inhale, the diaphragm….
flattens and moves downward and the external intercostal muscles move the rib cage upward and out.
When we exhale, the diaphragm and intercostal muscles…
relax and return to their resting positions
Inhalation ____ the size of the internal air pressure and air from the outside rushes into the lungs to equalize the pressure.
decreases
Exhalation ___ the size of the thoracic cavity, thereby ____ pressure and forcing air out of the lungs.
reduces; increasing
The _____ is the central compartment between the two pulmonary cavities.
mediastinum
Name the parts the mediastinum is divided into.
Anterior, superior, middle, and posterior
The heart is positioned ____ in the middle of the mediastinum
obliquely
True or False: The heart lies in the median plane.
False. 2/3 of the heart is located on the left of the median plan while the remaining 1/3 is to the right of the median plane
What does the middle mediastinum contain?
pericardium and the heart and roots of the great vessels
What is pericardium?
a double walled fibroserous sac surrounding the heart and roots of the great vessels
Name the two parts of pericardium.
fibrous and serous
Describe the fibrous pericardium.
- tough outer sac
- protects heart against sudden overfilling
- attached to the sternum
The fibrous pericardium is attached to the sternum by the sternopericardial ligaments and also the central tendon of the diaphragm (__________ ligament)
pericardiacphrenic
The serous pericardium consists of two layers. Name and describe where each is located.
- parietal- fused with the fibrous pericardium
2. reflected onto the heart (epicardium)
The potential space between opposing layers of parietal and visceral layers of serous pericardium is the ___ ____
pericardial cavity
The pericardial cavity contains the ____ ____ sinus and the ____ _____ sinus
transverse pericardial;
oblique pericardial
The middle mediastinum gets its blood supply from branches of the ____ ____ artery, specifically the ____ and _____ arteries.
internal thoracic,
percardiacphrenic and musculophrenic
The venous drainage of the middle mediastinum is….
azygos system of veins
The innervation of the middle mediastinum is…
vagus and phrenic (sensory fibers) and sympathetic truncks
The base of the heart is on its posterior surface formed mainly by the ____ ____
left atrium
The apex of the heart is formed primarily by the ___ ____ and is related to the ____ left intercostal space and midclavicular line (good for listening to heart sounds)
left ventricle; 5th
Name the four surfaces of the heart and what forms them.
- sternocostal surface- formed mainly by right ventricle
- diaphragmatic surface- formed by both ventricles
- left pulmonary surface- formed mainly by left ventricle
- right pulmonary surface- formed mainly by right atrium
The ______ surface of the heart is related to the central tendon of the diaphragm.
diaphragmatic
The left pulmonary surface occupies the…
cardiac notch of the left lung
Name the borders of the heart and what forms them.
- right- right atrium and extending between SVC and IVC
- inferior- mainly by right ventricle and slightly by left ventricle
- left- mainly by left ventricle and slightly by left auricle
- superior- right and left atria and auricles in an anterior view
The heart has ____ chambers.
4
The heart has two ____ and two ____, both lined with endocardium
atria, ventricles
What separates the atria from the ventricles? What separates the two ventricles from one another?
coronary groove; anterior and posterior interventricular grooves
The right atrium contains muscular ridges called ___ ____
pectinate muscles
The ___ ____ is a smooth vertical ridge extending from superior to inferior vena cava
crista terminalis
The fossa ovalis of the right atrium is the site of the ___ ____
foramen ovale
The ____ ____ is known as the great vein of the heart associated with the right atrium
coronary sinus
The ____ ____ is located in the right atrium and is also known as the pacemaker of the heart.
sinuatrial node
Specifically the SA node is located at the upper end of the _____ _____
crista terminalis
The infundibulum in the right ventricle is also called the ___ ____
conus arteriosus
The irregular muscular ridges of the left ventricle are called…
trabeculae carneae
What is contained in the septomarginal trabeculae or moderator band in the right ventricle?
the right branch of the atrioventricular bundle (AV bundle)
The 3 papillary muscles of the right ventricle are…
anterior-largest
posterior
septal (medial)-small variable in number
What do the papillary muscles function to do?
prevent prolapse when contracting
Each papillary muscle is attached to ____ cusps of the valves.
two
The pulmonary veins enter the posterior wall of the ___ ___
left atrium
There are ___ pulmonary veins
4, two right and two left
The left auricle of the left atrium has _____ muscles
pectinate
The _____ ventricle performs more work than the ____ ventricle because it has to pump blood out to the rest of the body
left, right
The ____ _____ is a smooth area leading up to the aorta
aortic vestibule
The muscular ridges of the left ventricle are called _____ _____
trabeculae carneae
The left ventricle has ___ and ____ papillary muscles which function to….
anterior and posterior; help close mitral (bicuspid) valve
The ____ _____ of the left ventricle attached cusps of the left atrioventricular valve to the papillary muscles
chordae tendinae
The ____ _____ is composed of muscular and membranous parts and is the partition between right and left ventricles
interventricular septum
What does VSD stand for?
ventricular septic defect
Name the 4 valves of the heart.
- tricuspid
- mitral (bicuspid)
- pulmonary
- Aortic
The tricuspid valve is located between ___ ___ and the ___ ____ and has 3 cusps named…
right atrium and right ventricle;
septal, anterior, posterior
The mitral valve is located between ___ ___ and the ___ ____ and has 2 cusps named…
left atrium and left ventricle;
anterior and posterior
The pulmonary valve is located at the beginning of the pulmonary trunk and has ____ cusps named…
3.
right, left and anterior
The aortic valve is located at the beginning of… and has 3 cusps named right, left, and posterior. It also has 3 ___ ___
beginning of the ascending aorta;
aortic sinuses
The right aortic sinus of the aortic valve contains the opening of the….
The left aortic sinus contains the opening of the…
The posterior aortic sinus contains….
right coronary artery
left coronary artery
no opening
Both the aortic and pulmonary valves have a central nodule with lateral lunules, creating _____ _____
semilunar valves
When is the first heart sound made?
S1 (lub)- made when blood leaves the atria and flows into the ventricles and the tricuspid and mitral valves snap shut
When is the second heart sound made?
S2 (dub)- heard when blood is expelled from the ventricle and the valves of the pulmonary artery and aorta snap shut
What does it mean to have a left dominant heart?
The posterior interventricular artery comes from the left coronary artery
True or False: Variations of the coronary arteries and their branching patterns are very rare.
False, they are very common
The right coronary artery supplies…
right atrium, most of right ventricle, part of left ventricle, SA and AV nodes
The right coronary artery arises from…
right aortic sinus
The right coronary artery runs is the ____ ____ between the atria and ventricles
coronary groove
Name the branched of the right coronary artery.
- marginal artery
2. posterior interventricular (descending) artery- between right and left ventricle
The left coronary artery supplies…
left atrium, most of left ventricle and part of right ventricle and most of the IV septum
The left coronary artery arises from…
left aortic sinus
Name the branches of the left coronary artery.
- anterior interventricular artery (LAD)/ left anterior descending
- circumflex artery- gives off marginal branch
Which artery is known as the widow maker because it is the most commonly blocked?
anterior interventricular descending (LAD)
What does the following describe?
- main vein of the heart
- runs in posterior part of coronary groove
- drains most of venous blood from the heart
coronary sinus
The coronary sinus opens into the ____ ____
right atrium
What are the tributaries of the coronary sinus (6)?
- great cardiac vein
- middle cardiac vein
- small cardiac vein
- posterior vein of left ventricle
- anterior cardiac vein
- smallest cardiac veins
Name which artery the following three veins run with.
- great cardiac vein
- middle cardiac vein
- small cardiac vein
- anterior interventricular artery
- posterior interventricular artery
- marginal branch of right coronary artery
The vein is typically located ____ to the accompanying artery.
anterior
What supplies the SA node?
SA nodal artery (usually a branch of right coronary)
What supplies the AV node?
AV nodal artery (usually branch of right coronary)
Where is the AV located?
interatrial septum
The AV node distribute impulse from…
both atria via the right and left AV bundle
The AV bundle is also called…
The bundle of His
The AV bundle divides into right and left bundles which run in the _____ _____
interventricular septum
The right and left bundles of the AV node divide into….
subendocardial branches
Purkinje fibers project…????
into endocardium of the heart???
The right branch of the AV node stimulates…. while the left branch stimulates….
the anterior papillary muscle and wall of right ventricle;
the anterior and posterior papillary muscles and wall of the left ventricle
The heart is innervate by the ___ ____
cardiac plexus
Where is the cardiac plexus located?
in an area where the trachea bifurcates and the aorta arches
What is included in the cardiac plexus?
a. sympathetic trunk (T1-T5)
b. vagus nerve
c. GVA fibers
Heart muscle is relatively ____ to pain
insensitive
The sympathetic cardiopulmonary splanchnic nerve would cause a _____ in HR while the parasympathetic (vagus nerve) would cause a ____ in HR.
increase
decrease
The thoracic mediastinum is the space between….and contains all the structures of the thorax except the ____ and _____.
the two pleural sacs;
lungs and pleurae
The thoracic mediastinum extends from the ____ ____ ____ to the _____ inferiorly and from the sternum and costal cartilages anteriorly to the bodies of thoracic vertebrae posteriorly
superior thoracic aperture
diaphragm
In the supine position, the superior mediastinum extends inferiorly from the ____ ____ _____ to a horizontal plane passing through the ______ ______ and the inferior border of ____
superior thoracic aperture,
sternal angle,
T4
The main contents of the superior mediastinum are… (9 things)
- thymus
- great vessels
- phrenic and vagus nerves
- cardiac plexus
- left recurrent laryngeal nerve
- trachea
- esophogus
- thoracic dut
9 prevertebral muscles
The thymus plays an important role in the development and maintenance of the _____ system, using ______
immune, T cells
The thymus is located posterior to the _____ and extends into the _____ _____
manubrium; anterior mediastinum
Describe a typical characteristics in the thymus gland of an an adult.
composed largely of fat and fibrous tissue, still continues to produce T-lymphocytes
The thymus gland has a rich blood supply from branches of the ____ _____ _____ which is a branch of the ______ artery
internal thoracic artery; subclavian
The brachiocephalic veins are also known as ____ _____
innominate veins
The brachiocephalic veins are formed by the union of the ____ ______ and ______ veins
internal jugular and subclavian
The right and left brachiocephalic veins join together to form the ____ ____ ___
superior vena cava
The right brachiocephalic vein receives the _____ ____ duct while the left brachiocephalic vein receives the _____ duct
right lymphatic, thoracic
The largest lymph vessel is the ______ duct
thoracic
The superior vena cava ends in the ____ ____
right atrium
What is the purpose of the superior vena cava?
to return blood from all structures superior to the diaphragm, except the lungs and heart
The arch of the aorta begin at the level of the ___ ___ and ends/continues on as the _____ _____ _____
sternal angle, descending thoracic aorta
The arch of the aorta passes anterior to the trachea to reach the left side of the trachea and esophagus. It then arches over the root of the left lung as it passes on the left side of the body of vertebra ___
T4
Name the branches of the aorta from medial to lateral. Which is the largest?
M- brachiocephalic trunk (largest)
common carotid artery
L- left subclavian artery
The brachiocephalic trunk divides into….
the right common carotid and right subclavian arteries
The left subclavian artery arises ____ to the left common carotid
posterior
The ______ ______ is a remnant of the ductus arteriosus, it passes from the root of the left pulmonary artery to the inferior surface of arch (connection to the aorta)
ligamentum arteriosum
The vagus nerve is cranial nerve ____, and arise from the ___ of the brain
X (10), medulla
The right vagus nerve enters the thorax anterior to the ___ _____ artery and on the right side of the trachea
right subclavian
The right vagus nerve gives rise to the _____ ____ ____ nerve which hooks around the right subclavian artery and ascends in the neck between the trachea and the esophagus to supply the ____
right recurrent laryngeal, larynx
The right and left vagus nerves pass ____ to the root of the lung
posterior
The right and left vagus nerves make contributions to the following plexuses…
right (right vagus) and left pulmonary (left vagus) plexuses
esophageal plexus
cardiac plexus
The left vagus nerve descends ______ to the left common carotid artery and _____ to the left subclavian artery
posterior, anterior
The left vagus nerve gives off the ____ _____ _____ nerve, which hooks around the ligamentum arteriosum and passes superiorly on the right side of the aortic arch
left recurrent laryngeal nerve
The left recurrent laryngeal nerve ascends to the larynx in a groove between the ______ and the _____
trachea and esophagus
The phrenic nerve is the sole motor supply to the ______
diaphragm
The phrenic nerve also gives partial sensory innervation to the _____ portion of the diaphragm
central
The phrenic nerves travel with what artery and vein?
pericardiacophrenic artery and vein
The phrenic nerves pass _____ to the root of the lung
anterior
The trachea descends _____ to the esophagus and ends at the level of the ____ _____ where it divides into right and left ____ ______
anterior;
sternal angle
main bronchii
The esophagus is a narrow ______ tube that connects the _____ with the _______
fibromuscula, pharynx with the stomach
The inferior mediastinum is located between the inferior border of the superior mediastinum and the ______
diaphragm
At the inferior border of he superior mediastinum, a horizontal plane would pass through the sternal angle and the inferior border of vertebral body ____
T4
The anterior mediastinum of the inferior mediastinum lies between the body of the sternum and the _____ ______ muscles anteriorly and the ______ posteriorly
tranversus thoracis
pericardium
The anterior mediastinum consists of…..
loose connective tissue, fat, lymph vessels, some lymph nodes, a few branches of the internal thoracic artery and inferiorly the sternopericardial ligaments
The posterior mediastinum is located anterior to vertebrae ___-_____ and posterior to the pericardium and diaphragm
T5-T12
The thoracic aorta is a continuation of the arch of the aorta and terminates anterior to the vertebral column at the level of ____
T12
Name the branches of the thoracic aorta.
a. bronchial
b. esophageal
c. pericardial
d. mediastinal
e. posterior intercostal
f. subcostal
g. superior phrenic
The bronchial branches of the aorta include ___ left and ___ right
2 left 1 right (actually arises from the posterior intercostal artery)
The bronchial arteries supply the blood for the…
bronchial tree
The posterior intercostal artery has ___ pairs between intercostal spaces ___-____
9;
3-11
The thoracic aortic plexus travels to what structures?
esophagus, lungs, heart, etc.
The thoracic duct is located between….
the descending aorta and azygos vein
The thoracic duct is the main lymphatic duct, conveying most of the lymph of the body to the venous systems and drain the ____ ____
cisterna chyli
The thoracic duct usually empties into the venous system near the union of the ____ ____ ____ vein and ______ vein
left internal jugular vein, sublclavian
The _____ system of veins consists of veins on each side of the vertebral column that drain the back and thoracic and abdominal walls
azygos
True or False: It is common for the azygos system of veins to have many variations.
True
The azygos system of veins is important in _____ ______
collateral circulation
Name the specific veins of the azygos system.
- azygos
- hemiazygos
- accessory hemiazygos
The azygos vein arises from the posterior aspect of the ____ ____ ____
inferior vena cava
The aygos vein is a connection point between….
the superior and inferior vena cava
The heamiazygos vein usually arises from the ____ vein
renal
The hemiazygos vein arises on the left side and ascends as far as vertebra ___ where it crosses to the right to join the ___ vein
T9, azygos
The accessory hemiazygos vein descends on the left side from ___-____
T5-T8
The accessory hemiazygos vein crosses over as the level of ___ or ___ and joins the azygos vein
T7 ot T8
Name the three thoracic sympathetic trunks of the thoracic region.
- greater splanchnic nerve (T5-T9)
- lesser splanchnic nerve (T10, 11)
- least splanchnic nerve (T12)
Name the three constrictions of the esophagus.
- pharynx/ esophageal junction
- crossing of the aorta and left bronchus
- passage through diaphragm at esophageal hiatus
The anterior vagal trunk is formed primarily by the… and the posterior vagal trunk is formed primarily by the….
left vagus nerve;
right vagus nerve
The abdomen is part of the trunk and lies between the ____ and the _____
thorax and pelvis
What is the most obvious feature of the anterior abdominal wall?
umbillicus (belly button)
The ____ _____ is a median white fibrous band that divides into right and left halves indicated by the line joining the xiphoid process to the pubic symphysis
linea alba
The ____ _____ is a curved line or groove extending form the 9th costal cartilage to the pubic tubercle
linea semilunaris
The linea semilunaris indicates the….
lateral border of the rectus abdominus
The pubic tubercle is the prominent rounded elevation of the body of the pubis to which the ____ ligaments attach
inguinal
The inguinal ligament attaches to the ___ superiorly
ASIS
The anterior abdominal wall is divided into ____ quadrants.
4 (right upper, left upper, right lower, left lower)
The fatty superficial layer of subcutaneous fascia of the anterolateral abdominal wall is called….
Camper’s fascia
The membranous deep layer of subcutaneous fascia that is very tight of the anterolateral abdominal wall is called….
Scarpa’s fascia
The very thin, strong layer over the three muscles of the anterolateral abdominal wall is called….
investing (deep) fascia
The other layers of the anterolateral abdominal wall include…
endoabdominal fascia, extraperitoneal fat, and parietal peritoneum
The endoabdominal fascia is also called _____ fascia
transversalis fascia
Name the three flat abdominal muscles.
- external oblique
- internal oblique
- tranversus abdominus
The external oblique has fibers running in the direction of….
hand in pockets
The internal oblique have fibers running… above the ASIS, …. at the ASIS, and …. below the ASIS
at right angles to the external oblique above,
horizontally at,
and downward below
The aponeurosis of the external oblique contributes to the _____ _____ _____
anterior rectus sheath
An aponeurosis refers to a….
broad flat tendon
The aponeurosis of the internal oblique splits to form a sheath for the _____ _____
rectus abdominus (1/2 runs posterior, 1/2 runs anterior)
The ____ _____ is the area where the internal oblique inserts into the pubic crest
conjoint tendon
The transversus abdominus has fibers running….
more or less horizontally except for those most inferior which pass inferiorly and run parallel to the internal oblique
The aponeurosis of the transversus abdominus contributes to the _____ _____ _____
posterior rectus sheath
The internal oblique and transversus abdominus also contribute to the _____ _____
thoracolumbar fascia
What are the actions of the the three flat abdominal muscles?
- formation of a strong, expandable support which provides protection for the abdominal viscera
- increases the intra-abdominal pressure
The rectus abdominus is enclosed in the rectus sheath. It is the principal vertical muscles, stabilizes the pelvis during _____ allowing the thigh muscles to act efficiently
walking
What forms the anterior wall of the rectus sheath?
the aponeurosis of the external oblique and the anterior lateral of the internal oblique
What forms the posterior wall of the rectus sheath?
the posterior layer of the internal oblique and the aponeurosis of the transversus abdominus
The posterior wall of the rectus sheath is deficient in two places, where?
- superior to the costal margin
2. inferior 1/4 arcuate line
What is contained within the rectus sheath?
superior and inferior epigastric arteries and the terminal parts of the inferior 5 intercostal vessels and nerves are contained within the sheath
The pyramidalis is a muscles located anterior to the inferior rectus present in about ____% of the population.
80
The arcuate line lies a bit below the ____ ____. What happens below this point?
belly button;
all three flat abdominal muscles go anterior to the rectus abdominus
The ____ _____ is endoabdominal fascia that lines the abdominal wall beneath the transversus abdominus
transversalis fascia
What forms the femoral sheath?
the transversalis fascia and iliac fascia
Name the 5 sets of nerves/nerves of the anterior abdominal wall.
- ventral rami T7-T11 spinal nerves and subcostal nerve (T12)
- iliohypogastric (L1)
- ilioinguinal (L1)
- main trunks of the intercostal nerves
- anterior cutaneous nerves
The iliohypogastric nerve supplies the ____
groin
The ilioinguinal nerve supplies….
the skin on the superomedial aspect of the thigh
The main trunks of the intercostal nerves run between the _____ _____ and the ____ ____, and are accompanied by the inferior intercostal, subcostal, and lumbar arteries.
internal oblique
transversus abdominus
What do the following anterior cutaneous nerves supply?
- T7-T9
- T10
- T11, T12, L1
- skin superior to umbilicus
- skin around umbilicus
- skin inferior to umbilicus
Name the branches of the external iliac artery.
- inferior epigastric
2. deep circumflex iliac artery
The inferior epigastric artery runs superiorly in the transversalis fascia to the ___ ____ and there it enters the rectus sheath
arcuate line
The deep circumflex iliac artery runs on the deep aspect of the abdominal wall between the tranversus abdominus and internal oblique muscles. It run parallel to the ____ ___
inguinal ligament
The superior epigastric which is a branch of the ___ ____ artery enters the rectus sheath superiorly just inferior to the ____ costal cartilage.
internal thoracic;
7th
The superficial epigastric which is a branch of the ______ artery runs in subcutaneous tissue toward the umbilicus
femoral
The venous drainage of the anterior abdominal wall is….
superficial epigastric–> lateral thoracic
The lateral thoracic vein travels with the ___ ____ artery
lateral thoracic
Lymphatic drainage of the anterior abdominal wall includes superficial lymph nodes. Those superior to the umbilicus drain into ____ lymph nodes while those inferior to the umbilicus drain into _____ _____ lymph nodes
axillary;
superficial inguinal
The lymphatic drainage of the anterior abdominal wall also includes deep lymphatic vessels which drain into the…. and…. lymph nodes
external and internal iliac lymph nodes,
and lumbar lymph nodes
What is the inguinal canal?
an oblique passage approx 4 cm long through the anterior abdominal wall- parallel to the medial half of the inguinal ligament
The inguinal canal houses both a ____ _____ ring
deep and superificial
The _____ ring is lateral to the inferior epigastric artery and is a slitlike opening in the transversalis fascia
deep
The ______ ring is a triangular aperture in the aponeurosis of the external oblique muscle
superficial
The ____ ring is the entrance to the inguinal canal and the ____ ring is the exit.
deep, superficial
The _____ _____ run between the lateral and medial crura
intercrural fibers
Emerging from the superficial ring is the ____ _____ in a male and the ____ ____ of the uterus in a female
spermatic cord;
round ligament
The _____ nerve exits the superficial inguinal ring but does NOT run through the inguinal canal.
ilioinguinal nerve
What is a direct inguinal hernia?
weakening of the abdominal wall-medial to inferior epigastric artery
What is an indirect inguinal hernia?
enters the deep inguinal ring lateral to inferior epigastric artery
Which hernia is more common?
indirect inguinal hernia
The _________ ______ is a thin transparent serous membrane that lines the abdominal wall. The ____ ______ is a thin transparent serous membrane that invest the abdominal viscera.
parietal peritoneum
visceral peritoneum
Pain is very well localized in the ______ peritoneum
parietal
The visceral peritoneum is more sensitive to…
stretching and chemical irritation
The _____ ______ is a potential space between the parietal and visceral peritoneum
peritoneal cavity
What is a mesentery?
double layer of peritoneum enclosing an organ and attaching to the abdominal wall
A mesentery functions to allow for…
mobility and passage of neurovascular structures
A ______ is a double layered sheet or fold of peritoneum.
omentum
The lesser omentum connects the….. and the ……
lesser curvature of the stomach and proximal part of the duodenum to the liver
Describe the greater omentum.
fat laden, four layers, prevents viscera from adhering to the abdominal wall
The _____ omentum acts as the “policeman” of the abdominla region, sometimes shifting positions to protect an area of infection
greater
The lesser sac also called the ____ ____ is located ______ to the stomach and is a dead end of sorts`
omental bursa; posterior
The greater sac is consider to be…
everything else outside of the lesser sac
Give the two names for the entrance into the lesser sac.
omental foramen (epiplocic foramen of Winslow)
A ____ _______ is a double layer of peritoneum that connects an organ with another organ or to the anterior abdominal wall
peritoneal ligament
Two examples of peritoneal ligaments are the ______ ligament and the ______ ligament
hepatogastric and hepatoduodenal
The ________ ligament contains the portal triad.
hepatoduodenal
What is included in the portal triad?
portal vein, hepatic artery proper, and bile duct
- ________ describes an organ almost completely covered with peritoneum.
- ______ decribes location external or posterior to the parietal paritoneum
- intraperitoneal
2. retroperitoneal
The esophagus is a muscular tube extending from the ______ to the ______. It includes both internal circular layers and external longitudinal layers
pharynx to the stomach
The upper esophageal sphincter is located at the _____ ______ and the lower esophageal sphincter is located ….
pharyngoesophageal junction
passing through the diaphragm
The esophagus enters the stomach at the ____ ____
cardiac orifice
The ____ _____ is a network on nerves on the surface of the esophagus
esophageal plexus
The stomach is located between…
the esophagus and small intestine
The lesser curvature of the stomach is ____ and the greater curvature is ____
concave;
convex
Name the parts of the stomach.
cardiac part, fundus (expanded upper portion- often filled with air), body, pyloric part
The ____ _____ is the point between the stomach and duodenum.
pyloric sphincter
_____ are gastric folds on the internal surface of the stomach
rugae
The small intestine is the location for ______ of nutrients
absorption
Name the three parts of the small intestine.
- duodenum
- jejunum
- ileum
The ______ is the shortest, widest, and most fixed part of the small intestine.
duodenum
The duodenum receives opening of the _____ and ______ ducts
bile and pancreatic
What shape does the duodenum have?
c-shaped (opening to the left)
The duodenum is divided into _____ parts.
4
Name the 4 parts of the duodenum.
superior, descending, inferior (horizontal), and ascending
The descending part of the duodenum includes the _____ _____ and the major duodenal papilla.
hepatopancreatic ampulla
The hepatopancreatic ampulla is also known as…. and is the site where what two ducts come together?
“ampulla of Vater”; bile and pancreatic ducts
The ascending part of the duodenum has a ligament called the…. which is a slip of muscle from the diaphragm.
ligament of Treitz
The ligament of Treitz functions to…
widen the angle of the junction of the duodenum and jejunum for better passage of contents
The jejunum has a ticker wall, circular folds called _____ _____ and ______ vasa recta
plicae circulares; longer
The jejunum is primarily located in what quadrant?
left upper
The ileum is primarily located in what quadrant?
right lower
The plicae circulares in the ileum are…
significantly decreased and absent in the terminal part
The ileum has ______ complex arterial arcades than the jejunum
more
Both the ileum and jejunum are suspended from the posterior abdominal wall by a….Within this area are the arterial arcades from which the vasa recta arise.
fan shaped mesentery
The function of the large intestine focuses on….
absorption of water and formation of stool
What distinguishes the large intestine from the small intestine?
- teniae coli-longitudinal bands of muscle
- haustra- sacculations
- omental appendages (appendices epiploicae)
The ______ is the first part of the large intestine (blind pouch) just after the _______ junction
cecum, iliocecal
The function of the appendix is now thought to be for….
storage of good bacteria
The appendix opens into the cecum about ____ cm inferior to the ileocecal junction
2.5
The ascending colon ascends of the ____ side of the abdominal cavity.
right
The right colic (hepatic) flexure connects the ____ ____ and ____ ____
ascending colon and transverse colon
The transverse colon is the _____ and most ______ part of the intestine
largest, mobile
The left colic (hepatic) flexure connects the ____ _____ and the ____ _____
transverse colon and descending colon
The descending colon is further continuous with the _______ ____
sigmoid colon
The sigmoid colon has is ____-shaped and includes the ____ _____ which allows for freedom of movement.
S-shaped, sigmoid mesocolon
The omental appendages of the sigmoid colon are ____ _____
very long
The _____ is the fixed terminal part of the large intestine.
rectum
The rectum is continuous with the anal canal which is why is is also considered a ______ organ
pelvic
Reabsorption of _____ and _____, but not _____ occur in the rectum
water and electrolytes
not nutrients
Name the parts of the pancreas.
head, neck, body, tail
The pancreas is considered to be both a ____ and _____ gland
exocrine and endocrine
The pancreas is an exocrine gland because…
The pancreas is an endocrine gland because…
is has a duct for pancreatic juices;
secretes glucagon and insulin into the bloodstream
Glucagon and insuline regulate….
blood glucose levels
When blood glucose levels rise, _____ is secreted.
When blood glucose levels fall, _____ is secreted.
insulin
glucagon
What is type I diabetes?
inadequate insulin production
What is type II diabetes?
insulin levels are normal but peripheral tissues no longer respond normally (typically adults, affected largely by diet and amount of physical activity)
The pancreas is approximateld located at the level of ___ vertebrae
L1/L2
True or False: The main pancreatic ducts runs through the substance of the gland.
True
The main pancreatic duct unites with the ___ ____ at the hepatopancreatic ampulla, where it opens to the duodenum.
bile duct
The accessory pancreatic duct(s) is/are variable and usually connect to the main pancreatic duct. Its/Their function is to drain….
part of the head of the pancreas
The spleen is located in what quadrant?
left upper
The spleen functions as a _____/______ organ
lymphatic/immune
Name some specific functions of the spleen
- upo exposure to blood borne pathogens, B lymphocytes differentiate and produce antibodies
- filter blood- remove old erythrocytes (RBC) and white cells from circulation
- stores and concentrates blood cells and platelets
- important site of erythrocyte formation in infants
The spleen is located connected to the greater curvature of the stomach by the _______ ligament and to the left kidney by the ______ ligament. It is associated posteriorly with ribs ____-____.
gastrosplenic ligament and splenorenal ligament;
ribs 9-11
The _____ is the largest gland in the body.
liver
The liver lies in what quadrant?
right upper and partly in left upper
What protects the liver?
thoracic cage
The highest point of the liver is posterior to rib ____
5
Name the five main functions of the liver. (5)
- maintain normal blood glucose concentration
- secrete bile
- synthesize components of plasma
- uptake and excretion of bilirubin
- receive venous blood returning from GI tract by the portal vein
Name any other functions of the liver you can think of.
a. storage of iron reserves
b. storage of fat soluble vitamins
c. blood storage
d. absorption and inactivation of lipid-soluble drugs
e. inactivation of toxins
f. major lymph producing organ
_______ is the conversion of glucose to glycogen while _____ is the breakdown of stored glygogen
glycogenesis
glycogenolysis
Secretion of bile is important in digestion of _____
fats
Bile is also a vehicle for ______ as it may carry detoxified waste and potentially harmful materials to the the intestine for elimination
excretion
Synthesis of components of plasma is important in ______
coagulation
Bilirubin is conjugated in the _____ and excreted in the ____
liver; bile
Accumulation of bilirubin in the blood results in _____ and may be due to increased production, decreased uptake, disturbance in conjugation, or obstruction of the bile duct
jaundice
Absorbed products of digestion are taken up and metabolized or are transformed and returned to the ____ for utilization elsewhere.
blood
The _____ ____ & ______ _____ attach the liver to the diaphragm and anterior wall.
falciform ligament, and coronary ligament
The falciform ligament has a remnant of the umbilical vein, called the ____ ______
ligamentum teres
The bare area of the liver is in direct contact with the ______ The ___ ____ ____ occupies a fossa in the bare area.
diaphragm; inferior vena cava
The ___ ____ for the liver is similar to the hilum of the lung
porta hepatis
The porta hepatis is a deep fissure on the visceral surface of the liver that contains….(5 things)
- portal vein
- hepatic artery proper
- hepatic nerve plexus
- hepatic ducts
- lymphatic vessels
The ___ ______ is a remnant of the ductus venous- shunted blood from the umbilical vein to the IVC.
ligamentum venosum
True or False. Each lobe of the liver has its own arterial supply, venous drainage, and biliary drainage.
True
True or False. The lobes of the liver function independently.
True
The ___ lobe of the liver is demarcated by the gallbladder fossa, and fossa for the inferior vena cava on the visceral surface and an imaginary line running from the fundus of the gall bladder to the IVC on the diaphragmatic surface
right
The right lobe includes the right branch of the ___ ____ and ____ ____ ___. It also includes the right ____ ____
right portal vein; right hepatic artery proper;
right hepatic duct
The anotomic right lobe includes the _____ lobe and ____ lobe, which is different from the functional subdivisions.
caudate and quadrate
The left lobe includes the left branch of the ___ ____ and ____ ____ ___. It also includes the left ____ ___
left portal vein; left hepatic artery proper;
left hepatic duct
The functional left lobe includes the _____ lobe and most of the ____ lobe
quadrate; most of caudate
The caudate lobe receives vessels from….
both right and left hepatic arteries/ hepatic portal veins
True or False: Functional lobes are independent for right and left portions of liver
True
Each part of the liver receives its own primary branch of the hepatic artery and hepatic portal vein and is drained by its own ____ _____
hepatic duct
For the functional lobes, there are _____ divisions and ____ hepatic segments.
4
8
There are approximately ________ lobules in the liver.
100,000
A typical lobule is _______ in shape with a portal triad at each corner
hexagonal
The portal triad (canal) is a small branch of portal vein and hepatic artery and a bile ductule enclosed in _____ _______
connective tissue
The ______ vein merges to form the hepatic veins which empty into the ___ ____ _____
central; inferior vena cava
The ____ _____ are endothelial cells, Kupffer cells (phagocytic cells), and fat-storing cells
hepatic sinusoids, function to detoxify and reabsorb
The liver has a double blood supply. Name the two main sources.
- Common hepatic artery
2. Portal vein
The commmon hepatic artery accounts for ___% of the blood supply for the liver and the portal vein accounts for ____%.
30%, 70%
The common hepatic artery arises from the ____ ____
celiac trunk
The common hepatic artery gives off a ______ artery and continues on as the _____ ____ ______.
gastroduodenal; hepatic artery proper
The hepatic artery proper then divides into…
right and left hepatic arteries
The common hepatic artery carries _______ blood back to the liver.
oxygenated
The portal vein in the principal _____ blood vessel.
afferent
The portal vein carries venous blood containing the products of digestion absorbed from the ___ ____
GI tract
Portal vein is formed by the union of the what two veins?
superior mesenteric and splenic veins (inferior mesenteric usually joins the splenic)
The portal vein terminates by dividing into…
right and left branches
The hepatic veins are formed by the union of the ___ _____ in its lobules and open to the ____ _____ ____
central veins, IVC
lymphatic drainage of the abdominal cavity include ___ and ____ portions
deep and superficial
The deep lymphatics include the hepatic lymph nodes which drain into the ______ lymph nodes which then enters the ____ ______
celiac; thoracic duct
The superficial lymphatics join lymph vessels in the ___ _____ and then enter the hepatic lymph nodes
porta hepatis
The ______ is a thin walled bliush green sac
gallbladder
The gallbladder functions to….
concentrates bile and stores
The _____ duct joins the common hepatic duct to form the ____ duct
cystic duct; bile
Eating fatty food causes secretion of ______ which causes the gallbladder to contract
cholecystokinn
Bile is secreted into ____ ______ which drain into interlobular bile ducts which form progressively larger ducts
bile canaliculi
Right and left hepatic ducts emerge from the porta hepatis and unite to form the ___ ____ ____
common hepatic duct
What two ducts join to form the common bile duct?
common hepatic duct and cystic duct
The bile duct joins with the with the _______ duct to form the hepatopancreatic ampulla (ampulla of Vater), which opens to the duodenum
pancreatic
Name some examples of structures considered to be intraperitoneal.
intestine, liver, stomach
Name some examples of structures considered to be retroperitoneal.
bladder, rectum, kidney
Name some examples of structures considered to be secondarily retroperitoneal
duodenum, ascending colon
The celiac artery/trunk arises from the ____ _____ almost immediately after it pieces the ________
abdominal aorta, diaphragm
The celiac artery divides into ____ main branches
3
Name the three main branches of the celiac artery.
- splenic
- left gastric
- common hepatic
The splenic artery has branches to…
pancreas, short gastrics (to stomach), left gastroomental
The left gastroomental is also called the _______ artery. It supplies the greater curvature of the stomach and anastomoses with the ______ _______ artery.
gastroepiploic, right gastroomental
The left gastric artery supplies… and has ________ (type not #) branches
lesser curvature of the stomach, esophageal
The common hepatic has branches for the ____ ____, _____, and ____ _____ arteries
right gastric, gastroduodenal, and proper hepatic
The right gastric supplies the …. and anastomoses with the left gastric artery
lesser curvature of the stomach
The gastroduodenal gives off the ____ ____ and ____ _____ arteries
right gastromental and superior pancreaticduodenal
The proper hepatic artery gives off the ___ ____ and ____ branch and the ____ _____
right hepatic, cystic, left hepatic
The right hepatic and cystic branch go to the _______
gallbladder
Name all the organs supplied by the celiac trunk.
stomach, spleen, liver, gallbladder, duodenum, pancreas
The pancreas and duodenum are also partially supplied by the….
superior mesenteric artery
The superior mesenteric artery gives rise to the following:…
- inferior pancreaticoduodenal
- jejunal and ileal branches
- ileocolic
- right colic
- middle colic
The superior mesenteric artery gives off about ___-___ jejunal and ileal branches that travel in the mesentery. They form….
12-15; form loops and arcades/vasa recta
The ileocolic artery gives branches to the _____ and ____ ____
ileum and ascending colon
The right colic artery divides into ascending and descending branches which anastomose with the ____ ____ and ______ arteries
middle colic, ileocolic
The middle colic supplies the….
transverse colon
Name all that the superior mesenteric supplies.
pancreas and duodenum (along with supply from celiac trunk), jejunum, ileum, cecum, appendix, ascending colon, part of the transverse colon
The inferior mesenteric artery arise just above…
where the aorta divides into right and left common iliac arteries
The inferior mesenteric gives off what three branches?
- left colic
- sigmoidal
- superior rectal
The left colic artery has several branches to the ______ ______ and _____ _____. It then anastomoses with the branches of the middle colic artery
transverse colon and descending colon
The sigmoidal artery anastomoses with what?
left colic and superior rectal
Name all that the inferior mesenteric artery supplies.
part of the transverse colon, the descending colon, sigmoid colon, rectum
The vessels involved in the venous drainage system of the abdomen are part of the ____ _______ ______
hepatic portal system
Name the three main veins of the hepatic portal system.
- superior mesenteric
- splenic
- Portal
What does the superior mesenteric vein drain?
pancreas, duodenum, jejunum, ileum, appendix, cecum, ascending colon, and transverse colon
What does the splenic vein drain?
spleen, stomach, pancreas;
also drains the descending colon, sigmoid colon, and rectum, by way of the inferior mesenteric vein which drains into the splenic
What forms the portal vein?
union of the superior mesenteric and the splenic
Additional tributaries of the portal vein include the ____ and _____ _____, which divides into right and left branches before entering the liver– the ____ vein usually drain into the right branch.
right and left gastric;
cystic
Overall, the hepatic portal system drains the stomach, the intestines as far as the rectum, the pancreas, spleen, and gallbladder and carries this blood to the ______ where absorbed nutrients are attacked and detoxified.
liver
Name the connections between the portal venous system and the systemic venous system.
- esophageal veins-draining into azygos vein
- rectal veins-drains into IVC
- paraumbilical veins- anastomosing with superficial epigastric veins
The ____ ____ ____ is an efferent (motor) system only
autonomic nervous system
The ANS is a ____ neuron system
2
The ______ neuron has cell bodies in the CNS
preganglionic
The postganglionic neuron has cell bodies in the…
autonomic ganglia
The two divisions of the ANS are the… and ….
sympathetic and parasympathetic
The sympathetic division is also called the _____ and the parasympathetic is also called the _______
thoracolumbar; craniosacral
Where are the ganglia located for the sympathetic division of the ANS? For the parasympathetic?
S- located some distance away from the target organ
P- located close or within the walls of target organ
The sympathetic splanchnic nerves originate in the spinal cord (cell body in the _________ celll column) and pass via……to the sympathetic chain
(interomedioateral); white rami communicantes
True or False: The sympathetic splanchnic nerves pass through the sympathetic ganglia but do not synapse there.
True
Where do the sympathetic splanchnic nerves synapse?
in preaortic (prevertebral) ganglia and postganglionic fibers are distributed to target organs
True or False: There are both right and left greater splanchnic nerves.
True
The greater splanchnic nerve is formed by ___-_____ roots from the sympathetic trunk between the ____ and _____ ganglia
4-5; 5th and 9th (T5-T9)
The greater splanchnic nerves synapse in the ______ _____ near the celiac trunk
celiac ganglion (solar plexus)
The postganglionic fibers of the greater splanchnic nerves distribute along branches of the ______ artery to the stomach liver, pancreas, spleen, and part of the duodenum
celiac
The lesser splanchnic nerve is formed by ___ roots from the ___ and _____ sympathetic ganglion
2; 10th and 11th (T10-T11)
The lesser splanchnic nerve synapses in the ______ _______ _______
superior mesenteric ganglion
Postganglionic fibers of the lesser splanchnic nerve are distributed along branches of the ____ ____ artery to part of the duodenum, jejunum, ileum, cecum, appendix, ascending, and transverse colon
superior mesenteric
Name the 5 main sympathetic splanchnic nerves.
- greater splanchnic nerve
- lesser splanchnic nerve
- least splanchnic nerve
- lumbar splanchnic nerves
- sacral splanchnic nerves
The least splanchnic nerve is formed by branches of the ___ sympathetic ganglion
12th (T12)
The least splanchnic nerve synapses in the _____ _______
aorticorenal plexus
Postganglionic fibers of the lest splanchnic nerve are distributed to the ____
kidney
The lumbar splanchnic nerves arose from the sympathetic chain at the ___-____ lumbar ganglia
1st-4th
The lumbar splanchnic nerves synapse in the ___ ____ ____ (inferior mesenteric ganglion) and is distributed to the descending colon, sigmoid colon, and rectum
abdominal autonomic plexus
The sacral splanchnic nerves arise from the ____ _____ ______
sacral sympathetic chain
The sacral splanchnic nerves synapse in the ____ ____ _____ and is distribute in the area
inferior hypogastric plexus
Parasympathetic innervation for the abdominal region includes innervation from the ____ _____ and ____ ____ ___
vagal trunks and pelvis splanchnic nerves
Vagal trunks provide the parasympathetic innervation to the abdominal visceral from the _____ to the ____ _____
esophagus to transverse colon
The vagal trunks form at the…
inferior aspect of the esophagus
The pelvic splanchnic nerves are the only splanchnic nerves to carry what?
parasympathetic fibers
Ganglia of the parasympathetic splanchnic nerves are ins the walls of the viscera meaning they are ____/______ ganglia
intrinsic/enteric
The parasympathetic splanchnic nerves-pelvic splanchnic nerves arise from the sacral segment of the spinal cord (S__-S___)
S2-S4
The pelvic splanchnic nerves contribute to the formation of the ____ ____ (pelvic)______
inferior hypogastric plexus
The parasympathetic splanchnic nerves-pelvic splanchnic nerves supplies what?
descending colon, sigmoid colon, and other viscera in the pelvis and perineum
**For General Visceral Afferent fibers carrying pain sensation up to the middle of the sigmoid colon run with _____ fibers and then through the ____ ______ to the spinal nerve and then to the ___ _____ in the spinal cord
sympathetic;
white rami;
dorsal root
GVA fibers: Unconscious sensations (mostly reflex) proximal to the middle of the sigmoid colon travel along the ____ fibers
vagal
GVA fibers: Fibers carrying pain and reflex information distal to the middle of the sigmoid colon travel along the….
parasympathetic splanchnic nerves
The pelvic autonomic plexus (superior and inferior hypogastric) is an extension of the ____ plexus below the bifurcation of the aorta into the common iliac arteries
aortic
sympathetic innervation of the pelvic autonomic plexus comes from ______ ______ ganglion while parasympathetic innervation comes from _____ ______ nerves.
superior sympathetic;
pelvic splanchnic
The kidneys are located at the level of ____-_____ vertebrae on the posterior abdominal wall
T12-L3
The ______ fat is located outside the fascia while the the _____ fat is directly against the kidney
perirenal; pararenal
Functions of the kidneys include….
- remove excess water, salts and products of protein metabolism from blood
- maintain pH
The lateral margin of the kidney is ________ while the medial margin is _____
convex
concave
The renal _____ describes the cleft of the medial aspect of the kidney while the renal ____ is the actual space.
hilum, sinus
The renal pelvis is an expanded part of the _____
ureter
Describe the flow of urine through the kidney
nephron –> papilla –> minor calix–> major calix–> renal pelvis –> ureter –> urinary bladder
The renal papilla are at the tip of the ____ ____
renal pyramids
The ___ is the functional unit of the kidney
nephron
Different things are absorbed at different parts of the nephron. Name some parts of a nephron.
Bowman’s capsule (glomerulus), proximal convoluted tubule, Henle’s loop, distal convoluted tubule, collecting tubule, collecting duct
The kidney’s receive blood from the _____ arteries.
renal
The renal arteries arise from the ____ and each divides into ____ segmental arteries
aorta; 5
The renal vein drains the kidney and drains into the ____ ___ ____
IVC
The kidneys are innervated by…
renal plexus- supplied by fibers of the lesser and least splanchnic nerves;
nerves of the ureters
The nerves of the ureters derive from several plexuses. Visceral afferent fibers follow sympathetic fibers back to the ____ root ganglia and cord segments T11-L2
dorsal
The ____ ______ is the outer and major part of the suprarenal gland
suprarenal cortex
The suprarenal cortex secretes steroid hormones (________) while the inner suprarenal medulla secretes ______ (adrenaline) and ______ (noradrenaline)
glucocorticoids;
epinephrine
norepinephrine
The suprarenal glands have a rich blood supply from the _____ arteries.
suprarenal
The superior renal artery arises from the ……
The middle suprarenal artery arises from the ….
The inferior suprarenal artery arises from the …
inferior phrenic artery
aorta
renal artery
The venous drainage of the suprarenal glands include the ____ ____ ____ which drains into the IVC and the and the ____ ____ ___ which joins the renal vein
right suprarenal vein
left suprarenal vein
The suprarenal glands are innervated by the _____ plexus and the ___ _____ nerves
celiac;
thoracic splanchnic
