Midterm Flashcards
diaphragm motor innervation
phrenic nerve C3-5)
diaphragm sensory innervation
- mostly phrenic nerve
- peripheral edges supplied by intercostal nerves
distribution of nerve in diaphragm
- L and R phrenic distributed radially = central incisions in radial fashion
- intercostals distribute transversely at peripheral edge = transverse incisions transverse or circumferential
diaphragm arterial supply
- superior surface: superior phrenic arteries, musculophrenic artery, pericardiophrenic arteries
- inferior surface: inferior phrenic arteries
venous drainage of diaphragm
- R inferior phrenic vein drains into IVC at caval hiatus
- L inferior phrenic vein joins L adrenal vein and drains in to left renal vein
diaphragmatic hiatuses
- caval T8
- esophageal T10
- aortic T12
paired branches of abdominal aorta
- inferior phrenic (upper L1/lower T12)
- middle adrenal (L1)
- lumbar (L1-L4)
- renal (L2)
- gonadal (lower L2)
- bifurcation to common iliacs (L4)
unpaired branches of abdominal aorta
- celiac axis (upper L1/lower T12)
- superior mesenteric (lower L1)
- inferior mesenteric (L3)
- median sacral (L5)
spinal cord blood supply
great radicular artery arising from lumbar arteries
azygous formation
right ascending lumbar vein merges with right subcostal vein
hemiazygous formation
left ascending lumbar vein merges with left subcostal vein
IVC bypass
left/right ascending lumbar veins connect common iliac, iliolumbar, and lumbar veins to azygous/hemiazygous systems and can bypass IVC in case of thrombosis
distribution of vagus nerves
- celiac plexus
- renal plexus
- superior mesenteric plexus
- superior to splenic flexure to supply foregut and midgut
- gonads
lower esophageal sphincter
- not a true sphincter and more of a high pressure area
- angle of his near cardia helps prevent reflux
barrett’s esophagus
- esophagus is normally stratified squamous epithelial
- chronic reflux results in columnar cell metaplasia and can be treated with anti-reflux
Z line
junction of esophageal and gastric tissue (squamous and columnar junction)
cardia
portion of stomach just distal to esophageal-gastric junction
fundus
most superior portion, superior to place of esophageal-gastric junction
body
main reservoir of the stomach, distal half is the antrum
pylorus
muscular sphincter area that connects to the duodenum
chief cells
- located in the body
- secrete enzymes
parietal cells
- located in the body
- secrete gastric acid
G cells
- located in the antrum
- secrete gastrin
lesser curvature blood supply
L/R gastric arteries
greater curvature blood supply
L/R gastroepiploic arteries
gastro-omental
fundus and upper body blood supply
short and posterior gastric arteries
pyloric blood supply
gastroduodenal artery
innervation of stomach and duodenum
- parasympathetic: anterior/posterior vagal trunks
- sympathetic: celiac ganglia
4 parts of duodenum
- transverse
- descending (overlies hilum of right kidney, IVC, and iliopsoas)
- ascending (crossed by SMA and SMV)
- transitional (becomes jejunum at ligament of treitz)
transverse duodenum ulceration
posterior penetrating ulceration of transverse duodenum can cause severe hemorrhage from gastroduodenal artery
duodenal papilla
- major papilla: opening into descending duodenum the drains the common bile ducts and major pancreatic duct through sphincter of oddi
- minor papilla: opening in to duodenum that drains accessory pancreatic duct
ampulla of vater
- union of major pancreatic duct and common bile duct that drains into the major papilla through sphincter of oddi
- located halfway down descending duodenum
- marks transition from foregut to midgut
blood supply of duodenum
inferior and superior pancreaticoduodenal arteries
pancreatic buds
- dorsal: becomes head, neck, body, tail
- ventral: becomes uncinate process
pancreatic duct formation
- dorsal duct degenerates or may become accessory pancreatic duct of santorini
- ventral duct becomes main pancreatic duct of wirsung
parts of pancreas
- head (in duodenum C curve)
- neck (overlies SMA/SMV)
- body
- tail
- uncinate process (posterior to SMV)
spleen functions
- oversized lymph node
- storage of RBC and platelets
- eliminate senescent and damaged cells
- filter antigens
splenectomy complications
- thrombocytosis leading to thrombosis
- toxic shock syndrome from encapsulated gram + cocci
extrahepatic bile ducts
- junction of cystic duct and common bile duct is highly variable
- common bile duct empties into ampulla of vater and met by pancreatic duct
triangle of calot
- inferior edge: cystic duct
- superior edge: liver
- medial edge: common/R hepatic duct
- contains the cystic artery
epiploic foramen of winslow
hole in gastrohepatic ligament behind the portal hepatis that can be used to tamponade bleeding from hepatic arteries
portal triad
- portal vein
- proper hepatic artery
- common bile duct
hepatic portal vein
-IMV joins the splenic vein and merges with SMV to form portal vein
portal hypertension
- can be caused by alcoholic or post-necrotic cirrhosis
- dilation of portal systemic anastomes can cause life threatening bleeding form varices
portal-systemic anastomoses
- paraesophageal (varices)
- paraumbilical (caput medusa)
- superior/inferior rectal (hemorrhoids)
- retroperitoneal
ventral mesentery
becomes the liver, falciform ligament, and lesser omentum
hepatic ligaments
- falciform ligament: contains ligamentum teres and ligamentum venosum
- round ligament: connects liver to umbilicus
- coronary ligament: continuation of falciform that runs along superior surface
lobes of liver
-divide by gallbladder fossa
-right lobe
-left lobe:
caudate (anterior between vena cava and
falciform);
quadrate (posterior between gallbladder fossa and
falciform);
lateral segment (everything left of falciform)
parts of small intestine
- duodenum
- jejunum
- ileum
penetrating vs perforating ulcers
- anterior ulcers perforate
- posterior ulcers penetrate (can cause pancreatitis and typically treated surgically)
superior mesenteric artery branches
- inferior pancreaticoduodenal artery
- middle colic artery (transverse colon)
- right colic artery (ascending colon)
- ileocolic artery (cecum)
- jejunal/ileal branches (small intestine anastomoses)
contrast jejunum and ileum
- vasa recta become shorter moving distally
- vascular arcades become fore complex moving distally
- plicae circulares become shorter and fewer moving distally
- lymphoid peyers patches increase moving distally
myenteric plexus
- superficial
- contains parasympathetic and sympathetic innervation
submucosal plexus
- deeper
- contains parasympathetic innervation
migrating motor complexes
- coupled segmental and longitudinal contractions
- facilitated by motilin
- move undigested food towards the colon in fasting state
meckel’s diverticulum
- remnants of omphalomesenteric duct
- occurs in 2% of population
- found within 2 feet of ileocecal valve
- ectopic mucosa in 2% of patients
- can mimic appendicitis
intussusception
- obstruction where small intestine telescopes through ileocecal valve
- characterized by red currant jelly like stool
parts of large intestine
- cecum
- appendix
- colon (ascending, transverse, descending, sigmoid)
- rectum
- anal canal
teniae coli
- three bands of longitudinal smooth muscle that assist in peristalsis
- not found in the rectum
haustra
pouching of large intestinal segments separated by longitudinal muscles
omental appendages
peritoneal fat accumulations on the colon
ileocecal valve
- one way valve separating small and large intestine
- critical in limiting colonic reflux
- closure of valve stimulated by colonic distention
mcburney’s point
- 1/3 distance moving from ASIS to umbilicus
- point on abdomen with max tenderness in acute appendicitis
inferior mesenteric branches
- left colic artery(descending colon)
- sigmoid arteries (sigmoid colon)
- superior rectal artery (rectum)
marginal artery of drummond
terminal anastomoses of superior and inferior mesenteric arterial branches
diverticulosis
- outpouching of colonic wall, often at point of penetration of blood vessels
- only found proximal to the rectum
volvulus
- sigmoid colon wraps around itself and its mesentery causing a closed loop obstruction
- often caused by chronic constipation and subsequent progressive dilation
nerve supply of intestines
-celiac plexus: small intestine, ascending/transverse colon, abdominal visceral organs
-sympathetic: greater, lesser, least splanchnic
-parasympathetic: vagus
-aortic plexus: descending/sigmoid colon and proximal rectum
-sympathetic: lumbar splanchnic
-parasympathetic: pelvic splanchnic of sacral
plexus
perirenal fat
extraperitoneal fat that surrounds the kidney and is enclosed by the renal fascia
pararenal fat
fat that separates the anterior layer of the renal fascia from the peritoneum and separates the posterior layer of the renal fascia from the quadratus lumborum
kidney poles
- superior pole associated with suprarenal gland
- right superior pole more inferior due to the liver
- inferior pole close to iliac crest
kidney sinus
deep opening found on medial surface of kidney
kidney hilum
found in the sinus of the medial margin of the kidney
renal pelvis
internal portion of the hilum that drain in to ureters
renal cortex
continuous band of tissue just deep to the capsule that contain glomeruli
renal columns
invaginations of the renal cortex that divide the medulla into pyramids
renal medulla
darker and more striated that the cortex, contains the loop of henle, renal tubules, and collecting ducts
renal pyramids
subsections of the renal medulla separated by renal columns
renal rays
longitudinal striations in the renal medulla
renal papillae
apical projections of renal pyramids that extend towards the center of the kidney
minor calyx
accepts contents of collecting tubules and surrounds renal papillae
major calyx
accepts contents of 2-3 minor calyx and drains in to renal pelvis
adrenal blood supply
superior, middle, inferior adrenal arteries
renal vein drainage
- right side directly into IVC
- left side renal vein collects drainage from many other veins
adrenal cortex
- secretes corticosteroids and androgens
- receives no innervation
- controlled by pituitary secretions
adrenal medulla
- secretes epinephrine/norepinephrine
- sympathetic innervation from greater splanchnic nerves
lumbar plexus
I “twice” Get Laid On Fridays
- subcostal nerve (T12)
- iliohypogastric nerve (T12-L1)
- ilioinguinal nerve (L1)
- genitofemoral nerve (L1-2)
- lateral cutaneous nerve of the thigh (L2-3)
- obturator nerve (L2-4)
- femoral nerve (L2-4)
male urethra
- preprostatic: contains internal urinary sphincter and is the shortest part
- prostatic: widest part
- membranous: contains external urinary sphincter and is the skinniest part
- spongy: longest part
ductus deferens
transports spermatazoa to the ejaculatory duct from the testes
ejaculatory ducts
fusion of seminal vesicle and ductus deferens that opens into the prostatic urethra
corpus cavernosum
- 2
- each supplied by deep artery of the penis
corpus spongiosum
contains spongy urethra and is supplied by bulbourethral artery
tunica vaginalis
- closed peritoneal sac with a parietal and visceral layer
- not found in the ovaries
tunica albuginea
- tough connective tissue capsule of the testicle
- has analogous structure in the ovaries
cremaster muscle
- found in inguinal canal and scrotum
- surrounding testis and spermatic cord
- reflexively raise and lower testes to maintain temperature
epididymis parts
- head: coiled mass formed from efferent ductules
- body: true epididymis, single duct into which efferent ductules drain
- tail: inferior enlargement continuous with ductus deferens
seminal vesicles
- accessory glands that sit posterior to bladder and join ductus deferens to make ejaculatory duct
- secretions add volume to ejaculate
- do not store sperm
prostate
- accessory structure that surrounds the urethra, anterior to the rectum
- comprised of 30-40 individual glands that empty independently into prostatic sinus
- add volume to ejaculate
ovaries
- site of egg production
- estrogen/progesterone synthesis
ovarian blood supply
ovarian artery
ovarian innervation
- ovarian plexus
- sympathetic: lesser splanchnic
- parasympathetic: vagus
suspensory ligament
attaches ovaries to lateral pelvic wall
utero-ovarian ligament
attaches ovaries to lateral uterus and is part of broad ligament
mesovarium
part of broad ligament most proximal to ovaries
uterus parts
- body: main part
- fundus: rounded superior portion
- isthmus: constricted region connecting body and cervix
- cervix: cylindrical inferior part surrounded by vaginal fornix (has internal and external os)
infundibulum
trumpet shaped end of fallopian tube
frimbrae
tentacle like projections at end of infundibulum
ampulla
progressively widening portion connecting to the uterus
vaginal innervation
- innervated by uterovaginal plexus
- sympathetic: lower thoracic and upper lumbar splanchnic nerves
- parasympathetic: pelvic splanchnic nerves that respond to stretch
- only lower 1/4 receives somatic innervation from pudendal nerve
clitoris
-2 corpora cavernosa and no spongiosum
arterial supply of femoral head
- femoral profunda artery
- medial and lateral femoral circumflex arteries
- obturator artery, but is not a major contributor
anterior compartment of thigh
- hip flexors and knee extensors
- innervated by femoral nerve
- supplied by femoral artery
- sartorius
- rectus femoris
- vastus lateralis, medialis, intermedius
- iliopsoas
- pectineus
anteromedial compartment of the thigh
- hip adductors
- innervated by obturator nerve
- supplied by obturator artery
- adductor longus, brevis, magnus
- gracilis
- obturator externus
posterior compartment of thigh
- hip extensors and knee flexors
- innervated by tibial division of sciatic nerve
- supplied by deep femoral artery
- semitendinosus
- semimembranosus
- biceps femoris (short head common fibular nerve)
anterior compartment of leg
- dorsiflexion of foot and toe extension
- innervated by deep fibular nerve
- supplied by anterior tibial artery
- tibialis anterior
- extensor hallicus longus
- extensor digitorum longus
- fibularis tertius
lateral compartment of leg
- foot eversion and weak plantar flexion
- innervated by superficial fibular nerve
- fibularis longis
- fibularis brevis
superficial posterior compartment of the leg
- plantarflexion of foot
- innervated by tibial nerve
- gastrocnemius
- soleus
- plantaris
deep posterior compartment of the leg
- plantarflexion
- innervated by tibial nerve
- contains posterior tibial artery
- popliteus
- flexor hallicus longus
- flexor digitorum longus
- tibialis posterior
