Mediastium and Abdominal Viscera (interval 3) Flashcards
Fibrous Pericardium
Strong fibrous connective tissue that secures the parietal pericardium
Parietal Pericardium
Mix of the serous pericadium and the non-serous fibers (pg 55 iBook)
The parietal layer of the serous pericardium is fused to the inside of the fibrous pericardium
Innervated by sensory phrenic nerves
What is the epicardium
The visceral pericardium (on heart)
Pectinate Muscles
Rough part of the right atrium (including anterior wall and the auricle) Rough part of the left atrium that goes into the auricle. Stops at the crista terminalis
Crista Terminalis
Separates the rough wall part from the smooth wall (sinus venarum) part of the atria (mostly in right atrium)
IVC
Runs along the entire body, collects venous blood, enters into the right atria
SVC
Superior vena cava that enters the right atrium and is continuous with the IVC
Oblique pericardial sinus
Recess in pericardial cavity. Inferior to the pulmonary veins and to the left of the inferior vena cava
Transverse pericardial sinus
Recess in paricardial cavity. Found between the ascending aorta/pulmonary trunk and the SVC. Behind aorta and pul trunk and in front of the SVC
Can clamp the outflow vessels (aorta and pulmonary trunk) during surgery here
Coronary sinus
The cardiac veins drain into the coronary sinus (which enters the right atrium) EXCEPT the anterior cardiac veins which drain the right ventricle and empty directly into the right atrium
Ostium of the coronary sinus
opening of the coronary sinus (right atrium)
Fossa Ovalis
Remnant of the foramen ovale which shunted blood from the right to left atrium to bypass the lungs
Chordae Tendineae
‘Heart strings’. Tendons (mainly collagen) that connect the papillary muscles to the leaflets of the atrialventricular valves
Right atrium wall names and what is in them?
Smooth wall: sinus venarum
Rough wall: includes anterior wall and the auricle. Contains pectinate muscles
IVC, SVC, ostium of the coronary sinus, openings of anterior cardiac veins (drain right ventricle)
Trabeculae Carneae
Muscle that is part of the rough walled part of ventricles
Right ventricle papillary muscles
- Anterior/great papillary muscle
- Posterior
- Septal
Interventricular Septum
Septum between the L and R ventricles
Septomarginal trabecula/moderator band
In the right ventricle. Extends from the base of the anterior papillary muscle to the interventricular septum. Contains the right branch of the bundle of His.
Conus Arteriosus/ infundibulum
Smooth walled part of the right ventricle
Tricuspid valve and its leaflets
Between the right atrium and right ventricle
Has 3 leaflets (anterior, posterior, septal leaflets that attach to their corresponding papillary muscle)
Pulmonary valves and its cusps
Semilunar valve, between right ventricle and the pulmonary artery
Left atrium
Is smooth walled and has the auricle which is rough walled and includes the pectinate muscles.
Contains the left atrioventricular orifice which opens into the left ventricle and is closed by the mitral valve.
Pulmonary Veins
Drain oxygenated blood into the left atrium. There are 4 of them
Left ventricle
Most muscular wall with trabeculae carneae. Contains a smooth walled part (aortic vestibule)
Two papillary muscles: anterior and posterior
Mitral valve
Between the left atrium and left ventricle. Two leaflets, anterior and posterior (corresponding to their papillary muscles)
Aortic valve
Between the left ventricle and the aorta
No papillary muscles
SA node
Located in the sinus venarum of the right atrium near the entrance of the SVC
Pracemaker, controls depolarization of the atrium
Beats faster on its own than it does when innervated by the vagus nerve. Stronger parasympathetic innervation keeping it slower.
AV node
Located in the interatrial septum near the right atrialventricular oriface
Delays depolarization to the ventricles so that the atria can fully contract before the ventricles contract
Bundle of His
Arises from cells of the AV node, passes into the interventricular septum. Divides into right and left branches that divide into the purkinje fibers.
Causes each of the papillary muscles to contract to keep AV valves shut
Purkinje Fibers
Spread a wave of depolarization to the right and left ventricles
Right branch is carried by the septomarginal trabecula/moderator band
Aortic sinuses
Left and a right one that come off ascending aorta. They give rise to the right and left coronary arteries. They are located just distal to right and left semilunar cusps of the aortic valve
Left coronary artery
Derived from the left aortic sinus. Short (1cm) branches into the LAD and the circumflex. Supplies the AV bundle of His, the right bundle branch, the IVS and part of the left bundle branch.
LAD
Branches from the left coronary artery. Separates the right and left ventricle. Anastamoses with the PDA
Circumflex
Also called the LCX. Wraps around and down the posterior side and supplies the left atrium and left ventricle. Courses through the coronary sulcus (intersection between the atrium and ventricle). Anastamoses with the RCA
Right coronary artery
Branches from the right aortic sinus. Anastamoses with the circumflex branch (LCX). Branches into the marginal branch and usually the PDA. Supplies blood to the right atrium, SA/AV nodes, and the left purkinje branch
Marginal branch
From the RCA, supplies the right ventricle
PDA
From the RCA, supplies the lower 1/3 of the interventricular septum and the r/l ventricles. Anastamoses with the LAD.
Great cardiac vein
Courses with the anterior interventricular artery (LAD) and drains into the coronary sinus
Middle cardiac vein
Courses with the posterior interventricular artery (PDA) and drains into the coronary sinus
Anterior cardiac vein
Drains the right ventricle and empties directly into the right atrum (an exception)
Celiac artery/trunk
Supplies the foregut and spleen
Branches off of the abdominal aorta
Branches into the:
- Common hepatic artery
- Left gastric artery
- Splenic artery
Hepatoduodenal Ligment
Contains the common bile duct (made from the cystic duct and the heptaic duct), portal vein, proper hepatic artery
Left/right gastric arteries
Supply the lesser curvature of the stomach
Splenic artery and its branches
Supplies the spleen, neck/body/tail of pancreas, left side of the greater curvature of the stomach, stomach fundus
Important Outbranchings:
- Left Gastro-omental/gastroepiploic artery
- Short gastric branches
Gastro-omental/gastroepiploic artery
Branches from the splenic artery, supplies the left side of the greater curvature of the stomach
Short gastric branches/arteries
Branches from the splenic artery, supplies blood to the fundus of the stomach
Common hepatic artery
A branch from the celiac artery that splits into the proper hepatic artery and the gastroduodenal artery on the right side of the body
Proper hepatic artery
A branch from the common hepatic artery. Supplies part of the lesser curvature via the right gastric artery and branches into the right and left hepatic arteries which supply the liver. The right hepatic artery contains a branch called the cystic artery, which supplies the gallbladder
(N:283)
Right gastric artery
Joins with the left gastric artery and supplies the lesser curvature of the stomach
Left hepatic artery
Supplies the left functional lobe of the liver
Right hepatic artery
Supplies the right functional lobe of the liver
Left gastric artery
Supplies most of lesser curvature of stomach, abdominal part of esophagus, penetrates Maddy, i mean ulcers (just kidding, it doesn’t do either)…but it does penetrate things within her…hopefully not perforating any bowels while it does
At what location would an ulcer be to erode the left gastic artery
Lesser omentum
Cystic Artery
Supplies the gallbladder
Gastroduodenal artery
Branches from the common hepatic duct and supplies the foregut part of the duodenum (upper 1/3), superior part of head of the pancreas (via SPDs)
Goes to the greater curvature of the stomach via right gastro-omenta/epiploic artery
Branches off of it include:
- Posterior superior pancreaticoduodenal (PD) artery
- Anterior superior PD artery
- Right gastroepiploic artery (which it turns into, not really a branch)
Superior pancreaticoduodenal arteries
Have a posterior and anterior. Branches off of the gastroduodenal artery. Supply the superior part of the head of the pancreas and the proximal part of the duodenum.
Right gastroepiploic/omental artery
Extension of the gastroduodenal artery that meets with its left partner to supply the greater curvature of the stomach with blood
Where would an ulcer have to be to erode the gastroduodenal artery?
Posterior wall of the first part of the duodenum. These people might have pain referred to their shoulder
Spleen
Supplied by celiac artery. Functions as a lymphatic organ and filters RBCs. Is peritoneal. Supplied by the splenic artery. Protected posterior by ribs 9-12. Most frequently injured organ in the abdomin (perhaps because maddy is penetrated through ribs 9-12)
Superior mesenteric artery (SMA)
Supplies the midgut
Branches include
1. Right colic
2. Middle colic
3. Ileocolic
4. Intestinal branches (vesa recta) of the ilium and jejunum
5. Inferior pancreaticduodenal (anterior and posterior)
Right colic artery
Branch of the SMA, supplies ascending colon
Middle colic artery
Branch of the SMA, supplies the first 2/3 of the transverse colon
Ileocolic artery
Branch of the SMA, supplies the distal part of the ilium, the appendix, the cecum and the proximal part of the ascending colon
Ileal and jejunal intestinal branches
Branches of the SMA
Jejunum: form the simple arcades and long vasa recta
Ilium: forms complex arcades and short vasa recta
Note: Arcades and vasa recta run at a right angle
Inferior PD arteries
Split into an anterior and a posterior artery which supplies the midgut part of the duodenum and inferior part of the head of the pancreas and a process of the pancreas
Inferior mesentery artery (IMA)
Supplies the hindgut Its branches include: 1. Left colic artery 2. Sigmoidal artery 3. Superior rectal artery 4. Marginal artery
left colic
supplies descending colon and distal 1/3 of transverse colon
sigmoidal arteries
supply the sigmoid colon
superior rectal artery
supplies the rectum and anal canal to the pectinate line
marginal artery of the colon
anastomoses the IMA with the SMA
inferior mesenteric vein
vein of IMA
drains the hindgut, usually empties into the splenic vein but can drain into the SMV
splenic vein
drains parts of the foregut
superior mesenteric vein
drains the midgut
hepatic portal vein
formed posterior to the neck of the pancreas, where the SMV unites with the splenic vein
receives poorly oxygenated blood from GI structures, delivers that blood to the hepatic sinusoids
(note: hepatic veins drain blood from there to IVC)
hepatic veins
drain blood from the hepatic sinusoids to IVC
cystic duct
comes from the gallbladder and unites with common hepatic duct to form the common bile duct
hepatic ducts
right and left common hepatic ducts drain bile from the right and left functional lobes of the liver, respectively, and unite to form the common hepatic duct
common bile ducts
formed from the union of the common hepatic duct and the cystic duct
passes posterior to first part of the duodenum and through the head of the pancreas, enters the second part of the duodenum
hepatopancreatic ampulla of Vater
formed by the joining of the main pancreatic duct and the bile duct
landmark on the duodenum (second part)
marks the anatomic transition between foregut and midgut
liver lobes
left, right, quadrate (bottom), caudal (top)
each functional lobe has separate arterial blood supply, venous drainage and biliary drainage
functional left lobe of the liver
includes left lobe, quadrate lobe and part of caudate lobe
functional right lobe of the liver
right lobe and part of the caudate lobe
round ligament of the liver (whats it’s other name)
ligamentum teres hepatis
remnant of fetal umbilical vein
ligamentum venosum
remnant of the ductus venosus
what anatomical structures separate the anatomical right and left lobes of the liver?
round ligament and ligamentum venosum
what separates the functional left and right lobes of the liver?
line from the gallbladder through the IVC
coronary ligament
derivative the helps to suspend the liver to diaphragm
bare area of the liver
nonperitoneal area
large triangular surface of liver devoid of peritoneal covering
left/right triangular ligaments
connects liver to the diaphragm
mesentery of the ileum versus the jejunum
ileum - more fat in mesentery due to Peyer’s patches
how is the jejunum different from the ileum?
jejunum has thicker walls, larger luminal diameter, more prominant plica circularas, greater vascularity
mesoappendix
mesentery of the appendix, suspends the appendix
transverse mesocolon
mesentery of the transverse colon
sigmoid mesocolon
mesentery of the sigmoid colon
ileocecal junction
bw the ileum and the cecum (first part of the ascending colon)
right colic/hepatic flexure
transition point bw the ascending and transverse colon
left colic/splenic flexure
transition point bw the transverse and descending colon
where the middle colic branches of the SMA and left colic branches of the IMA anastomose
what is the most common site for ischemic bowel infarction?
splenic flexure, where the middle colic branches of the SMA and left colic branches of the IMA anastomose
taenia coli
three independent longitudinal bands of smooth muscle that begin at base of appendix and end at junction between sigmoid colon and rectum
convergent point of the three taenia coli is called the appendix of the colon
appendices epiploicae
small pouches of peritoneum filled with fat along the colon
haustra
crinkles formed bc taenia coli is shorter than the total length of the colon
gives the colon its segmental appearance
aortic hiatus of diaphragm
marks the beginning of the abdominal aorta
hole in the diaphragm for the aorta
ligament of treitz
fibromuscular bands that supports the duodenojejunal flexure
hilum of the spleen
point of attachment for gastrosplenic ligaments
hilum = where artery, nerve, veins and lymphatic vessels enter/leave a structure
pyloric sphincter
bw stomach and duodenum
parts of the stomach
fundus cardiac region body antrum pyloric canal