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FRACS study > Imaging of import and archetypic anatomy > Flashcards

Imaging of import and archetypic anatomy Flashcards

1
Q

Gross lymphatic drainage

A

By depth

  • Superficial follow veins
  • Deep follow arteries

By region

  • Thoracic duct
    • lower half of the body
    • left hemithorax
    • left upper limb
    • Left head and neck
  • Right lymphatic duct
    • Right head and neck
    • Right upper limb
    • Right hemithorax
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2
Q

Describe the course of the major lymphatic trunks

A

Thoracic duct

  • Formation of cisterna at L1, L2,
    • beneath the cover of the right crus
    • between the aorta and azygous
  • Formation of thoracic duct at T12
    • Passes upward alonside the aorta
    • comes to abut the right side of the oesophagus
    • passes posterior to the oosophagus, infront of the intercostal vessels
    • Drains into the junction to the left IJ and subclavian veins

Right more variable, all may enter the brachiocephalic as the right lymphatic or seperately join the great vessels

  • Right lymphatic duct- Right hemithorax
  • Right subclavian trunk- upper limb
  • Right Jugular- H+N
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3
Q

Elements of the lymphatic system

A

Lymphatic capillaries

Collecting vessels

Nodes

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4
Q

Functions of the lymphatic system

A
  1. Return of ultrafiltrated ECF to circulation
  2. Presentation of antigens, immune cells, pathogens and defective cells to the node
  3. Transport of dietary fats from the GI tract to systemic circulation
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5
Q

Branches of the Abdominal Aorta

A

3 unpaired visceral

  • Coeliac
  • SMA
  • IMA

3 Paired visceral

  • Suprarenal/Adrenal
  • Renal
  • Gonadal

3 Terminal

  • Left common iliac
  • Right common iliac
  • Median sacral

5 Paired non visceral

  • Inferior phrenics
  • 4 Lumbars
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6
Q

Femoral triangle

A

Borders

  • Inguinal ligament
  • medial border of sartorius
  • medial border of adductor longus

Floor

  • gutter shaped
  • Iliacus, Psoas
  • Pectineus
  • Adductor longus
    • A glimpse of adductor brevis with the anterior branch of the obturator on it

Content

  • Femoral nerve
    • Posterior rami of L2,3,4
  • Fem. artery
  • Fem. vein
  • Lymphatics
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7
Q

to which lumbar vertebrae is the right crus attached

A

L1,2,3

Lateral aspect of anterior curviture of vertebral body

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8
Q

To which vertebrae is the left crus attached

A

L1,2

Lateral margin of the anterior curvature of the body

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9
Q

At what level does the aorta pass BEHIND the diaphragm

What structures run with it

A

T12, usually just left of midline

  • behind the median arcuate ligament (comprised of the crura)

Azygous vein

  • to the right

Thoracic duct

  • between azygous and aorta
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10
Q

Oesophageal opening

What structures run with it

A

T10

Technically within left crus fibres but right crus slings around it

  • the borders of the oesophageal opening at the phrenoesophageal opening are thus the left and right pillars of the right crus

Runs with

  • vagal nerves
  • oesophageal branches of left gastric
  • lymphatics
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11
Q

What level is the caval foramen of the diaphragm

What structures run through it

A

Level

  • T8
    • In the central tendon

Structures

  • Right phrenic nerve
  • IVC
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12
Q

What structures pierce the crura

A

Hemiazygous (left)

Greater, lesser, least sphlancnic nerves

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13
Q

What passes behind the medial arcuate ligament

A

Sympathetic trunks

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14
Q

What passes behind the lateral arcuate ligament of the diaphragm

A

Subcostal bundle

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15
Q

Bochdalek Hernia

A

Bochdalek at the back

Failure of the lateral arcuate ligamant fibres to fuse between the L1 transverse process and the tip of the 12th rib

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16
Q

Morgagni Hernia

A

Failure of union of the costal and xyphoid (sternal) costal fibres

Small hernias

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17
Q

Gross distribution of lymphatic drainage

A

Superficial lymphatics (subcutaneous) follow veins

Deep lymphatics follow the arteries

The thoracic duct drains the:

  • Lower half of the body
  • Left upper limb
  • Left hemithorax
  • Left head and nec

The right lymphatic duct drains the:

  • Right hemithorax
  • Right upper limb
  • Right head and neck
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18
Q

What are the branches of the facial nerve

A

Temporal

Zygomatic

Buccal

Marginal mandibular

Cervical

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19
Q

Gross anatomy of the oesophagus

A

Muscular tube

Mesodermal origin

25cm in length

Begins beneath crichopharyngeus in midline

inclines left at the thoracic opening

inclines right in mediastinum

Passes through diaphragm at T10

Ends at GOJ

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20
Q

What are the natural narrowings of the oesophagus

A

Crichopharyngeus

  • 15cm

Aorta

  • 22cm

Diaphragm

  • 38-40cm
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21
Q

What are the basic derivatives of the embryologic germ layers

A

Mesoderm

  • Muscle
  • Bone
  • Heart
  • Circulatory system
  • Sex organs
  • Kidneys

Ectoderm

  • Skin
  • Nervous system

Endoderm

  • Mucosa
  • Pancreas
  • Liver
  • Some viscera
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22
Q

Blood supply of the oesophagus

A

Inferior thyroid

Bronchial

Thoracic aorta

Inferior phrenics

Left Gastric

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23
Q

Venous drainage of the oesophagus

A

Important in portal hypertension

  • Left gastric vein
  • Azygous and hemiazygous
  • Inferior thyroid veins
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24
Q

Innervation of the oesophagus

A

Vagus

Cervical and thoracic sympathetic trunks

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25
Q

Risk factors for developing Barrett’s

A

Age (60+)

Caucasian

Male

GORD

Obesity

Hiatus hernia

Smoking

Maybe red meat (unclear)

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26
Q

What are the borders of the foramen of Winslow

A

Posterior

  • IVC

Inferior

  • D1

Anterior

  • Portal triad

Superior

  • Caudate lobe
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27
Q

Sympathetic outflow

A

T1-L2

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28
Q

Parasympathetic outflow

A

Cranial nerves

S2-4

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29
Q

Arteries of the pancreas

A

Head and uncinate

  • Anterior and posterior, superior pancreaticoduodenal arteries
    • From coeliac
  • Anterior and posterior, inferior pancreaticoduodenal arteries
    • From SMA

Neck, body, tail

  • Dorsal pancreatic (level of neck/body)
    • Splenic
  • Greater pancreatic (level of body/tail)
    • Splenic
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30
Q

USS lingo

A

Echoic

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31
Q

How does USS work

A

Parallel pisoelectric nodes simultaneously transmit and sense ultrasonic waves

Return signal speed and intensity is shown in imaging format

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32
Q

CT Lingo

A

Attenuating

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33
Q

MRI lingo

A

Intense

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34
Q

What is primovist

A

Hepatocyte specific gadolinium contrast agent

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35
Q

Lingo in PET

A

Avid

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36
Q

Thyroid gland gross anatomy

A

Weight 10-20g

Bilobed butterfly shaped gland

  • Pyramidal lobe in 30%

Attached to tracheal rings 2,3,4

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37
Q

Describe the course of the femoral artery and its major branches

A

External iliac becomes femoral artery as it passes behind the inguinal ligament

Femoral nerve lies lateral, vein medial

  • As they descend the they rotate with nerve passing anteriorly and vein posteriorly to invert this arrangement

4cm below the inguinal ligament th profunda arises

Run inferiorly in the groove between iliacus and pectineus on the psoas tendon

Traverses the femoral triangle to pass behind sartorius

descends along the medial border of vastus medialis to enter the adductor hiatus

On the posterior aspect of the distal femur the artery is medial to the vein

As the vessels arise throught the posterior aspect of the hiatus they are joined by the tibial branch of sciatic nerve which runs posterior to the vessels

  • The common peroneal branches higher (2/3 down femur) and passes laterally

Below the tibial plateau the artery generally gives off anterior tibial artery ans runs a variable distance as the TP trunk

  • then divides into peroneal and posterior tibial arteries.
  • PT artery runs with the tibial nerve
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38
Q

Describe the expected neurovasculature encountered during an AKA

A

Superficial

  • GSV medial aspect, passes a hands breadth behind the medial border of the patella
    • Gentle anterior course to join the SFV

Deep

  • Anterior
    • Not much
  • Posterior
    • Femoral artery and vein usually through the adductor hiatus (within adductor magnus) and therefore on the back of the femur
    • Sciatic nerve is encountered above, below or at is bifurcation to common peroneal and tibial nerves
      • The tibial branch becomes intimate with the vascular bundle on the posterior aspect of the femur
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39
Q

The anatomy of the SFJ

A

GSV joins the femoral vein by passing through the cribriform fascia covering the saphenous opening of the fascia lata in the femoral triangle

  • The landmark for this opening is 3.5cm inferior and lateral to the pubic tubercle
    • Groin crease is used clinically most often

GSV recieves multiple tributaries

  • Variable but usually at least 4
    • Superficial circumflex iliac
    • Superficial eigastric
    • Superficial external pudendal
    • Deep external pudendal

The femoral vein receives ONLY the GSV at this level

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40
Q

The subclavian artery

A

Origin:

  • Right
    • brachiocephalic after division of carotid
  • Left
    • from the arch of aorta

Passes behind scalenius anterior

  • Three parts divided by this muscle
    • First part (medial)
      • Vertebral
      • Thyrocervical trunk
      • Internal mammary
    • Second part (behind)
      • Costocervical trunk
    • Third part (lateral)
      • Dorsal scapular

Termination

  • Becomes axillary artery at outer border of first rib
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41
Q

Content of the posterior triangle of the neck

A

Lymph nodes

  • most notable at the apex

Nerves

  • Accessory nerve
    • Emerges FROM posterior border of SCM
      • Half way down posterior border
      • Passes almost vertically downward
  • Cutaneous brances of cervical plexus
    • Emerge BEHIND SCM

Arteries

  • Subclavian (but very low)
  • Transverse cervical
  • Suprascapular

Vein

  • External jugular traverses the lower anterior corner
  • NB the subclavian vein is not in the posterior triangle
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42
Q

What muscles comprise the infrahyoid muscles

A
  • Sternohyoid
  • Omohyoid
  • Thyrohyoid
  • Sternothyroid
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43
Q

What muscles comprise the suprahyoid muscles

A
  • Digastric
  • Stylohyoid
  • Mylohyoid
  • Geniohyoid
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44
Q

Pelvic osteology:

What is the medial attachement of the inguinal ligament

A

Pubic tubercle

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45
Q

What is the landmark for the femoral artery entering the thigh

A

The mid inguinal point

  • midway between ASIS and symphysis
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46
Q

What is the landmark for the deep inguinal ring

What is the relationship to the femoral artery

A

The midpoint of the inguinal ligament

The femoral artery enters the thigh more posteriorly at the midinguinal point which is more medial than the midpoint of the inguinal ligament

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47
Q

At what vertebral level is the bifurcation of the aorta?

A

L4

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48
Q

At what vertebral level is the origin of the renal arteries

A

L2

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49
Q

What the relationship of the left renal artery to the left renal vein

A

the artery runs behind and above the vein

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50
Q

What is the relationship of the right renal artery to the IVC and renal vein

A

The artery passes behind the IVC and runs behind the renal vein

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51
Q

What is the relationship of the gonadal vessels to the ureters

A

the gonadal vessels pass from medial to lateral anterior to the ureters

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52
Q

between which muscles is the neurovascular plane of the abdominal wall

A

transversalis

internal oblique

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53
Q

At what vertebral level is the origin of the IVC

A

L5

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54
Q

What is the relationship of the IVC and iliac veins to the iliac arteries

A

the IVC forms behind the right iliac artery

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55
Q

What are the tributaries of the left renal vein

why is this so disparate to the right

A

Venous tributaries

  • Inferior phrenic (inconstant- may drain to IVC)
  • Suprarenal
  • Gonadal
  • Anastomosis with lumbar azygous and hence to the azygous and vertebral systems

Embryological remnant of the obliteration of the left cardinal vein and preservation of the right

56
Q

From which embrological structure do the inferior parathyroid glands derive

what else arises here

A

from the third pharyngeal pouch

The thymus also arises here before descending along the thyrothymic tract to the superior mediastinum

57
Q

From which embrological structure do the superior parathyroid glands derive

what else arises here

A

The fourth pharyngeal pouch.

the parafollicular C cells also arise here from the ultimobranchial body

58
Q

How often are aberrant numbers of parathyroid glands encountered?

A

Supernumary glands are seen in 13% of patients

<3% have fewer than four glands

59
Q

The parathyroid glands

A

Endodermal in origin derived from the 3rd and 4th pharyngeal pouches.

Usually 4 in number

  • 13% will have supernumerary
  • 3% have 3 or fewer

Weight 30-50mg each (combined weight not more than 200mg)

  • approximately the size of a grain if rice

Endocrine function is secretion of PTH and thence maintenance of calcium homeostasis by direct feedback of ionized calcium

Blood supply

  • 80% of people derive both inferior and superior gland supply from the inferior thyroid aretry
  • 20% will have superior supplied by superior thyroid artery
60
Q

Anterior to posterior:

  • anterior scalene
  • subclavian artery
  • subclavian vein
  • middle scalene
  • phrenic nerve
A
  1. vein
  2. phrenic nerve
  3. anterior scalene
  4. artery
  5. middle scalene
61
Q

Triangles of the neck:

boundaries of the anterior triangle

A

Midline

Anterior border of SCM

Inferior border of mandible

62
Q

Triangles of the neck:

Posterior triangle

A

Posterior border of SCM

Anterior border of trapezius

Middle third of clavicle

63
Q

Recurrent laryngeal nerve function and course

A

Branch from vagus nerve bilaterally

Function: innervation of the muscles of the larynx

  • except crichothyroid (superior laryngeal)

Right wraps anterior to posterior around subclavian

Left wraps anterior to posterior around arch of aorta

  • between left carotid and subclavian branches
  • lateral to ductus arteriosus

both run up the tracheosophegeal groove to enter the larynx beneath crichopharyngeus portion of inferior pharyngeal constrictor

64
Q

What nerve innervates the crichopharyngeus muscle

A

Superior laryngeal

65
Q

What Plane

How do you know?

A

T4-5 plane

Ascending and descending aorta seen

Branching of the pulmonary artery

66
Q

Imaging:

Hepatic haemangioma

USS

A

Well-demarcated homogeneous hyperechoic mass

May be hypoechoic in patients with fatty infiltration of the liver due to the bright signal from the surrounding parenchyma

No flow should be seen on USS doppler due to slow and chaotic flow

67
Q

Imaging:

Hepatic haemangioma

CT

A

Well-demarcated hypodense mass on precontrast study

Peripheral nodular enhancement in the early phase, followed by a centripetal pattern or “filling in” during the late phase

Lesion usually opacifies after a delay of ≥3 minutes and remains isodense or hyperdense on delayed scans

68
Q

Imaging:

Hepatic haemangioma

MRI

A

Smooth, well-demarcated homogeneous lesion that has low-signal intensity on T1-weighted images and is hyperintense on T2-weighted images

With contrast enhancement, early peripheral discontinuous nodular or globular enhancement is seen in the arterial phase with progressive centripetal enhancement or “filling-in” on delayed scans

69
Q

Imaging:

Focal nodular hyperplasia

USS

A

Variable appearance: May be homogenous hyper-, hypo-, or isoechoic lesion

Central hyperechoic area (central scar)

70
Q

Imaging:

Focal nodular hyperplasia

CT

A

Hypo- or isodense on noncontrast imaging with a central scar

Hyperdense during the arterial phase

Typically isodense during the portal venous phase, although the central scar may become hyperdense as contrast diffuses into the scar

71
Q

Imaging:

Focal nodular hyperplasia

MRI

A

As FNH is a liver cell hamartoma they image like liver without contrast and may not be well seen.

  • an isointense lesion is noted on T1-weighted images, while an isointense to slightly hyperintense mass appears on T2-weighted images

Contrast administration shows homogenous bright enhancement in arterial phase.

  • This remains as prolonged enhancement on delayed imaging
72
Q

Imaging:

Hepatocellular adenoma

USS

A

Heterogenous, hyperechoic lesion in relation to the surrounding liver parenchyma

73
Q

Imaging:

Hepatocellular adenoma

CT

A

Typically well-demarcated lesion with peripheral enhancement during early phase with centripetal flow during portal venous phase

Hepatocellular adenoma with recent hemorrhage appears as a high attenuating lesion

74
Q

Imaging:

Hepatocellular adenoma

MRI

A

Typically a well-demarcated lesion with arterial phase enhancement

Enhancement pattern in subsequent phases varies with lesion subtype

75
Q

Imaging:

Hepatocellular carcinoma

USS

A

Poorly-defined margins and coarse, irregular internal echoes

76
Q

Imaging:

Hepatocellular carcinoma

CT

A

Hypervascular relative to the liver parenchyma during the arterial phase, with washout of the contrast during later phases

77
Q

Imaging:

Hepatocellular carcinoma

MRI

A

Lesion with low-intensity pattern on T1-weighted images and high-intensity pattern on T2-weighted images

Liver specific and extracellular contrast are both effective and show arterial hyperenhancement with washout

78
Q

Imaging:

Intrahepatic cholangiocarcinoma

USS

A

Homogenous hypoechoic mass

79
Q

Imaging:

Intrahepatic cholangiocarcinoma

CT

A

Hypodense lesion with peripheral (rim) enhancement

80
Q

Imaging:

Intrahepatic cholangiocarcinoma

MRI

A

Hypointense lesion on T1-weighted images and hyperintense lesion on T2-weighted images

Dynamic images show peripheral rim enhancement followed by progressive and concentric filling-in of the tumor with contrast material

81
Q

Imaging:

Liver metastasis

USS

A

Usually multiple lesions

Metastases from adenocarcinoma are hypoechoic in comparison with the surrounding liver parenchyma

82
Q

Imaging:

Liver metastasis

CT

A

Metastatic liver lesions from the colon, stomach, and pancreas usually show lower attenuation (ie, are darker) in contrast to the brighter surrounding liver parenchyma

Hypervascular metastases (eg, neuroendocrine tumor, renal cell carcinoma) appear as rapidly enhancing lesions visible on the arterial phase

83
Q

Imaging:

Liver metastasis

MRI

A

Low-signal areas on T1-weighted images and moderately high-signal areas on T2-weighted images.

Hepatocyte specific gadolinium contrast media (e.g primovist) show enhancement on arterial phase (usually peripheral or perilesional) but as the lesions are not hepatocyte derived there is rapid and complete washout on delayed imaging.

84
Q

What is the axilla

what are its boundaries

A

The axilla is a pyramidal space between the lateral chest wall and the upper arm through which structures run from the posterior triangle of the neck to the lateral chest wall and the upper arm

Boundaries

  • anterior
    • pectoralis major
    • pectoralis minor
    • subclavius
    • clavipectoral fascia
  • posterior
    • subscapularis
    • teres major
  • floor
    • axillary fascia
      • extends from serratus fascia to deep fascia of the upper arm
    • Inferior aspect is defined as the fourth rib
  • medial
    • serratus anterior
  • apex
    • clavicle
    • scapula
    • outer border of first rib
85
Q

What are the contents of the axilla

A

Axillary artery

Axillary Vein

Brachial plexus

Lymph nodes

Fibrofatty tissue

86
Q

What is the relationship of the axillary vein to the axillary artery and brachial plexus

A

The vein runs medial to the artery which is inturn clasped in its second part by the three cords of the brachial plexus

87
Q

at what point does the subclavian artery become the axillary

A

outer border of the first rib

88
Q

At what point does the axillary artery become the brachial artery

A

The outer border of teres major

89
Q

What are the branches of the axillary artery

A

The artery is divided into 3 parts by its relationship to the pectoralis minor

  • one branch from the first part
    • superior thoracic
  • two branches from the second part
    • thoracoacromial
    • lateral thoracic
  • three branches from the third part
    • subscapular
    • anterior circumflex humeral
    • posterior circumflex humeral
90
Q

branches of the first part of the axillary artery

A

superior thoracic

91
Q

branches of the second part of the axillary artery

A

Thoracoacromial

Lateral thoracic

92
Q

Branches of the third part of the axillary artery

A

subscapular

anterior and posterior circumflex humeral

93
Q

How long is the small bowel

A

270-290cm

  • duodenum 20
  • jejunum 100-110
  • ileum 150-160
94
Q

Vertebral relationships to the SB mesentary

A

From left of L2 to right SIJ

95
Q

In which autonomic nerve fibres do visceral pain impulses run

A

Sympathetics

96
Q

Auerbach plexus:

AKA

Between which layers of the SB wall are the ganglion cells found

A

AKA myenteric plexus

Between the inner circular and outer longitudinal muscle layers

97
Q

What is the strongest layer of the intestinal wall

A

The submucosa

  • it must therefore be incorporated into any anastomosis
98
Q

What are the layers of the musosa of the small bowel

A

Epithelial layer

Lamina propria

  • connective tissue layer with embedded matrix and immune cells

Muscularis mucosae

  • thin layer of smooth muscle
  • provides the boundary between mucosa and submucosa
99
Q

Discuss the anatomy of the crura and the pillars

A

The crura arise from the anterolateral curvatures of the bodies of the upper lumbar vertebrae

  • left L1,2
  • right L1,2,3

The oesophageal hiatus is formed by the fibres of the right crus which encircle the opening

  • The boundaries of the oesophageal hiatus are thus not formed by the right and left crura but rather the right and left pillars of the right crus
100
Q

Embryology of the thyroid

A

Endodermal cells descend from the foramen caecum at the base of the primative tongue

Parafollicular C cells of neural crest origin descend from the 4 pharyngeal pouch

101
Q

Describe the course of the of the genitofemoral nerve

A

Formed within the substance of the psoas muscle from L1 and L2 fibres.

Arises from the anterior surface of psoas

crossed anteriorly by mesentary (sigmoid or ileocolic), mesenteric vessels, ureter and gonadals

Perforates psoas fascia just above the inguinal ligament and dives to form:

  • genital branch (L2)
    • passes through transversalis
    • enters the coverings of the spermatic cord
      • motor to cremaster
      • senxory to tunica vaginalis
  • femoral branch (L1)
    • runs anterior to femoral artery
      • pierces femoal sheath and fascia lata
        • sensory to skin below mid portion of the inguinal ligament
102
Q

How does FDG PET work

A

18F -Fluorodeoxyglucose is a synthetic glucose analog containing radioactive 18F instead of a normal OH group

  • The FDG molecule is taken up normally by metabolically active tissues and undergoes phosphorylation which prevents it from moving out of the cell
    • The next step in metabolism requires the missing OH grouping so FDG sits in tissues until 18F radioactively decays to heavy O- where is picks up an H+ and can then be metabolised normally
  • 18F decays by positron emission.
    • The released positron collides with an electron in the surrounding tissues and converts mass to energy (E=mc2) in the form of 2 photons
      • the interaction if the positron to the surrounding tissues accounts for the calssic halo on imaging
        • PET camera detects the photons by scintillation crystals
  • Imaging is performed at the same time as CT to provide an overlay of the imaging modalities

Note the metabolically active tissues of brain and kidney will show significant activity at baseline

103
Q

What radiation safety advice should be given to people undergoing PET

A

Avoid close contact with radiation sensitive individuals (infants, children and pregnant women) for 12 hours

104
Q

Describe how you identify the saphenous vein at the SFJ

A

The landmark is a finger breadth medial to the femoral pulse or 3.5cm inferior and lateral to the pubic tubercle

The femoral vein receives only the saphaneous vein at the groin

The saphenous receives multiple tributaries at the groin

Differentiation of the two is critical in ligation of the GSV

105
Q

What are the tributaries of the GSV below the SFJ

A

Usually 4 veins corresponding to the cutaneous branches of the femoral artery

  • Pudendals
    • Superficial
    • Deep
  • Superficial circumflex iliac
  • Superficial epigastric

2 inconstant branches

  • Anteromedial and posteromedial femoral veins
106
Q

Surface markings for the GSV

A

Anterior to medial malleolus

A hands breadth posterior to the medial aspect of the patella

A finger breadth medial to the femoral pulse below the inguinal ligament

  • the artery passes behind the midinguinal point (rather than the midpoint of the inguinal ligament)
107
Q

Should gadolinium be used in pregnancy

A

No, not without considered reasoning

There is an increased risk of a broad set of rheumatologic, inflammatory, or infiltrative skin conditions and for stillbirth or neonatal death for pregnancies exposed to MRI with gadolinium

108
Q

McBurney’s point

A

1/3 from ASIS to umbilicus

109
Q

What does the first pharyngeal pouch become

A

The ear drum and eustacian tube

110
Q

What does the second pharyngeal pouch become

A

The palatine tonsil

111
Q

What does the third pharyngeal pouch become

A

the thymus and the inferior parathyroid gland

112
Q

What does the fourth pharyngeal pouch become

A

The superior parathyroid gland and the ultimobranchial body (parafollicular c cells)

113
Q

What is the importance of the pharyngeal clefts

A

The first is preserved as the external auditory canal

Clefts 2,3,4 are obliterated by the inferior proliferation and descent of the second pharyngeal arch.

  • failure to obliterate the pharyngeal clefts results in a branchial fistula or cysts
    • the most common site of cysts/fistula is at the angle of the jaw anterior to SCM
114
Q

Discuss the embryology of the diaphragm

A

The diaphragm is formed initially in the upper cervical region hence the innervation

  • phrenic nerve (motor C3,4,5)
  • sensory from the lower 6 intercostals

It passes inferiorly as the respiratory bud forms and the lungs descend pushing the diaphragm beneath it

It is formed by the:

  • Septum transversum
    • Forms the central tendon
  • Pleuroperitoneal membranes
    • Posterolateral component
  • Dorsal mesentary around the oesophagus and the aorta
    • Crura
  • Lateral body walls
    • Peripheral component
115
Q

What are the boundaries of the adductor hiatus

A

the hiatus is formed by a defect in the fibres of the adductor magnus

the medial border is formed by the femur

116
Q

Meissners plexus:

AKA

In which bowel wall layer are the ganglia located

A

AKA the submucosal plexus

Located within the submucosa

117
Q

Describe the course of the obturator nerve

A
  • The nerve to the adductor compartment of the thigh
  • Branch of the lumbar plexus
  • L2,3,4
  • Formed within the substance of psoas
    • emerges from the medial border of the muscle
    • passes along side wall of the pelvis to obturator foramen
      • deep to internal iliacs
      • above the fascia of the obturator internus muscle
    • crossed by ureter
    • divides into anterior and posterior divisions and passes through the obturator foramen to enter the thigh
      • The anterior division is briefly present in the femoral triangle running on adductor brevis
118
Q

Why may ovarian pain be felt in the medial aspect of the thigh

A

The peritoneum overlying the obturator nerve as it passes the normally posistioned ovary is supplied by that nerve

119
Q

What is the organ of Zuckerkandl

A

The organ of Zuckerkandl is a chromaffin body derived from the neural crest located at the bifurcation of the aorta or at the origin of the inferior mesenteric artery.

It can be the source of a paraganglioma

120
Q

What neurovascular structures are encountered crossing the operative field in carotid surgery

how can they be dealt with

A

The common facial vein crosses superficial to the external and internal carotid arteries just above the bifurcation of those vessels.

  • this vessel is a useful landmark to the bifurcation
  • It should be ligated to facilitate safe access to the carotid and bifurcation

The hypoglossal nerve (CN XII)

  • Usually crosses above the bifurcation but in a high bifurcation may lie deep to the common facial
  • this structure should be preserved

The non recurrent laryngeal nerve.

  • more common the left (as per Fischer’s)
  • may cross superficial to the carotid after arising directly from the vagus
121
Q

What are the inferior umbilical folds and what is the content of each

A

Median

  • obliterated uracus

Medial

  • obliterated umbilical artery

Lateral

  • inferior epigastrics
122
Q

What are the branches of the lumbar plexus

From which aspect of the psoas does each depart

A

The lumbar plexus is formed form divisions of T12 to L4

  • the plexus is within the substance of the psoas muscle
    • iliohypogastric T12,L1
      • lateral
    • ilioinguinal L1
      • lateral
    • genitofemoral L1,2
      • anterior
    • lateral femoral cutaneous L2,3
      • lateral
    • obturator L2,3,4
      • medial
    • femoral L2,3,4
      • lateral
123
Q

Nerve roots:

Phrenic nerve

A

C3,4,5

124
Q

Nerve roots:

Long thoracic nerve

A

From the roots of the brachial plexus

posterior divisions of C5,6,7

125
Q

Nerve roots:

Thoracodorsal nerve

A

From the posterior cord of the brachial plexus

C6,7,8

126
Q

Nerve roots:

Medial pectoral

A

From the medial cord of the brachial plexus

C8, T1

127
Q

Nerve roots:

Iliohypogastric

A

From the lumbar plexus

L1

128
Q

Nerve roots:

Ilioinguinal

A

Lumbar plexus

L1

129
Q

Nerve roots:

Lat. fem. cutaneous

A

From lumbar plexus

L2,3

130
Q

Nerve roots:

genitofemoral

A

From the lumbar plexus

L1,2

131
Q

Nerve roots

Obturator

A

From the lumbar plexus

L2,3,4

132
Q

Nerve roots:

Femoral

A

From the lumbar plexus

L2,3,4

133
Q

Nerve roots:

Sciatic nerve

A

L4,5 S1,2,3

134
Q

Nerve roots:

Median nerve

A

From the union of medial and lateral cords of the brachial plexus

  • receives contribution from all the roots (C5-T1)
135
Q

What muscles of the forearm are innervated by the median nerve

A

All of the flexors compartment except for:

  • the medial aspect of flexor digitorum profundus
  • flexor carpii ulnaris
  • these are both supplied by the ulnar nerve
136
Q

What muscles form the pes anserinus tendon

  • where does it it insert
  • what is its operative relavance
A

The pes anserinus is formed by the sartorius, gracilis and semitendinosis muscles

  • it crosses the medial aspect of the knee to insert into the tibia
  • the operative relavance is in access to the below knee popliteal artery
    • the tendon will usually need to be divided to gain access to the upper aspect of the soleal arch
      • the soleus then need to be divided from the posterior aspect of the tibia to access the artery.
137
Q

What is the relationship of the ureter to the female reproductive structure and to the vas differens in the male

A

In each sex only one important structure runs superficial to the ureter

  • in the female pelvis
    • the ureter passes across the pelvic sidewall and passes in the base of the broad ligament the uretine artery passes over the ureter to reach the base of the uterus
  • in the male pelvis the ureter
    • the ureter passes deep to the vas deferens

FRACS study (13 decks)

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