Thorax & Abdomen Flashcards
Vagus nn
Parasympathetics to kidney walls, heart, foregut, midgut, 2/3 of transverse colon,
Autonomics: Pericardium
Somatic motor/Sens: Pharynx and Larynx via right and left recurrent laryngeal
Plexuses: Pulmonary, esophageal, cardiac
Phrenic nn.
Somatic: Pericardium
Sensory: mediastinum, diaphragm
Motor: diaphragm
Intercostal nn.
T1-T11, run in costal grooves
Runs between internal and innermost intercostal mm
Collateral branch runs thru inferior costal groove
Sensory of parietal pleura
Subcostal n
T12, Rib 12
Collateral branch inferior margin btwn internal and innermost IC mm
Pulmonary Plexuses
Mixed fibers from Vagus (parasymp, bronchoconstriction, gland secretion) and Cardiopulmonary Splanchnic nn (sympathetics, bronchodilation)
Iliohypogastric n
L1 - inferior to subcostal, superior to ilioinguinal
Ilioinguinal n
L1 - inferior to iliohypogastic, superior to lat. cutaneous. enters the inguinal canal
Genitofemoral n
L1-L2: sits atop psoas
Lateral cutaneous n. of thigh
L2-L3: lateral aspect of psoas
Femoral n
L2-L4: lateral to psoas
Obturator n
L2-L4: medial to psoas
Hindgut innervation
Parasympathetics: Pelvic splanchnic nerves to wall of hindgut organs
Sympathetics: lumbar splanchnic nerves to inferior mesenteric ganglion
midgut innervation
Parasympathetics: Vagus nn to wall of midgut organs
Sympathetics: Thoracic splanchnic nerves to celiac or superior mesenteric ganglion
foregut innervation
Parasympathetics: vagus nn to wall of foregut organs
Sympathetics: Greater thoracic splanchnic nerve to celiac ganglion
Foregut: Contents, blood supply, veins, lymphatics
Contents: Esophagus, stomach, proximal duodenum, liver, gallbladder, pancreas
Blood supply: Celiac trunk and branches
Venous drainage: gastric veins, splenic vein
Lymphatics: celiac lymph nodes to chyle cistern to thoracic duct
Midgut: Contents, blood supply, veins, lymphatics
Contents: distal duodenum, jejunum, ileum, cecum, appendix, ascending colon, proximal 2/3 of transverse colon
Blood supply: SMA
Venous drainage: SMV
Lymphatics: superior mesenteric lymph nodes to chyle cistern to thoracic duct
Hindgut: Contents, blood supply, veins, lymphatics
Contents: Distal 1/3 of transverse colon, descending colon, sigmoid colon, rectum
Blood supply: IMA
Venous drainage: IMV
Lymphatics: inferior mesenteric lymph nodes to chyle cistern to thoracic duct
Greater Splanchnic n
T5-T9: foregut sympathetics, synapse at celiac ganglia
Lesser splanchnic n
T10-T11: midgut sympathetics, synapse at superior mesenteric ganglia
Least splanchnic n
T12: kidney sympathetics, synapse at renal ganglia
Kidney Innervation
Parasympathetics: Vagus to kidney wall
Sympathetics: thoracic splanchnic nn (least splanchnic) to renal ganglion
Adrenal innervation
Sympathetic only: Thoracic splanchnic nerves, mainly greater splanchnic n.
Lymph drainage of abdominal wall
superior to umbilicus: axillary nodes
inferior to umbilicus: superficial inguinal nodes
testes/ovaries: lumbar nodes
Unpaired branches of aorta
Supply primarily retroperitoneal organs, gonads, body wall
Contains:
Subcostal aa.
Inferior Phrenic aa –> superior suprarenal aa.
Middle suprarenal aa.
renal arteries –> inferior suprarenal aa.
Gonadal aa
Lumbar aa.
Secondarily retroperitoneal organs
Had own mesentery during development.
HAD PAD
Horizontal, Ascending, Descending Duodenum
Pancreas, Ascending Colon, Descending Colon
Primarily retroperitoneal organs
Pee and Poop are Primary:
Suprarenal glands, kidneys, ureters, bladder, esophagus, rectum, aorta, IVC
Intraperitoneal organs
Abdominal esophagus, superior duodenum, stomach, spleen, liver, jejunum, ileum, transverse colon, signoid colon
Lesser omentum
Hepatogastric ligament (liver to lesser curve of stomach),
hepatoduodenal ligament (liver to duodenum)
Omental foramen (deep to hepatoduodenal lig.)
portal triad (portal v, proper hepatic a., bile duct)
Divisions of ribs
ribs 1-7: Vertebrocostal or True ribs
ribs 8-10: Vertebrochondral or False ribs
Ribs 11-12: Vertebral or Floating ribs
Diaphragm openings
Caval Opening (T8): IVC
Esophageal Hiatus (T10): Right crus, esophagus
Aortic Hiatus (T12): Left & Right Crura, Aorta, Azygos v. thoracic duct
“I ate 10 eggs at noon”
Anatomical warnings of breast cancer
Asymmetry in size, discharge from nipple, redness of skin,
dimpling - tumor pulling suspensory ligaments
retracted nipple: blocked areolar lymph nodes
abnormal contours: tumor pulling suspensory ligaments
Edema: tumor blocked lymph ducts
Pleuritis
inflammation of pleura: pain w/ activity, audible friction
Pneumothorax
air in pleural cavity
Pleural effusion
hemothorax (blood), chylothorax (lymph)
Pools in costodiaphragmatic recess
thoracentesis to remove fluid from costodiaphragmatic recess
Right lung impressions
SVC, Cardiac (Medial to hilum)
Arch of Azygos (superior to hilum)
esophagus (lateral to hilum)
Left lung impressions
Cardiac (medial to hilum)
thoracic aorta (lateral to hilum)
Arch or Aorta (superior to hilum)
Innervation of lungs and visceral pleura
Pulmonary plexuses: mixed fibers from Vagus and Cardiopulmonary Splanchnic nn
sympathetics: bronchodilation
Parasympathetics: bronchoconstriction, gland secretion
Innervation of parietal pleura
IC and phrenic nn (mediastinal)
Pericardial clinical correlations:
Pericarditis: audible friction, pain
Cardiac tamponade: blood/fluid in pericardium
Drainage by pericardiocentesis
Auscultation of valves
Aortic Valve: 2nd IC, right sternal border
Pulmonary valve: 2nd IC, left sternal border
Tricuspid: 5th IC, near sternum
Bicuspid: 5th IC, distal
Innervation of Heart
Sypmathetics: cardiopulmonary splanchnic nn to cardiac plexus
Parasympathetics: vagus nerve
Branches of Thoracic Aorta
Bronchial: 1 pair
Esophageal: 3-5 pairs
Posterior intercostal: 9 pairs
Subcostal: 1 pair
Clinical Correlation: Rectus sheath
inferior to arcuate line, rectus sheath only composed of transversalis fascia. Weak point. Hernia risk
Innervation of Anterior Abdominal Wall
thoracoabdominal (from IC nn) nn (T6-T11)
Subcostal n (T12)
Iliohypogastric (L1)
Ilioinguinal (L1)
Abdominal wall arteries
Posterior IC and Subcostal (outside sheath)
Superior epigastric (from internal thoracic a., posterior superior rectus abdominus )
Inferior epicastric (from external iliac a, posterior inferior rectus abdominus)
Superficial epigastric a. (from femoral, anterior inferior rectus abdominus)
Caval-Caval anastomoses
Superior epigastric vv. to internal thoracic vv to SVC
Inferior epigastric vv to external iliac vv to IVC
hiatial hernia
sliding: abdominal espohagus and cardiac stomach slide thru esophageal hiatus
paraesophageal: stomach fundus slides thru esophageal hiatus
direct inguinal hernia
push through abdominal fascia to enter posterior wall of inguinal canal
Indirect inguinal hernia
most common
hernia lateral to inferior epigastric vessels
herniate into deep inguinal ring and into inguinal canal
Suspensory Muscle/Ligament of Treitz
supports flexure of ascending duodenum
transverse colon innervation
proximal 2/3 vagus, distal 1/3 pelvic splanchnic nn.
Lateral flexures
muscular inlets on rectum, help prevent incontinence
Puborectalis
maintains anorectal flexure, prevents incontinence
Portal system
3 main tributaries: Splenic vein, SMV, IMV
Blood from organs drain to portal vein, to the liver, to hepatic veins, to IVC
Portal vein: Foregut
Right gastric, left gastric
Splenic: short gastric, left gastroomental
SMV: right gastro omental
Portal vein: midgut
SMV, veins parallel arteries.
Ileal and Jejunal vv, iliocolic, right colic, middle colic vv
Portal vein: hindgut
IMV veins parallel arteries
left colic, sigmoid, superiorrectal
Portal Caval anastomoses
- Umbilicus - Caput madusae
- Distal esophagus - esophageal varices
- rectum/anus - rectal varices
- colon : hidden retroperitoneal varicies
Adrenal Gland blood supply
Superior Suprarenal aa: from inferior phrenic aa
Middle suprarenal aa: from aorta
Inferior suprarenal aa: from renal aa
