Nov 2020 Flashcards
Describe extensor tendon compartments
Each tunnel is lined internally by a synovial sheath and separated from one anoyher by fibrous septa.
Compartment 1: Extensor Pollicis Brevis , Abductor pollicis longus
Compartment 2: Extensor Carpi Radialis Brevis, Extensor Carpi radialis longus
Compartment 3: Extensor pollicis longus
Compartment 4: Extensor digitorum, Extensor indicis
Compartment 5: Extensor digiti minimi
Compartment 6: Extensor carpi ulnaris
What structure separates Compartment 2 and 3
Lister’s tubercle
Describe course of Musculocutaneous nerve
Terminal branch of lateral cord of BP (c567)
Emerges at the inferior border of pec Minor
Leaves the axilla and pierces the coracobrachialis muscle near the humerus.
The musculocutaneous nerve passes down the flexor compartment of the upper arm- superficial to brachialis but deep to the biceps brachii.
Then pierces the deep fascia lateral to biceps brachii to emerge LATERAL to Biceps tendon and brachioradialis. Continues to forearm as the lat. cutaneous nerve of forearm
What muscles does Musculocutaneous nerve innervate?
BBC
Brachialis, Biceps brachii, Coracobrachialis
Hand muscles supplied by Median Nerve
LOAF Lateral two lumbricals Opponens pollicis Abductor pollicis brevis Flexor pollicis brevis
Describe anatomical location of the base of the breast
Lies between the 2nd to 6th rib vertically and between the lateral border of the sternum and the mid-axillary line horizontally
Muscular attachements in and around the bicipital groove
a LaDy between two MAJORS
MAJOR - Pec Major attaches to lateral lip of bicipital groove
MAJOR - Teres Major attaches to medial lip of the bicipital groove
LD - Latissimus Dorsi attaches to the floor of bicipital groove in between the two
Describe the course of basillic vein
Originates from the dorsal venous network of the hand and ascends the medial aspect of the upper limb.
At the border of TERES MAJOR the vein moves deep into the arm, combines with brachial veins and forms AXILLARY VEIN
Describe the course of Cephalic vein
Originates from the radial aspect in anatomical snuffbox It ascends the anterolateral aspect of the upper limb. passes ANTERIORLY at the elbow.
At the shoulder, the cephalic vein travels in DELTOPECTORAL GROOVE pierces the Enters axilla region via CLAVIPECTORAL triangle.
What connects cephalic and basilic veins
Median cubital vein
Origin and insertion of long head of biceps
Originates from supraglenoid tubercle - the long head tendon travels through the capsule of the glenohumeral joint and the intertubercular sulcus of the humerus - risk of tupture. Tendon inserts on to radial tuberosity. Gives off bicipital aponeurosis distally, forms a sheet of fascia that covers antecubital fossa
What is the blood supply of the ureters?
Superior - Ureteric branches of the renal arteries
Middle - Branches of gonaldal arteries
Inferior - Branches of common and external iliac
Pelvic - Brances of internal iliac and vesical arteries
Order of structures in Renal Hilum
Anterior to posterior
Vein, artery, renal pelvis and ureter
Arterial Blood supply to adrenal glands
Superior adrenal artery arises from inferior phrenic
Middle adrenal artery arises from abdominal aorta
Inferior adrenal artery arises from renal arteries
Venous drainage of adrenal glands
Right adrenal vein drains into the inferior vena cava
left adrenal vein drains into the left renal vein
What is the origin of hepatic portal vein
Hepatic portal vein is formed of the confluence of splenic and superior mesenteric veins - Just posteror to the neck of the pancreas
Venous drainage of rectum
Superior rectal vein, rectosigmoid veins, sigmoid veins and left colic vein drains tto inferior mesenteric vein
IMV drains into splenic vein
Boundaries of Portal vein, where does it run
Superior - Caudate lobe of liver
Inferior - D1
Posterior - IVC
Portal vein runs in the free edge of the lesser omentum (Hepaatoduodenal ligament)
Which segments of liver does Portal vein supply/
Segments II, III, IV (left)
Right anterior - V AND VIII
Right posterior - VI and VII
Segment 1 caudate lobe lobe either
Lights Criteria
Pleural protein: serum protein > 0.5
Pleural LDH: Serum LDH >0.6
Effusion LDH level greater than 2/3 of the upper range of serum
Dukes classification
Dukes A Tumour confined to the bowel but not extending beyond it, without nodal metastasis (95%)
Dukes B Tumour invading bowel wall, but without nodal metastasis (75%)
Dukes C Lymph node metastases (50%)
Dukes D Distant metastases (6%)(25% if resectable)
Parathyroid Hormone - where is it secreted? What are its actions
chief cells of the parathyroid glands.
Acts to increase serum calcium conc.
How does PTH act to increase serum calcium concentation?
Bone
Binds to osteoblasts which signal to osteoclasts to cause resorption of bone and release calcium.
Kidney
Active reabsorption of calcium and magnesium from the distal convoluted tubule. Decreases reabsorption of phosphate.
Intestine via kidney Increases intestinal calcium absorption by increasing activated vitamin D. Activated vitamin D increases calcium absorption.
What are two types of K+ sparing diuetics, how do they work?
Amiloride - Epithelial Na channel blocker in DCT, weak diuretic, used with other diuretics (thiazides) as an alternative to k+ replacement
Spirolonolactone - Aldosterone antagonist in DCT
How does TXA work?
Antifibrinolytic
Inhibits the conversion of plasminogen to plasmin
Plasmin degades fibrin and therefore renders plasmin inactive slows this process
Benefit when adminstered in the first 3 hrs in bleeding trauma
What receptors does Adrenaline work on??
Low doses - beta adrenergic receptor agonist
Higher doses - Alpha receptor agonist
What receptors does Dopamine work on
Causes domapine receptor mediated renal and meserteric vascular dilatation and beta 1 receptor agnoism at high doses
Dobutamine action receptors?
. Dobutamine is a predominantly beta 1 receptor agonist with weak beta 2 and alpha receptor agonist properties.
Noradrenaline actioni receptors?
Noradrenaline is a catecholamine type agent and predominantly acts as an alpha receptor agonist and serves as a peripheral vasoconstrictor.
Hypokalaemia - Potassium and H+ are competitors, H+ tends to be associated with acidosis.
Hypokalaemia with Alkalosis
Hypokalaemia with alkalosis Vomiting Diuretics Cushing's syndrome Conn's syndrome (primary hyperaldosteronism)
Causes of Hypokalaemia with acidosis
Diarrhoea
Renal tubular acidosis
Acetazolamide
Partially treated diabetic ketoacidosis
Wernicke’s encephalopathy
Acute confusion
Ataxia
Opthalmoplegia
Insulin release stimulation
Glucose Amino acid Vagal cholinergic Secretin/Gastrin/CCK Fatty acids Beta adrenergic drugs
Source Stimulus and Actions of Gastrin
Source: G cells in antrum of the stomach
Stimulus: Distension of stomach, extrinsic nerves
Inhibited by: low antral pH, somatostatin
Action: Increase HCL, pepsinogen and IF secretion, increases gastric motility, trophic effect on gastric mucosa
Source Stimulus and Actions of Secretin
Source: S cells in upper small intestine
Stimulated by:
Acidic chyme, fatty acids, Increases secretion of bicarbonate-rich fluid from pancreas and hepatic duct cells, decreases gastric acid secretion, trophic effect on pancreatic acinar cells
Source Stimulus and Actions of VIP
Small intestine, pancreas
Neural stimulation
Stimulates secretion by pancreas and intestines, inhibits acid and pepsinogen secretion
Source Stimulus and Actions of Somatostatin
D cells in the pancreas and stomach
Stimulus: Fat, bile salts and glucose in the intestinal lumen
Action: Decreases acid and pepsin secretion, decreases gastrin secretion, decreases pancreatic enzyme secretion, decreases insulin and glucagon secretion
inhibits trophic effects of gastrin, stimulates gastric mucous production
Source Stimulus and Actions of CCK
I cells in upper small intestine
Partially digested proteins and triglycerides
Increases secretion of enzyme-rich fluid from pancreas, contraction of gallbladder and relaxation of sphincter of Oddi, decreases gastric emptying, trophic effect on pancreatic acinar cells, induces satiety
Sympathetic nervous system - response to surgery
1) NA from Sympathetic nerves and adrenaline from adrenal medulla
2) Blood diverted to visceral organs -
Bronchodilation, reduced intestinal motility, increased glucacon and glyogenolysis, insulin reduced.
3) HR and Myocardial contractility are increased
Endocrine response- Response to surgery
Hypothalamus, Pituitary, adrenal axis
Increased ACTH and cortisol production
Increases protein breakdown
Increases Blood glucose levels
- Aldosterone increases sodium re-absorption
- Vasopression increases water re-absorption and causes vasocontriction
Vascular endothelium-
Nitric oxcide produces vasodilatiation
Platelet activating factor enhances the cytokine responses
Prostaglandins produce vasodilatation and induce platelet aggregation
Factors increasing Anatomical dead space
Standing, increased size of person, increased lung volume and drugs causing bronchodilatation e.g. Adrenaline
Describe path of Radial Nerve
Continuation of posterior cord of the brachial plexus (root values C5 to T1)
n the axilla: lies posterior to the axillary artery on subscapularis, latissimus dorsi and teres major.
Enters the arm between the brachial artery and the long head of triceps (medial to humerus).
Spirals around the posterior surface of the humerus in the groove for the radial nerve.
At the distal third of the lateral border of the humerus it then pierces the intermuscular septum and descends in front of the lateral epicondyle.
At the lateral epicondyle it lies deeply between brachialis and brachioradialis where it then divides into a superficial and deep terminal branch.
Deep branch crosses the supinator to become the posterior interosseous nerve.
