November 4 Flashcards
The perineum
Adrenal Rest
Adrenal rests are a very common finding in term neonates (50%) and most regress so that by adulthood the population incidence is 1%. The adrenal glands and gonads both develop from the urogenital ridge. In early embryogenesis, the adrenal cortical tissue can migrate with the descending gonads.
herniotomy is done on neonates. inguinal hernia are unlikely to resolve on its own compared to umbilical hernia.
Walls of the Inguinal Canal
MALT : 2M 2A 2L and 2T
superior wall ( roof ) : 2 muscles - Transversus Abdominis and internal oblique
Anterior Wall : 2 Aponeurosis - APoneurosis of external Oblique and Internal Oblique
Inferior Wall : 2 Ligaments - Inguinal Ligament and Lacunar Ligament
Posterior wall : 2 Ts - trasversalis Fascia and Conjoint Tendon
Inguinal canal
Location
Above the inguinal ligament
The inguinal canal is 4cm long
The superficial ring is located anterior to the pubic tubercle
The deep ring is located approximately 1.5-2cm above the half way point between the anterior superior iliac spine and the pubic tubercle
Boundaries of Inguinal Canal
**Floor **
External oblique aponeurosis
Inguinal ligament
Lacunar ligament
**Roof **
Internal oblique
Transversus abdominis
**Anterior wall **
External oblique aponeurosis
**Posterior wall **
Transversalis fascia
Conjoint tendon
**Laterally **
Internal ring
Transversalis fascia
Fibres of internal oblique
Medially
External ring
Conjoint tendon
Contents of Inguinal Canal
Males
Spermatic cord and ilioinguinal nerve
As it passes through the canal the spermatic cord has 3 coverings:
External spermatic fascia from external oblique aponeurosis
Cremasteric fascia
Internal spermatic fascia
**Females **
Round ligament of uterus and ilioinguinal nerve
Retromandibular Vein
Formed by a union of the maxillary vein and superficial temporal vein
It descends through the parotid gland and bifurcates within it
The anterior division passes forwards to join the facial vein, the posterior division is one of the tributaries of the external jugular vein
Medial Malleolus relations
The structures passing behind the medial malleolus from anterior to posterior include: tibialis posterior, flexor digitorum longus, posterior tibial vein, posterior tibial artery, nerve, flexor hallucis longus.
Anterior Interosseous Nerve
The anterior interosseous nerve (volar interosseous nerve) is a branch of the median nerve that supplies the deep muscles on the front of the forearm, except the ulnar half of the flexor digitorum profundus.
It accompanies the anterior interosseous artery along the anterior of the interosseous membrane of the forearm, in the interval between the flexor pollicis longus and flexor digitorum profundus, supplying the whole of the former and (most commonly) the radial half of the latter, and ending below in the pronator quadratus and wrist joint.
Innervation
The anterior interosseous nerve classically innervates 2.5 muscles:
Flexor pollicis longus
Pronator quadratus
The radial half of flexor digitorum profundus (the lateral two out of the four tendons).
These muscles are in the deep level of the anterior compartment of the forearm.
Sternal Angle Relations
Location - T4-T5
RATPLANT
R- ribs (2nd)
A- Arch of aorta start and end
T - Trachea bifurcation
P - Pulmonary trunk bifurcation
L - left recurrent laryngeal nerve ( loops under the arch of aorta) and Ligamentum arteriosum
A - azygos system drains into SVC
N - Nerves (Cardiac Plexus)
T - Thoracic duct
Level of manubrium and upper sternum
Anatomical structures at the level of the manubrium and upper sternum
Upper part of the manubrium
Left brachiocephalic vein
Brachiocephalic artery
Left common carotid
Left subclavian artery
External oblique muscle
**Origin **
Outer surfaces of the lowest eight ribs
**Insertion **
Anterior two thirds of the outer lip of the iliac crest.
The remainder becomes the aponeurosis that fuses with the linea alba in the midline.
**Nerve supply **
Ventral rami of the lower six thoracic nerves
**Actions **
Contains the abdominal viscera, may contract to raise intra abdominal pressure. Moves trunk to one side.
Rotator Cuff Muscle
SITS
S- supraspinatus
I - Infraspinatus
T - Teres minor
S- Subscapularis
Stability is provided by muscles of the rotator cuff that pass from the scapula to insert in the greater tuberosity (all except sub scapularis-lesser tuberosity).
Shoulder Movements
1) Flexion
Anterior part of deltoid
Pectoralis major
Biceps
Coracobrachialis
**2) Extension **
Posterior deltoid
Teres major
Latissimus dorsi
**3) Adduction **
Pectoralis major
Latissimus dorsi
Teres major
Coracobrachialis
**4) Abduction **
Mid deltoid
Supraspinatus
5) Medial rotation
Subscapularis
Anterior deltoid
Teres major
Latissimus dorsi
6) Lateral rotation
Posterior deltoid
Infraspinatus
Teres minor
Esophagus - Histology
Mucosa :Non-keratinized stratified squamous epithelium
Submucosa: glandular tissue
Muscularis externa (muscularis): composition varies.
Adventitia
