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human structure > Thorax and Abdomen > Flashcards

Thorax and Abdomen Flashcards

1
Q

Chambers of the Heart

A
  • right atrium
  • right ventricle
  • left atrium
  • left ventricle
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2
Q

Vessels to and from the Heart

A
  • superior vena cava
  • inferior vena cava
  • pulmonary trunk/pulmonary arteries
  • pulmonary veins
  • aorta
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3
Q

Valves of the Heart

A
  • tricuspid valve - RA and RV
  • pulmonary valve - RV and pulmonary trunk
  • bicuspid/mitral valve - LA and LV
  • aortic valve - LV and aorta
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4
Q

Blood Circulation Through Heart

A
  • venous/pulmonary system:
    • inferior and superior vena cava + coronary sinus
    • right atrium
    • tricuspid valve
    • right ventricle
    • pulmonary valve
    • pulmonary trunk/arteries
  • lungs
  • arterial system
    • pulmonary veins
    • left atrium
    • bicuspid/mitral valve
    • left ventricle
    • aortic valve
    • aorta
    • body
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5
Q

2 Phases of Heartbeat

A
  • diastole
  • systole
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6
Q

Diastole

A
  • relaxation and filling of ventricles with blood
    • ventricle walls relax
    • pulmonary and aortic valves close
    • tricuspid and bicuspid valves open (atrial pressure > ventricular pressure)
    • end of diastole: atria conract and push blood in ventricles
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7
Q

Systole

A
  • ventricular contraction - emptying of blood from ventricles into aorta or pulmonary trunk
    • walls of ventricles contract
    • tricuspid and bicuspid valves close
    • pulmonary and aortic valves open (ventricular pressure > atrial pressure)
    • end systole: ventricles contract further, blood flows into aorta/pulmonary trunk until vessel pressure > ventricular pressure
    • blood fills atria
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8
Q

Borders of the Heart (Anterior)

A
  • superior border
    • pulmonary trunk
    • ascending aorta/arch of aorta
    • atrioventricular groove
    • anterior interventricular groove
  • left border
    • left ventricle
    • apex
  • inferior border
    • right ventricle
  • right border
    • right atrium and auricle
    • superior and inferior vena cava
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9
Q

Borders of the Heart (posterior)

A
  • superior border
    • pulmonary veins
  • left border
    • left ventricle
    • apex
  • inferior border
    • left atrium
  • right border
    • superior and inferior vena cava
    • right atrium
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10
Q

Atrioventricular Groove/Coronary Sulcus

A

separates atriums and ventricles, visible both posteriorly and anteriorly

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11
Q

Anterior Interventricular Groove

A

separates left and right ventricles, visible only anteriorly

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12
Q

Auscultation of Heart Valves

A
  • aortic - 2nd intercostal space, right of sternum
  • pulmonary - 2nd intercostal space, left of sternum
  • tricuspid - 5th intercostal space, left of sternum
  • mitral/bicuspid - 5th intercostal space, left midclavicular line
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13
Q

Characteristics and Function of Thoracic Wall

A
  • rigid
    • protect organs from external forces
    • resist negative internal pressure
  • flexible
    • allow for breathing movement
  • provides attachment and support for upper limbs and muscles
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14
Q

Bones of Thoracic Wall

A
  • thoracic vertebrae
  • ribs
  • sternum
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15
Q

Thoracic Vertebrae

A
  • Costal facet - tubercle of rib
  • Costal demifacets - head of rib
    • head of one rib articulates with demifacet of 2 adjacent vertebrae
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16
Q

Costal Cartilage

A

anterior portion of rib attached to sternum

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17
Q

Costal Margin

A

upturned cartilages of ribs 8-10, connected to the costal cartilage of rib 7

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18
Q

Types of Ribs

A
  • 1-7: true ribs
  • 8-10: false ribs
  • 11-12: floating ribs
  • 3-9: typical ribs
  • 1-2, 10-12: atypical ribs
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19
Q

True Ribs

A

articulate directly with sternum via costal cartilage

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20
Q

False Ribs

A

articular with sternum indirectly via costal margin

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21
Q

Floating Ribs

A

no articulation with sternum

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22
Q

Typical Rib Structure

A
  • head - articulates with costal demifacets on verterbral body
  • neck
  • tubercle - articulates with costal facet on transverse process
  • shaft/body
  • costal groove
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23
Q

Costal Groove

A

depression on inferior border of rib where intercostal veins, arteries, and nerves reside

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24
Q

Costovertebral Joints

A
  • head of ribs to vertebrae - articulates with 2 adjacent vertebral bodies at demifacets
  • costotransverse joint - tubercle of rib articulates with costal facet on transverse process
  • ligaments restrict rotation of ribs
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25
Q

Sternocostal Joints

A
  • via costal cartilage
  • synovial joints
    • except rib 1 + manubrium - synchondrosis
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26
Q

Parts of the Sternum

A
  • jugular notch
  • manubrium
  • sternal angle
  • body
    • costal notches
  • xiphoid process
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27
Q

Sternal Angle

A
  • junction of the manubrium with body of sternum
  • articulates with rib 2
  • often palpable
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28
Q

Xiphisternal Junction

A
  • junction of the body and xiphoid process
  • articulates with rib 7
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29
Q

Thoracic Inlet/Superior Thoracic Aperture

A
  • passage between neck and thorax
  • first vertebral body, first rib, manubrium
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30
Q

Thoracic Outlet/Inferior Thoracic Aperture

A
  • filled by diaphragm
  • body of T12, rib 12, costal margins, xiphisternal joint
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31
Q

Landmarks on Thoracic Wall

A
  • midaxillary line
  • midscapular line
  • midclavicular line
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32
Q

Muscles of Thoracic Wall

A
  • intercostal muscles
    • external
    • internal
    • innermost
  • transversus thoracis
  • subcostals
  • serratus posterior superior and inferior
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33
Q

External Intercostal Muscles and Membrane

A
  • most superficial
  • “hands in pocket”
  • muscles run from tubercle to midclavicular line
  • membrane runs from midclavicular line to sternum
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34
Q

Internal Intercostal Muscles and Membrane

A
  • oriented at right angle to external intercostal muscles
  • muscles run from sternum to midaxillary line
  • membrane runs from midaxillary line to neck of rib
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35
Q

Innermost Intercostal Muscles and Membrane

A
  • same orientation as internal layer
    • separated from internal layer by nerves
  • muscles - at midaxillary line
  • membrane posteriorly and anteriorly
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36
Q

Transversus Thoracis

A
  • located on posterior surface of anterior ribs
  • span multiple intercostal spaces
  • same level as innermost costals
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37
Q

Subcostal Muscle

A
  • on anterior surface of posterior ribs
  • span multiple intercostal spaces (how you differentiated from innermost)
  • same level as innermost
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38
Q

Accessory Muscles of Respiration

A
  • pectoralis major and minor
  • serratus anterior
  • scalenes
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39
Q

Intercostal Nerves

A

ventral rami of spinal nerves 1-11

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40
Q

Subcostal Nerve

A

ventral ramus of spinal nerve 12

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41
Q

Branches of Intercostal Nerves

A
  • muscular branches - between internal and innermost
  • anterior cutaneous branch - superficial
  • lateral cutaneous branch - superficial
  • rami communicans
  • collateral branches
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42
Q

Arteries of Thoracic Wall

A
  • subclavian artery
  • internal thoracic artery
  • anterior and posterior intercostal arteries
  • superior epigastric artery
  • musculophrenic artery
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43
Q

Internal Thoracic Artery

A
  • branch of the first part of the subclavian
  • runs laterally to sternum
  • gives off pericardiacophrenic branch
  • terminal branches - musculophrenic nerve, superior epigastric nerve
  • held against ribs by transversus thoracis
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44
Q

Superior Epigastric Artery

A

branch of internal thoracic artery that continues to anterior abdominal wall

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45
Q

Musculophrenic Artery

A

lateral branch of internal thoracic that supplies diaphragm

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46
Q

Anterior Intercostal Arteries

A
  • 1-6: internal thoracic artery branches
  • 7-9: musculophrenic artery branches
  • 10-11: absent
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47
Q

Posterior Intercostal Arteries

A
  • 1-2: subclavian 3rd part –> costocervical trunk –> supreme intercostal artery –> 1st and 2nd intercostal arteries
  • 3-11: branches of descending aorta
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48
Q

Veins of Thoracic Wall

A
  • brachiocephalic vein
  • internal thoracic vein
  • anterior and posterior intercostal veins
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49
Q

Right Side Venous Drainage

A
  • intercostal veins
  • azygos vein
  • superior vena cava
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50
Q

Left Side Venous Drainage

A
  • intercostal veins
  • hemiazygos vein
  • azygos vein
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51
Q

Intercostal Neurovascular Bundle

A
  • VAN - vein, artery, nerve
  • between innermost and internal muscle layers
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52
Q

Diaphragm

A
  • chief muscle of respiration
  • separates thoracic and abdominal cavities
  • central tendon and muscular portions
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53
Q

Openings in Diaphragm

A
  • vena caval foramen - inferior vena cava, T8
  • esophageal hiatus - esophagus and vagal trunks, T10
  • aortic hiatus - aorta, thoracic duct, and azygos vein, T12
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54
Q

Blood Supply to Diaphragm

A
  • pericardiacophrenic artery
  • musculophrenic artery
  • inferior phrenic artery (from abdominal aorta)
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55
Q

Innervation to Diaphragm

A
  • phrenic nerves (C3-5)
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56
Q

Visceral Pleura

A
  • attached to lungs
  • continuous with parietal pleura at root of lung
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57
Q

Parietal Pleura

A

lines thoracic wall, diaphragm, and mediastinum

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58
Q

Parts of Parietal Pleura

A
  • cervical part - cupla
  • costal part
  • diaphragmatic part
  • mediastinal part
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59
Q

Pleural Cavity

A
  • between visceral and parietal pleura
  • contains pleural fluid
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60
Q

Pleural Recesses

A
  • areas where two layers of parietal pleura are not separated by lung during quiet respiration
  • right and left costodiaphragmatic
  • left costomediastinal recess
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61
Q

Lines of Pleural Reflection

A

where one type of parietal pleura becomes continuous with another

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62
Q

Innervation of Visceral Pleura

A
  • autonomic - vagus and sympathetic trunk
  • insensitive to pain
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63
Q

Innervation of Parietal Pleura

A
  • somatic innervation
    • costal - intercostal nerves
    • diaphragmatic and mediastinal - phrenic nerve
  • pain - dermatomes
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64
Q

Locations of Lungs and Pleura during Quiet Respiration at Thoracic Wall Landmarks

A
  • midclavicular line - lungs at 6, pleura at 8
  • midaxillary line - lungs at 8, pleura at 10
  • midscapular line - lungs at 10, pleura at 12
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65
Q

Right Lung Structure

A
  • wider and heavier than left
  • right inferior part limited by liver
  • superior, middle, and inferior lobes
  • oblique and horizontal fissures
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66
Q

Left Lung Structure

A
  • superior and middle lobes
    • cardiac notch
    • lingula
  • oblique fissure
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67
Q

Hilum of the Lung

A
  • bronchi
  • pulmonary arteries and veins
  • bronchial arteries and veins
  • pulmonary plexus
  • lymph vessels and nodes
  • left and right side differences
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68
Q

Hila of Right Lung

A
  • superior lobar bronchus superior to main bronchus
  • 2 pulmonary arteries = superior and anterior to bronchus
  • pulmonary veins - anterior and inferior to bronchi and arteries
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69
Q

Hila of Left Lung

A
  • 1 pulmonary artery superior to main bronchus
  • pulmonary veins anterior and inferior
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70
Q

Bronchial Branches

A
  • principal - main
    • right is wider, shorter, more verticle (more likely for objects to lodge here)
  • secondary - lobar
    • 2 left, 3 right
  • tertiary - segmental
    • bronchopulmonary segments
  • bronchioles
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71
Q

Bronchial Arteries

A
  • right: right bronchial artery from first intercostal or superior left bronchial
  • left: aorta –> superior left bronchial and inferior left bronchila artery
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72
Q

Bronchial Veins

A
  • right: azygos
  • left: hemiazygos
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73
Q

Movement of Planes during Respiration

A
  • vertical plane - diaphragm contracts and moves inferiorly
  • transverse plane - rib 2-10 elevate, lateral edges of ribs move away from midline
  • anteroposterior plane - sternum moves superiorly, anterior ends of ribs elevate
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74
Q

Muscular Movement during Inspiration

A
  • quiet - diaphragm
  • forced - elevate ribs and sternum
    • primary: scalenes and SCM
    • secondary: pec major and minor, serratus anterior, serratus posterior superior and inferior
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75
Q

Muscular Movement during Expiration

A
  • quiet - diaphragm, lung elastic recoil
  • forced - contract of abdominal muscles to pull ribs and sternum inferiorly and diaphragm superiorly
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76
Q

Mediastinum

A

space between the pleural cavities, end of retropharyngeal space

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77
Q

Transverse Thoracic Plane

A

from sternal angle of sternum to T4-5 intervertebral disc

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78
Q

Structures Defined at Transverse Thoracic Plane

A
  • tracheal bifuration at carina
  • aortic arch above thoracic plane, ascending/descending aorta below this line
  • superior extent of pericardium
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79
Q

Borders of Superior Mediastinum

A
  • superior: thoracic inlet
  • inferior: transverse thoracic plane
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80
Q

Viscera of Superior Mediastinum

A
  • thymus
  • trachea
  • esophagus - between trachea and vertebral column
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81
Q

Thymus (arteries and veins)

A
  • large in children, regresses in adults
  • artery: anterior mediastinal branches of internal thoracic arteries
  • veins: drain into left brachiocephalic, internal thoracic, and inferior thyroid veins
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82
Q

Trachea

A
  • anterior and to the right of the esophagus
  • starts at cricoid cartilage
  • ends at carina
  • tracheal cartilage - C-shaped rings open posteriorly (connected with muscle and connective tissue
  • annular ligaments - fibrous cartilage connecting rings of tracheal cartilage
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83
Q

Arteries of Superior Mediastinum

A
  • arch of the aorta
  • brachiocephalic trunk (branches into right common carotid and subclavian in the neck)
  • left common carotid artery
  • left subclavian artery
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84
Q

Veins of the Superior Mediastinum

A
  • all drain into superior vena cava
  • superiorly: subclavian and internal jugular (not in superior mediastinum) drain into right and left brachiocephalic veins
  • inferiorly: azygos vein
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85
Q

Left vs. Right Brachiocephalic Veins

A

left is longer and crosses aortic arch

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86
Q

Nerves in the Superior Mediastinum

A
  • vagus (CN X) - posterior to hiatus of lung
    • left recurrent laryngeal (not right) - wraps under aortic arch and ligamentum arteriosum
  • phrenic - from cervical plexus, anterior to hilum of lung
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87
Q

Anterior Mediastinum (Borders and Contents)

A
  • borders
    • anterior: sternum
    • posterior: pericardium
    • superior: transthoracic plane
  • contents:
    • thymus in children
    • remnants of thymus and fat in adults
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88
Q

Middle Mediastinum (Borders and Contents)

A
  • borders: pericardium
  • contents: heart
    • also roots of great vessels, phrenic nerves, pericariacophrenic vessels (branch of internal thoracic artery, run with phrenic nerves to diaphragm)
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89
Q

Borders of Posterior Mediastinum

A
  • superior: transthoracic plane
  • anterior: pericardium and diaphragm
  • posterior: bodies of T5-12
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90
Q

Arteries of Posterior Mediastinum

A
  • descending aorta/thoracic aorta - from T4 (transthoracic plane) to T12 (aortic hiatus)
  • posterior intercostal arteries
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91
Q

Veins of Posterior Mediastinum

A
  • posterior intercostal veins - drain into azygos and hemiazygos
  • hemiazygos veins (left) - drains into azygos
  • azygos vein (right) - drains into superior vena cava
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92
Q

Nerves of Posterior Mediastinum

A
  • vagus (X) - posterior to root of lung
  • esophageal plexus - on esophagus from vagus
  • anterior vagal trunk - from left vagus
  • posterior vagal trunk - from right vagus
  • splanchnic nerves (greater, lesser, least) - branch off sympathetic trunks, run anterior to vertebral bodies
  • sympathetic trunks not in posterior mediastinum because not anterior to vertebral bodies
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93
Q

Viscera of Posterior Mediastinum

A
  • esophagus
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94
Q

Lymphatics of Posterior Mediastinum

A

thoracic duct

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95
Q

Branches of Thoracic Aorta

A
  • visceral branches
    • unpaired: esophageal, pericardial, mediastinal
    • paired: bronchial
  • parietal branches
    • posterior intercostal arteries
    • superior phrenic arteries
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96
Q

Esophagus

A
  • posterior and to the left of the trachea
  • anterior and to the right of the descending aorta
  • muscular tube between pharynx and stomach
  • exits at esophageal hiatus in diaphragm
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97
Q

Constrictions of the Esophagus

A
  • pharynx (C5)
  • left root of the lung and arch of aorta (T4)
  • esophageal hiatus (T10)
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98
Q

Sympathetic Nervous System

A
  • columnar arrangement
  • preganglionic nerves from lateral horn gray matter in T1-L2/3
  • innervate according to body organization
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99
Q

Course of Sympathetic Nerves

A
  • preganglionic neuron leaves ventral root
  • meets dorsal root to form dorsal root ganglion and spinal nerve
  • quickly incorporated into rami communicantes and is connected to sympathetic trunk
  • some go back out to the skin, some become splanchnic nerves, some become intercostal nerves
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100
Q

Rami Communicantes

A
  • white - carry preganglionic sympathetic fibers from intercostal nerves to sympathetic trunk
  • gray - carry postganglionic sympathetic fibers from sympathetic trunk to intercostal nerves
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101
Q

Splanchnic Nerves

A
  • carry preganglionic sympathetics fom sympathetic trunk to abdominal viscera
  • greater - T5-9
  • lesser - T10-11
  • least - T12
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102
Q

Mammary Glands

A
  • both males and females have but more pronounced in females due to hormonal differences
    • women proliferates glandular tissue, lactiferous ducts, fat
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103
Q

Path of Milk

A

alveoli (milk producing cells) –> lobule of gland –> lactiferous duct –> lactiferous sinus –> nipple

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104
Q

External Breast

A
  • nipple
  • areola
  • pectoralis major
  • serratus anterior
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105
Q
A
  • retromammary space - loose connective tissue between the breast and deep pectoral fascia, allows limited movement
  • suspensory ligaments of cooper - between skin and deep pectoral fascia to support breast
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106
Q

Arteries of Breast

A
  • internal thoracic artery - gives off medial mammary branches
  • posterior intercostal arteries - lateral cutaneous branches give off lateral mammary branches
  • lateral thoracic arter y - also give off lateral mammary branches
  • thoracoacromial artery
  • axillary artery
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107
Q

Innervation of Breast

A
  • lateral cutaneous branch of T4-T6 intercostal nerves - give off lateral mammary branches
  • anterior cutaneous branch of T4-T6 intercostal nerves - give off medial mammary branches
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108
Q

Lymphatic Drainage of Breast

A
  • 75% axillary nodes (lateral)
  • parasternal lymph nodes (medial)
109
Q

Functions of Lymphatic System

A
  • drainage of extracellular fluid
  • carries proteins and cell materials that can’t pass through capillaries
  • absorption and transport of dietary fat
  • defense
110
Q

Lymphatic Vessels

A
  • right lymphatic duct - drains right side of head and right arm
    • drains at right venous angle (internal jugular + subclavian)
  • thoracic duct - drains rest of body
    • drains at left venous angle
    • usually on right side
111
Q

Lymph Nodes

A
  • small masses of lymphatic tissue
  • contain macrophages
  • afferent and efferent vessels
  • skin above umbilicus –> axillary nodes
  • below umbilicus –> inguinal nodes
  • head and neck –> cervical nodes
112
Q

Axillary Dissection

A
  • done in cases of breast cancer metastasis into axillary lymph nodes
  • tons of nerves in axilla could be damaged
    • long thoracic nerve –> reduced movement of upper lumb
    • intercostobrachial nerve –> pain
    • thoracodorsal nerve
    • lymphoedema
113
Q

Pericardium

A
  • fibrous pericardium
  • serous pericardium - secretes fluid into pericardial cavity
    • parietal layer - stuck to fibrous pericardium
    • visceral layer - stuck to heart, also the epicardium
114
Q

Innervation of Pericardium

A

phrenic nerves

115
Q

Blood Supply to Pericardium

A

pericardiacophrenic arteries (branch of internal thoracic)

116
Q

Transverse Pericardial Sinus

A

space between major vessels of the heart

(posterior to ascending aorta and pulmonary trunk

anterior to inferior vena cava)

117
Q

Oblique Pericardial Sinus

A

between pulmonary arteries

118
Q

Fibrous Skeleton of the Heart

A
  • provides attachment and support for muscles of the heart and valves
  • functions as insulator between atria and ventricles
  • parts:
    • fibrous rings around valves
    • 2 trigones connect the rings
    • membranous portion of interatrial and interventricular septa
119
Q

Right Atrium

A
  • smooth region
    • superior and inferior vena cava
    • coronary sinus opening
    • fossa ovalis - remnant of fetal foramen ovale
    • tricuspid valve (right AV valve)
  • rough region
    • pectinate muscles
    • right auricle
  • crista terminalis - separates smooth and rough regions
120
Q

Right Ventricle

A
  • trabeculae carnae - like pectinate muscles but in ventricle
  • papillary muscles - attached to tricuspid valve
  • chordae tendinae - connect papillary muscles to valve cusps
  • septomarginal trabecula - moderator band, from interventricular wall to base of anterior papillary muscle, contraction
  • conus arteriosus - leading into pulmonary valve, also infundibulum
121
Q

Tricuspid Valve

A
  • 3 cusps: anterior, posterior, septal
    • each attached to a papillary muscle via chordae tendinae
  • open during diastole - ventricles filling
  • closed during systole - ventricular contraction –> papillary muscle contraction –> closure of valve
122
Q

Pulmonary Valve

A
  • semilunar valve with 3 cusps: anterior, right, left
  • closed during diastole
  • open during systole when ventricle pumps
123
Q

Left Atrium

A
  • smooth region
    • pulmonary veins
    • fossa ovalis
  • rough region
    • pectinate muscle in left auricle
124
Q

Left Ventricle

A
  • trabeculae carnae
  • papillary muscles - anterior and posterior
  • chordae tendinae
  • aortic valve and mitral valve
125
Q

Mitral Valve

A
  • also bicuspid and left AV valve
  • anterior and posterior cusps attached to papillary muscles via chordae tendinae
126
Q

Aortic Valve

A
  • 3 cusps: right, left, posterior
  • open during systole: blood pressure in ventricle is high so cups pressed against the wall
    • cups made of nodule and lunula around the edges
  • diastole: when blood pressure in ventricle decreases, blood starts to flow back into ventricle and goes into the cups and closes the valve
  • right coronary artery from right cusp
  • left coronary artery from left cusp
    *
127
Q

Coronary Arteries

A

right and left branching from ascending aorta to supply myocardium

128
Q

Right Coronary Artery

A
  • runs in coronary sulcus/AV groove
  • branches:
    • right atrial branch
    • marginal branch - along border of right ventricle
    • posterior interventricular branch in posterior interventricular groove
      • referred to as posterior descending artery (PDA)
    • sinoatrial nodal and atrioventricular nodal branches
129
Q

Left Coronary Artery

A
  • bifurcates into
    • anterior interventricular branch in anterior interventricular groove
      • referred to as left anterior descending artery (LAD)
    • circumflex branch - runs in coronary sulcus
130
Q

Balanced Distribution of Coronary Arteries

A
  • right coronary artery supplies right lateral wall, most of right posterior wall and some of posterior septa
  • left coronary artery supplies most
  • variations: left coronary dominance, right coronary dominance
131
Q

Coronary Veins

A

arise from myocardium and drain into right atrium at coronary sinus

132
Q

Coronary Veins Path

A
  • small cardiac vein - runs with marginal artery branch of right coronary artery
  • great cardiac vein - runs with anterior AV artery
  • middle cardiac vein - runs with posterior AV artery
  • anterior cardiac veins - arise from anterior surface of RV
133
Q

Intrinsic Impulse Conducting System

A
  • SA node
  • AV node
  • AV bundle
  • Purkinje fibers/subendocardial branches
134
Q

Sinoatrial (SA) Node

A
  • in wall of right atrium at superior end of crista terminalis
  • pacemaker for heart
  • impulse spreads through atria and causes contraction
135
Q

Atrioventricular (AV) Node

A
  • in floor fo right atrium
  • distribuets impulses to atriventricular bundle
136
Q

Atrioventricular Bundle

A
  • also bundle of His
  • bridges fibrous skeleton to bring conduction to ventricles
  • divides into left and right branches to go to ventricles
    • right bundle goes via septomarginal trabecular to reach anterior papillary muscle
137
Q

Cardiac Plexus

A
  • sympathetic: from sympathetic trunks to increase heart rate and contraction, dilate coronary arteries
    • cervical sympathetic ganglia, cervicothoracic ganglion, thoracal sympathic ganglia
  • parasympathetic: from vagus, decreases heart rate and contraction, constricts coronary arteries
138
Q

Cardiac Tamponade

A

build-up of blood or other fluid in pericardial sac that puts pressure on the heart and can prevent it from pumping effectively

fixed with pericardiocentesis

139
Q

Constrictive Pericarditis

A

after extensive inflammation, pericardium can scar and limit heart contractions

fixed with pericardiectomy (pericardial stripping)

140
Q

Myocardial Infarction

A

blockage in coronary arteries causes muscle damage

141
Q

Coronary Catheterization

A

insert stent and balloon into coronary artery to allow blood flow

142
Q

Post-Myocardial Infarction Ventricular Septal Defects

A

muscle death causes a hole between the ventricles

get mitral regurgitation

long term: volume overload to right ventricle, increased presure in pulmonary vessels and pulmonary edema

143
Q

Blockage in RCA

A

serves inferior wall, right ventricle, and conduction system

can have issues with arrythmias due to damage to conduction system and papillary muscles

144
Q

Biventricular Pacemaker

A

right atrial lead, right ventricular lead, LV coronary sinus lead

145
Q

Chest X-ray (CXR) Views

A
  • PA - posterior anterior, frontal, standing
  • lateral - standing
  • AP - anteiror posterior, frontal, supine
146
Q

Measuring Heart Size on CXR

A
  • PA view only
  • cardiothoracic ratio = heart size/thoracic diameter
    • normal <50%
147
Q

Cardiac Silhouette Borders on CXR (Frontal PA)

A
  • right: RA
  • left: aortic arch, pulmonary artery, left auricle, left ventricle
148
Q

Cardiac Silhouette Borders on XCR (Lateral)

A
  • anterior: RV
  • posterior: LA
149
Q
A

Mediastinum on CXR

150
Q
A

Mediastinum on CXR (Lateral)

151
Q
A

Thymic Tumor

152
Q
A

Aorta on frontal CXR

153
Q
A

Aorta on lateral CXR

154
Q
A

Aorta on frontal and lateral CT

155
Q
A

Aorta on CT cross sections

156
Q
A

Aortic dissection on CXR- enlargement

157
Q
A

Aortic dissection CT - diagnostic intimal flap

158
Q
A

Pulmonary arteries on CXR

159
Q
A

Pulmonary arteries on CT

160
Q
A

Superior vena cava - right superior mediastinal border

Azygos Vein - oval density in angle between trachea and right main stem brochus

161
Q
A

trachea - midline air containing structure

carina - important landmark

bronchi - right is wider, shorter, more vertically oriented

162
Q

Endotracheal Intubation

A

placement confirmed with CXR

want it to go into right or above carina

163
Q

Lungs on CXR

A

not usually recognizable so surmise based on adjacent structures

  • right and left upper lobe - adjacent to thoracic apex
  • right middle lobe - adjacent to right heart border, anterior on lateral
  • right and left lower lobe - adjacent to right hemodiaphragm
164
Q
A

Left Lung on CXR

165
Q
A

Right Lung on CXR

166
Q

Pneumothorax on CXR

A

can see thin line or edge

167
Q

Pleural Recesses

A
  • where the two layers of parietal pleura are not separated by lung during quiet respiration
  • costodiaphragmatic angles
    • anterior - 8th rib
    • lateral - 10th rib
    • posterior - 12th rib
168
Q
A

Pleural Fluid in Costodiaphragmatic Angle

169
Q
A
  • right slightly higher than left usually
  • convex upward
170
Q

Anterior Abdominal Wall Bony Landmarks

A

arae between xiphoid process and costal margin

xiphoid process, costal margin, pubis, ilium

171
Q

Features of Anterior Abdominal Wall

A

umbilicus

tendinous intersections

linea alba

semilunar lines

172
Q

Sagittal Planes of the Anterior Abdomen

A

median - through umbilicus

midclavicular

173
Q

Transverse Planes

A

subcostal - inferior border of 10th costal cartilage

transtubercular - level of iliac tubercles, L5

transpyloric - level of pylorus of stomach, ~L1, midpoint between superior aspect of manubrium and superior aspect of pubis

transumbilical - about level of umbilicus, iliac crests, L3/4

174
Q

Quadrants of Anterior Abdomen

A

formed by median sagittal plane and transumbilical plane

right and left upper, right and left lower, periumbilical

175
Q

Regions of Anterior Abdomen

A

formed by the midclavicular, subcostal, and transtubercular planes

subcostal regions: right and left hypochondriac, epigastric

lumbar regions: right and left lateral, umbilical

iliac regions: right and left inguinal, hypogastric

176
Q

Functions of Anterior Abdominal Wall

A
  • support and protection for abdominal viscera
  • increase intra-abdominal pressure - forced expiration, defecation, micturition, coughing, parturition
  • flexion and rotation of trunk
177
Q

Layers of the Anterior Abdominal Wall

A
  1. skin
  2. superficial fascia (Campers fascia, Scarpas fascia)
  3. external oblique
  4. internal oblique
  5. transversus abdominis
  6. transversalis fascia
  7. extraperitoneal fat
  8. parietal peritoneum
178
Q

Superficial Fascia

A

Campers fascia - outer fatty layer

Scarpas fascia - inner membranous layer inferior to umbilicus; connections to scrotum, penis, and perineum

179
Q

External Abdominal Oblique

A
  • lateral muscle, aponeurosis anteriorly
  • hands in pocket fibers: lateral to medial
  • contributes to rectus sheath
  • free lower edge - forms inguinal ligament
180
Q

Internal Abdominal Oblique

A

fibers run perpendicular to external oblique

aponeurosis contributes to rectus sheath inferior to arcuate line; goes anterior and posterior superior to arcuate line

contributes to inguinal canal

181
Q

Transversus Abdominus

A
  • innermost muscle layer
  • fibers run horizontally
  • aponeurosis contributes to anterior wall of rectus sheath inferior to arcuate line, contributes to posterior wall superior to arcuate line
  • nerves/blood vessels travel between internal oblique and transversus abdominus
182
Q

Transversalis Fascia

A
  • part of endoabdominal fascia - lines abdominal cavity, continuous with pelvic fascia
  • forms deep inguinal ring
183
Q

Rectus Abdominis

A
  • O: medial pubis
  • I: costal margin/inferior sternum
  • A: flexion of lumbar spine, compresses abdominal viscera, stabilizes pelvis
  • I: thoracoabdominal nerves (ventral primary rami T7-12)
  • A: superior and inferior epigastric artery anastamose
184
Q

Arcuate Line

A

posterior to rectus muscle, 1/3 between umbilicus and pubic crest

185
Q

Rectus Sheath

A
  • above arcuate line:
    • anterior - ext. and int. oblique
    • posterior - int. oblique and transversus abdominus
  • below arcuate line
    • anterior - ext. and int. oblique, transversus abdominus
    • posterir - only transversalis fascia
186
Q

Hernias of the Abdominal Wall

A
  • outpouching of peritoneum through an acquired weakness or defect in the abdominal wall
  • types: epigastric, spigelian, inguinal, incisional
187
Q

Epigastric Hernia

A

between sternum and umbilicus through linea alba

188
Q

Spigelian Hernia

A

occur along semilunar lines

189
Q

Umbilical Hernia

A

through umbilical ring

most common in women and obese individuals

190
Q

Inguinal Hernia

A
  • direct/acquired - projection into area of superficial inguinal ring
    • often through Hesselbach’s Triangle (inguinal ligament, lateral border of rectus abdominis, inferior epigastric vessels)
    • medial to inferior epigastric artery
  • indirect/congenital - projection into deep inguinal ring, down the inguinal canal, and through superficial inguinal ring into scrotum
    • lateral to inferior epigastric artery
191
Q

Nerves of Anteiror Abdominal Wall

A
  • ventral primary rami from T7-L1
    • thoracoabdominal nerves (T7-11)
    • subcostal nerve (T12)
    • iliohypogastric (L1)
    • ilioinguinal (L1)
    • genitofemoral (L1-2)
192
Q

Thoracoabdominal Nerves (T7-11)

A

sensory: skin
motor: abdominal muscles

193
Q

Subcostal Nerve (T12)

A

sensory: skin
motor: abdominal musculature

194
Q

Iliohypogastric Nerve (L1)

A

sensory: skin over iliac crest to pubic region
motor: internal bolique, transversus abdominis

195
Q

Ilioinguinal Nerve (L1)

A

sensory: external genitalia, medial thigh
motor: internal oblique, transversus abdominus

196
Q

Genitofemoral Nerve (L1-2)

A

genital branch: cremaster muscle and scrotum, skin of mons pubis and labia majora

femoral branch: skin on anterior superior thigh

197
Q

Landmarks for Dermatome Levels In Abdomen

A

xiphoid process: T5-6

umbilicus: T10
pubis: L1

198
Q

Arteries of Anterior Abdominal Wall

A

complex anastomotic network - internal thoracic (superior epigastric, musculophrenic), thoracic aorta, abdominal aorta (external iliac, femoral, inferior epigastric)

superior epigastric (internal thoracic) and inferior epigastric (abdominal aorta and external iliac) provides collateral circulation

199
Q

Veins of the Anterior Abdominal Wall

A
  • complex venous plexus
  • deeper veins follow arteries
  • collateral circulation is important!
200
Q

Lymphatics of Anterior Abdominal Wall

A
  • superior to transumbilical plane: superficial lymphatic vessels, drain to axillary lymph nodes
  • inferior to transumbilical plane: superficial inguinal lymph nodes, converge to thoracic duct
201
Q

Internal Surface of Anterior Abdominal Wall

A
  • median umbilical fold - bladder to umbilicus, parietal peritoneum over urachus ligament
  • medial umbilical folds - parietal peritoneum over obliterated umbilical arteries
  • lateral umbilical folds - parietal peritoneum over inferior epigastric vessels
202
Q

Inguinal Region

A

region between anterior superior iliac spine and pubic tubercle

site for inguinal hernias

203
Q

Inguinal Ligament

A
  • created by free inferior edge of ext. oblique
  • anterior superior iliac spine to pubic tubercle
  • forms inguinal canal
  • boundary between atenrior abdominal wall and thigh
  • maintains the integrity of the muscles and vessels
204
Q

Inguinal Canal

A
  • superior-lateral opening - deep/internal inguinal ring in transversalis fascia
  • inferior-medial opening - superficial/external inguinal ring in ext. oblique aponeurosis
  • males: spermatic cord; females: round ligament
  • ilioinguinal nerve and genital branch of genitofemoral
205
Q

Scrotum

A
  • fibromuscular sac developed as an outpouching of the anterior abdominal wall
    • skin and Dartos fascia (continuation of Scarpas fascia, includes small muscle fibers)
    • scrotal septum - separates scrotum into 2 non-communicating compartment
206
Q

Scrotal Ligament

A

anchors inferior pole of testis to bottom of scrotum, remnant of gubernaculum

207
Q

Spermatic Cord

A

carries blood, nerves, and lymphatics for testis and transports sperm from testis to inside pelvic cavity via ductus deferens

208
Q

Coverings of Spermatic Cord

A
  • external spermatic fascia - continuation of ext. oblique aponeurosis
  • cremaster muscle and fascia - continuation of int. oblique and fascia
  • internal spermatic fascia - continuatoin of transversalis fascia
209
Q

Cremaster Muscle

A

innervated by genital branch of genitofemoral

elevate testes in response to cold, fear, or sexual stimulation

210
Q

Contents of Spermatic Cord

A
  • ductus deferens and artery - transport sperm from testis to pelvic cavity
  • testicular artery - supplies testis and epididymis, from abdominal aorta
  • pampiniform plexus of veins
  • autonomic nerves and genital branch
  • lymphatics
211
Q

Testis

A
  • seminiferous tubules - sperm formed
  • travel in efferent ductules
  • stored in epidiymis
  • tunica albuginea - capsule, septa separate blocks of seminiferous tubules
  • tunica vaginalis - closed peritoneal sac, pareital and visceral parts
212
Q

Lymphatic Drainage of Male Genitals

A
  • scrotum - to superficial inguinal lymph nodes
  • testis - to lumbar and pre-aortic lymph nodes
213
Q

Descent of the Testis and Ovary

A
  • both originate on posterior abdominal wall then pulled inferiorly by relative shortening of gubernaculum
  • ovary stops at pelvic brim
    • gubernaculum –> round ligament of the utereus, proper ligament of the ovary
  • testis continues to scrotum
214
Q

Opened Peritoneal Cavity

A
  • opens greater sac of peritoneum
  • falciform ligament - anterior body wall to liver
    • ligamentum teres
  • can see right and left lobe of liver and some gallbladder
  • part of stomach
  • greater omentum - covers all organs located inferior to stomach
215
Q

Layer 2: Liver Reflected

A
  • lesser omentum - made of hepatogastric and hepatoduodenal ligaments, connect liver to stomach and duodenum
    • portal triad runs through
  • omental foramen - opening deep to free edge of lesser opening, into lesser sac of peritoneum
  • spleen to the left of the stomach
216
Q

Layer 3: Greater Omentum and Stomach Reflected

A
  • small intestine and large intestine
  • ascending colon along right body wall
  • transverse colon inferior to stomach, attached to greater omentum
  • descending colon along left body wall
217
Q

Layer 4: Most of GI Tract Removed

A
  • pancreas
  • inferior vena cava
  • abdominal aorta
  • kidneys
218
Q

Liver

A
  • diaphragmatic and visceral surfaces
  • diaphragmatic surface with bare area
219
Q

Anatomical Lobes

A
  • right, left, caudate, quadrate lobes
  • falciform ligament and ligamentum teres divide left and right
  • posterior division at left sagittal fissure - ligament venosum
220
Q

Functional Lobes of Liver

A
  • right sagittal fissure - gallbladder and inferior vena cava
  • right, left, caudate lobes
  • 8 surfically resectable hepatic segments - each with portal vein, hepatic artery, biliary drainage
221
Q

Right Sagittal Fissure

A

inferior vena cava, gallbladder

222
Q

Left Sagittal Fissure

A

ligamentum teres and venosum

223
Q

Porta Hepatis

A

portal triad - common bile dict, proper hepatic artery, portal vein

224
Q

Biliary System

A
  • bile produced in liver
  • drains through hepatic ducts (right and left) into ccommon bile duct
  • then to cystic duct to be stored in gallbladder
  • during digestion, gallbladder contracts and forces bile down common bile duct
  • bile duct and main pancreatic duct join to form main hepatopancreatic ampulla
  • then opens into duodenum and major duodenal papilla
225
Q

Gallstones

A
  • cholesterol stones - yellow and large
  • pigmented stones - small and dark
226
Q

Spleen

A
  • left upper quadrant, posterior
  • largest lymphatic organ
  • removes old RBC
227
Q

Pancreas

A
  • secondarily retroperitoneal
  • parts:
    • head - tucked into C loop of duodenum
    • neck - anterior to superior mesenteric artery
    • body - between neck and tail
    • tail - near spleen
  • main pancreatic duct joins bile duct –> hepatopancreatic ampulla
  • hepatopancreatic sphincter of Oddi surrounds ampulla
  • opens into descending duodenum at major duodenal papilla
228
Q

Stomach

A
  • cardia - near esophagus
  • fundus - dilated superior portion
  • body - major portion
  • pyloric part - outflow region, antrum + canal
  • pyloric sphincter
  • greater and lesser curvature
229
Q

Small Intestine

A
  • duodenum, jejunum, ileum
230
Q

Duodenum

A
  • 4 parts
    • superior - intraperitoneal, horizontal
    • descending - bile and pancreatic ducts
    • horizontal
    • ascending
  • ligament of Treitz - suspensory ligament, suports duodenal-jejunal junction
231
Q

Jejunum vs Ileum

A
  • jejunum is more red - more vascularization
  • jejunum has thicker wall
  • jejunum has larger, talller, more closely packed internal folds
  • jejunum arcades are fewer and larger
  • jejunum vasa recta are longer
232
Q

Large Intestine

A
  • cecum - enlarged area that receives material from small intestine
    • appendix (McBurney’s point)
  • ascending colon - right body wall, ends at right colic/hepatic flexure
  • transverse colon - between right colic/hepatic and left colic/splenic flexures
  • descending colon - left body wall, ends in sigmoid
  • sigmoid colon - S-shaped, meets rectum
  • teniae coli, haustra, omental appendices
233
Q

Arterial Supply to GI Tract

A
  • 3 major branches from abdominal aorta
    • celiac trunk - foregut
    • superior mesenteric artery - midgut
    • inferior mesenteric artery - hindgut
234
Q

Parts of Gut and Divisions

A
  • foregut and midgut - duodenum
  • midgut and hindgut - transverse colon
235
Q

Celiac Trunk

A
  • 3 branches
    • splenic artery
    • left gastric artery
    • common hepatic artery
236
Q

Branches of Common Hepatic Artery

A
  • gastroduodenal
    • right gastro-omental - greater curvature of stomach
    • superior pancreaticoduodenal - duodenum and head of pancreas
  • proper hepatic artery
    • right gastric - lesser curvature of stomach
    • left hepatic - left lobe of liver
    • right hepatic - right lobe
      • cystic branch - gallbaldder
237
Q

Left Gastric Artery

A

supplies esphagus and lesser curvature of stomach

238
Q

Branches of Splenic Artery

A
  • pancreatic branches - to pancreas
  • left gastro-omental - greater curvature of stomach
  • short gastrics - fundus
239
Q

Superior Mesenteric Artery

A
  • inferior pancreaticoduodenal - distal duodenum and head of pancreas
  • intestinal branches - small intestine
    • form arcades and vasa recta
  • ileocolic artery - distal ileum, cecum, appendix
  • right colic - ascending colon
  • middle colic - transverse colon
240
Q

Inferior Mesenteric Artery

A
  • left colic - transverse colon, descending colon
  • sigmoid arteries - sigmoid colon, descending colon
  • superior rectal artery - proximal rectum
241
Q

Marginal Artery

A

between superior and inferior mesenteric arteries

242
Q

Portal Venous System

A
  • portal vein - carries blood from GI tract to liver
  • distal branches - same names as arteries, except no celiac trunk vein
    • splenic vein - spleen, stomach, pancreas
    • superior mesenteric vein - stomach, ancreas, small intestine, cecum, ascending and transverse colon
    • inferior mesenteric vein - transverse colon, descending colon, sigmoid colon, proximal rectum
  • inferior mesenteric drains to splenic
  • splenic joins superior mesenteric to form portal vein
  • after liver, blood drains via right, middle, left, hepatic veins into inferior vena cava
243
Q

Portal/Caval Anastomoses

A
  • portal system lacks valves!
  • gastroesophageal region - system esophageal veins to left gastric branch
  • anal canal - systemic middle and inferior rectal veins to superior rectal branch
    • hemorrhoids
  • paraumbilical region - small cutnaeous veins with paraumbilical veins of falciform ligament to drain into portal vein
    • caput medusae
  • retroperitoneal region - posterior aspects of secondarily retroperitoneal viscera or liver with systemic retroperitoneal veins
244
Q

Visceral Motor Innervation to GI Tract

A
  • provided by autonomic nervous system
    • sympathetics - vasoconstriction
    • parasympathetics - rest and digest
  • preganglionic sympathetics synapse at prevertebral ganglion
  • postganglionic sympathetics + preganglionic parasympathetics –> peri-arterial plexuses –> travel to targets via blood vessels
245
Q

Sympathetic Visceral Motor

A
  • preganglionic
    • thoracic splanchnics from T5-12
      • greater T5-9
      • lesser T10-11
      • least T12
    • lumbar splanchnics from L1-2
    • contribute to aortic plexus
  • synapse at prevertebral sympathetic ganglia near roots of central arteries
    • greater –> celiac ganglion
    • lesser - superior mesenteric ganglion
    • least - aorticorenal ganglion
    • lumbar - inferior mesenteric ganglion
  • postganglionic fibers distributed to nearby arteries and go to target organs
246
Q

Parasympathetic Visceral Motor

A
  • preganglionic
    • vagus nerve - anterior and posterior vagal trunks
      • distal esophagus to left colic flexure
      • contribute to aortic plexus
      • distributed via peri-arterial plexuses
    • pelvic splanchnics from S2-4
      • distal to left colic flexure
      • distribued by inferior hypogastric plexus
  • synpase near targets
247
Q

Visceral Sensory Innervation to GI Tract

A
  • internal stimuli, reflexes - follow parasympathetic
  • pain -
    • distal esophagus to midpoint of sigmoid
    • follows sympathetic (thoracic or lumbar splanchnics)
    • goes to thoracolumbar spinal sensory ganglia
248
Q

Referred Pain

A
  • pain in GI tract is referred to dermatome levels supplised by the same spinal cord levels from which the specific sympathetic/parasympathetic nerves
  • ex: appendix
    • supplied by T10 - referred to paraumbilical region
    • later pain is from irritation of parietal peritoneum localized to area of skin superficial - right lower quadrant
249
Q

Diaphragm (Abdominal Perspective)

A
  • central tendon
  • sternal, costal, lumbar portions
  • right and left crura - musculotendinous extensions of the diaphragm from bodies L1-3 and interior longitudinal ligament
    • right crus loops and forms esophageal hiatus
    • right crus + left crus + median arcuate ligament forms aortic hiatus
250
Q

Arcuate Ligament

A
  • median arcuate ligament - connects right and left crus
  • medial arcuate ligament - over psoas major
  • lateral arcuate ligament - over quadratus lumborum
251
Q

Openings in the Diaphragm

A
  • “I 8 10 Eggs At 12”
  • vena caval foramen - T8
    • inferior vena cava
  • esophageal hiatus - T10
    • esophagus, anterior and posterior vagal trunks
  • aortic hiatus - T12
    • aorta, thoracic duct, azygos vein
252
Q

Branches of Abdominal Aorta

A
  • anterior unpaired - to GI
    • celiac trunk
    • superior mesentery
    • inferior mesentery
  • lateral paired - to glands
    • renal arteries
    • middle suprarenals
    • gonadal
  • posterior paired - to body wall
    • inferior phrenic
    • lumbar arteries - 4 pairs
  • terminal branches
    • right and left common iliac - L4 bifurcation
      • external iliac and internal iliac
    • median sacral
253
Q

Abdominal Aortic Aneurysm

A

dilations of arteries

may burst if it gets too big

254
Q

Branches of Inferior Vena Cava

A
  • left and right renal veins
    • left gonadal vein branches from left renal
  • right gonadal
  • common iliac veins - bifurcation at L5
    • external and internal iliac veins
255
Q

Left vs. Right Renal Veins

A
  • left is longer than right
  • left gonadal comes directly from left renal
  • right gonadal comes from IVC
256
Q

Kidneys

A
  • primarily retroperitoneal
  • T12-L3 on posterior abdominal wall
  • right slightly inferior to left - liver on right
  • perinephric fat - goes around kidneys
    • 2 layers separated by Gerota’s fascia/renal fascia
257
Q

Structure of Kidney

A
  • renal hilum - indentation on medial surface, where arteries enter and veins and renal pelvis leave
  • fibrous capsule
258
Q

Sagittal Section of Kidney

A
  • cortex and renal columns
  • renal pyramids with renal papillae - medulla
  • minor and major calyx
  • renal pelvis
  • ureter
259
Q

Areas of Constriction on Ureters

A
  • where renal pelvis drains into ureter
  • where ureter crosses the common iliac artery
  • where ureter enters the bladder
260
Q

Adrenal/Suprarenal Glands

A

endocrine glands surrounded by renal fascia and attached primarily to the diaphragmatic crura

261
Q

Arterial Supply to Suprarenal Glands

A
  • superior suprarenal - from inferior phrenic
  • middle suprarenal - from aorta
  • inferior suprarenal - from renal artery
262
Q

Venous Drainage of Suprarenal Glands

A
  • suprarenal veins
  • left is longer and drains directly to left renal vein
  • shorter right one drains to IVC
263
Q

Muscles of Posterior Abdominal Wall

A
  • quadratus lumborum
  • psoas major and minor
  • iliacus
  • transversus abdominus
264
Q

Quadratus Lumborum (QL)

A
  • iliac crest to lumbar vertebrae and 12th rib
  • ventral primary rami T12-14
  • draws pelvis towards ribs, lateral flexion of vertebral column
265
Q

Psoas Major

A
  • extends from vertebral bodies of T12-L5 to lesser trochanter of femur
  • flexes thigh and trunk
  • ventral primary rami L1-3
266
Q

Iliacus

A
  • extends form sacrum to femur
  • flexes thigh
  • innervated by femoral nerve
267
Q

Nerves of Posterior Abdominal Wall

A
  • subcostal (T12)
  • lumbar plexus branches
    • iliohypogastric (L1)
    • ilioinguinal (L1)
    • genitofemoral (L1-2)
    • lateral femoral cutaneous (L2-3)
    • femoral (L2-4)
    • Obturator (L2-4)
  • lumbosacral trunk (L4-5)
  • sympathetic trunk
268
Q

Testicular Torsion

A
  • twist in the spermatic cord –> cut off blood supply –> testes can die
  • check for cremasteric reflex - touch inner thigh (L1 does cutaneous), goes to spinal cord, L1 component of genitofemoral –> cremaster contracts
  • if there is no reflex, then you have a case of testicular torsion

human structure (5 decks)

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