Anatomy Flashcards
(278 cards)
1
Q
How many vertebrae does the vertebral column consist of?
A
33
2
Q
How long is the average adult’s vertebral column?
A
71cm (28in)
3
Q
Why are you 1% shorter in the morning?
A
Because when upright, the weight of the body against gravity compresses the intervertebral disks, forcing water out of them. When sleeping, the weight of the body is removed from the spine allowing water to be reabsorbed into the intervertebral disks.
4
Q
How many groups of vertebrae are there? Where are they?
A
Cervical vertebrae (Neck) Thoracic vertebrae (Chest) Lumbar vertebrae (Lower back) Sacral vertebrae (base of spine) Coccygeal vertebrae (tiny)
5
Q
How many cervical vertebrae are there and where are they located?
A
7 (neck)
6
Q
How many thoracic vertebrae are there and where are they located?
A
12 (chest)
7
Q
How many lumbar vertebrae are there and where are they located?
A
5 (Lower spine)
8
Q
How many sacral vertebrae are there and where are they located?
A
5 (Base of spine)
9
Q
How many coccygeal vertebrae are there?
A
4 (tiny)
10
Q
Beyond the age of 3, the spine begins to curve, what are the names of the 4 bends?
A
Cervical, thoracic, lumbar and pelvic curvatures.
11
Q
What are the primary curvatures?
A
The thoracic and pelvic curvatures as they exist from birth.
12
Q
What are the secondary curvatures?
A
The Lumbar and cervical curvatures as they develop later on, in the child’s first few years of crawling and walking.
13
Q
Name two functions of the thoracic cage.
A
Provides protection to the heart and lungs
Provides attatchment for the pectorial girdle and upper limb
14
Q
What is the costal margin?
A
The lower edge of the chest formed by the arch of the lower ribs
15
Q
What are the three regions of the sternum?
A
Manubrium, body and xiphoid process
16
Q
Where is the manubrium of the sternum located? And what level of vertebrae does it lie?
A
It is the first (broad superior) region, shaped like a know of a necktie. It lies at the level of vertebrae T3 to T4
17
Q
What is the secondary cartilaginous that articulates the manubrium to the body of the sternum?
A
Manubrio-sternal joint`
18
Q
What is the manubrio-sternal joint referred to and why?
A
The manubrio-sternal joint is the secondary cartilaginous joint which articulates the manubrium to the body of the sternum, this joint is referred to as the Sternal Angle of Louis because of the very small angulation it causes between the manubrium and the body of the sternum.
19
Q
Why is the Sternal angle of Louis useful?
A
It can be used to count the ribs. Just lateral to it are the second costal cartilage and to that the second ribs, from then you can count the subsiquent ribs.
20
Q
Why cant we use the 1st ribs as a starting point for counting the rest of the ribs?
A
The first ribs are concealed by the clavicles (collarbones) so cannot be felt.
21
Q
Where and what is the Jugular (superasternal) Notch?
A
Located at the top of the manubrium and infront of the trachea.
22
Q
At what joint does the Manubrium articulate with the medial end of the left and right clavicles?
A
Sterno-clavicular joint (synovial joint)
23
Q
At what joint does the Manubrium articulate with the first costal cartilage?
A
This is a primary cartilaginous joint called the 1st chondro-sternal joint.
24
Q
What is another anatomical name for the body of the sternum?
A
Gladiolus.
25
Between which vertebrae does the gladiolus (Body of the sternum) lie?
Between vertebrae T5 to T9
26
What is a synovial joint?
A joint that joins bones with a fiberous joint capsule that is continuous with the periosteum of the joined bones.
27
What is the periosteum?
A dense layer of vascular connective tissue enveloping bones, except at joints.
28
Between which vertebrae does the xiphoid process lie?
T10 and T11
29
What is the function of the xiphoid process?
Provides attachment for some small abdominal muscles.
30
Why can cardiopulmonary resuscitation be dangerous because of the xiphoid process?
Improper chest compressions (in the wrong place) can force the Xiphoid process into the liver and cause a fatal hemorrhage.
31
Describe the distribution of rib size.
Between ribs 1-7 then from 7-12 they get progressively smaller
32
Describe the distribution of obliqueness of the ribs.
They get increasingly more oblique between ribs 1 to 9. they then decrease from 10-12
33
Describe rib 1's structure and location,
| use the words - Knobby Head, Neck, Tubercle, shaft, Facet.
Rib 1 lies above the level of the clavicle.
On an articulated skeleton you would look for its vertebral attachment at the bast of the neck. More specifically, at the vertebral end, rib 1 has a KNOBBY HEAD which articulates with the body of vertebra T1 (thoracic).
Immediately distal to the head is a region where the rib narrows to a NECK and then widens again to form a rough region called a TUBERCLE. This is the region where the rib connects to the TRANSVERSE COSTAL FACET.
The rib then flattens and widens into a bladelike structure called the SHAFT. The shaft then becomes squared off, here is where the costal cartilidge begins and spans all the way to the upper sternum.
The upper face of rib 1 has a pair of shallow grooves, these serve as platforms for the subclavian artery and subclavian vein.
34
What are the subclavian arteries?
There is a left and right subclacian artery, they're a pair of arteries which supply the upper thorax. Blood is supplied to them from the aortic arch and they supply blood to the left and right arms respectively.
35
What is the costal groove?
The inferior margin of the rib shafts which marks the path for intercontinental blood vessels and nerve.
36
What are and what is the difference between true and false ribs?
True ribs each have their own costal cartilage connecting to them. False ribs lack independent cartilaginous connections to the sternum.
Ribs 1-7 are true ribs
Ribs 8-12 are false ribs
37
What is the alternative to cartilage connecting to the sternum in false ribs?
Instead of connecting to the sternum, the costal cartilage of ribs 8-10 sweep upwards and end on the costal cartilage of rib 7
38
Why is rib 10 different of ribs 1-9?
Rib 10 attaches to a single vertebrae (T10) as oppose to being between two. So vertebrae T10 has a complete costal facet for rib 10.
39
Give 3 features of ribs 11-12 that make them floating ribs.
They articulate with vertebrae T11 and T12. Ribs 11 and 12 don't have tubercles and so these two vertebrae don't have transverse costal facets.
At the distal end of each rib is a small cartilaginous region, this doesn't extend up and join with the sternum, or any higher costal cartilage , the ribs are just embedded in lumbar muscle.
40
What's the difference in rib anatomy in Japanese people?
Rib 10 is a floating rib.
41
Where do the clavicle join to the manubrium?
Clavicular notch
42
What does the pictorial gridle consist of?
Clavicle (collarbone) and scapula (shoulder blade)
43
What is the mediastinum?
The mediastinum contains all the chest organs apart from the lungs
44
What is the superior mediastinum?
Spanning posterior to vertebrae 1-4 and anterior of the manubrium is the superior mediastinum
45
What is the inferior mediastinum?
Split into 3 regions, the inferior mediastinum is the entire region below the superior mediastinum (below the manubrium). This is split into the anterior, middle and posterior mediastinum.
The anterior is in front of the pericardium, just posterior to the manubrium.
The middle contains the pericardium and it's contents
The posterior is located behind the pericardium
46
How many pairs of intercostal muscles are there?
22 pairs, 11 internal, 11 external
47
What is the structure and function of the external intercostal muscles?
The external intercostal muscles aid forced and quiet inhalation, the originate at ribs 1-11 but form insertions are ribs 2-12. They elevate the ribs and bend the ribs open to expand the transverse dimension of the thoracic cavity.
48
What is the structure and function of the internal intercostal muscles?
The internal intercostal muscles aid forced expiration (quiet is a passive process). They originate at ribs 2-12 but form interiors at ribs 1-11. They depress the ribs and cause the, to bend inwards, decreasing the transverse dimension of the thoracic cavity.
49
What 3 muscles make the innermost intercostal muscles?
- transverse thoracis
- levatores costarum muscle.
- subcostales muscle
50
Name the three thoracic muscles outside the ribs.
Serratus Anterior
Serratus posterior -superior
Serratus posterior - inferior.
51
Describe the serratus posterior superior and it's function.
Originates from C7 to T3 and inserts on the upper boarders of ribs 2-5 and are innovated by intercostal nerves 2-5.
52
Describe the serratus posterior inferior and it's function.
Originates from T11 to L2 and inserts on the upper boarders of ribs 9-11.
53
Describe the serratus posterior inferior function
The function is to depress through lower ribs so aids FORCED EXPIRATION
54
Describe the serratus posterior superior function
The function is to elevate the ribs. The angle of the muscles pulls up and elevates the ribs so assists INSPIRATION.
55
Describe the serratus anterior
Originates at ribs 1-8. Instead itself on the medial border of the scapula on its costal surface.
56
What is the function of the serratus anterior?
Function is to contract and stabilise the scapula alongside pulling the scapula forwards towards the thorax, keeping it pressed against it.
57
What nerve mediates the serratus anterior?
Long thoracic nerve.
58
How are the external intercostal muscles orientated?
They are orientated in the inferior medial direction. Hands in pockEts.
59
How are the internal and innermost intercostal muscles orientated?
They are orientated in the superior medial direction.
| Hands on tIts.
60
How are the external intercostal muscles attached to the sternum?
Anterior ally, before it meets the sternum the it forms an aponeurosis (fibrous tissue) called the sternal intercostal membrane.
61
Describe the layers of muscle plura of the thorax, starting either external intercostal muscles and ending with the lungs.
External intercostal muscles ➡ Internal intercostal muscles ➡ innermost intercostal muscles ➡ endothoracic fascia ➡ parietal plura ➡ Pluralcavity ➡ visceral plura ➡ lungs
62
What is the function of the endothoracic fascia?
It is a fibrous connective tissue which separates the parietal plura from the innermost intercostal muscles.
63
Which intercostal muscles are important for inspiration?
External intercostal muscles
64
Which intercostal muscles are important for expiration?
Interact and innermost intercostal muscles. (Due to similar muscle orientation)
65
Where is the neurovascular bundle located?
Between the internal and innermost intercostal muscles, in the costal groove which lie in the inferior margin of the rib.
66
What does the neurovascular bundle consist of?
The intercostal artery, nerve and vein
67
What is the orientation of the neurovascular bundle in the costal groove?
Superior Vein
⬇ Artery
Inferior Nerve
VAN
68
Describe the how the levatores costarum is positioned.
They attach from the transverse processes (transverse articular facets) of a vertebrae and attaches to the rib below (I.e T4 to rib 5)
69
What is the function of the levatores costarum muscles.
To assist elevation of the thoracic rib cage.
70
Describe how the subcostales muscle is positioned.
Attaches from one rib to either the one below or the one below that.
Lies on the internal surface of the ribs
71
What is the function of the subcostales muscle?
Assists in depressing the ribs.
72
What is the function of the transverse thoracis muscle?
Assists in depressing the ribs.
73
Define flexion.
The bending movement of a limb or joint that decreases the angle between the bones of the limb at the joint.
74
Define extension.
An unbending movement of a limb or joint that increases the angle between the bones of the limb at the joint.
75
Define abduction.
The movement of a limb away from the midline of the body.
76
Define adduction.
The movement of a limb towards the midline of the body.
77
From right to left, name the 3 branches of the aortic arch?
Brachiocephalic artery
left common carotid artery
left subclavian artery.
78
What are the name of the two branches of the brachicephalic artery? (from right to left)
Right subclavian artery
| Right common carotid artery.
79
What is the ligamentum arteriosum and describe its attachments.
The ligamentum arteriosum is a small ligament. The superior end attaches to the final part of the aortic arch (and beginning of the descending aorta) called the isthmus of aorta. The inferior end is attached to the top of the left pulmonary artery.
80
What veins does the superior vena cava branch off into?
Left and right branchiocephalic veins.
81
Describe the heart's position relative to the ribcage.
The heart is mainly located behind the sternum (T3-T4). The apex of the heart protrudes slightly to the left and can be palpated (felt) in the 5th left intercostal space).
82
Why does the heart move during respiration?
It is attached to the diaphragm via ligaments protruding from the pericardium so moves during respiration as a result of the contraction and relaxation of the diaphragm. The anterior side of the pericardium is also attached to the sternum.
83
Where can the apex of the heart be palpated (felt) and why?
It can be palpated in the 5th left intercostal space because the apex of the heart is made up of the tip of the left ventricle - making the apex protrude to the left.
84
What distinct anatomical feature of the heart indicates the difference between an anterior and a posterior x ray?
Anterior (belly) the apex of the heart will be towards the left whereas in a posterior (back) x ray, the apex will be protruding to the right and the spinal column will be more visible.
85
What is the name of the partition of which the heart lies?
Mediastinum.
86
What is the pericardium.
The pericardium is a double walled sac that encloses the heart.
87
What are the two layers of the pericardium?
Outer layer is the pericardial sac (parietal pericardium) - this is a though, superficial fiberous layer formed of dense connective tissue.
The inner layer is the epicardium (Visceral pericardium) - this is a serous layer.
88
What is the function of a serous layer?
The serous layer secretes lubricant to reduce friction from muscle movement.
89
What is the pericardium attached to?
Linked to the diaphragm via ligaments and the anterior section is linked to the posterior region of the sternum.
90
What is the name of the space between the parietal and visceral pericadium? (Pericardial sac and epicardium)
Pericardial cavity.
91
Describe how the heart is placed in the pericardial cavity.
The heart isn't necessarily inside the pericardial sac but rather enclosed in it.
The heart is enclosed in the pericardial sac similar to that of a fist in a deflated balloon. The surface of the balloon in contact with the heart is the Epicardium (visceral pericardium) whist the outer surface of the balloon is the pericardial sac. The air space inside the balloon is the pericardial cavity.
92
What is inside the pericardial cavity?
Around 5 to 30ml of Pericardial Fluid produced by the serous layer (epicardium) of the pericardial sac.
93
What is the function of the pericardial fluid?
Acts as a lubricant for the membranes and allows the heart to beat with minimal friction.
94
What is pericarditis and what are its consequences?
Pericarditis is inflammation of the pericardium. Thge membranes become roughened and produce a painful friction rub between heartbeats.
95
What is the coronary sinus?
A collection of collecting veins that join together to form a large collecting blood vessel. Located at the Right Atrium.
96
What is the function of the coronary sinus?
Collects deoxygenated blood from the heart muscle (Myocarium) and delivers it to the right atrium along with the superior and inferior vena cava.
97
What is pulmonary circulation?
Pulmonary circulation is part of the cardiovascular system which carries deoxygenated blood away from the heart to the lungs and returns oxygenated blood back from the lungs to the heart.
98
What is the name for the irregular muscle columns lining the ventricles?
Trabeculae Carnae
99
What are Papillary muscles?
Muscles which attach to the trabeculae carnae and the cordae tendineae of the Bicuspid and Tricuspid valves.
100
What is one of the main functions of the papillary muscles?
Their main function is to attach to the cusps of the tricuspid and bicuspid valves via the cordae tendineae and prevent the inversion and prolapse of these valves during ventricular systole.
101
What is the function of the irregular muscle folds (trabeculae carnae) in the ventricles? And what would be the benefit?
It is thought that they prevent the ventricular walls sticking to each other like suction cups, this is due to their ridged nature.
The benefit would be allowing the chambers to expand easily when they refill.
102
What are the names of the cord like tendos which attach papillary muscles to the tricuspid and bicuspid valves?
Chordae Tendineae
103
What is the function of the moderator band in the right ventricle?
Prevents over distention (swelling, enlarging due to an increase in internal pressure)
104
What is a common name for the moderator band?
Septomarginal trabecula.
105
Where does the moderator band extend from?
Extends from the anterior papillary muscle to the ventricular septum.
106
What is the name of the wall separating the left and right ventricles?
Interventricular septum
107
What is systemic circulation?
Systemic circulation is the part of the cardovascular system which carries oxygenated blood away from the heart, to the body and returns deoxygenated blood back to the heart.
108
Why is the left ventricles the thickest heart chamber?
Because it pumps blood around the systemic circulatory system, which is much further than to the lungs like the right ventricles.
109
What does the anterior inter-ventricular branch (Left anterior descending) supply?
Both the ventricles and the anterior two-thirds of the interventricular septum.
110
What two branches does the left coronary artery divide into?
- Anterior interventricular branch (Left anterior descending artery)
- Circumflex branch
111
What does the right coronary artery supply?
Supplies the right atrium and the Sinoatrial node.
112
Where does the right coronary artery arise?
It's opening is located just superior to the right aortic cusp (in the aortic valve) where it then flows along the right coronary sulcus.
113
What two branches does the right coronary artery divide into?
- Right marginal branch
| - Posterior interventricular branch.
114
What is collateral circulation in coronary arteries and how can it provide protection against myocardial infarction? (use anastomes in the answer)
Blockage of coronary arteries can cause ischemic damage (blockage of blood to tissue) which may result in a myocardial infarction (due to death of myocardium). Protection from this is provided through anastomes which are points of convergence in the arteries to provide an alternative route of blood - this is collateral circulation (the process of allowing an alternative route of blood to the myocardium if the primary route becomes blocked).
115
In most organs, blood flow increases during ventricular systole (contraction) as blood is being forced through the arteries. However, this is the opposite in coronary arteries. I.e when the hear relaxes, blood flow increases. Give 3 reasons to why this occurs.
1 - Contraction of the myocardium during ventricular systole constricts the coronary arteries, thus obstructing them.
2 - During ventricular constriction the aortic valve is forced open and its cusps cover the openings of the coronary arteries so no blood can flow into them.
3 - During ventricular relaxation, some blood forced into the arteries travels back towards the heart. Some of this blood then flows into the coronary arteries. Explaining why blood flow increases during relaxation. (like a hole in a water bucket).
116
Name 4 parts of venous drainage in the coronary circulation.
Great cardiac vein
Posterior interventricular vein
Left marginal vein
Coronary sinus.
117
Describe the coronary sinus
A large transverse vein located in the coronary sulcus on the posterior side of the heart.
Collects blood from small veins, great cardiac vein, posterior atrioventricualr vein and the left marginal vein.
Empties blood into the right atrium.
118
What are the 4 main valves of the heart?
Tricuspid
Pulmonary semilunar
Bicuspid/mitral
Aortic semilunar
119
What does the tricuspid valve separate?
Right atrium and right ventricle.
120
What does the pulmonary semilunar separate?
Right ventricle and pulmonary trunk.
121
What does the bicuspid/mitral valve separate?
Left atrium and left ventricle.
122
What does the aortic semilunar valve separate?
Left ventricle and ascending aorta.
123
Where is the fossa ovalis located?
Right atrium.
124
What is the fossa ovalis a remnant of?
Foramen ovale
125
What is the name for the parallel ridges located in the walls of the atria?
Pectinate muscles.
126
What is the name of the upper front region of the right ventricle?
Conus arteriosus
127
What is the name of the tissue separating the right and left atria?
Interatrial septum.
128
What is the function of the formen ovale during fetal development?
Allows the passage of blood from the right atrium to the left atrium, bypassing the fluid filled non-functioning lungs while the fetus obtains its oxygen from the placenta.
129
How is the fossa ovalis formed?
After birth, the introduction of air into the lungs decreases the pressure in the pulmonary circulation system. The change in pressure pushes the spetum primum against the arterial septum, slosing the formen ovale, these eventually fuse and seal, leading to the formation of a depression called the fossa ovalis.
130
Where would you place a stethoscope to listen to the sound generated by the tricuspid valve?
5th intercostal space at right sternal margin.
131
Where would you place a stethoscope to listen to the sound generated by the the aortic semilunar valve?
2nd intercostal space at right sternal margin.
132
Where would you place a stethoscope to listen to the sound generated by the mitral valve?
5th intercostal space at left sternal margin.
133
Where would you place a stethoscope to listen to the sound generated by the pulmonary semilunar valve?
2nd intercostal space at left sternal margin.
134
What anatomical parts of the respiratory system lie in the conduction region?
Nasal cavities, nasopharynx, larynx, trachea, bronchii, bronchioles
135
What is the function of the conduction region?
To condition the air in preparation for gaseous exchange in the respiratory region.
136
What 3 processes does conditioning consist of in the conduction region?
Humidifying (By serous and mucous secretions)
Warming (by underlying blood vessles)
Filtering (by particles being trapped in the mucous layer)
137
What anatomical location is the last part of the conduction region?
Bronchioles
138
What word describes the splitting of the trachea into the left and right bronchii?
Bifurcation
139
What is the name of the region where the trachea bifurcates?
Carnia
140
At what vertebral level does the trachea bifurcate?
At the sternal angle (T4-T5)
141
Why is there cartilage in the trachea and the bronchi?
The trachea consists of between 16-20 C shaped hayline cartliage discs, these portions of connective tissue provide strength and stability, allowing the trachea and bronchii to flex and move during inhalation/expiration
142
Why is there no cartilage in smaller respiratory vessels?
Cartilage (being connective tissue) is strong and sturdy, this would drastically increase the diffusion time of the respiratory region thus making passive diffusion less efficient.
Also, the bronchioles are surrounded by smooth muscle as they're requires to contract and relax in order to alter the diameter of the lumen, cartilage would make this very difficult and much needed energy would be wasted in order to overcome the cartilaginous obstacle.
143
What does the respiratory mucosa consist of?
Epithelium and a thin underlying connective tissue region called the Lamina Propria
144
What cell types does the respiratory mucosa epithelium consist of?
Tall columnar pseudostratified cells with cilia and goblet cells (mucous secreting cells)
145
What is the function of the Lamina Propria in the trachea?
Located beneath the epithelium, the lamina propria is a thin layer of connective tissue containing elastin, this region is responsible for the elastic stretch and recoil of the trachea during inspiration and expiration.
146
Describe the submucosal layer of the trachea.
Contains mixed sero-mucous glands. The watery secretions humidify the inspired air whilst the goblet cells secrete mucous which traps particles allowing air filtration.
147
What type of cells are present in the broncholes?
Larger bronchioles have ciliated large columnar cells whilst smaller have non-ciliated cells. These don't contain goblet cells, instead they contain Clara cells. These secrete a component for surfactant.
148
What is the function of surfactant in the lungs?
Surfactant is a mixture of proteins and lipids. This mixture lowers the surface tension between the air/liquid interface within the alveoli of the lung.
149
What can happen to the bronchioles during an asthmatic attack?
The diameter of the bronchioles is determined by smooth muscle tone. During an asthmatic attack, the smooth muscle can contract so drastically that it completely shuts off the airway.
150
Stimulation of what nerve induces the contraction of terminal bronchioles?
Vagus nerve (parasympathetic). The lumen of terminal bronchioles is surrounded by smooth muscle, this muscle is innovated by the vagus nerve. Vagus stimulation induces the muscle to contract, thus decreasing the diameter of the lumen.
151
Which bronchus is a foreign object likely to travel down and why?
It is more likely to travel down the RIGHT BRONCHUS.
The left lung is smaller than the right due to the heart being located towards the left side of the chest cavity, as a result the left bronchus is smaller than the right and orientated at more of an angle to bypass the heart, the right bronchus however is larger and more vertically orientated thus making it the first and easiest location for a foreign inhaled object to travel.
152
Why is it difficult to study the respiratory regions of the lungs?
Because, when removed, the lungs collapse.
153
What type of cells are present in respiratory bronchiole epithelium?
Ciliated cuboidal cells, also with the presence of clara cells.
154
What is a pneumocyte? and how many types are there?
An alveolar cells. 2 Types: Type 1 pneumocytes and Type 2 pneumocytes.
155
Describe type 1 pneumocytes
Large flattened cells with a very thin diffusion barrier connected to eachother by tight junctions. Squamous.
156
What alveolar area do type 1 pneumocytes constitute for?
95% of total alveolar area.
157
Describe type 2 pneumocytes
Shorter and fatter cells with a paler staining nuclei. Connected to the epithelium and constituent cells via tight junctions. Cuboidal
158
What alveolar area do type 2 pneumocytes constitute?
5% or total alveolar area but constitute 60% of total number of alveolar cells.
159
What is the function of type 2 pneumocytes?
Secrete surfactant which lowers the surface tension of the air/liquid interface in the alveoli, this helps prevent alveoli from collapsing.
160
What are the 4 types of parietal pleura surrounding the lungs?
Mediastinal pleura
Cervical pleura
Costal pleura
Diaphragmatic pleura
161
What does parietal pleura cover?
Covers the internal surface of the thoracic cavity
162
What does the visceral pleura cover?
The lungs.
163
What is the pleural cavity?
The potential space between the parietal and visceral pleura containing serous fluid.
164
What is the function of the serous fluid in the pleural cavity?
Has 2 functions:
- Acts as a lubricant allowing the Parietal and visceral pleurae to slide on top of one another
- Acts to provide surface tension pulling the parietal and visceral pleurae closer together, this ensures that when the thorax expands, so do the lungs, thus filling them with air.
165
What condition occurs when air enters the pleural cavity?
Pneumothorax - collapsed lung. When air enters the pleural cavity, the surface tension is then lost, thus causing the lung to collapse.
166
What is a plueral recess?
These are potential spaces in the pleural cavity where, particularly during expiration, the visceral and parietal pleurae are relatively distant.
167
Name two pleural recesses.
Costodiaphragmatic
| Costomediastinal
168
Where is the costodiaphragmatic recess located?
Located between the costal pleurae and diaphragmatic pluerae
169
Where is the costomediastinal recess located?
Located between the costal pleurae and mediastinal pleurae behind the sternum.
170
What is the clinical relevance of pleural recesses?
They are locations where excess serous fluid can be removed. This condition is called Pleural Effusion.
171
What is pleural effusion and when does it occur?
```
Abnormal volume of fluid around the lung.
Can occur during:
- Congestive heart failure
- Pneumonia
- Liver disease (cirrhosis)
- Plumonary embolism
- Nephrotic syndrome
- End stage renal disease
- Lupus and auto immune diseases.
```
172
What mediastinal structures does the medial surface of the right lung lie in close proximity to?
```
Esophagus
Inferior vena cava
superior vena cava
heart
azygous vein
```
173
What mediastinal structures does the medial surface of the left lung lie in close proximity to?
Esophagus
heart
aortic arch
thoracic aorta
174
How many lobes is the left lung divided into? and what is the name of the fissure which divides them?
2 - superior and inferior lobes divided by an Oblique fissure
175
How many lobes is the right lung divided into? and what is the name of the fissure which divides them?
3 - superior, middle and inferior lobes. The superior and middle lobes are divided by the Horizontal fissure whilst the middle and inferior lobes are divided by an oblique fissure.
176
At what anatomical location is the horizontal fissure found in the right lung?
4th rib
177
What what anatomical location is the oblique fissure found in the right lung?
2nd thoracic vertebrae (T2) - rib 6
178
What is the purpose of the C shaped rings of Hyaline cartilage in the Trachea?
The cartilage reinforces the trachea and helps prevent it form collapsing during inhalation.
179
Where is the trachealis muscle and what is its function?
The Open part of the C faces posteriorally and is spanned by smooth muscle, this is the trachealis muscle. The gap in the C shape allows the esophagus to expand as swallowed food passed through it. The trachealis muscles contract and relax to regulate airflow.
180
What is the name for the process of debris removal in the trachea and describe how it occurs.
Mucociliary escalator. Mucous is secreted by goblet cells in the trachea, this traps any foreign particles or bacteria, the upward beating of cilia (present on ciliated cells) transports the mucous to the pharynx where it's swallowed.
181
Why is the right lung shorter than the left?
Because the right lobe of the liver rises higher than the left, thus shortening the right lung.
182
Why is the left lung narrower than the right?
The heart is present on the left side of the thoracic cavity, its presence in the left side of the mediastinum means the left lung has to cater for its occupation, it does this in the form of a cardiac impression, thus narrowing the lung.
183
What are the divisions of the bronchii called that supply the lung lobes?
Superior, middle (only right) and inferior lobar bronchi (secondary)
184
What do the lobar bronchii divide into?
Segmental (tertiary) bronchi
185
How many segmental (tertiary) bronchi are in the right lung?
10
186
How many segmental (tertiary) bronchi are in the left lung?
8
187
What blood vessel services the bronchial tree and where does it arise?
Bronchial artery, arises from the aorta and carries systemic blood (carries oxygenated blood away from the heart and deoxygentated blood back to the heart)
188
Describe the passage of air through the respiratory centre, beginning with the nasal cavity and ending in the alveoli.
Nasal cavity - Pharynx - trachea - main bronchus- lobar bronchus - segmental bronchus - bronchiole - terminal bronchiole -( respiratory bronchiole - alveolar duct - atrium - alveoli.) Those in brackets have alveoli along their walls.
189
Describe venous drainage in the lungs.
Bronchial veins provide venous drainage in the lungs.
The right bronchial vein drains into the Azygous vein
The left bronchial vein drains into the Accessory hemiazygous vein.
190
Describe the nerve supply to the lungs
Nerves supplied by a collection of nerve fibres called the Plumonary Plexus.
Consists of parasympathetic (vagus), sympathetic (sympathetic trunk) and visceral nerve fibres.
191
What is the function of parasympathetic nerve fibres in the lungs?
Stimulate secretions from bronchial glands
Stimulates constriction of bronchial smooth muscle
Stimulates vasodilation of plumonary blood vessels
192
What is the function of sympathetic nerve fibres in the lungs?
Stimulates relaxation of bronchial smooth muscle
| stimulates vasoconstriction of pulmonary blood vessels.
193
What is the function of visceral nerve fibres in the lungs?
Conduct pain impulses to the sensory ganglia of the vagus nerve.
194
What is pulmonary embolism?
The obstruction of a pulmonary artery by a substance that has traveled from elsewhere in the body.
195
Name and describe 3 types of pulmonary embolism
Thrombus - most common type, occurs in distal veins
Fat - Occurs after a bone fracture or orthopaedic surgery
Air - Occurs following a cannulation in the neck
196
Describe and locate the thoracic diaphragm.
The chest is bound to the ribcage laterally and the thoracic diaphragm internally.
The thoracic diaphragm separates the diaphragm and the abdomen
the aortic hiatus is located at vertebrae level T12
It is pierced by the eosophagus and the inferior vena cava.
197
Describe the location and origin of the vagus nerve through the throax and the structures they supply.
Vagus nerve originates from the medulla of the brainstem and exists the cranium via the jugular foramen. It enters the chest from the neck close to the sides of the trachea and eosophagus, supplying the organs of the chest before penetrating the chest to supply the abdominal viscera.
198
What is the abdominal viscera?
The rogans enclosed in the abdominal cavity, i.e stomach, intestines, digestive tract, spleen, pancreas, liver ect.
199
Describe the location and origin of the phrenic nerve through the thorax and the structures it supplies.
Lies lateral to the vagus nerve (there's a left and right one).
It arises in the neck (C3-C5) and runs parallel to the heart vessels. It passes in front of the root of each lung and goes on to supply the pericardium and diaphragm
200
What can damage to the phrenic nerve cause?
Mediocre damage causes a hiccup motion in that the diaphragm contracts abnormally, resulting in a small intake of air.
Server damage can cause complete paralysis of the diaphragm, making it difficult for the patient to control breathing.
201
Where is the boundary (demarcation) for the superior mediastinum?
It is demarcated by a horizontal plane passing through the body of the 4th Thoracic vertebrae and manubrio-sternal joint. At this level of the arch, the aorta gives off the brachiocephalic trunc, left carotid artery and left subclavian.
202
What is the thymus gland and where is it located?
The thymus gland is made up of two lobes. It is positioned between the lungs, posterior to the sternum and anterior to the heart. Its role is to produce T lymphocytes for the immune system.
Atrophies (wastes away) with age. Gets smaller on approach to puberty.
203
Why is the left interventricular artery considered a critical coronary vessel?
Because it supplies 50% of the left ventricle with oxygenated blood.
204
What does the left coronary artery split off into anteriorally and posteriorally?
Splits anteriorally into the anterior interventricular artery
Splits posteriorally into the circumflex artery.
205
What does the circumflex artery supply?
Supplies the posterolateral left ventricle and the SA node in 38% of people.
206
What does the left interventricular artery supply?
Anteriolateral myocardium, apex and interventricular septum.
207
What does the right coronary artery split off into anteriorally and posteriorally?
Splits anteriorally into the marginal artery
| splits posteriorally into the posterior interventricular artery.
208
What does the marginal artery supply?
Supplies all surfaces of the right ventricle
209
What does the posterior interventricluar artery supply?
Supplies the posterior interventricular septum
210
Identify the interventricular septum and its significance.
The wall separating the left and right ventricles.
The greater portion (the left side) is thicker and muscular and constitutes the muscular interventricular septum. This contributes the pumping action of the left ventricle.
211
Where is the SA node located?
Wall of the right atrium
212
What is the AV node and what is its function?
Specialised tissue located between the Atria and ventricles. The AV node delays the impluses produced by the SA node by 0.12s, ensuring the the atria have ejected all of their blood into the ventricles, before the ventricles contract.
213
Where would you listen to heart sounds? (4 corners of the heart, what are they and where are they located?)
Aortic valve - located 2nd intercostal space at right sternal margin
Pulmonary valve - located 2nt intercostal space at left sternal margin
Mitral valve - Located at 5th intercostal space at left sternal margin (apex of heart, in line with the middle of the clavicle)
Tricuspid valve - Located at 5th intercostal space at right sternal margin.
214
What are the 3 lateral, flat abdominal muscles?
External oblique
Internal oblique
Transversus Abdominis.
215
What are the other 2 abdominal muscles?
Rectus Abdominis
| Pyramialis
216
What is the rectus sheath? and what is its function?
A sheath formed from the aperneuroses of the 3 flat muscles.
| Function is to enclose the rectus abdomnis and pyramidalis
217
How are the anterior and posterior walls of the rectus sheath formed?
Anterior - Formed by the aponeurosis of the external oblique and half of the internal oblique
Exterior - Formed by the aponeurosis of half of the internal oblique and the transversus abdominis
218
What is the arcuate line?
The area of transition between having a posterior wall and not.
219
What artery is the body wall of the abdomen supplied by laterally?
Segmental lumbar arteries which arise directly from the abdominal aorta.
220
What arteries supply the body wall of the abdomen anteriorally?
Superior and inferior epigastric arteries.
221
What is the superior epigastric artery a branch of?
Inferior thoracic artery
222
What is the superior epigastric artery a branch of?
External eliac artery
223
How does the superior epigastric artery pass through the rectus sheath?
Enters the rectus sheath and descends on the posterior surface of the rectus abdominis. It then anastomoses with the inferior epigastric artery within the rectus abdominis.
224
What is the inferior epigastric artery a branch of?
External eliac artery (Banch of the aorta)
225
How does the inferior epigastric artery pass through the rectus sheath?
Enters the rectus sheath and ascends between the rectus abdominis and posterior layer of the rectus sheath.
226
What nerves innovate the muscles of the abdominal wall?
Successive segmental nerves from thoracic segment T8 to Lumbar segment L1
227
What are the anatomical divisions of the abdominal cavity?
Right hypochondriac - Epigastric - Left hypochondriac
Right lumbar - Umbilical region - Left lumbar
Right iliac - hypogastric - left iliac
228
What is the name of the first horizontal line dividing the abdominal cavity?
Transpyloric plane.
229
What is the transpyloric plane?
A horizontal line between the xiphoid process and umbilicus which passes through the pylorus of the stomach.
230
What is the name of the second horizontal line dividing the abdominal cavity?
Intertubercular plane
231
What is the intertubecular plane?
Horizontal line that joins the iliac crests.
232
What is the pylorus?
Part of the stomach that connects the stomach to the duodenum
233
What are the two vertical lines dividing the abdominal cavity called?
Mid clavicular lines. As they run from the middle of the clavicle to the mid-inguinal point.
234
Whats the difference between intraperitoneal and retroperitoneal organs?
Intraperitoneal organs are completely covered in visceral peritoneal
retroperitoneal organs are only covered in peritoneal on their anterior surface.
235
Name retroperitoneal organs. Use the mnemonic SADPUCKER.
```
Superadrenal glands
Aorta
Deuodenum
Pancreas
Urethra
Colon (ascending and descending)
Kidneys
(E)osophagus
Rectum
```
236
What is mesentery?
A double layer of visceral peritoneum surrounding interperitoneal organs and connects them to the posterior abdominal wall.
237
What is the greater omentum? Where does it arise? Where does it attach?
4 layers of peritoneum that descends from the greater curvature of the stomach and proximal part of the duodenum. Attaches to the anterior surface of the transverse colon.
238
What is the lesser omentum? Where does it arise?
Smaller than the greater omentum, the lesser omentum arises from the lesser curvature of the stomach and the proximal part of the duodenum to the liver.
239
What are the two parts of the lesser omentum?
Hepatogastric ligament and hepatoduodenal ligament.
240
What is appendicitis?
Inflammation of the appendix and irritation to the parietal peritoneum. Pain becomes localized to the right iliac region.
241
What is the small intestine divided into?
Duodenum, jejenum and ileum.
242
What does the small intestine extend from and to?
From the pylorus of the stomach to the iliocaecal junction.
243
How many sections is the duodenum divided into?
4 - superior, descending, inferior, ascending
244
Describe the superior section of the duodenum.
Located at vertebrae level L1
Ascends upwards from the pylorus and is connected to the liver via hepatoduodenal ligament
Common site for duodenal ulceration
245
Describe the descending section of the duodenum.
Located at vertebrae level L1 to L3
Curves inferiorally around the head of the pancreas
Marked by the major duodenal papilla - an opening carrying bile and secretions from the pancreas via a duct called the hepatopancreatic ampulla.
246
Describe the inferior section of the duodenum.
Located at vertebrae level L3.
Travels laterally to the left, crossing the inferior vena cava and the aorta.
Located inferior to the pancreas and posterior to the superior mesenteric artery and vein.
247
Describe the ascending section of the duodenum?
Located at vertebrae level L3-L2
| Ascends and curves anteriorally to join the jejunum at the duodenojejunal flexure.
248
What is the name of the sphincter that opens and closes around the hepatopancreatic ampulla?
Sphincter of Oddi.
249
What is the muscle at the duodenojejunal flexure and what is its function?
Suspensory muscle. Contraction widens the angle of the flexure, aiding the movement of intestinal contents
250
What is the name of the valve separating the ileum and the cecum (start of large intestine)
Iliocecal valve.
251
What are the fatty tags on the large intestine called?
Appendices epiploica
252
What are the 3 bands in the outer layer of the large intestine and what do they do?
They're the tenae coli. These for haustrations in the large intestine, giving it it's segmented appearance.
253
Name some differences between the large and small intestine.
Microscopically, small intestine had villi whilst the large intestine doesnt
Anatomically, small intestine has more circular folds (Pilicae circularis) whilst large intestine has haustrations.
254
What are the names of the circular folds in the small intestine?
Pilicae circularis.
255
What is the name of the sharp bend between the ascending and transverse colon? And which abdominal division is it located?
Hepatic flexure. Located in the right lumbar region
256
What is the name of the sharp bend between the transverse and descending colon? And which abdominal division is it located?
Splenic flexure. Located in left lumbar region.
257
Why is the splenic flexure at risk of ischemia during low blood pressure conditions?
It doesnt have its own primary blood supply as it is supplied by the terminal ends of the superior and inferior mesenteric arteries. In low blood pressure, blood isn't forced far enough to reach the distal end of the arteries (the location of the splenic flexure) thus leading to ischemia (lack of blood circulation in this area).
258
Where does the jejunum start?
Duodenojejunal junction
259
Where does the ileum end?
Iliocecal junction/valve.
260
Name 4 differences between the jejunum and ileum.
Jejunum red whilst ileum pink.
Jejunum has less arterial loops than ileum
Jejunum has longer vesa recta.
Jejunum is covered in pilicae circulares whereas the ileum has less folds.
261
What vertebral level does the coeliac trunk branch from the abdominal aorta?
T12
262
What vertebral level does the Superior mesenteric artery branch from the abdominal aorta?
L1/2
263
What vertebral level does the Inferior mesenteric artery branch from the abdominal aorta?
L3/4
264
What does the inferior mesnenteric artery supply?
Last (left, distal) 1/3 of transverse colon, descending colon, sigmoid colon and rectum
265
What does the inferior mesenteric artery branch off into
Left colic artery
sigmoic artery
Superior rectal
266
What does the superior mesenteric artery supply?
Supplies first (proximal) 1/3 of transverse colon, jejunum, ileum, caecum, appendix, ascending colon.
267
What does the superior mesenteric artery branch off into?
Jejunal and ileal arteries
Ileocolic artery
middle and right colic arteries.
268
The middle colic artery is a branch of the superior mesenteric artery, what does it supply?
Ascending colon
269
The right colic artery is a branch of the superior mesenteric artery, what does it supply?
Proximal 1/3 of transverse colon.
270
What do the branches of the superior mesenteric artery anastomose to form?
Marginal artery.
271
What is the beginning of the large intestine called?
cecum
272
What is the junction that separates the cecum from the ascending colon?
Cecocolic junction
273
What is the anatomical position on the surface of the abdomen that the posterior region of the appendix is found?
Mcburney's point
274
What artery supplies the appendix?
Appendicular artery (branch of ileocolic)
275
What is Merckel's Diverticulum?
A vestigal remnant of the Vitelline duct. Found around 10cm from the end of the ileum. Malformation of gastrointestinal tract found in 2% of people.
276
Name come of the contents of the foregut
Respiratory tract, trachea, lungs, stomach, osophagus, liver, gall bladder, pancreas, upper duodenum
277
Name come of the contents of the midgut
Lower duodenum, jejunum, ileum, cecum, appendix, ascending colon, 2/3 (proximal) transverse colon.
`
278
Name come of the contents of the hindgut
1/3 (distal) transverse colon, descending, sigmoid colon, rectum.
