Heart/Mediastinum & Abdomen Flashcards
1
Q
__ (fraction) of the heart is situated to the right of the midline, and ___ (fraction) is to the left of the midline. Knowing that, we can say that the heart does NOT sit in the ___ plane.
A
1/3 of heart is to RIGHT of midline, 2/3 is to LEFT of midline. Heart does NOT sit in MEDIAN plane.
2
Q
Superiorly to inferiorly, the heart extends from the level of ___ to ____.
A
From level of STERNAL ANGLE to 5th INTERCOSTAL SPACE
3
Q
At the sternal angle, the heart extends __ inches lateral to the lateral border of the sternum.
A
1/2 inch lateral to lateral border of sternum at sternal angle
4
Q
On the left side, the heart protrudes out. In the 5th intercostal space, the ___ of the heart extends __ inches to the left of the sternum.
A
At the 5th intercostal space, the APEX of the heart extends 3.5 INCHES to the left of the sternum
5
Q
From an anterior in situ view, what parts of the heart can we see?
A
Right atrium, right auricle, right ventricle
Part of left ventricle, left auricle
6
Q
Describe the borders of the heart (chambers, not where it is situated in situ)
A
Right: Right atrium (mostly)
Inferior: Right ventricle, part of left ventricle
Left: Left ventricle and auricle
7
Q
The base of the heart faces __ [ant/post/med/lat]. It consists mostly of which chamber? We also see small portions of what other chambers? What exits from the base of the heart?
A
Base of heart faces POSTERIORLY. Consists mostly of LEFT ATRIUM, with small portions of RIGHT ATRIUM and RIGHT VENTRICLE. 4 PULMONARY VEINS emerge from base of heart
8
Q
The inferior surface of the heart is AKA the ____ surface. It sits on ___, and consists mostly of ___ and a small part of ___.
A
Inferior surface = DIAPHRAGMATIC surface. Sits mostly on DIAPHRAGM. Mostly LEFT VENTRICLE and small part of RIGHT VENTRICLE
9
Q
What are sulci? Describe the 3 sulci of the heart. What do they separate? Where do they run? What, if anything, is in it?
A
Sulci = grooves in heart where blood vessels run.
Coronary Sulcus (atrioventricular sulcus) = separates atria from ventricles, separates base of heart from diaphragmatic surface. Runs around the top of ventricles, putting boundary of atria above and ventricles below
Anterior Interventricular (longitudinal) sulcus = separates R from L ventricle
Posterior Interventricular (Longitudinal) Sulcus = on posterior side
10
Q
There are __ (#) coronary arteries: [list name(s)]. They come off of the ____.
A
2 coronary arteries: RIGHT coronary artery and LEFT coronary artery. They come off of the ascending aorta from the right and left aortic sinuses, respectively.
11
Q
The right coronary artery comes from the ____. It runs in the ___ between the ___ and ___. It gives off the ___ branch, which supplies the sinoatrial node via the ___ branch. As the RCA reaches the ___ of the heart, it gives off the marginal branch. The RCA continues to the back side of the heart where it gives off the __ in the ___. A smaller branch continues along to the [right/left] side.
A
The right coronary artery comes from the RIGHT AORTIC SINUS. It runs in the CORONARY SULCUS between the RIGHT ATRIUM and RIGHT VENTRICLE. It gives off the RIGHT ATRIAL branch, which supplies the sinoatrial node via the NODAL branch. As the RCA reaches the ACUTE MARGIN of the heart, it gives off the marginal branch. The RCA continues to the back side of the heart where it gives off the POSTERIOR DESCENDING (INTERVENTRICULAR) BRANCH in the POSTERIOR INTERVENTRICULAR GROOVE. A smaller branch continues along to the LEFT side.
12
Q
The right coronary artery supplies…
A
(1) Right atrium
(2) Right ventricle (most of it)
(3) S-A and A-V notes and interarterial septum (conducting system in R atrium)
(4) Posterior part of left ventricle
13
Q
The left coronary artery comes from the ____. It divides __ [how soon?] into two branches: __ & ___.
A
The left coronary artery comes from the LEFT AORTIC SINUS. It divides ALMOST IMMEDIATELY (~1/2”) into two branches: LEFT ANTERIOR DESCENDING (INTERVENTRICULAR) A. & LEFT CIRCUMFLEX BRANCH.
14
Q
The left anterior descending (interventricular) a. comes from the __ and runs in the __ and is the main supplier of the ____. It’s AKA ____.
A
Comes from the L CORONARY A., and runs in the INTERVENTRICULAR GROOVE, aka WIDOWMAKER (frequently blocked and bypassed)
15
Q
The left circumflex branch of the ___ runs in the ___ on the [left/right]. It ends and then throws off branches to the ___.
A
L circumflex branch of L CORONARY A. runs in the CORONARY SULCUS on LEFT. It ends and throws off branches to L VENTRICLE
16
Q
The left coronary artery supplies…
A
(1) L Atrium, (2) most of L Ventricle, (3) A-V bundle in interventricular septum (deep in heart)
17
Q
In general, the cardiac veins mostly parallel ___. They empty into the ___ (in the ___), which empties into the __.
A
Mostly parallel arteries. They empty into CORONARY SINUS in CORONARY SULCUS. Most of the blood gets collected here. THEN it empties into the R ATRIUM
18
Q
Right atrium receives venous blood from…
A
(1) Superior vena cava, (2) Inferior vena cava, (3) Coronary sinus
19
Q
The posterior wall of the R Atrium is [rough/smooth] between the SVC and IVC.
A
Posterior wall between SVC and IVC is SMOOTH
20
Q
Within the R Atrium on the interatrial septum, the impression is called __. Explain what this is.
A
Impression = fossa ovalis (remnant of foramen ovale). During development, there is a connection between 2 atria. The opening is called the foramen ovale, designed to get blood from the left side of the heart (along with ductus arteriosus) and to keep blood from getting to lung. This foramen closes with the first breath, leaving behind the fossa ovalis.
21
Q
What is the clinical relevance of the orientation of the SVC to the IVC?
A
In a bedridden patient (acute care), an umbrella-shaped filter may be put into IVC to catch any blood clots from lower limbs and prevent embolisms. To remove the filter, they take advantage of the fact that IVC and SVC are in a straight line!
22
Q
Describe the walls of the left atrium
A
Posterior wall = smooth, pulmonary veins enter here
Anterior wall = pectinate muscles
23
Q
Compare the muscle thickness in the right vs. left ventricles
A
Right ventricle is ~1/3 as thick as left ventricle
24
Q
Describe the features of the right ventricle (including muscles, valves, etc.)
A
3 Papillary muscles (ant. is largest) protruding from tribeculae carnae.
Chordae tendinae run between papillary muscles and valve leaflets
Moderator band - muscle connects interventricular septum to anterior papillary muscle. Moderator band is a branch of the right conduction bundle branch. It sends impulse directly to the arch
Tricuspid valve between the right atrium and right ventricle.
Pulmonary valve - at exit of pulmonary trunk, 3 semilunar cusps
25
Describe trabeculae carnae, papillary muscles, and chordae tendinae and their relationship.
Tribeculae carnae: Rough ridges of muscle found in both ventricles. They give rise to papillary muscles, which are 3 nipple-like protrusions of the trabeculae carnae (in RV) and 2 papillary muscles in the LV. The chordae tendonae are tendons that run between papillary muscles and valve leaflets.
26
Describe the features of the Left Ventricle
Muscle is thicker than in the right.
2 papillary muscles come off of trabeculae carnae, from which chordae tendonae run to AV valve (bicuspid, mitral valve) between atrium and ventricle. No obvious moderator band is present. The aortic valve features 3 semilunar cusps.
27
Why are the muscles in one ventricle thicker than the other?
In diastole, the atria contract, push blood into ventricles (bottom # of BP; low pressure) [atria = low pressure, thinner walls]
The ventricles then contract to push blood to right side (pulmonary to lungs, and out to body) so they must have stronger, thicker walls to maintain that higher pressure contraction
28
What's the purpose of the chordae tendonae?
Without chordae tendonae, the valve leaflets would invert and blood would gush back into atriums (rather than going out pulmonary trunks or into aorta); SO with these muscles, the blood goes into ventricle and when it contracts, the pectinate muscles also contract and hold the valve leaflets down; the blood pushes against them, but b/c of the pectinate muscle contraction, the leaflets stay down (closed) and the blood doesn’t regurgitate; IF the valves flip up and it fails, you hear a swooshing sound and you get prolapse (valve inverts), so then the ventricles have to work harder to get blood to lungs and aorta!
29
__ forms the skeleton of the heart and acts to do what? It surrounds ____ and separates __ from ___, except at ___.
Fibrous connective tissue acts to LIMIT SPREAD OF IMPULSES. It surrounds the valves and separates the atrium from the ventricle EXCEPT at the A-V bundle
30
Conducting tissue of the heart is modified muscle tissue called __.
Purkinje cells
31
Describe the conducting tissue of the heart: __ is the pacemaker of the heart. The impulse spreads over the ___ and arrives at the ___ node. The impulse is then sent down the __(A)_, which runs in the ___. The __(A)__ branches into right and left bundle branches.
SINO-ATRIAL (SA) NODE is the pacemaker of the heart. The impulse spreads over the ATRIA and arrives at the ATRIO-VENTRICULAR (A-V) node. The impulse is then sent down the ATRIO-VENTRICULAR BUNDLE (A-V BUNDLE/ BUNDLE OF HIS), which runs in the INTERVENTRICULAR SEPTUM. The BUNDLE OF HIS branches into right and left bundle branches.
32
The ___ is a visceral serous layer of the pericardial sac.
EPICARDIUM
33
The ___ is cardiac muscle (contracting muscle).
MYOCARDIUM
34
The ___ is the inner layer of chambers, an endothelium. This layer becomes modified to form ___.
ENDOCARDIUM, modified to form the VALVES
35
There [is/is not] direct contact between blood and myocardium?
There is NO direct contact betwen blood and myocardium. Myocardium is ensheathed by epicardium and endocardium on each sides.
36
The coronary arteries fill during ___. This is when the cusps are filled with blood, [low/high] pressure. The coronary arteries do NOT fill during __, when the cusps are pressed against the wall, blocking the opening of the coronary arteries.
Coronary arteries fill during DIASTOLE not during SYSTOLE.
37
During systole, the ___ are open and against the wall of the ascending aorta, blocking the openings of the coronary tissues.
AORTIC VALVE LEAFLETS are open in systole, blocks openings of coronary tissues
38
During diastole, leaflets fill with blood from the ___, which drops back down at the end of systole
Leaflets fill with blood from ASCENDING AORTA
39
Blood that falls back down into the ascending aorta at the end of systole fills ____. This filling is [active/passive].
Blood that falls back into ascending aorta at the end of systole is the blood that fills the CORONARY ARTERIES. This means it is completely PASSIVE filling of the coronary arteries.
40
Name the subdivisions of the mediastinum
Superior, middle, anterior, posterior
41
Describe the boundaries of the superior mediastinum
(1) Thoracic aperature, (2) plane from angle of sternum to T4, (3) bodies of vertebrae T1-T4, (4) inner surface of manubrium, (5) pleural sac on either side
42
Describe the boundaries of the middle mediastinum
(1) Anterior portion of pericardial sac, (2) posterior portion of pericardial sac, (3) pleural sac on either side, (4) diaphragm, (5) sternal angle/T4 line
43
Describe the boundaries of the anterior mediastinum
(1) Anterior portion of pericardial sac, (2) Posterior surface of sternum, (3) Plane from angle of sternum to T4, (4) diaphragm, (5) pleural sac on either side
44
Describe the contents of the anterior mediastinum
Loose connective tissue, mediastinal branches of internal thoracic artery, lymph nodes, thymus may extend down into it
45
Describe the boundaries of the posterior mediastinum
(1) Vertebral bodies T4-T12, (2) Posterior portion of pericardial sac, (3) Pleural sacs on either side, (4) plane from angle of sternum to T4, (5) diaphragm (way down at bottom)
46
The middle mediastinum contains the pericardial sac and its contents, i.e. ___. It also contains the __ nerve and ___ vessels
Heart and roots of great vessels: ascending aorta, pulmonary trunk, superior vena cava, inferior vena cava (plus pulmonary veins and arteries). ALSO contains the phrenic nerve and pericardiacophrenic vessels.
47
Name the three layers of the pericardial sac
Outer to inner: Fibrous pericardium, Parietal serous pericardium, Visceral serous pericardium (epicardium)
48
The fibrous pericardium is the __ layer of the pericardial sac. It is in contact with the ___. The ___ nerve and __ vessels are located on either side, [ant./post.] to the root of the lung. This layer is penetrated by what vessels? Finally, the fibrous pericardium is fused to ___.
Fibrous pericardium is the OUTER layer of the pericardial sac and is in contact with the PLEURA. PHRENIC n. and PERICARDIACOPHRENIC vessels located on either side ANTERIOR to the root of the lung. Layer is penetrated by great vessels: aorta, pulmonary artery, pulmonary veins, superior and inferior vena cava. Fused to the central tendon of the diaprhagm
49
What does the term "serous" mean, e.g parietal serous pericardium?
Serous = epithelium that produces FLUID, thereby reducing friction
50
The parietal serous pericardium is the ___ lining of the pericardial sac. It's analogous to the __ pleura and reflects over the roots of the great vessels to form 2 sinuses: [name and give orientation/location]. While this is one continuous layer, once this layer is in contact with the heart, it becomes the __.
Parietal serous pericardium = INNER lining of sac. Analogous to the PARIETAL PLEURA. Forms 2 sinuses: OBLIQUE SINUS [between posterior wall of heart and pericardial sac], TRANSVERSE SINUS [between aorta and pulmonary trunk, in front of SVC and left atrium]. Once in contact with the heart, it becomes the VISCERAL SEROUS PERICARDIUM
51
The visceral serous pericardium is AKA the ___. It lines the surface of the heart and is continuous with the __.
Epicardium. Continuous with the parietal serous pericardium
52
The superior mediastinum contains A LOT! List the structures from ANTERIOR to POSTERIOR.
Origin of infrahyoids, Internal thoracic arteries, Thymus gland, Brachiocephalic veins (2), SVC, Left Phrenic N, Right Phrenic N, Arch of Aorta, Left Vagus N., L recurrent Laryngeal N., Right Vagus N., Trachea, Cardiac Plexuses, Esophagus, Thoracic Duct
53
The thymus gland generates ___. It tends to atrophy in adults, and appears as the ___ of __ (#) lobes.
Generates WHITE BLOOD CELLS. Atrophies in adults, and is the FATTY REMNANT of 2 LOBES
54
The brachiovephalic veins are formed by the junction of the __ and ___ veins. The left brachiocephalic vein runs [anterior/posterior] to the arch of the aorta.
Junction of the SUBCLAVIAN and INTERNAL JUGULAR VEINS. Left Brachiocephalic v. runs ANTERIOR to arch of aorta.
55
The superior vena cava is formed by ____ and located to the [right/left] of the aorta.
Formed by 2 BRACHIOCEPHALIC veins and it's located to the RIGHT of the aorta
56
The LEFT phrenic nerve runs [ant/post] to anterior scalene, [ant/post] to the left brachiocephalic vein and then [ant/post] to the arch of the aorta. Then, it runs through the middle mediastinum on the ___, [ant/post] to the root of the lung.
Left phrenic nerve runs ANTERIOR to anterior scalene, POSTERIOR to the L brachiocephalic vein, then ANTERIOR to the arch of aorta. Then it runs ANTERIOR to the root of the lung
57
The RIGHT phrenic nerve runs [ant/post] to the anterior scalene, deep to Right subclavian, and then runs [ant/post/next to] the right brachiocephalic vein. It runs [ant/post] to the Superior vena cava before it runs into the mediastinum along the ___ and [ant/post] to root of the lung.
Right phrenic n. = ANTERIOR to anterior scalene, deep to R subclavian, runs NEXT TO right brachiocephalic vein. Runs POSTERIOR to SVC. Runs along pericardial sac ANTERIOR to root of lung
58
What runs within [i.e. under the hook of] the aortic arch?
Right pulmonary artery and left bronchus
59
What are the branches off of the aortic arch?
BCS: Brachiocephalic trunk, Left Common Carotid, Left Subclavian
60
The ___ attaches to the inferior surface of the arch with the left pulmonary artery. It is the remnant of the ductus arteriosus
Ligamentum arteriosum
61
At the __ level in the posterior mediastinum, the aorta becomeos vertical, forming the __.
T4, forms descending aorta
62
The left vagus nerve descends along the ___, anterior to the ___. It gives off the ___ nerve which innervates the __. Then, it passes [ant/post] to the root of the lung to the posterior mediastinum. Finally, it goes to the esophagus where it forms the ___.
L Vagus Nerve: descends along LEFT COMMON CAROTID A. anterior to the ARCH OF THE AORTA. It gives off the RECURRENT LARYNGEAL NERVE which innervates the LARYNX. It passes POSTERIOR to the root of the lung. At esophagus, forms ESOPHAGEAL PLEXUS
63
The left recurrent laryngeal nerve is a branch of the __. It passes under the ___, [medial/lateral] to what other structure? It ascends between the __ and__ to the larynx.
Left recurrent laryngeal nerve is a branch of the LEFT VAGUS NERVE. Passes under the ARCH OF THE AORTA, LATERAL to the ligamentum arteriosum. It ascends between the ESOPHAGUS and TRACHEA to the larynx.
64
The right vagus nerve crosses the right bronchus [anteriorly/posteriorly] to go toward the esophagus. It passes [ant/post] to the root of the lung and enters the [ant/post/middle] mediastinum. Note that the right recurrent laryngeal nerve loops under __, [in/not in] the mediastinum.
R Vagus N. crosses right bronchus POSTERIORLY, and passes POSTERIOR to root of lung where it enters the POSTERIOR mediastinum. The right recurrent laryngeal nerve loops under the SUBCLAVIAN A., NOT IN the mediastinum
65
The trachea biforcates at the ___, spinal level __.
Lower border of superior mediastinum, T4
66
The cardiac plexuses consist of ___ nerves innervating the __. It has contributions from the ___ nerve (what branches?). It is [parasympathetic/sympathetic] and has a branch from each ___.
Autonomic nerves innervating heart. Has contributions from the VAGUS Nerve (UPPER AND LOWER CERVICAL CARDIAC branches and THORACIC CARDIAC branch). It is SYMPATHETIC with a branch from each CERVICAL SYMPATHETIC GANGLION
67
The esophagus runs [ant/post] to the trachea in the superior mediastinum. It passes through the __ in the diaphragm and continues into the posterior mediastinum.
Esophagus runs POSTERIOR to (behind) trachea in superior mediastinum. Passes through ESOPHAGEAL HIATUS in diaphragm
68
The thoracic duct empties at the junction between the ___ and ___ (in the __) on the [right/left]. It is viewed best in the [ant/post/middle/sup] mediastinum. It empties lymph from the ___.
Empties at junction between LEFT SUBVLAVIAN and LEFT JUGULAR veins (in the NECK) on the LEFT. Viewed best in POSTERIOR mediastinum. Empties lymph from lower limb, left, and upper extremity
69
What do we see in the posterior mediastinum?
Descending aorta, esophagus, vagus nerve, azygos venous system, thoracic duct, sympathetic chain and ganglia
70
The descending aorta starts at ___ and runs through __ (spinal levels. It runs [in front of/behind] the pericardial sac. It has branches to structures on the way including... Finally, it passes through the ___ to enter the abdomen.
Runs T4-T12. Branches to: BRONCHI, ESOPHAGUS, POSTERIOR INTERCOSTAL ARTERIES, DIAPHRAGM. Passes through AORTIC HIATUS to enter abdomen. This is its own opening!
71
Explain the embryological significance of the ligamentum arteriosum.
The ligamentum arteriosum was an OPEN vessel embryologically. When the right side of the heart pumped, the lungs produced back pressure on the heart (because the air system wasn't open), so this open vessel existed between the L pulmonary artery and the arch of the aorta. Most blood leaving the right ventricle was shunted back to the aorta and out to fetus's body, bypassing the lungs during development. At the first breath, the lungs fill with air, reducing the intralung pressure. The ligamentum arteriosum collapses and closes, turning into a ligament, and the pulmonary arteries open!
72
The esophagus is a ___ tube. It contracts in a coordinated way to move food bolus down toward stomach. It pierces the diaphragm through the ____. Sits most [ant/post] of all of these organs. The descending aorta is shifted to the [right/left] relative to the esophagus.
Esophagus = MUSCULAR tube. Pierces diaphragm through esophageal hiatus. Sits most POSTERIORLY of these organs. Descending aorta is shifted LEFT relative to esophagus.
73
In the posterior mediastinum, the vagus nerve branches and forms the ___. Then, __ (#) trunks reform (name them and tell which side they rotated from). Explain the developmental significance of this rotation and naming.
Branches and forms esophageal plexus. Then, 2 trunks reform: ANTERIOR (rotated from the LEFT) and POSTERIOR (rotated from the RIGHT). Naming comes from when stomach was developing external to fetal body: right trunk flips around to be posterior, left becomes anterior as stomach squishes to right side
74
The azygos venous system drains blood from ___. "Azygos" means ___. The azygos vein on the right is [larger/smaller]. On the left, the ___ [inf/sup] and ____ [inf/sup] run interconnected with each other and train by connecting veins into the azygos. The azygos extends up to spinal level __ and loops [over/under] root of lung and empties into __.
Azygos venous system drains blood from BODY WALL. Azygos means UNPAIRED. Vein on right is LARGER. On left, the HEMIAZYGOS (inferior) and ACCESSORY HEMIAZYGOS (superior) run interconnected. Azygos extends to T4 and loops OVER root of lung before emptying into SUPERIOR VENA CAVA
75
The thoracic duct ascends from the abdomen via the ___. It takes care of lymphatic drainage from ___. It ascends [ant/post] to the esophagus between the __ and___. It turns __ and __ before it enters the ___.
Acends from abdomen through AORTIC HIATUS. It drains lymph from BELOW DIAPHRAGM. Ascends POSTERIOR to esophagus between AZYGOS V. and AORTA. Turns LATERAL and ANTERIOR then enters the SUPERIOR MEDIASTINUM.
76
The sympathetic chain and ganglia are covered by ___ superiorly. It consists of ___ for each spinal nerve and and __ or __ (#) ganglia. It is responsible for the ___ response of the autonomic nervous system.
Covered by PLEURA superiorly. Consists of GREY AND WHITE COMMUNICANTES for each spinal nerve and 11 or 12 ganglia. "Fight or Flight" response of ANS.
77
In the sympathetic chain and ganglia, cell BODIES of neurons only exist between the spinal bodies of __ and __ of the spinal cord. The chain then acts as a highway for sympathetic neurons to exit the spinal cord and travel where they need to go!
Cell bodies exist between spinal bodies of T1 and L2
78
The splanchnic nerves are [preganglionic/postganglionic] [sympathetic/parasympathetic] fibers. There are __ (#) splanchnic nerves. Name them and describe their spinal level origins.
Preganglionic sympathetic fibers. 3 splanchnic nerves:
(1) Greater - T5- T9 to celiac ganglion
(2) Lesser - T10 and T11 to aortico-renal ganglion
(3) Lowest (or least) - last thoracic ganglion to renal ganglia
79
The pattern for splanchnic nerves is that the pass through the ___ [without synapsing/where they synapse] and then pierce the diaphragm to enter abdomen. There they synapse in ___ that are located near __. The postganglionic axons then travel from the blood vessels to the organs they are going to innervate.
The pattern for splanchnic nerves is that the pass through the SYMPATHETIC CHAIN GANGLIA WITHOUT synapsing and then pierce the diaphragm to enter abdomen. There they synapse in GANGLIA that are located near MAJOR BLOOD VESSELS. The postganglionic axons then travel from the blood vessels to the organs they are going to innervate.
80
The vagus nerve is all [sympathetic/parasympathetic]
Vagus = Parasympathetic
81
True or false: there is no parasympathetic innervation of the limbs (periphery).
TRUE: there is NO parasympathetic innervation of the limbs.
82
The abdominal cavity is lined by ___ creating the ___ cavity. This cavity is filled with __ which acts to ___.
Lined with PERITONEUM creating the PERITONEAL cavity. Fluid-filled, allows organs to move without pain/friction
83
Abdominal organs are suspended from the [ant/post] body wall by a portion of the peritoneum called ___. These organs that are suspended are referred to as "___;" organs that are fixed against the wall are called "___."
Abdominal organs are suspended from POSTERIOR body wall by the mesentary. Suspended organs = "PERITONEAL;" fixed against wall = "RETROPERITONEAL"
84
Name the parts of the visceral peritoneum.
Greater omentum, lesser omentum, mesentary, many other 'ligaments'
85
The Greater Omentum is a curtain of ___ that hangs from the ___ of the ___ [organ]. It also suspends the ___.
Curtain of MESENTARY that hangs from the GREATER CURVATURE of STOMACH. Suspends TRANSVERSE COLON
86
The lesser omentum runs between the ___ of the __ [organ] and the 1st part of the ___ and the ___. It divides the peritoneal cavity into the __ and __.
Lesser omentum runs between LESSER CURVATURE OF STOMACH and 1ST PART OF DUODENUM and LIVER. Divides peritoneal cavity into GREATER SAC and LESSER SAC
87
The ___ suspends the small intestine and other organs from the [ant/post] body wall. It is part of the __.
MESENTARY, suspends organs from POSTERIOR body wall; part of PERITONEUM
88
The esophagus pierces the ___ to the [left/right] of the midline opposite __ [vertebral level]. It is about __ inches long, with the last inch in the abdomen as it enters the __.
Esophagus pierces the DIAPHRAGM to the LEFT of the midline, opposite T10. It is ~12 inches long, last inch in abdomen as it enters STOMACH
89
List the parts of the stomach
Cardia, fundus, body, pylorus
90
The __ closes off the esophagus from the stomach
CARDIAC SPHINCTER
91
The __ closes off the stomach from the duodenum. This is [thin/thick] and consists of __ (#) interlacing layers of smooth muscle running in different directions.
PYLORIC SPHINCTER. Consists of 3 interlacing layers of smooth muscle
92
What attaches to the lesser curvature of the stomach? The greater curvature?
Lesser curvature: Lesser omentum attaches; Greater curvature: Greater omentum attaches
93
What is the function of the stomach?
Mechanical breakdown and digestion of food
94
The small intestine is about __ feet long and consists of 3 parts: _, _, _.
~20 feet long, parts include DUODENUM, JEJUNUM, and ILEUM
95
The duodenum is the [1st/2nd/3rd] part of the small intestine and is about __ inches long. It is __-shaped and curves around the ___ and it's [peritoneal/retroperitoneal]. It ends at the ___ and its function is ___.
Duodenum = 1st part of small intestine, ~12 inches long. C-shaped and curves around the HEAD OF THE PANCREAS. It is RETROPERITONEAL. Ends at the DUODENOJEJUNAL flexure and functions in DIGESTION and ABSORPTION of NUTRIENTS
96
The jujunum makes up the proximal __ [fraction] of the small intestine beyond the duodenum. It is suspended by the __ and functions to ___.
Makes up proximal 2/5 beyond duodenum. Suspended by MESENTARY and functions to DIGEST AND ABSORB NUTRIENTS
97
When comparing the jejunum and the ileum, the jejunum has:
(1) [more/less] numerous internal mucosal folds, (2) [thinner/thicker] walls, (3) [narrower/wider] diameter, (4) [More/fewer] arterial arcades, (5) [more/less] fat in mesentary
When comparing the jejunum and the ileum, the jejunum has:
(1) MORE numerous internal mucosal folds, (2) THICKER walls, (3) WIDER diameter, (4) FEWER arterial arcades, (5) LESS fat in mesentary than the ileum
98
The large intestine (AKA __) is about ___ [inches/feet/yards] long. It begins at the ___ and ends at the __. It functions to ___ .
Colon, 1.5 YARDS long. Begins at ILEOCECAL junction and ends at ANUS. Function: maintain fluid balance, reabsorption
99
List the parts of the large intestine in order.
(1) Cecum
(2) Appendix
(3) Ascending colon [ends at right colic (hepatic) flexure]
(4) Transverse colon [ends at left colic (splenic) flexure]
(5) Descending colon
(6) Sigmoid colon [S-shaped]
(7) Rectum
100
List the 3 significant gross features of the colon (large intestine).
(1) Teniae colon: 3 long bands of longitudinal smooth muscle
(2) Haustra: sacular enlargement
(3) Appendices epiploicae: tags of fat
101
The spleen is considered a ___ organ. It acts to ___. It has a {big/small] blood supply, and is supplied by the ___ artery and vein. It is located [ant/post] at the level of the __ (#) rib on the [right/left] behind the __ [other organ] and extends [forward/backward] to the ___ line. It is [retroperotineal/peritoneal].
Spleen = LYMPHOID organ. Filters blood. MASSIVE blood supply thanks to the huge SPLENIC artery and vein. Located POSTERIORLY at level of 10th rib on LEFT, behind STOMACH. Extends FORWARD to MIDAXILLARY line. PEROTINEAL (moveable, in mesentary)
102
The pancreas is a __-shaped organ that has 2 categories of functions: __ and __. It extends across the [ant/post] abdominal wall [in front of/behind] the stomach from the __ to the ___. The head of the pancreas is in the _____ of the ___.
J-shaped, EXOCRINE and ENDOCRINE functions. Extends across POSTERIOR abdominal wall BEHIND stomach from DUODENUM to SPLEEN. Head of pancreas is in the CURVE OF DUODENUM
103
What does exocrine mean? Describe the exocrine functions of the pancreas.
Exocrine = secretes into a DUCT. The pancreas secretes PANCREATIC JUICE into the DUODENUM. Juices aid in digestion.
104
What does endocrine mean? Describe the endocrine functions of the pancreas.
Endocrine = secretes into the BLOOD. Insulin is made by beta cells in the islets of Langerhans and then secreted to blood.
105
The __ is the largest gland in the body.
LIVER
106
Describe the functions of the liver.
(1) Produce bile, (2) store and filter blood, (3) Metabolize carbohydrates, fats, and proteins
107
The liver is located on the [right/left] side of the abdomen under the rib cage. It is in [direct/indirect] contact with the diaphragm. It has __(#) lobes. Name/describe them.
Liver = RIGHT side under rib cage. DIRECT contact with diaphragm.
2 lobes:
RIGHT (large, includes caudate [posterior] and quadrate lobes)
LEFT (smaller)
108
Describe the path of the excretory ducts leaving the liver.
(1) R & L heptatic ducts join and form COMMON HEPATIC DUCT
(2) Common hepatic duct joins with CYSTIC DUCT from gall bladder to form COMMON BILE DUCT
(3) Common bile duct empties into SECOND PART OF DUODENUM
109
The gall bladder is located between the __ and the ___. Its function is to store ___ formed by the ___ and secrete it into the __ as needed.
Located between QUADRATE and rest of the RIGHT LOBE OF LIVER. Function: STORES BILE formed by LIVER. SECRETES BILE into DUODENUM as needed.
110
The arterial branches off of the abdominal aorta include the __, ___, and ___. Name the spinal level for each. At what level does the aorta end?
(1) Celiac trunk (T12 level), (2) Superior mesenteric (L1 level), (3) Inferior mesenteric (L3 level). Aorta ends at L4, DIVIDING INTO 2 COMMON ILIAC AA.
111
The celiac trunk is a branch of the __. It has __ (#) branches which include the ___, ___, and ___. Tell what organs/structures each supplies.
Celiac trunk is branch of ABDOMINAL AORTA. Celiac trunk has 3 branches:
(1) Common hepatic - supplies gall bladder, liver, pancreas, duodenum
(2) Left gastric - supplies esophagus and lesser curvature
(3) Splenic a. - supplies pancreas, spleen, stomach
112
The superior mesenteric a. is a branch off of the ___. It supplies which organs/structures? Where does it run? What may anastomose with this vessel?
Superior mesenteric is branch of abdominal aorta. Supplies pancreas, duodenum, jejunum, ileum, ascending and (1/2 of) transverse colon. Also supplies small intestine. Runs IN FRONT OF DUODENUM but BEHIND PANCREAS. May anastomose with the INFERIOR MESENTERIC A.
113
The inferior mesenteric is a branch off the __ . It supplies what organs/structures? What may anastomose with this vessel?
Inferior mesenteric a. is a branch off the ABDOMINAL AORTA. It supplies the transverse, descending, and sigmoid colon and part of rectum. May anastomose with the SUPERIOR MESENTERIC A.
114
List the 4 primary veins of the abdomen.
Splenic Vein, Superior mesenteric vein, Inferior mesenteric vein, Portal vein
115
The superior mesenteric vein drains what organs/structures?
SMV drains pancreas, duodenum, jejunum, ileum, ascending and transverse colon
116
The inferior mesenteric vein drains what organs/structures? As it courses back, what vein does it join?
IMV drains transverse colon, descending and sigmoid colon, part of rectum. Joins the SPLENIC vein
117
The portal vein is formed by the joining of the __ and __ veins. The hepatic portal system is one of __ (#) portal systems in the body. A portal system is where veins connect ___.
Portal vein formed by joining SPLENIC and SUPERIOR MESENTERIC VV. Hepatic portal system is one of 3 portal systems in body.
Portal system = veins connect 2 capillary beds
118
The hepatic portal system brings nutrient [poor/rich] blood through capillary beds from the intestines to the ___, where nutrients are extracted from blood and processed. After blood is filtered in the __, it returns to the systemic venous through ___ that exit the [ant/post] surface of the __ and empty into the __.
Hepatic portal system brings nutrient RICH blood through capillary beds from intestines to LIVER. After blood is filtered in the LIVER, it returns to systemic venous through HEPATIC VEINS that exit the POSTERIOR surface of the LIVER and empty into the INFERIOR VENA CAVA
119
Lymphatic channels and nodes (up to __ (#)) are found in the ___. They eventually empty into the ___. This means that there is [a lot/little] exposure to antigens in this region.
Up to 100 lymphatic channels/nodes in the MESENTARY. Eventually empty into THORACIC DUCT. A LOT of exposure to antigens in this area.
120
The abdomen features heavy __ innervation for blood vessels and smooth muscles of the gut.
Heavy AUTONOMIC innervation for blood vessels and smooth muscles of gut
121
What types of nervous fibers travel in the mesentary?
Both SYMPATHETIC and PARASYMPATHETIC fibers to the smooth muscle and glands travel in the mesentary
122
Sympathetic innervation in the abdomen is provided by the ___ nerves, in the [upper/lower] abdomen.
Sympathetic innervation provided by SPLENIC nerves (upper abdomen)
123
Parasympathetic innervation is provided by the __ n. up to the middle of the transverse colon. The ___ innervates the rest of the large intestine and pelvis.
Parasympathetic innervation is provided by the VAGUS N. from the head, neck, thorax [heart/lungs], upper abdomen, and 1/2 of transverse colon. The SACRAL PARASYMPATHETIC NN. innervates the rest of the large intestine and pelvis
124
The two layers of the superficial fascia of the abdomen are the ___ and ___. Describe them.
Camper's fascia (fatty, superficial layer; aka hypodermis)
| Scarpa's fascia (deep, membranous layer that opposes deep fascia covering muscles)
125
The muscles of the midline include the __ and __ (a tiny muscle down lower). The larger of the two muscles is broken into segments by ____ which allow you to ___.
Rectus abdominus and Pyramidalis (small muscle). Rectus Abdominus is broken into segments by INTERTENDINOUS INSERTIONS which allow you to activate different parts of the muscle segmentally
126
The linea alba is the point where __. It extends from the __ to __.
Aponeuroses of left and right sides fuse. Extends from XIPHOID PROCESS to PUBIS.
127
In general, the muscles of the anterior abdominal wall are ___.
Oblique, flat muscles, tend to run at angles
128
The external abdominal oblique interdigitates with what other muscle? Where?
Interdigitates with serratus anterior at lower 8 ribs
129
Describe the inguinal ligament
Not really a ligament. Goes from ASIS to pubic tubercle. It's the lower edge of the EXTERNAL OBLIQUE rolling under itself. Fuses with deep fascia of thigh
130
Which abdominal muscles originate from the thoracolumbar fascia?
Transversus Abdominus and Internal Abdominal Oblique
131
Describe the functions of all abdominal muscles
- Add strength to abdominal wall
- support posture (esp. via transversus abdominus attachment to thoracolumbar fascia)
- Forced expiration
- Protection and support of abdominal contents
- Bowel movement (compress ab contents)
- Child birth
- Movements of trunk: Simple (sagittal) flexion, pelvic tilts, oblique flexion or rotation
132
Anterior tilt involves rotating the ASIS [up/down}, AKA __.
Anterior tilt: rotate ASIS DOWN, stick butt out, belly out; posterior tilt is tucking your butt under
133
Name the layers of the abdominals from superior to deep.
External abdominal oblique, internal abdominal oblique, transversus abdominus, TRANSVERSALIS FASCIA
134
Describe the rectus sheath above and below the arcuate line
Above: anterior sheath consists of layered aponeuroses of (sup. to deep) external abdominal oblique, 1/2 internal abdominal oblique; posterior sheath consists of 1/2 internal abdominal oblique, transversus abdominus, transversalis fascia, and peritoneum
Below: anterior sheath consists of ALL aponeuroses of muscles. Transversalis fascia STAYS POSTERIOR (as does peritoneum)
135
Vessels and nerves in the abdominal wall run between which two muscles?
In between INTERNAL ABDOMINAL OBLIQUE and TRANSVERSUS ABDOMINUS
(just like in the intercostals: vessels run between internal intercostals and innermost intercostals!)
136
What vessels run deep to the rectus abdominus?
Superior and inferior epigastric
137
The inguinal canal is a passageway for the ___ and __ on the way to the ___ through the abdominal wall.
Passageway for TESTES and SPERMATIC CORD on way to SCROTUM through abdominal canal
138
The inguinal canal is a [straight/oblique] path through the abdominal wall. The opening to the canal is most [medial/lateral] in the superficial layer, and most [medial/lateral] in the deep layers.
Inguinal canal is an OBLIQUE path through abdominal wall. Most medial opening is in the SUPERFICIAL layer, most LATERAL opening is in the DEEP layer
139
How many layers are involved in the formation of the inguinal canals? What do they consist of?
Deep ring: opening in transversalis fascia
Middle: Internal Oblique and Transversus Abdominus both ARCH OVER the spermatic cord, offset from the deep ring
Superficial: Ext. Abdominal Oblique has an opening that allows cord to exit abdomen and descend (most medial)
140
What does the spermatic cord consist of? What is the female homologue and where does it go?
In males, spermatic cord consists of: Vas deferens, testicular artery and plexus of veins
IN FEMALES: the ROUND LIGAMENT passes through inguinal canal to LABIA MAJORA
141
What's a hernia? What are different types/names of hernias that can arise?
Hernia: openings in inguinal canal (or other places in body) get weak and enlarged. Generally, abdominal contents is poking out where it shouldn't be.
Hernias are named by region: Epigastric, Umbilical, Inguinal, or Femoral hernias. Similarly, Hiatial Hernias is a hernia of the stomach up through diaphragm
142
What is diastisis recti?
Separation of the rectus abdominus as the abdomen expands (e.g during/after childbirth). Widened linea alba
143
Describe the size and shape of the spinal cord
Elongated, nearly cylindrical, flattened DORSOVENTRALLY. 1cm in diameter, ~45 cm long
144
What is the space called in which the spinal cord lies?
Spinal (vertebral) canal
145
The rostral end (cranial) is continuous with the ___.
Medulla oblongata, at the upper border of the atlas
146
As you grow, the vertebral column continues to grow even after the spinal cord stops growing. At the ___ vertebral interspace, the spinal cord tapers to a point called the ___.
At L1-L2 vertebral interspace, spinal cord tapers to a point = CONUS MEDULLARIS
147
Describe the spinal cord enlargements (name, why they're enlarged, spinal cord levels)
```
Cervical enlargement (C5-T1 spinal cord levels), brachial plexus found here
Lumbar enlargement (L2-S3 spinal cord levels), lumbar plexus found here
```
148
The spinal cord has __ (__) (#) segments or levels, each of which has a pair of spinal nerves associated with it. Give the numbers and the names.
31 (33) segments: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 (3) coccygeal. Named according to where the spinal nerves exit the vertebral column
149
The level where a pair of spinal nerve roots exits the spinal cord is usually [the same as /different from] where the spinal nerve exits the vertebral column. Why?
Level spinal nerve roots exit spinal cord is DIFFERENT from where the spinal nerve exits the vertebral column...because the spinal cord and vertebral column grow at different rates
150
Describe where each spinal nerve root exits the vertebral column
C1-C7 exit ABOVE numbered vertebrae, C8 exits BELOW numbered vertebrae
T1 to coccygeal exit BELOW numbered vertebrae.
151
The lumbar, sacral, and coccygeal nerves descend in the ___ before exiting the vertebral column.
DURAL SAC
152
What is the cauda equina?
A descending collection of dorsal and ventral nerve rootlets beyond the termination of the spinal cord
153
The meninges are ___ that act to ____ the spinal cord. The meningeal layers are ___.
Meninges are membranous layers that act to anchor and protect the spinal cord. Layers consist of Dura mater, Arachnoid mater, and Pia Mater
154
Spinal dura is an extension of ___. It is separated from the periosteum by ____. This space is filled with ___ and the ___, and clinically, it is used for ___.
Spinal dura is an extension of CRANIAL DURA. Separated from periosteum by EPIDURAL SPACE, which is filled with FAT and VERTEBRAL VENOUS PLEXUS. Used for administration of anesthetic for "epidurals"
155
The spinal dura forms a ___ around the roots and spinal nerve at each level as they run through the ___, then the dura blends with the ___.
Dura forms a DURAL SLEEVE around roots and spinal nerve at each level as they run through the INTERVERTEBRAL FORAMEN. Dura then blends with EPINEURIUM
156
Dural sac extends down to __ level, after which a thin dural string continues to the __ as the ___. The dural sac [does/does not] cover the cauda equina.
Extends to S2 level. Thin dural string continues to COCCYX as FILUM TERMINALE EXTERNUM. Dural sac DOES cover the cauda equina.
157
The arachnoid is a [thin/thick] membrane inside the dura. It is an extension of the ___. Like the dura, it also ensheaths roots in the intervertebral foramen but not as far as the dura. The arachnoid is widest in the region of the subarachnoid space containing the ___ and is called the ___. This area extends from the ___ (__-___ vertebral interspace) to ___ (AKA end of ___). Clinically, this area is used for ___.
Arachnoid is THIN, delicate membrane. Extension of CRANIAL ARACHNOID. The arachnoid is widest in the region of the subarachnoid space containing the CAUDA EQUINA and is called the LUMBAR CISTERN. This area extends from the CONUS MEDULLARIS (L1-L2 vertebral interspace) to S2 (AKA end of DURAL SAC). Clinically used for LUMBAR PUNCTURES
158
The subarachnoid space exists between the __ and __. It contains ___ .
Subarachnoid space exists between PIA MATER and ARACHNOID SPACE. It contains CEREBROSPINAL FLUID (CSF)
159
The ___ is the meningeal layer directly in contact with the spinal cord.
Pia mater
160
The pia mater covers the cord itself as well as ___. It anchors the spinal cord to the dura by ____ ligaments. These ligaments are __-__ (#) flattened bands of epipial tissue that come off in pairs at different places along the cord.
Covers the cord AND the vessels supplying the cord. Anchors spinal cord to dura by DENTICULATE ligaments. 18-24 flattened bands of epipial tissue.
161
The pia mater extends beyond the conus medullaris as the ___. This attaches to the ___ along with the ___.
Filum Terminale Internum. Attaches to COCCYX along with FILUM TERMINALE EXTERNUM
162
The spinal cord is anchored superiorly by its attachment to the ___ as well as the continuation of spinal cord __ with the brain __. Inferiorly, it is anchored by its attachments to the ___ via the __ and ___. Laterally, the spinal cord is anchored by ___ from the __ to ___ and ___ over the roots.
Spinal cord anchored SUPERIORLY by attachment to the MEDULLA and continuation of BRAIN DURA into SPINAL CORD DURA. Inferiorly, the FILUM TERMINALE INTERNUM and EXTERNUM anchor the cord to the COCCYX. Laterally, the cord is anchored by DENTICULATE LIGAMENTS from the PIA MATER to the DURA and DURAL SLEEVES OVER THE ROOTS
163
Describe the blood supply of the spinal cord. Where do they run? What parts of the spinal cord to they supply?
The Anterior Spinal artery has 2 roots (one from each vertebral artery), supplies anterior 2/3 of spinal cord. The singular anterior spinal artery runs on VENTRAL surface of the cord in the ANTERIOR MEDIAN FISSURE.
The 2 Posterior Spinal Arteries usually arise from the vertebral artery and supply the posterior 1/3 of the cord.
These are supplemented by reticular arteries from the aorta as they get further down the body
164
Name the curves of the spine.
Cervical LORDOSIS, Thoracic KYPHOSIS, Lumbar LORDOSIS
165
What do the curves of the spine act to do?
Improve shock absorption in spine
166
Facet joints, AKA ___ joints, are found [superiorly/inferiorly/both] on each vertebrae.
Facet joints AKA Zygapophyseal are found BOTH superiorly and inferiorly on each vertebrae (2 of each: Right and Left Superior Articular Facets, and R & L Inferior Articular Facets)
167
One spinal segment is comprised of __ (#) joints. Describe them
3 joints: (1) Between the bodies above and below with the intervertebral disc (Fibrocartilaginous Symphysis), (2 & 3) Between the bodies above and below at the FACET (ZYGAPOPHYSEAL) JOINTS (1 on either side between superior and inf. articular facets)
168
What type of joints are found in one spinal segment?
Fibrocartilaginous Symphysis and Synovial joints (PLANE joints at facets). The synovial facet joints allow for 3 degrees of freedom: flexion/extension, right/left lateral flexion, and right/left rotation.
169
Spinal nerves exit [above/below] the numbered vertebrae (starting at T1). They exit via the ___
Spinal nerves exit BELOW the numbered vertebrae (starting at T1). They exit via the INTERVERTEBRAL FORAMEN
170
A herniated disc at L2-3 will most likely compress the ___ nerve roots. Why?
L2-L3 herniation will likely compress the L3 nerve roots because they exit BELOW L3
171
Intervertebral discs are found between adjacent vertebrae EXCEPT between which two?
NO intervertebral disc between C1 and C2
172
Intervertebral discs are composed of primarily ___. There are 2 parts: ___ and ___.
Primarly composed of FIBROCARTILAGE. 2 parts: Annulus Fibrosus and Nucleus Pulposus
173
The annulus fibrosus is composed of ____. It is tough, but it is thinner [posteriorly/anteriorly]. It is constructed in layers, known as ___, at ___ degree angles to each other. Why?
Annulus fibrosus is composed of FIBROUS CONNECTIVE TISSUE. It is tough but it is thinner POSTERIORLY [herniate backwards!]. It is constructed in layers called LAMINAE at 90 degree angles to each other. These perpendicular fiber directions increase the strength of the disc.
174
The nucleus pulposus is a ___ structure, [superifical/deep] to the annulus fibrosus. It gives __ to the disc. With flexion of the spine, the disc moves [ant/post/lat]. It can herniate through a torn ___, generally [ant/post].
Nucleus pulposus is a GELATINOUS structure DEEP to annulus fibrosus. Gives HEIGHT to the disc. Moves POSTERIORLY with flexion of spine. Can herniate through torn ANNULUS FIBROSUS, generally POSTERIORLY since that ligament is thinner.
175
What happens when you "herniate a disc?"
The Nucleus pulposus escapes the annulus, generally because the annulus tore posteriorly
176
The fluid of the ___ resorbs and dries out with age. This results in a loss of ___ between the vertebrae.
Fluid of Nucleus Pulposus resorbs/dries with age. Results in a loss of HEIGHT between vertebrae.
177
The supraspinous ligament runs over the ____ and blends with the ___ ligament. In the cervical spine, the supraspinous ligament is thick and deep and called the ___. The supraspinous ligament limits ___.
Runs over spinous processes and blends with INTERSPINOUS LIGAMENT. In C-spine, it is thick and deep = LIGAMENTUM NUCHAE. Limits FLEXION.
178
The ligamentum nuchae is a specialization of what?
Specialization of SUPRASPINOUS LIGAMENT in cervical spine
179
The interspinous ligament runs from the ___ of one [spinous/transverse] process to the ___ of the next [spinous/transverse] process. It limits ___.
Interspinous ligament runs from the LOWER BORDER of one SPINOUS process to the UPPER BORDER of the next SPINOUS process. Limits FLEXION
180
The ligamentum flavum is the [strongest/weakest] of these spinal ligaments. It runs between the ___ and limits ___. There is one on each side, and they are separated in the ___. Laterally, they blend with and attach to the synovial ___ joint capsule. They are highly ___, hence their ___ color.
Ligamentum flavum = STRONGEST of spine ligaments. Runs between LAMINAE and limits FLEXION. One on each side, separated by MIDLINE. Laterally, blend with and attach to synovial FACET joint capsule. VERY ELASTIC hence yellow color
181
The posterior longitudinal ligament runs on the [ant/post] side of the vertebral ___ within the ____. They limit flexion. They're [thin/thick] in the lumbar region. What is the clinical relevance of this? What is the homologue of the PLL in the cervical spine?
Posterior longitudinal ligament runs on POSTERIOR side of vertebral BODIES within VERTEBRAL CANAL. THIN in lumbar region and limit FLEXION. Clinical result = most herniated discs in lumbar region because PLL doesn't support the disc quite as well as its homologues do in other regions of the spine. Tectorial membrane is the cervical spine homologue to the PLL
182
The anterior longitudinal ligament runs between the vertebral __ [ant/post]. It crosses over the intervertebral ___ and limits ___. It is particularly dense in the ___ region.
Runs between vertebral BODIES ANTERIORLY. Crosses over intervertebral DISC and limits EXTENSION. Particularly dense in the LUMBAR region.
183
Anterior ligaments are thinner/thicker in which spinal area? Alternatively, posterior ligaments are thinner/thicker in which spinal area?
Anterior ligaments are THICKEST in LUMBAR REGION and posterior ligaments are THINNEST in lumbar regions. Alternatively, Ant. ligaments are THINNEST in cervical region and Post. ligaments are THICKEST in cervical region
184
Name the two specialized ligaments of the upper cervical spine. Which is deep to the other?
Tectorial membrane and Cruciform ligament (deep to tectorial membrane)
185
The tectorial membrane is an upper extension of what ligament? It attaches to the ___ superior to the ___.
Tectorial membrane is upper extension of POSTERIOR LONGITUDINAL LIGAMENT that attaches to OCCIPITAL BONE superior to the FORAMEN MAGNUM
186
The cruciform ligament runs [superficial/deep] to the tectorial membrane. It is shaped like a ___. It has two parts: __ and __.
Cruciform ligament runs DEEP to tectorial membrane. Shaped like a cross. 2 parts: Transverse part (AKA Transverse Ligament of Atlas) and Vertical Portion
187
The transverse part of the cruciform ligament is AKA __. It attaches at both ends to the ___ (inner ant/post surface), and passes [ant/post] to the dens. It acts to ___.
Attaches at both ends to the ARCH OF THE ATLAS (inner ANTERIOR surface), passing POSTERIOR to the dens. It holds the dens to the anterior arch of the atlas
188
The vertical portion of the cruciform ligament runs from the body of the ___ to the ___.
Vertical portion of cruciform ligament runs from the bod of the AXIS to the OCCIPITAL BONE.
189
The apical ligament runs [sup/deep] to the cruciform. It runs between the __ and ___. It likely limits the tipping of the __ backward, and [does/does not] restrict rotation.
Apical ligament runs DEEP to cruciform between the DENS and OCCIPITAL BONE. Limits tipping of the dens BACKWARD, but DOES NOT restrict rotation
190
The Alar ligament runs from the sides of the ___ to the edge of [ant/post] aspect of ___. It acts to ___.
Alar ligament runs from sides of the DENS to the edge on the ANTERIOR aspect of the FORAMEN MAGNUM. It RESTRICTS ROTATION OT 45 DEGREES
191
Of the 90 degrees of normal cervical rotation, ___ comes from rotation of ___.
HALF of 90 degrees (~45 degrees) comes from rotation of C1 on C2
192
The deep fascia of the back is bound to underlying muscle and envelops the ___ and ___. Part of the deep fascia is made up of the ___, which covers and surrounds the deep back muscles. It is made from the ____ of which muscles?
Deep fascia of back envelops LATISSIMUS DORSI and TRAPEZIUS. Part of the deep fascia is made up of the THORACOLUMBAR FASCIA which is made from the APONEUROSES of the TRANSVERSUS ABDOMINUS, INTERNAL ABDOMINAL OBLIQUE, and LATISSIMUS DORSI
193
The deep back muscles are all innervated by the ___.
DORSAL RAMI OF SPINAL NERVES
194
What are the 5 general groups of back muscles?
Splenius, Erector Spinae, Transversospinalis Muscles, Segmetnal Muscles, Suboccipital
195
Describe the action of the splenius group
Neck extension (Bilateral Contraction) and rotates head to same side (Unilateral contraction)
196
Describe the action of the Erector spinae group
(1) Back extension, (2) Lateral flexion of trunk, (3) Controls flexion eccentrically against gravity
197
Describe the action of the Transversospinalis group
Rotation of spine to opposite side
198
Describe the action of the Segmental Muscles
Extends from one vertebra to the next
199
Describe the action & innervation of the Obliquus Capitis Inferior
Rotation of C1 to same side; Suboccipital N. (C1)
200
Describe the action & innervation of the Obliquus Capitis Superior
(1) Extends head (bilateral contraction), (2) Lateral flexion of neck (unilateral contraction); Suboccipital N (C1)
201
Describe the action & innervation of the Rectus Capitis Minor and Major
Extends the head (bilateral contraction); Supoccipital N (C1)
202
What sites comprise the "common origin" for the deep back muscles?
(1) Sacrum, (2) Iliac crest, (3) Lumbar vertebrae, (4) Spinous processes of T11 & T12
203
What muscle group lies deep to the erector spinae?
Transversospinalis (Semispinalis, Multifidus, Rotatores)
204
The interspinales muscles are in the ___ group. They lie deep on the ___ processes in the __ and __ regions. They act to do ___
Interspinales muscles are in Segmental Muscle group. Lie deep on SPINOUS processes in the cervical and lumbar regions. Action: Extension
205
The intertransversarii muscles are in the __ group. They attach to adjacent ___ processes in the __ and ___ regions. They act to do __.
Intertransversarii = Segmental muscle group. Attach to adjacent TRANSVERSE processes in CERVICAL and LUMBAR regions. Action: Lateral Flexion
206
The Greater Occipital N. comes from the ___. It emerges from under the ____ and traverses the ___ triangle. It pierces the ___ on its way toward the scalp where it is associated with the ___ artery. That spinal level innervates the skin/scalp on the ___.
Greater Occipital N. AKA C2 dorsal primary ramus. Emerges under the OBLIQUUS CAPITIS INFERIOR, traverses the SUBOCCIPITAL TRIANGLE, pierces the SEMISPINALIS CAPITIS and is associated with OCCIPITAL A. C2 innervates skin/scalp on BACK OF HEAD
