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Anatomy > High Yield > Flashcards

High Yield Flashcards

1
Q

Basal Ganglia: Description

A

The basal ganglia is a group of nuclei located in the deep white matter of the brain. That is interconnected with the cerebral cortex, thalami and brain stem.
Function: Memory formation and regulation of motor control

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2
Q

Basal Ganglia: Gross Anatomy

A
  • Gross anatomy:
  • It contains 3 paired nuclei that together comprise the corpus striatum:
    • Caudate nucleus
    • Putamen
    • Globus pallidus
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3
Q

Caudate Nucleus

A
  • Located lateral to the lateral ventricle
  • Head indents the anterior horn
  • Curves along the lateral ventricle
  • Tail extends into the temporal lobe
  • Bounded laterally by the internal capsule
  • The head of the caudate is supplied by the recurrent artery of Heubner, the rest is supplied by the lenticulostriatal arterys
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4
Q

Putamen

A
  • Paired rounded, most lateral structure of the basal ganglia
  • Medial to the external capsule
  • Connected to the substantia nigra and subthalamic nuclei to control movement
  • Supplied by the lenticulostriatal arteries
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5
Q

Globus Palladus

A
  • The paired, medialt to the putamen, lateral to the thalamus
  • Subdivided into internal and exernal parts separated by a internal medullary lamina.
  • Supplied by the lenticulostriatal arteries
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6
Q

Subthalamic Nuclei

A
  • Small, located inferior to the thalamus
  • Medial to internal capsule
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7
Q

Substantia Nigra

A
  • Anterior midbrain, transition point of the tegmentum and cerebral peduncles
  • Produces dopamine
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8
Q

Cerebellum: Description

A

There cerebellum is brain structure located in the posterior fossa below the tentorium and behind
the brain stem
Function: Integration and mediation of proprioceptor and movement data

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9
Q

Cerebellum: Gross Anatomy

A
  • Globular structure located in the posterior aspect of the posterior fossa
  • Three surfaces: anterior, superior and inferior
  • Three fissures: Primary, horizontal and sub-occipital
  • Two hemispheres: right and left
  • Single median vermis
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10
Q

Cerebellar divisions

A
  • Vermis: Divided into nine lobules
  • Cerebellar hemispheres:
  • Onion configuration of folia
  • 18 lobules associated bilaterally associated with the vermis lobules
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11
Q

Cerebellum/Cerebrum connections

A
  • Midbrain via the superior cerebellar peduncle
  • Pons via the middle cerebellar peduncle
  • Medulla via the inferior cerebellar peduncle
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12
Q

Cerebellum: Vasculature

A
  • Arterial supply:
    • Superior cerebellar arteries (from basil)
    • Anterior and posterior inferior cerebellar arteries (basil and vertebral)
  • Venous drainage:
    • Occipital venous sinus
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13
Q

Cerebellar: Relations

A
  • Anterior: 4 th ventricle
  • Posterior: cisterna magna
  • Superior: occipital lobes
  • Inferior: basiocciput
  • Lateral: cerebella-pontine angle cisterns
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14
Q

Cerebellar Variants

A
  • Variable blood supply
  • Megacisterna magna
  • Tonsilar ectopia / Chiari malformation
  • Agenesis
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15
Q

Corpus Callosum: Description

A
  • The corpus callosum is the largest white matter tract in the brain
  • Function: Interhemispheric communication
  • Location: Between the cerebral hemispheres above the septum pellucidum
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16
Q

Corpus Callosum: Gross Anatomy

A
  • C-shaped – concave up
  • 10cm in length

Divisions:

  • Rostrum anterior and inferior part (anterior hook of the c) continues as the copula then lamina terminalis
  • Genu most anterior part (elbow like bend), location of forceps minor
  • Body largely linear most superior part
  • Splenium most posterior part location of forceps major
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17
Q

Corpus Callosum: Vasculature

A
  • Arterial supply:
    • Anterior and posterior pericallosal arteries (From ACA and PCA)
    • Subcollosal artery
  • Veins:
    • Anterior and posterior pericallosal veins draining into the deep cerebral veins
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18
Q

Corpus Callosum: Relations

A
  • Superior: Interhemispheric fissure, indusium griseum, falx cerebri, cingulate gyrus, callosal sulcus
  • Inferior: septum pellucidum anteriorly and the body of the fornix posteriorly
  • Lateral: corona radiata
  • Anterior: Frontal lobes, fornix anterior
  • Posterior: occipital lobes, fornix posterior
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19
Q

Corpus Callosum: Variants

A
  • Agenesis/dygenesis of the corpus callosum
  • Cavum septum pellucidum
  • Cavum et vergae
  • Cavum veli interpositi
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20
Q

Internal Capsule: Description

A
  • The internal capsule is a deep subcortical structure that contains a concentration of white matter projections.
  • Function: Transmision of the motor and sensory information to and form the cortex and the rest of the CNS
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21
Q

Internal Capsule: Gross anatomy

A
  • Divided into 5 parts:
  • Anterior limb: lies between the head of the caudate nucleus medially and the lentiform nucleus laterally. Contain thalamic radiations.
  • Genu: Medial to the apex of the lentiform nucleus. Contains corticobulbar tracts.
  • Posterior limb: between the thalamus and the lentiform nucleus. Contains corticospinal tracts.
  • Retrolentiform: behind the lentiform nucleus. Contains optic radiation.
  • Sublentiform: below the lentiform nucleus. Contains the auditory radiation.
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22
Q

Internal Capsule: Vasculature

A
  • Arterial:
    • Perforators from the MCA and ACA
    • Lenticulostriatal and recurrent artery of Heubner.
    • Internal carotid supplies the posterior limb
  • Venous:
    • Internal cerebral vein
    • Inferior sagittal sinus
    • Posterior vein of the corpus callosum
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23
Q

Temporal Lobe: Description

A

The temporal lobe is one of four lobes of the brain and largely occupies the middle cranial fossa
Function: Memory formation, communication

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24
Q

Temporal lobe: Gross Anatomy

A
  • Gross anatomy:
    • Second largest lobe (after the frontal lobe)
  • Borders:
    • Superiorly – Sylvian fissure
    • Posteriorly – imaginary parietotemporal line
    • The middle cranial fossa forms its anterior and inferor boundaries
  • The temporal lobe can be divided into two main sections:
    • Neocortex – lateral and inferolateral surfaces
    • Mesial temporal lobe – hippocampus, amygdala, parahippocampal gyrus
  • The temporal lobe is divide into five gyri, from superolateral to inferomedial:
    • Superior temporal gyrus – containing Wernicke’s area
    • Middle temporal gyrus
    • Inferior temporal gyrus
    • Fusiform gyrus
    • Parahipocampal gyrus (anterior) lingual gyrus (posterior)
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25
Q

Temporal Lobe: Vasculature

A
  • Arterial supply:
    • Anterior choroidal
    • Middle cerebral
    • Basilar
  • Venous drainage:
    • Superficial middle cerebral vein
    • Inferior anastomotic vein of Labbe
    • Posterior choroidal vein
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26
Q

Temporal Lobe: Variants

A

Wernicke’s area can be on either side, most commonly the left

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27
Q

Frontal lobe: Description

A

The frontal lobe is by far the largest of the four lobes of the cerebrum (along with the parietal lobe, temporal lobe, and occipital lobe), and is responsible for many of the functions which produce voluntary and purposeful action.

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28
Q

Frontal Lobe: Gross Anatomy

A

The frontal lobe is the largest lobe accounting for 41% of the total neocortical volume. The frontal lobe resides largely in the anterior cranial fossa. Its most anterior part is known as the frontal pole, and extends posteriorly to the central (Rolandic) sulcus which separates it from the parietal lobe.
Posteroinferiorly it is separated from the temporal lobe by the lateral sulcus (sylvian fissure), although not seen from the surface is the insular cortex which is hidden deep to the lateral sulcus
The interhemispheric fissure separates its medial surface from the contralateral frontal lobe.
The frontal lobe is roughly pyramidal in shape, with three cortical surfaces:

  • Lateral surface (largest)
  • Medial (inter-hemispheric) surface
  • Inferior surface
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29
Q

Frontal Lobe: Lateral surface

A
  • Gyri:
    • superior frontal gyrus
    • middle frontal gyrus
    • inferior frontal gyrus
    • precentral gyrus (primary motor area)
  • Sulci:
    • superior frontal sulcus
    • inferior frontal sulcus
    • precentral sulcus
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30
Q

Frontal lobe: Medial Surface

A

The medial surface of the frontal lobe, abutting the falx in the midline, is primarily divided by the curving cingulate sulcus, which parallels the outer outline of the corpus callosum.
Above the cingulate sulcus is the medial continuation of the superior frontal gyrus
which is usually divided into two parts by a short ascending branch from the cingulate sulcus.

  • medial frontal gyrus
  • paracentral lobule
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31
Q

Frontal lobe: Inferior surface

A

Gyrus recti medially
Orbital gyri arranged in a H configuration (Medial, lateral, anterior and posterior orbital gyri)

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32
Q

Frontal Lobe: Relations

A
  • anterior: frontal bone
  • superiorly: frontal bone (anteriorly), coronal suture, and parietal bone (posteriorly)
  • posterior: central sulcus and parietal lobe
  • inferolaterally: lateral sulcus and temporal lobes
  • inferior: floor of anterior cranial fossa
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33
Q

Frontal lobe: Arterial supply

A
  • middle cerebral artery (MCA): lateral frontal lobe
  • anterior cerebral artery (ACA): medial frontal lobe
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34
Q

Occipital lobe: Description

A

The occipital lobe is the smallest of the four lobes of the brain.
Location: Posterior to the temporal and parietal lobes, sitting on top of the tentorium
Function: Primary and secondary visual cortex

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35
Q

Occipital Lobe: Gross anatomy

A
  • Triangular in shape
  • Seperated from the parietal and temporal lobes by the parieto-occipital sulcus and the parietotemporal line
  • Medially it is devided into hemisphere by the longitudinal fissure
  • The calcarine sulcus runs horizontally across with the cuneus above and the lingual gyrus below
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36
Q

Occipital lobe: Functional areas

A
  • Primary visual cortex – primary visual processing
  • Secondary visual cortex – visual association
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37
Q

Occipital Lobe: Relations

A
  • Anterior: parietal and temporal lobes
  • Posterior: occipital bone
  • Superior: Parietal lobe and parietal bone
  • Inferior: tentorium cerebelli
  • Medial: transverse sinuses, confluence of sinuses, straight sinus
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38
Q

Occipital lobe vasculature

A
  • Arterial supply:
    • Branches of the posterior cerebral artery
  • Venous:
    • Straight sinus
    • Superior sagittal sinus
    • Transverse sinuses
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39
Q

Parietal Lobe: Description

A

The parietal lobe is one of the four lobes of the brain located between the frontal and occipital lobes.
Function: Sensory processing, communication, proprioception

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40
Q

Parietal Lobe: Gross Anatomy

A
  • Lobe extends from the central sulcus anteriorly to the parieto-occipital fissure posteriorly.
    • The lateral sulcus corresponds to its inferolateral boundary, separating it from the temporal lobe. Divided by the medial longitudinal fissure

Gyri:

  • postcentral gyrus (primary sensory area)
  • superior parietal lobule
  • inferior parietal lobule (Wernicke’s area)
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41
Q

Parietal Lobe: Relations

A
  • Anterior: frontal lobe
  • Posterior: occipital lobe
  • Superior: parietal bone
  • Inferior: temporal lobe
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42
Q

Parietal lobe: Vasculature

A
  • Blood supply:
    • middle cerebral artery (MCA)
    • anterior cerebral artery (ACA): medial parietal lobe
    • posterior cerebral artery (PCA): posterior medial parietal lobe
  • Venous:
    • Superior sagittal sinus
    • Straight sinus
    • Inferior superficial cerebral vein (Labbe)
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43
Q

Arterial supply of the cerebellum: Description

A

The cerebellum is a specialised part of the brain located in the posterior cranial fossa

Function: Computation of movement and proprioceptive data

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44
Q

Arterial supply of the cerebellum

A
  • Superior cerebellar from the basilar –supplies the superior surface
  • Anterior inferior cerebellar from the basilar – anterior inferior
  • Posterior inferior cerebellar from the vertebral – posterior inferior
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45
Q

Basilar artery: Description

A

The basilar artery is a large artery of the posterior circulation of the brain.

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46
Q

Basilar artery: Gross anatomy

A

Origin: Formed from the confluence of the vertebral arteries at the base of the pons.

Course: Ascends parallel to the ventral pons in the central groove of the pons in the pre-pontine cistern

Branches: Numerus small braches to the pons and cerebellum including the:

  • The anterior inferior cerebellar artery (AICA)
  • Labyrinthine arteries (normally from AICA)
  • Superior cerebellar arteries

Termination: bifurcates to form the two posterior cerebral arteries at the upper pontine boarder

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47
Q

Basilar artery: Relations

A
  • Anterior: clivus
  • Posterior: Basilar pons
  • Superior: Posterior cerebral arteries
  • Inferior: vertebral arteries
  • Lateral: Origin; origin of the abducens nerve, termination: origin of the oculomotor nerve
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48
Q

Basilar artery: Variants

A
  • Fenestration
  • Persistent carotid-basilar artery anastomosis
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49
Q

Internal carotid artery: Description

A

Internal carotid arteries are the primary supply to the anterior circulation of the brain

Function: supply oxygenated blood to the brain and meninges

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50
Q

Internal Carotid Artery: Gross anatomy

A

Divides into the following segments (Bouthillier classification):

  • Cervical
  • Petrosal
  • Lacerum
  • Clinoid
  • Caverous
  • Ophthalmic
  • Communicating

Origin:

Bifurcation of the common carotid at the level ~L4

Course: ascending through the carotid space, enters the cranial cavity via the carotid canal

Termination: Branches to for the anterior and middle cerebral arteries

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51
Q

Internal carotid artery: Branches

A

2nd segment:

  • Caroticotympanic
  • Vidian

4th segment:

  • Meningohypophyseal
  • Inferolateral trunk

6th segment

  • Ophthalmic artery
  • Superior hypophyseal

7th segment:

  • Posterior communicating artery
  • Anterior choroidal artery
  • Anterior communicating artery
  • Middle cerebral artery
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52
Q

Internal carotid artery: Relations

A
  • Anterior: External carotid artery
  • Lateral: internal jugular vein
  • Medial: larynx, oropharynx, nasopharynx
  • Superior: suprasellar cistern
  • Inferior: Carotid bulb
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53
Q

Internal Carotid artery: Variants

A
  • Aberrant ICA course
  • Kissing carotids
  • Persistent carotid-vertebrobasilar anastomoses
  • Retropharyngeal ICA
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54
Q

Middle cerebral artery: Gross anatomy

A

Origin: Terminal bifurcation of the Internal carotid artery (the other branch is the anterior cerebral artery

Course:

Divided into segments: (HIOC)

  • M1 – the horizontal segment – from origin to bi/trifurcation
  • M2 – insular segment from bi/trifurcation to the circular sulcus of the insular lobe
  • M3 – Opercular branches – within the sylvian fissure
  • M4 – Cortical segment – branches emerging from the sylvian fissure
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55
Q

MCA Branches

A

Branches:

M1: (PAUL)

  • Medial and lateral lenticulostriate
  • Anterior temporal
  • Polar temporal

M2:

  • Superior and inferior trunks
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56
Q

M1 Supply

A

M1:

  • Basal ganglia
  • External and internal capsule
  • Anterior third of the superior, middle and inferior temporal gyri
  • Polar Regions of the temporal lobe
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57
Q

Cerebral Venous sinuses: Description

A

The cerebral venous sinus are venous system formed from folds of the meninges

Function: return of deoxygentated blood from the brain to the system circulation

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58
Q

Cerebral venous sinuses: Gross anatomy

A

Folded dura form sinus which drain from veins to other sinuses or veins

Valveless

There are paired and unpaired cerebral venous sinuses

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59
Q

Paired Cerebral venous sinuses

A

Transverse sinuses – from the confluence of sinuses to the sagittal sinuses, receives the superficial cerebral vein of labbe

Sigmoid sinuses – from the transverse sinus s-shaped course draining into the jugular bulbs , also receives the sphenoparietal sinus and the superior petrosal sinsu

Superior and inferior petrosal sinuses – From the right and left cavernous sinuses to the sagittal and jugular bulb respectively

Sphenoperietal sinus courses along the ridge of the greater wing of the sphenoid to the cavernous sinsus, also receives the middle superficial cerebral vein

Caverous sinuses located either side of the sella, receives the ophthalmic veins (superior and inferior) connected by the anterior and posterior intercavernous sinsus, drains into the superior and inferior petrosal sinuses and basiclival plexus

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60
Q

Unpaired cerebral venous sinuses

A

Internal cavernous sinuses as noted earlier

Superior sagittal sinus midline between the falx drains into the confluence of sinuses

Inferior sagittal sinus runs in the over the corpus callosum drains into the straight sinus

Straight sinus – from the vein of Galen to the confluence of sinuses

Occipital sinus – from the occipital bone midline between the cerebellar hemispheres drains into the confluence of sinuses

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61
Q

Cerebral venous sinuses: Variants

A

No confluence – straight and superior sagittal sinuses drain into the right and left transverse sinuses separately

No confluence – straight and superior sagittal sinuses fork prior to drain into the straight sinuses

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62
Q

Cerebral venous drainage: Description

A

The cerebral veins drain the brain parenchyma and are located in the subarachnoid space. They pierce the meninges and drain further into the cranial venous sinuses.

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63
Q

Cerebral venous drainage: Gross anatomy

A

The cerebral veins lack muscular tissue and valves.

The cerebral venous system can be divided into:

  • superficial (cortical) cerebral veins
  • deep (subependymal) cerebral veins
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64
Q

Venous drainage of the orbit

A

The venous drainage of the orbit is the venous system to drain deoxygenated blood from the orbit to the systemic circulation.

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65
Q

Intracranial Cisterns: Description

A

The subarachnoid cisterns are discrete named spaces within the subarachnoid space where the pia mater and arachnoid membrane are not in close approximation. The subarachnoid tissue is not as abundant here as in the normal subarachnoid space and cerebrospinal fluid (CSF) gathers to form pools or cisterns (Latin: “box”).

As they are interconnected, the patency is essential for CSF circulation. Being within the subarachnoid space, the cisterns may have vessels and/or cranial nerves passing through them.

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66
Q

Named intracranial cisterns (9)

A
  • cisterna magna: the largest of the subarachnoid cisterns
  • prepontine cistern: anterior to the pons
  • suprasellar cistern: surrounding the infundibulum
  • interpeduncular cistern: between the cerebral crura
  • quadrigeminal cistern: superior cistern or cistern of the great cerebral vein
  • ambient cistern: surrounds the back of the midbrain
  • cerebellopontine cistern: at the cerebellopontine angle
  • premedullary cistern: anterior to the medulla
  • sylvian cistern: superficial to the insular cortex
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67
Q

Bony Orbit: Gross Anatomy

A
  • Gross anatomy
    • Superiorly
      • Frontal bone
      • Sphenoid (lesser wing)
    • Medially
      • Maxilla
      • Lacrimal bone
      • Ethmoid (lamina papyracea)
      • Sphenoid (lesser wing)+/- palatine
    • Inferiorly
      • Maxilla
      • Zygomatic (laterally)
      • Palatine(inferomedial)
    • Laterally
      • Zygomatic
      • Sphenoid (greater wing)
    • Foramina
      • Optic foramina
      • Superior orbital fissure
      • Inferior orbital fissure
  • Contents
    • Orbit
    • Lacrimal gland
    • Optic foramina
      • Optic nerve (CN2)
      • Ophthalmic artery (C6 ICA)
    • Superior orbital fissure
      • CN 3 occulomotor
      • CN 4 trochlea
      • CN 5 (V1 ophthalmic division of trigeminal)
      • CN 6 abducens
      • +/- middle meningeal contribution to ophthalmic artery (variantion)
    • Inferior orbital fissure
      • Infraorbital nerve
      • Infraorbital artery
      • Inferior ophthalmic vein
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68
Q

Bones of the orbit

A

The bony orbit is made up of:

  • Maxillary bone
  • Lacrimal bone
  • Ethmoid bone
  • Zygomatic bone
  • Frontal bone
  • Orbital process of the palatine bone
  • Greater and lesser wings of the sphenoid
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69
Q

Spaces of the Orbit

A
  • Optic nerve sheath complex – optic nerve, central retinal artery and vein, meninges
  • Intraconal space – orbital fat, ophthalmic artery, cranial nerves
  • Conal space – extra ocular muscles
  • Extraconal space – fat, lacrimal gland, lacrimal and frontal braches of V1
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70
Q

Communication with the orbit

A
  • Optic canal to intracranial cavity
  • Superior orbital fissure also to the intracranial cavity
  • Inferior orbital fissure to infratemporal fossa
  • Anterior ethmoidal foramen
  • Posterior ethmoidal foramen
  • Supra and infra orbital foramen
  • Nasolacrimal foramen
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71
Q

Mandible: Description

A

The mandible is a large single midline bone of the lower face

Function: respiration, verbalisation, mastication

Location: Jaw

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72
Q

Mandible: Gross Anatomy

A

Irregular bone. It consists of a curved horizontal portion the body and two perpendicular portions, the rami. The rami and the body unite at almost right angles (the angle of the jaw).

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73
Q

Mandible: Features

A

Body:

  • Mandibular symphysis – midline point of fusion
  • Mental foramen - inferior to the second pre-molar (mental vessels and nerve, the terminal branches of the inferior alveolar vessels and nerves)
  • Fossae for the sublinguinal and submandibular glands
  • Alveolar process of the teeth
  • Groove for the facial artery of the inferior border

Ramus:

  • Mandibular foramen – opening of the mandibular canal, which transmits the inferior alveolar vessels and nerves
  • Coronoid process – anteriorly
  • Condylar process – posterior
  • Mandibular notch – space between the above two
  • Mandibular canal – between the mandibular foramen and the mental foramen
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74
Q

Mandible: Articulation

A
  • Gomphosis joints with the lower row of teeth
  • Temporomandibular joint – between the condylar process of the mandible and the mandibular fossa and the articular eminence of the temporal bone. Atypical synovial joint with a fibrocartilage articular disc
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75
Q

Temperomandibular joint: Description

A

Bilateral joint of the jaw. Modified hinge joint.

Function: Mastication, verbalisation, respiration

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76
Q

TMJ: Anatomy

A

The temporomandibular joint (TMJ) is an atypical synovial joint located between the condylar process of the mandible and the mandibular fossa and articular eminence of the temporal bone.

It is divided into a superior discotemporal space and inferior discomandibular space by the TMJ disc (or meniscus).

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77
Q

TMJ: Movement

A
  • upper compartment: protraction, retraction and gliding side-to-side
  • lower compartment: opening and closing
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78
Q

TMJ: Ligaments

A
  • temporomandibular
  • stylomandibular
  • sphenomandibular
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79
Q

TMJ: Muscles

A
  • Medial and lateral pterygoids
  • Masseter
  • Temporalis
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80
Q

TMJ: Neurovasculature

A

Arterial:

Superficial temporal

Vein:

Retromandibular

Innervation:

  • auriculotemporal nerve
  • masseteric nerve
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81
Q

Extra-ocular muscles: Description

A

The extra-ocular muscles are the six muscles that insert onto the eye and hence control eye

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82
Q

Extraocular muscles: Gross Anatomy

A
  • superior rectus: elevation, annulus of Zinn to the superior globe
  • superior oblique: intorsion, sphenoid bone via catelaginous trochlear to superior lateral globe
  • medial rectus: adduction, annulus of Zinn to the medial globe
  • lateral rectus: abduction, annulus of Zinn to the lateral globe
  • inferior oblique: extorsion, Maxillary bone to inferior lateral globe
  • inferior rectus: depression, annulus of Zinn to the inferior globe
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83
Q

Extra-ocular muscles: innervation

A

oculomotor nerve:

  • superior, medial, and inferior rectus
  • inferior oblique

trochlear nerve:

  • superior oblique

abducens nerve:

  • lateral rectus
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84
Q

Extra-ocular muscles: neurovasculature

A

Arterial:

Ophthalmic artery

Vein:

Superior and inferior ophthalmic veins

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85
Q

Nasolacrimal apparatus: Description

A

The nasolacrimal apparatus is the system responsible for drainage of tears. Production of tears by the lacrimal gland is included in some text under this heading.

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86
Q

Lacrimal gland Gross Anatomy

A
  • Location in the superior lateral orbit in the extraconal space
  • Almond shaped
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87
Q

Lacrimal Apparatus: Gross anatomy

A

Location: From the medial canthus to the inferior concha

Consists of:

  • Lacrimal canaliculi which drain the lacrimal lake via the lacrimal puncta
  • Lacrimal sac – the superior and inferior lacrimal canaliculi drain into the lacrimal sac which lies in the lacrimal fossa, it drains into the nasolacrimal duct via the valve of Krause, the sac is enclosed in the lacrimal fascia and the orbicularis oculi
  • Nasolacrimal duct – Is the inferior continuation of the lacrimal sac, it is approximately 17mm in length, it has 2 parts: intraosseous part which lies within the nasolacrimal canal of the maxilla, the membranous part which runs in the nasal mucosa. It terminates below the inferior nasal meatus as a slit like opening where it is covered by a mucosal fold called the valve of Hasner
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88
Q

Nasolacrimal Apparatus: Neurovasculature

A

Artery: lacrimal artery from the ophthalmic artery

Vein: Superior ophthalmic vein

Nerves: greater petrosal nerve (from facial nerve) and lacrimal nerve (ophthalmic division of the trigeminal nerve)

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89
Q

Nasolacrimal apparatus: Relations

A
  • Medial: the maxilla
  • Lateral: Lacrimal lake
  • Superior: Superior orbital rim
  • Inferior: Floor of the nasal cavity
  • Posterior: ethmoid labyrinth and nasal cavity
  • Aterio-medial: Nasal vestibule
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90
Q

Nasolacrimal Gland Variants

A
  • Incompetent valve of Hasner
  • Absence
  • Accessory glands
  • Draining to the middle meatus
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91
Q

Extra-ocular spaces of the orbit: spaces

A

The orbit is a space of the anterior face

Function:

  • Contain the globe and associated support structures and organs
  • Passage of nerve arteries and veins
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92
Q

Orbit: Relations

A
  • Superior: frontal bone, and anterior fossa
  • Inferior: Maxillary sinus
  • Lateral: infratemporal space
  • Medial: ethmoidal air cells
  • Posterior: the cavernous sinuses
  • Anterior: Superior and inferior palabra
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93
Q

Constrictors of the pharynx

A

The constrictor muscles of the pharynx are a set of 3 pharyngeal constrictors that constrict the pharynx to deliver a bolus of food to the oesophagus.

Type: skeletal muscles under semi-voluntary control

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94
Q

Superior pharyngeal constrictor

A
  • Origin: pterygoid hamulus, pterygomandibular raphe and mandible
  • Insertion: Pharyngeal raphe
  • Artery: ascending pharyngeal artery, branch of the external carotid artery
  • Nerve: pharyngeal plexus from vagus
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95
Q

Middle Pharyngeal constrictor

A
  • Origin: Greater and lesser conu of the hyoid bone
  • Insertion: Pharyngeal raphe
  • Artery: Ascending pharyngeal artery (external carotid artery)
  • Nerve: pharyngeal plexus from vagus
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96
Q

Inferior pharyngeal constrictor

A
  • Origin: Cricoid and thyroid cartilage
  • Insertion: Pharyngeal raphe
  • Artery: Ascending pharyngeal artery
  • Nerve: pharyngeal plexus from vagus
  • Incorporates cricopharyngeus inferiorly
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97
Q

Pharyngeal constrictors: Relations

A
  • Anterior – pharynx
  • Posterior – Cervical spine vertebrae and retrophpharyngeal space
  • Lateral – carotid sheath and it’s contents
  • Superior – base of the skull
  • Inferior – Cricopharyngeus muscle
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98
Q

Pharyngeal Constrictors:Variants

A
  • Cricopharyngeal bar
  • Zenker’s diverticulum
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99
Q

Sternocleidomastoid Muscle

A

The sternocleidomastoid (SCM) is a muscle of the neck. It has two heads that meld to form one insertion. SCM, along with the trapezius muscle, is invested by the superficial layer of the deep cervical fascia, which splits around it. SCM divides the neck into anatomical anterior and posterior triangles.

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100
Q

SCM: Gross Anatomy

A

origin: manubrium (sternal head – tendinous), medial clavicle (clavicular head – muscular)

insertion: mastoid process of the temporal bone, superior nuchal line of the occipital bone

Artery: Superior thyroid and occipital arteries

innervation: accessory nerve (CN XI)

action: lateral flexion, flexion and rotation of the head on the neck, raise sternum (secondary muscle of respiration).

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101
Q

SCM: Relations

A

upper half:

anteriorly: platysma muscle, external jugular vein

Medial: anterior scalene muscle, common carotid artery, internal jugular vein, carotid sheath

lower half:

anteriorly: platysma
posteriorly: anterior scalene muscle, common carotid artery, internal jugular vein, carotid sheath

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102
Q

SCM: Variants

A
  • absent mastoid insertion (occipital insertion only)
  • absent clavicular or sternal head
  • fusion with trapezius muscle
  • additional clavicular head
  • separate muscle bellies for sternomastoid and cleidomastoid
  • separate muscle bellies for cleidooccipital and sternocleidomastoid
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103
Q

External Carotid artery: Description

A

The primary blood supply to the face and neck

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104
Q

ECA: Gross anatomy

A

Origin: at the common carotid bifurcation level C4

Course:

  • Through the carotid sheath
  • Divided from the internal carotid artery by styloglossus and stylopharangeus
  • Exiting to pass through the parotid gland

Termination: bifurcation in the maxillary and superficial temporal artery

Distinguishable from ICA due to the many branches of the ECA

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105
Q

Branches of the ECA

A
  • Superior thyroid artery
  • Asecnding laryngeal
  • Lingual
  • Facial
  • Occipital
  • Posterior auricular
  • Maxillary
  • Superficial temporal
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106
Q

Relations of ECA

A
  • Anterior – sternocleidomastoid
  • Posterior – internal carotid artery
  • Medial – larynx
  • Lateral – sternocleidomastoid
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107
Q

Variants of the ECA

A
  • Branch height

Trunks:

  • Lingofacial trucnk
  • Thryolingual
  • Thyrolingualfacial
  • Occipital and posterior auricular have common trunk
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108
Q

Jugular veins: Description

A

There are 4 paired jugular veins which provide drainage of deoxygenated blood from the face, head and brain:

  • Internal jugular veins
  • External jugular veins
  • Posterior external jugular veins
  • Anterior jugular veins
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109
Q

Internal jugular vein: Gross Anatomy

A

Origin: Formed by the union of the inferior petrosal and sigmoid dural venous sinuses at the jugular foramen.

Course: Descending in the carotid sheath, anterior to the internal carotid and vagus nerve, enters the thorax posterior to the two heads of the sternocleidomastoid

Drains to: unites with the subclavian vein to form the brachiocephalic vein

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110
Q

Internal jugular vein: Tributaries

A

Tributaries:

(medical school lets fun people in)

  • Middle thyroid v
  • Superior thyroid v
  • Lingual v
  • Facial v
  • Pharyngeal v
  • Inferior petrosal sinus
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111
Q

External Jugular veins: Gross anatomy

A

Origin: Retromendibular and posterior auricular veins unite to form the external jugular vein at the angle of the mandible

Course: Descends deep to the platysma but superficial to SCM, pierces the cervical fascia posterior to the head of the clavicle

Drains to: subclavian veins

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112
Q

External jugular veins: Tributaries

A
  • Anterior jugular vein
  • Posterior external jugular vein
  • Suprascapular vein
  • Transverse cervical vein
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113
Q

Anterior jugular veins

A

Origin: Arise in the region of the hyoid bone confluence of multiple submandibular vessels

Course: Descending medial to the anterior boarder of the sternocleidomastoid

Drains to: passes deep to SCM to drain into the external jugular vein

Tributaries: Small submandibular, laryngeal and thyroid veins

Variant: may drain directly to the subclavian veins

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114
Q

Posterior jugular veins

A

Origin: Confluence of superficial veins of the posterosuperior neck and scalp

Course: Supeficial course over the posterior triangle

Drains to: External jugular vein

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115
Q

Level 1 lymphatics in the neck

A

Submental and submandibular nodes

  • Below mylohyoid muscle and above the lower margin of the hyoid bone (or the carotid bifurcation)
  • anterior to the posterior border of the submandibular glands
  • level Ia: submental nodes, i.e. between the anterior bellies of the digastric muscles
  • level Ib: submandibular nodes between the anterior and posterior bellies of digastric muscles
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116
Q

Level II lymphatics in the neck

A

Superior Internal jugular (deep cervical) chain

  • base of the skull to the inferior border of hyoid bone (or the carotid bifurcation)
  • anterior to the posterior border of sternocleidomastoid (SCM) muscle
  • posterior to the posterior border of the level I glands
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117
Q

Level III lymphatics in the neck

A

Middle Internal jugular (deep cervical) chain

  • lower margin of hyoid to lower margin of cricoid cartilage (or the intermediate tendon of Omohyoid)
  • anterior to the posterior border of SCM
  • Posterior to the anterior boarder of SCM
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118
Q

Level IV lymphatics in the neck

A

Inferior Internal jugular (deep cervical) chain

  • lower margin of cricoid cartilage to level of the clavicle
  • anterior and medial to an oblique line drawn through the posterior edge of SCM and the posterolateral edge of the anterior scalene muscle
  • Posterior to the anterior border of SCM
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119
Q

Level V lymphatics in the neck

A

Posterior triangle (spinal accessory) nodes, posterior to posterior edges of SCM and scalenus anterior

  • level Va: superior half, posterior to levels II and III
  • level Vb: inferior half, posterior to level IV
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120
Q

Level VI lymphatics in the neck

A

prelaryngeal / pretracheal / Delphian node

  • from the inferior margin of hyoid bone to the manubrium
  • anterior to levels III and IV
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121
Q

Level VII lymphatics in the neck

A
  • superior mediastinal nodes
  • between CCAs, below superior aspect of manubrium to level of the brachiocephalic vein
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122
Q

Thyroid gland: Description

A

The thyroid gland is an endocrine gland located in the pre-tracheal fascia of the neck

Function: endocrine control of metabolism

Location: Pre-tracheal fascia anterior to the thyroid, cricoid and first 3 tracheal cartilages

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123
Q

Thyroid: Description

A
  • Butterfly shaped with a lobe bilaterally joined by a central isthmus
  • Each lobe may be divided into an upper and lower pole
  • Parathyroid glands lie with each pole and are sometime intracapsular
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124
Q

Thyroid: Neurovasculature

A

Arterial supply:

  • Superior thyroid artery (from the ECA)
  • Inferior thyroid artery (from the thyrocervical trunk)

Venous drainage:

  • Superior, middle and inferior thyroid veins (internal jugular, internal jugular and brachiocephalic vein)

Innervation:

  • Superior, middle and inferior cervical ganglia

Lymphatics:

  • Level 6 cervical nodes
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125
Q

Thyroid relations

A
  • Anterior – strap muscle
  • Posterior – thyroid and cricoid cartilage, trachea
  • Posterior medial – trachea-oesophageal groove with the parathyroid glands and the recurrent laryngeal nerves
  • Posterior lateral – carotid space
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126
Q

Thyroid: Variants

A
  • Pyramidal lobe
  • Lobar hemigenesis
  • Thyroglassal duct cyst
  • Ectopic thyroid tissue – lingual thyroid
  • Zuckerkandl’s tubercle
  • Thyroidea Ima artery
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127
Q

Humerus: Description

A

Single long bone of the arm Location: between the shoulder and the elbow

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128
Q

Humerus: Gross Anatomy

A
  • Proximal: Rounded head covered with articular cartilage, greater and lesser tubercles, intertubercular groove
  • Mid: Surgical neck inferior to the tubercles, deltoid tuberosity, spiral groove from radial nerve
  • Distal: condyle of the humerus which consists of: capitulum, trochlear, medial and lateral epicondyles, radial fossa, olecranon fossa, coronoid fossa
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129
Q

Humerus: Articulations

A
  • Proximal: the head of the humerus articulates with the glenoid of the scapula
  • Distal: capitulum with the radial head, trochlear with the trochlear notch of the ulnar
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130
Q

Humerus: Ligaments

A
  • Superior, middle, inferior and spiral glenohumeral ligaments
  • Radial and ulnar collateral ligaments
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131
Q

Humerus: Relations

A
  • Anterior: brachialis, bicep brachii, coracobrachialis
  • Posterior: Profunda brachii, radial nerve, triceps brachii
  • Lateral: deltoid
  • Medial: brachial plexus, brachial artery, supratrochlear nodes
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132
Q

Humerus: Neurovasculature

A

Blood supply:

  • Anterior and posterior humeral circumflex arteries and veins
  • Perforators from profunda brachii

Lymphatics:

  • Supratrochlear and axillary nodes

Innervation:

  • Radial nerve
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133
Q

Humerus: Variants

A
  • Supracondylar process
  • Olecranon foramen
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134
Q

Elbow Joint: Description

A

The elbow joint is a complex synovial joint between the arm and the forearm

Has a joint capsule
Synovial

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135
Q

Elbow Joints: Movements

A

Combination hinge pivot joint:
Internal and external rotation of the arm
Flexion and extension of the arm

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136
Q

Elbow Joint: Articulation

A
  • Proximal head of the radius the capitulum of the humerus
  • Trochlea notch of the ulnar with the trochlear of the humerus
  • Proximal radial head the proximal radial notch of the ulnar
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137
Q

Elbow Joint: Muscles

A
  • Brachioradialis
  • Biceps brachii
  • Triceps brachii
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138
Q

Elbow Joint: Ligaments

A
  • Annular ligament
  • Proximal radial and ulnar collateral ligament complexes
  • Oblique cord- thickening of the supinator
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139
Q

Elbow Joint: Fat Pads

A
  • Coronoid and radial fossa fat pads anteriorly
  • Olecranon fat pad posteriorly
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140
Q

Elbow Joint: Neurovasculature

A

Blood supply:

  • Anastomotic arcade formed from branches of the radial, ulnar and brachial arteries

Nerves:

  • Median, radial, ulnar and musculocutaneous nerves
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141
Q

Elbow Joints: Relations

A
  • Anterior: biceps brachii tendon, brachialis muscle, median nerve, brachial artery
  • Posteriorly: Olecranon bursae, triceps brachii tendon
  • Laterally: Common extensor tendon, supinator muscle
  • Medially: ulnar nerve
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142
Q

Elbow Joint: Variants

A
  • Variation in carry angle between males and females, females have larger angles usually
  • Synovial folds
  • Capitellar and olecranon pseudofacets
  • Accessory ossicles: os supratrochlear dorsale, patella cubiti
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143
Q

Glenohumeral Joint: Description

A

The shoulder joint also known as the gleno-humeral joint is a ball and socket synovial joint between the humerus and the glenoid.

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144
Q

Glenohumeral Joint: Movement

A
  • Most mobile joint in the body
  • Flex/extension, int. ext. rotation, ab and adduction
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145
Q

Glenohumeral joint: Articulation

A

Head of the humerus with the glenoid fossa of the scapula. The glenoid labrum adds depth to the glenoid fossa.

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146
Q

Glenohumeral Joint: Capsule

A
  • Attached to the margin of the glenoid fossa to the anatomical neck of the humerus, the long head of the biceps travels through it.
  • It is re-enforced by the rotator cuff except inferiorly where it is at its weakest
147
Q

Glenohumeral Joint : Bursa

A
  • Subacrominal – subdeltoid bursa
  • Subscapular bursa (communicates with the joint by the foramen of Weitbrecht)
148
Q

Glenohumeral Joint: Ligaments

A
  • Superior, middle and inferior glenohumeral ligaments
  • Coracohumeral ligaments
  • Transverse humeral ligament
149
Q

Glenohumeral Joint: Muscles

A
  • abduction
    • produced by the deltoid assisted by the supraspinatus
  • adduction
    • produced by the short scapular muscles (except supraspinatus) when the deltoid relaxes. Assisted by the pectoralis major and latissimus dorsi
  • flexion
    • clavicular head of the pectoralis major and the anterior fibers of the deltoid, assisted by the coracobrachialis and biceps
  • extension
    • latissimus dorsi, posterior fibers of the deltoid and the long head of the triceps
  • rotation
    • lateral rotation: infraspinatus and teres minor
    • medial rotation: subscapularis and teres major
150
Q

Glenohumeral Joint: Neurovasculature

A

Arterial supply:

  • Anterior and posterior humeral circumflex and subscapular arteries

Innervation:

  • Axillary (C5-C6), suprascapular, subscapular, musculocutaneous nerves

Lymphatics:

  • Axillary
151
Q

Glenohumeral joint: Variants

A
  • Buford complex – cord like middle glenohumeral ligament
  • Os acrominale
  • Capsule attached to labrum
  • Long head of biceps insertion – glenoid, glenoid and labrum, labrum only
152
Q

Biceps Brachii: Description

A

The biceps brachii muscle (also known simply as biceps) is a two-headed muscle in the anterior compartment of the arm that flexes at the elbow and supinates the forearm.

153
Q

Biceps Brachii: Attachments

A
  • Origin:
    • Short head: coracoid process of the scapula
    • Long head: supraglenoid tubercle of the scapula
  • Insertion:
    • Radial tuberosity of the proximal radius
154
Q

Biceps Brachii: Innervation

A

musculocutaneous nerve

155
Q

Biceps Brachii: Action

A
  • arm abduction, arm adduction and ventral flexion
  • supination
  • flexion of the supinated forearm
156
Q

Biceps Brachii: Variants

A
  • Duplicated long head of biceps tendon: can mimic longitudinal tear
  • Bifid/bifurcated insertion: anatomic variant that arises from persistent division between the short head and long head of the distal biceps brachii tendon
157
Q

Brachial Plexus: Description

A

A plexus of nerves innervating the arm and part of the upper thorax
Location: in the neck extending into the axilla, posterior to the clavicle

Supply: motor and sensory to upper limb and upper thorax

158
Q

Brachial Plexus: Components

A

Roots – C5 to T1
Trunks – upper C5-6, middle C7, lower C8-T1
Divisions – anterior and posterior
Cords – named to their relation to the axillary artery – medial, lateral, posterior
Branches:

  • Axillary (C5-6)
  • Musculocutaneous (C5-7)
  • Radial (all)
  • Medial (all)
  • Ulnar (C7, 8 T1)
159
Q

Brachial Plexus: Course

A

Emerges between the middle and anterior scalenes
Course intimately related to the axiallary artery

160
Q

Brachial Plexus: Variant Anatomy

A
  • ~50% Pre-fixed – C4 contribution or Post-fixed – T2 contribution
  • Variation in branching patterns
161
Q

Venous drainage of the left upper limb: Description

A

Venous drainage of the upper limb is a vascular system for the return of deoxygenated blood from the capillary beds of the upper limb to the heart via the superior vena cava.

162
Q

Venous drainage of the left upper limb: Deep System

A

The deep veins are located under the deep fascia. They are typically paired and lie on either side of an artery from which they take their name (venae comitantes).

163
Q

Venous drainage of the left upper limb: Hand

A
  • Deep venous palmar arch - receives the palmar metacarpal veins, drains to the radial veins
  • Radial veins - Receives the deep venous palmar arch, run with the the radial artery, drains into the brachial veins
  • Ulnar veins – Receives the surficial venous palmar arch, runs with the ulnar artery, drains into the brachial veins
  • Brachial veins – Origin at the union of the radial and ulnar veins, course following the brachial artery, ending at the inferior border of teres major, at this point the brachial veins join the basilic vein to form the axiliary vein
  • Axillary veins – the axillary vein continues with the axillary artery and is joined by the cephalic vein, subscapular vein, circumflex humeral vein, lateral thoracic vein and thoraco-acromial vein. It terminates at the lateral margin of the first rib where it becomes the subclavian vein.
164
Q

Venous drainage of the left upper limb: Superfical System

A
  • Superficial venous palmer arch: accompanies the superficial palmer arch, drains the commo palmer digital veins, drains into the ulnar vein
  • Dorsal venous network: formed from the dorsal metacarpal veins drains into the basilic and cephalic veins
  • Cephalic – origin the dorsal venous plexus, runs up the superficial space of the lateral aspect of the arm, drains to the median cubital and axially vein
  • Basilic – origin the dorsal venous network, up the superficial tissue of the medial aspect of the arm, also receives the median cubital vein, drains to the brachial veins mid arm
165
Q

1st rib: Description

A

The ribs are the main structural element of the thorax.

Function: Protection, respiration

166
Q

1st Rib: Gross Anatomy

A

There are 12 ribs which are separated by intercostal spaces.

The first 7 ribs increase in length the lower five decrease in length.

The 1st, 11th and 12th ribs are considered atypical ribs.

167
Q

Ribs: Description

A

True ribs – First 7 attached to the sternum directly by their own costal cartilage

False ribs – 8th to 10th, converge anteriorly via the costal cartilage to the 7th costal cartilage thus have indirect connection to the sternum.

Floating ribs – the 11th and 12th have no anterior direct or indirect sternal attachment

The first rib is the most superior of the twelve ribs. It is an atypical rib because of number differentiating features and is an important landmark for the borders of the superior thoracic aperture.

168
Q

1st Rib: Features

A
  • Compared to a typical rib the first rib is short and thick.
  • It has a singular articular facet of the costovertebral joint.
  • The first rib has a head, neck and shaft but lacks a discrete angle.
  • Groove for the subclavian artery – laterally
  • Groove for the subclavian vein – anterior to the scalene turbicle
  • Transverse tubercle – Posterior and lateral to the neck it bears a facet for the transverse process of T1
  • Scalene tubercle – anterior between the grooves for the subclavian artery and vein.
169
Q

1st Rib: Articulation

A
  • Costovertebral joint
  • Costotransverse joint
  • Costochondral joint
170
Q

1st Rib: Attachments

A
  • Anterior and middle scalene
  • Intercostal muscles
  • Subclavius muscle
  • Serratus anterior
  • Costoclavicular ligaments
171
Q

1st Rib: Neurovasculature

A

Blood supply:

Arterial: internal thoracic and superior intercostal arteries, venous: intercostal veins

Innervation: first intercostal nerve

172
Q

1st Rib: Relations

A
  • Anterior: Sympathetic trunk over the neck, superior intercostal artery, ventral T1 nerve root
  • Superior: lower trunk of the brachial plexus, subclavian artery and vein, clavicle
  • Inferior: Intercostal vessels and nerves, parietal pleura
  • Medial: contents of the superior thoracic aperture
  • Lateral: Axillary artery and vein, divisions and cords of the brachial plexus
173
Q

1st Rib: Variants

A
  • First cervical rib
  • Bifid (forked) rib
  • Hypoplastic rib
174
Q

Aortic Arch: Gross anatomy

A

Layers: adventitia, media and intima

Origin: T4 plane continuation of the ascending aorta

Course: posterior and to the left in the superior mediastinum

Termination: continuation as the descending aorta pass the level T4

Branches: brachiocephalic trunk, Left common carotid artery, left subclavian artery

175
Q

Aortic arch: Relations

A

Superior: Large vessels of the superior mediastinum

Inferior: recurrent laryngeal (which one), ligament arteriosum, the bifurcation of the pulmonary trunk

Anterior: thymus or thymic reminant, fat

Posterior: trachea, oesophagus, thoric duct crosses from right to left

Lateral: right superior vena cava, terminination of the azygos, right upper lobe left: left upper lobe lung

176
Q

Variants of the Aortic arch

A
  • Double arch
  • Bovine arch common origin of the left common carotid and brachiocephalic trunk
  • Left common carotid from the brachiocephalic trunk

Branches directly from the aorta:

  • Thyroid Ima
  • Vertebral artery (most commonly the left)
  • Right subclavian and right common carotid

Right sided arch:

  • Type 1 - mirror
  • Type 2 – absent left subclavian
  • Type 3 – isolated left subclavian
177
Q

Thoracic duct

A

The thoracic duct is the main lymphatic channel for the return of chyle to the venous system.

178
Q

Thoracic duct: Gross anatomy

A
  • Origin: continuation from the cistern chyli
  • Course in the retroperitneum posterior to the great vessels ascending, entering the thoracic cavity via the aortic hiatus at T12, continues to ascend in the posterior mediastinum on the right hand side initially, swapping sides at the level T4, continuing superiorly through the thoracic inlet, anterior to the subclavian artery, anterior to the anterior scalene, draining in the convergence of the left subclavian and internal jugular.
179
Q

Thoracic Duct: Relations

A
  • Anterior: oesophagus, left atrium, carina
  • Posterior: vertebral column, symphathetic chain of ganglion
  • Left lateral: descending aorta, left lung and pleura
  • Right lateral: azygos vein, right lung and pleura
180
Q

Thoracic Duct: Variants

A
  • Variant anatomy in 40% of the population
  • Duplication
  • Aberrant termination
  • Multiple terminal channels

Continues on the right to terminate in the right internal jugular vein

181
Q

Trachea: Description

A

The trachea is the primary trunk of the conductive airways

Function: transmission of gas between the larynx and the main bronchi

Location: Visceral space of the neck and posterior mediastinum

182
Q

Trachea: Gross anatomy

A

Made up of posteriorly incomplete cartilage rings with interspaced annular ligaments

Enveloped by the trachealis muscle which is particularly prominent posteriorly

Lined with ciliated epithelium

Divided into: cervical and thoracic trachea

Origin: continuation of the airway distal to the cricoid cartilage (C6)

Termination: birfucates at the carina level L4

183
Q

Trachea: Neurovasculature

A

Arterial supply:

  • Inferior thyroid arteries
  • Bronchial arteries

Venous drainage:

  • Inferior thyroid veins
  • Azygos system

Lymphatics:

  • Drainage into deep cervical, peri and para-tracheal nodes of the mediastinum

Innervation:

  • Vagus and sympathetic trunk
184
Q

Trachea: Relations

A
  • Posterior: oesophagus and recurrent laryngeal nerve
  • Anterior: Thyroid strap muscle, jugular notch, manubrium, great vessels of the superior mediastinum
  • Lateral: Sternocleidomastoid, brachiocephalic veins and arteries
  • Superior: larynx
  • Inferior: Sub-carinal lymph nodes, main bronchi
185
Q

Trachea: Variants

A
  • Trachea oesophageal fistula
  • Tracheal atresia
  • Pig bronchus
  • Lunate trachea
  • Tracheal diverticulum
186
Q

Bronchial tree: Description

A

Branching tree of airways beginning at the carina.

The lumen diameter decreases with each branching.

Airways down to the level of the bronchioles contain c-shaped rings of hyaline cartilage to maintain the patency of the lumen.

Function: transmission of gas between the trachea and the respiratory airways of the lungs

187
Q

Branches of the Bronchial tree

A

Right side:

  • Right main bronchus
  • Bronchus intermedius
  • Right Upper lobe bronchus
  • Right middle lobe bronchus
  • Right lower lobe bronchus

Left side:

  • Left main bronchus
  • Left upper lobe bronchus
  • Left lower lobe bronchus

Further branches:

  • Segmental bronchi
  • 20 to 25 generations of bronchioles
  • Terminal bronchioles
188
Q

Bronchial tree: Vasculature

A

Arterial supply:

  • Bronchial arteries
  • Branches of the descending aorta

Venous drainage:

  • Bronchial veins draining into the azygos system

Lymphatic drainage:

  • Hilar nodes
189
Q

Bronchial Tree: Variants

A
  • Bronchial cyst
  • Pig bronchus
  • Oesophageal branch
  • Azygos bronchus
  • Cardiac bronchus
190
Q

Superior thoracic apeture: Description

A

The superior thoracic aperture is the superior opening into the thorax

Function: Allow the passage of a large number of structure into and out of the thorax

Location: Encircled by the first rib, the T1 vertebrae and the manubrium

191
Q

Thoracic inlet: Organs

A
  • Lung apices
  • Trachea
  • Oesophagus
  • Thymus
  • Sometimes the thyroid
192
Q

Thoracic inlet: Vasculature

A
  • Brachiocephalic veins
  • Internal thoracic arteries
  • Brachiocephalic truck
  • The left common carotid artery
  • The left subclavian artery

Lymphatics:

  • Cervical lymph nodes
  • Thoracic duct
193
Q

Thoracic inlet: Nerves

A
  • Vagus nerves
  • Phrenic nerves
  • Ascending laryngeal nerves
  • The sympathethetic chain of ganglion
194
Q

Thoracic inlet: Muscles

A
  • Part of sternocleidomastoid
  • Sternohyoid
  • Sternothyroid
195
Q

Thoracic inlet: Variants

A
  • Right common carotid and subclavian can pass through
  • Thyroid IMA artery can pass through
  • Thyroid can extend through
  • Cervical ribs
196
Q

Biliary Tree: Description:

A

The biliary tree is the system of biliary vessels of the liver and abdomen
Location:
Intrahepatic and within the free edge of the lesser omentum

197
Q

Biliary tree: Gross Anatomy

A

Dividable into intrahepatic and extrahepatic ducts
Each liver segment has its own biliary drainage duct, where biliary canaliculi unite to form segmental ducts. There ducts join to form:

  • Right posterior duct
  • Right anterior duct
  • Right hepatic duct
  • Left hepatic duct
198
Q

Biliary Tree: Course

A

The right and left hepatic duct unite to form the common hepatic duct, segment I drains directly here also. The common hepatic duct then leaves the liver parenchyma.
The common hepatic duct is joint by the cystic duct of the gallbladder arfter ~2-3cm, they unite to form the common bile duct.
The common bile duct runs in the free edge of the lesser omentum, behind the head of the pancreas to join with the main pancreatic duct forming the ampulla of Vater draining into the D2 via the sphincter of oddi.

199
Q

Biliary Tree: Neurovasculature

A

Blood supply:

  • Right and left hepatic artery
  • Cystic artery
  • Branches of the common hepatic artery
  • Posterior pancreaticoduodenal artery branches
  • Gastroduodenal artery

Venous:

  • Into the portal system

Lymphatics:

  • Porta hepatis nodes
  • Coeliac nodes

Innervation:

  • Coeliac plexus
200
Q

Biliary Tree: Relations

A

At the porta hepatis:
The common hepatic duct lies in front and is to the right of the hepatic artery, the portal vein is between the two

201
Q

Biliary Tree: Variants

A

Cystic duct:

  • Duplication
  • Low insertion
  • High insertion
  • Cystic artery posterior to the right hepatic duct

Common hepatic duct:

  • Triple confluence
  • Aberrant hepatic duct
  • Non-union of the left and right hepatic ducts

CBD:

  • May pass behind through or around the pancreatic head
  • Variable location of the ampulla
  • CBD may drain separately from the main pancreatic duct
  • Pancreatic divisum
202
Q

Extrahepatic Biliary Tree: Description

A

The extra hepatic biliary tree is the system responsible for the drainage and storage of bile from the liver to the D2 segment of the duodenum.

203
Q

Extrahepatic biliary tree: Gross Anatomy

A

The left and right intrahepatic ducts join to form the common hepatic duct which leaves the liver parenchyma at the porta hepatis anterior to the hepatic artery and to the right of the portal vein.
The common hepatic duct joins the cystic duct to form the common bile duct.
The common bile duct initially travels in the free edge of the lesser omentum, then courses posterior to the duodenum and the pancreas joining the main pancreatic duct to form the ampulla of Vater.
The ampulla of Vater drains into D2 via the major duodenal papillae

204
Q

Extrahepatic Biliary Tree: Neurovasculature

A

Arteries:

  • Cystic
  • Right hepatic
  • Posterior superior pancreaticoduodenal artery

Venous:

  • Drains to portal vein

Lymphatics:

  • Porta hepatis
  • Coeliac
205
Q

Extrahepatic Biliary Tree: Variants

A

Cystic duct:

  • Low insertion
  • Medial insertion
  • Parallel course
  • Cystic artery anterior to the cystic duct

Common hepatic duct:

  • Triple confluence
  • Aberrant hepatic duct
  • Non-union of the right and left hepatic ducts

Common bile duct:

  • Partially covered posteriorly
  • Completely covered
  • Completely uncovered
  • Lateral to pancreatic head
206
Q

Duodenum: Description

A
  • The duodenum is the first part of the small intestine
  • Location: between the pylorus of the stomach and the jejunum, in the anterior pararenal space
  • Function: Alkalinisation of chym, mixing of bile with chyme, sensing of chyme to produce gastrointestinal reflexes
207
Q

Duodenum: Gross Anatomy

A

C-shape of small bowel lies at the level L1-3
Encompasses the head of the pancreas in the duodenal sweep
Length 20-30 cm in length

208
Q

Duodenal Segments

A
  • D1 from the pylorus of the stomach courses to the right, features duodenum bulb
  • D2 from the D1 segment descending approximately 3-4cm, features major and minor duodenal papilla
  • D3 from D2 turn to the left around the pancreatic head course
  • D4 from D3 continues to course to the left however also ascends to the ligament of Treitz, after the small bowel continues as the jejunum
209
Q

Duodenal Relations

A
  • SMA and SMV are anterior to the D3 segment
  • Inferior vena cava and the abdominal aorta are posterior to the D3 and D2
  • D1, D2, D3 form a c shaped around the pancreatic head
210
Q

Duodenum: Neurovasculature

A

Arterial:

  • Duodenal cap – right gastric and right gastroepiploic arteries
  • Superior and inferior, posterior and anterior pancreaticoduodenal arteries

Venous drainage:

  • Duodenal cap – prepyloric vein into the portal vein
  • Superior and inferior, anterior and posterior pancreaticoduodenal veins draining into the superior mesenteric vein

Lymphatics:

  • Coeliac and superior mesenteric nodes

Innervation:

  • Vagus and superior mesenteric plexus
211
Q

Duodenal variants

A
  • Duodenal papilla inserts into different segments
  • Duodenal duplication
  • Duodenal diverticulum
212
Q

Left kidney: Description

A

The kidneys are paired retropenritoneal organs. Function: production of urine, water and electrolyte homeostatsis, hormone production Location: Perirenal space, long axis parallel to psoas, lies on quadratus lumborum

213
Q

Left Kidney: Gross Anatomy

A
  • 9-14cm long, left usually larger than the right
  • Bean shaped
  • Fibrous capsule
  • Divided in the superior, mid and inferior poles
  • The parenchyma consists of cortex and medulla.
  • The renal sinus consists of the renal pelvis, calyces, vessels, nerves, lymphatics and fat
  • The renal cortex lie peripheral
  • The medulla consists of 10-14 hilum facing pyramids, separated by renal columns
  • Each pyramid drains into minor calyces via a papilla, which inturn 3-4 join to form the major calyces, of which 2-3 join to drain into the renal pelvis
214
Q

Left kidney: Neurovasculature

A
  • Arterial: right and left renal arteries from the abdominal aorta level L1
  • Venous: Right and left renal veins into the inferior vena cava
  • Innervation: Renal plexus
  • Lymphatics: Peri-renal and para-aortic
215
Q

Right Kidney: Relations

A
  • Anterior: Hepatic flexure, liver
  • Posterior: Diaphragm, quadratus lumborium
  • Superior: right adrenal gland, liver
  • Inferior: Right ureter
  • Medial: duodenum, inferior vena cava
216
Q

Left Kidney: Relations

A
  • Anterior: Splenic flexure, stomach, lesser sac
  • Posterior: quadratus lumborum
  • Superior: Spleen
  • Inferior: Left ureter
  • Medially: Jejunum and pancreas
217
Q

Kidney: Variants

A

Horseshoe, agenesis, cross fused renal ectopia, pancake, pelvic kidney, colomn of bertin, dromedary
hump, accessory renal arteries, duplex collecting system, retrocaval ureter

218
Q

Pancreatic Duct: Gross Anatomy

A

Main pancreatic duct (Wirsung) – runs the length of the pancreas terminates at the ampulla of Vater, formed by the fusion of the dorsal and ventral ducts.
Accessory pancreatic duct (Santorini) – Variant, usually connects to the main duct, runs in the head of the pancreas drains to the minor duodenal papilla. Ruminant of the dorsal duct.
Smaller ducts – clusters of exocrine pancreastic cells for acini which are connected to:
intercalated ducts
Intralobular ducts join to the main pancreatic duct in a herringbone pattern

219
Q

Pancreatic Duct Variants

A
  • Pancreatic divisum – most common variant, failure of fusion of the dorsal and ventral ducts. As a result the majority of pancreastic secretions are drained via the minor papilla, believed to increase the risk of pancreatitis. Types;
    • 1 no connection
    • 2 Absent ventral duct
    • 3 Inadequate connection
  • Santorrinicele – cystic dilation of the of the dorsal duct in the setting of pancreatic divisum
  • Meandering main pancreatic duct – maybe z-type or loop type
  • Ansa pancreatica – loop like connection between the main and accessory ducts
  • Anomalous pancreaticobiliary junction – union of the pancreatic duct and the common bile duct outside of the duodenal wall
220
Q

Segmental Anatomy of the liver: Descriptions

A

The liver can be divided into 8 functionally independent segments using the Couinaud classification
system.

221
Q

Segmental anatomy of the liver: Gross anatomy

A

Each segment has its own dual blood inflow, lymphatic and biliary drainage
Each segment is a wedge pointed at the porta hepatis
The segement are divided in to a superior and inferior group by a horizontal plane drawn at the level of the bifurcation of the portal vein.
The segments are divided right to left by vertical planes following the hepatic veins.

222
Q

Segments of the liver

A

Segment 1 – caudate lobe special in this system as is can receive supply from the left and right portal system, location – around the vena cava, divided into medial caudate process and lateral papillary process. Drains directly into the IVC
Segment 2 and 3 – to the left of the left hepatic vein, superior and inferior to the portal vein bifurcation
Segement 4 – between the left and middle hepatic veins, divided into A for part above the bifurcation of the portal vein and B for below
5 and 6 – Both inferior to the portal bifurcation, 5 between the middle and the right hepatic veins, 6 to the right of the right hepatic vein
7 and 8 - both above the portal vein bifurcation, 7 to the right of the right hepatic vein, 8 between
the right and middle hepatic veins

223
Q

Segmental anatomy of the liver: Variants

A
  • Right or left supply to the caudate
  • Hepatic vein duplication
  • Reidels lobe
  • Beavertail liver
224
Q

Spleen: Description

A

The spleen is an unpaired haematological organ of the abdomen
Function: Immune, red cell production and maturation
Location: left hypochondrium

225
Q

Spleen: Gross Anatomy

A
  • Wedge shaped
  • ~12.5cm in length
  • Enclosed by a thin capsule
  • Tissues consists of inner red pulp and outer white pulp
  • Has a upper and lower pole
  • Has a visceral and diaphragmatic surface
  • Covered by peritoneum except the hilum which has the:
    • Gastrosplenic ligament
    • Splenorenal ligament
226
Q

Spleen: Neurovasculature

A

Arterial: Splenic artery (coeliac trunk)
Venous: splenic vein into portal
Lymphatics:
Splenic hilar, retropancreatic, coeliac
Innervation:
Coeliac plexus (vagal trunks)

227
Q

Spleen: Relations

A

Diaphragmatic surface – dome of the left hemidiaphragm
Visceral surface – tail of the pancreas, left kidney, adrenal gland, stomach

228
Q

Spleen: Variants

A
  • 10% accessory spleen
  • Wondering spleen
  • Polysplenia
  • Aspenia
  • Splenogonal fusion
  • Retrorenal spleen
229
Q

Stomach: Description

A

Muscular organ between the oesophagus and duodenum.
Location: upper abdomen
Function: storage and digestion of food

230
Q

Stomach: Gross Anatomy

A
  • Divided into:
  • Cardia – receives the oesophagus
  • Fundus – superolateral dome
  • Body – main region
  • Pyloris – lower section exit point
231
Q

Stomach: Muscles

A
  • Lower oesophageal sphincter
  • Pylorus
232
Q

Stomach: Neurovasculature

A

Arterial supply:

  • Right gastric common hepatic
  • Left gastric from the coeliac trunk
  • Right gastroepiploic from the superior gastroduodenal
  • Left gastroepiploic from the splenic
  • Short gastric from splenic and terminal left gastroepiploic

Venous drainage:

  • Right and left gastric veins to the portal vein
  • Right gastroepiploic to the superior mesenteric vein
  • Left gastroepiploic veins and short veins to the splenic

Lymphatics:

  • Coeliac and para-aortic nodes

Innervation:

  • Gastric plexus (coeliac and vagus)
233
Q

Stomach: Relations

A
  • Anterior: left lobe of the liver, anterior abdominal wall
  • Posterior: lesser sac and stomach bed
  • Medial: abdominal aorta, coeliac trunk and nodes
234
Q

Stomach: Variants

A
  • Situs inversus
  • Hypertonic or hypotonic stomach
  • Pyloric stenosis
  • Congenital hiatus hernia
235
Q

Rectus Abdominis and Sheath: Gross Anatomy

A

Has three to four horizontal tendinous intersections that divide the muscle into segments.
Origin: Pubic symphysis, tubercle and crest
Insertion: Xiphisternum and the 5-7 th costal cartilages

236
Q

Rectus Abdominis and Sheath: Features

A
  • The linear alba divides the recti into right and left
  • Laterally the rectus sheath fuses to form the linea semilunaris
  • Above the arcute line the IO splits to form the rectus sheath
  • Below the arcute line the transversalis fascia passes anterior to the rectus abdominus
237
Q

Rectus Abdominis and Sheath: Neurovasculature

A

Arterial supply:

  • Superior and inferior epigastric arties

Venous drainage:

  • Superior and inferior epigastric veins

Innervation:

  • Anterior rami of T6 to L1 spinal nerve

Lymphatics:

  • Above the umbilicus to the axillary nodes
  • Below the umbilicus to the inguinal nodes
238
Q

Rectus Abdominis and Sheath: Relations

A
  • Anterior: Rectus sheath, Camper’s fascia, Scarper’s fascia
  • Posterior: pre-peritneal fat, peritoneum
  • Lateral: hiatus semilunaris
  • Medial: Linea alba
  • Superior: xiphoid process and the 5 th to 8 th costal cartilages
  • Inferior: Pubic symphysis
239
Q

Rectus Abdominis and Sheath: Variants

A

Variation in the number of segments
Pyramidalis

240
Q

Arterial supply and venous drainage of the kidneys: Description

A

The kidneys are retroperitoneal organs involved in the filtration of blood, production of urine, water
and electrolyte balance and the production of hormones

241
Q

Arterial supply of the kidneys: Origin

A

Typically a single renal artery from the aorta at the level L1 inferior to the origin of the
superior mesenteric artery, however there is commonly additional accessory arteries.

242
Q

Arterial Supply of the kidneys: Course

A

the right renal artery passes posterior to the IVC and the right renal vein, the left renal
artery courses posterior to the left renal vein

243
Q

Arterial Supply of the Kidneys: Branches

A
  • Dorsal and ventral rami
    • The dorsal and ventral rami divide into segmental branches within the renal hilum these branches are:
      • Apical
      • Anterior superior
      • Posterior superior
      • Inferior
      • Posterior
  • These segmental branches divide to form the:
    • Arcute
    • Interlobar
    • Interlobular
  • Inferior adrenal artery
  • Ureteric artery
  • Capsular artery
244
Q

Inferior Mesenteric Artery: Description

A

The inferior mesenteric artery is the primary arterial supply for the hindgut

245
Q

Inferior Mesenteric Artery: Gross Anatomy

A
  • Origin: 3 rd unpaired/anterior branch of the abdominal aorta at the level L3
  • Course: Obliquely descends in the retroperitoneum, initially anterior to the aorta then to the left.
  • Termination: continues as the superior rectal artery
246
Q

Inferior Mesenteric Artery: Branches

A
  • Left colic
  • Two to four sigmoid arteris
  • Superior rectal artery
247
Q

Inferior Mesenteric Artery: Supplies

A

Bowel from the splenic flexure to the upper 2/3 of the rectum

248
Q

Inferior Mesenteric Artery: Relations

A
  • Anterior: D3
  • Posterior: abdominal aorta, left psoas, left common iliac artery
  • Lateral (left): Inferior mesenteric vein
249
Q

Inferior Mesenteric Arteries: Variants

A
  • Doubled IMA
  • Absent IMA
  • Common trunks
  • Absent left colic branch
  • Arc of Riolan (SMA/IMA connection)
250
Q

Coeliac Trunk

A

Also known as the coeliac axis is the primary abdominal arterial supply to the foregut.
Location: first unpaired branch of the abdominal aorta (T12)

251
Q

Coeliac Trunk: Gross Anatomy

A
  • Origin: anterior branch of the abdominal aorta at the level of T12, just under to the medial arcuate ligament
  • Course: Very short course before under the median arcuate ligament
  • Termination: trifurcation into its three branches:
    • Common hepatic – (right gastric, properhepatic, gastroduedenal)
    • Splenic
    • Left gastric arteries
252
Q

Coeliac Trunk: Supplies

A
  • Gut from the distal oesophagus to the D2
  • Liver
  • Gallbladder
  • Spleen
  • Pancreas
253
Q

Coeliac Trunk: Variants

A
  • Classical branching is seen in 70%
  • Branches may arise independently from the aorta
  • Coeliacomesenteric trunk
  • Other branches may arise from the trunk including:
    • Dorsal pancreatic artery
    • Right hepatic artery
    • Inferior phrenic artery
254
Q

IVC: Description

A
  • The inferior vena cava is the primary blood return pathway from the abdomen and lower limbs back to the heart
  • Function: return of de-oxygenated blood from the abdomen and lower limb to the heart
  • Location: Retroperitoneum and short course in the posterior mediastinum
255
Q

IVC: Gross Anatomy

A
  • Has valves
  • Origin: Formed as the confluence of the common iliac veins at the level L5
  • Course: Ascending in the great vessel space, passes through the posterior aspect of the liver, through the caval hiatus of the diaphragm at the level T8 short course in the posterior mediastinum
  • Termination: right atrium
256
Q

IVC: Tributaries

A
  • Common iliac veins (L5)
  • Lumbar veins (L1-L5)
  • Right gonadal veins L2
  • Bilateral renal veins L1
  • Right adrenal veins L1
  • Right and left inferior phrenic veins T8
  • Right, middle and left hepatic veins T8
257
Q

IVC: Relations

A
  • Anterior: Right common iliac artery, right gonadal vessels, D3, common bile duct, portal vein, head of the pancreas, D1, epiploic foramen, liver
  • Posterior: Lower lumbar vertebrae and discs, anterior longitudinal ligament, Right psoas belly, sympathetic trunk
  • Lateral left: abdominal aorta, caudate lobe of the liver, right crus
  • Lateral right: right kidney, right ureter, D2
258
Q

IVC: Variants

A
  • Duplication
  • Agenesis
  • Circumcaval ureter
  • Circumaortic vena cava
  • High union
  • Double inferior vena cava
  • Left sided vena cava
  • IVC webs
  • Portocaval shunt
259
Q

Portal Vein: Gross Anatomy

A
  • Origin: L1 confluence of the splenic and superior mesenteric veins
  • Course: runs in the free edge of the lesser omentum enter the porta hepatic as a posterior structure
  • Termination: bifurcated to form right and left braches, the level of bifurcation in used to define the boundaries of the liver segments
260
Q

Portal Vein: Variants

A
  • Portal trifurcation
  • Absent right portal vein
  • Portal vein duplication
  • Left renal veins drains into the portal system
  • Absent SMV, all branches converge to for the portal vein
  • Abernathy malformation portosystemic shunt
261
Q

Retroperitoneal Spaces: Description

A

The retroperitoneum is a space in the abdominal cavity
Location: between the posterior parietal peritoneum and the muscle of the back

262
Q

Retroperitoneal Spaces: Gross Anatomy

A

Dividable into 4 spaces by the pararenal fascia

  • Anterior pararenal space –anterior to the kidneys, extends from the diaphragm to the pelvis
  • Perirenal space – around the kidney, from the bare area of the liver and subphrenic space, continuous with the mediastinum through the diaphragmatic hiatuses, inferiorly it is closed below the kidneys
  • Posterior pararenal space – posterior to the kidneys, extends from the inferior phrenic fascia opens into the pelvis
  • Great vessel space - the space around the abdominal aorta and inferior vena cava, only named in some sources
263
Q

Anterior Pararenal Space: Contents

A

Duodenum, pancreas, ascending and descending colon, roots of the small bowel mesentery and transverse mesocolon.

264
Q

Perirenal Space: Contents

A

kidneys, adrenal glands, the proximal collecting system, perirenal fat, renal vessels

265
Q

Posterior pararenal space: contents

A

small space containing olny fat, lymphatics, blood vessels, no major organs

266
Q

Great Vessel Space: Contents

A

Abdominal aorta and inferior vena cava

267
Q

Anterior Perirenal Fascia

A

thinner of the two courses from the lateral origin at the lateral
parietal peritoneum to cross anterior to the great vessels of the abdomen. Also known as Gerota’s fascia.

268
Q

Posterior Perirenal Fascia

A

thicker of the two origin is the psoas fascia coursing laterally to
become the laterconal fascia continuing on as the lateral parietal peritoneum. Also known as Zuckerkandl’s fascia.

269
Q

Sacrum: Gross anatomy

A

Inverted triangle in shape

Formed by the fusion of 5 sacral vertebrae

Concave anterior

270
Q

Sacrum: Features

A
  • Sacral prominence
  • Superior articular processes with associated facets
  • Sacral body
  • Alar wings laterally
  • Median sacral crest
  • Sacral canal (triangular in shape)
  • Termination of the sacral canal is at the sacral hiatus
  • First four nerve roots exit via the paired anterior and posterior foramen
  • The fifth sacral nerves exit via the sacral hiatus
271
Q

Sacrum: Articulation

A
  • Superiorly with the L5 vertebrae via the sacral prominence and the body of L5 and via the superior articular facets with the inferior articular facets of the L5 vertebrae
  • Laterally the sacrum articulates with the ilium via the sacroiliac joints (mixed fibrous/synovial joints)
  • Sacrococcygeal – inferiorly the sacrum articulates with the first coccygeal segment
272
Q

Sacrum: Ligaments

A
  • Lumbosacral
  • Iliolumbar
  • Sacroiliac ligaments
  • Sacrospinous
  • Sacrotuberous
  • Sacrococcygeal ligaments
273
Q

Sacrum: Neurovasculature

A

Blood supply:

  • Iliolumbar arteries (Posterior division of the internal iliac arteries)
  • Lateral sacral arteries (post. Div. int. iliac)
  • Median sacral artery from the aorta

Venous drainage:

  • Via the internal and external vertebral plexuses to the median and lateral sacral veins

Lymphatics:

  • Perirectal and internal iliac nodes
274
Q

Sacrum: Variants

A
  • Lumboralisation of the S1
  • Sacralisation of the L5
  • Sacral agenesis
275
Q

Levator ani: Description

A

The lavatory ani also known as the muscular pelvic diaphragm is the musculotendinous sheet that forms the majority of the pelvis floor.

Function: supports the pelvic viscera and aided in urinary and faecal continence

276
Q

Levator ani: Gross anatomy

A

Pubococcygeus:

  • From the inner surface of the pubis merging medially to form the perineal body

Iliococcygeus:

  • From the inner tip of the coccyx to the ischial spine.

Puborectalis:

  • From the body of the pubis forming a sling around the rectum
  • Coccygeus is not formally part of lavatory ani however it is an important element of the pelvic floor. It is between the sacrospinous ligament/ischial spine and the lateral border of the coccyx and sacrum.
277
Q

Levator ani: Neurovasculature

A

Arterial supply:

  • Inferior gluteal artery

Venous drainage:

  • Inferior gluteal veins

Innervation:

  • Pudendal nerve (internal surface)
  • Branches of S3,4 (external surface)
278
Q

Anterior division of internal iliac: Description

A

The internal iliac artery is the primary blood supply to the pelvis, pelvic viscera, external genitals, perineum, buttocks and medial thigh

279
Q

Anterior division of internal iliac artery: Gross anatomy

A

Origin: The bifurcation of the common iliac artery at the level of the pelvic brim

Course: Posteromedial toward the greater sciatic foramen.

Termination: Divides into the anterior and posterior division just prior to the greater sciatic foramen

280
Q

Branches of the anterior division of internal iliac artery

A

Rule of 3’s: 3 bladder, 3 muscular, 3 female

ISO POG MUV

  • Superior vesicular
  • Inferior vesicular
  • Obliterated umbilical
  • Inferior gluteal
  • Obturator
  • Internal pudendal
  • Middle rectal
  • Uterine
  • Vaginal
281
Q

Anterior division of internal iliac artery: Variants

A
  • Persistent sciatic artery
  • Obturator artery origin from the external iliac
282
Q

Posterior division of internal iliac artery: Gross anatomy

A

Origin: The internal iliac artery divides into anterior and posterior divisions at the superior border of the greater sciatic foramen

Course: Posterior towards the great sciatic foramen

283
Q

Posterior division of internal iliac artery: Branches

A

Iliolumbar artery – with lumbar and ilial branches – ilium, iliacus, L5/S1 foramen

Lateral sacral artery – with superior and inferior branches – supplies the sacrum and piriformis

Superior gluteal artery – superficial and deep braches – supplies the gluteal muscles

284
Q

Posterior division of internal iliac artery: Variants

A
  • Persistent sciatic artery
  • Superior and inferior branches of the lateral sacral origin directly from the posterior division of the internal iliac artery
  • Superior gluteal may arise directly from the internal iliac
285
Q

Uterus: vasculature

A

the ovarian and uterine arteries unite and form an anastomotic network, venous drainage uterine veins into the internal iliac veins

286
Q

Uterus: lymphatic drainag

A
  • Uterus fundus – pre and para-aortic lymph nodes due to the anastomotic network
  • Uterus body and cervical – predominantly to the internal and external iliac chains however there is some drainage to the superficial inguinal nodes via the round ligament
287
Q

Anal canal: Description

A

The anal canal is the section of the gastrointestinal tract between the rectum and the anal verge.

Function:

  • Control of defecation
288
Q

Anal canal: Gross anatomy

A
  • Approximately 4cm in length

Origin: anorectal angle (the right angle turn at lavator ani)

Termination: The anal verge

  • Dentate line – separates the anal canal into an upper and lower part. These parts differ in structure and neurovascular supply. The dentate line is formed by the anal columns (of Morgani), which are a series of anal sinuses that drain the anal glands. It is located at approximately the middle of the anal canal.
  • Above the dentate line the epithelium is a mucous membrane and below the dentate line the epithelium is a stratified squamous cells.
  • Anal sphincters – divided into internal and external. Internal is a continuation of the inner rectal muscle, thickened muscular ring, composed of visceral muscle. External skeletal muscle with deep, superficial and subcutaneous parts
  • The anal margin is the 5cm of skin around the anal verse
289
Q

Anal canal: Relations

A
  • Laterally – inchioanal fossa
  • Anterior – bulbospongiosus, perineal body, vagina
  • Posterior – tip of the coccyx
290
Q

Anal canal: Neurovasculature

A

Blood supply:

  • Above the dentate line: superior and middle rectal arteries. (Superior from the inferior mesenteric, middle rectal from the internal iliac artery) and median sacral artery.
  • Below the dentate line: inferior rectal artery a branch of the internal pudendal artery

Venous drainage:

  • Above the dentate line: superior rectal vein to the inferior mesenteric vein (portal system)
  • Below the dentate line: inferior and middle rectal veins to the internal iliac veins

Lymphatic drainage:

  • Above the dentate line: internal iliac nodes
  • Below the dentate line: superficial inguinal nodes

Innervation:

  • Above the dentate line: inferior hypogastric plexus
  • Below the dentate line: Inferior rectal branches of the pudendal nerve (S2-4)
291
Q

Anal canal: Variant anatomy

A

Imperforate anus

292
Q

Uterus: Description

A

The uterus is a primary reproductive organ of females

Function:

Gestation of an embryo to birth

Location: Extraperitoneal pelvis, peritoneum drapes over the fundal uterus

293
Q

Uterus: Gross anatomy

A

Inverted pear shaped, most of the bulk is myotrium -> smooth muscle

Typically 7.5cm in length, can grow to 40 in length during pregnancy

Consists of:

  • Body
  • Isthmus between the body and the cervix
  • Cervix at the base
  • Rounded fundus superiorly above the plane of the insertion of the fallopian tubes
  • Cornu laterally
  • Endometrial cavity internally which is lined with endometrial tissue
294
Q

Uterine ligaments

A
  • Pubocervical
  • Uterosacral
  • Transverse cervical
  • Broad ligament
  • Round ligament
  • Suspensory ligament of the ovaries
  • Ovarian ligament
295
Q

Uterus: Neurovasculature

A

Blood supply:

Uterine arteries, branches of the anterior division of the internal iliac arteries

Venous drainage:

Uterine veins into the internal iliac veins

Lymphatics:

  • Fundus: para-aortic nodes
  • Body/cervix: internal and external iliac nodes, superficial inguinal nodes via the round ligament

Innervation:

Inferior Hypogastric plexus, uterovaginal and ovarian plexus

296
Q

Uterus: Relations

A
  • Posterior: Rectum and pouch of Douglas
  • Anterior: Urinary bladder, uterovesical pouch
  • Lateral: the adexal spaces, multiple vessels, the ovaries, broad ligament
  • Superior: the intraabdoinal cavity
  • Inferior: vagina
297
Q

Uterus: Variants

A
  • Bicornate
  • Arcuate
  • Septated
  • Unicornated
  • Agenisis
  • Anteverted
  • Retroverted
  • Uterus didephys
298
Q

Typical thoracic vertebra: Description

A

T2 to T8 are considered typical thoracic vertebrae.

299
Q

Typical thoracic vertebra: Description

A

T2 to T8 are considered typical thoracic vertebrae.

300
Q

Typical thoracic vertebra: Description

A

T2 to T8 are considered typical thoracic vertebrae.

301
Q

Typical Thoracic vertebra: Gross anatomy

A

Relative to cervical and lumbar vertebrae, thoracic vertebrae have:

  • medium-sized, heart shaped vertebral bodies
  • medium-sized vertebral canal
  • prominent transverse processes with costal facets
  • long spinous processes angulating downwards
302
Q

Typical thoracic vertebra: Features

A

Anterior components of thoracic vertebrae:

  • body
  • pedicle
  • superior and inferior costal demifacets

Posterior components of typical thoracic vertebrae:

  • downward angled spinous processes
  • transverse processes with transverse costal facets
  • Superior and inferior articular facets
  • lamina
  • intervertebral foramen
303
Q

Typical thoracic vertebra: Articulations

A

Ribs

Each vertebra contains three points of articulation with ribs.

  • The superior demifacet of a thoracic vertebra articulates with the corresponding rib (costovertebral joint).
  • This rib articulates again with the costal facet on the transverse process (costotransverse joint).
  • The inferior demifacet articulates with the rib below.

Intervertebral:

Facet (zygapophyseal) Joints

  • The superior articular process arises from the upper border of pedicle. An oval facet faces posterolaterally.
  • The inferior articular process arises from the lower border of the pedicle. The facets face anteromedially.

Intervertebral discs

  • Similar to other vertebrae, discs are interposed between hyaline cartilage on the centrum of the vertebral bodies. The disc height is slightly less than cervical vertebrae.
304
Q

Atlanto-occipital joint

A

The atlanto-occipital articulation is comprised of a pair of condyloid synovial joints that connect the occiput to the first cervical vertebra (atlas/C1).

305
Q

Atlanto-occipital joint: Gross anatomy

A
  • Concave surface on the lateral mass articulates with the convex surface of the occipital condyle.
  • The joint is reinforced by fibrous capsules which support each joint.
306
Q

Atlanto-occipital joint: Attachments

A
  • anterior atlanto-occipital membrane – continuation of the anterior longitudinal ligament, between the anterior arch and the anterior foramen magnum.
  • posterior atlanto-occipital membrane – continuation of the posterior atlantoaxial membrane, connects the posterior aspect of the posterior edge of the foramen magnum.
307
Q

Atlanto-occipital joint: Neurovasculature

A

Arterial supply:

Vertebral arteries

Venous drainage:

Internal and external, posterior and anterior vertebral plexi

Innervation:

The joint capsule is innervated by the C1 nerve.

308
Q

Atlanto-occipital joint: Variant anatomy

A
  • Variable degree of communication between the atlanto-occipital joint and the cavity between the dens (odontoid peg) and transverse ligament
  • Third occipital condyle (condylus tertius) which may articulate with the anterior arch of the atlas, or the dens
  • Paracondylar process
  • Occipital condyle hypoplasia
  • Division of the superior articular facet of the atlas
309
Q

Calcaneus: Description

A

The calcaneus is the largest of the tarsal bones and is colloquially refered to as the heel bone.
Function: Inversion and eversion, transfer of force between the leg and the heel pad.
Location: below the talus

310
Q

Calcaneus: Gross Anatomy

A
  • Irregular box shaped bone

Features:

  • Calcaneal tuberosity (heel) – posterior projection with:
    • Lateral process
    • Medial process
    • Posteriorly – superior, middle (attachment for the Achilles) and inferior facet
  • Sustentaculum tali – antero-medial process inferior to which is a groove from the flexor halluces longus
  • Dorsal surface – location of the anterior, middle and posterior talocalcaneal facets, the tarsal sinus runs between the middle and posterior facets.
  • Anterior process - anterior projection the anterior surface of which has the facet for the cuboid
311
Q

Calcaneus: Articulation

A
  • Talus via the anterior, middle and posterior articular facets
  • Cuboid via the facet for the cuboid on the anterior surface
  • Shares a joint space with the talonavicular joint forming the talocalcaneonavicular joint
312
Q

Calcaneus: Relations

A
  • Superior: talocalcaneal joint, talus, sinus tarsi
  • Inferior: fad pad, long and short plantar ligaments
  • Anterior: calcaneocuboidal joint, cuboid bone
  • Posterior: Achilles tendon
  • Medial: Tendon of flexor hallucis longus, deltoid ligament of the ankle, tibial nerve, posterior tibial artery
  • Lateral: Tendons of peroneus longus and brevis
313
Q

Calcaneus: Neurovasculature

A
  • Medial and lateral calcaneal arteries from the posterior tibial and fibular arteries
  • Artery of the tarsal sinus

Innervation:

  • Tibial, sural and deep fibular nerves
314
Q

Calcaneus: Variants

A
  • Talocalcaneal coalition
  • Calcaneonavicular coalition
  • Os calcaneus secundaris
315
Q

Femur: Description

A

Long bone of the thigh
Function: transfer force between the hip and leg

316
Q

Femur: Gross Anatomy

A

Proximal portion:

  • Head globular hemisphere covered in synovial cartilage except for the central fovea (attachment of ligamentum terres)
  • Neck thinner process through which a large majority of the blood supply to the head flows
  • Greater trochanter – large irregular lateral attachment site
  • Lesser trochanter – conical posteromedial attachment site
  • Intertrocanteric line anteriorly
  • Intertrocanteric crest posteriorly

Shaft:

  • Long
  • Linea aspera – posterior ridge that serves as the attachment for multiple muscle and the intermuscular septa, 3 ridges superiorly becomes two ridges inferiorly that diverge to for the triangular popliteal surface

Distal:

  • Flared head with two rounded synovial line condyles
  • Synovial surface anteriorly for articulation with the patella
  • Bilateral epicondyles superior to each condyle
317
Q

Femur: Joints

A

Femoroacetabular – femoral head with the acetabulum, synovial ball and socket with fibrous capsule
Patellofemoral – between the patella groove and the articular surface of the patella
Tibiofemoral – between the medial and lateral condyles and the medial and lateral tibial plateau

318
Q

Femur: Neurovasculature

A

Arterial:

  • Artery of ligamentum terres
  • Anterior and posterior humeral circumflex
  • Perforating braches from profunda femoris
  • Popliteal and genicular arteries distally

Venous:

  • Anterior and posterior femoral circumflex veins to the greater saphenous veins
  • Popliteal and deep femoral veins to the common iliac veins

Innervation:

  • Femoral and tibial nerves
319
Q

Femur: Variants

A
  • Coxa valgus/varus
  • Hip dysplasia
  • Os acetabula
320
Q

Patella: Description

A

The patella is the largest sesamoid bone in the human body. It lies within the quadriceps tendon / patellar ligament and forms part of the knee joint.

321
Q

Patella: Articulation

A

Articular surface is covered in hyaline cartilage. It articulates with the trochlear groove of the femur (anterior distal surface between the medial and lateral condyles).

322
Q

Patella: Gross Anatomy

A
  • The patella is triangular in shape with a superior base and inferior apex.
  • The posterior surface is smooth, composed of articular cartilage, and is divided into medial and lateral facets, which are sub divided into superior, middle and inferior portions.
  • The lateral facet is the largest (this counters the tendency for the quadriceps to pull the patella laterally).
  • The anterior surface is rough, for attachment of tendons and ligaments.
323
Q

Patella: Attachments

A

Ligaments:

  • Patellar ligament – from the apex of the patella to the tibial tuberosity
  • Medial and lateral patellar retinaculum
  • Medial and lateral patellofemoral ligament (MPFL and LPFL).

Muscles:

  • Quadriceps tendon superiorly (really the same thing as the patellar ligament).
324
Q

Patella: Relations

A
  • superior: common tendon of quadratus femoris, suprapatellar bursa
  • inferior: patellar tendon, infrapatellar bursa, infrapatellar fat pad
  • lateral: lateral patellar retinaculum
  • medial: medial patellar retinaculum
  • posterior: knee joint, femur
  • anterior: prepatellar bursa
325
Q

Patella: Neurovsculature

A

Blood supply:

  • Anastomotic rings formed from the branches of the superior and inferior geniculate arteries

Innervation:

  • branches of nerves to vastus medialis and vastus lateralis
326
Q

Patella: Variants

A
  • bipartite patella
  • multipartite patella
  • absent patella
  • variation in shape (see: Wiberg classification)
  • dorsal defect of the patella (may occasionally be symptomatic)
327
Q

Knee Joint: Description

A

The knee joint is a modified hinge joint between the thigh and the leg
Movements: Flexion and extension

328
Q

Knee Joint: Gross Anatomy

A

Type: Synovial joint with a capsule (largest synovial joint in the body)
Articulations:

  • Femoral condyles with tibial plateaus
  • Patella with the patella groove of the femur
329
Q

Knee Joint: Ligaments

A
  • Medial collateral ligament
  • Lateral collateral ligament
  • Anterior cruciate ligament
  • Posterior cruciate ligament
  • Meniscofemoral ligaments
  • Anteriolateral and posterolateral ligaments
330
Q

Knee Joint: Menisci

A
  • Medial – larger, c-shaped, attached to the MCL laterally
  • Lateral – smaller, almost a complete circle
331
Q

Knee Joint: Bursa

A
  • Pre-patella bursa
  • Supra-patella bursa
  • Deep and superficial Infrapatella bursa
  • Semimembranous bursa
332
Q

Knee Joint: Fat pads

A
  • Hoffa’s deep to the patella tendon
  • Suprapatella fat pad
333
Q

Knee Joint: Neurovasculature

A

Arterial supply:

  • Superior and inferior, medial and lateral, Genicular branches of the popliteal artery
  • Descending genicular from the femoral
  • Descending branch of the lateral circumflex
  • Circumflex fibular

Venous: into the popliteal and femoral veins

Innervation: Femoral and genicular branches from the tibial and fibular nerves

334
Q

Knee Joint: Variants

A
  • Patella – dorsal patella defect, bipartite, absent
  • Baker’s cyst
  • Discoid meniscus
  • Flabella
335
Q

Hamstrings: Description

A

The hamstrings are the muscles of the posterior compartment of the thigh and include the:

  • lateral: biceps femoris
  • medial: semimembranosus and semitendinosus

Function: flex knee and extend hip

336
Q

Hamstrings: Gross anatomy

A

Apart from the short head of biceps femoris, the muscles share two common features:

  • span both the hip and knee joints
  • originate from the ischial tuberosity

The short head of the biceps femoris originates from the linear aspera

337
Q

Hamstrings: Biceps femoris

A

2 heads (long and short)
Origin is the Ischial tuberosity (long) and linea aspera (short)
Insertion is the fibular head
Innervation: tibial nerve
Artery: Inferior gluteal and popliteal artery

338
Q

Hamstrings: Semitendinosus

A

Origin Ischial Tubersotirty
Accompanies semimembranoiss however forms tendon 2/3 down thigh
Inserts on the medial superior tibial condyle, pes anserisus posterior to the gracillis
Innervation: tibial nerve
Artery: Inferior gluteal and popliteal artery

339
Q

Hamstrings: Semimembranosus

A

Origin Ischial tuberositiy
Inserts on the medial tibial condyle and posterior joint capsule
Innervation: tibial nerve
Artery: Inferior gluteal and popliteal artery

340
Q

Hamstrings: Pes Anserius

A
  • Sartorius
  • Gracilis
  • Semitendinoisis
341
Q

Gastrocnemius: Attachments

A
  • origin: above the lateral and medial femoral condyle
  • insertion: calcaneal (Achilles) tendon into mid-posterior calcaneus
342
Q

Gastrocnemius: Neurovasculature

A
  • arterial supply: sural arteries
  • innervation: tibial nerve (sciatic nerve nerve roots S1 and S2)
343
Q

Gastrocnemius: Description

A

antagonist: tibialis anterior
action: plantar flexes foot and flexes knee

344
Q

Gastrocnemius: Relations

A
  • superficial to soleus
  • forms the inferior borders of the popliteal fossa
345
Q

Gastrocnemius: Variants

A

Fabella

346
Q

Arterial Supply of the foot: Description

A

Arterial supply of the foot is the vascular system that supplies oxygenated blood to the foot

Gross anatomy:
The arterial supply of the foot can be divided into plantar and dorsal components:

347
Q

Medial Plantar artery

A

Origin: posterior tibial branch
Supplies: the medial side of the foot and the first toe
Termination: the 1 st medial plantar digital artery

348
Q

Lateral Plantar artery

A

Origin: Posterior tibial artery
Course: Cross the foot toward the base of the 5 th metatarsal
Supplies: lateral intrinsic muscle of the foot
Termination: As the Plantar arch

349
Q

Plantar arch

A

Connects the dorsalis pedis with the lateral plantar artery
Lies deep to the plantar aponeurosis
Branches: Plantar metatarsal arteries
Termination: connects with dorsalis pedis in the first metatarsal interspace

350
Q

Dorsal Arterial Supply of the foot

A

Dorsalis pedis
Origin: Continuation of the anterior tibial artery
Course: Runs lateral to the extensor halluces longus tendon
Termination: continues as the first metatarsal artery
Branches:

  • First dorsal metatarsal artery
  • Medial tarsal arteries
  • Lateral tarsal arteries
  • Arcuate artery
  • Dorsal metatarsal arteries
351
Q

Popliteal Artery: Description

A

Large artery of the popliteal fossa
Supplies: Primary supply for the leg below the knee

352
Q

Popliteal Artery: Gross Anatomy

A

Origin: A continuation of the superficial femoral artery as it passes out of the adductor hiatus
Course:

  • Through the popliteal fossa where it is the deepest structure
  • Through the fibrous arch of soleus

Termination:
Bifurcation into the anterior tibial and the tibioperoneal trunk

353
Q

Popliteal Artery: Branches

A

Medial and lateral, superior and inferior genicular arteries
Middle genicular artery

354
Q

Popliteal Artery: Relation

A

Popliteal artery is the most deep structure in the popliteal fossa
Deep to the popliteal vein

355
Q

Popliteal Artery: Variation

A
  • Trifurcation
  • Peroneal from the anterior tibial
  • High origin of the anterior tibial
  • High origin of the posterior tibial
  • Very long tibioperoneal trunk
  • Hypoplastic infrapopliteal vessels
  • Popliteal artery entrapment
356
Q

Great Saphenous Vein: Description

A

The long and short saphenous veins are superficial veins of the lower limb
Function: return oxygenated blood from the lower limb to the iliac veins
Gross anatomy:
Both have valves

Origin: continuation of the medial marginal vein of the foot

Termination: Pierces the deep facia of the femoral triangle draining into the spahenofemoral
junction. 99% have a valve within 2mm of the SFJ

357
Q

Great Saphenous Vein: Course

A

It passes anterior to the medial malleolus, ascending in the saphenous space between the
saphenous fascia superficially and the deep fascia, it is closely related to the saphenous nerve(s)
below the knee.

358
Q

Great Saphenous Vein: Tributaries

A
  • Small saphenous vein
  • Unnamed superficial veins of the leg
  • Medial marginal vein of the foot
  • Superficial epigastric
  • Superficial circumflex iliac
  • Superficial external iliac
  • Superficial external pudendal
  • Multiple deep perforators to the deep system
359
Q

Lesser Saphenous Vein: Description

A

Origin: Confluence of the lateral aspect of the venous network of the dorsum of the foot

Termination: Pierces the deep fascia of the popliteal fossa to drain into the popliteal vein

360
Q

Lesser Saphenous Vein: Course

A

Posterior to the lateral malleolus, ascending in the subcutaneous tissues of the lateral leg

361
Q

Lesser Saphenous Vein: Tributaries

A
  • Multiple unnamed superficial branches
  • Great saphenous vein
  • Multiple perforators to the deep venous system
362
Q

Lesser Saphenous Vein: Relations

A

Course closely associated with the sural nerve

363
Q

Lesser Saphenous Vein: Variants

A
  • Vein of Giacomini
  • Duplication
  • Absence
  • Fenestration

Anatomy (11 decks)

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