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Exam review Flashcards

1
Q

Sciatic Nerve: Description

A

The sciatic nerve is the major posterior nerve of the leg and thigh. It is the largest nerve in the body

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2
Q

Sciatic Nerve: Gross anatomy

A

It is a branch of the sacral plexus arising from the L4-S3

  • It passes through the greater sciatic foramen to the piriformis muscle and then continues between the gluteus medius and maximus in the inferomedial portion of the buttock.
  • There are two key components which are present from its origin, which are the tibial nerve and the common peroneal nerve.
  • It passes down the back of the thigh between the heads of biceps femoris and passes into the popliteal fossa
  • It is the deepest structure within the popliteal fossa
  • Within the popliteal fossa it divides into the tibial and common peroneal nerves
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3
Q

Sciatic nerve: Branches

A
  • Articular and muscular branches before dividing into terminal branches
    • Supply the hip joint
  • Muscular branches
    • Biceps femoris
    • Semimembranosus
    • Semitendinosus
    • Adductor magnus
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4
Q

Sciatic nerve arterial supply

A
  • Perforating branches of the profunda femoris
  • Branches of the superior and inferior gluteal muscles
  • Branches of the popliteal artery
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5
Q

Sciatic nerve: supplies

A
  • Hamstrings (tibial division)
  • Knee joint
  • Posterior cutaneous branches of the thigh
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6
Q

Sciatic nerve: Relations

A
    • Upper – posterior part of the ischium, nerve to quad femoris, obturator internus, gemelli
      • Lower: adductor magnus
    • Upper – gluteus maximus
      • Lower – long head of biceps femoris
  • Accompanied by the posterior femoral cuteanous nerve and the inferior gluteal arrtery
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7
Q

Sciatic nerve variants

A
  • Abnormal course
  • Abnormal branching
  • Contributions from other nerve roots
  • High division prior to the popliteal fossa
  • Low division below the popliteal fossa
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8
Q

Common hepatic artery

A
  • Terminal branch of the coeliac artery
    • Anterior to the pancreas
      • Inferiorly in the lesser sac towards the first part of the duodenum
      • Gives off the right gastric artery running superiorly along the right lesser curvature of the stomach
      • Passes slightly upwards and runs anterior to the portal vein and medial to the CBD in the free edge of the lesser omentum
  • Gives off the gastroduodenal artery
    • Becomes the proper hepatic artery
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9
Q

Proper hepatic artery

A
  • Anteromedial to the portal vein and medial to the CBD within the hepatoduodenal ligament
  • Terminates by bifurcating into the right and left hepatic arteries before entering the porta hepatis
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10
Q

RIght hepatic artery

A
  • Course:
    • Passes upwards and to the right
    • Behind the common hepatic duct to enter Calots triangle
    • Gives off the cystic artery
    • Turns upwards to enter the right lobe
    • Anterior segmental branch (segments V, VIII and I)
      • Posterior segmental branch (VI, VI)
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11
Q

Left hepatic artery

A
    • Runs vertically towards the umbilical fissure and supplies segments I, II and III
      • Gives off a middle hepatic artery running towards the right side of the umbilical fissure
    • Medial segmental branch
      • Lateral segmental branch
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12
Q

Hepatic artery variants

A
  • Common hepatic artery
    • From aorta
    • From SMA
    • Trifurcation
    • From coeliacomesenteric trunk
  • RHA
    • From coeliac artery
    • From SMA
    • Accessory right hepatic from SMA
  • LHA
    • From LVA
    • Accessory left hepatic from LGA
  • MHA
    • From the LHA
    • From RHA
    • Trifurcation of PHA
    • Can have an extrahepatic course and traverse Calot’s triangle
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13
Q

Lymph nodes of the neck: Level 1

A
  • Submental and submandibular
    • S: mylohyoid muscle and mandible
    • I: inferior border of the hyoid
    • A: platysma
    • P: posterior border of the submandibular
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14
Q

Lymph nodes of the neck: Level 2

A
  • S: base of skull at the jugular fossa
  • I: inferior border of the hyoid
  • A: posterior border of the submandibular gland
  • P/L: posterior border of the SCM
  • M: medial border of the ICA
  • Level 3
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15
Q

Lymph nodes of the neck: Level 3

A
  • S: inferior border of the cricoid cartilage
  • I: level of the clavicle
  • A: anterior border of the SCM
  • PL: postborder of the SCM
  • M: medial border of the CCA
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16
Q

Lymph nodes of the neck: Level 4

A
  • S: inferior border of the cricoid
  • I: level of the clavicle
  • A: ant border of the SCM
  • PL: oblique line drawn through PL edge of the SCM and the anterior scalene
  • M: medial border of the CCA
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17
Q

Lymph nodes of the neck: Level 5

A
  • S: skull base at convergence of SCM and trapezius
  • I: clavicle
  • AM: post border of SCM
  • PL: ant border of trapezius
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18
Q

Lymph nodes of the neck: Level 6

A
  • S: inferior border of hyoid
  • I: manubrium
  • A: platysma
  • P: trachea, and prevertebral space
  • L: medial borders of the CCA
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19
Q

Pericardium: gross anatomy

A
  • Two sacs from the pericardium: outer sac fibrous pericardium, inner sac double layered serous pericardium.
    • Fibrous pericardium
      • Tough connective tissue continuous with and bound to the central tendon of the diaphragm, roots of the major vessels, pretracheal layer of the deep cervical fascia, sternum via the superior and inferior sternopericardial ligaments
    • Serous pericardium
      • Parietal serous pericardium
      • Visceral serous pericardium
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20
Q

Rotator cuff: description

A
  • The rotator cuff is a group of four muscles which act to support the unstable shoulder muscles. Provides support to the shoulder capsule except inferiorly, where it is the weakest. These consist of the supraspinatus, infraspinatus, subscapularis and the teres minor muscles.
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21
Q

Supraspinatus

A
  • O: supraspinous fossa
  • I: superior facet of GT of the greater tubercle of the humerus
  • Innervation: suprascapular nerve
  • A: suprascapular artery
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22
Q

Infraspinatus

A
  • O: infraspinous fossa of the scapula
  • I: middle facet of the GT of the humerus
  • N: suprascapular nerve
  • A: suprascapular artery and circumflex scapular artery
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23
Q

Subscapularis

A
  • Supply
    • Arterial: subscapular artery
    • Similarly named vein
    • Innervation: subscapular nerve
    • Lymphatics: axillary
  • Action: internal rotation
  • O: subscapular fossa
  • I: lesser tubercle
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24
Q

Teres Minor

A
  • O: middle half of the lateral border of the scapula
  • I: inferior facet of the GT
  • A: posterior circumflex humeral artery, circumflex scapular artery
  • N: axillary nerve!!!!!
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25
Q

Rotator cuff relations

A
  • A: Tendon of pectoralis major
  • P: tendon of latissimus dorsi
  • M: Pectoral muscles
  • L: deltoid
  • S: Deltoid
  • I: unstable free edge
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26
Q

Rotator cuff variants

A
  • Absence or hypoplasia of any of the muscles
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27
Q

Pituitary gland: Description

A
  • The pituitary gland is a major extradural endo- and exo-crine gland located within the pituitary fossa within the calvarium
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28
Q

Pituitary gland: Anterior

A
  • Pars distalis
    • Largest part – anterior wall of the Rathke pouch
  • Pars tuberalis
    • Part of the adenohypophysis surrounding the anterior aspect of the infundibular stalk
  • Pars intermedia
    • Thin layer of cells between the pars distalis and the neurohypophysis
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29
Q

Pituitary gland: Posterior

A
  • Also known as the neurohypophysis
  • Considered to be an extension of the brain and from an embryologically different source
  • Secretes hormone stimulating hormones (ACTH etc)
  • Produces the pituitary bright spot on MRI
  • Continuous with the infundibulum
  • Continuous with the hypothalamus
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30
Q

Borders of the pituitary fossa

A
  • A: Anterior clinoid process
  • P: dorsum sellae, posterior intercavernous sinus
  • M: infundibulum
  • L: dura mater cavernous sinuses and their contents
  • S: Optic chiasm, suprasellar cistern, pituitary aneurysm
  • I: sphenoid sinus
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31
Q

Pituitary: Arterial supply

A
  • Rich anastamotic supply from the hypophyseal plexus which has branches from the meningohypophyseal trunk, and the anterior and posterior hyphohyseal arterial. This also allows for diffusion of the hormones
  • 6 arteries, 3 from above, 3 from below
  • Circuminfundibular anastomosis
  • Inferior hypophyseal arterial circle
  • Branches
    • Above
      • Superior hypohyseal artery
      • Infundibular artery
      • Prechiasmal artery
    • Below
      • Inferior hypophyseal artery
      • Capsular
      • Artery of the inferior cavernous sinus
  • Portal
    • Blood from hypothalamus
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32
Q

Pituitary relations

A
  • S: optic chiasm
  • I: sphenoid sinus
  • L: cavernous sinus
  • A: frontal/sphenoid sinus
  • P:4th ventricle
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33
Q

Pituitary variants

A

o Empty sella

o Hypoplasia

o Hyperplasia

o Duplication

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34
Q

Peritoneum: description

A
  • Large, complex serious membrane, forming a closed sac within the abdominal cavity
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35
Q

Peritoneum Gross anatomy

A
  • Can be divided into two main compartments, separated by the roots of the transverse mesocolon
    • Supramesocolic space
    • Inframesocolic space
  • Can also be divided into greater and lesser sac
  • Innervation:
    • Parietal: spinal nerves
      • Diaphragmatic: phrenic
      • Visceral: no afferent
      • Mesenteroc: Pacinian corpuscles
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36
Q

Peritoneum: Retroperitoneal organs

A
  • Adrenal glands
  • Kidneys
  • Pancreas
  • Aorta/IVC
  • Duodenal segments D1/4
  • Ascending and descending colon.
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37
Q

Peritoneal reflections

A
  • There are multiple peritoneal reflections which provide support for intraabdominal organs including
  • In the female:
    • The broad ligament - doubled layer of peritoneum which drapes over the uterus, and contains the ovaries and Fallopian tubes
    • Mesentery – doubled layer of peritoneum which contain neurovasculature for the abdominal viscera
      • The appendix may have its own mesentery
      • This allows for identification of the rectosigmoid junction – the rectum loses the mesentery
  • Gastroduodenal
  • Ligament of trietz
    • Supports the duodenal-jejunal flexure
  • Hepatorenal
    • Contains the portal triad (portal vein, hepatic artery and the common bile duct)
  • Lienorenal
    • Contains the splenic artery and vein
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38
Q

Triceps brachii: Description

A
  • The triceps is the muscle of the posterior compartment of the arm bilaterally
  • Allows for extension of the elbow
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39
Q

Triceps brachii: Gross anatomy

A
  • Originates as three heads:
    • Long head – infraglenoid tubercle of the scapula
    • Medial – posterior humerus inf to the radial groove
    • Posterior and lateral intermuscular septum
  • Insertion: olecranon process of the ulna
  • Neurovasculature
    • Innervation: radial nerve
    • Arterial supply: branches of the brachial artery
    • Venous drainage: venae commitantes
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40
Q

Triceps: Relations

A
  • A: Radial nerve, humerus
  • P: muscular fascia, skin, fat
  • S: shoulder joint
  • I: elbow joint
  • M: coracobrachialis
  • L: deltoid
  • Radial nerve and profunda brachii vessels run in the groove between origins of lateral and medial heads
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41
Q

Triceps: variants

A
  • Hypoplasia
  • Abnormal insertion
  • Abnormal origin
  • Duplication of the long head
  • Patella cubiti
  • Long head may be supplied by axillary nerve
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42
Q

Pancreas: gross anatomy

A
  • The pancreas consists of four parts
    • Head (
      • Uncinate process -
    • Neck: thinnest part, ant to SMA, SMV
      • SMV joins splenic vein behind the pancreatic neck to form the portal vein
    • Body:
      • Ant surface: covered by peritoneum
      • Splenic vein
    • Tail

Between layers of splenorenal ligament

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43
Q

Pancreas: Ducts

A
  • Main pancreatic duct
    • Portion, proximal to the dorsal ventral fusion point
    • Drains at ampulla of vater
    • Connects with accessory pancreatic duct
  • Pancreatic duct of Wirsung
    • Distal portion
    • Segment of the ventral duct between the dorsal ventral fusion point and the major papilla
  • Accessory pancreatic duct of Santorini
    • Portion of the duct distal to the dorsal ventral fusion point
    • Drains anterior and superior portion of head
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44
Q

Pancreas Neurovasculature

A
  • Arterial supply
    • Superior pancreaticoduodenal artery (Coeliac trunk)
    • Inferior pancreaticoduodenal artery (SMA)
    • These divide into anterior and posterior branches
    • Branches of the splenic
  • Venous drainage
    • Veins of the same name as the arteries
    • Superior pancreaticoduodenal – portal vein
    • Inferior pancreaticoduodenal - SMV
    • Drains into the portal circulation
  • Innervation
    • Sympathetics via the pre-aortic and coeliac plexi
    • Parasympathetics
  • Lymphatics
    • Coeliac, splenic, superior mesenteric, hepatic group of lymph nodes
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45
Q

Pancreas: Relations

A
  • P:
    • L2 vertebral body
    • Right kidney hilum, portal vein and IVU|C
    • CBD
    • Aorta
    • Left kidney hilum, left suprarenal gland, right crus
    • Splenic vein, IMV and confluence of splenic and SMV to form portal vein
  • A:
    • Lesser sac: separating from stomach
    • Lesser omentum and liver
    • Attachment of the transverse mesovolon
    • D1
    • Infracolic compartment
  • S:
    • Origin of coeliac trunk
    • SHA
    • Splenic artery
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46
Q

PancreasL Variants

A
  • Ansa pancreatica
  • Pancreatic division
    • 3 types
  • Annular
  • BIfid
  • Ectopic
  • Pancreactic clefts
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47
Q

Wrist joint: Description

A
  • Synovial condyloid articulation
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48
Q

Wrist joint: Gross anatomy

A
  • Articular surfaces
    • Distal radius
    • Triangular articular disc
    • Scaphoid
    • Lunate
    • Triquetrum
  • Ligaments
    • Palmar radiocarpal ligament
    • Dorsal radiocarpal ligaments
    • Ulnar and radial collateral
    • Palmar and dorsal radioulnar ligaments
  • Capsule
    • Continuous with midcarpal joint
    • Proximally extends as the palmar radial recess
  • Movement
    • Flexion and extension

Radial and ulnar deviation

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49
Q

Wrist joint: neurovasculature

A
  • Arterial supply
    • Ulnar and radial arteries
    • Dorsal and palmar carpal arches
  • Venous drainage
    • Cephalic and basilic veins
  • Innervation
    • Median nerve
    • Radial nerve
    • Ulnar nerve
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50
Q

Wrist joint relations

A

Anterior: radial artery, ulnar artery, median nerve, ulnar nerve, numerous flexor tendons

Posterior: numerous extensor tendons

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51
Q

Prostate: gross anatomy

A
  • It is a pyramidal structure with the apex pointing inferiorly, measuring approximately 10cc in volume
  • There are three surfaces: anterior, inferolateral and posterior
    • AnteriorL posterior limit of the retropubic space. Connected to the pubic bone by puboprostatic ligaments
    • Inferolateral: rests on the levator ani fascia
    • Posterior: triangular and flat surface. Anterior to the rectum and has a vertical median groove. Separated by Denonvillier’s fascia.
  • Has a pseudocapsule formed by fibromuscular tissue surrounding 3 distinct layers of fascia. Anterior, lateral and posterior . Laterally it fuses with the levator fascia
  • It can be divided into to peripheral and central zone, which is connected by the transitional zone
  • Zonal anatomy
    • Peripheral
      • Accounts for approximately 70% of the total in a young adult, deficient anteriorly
    • Central
      • Contains ejaculatory ducts
      • Posterior to the prostatic urethra, forms the base
    • Transition
      • Remaining 5%
      • Anterolateral to the prostatic urethra
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52
Q

Prostate: neurovasculature

A
  • Arterial supply: prostatic arteries from the inferior vesical
  • Venous drainage into the prostatic plexus, which communicates with the internal pudendal plexus which communicates potentially with Baton’s vertebral plexus
  • Lymphatic drainage is into the iliac and pre-aortic lymph nodes
  • Innervation: pelvic splanchnic nerves and the hypogastric plexus.
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53
Q

Prostate: Relations

A
  • A: Pubic symphysis
  • P: rectum, fascia
  • S: bladder
  • I: penis, pelvic diaphragm
  • M: prostatic urethra
  • L: ischiorectal fossa
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54
Q

Prostate: Variants

A

Additional lobes

Missing lobes

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55
Q

Cubital fossa: Description

A
  • Inverted triangular space which forms the transition between the arm and the forearm.
  • Located anterior to the elbow joint
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56
Q

Cubital fossa: Boundaries

A
  • S: line joining the medial and lateral humeral epicondyles
  • L: medial border of brachioradialis
  • M: lateral border of pronator teres
  • Apex: meeting of the medial and lateral boundaries
  • Roof:
    • Deep fascia of the forearm
    • Medial cutaneous nerve of the forearm, lateral cutaneous nerve of the forearm
    • Basilic vein, cephalic vein, median cubital
    • Floor: brachialis, supinator
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57
Q

Cubital fossa: Contents

A
  • Brachial artery
  • Brachial vein
  • Median nerve
  • Biceps tendon
  • Radial nerve
  • Posterior interosseous branch of radial nerve
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58
Q

Vertebral artery: Description

A
  • The vertebral arteries are major arteries of the posterior circulation of the brain.
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59
Q

Vertebral artery: Gross anatomy

A
  • Origin
    • 1st part of the subclavian vein
  • Termination
    • Within the calvarium as the basilar arteries
  • Course
    • Can be divided into segments
      • V1: angles posteriorly between longus colli medially and scalenus anterior laterally through the colliscalene triangle behind the CCA to entre the transverse foramen at C6
          • Ant: CCA, VV, thoracic duct, lymphatic duct
            • Post: ventral rami of spinal nerves C7 and C8, TP C7, inferior cervical ganglion
            • AM: inferior thyroid artery, middle cervical ganglion
      • V2: through the transverse foramina from C6-3. Accompanied by VV and sympathetic nerves. Turns superolateral through inverted L shaped transverse foramen of C2
      • V3: emerges from TP of C2 sweeping laterally to pass through the transverse foramen of C1, passes around the posterior border of lateral mass of C1, below the inferior border of the posterior atlanto-occipital membrane. Pierces the dura and arachnoid.
      • V4: anterior to the roots of the hypoglossal nerve and joints its contralateral counterpart at the lower border of the pons
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60
Q

Vertebral arteries: branches

A
  • V1: segmental cervical muscular and spinal
  • V2: anterior meningeal artery, muscular and spinal
  • V3: posterior meningeal
  • V4: anterior and posterior spinal arteries, medullary perforators, PICA
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61
Q

Vertebral artery: relations

A
  • Relations
    • A: clivus
    • P: cerebellum
    • M: Transverse foramina
    • L: Transverse foramina
    • S: Basilar artery
    • I: subclavian artery (1st part)
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62
Q

Vertebral arteries: variants

A
  • Hypoplastic
  • Aplastic
  • Duplicated
  • Fenestrated
  • Termination as the PICA
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63
Q

Inguinal canal: Description

A
  • Passage in the anterior abdominal wall that transmits structures from the pelvis to the perineum
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64
Q

Deep inguinal ring

A
  • Deep inguinal ring
    • Laterally by the angle between the transversus abdominis and inguinal ligament
    • Medially: inferior epigastric vessels
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65
Q

Superficial inguinal ring

A
  • Inverted V shaped, triangular opening in the medial end of the external oblique aponeurosis
  • Lateral crus: pubic tubercle
  • Medial crus: pubic crest near the symphysis
  • Posterior crus: pass behind the cord to attach to the rectus sheath
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66
Q

Inguinal canal: boundaries

A
  • Superior: internal oblique, transversus abdominis
  • Ant: external oblique aponeurosis and internal oblique aponeurosis
  • I: inguinal ligament and lacunar ligament
  • P: transversalis fascia, conjoint tendon
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67
Q

Inguinal canal: contents

A
  • Spermatic cord in the male
    • Ductus deferens
    • Artery to the ductus deferens
    • Genital branch of the genitofemoral nerve
    • Iliolumbar
    • Iliohypogastric
  • Round ligament in the female
  • Ilioinguinal nerve
  • Genital branch of the genitofemoral nerve
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68
Q

Anal canal: Description

A
  • The anal canal is the final part of the alimentary tract and is located within the pelvis. It is a single, midline organ
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69
Q

Anal canal: Gross anatomy

A
  • Structure
    • The anus can be separated into by the dentate line into superior and inferior segments
    • The superior segment is considered visceral and the inferior segment is considered somatic
    • Continence is partially preserved by the puborectalis sling.
  • Boundaries
    • Superior: levator ani
    • I: external anal sphincter
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70
Q

Anal canal: neurovasculature

A
  • Above the dentate line:
    • A: superior rectal,
    • N: least splanchnic nerve
    • V: vein
    • L: rectal nodes
  • Below the dentate line:
    • A: inferior rectal ,
    • N: inferior rectal branches of the pudendal nerve
    • V: internal iliac
    • L:
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71
Q

Anal canal: Relations

A
  • S: small bowel
  • I: external anal sphincter
  • M: anal canal
  • L: ischio anal fossa
  • A: female: uterus, pouch of douglas. Male: bladder, rectovesical pouch
  • P: sacrum, pre-sacral fat
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72
Q

Rectum: Gross anatomy

A
  • At the level of the S3 vertebral body,the sigmoid colon loses it mesentery
  • Taenia coli flatten and fuse
  • The anal canal extends from the levator ani to the external anal sphincter
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73
Q

Rectum: neurovasculature

A
  • A: superior, middle and inferior rectal arteries,
  • N: least splanchnic nerves, sympathetic nodes
  • V: internal iliac plexus, external iliac plexus
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74
Q

Fallopian tubes: Gross anatomy

A
  • Approximately 10-12cm long and 1-4mm in diameter
  • The fallopian tubes consist of 5 parts
    • Fimbriae
    • Infundibulum
    • Ampulla
    • Isthmus
    • Interstital or intramural
  • They are open to the peritoneum bilaterally and are not directly connected to the ovaries
  • They are directly continuous with the cornu of the uterus bilaterally
  • They are contained within the doubled layer of peritoneum called the broad ligament, and have a separate section within it called the mesosalpinx.
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75
Q

Fallopian tube: neurovasculature

A
  • A: branches of the ovarian and uterine arteries (
  • N: pelvic splanchnic nerves
  • V: uterine plexus which then drains into the internal iliac veins
  • L: iliac group of lymph nodes
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76
Q

Fallopian tubes: relation

A
  • A: bladder
  • P: rectum
  • S: broad ligament
  • I: pelvic soft tissue
  • M: cornu of the uterus
  • L: pelvic side wall, ovaries
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77
Q

Fallopian: variants

A
  • Duplication
  • Absence
  • Hypoplastic unilateral
  • Hypoplastic bilateral
  • Abnormal entry into the uterine body or fundus
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78
Q

Uterus: Gross anatomy

A
  • 7.5cm in length, 5cm wide at its upper part, 2.5cm in thickness
  • Divisible into two parts, cervix and body
  • The uterus is a muscular structure which has multiple layer including endometrium and myometrium
  • It is shaped as an inverted pear, with the broad side usually facing superiorly
  • There is are cornu bilaterally which communicate with the fallopian tubes
  • The central cavity is triangular in shape
  • It is continuous with the cervix inferiorly, through the cervical os and canal
    • A: pubocervical
      • L: transverse cervical ligaments
      • P: uterosacral
      • I: puborectalis and pubovaginalis
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79
Q

Uterus: neurovasculature

A
  • Arterial
    • Uterine branches of the superior vesical branches
    • Anastamoses with the ovarian arteries
  • Venous
    • Uterine venous plexus draining into the internal iliac veins
  • Lymphatics: inguinal and iliac
  • Innervation: hypogastric and ovarian plexi, ¾ sacral nerves
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80
Q

Uterus: relations

A
  • A: bladder
  • P: rectum
  • S: broad ligament
  • I: cervix, vagina
  • M: uterine cavity, endometrium
  • L: fallopian tube s
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81
Q

Uterus: variants

A
  • Didelphys
  • Bicornuate
  • Unicornuate
  • Anteverted/retroverted
  • Anteflexed/retroflexed
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82
Q

Ovaries: Gross anatomy

A
  • They are egg shaped structures located along the lateral pelvic wall bilaterally measuring approximately 2cc in volume
  • Within the shallow fossa in the angle between the internal and external iliac vessels
  • They are surrounded by a doubled layer of peritoneum known as the broad ligament, within a separate enclosure known as the mesovarium
  • Suspended within the suspensory ligament of the ovary running from the side wall to the ovary
  • They communicate with the peritoneum and have the fimbriae of the fallopian tubes medial to them
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83
Q

Ovaries: neurovasculature

A
  • A: ovarian arteries from the aorta, immediately below the renal arteries
  • V: right drains directly into the IVC, left drains into the left renal vein.
  • L: iliac lymph nodes or para-aortic
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84
Q

Ovarian relations

A
  • A: broad ligament, mesovarium, obliterated umbilical artery
  • P: ureter, internal iliac vessels, suspensory ligament with ovarian vessels
  • S: external iliac vessels
  • I: levator ani
  • M: ovarian ligament, rectouterine pouch, bowel
  • L: obturator vessles and nerves, obturator internus and fascia, parietal peritoneum
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85
Q

Ovarian variants

A
  • Suprapelvic position on psoas major
  • Inguinal canal location
  • Shape: spheroidal, flattene, cresenteric
  • Supranumerary
  • Absence or hypoplasia
  • Ectopic adrenal or thyroid tissue
  • Polycystic
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86
Q

Testis: gross anatomy

A
  • They are oval, egg shaped structures which measure approximately cc in volume
  • They are surrounded by a fascial layer known as the tunica albuginea,
  • From the mediastimum testis, there are several radiating septa extending into the testis forming 250-400 lobules. Contains 2-3 seminiferous tubules. Drains into the epididymis
  • Efferent ducts in the head of the epididymis unite to form the globus minor in the body and tail region which continues as the ductus deferens

They are connected to the medial spermatic cord bilaterally which allows for ejaculation of sperm.

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87
Q

Testis: neurovasculature

A
  • Testicular arteries are from the
  • Venous drainage into the pampiniform plexus which surrounds the testes, then into the right and left testicular veins. The right drains directly into the IVC, the left drains into the left renal vein
  • Innervation is from the
  • Lymphatics: into the para-aortic or inguinal
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88
Q

TEsticular relations

A
  • Superolaterally: epididymis
  • Otherwise surrounded by the pampiniform plexus and the layers of fascia forming the scrotum
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89
Q

Testicular variants

A
  • Unilateral undescended
  • Bilateral undescended
  • Unilateral/bilateral agenesis
  • Polyorchidism
  • Bilobed testes
  • Tersticular appendages
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90
Q

Epididymis: Gross anatomy

A
  • Elongated structure, posterolateral to the testis, can be subdivided into 3 parts. Head, body and tail
  • Total length is 6-7cm
  • Head is the largest and most prominent part, at the superior pole of the testis, measures approximately 5-12 mm in length can have an appendix
  • Tail is found at the inferior pole
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91
Q

Male urinary bladder: gross antomy

A
  • The bladder is a rounded structure
  • It has a smooth outer surface and a slightly trabeculated inner surface, caused by the undistended detrusor muscle
  • At the posterior inferior surface there is the with the two urerteric and single urethral orifice.
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92
Q

Male urinary bladder: neurovasculature

A
  • A: superior (internal iliac) and inferior (internal ) vesical arteries
  • V: similarly named veins
  • Lymphatics: iliac and inguinal lymph nodes
  • N: pelvic splanchnic, hypogastric plexus, sacral branches
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93
Q

Male urinary bladder: relations

A
  • A: pubic symphysis
  • P: rectum
  • S: peritoneum – small bowel
  • I: levator ani
  • M: N/A
  • L: iliac vessels
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94
Q

Male urinary bladder: variants

A
  • Hypospadias
  • Agenesis
  • Duplication
  • Ectopic ureteric insertion
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95
Q

Ischiococcygeus

A
  • Attaches to the inner tip of the coccyx
  • Ischial spine and along the tendinous arch of the obturator fascia
  • Fuses with the pubococcygeus
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96
Q

Puborectalis

A
  • Causes the angle at the recto-anal angle, and assists in faecal continence
  • Is sling shaped
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97
Q

Pubococcygeus

A
  • From the inner surface of the pubis and the obturator fascia with fibres fusing medially at the perineal body and musculature of the prostate/vagina
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98
Q

Levator ani: neurovasculature

A
  • A: Internal pudendal branches of the internal iliac
  • V:Into the pudendal branches of the internal iliac
  • N: via the pudendal nerves of the lumbar and sacral plexi
  • L: inguinal and iliac lymph node chains
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99
Q

Levator ani: relations

A
  • A: pubic symphysis
  • P: coccyx
  • S: bladder, rectum, small bowel
  • I: anus, ischioanal fossa
  • M: N/A
  • L: side walls of the pelvis
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100
Q

Psoas muscle: description

A
  • Large paired muscle of the posterior abdominal wall and pelvis.
  • Function: assists flexion of the hip, lateral flexion of the trunk. Stabiliser and flexor of the hip
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101
Q

Psoas muscles: relations

A
  • The lumbar plexus forms within the psoas muscle bilaterally
  • A: genitofemoral
  • L: iliohypogastric, ilioinguinal, lateral femoral cutaneous, femoral nerves
  • M: obturator, lumbosacral trunk
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102
Q

Psoas muscle: Variants

A
  • Hypoplasia – unilateral/bilateral.
  • Division of the femoral nerve into multiple slips within the psoas prior to uniting as a common trunk
  • Origin from the sacrum
  • Separate tendinous insertion to the iliacus
  • Agenesis
  • Psoas minor muscle
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103
Q

Anterior division of the internal iliac artery: Gross antomy

A
  • Origin
    • At the level of the pelvic brim where the internal iliac artery divides into its anterior and posterior divisions
    • Division at the superior brim of the greater sciatic foramen
  • Course
    • Courses down the lateral wall of the pelvis
    • Down the ischial spine anterior to piriformis giving off visceral and parietal branches
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104
Q

Branches of anterior division of internal iliac artery

A
  • Umbilical artery
  • Superior vesical
  • Obturator
  • Vaginal
  • Inferior vesical artery
  • Uterine artery
  • Middle rectal
  • Internal pudendal
  • Inferior gluteal
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105
Q

Posterior division of the internal iliac artery: branches

A
  • Iliolumbar
  • Lateral sacral
  • Superior gluteal
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106
Q

Femoral artery: Branches

A
  • Superficial epigastric artery
  • Superficial circumflex iliac artery
  • Superficial external pudendal artery
  • Deep external pudendal artery
  • Terminal
    • Profunda femoris
    • Superficial artery
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107
Q

Femoral artery: course

A
  • Emerges from the inguinal ligament medial to the midpoint of the inguinal ligament and medial to the deep inguinal ring, halfway between the ASIS and symphysis pubis
  • Femoral vein medially
  • Runs down the anterior and medial thigh with first 4 cm enclosed within the femoral vein
  • Terminates within the femoral triangle
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108
Q

Femoral artery: Relations

A
  • A: skin, superficial fascia, superficial iliac circumflex vein, superficial layer of fascia lata, anterior femoral sheath
  • P: posterior femoral sheath, pectineal fascia, psoas major tendon, hip joint capsule, adductor longus, femoral vein
  • L: femoral nerve
  • M: femoral vein
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109
Q

Femoral triangle: boundaries

A
  • L: Medial border of sartorius
  • M: medial border of adductor longus
  • S: inguinal ligament
  • F: iliopsoas, pectineus
  • R: skin, subcut tissue, scarpas fascia, GSV, superficial lymph nodes
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110
Q

Femoral triangle: contents

A
  • Femoral nerve
  • Femoral sheath: femoral artery, femoral vein, femoral canal
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111
Q

Popliteal artery: gross anatomy

A
  • O: at the adductor canal
  • Course
    • Deepest structure on the floor of the popliteal fossa, superficial muscle
  • T: lower border of popliteus, divides into the anterior tibial and the tibioperoneal trunk
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112
Q

Popliteal arteries: branches

A
  • Superior and inferior, medial and lateral genicular arteries
  • Middle genicular
  • Muscular
  • Cutaneous
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113
Q

Popliteal artery: relations

A
  • Starts medial to tibial nerve and ends lateral to it
  • Deep: popliteal surface of femur, knee joint capsular, popliteus
  • S: popliteal vein, tibial nerve
  • L: biceps femoris, lateral condyle of the femur, plantaris and lateral head of gastrocs
  • M: semimembranosus, medial condyle of femur, medial head of gastrocs
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114
Q

Common fibular N: Gross anatomy

A
  • O: one of the two terminal branches of the sciatic nerve , posterior divisions of the anterior rami of L4-S2
  • Course: Diverges from the sciatic by sloping lateral and downwards to lie laterally in the popliteal fossa
  • Remains subfascial and winds around the fibular neck and enters lateral compartment of the leg
  • Divides into terminal branches into peroneus longus
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115
Q

Common fibular N: branches

A
  • Peroneal communicating nerve
  • Lateral sural
  • Superior and inferior genicular
  • Recurrent genicular
  • Muscular
  • Terminal branches
    • Superficial and deep peroneal
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116
Q

Common fibular nerve: relations

A
  • Ant
    • Plantaris
    • Lateral head of gastrocs
    • Knee joint capsule
    • Fibular origin of soleus
  • Post
    • Peroneus longus
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117
Q

Common peroneal nerve variants

A
  • Level of the division
  • Sural communicating branch- absent 20%
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118
Q

Femoral nerve: Gross anatomy

A
  • Origin: post division of L2-L4
  • Course:
    • From lateral border of psoas to descend between the iliacus and psoas muscles
    • Motor branch to iliacus prior to passing under the inguinal ligament
  • Femoral triangle
    • Above iliacus, outside and lateral to the femoral sheath
    • Branch to pectineus
    • Lateral femoral circumflex artery separates nerve into superficial and deep divisions
    • Terminal branch reaches apex of the femoral triangle to become the saphenous vein
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119
Q

Femoral nerve: Branches

A
  • Superficial division
    • Nerve to sartorius
    • Medial cutaneous nerve of the thigh
    • Intermediate cuteaneous nerve
    • Sympathetic vasomotor supply to blood vessels
  • Deep
    • Rectus femoris, vastus lateralis, intermedius and articularis genu, medialis,
    • Continues as the saphenous nerve (passing behind sartorius)
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120
Q

Femoral Nerve: Variants

A
  • Splits into separate slips within the psoas
  • Accessory femoral nerve
  • Femoral branch of the lateral femoral cutaneous nerve
  • Saphenous nerve
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121
Q

Gluteus maximus

A
  • O: Gluteal surface of ilium, behind posterior gluteal line, lumbar fascia, sacrum, sacrotuberous ligament
  • I: Gluteal tuberosity, ITB
    *
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122
Q

Gluteus medius

A
  • O: gluteal surface of ilium, between the middle and posterior gluteal line
  • I: GT
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123
Q

Gluteus minumus

A
  • O: gluteal surface of the ilium between middle and inferior gluteal lines
  • I: GT
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124
Q

Gluteal muscle: surfaces and relations

A
  • M: natal cleft
  • L: hip joint
  • S: muscles of the posterior back
  • I: hamstrings muscles
  • A: ilium
  • I: sciatic nerve
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125
Q

Gluteal muscles: neurovasculature

A
  • Max: superior and inferior gluteal arteries, med and min: superior gluteal artery
  • V: Similar to arterial supply
  • N: Medial and lateral gluteal nerves via the sacral plexus
  • L: into the inguinal lymphatic chain
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126
Q

Gluteal muscles: actions

A
  • Extends flexed thigh at that hip
  • Stabilises hip and knee via attachment to ITB
  • Gluteus medius and minimus abduct the hip joint
  • Medial rotation of the thigh.
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127
Q

Guteal muscles: Variants

A
  • Gluteus quartus
  • Fusion of the gluteus maximus and TFL
128
Q

Sartorious

A
  • Origin: ASIS
  • Insertion: most anterior tendon of the pes ansarenus, then to the medial tibia
129
Q

Sartorius relations

A
  • Posterior: rectus femoris, pectineus, adductor longus, adductor magnus
  • Medial: femoral nerve/artery/vein
  • Ant to the superficial femoral nerve
  • Deep: fascial roof of the adductor canal (superficial femoral vessels, saphenous, nerve to vastus medialis muscle)
  • Near origin: pierced by intermediate cutaneous nerve of the thigh
  • Near insertion:
    • Posterior: gracilis and semitendinosis
    • Deep: bursae
    • Infrapatellar branch of the saphenous nerve
130
Q

Sartorius: neurovasculature

A
  • Arterial supply:
  • Venous drainage: small tributaries into the femoral vein
  • N: nerve of the anterior compartment of the thigh, femoral nerve (muscular branch from ant division for the femoral nerve)
  • L: into the inguinal chain
131
Q

Arterial supply of the foot:

A
  • Posterior tibial artery
  • Medial plantar artery
  • Lateral plantar artery
  • Dorsalis pedis
132
Q

Arterial supply of the foot: course

A
  • Posterior tibial artery
    • Runs within the tarsal tunnel posterior to the medial malleolus
  • Lateral plantar artery
    • Crosses the sole of the foot obliquely towards the base of the 5th metatarsal
  • Plantar arch: lies within the neurovascular plane deep to the plantar anastomoses, superficial to the long tendons
133
Q

Tributaries of the great saphenous vein

A
  • Small saphenous
  • Lateral accessory
  • Superficial epigastric
  • Superficial circumflex iliac
  • Superficial external iliac
  • Superficial external pudendal
  • Deep external iliac veins
  • Anterior accessory saphenous
134
Q

Tributaries of the small saphenous

A
  • Communicating branches with great saphenous
  • Cutaneous venous tributaries
135
Q

Course of the GSV

A
  • Originates as the continuation of the medial marginal vein
    • Anterior to the medial malleolus to ascend medial to and then posterior to the medial aspect of the tibia
  • Winds around the medial aspect of the knee and continues upwards to pierce the saphenous hiatus of deep fascia, 1-3cm distal to the inguinal ligament to drain into the femoral vein at the saphenofemoral junction
  • Relations
    • Branches of the saphenous nerve
136
Q

Small saphenous course

A
  • Originates at the lateral aspect of the foot, and continues superiorly along the lateral surface, it passes over the popliteal fossa and drains into the popliteal vein at the popliteal fossa
137
Q

Saphenous vein variants

A
  • Fenestrated great saphenous
  • Duplicated greater or lesser saphenous
  • Absence of the superficial system
  • Variable termination
138
Q

Popliteal fossa: Boundaries

A
  • Floor: popliteus muscle
  • Roof: posterior fascia
  • Superior medial: biceps femoris
  • Superior lateral: Biceps femoris
  • Inferior medial and lateral: heads of gastrocnemius
139
Q

Popliteal fossa contents

A
  • Popliteal artery and vein
  • Tibial nerve and fibular nerve
  • Knee joint
  • Geniculate arteries
  • Posterior femoral cutaneous nerve
  • Small saphenous vein
  • Popliteal lymph nodes
140
Q

Fibularis longus

A
  • O: head of the fibula
  • I: 1st metatarsal and medial cuneiform
141
Q

Fibularis brevis

A
  • Medial to the fibularis longus
  • Origin: lower 3 of the lateral surface of the fibula
  • Reaches under the sole of the foot to insert into the base of the 5th metatarsal
142
Q

FIbularis brevis and longus: Neurovascualture

A
  • A: branches of the peroneal nerve -
  • V: into the short saphenous vein
  • N: muscular branches of the common peroneal nerve -
  • L: popliteal lymph nodes
143
Q

FIbularis muscle variants

A
  • Duplex belly of fibularis longus
  • Fusion of fibularis brevis and longus
  • Os peroneum
144
Q

Biceps femoris

A
  • Origin: long head - ischial tuberosity as conjoint tendon, short head – lateral linear aspera and lateral supracondylar line of the femur and adjacent intermuscular septum
  • Insertion: Fibular head, crural fascia, lateral tibial condyle
  • A: inferior gluteal artery, perforating artery, popliteal artery
  • V: femoral vein
  • N: long head: tibial division of the sciatic nerve, short head – common peroneal
145
Q

Semimembranosus

A
  • O: Ischial tuberosity
  • I: infraglenoid tubercle of the posterior medial tibial condyle, posterior joint capsule, popliteal fascia, posterior horn of medial meniscus
  • A: same as biceps
  • N: tibial N
146
Q

Semitendinosus

A
  • O: ischial tuberosity as conjoint tendon
  • I: most posterior tendon inserting into the pes anserinus
147
Q

Hamstrings variants

A
  • Absence of short head
  • Exclusive tibial insertion
  • Absent semimembranosis
  • Accessory semimembanosus
148
Q

Arterial supply of the hand: superficial palmar

A
  • Superficial palmar arch
    • Superficial branch of the ulnar artery
    • Distal to the flexor retinaculum
    • Superficial to the long flexor tendons of the digits and deep to the palmar aponeurosis
    • Across the centre of the palm at the level of the distal border
  • Palmar digital artery
    • Branches off the superficial palmar arch
    • Runs on the ulnar side of the little finger
  • Common palmar digital arteries
    • 3
    • Run in the webs between fingers,
  • Proper palmar digital arteries
    • Either side of the palmar aspect of each finger
    • Occasionally gives off a dorsal branch
  • Superficial palmar branch
    • Branch of the radial artery
    • Superficial to the thenar muscles
149
Q

Arterial supply of the hand: deep palmar

A
  • Radial artery
    • Passes into the hand along the roof of the anatomical snuffbox then dorsally around the scaphoid and trapezium passing between the two heads of the 1st dorsal interosseus muscle and between the two heads of adductor pollicis to enter the deep plane of the palm
  • Princeps pollicis
    • Along first metacarpal
    • Divides into two palmar digital branches at the metacarpal head
  • Radialis indicis
    • Radial aspect of index
  • Deep palmar arch
    • Originates between oblique and transverse heads of the adductor pollicis
  • Palmar metacarpal
    • 3 palmar metacarpal arteries
    • At the metacarpal heads
    • Perforate the interosseous spaces to anastamose with the dorsal metacarpal arteries
150
Q

Arterial supply of the hand: dorsal

A
  • Posterior carpal arch
    • Anastamosis between the dorsal carpal branches and the dorsal branch of the anterior interossesous artery
  • Dorsal metacarpal arteries
    • Split at the webs to supply dorsal sides of the fingers via the dorsal digital arteries

Anastamose with the deep palmar arch via the palmar metacarpal arteries

151
Q

Axillary artery: gross anatomy

A
  • Origin
    • At the border of the first rib as the continuation of the subclavian
  • Termination
    • At the inferior border of teres major where it continues as the brachial artery
  • Parts
    • Divided into three parts by the pectoralis minor muscle
      • 1st part: proximal to the pectoralis minor
      • 2nd part: behind the pectoralis minor
      • 3rd part: distal to the pectoralis minor
152
Q

Axillary artery: branches

A
  • 1st part: 1 branch
    • Superior thoracic artery (supplied pec maj and min)
  • 2nd part: 2 branches
    • Thoracoacromial
    • Lateral thoracic
  • 3rd part: 3 branches
    • Subscapular artery
    • Anterior humeral circumflex
    • Posterior humeral circumflex
153
Q

Basilic vein

A

• Commences at the confluence of the dorsal veins of the hand runs along the medial aspect of the arm • Anterior the medial epicondule of the humterus • Penetrates the brachial fascia at the basilic hiatus • Courses medially to the brachial artery • Tributaries: median cubital vein, median antebrachial vein

154
Q

Cephalic

A

• Origin is at the anatomical snuffbox on the radial side of the superficial venous network • Course o Around the radial aspect of the foream, through the anterolateral forearm o Passes upwads over the anterior elbow region and through the anterolateral brachium lateral to the biceps muscle in the deltopectoral gorrve o Through the anterior wall of the axilla perforating the clavipectoral fascia • Tributaries o Accessory venous plexi o Unite medial to the elbow.

155
Q

Brachial vein

A

origin: union of the ulnar and radial veins in the cubital fossa location: courses superiorly in the upper arm, often in close proximity to the brachial artery1 drainage: deep and superficial palmar venous arches termination: union of the brachial and basilic veins at the inferior border of teres major forms the axillary vein

156
Q

Median nerve: origin

A

 Two roots:  Lateral cord – C5,6,7  Medial cord – C8, T1

157
Q

Median nerve: course

A

 Lies medial to the axillary artery  Enters the arm from the axilla at the inferior margin of the teres major and descends medially between biceps and triceps.  In the arm, laterally to the brachial artery and crosses it anteriorly from lateral to medial. Lies on corachobrachialis then brachialis  Cubital fossa: medial to the brachial artery and biceps brachii  Enters the forearm between the two heads of pronator teres  Gives off the anterior interosseus nerve  Deep to FDS and superficial to FDP  Enters the hand through the carpal tunnel

158
Q

Median nerve: branches

A

 Muscular branch: pronator teres  Elbow: superficial layer of forearm flexors and intermediate latyer  Anterior interosseus nerve  Palmar cutaneous branch  Recurrent branch in the hand: thenar muscles  Digital cutaneous branch  Articular branches of: elbow, wrist, carpal and phalangeal joints

159
Q

Median nerve: variants

A

o Persistent median artery of the forearm o Accessory branches arising proximal or distal to the carpal tunnel o Variant course of the thenar branch o Aberrant origin to the motor branch o Anastamoses between median and ulnar

160
Q

Neurovasculature of the the L ventricle

A
  • A: left anterior descending, left circumflex artery
  • V: drains into the great cardiac vein, through thebesian veins
  • N: receives both parasympathetic supply (via the vagus) and parasympathetic supply (via the cardiac plexus)
  • Lymph: drains to the perihilar and mediastinal lymphnode groups
161
Q

Left ventricle: Relations

A
  • A: IV septum, RV
  • P: descending aorta, L vagus, sympathetic chain
  • S: L atrium
  • R: Right pleura
  • L: L lung pleura and L phrenic
  • I: diaphragm
162
Q

Left ventricle: variants

A
  • Parachute valve
  • Double inlet ventricle
  • Interventricular septal defect
  • Tetralogy of Fallot
  • Transposition of the great vessels
163
Q

Right atrium: boundaries

A
  • S: SVC
  • I: IVC
  • P: interatrial septum, fossa ovalis
  • A: cardiac wall
  • L: R AV ostium
164
Q

RIght atrium: parts

A
  • Divided into 2 parts by the crista terminalis
    • Sinus venarum cavarum
      • Posterior to the crista terminalis
      • Drains IVC and SVC
      • Smooth wall
    • Atrium
      • Anterior half
      • Ridged by pectinate muscles fanning out from crista terminalis
165
Q

Right ventricle: openings

A
  • SVC
  • IVC
  • Coronary sinus
  • AV ostium
166
Q

Right atrium: neurovasculature

A
  • A: right coronary, conus and sinoatrial, acute marginal
  • V: thebesian veins,
  • N: cardiac plexus and vagus nerve
  • Lymph: mediastinal groups
167
Q

RIght atrium: relations

A
  • P: left atrium,
  • R: right lung,
  • L: right ventricle, aortic root and valve
  • S: SVC

I: IVC

168
Q

Right atrium: variants

A
  • Chiari network
  • Incomplete closure of the foramen ovale
  • Variable size of the fossa ovalis
  • Doubled coronary sinus
  • May drain into left atrium
  • SVC may be joined into the left atrium
169
Q

Oesophagus: Course

A
  • Initially runs down the midline of the neck, posterior to the trachea
  • Returns to midline at the level of T4-5
  • Returns to left of midline in posterior mediastinum
  • Passes through the oesophageal hiatus at the level of T10 along with the thoracic duct
  • Has a very short abdominal course and terminates as the cardiac sphincter
170
Q

Oesophageal: constrictions

A
  • Cervical: cricoid cartilage at C5-6
  • Thoracic: aortic arch at T4-5
  • Abdominal: oesophageal hiatus at T10
171
Q

Oesophagus: neurovasculature

A
  • Superior 1/3
    • A: inferior thyroid
    • V: inferior thyroid
  • Middle 1/3
    • A: direct branches from the aorta
    • V: azygos direct branches into the IVC
  • Inf:
    • A: branches of the left gastric artery
    • V: left gastric vein into the portal circulation
  • Lymphatics: deep cervical, posterior mediastinal, left gastric and coeliac group
  • Innervation: symp: oesophageal plexus, parasym: vagus
172
Q

Oesophagus: relations

A
  • A: trachea, recurrent laryngeal nerves, Left main bronchus, left atrium
  • P: vertebral column, descending aorta, thoracic duct, accessory hemiazygous and hemiazygos
  • L: lung, pleura, L subclavian artery, thoracic duct
  • R: lung, pleura, azygos vein
173
Q

Oesophagus: variants

A
  • Oesophageal atresia
  • Tracheo-oesophageal fistula
  • Oesophageal bronchus
  • Aberrant right subclavian artery
174
Q

Pericardial sinuses

A
  • Oblique pericardial sinus
    • Formed by the superior and inferior vena cava and the four pulmonary veins, posterior to the left atrium
  • Transverse pericardial sinus
    • Between the aorta and the atria, surrounding the ascending aorta
175
Q

Pericardial variants

A
  • Agenesis
  • Dysgenesis
  • Partial covering
  • Variant recesses
176
Q

Pericardial recesses

A
  • Aortic (from the transverse)
    • Superior aortic recess: from its mouth located inferiorly, ascends posterior to then to the right of the ascending aorta and ends at the level of the sternal angle
      • Diverticulum descending from superiorly located mouth to run between the lower ascending part of the aorta and the right atrium
  • Pulmonic recesses
    • Right: posterior to the right pulmonary artery and anterior to the oesophagus
    • Left: superior relation is the left superior pulmonary vein and medially by the ligament of Marshall
  • Post caval
    • Posterior to the superior vena cava, superior to the right superior pulmonary vein, inferior to the right pulmonary artery
  • Pulmonary venous recesses
    • Right and left: medially and upward on the back of the left atrium between the superior and inferior pulmonary veins on each side, indenting the side walls
177
Q

Pericardial neurovasculature

A
  • A: internal thoracic and pericardiophrenic and musculophrenic branches, branches from the descending thoracic aorta
  • V: pericardiophrenic veins
  • I: phrenic nerves, vagus n, sympathetic trunks

L: tracheobronchial nodes, pre-pericardial nodes

178
Q

Pericardial relations

A
  • A: body of the sternum, cartliages of the L 3-7 ribs, pleura and lungs and thymus
  • P: oesophagus, descending thoracic aorta, pleura, lungs
  • Laterally: pleura and lungs, phrenic nerves
  • I: blends with central tendon of the diaphragm
179
Q

Pleura: gross anatomy

A
  • Parietal: continuous with the chest wall, named according to the site it lines
    • Cervical
    • Costal
    • Diaphragmatic
    • Mediastinal
  • Visceral: continuous with the lungs, this has multiple fissures and invaginations
180
Q

Pleural lines of reflection

A
  • Lines of reflection
    • Above clavicle 1 inch above the mid point of the medial third of the clavicle
    • 2nd rib: both descend down the midline
    • 4th rib: left pleural line deviates laterally to accommodate the heard
    • 6th rib: both lines deviate laterally to accommodate the heart
    • 8th rib: both pass the MCL
    • 10th rib: right and left pleural lines pass the midaxillary line
    • 12th rib: both travel posteriorly around the chest wall
181
Q

Pleural recesses

A
  • Costodiaphragmatic
  • Costomediastinal
  • Phrenicomediastinal
  • Vertebromediastinal recesses
182
Q

Pleural neurovasculature

A
  • Neurovasculature
    • A: parietal = internal thoracic, intercostal and phrenic arteries, visceral = bronchial
    • V: parietal = internal thoracic, intercostal and phrenic veins, visceral = pulmonary veins
    • Lymphatics: within the deep pulmonary plexus

Innervation: costal = intercostal nerves, mediastinal and diaphragmatic = phrenic

183
Q

Pleural variants

A
  • Accessory fissures
    • Left accessory
    • Right azygos
184
Q

Larynx: borders

A
  • Superior: superior border of the cricoid cartilage
  • Inferior: inferior border of the thyroid cartilage
185
Q

Larynx: Subglottic region

A
  • Below the level of the vocal cords
  • To the inferior aspect of the cricoid cartilage
186
Q

Larynx: glottic

A
  • At the level of the vocal cord
  • Anterior and posterior commisures
187
Q

Larynx: supraglottic

A
  • Contains the aryepiglottic folds
  • Epiglottis
  • Pre-epiglottic space
  • Arytenoid cartilages
  • False vocal cords
  • Paraepiglottic space
188
Q

Larynx: paired cartilages

A
  • Areytenoid
  • Accessory
    • Cuneiform
    • Corniculate
189
Q

Larynx: unpaired cartilages

A
  • Thyroid
  • Cricoid
  • Epiglottic
  • Connected by the cricothyroid membrane
190
Q

Laryngeal relations

A
  • Ant: strap muscles, anterior jugular
  • Post: oesophagus, laryngopharynx
  • Sup: hyoid, laryngopharynx
  • Inf: trachea
191
Q

Larynx: neurovasculature

A
    • Above the vocal cords: superior laryngeal artery
      • Below: inferior laryngeal artery
  • Venous
    • Above: superior laryngeal vein
    • Below: inferior laryngeal vein
  • Lymphatics
    • Supraglottic: follows the superior laryngeal artery in to the superior deep cervical nodes and the pre-epiglottic nodes
    • Subglottic: inferior deep cervical chain nodes, into the right lymphatic duct and thoracic duct on left
  • Innervation
    • Recurrent laryngeal nerves provide motor control to the vocal folds
    • Sensory above the supraglottic region: internal laryngeal nerve
    • Subglottic region: recurrent laryngeal nerve
192
Q

Thyroid: gross anatomy

A
  • It is formed by two paired lobes which are connected by a central isthmus
  • Lies from C5-T1
  • Butterfly shaped
  • Two lobes, each with a superior and inferior pole
  • Isthmus is adherent to 2-4th tracheal rings
193
Q

Thyroid: neurovasculature

A
  • Supplied by the superior and inferior thyroid arteries
    • Superior from the external carotid artery
    • Inferior from the thyrocervical trunk from the subclavian artery
    • Superior thyroid
      • Middle thyroid
      • Inferior thyroid
    • Into perithyroid lymph nodes, prelaryngeal, pretracheal and paratracheal
  • Neuro
    • Superior, middle and inferior cervical ganglia
194
Q

Thyroid relations

A
  • Posterior: parathyroid glands are embedded within it, one in each of the superior and inferior portions of the lobes, trachea
  • Anterior: platysma, visceral fascia,
  • Lateral: carotid sheath containing the common carotid arteries, internal jugular veins, vagus nerve, sternocleidomastoid
  • Superior: Cricoid cartilage
195
Q

Thyroid variants

A
  • Pyramidal lobe
  • Hemithyroid agenesis
  • Ectopic thyroid tissue
    • Base of tongue
  • Thyroglossal duct cysts
  • Arterial supply via the thyroid ima artery from the aortic arch
196
Q

Thyroid: embryology

A
  • At the foramen caecum in the midline of the base of the tongue
  • During the 5th embryonic week, migrates inferiorly to the body of the hyoid bone,
  • Forms the thyroglossal duct
197
Q

Superior pharyngeal constrictor

A
  • Origin: pterygoid hamulus, pterygomandibular raphe, mandible
  • Artery: ascending pharyngeal artery

N: pharyngeal plexus

198
Q

Middle pharyngeal constrictor

A
  • Origin: greater cornu of the hyoid bone, lesser cornu and the stylohyoid ligament
  • A: pharyngeal branch o the ascending pharyngeal artery, tonsillar branch of the facial artery
  • N: pharyngeal plexus
199
Q

Inferior pharyngeal constrictor

A
  • Origin: Cricoid cartilage,
  • A: ascending pharyngeal,
  • Thyropharyngeal muscle
  • Cricipharyngeal muscle
200
Q

Structures passing above the superior pharyngeal constrictor

A
  • Common carotid artery
  • Auditory tube
  • Levator palati
  • Ascending palatine artery
201
Q

Structures between the superior and middle pharyngeal constrictors

A
  • Superior laryngeal artery and nerve
  • Stylopharyngeus
  • Glossopharyngeal
202
Q

Structures passing between the middle and inferior pharyngeal constrictors

A
  • External laryngeal nerve
  • Internal branch of the superior laryngeal nerve
  • Superior laryngeal artery
203
Q

Structures passing below the inferior pharyngeal constrictor

A
  • Inferior laryngeal nerve
  • Inferior laryngeal artery
204
Q

Scalenus anterior: gross anatomy

A
  • Origin: TP of 3rd-6th cervical processes
  • Insertion at the scalene tubercle on the first rib
205
Q

Scalenus anterior: relations

A
  • A: phrenic and vagus neves, ascending cervical, transverse cervical and suprascapular arteries, internal jugular and subclavian veins, sternocleidomastoid and omohyoid muscles, clavicle
  • P: second portion of subclavian, scalenius medius, anterior rami of C3-t1
  • M: CCA, 1st portion of subclavian, thyrocervical trunk, vertebral artery and vein, stellate ganglion, thoracic duct/lymphatic duct
  • L: trunks of the brachial plexus, 3rd portion of the subclavian
206
Q

Scalenus anterior: Neurovasculature

A
  • Branches of the ansa cervicalis
  • Arterial supply from the
  • Venous drainage into the intercostal veins
207
Q

SCM: gross anatomy

A
  • There are two head:
    • Insertions: Mastoid process, lateral half of the superior nuchal line
    • Medial third of the clavicle
    • Suprasternal notch of the sternum
    • Sternal head passes over the sternoclavicular joint and joins the clavicular head halfway up the neck
      • Common belly then passes posterolaterally to the insertion
208
Q

SCM: neurovasculature

A
  • Spinal accessory nerve
  • Arterial: superior thyroid and occipital arteries
  • Venous: jugular veins
209
Q

SCM: Neurovasculature

A
  • Upper half
    • P: cervical plexus,
    • A: platysma, external jugular vein
  • Lower half :
    • Post: ant scalene, CCA, IJV, carotid sheath
    • Ant: platysma
210
Q

SCM: variants

A
  • Separate sternomastoid and cleidomastoid heads
  • Absent clavicular or sternal head
  • Fusion with trapezius
  • Additional clavicular head
  • Doubled or quadrupled
  • Absent
211
Q

Nasolacrimal apparatus: gross anatomy

A
  • Parts: gland, canaliculi, sac, duct
  • Drains to the inferior nasal meatus
  • Lacrimal canaliculi: superior and inferior on each side
  • Common canaliculis drains to the lacrimal sac posterior to MPL and anterior to the orbicularis occuli
  • Lacrimal sac
    • Lies within the lacrimal fossa
    • Superior fundus which tapers inferiorly
    • Enclosed by the lacrimal fascia
  • Nasolacrimal duct
    • Two parts: membranous and osseus
      • Inraossueus : lies within the nasolacrimal canal of the maxilla
      • Membranous part: within the nasal mucosa, terminates below the inferior nasal meatus, valve of HASLER
212
Q

Nasolacrimal duct: vasculature

A
  • Arterial: ophthalmic artery

Vein: superior and inferior ophthalmic veins

213
Q

Nasolacrimal duct innervation

A
  • Parasympathetics: lacrimal branch of the frontal nerve (ophalthamic division of trigeminal)
  • Sympathetics
    • Via the superior ophthalmic plexus

Greater and deep petrosal nerves

214
Q

Nasolacrimal duct variants

A
  • Incompetent valve of hasler
  • Drains into the inferior meatus
  • Variable number and course of the canaliculi
215
Q

Nasolacrimal duct: relations

A
  • Of the lacrimal gland
    • S: superior wall of the orbit
    • Inferomedial: globe
216
Q

Extra-ocular muscles: gross anatomy

A
  • There are 6 muscles: Superior rectus (SR), Inferior rectus (IR), Medial rectus (MR), Lateral rectus (LR), inferior oblique (IO), and superior oblique (SO)
    • SR, MR, IR and LR have a common origin at the tendinous annulus of Zinn
    • IO originates from the superior surface of the maxilla
    • SO originates from the greater wing of the sphenoid and hooks over the tendinous trochlear prior to insertion
217
Q

Extraocular muscles: neurovasculature

A
  • Innervation
    • IO, SR, IR and MR are supplied by the inferior division of the oculomotor nerve
    • LR is supplied by abducens nerve
    • SO is supplied by the trochlear nerve
  • Arterial supply
    • Branches of the ophthalmic artery
  • Venous drainage
    • Via the superior and inferior ophthalmic veins and the infraorbital vein
218
Q

Extraocular muscles: variants

A
  • Variable blood supply
  • Variable origins of the IO and SO
219
Q

Arteries of the nose

A
  • Sphenopalatine
  • Anterior ethmoidal
  • Posterior ethmoidal
  • Superior labial
  • Greater palatine
220
Q

Nasal artery variants

A
  • Division of sphenopalatine
  • Common trunk ant and post ethmoidal
221
Q

Boundaries of the the pterygopalatine fossa

A
  • M: perpendicular plate
  • L: pterygomaxillary fissure
  • A: post wall of maxilla
  • P: medial and lateral pterygoid plates, inferior aspect of the lesser wing of the sphenoid
  • R: inferior orbital fissure, sphenoid bone

Floor palatine canal

222
Q

Communications: pterygopalatine fossa

A
  • Sphenpalatine foramen: communicates with the nose, transmits the sphenopalatine artery
  • Pterygomaxillary fissure: communicates with the masticator face (infratemporal fossa)
  • Inferior Orbital fissure:
  • Foramen rotundum: meckel’s cave, cavernous sinus
  • Vidian canal – vidian N
  • Greater and lesser palatine canals
223
Q

Pterygopalatine foss: contents

A
  • The part of the maxillary artery
  • Pterygopalatine ganglion
  • Maxillary artery
  • Maxillary division trigeminal
  • N of pterygoid canal
224
Q

Bones contributing to the orbit

A
  • Frontal
  • Zygomatic
  • Maxillary
  • Ethmoid
  • Lacrimal
  • Sphenoid – both greater and lesser wings
  • Palatine
225
Q

Communications with the orbit

A
  • The orbit has three main communicating orifices
  • Superior orbital fissure
    • Contains the ophthalmic artery, ophthalmic nerve, frontal and lacrimal nerves, CN III,IV and VI and the superior ophthalmic vein
  • Optic canal
    • CN II, central retinal artery, sympathetic nerves, meningeal layers
  • Inferior orbital fissure
    • Inferior ophthalmic vein
  • Infraorbital canal
    • Contains the infraorbital nerve
  • Anterior and posterior ethmoidal foramina
  • Anterior and posterior sphenopalatine foramina
226
Q

Variants of the orbit

A
  • Variable presence of sutures and joints
  • Ophthalmic artery can originate from the middle meningeal artery
  • Absent IOF
  • Accessory SOF
227
Q

Contents of the orbit

A
  • There are 4 key spaces of the bony orbit
    • Globe
    • Optic nerve complex
    • Intraconal
    • Conal
    • Extraconal
228
Q

Maxillary sinus description

A
  • The maxillary sinuses form part of the paranasal sinuses
  • They are contained within the maxillary bones
  • Paired structure located at the front of the face, which hare shaped as inverted pyramids, with the apex directed inferomedially
  • Allow for vocal resonance and lightens the head
229
Q

Maxillary sinus: relations

A
  • S: floor of orbit
  • I: hard palate
  • M: vomer
  • L: zygoma
  • A: maxilla, infraorbital nerve
  • P: Base of skull, middle cranial fossa
230
Q

Neurovasculature of the maxillary sinus

A
  • Art: sphenopalatine, branches of the external carotid and maxillary arteries
    • Facial, maxillary, infraorbital and greater palatine
  • V: facial vein, -
  • Neuro: sphenoparietal
  • Lymph: into the submental or anterior chain lymph nodes
231
Q

Variants of the maxillary sinus

A
    • Concha bullosa
      • Haller cells
      • Infraorbital air cells

Silent sinus

232
Q

Tympanic membrane: gross anatomy

A
  • Shaped as a flat cone pointing to the middle and inner ear
  • The deepest point is the umbo
  • Attaches to an incomplete ring of bone along the wall of the EAC, tympanic annulis
  • 3 layers
    • Cutaeneum
    • Radiatum circulare
    • Mucosa
233
Q

Parts of the tympanic membrane

A
  • Pars tensa
    • Tense, largerportion of the membrane
    • Extends from the anterior and posterior malleolar folds at the level of the lateral process of the malleus to the inferior edge of the membrane
  • Pars flaccida
    • Smaller and is the portion above the anterior and posterior malleolar folds
234
Q

Tympanic membrane: neurovasculature

A
  • Innervation
    • External surface: auricular temporal, greater auricular nerve, arnold’s nerve
    • Internal surface: Jacobson’s nerve
  • Arterial supply
      • Deep auricular artery
      • Anterior tympanic
        • Stylomastoid branch of the posterior auricular artery
  • Venous drainage
    • Pterygoid plexus
    • Superior petrosal sinus
    • Pre-auricular nodes
      • Retropharyngeal nodes
      • Superior deep cervical nodes
235
Q

Tympanic membrane relations

A
  • S: tegmen tympani, jugular bulb
  • I: parotid
  • A: TMJ
  • P: Mastoid
  • M: stapedius
  • L: external acoustic canal
236
Q

Tympanic membrane: variants

A
  • Agenesis
  • Variant nervous supply
237
Q

Parotid gland: gros anatomy

A
  • It can be divided into a superficial and deep lobe
  • Completely enclosed by the parotid fascia
  • Transmits saliva along Wharton’s duct, which opens behind the second molar
  • Structures enclosed within it
    • Retromandibular vein
    • Division of the extracranial facial nerve
    • Intraparotid lymph nodes
    • ECA: branches into its terminal branches: superficial temporal and Maxillary artery
  • Inferior projection is known as the tail, lower 2cm of the gland
238
Q

Parotid gland: neurovasculature

A
  • Innervation: sensory – auriculotemporal, greater auricular, parasympathetic – aurocotemporal, sympathetic – plexus surrounding the ECA
  • Arterial spply
    • Transverse facial artery
    • Plexus then into the internal jugular vein
  • Lymphatics
    • Deep cervical chain
239
Q

Parotid gland relations

A
  • Superior pole: external acoustic meatus, TMJ
  • Lower pole: behind angle of mandible, ant to SCM and post belly of digastric
  • Lateral surface: SC tissue
  • Ant: ramus of the mandible, masseter on its outer surface and medial pterygoid on its inner surface
    • Parotid duct and facial nerve branches emerge
    • Deeper part: ST and maxillary arteries emerge
  • Deep surface
    • Indented by the mastoid process
    • ECA enters
    • Styloid process separates form the IJV and the ICA
240
Q

Parotid gland variants

A
  • Agenesis
  • Accessory parotid glands
  • Accessory parotid ducts
  • Facial nerve divides proximal to its entrance to the parotid
  • Facial nerve divides distal to its entrance to the parotid.
  • Facial process
  • Ectopic parotid tissue
  • Parotid duct duplication
  • Congenital agenesis
241
Q

Temporalis

A
  • Temporalis
    • O: from the temporal fascia
    • I: coronoid process
    • A: Deep temporal branches and middle temporal

V: retromandibular/facial vein

242
Q

Masseter

A
  • O: zygoma
  • I: inferior aspect of the angle of the mandible
  • A: masseteric artery of the maxillary artery, facial artery, transverse facial branch of the superficial temporal artery
243
Q

Medial pterygoid

A
  • O: Two heads
    • Superficial head: maxillary tuberosity, pyramidal process of the palatine bone
    • Deep head: from the medial aspect of the lateral pterygoid plate
  • I: Mandibular angle and ramus
  • Innervation: mandibular division of the
  • Arterial supply: maxillary artery
244
Q

Lateral pterygoid

A
  • O: two heads
    • Upper: lower part of the lateral surface of the greater wing of the sphenoid and infratemporal crest
    • Lower: lateral surface of the lateral pterygoid
  • I:
    • Upper: TMJ capsule
    • Lower: pterygoid fovea

Action: opens the mouth

245
Q

Relations of the muscles of mastication

A
  • All are contained within the masticator space
  • A: Skin
  • P: Mandible, pterygopalatine fossa
  • S: Zygoma, temporal fossa, middle cranial fossa, orbit
  • I: submandibular glands, digastric, floor of mouth, tongue
246
Q

Ophthalmic artery: gross anatomy

A
  • Originates from the ICA from the ophthalmic portion
  • Course
    • Passes through the optic canal
    • Gives off its major branches
  • Termination
    • Two terminal branches are
247
Q

Branches of the ophthalmic artery

A
  • Orbital
    • Lacrimal
    • Supraorbital
    • Ethmoidal – anterior and posterior
    • Internal palpebral
    • Supratrochlear
    • Dorsal nasal
  • Ocular
    • Central retinal
    • Long and short posterior ciliary
    • Anterior ciliary
    • Muscular
248
Q

Innervation of the ophthalmic artery

A
  • Sympathetics: internal carotid plexus
  • Parasymp: via the vagus
249
Q

Gross anatomy: EC facial nerve

A
  • Course
    • Through the stylomastoid foramen
    • Gives off the posterior auricular
    • Passes between the posterior belly of digastric muscle and the stylohyoid muscle
    • Passes anteriorly through the parotid
    • Where it divides
  • Terminal branches
    • Temporal
    • Zygomatic
    • Buccal
    • Marginal mandibular
    • Cervical
250
Q

EC facial nerve supply

A
  • Muscles of facial expression
  • Stylo
  • Posterior belly of digastric

Stapedius muscle

251
Q

Arterial supply of the EC Facial N

A
  • Labyrinthine
  • Superficial petrosal

Stylomastoid

252
Q

Boundaries of the extraconal space

A
  • Defined as the area outside the conal muscles
  • Base which is anterior and formed by the orbital septum. External sides formed by the bones of the orbit. Internal sides formed by the extraocular muscles
253
Q

Contents of the extraconal space

A
  • Lacrimal gland
  • Lacrimal duct
  • Lacrimal, and frontal, nasociliary nerves
  • Zygomatic nerves, infraorbital nerve
  • Lacrimal, supraorbital, ant and post ethmoidal, internal palpebral, supratrochlear, dorsal nasal, infraorbital
  • Levator palpabrae superioris muscle
  • Superior ophthalmic, inferior ophthalmic vein, infraorbital vein

Extraocular fat

254
Q

Conal space

A
  • Contains the extraocular muscles
    • Inferior rectus, SR, MR,LR,
  • Periorbital fascia
  • Space containing the structures attaching the tendinous annulus of Zinn
255
Q

Intraconal space

A
  • Neves: Optic, oculomotor and nasociliary, abducens, ciliary
  • Ophthalmic – central retinal

Fat

256
Q

Boundaries of the nasopharynx

A
  • Ant: posterior nares, posterior margin of nasal septum
  • Inf: soft palate
  • Sup: basisphenoid, basiocciput.
  • Post: C1, 2
  • L: pharyngeal opening of the Eustacian tube, fossa of Rosenmuller
257
Q

Neurovasculature of the nasopharynx

A
  • Art: ascending pharyngeal, ascending palatine, ascending cervical, maxillary
  • Venous: pharyngeal venous plexus, pterygoid plexus
  • Innervation
    • Motor: Pharyngeal plexus
    • Sensory, pharyngeal nerve of the max division of trigeminal, glossopharyngeal
  • Lymphatics
    • Anterior cervical chain
258
Q

Nasopharynx: relations

A
  • A: nasal cavity
  • P: clivus/ BOS
  • I: oropharynx
  • S: middle cranial fossa
  • M: none

L: pterygopalatine fossa

259
Q

Boundaries of the superior orbital fissure

A
  • Med: body of sphenoid
  • Sup: lesser wing
  • Inf: greater wing
  • Lat: frontal bone
260
Q

Contents of the SOF

A
  • Lacrimal
  • Frontal
  • Superior ophthalmic vein
  • Trochlear
  • Superior division of oculomotor
  • Nasociliary
  • Inferior division of oculomotor
  • Abducens
  • Inferior ophthalmic vein
261
Q

Gross anatomy of the ethmoid air cells

A
  • Air cells (3-18) separated by bony septa
  • Separated into anterior and posterior groups by the basal lamella, lateral attachment of the middle turbinate to lamina papyracea
  • Anterior: drain to the hiatus semilunaris and middle meatus via the ethmoid bulla

Posterior: drain to the superior meatus via the sphenoethmoidal recess

262
Q

Ethmoid air cells: neurovasculature

A
  • Supplied by the anterior and posterior ethmoidal arteries,
  • Venous drainage: inferior petrosal sinus
  • Innervation:

Lymphatics: submandibular and retropharyngeal

263
Q

Ethmoid air cell: relations

A
  • Anteriorly: nasal bone
  • Posteriorly: sphenoid sinus
  • Medially: nasal septum
  • Laterally: lamina papyracea
  • S: orbits/ middle cranial fossa
  • I: nasal cavity
264
Q

Ethmoid air cell variants

A
  • Accessory cells
  • Agger nasi
  • Haller
  • Onodi
265
Q

Parts of the ostiomiatal complex

A
  • Maxillary ostium
    • Drainage channel of the maxillary sinus
  • Infundibulum
    • Common channel draining the ostia of the maxillary antra and anterior ethmoid air cells
  • Ethmoid bulla
    • Single air cell projecting over the hiatus semilunaris
  • Uncinate process
    • Hook like process arising from the posteromedial aspect of the nasolacrimal duct
  • Hiatus semilunaris
266
Q

Drainage of the sinuses

A
  • The maxillary sinus and ethmoid air cells drain into the anterior portion of the hiatus semilunaris
  • The frontal and sphenoid sinuses drain into the posterior portion of the hiatus semilunaris
  • Drains into the middle meatus of the nasal cavity
267
Q

Variants of the ostiomeatal complex

A
  • Concha bullosa
  • Intralamellar cell
  • Haller cells
  • Deviation of the uncinate process
  • Deviated nasal septum
268
Q

Gross anatomy of the biliary tract

A
  • Origin
    • The biliary ducts originate at the center of the hepatic cell
    • They then course through the liver and coalesce
  • Course
    • Right: anterior and posterior
      • Segments VI and VII right posterior
      • Segment V and VIII right anterior
    • Left: superior and inferior
    • Combine to form the right and left hepatic ducts
    • Combine to form the common hepatic duct
    • This courses anteriorly to the portal vein and laterally to the right and left hepatic arteries at the porta hepatis
    • This then courses down in the free edge of the omentum, giving off the cystic duct within Calot’s triangle
    • It continues as the common bile duct at this point
  • Termination
    • Forms the Ampulla of vater with the pancreatic duct
    • In the major duodenal papilla in the inferior aspect of the D2 segment of the duodenum
269
Q

Biliary tree: neurovasculature

A
  • Art: hepatic arteries, cystic artery and branches of the pancreaticoduodenal and gastroduodenal artery
  • Vein: directly into the portal system
  • Nerve: sympathetics by the greater splanchnic, parasympathetics from the coeliac plexus
  • Lymphatic: portal lymph nodes
270
Q

Biliary tree relations

A
  • Posteriorly: portal vein
  • Laterally: hepatic artery
271
Q

Variants of the biliary tree

A
  • Trifurcation at the porta hepatis
  • Duplication
  • Combines with the pancreatic duct
272
Q

Caecum: gross antomy

A
  • Part of the large bowel
  • Blind ending sac
  • Measuring 6cm
  • Covered by peritoneum
  • Variable mesentery
  • Located within the right iliac fossa
  • Originates with the fatty iliocaecal valve
  • Continuous superiorly with the ascending colon
  • Has the expected 3 layers
    • Mucosa, submuscosa and muscularis propria
  • The teniae coli continue through the small bowel.
  • These converge at the base of the appendix which is continuous with the caecum inferiorly
273
Q

Caecum neurovasculature

A
  • Art: branches of the SMA
  • Venous drainage: caecal veins draining into the SMA
  • Lymphatics: mesenteric then SMA nodes
  • Innervation: parasymp: sma plexus, symp from the great splanchnic nerves
274
Q

Caecum: relations

A
  • A: small bowel, anterior abdominal wall
  • P: ilium
  • S: ascending colon
  • I: lateral pelvic wall and appendix,
  • M: terminal ileum, ileocaecal valve

L: pelvic side wall

275
Q

Caecum variants

A
  • Caecal bascule
  • Subhepatic caecum
  • Mobile caecum
  • Variable position of the appendix
276
Q

Duodenum gross antomy

A
  • The first and 3 parts are retroperitoneal structures
  • It forms a rough C shape: with the head of the pancreas lodged within the curve
  • Measures 20-30cm
  • At the level of L1-3
277
Q

D1

A
  • First part of the duodenum
  • Horizontally: passes laterally to the right, superiorly and posteriorly for approximately 5cm, makes a sharp curve inferiorly
  • Relations
    • A: gallbladder, liver
    • P: gastroduodenal artery, portal vein, common bile duct
    • I: head of pancreas
    • S: epiploic foramen

M: pyloric sphincter

278
Q

D2

A
  • Second part of the duodenum
  • Vertically: passes inferiorly to the lower border of the vertebral body, makes a sharp turn to the inferior duodenal flexure
    • A: transverse mesocolon
    • P: right kidney, right ureter, right adrenal gland
    • S: liver/gallbladder
    • I: jejunum
    • M: head of the pancreas
    • L: ascending colon, hepatic flexure, right kidney
  • Ampulla of vater is at the inferior portion
279
Q

D3

A
  • 3rd part
  • Horizontal: passes transversely to the left crossing the vertebral column
    • A: root of the small bowel mesentery
    • P: right psoas, right ureter, gonadal vessels, aorta, IVC
    • M: duodenum
    • L: duodenum
    • S: head of pancreas

I: jejunum

280
Q

D4

A
  • 4th part
  • Angles superiorly: to the ligament of trietz
  • Relations
    • S: stomach
      • I: loops of ileum
      • P: left psoas, aorta
281
Q

Duodenal: neurovasculature

A
  • Arterial: From the coeliac trunk and the SMA via the , inferior and superior pancreaticoduodenal arteries
  • Venous: similarly named veins draining into the portal venous system
  • Lymphatics: into the SMA and coeliac plexi
  • Innervation: greater splanchnic nerve
282
Q

Duodenal variants

A
  • Duodenal diverticulum
  • Duodenal duplication
283
Q

Gallbladder: gross anatomy

A
  • Its is an approximately 10cm sac
  • Has a fundus, neck and body
  • Communicates with the biliary tree via the cystic duct
  • Microscopic
    • Serosa
    • Muscular
    • Lamina propria

Mucosa

284
Q

Gallbladder: neurovasculature

A
  • Arterial: cystic artery from the common hepatic artery
  • Venous: directly into the portal venous system
  • Lymphatics: cholecysto-retropancreatic, choleycsto-coeliac, cholecysto-mesenteric

Innervation: greater splanchnic, coeliac plexus

285
Q

Gallbladder relations

A
  • A: visceral surface of the liver, transverse colon, 9th costal cartilage
  • P: right kidney, distal first part, proximal second part of the duodenum
  • M: first part of the duodenum, free margin of the lesser omentum and epiploic foramen
  • L: right lobe of the liver
  • S: visceral surface of the liver, anterior abdominal wall
  • I: transverse colon, second part of the duodenum
286
Q

Gallbladder variants

A
  • Phrygian cap
  • Sigmoid
  • Septation
    • Single or multiple
  • Hartmann pouch
  • Floating gallbladder
  • Accessory gallbladder
  • Agenesis
  • Duplication
    • Cystic duct
    • Cystic artery
287
Q

Ureters: gross anatomy

A
  • 25-30cm long
  • 3 parts
    • Abdominal: from the renal pelvis to the pelvic brim
    • Pelvic: pelvic brim to the bladder
    • Intramural: within the bladder wall
  • Origin
    • They originate at the renal pelvis passing anteriorly to the renal vein and posterior to the renal artery
    • They are formed by the superior and inferior calyces
  • Constrictions
    • PUJ
    • Pelvic brim
    • VUJ
288
Q

Ureters: Course

A
  • Course within the retroperitoneum
  • Along the transverse processes of the L2-5, anterior to the medial edge psoas muscles
  • Enter the pelvis and pass anteromedially to the sacroiliac joint at the bifurcation of the common iliac vessels
  • Down anterior to the internal iliac artery down the lateral pelvic sidewall
  • At the level of the ischial spine it turns forward and medially to enter the posterolateral wall of the bladder where it runs an oblique 1-2cm course
289
Q

Ureteric neurovasculature

A
  • Upper
    • A: ureteric branches of the renal arteries
    • V: ureteric veins draining into the renal veins
  • Middle
    • Branches of the lumbar arteries and veins
  • Lower
    • Branches of the superior vesical arteries and veins
  • Lymphatic
    • Aortocaval and common iliac, internal and external iliac
  • Innervation
    • Renal, aortic, hypogastric autonomic plexi
290
Q

Relations of the abdominal ureter

A
  • Post: psoas, genitofemoral nerve, common iliac vessels, tips of L2-5 TP
  • Ant:
    • Right: descending duodenum, gonadal vessels, right colic vessels, ileocolic vessels
    • L: gonadal artery, left colic, loops of jejunum, sigmoid mesentery and colon
  • M:
    • R: IVC
    • L: abdominal aorta, IMV
291
Q

Relations of the pelvic ureter

A
  • Post: Sacroiliac joint, internal iliac artery
    • Male: seminal vesicle
      • Female: lateral fornix of the vagina
    • Male: ductus deferens
      • Female: uterine artery
    • Female: cervix
292
Q

Ureters: Variants

A
  • Duplex
  • Bifid
  • Agenesis
  • Partially duplicated
  • Ectopic insertion
  • Ureterocele
  • Cicumcaval
293
Q

Right adrenal gland: gross anatomy

A
  • Enclose within the perirenal fascia
  • Two portions, outer cortex, inner medulla.
  • Surrounded by a collagenous cpsule
  • Cortex is subdivided into 3 zones
    • Glomerulosa
    • Fasciculata
    • Reticulata
  • Each adrenal gland is formed by a medial and lateral limb with a common body.
  • They are located above the superior pole of the kidneys bilaterally and are therefore retroperitoneal organs
294
Q

Adrenal gland: neurovasculature

A
  • A: superior, middle and inferior adrenal glands (from the aorta and renal arteries)
  • V: superior middle and inferior adrenal glands
  • Innervation: sympathetics from the paraortic plexus

Lymphatics: para-aortic lymph nodes

295
Q

Right adrenal: relations

A
  • A: peritoneum
  • P:right kidney
  • S: right hemidiaphragm
  • I: IVC
  • M: right crus, right inferior phrenic artery
  • L: bare area of the liver
296
Q

Adrenal variants

A
  • Pancake
  • Ectopic
  • Agenesis
  • Duplication
  • Accessory
  • Hypoplasia
  • Horseshoe
297
Q

Liver segments

A
  • Segments
    • 1:caudate lobe
      • Bounded posteriorly by the fossa for the IVC, ant by the ligamentum venosum, inf by portal hepatic
    • 2: above the portal vein, to the left of the left hepatic vein
    • 3: below the portal vein to the left of the hepatic vein
    • 4a: above the portal vein between the middle and left hepatic veins
    • 4b: below the portal vein, between the left and middle hepatic veins
    • 5: below the portal vein, between the middle and right hepatic veins
    • 6: below the portal vein, to the right of the right hepatic vein
    • 7: above the portal vein, to the right of the right hepatic vein
    • 8: above the portal vein, between the middle and right hepatic veins
298
Q

Spleen: gross anatomy

A
  • It is approximately 3 x5x 7 inches
  • Lies between ribs 9-11
  • The spleen has three borders
    • Superior
    • Inferior
    • Intermediate
  • Two surfaces
    • Diaphragmatic and visceral
  • Enclosed in a thin capsule
  • There are often multiple spenuncules
  • Ligaments
    • Gastrosplenic
      • Attaches the spleen to the greater curvature of the stomach
      • Contains the short gastric and left gastroepiploic arteries
    • Splenorenal
      • Attaches the spleen to the left kidney
      • Contains splenic artery and vein and the pancreatic tail
299
Q

Spleen: neurovasculature

A
  • Art: splenic artery (direct branch of the coeliac
  • V: splenic vein (drains into the portal)
  • L: retropancreatic lymph nodes
  • Innervation: symp: coeliac plexus, parasym: vagal trunk
300
Q

Spleen: relations

A
  • A: ribs 9-11
  • P: right hemidiaphragm
  • S: right hemidiaphragm
  • I: splenic flexure of the colon
  • M: pancreatic tail

L: ribs

301
Q

Spleen: variants

A
  • Wandering
  • Polysplenia
  • Asplenia
  • Splenogonadal fusion
  • Retrorenal
  • Splenic cleft
302
Q

Anterior abdominal wall: layers

A
  • Skin
  • Campers
  • Scarpas
  • External oblique
  • Internal oblique
  • Transversus abdominis
  • Fascia transversalis
  • Parietal peritoneum
303
Q

Anterior abdominal wall: neurovasculature

A
  • A: superior and inferior epigastric arteries from the internal thoracic and anterior divisions of the internal iliac arteries, superficial epigastric, superior circumflex iliac, superficial external pudendal arteries
  • V: similarly named veins
  • Innervation: anterior rami of the lumbar segmental nerves
  • Lymph
    • Above the umbilicus : axillary and sternal
    • Below umbilicus: superficial inguinal
304
Q

Anterior abdominal wall: variants

A
  • Rectus dibarification
  • Spigellen hernia
  • Level of the arcuate line
  • Number of the horizontal septations
  • Pyrimidalis and sternalis
305
Q

Rectus sheath

A
  • Composed of the aponeuroses of the transversus abdominis, external oblique and internal oblique muscle
  • Fuse laterally at the linea semilunaris
  • Inferior to the arcuate line, the internal oblique aponeurosis passes anterior to the rectus abdominis, the posterior surface of rectus abdominis is in contact with the transversalis fascia
  • Contains
    • Rectus abdominis and pyramidalis muscles
    • Lower 6 thoracic nerves, branches of the posterior intercostal vessels
    • Superior and inferior epigastric vessels
306
Q

Kidney arterial supply

A
  • The kidneys are supplied by the renal arteries bilaterally
  • These arise at the level of
  • Courses inferiorly and passes posterior to the IVC and the right renal vein to reach the renal hilum.
  • They are retroperitoneal
  • Divide into 3 branches
    • Superior
      • Gives off the inferior adrenal artery
    • Middle
    • Inferior
  • Further divide into ureteric, capsular and cortical branches
  • There are also lobar, and interlobar branches
307
Q

Kidney venous anatomy

A
  • Drained by similarly named veins
  • The right renal vein drains directly into the IVC
  • The left renal vein drains into the IVC after receiving the adrenal veins and the gonadal veins, inferior phrenic
308
Q

Variants of the renal artery and venous

A
  • Duplicated or accessory renal arteries
  • Aberrant renal arteries
  • Duplicated renal veins
  • Pelvic kidney
  • Horseshoe kidney
  • Cross fused ectopia
  • Early branching
  • Four types of renal vein abnormalities
  • Non-classified: supernumerary renal veins
309
Q

SMA: gross antomy

A
  • Originates from the abdominal aorta at the level of L1
  • Behind the neck of the pancreas and the splenic vein
  • Crosses anterior to the 3rd part of the duodenum
  • Enters upper portion of the small bowel mesentery
310
Q

SMA branches

A
  • Inferior pancreaticoduodenal
  • Right colic
  • Middle colic
  • Ileocolic
  • Jejunal
  • Ileal branches
  • Marginal artery of Drummond
311
Q

SMA supplies

A
  • Pancreas
  • Duodenum
  • Ascending and transverse colon
  • Ileum and jejunum
  • Appendix

Caecum

312
Q

SMV: gross anatomy

A
  • Mesenteric venous arcades unite to form the jejunal and iliac veins
  • Gastrocolic trunk drains into the right hand side of the SMV anterior to the uncinate process
  • Lies to the right of the SMA
313
Q

SMV: tributaries

A
  • Mesenteric venous arcades
  • Ileocolic veins
  • Right colic vein
  • Inferior pancreaticoduodenal vein
  • Gastrocolic trunk
    • Right gastroepiploic vein
    • Middle colic
    • Anterior superior pancreaticoduodenal vein
314
Q

Relations of the IVC

A
  • A: right common iliac artery, right gonadal vessels D3, CBD, PV, head of pancreas, D1, epiploic foramen, liver
  • P: lower lumbar vertebrae, IV discs, ALL, R psoas major, sympathetic trunk, right coeliac ganglion, R 3rd and 4th lumbar arteries, right renal artery, right adrenal artery, right inferior phrenic artery
  • Left lateral: abdominal aorta, caudate lobe, right crus
  • Right lateral: right kidney, right ureter, D2, liver
  • S: right atrium
  • I: confluence of the common iliac veins
315
Q

IVC: variants

A
  • Duplication
  • Left sided
  • Drainage of the azygous directly into the RA
  • IVC webs
  • Azygous continuation of the IVC
  • Cicumaortic venous collar

Anatomy (11 decks)

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