High Yield Flashcards
Retroperitoneum and spaces
- boundaries: by the posterior aspect of the parietal peritoneum to tranvsersalis fascia.
- anterior pararenal: anterior: parietal peritoneum
posterior: Gerota’s fascia
lateral: lateroconal fascia
superior: dome of diaphragm
inferior: iliac fossa into pelvis
contains: duodenum, pancreas, ascending and descending colon, small bowel mesentery and transverse mesocolon - perinepheric space
anterior: gerota’s fascia
posterior: Zuckerkandl’s fascia
lateral: lateral conal fascia
superior: bare area of liver on right and left subphrenic space. communicates with mediastinum via the various diaphragmatic hiatus
inferior: closed
contents: adrenal glands, kidneys, renal vessels, perinephric fat - posterior para renal space
anterior: Zuckerkandl’s fascia
posterior: transversalis fascia
medial: paraspinal muscle and fascia
superior: limited by fusion of psoas and quadratus lumorum within inferior phrenic fascia
inferior: pelvis
contents: fat, blood vessels, lymphatics
Superior thoracic aperture
aka thoracic inlet. communication between the root of the neck and the thorax
-kidney bean shaped aperture tilted in an oblique orientation
boundaries:
- anterior: superior border of manubrium and 1st costal cartilage
- lateral: 1st ribs bilaterally
- posterior: 1st thoracic vertebrae
contents:
viscera: thymus, trachea, oesophagus, lung apices
vessels, nerves, lymphatics:
common carotid arteries, subclavian arteries, brachiocephalic veins, phrenic nerves, vagus nerve, recurrent laryngeal nerves, thoracic duct, sympathetic trunk
muscles: sternohyoid, sternothyroid
1st rib
superior most rib of the thoracic cage. forms part of the superior thoracic aperture.
atypical rib: short, thick, single articular facet for the costovertebral joint and 2 tubercles.
- transverse tubercle for transverse process of T1
- scalene tubercle for anterior scalene muscle insertion. divides the subclavian vein and artery grooves
articulations
costovertebral
costotransverse
costochonrdral
attachments anterior scalene middle scalene between the subclavian artery groove and transverse tubercle first digitation of serratus anterior parietal pleura inner border costoclavicular ligament
blood supply
- internal thoracic artery and superior intercostal arteries
- venous: intercostal veins
innervation:
1st intercostal nerve
relations:
superior: lower trunk of brachial plexus, subclavian vessels, clavicle
inferior: intercostal vessels and nerves
anterior: sympathetic trunk, superior intercostal artery
medial: superior thoracic aperture
lateral: axillary vessels, division and cords of brachial plexus
variant
- bifid first rib
- rudimentary rib
- osseous or fibrous articulation or fusion with a cervical rib
- pseudoarthrosis of 1st rib
Corpus callosum
largest commisural fibres in the brain. linking the right and left cerebral hemispheres. largest white matter tract.
C shaped, 4 parts: rostrum (continuous with lamina terminalis), genu, body, splenium. formation started from genu to splenium but myelination is opposite. covered superiorly by the indusium griseum
relations:
superior: interhemispheric fissure, falx cerebri
lateral: callosal sulcus, cingulate gyrus
inferior: lateral ventricles, interventricular foramen, septum pellucidum, fornix
fibre tracts:
genu: forceps minor. medial and lateral frontal
rostrum: orbital frontal lobe
body: corona radiata to hemispheres
splenium: forceps major. occipital lobes
blood supply:
anterior and posterior pericallosal arteries
variant:
dysgenesis of corpus callosum
median callosal artery
subcallosal artery
Pericardium and recesses
Pericardium has 2 layers: fibrous and serous layers (visceral and parietal).
fibrous in continuation with the central tendon of the diaphragm. serous layer forms the epicardium.
prevents over distention of the heart and also provides physical barrier against infections.
Serous pericardium invaginated by heart to form 2 sinuses:
transverse and oblique sinuses
- transverse: between aorta and pul artery
- oblique: superior and inferior vena cava and 4 pulmonary veins, posterior to left atrium
7 recesses: pulmonic: left and right aortic: superior inferior pulmonary venous: left and right post caval
relations:
anterior: body of the sternum, costal cartilages
lateral: phrenic nerve, vagus nerve, left and right lungs and pleura
posterior: oesophagus, vertebral bodies and intervertebral discs
inferior: central tendon of diaphragm
blood supply:
- internal thoracic artery, pericardiophrenic and musculophrenic arteries
- descending thoracic aorta
venous: pericardiophrenic veins
innervation:
phrenic nerve, vagus nerve, sympathetic trunk
lymphatic:
tracheobronchial lymph nodes, prepericardial lymph nodes
variants:
pericardial agenesis
Cavernous sinus
cavernous sinus located on either side of the pituitary fossa and body of sphenoid. between endosteal and meningeal layers of dura. spans from the orbital apex to the apex of the petrous temporal bone. divided by multiple fibrous septa into small caves.
boundaries:
anterior: orbital apex
posterior: apex of petrous temporal bone
lateral: dura mater of middle cranial fossa
medial: endosteum of body of sphenoid bone
floor: endosteum of greater wing of sphenoid
roof: dural fold between anterior and middle clinoid processes
relations:
superior: MCA, optic chiasm, suprasellar cistern
anterior: apex orbit
posterior: cerebral peduncle
medial: pituitary fossa and gland
lateral: temporal lobe and Meckels cave
inferior: sphenoid sinus
venous tributaries
- superior and inferior ophthalmic veins, intercavernous sinus, sphenoparietal sinus, superficial middle cerebral vein
drainage:
- superior petrosal sinus to transverse sinus
inferior petrosal sinus to jugular bulb
venous plexus of ICA to clival venous plexus
contents:
CN III, IV, V, VI
C4 segment (cavernous segment of ICA): meningohypophyseal and inferolateral trunk
fat
Great saphenous vein
superficial drainage of the lower limb. lies within subcutaneous tissue of the leg. posteriorly bounded by the deep fascia and superficially by the saphenous fascia.
continuation of the medial marginal vein travels anterior to the medial malleolus and ascends superiorly medial then posterior to medial aspect of tibia.
wind around medial aspect of knee to continue in medial aspect of thigh.
pierce the saphenous opening in the deep fascia of the thigh to drain into femoral vein at the saphenofemoral junction in the femoral triangle.
communicates with deep veins via perforators
tributaries small saphenous vein lateral accessory vein superficial epigastric superficial external iliac superficial external pudendal anterior accessory vein
variants
segmantal hypoplasia
duplication
accessory saphenous veins
short saphenous vein
superficial venous drainage of the lower limb. within subcutaenous tissue. superficial to deep fascia of leg.
continuation of the lateral marginal vein of the foot
ascends posterior to the lateral malleolus and ascends posteriorly up the calf
pierces the deep fascia and drain into popliteal vein
tributaries
- communicating branches with great saphenous vein
cutaneous venous branches
relations
- accompanied by sural nerve
variant
duplication
variable termination
thigh extension of SSV (Giacomini)
Orbit
feature of the face containing the globe and its supporting structures
roof, floor, medial and lateral wall
open anteriorly and bounded by orbital septum
posteriorly angles inwards and communicate with the intracranial compartment via optic canal and superior orbital fissure
contents
globe, extraocular muscles, optic nerve, oculomotor nerve, trochlear nerve, ophthalmic branch of trigeminal nerve, maxillary branch of trigeminal nerve, abducens nerve, ophthalmic artery, infraorbital artery, superior and inferior ophthalmic vein, lacrimal gland, fat
bony margins: pars orbitalis of frontal bone lacrimal bone lamina papyracea of ethmoid zygomatic bone palatine bone great and lesser wings of sphenoid
2 spaces:
intra conal and extra conal
- intraconal is the conical space within the musculofascial cone. anteriorly formed by posterior half of globe, sides by extraocular muscles and surrounding fascia, posteriorly converging onto tendinous ring of Zinn.
contents: II, III, nasociliary nerve, VI, ciliary ganglion, ophthalmic artery, fat
extra conal space
- outside the musculofacial cone
contents: trochlear nerve, ophthalmic division of trigeminal, lacrimal artery, supraorbital artery, anterior and posterior ethmoidal artery, internal palpedbral artery, frontal artery, dorsal nasal artery
veins: superior and inferior ophthalmic veins
lacrimal gland
fat
Orbital venous drainage
Superior ophthalmic vein
- prominent vein
- confluence of several veins within superior orbit above the medial palpebral ligament
- courses medially towards trochlea between optic nerve and ophthalmic artery
exits fibromuscular cone and drain into cavernous sinus via the superior orbital fissure
- drains globe, extra ocular muscles and lacrimal gland
Inferior ophthalmic vein
- confluence of several veins in the anteroinferior orbit along the infraorbital margin from facial vein tributaries
- posterior within intraconal space
exit fibromuscular cone
drain out via superior orbital fissure intocavernoues
- infraorbital fissure to pterygoid venous plexus
- lower eyelid, globe and EOM
Biliary tree
biliary tree can be divided into intra and extrahepatic components.
primarily facilitates the transport of bile from hepatic parenchyma to duodenum
8 liver lobes with their own portal triad.
each lobe has its own biliary drainage.
bile is produced by the hepatocytes and transported into the ducts via bile canaliculi.
right anterior and posterior hepatic ducts and left hepatic duct
right anterior drains: V, VIII
right posterior drains: VI, VII
left drains: II, III, IV
caudate lobe drains directly into the common hepatic duct
the right posterior and anterior joins to form the right hepatic duct and left joins together to form the common hepatic duct which joins with the cystic duct to form the common bile duct
the common bile duct travels the free edge of the lesser omentum then posterior to the neck of the pancreas and duodenum
inserts into the posteromedial wall of 2nd part of the duodenum into the major papillae with the pancreatic duct
relations:
anterior: neck of pancreas, duodenum
posterior: inferior vena cava, vertebral bodies, portal vein, hepatic artery
superior: liver
variants - right posterior duct joins left hepatic duct - right anterior joins left duct - triple confluence - low insertion of the cystic duct - accessory hepatic ducts middle hepatic duct
Liver segments
liver is divided in 8 functionally independant segments based on the Couinard classification.
pyramidal lobes with apexes directed towards the porta hepatis
Right, middle and left hepatic veins:
- left hepatic vein divides the liver into left lateral and left medial section, within the left intersegmental fissure
- middle hepatic vein divides the liver into right and left lobes. Cantle’s line.
- right hepatic vein divides the liver into right medial and right lateral sections within the right intersegmental fissure
the bifurcation of the portal vein is the horizontal plane that divides the lobes into superior and inferior segments
left lateral superior and inferior: II, III left medial superior inferior: IVa, IVb right medial superior and inferior: VIII, V right lateral superior and inferior: VII, VI Caudate lobe is within the posterior aspect, drains directly into the IVC and biliary drainage drains directly into the common hepatic duct
relations
superior: right hemidiaphragm
inferior: pancreas, duodenum, transverse colon, ascending colon
left: IVC, aorta, oesophagus
anterior: capsule
blood supply
portal vein 75%
hepatic artery 25%
venous drainage into IVC via hepatic veins
nerves:
celiac plexus
vagus nerve
lymphatics: porta hepatis lymph nodes to celiac lymph nodes
variants Riedel's lobe Beaver's tail lobe agenesis of right or left lobes of liver supradiaphragmatic liver pseudolipoma of Glisson capsule
Cruciate ligaments
cruciate ligaments are part of the knee stabilizing ligaments against rotational, anterior or posterior translational forces
anterior and posterior cruciate ligaments
anterior: originates from the anteromedial aspect of the intercondylar eminence and inserts on the medial aspect of the lateral femoral condyle
- two bundles: anteromedial, posterolateral bundles
posterior: originates from the medial aspect of the medial femoral condyle to the anterolateral aspect of the intercondylar eminence
- two bundles: anterolateral, posteromedial
blood supply
middle genicular artery
lateral and medial geniculate arteries
innervation: tibial, peroneal, femoral nerves, obturator
variants
- absent acl
- absent pcl
Tibial plateau
proximal end of the tibia which could be divided into the articular surfaces and the intercondylar eminence
medial and lateral articulating surface which articulates correspondingly to the medial and lateral femoral condyles
deepened by the medial and lateral menisci
hyaline lined surface and part of a synovial joint
intercondylar notch is the origin of the cruciate ligaments and menisci
blood supply
- inferior medial and lateral genicular arteries
middle genicular artery
similar name veins
innervation
- obturator, femoral, tibial, common peroneal nerves
Menisci
medial and lateral menisci which sits between the articular surfaces of the medial and lateral femoral and tibial surfaces of the knee joint
shock absorption, load transmission and improved stability
medial:
c shaped, larger, more open and wider
lateral:
incomplete circle
smaller
Attachments
medial:
anterior horn attaches to ACL attachment of the intercondylar area
posterior horn posterior intercondylar area between PCL insertion and posterior insertion of lateral menisci
lateral:
anterior horn lateral to ACL attachmen of the intercondylar area
posterior anterior to medial meniscus and ACL
meniscofemoral liagment:
- posterior horn of lateral meniscus to medial femoral condyle: posterior and anterior Wrisberg and Humphreys
transverse meniscal ligament of winslow anterior horns
Blood supply
- outer 1/3: medial, lateral and middle genicular arteries
inner 2/3 by diffusion
innervation: tibial, terminal obturator, femoral nerve
variant - discoid menisci congenital hypoplasia or absence aberrant insertion meniscal ossicle speckled anterior horn of lateral meniscus
