RA1 Flashcards
CRANIUM
divisible into calvaria/neurocranium (upper bony structure that houses brain) & facial skeleton/viscerocranium
NECK REGION
- conduit (join head to body)
- must be open as nutrient substances (food, gas) must pass from head to abdomen via neck
THORACIC CAVITY
- split into 2 lateral components (lungs)(by fibrous pericardium) & 1 medial component (mediastinum)
- lined by visceral/parietal pleura
- organs split into resident thoracic viscera (always there) & viscera en-passant (exit compartment at dif. levels)
ABDOMINOPELVIC CAVITY
1 internal membrane sheet (parietal peritoneum) lines both cavities & they are continuous with each other (no bony boundary between abdomen & pelvis)
ANATOMICAL CAVITY
opening/dilation within confines & is a defined space with defined boundaries, shape, contents
ANATOMICAL COMPARTMENT
a separate sub-section of a cavity
ANATOMICAL SPACE
- unoccupied domains in anatomical compartments
- true anatomical space = occur normally e.g. oral cavity
- potential anatomical space = don’t normally exist & are created by pathologies creating spaces that didn’t exist before e.g. blisters
PACKING OF TISSUES
skin -> superficial fascia (bind skin to rest of body) -> deep fascia (enclose organs & divide muscle to compartments) -> muscles -> deepest layer of deep fascia
ORDER OF NERVE ENVELOPES
endoneurium ensheaths single cell axon -> perineurium ensheaths nerve fascicle -> epineurium ensheaths entire nerve
SKELETAL MUSCLE TISSUE ENVELOPES
endomysium ensheaths single myofibril -> perimysium ensheaths fascicle (collection of myofibrils) -> epimysium ensheaths all fascicles of muscle (perimysiums) & its neurovascular bundle (runs in between muscle fascicles)
BONE
- compact bone (solid mass of dense connective tissue) & cancellous bone (branching network of non-solid bone)
- 5 types (flat, short, long, sesamoid, irregular)
FLAT BONE
- made from 3 layers of bone; compact bone (outer table) -> spongy bone (has bone marrow) -> compact bone (inner table)
- outer & inner table lined with periosteum
LONG BONE
- bone longer than it is wide & has a narrow cavity
- surfaces covered with periosteum (lines outer surface of bone) & endosteun (lines inner surface wall)
PERIOSTEUM
- generate osteoblasts of bone which give rise to osteocytes (secrete bone) & osteoclasts (break down bone)
- has blood supply & has innervation from sensory nerves of somatic NS for pain sensations from bone
- outer layer made of collagen (in contact with bones) & inner layer has the osteoblasts
CARTILAGE
covered in soft tissue lining called perichondrium which supports cartilage in the same way that periosteum supports parent bone
PERICHONDRIUM
has fibrous outer layer (maintained by fibroblasts) & inner layer (has chondroblasts which make chondrocytes which make collagen)
BONY SPACE
- surfaces of bones onto which muscles, tendons, ligaments & soft tissue attach
- can be fossae (pit/cavity in bone)
PARANASAL SINUSES
cavities within bones of head that open into nasal cavity & are lined by 2 layers of soft tissue; periosteum & secretory epithelium (ciliated pseudo-stratified columnar epithelium with goblet cells)
NEURONAL INNERVATION OF PARANASAL SINUSES
- somatic sensory innervation (somatic sensations e.g. pain, temp, irritation)
- autonomic parasympathetic innervation (increase secretions from nasal cavity & paranasal sinuses)
MUSCLES OF BODY ORDER
skin/epidermis -> muscle tissue -> epithelium layer (parietal peritoneum)
CRANIAL CAVITY
meninges divide intracranial compartment to 2 main sub-compartments (supra-tentorial & infra-tentorial compartment) & meninges receive somatic sensory innervation
THORAX JOB
provide nutrient substances to body & excrete large volumes of used fuels
ABDOMINO-PELVIC JOB
absorption of nutrients, excretions from GI & urinary tracts (has bladder)
BONES OF THORAX
12 pairs of ribs, 12 thoracic vertebrae, sternum, manubrium, manubriosternal joint, xiphisternal joint, xiphoid process
INTERCOSTAL MUSCLES
- muscles between ribs; external = superficial to ribs, internal = blends into ribs, innermost = deep to ribs
- strengthened by interweaving grain of muscle fibres of intercostal muscle (all 90 degrees to one another)
PARIETAL PLEURA
lines internal surface of thorax body wall & is made of simple squamous epithelium
VISCERAL PLEURA
lines outer surface of organs of the thorax
PLEURAL CAVITY
- space between the visceral & parietal pleura (filled with pleural fluid to create fluid seal between lung & ribcage) (too much fluid = fluid seal lost so lung is squashed within cavity (pleural effusion))
- lines lungs & secretes fluid daily to act as anti-inflammatory
PNEUMOTHORAX
when air enters pleural cavity & lung collapses
SOFT TISSUES OF THORAX
pleura (parietal & visceral), diaphragm, intercostal muscles, great vessels, nerves, viscera, pleural fluid
BOUNDARIES OF THORAX
SUPERIOR - thoracic inlet & jugular notch (large visible dip between neck & 2 collarbones)
INFERIOR - thoracic outlet & diaphragm
ANTERO-LATERO-POSTERIOR - ribs (front, side & back)
ANTERIOR - manubrium, sternum & xyphoid process
POSTERIOR - thoracic vertebrae, scapulae (shoulder blade)
BOUNDARIES OF ABDOMINAL CAVITY
SUPERIOR - diaphragm & lower ribs
INFERIOR - pelvic brim
ANT-LAT - anterolateral abdominopelvic wall
POSTERIOR - posterior abdominal wall
PERITONEUM
- parietal - lines inner walls of abdomen, diaphragm, pelvis (innervated by sensory division of somatic NS so pain sensations are sharp & localised)
- visceral - lines visceral organs of abdomen (innervated by sensory division of autonomic NS so pain sensations are perceived as non-defined area of discomfort not localised)
PERITONEAL/ABDOMINAL CAVITY
- cavity created between parietal & visceral peritoneum
- structures outside peritoneal organs are extraperitoneal organs (formed as parietal peritoneum folds in on itself to trap organs & form an axtraperitoneal space)
- split into greater sac & lesser sac (smaller & just behind stomach (full stomach gets rid of lesser sac)
- omental foramen is bit between greater & lesser sac which allows for communication between them
HERNIA
protrusion (extension) of a viscus through wall of cavity in which it is normally contained
ACQUIRED HERNIA
caused by wear & tear of life e.g. childbirth
CONGENITAL HERNIA
present from birth & happen at points of weakness in abdominal wall
SPIGELIAN HERNIA
protrusion of intestine due to weakness between muscle fibres of abdominal wall (causes are sport, obesity, chronic coughing)
REDUCIBLE HERNIA
hernia with a bulge that flattens if you push it
INCISIONAL HERNIA
appears in hernia at site of previous surgery
IMPORTANCE OF THORAX
- houses lungs, heart & great vessels
- musculature acts as bellow that deflate/inflate lungs
THORACIC WALL TISSUE LAYERS (SUPERFICIAL TO DEEP)
skin -> superficial fascia pectoralis -> pectoral fascia -> pectoralis major -> clavipectoral/deep pectorial fascia (separates pectoralis major or minor) -> pectoralis minor -> external intercostal muscle -> internal intercostal muscle & ribs -> innermost muscle -> endothoracic fascia (deepest layer & separates internal thoracic wall from underlying pleura)
TYPICAL RIBS
- have head (has 3 tubercles (these make contact with 3 other bones), neck (separates head from tubercle) and body (body has an angle, costal groove & shaft)
- the tubercles have facets & demifacets on them (to articulate with sites on heads of adjacent ribs)
- superior costal facets articulate with head of its own rib
- inferior costal facets articulate with head of the rib below
ATYPICAL RIBS
- 3 of the 12 ribs are atypical (rib 1, 11, 12)
ANTERIOR ARTICULATIONS OF RIBS
- RIB 1 - joins to sternum
- RIB 2-7 - true ribs as connect to sternum using their own costal cartilage
- RIB 8-10 - false ribs as costal cartilages join to costal cartilage number 7 to join to the sternum
- RIB 11-12 - false ribs and these float (costal cartilages connect to nothing)
PECTORALIS MAJOR MUSCLE
CLAVICULAR PART (elevates shoulder, draws arm forward & simultaneously towards midline) STERNOCOSTAL PART (same action as clavicular but also draws shoulder downwards)
SCAPULA
- serratus anterior binds inferior aspect of scapula to body wall
- spine of scapula divides supraspinous fossa (seen superiorly & covered by supraspinatus muscle) from infraspinous fossa (seen posteriorly & covered by infraspinatus muscle)
SERRATUS ANTERIOR
- attaches on lateral surfaces of upper 8-9 ribs &
- supplied by long thoracic nerve
- actions are extension & rotation of scapula
COSTAL CARTILAGE
gives the ribcage flexibility
RETROPERITONEAL STRUCTURES
- organs just behind peritoneal sac (is extraperitoneal but called retroperitoneal as directly behind peritoneal sac)
- sad pucker
- adrenal gland, aorta/IVC, duodenum, pancreas, ureters, colon, kidneys, oesophagus, rectum
PRIMARY VS SECONDARY RETROPERITONEAL ORGANS
primary never had a mesentery (always been outside of peritoneum)(e.g. aorta, IVC, kidneys) but secondary once had a mesentery but lost it in development (initially intraperitoneal but became retro as mesentery fused with abdominal wall)(e.g. pancreas, duodenum, ascending & descending colons)
MESENTERY
a fused double layer of parietal peritoneum that suspends GI tract/intestines from posterior body wall
OMENTUM
- abdominal structures formed from peritoneum. Visceral peritoneum covering stomach extends on both sides to form double layered sheets filled with prominent patches of fat
- double fold of peritoneum that connects greater curvature of stomach to intestines (greater omentum) OR lesser curvature to liver (lesser omentum)
LINEA ALBA
- attaches to xiphoid process superiorly & pubic symphysis inferiorly
- separates abdomen into L + R
- made by aponeurosis (takes place of tendon) layers of the surround muscles
MEDIASTINUM
- the middle of thorax (between the 2 pleural sacs)
- ANTERIOR - sternum
- POSTERIOR- spine
- SUPERIOR - superior thoracic aperture
- INFERIOR - diaphragm
- LATERAL - 2 pleural sacs
TISSUE LAYERS OF MEDIASTINUM (SUPERFICIAL TO DEEP)
fibrous pericardium layer -> parietal layer of serous pericardium -> pericardial cavity -> visceral layer of serous pericardium -> myocardium -> endocardium
TISSUE LAYERS OF PULMONARY CAVITIES (SUPERFICIAL TO DEEP)
- pulmonary cavities (L & R) are separated by mediastinum & occupied by their respective lungs
- endothoracic fascia –> parietal pleura –> pleural cavity –> visceral pleura –> outer surface of lung –> parenchyma of lung (has the alveoli)
PERICARDIAL SAC
- double walled sac containing heart & great vessels
- outer layer is fibrous pericardium & inner layer is serous pericardium (Serous pericardium further sub-divided into parietal & visceral pericardium)
PERICARDIUM
- visceral pericardium forms outer covering of heart
- parietal pericardium is derived from thoracic wall
PERICARDIAL SINUSES
lines of reflection between visceral & parietal pericardium called transverse & oblique pericardial sinus (posterior to heart in pericardial sac)
TRANSVERSE PERICARDIAL SINUS
- anterior to superior vena cava & posterior to ascending aorta
- leaves a hole in heart where you can put your finger & not rupture anything (tourniquet placed in sinus to stop blood flow to vessels in surgery)
HEART LOCATION
- WHERE - in pericardial sac
- ANTERIOR - sternum
- POSTERIOR - trachea, oesophagus
- INFERIOR - diaphragm
LUNGS
- attached to trachea by main bronchus & attached to heart by pulmonary vessels
- divided into lobes (R = 3 (divided into 10 segments), L = 2 (divided into 8 segments)) divided by fissures which are further divided into segments
LOOK AT RA1 WK6 - THORAX DIAGRAM ON PAGE 3/4
MUSCLES OF ANTEROLATERAL ABDOMINAL WALL
- we have three main muscles (external oblique, internal oblique & transversus abdominis)
- between these 3 muscles (in medial aspect) we have linea alba, rectus abdominis muscle, rectus sheath
LOOK AT RA1 W8 - ABDOMEN & VISCERA
POINTS OF REFERENCE FOR 4 QUADRANT MODEL
Linea alba (the vertical middle line formed from xyphoid process (at top) to pubic symphysis (at bottom) & the umbilicus (horizontal line)
EXTRAPERITONEAL ORGANS
organs that sit within abdominal cavity but outside of peritoneal cavity
INTRAPERITONEAL ORGANS
when organs are covered throughout their whole surfaces with visceral peritoneum (not just sitting within a peritoneal cavity but actually surrounded by it)
BARE AREA OF LIVER
part of liver whose surface is not covered by visceral peritoneum (clinically important as has no sensory or nervous innervation (so any damage here is unnoticed as patient feels no pain))
LIGAMENT OF ABDOMEN
any double fold of visceral peritoneum that joins any 2 abdominal organs (e.g., if one double fold covers stomach & then spleen) OR any double fold of visceral peritoneum that attaches a visceral organ to posterior abdominal wall
SMALL INTESTINE
- neuronal innervation via vagus nerve (CN X)
- supplied by superior mesenteric artery
- starts off as duodenum -> duodenojejunal junction -> ileum -> large intestine
LARGE INTESTINE
blood supply to LHS (descending column) is by inferior mesenteric artery but ascending column & transverse column (right hand side & top) are supplied by superior mesenteric artery
COELIAC TRUNK
branch of abdominal aorta (at L1) & supplies most of the blood to stomach
TRANSVERSE MESOCOLON
transverse mesoderm that divides abdomen into supracolic & infracolic compartments
RA1 W8 - ABDOMEN
INFRA-COLIC COMPARTMENT
- ANATOMY - inferior to mesentery of transverse colon & superior to pelvic inlet
- contains small intestine, ascending & descending colon
PARACOLIC GUTTERS (L & R)
join supracolic compartment to infracolic compartment
TYPES OF COLLAGEN FIBRE
bone contains type 1 & cartilage contains type 2
COELIAC TRUNK
branch of abdominal aorta (at L1) that supplies blood to stomach
FUNCTION OF PERIOSTEUM
lines bones & produces osteoblasts (produce osteoclasts/cytes)
COMPONENTS OF PERITONEAL CAVITY
greater sac & lesser sac
WHY LARGE INTESTINE HAS SACCULATIONS (LOOK LIKE BUBBLES)
due to the tenia coli (longitudinal muscle that is thinner than circular muscle)
FUNCTIONAL OF PERITONEAL FLUID
to reduce friction between abdominal organs
LINE OF DOUGLAS/ARCUATE LINE
horizontal line showing lower limit of posterior layer of rectus sheath
STRANGULATED HERNIA
hernia has a compromised blood supply (due to compression)
PARIETAL PLEURA TISSUE TYPE
it is simple squamous epithelium
ANGLE OF LOUIS/STERNAL ANGLE
- between T4-5 (at manubriosternal joint) & divides mediastinum into superior & inferior mediastinum
- cuts through where trache goes into 2 bronchi & cuts where the arch of the aorta leaves the pericardial sac
SCARPA FASCIA
deepest part of superficial fascia
DERIVATIVE OF GREATER OMENTUM
dorsal mesentery
PERITONEAL LIGAMENTS
2 layers of peritoneum that connect two organs to each other or connect organ to body wall
AZYGOUS SYSTEM OF VEINS
- return blood from lower parts of body wall into heart (useful for if IVC is blocked)
- azygous vein, hemiazygos vein, accessory hemiazygos vein
FALCIFORM LIGAMENT
attaches liver to front body wall & separates liver into left & right segments
TRUE PELVIS
the empty gap in the middle of pelvis (false pelvis is all the bones)
DIAPHRAGM CRURA
tendinous structures that are part of diaphragm & arise from vertebrae
- right crus is L1-3 & surrounds oesophageal opening to prevent reflux of gastric components
- left crus is L1-2
PERICARDIAL EFFUSION
when fluid gathers within the pericardial cavity
THORACIC INLET ANATOMY
- anterior - top of manubrium/clavicle
- posterior - T1
THORACIC OUTLET ANATOMY
- anterior - xyphoid process/xiphisternal joint
- posterior - T12
- posterolateral - 12th ribs
RECTUS SHEATH
surrounds the rectus abdominis muscle
LINEA SEMILUNARIS
curved tendon intersection on either side of rectus abdominis
OBLIQUE FISSURE
In the right lung, the oblique fissure separates the inferior lobe from the superior lobe and middle lobe. In the left lung, the oblique fissure separates the inferior lobe from the superior lobe
ESCHAROTOMY
done if patient has very deep burns as they restrict circulation
- relieves pressure & swelling in the limb
5 GENERAL PRINCIPLES OF BURNS
rescue (remove from danger), resuscitate (replace fluids), resurface, reconstruct, rehabilitate
ASSESSING BURNS
ABC approach (air & breathing - give oxygen, check for airway burns, listen to chest) (circulation - replace lost fluids, capillary refill, monitor BP)
SIZE OF BURNS MEASUREMENT
measured as percentage of total body surface area
BONE OF SKULL WHICH HAS DEPRESSION THAT THE PITUITARY GLAND LIES IN
sphenoid
TYPES OF CELLS IN POSTERIOR PITUITARY
neuroendocrine cells
PERIOSTEUM LAYERS
- outer layer is fibrous (has collagen)
- inner layer is cellular (has osteoblasts/osteocytes)
HOW BONE GETS BLOOD
periosteum has blood & nerves as bone is living so needs oxygen
INTERCOSTAL BUNDLE
runs in costal groove & is protected by the ribs as in innermost intercostal
JOINT BETWEEN RIB 1 & STERNUM
fibro-cartilagenous joint (can’t move)
JOINT BETWEEN REST OF RIBS & STERNUM
synovial joint
IMPORTANCE OF SYNOVIAL JOINTS
synovial joints are important as flexible for CPR & for chest to expand in relation to each other for inhalation
CARTILAGE JOB
acts as a shock absorber
VERTEBRA PROMINENS
c7 & is prominent spinous process
COSTAL MARGAIN
WHERE COSTAL CARTILAGE 7 SPLITS OFF INTO 8-10 (attaches to diaphragm)
CHEST DRAIN
- insert into 5th intercostal space under arm but ABOVE rib (as neurovascular bundle is below rib)
- treats effusion
IMPORTANCE OF LOBES
if cancer, you can remove only one lobe if infected instead of having to remove whole lung
LIGAMENT
double layer of peritoneum that 2 organs or one organ to a wall
POUCH OF DOUGLAS/RECTOURINE POUCH
- lowest point where free fluid accumulates in woman
- in the infra-colic compartment
L+R PARACOLIC GUTTER
left has a ligament across it that is important as right paracolic gutter has fluid going up & down but in left paracolic gutter fluid doesn’t move up or down
WHY IS LINEA ALBA BEST PLACE TO MAKE AN INCISION
as it has limited neuronal supply so it is best place to make an incision & not hit any nerves
EPITHELIUM OF SKIN
keratinised stratified squamous epithelium
DIVISIONS OF INFERIOR MEDIASTINUM
anterior, posterior & middle mediastinum compartment by pericardium
JOB OF A BONE
- provide shape (length + geometric attachments)
- muscle attachment (lever arm + metabolic)
MEDIASTINUM DEFINITION
A thick partition of tissue at and on either side of the median plane in the thoracic cavity
DIAPHRAGM
- separates thoracic cavity from the abdominal cavity
- attachments - (anterior - xyphoid process & costal margin), (anterolateroposterior - ribs), (posterior - lumbar vertebrae)
- has 3 perforations (t8,10,12) for openings that structures between cavities pass through
- 8 = IVC, 10 = oesophagus, 12 = aorta
- attached to lumbar vertebrae by L (l1-2) & R crus (l1-3)
- motor & sensory innervation is phrenic nerve (formed by C3,4,5 spinal nerves coming together)
- superior surface is covered diaphragmatic part of parietal pleura
- inferior surface is parietal peritoneum
- learn attachments
- attaches directly to ribs 11 & 12
- middle of it is central tendon
PARTS OF PARIETAL PLEURA
- costal pleura (covers inner aspect of ribs, costal cartilage))
- diaphragmatic pleura (covers thoracic (superior) surface of the diaphragm)
- cervical pleura (pops out of thoracic inlet & lines extension of pleural cavity into neck)
- mediastinal pleura
CARDIAC TAMPONADE
- fluid within pericardial cavity
- because the fibrous pericardium is tough, it can’t exert pressure outwards so it exerts it on the heart
PERICARDITIS
inflammation of pericardium
HOLE BETWEEN PEDICLES
vertebral foramen
JOINT BETWEEN RIB & TRANSVERSE PROCESS
costotransverse joint - between tubercle of rib & transverse costal facet of corresponding vertebrae
JOINT BETWEEN RIB & VERTEBRAL JOINT
costovertebral joint - between head of the rib, the superior costal facet of the corresponding vertebrae, and the inferior costal facet of the vertebrae above
RIB FACET STUFF
- typical ribs have 2 articular facets separated by crest & have a tubercle with another facet
- typical ribs also have a costal groove where the vessels run
- rib 1 has one facet on head as direct connection to manubrium & has scalene tubercle for muscle to attach to
- ribs 11 & 12 have only one facet for attachment with bodies of their own vertebrae. they have no tubercles & both ribs are short & are floating as they have no anterior attachment to sternum (that is why they only have one facet)
- ribs 2 & 7 connect to demi-facets on the sternum (small facets)
- posterior surface of rib is closest to the costal groove
- rib has tubercle (which has facets) & vertebrae has demi facets
- superior facet of rib articulates with inferior demi facet of upper thoracic vertebrae
- inferior facet of rib articulates with superior demi facet of lower thoracic vertebrae
- tubercle of rib articulates with transverse process of the thoracic vertebrae
LAYERS OF ANTERIOR ABDOMINAL WALL
skin -> superficial fascia -> anterior rectus sheath -> rectus abdominis -> posterior rectus sheath -> transversalis fascia -> extraperitoneal fascia -> parietal peritoneum
MENINGES NEURONAL INNERVATION
somatic sensory from trigeminal nerve
NAME OF INNER LAYER OF PERICHONDRIUM
chondrogenic layer
ATTACHMENTS OF STERNUM BODY
- Articulates with the manubrium superiorly to form the manubriosternal joint.
- Articulates with the xiphoid process inferiorly to form the xiphisternal joint.
- Lateral edges of the body are marked by numerous articular facets (cartilage lined depressions in the bone)
- Articular facets articulate with the costal cartilages of ribs 3-6.
- There are demifacets (smaller facets) for articulation with parts of the 2nd and 7th ribs
ORDER OF VERTEBRAL CANAL SIZE (SMALLEST TO LARGEST)
lumbar, sacral, thoracic
MUSCULATURE OF STOMACH
outer layer is longitudinal muscle layer then circular muscle layer then oblique muscle layer
FORAMEN OF WINSLOW
opening of lesser sac
SUPRACOLIC COMPARTMENT
- Divided into left & right sub-phrenic spaces by coronary ligament
- Divided into left & right sub-hepatic spaces by falciform ligament
CORONARY LIGAMENT
connects liver to diaphragm (and skips out bare area of liver)
WHAT IS INSIDE OMENTUM
Between the two layers of visceral
peritoneum is found fat, peritoneal fluid and
white blood cells
REFERRED PAIN
pain in diaphragm –> pain in shoulder
