Anatomy 🫀 Flashcards
(178 cards)
1
Q
what are the muscles of the tongue?
A
The tongue has 2 groups of muscles: intrinsic and extrinsic muscle.
A) Intrinsic muscle: 4 muscles
1. Superior longitudinal muscle
2. Inferior longitudinal muscle
3. Vertical muscle
4. Transverse muscle
B) Extrinsic muscles
These are muscles which arise from structures outside the tongue and inserted into the substance of the tongue.
1. Genioglossus.
2. Hyoglossus.
3. Styloglossus.
4. Palatsglossus.
2
Q
what is the origin of Genioglossus muscle?
(Fan shaped muscle)
A
Superior genial tubercle of the mandible.
3
Q
what is the insertion of Genioglossus muscle?
A
❖ the whole length of the tongue.
❖ the body of the hyoid bone.
4
Q
what is the nerve supply of Genioglossus muscle?
A
Hypoglossal nerve
5
Q
what is the action of Genioglossus muscle?
A
- Both sides: protrude the tongue
- One side: protrude the tongue and push it to the opposite side.
6
Q
what is the origin of Hyoglossus muscle?
A
Body & greater horn of hyoid bone.
7
Q
what is the insertion of Hyoglossus muscle?
A
The side of the tongue.
8
Q
what is the nerve supply of Hyoglossus muscle?
A
Hypoglossal nerve
9
Q
what is the action of Hyoglossus muscle?
A
Depression of the tongue
10
Q
what is the origin of styloglossus muscle?
A
❖ styloid process.
❖ stylomandibular ligament.
11
Q
what is the insertion of styloglossus muscle?
A
The side of the tongue.
12
Q
what is the nerve supply of styloglossus muscle?
A
Hypoglossal nerve
13
Q
what is the action of styloglossus muscle?
A
Retracts the tongue.
14
Q
what is the origin of Palatoglossus muscle?
(runs in the palatoglossal fold)
A
Lower surface of palatine aponeurosis.
15
Q
what is the insertion of Palatoglossus muscle?
A
The side of the tongue.
16
Q
what is the nerve supply of Palatoglossus muscle?
A
From the pharyngeal plexus (vagoaccessory complex)
17
Q
what is the action of Palatoglossus muscle?
A
- Elevates the tongue.
- Depresses the palate.
- approximate the two palatoglossal folds.
18
Q
what is the function of longitudinal muscles of the tongue?
A
The superior longitudinal muscle:
- Curls the tip upwards and rolls it posteriorly.
The inferior longitudinal muscles:
- They curl the tip of the tongue inferiorly, and act with the superior muscle to retract and widen the tongue.
19
Q
origin and insertion of transverse muscles of the tongue
A
Run from the septum (at the midline) to the margins.
20
Q
what is the function of transverse muscle of the tongue?
A
They narrow the tongue and increase its height.
21
Q
what is the function of vertical muscle of the tongue?
A
❖ They flatten the dorsum, increase the transverse diameter, and tend to roll up the margins.
❖ Acting with the transverse muscles, they increase the length of the tongue and assist with protrusion.
22
Q
what are the articular surfaces of TMJ?
A
head of the mandible - Mandibular fossa and articular tubercles (parts of the temporal bone)
23
Q
what is the type of TMJ?
A
synovial condylar
24
Q
what does TMJ consist of?
A
❖ It has two (superior and inferior) synovial cavities divided by a fibrous articular disc.
❖ It Consists of:
➢an upper gliding joint between the articular tubercle and mandibular fossa above and the articular disk below where forward gliding or protrusion and backward gliding or retraction (translation by dentists) takes place.
➢ a lower hinge joint between the disk and the mandibular head (condyle) where elevation or closing and depression or opening of the jaw takes place.
25
what are the accessory ligaments of TMJ?
**Lateral temporomandibular ligament**
- Thickening of the lateral part of the fibrous capsule
- Function: prevents dislocation of the jaw.
**Sphenomandibular ligament**
**Stylomandibular ligament**
26
what are the movements done by TMJ?
elevation, depression, protrusion, retraction and side to side movement.
27
Dislocation of the temporomandibular joint
occurs anteriorly as the mandible head glides across the articular tubercle during yawning and laughing.
28
what is the origin of Temporalis muscle?
1. Temporal fossa.
2. Temporal fascia.
29
what is the insertion of Temporalis muscle?
Coronoid process of the mandible.
30
what is the nerve supply of Temporalis muscle?
anterior division of mandibular nerve.
31
what is the action of Temporalis muscle?
Elevation and retraction of the mandible
32
what is the origin of Masseter muscle?
from the zygomatic arch.
33
what is the insertion of Masseter muscle?
Outer surface of the ramus of the mandible
34
what is the nerve supply of Masseter muscle?
anterior division of mandibular nerve.
35
what is the action of Masseter muscle?
Elevation and protraction of the mandible
36
what is the origin of Lateral pterygoid muscle?
1. Upper head: greater wing of sphenoid.
2. Lower head: lateral surface of lateral pterygoid plate.
37
what is the insertion of Lateral pterygoid muscle?
1. capsule and intra articular disk of TMJ.
2. pterygoid fovea on the neck of mandible.
38
what is the nerve supply of Lateral pterygoid muscle?
anterior division of mandibular nerve.
39
what is the action of Lateral pterygoid muscle?
1. depression and protraction of the mandible (opening of the mouth).
2. grinding (side to side) movements.
40
what is the origin of Medial pterygoid muscle?
**1. Superficial head:** from tuberosity of maxilla.
**2. deep head:** from medial surface of lateral pterygoid plate
41
what is the insertion of Medial pterygoid muscle?
Inner surface of the angle of the mandible.
42
what is the nerve supply of Medial pterygoid muscle?
trunk of mandibular nerve.
43
what is the action of Medial pterygoid muscle?
1. Elevation and protraction of the mandible
2. grinding (side to side) movements.
44
what is the definition of the esophagus?
Narrow muscular tube for food passage between the pharynx and the stomach.
45
what is the length of the esophagus?
10 inches.
46
what is the beginning, course & termination of the esophagus?
**Beginning:** Continuation of the pharynx at the lower border of C6.
**Course:**It descends downward in the neck, through superior and posterior mediastinum.
**Termination:** It traverses the esophageal orifice in the right crus of the diaphragm at the level of the T10, Enters the stomach at the cardiac orifice opposite T11, one inch to the left of median plane.
47
what are the constrictions of the esophagus?
**Sites:**
1. At the beginning of the esophagus.
2. Opposite the arch of the aorta.
3. Opposite the point of crossing of the left principle bronchus.
4. At the esophageal opening of the diaphragm.
**Importance:** These constrictions are of clinical importance during the passage of the instruments (gastroscope) along the esophagus.
48
what are the parts of the esophagus?
1. **Cervical portion:** in the lower part of the neck.
2. **Thoracic portion:** in the superior and posterior mediastinum.
3. **Abdominal portion:** in the upper part of the abdominal cavity.
49
what are the relations in the thoracic part of the esophagus?
**➢ In the superior mediastinum:**
- It descends anterior to vertebral column behind the trachea.
- The thoracic duct ascends on its left side
**➢ In the posterior mediastinum:**
- At T7: the esophagus crosses anterior to aorta from right to left side.
- At T5: The thoracic duct crosses behind esophagus from right to left.
- Related anteriorly to oblique sinus of the pericardium separating it from the left atrium.
50
what is the blood supply of the esophagus?
**Arterial supply:**
* Cervical portion: inferior thyroid artery.
* Thoracic portion: descending thoracic aorta.
* Abdominal portion: left gastric artery - inferior phrenic artery.
**Venous drainage:**
* Cervical portion: brachiocephalic vein.
* Thoracic portion: azygos and hemiazygos.
* Abdominal portion: left gastric vein.
51
what is the site of the stomach?
Left hypochondriurn, epigastrium and umbilical regions.
52
what are the divisions of the stomach?
1. Cardiac portion
2. pyloric portion
53
cardiac portion of the stomach
**1. Fundus:** Full rounded upper most part stomach.
**2. Body:** Extends from cardiac end to angular notch at the lesser curvature of the stomach, including the corresponding area on the greater curvature.
54
pyloric portion of the stomach
**1. Pyloric antrum:** dilatation on the greater curvature opposite the angular notch of the lesser curvature.
**2. Pyloric canal:** cylindrical canal 1 inch long to the right of pyloric antrum.
**3. Pyloric sphincter.**
55
compare between cardiac orrifice & pyloric orifice according to site and sphincter
56
compare between Lesser curvature & Greater curvature Acc to shape, peritoneal folds and related vessels
57
what is the peritoneal covering of the Antero-superior surface?
Completely covered by the peritoneum of the greater sac
58
what are the structures related to the Antero-superior surface?
1) Anterior abdominal wall
2) Left lobe of the liver
3) Diaphragm
59
what is the peritoneal covering of the Postero-inferior surface?
Completely covered by the peritoneum of the lesser sac except the bare area of the stomach
60
what are the structures related to the Postero-inferior surface?
**(stomach bed)**
**- 4 transverse structures**
1. pancreas.
2. Splenic artery
3. Transverse mesocolon
4. Transverse colon.
**- 4 left sided structures**
1. Left crus of diaphragm.
2. Left kidney.
3. Left suprarenal gland.
4. Spleen
61
what are the parts of the small intestine?
divided into three parts:
**❖ Duodenum:** it is the proximal part.
**❖ Jejunum:** follows the duodenum.
**❖ Ileum:** it is the distal part.
62
what is the definition of the Duodenum?
The widest, shortest and most fixed part of small intestine
63
what is the shape and length of the Duodenum?
**Shape:** is a C-shaped tube
**Length:** ten inches (25 cm) long.
64
mobility and peritoneal coverings of the Duodenum
**- The proximal one-inch:** is free and mobile because of its attachment to the lesser and greater omenta (completely covered)
**- The rest:** is fixed to the posterior abdominal wall (retroperitoneal)
65
what is the beginning of the Duodenum?
Begins at At the junction of pylorus & duodenum One inch to the right of the median plane at level of L1 (transpyloric plane).
66
what is the termination of the Duodenum?
It ends at the **duodenojejunal flexure** **one inch** to the **left of median plane** at the level of the **2nd lumbar** vertebra. This duodenojejunal flexure is **attached** to the **diaphragm** by the **suspensory muscle** (ligament) of duodenum **(ligament of Treitz).**
67
what are the parts of the Duodenum?
is divided into four parts :
A. Superior (first part): 2 inches long.
B. Descending (second part): 3 inches long.
C. Horizontal (third part): 4 inches long.
D. Ascending (fourth part): 1 inch long.
68
what does the Duodenum surround?
the head of the pancreas.
69
Relations of the first part of the Duodenum
**A. Posterior relations:** common bile duct, gastroduodenal artery, portal vein, and inferior vena cava.
B. clinically, **the beginning of this part** of the duodenum is referred to as **the ampulla or duodenal cap,** and **most duodenal ulcers occur in this part of the duodenum**
70
Relations of the second part of the Duodenum
A. crossed **anteriorly** by the **transverse colon**
B. contains the **major duodenal papilla**, which is the common entrance for the common bile and main pancreatic ducts, and the **minor duodenal papilla**, which is the entrance for the accessory pancreatic duct
C. the **junction** of the **foregut and the midgut** just below the major duodenal papilla.
71
Relations of the third part of the Duodenum
**A. Posterior relations:** the inferior vena cava and the aorta.
**B. Anterior relations:** the superior mesenteric artery and vein.
72
what is the length of Jejunum and Ileum?
six meters, long.
73
what is the position of Jejunum and Ileum?
most of the **jejunal loops lie above the umbilicus** while most of the **ileal loops lie below it**.
74
what is the peritoneal covering of Jejunum and Ileum?
they are **completely covered and suspended from the posterior abdominal wall** by a large fold of peritoneum called **mesentery**.
75
what is the extent of Jejunum and Ileum?
the jejunum joins the duodenum at the **duodenojejunal flexure**, while the ileum joins the beginning of the large intestine (caecum) at the **ileocaecal junction**.
76
what are the differences between Jejunum and Ileum?
77
what are the main charachters of large intestine?
**1. Taenia coli:**
- Are three longitudinal bands in the wall of the colon, which represent the longitudinal muscle layer.
**2. Sacculations (haustration):**
- Is the presence of sac-like dilatations in the wall of the large intestine
**3. Appendices epiploicae:**
- small fat-filled sacs of peritoneum attached along taenia.
78
what are the parts and peritoneal covering of the large intestine?
79
what are the openings in the caecum?
**1. Ileum:**
- Opens into the **posteromedial** aspect of its **upper end (at the junction between the caecum and the ascending colon)**.
- The ileocaecal orifice, is guarded by the **ileocaecal valve**.
**2. Vermiform appendix:**
- 2 cm below the ileocaecal opening. **"with no valve"**
**3. Ascending colon:**
- at its upper end.
80
what are the positions of the appendix?
81
what is the surface anatomy of the appendix?
**(The McBurney's point)**
- This point lies at the junction of the lateral one-third and the medial two- thirds of a line from the anterior superior iliac spine to the umbilicus.
- It marks the **base of the appendix (its opening into the caecum)**
82
what is the site of the rectum?
In the posterior part of the true pelvis.
83
What is the length of the rectum?
5 inches.
84
what is the beginning of the rectum?
At the third sacral vertebra as a continuation of the sigmoid colon.
85
what is the termination of the rectum?
Ends 1 inch below and in front of the tip of the coccyx becomes continuous with the anal canal.
86
what are the differences between the rectum and large intestine?
The three cardinal features of the large intestine; sacculations, taniae coli and appendices epiploicae are absent in the rectum.
87
what is the site of the liver?
It lies in the right hypochondrium, epigastrium and extends to the left hypochondrium.
88
what are the anatomical lobes of the liver?
The liver consists of a larger right lobe and a smaller left lobe
89
what separaes the anatomical lobes of the liver?
**1. Attachment of falciform ligament:** on the anterior and superior surfaces.
**2. Fissure for ligamentum teres:** on the inferior surface.
**3. Fissure for ligamentum venosum:** on the posterior surface.
90
what are the two small lobes on the right lobe of the liver?
**1. Quadrate lobe:** (on the inferior surface) between the gall bladder and fissure for ligamentum teres.
**2. Caudate lobe:** (on the posterior surface) between the inferior vena cava and the fissure for ligamentum venosum.
91
what are the surfaces of the liver?
The liver is wedge-shaped having 5 surfaces:
- Inferior (visceral) surface
- posterior surface
- superior surface
- anterior surface
- right surface
92
inferior (visceral) surface of the liver
- The inferior surface of the left lobe is related to the body of the stomach and the lesser omentum.
- The quadrate lobe lies between the fissure for the ligamentum teres and the gallbladder.
- The quadrate lobe: related to the pylorus, the first part of the duodenum, the lower part of the lesser omentum and the transverse colon
- fossa for the gallbladder: it may have a short mesentery or be completely intrahepatic and lie within a cleft in the liver parenchyma.
- To the right of the gallbladder, the inferior surface is related to the hepatic flexure of the colon, the right suprarenal gland and right kidney, and the duodenum
93
what is the inferior surface of the liver related to?
to the body of the stomach and the lesser omentum.
94
where does the quadrate lobe lie?
between the fissure for the ligamentum teres and the gallbladder.
95
what is the quadrate lobe related to?
related to the pylorus, the first part of the duodenum, the lower part of the lesser omentum and the transverse colon
96
fossa of gall bladder
it may have a short mesentery or be completely intrahepatic and lie within a cleft in the liver parenchyma.
97
what is the inferior surface of the liver (to the right of the gall bladder ) related to?
To the right of the gallbladder, the inferior surface is related to the hepatic flexure of the colon, the right suprarenal gland and right kidney, and the duodenum
98
what is the definition of porta hepatis?
It is a transverse fissure situated near the posterior aspect of the inferior surface.
99
what are the boundaries of porta hepatis?
* Anteriorly: quadrate lobe
* Posteriorly: caudate lobe
100
what are the contents of porta hepatis?
1. Portal vein (right and left branches): most posterior
2. Hepatic artery (2 terminal branches): intermediate position.
3. Hepatic (bile) ducts: most anterior
4. lymph node and lymph vessels.
101
relations of the posterior surface of the liver
related to: (from right to left):
- diaphragm at the triangular bare area
- The inferior vena cava in a groove or tunnel
- caudate lobe.
- The fissure for the ligamentum venosum separates the caudate lobe from the left lobe
- a shallow impression caused by the abdominal oesophagus
- impression related to the fundus of the stomach
**(These structures forms the bed of the liver)**
102
relations of the superior surface of the liver
Related to the diaphragm which separates the liver from:
1. Heart and pericardium: in the median plane
2. Lung and pleura: on each side
103
relations of the anterior surface of the liver
Related to:
1. Diaphragm: separates the liver from the pleurae and lungs.
2. Anterior abdominal wall
104
relations of the right surface of the liver
Related to the diaphragm which separates it from the right pleura and lung.
105
peritoneal covering of the liver
The liver is completely covered by peritoneum except:
- The main bare area lies on the posterior surface of the right lobe between the 2 layers of the coronary ligament. It is triangular in shape with its base situated at the groove for the I.V.C.
- The fossa for gall bladder
- The groove for I.V.C.
- The porta hepatis.
106
what are the peritoneal folds attached to the liver?
1. Coronary ligament: to diaphragm (on right lobe)
2. Right triangular ligament: to diaphragm (on right lobe).
3. Left triangular ligament: to diaphragm (on left lobe)
4. Falciform ligament: to diaphragm and anterior abdominal wall (between the 2 lobes).
5. Lesser omentum: to stomach and 1st inch of duodenum.
107
what is the number of surgical segments of the liver?
8 surgical segments
108
What is liver segmentation based on?
This segmentation is based on:
- Portal triad: Hepatic artery, Portal vein, and CBD Each segment has one branch from them.
- Hepatic vein:
Right → runs in the right portal fissure
Middle → runs in the main portal fissure
Left → runs in the left portal fissure
109
what divides the liver into equal right and left lobes?
The Liver is divided into 2 equal right & left lobes by Cantlie’s plane (main portal fissure) which extends from the midpoint of the gallbladder fossa to the midpoint of the inferior vena cava.
110
what are the segments of the right and left lobes?
- The right lobe contains segments 5, 6, 7, and 8.
- The left lobe contains segments 1, 2, 3, and 4.
111
what is the site of the gall bladder?
It lies in a fossa on the inferior surface of the liver.
112
what are the parts of the gall bladder?
fundus, body & neck
113
position and relations of the fundus of the gall bladder
- Projects beyond the inferior border of the liver.
- related to the anterior abdominal wall opposite the of 9th right costal cartilage
114
position & relations of the body of gall bladder
- Its upper surface is adherent to its fossa on the inferior surface of the liver, while its lower surface is covered by peritoneum.
- It is related to:
1. Transverse colon
2. duodenum
115
what are the characters of the neck of the gall bladder?
- It is the narrowest part, and is related to the duodenum
- May have an abnormal conical pouch called Hartmann’s pouch (common site for stone formation).
116
what forms the duct system of the gall bladder?
- cystic duct
- hepatic ducts
- the common bile duct
117
start and termination of the cystic duct
It arises from the neck of gall bladder and joins the common hepatic duct to form the common bile duct.
118
what is the shape and length of the cystic duct?
It is S-shaped and measures about 4 cm in length.
119
heaptic ducts of the gall bladder
- The bile is secreted by the liver cells and passes in fine canaliculi inside the liver.
- It is then collected into the right and left hepatic ducts (from each lobe of liver).
- So, 2 hepatic ducts leave the porta hepatis anterior to the hepatic artery, and join each other to form the common hepatic duct.
120
what forms the common bile duct?
at the porta hepatis by union of the common hepatic duct and the cystic duct.
121
course & relations of the common bile duct
- It passes downwards in the free edge of lesser omentum superficial to the portal vein and to the right of the hepatic artery.
- Then, runs behind the 1st part of duodenum on the right side of the gastroduodenal artery.
- Then, runs in a groove on the posterior surface of the head of pancreas in front of the I.V.C.
122
termination of common bile duct
- It unites with the main pancreatic duct to form hepato-pancreatic ampulla (ampulla of Vater).
- The ampulla of Vater opens on the top of the major duodenal papilla
- The circular muscle fibres around the hepato-pancreatic ampulla are thickened to form the sphincter of Oddi.
123
what are the boundaries and contents of calot's triangle?
- bounded by the visceral surface of the liver superiorly, the cystic duct inferiorly, and the common hepatic duct medially. It contains the cystic artery (supplies the gall bladder)
124
what is the site of the spleen?
It lies in the left hypochondrium.
125
what is the surface anatomy of the spleen?
- opposite the 9th, 10th, and 11th left ribs with its long axis parallel to the 10th rib.
- Its anterior (lateral) end does not extend beyond the mid-axillary line.
- Its posterior (medial) end is about 1.5 inches from the T10 spine.
126
what are the surfaces of the spleen?
diaphragmatic & visceral
127
diaphragmatic surface of the spleen
Convex and is related to the diaphragm which separates it from the lung and pleura.
128
visceral surface of the spleen
Presents the following impressions:
**1. Gastric impression:**above the hilum of the spleen.
**2. Renal impression (for the left kidney:** below the hilum of the spleen.
**3. Colic impression:** (for the left colic flexure) close to the anterior (lateral) end of the spleen.
**4. Pancreatic impression:** (for the tail of pancreas) a small area below the lateral end of the hilum.
129
what are the peritoneal relations of the spleen?
- The spleen is completely covered by peritoneum except its hilum and at the pancreatic impession.
130
what are the peritoneal ligaments related to the spleen?
**- Gastro-splenic ligament:** connects the spleen to the stomach.
**- Lieno-renal ligament:** connects the spleen to the left kidney.
**- the phrenico-colic ligament:** connects diaphragm and left colic flexure and supports the spleen in its position.
131
what is the site of the posterior abdominal region?
posterior to the abdominal part of the gastrointestinal tract.
132
what are the bones of the posterior abdominal wall?
**Posteriorly:** Lumbar vertebrea & sacrum
**Superiorly:** Last 2 ribs.
**Laterally:** Ilia of the hip bone.
133
what is the origin of Psoas major?
1. Transverse process of all lumbar vertebrae.
2. The adjoining parts of the bodies of (T12- L5) & intervertebral discs in between.
| T12-L5
134
what is the insertion of Psoas major?
lesser trochanter of the femur
135
what is the nerve supply of Psoas major?
L1, L2 & L3
136
what is the action of Psoas major?
❖ Flexion of the thigh.
❖ flexion of the trunk (bend the trunk forwards).
| "as it is present in trunk & thigh"
137
what is the origin of Psoas minor?
From the sides of the bodies of (T12- L1) and the disc in between.
| "No transvers processes"
138
what is the insertion of Psoas minor?
Iliopupic eminence of the hip bone.
139
what is the nerve supply of Psoas minor?
L1
140
what is the action of Psoas minor?
weak flexor of the trunk
| "in trunk only"
141
what is the origin of Quadratus lamborum?
❖ iliac crest.
❖ iliolumbar ligament.
❖ Transverse process of L5
142
what is the insertion of Quadratus lumborum?
- The medial half of last rib.
- Transverse processes of (L1- L4).
143
what is the nerve supply of Quadratus lumborum?
- Subcostal nerve (T12).
- L1, 2, 3, 4
144
what is the action of Quadratus lumborum?
1. lateral flexion of the trunk.
2. Stabilize the last rib.
145
what is the origin of Iliacus?
From the upper 2/3 of iliac fossa.
146
what is the insertion of Iliacus?
With the psoas major into the lesser trochanter of the femur.
147
what is the nerve supply of Iliacus?
femoral nerve (L2,3,4).
148
what is the action of Iliacus?
Assists the psoas major muscle in flexion of the thigh.
| "in thigh only"
149
what is the origin of descending abdominal aorta?
begins at the aortic opening of the diaphragm as a continuation the descending thoracic aorta, **at the lower border of T12**.
150
what is the course of descending abdominal aorta?
descends in front of the bodies of the vertebral column.
151
what is the termination of descending abdominal aorta?
at the **lower border of L4 by dividing into right and common iliac arteries**.
152
branches and levels of descending abdominal aorta
There are also lumbar branches
153
what is the beginning of inferior vena cava?
begins by the **union of the two common iliac veins**, at the level of the **body of L5**.
154
what is the course of inferior vena cava?
- Ascends in front of the vertebral column **on the right side of DAA**.
- Leaves the abdomen by **piercing the central tendon of the diaphragm at the level of T8**.
155
termination of inferior vena cava
Pierces the **pericardium** to enter the the **posterior part of the right atrium** opposite the **right 6th costal cartilage**.
## Footnote
"the IVC is longer than the abdominal aorta"
156
what are the tributaries of inferior vena cava?
**1. The right and left common iliac veins.**
**2. The third and fourth lumbar veins: of both sides ( the first and second lumbar veins ends into the ascending lumbar veins).**
**3. The right gonadal vein: (the left vein joins the left renal vein).**
**4. The right suprarenal Vein: (the left vein joins the left renal vein).**
**5. The right and left renal veins.**
**6. The right and left phrenic veins.**
**7. The right and left hepatic veins.**
157
what is the location of Lumbar plexus?
Inside the psoas major
158
what forms the Lumbar plexus?
**Ventral** rami of upper 4 lumbar nerves.
159
what are the branches of Lumbar plexus?
**Muscular:**
1. Psoas minor: L1.
2. Psoas major: L2, 3, 4.
3. Quadratus lumborum: L 1, 2, 3.
**6 Named branches:**
1. Iliohypogastric: L1
2. Ilioinguinal: L1
3. Genitofemoral: L1, 2
4. Lateral cutaneous nerve of the thigh: L2, 3
5. Femoral nerve: posterior division of L2, 3, 4
6. Obturator nerve: anterior division of L2, 3, 4
160
what are the relations of Lumbar plexus to psoas major?
**Anterior:**
- Genitofemoral nerve
**Lateral:**
- Iliohypogastric nerve
- Ilioinguinal nerve
- Lat cutan nerve of the thigh
- Femoral nerve
**Medial:**
- Obturator nerve
- Lumbosacral trunk
161
what is the site of the Pancreas?
lies across the **upper part of the posterior abdominal wall behind the peritoneum of the lesser sac**. It crosses from the concavity of the duodenum to the hilum of the spleen.
162
what are the parts of the pancreas?
head, neck, body & tail
163
what is the site of the head of the Pancreas?
Lies in the **concavity of the duodenum**, separated from it by **groove** containing the **pancreaticoduodenal vessels**.
164
what is the direction of uncinate process?
projects upwards and to the left.
165
relations of the head of the Pancreas
**❑ Anterior relations:**
1. The transverse colon.
2. The coils of the jejunum
3. The superior mesenteric vessels: in front of the uncinate process.
**❑ Posterior relations:**
1. The I.V.C.
2. The common bile duct.
3. The aorta: behind the uncinate process
166
relations of the neck of the Pancreas
**❑ Anterior relations:**
1. The pylorus and the first part of the duodenum.
2. The peritoneum of the lesser sac.
**❑ Posteriorly:**
- It is related to the beginning of the portal vein and the termination of the superior mesenteric and splenic veins.
167
site of the body of the pancreas
It extends to the left behind the lesser sac.
168
what are the characters of the body of the Pancreas?
It is triangular in cross section. It has three surfaces and three borders.
169
relations of the surfaces of the body of the Pancreas
**The anterior surface:** "to stomach"
➢ Is covered by the peritoneum of the lesser sac.
➢ Is separated from the posterior surface of the stomach by the cavity of the lesser sac.
**The inferior surface:** "to intestine"
➢ Is covered by the peritoneum of the greater sac.
➢ It is related to: The duodenojejunal flexure and left colic flexure.
**The posterior surface:** "to vessels"
- It is not covered by peritoneum, and it is related directly to:
1. The abdominal aorta.
2. The splenic vein: above the superior mesenteric artery.
3. The left renal vein: below the superior mesenteric artery.
170
relations of the borders of the body of pancreas
**The upper border:** Related to the splenic artery.
**The anterior border:** Gives attachment to transverse mesocolon.
**The posterior border:** the same relations as posterior surface.
171
what are the characters of the tail of pancreas?
❑ Is thick and blunt.
❑ It lies between the two layers of the lienorenal ligament.
❑ It is related to the terminal parts of the splenic vessels.
❑ It comes into direct relation with visceral surface of spleen close to its hilum.
172
what is the site of the tail of the pancreas?
It lies between the two layers of the lienorenal ligament.
173
what is the tail of pancreas related to?
- It is related to the terminal parts of the splenic vessels.
- It comes into direct relation with visceral surface of spleen close to its hilum.
174
where does the main pancreatic duct pass through?
It passes through tail, body and lower part of head.
175
course and relations of the main pancreatic duct
- In the lower part of the head of pancreas, the pancreatic duct joins the bile duct. The joining of these two structures forms the hepatopancreatic ampulla (ampulla of Vater), which enters the 2nd part of the duodenum at the major duodenal papilla.
- Surrounding the ampulla is the sphincter of ampulla (sphincter of Oddi), which is a collection of smooth muscle
176
where does the accessory pancreatic duct pass through?
It is small duct, which begins in the upper part of the head.
177
where does the accessory pancreatic duct open?
It opens into the second part of the duodenum on the summit of the minor duodenal papilla, **one inch above the major duodenal papilla**.
178
what are the muscles of the posterior abdominal wall?
❑ Psoas major muscle.
❑ Psoas minor muscle.
❑ Quadratus lumborum muscle.
❑ Iliacus.
