Head, Neck, Trunk slides 233 to 297 (end) Flashcards
Is a dome-shaped musculotendinous partition separating the thoracic and abdominal cavities
Diaphragm
Its mainly convex superior surface faces the thoracic cavity; its concave inferior surface faces the abdominal cavity
It is the chief muscle of inspiration, and _____ during inspiration
Descends
Diaphragm:
The sternal part consists of two muscle slips that attach to the ___ ___
Xiphoid Process
Diaphragm:
The costal part (costal attachment) consists of wide muscular slips that attach to internal surfaces of the inferior __(#) costal cartilages
Six
Diaphragm:
The ____ are musculotendinous bundles arising from the superior three lumbar vertebrae
Crura
Diaphragm:
The central tendon is the convergence of tendon fibers into an _____
Aponeurosis
The terminal part of the inferior ____ ____ perforates the central tendon at the caval foramen (caval opening) to enter the heart
Vena Cava
The esophageal ___ and aortic ___ are passages for the esophagus and aorta, respectively
Hiatus
Paralysis of half of the diaphragm (one dome or hemidiaphragm) due to injury to its motor supply (___ Nerve) does not affect the other half, since each dome has a separate nerve supply
Phrenic Nerve
The paralyzed dome ____ during inspiration, instead of ____ as it normally would
Ascends
Descending
Term for when the paralyzed dome is pushed superiorly by the abdominal viscera which are compressed by the active contralateral dome
slide 242
Paradoxical Movement
The ____ is the central compartment of the thoracic cavity (between the two pulmonary cavities)
It extends. . .
Vertically from the superior thoracic aperture to the diaphragm
From the sternum and costal cartilages anteriorly to the bodies of the thoracic vertebrae posteriorly
Mediastinum
The superior mediastinum is basically the region behind the ____ of the sternum
Inferior mediastinum is inferior to this, and is further subdivided into anterior, middle, and posterior parts
Manubrium
Sup. Mediastinum planes: These make up the \_\_\_\_ plane: -Thyroid -Remnant of the thymus -Some lymph glands
Glandular Plane
Sup. Mediastinum planes: These make up the \_\_\_\_ plane: -Left brachiocephalic vein -Right brachiocephalic vein -Superior vena cava -Arch of azygos vein
Venous Plane
Sup. Mediastinum planes: These make up the \_\_\_\_ plane: Aortic arch and its branches: -Brachiocephalic artery -Left common carotid artery -Left subclavian artery
Arterial-nervous Plane
Sup. Mediastinum planes:
These make up the ____ plane:
-Vagus (left and right)
-Phrenic (left and right)
Nerves
Sup. Mediastinum planes: These make up the \_\_\_\_ plane: -Trachea -Esophagus -Left recurrent laryngeal nerve
Visceral-Nervous Plane
Branch of vagus
Innervates larynx, muscles of pharynx, and is sensory for bronchial tree below the vocal cords
Recurrent because it branches from vagus, then progresses inferiorly, but then loops back superiorly
Left Recurrent Laryngeal Nerve
Sup. Mediastinum planes:
These make up the ____ plane:
-Thoracic duct
Lymphatic Plane
Main duct for return of lymph to blood
Terminates at junction of left subclavian and jugular veins
Thoracic Duct
This is the “blue side” of the mediastinum.
It is dominated by the arch of the azygos vein, the superior vena cava, and the right atrium
Inferior Mediastium (Right Side)
This is the “red side” of the mediastinum
It is dominated by the arch of the aorta, the left common carotid artery, and the subclavian arteries
Inferior Mediastinum (Left Side)
The anterior mediastinum contains connective tissue and fat, a few blood vessels, a few lymph nodes, and sometimes the lower end of the ____ (or what used to be the ____ in adults)
Thymus
The heart and its pericardium make up the contents of the ____ mediastinum
Middle
These are in the \_\_\_\_ mediastinum: Thoracic aorta Thoracic duct Lymph nodes Azygos and hemiazygos veins Esophagus Esophageal plexus Thoracic sympathetic trunks Thoracic splanchnic nerves
Posterior
Most of the intestine is covered by the ___ ___, which is an apronlike peritoneal fold hanging from the stomach
Greater Omentum
There are five bilaterally paired muscles in the anterolateral abdominal wall:
3 flat
2 vertical
The flat muscles have an anterior and medial aponeuroses which collectively form a rectus sheath, which contains the vertical muscles
slide 261
Three flat muscles:
- external oblique
- internal oblique
- transverse abdominal
Two vertical muscles
- rectus abdominis
- pyramidalis
All three abdominal muscle layers compress and support the abdominal viscera. One of the consequences of this action is that they act as _____ of the diaphragm to produce expiration.
Additionally the obliques – external and internal obliques – flex and rotate the trunk
slide 262
Antagonists
There are two vertical muscles of the anterolateral abdominal wall: the rectus abdominis and the ____.
Pyramidalis
The rectus abdominis is the principal vertical muscle of the anterior abdominal wall consisting of a pair of muscles separated by the ___ ___.
Linea Alba
It is a long, broad straplike muscle that originates at the pubis and inserts on the xiphoid process and 5th to 7th costal cartilages, It flexes the trunk, compresses the viscera, and acts as an antagonist of the diaphragm to produce expiration
Rectus Abdominis
The ____ is a small triangular muscle that is absent in about 20% of people. It is anterior to the inferior part of the rectus abdominis, and attaches to the anterior surface of the pubis and ends in the linea alba.
It tenses the linea alba.
Pyramidalis
The ___ ___ consists of fused or interlaced aponeuroses of the three flat muscles of the anterolateral abdominal wall, which form a fibrous compartment around the rectus abdominis and pyramidalis muscles.
slide 266
Rectus Sheath
The ___ ___ is a fibrous band running vertically the length of the anterior abdominal wall. It receives the attachments of the oblique and transverse abdominal muscles. It also contains small blood vessels and nerves that go to the skin
Linea Alba
Most fibers of the ___ ___ muscle run inferomedially—in the same direction as the fingers do when the hands are in one’s side pockets
External Oblique
The ___ ___ iliac spine (of the ilium) is an easily palpable landmark
Anterior Superior
The inferior margin of the aponeurosis of the external oblique folds under and back on itself to form the ___ ___.
It is a fibrous band extending between the anterior superior iliac spine and the pubic tubercle (of pubic bone).
Inguinal Ligament
The superior epigastric artery is a continuation of the ___ ___ ___. It enters the rectus sheath, and provides arterial blood to the rectus abdominis and superior part of the anterolateral abdominal wall.
Internal Thoracic Artery
The inferior epigastric artery arises from the ___ ___ and runs superiorly to enter the rectus sheath. It supplies the lower part of the rectus abdominis.
External Iliac
_____ between the superior and inferior epigastric arteries is approximately in the umbilical region
Anastomisis
Anterior cutaneous arterial branches derive from the superior and inferior epigastric arteries.
The inferior epigastric artery is a branch of the external iliac artery
Slide 271
Most superficial lymphatic vessels superior to the umbilicus drain to the axillary lymph nodes, although a few drain to the ____ lymph nodes.
Parasternal
Superficial lymphatic vessels inferior to the umbilicus drain to the superficial ___ lymph nodes.
Inguinal
The abdominal aorta is a continuation of the thoracic aorta
It begins at the aortic hiatus in the diaphragm
It ends about the level of the ____ lumbar vertebra, where it divides into right and left common iliac arteries
Fourth
Abdominal aorta gives off which two branches:
Visceral Branches
Parietal Branches
Abdominal Aorta Distribution:
See slide 278!
The celiac trunk divides into three branches: left gastric, ___, and common hepatic arteries.
Splenic
The left gastric branch supplies the stomach and ____
Esophagus
Splenic has branches that supply the spleen, pancreas, greater omentum, and ____
Stomach
Common hepatic has branches that supply the____, gallbladder, stomach, duodenum, pancreas, and greater omentum
Liver
The superior mesenteric artery has branches that supply the pancreas, duodenum, jejunum, ileum, ____ and ___ colon
Ascending and Transverse
The inferior mesenteric artery has branches that supply the transverse colon, descending colon, sigmoid colon, and ___.
Rectum
Blood from the gastrointestinal tract, spleen, pancreas, and gallbladder enters into a common vein, the ___ ___ vein, which delivers the blood to the liver
Hepatic Portal
What are the two portal systems in the body:
Hepatic portal system
Hypophyseal portal system.
A ___ system is formed when one venous capillary system coalesces and then branches out to form another capillary system without the heart being between them.
Portal
Capillaries of the intestines coalesce to form the inferior and superior mesenteric veins, then come together (with the ___ ___) to form the hepatic portal vein.
It then goes to the liver and forms sinusoidal capillaries (no heart between capillary systems).
Splenic Vein
Capillaries of the intestines coalesce to form the inferior and superior mesenteric veins, then come together (with the splenic vein) to form the hepatic portal vein.
It then goes to the liver and forms ___ capillaries (no heart between capillary systems).
Sinusoidal
After passing through the liver for processing, blood drains into the hepatic veins which empty into the ___ ___ ___.
Inferior Vena Cava
The portal venous system is not limited to spanning the interval between the intestines and the liver. It connects with the systemic venous system (conventional system of veins) at a number of locations: between esophageal veins that drain into the ___ vein, rectal veins, and paraumbilical veins of the anterior abdominal wall.
Azygos vein
Esophageal varices are extremely dilated sub-mucosal veins in the (upper/middle/lower)? third of the esophagus, most commonly consequence of portal hypertension. These veins have a strong tendency for bleeding.
Lower 1/3rd
Most of the blood from the esophagus is drained by esophageal veins which enter the azygos vein, then to the superior vena cava. These veins have no part in esophageal varices.
slide 292
Varices in the rectal area are termed ____
Hemorrhoids
Scarring and fibrosis from cirrhosis obstruct the portal vein in the liver, causing pressure in the portal vein to rise.
In severe cases of portal obstruction, the paraumbilical veins become varicose and look somewhat like small snakes radiating under the skin around the umbilicus. This is referred to as ___ ___ due to its resemblance to the serpents on the head of Medusa in Greek mythology.
Caput Medusae
Caput medusae is caused by the umbilical vein becoming recanalised due to portal ____.
Hypertension
Esophageal varices result when submucosal veins in the esophagus become ____.
Because such varices are easily eroded leading to massive gastrointestinal hemorrhage, they are a serious problem produced by portal hypertension
Dilated
