Gross Anatomy Exam 2 - weeks 6-9 Flashcards
heWhat is the action of the pyramidalis?
Tenses the linea alba. Fun fact its absent in 20% of people.
Where are the important places where the ribs articulate with the sternum?
2nd rib at angle of Louis/manubriosternal joint. 7th rib at xiphisternal joint.
What is the venous drainage to the diaphragm?
Thoracic surface: pericardiacophrenic, musculophrenic (to internal thoracic), superior phrenic (to IVC or azygos). Abdominal surface: inferior phrenic (right to IVC, left anteriorly to IVC, posteriorly to left renal vein).
What are the vestibular glands of the genitals?
Greater/Bartholin’s is in the superficial perianal pounch on either side of the vestibule of vagina, and they secrete mucus in arousal. Lesser/Shene’s are paraurethral glands on either side of vestibulr of vagina, open into vestibule near urethra and secrete mucus to moisten labia and vestibule.
Where are the jejunum and ileum located?
Proximal 2/5 LUQ, distal 3/5 RUQ.
Describe the venous and lymphatic drainage of the esophagus.
Left gastric vein (drains into portal venous system). Esophageal vein (drains into Azygos). The left gastric LNs drain into the celiac LNs.
What are the parts of the stomach?
Cardia (T1 when supine), fundus, body, pylorus (antrum at ~L1 and canal) with sphincter.
Where do the pancreatic ducts enter the duodenum?
Main via major duodenal papilla (joins common bile duct). Accessory via minor duodenal papilla. Common bile duct and main pancreatic duct each have a sphincter. The major duodenal papilla has a hepatopancreatic ampulla (of Vater) and a sphincter (of Oddi).
What determines heart dominance?
The origin of the posterior interventricular artery. Right dominance (RCA) ~70%.
What are the layers covering the testes?
Skin, Tunica Dartos, 3 spermatic layers, Tunica vaginalis (parietal and visceral), tunica albuginea.
What is the reflected inguinal ligament?
Superior fibers of the external oblique aponeurosis and lacunar ligament fans upwards crossing the libea alba instead of inserting into the pubic tubercle.
Descrine the broad ligament of the uterus.
2 peritoneal layers. It connects the lateral uterus to the lateral pelvic wall. Mesosalpinx (supports uterine tube), Mesovarium (attaches to ovary), Mesometrium (attaches to uterus).
What are the innervations to the heart?
Vagus (parasympathetic), Sympathetic (presynaptic T1-T4 and postsynaptic cervical and superior thoracic ganglia), Visceral afferent fibers (travel with sympathetic fibers).
List the anterior divisions of the internal iliac artery.
Obturator (20% from external iliac), Umbilical (gives off superior vesical_, Inferior vesical, Uterine, Vaginal, Internal pudendal, Inferior gluteal, Middle rectal.
What are the infraperitoneal organs?
They are only partly covered by parietal peritoneum. The distal 2/3 of the rectum, urinary bladder.
What is the insertion of rectus abdominis?
Costal cartilages 5-7.
What is the origin of psoas major?
Transverse process of lumbar vertebrae, sides of T12-L5 bodies and IV discs,
What are the boundaries of the inguinal canal?
Anterior wall - External oblique aponeurosis. Posterior wall - Transversalis fascia. Floor - Inguinal ligament. Roof - Conjoint tendon.
What is the inguinal ligament of Poupart?
Fibrous, thickcned, folded margin of external oblique aponeurosis spanning from the ASIS to the pubic tubercle.
What is the deep venous drainage to the abdominal wall and what do they drain into?
Superior epigastric (into internal thoracic). Inferior epigastric (into external thoracic). Paraumbilical (into hepatic portal vein - communicates with periumbilical).
What is the thoracic duct?
The largest lymphatic channel in the body. originates from chyle cistern at L2 level - ascends to right of T5-L2 and thoracic aorta, left of azygous vein, posterior to esophagus, crosses to left at sternal angle, empties at left venous angle (union of left internal jugular and subclavian vein). It drains everything except the right upper quadrant (right lymphatic duct - right venous angle).
What are the arteries of the penis?
Dosral, perianal, artery of bulb, deep arteries that supply corona cavernosa (have Helicine branches).
What is the sympathetic, parasympathetic innervation, general venous and lymphatic drainage to the midgut?
T9-T12 splanchnic nerves and superior mesenteric ganglion, Vagus nerve, SMV, SM LNs.
Describe the intercostal veins.
11 posteriorly on each side. 1st drains (usually) into BCV. 2-3rd form superior intercostal trunk, which branches into the azygous to the right and the BCV to the left. 4-11th drain into the azygous/hemiazygous system, which goes into the SVC. The anterior intercostal veins drain into the internal thoracic vein. The anterior and posterior intercostal veins anastomose as they approach the vertebral column.
Where do you auscultate the inferior lobe of the lung?
Anteriorly in the 6/7th intercostal space Posteriorly in the triangle of auscultation (trapezius, latissimus dorsi, medial border of scapula)
Describe the right vagus nerve.
Enters anterior to the right subclavian artery, travels between right BCV and trachea, posterior to right hilum. Gives off right recurrent laryngeal branch - hooks under subclavian artery and ascends between trachea and esophagus.
What is the innervation of the external obliques?
Anterior rami of T7-T12.
What are the renal blood supply segments?
Apical, anterosuperior, anterioinferior, posterior, inferior.
What are the structures in the posterior mediastinum?
Descending aorta Azygous (and hemiazygous and accessory hemiazygous veins) Thoracic duct Esophagus Sympathetic trunk/splanchnic nerves Intercostal arteries Vagus nerve plexus and trunks (DATES IV)
Describe the renal medulla.
Has columns and calyces. 2-3 minor calyces drain into a major one, 2-3 major calyces drain into the renal pelvis. The apex of the renal pyramid is a renal papilla - indents each minor calyx.
Where does the inferior epigastric artery branch from? What does it anastomose with?
The external iliac artery. The superior epigastrics.
What are the typical ribs and what do they have?
3-9. Head, neck, shaft, costal angle, transverse tubercle, articular facet, costal groove.
Describe the urogenital triangle.
From the ischiopubic rami to prepuce of the clitoris. Skin, superficial perineal fascia, deep perineal / Colles fascia, superficial perineal pounch, perineal membrane, deep perineal pouch.
What is the transverse sinus of the pericardium?
Passage between the ascending aorta and the pulmonary trunk. A ligature is passed through this to clamp ascending aorta and pulmonary trunk during surgery.
Describe the structure of the liver.
Largest gland, major lymph producing organ, 9 functional lobes based on blood supply. Right and left lobes divided by falciform ligament (round ligament inferiorly). Interiorly and anteriorly there is the quadrate lobe, posteriorly the caudate lobe. There is the coronary ligament with the triangular ligaments laterally. The visceral surface has the ligamentum venosum. Inferiorly is the porta hepatis. The bare area is not covered by visceral peritoneum.
What spaces are made by the folding of the peritoneum in the female pelvic cavity?
Vesociuterine and retrouterine spaces.
What is the venous drainage of the stomach and where do the veins go?
Prepyloric veins -> right gastric veins Gastric veins -> hepatic portal vein Left gastro-omental and short gastric veins -> splenic vein Right gastro-omental veins -> SMV
What are the anterolateral abdominal wall muscles?
External and internal obliques, transversus abdominis.
What are cervical ribs?
0.5-2% of the population, can be uni or bilateral. They are associated in thoracic outlet syndrome - compression of neurovascular structures exiting/entering the superior thoracic aperture.
Describe the rectus sheath.
The aponeuroses of the anterolateral abdominal muscles. It contains the rectus abdominis muscles, superior and inferior epigastric vessels, T7-T12 anterior rami.
Where does spleen lymphatic drainage go?
To the celiac LNs.
Describe the external intercostal muscles.
“Hands in pockets” orientation. Exist posteriorly, then the membrane comes. Go from rib tubercles to the costochondral junction
Describe rib dislocation vs rib separation.
Dislocation is at the sternocostal joint or between the interchondral joints. Separation is at the costochondral joints and can displace superiorly and overlie rib above.
Describe pulmonary circulation - the pulmonary veins and arteries.
Pulmonary arteries turn into lobar arteries which turn into tertiary segmental arteries (and segmental branches) which supply a single bronchopulmonary segment. 2 pulmonary veins drain into a single lung, run independent of arteries and bronchi. They are intersegmental.
What is the anatomical location and auscultation site of the pulmonic valve?
Medial left 3rd costal cartilage. Auscultation site: Left parasternal 2nd intercostal space.
What is the sympathetic innervation to the liver?
The hepatic nerve plexus (part of the celiac plexus).
What is the innervation of the transversus abdominis?
Anterior rami of T6-L1.
What section of the mediastinum is the heart in?
The middle.
What is the action of the internal obliques?
Bilaterally - flexion of the trunk and compression of viscera. Unilaterally - Lateral flexion and ipsilateral trunk rotation.
What muscle aponeuroses are anterior to the rectus sheath above the arcuate line?
External oblique and 1/2 of internal oblique.
What is the fundus of the bladder?
The posterior surface.
Describe the paths of the phrenic nerves.
Anterior to the lung roots. Right descends along right side of SVC/IVC and pierces diaphragm near caval opening. Left descends lateral to left subclavian artery, course superficial to left atrium and ventricle, pierces diaphragm to left of pericardium.
Describe the thoracic aorta and its branches.
Begins left of T4 and descends posterior to esophagus. The most inferior part is dead center, esophagus displaced left. Anterior unpaired branches - to gut, pericardial, mediastinal Lateral paired branches - to viscera other than guts Posterolateral paired branches - 3-11th posterior intercostal arteries, subcostal arteries (1 each side) that supplies diaphragm
What are the ligaments connected to the ovary?
Mesovarium (attaches to lateral pelvic wall, part of broad ligament), Suspensory ligament (to lateral pelvic wall), Ovarian ligament (to the uterus).
Describe the pelvic diaphragm/floor.
Made up of the coccygeus and levator ani (puborectalis, pubococcygeal, iliococcygeus). Contains the pudendal nerve.
Describe the endopelvic fascia.
CT condensations that passively support the uterus. Uterosacral ligament (cervix to sacrum), Transerse Cervical / Cardinal ligament (cervix to lateral wall of pelvis), Pubocervical ligament (pubis to cervix).
What makes up the superior and inferior/diaphragmatic borders of the heart?
Superior: atria and auricles Inferior: RV (mainly) and LV
What are the anastomoses between the SMA and IMA?
The middle colic and left colic arteries. Form the marginal artery of Drummond.
What does the internal pudendal artery supply?
The main supply to the perineum, perianal muscles, external genitalia, erectile tissues.
Describe the thoracolumbar fascia.
Covers deep back muscles. Posterior sheath is thick, lumbar part of posterior sheath extends between the 12th rib and the iliac crest and attaches laterally to the internal obliques and transversus abdominis. Includes quadratus lumborum and psoas fascia.
Describe the internal intercostal muscles.
Anterior and then a membrane. Go from sternum to angle of ribs. The neurovascular bundle is deep to them.
What are the peritoneal recesses?
Paracolic gutters, subphrenic recess, subhepatic space, hepatorenal recess.
Describe the ilohypogastric nerve.
L1. Innervates abdominal muscles and skin of inguinal and pubic region.
What does rib 1 have that typical ribs do not?
A groove for the scalene tubercle and subclavian vessels. It also only has a single facet.
What is the insertion of the transversus abdominis?
Pubis via conjoint tendon, linea alba.
What innervates the suprarenal glands, kidneys, and ureters?
Suprarenal glands by the celiac plexus (no parasymp.), Kidneys by the renal plexus and the vagus nerve. Ureters by the renal, abdominal aortic, and superior/inferior hypogastric plexi. They also have pain/GVA axons that follow the sympathetic fibers to T11-L2.
What are the three parts of the muscular part of the diaphragm?
Sternal (2 muscular slips from xiphoid process), Costal (forms domes, interdigitates with transversus abdominis), Lumbar (arises from medial and lateral arcuate ligaments, forms right and left crura - right is bigger).
Describe the cysterna chyli.
Anterior to L2, marks beginning of the thoracic duct. Intestinal trunk - GI tract, liver, spleen, pancreas. Lumbar trunks - posterior abdominal wall, kidney, ureter, gonads, uterus, uterine tubes.
What is the innervation of the internal obliques?
Anterior rami of T6-L1.
Describe the aortic arch.
Begins and ends at level of sternal angle, arches over the left hilum superiorly and posterolaterally to the left, then descends inferiorly beside T4-T12 vertebrae (thoracic aorta). Branches are brachiocephalic trunk, left common carotid artery, left subclavian artery. Variations - can have retroesophageal right subclavian artery (no brachiocephalic trunk), esophagus compressed. Can also have double arch of the aorta/vascular ring anomaly. Can cause stridor and dysphagia.
What are the layers of the anterolateral abdominal wall?
Camper’s fascia, Scarpa’s fascia, 3 muscles, transversalis fascia, extraperitoneal fat, parietal peritoneum.
Where do you auscrultate the middle lobe of the right lung?
Anteriorly in the 4th intercostal space
What muscles make up continence?
Puborectalis forms a sling around the anorectal junction, Pubococcygeus compression.
Describe the posterior abdominal wall veins.
Tributaries of IVC, begins L5 where the common iliac veins meet. Tributaries correspond to the paired visceral and parietal branches of the aorta.
What is the insertion of the internal obliques?
Pubic via conjoint tendon, ribs 10-12, linea alba.
What are the peritoneal folds?
Medial umbilical, medial umbilical (x2), lateral umbilical (x2).
Where do the lineae semilunaris go from/to and what does it mark?
From costal cartilage to pubic tubercles. It marks the lateral border of the rectus sheath.
What does the superior vesical artery supply?
The superior bladder and vas deferens.
What is the arterial supply to the ureters?
Descending branches by renal and gonadal arteries. Ascending branches by internal iliac arteries.
What is the arterial supply and venous drainage of the testicles?
Testicular arteries (arise from aorta at L2), cremasteric arteries and artery of vas deferens exist. The right pampiniform plexus drains into the IVC, left into left renal vein.
Roughly what vertebral levels are the kidneys at?
Approximately T12-L3.
Describe the left coronary artery.
Gives off Anterior IV Artery/LAD (supplies RV, LV, anterior 2/3 of IV septum, apex, anastomoses with post. IV branch of RCA at apex, gives off diagonal branch). Gives off Circumflex artery (supplies LA, LV, anastomoses with RCA at coronary sulcus), which gives off Left Marginal artery (supplies LV, anastomoses at IV branches).
What is the lymphatic drainage of the liver?
Superficial (associated with bare area) goes to the phrenic or posterior mediastinal LNs. Deep (associated with porta hepatis) go to hepatic or celiac LNs.
What is the insertion of psoas major?
Lesser trochanter of femur.
Where is pain referred to in the gallbladder?
The right shoulder - the gallbladder also gets GSA fibers of the right phrenic nerve.
Describe the path of the 3rd part of the duodenum.
Transverse/inferior/horizontal part. It crosses ~L3 posteriorly under SMA and anteriorly over IVC. It’s the longest part of the duodenum.
What does the azygous vein drain?
Back, mediastinal, viscera, thoracoabdominal wall.
Where is the prostate?
At the neck of the bladder, where the IUS is.
What are the true, false, floating ribs?
True (1-7): vertebrosternal. False (8-10): vertebrochondral Floating (11-12): vertebral (terminate in posterior abdominal muscles).
Can the visceral pleura feel pain?
No
What is the innervation of psoas major?
Anterior rami of L1-L5.
Describe the femoral nerve.
L2-L4. Emerges from lateal border of psoas major. Innervates iliacus and anterior thigh.
What does the small cardiac vein run with?
The right marginal artery.
What is mesentery?
Connects organs to the posterior abdominal wall, double layer of parietal peritoneum.
Which kidney is lower?
The right kidney - left is also slightly under rib 11 and they’re both under 12.
Describe the left vagus nerve.
Enters between the left common carotid and left subclavian artery, descends along left side of aortic arch - courses posterior to left hilum. Gives off left recurrent laryngeal branch - loops under aortic arch (lies posterior to ligamentum arteriosum), ascends between trachea and esophagus.
What are thoracoabdominal nerves?
When spinal nerves pass the costal cartilage they change their names. T7-L1 do this. T12 is subcostal under the 12th rib. L1 divides into the ilioinguinal and ilihypogastric.
What are the sites of ureter constriction?
The utereropelvic junction (L2), the utererovesical junction, and the point where it crosses anteriorly over the external iliac artery at the pelvic brim/inlet.
What is the origin of rectus abdominis?
Pubis.
What is tie insertion of iliacus?
Lesser trochanter of femur, major tendon of psoas.
Where is the arch of the azygous vein? How can it be compressed?
Loops superiorly over the right lung hilum before opening into the SVC. Can be compressed by enlarged right superior tracheobronchial or hilar nodes, or by tracheal or right lung tumours.
Where is the deep ring of the inguinal canal?
An opening in the posterior wall lateral to the inferior epigastric vessels.
What does the SVC drain?
All structures superior to the diaphragm except the heart.
At what level is the horizontal fissure of the right lung?
Along the 4th rib and costal cartilage
Describe the pericardium.
Fibrous (tough, hard, attached to central tendon of diaphragm and sternum), serous parietal layer, serous visceral layer/epicardium. In between serous layers there is a pericardial cavity with fluid secreted by the serous mesothelium. Has transverse sinus and oblique sinus. Supplied by pericardiocophrenic arteries (run with phrenic nerves), and innervated by vagus nerces and sympathetic trunk.
What does the iliolumbar artery supply?
The posterior abdominal and pelvic wall.
What are the branches of the pudendal nerve?`
Dorsal nerve of penis/clitoris, inferior rectal nerve (sensory to anal triangle, motor to lower 1/3 of anal canal), perineal nerve (sensory to posterior labia/scrotum, motor to perineal pouch contents).
What organs comprise the foregut?
Distal esophagus, stomach, spleen, pancreas, liver, gallbladder, 1st and 2nd part of duodenum.
Describe the brachiocephalic veins.
Right is short and runs vertically, left runs diagonally and overlies the three branches of the aortic arch. They join into the SVC posterior to the sternoclaviicular joint at the 1st right costal cartilage.
What is Hesselbach’s triangle?
A weak area in the posterior inguinal canal between the medial and lateral peritoneal folds. Medial border - lateral wall of rectus abdominis Lateral border - inferior epigastric vessels Inferior border - inguinal ligament
What does the round ligament of the uterus do?
Holds the fundus forward. Goes through the inguinal canal, inserts into the subcutaneous labia majora.
Where does the superior epigastric artery branch from? What does it anastomose with?
Internal thoracic artery. The inferior epigastrics.
What is the action of the external obliques?
Bilaterally - flexion of the trunk and compression of viscera. Unilaterally - Lateral flexion and contralateral trunk rotation?
How is the bladder attached to the umbilicus?
The apex is attached by the median umbilical ligament (urachus remnant).
What do the renal arteries branch into? What do the veins drain into?
The segmental arteries, then the interlobar arteries, then the arcuate arteries. The arcuate veins drain into the interlobar veins then into the segmental veins then the renal veins then the IVC.
Describe the right atrium.
Gets deoxygenated blood from the SVC, IVC, coronary sinus, anterior cardiac veins. Has smooth segment (sinus venarum), rough segment (pectinate muscle), crista terminalis, fossa ovalis, auricle (space for increased blood flow).
Describe the left ventricle.
Rough segment (trabeculae carnae), smooth segment (aortic vestibule), mitral/bicuspid valve (chordae tendinae, anterior and posterior papillary valves), a thicker wall.
What is the sympathetic, parasympathetic innervation, general venous and lymphatic drainage to the foregut?
T5-T9 spanchnic nerves and celiac plexus, Vagus nerve, Hepatic portal vein, Celiac LNs.
Where do the adrenal glands derive from embryologically?
Cortex from the mesoderm, medulla from the neural crest cells.
What does the uterine artery supply? Describe its course briefly.
Just in women, the uterus, fallopian tubes, ovaries, vagina. Ascends along the lateral border of hte uterus, anastomoses with ovarian artery at origin of tubes, crosses superiorly over the ureter.
What is the insertion of the pyramidalis?
Linea alba.
How much of continence is provided by the internal anal sphincter?
80%.
What is the most superior structure in the right hilum?
Eparterial bronchus.
Describe the greater omentum.
4 layered visceral peritoneal structure, connects transverse colon to greater curvature of the stomach. It can move within the peritoneal cavity, is the abdominal policeman.
Describe the right coronary artery.
Descends in interventricular groove. Supplies RA. Gives off SA nodal branch (supplies PT, SA node), Right marginal branch (supplies RN, apex, anastomoses at IV branches), Posterior Interventricular branch (supplies RV, LV, posterior 1/3 of IV septum. Anastomoses with LAD. Gives off AV node.)
