Anatomy Flashcards
(713 cards)
0
Q
What do superficial and deep mean?
A
Closer or further from the body surface.
1
Q
What do external and internal mean?
A
Closer or further from the bodies/organs centre.
2
Q
What is the underside of the tongue called?
A
The ventral surface.
3
Q
What is the anterior surface of the wrist called?
A
Volar surface.
4
Q
What is the name for 3d circular movement at a joint?
A
Circumduction.
5
Q
What is a useful rule to remember about flexion and extension movements?
A
All anterior movements superior to the knee joint are flexions. All anterior movements below the knee are extensions.
6
Q
What do flexion and extension mean?
A
Flexion is decreasing the angle between the bones at a joint and extension is the opposite.
7
Q
What are the terms for rotating the sole of the foot towards and away from the midline of the body?
A
Towards the midline = inversion.
Away from the midline = eversion.
8
Q
What is it called when we bring the thumb and pinky together across the palm?
A
Opposition of the digits. Putting them back to normal is reposition.
9
Q
What is abduction of the digits?
A
Spreading the fingers. Adduction is bringing them back together.
10
Q
What way does the thumb move when it is abducted?
A
Anterior my from the anatomical position. Adduction is putting it back to normal.
11
Q
What are the terms for moving the shoulders up and down?
A
Elevation and depression, can also be used for the tongue etc.
12
Q
What are the terms for the forward and backwards movements of the jaw or shoulders?
A
Protraction (anterior).
Retraction (posterior).
13
Q
How often do skin cells shed?
A
Every three months.
14
Q
How long do red blood cells survive?
A
120 days.
15
Q
What is the integumentary system?
A
The skin and mucosa.
16
Q
Where are some discrete areas of lymphatic tissue in the body?
A
Tonsils, spleen and the GI tract.
17
Q
What different joint types are there?
A
Fibrous, cartilaginous and synovial.
18
Q
What subtypes of fibrous joint do we have, with examples?
A
Sutures e.g. Fontanelles.
Syndesmoses (fibrous sheets) e.g. Interosseus membrane between the radius and ulnar.
19
Q
What are the subtypes of cartilaginous joints, with examples?
A
Primary- Epiphyseal growth plate (hyaline cartilage) and secondary - symphyses e.g. Intervertebral discs.
20
Q
What is extension of the thumb?
A
Extending it out in the coronal plane. Flexion is putting it across the palm.
21
Q
What is the structure of an intervertebral disc?
A
Outer anulus fibrosis (fibrocartilage) and inner soft nucleus pulposus (like the pulp inside teeth - up to 90% water in young people).
22
Q
What are the 8 typical features of a synovial joint?
A
- Two or more bones articulating.
- Hyaline cartilage at articulations surfaces.
- A capsule.
- A joint cavity.
- Supported by ligaments.
- Associated with skeletal muscle and tendons.
- Associated with bursa.
- Often have special features.
23
Q
What constitutes the synovial joint capsule?
A
A superficial strong fibrous layer and a deeper synovial membrane layer that secretes synovial fluid.
24
What does a ligament do?
Connects bone to bone.
25
What are tendons and what do they do?
Fibrous bands that connect skeletal muscle to bone. They insert into the bone lying either side of a joint.
26
What are the two types of bursa in a synovial joint? And what do they do?
Synovial fluid filled extensions of the capsule that are continuous with it.
Closed sacs, near but deprecate from the joint cavity.
They prevent friction around the joint during movement.
27
Where does the joint capsule attach?
To the edges of the bone articulatory surfaces.
28
What is contained inside a joint cavity and why?
Synovial fluid. It lubricates, acts as a shock absorber and has nutrients for hyaline cartilage.
29
What are the 5 subtypes of synovial joint and their movements? Give an example of each.
Pivot joints - superior part of the neck. 45deg movement.
Ball and socket - hip - good multi axial movement.
Plane joints - acromioclavicular - minimal movement in one plane.
Hinge joints - elbow - reasonable range of movement in one plane.
Biaxial - hands - reasonable range in one, less in another.
30
What is subluxation?
Reduced area of contact between articulations.
31
What is dislocation?
Complete loss of contact between articular surfaces.
32
What is relaxin and what does it do?
A placental hormone that relaxes the pubic symphysis during pregnancy.
33
What is the TMJ?
The synovial articulation between the mandibular fossa and articular tubercle of the temporal bone superiorly and the head of the condylar process inferiority.
34
What are the special features of the TMJ?
The superior articular cavity, the inferior articular cavity and the articulating disc.
35
What happens when the TMJ dislocates?
The head of the condylar process of the mandible becomes stuck anterior to the articular tubercle of the temporal bone. The patient cannot close their mouth.
36
What kind of nerves supply joints?
Sensory nerves that can feel: pain, touch, temperature, proprioception (joint position sense).
37
How many bones are their in the adult?
206.
38
What are the sections of a bone starting from the top and working down?
Epiphysis, Epiphyseal growth plates, metaphysis, diaphysis then m, egp and e again.
39
What are the layers of bone?
Outer cortex made of heavy dense compact (cortical) bone.
Inner medulla made of spongy, porous weak spongy (trabecular/cancellous) bone.
Medulla may contain bone marrow.
40
What vessels does the periosteum house?
Periosteal arteries, sensory nerves, a nutrient vein and a nutrient artery cross the membrane to feed the medulla. Also has lymphatic vessels.
41
What part of the skull is superior to the skull base?
Bones of the cranial vault, the neurocranium.
42
What part of the skull is below the base of skull line?
The viscerocranium or facial bones.
43
What are the nose bones called?
The nasal bones.
44
What are the cheekbones called?
The zygomatic bones.
45
What are the top and bottom jaw bones called?
The maxilla and mandible.
46
Name the vertebrae sections and the numbers of each?
7 cervical, 12 thoracic, 5 lumbar, 5 sacral and 4 coccygeal. 33 in total.
47
What happens to the relative size of the vertebra in the spine?
Becomes larger from head to sacrum as weight bearing is increased. Then reduces in size after weight is transferred to the hip bones at the sacrum.
48
Where are the intervertebral foramen? And what is their purpose?
Between the facet joints and the vertebral body and discs. The protect spinal nerves joining with the spine.
49
What are C1 and C2 called? And what is special about them?
```
C1 = atlas. Has no body or spinous process instead it has anterior and posterior arches.
C2 = axis. Has stolen C1's body for an Odontoid process (peg).
```
50
What special features do the cervical vertebrae have?
All have a foramina in their transverse process.
51
What is the first readily palpable vertebrae in the neck?
C7 spinous process, called the vertebra prominens.
52
What rib is least likely to fracture and why?
The first rib, as it is protected by the clavicle.
53
How many pairs of ribs do we have and what are the different sections called?
12 pairs.
True ribs- 1 to 6. Attach via costal cartilages to the sternum.
False ribs 7-10. Attach via costal cartilage above to the sternum.
Floating ribs 11 and 12. No attachment.
54
What are the categories of bones in the hand,
Carpals - wrist bones.
Metacarpals - Palm.
Phalanges -fingers.
55
What blood vessel structures are commonly found around joints?
Peri articular arterial anastomoses.
56
Where is the superior mediastinum?
From the angle of the sternum and above.
57
Where is the anterior mediastinum?
Below the angle of the sternum, above the diaphragm in front of the heart.
58
Where is the posterior mediastinum?
From the bottom of t4 downwards, behind the heart and above the diaphragm.
59
Describe the pericardium.
3 layers. Outer fibrous pericardium. Inner serous pericardium in two layers. The visceral and the parietal.
60
What are the first branches of the aorta?
The coronary arteries.
61
What is another name for the apex of the heart?
The chin.
62
What forms the anterior surface of the heart?
Mainly the right ventricle.
63
What forms the base of the heart?
Opposite from the apex. Is the posterior surface and is formed from both atria.
64
What are the three layers of the heart muscle?
Epicardium (visceral pericardium), myocardium and endocardium.
65
What forms the inferior surface of the heart?
It is formed from both ventricles and sits on top of the diaphragm.
66
What are the heart edges called and what structures form them?
Left lateral border (left ventricle), the right border (right atrium) and the inferior surface.
67
Where is the AV node situated?
In the interatrial septum.
68
How does the cardiac impulse move from atria to ventricles?
via the atrioventricular bundle in the crux of the heart. The down the left and right bundle branches in the interventricular septum and around the purkinje/conducting fibres.
69
What is the crux of the heart?
The junction of all four chambers inside the heart.
70
What restricts the spread of cardiac impulse between the atria and ventricles and what does it consist of?
The fibrous part of the septum.
The fibrous rings of the cardiac valves.
The crux of the heart.
71
What is the cardiac plexus?
A mixture of nerves that supplies the heart. Sensory and motor nerves.
72
Describe 7 different types of skeletal muscle.
Flat muscle with aponeurosis (abdominal), fusiform (bicep), pennate (feathered muscles), quadrate and circular or sphincteral muscle.
73
What are aponeurosis?
flattened tendon, most commonly associated with flat muscles. They attach from muscle to short tissue.
74
How do muscles attach to bones?
The origin - on one side of a joint. The insertion on the other side of a joint. Contraction brings them closer together.
75
Describe the origins and insertions of the biceps brachii.
2 origins, both on the scapula. one insertion on the radius.
76
Describe the origins and insertions of the deltoid muscle.
Three origins - one on the spine of the scapula, one on the acromiun process of the scapula and one on the lateral third of the clavicle. It has its insertion on the the deltiod tuberosity of the humerus.
77
Describe the fibres of the deltiod muscle.
Posterior firbes cause extension of the shoulder. Middle fibres cause abduction of the shoulder and anterior fibres cause flexion of the shoulder.
78
What are the two main skeletal muscle reflexes?
The stretch reflex and the flexion withdrawal reflex.
79
What is the flexion withdrawal reflex?
occurs when we touch something damaging e.g. hot. Makes a sudden flexion movement to withdrawal from the danger. Doesnt involve the brain, just the reflex arc.
80
What are the different deep tendon reflexes?
biceps jerk, triceps jerk, knee jerk and ankle jerk.
81
What kind of reflex is a deep tendon reflex?
a stretch reflex.
82
What happens to the muscle during the deep tendon reflex test?
the muscle belly should twitch causing contraction and a movement in the normal direction
83
Describe the stretch reflex arc?
Sensory muscle detects the stretch, and send a signal to the spinal cord, descending controls damp down overly brisk reflexes. The signal is transferred via a synapse to a motor nerve which causes the twitch.
84
What does a normal stretch reflex tell us?
That a list of things are working normally: the muscle the sensory and motor nerves, the spinal cord connections between the two, the NMJ and the descending controls.
85
Where does skeletal muscle turn to smooth muscle and back again in the alimentary canal?
The trachea and the middle third of the oesophagus. At the bottom its the lower part of the urinary tract and the lower part of the anal canal and anus.
86
What is the pelvic floor?
The internal wall of skeletal muscle that separates the pelvic cavity above from the perineum below. Otherwise called the pelvic diaphragm. Sits right below the bladder.
87
Where is the perineum?
The area inferior to the pelvic floor that lies between the proximal parts of the lower limbs.
88
What is the function of the pelvic floor?
allows the distal ends of the alimentary, renal and reproductive tracts to pass from the pelvic cavity to the perineum.
89
What is the pouch of Douglas?
The rectouterine pouch. It is the most inferior part of the peritoneal cavity and is a pouch of peritoneum. Any abnormal fluid in the peritoneum will gather here when in the upright position.
90
What is the vesico-uterine pouch?
it is between the bladder and the uterus. Formed from the pelvic roof/peritoneal cavity.
91
What is the anatomical position of the penis?
erect. so the underside is the anterior side.
92
What happens to the testis during embryological development?
They descend from their original position on the posterior wall of the abdominal cavity to the scrotum. The vas deferens follows them down. Via the inguinal canal.
93
What is the function of the dartos muscle?
It is a smooth muscle in the superficial fascia of the scrotum that contracts to wrinkle and thicken the scrotum, to decrease surface area and loss of heat, when temps drop.
94
Describe the journey sperm take to leave the body?
Made in the seminiferous tubules, pass into the rete testes, then into the head of the epididymis, which then turns into the vas deferens and then into the urethra (prostatic and spongy).
95
What does the spermatic cord contain?
The vas deferens, testicular artery and the pampiniform venous plexus. ( artery and veins deliver and take blood from the testis)
96
What is the inguinal canal?
A passageway through the abdominal wall for the vas deferens.
97
What comprises the upper respiratory tract?
nasal cavities, oral cavity, pharynx and the larynx.
98
What comprises the lower respiratory tract?
The respiratory tree. trachea, main bronchi, lobar bronchi, segmental bronchi, bronchioles and alveoli.
99
What happens at the level of the C6 vertebrae?
The larynx becomes the trachea and the pharynx becomes the oesophagus.
100
How many bronchopulmonary segments does each lung have?
10, each supplied by a segmental bronchi.
101
What are pulmonary fissures?
The deep crevices that separate the lobes from each other.
102
What vessels go to each bronchopulmonary lobe?
segmental bronchi, blood supply, lymphatic drainage and nerves.
103
How thick are bronchioles?
less than 1mm in diameter.
104
What parts of the respiratory tree do and do not contain cartilage?
The trachea down to some bronchioles. The most distal bronchioles and alveoli dont.
105
What happens to smooth muscle in the different parts of the respiratory tree?
Becomes progressively more prominent as you go more distal. It is the most prominent feature of the distal bronchioles allowing them to constrict and dilate. Alveoli have no cartilage or smooth muscle as this would impact diffusion.
106
What separates the two nasal cavities and what are the parts of it?
the nasal septum. made up of a bony part at the posterior. This consists of the ethmoid bone superiorly and the vomer inferiorly. Also a cartilaginous part at the anterior called the septal cartilage (made of hyaline).
107
What is the rima glottidis?
The narrowest part of the larynx.
108
What is phonation?
producing sound. Air is expired across the vocal cords making them vibrate.
109
What are the three layers of skeletal muscle between the ribs?
external, internal and innermost intercostal muscles.
110
What is the parietal pleura adherent to?
The chest wall and the structures of the mediastinum.
111
What is another name for the hilum?
The lung root.
112
What is the head of the rib?
the part that articulates with the vertebra of the same number and the body of the vertebra superiorly.
113
What do rib tubercles articulate with?
Articulates with the transverse process of the the vertebra of the same number.
114
What does the azygous vein do and where does it lie?
to the right of the aorta. Drains the posterior parts of the intercostal spaces.
115
What supplies the posterior parts of the intercostal spaces with blood?
the thoracic aorta, through intercostal arteries (lateral surface of the aorta.
116
What do the internal thoracic artery and vein do? Where do they lie?
supply the anterior parts of the intercostal spaces. lie vertically either side of the deep surface of the sternum.
117
What supplies the lung tissues with blood?
the bronchial arteries which are branches from the anterior surface of the aorta.
118
What is the innervation of the intercostal muscles?
The anterior ramus of the same numbered vertebrae. There are lateral and anterior branches that take sensory supply to the skin.
119
Where does the muscular part of the diaphragm attach?
The sternum, the lower 6 ribs and costal cartilages and the L1- L3 vertebral bodies.
120
What innervation does the muscular part of the diaphragm have?
The phrenic nerve, C3, 4, and 5 anterior rami.
121
What are the phrenic nerves? What do they supply?
the combined anterior rami of the cervical spinal nerves 3, 4 and 5. They supply somatic sensory and sympathetic axons to the diaphragm and the fibrous pericardium. It also supplies somatic motor axons to the diaphragm.
122
Where are the phrenic nerves located?
Found in the neck on the anterior surface of the scalenus anterior and found in the chest descending over the lateral aspect of the fibrous pericardium.
123
Where do the lateral quadrants of the breast lymph nodes drain?
Unilaterally into the axillary nodes.
124
Where do the medial quadrants of the breast lymph nodes drain?
Bilaterally into the parasternal nodes. the chains run deep to the sternal edges.
125
What is the pectoral fascia made of?
fibrous material.
126
Where does the cephalic vein lie?
the delto-pectoral groove (basically down the front of the armpit).
127
What are the two heads of the pectoralis major?
The clavicular and the sternocostal.
128
Where do the heads of the pectoralis major muscle attach.
laterally to the lateral side of the intertubercular groove of the humerus.
129
What does the long thoracic nerve innervate and where does it originate?
The serratus anterior via its anterior surface. It comes from the brachial plexus.
130
What do patients display when they get paralysis of the serratus anterior?
A winged scapula.
131
What does the serratus anterior do?
Anchors the medial border of the scapula to ribs 1-8.
132
What does the pectoralis minor do?
Attaches the coracoid process of the scapula to ribs 3-5.
133
What happens to the subclavian vessels as they progress laterally?
After the lateral border of the first rib the vessels names change to axillary artery and vein.
134
What does the scalanus anterior do?
Attaches the cervical vertebrae to the first rib.
135
What do the anterior intercostal arteries and vein drain into?
Internal thoracic vein and artery.
136
What is another name for the costodiaphragmatic recess and where is it?
The costophrenic recess. It sits between the very bottom points of the lungs and the edges of the diaphragm in the chest cavity. the angle it has is the costophrenic angle, abnormal fluid can drain into this causing blunting of the angle on xray.
137
What structures lie in the root of the lungs?
1 main bronchus. 1 pulmonary artery, 2 pulmonary veins, lymphatics, visceral afferents, sympathetic nerves, parasympathetic nerves.
138
What is the lingula in the left lung?
The tongue of the superior lobe. E.g. It's most inferior point.
139
What is the surface anatomy of the lung fissures?
The horizontal - follows the right rib 4.
| Both obliques - at the level of rib 6 in the front, round to T3 e.g. Diagonally half way through the scapula.
140
What parts of the alimentary canal are in the pelvis?
The rectum and anal canal.
141
When does the upper GI tract turn into the lower?
After the small intestine.
142
How does the GI tract protect against poison?
Taste buds (sensory receptors) getting you to spit it out.
143
What is mastication?
Chewing.
144
What are the muscles of mastication?
Masseter, temporalis, medial pterygoid and lateral pterygoid.
145
What do the muscles of facial expression do?
Attach between the bones of the face and the superficial fascia just deep to the skin of the face. They pull the face into expressions and prevent drooling.
146
Where is the orbicularis oris and what does it do?
Circular muscle around the lips, pulling the lips together stopping drooling during chewing.
147
What lines the oral cavity?
Stratified squamous epithelium. And keratin in the gingivae and hard palate.
148
Describe the sensitivity of the oral cavity.
Most sensitive area in the body. Can feel pain, temperature, touch, and proprioception. Also has the special sensation of taste.
149
What are papilla?
Finger like structures on the tongue. Some give the tongue texture, others manipulate food and others are for taste.
150
Where does the tongue lie?
The posterior third lies vertically in the oropharynx, the anterior two thirds are horizontal in the oral cavity.
151
Name the four types of papillae and what they do?
Foliate, vallate, fungiform - taste buds.
Filiform - touch and temperature etc.
They are listed in order above going from the back of the tongue to the front.
152
What suspends the tongue in the oral cavity?
The 4 pairs of skeletal extrinsic muscles. They originate external to the tongue and insert into it.
153
What is the function of the oral extrinsic muscles?
Move the tongue around during mastication, swallowing and speech.
154
Where are the intrinsic muscles of the tongue located and what do they do?
Mainly dorsally posteriorly and they modify the shape of the tongue during function.
155
What two muscles close the jaw?
The temporalis and the masseter.
156
What does the buccinator muscle do and where is it?
It's in the cheek and together with the tongue it moves a food bolus between the biting surfaces of the teeth.
157
What does the serratus anterior do?
Anchors the medial border of the scapula to ribs 1-8.
158
What does the pectoralis minor do?
Attaches the coracoid process of the scapula to ribs 3-5.
159
What happens to the subclavian vessels as they progress laterally?
After the lateral border of the first rib the vessels names change to axillary artery and vein.
160
What is the surface anatomy of the lung fissures?
The horizontal - follows the right rib 4.
| Both obliques - at the level of rib 6 in the front, round to T3 e.g. Diagonally half way through the scapula.
161
What parts of the alimentary canal are in the pelvis?
The rectum and anal canal.
162
When does the upper GI tract turn into the lower?
After the small intestine.
163
How does the GI tract protect against poison?
Taste buds (sensory receptors) getting you to spit it out.
164
What is mastication?
Chewing.
165
What are the muscles of mastication?
Masseter, temporalis, medial pterygoid and lateral pterygoid.
166
What do the muscles of facial expression do?
Attach between the bones of the face and the superficial fascia just deep to the skin of the face. They pull the face into expressions and prevent drooling.
167
Where is the orbicularis oris and what does it do?
Circular muscle around the lips, pulling the lips together stopping drooling during chewing.
168
What lines the oral cavity?
Stratified squamous epithelium. And keratin in the gingivae and hard palate.
169
Describe the sensitivity of the oral cavity.
Most sensitive area in the body. Can feel pain, temperature, touch, and proprioception. Also has the special sensation of taste.
170
What are papilla?
Finger like structures on the tongue. Some give the tongue texture, others manipulate food and others are for taste.
171
Where does the tongue lie?
The posterior third lies vertically in the oropharynx, the anterior two thirds are horizontal in the oral cavity.
172
Name the four types of papillae and what they do?
Foliate, vallate, fungiform - taste buds.
Filiform - touch and temperature etc.
They are listed in order above going from the back of the tongue to the front.
173
What suspends the tongue in the oral cavity?
The 4 pairs of skeletal extrinsic muscles. They originate external to the tongue and insert into it.
174
What is the function of the oral extrinsic muscles?
Move the tongue around during mastication, swallowing and speech.
175
Where are the intrinsic muscles of the tongue located and what do they do?
Mainly dorsally posteriorly and they modify the shape of the tongue during function.
176
What two muscles close the jaw?
The temporalis and the masseter.
177
What does the buccinator muscle do and where is it?
It's in the cheek and together with the tongue it moves a food bolus between the biting surfaces of the teeth.
178
What does the long thoracic nerve innervate and where does it originate?
The serratus anterior via its anterior surface. It comes from the brachial plexus.
179
What does the pectoralis minor do?
Attaches the coracoid process of the scapula to ribs 3-5.
180
What happens to the subclavian vessels as they progress laterally?
After the lateral border of the first rib the vessels names change to axillary artery and vein.
181
How many teeth does an adult have?
32.
182
How are the teeth divided?
Into 4 quadrants each containing 2 incisors, 1 canine, 2 premolars and 3 molars.
183
How are teeth numbered?
From the middle counting out e.g. The front tooth is number 1 and the wisdom tooth number 8.
184
How do we wrote down what tooth we are talking about in a patients notes?
A horizontal line either above or below the number and a vertical line on one side with the number written inside. E.g 6 in the upper right quadrant would have a line below it and a line up to the left of it.
185
What is occlusion in relation to teeth and what should we ask a patient with a fracture?
How the occlusive surfaces of the teeth close together. We should ask a patient how their bite feels.
186
What are the 3 major pairs of glands in the mouth?
Parotid glands (near the ears), submandibular glands (under the mandible) and sublingual glands (under the tongue). They produce 90% of our 500ml to 750 ml per day.
187
What stimulates salivation?
The thought, sight or smell of food, or its presence in the mouth. Or painful oral conditions e.g. A fracture.
188
Where do the parotid ducts and submandibular glands go?
The parotid crosses the cheek and the submandibular goes to the floor of the mouth (several ducts).
189
What are the functions of the pharynx?
Important in swallowing, breathing and defence against infection (tonsils), conduit for food and gasses. Important in protective reflexes.
190
What tissues do the pharynx consist of?
Muscular tube lines with non-keratinised stratified squamous mucosa, containing MALT. It is an incomplete tube made of skeletal muscle and is continuous with the oesophagus.
191
What is Waldeyers ring?
A "ring" of tonsils in the naso and oropharynx that produce white blood cells and protect against infection.
192
What is the laryngeal inlet?
The part of the pharynx that opens into the larynx, covered by the epiglottis at times.
193
What does the uvula and epiglottis (partly) do?
Guide boluses away from the midline e.g. Laryngeal inlet.
194
What is the arrangement of the inner layer of pharynx muscles, where do they attach and what do they do?
Longitudinal. Attach inferiorly to the larynx. Contract to shorten the larynx to reduce bolus transit time and raises the larynx towards the epiglottis closing it over the laryngeal inlet.
195
What is the arrangement of the outer layer of laryngeal muscle and what does it do?
Circular muscle. Arranged in superior, middle and inferior constrictors of the pharynx. Contract in sequence to move the food bolus to the oesophagus.
196
Describe the oesophagus.
The inferior continuation of the laryngopharynx. Starts of as skeletal muscle but changes to smooth. Lined with non-keratinised stratified squamous epithelium.
197
How long is the small intestine?
7m
198
What does the outer longitudinal layer of muscle do in the GI tract?
Shortens the tube.
199
What does the inner circular layer of muscle do in the GI tract?
Constricts the diameter.
200
What is the body soma?
The body wall e,g. The abdominal or cheat walls and the upper and lower limbs.
201
What is the abdominopelvic cavity?
The abdominal and pelvic cavities considered together excluding the peritoneum separating them.
202
What are the three embryologically named parts of the gut?
The foregut, the midgut and the hindgut.
203
What are the organs of the foregut?
Oesophagus to mid duodenum. Including the liver, gallbladder, spleen and half of the pancreas.
204
What are the organs of the midgut?
Mid-duodenum to proximal 2/3rds of the transverse colon and half of the pancreas.
205
What are the organs of the hindgut?
Distal 1/3rd of the transverse colin to the proximal half of the anal canal.
206
In what part of the abdomen do the svc and aorta lie?
The retroperitoneum.
207
What is the arterial supply for the three embryo logical areas of the gut?
3 midline branches of the abdominal aorta.
Foregut = coeliac trunk.
Midgut = superior mesenteric artery.
Hindgut= inferior mesenteric artery.
208
What does the hepatic portal vein do?
Drains blood from all gut areas to the liver for first pass metabolism.
209
What does the IVC do in the retroperitoneum?
Drains blood from the hepatic veins into the right atrium.
210
What vein drains the foregut and to where?
The splenic vein to the HPV.
211
What vein drains the blood from the hindgut and to where?
The inferior mesenteric vein into the splenic vein.
212
What vein drains the blood from the midgut and to where?
The superior mesenteric vein, into the HPV.
213
What are the two venous systems in the abdomen?
The portal venous system and the systemic venous system.
214
What does the portal venous system do?
Drains blood from the absorptive part of the GI tract and associated organs to the liver via the HPV. Deoxygenated but venous rich blood.
215
What are the two veins going in and out of the liver?
Hepatic portal vein in and the IVC out.
216
What pattern does the lymphatic drainage of the gut follow?
Tend to follow the arteries.
217
What is the lymphatic drainage of the foregut?
Via lymph nodes along the splenic artery to the coeliac nodes located around the coeliac trunk.
218
What is the lymphatic drainage of the midgut?
Via nodes along the superior mesenteric artery towards the superior mesenteric nodes around the origin of the artery.
219
What is the lymphatic drainage of the hindgut?
Drain via nodes along the inferior mesenteric artery. Towards the inferior mesenteric nodes at the origin of the artery.
220
What is guarding and when can it occur?
The abdominal muscles contracting to guard the cavity when injury threatens. Can happen in peritonitis.
221
What sphincters control flow of contents through the GI tract and where are they?
Cricopharyngeal at the junction between the laryngopharynx and the oesophagus.
Pyloric- at the junction of the stomach and duodenum.
The external anal sphincter.
222
What is an anatomical sphincter?
An area where smooth muscle completely encircles the lumen of the tract. Can be smooth or skeletal muscle.
223
What kind of pain might a patient with a GI obstruction have?
A colicky pain, that comes and goes due to the wave of peristalsis at the blockage.
224
What is the body's response to a GI obstruction both internal or external?
Increased peristalsis proximal to the obstruction site, to try and clear it.
225
What is the combined name for the hypothalamus and the pituitary glands?
The hypophysis.
226
What is another name for the adrenal glands?
Suprarenal.
227
Where are the ovaries?
In the broad ligaments.
228
What is the name for the hypothalamus and the thalamus?
The diencephalon.
229
What are the three parts of the brainstem?
Midbrain, pons and medulla oblongata.
230
Where is the diencephalon?
Forms the centre core of the cerebrum. Has connections to the right and left hemispheres and the midbrain.
231
Where does the pituitary gland sit?
The pituitary fossa of the sphenoid bone, which is on the midline.
232
What does the cribiform plate do?
Transmits olfactory nerves.
233
What lies superior to the temporal bones?
The organs of hearing and balance.
234
Describe the structure and relationship of the hypothalamus and pituitary glands.
Hypothalamus superiorly. Linked to the pituitary by the infundibulum (pituitary stalk). Pituitary gland is separated into the anterior and posterior lobes. The hypothalamic neuronal bodies travel down the infundibulum into the posterior pituitary.
235
What is the physiological relationship between the hypothalamus and the posterior pituitary?
The hypothalamic neurones manufacture oxytocin and vasopressin (ADH). These are transported to the posterior pituitary in the axoplasm (axon cytoplasm) by axoplasmic transport.
236
What so the physiological relationship between the hypothalamus and the anterior pituitary?
Hypothalamic neurones either secrete releasing hormones or inhibitory hormones which stimulate or stop the pituitary releasing hormones.
237
What hormones does the anterior pituitary release?
Growth hormones, prolactin (milk production), thyroid stimulating hormone, ACTH (adrenocorticotrophic hormone), LH and FSH.
238
What is the hypophyseal portal system?
A portal system of veins, that drains blood from the hypothalamus to the anterior pituitary capillary beds (contains releasing or inhibitory hormones). After this a second set of veins draws the venous blood to the hypophyseal veins and then eventually to the SVC (blood has AP hormones in it).
239
What is a portal system?
When a capillary bed lies between two sets of veins.
240
List the veins involved in the hepatic portal system.
Splenic to superior mesenteric vein to inferior mesenteric (blood from GI tract). Hepatic portal vein. Into hepatic capillary bed then hepatic veins and then the IVC.
241
What is the hypophysis?
The hypothalamus and the pituitary gland.
242
What is the master gland and why?
The pituitary gland, as hormones released from the anterior lobe controls the output of many other endocrine glands.
243
What is a goitre?
An enlarged gland.
244
Where is the thyroid gland attached and what clinical importance does this have?
Attached the larynx. So a goitre here will move up and down during swallowing.
245
What is the middle part of the thyroid gland called?
Isthmus.
246
What hormones does the thyroid gland produce and what substance does it require to do this?
Triiodothyronine (T3) and thyroxine (T4). It needs iodine for this. Lack of T3 is lethal.
247
What do thyroid hormones do?
regulate metabolism and growth.
248
What is one cause of a goitre?
Dieatary lack of iodine can cause an enlarged gland.
249
Where are the parathyroid glands located?
the posterior surfaces of the thyroid glands lobes.
250
What do the parathyroid glands do?
manufacture and secrete parathyroid hormone. It is not under pituitary control. The glands monitor and control it directly.
251
What does parathyroid hormone do?
Controls the amount of calcium in blood and bone. We cant live without PTH. Normal muscle and nerve unction depend on Ca levels being in the normal range.
252
What vessels are associated with the parathyroid and thyroid glands?
The superior and inferior thyroid arteries and the superior, middle and inferior thyroid arteries.
253
Is the spleen retro on intraperitoneal?
intraperitoneal.
254
Where does the pancreas lie?
transversely across the retroperitoneum, between the duodenum and the spleen. The stomach in front and the aorta and IVC behind. It is in the foregut and the midgut.
255
What are the vessels associated with the pancreas?
Arterial blood from the coeliac trunk and the superior mesenteric artery. The venous blood drains into both the splenic vein and the superior mesenteric vein into the hepatic portal vein.
256
describe the parts and functions of the pancreas.
Not under pituitary control. Endocrine pancreas (islets of langerhans) manufacture 6 hormones including insulin which is secreted into veins when the islets sense increased blood glucose. The exocrine pancreas manufactures digestive enzymes and electrolyes that pass via a duct system into the duodenum.
257
Describe the adrenal glands?
2 functionally and anatomically separate parts. The adrenal cortex (edges) and the adrenal medulla (middle).
258
What does the adrenal cortex do?
Manufactures glucocorticoids (metabolism), mineralcorticoids (BP control) and androgens. The release of glucocorticoids is under pituitary ATCH control.
259
What does the adrenal medulla?
releases adrenaline and noradrenaline (secreted from fight or flight response).
260
Describe the vessels associated with the adrenal glands.
The superior, middle and inferior suprarenal arteries.
261
What are the three unpaired (midline) branches of the abdominal aorta?
coeliac trunk, superior ad inferior mesenteric arteries. The suprarenal veins drain into the IVC.
262
What are the three (bilateral) branches of the abdominal aorta?
Adrenal, renal and gonadal arteries.
263
What hormones do the testes secrete?
testosterone in response to LH from the anterior pituitary.
264
What hormones do the ovaries secrete?
Oestrogen and progesterone in response to FSH and LH from the anterior pituitary.
265
What is the gonadal venous drainage?
The right gonad into the IVC, the left gonad into the left renal vein.
266
What do testosterone and oestrogen do?
control the development of secondary characteristics. Promote the closure of epiphyseal growth plates and stimulate sperm and ovum production.
267
What does progesterone do?
Prepares the uterus for pregnancy.
268
What is the PNS?
cranial nerves, spinal nerves and autonomic nerves (sympathetic and parasympathetic).
269
What is a group of nerve cell bodies in the CNS?
A nucleus.
270
What is a group of nerve cell bodies in the PNS?
a ganglion.
271
What is a bundle of axons travelling together called in the CNS?
a tract.
272
What is a bundle of axons travelling together called in the PNS?
a peripheral nerve.
273
What is a peripheral nerve?
bundle of axons, wrapped in connective tissue travelling together. Bundles can leave the nerve as named branches. They can contain thousands of axons.
274
What is a synapse?
One neurone communicating with another in a ganglion or nucleus. The action potential is electrical and then chemical and then electrical again.
275
What are the folds of the cerebral neocortex called?
gyri and sulci.
276
What separates the 2 cerebral hemispheres?
longitudinal fissure.
277
Name the cranial nerves.
```
CNI - olfactory nerve.
CNII - optic nerve.
CNIII - oculomotor nerve.
CNIV trochlear nerve.
CNV - trigeminal nerve.
CNVI - abducent nerve.
CNVII - a facial nerve.
CNVIII - vestibulocochlear nerve.
CNIX - glossopharyngeal nerve.
CNX - the vagus nerve.
CNXI - the spinal accessory nerve.
CNXII - hypoglossal nerve.
```
278
What are the three fossa of the cranial cavity?
anterior, middle and posterior cranial fossa.
279
Where does CN1 exit the skull?
The cribiform plate of the ethmoid bone.
280
Where do cranial nerves II, III, IV, V(1) and VI exit the skull?
optic canal.
281
Where do the cranial nerves CV 2 and 3 exit the skull?
2 is the formane rotundum and 3 is the foramen ovale.
282
Where do CNVII and VIIIexit the skull?
Internal acoustic meatus.
283
Where do CN IX, X and XI exit the skull?
jugular foramen.
284
Where do CNXII exit the skull?
Hypoglossal canal.
285
What is the journey of a nerve between the CNS and the periphery called?
Its course e.g. the brainstem then the intracranial part and then the extracranial part.
286
Where and what is the grey matter in the brain?
It is the nerve cell bodies on the outer cerebral cortex of the brain.
287
Where and what is the white matter in the brain?
Deep to the grey matter. Is the axons which are myelinated giving it the white appearance.
288
Where are the grey and white matters in the spinal cord?
The white matter is superficial and the grey matter deep.
289
What are the horns of the spinal cord.
the edges/points of the grey matter.
290
What are the four sections of the spinal cord?
cervical, thoracic, lumbar and sacral/coccygeal.
291
Where are the two enlargements of the spinal cord?
cervical enlargement due to the upper limb nerves and lumbosacral enlargement due to the lower limb nerves.
292
How many pairs of spinal nerves are there?
31 pairs.
293
Where does the spinal cord end?
L1/L2 intervertebral disc level. Called the conus medullaris.
294
How many vertebra are in the sacrum?
5.
295
How many vertebra are in the coccyx?
4.
296
What is the cauda equina?
lumbar and sacral nerve roots descending to there intervertebral foramina.
297
How many cervical spinal nerve pairs are there?
8
298
How many thoracic spinal nerve pairs are there?
12
299
How many lumbar spinal nerve pairs are there?
5
300
How many sacral spinal nerve pairs are there?
5
301
How many coccygeal spinal nerve pairs are there?
1
302
Where is a spinal nerve located?
The part within the intervertebral foramen below the vertebra of the same number except in the cervical region.
303
What connects the spinal nerves to the spinal cords?
The roots and rootlets. The roots are large and then the roots are small branches of these.
304
What connects the spinal nerve to the structures of the soma?
The rami.
305
What dermatome is at nipple level?
T4.
306
What dermatome is the umbilicus at?
T10.
307
What is a dermatome?
The skin strip supplied by both the anterior and posterior rami of a spinal nerve.
308
What do the posterior rami supply?
The small posterior paramedian strip of the dermatome e.g. the bit just slightly beside the midline.
309
What do the anterior rami supply?
the remainder of the posterior part that the posterior rami dont do and the lateral and anterior parts of the dermatome. And ALL of the limb dermatomes.
310
What is a nerve plexus?
plexi of networks of intertwined anterior rami axons.
311
What is the cervical plexus?
Ci - C4 anterior rami, supplies mainly the neck wall.
312
What is the brachial plexus?
C5 - T1 anterior rami, supplies the upper limb. Mixing fibres from the 5 nerves anterior rami in the plexus.
313
What is the lumbar plexus?
L1 - L4 anterior rami, supplies the lower limb.
314
What is the sacral plexus?
L5 - S4, supplies the pelvis/perineum and lower limb.
315
What comprises the musculocutaneous nerve?
axons from both the C5 and C6 anterior rami.
316
What are named nerves?
they contain axons from more than 1 spinal cord segment/spinal nerve and result from a plexus.
317
How many named nerves arise from the brachial plexus and what are their names?
5. axillary, meidan, musculocutaneous, radial and ulnar nerve.
318
Where do we find lateral horns and what do they do?
T1 to L2 of the spinal cord. They are for the cell bodies of the next sympathetic neurone on the chain.
319
Where are the sympathetic axons in the spinal cord?
In the white matter.
320
Where are sympathetic trunks?
They run parallel to the vertebral column.
321
What are rami communicans?
The part of the sympathetic nerve that communicates between the anterior rami of spinal nerves and the sympathetic trunk.
322
What is the name for a visceral afferent nerve travelling to an organ or a prevertebral ganglion?
Splanchnic nerve.
323
How do sympathetic nerve fibres travel?
They enter all spinal nerves and travel along all posterior and anterior rami.
324
What do cranial nerves III, VII, IX and X contain?
Mainly vagus nerves containing parasympathetic axons travelling to the organs of the head, neck, chest and abdomen as far as the midgut.
325
What do craniosacral outflow nerves supply?
Contain parasympathetic axons travelling to only the internal organs, not the body wall.
326
What do sacral spinal nerves contain?
parasympathetic axons for organs of the hindgut, pelvis and perineum.
327
What does the somatic nervous system do?
Provides the body wall. Senses and responds to the external environment.
328
What does the autonomic nervous system do?
Also called the visceral motor system. Supplies body organs and senses and responds to the internal environment.
329
What body parts are supplied by the somatic nervous system?
head, neck and chest walls. The diaphragm, the anterolateral abdominal and pelvic walls and all 4 limbs.
330
What is supplied by the autonomic nervous system?
organs, glands, smooth and cardiac muscle, arterioles and visceral linings e.g. pleura.
331
what are the body wall organs (supplied by ANS)?
sweat glands, arrector smooth muscles and arterioles.
332
What are the different types of neurones and what do they do?
Body wall - somatic motor or somatic sensory nerve.
Organs - visceral afferent (sympathetic or parasympathetic)
special sense organs e.g. eyes are special sensory (parasympathetic or sympathetic). Or a mixed nerve.
333
What are the 6 different neurone modalities?
somatic motor, somatic sensory, special sensory, sympathetic, parasympathetic and mixed.
334
What is a mixed nerve?
a peripheral nerve consisting of neurone fibres of different modalities. Usually spinal nerves and their named branches are mixed, containing somatic sensory and motor and sympathetic nerves. 5 of the cranial nerves are also mixed.
335
What cranial nerves are mixed and what do they contain?
CNIII - motor and parasympathetic.
CNV - V1 and V2 are sensory only but V3 is sensory and motor.
CNVII - special sensory, motor and parasympathetic.
CNIX - special sensory, sensory, motor and parasympathetic.
CNX - sensory motor and parasympathetic.
336
Which cranial nerves are special sensory only?
CNI, CNII and CNIII.
337
Which cranial nerves are motor only?
CNIV, CNVI, CNXI and CNXII.
338
What sensations can the body wall perceive?
coarse and fine touch, vibration, proprioception (all of previous are mechanoreceptros), temperature (thermoreceptors) and pain. (nociceptors)
339
Describe how a sensory signal travels from the left thumb to the brain?
sensory action potential from the left hand towards the brachoal plexus, then to the left C6 anterior ramus to arrive at the [posterior left side of the spinal cord segment C6. It has a synapse with a second sensory neurone in the posterior horn, then crosses over to the other side of the spinal cord, into a spinal cord tract ascending to the thalamus.
340
What is the somatic sensory pathway for temperature.
A 3 neurone chain.
341
Where is the primary somatosensory area and what does it do?
In the right/left parietal lobe. It brings snesory AP's ariving here from the opposite body side into consciousness.
342
Where is the primary somatomotor area and what does it do?
The frontal lobe. Motor AP's originate here bring about movement of the opposite side of the body.
343
What is the somatic motor pathway?
A 2 neurone chain, consosts of upper (CNS) and lower (PNS) motor neurones. The axons cross over to the opposite side in the brainstem.
344
Describe the journey of a motor AP from the brain to the left upper limb.
Right cerebral cortex, down upper motor neurone, crosses side in the brainstem and descends to the left anterior horn. Exits in the lower motor neurone through the left anterior root and rami, through brachial plexus to the hand.
345
What sensations can organs perceive?
apart from the brain, they can feel: touch, temperature, and pain e.g. ischemic or colicky.
346
What kind of pain can an organ feel?
dull, aching/nausea and is poorly localised. May be sharp and more redily localised if collicky (obstruction of a hollow viscus). May also be referred pain to other parts.
347
What kind of pain does the soma feel?
sharp, stabbing and well localised.
348
What does the parasympathetic nervous system not supply?
Any body wall organs or any arterioles. Rest and digest - a return to homeostasis.
349
What cranial nerves contain parasympathetic axons?
III, VI, IX and X.
350
What is the renal system for?
blood pH control, H2O balance, electrolyte balance, Bp control, metabolism of waste products and drugs, RBC production stimulation and absorption of calcium from the GI tract.
351
What tissue lines the ureter and upper urethra?
transitional epithelium. Also called urothelium.
352
What lines the distal urethra?
stratified squamous mucosa.
353
What comprises the upper urinary tract?
The kidneys ad ureters.
354
What comprises the lower urinary tract?
The bladder and urethra.
355
What quadrants/regions are the kidneys in?
left and right flank/upper quadrants.
356
What protects the kidneys?
the transverse processes of the vertebra, ribs 11 and 12. Guarding of the skeletal muscles. renal fascia, paranephric and perinephric fat and the renal capsules.
357
Where do the left and right kidneys lie and why?
right kidney L1 to L3 due to the liver. left kidney T12 to L2 (higher than the right).
358
What organs do the kidneys tough?
the liver and spleen superiorly. The kidneys move up and down with the diaphragm on inspiration and expiration.
359
What structures are in the renal hilum?
The renal artery, vein and ureter.
360
What are the three paired bilateral branches of the abdominal aorta?
adrenal arteries, renal arteries and gonadal arteries.
361
How do the kidneys receive blood?
ureters receive blood supply from multiple branches from the renal arteries, gonadal arteries and the aorta.
362
What is the venous drainage of the kidneys?
adrenal glands - suprarenal veins drains into the left renal vein.
The renal veins - drains blood into the IVC.
363
Where does the gonadal vein drain?
The left renal vein.
364
What are the kidney branches of the renal arteries?
The 5 segmental branches that each supply a segment.
365
What is the structure of the kidney?
An outer cortex and a medulla. The medulla contains 27 pyramids, which contain around 50k nephrons.
366
What gives the renal pyramids their striped appearance?
regularly arranged nephrons running axially towards the apex of each pyramid.
367
Describe the structure of a nephron?
Glomerulus (ultrafiltration of blood from renal artery branches), proxinal convoluted tubule, loop of henle, distal convoluted tubule, into the collecting duct.
368
What does the kidney collecting duct do?
passes through the pyramid to drain the modified filtrate into the minor calyx as urine.
369
What is the path of urine draining through the kidneys?
nephron collecting duct, minor calyx, major calyx, renal pelvis and the ureter.
370
Describe the diameter of urine drainage tubes?
increases as they get out the kidney until a constriction at the pelviureteric junction, where the wider renal pelvis becomes the narrower ureter.
371
What are the anatomical sites of ureteric constriction?
The peviureteric junction, where the ureter crosses the anterior aspect of the common iliac artery. The ureteric orifice, which opens into the posterior surface of the bladder.
372
What forms renal calculi?
urine calcium salts.
373
What is renal colic?
ureteric waves around an obstruction e.g. calculi or external blockage.
374
Describe the bladder.
expandable urine storage bag. The trigone is located on the floor of the bladder between the bilateral ureteric and midline urethral orifices. As the bladder fills the apex rises and the trigone does not stretch or move (helps to prevent obstruction of the orifices). Detrusor muscle in the walls.
375
What is micturation?
passing urine.
376
What is the detrusor muscle?
smooth muscle in the bladder that contracts to void during micturition. Fibres encircle the ureteric orifices to prevent reflux into the ureters during micturition. Other encircle the bladder neck (males only) to prevent ejaculatory reflux.
377
Describe the urethral sphincters?
Internal - around the bladder neck, is involuntary.
| External - inferior to the prostate (voluntary).
378
Describe the female urethra.
It is short, distendible and opens into the vestibule. This means it easy to catheterise but also easy to get UTI's.
379
What is the definition of the great vessels?
Those directly attached to the heart chambers.
380
What is the name for the area an artery supplies?
It's territory.
381
What is the bifurcation of an artery?
Where it ends by dividing into two terminal branches.
382
What is the trifurcation of an artery?
Where it ends by dividing into three terminal branches.
383
If an artery has the name trunk, what can we definitely tell about it?
That it will divide again.
384
What does tortuous mean in relation to an artery, and what is its purpose?
it follows a snake like course. This prevents overstretching or tearing.
385
Where are arteries normally located in relation to veins?
Deep to them.
386
How can we limit blood loss from an artery in the field?
By pressing on a pulse point proximal to the injury.
387
Where are elastic fibres found in arteries?
In the proximal largest branches/arteries.
388
What is the purpose of elastic fibres in arteries?
To accommodate blood flow during contraction and to help maintain blood pressure. In the aorta it maintains peripheral blood flow when the heart relaxes.
389
What is the purpose of smooth muscle in arteries?
dilation or contraction. can spasm when an injury has been sustained to reduce blood loss.
390
What is the sympathetic tone?
the arterioles always exist in a state that is slighlty narrowed compared to their maximum internal diameter. It is due to tonic (continuous) conduction of action potential to arterioles from sympathetic nerves.
391
What are the regions of the body the aorta supplies?
Head and neck, upper limbs, chest and back, abdomen, pelvis and peritoneum and the lower limbs.
392
What are the 4 parts of the aorta?
The ascending (2 branches - coronary arteries).
The arch of the aorta (3 branches).
The thoracic aorta (numerous branches).
The abdominal aorta (3 unpaired midline and 3 paired bilateral branches.
393
What are the branches of the arch of the aorta, form proximal to distal?
brachiochephalic trunk, common carotid and the subclavian.
394
What is the bifucation of the brachiocephalic trunk?
the right common carotid and the subclavian arteries.
395
What is the arterial supply to the brain?
The vertebral artery, internal carotid artery and the external carotid artery.
396
What is the bifucation of the common carotid artery?
The internal and external carotids.
397
Describe the course of the vertebral artery.
branches from the subclavian artery, through the transverse foramen of the vertebrae and through the foramen magnum to the brain.
398
Where does the internal carotid artery enter the skull?
Via the carotid canal.
399
What does the external carotid artery supply?
The face and scalp.
400
What arteries comprise the circle of Willis?
right and left internal carotid.
401
What forms the basilar artery?
The right and left vertebral arteries. It joins to the circle of willis.
402
What is the carotid sinus?
The most proximal, usually dilated part of the internal carotid. Located at the superior border of the thyroid cartilage. It is innervated by the glossopharyngeal nerve (CNIX).
403
What is the function of the carotid sinus?
to detect stretching in the walls of the sinus. It monitors the blood supply to the brain.
404
What does the carotid body monitor?
blood gas levels and pH. Also supplied by CN IX.
405
What is the blood brain barrier?
Tight junctions between brain capillary endothelial cells (not leaky) and astrocyte (support cell) processes surround the brain capillaries. This prevents diffusion of some substances into brain tissues e.g. some antibiotics.
406
What can weaken the blood brain barrier?
Injury, inflammation and neoplasia.
407
What is a vessel anastamoses?
where arteries connect without an intervening capillary network.
408
How do vessel anastamoses help?
provide an alternative pathway for blood, helping prevent things like CVA's.
409
What is a vessel collateral?
an alternative route in any given anastamoses. In a limb the collaterals allow blood flow no matter what position it is in.
410
What is an end artery?
The only blood supply to an area. Occlusion of this results in infarction.
411
What does infarction mean?
irreversible death due to hypoxia.
412
What are the names the subclavian artery has as it moves down the arm?
subcalvian to axillary to brachial which then bifurcates in to the radial and ulnar arteries.
413
How does the aorta pass from the thoracic cavity to the abdominal cavity?
Through the aortic hiatus in the diaphragm.
414
What separates the abdominal cavity from the thoracic an the pelvic cavities?
The diaphragm superiorly and the pelvic inlet inferiorly (superior pelvic aperture). When viewed on the Sagittarius plane it it a line between the public symphysis and the top of the sacrum.
415
What planes separate the 9 abdominal quadrants?
Midclavicular lines bilaterally (crosses through the midinguinal line in the pelvis). The subcostal plane superiorly and the transtubercular (L5) inferiorly. Some clinicians use the transpyloric plane (L1) and the interspinous plane.
416
Where does the umbilical plane lie?
Through the disc between L3/L4.
417
Name the first three branches of the aortic arch.
Brachiocephalic trunk, left common carotid and left subclavian.
418
What are the bilateral posterior branches of the thoracic aorta?
The intercostal arteries.
419
What does the aorta pass through to enter the abdomen?
The aortic hiatus.
420
What are the anterior branches of the thoracic aorta?
Bronchial arteries (supply lung tissue), oesophageal, mediastinal, pericardial and the phrenic arteries (for the diaphragm).
421
What arteries supply the head and neck?
The common carotids and the vertebral arteries.
422
Which arteries supply the upper limbs?
The right and left subclavian.
423
Which arteries supply the lower limbs?
The left and right external iliac arteries (bifurcation of the aorta).
424
What arteries supply the perineum and pelvis?
The internal iliac arteries (fbifurcation off external iliac).
425
Where can we feel the carotid pulse?
At the bifurcation of the common carotid posterior but level with the thyroid cartilage.
426
What are the pulses to feel in the lower limbs?
The femoral, the polpiteal, the posterior tibial and the dorsalis pedis.
427
What do we call the branches of veins that merge together to form a larger one?
tributaries.
428
roughly what percentage of the bodies blood do veins contain at rest?
60% (called capitance vessels due to this).
429
What are the courses of veins and arteries like compared to each other?
Veins are straight and arteries torturous.
430
What aids veins in returning blood to the heart?
The skeletal muscle pump, the changes in thoracic pressure and valves.
431
Where do superficial and deep veins run?
Superficial in the superficial fascia and deep in the deep fascia often in NVB.
432
What are the bodies two main venous systems?
Hepatic portal system and the systemic venous system.
433
Where do the thoracic and lymphatic ducts drain?
Into the venous angles in the root of the neck. This is where the central veins returning from the head, neck and upper limbs drain. Right = lymphatic. left = thoracic.
434
Where do superficial lymphatics drain?
Into deep lymphatics.
435
What three muscles close the mouth?
The masseter, the temporalis and the medial pterygoid.
436
What muscle opens the mouth?
Lateral pterygoid.
437
hat nerve supplies the muscles of mastication?
All supplied by the madibular division of the trigeminal nerve CN V3.
438
What is the course of CN V3?
Exits the CNS at the pons from the foramen ovale.
439
What two parts make up the course of a cranial nerve?
the intracranial and the extracranial.
440
What nerves supply the tongue and what do they do?
posterior third = sensation and taste from CNIX. Anterior 2/3 rds = sensation by CN V3 and taste by CN VII.
441
What nerves supply the mouth?
The gingiva and palate of oral cavity (superior half) - general sensation = CN V2. The inferior half gingiva and floor of mouth - general sensation = CN V3.
442
Explain the nerves involved in the gaga reflex.
The sensory part (limb) is nerve fibres within (CNIX). The motor limb is CNIX and CNX. Upon stimulation of the posterior oropharynx the pharynx constricts.
443
Name CNVII and where does it exit the skull?
The facial nerve it exits at the internal accoustic meatus and the stylomastoid foramen.
444
describe the course of the facial nerve and what it supplies?
Exits the CNS at junction of pons and medulla, through the internal accoustic meatus and then through the stylomastoid foramen. The posterior branch innervated the face and the anterior chorda tympani brings taste to anterior the tongue in the oral cavity and parasympatheitc secretomotor to submandibular and sublingual glands.
445
What is the course of CNV2?
Exits at the pons through the foramen rotundum.
446
Describe the course of CNIX.
exits at the medulla through the jugular foramen and innervates the posterior wall of the oropharynx. Also gives secretomotos to parotid salivary gland.
447
Where do the different salivary glands drain?
```
Parotid = through maxilla into top of back of mouth.
Submandibular = curls under mandible up through floor of mouth and out the frenulum.
Sublingual = both sides of floor of mouth.
```
448
What are the 4 pairs of tongue extrinsic muscles?
palatoglossus, styloglossus, hyoglossus and genioglossus.
449
What do extrinsic muscles of the tongue do and where do they originate?
Originate external to the tongue and insert into it. move the tongue around in the oral cavity.
450
Where do intrinsic tongue muscles originate and what do they do?
Originate and insert within the tongue. Modify the shape of the tongue during function.
451
What nerve innervates the tongue muscles?
CNXII except the palatoglossus.
452
What is the course of CN XII?
exists at the medulla, through the hypoglossal canal.
453
What nerve supplies the inner longitudinal muscle of the pharynx?
CN IX and X.
454
What level is the upper oesophageal sphincter at?
C6.
455
What nerve innervates the outer circular muscles of the pharynx?
CN X.
456
What are the circular muscles of the pharynx called?
superior, middle and inferior pharyngeal constrictors.
457
Describe the muscles and innervation of swallowing.
1. obicularis oris closes with cranial nerve VII.
2. Tongue and CN XII push bolus back.
3. pharangeal muscles with nerves X and IX push food down.
4. Bolus reaches the oesophagus.
458
Briefly describe the enteric nervous system?
nerves found only in GI tract, independent of rest of nervous system but can be affects by autonomic motor nerves. Parasympathetic speeds up peristalsis and sympathetic slows down.
459
Describe the oesophageal sphincters.
Upper anatomical spincter of crichopharangeal muscle. Lower physiological sphincter.
460
What is the oesophageal nervous supply?
The oesophageal plexus runs on the surface to supply the distal smooth muscles. contains parasympathetic (vagal trunks) and sympathetic nerves.
461
Where does the oesophagus terminate?
By entering the cardia of the stomach.
462
Describe the normal constrictions of the oesophagus?
cervical constriction from crichopharyngeal muscle. Thoracic constriction from the arch of the aorta and left main bronchus. Diaphragmatic constriction.
463
Describe the lower oesophageal sphincter.
physiological. helps reduce reflux, hiatus hernia can disturb this. Lies immediately to the gastro-oesophageal junction. There is a Z line and abrupt change in the mucosa lining the wall.
464
Describe what factors produce the sphincter effect in the lower oesophageal sphincter.
diaphragm contraction. intraabdominal pressure slightly higher than intragastric pressure. the oblique angle at which the oesophagus enters the cardia of the stomach.
465
Name the different parts of the stomach.
cardia, fundus, body, and pyloric antrum. Greater and lesser curvatures. The incisura angularis.
466
Where does the stomach lie in the abdomen?
mainly in the left hypochondrium, epigastric and umbilical regions. Is J shaped.
467
What can stimulate sensory receptors in the mucosa of the respiratory tree?
inflammatory mediators, irritant chemicals, mucus buildup and certain drugs.
468
What lobe are foreign bodies most likely to settle in?
Right lower lobe.
469
What is a small pneumothorax?
less than 2cm.
470
What is a large pneumothorax?
Over 2 cm big.
471
How is a pneumothorax diagnosed?
history, chest expansion, breath sounds and hyper-resonance. CXR with absent lung markings and visible lung edge.
472
What is a tension pneumothorax?
tear creates a one way valve.. Lung collapses to the root and pressure eventually effects mediastinal structures e.g. a mediastinal shift.
473
What are the consequences of mediastinal shift?
tracheal deviation away from tension pneumothorax, palpable in the jugular notch. SVC can become compressed, leading to reduced venous return to the heart and therefore hypotension.
474
How is a large pneumothorax managed?
needle aspiration (thoracentesis) or chest drain insertion between the 4th and 5th intercostal space in the mid axillary line.
475
What is the safe triangle we use for chest drain insertion?
the anterior border of the latissimus dorsi, the posterior border of the pectoralis major. and the axial line superior to the nipple.
476
What is the emergency management of a tension pneumothorax?
large gauge cannula in via the 2nd or 3rd intercostal space in the mid clavicular line.
477
What is VATS?
video assisted thorascopic surgery. Access via the safe triangle.
478
What can be achieved with VATS?
suturing or stapling, biopsy, pleurectomy or chemical pleurodesis.
479
What two factors a re usually required to develop a hernia?
weakness of one structure and increased pressure.
480
What body parts have normal anatomical weaknesses that can form hernias?
diaphragm, umbilicus, inguinal canal and femoral canal.
481
Where can diaphragmatic hernia develop?
normal anatomical weakness at the attachments to the xiphoid, the oesophageal hiatus or at the posterior attachments.
482
What are the two types of diaphragmatic hernia and their differences?
paraoesophageal - stomach slides through parallel to the oesophagus.
sliding hiatus hernia - the whole gastro-oesophageal junction slides up into the chest.
483
Where do inguinal hernias form?
In the medial half of the inguinal region. Specifically in a weakness in the inguinal canal in the anterolateral abdominal wall.
484
How is the inguinal canal formed?
the embryological passing of the testes or the round ligament of the uterus into the perineum. Contains the spematic cord or round ligament in the adult.
485
What can cause inguinal hernias?
chronic cough, constipation, lifting of heavy weights and athletic effort.
486
Where does the inguinal ligament attach?
The anterior superior iliac spine (asis) and the pubic tubercle.
487
What forms the floor of the inguinal canal?
The medial halves of the inguinal ligament.
488
What are the inguinal lligaments?
The inferior borders of the external oblique aponeurosis.
489
Describe the inguinal canals.
4cm long passageways through the anterior abdominal wall in the inguinal region. Floor made from medial half of inguinal ligament. Runs between a deep ring and a superficial ring at the entrance and exits. Deep is superior.
490
Describe the inguinal superficial ring.
v shaped defect in the external oblique aponeurosis that lies superolateral to the pubic tubercle.
491
Describe the deep ring of the inguinal canal.
located superior to the midpoint of the inguinal ligament. Higher than the superficial ring. It is where the testis pushed through the transveralis fascia.
492
Describe formation of the inguinal canal.
1. The testes alongside the process vaginalus, moves through the transveralis fascia.
2. The transversalis fascia stays surrounding the descending testicle and PV as it travels through the transverse abdominus.
3. The lot then go through the internal oblique.
4. a covering of the internal oblique joins the lot and they travel through the V shaped defect in the inguinal ligament, just above the pubic tubercle.
5. Along with a aponeurosis fascia, the lot travel through the superficial fascia into the scrotal skin.
493
What is the gubernaculum?
The line that the testes follow to create the inguinal canal.
494
What is the process vaginalus?
An outpouching of the parietal peritoneum that travels with the descending testes and exists in the inguinal canal.
495
What is the internal spematic fascia?
Covering of the testes formed by the transveralis fascia.
496
What is the cremasteric fascia?
covering of the testes formed from skeletal muscle fibres from the internal oblique.
497
What is the external spematic fascia?
a covering of external oblique aponeurosis.
498
What is the tunica vaginalis?
remains of the process vaginalis inside the spematic cord beside the testes.
499
What anchors the internal oblique and the transverse abdominis muscles to the pubic bone?
The conjoint tendon, made of medial ends of both muscles aponeurosis.
500
What layers cover the spermatic cord?
external spermatic fascia, the cremasteric fascia and the internal spermatic fascia.
501
What is contained in the spermatic cord?
The pampiniform plexus, the vas deferens, the testicular artery and the tunica vaginalis. autonomic nerves supplying the smooth muscle of the vas and the arterioles, the genitofemoral nerve and lymphatic vessels.
502
Where does the ilioinguinal nerve emerge?
from the inguinal canal via the superficial ring. It is external to the spermatic cord in the inguinal canal.
503
What are the two halves of the L1 anterior ramus?
The iliohypogastric nerve superiorly and the ilioinguinal inferiorly nerve.
504
Where do the inguinal canals emerge in the female?
The labium majus.
505
What do the inguinal canals contain in the female?
The fibrous embryological remnants of the round ligaments. Still in a spermatic cord.
506
What are the two types of inguinal hernia?
Direct and indirect.
507
What is a direct inguinal hernia?
a finger of peritoneum is forced through the posterior wall of the inguinal canal directly out of the superficial ring into the scrotum.
508
What is an indirect inguinal hernia?
a finger of peritoneum is first forced through the deep inguinal ring and then the superficial ring into the scrotum.
509
How do we differentiate clinically between a direct and indirect inguinal hernia?
reduce the hernia, occlude the deep ring with a fingertip and ask the patient to cough. If it is direct the lump will reappear and if its indirect it wont.
510
How can we differentiate surgically between indirect and direct inguinal hernias?
Direct - forced through the anterior abdominal wall via the inguinal or hesselbachs trinagle.
Indirect - into the inguinal canal via the deep ring lateral to the epigastric artery and vein.
511
What is hesselbachs triangle?
between the inguinal ligament inferiorly, inferior epigastric vessels laterally and the rectus abdominus medially.
512
What is contained in the lung hilum?
pulmonary artery, main bronchus, pulmonary veins, pulmonary lymphatic vessels and bronchopulmonary lymph nodes, pulmonary visceral afferents and autonomic motor nerves.
513
What innervates the diaphragm and where does it travel though the thoracic cavity?
The phrenic nerves. They descend across the lateral borders of the pericardium.
514
What is a pericardiocentesis?
drainage of fluid from the pericardium.
515
Where is the needle inserted for a pericardiocentesis?
via infrasternal angle, directed superoposteriorly, continuously aspirating.
516
What is the transverse pericardial sinus?
A space within the pericardial cavity posteriosuperiorly. Lies posterior to the ascending aorta and the pulmonary trunk.
517
What is the transverse pericardial sinus used for?
by surgeons to isolate the great vessels during bypass. Can put finger through it and it will come out anterior to the SVC.
518
What is another name for the anterior surface of the heart?
sternocostal surface.
519
What is the coronary groove?
the right coronary artery sits in it. It is the boundary between the right atrium and the right ventricle. It indicates the surface marking for the tricuspid valve.
520
What is the anterior interventricular groove?
indicates the boundary between the two ventricles. Holds the LAD.
521
What is the coronary sinus?
short venous conduit in the atrioventricular groove which recieves deoxygenated blood from most of the cardiac veins and drains into the right atrium.
522
What is the interventricular groove?
indicates the boundary between the 2 ventricles on the diaphragmatic surface of the heart.
523
Where do the coronary arteries lie?
just deep to the epicardium, usually embedded in the adipose tissue.
524
Where does the right coronary artery lie?
in the right atrioventricular groove, can see the origin if we retract the right auricle.
525
Where does the left (main stem) coronary artery lie?
left atrioventricular groove between the pulmonary trunk and the left auricle. We can retract the left auricle to see the origin.
526
What arteries lie after the bifurcation of the left coronary artery?
The circumflex and the left anterior descending (LAD).
527
Where do the coronary arteries arise from?
The right and left aortic sinuses just above the cusps in the aortic valve.
528
Describe the cusps of the pulmonary valve.
anterior right and left cusps.
529
Describe the cusps of the aortic valve.
right left and posterior cusps and sinuses.
530
Describe the cusps of the tricuspid valve.
anterior posterior and septal cusps.
531
Describe the cusps of the mitral valve.
anterior and posterior cusps.
532
What is the moderator band?
septomarginal trabecula. It carries fibres of the right bundle branch to the papillary muscle of the anterior cusp.
533
What is the thoracic inlet?
(or outlet) bounded by ribs 1, T1 vertebra and the jugular notch.
534
What is the transverse thoracic plane?
Between the sternal angle and T4/T5 intervertebral disc.
535
What is the thymus?
a lumphid organ that produces white blood cells in childhood and becomes replaced by adipose tissue after puberty. It sits in the anterior mediastinum.
536
What is in the anterior mediastinum?
The thymus.
537
What is in the middle mediastnum?
the pericardium, heart, the parts of the great vessels connected with the heart.
538
What does the azygous vein do and where does it sit?
conveys blood from the intercostal veins to the SVC. arches anteriorly superior to the lung.
539
Where do the vagal trunks pass from the thoracic cavity to the abdominal cavity?
through the diaphragm with the oesophagus and onto the stomach.
540
Where does the trachea bifurcate?
at the level of the sternal angle.
541
What lies in the posterior mediastinum?
the vagus nerves, the trachea and the 2 main bronchi, thoracic aorta, the oesophagus, the vagal trunks, the thoraci duct, the sympathetic chains and the azygous vein.
542
Where do the intercostal veins drain?
posteriorly into the azygous vein.
543
How does lymph drain from the lungs?
through tracheobronchial lymph nodes around the bifurcation of the trachea and bronchopulmonary lymph nodes around the main bronchus at the lung root.
In some patients lymph from the left inferior lobe drains into the right lymphatic duct.
544
What is the swollen start of the thoracic duct in the abdomen called?
cisterna chyli.
545
Where is the left venous angle in relation to the surface anatomy of the chest?
under the left sternoclavicular joint.
546
What does the right phrenic nerve do?
travels down the chest and through the diaphragm with the IVC to innervate the diaphragm inferiorly.
547
What does the left phrenic nerve do?
pierces through the left dome of the diaphragm to supply it from the inferior aspect.
548
What is in the superior mediastinum?
From anterior to posterior. Brachiocephalic veins, SVC, arch of the aorta, trachea, oesophagus, thoracic duct.
From lateral to medial: phrenic nerves, vagus nerves and recurrent laryngeal nerves.
549
What are the central veins?
those large veins close enough to the heart such that the pressure within them is said to approximately reflect the pressure within the right atrium (depending on posture).
550
Name the central veins.
internal jugular veins, subclavian veins, brachiocephalic veins, superior vena cava, right atrium, inferior vena cava, iliac veins and femoral veins.
551
What is another name for the sternal angle?
angle of louis.
552
What do the left and right recurrent laryngeal nerves hook under?
right - right subclavian artery.
| Left - arch if the aorta.
553
Describe the phrenic nerves.
formed form anterior rami of cervical spinal nerves 3,4 and 5. give somatic motor to the diaphragm.
Somatic sensory to: mediastinal pareital pleura, fibrous pericardium, diaphragmatic parietal pleura and the diaphragmatic parietal peritoneum.
554
Describe the vagus nerves.
Cranial nerve X
Comtain: somatic sensory nerves for the palate, laryngopharynx and larynx. Somatic motor nerves for the pharynx and larynx. (both of these are the recurrent laryngeal nerves).
Autonomic parasympathetic nervs for thoracic and abdominal organs.
So after recurrent laryngeal have left there is only autonomic parasympathetic fibres.
555
Why do we get shoulder tip pain?
liver or gallbladder etc. irritate the parietal peritoneum on the diaphragm which is supplied by phrenic nerves C3, 4 and 5. The supraclavicualr nerves C3 and 4 supply the shoulder tip dermatomes and enter the spine at the same level as the phrenic, so brain refers the pain to the most superficial structure.
556
What are the different types of innervation of the heart?
Autonomic - sympathetic and parasympathetic motor control.
| Visceral afferent nerves - pain and reflex e.g. baroreceptors.
557
How do the nerves supplying the heart reach it?
autonomic - reach the heart via the cardiac plexus.
Visceral afferent - pain reaches spinal cord alongside sympathetic nerves and the reflex afferents travel mainly in the vagus nerve and some in IX.
558
What neurotransmitters do sympathetic nerves have?
Acetylcholine for the presynaptic and noradrenaline in the post synaptic.
559
How do sympathetic signals reach organs from the CNS?
Travel down spinal cord - exit through thoracolumbar spinal nerves and then do one of the following.
1. go into the ganglion of that level and synapse.
2. travel superiorly up the sympathetic chain and synapse at a ganglion.
3. travel inferiorly and do the same.
4. travel straight through sympathetic chain ganglia and synapse at a prevertebral ganglion in the abdomen e.g. celiac ganglia.
5. pass straight to the adrenal medulla.
560
What are the sympathetic nerves to the heart and lungs called?
cardiopulmonary splanchnic nerves.
561
What kind of innervation do essentially midline organs get?
Bilateral innervation - predominantly left sided for the heart.
562
What do the cardiopulmonary splanchnic nerves consist of?
post synaptic fibres from cervical and upper thoracic sympathetic chains. plus pain visceral afferents from the chest organs.
563
What does the cardiac plexus contain?
sympathetic fibres, parasympathetic fibres and visceral afferent fibres.
564
what are the neurotransmitters of the parasympathetic nervous system?
ach x 2.
565
How do parasympathetic nerves reach the organs?
through cranial nerves III, VII, IX and X to chest and upper abdomen. Through pelvic planchnic nerves to the lower abdomen, pelvis and peritoneum.
566
Describe the course of the vagus nerve.
exits skull, travels through cranial nerve. Then presynaptic fibres synapse to postsynaptic nerones - with short axons within the walls of the organs of the chest and upper abdomen.
567
What is vagal tone?
continuous background AP's - slows down the HR in CNX.
568
Where do the postsynaptic sympathetic efferents go to in the heart?
The SA node and myocardium.
569
Where do the presynaptic parasympathetic efferents go to in the heart?
The SA node.
570
What is the postulated position of the chemoreceptor nerve endings in the heart?
The root of the aorta and the IV septum.
571
What is the postulated position of the baroreceptor nerve endings in the heart?
inner aortic arch, pulmonary trunk, around the SA node, outflow tracts from both ventricles, papillary muscles and the vena cavae.
572
What is the definition of pain?
unpleasant sensory and emotional experience associated with actual or perceived tissue damage described in terms of such damage.
573
What is radiating pain?
pain felt in one place and felt spreading from there e.g. chest and down arm.
574
What is referred pain?
Pain felt only at a site remote to the tissue damage.
575
What potential somatic pain sources do we have in the chest?
muscles, joints, bone, intervertebral discs, fibrous pericardium and nerves.
576
What potential visceral pain sources do we have in the chest?
heart and great vessels, trachea, oesophagus and abdominal viscerae.
577
What area of the brain brings somatosensory somatic sensations into consciousness?
postcentral gyrus of the parietal lobe.
578
What area of the brain controls somatomotor signals in the brain?
precentral gyrus of the frontal lobe.
579
Describe herpes zoster pain.
reactivation of dormant shingles virus in posterior root ganglion. Pain felt anywhere in that dermatome. Pain precedes blisters and so can present with central chest pain.
580
What are some sources of chest muscle, joint and bone pain?
pectoralis major or intercostal muscle strain. dislocated costochondral joint, costovertevral inflammation. Slipped thoracic disc.
581
What are sources of parietal chest pain?
pleurisy and pericarditis.
582
What are some sources of visceral chest pain?
tracheitis, ruptured AA, gastritis, cholecystitis etc. angina, MI or oesophagitis.
583
Where does the vagus nerve cross in the chest?
left side of aortic arch, heading posterior to the lung hilum towards the oesophagus.
584
What is the ligamentum arteriosum?
remnant of the ductus arteriosus connecting the PT to the arch of the aorta.
585
Describe how pain radiates from a somatic source?
along the affected dermatome.
586
Describe how pain radiates from a visceral source?
felt in a dermatomal pattern but dull achey and poorly localised.
587
Describe how pain radiates from the heart?
to the dermatomes supplied by the spinal cord levels at which the cardiac visceral afferents enter the sympathetic chain/spinal cord i.e. bilaterally to the cervical and upper thoracic dermatomes.
588
Why does referred pain happen?
due to afferent sensory fibres from soma and viscera entering the spinal cord at the same levels. The brain chooses to believe the pain is coming from the soma.
589
Where does pain from the liver.gallbladder or pancreas commonly refer to?
the top of the right shoulder and the base of the neck going down the back to the right shoulder tip.
590
Where does stomach pain refer to?
the centre of the back between the shoulder blades.
591
What is an MI?
irreversible death of the myocardium due to occlusion of its arterial supply?
592
What are the most common sites of coronary atherosclerosis?
anterior interventricular branch (another name for the LAD) of LCA (40-50%).
right coronary artery (30-40%).
circumplex branch of LCA (15-20%) and left main stem coronary artery.
593
What arteries supply blood to the septum of the heart?
The LAD and the posterior interventricular artery.
594
What causes complete heart block?
AV node damage.
595
What is required for faecal continence?
holding area (rectum), normal vsceral afferent nerves to sense fullness. Functioning sphincter muscles (to relax and to hold) and normal cerebral function to approximate correct time to defecate.
596
What can affect faecal continence?
medications, natural degeneration of innervation and stool consistency.
597
What is the pelvic floor muscle called?
Levator ani.
598
What passes through the levator ani?
alimentary canal, reproductive tracts and renal system- pass into the perineum.
599
Where does the sigmoid colon become the rectum?
anterior to S3 - the rectosigmoid junction.
600
When does the rectum become the anal canal?
anterior to the tip of the coccyx just prior to passing through the levator ani.
601
Where are the rectum, anal canal and anus?
rectum in pelvis.
| anal canal and anus in the perineum.
602
What is the dilated distal part of the rectum called?
The rectal ampulla.
603
Where is the rectal ampulla situated?
immediately superior to the lavator ani muscle.
604
What does the levator ani form?
The pelvic floor and the roof of the perineum.
605
describe the function of the levator ani and its innervation.
it is tonically contracted most of the time to support the pelvic organs. Reflexively contracts further when there is increased intra-abdominal pressure and relaxes when needed. Innervated by the nerve to levator ani, which is a branch of the sacral plexus.
606
What is the puborectalis muscle?
one part of the lavator ani muscle. Increases the anorectal angle when it contracts and acts like a sphincter. Skeletal muscle that helps to maintain continence.
607
Describe the internal anal sphincter.
smooth muscle, contraction stimulated by the sympathetic nerves. Contraction inhibited by the parasympathetic nerves. Contracted all the time and relaxes reflexively in response to distention of the rectal ampulla.
608
Describe the external anal sphincter.
skeletal muscle,. Contraction is stimulated by the pudendal nerve. Coluntarily contracted along with puborectalis muscle in response to rectal amupulla distension and internal sphincter relaxation.
609
What route do sympathetic fibres take to reach the rectum and anal canal?
travel from T12 - L2, synapse at the inferior mesenteric ganglia. They reach the rectum via periarterial plexuses around the branches of the IMA.
610
What do sympathetic nerves do to the rectum?
stimulate contraction of the internal anal sphincter and inhibit peristalsis.
611
How do somatic motor fibres reach the rectum and anus and what do they do?
fibres in the pudendal nerve (s2,S3 and S4) and the levator ani (S3, S4). They stimulate the external anal sphincter and puborectalis to contract.
612
How do parasympathetic fibres reach the rectum and anus and what do they do?
fibres travel from S2, S3 and S4 via the pelvic splanchnic nerves, then synapse as ganglia within the walls of the rectum. The open the internal anal sphincter and stimulate peristalsis.
613
How do visceral afferent fibres reach the rectum and anus and what do they do?
they run alongside parasympathetic nerve fibres from the rectum and enter the spinal cord as levels S2, S3 and S4. They sense ischaemia and stretch etc. They sense fullness of the ampulla.
614
Describe the right pudendal nerve.
It is a named nerve of the sacral plexus containing axons from S2, S3 and S4 anterior rami.
615
What are the organs of the hindgut?
the distal 1/3rd of the transverse colon to the proximal 1/2 of the anal canal superior to the pectinate line.
616
What is the pectinate line?
marks the junction between the part of the mebryo which formed the GI tract (endoderm) and the part that formed the skin (ectoderm).
617
How do the areas of the anal canal above and below the pectinate line differ?
the superior visceral part and the inferior parietal part differ in arterial supply, lymphatic drainage, venous drainage and nerve supply,
618
Describe the vessel and nerve supply to the part of the anal canal above the pectinate line.
autonomic nerve supply. Inferior mesenteric artery. Venous blood goes to portal venous system via the inferior mesenteric artery. Lyphatics go to the inferior mesenteric nodes (internal iliac nodes).
619
Describe the vessel and nerve supply to the part of the anal canal below the pectinate line.
Somatic nerve supply (pudendal nerve), arteries from internal iliac artery. Venous to the systemic venous system via the internal iliac vein and drainage to superficial inguinal lymph nodes.
620
describe the lymphatics of the pelvis.
vessels tend to lie beside arteries. The main lymph node groups draining the pelvic organs are: internal iliac (drain inferior pevic structures), external iliac (draining lower limb and more superior pelvic structures) and common iliac (drain the lymph nodes from the external and internal iliac nodes). The lymph that drains through the common iliac nodes then drains to the lumbar nodes.
621
What artery supplies the hindgut organs?
the inferior mesenteric artery which branches into the: superior, middle and inferior rectal arteries amongst others..
622
What artery supplies the rest of the GI tract after the hindgut?
The internal iliac artery.
623
What is the venous drainage from the anal canal?
collateral veins, inferiorand medial veins drain into the internal iliac vein. The superior rectal vein drain into the inferior mesenteric vein.
624
What is dilation of the rectal collateral veins called?
rectal varices.
625
Why do rectal varices form?
due to portal hypertension.
626
What are haemorrhoids?
prolapse of the venous plexus due to pregnancy or constipation etc.
627
What are the ischioanal fossae?
lie on either side if the anal canal, in front and beneath, filled with fat and loose connective tissue, they communicate with each other posteriorly.
628
What is an infection within the ischioanal fossa called?
ischioanal abcess.
629
What is jaundice?
Otherwise called icterus. Causes yellowing of the sclera and skin. Caused by an increase in the blood levels of bilirubin.
630
What is bilirubin?
normal byproduct of the breakdown of RBC mainly in the spleen.
631
What is bilirubin used for?
to form bile in the liver, which is then injected down the biliary tree into the 2nd part of the duodenum.
632
Where is the portal triad found?
in the free edge of the lesser omentum.
633
What does the portal triad consist of?
the hepatic artery, the hepatic portal vein and the common bile duct. It also contains nerves and lymphatics.
634
Describe the coeliac trunk.
first branch of the aorta. Retroperitoneal. It arises around T12 and supplies the foregut organs.
635
Describe the branches of the coelac trunk.
Trifurates into 3 branches: splenic, heaptic and left gastric arteries. Then gives rise to gastroduodenal artery and superior pancreatico-duodenal artery.
636
Where does the spelnic artery travel?
tortuous course along the superior border of the pancreas.
637
Where is the spleen located?
left hypocondrium in the peritoneum. The diaphragm lies posteriorly, the stomach anteriorly, the splenic flexure inferiorly and the left kidney medially.
638
What protects the spleen?
ribs 9-11.
639
What is the blood supply to the stomach?
mainly from: right and left gastric arteries which run along the lesser curvature. and the right and left gastro-omental arteries - which run along the greater curvature. Both sets of these arteries anastamose with each other. .
640
What is the blood supply to the liver?
the hepatic artery which branches into right and left hepatic arteries (20-25%). The rest is from the hepatic portal vein. Has a dual blood supply.
641
What ribs protect the liver?
7-11.
642
How can we describe the arrangement of the liver?
4 anatomical segments or 8 functional segments. The two sets are not related to each other.
643
What are the 4 anatomical segments of the liver?
right lobe, left lobe, caudate lobe and the quadrate lobe.
644
How many functional segments of the liver are there and how do they differ?
8 number with roman numerals. All have different arterial and venous supply and bile drainage.
645
What is the venous drainage from the liver?
via 3 hepatic veins to the IVC.
646
What special features do the hepatic veins and IVC have?
They lack valves.
647
What happens to the liver when there is a rise in central venous pressure?
it is directly transmitted to the liver, it engorges with blood (hepatomegaly).
648
What is part of the interlobular portal triad?
branch of the hepatic artery, a branch of the hepatic portal vein and a branch of the biliary duct.
649
What do the central veins in the liver do?
collects cleaned blood and drains into the hepatic veins.
650
What are the two clinically important areas of the peritoneal cavity related to the liver?
hepatorenal recess (morissons pouch - between the liver and the kidney) and the subphrenic recess (above the liver between is and the diaphragm. Both within the greater sac.
651
What is one of the lowest parts of the peritoneal cavity when the patient is supine?
hepatorenal recess. pus from an abcess in the subphrenic recess can drain into the hepatorenal recess if the patient is bedbound.
652
How does blood drain from the gut to the liver?
splenic vein - drains foregut to the hepatic portal vein. Inferior mesenteric from hindgut to splenic vein to HPV. The superior mesenteric from midgut to HPV.
653
Where does the IVC lie?
In the retroperitoneum.
654
What ligaments attach the liver to the diaphragm?
The coronary ligaments.
655
What ligament attaches the liver to the anterior abdominal wall?
The falciform ligament.
656
What is the ligamentum teres?
remnant of the embryological umbilical vein. Hangs off the bottom of the falciform ligament.
657
Where does the gallbladder lie?
underside of the liver, anterior to the duodenum.
658
describe the anatomy of the gall bladder?
has a body and a neck that narrows to become the cystic duct.
659
What is the blood supply of the gall bladder?
the cystic artery, which is a branch of the right hepatic artery in 75% of people.
660
Describe gallbladder pain?
visceral afferent enter the spinal cord between T6 and T9. early pain is epigastric but can refer to the right hypochondrion or shoulder.
661
What makes up the biliary tree?
The common bile duct (or just bile duct) formed from the cystic duct and the common hepatic duct. The common hepatic duct is made from the left hepatic duct and the right hepatic duct.
662
What is an ERCP?
endoscopic retrograde cholangiopancreatography. endoscope down and cannula placed in duodenal papilla with dye put in. Can radiograph and watch at the same time.
663
What course does the bile duct follow?
descends posterior to the 1st part of the duodenum, and into a groove on the posterior aspect of the pancreas. it joins the main pancreatic duct and both drain into the second part of the duodenum, through the major duodenal papilla.
664
What is the ampulla of vater?
The widened part of where the main pancreatic duct and bile duct meet. Also called the hepatopancreatic ampulla. Wmpties into the duodenum via the major duodenal papilla.
665
How does jaundice occur?
an obstruction of the biliary tree leading to backflow of bile into the liver and overspill into the blood of bile contents including bilirubin.
666
What parts make up the pancreas?
head (with uncinate process), neck, body and tail.
667
What is the uncinate process of the pancreas?
it is a curl round of the head of the pancreas which goes around the back of the superior mesenteric vessels.
668
What is the blood supply to the pancreas?
pancreatic arteries from the splenic artery. inferior pancreaticoduodenal artery from the superior mesenteric artery and superior pancreaticduodenal artery from the gastroduodenal artery.
669
What is a cause of pancreatitis?
blockage of the ampulla by a gallstone which diverts bile back and if it goes to the pancreas it causes irritation.
670
where is pancreatic pain present?
epigastric, umbilical or can radiate through to the patients back.
671
What are the parts of the duodenum?
```
4 parts.
1. superior (part intraperitoneal).
2.descending (retro).
3.horizontal (retro).
4 ascending (retro).
```
672
Where is the duodenal cap?
the initial section of the first part of the duodenum. It is just after the pyloric sphincter. It is intraperitoneal and fairly mobile.
673
What is the innervation of the pyloric sphincter?
sympathetic to contract it and parasympathetic to relax it.
674
What is the name of the section where the duodenum and the jejunum join?
duodenaljejunal flexure.
675
Where does the pain from a duodenal ulcer present?
the epigastric region.
676
What is the function of the duodenum in relation to the blood?
it secretes a number of peptide hormones into the blood e.g. gastrin and CCK.
677
What is the blood supply of the duodenum?
The gastroduodenal artery, the superior and inferior pancreaticoduodenal artery.
678
What are the tissue folds on the inside of the duodenum called?
plicae circularis.
679
Describe the absorption of fat from the small intestines.
Fats require bile to be absorbed. They are absorbed within chylomicrons into the specialised lymphatic vessels of the small intestine called lacteals. They travel via the lymphatic system to eventually drain into the left venous angle.
680
What are the lymphatics in the abdomen?
tend to lie alongside the arteries. The main groups of lymph nodes draining the organs are: celiac (foregut), superior mesenteric (midgut), inferior mesenteric (hindgut) and lumbar (drining kidneys, post abdominal wall, pelvis and lower limbs).
681
Where are the venous angles that the lymphatic duct/thoracic duct drains into?
between the subclavian and the internal jugular veins.
682
Describe where the colon lies in relation to the perioneum.
```
proximal ascending (intraperitoneal and quite mobile).
distal ascending - restroperitoneal.
transverse - intraperitoneal - very mobile and has own mesentery.
The descending - retroperitoneal until distal end at sigmoid which is intraperitoneal again mobile with its own mesentery.
```
683
Where and what are the paracolic gutters?
on the right and left sides between the lateral edges of the ascending and descending colon and the abdominal wall. Part of the greater sac of the peritoneal cavity and are a potential site of pus collection.
684
What are the muscle band in the colon called?
teniae coli. Thickened smooth muscle bands from the cecum to the distal sigmoid colon.
685
Where do the colonic flexures lie in relation to each other?
The splenic flexure lies higher than the hepatic.
686
What are the pouches of the colon called and how are they formed?
haustra. Formed from tonic contraction of the teniae coli.
687
What is the opening of the ilium into the cecum called?
ileocecal orifice and valve.
688
What is McBurneys point?
It correlates with the appendiceal orifice on the posteromedial wall of the caecum. It is a third of the way along the imaginary line drawn between the ASIS to the umbilicus (from the ASIS end).
689
Where does the appendix most commonly lie?
retrocecal.
690
Describe the sigmoid mesocolon and its effects?
very long giving it a significant degree of movement. Gives it a risk of twisting causing a sigmoid volvulus.
691
What arteries do the abdominal aorta bifurcate into?
Right and left common iliac artery which then bifurcates into the internal and external iliac arteries.
692
What are the branches of the SMA?
The middle colic artery, the right colic artery, the ileocolic artery, the jejunal and ileal arteries and the appendicular artery.
693
What are the branches of the IMA?
lef tcolic, sigmoid colic and superior rectal artery.
694
What is the predominant arterial anastamosis between the SMA and IMA.
the marginal artery (of Drummon). They can help prevent ischaemia.
695
Where are the 3 clinically important portal systemic anatsamoses?
Distal end of the oesophagus, skin around the umbilicus and the rectum/anal canal.
696
Why are the portal systemic anatsamoses important?
presence of small collateral veins means blood can flow both ways, either into the systemic or portal system. There are no valves in these veins and normally there is very little blood flow.
697
How does blood drain from the umbilicus?
distal part into the hepatic portal vein. More superior part to the azygous vein.
698
How does blood drain from teh distal end of the oesophagus?
via inferior epigastric veins to the IVC.
699
What is the ligamentum teres and what happens to it if portal pressure is raised.
It is normally closed during adult life. But if portal pressure raises it opens and blood flows through collateral veins, this diverts blood back to the systemic venous system. This causes increased blood flow and varices.
700
What are clinical presentations of portal hypertension?
caput medusae - dilated collareral and epigastric veins around the umbilicus. Oesophageal and rectal varices.
701
What are the layers of abdominal muscle from the outside working in?
external oblique, internal oblique and transversus abdominis. Rectus abdominis runs up the front.
702
Describe the omentum?
greater and lesser sacs - communicate at the omental foramen. The portal triad lies in the free edge of the lesser omentum. The lesser omentum is above the lesser curvature of the stomach and the greater lies below.
703
What procedure drain ascites ?
Paracentesis ( abdominocentesis).
704
Where is the needle inserted in paracentesis?
lateral to the rectus sheath to avoid the inferior epigastric artery.
705
What 4 main questions should we consider about abdominal pain?
location, pain referral pattern, character and timing (both onset and does it come and go).
706
Where do the spinal nerves leave the spine to go to the adrenal gland?
T10 -L1.
707
Where do foregut visceral afferent enter the spinal cord?
T6-T9
708
Where do midgut visceral afferent enter the spinal cord
T8-T12
709
Where do hindgut visceral afferent enter the spinal cord
T10 - L2.
710
What is the subcostal nerve?
T12 anterior ramus.
711
What is the iliohypogastric nerve?
half of L1 anterior ramus.
712
What is the ilioinguinal nerve?
other half of L1 anterior ramus from the iliohypogastric nerve,
