Anatomy Flashcards
Internal iliac branches
Posterior division - 3 somatic branches
- Superior gluteal
- Iliolumbar
- Lateral sacral
Anterior division - 9 branches
- Superior vesicle (persistant umbilical artery proximally)
- Obliterated distal umbilical artery and remains as the medial umbilical ligament
- Inferior vesicle
- Uterine
- Vaginal
- Middle rectal
- Inferior gluteal
- Obturator
- Internal pudendal
Components of the inferior hypogastric plexus
Sympathetic input
- Sacral splanchnic nerves (from sacral sympathetic trunk and ganglion impar)
- Superior hypogastric plexus (located around L5 and the bifruaction of the aorta) which then travels inferior via hypogastric nerves
Parasympathetic input
- Pelvic sphanchnic nerves S2,S3,S4 (nervi eregentes)
Blood supply to the GIT
Coeliac T12
Left gastric
Splenic
- Pancreatic branches
- Short gastrics
- Left gastroepiploic
CHA
- right gastric
- HA
- Gastroduodenal
—-right gastroepiploic
—-superior pancreaticoduodenal
SMA L1
-Inferior pancreaticoduodenal
- Middle colic
- Jejunal and ileal branches
- Right colic
- Ileocolic
IMA L3
- Left colic
- Sigmoid arteries
- Superior rectal
Points of anastamosis
- coeliac trunk and SMA at pancreaticoduodenal arteries
- SMA and IMA at Griffiths point via the marginal artery of drummond and arc of riolan
- IMA and internal iliac system at the rectum with the superior rectal and middle/inferior rectal vessels
Brachial plexus 3,1,0,3,5,5
5 roots between middle and anterior scalenes- 3 branches
- Nerve to subclavius (C5)
- Dorsal scapular nerve (C5, C6)
- Long thoracic nerve (C5, C6, C7)
3 trunks in posterior triangle of neck- 1 branch
- Suprascapular nerve (infra and supraspinatus)
6 divisions behind clavicle
3 cords in axilla
Lateral cord - 3 branches
- Lateral pectoral nerve
- Musculocutaneous nerve
- Lateral root of median nerve
Medial cord - 5 branches
- Medial pectroal nerve
- Medial cutaneous nerve of arm
- Medial cutaneous nerve of forearm
- Ulnar nerve
- Medial root of median nerve
Posterior cord
- Upper subscapular nerve
- Thoracodorsal nerve
- Lower subscapular nerve
- Radial
- Axillary
Subclavian artery 3,1,1
From right brachiocephalic or left arch of aorta to lateral aspect of 1st rib
Passes between anterior and middle scalene. ant scalene divides it into 3.
3,1,1 - Vit C/D
1st part
- Vertebral
- Internal thoracic
- Thyrocervical trunk
2nd part
- Costocervical trunk
3rd part
- Dorsal scapular
Axillary artery 3,2,1
From lateral 1st rib to lower border teres major. 3 parts according to pec minor tendon.
STL SAP
1st part
- superior thoracic
2nd part
- Thoracoacromial (cadavers are dead people: clavicular, acromial, deltoid, pectoral)
- Lateral thoracic
3rd part
- subscapular (thoracodorsal and circumflex scapular)
- Anterior circumflex humeral
- Posterior circumflex humeral
axillary/humeral spaces
Quadrangular space
- teres major, teres minor, humerus and long head triceps
- Transmits axillary nerve and posterior circumflex humeral artery
Triangular space
- Teres major and minor, long head of triceps
- Transmits circumflex scapular artery
Triangular interval
- teres major, humerus and long head of triceps
- Transmits radial artery, and deep artery of the arm
Lesser sac
Space within the peritoneal cavity posterior to the stomach
Anterior: Lesser omentum, posterior stomach, greater omentum
Posterior: Pancreas, diaphragm, left kidney and adrenal
Superior: Caudate lobe of liver
Left lateral: Gastrosplenic and splenorenal ligaments
Right lateral: Epiploic foramen
Abdominal aorta
Enters abdomen under median arcuate ligament at T12, terminates at L4 bifurcating into CIA.
3 anterior visceral branches
- Coeliac trunk T12
- SMA L1
- IMA L3
3 paired visceral branches
- Renal arteries L2
- Suprarenal arteries
- Gonadal arteries
Paired abdominal wall branches
- Inferior phrenic arteries
- Lumbar arteries
Single median sacral artery in some
Axilla boundaries and contents
Boundaries
- Anterior: pec major/minor, subclavius, clavipectoral fascia
- Posterior: Lat dorsi, teres major, subscapularis
- Medial: Seratus anterior and chest wall (lower border at level of 4th rib)
- Lateral inter-tubercular groove of humerus
- Floor - axilla fascia, suspected by suspensory ligament, skin
- Apex: First rib, clavicle, scapula
Contents:
Vascular:
- Axillary artery and 3 divisions with branches (1,2,3)
- Axillary vein
Nervous structures
- Brachial plexus cords
- Nerves of axilla (long thoracic, thoracodorsal, medial pectoral, intercostobrachial)
Lymphatics levels I,II,III
Femoral canal
Cone shaped canal communicating between pelvis and anterior thigh
Boundaries
- Medial: Lacunar ligament
- Lateral: Femoral vein
- Posterior: Pectineal ligament
- Anterior: Inguinal ligament
Contents
- Cloquet’s node and lymphatics
- fat
Femoral triangle
Triangle in the anterior thigh which transmits the neurovascular structures fromt he abdomen into the distal thigh
Boundaries
- Superior: Inguinal canal
- Inferior/ apex: Adductor canal
- Lateral: Sartorius
- Medial: Adductor longus
- Roof: Fascia lata
- Floor: Iliopsoas, pectineus, adductor brevis, adductor longus
Contents
- Femoral nerve
- Femoral Sheath
- GSV entering the femoral vein at the SFJ
- Superficial inguinal nodes, cloquets node
RLN anatomy
- Arises from vagus nerve at level of aortic arch on left and subclavian on right
- Ascends in the mediastinum and neck towards TOG (more obliquely on right)
- Passes most commonly through the left inf thyroid vessels and posterior to right inf thyroid vessels
- Passes in TOG, usually medial to the tubercle of Zuckerkandle
- Splits into large anterior muscular branch and smaller sensory branch just before passing under inferior constrictor to supply the larynx
Non recurrent R) RLN associated with arteria lusoria (right subclavian off aortic arch passing behind oesophagus)
Cervical fascia and neck spaces
Superficial cervical fascia
- Platysma
Deep cervical fascia
- Investing layer (encloses SCM, trapezius, parotid)
- Pretracheal (encloses thyroid, covers trachea)
- Pre-vertebral (encloses vertebral column and paravertebral muscles)
Spaces
- Submandibular space - Bordered by mandible, mylohyoid, anterior belly of digastric and hyoid bone. Communicates with sublingual space around the posterior edge of the mylohyoid muscle. Can cause gross swelling of the tongue and obstruction of the airway
- Parapharyngeal space - Inverted cone from the base of skull to apex at hyoid bone, lying deep to the constrictor muscles and containing the carotid sheathm sympathetic trunk, LN muscles and 9-12th cranial nerves
- Pre-tracheal space - Surrounds the trachea and oeosophagus and is continuous with carotid sheath laterally to connect with superior mediastinum
- Retropharyngeal space - Between buccopharyngeal fascia and alar fascia and communicates with parapharyngeal space. Extends to diaphragm through posterior mediastinum
- Danger space - Between alar fascia and pre-vertebral fascia. Extends to diaphragm.
- Pre-vertebral space - between vertebral column and pre-vertebral fascia. Extends to sacrum/ coccyx.
Neck triangles
Posterior
Boundaries: Trapezius, SCM, clavicle
Contents
- Nerves: Spinal accessory, branches of cervical plexus (transverse cervical, lesser occipital, greater auricular, supraclavicular), Trunks of brachial plexus, ?phrenic nerve
- Vessels: Subclavian artery and vein, thyrocervical trunk
- LN (level 5)
- Muscles: Inferior belly of omohyoid
Anterior
Submandibular
- Boundaries: Anterior and post bellies digastric, mandible
- Contents: Submandibular gland, lingual nerve, hypoglossal nerve, mylohyoid nerve, facial artery and vein, LN
Submental
- Boundaries: Anterior bellies of digastric and hyoid bone
- Contents: Anterior jugular veins, LN
Carotid:
- Boundaries: SCM, sup belly of omohyoid, post belly of digastric
- Contents: Bifurcation of CCA and branches of ICA, IJV, lingual, facial and superior thyroid veins, vagus, hypoglossal, internal and external laryngeal nerves and ansa cervicalis
Muscular
- Boundaries: SCM, superior belly of omohyoid, midline
- Contents: Strap muscles, larynx, trachea, pharynx, oesophagus, thyroid and parathyroid glands
