Flashcards in Anatomy Deck (156):
From superior to inferior - which arteries arise from the anterolateral aspect of the abdominal aorta (pairs)?
Adrenal, renal, gonadal
Which bone is a long bone and has a tuberosity and a malleolus?
Which bone is a flat bone and provides an attachment for abdominal wall muscles and forms part of the acetabulum?
Which bone has a proximal head, forms a tuberosity at the insertion of the biceps tendon and has sulci for several tendons on its distal dorsal aspect?
What are the three pairs of jaw closing muscles and what are their attachments?
1. Masseter - angle of mandible to zygomatic arch
2. Temporalis - coronoid process of the mandible to temporal fossa
3. Medial pteerygoid - angle of mandible (medial side) to pterygoid plates of sphenoid bone.
What is the pair of jaw opening muscles?
Lateral pterygoid - condyle of mandible to pterygoid plates of the sphenoid bone
What nerve are the masseter, temporalis, medial pterygoid and lateral pterygoid all supplied by?
Mandibular division of the trigeminal nerve (V3)
Where does trigeminal nerve V3 exit/enter the CNS
At the pons
What hole in the base of the skull does trigeminal nerve V3 go through?
What is the name of the droopy bit of soft pallate that hangs down?
Uvula of soft pallate
In the posterior third of the tongue what nerve supplies all general and taste sensation?
CN IX - glossopharyngeal
In the anterior 2/3rd of the tongue what is the general sensation and the taste sensation supplied by?
General - CN V3
Taste - CN VII (facial)
What nerve supplies the superior half of the tongues general sensation?
What nerve supplies the inferior half of the tongue general sensation?
The sensory part of the gag reflex is carried by what nerve?
The motor part of the gag reflex is carried by what nerve?
CN IX and CN X
When about to use an endoscope what nerves will be blocked by spraying a local anaesthetic?
CN V2, CN V3, CN VII and CN IX
Where does CN V2 enter/exit the CNS?
at the pons
Where does CN V2 leave the base of the skull?
Where does the facial nerve (CN VII) enter/exit the CNS?
Junction of pons and medulla
Where does the facial nerve (CN VII) exit/enter the base of the skull?
Exits the internal acoustic meatus (IAM) and enters the stylomastoid foramen (SMF)
What is the chorda tympani?
A branch of CN VII (facial nerve) that gives special sensory 'taste' to the anterior 2/3rd of the tongue
Which cranial nerve gives parasympathetic secretomotor to the submandibular and sublingual salivary glands?
The facial nerve (CN VII)
Where does the glossopharyngeal nerve (CN IX) enter/exit the CNS?
At the medulla
Which hole in the base of the skull does CN IX (glossopharyngeal nerve) enter/exit?
The jugular foramen
Which cranial nerve gives parasympathetic secretomotor to the parotid salivary glands?
Glossopharyngeal (CN IX)
What are the three pairs of salivary glands?
Parotid, submandibular and sublingual
What are the four pairs of extrinsic skeletal muscles of the tongue (originate external to the tongue and insert into it) and what do they do?
Suspend the tongue in the oral cavity, move the tongue around
Where are the 4 intrinsic skeletal muscles of the tongue (originate and insert within the tongue) and what do they do?
Located mainly dorsally and posteriorly
Modify the shape of the tongue during function
What nerve are all the tongue muscles suppled by except the palatoglossus?
The CN XII - hypoglossal
Where does the CN XII (hypoglossal) nerve enter/exit the CNS?
At the medulla
Where does the hypoglossal (CN XII) enter/exit the cranial cavity?
At the hypoglossal canal
At what vertebral level is the upper oesophageal sphincter located at?
What are the 3 outer circular layers of pharyngeal constrictor muscles (supplied by CN X)?
Superior pharyngeal constrictor
Middle pharyngeal constrictor
Inferior pharyngeal constrictor
What muscle and what nerve take part in the closing of the lips?
Orbicularis oris and CN VII (facial)
What nerves supply the innter longitudinal layer of pharyngeal muscles?
CN IX & X
What is another term for the upper oesophageal sphincter?
What do the para and sympathetic nerves do in relation to the speed of peristalsis?
Parasympathetic speeds up
Sympathetic slows down
What is the angle in the stomach called between the body and the pyloric antrum?
What five structures are in the foregut?
1. oesophagus to mid-deuodenum
3. Gall bladder
5. half of the pancreas
What two structures are in the midgut?
1. Mid-duodenum to proximal 2/3rd of transverse colon
2. Half of pancreas
What structure is present in the hindgut?
Distal 1/3rd of the transverse colon to proximal half of the anal canal
What can cause severe and painful inflammation of the peritoneum (peritonitis)?
Blood, pus or faeces
Is the liver intraperitoneal or retroperitoneal?
Name two organs that are retroperiteal?
Pancreas and kidneys
How many pouches does the peritoneum form in a male and female?
Male - one (rectovesical - behind bladder)
Female - two (uterovesical - in front of uterus) (rectouterine/pouch of douglas - behind uterus
During paracentesis (draining of ascitic fluid) where must the needle be placed?
Lateral to the rectus sheath (this avoids the inferior epigastric artery)
How do sympathetic nerve fibres get from the CNS to the abdominal organs?
Leave the spinal cord between levels T5 and L2
Enter the sympathetic chains (bilaterally) but do not synapse
Leave the sympathetic chains within the abdominopelvic splanchnic nerves
Synapse at prevertebral ganglia which are located anterior to the aorta at the exit points of the major branches of the abdominal aorta
In relation to how sympathetic nerve fibres get from the CNS to the abdominal organs: Post-synaptic sympathetic nerve fibres pass from what to what?
Postsynaptic sympathetic nerve fibres pass from the prevertebral ganglia (celiac, superior mesenteric etc) onto the surface of the arterial branches leaving the abdominal aorta
At what level of the spine to sympathetic nerve fibres for the adrenal gland leave the spinal cord?
What nerves supply smooth muscle/glands of teh descending colon to the anal canal?
(Presynaptic parasympathetic nerve fibres)
Pelvic Splanchnic Nerves (S2, 3, 4)
What region of the abdomen does foregut pain tend to be felt?
What region of the abdomen does midgut pain tend to be felt?
What region of the abdomen does hindgut pain tend to be felt?
Pain fibres from the foregut structures enter the spinal cord at what level?
T6 - T9
Pain fibres from the midgut structures enter the spinal cord at which level?
Pain fibres from hindgut structures enter the spinal cord at which level?
7th-11th intercostal nerves travel anteriorly, then leave the intercostal spaces and travel in the plane between which two muscles?
Internal oblique and transversus abdominis (as thoracoabdominal nerves)
What does the subcostal nerve come from?
T12 anterior ramus
What does the iliohypogastric nerve come from?
Half of L1 anterior ramus
What does the ilioinguinal nerve come from?>
Other half of L1 anterior ramus
What type of organ is the appendix?
What is jaundice caused by?
An increase in the blood levels of bilirubin
Bilirubin is the normal bi-product of what?
The breakdown of red blood cells in the spleen
What role does the gall bladder play in relation to bilirubin?
Stores and concentrates bile
What three tubes does the portal triad consist of?
Hepatic artery, hepatic portal vein and common bile duct
What is the first of the three midline branches of the abdominal aorta?
The celiac trunk
Is the abdominal aorta/celiac trunk retroperitoneal or intraperitoneal?
At what spinal level does the celiac trunk arise?
What three branches does the celiac trunk trifurcate into?
The splenic artery, hepatic artery and left gastric artery
What ribs protect the spleen?
The blood supply to the stomach comes mainly from which 4 arteries?
1. Right and left gastric arteries - run along the lesser curvature and anastomose together
2. Right and left gastro-omental arteries - run along the greater curvature and anastomose together
Where does the liver get its blood supply from?
1. the hepatic artery which branches into right and left hepatic arteries
2. the hepatic portal vein
What substance does the liver convert?
Bilirubin to bile
What ribs protect the liver?
7 - 11
What are the 4 anatomical segments of the liver?
1. Right lobe
2. Left lobe
3. Caudate lobe (behind liver)
4. Quadrate lobe
How is hepatomegaly caused?
The IVC and hepatic veins lack valves so a rise in central venous pressure is directly transmitted to the liver
What does each liver interlobular portal triad contain?
1. Branch of hepatic portal vein
2. Branch of hepatic artery
3. Biliary duct (bile formed in hepatocytes drains here)
What are the names of the two recesses related to the liver?
Hepatorenal recess (Morison's pouch)
What does the hepatic portal vein do?
Drains blood from the foregut, midgut and hindgut to the liver for first pass metabolism
What does the splenic vein do?
Drains the blood from the foregut to the hepatic portal vein
What does the inferior mesenteric vein do?
Drains the blood from the hindgut to the splenic vein
What does the superior mesenteric vein do?
Drains the blood from the midgut to the hepatic portal vein
Name the three ligaments that attach the liver?
1. Coronary ligaments (attachment to the diaphragm)
2. Falciform ligament (attachment to the anterior abdominal wall)
3. Ligamentum teres/round ligament (remnant of the embryological umbilical vein)
What does the neck of the gall bladder narrow to become?
Cystic duct (potential site for gallstone impaction)
What artery supplies the gallbladder?
The cystic artery (branch of right hepatic artery in 75% of people)
Is the gallbladder foregut, midgut or hindgut?
At what level of the spinal cord to gallbladder visceral afferents enter?
between T6 and T9
What is cholecystectomy?
Removal of the gallbladder
What do the right and left hepatic ducts drain into?
The common hepatic duct
What does the common hepatic duct unite with to form the bile duct (common bile duct)?
What part of the duodenum does the bile duct drain into?
What forms the ampulla of Vater?
The bile duct and main pancreatic duct
What forms the sphincter of Oddi?
The major duodenal papilla
Name two things that can obstruct the biliary tree?
2. Carcinoma at head of pancreas
What type of jaundice is caused by extra hepatic obstructions?
What are the five parts of the pancreas?
2. Uncinate process
What does a pancreatic acinar cell do? (exocrine)
Secretes digestive enzymes into the main pancreatic duct
What do the pancreatic cells - Islets of Langerhans - do? (endocrine)
Release insulin and glucagon into the bloodstream
What gives the pancreas its main blood supply?
Branches from the splenic artery (pancreatic branches)
What branches from the gastroduodenal artery that supplies the pancreas?
Superior pancreaticoduodenal artery
What branches from the superior mesenteric artery to supply the pancreas?
The inferior pancreaticoduodenal
What innervation causes the smooth muscle to contract at the pyloric sphincter?
What innervation causes relaxation of the smooth muscle at the pyloric sphincter?
Parasympathetic nerve (vagus)
Name two peptide hormones that the duodenum secretes into the blood?
What are the folds called in the mucosa of the jejunum?
What branches of the superior mesenteric artery supply the jejunum and ileum?
The jejunal and ileal arteries
What helps the absorption of fat from the GI tract lumen into the intestinal cells?
What are specialised lymphatic vessels of the small intestine called?
Where do lacteals eventually drain to?
The left venous angle
What makes up the right venous angle?
Angle between the right subclavian and right internal jugular veins
What makes up the left venous angle?
Angle between the left subclavian and left internal jugular veins
Where do the two paracolic gutters exist?
Between the lateral edge of the ascending and descending colon and the abdominal wall
What are the teniae coli?
Three distinct longitudinal bands of thickened smooth muscle running from caecum to the distal end of the sigmoid colon
What are haustra formed by?
Tonic contractions of the teniae coli
What two holes occur in the caecum?
1. The ileocaecal orifice and valve
2. The appendiceal orifice on posteromedial wall of caecum
Where is McBurneys point?
A third the way from the right ASIS to the umbilicus.
What is it called when the sigmoid colon twists around itself?
What does the right common iliac artery bifurcate into?
Right internal iliac artery and right external iliac artery
What does the inferior mesenteric artery branch into?
Left colic artery
Sigmoid colic artery
Superior rectal artery
What 6 arteries come from the superior mesenteric arteries?
1. Inferior pancreaticoduodenal artery
2. Middle colic artery
3. Right colic artery
4. Ileocolic artery
5. Appendicular artery
6. Jejunal and ileal arteries
What artery forms anastomoses with the branches of the SMA and IMA?
The marginal artery of Drummond
What two arteries does the internal iliac artery split into?
The middle and inferior rectal arteries
Which arteries supply the greater curvature of the stomach?
The right and left gastro-omental arteries
There are 3 clinically important sites of venous anastomosis between the systemic and the portal venous systems "portal systemic anastomoses". At these sites, the presence of small collateral veins means blood can flow both ways, either into the systemic or portal venous system (there are no valves in these veins). Normally there is very little blood flow within these collateral veins. Name the 3 anastomoses.
1. Distal end of the oesophagus
2. Skin around umbilicus
3. Rectum/anal canal
Describe the distal end of the oesophagus anastomosis
The most distal part drains into the hepatic portal vein
The most superior part drains into the azygous vein
Describe the skin around the umbilicus anastomosis?
Normally the ligamentum teres remains closed throughout adult life and blood flows from the skin around the umbilicus via the inferior epigastric veins to the IVC.
Decribe the rectum/anal canal anastomosis
The rectum adn superior anal canal drains to the inferior mesenteric vein
The most distal part of the GI tract drains to the internal iliac vein
What vein does the superior rectal vein drain into?
What vein does the middle rectal vein and inferior rectal vein drain into?
Internal iliac vein
During portal hypertension what can happen to the ligamentum teres?
It can re-open and blood flows through the collateral veins
Give two clinical features of portal hypertension
1. Caput medusae - dilated collateral veins and dilated epigastric veins
2. Oesophageal varices - dilated submucosal collateral veins
(also rectal varices)
What is the pelvic floor muscle?
The levator ani
Where is the rectum?
Where is the anal canal and anus?
Where does the rectal ampulla lie?
Immediately superior to the levator ani muscle
What two anatomical structures are anterior to the rectum in a male?
The bladder and prostate gland
What type of muscle is the levator ani?
A skeletal muscle
What nerve supplies the levator ani muscle?
Nerve to the levator ani - a branch of the sacral plexus
What part of the levator ani muscle is particularly important for maintaining faecal continence?
The puborectalis muscle
What does contraction of the puborectalis muscle do?
Decreases the anorectal angle, acting in effect like a sphincter
What type of muscle is the puborectalis muscle?
What type of muscle is the external anal sphincter?
What type of muscle is the internal anal sphincter?
What is contraction of the internal anal sphincter stimulated by?
Sympathetic nerves (i.e. sphincter closed)
What inhibits contraction of the internal anal sphincter?
What nerve stimulates contraction of the external anal sphincter?
Parasympathetic nerve fibres travel from S2, S3 and S4 via the pelvic splanchnic nerves, then synapse at ganglia within the walls of the rectum. What do the nerves do?
Inhibit the internal anal sphincter (open it)
Visceral afferent nerve fibres from the rectum run alongside parasympathetic nerve fibres and enter the spinal cord at levels S2, S3 and S4. What do they do?
They sense ischaemia, strech etc (as other visceral afferents do); they will sense fullness of the rectal ampulla
Somatic motor nerve fibres in the pudendal nerve (S2, S3, & S4) and the nerve to levator ani (S3, S4). What do they do?
Stimulate the external anal sphincter and puborectalis to contract
Sympathetic nerve fibres travel from T12-L2, synpase at the inferior mesenteric ganglia and then reach the rectum via periarterial plexuses around the branches of the IMA. What do they do?
Stimulate contraction of the internal anal sphincter (close it)
The axons make up the sacral plexus?
The S2, S3 and S4 anterior rami
What does prolapse of the venous plexus result in?
Rectal varices form in relation to what?
Where do the ischioanal fossae lie?
On each side of the anal canal
What are ischioanal foaase filled with?
Fat and loose connective tissue