Flashcards in Anatomy Deck (131):
Which veins shunt from the portal to the systemic system in esophageal varices?
Left gastric to esophageal
Which veins shunt from the portal to the systemic system in caput medusae.
Para umbilical to superior/inferior epi gastric below the umbilicus and superior epi gastric and lateral thoracic above the umbilicus
Which veins shunt from the portal to the systemic system in internal hemorrhoids?
Superior rectal to middle/inferior rectal veins
What is TIPS?
Transjugular intrahepatic portosystemic shunt between the portal and hepatic vein
Where is the CTZ zone located?
On the dorsal aspect of the medulla at the caudal end of the 4th ventricle (area postrema)
Where is the inferior thyroid artery?
Arises from subclavian.
Behind the carotid artery and jugular vein
Supplies the inferior pole of the thyroid gland
Where is the ansacervicalis?
Arises from C1-3 and innervates muscles in anterior neck
Where would penetrating trauma be to injure ansa cervicalis.
To the neck superior to cricoid cartilage
What nerve is injured with a positive Trendelenburg sign?
What would injury to the obturator nerve cause?
Loss of adduction
Loss of medial thigh sense
What would injury to the inferior gluteal nerve cause?
Glut max problems - can't climb stairs or get up from a chair
Extension and external rotation
What is lost in an injury to the femoral nerve?
Loss of knee reflex and anterior thigh sensory
What courses through the cribiform plate?
What goes through the optic canal?
Central retinal vein
What goes through the superior orbital fissure?
CN III, IV, V1, VI, ophthalmic vein, sympathetic fibers
What goes through foramen rotundum?
What goes through foramen ovale?
What goes through foramen spinosum?
Middle meningeal artery and vein
What are is the middle meningeal artery from?
What goes thru the internal acoustic meatus?
CN VII, VIII
What goes thru the jugular foramen?
CN IX, X, XI
What goes thru the hypoglossal canal?
What goes thru foramen magnum?
Spinal roots of CNXI, brain stem, vertebral arteries
What would injury to the middle frontal gyrus cause?
Deviation of eyes to the ipsilateral side (FEF lesion)
What is the area injured in Wernicke's aphasia?
Superior temporal gyrus (Brodmann 22)
From injury to posterior branch of middle cerebral artery
At what level does the facial nerve arise in the brain stem?
Dorsolateral aspect of the pontomedullary jxn
Where does oculomotor nerve arise in the brainstem?
The level of superior colliculus (mesencephalon)
Where does the trochlear nerve arise?
At level of inferior colliculus (crosses before exiting brainstem)
What nerve courses with the inferior thyroid artery?
Recurrent laryngeal nerve
Where does the recurrent laryngeal branch loop on the right?
Below the subclavian
Where does the recurrent laryngeal nerve loop on the left?
Around the aortic arch
What does the recurrent laryngeal nerve supply?
All muscles of the larynx except cricothyroid
What does injury to the recurrent laryngeal nerve cause?
Unilateral = hoarseness
Bilateral = respiratory difficulty
Which ribs overlie the spleen?
Where do T cells become double positive?
In the cortex of the thymus
Where do T cells undergo negative selection?
In the medulla
What leads have Q waves with an anterior wall MI?
Where is the infarction if leads II, III, aVF have q waves?
Where is the infarction if q waves are seen in leads V4-V6?
Anterolateral - lateral and posterior walls of left ventricle
Where is the infarction if you can see q waves in leads I and aVL?
Lateral wall of LV
Where is the infarction if q waves are in V1-V2
What structure does RCA provide?
SA and AV nodes
Posterior 1/3 of the inter ventricular septum and posterior walls of the ventricles
What does the LCX provide?
Supplies lateral and posterior walls of the left ventricle
What does the LAD supply?
The anterior 2/3 of the septum
Anterior papillary muscle
Anterior surface of the left ventricle
Where is the left atrium?
Base of the heart
What can enlargement of the left atrium cause?
Dysphagia and hoarseness due to compression of the left recurrent laryngeal nerve
Where are gastric glands located?
Which areas of the colon are most susceptible to ischemia?
Splenic flexors (watershed area from SMA and IMA)
Sigmoid colon (btween IMA and hypo gastric arteries
What is contraindicated in a patient suspects of toxic mega colon?
Colonoscopy and barium enema - perforation
What does the falciform ligament do?
Connects the liver to the anterior abdominal wall
Which ligament connects the greater and lesser sacs?
Which ligament holds the gastric arteries?
Which ligament separates the greater and lesser sacs on the right? The left?
What are the layers of the gut wall?
Mucosa = laminate propria, muscularis mucosa, epithelium
Submucosa = regulates BF, secretions, absorptions, meissner's
Muscularis externa = inner circular, myenteric nerve plexus (auerbach's), outer longitudinal
What is the histo of the duodenum?
brunner's glands (secrete alkaline fluid)
Crypts of lieberkuhn (have gi stem cells)
Tubular glands in submucosl layer
What is the histo of the jejunum?
Heavy lymphocytic infiltrate in the laminate propria
Crypts of lieberkuhn
What is the histo of the ileum?
Peyer's patches (laminate propria, submucosa)
Most goblet cells in small intestine
What is the histo of the Colon?
Lots of goblet cells
Ulcers in the lesser curvature of the stomach cause bleeding from what artery?
Obstruction of the splenic artery causes ischemia thru which bvs?
Short gastric because left gastroepiploic has good anastomoses
Which part of the duodenum is close to the head of the pancreas?
Which part of the duodenum is close to the aorta, IVC, and SMA?
The 3rd part (transverse)
May get caught between aorta and SMA
Where do internal hemorrhoids drain?
Superior rectal vein --> inferior mesenteric vein --> portal
To deep nodes
Where do external hemorrhoids drain?
Inferior rectal vein --> internal pudendal vein --> internal iliac vein --> IVC
To superficial inguinal nodes
What is the centrilobular portion influenced by?
Contains the p450 system and is furthest away from the portal triad
What are the features of an indirect inguinal hernia?
Lateral to the inferior epigastric vessels
Goes into the scrotum
Occurs due to failure of processes vaginalis to close
Covered by all 3 spermatic layers
Goes through transversalis
What are the features of a direct inguinal hernia?
Medial to the inferior epigastric arteries
Lateral to rectus abdominis
Covered by external spermatic fascia
Where is a femoral hernia?
Below the inguinal ligament
Lateral to pubic tubercle
More common in women and right side
Where are the G cells?
In the Antrum of the stomach
Where are the I cells in the GI tract?
Secrete CCK - delay gastric emptying, gall bladder contraction, relax sphincter of Oddi
Where are the S cells?
Secretin - cause pancreatic bicarbonate secretion and bile secretion
Where are the D cells?
Where are the K cells in the GI tract?
Glucose dependent insulinotropic peptide - increases insulin release and decreases gastric acid secretion
Causes oral glucose to be used more rapidly than IV glucose
Where is VIP secreted from?
Parasympathetic ganglia in sphincters, gallbladder, small intestine
Increases intestinal water and electrolyte secretion
Increases relaxation of sphincters
What secretes bicarbonate in the GI tract?
Mucosal cells of stomach, duodenum, salivary glands, brunner's glands, pancreas
Where are the peyer's patches?
In laminate propria and submucosa of ileum
What artery bleeds from a ruptured ulcer in the posterior wall of the duodenum?
Where does perforation of the duodenum often occur?
In the anterior part of the duodenum,
Where are ulcers in the stomach most often located?
In the lesser curvature of the stomach at the junction of the
Where is zenker's diverticulum
Between the thyropharyngeal and cricopharyngeal parts of the inferior pharyngeal constrictor
Due to cricopharyngeal muscle dysfunction
What is the in the mucosal layer of the gut wall?
Epithelium for absorption
Laminate propria for support
Muscularis mucosa for motility
What is in the submucosa layer of the gut wall?
Meissner's plexus - regulates blood flow, secretions, absorption
What is in the muscularis externa?
Auerbach's - myenteric plexus for contractility
What is the most common location for diverticulum?
Where do volvulus occur?
Cecum (young adult)
Sigmoid colon (elderly)
Where are angiodysplasia located?
In the cecum, terminal ileum and ascending colon
Where does the recurrent laryngeal nerve loop on the right?
Below the right subclavian at the jxn of brachiocephalic artery
Where does the recurrent laryngeal nerve on left?
Under the aortic arch
What lymph nodes does the distal 1/3 of the vagina, vulva, scrotum drain to?
What lymph nodes does the proximal 2/3 of vagina/uterus?
Obturator, external iliac and hypo gastric nodes
What lymph nodes do the glans penis and clitoris drain to?
Deep inguinal nodes
Where do the superficial and deep inguinal nodes drain?
External iliac nodes to the common iliac nodes
What ligament holds the ovarian vessels?
Suspensory ligament of the ovaries
What ligament holds the uterine vessels?
What is contained in the broad ligament?
What nerve mediates ejaculation?
Hypo gastric nerve
What nerve mediates erection?
Where are the Sertoli cells? What do they do?
In seminiferous tubules
Secrete inhibit, Mif, androgen-binding protein to maintain local levels of testosterone
Form blood-testis barrier
What cell makes hCG?
What is the outermost layer of the spermatic cord?
External spermatic fascia (from external oblique)
Originates from proximal tubule cells
Polygonal clear cells
Most common in men 50-70 yo
Ass. With gene deletion in ch.3
Invades renal vein - can present with varicocele
Resistant to chemo and radiation
Palpable flank mass with hematuria in a 2-4 yo
Small blue cells
Associate with beckwith Weismann and WAGR complex
Associated with exposure to phenacetin, rubbers, aniline dyes, cyclophosphamide, leather, textiles, plastics
Papillary growth with pleomorphism
Flat growth = high grade from p53 mutations
Presents with painless hematuria
Transitional cell carcinoma
Can be in calyces, pelvis, ureters, or bladder
Arises from urachal remnant at the dome of bladder
Chronic inflammatory infiltrate
Located As cystic and solid mass in Posterior fossa
Rosenthal fibers -Eosinophilic corkscrew
Midline cerebellum tumor of blue cells
Homer wright rosettes
Associated with Turcot's
Drop mets to spinal cord
Rod-shaped blepharoplasts found near nucleus
Found in 4th ventricle
Can secrete EPO
Cystic spaces with brown fluid and cholesterol
Keratin pearls lined by stratified squamous
May cause bitemporal hemianopsia
Impaired upward gaze
Germinoma in dorsal midbrain
Stains for GFAP
Pseudopalisading pleomorphic tumor cells
Central areas of necrosis and hemorrhage
May cross midline
Mutations in PDGF, p53, EGFR
Spindle cells with whorled pattern
Near parasagittal brain and surfaces
From arachnoid villi cells
May have dural attachment
Due to loss of Merlin in ch.22
Chicken-wire capillary pattern
Round nuclei with clear cytoplasm
Due to loss of heterozygosity
Only in white matter
Most often in frontal lobes
Present with facial numbness/weakness, tinnitus, hearing loss
Regular, oval nuclei with areas of dense, loose growth
Grows in epiphysis of long bones
Soap bubble or double bubble on X-ray
Spindle cells with multinucleated cells (grow in synctium)
Large red/brown cystic degeneration
Giant cell osteoclastoma
Bony stalk near growth plate of long bones
Mature bone with cartilaginous cap
In metaphysis of long bones
Makes new bone - mixed lytic/blastic lesion in X-ray
Mutations in RB
Rf: Paget's disease! Radiation, bone infarcts
In boys under 15
Arises in diaphysis
Anaplastic blue cell tumor
Responsive to chemo
Onion skin appearing in bone
Associated with t(11;22) translocation
Homer wright rosettes, necrosis/hemorrhage
May have systemic systems: fever, increased ESR, anemia, increased WBCs
Usually located in pelvis, spine, scapula, humerus, tibia or femur
Expansive glistening mass within medullary cavity
Pink pearly nodules with telangectasias
Driven by activating mutation in BRAF kinase
Nodular form is the worst
Orphan-Annie nuclei, nuclear grooves
Most common type
Papillary thyroid carcinoma
Uniform cells in capsule that are invading
Spreads hematogenous lay
Follicular carcinoma of thyroid
Sheets of cells in amyloid stroma
Associated with RET mutation
Can present with hypocalcemia
From para follicular cells (neuroectoderm)
Medullary carcinoid of the thyroid
Where do the ureters course?
On top of psoas
Under the uterine artery and ductus deferens
Crosses over external iliac artery and vein
Medial to gonadal veins and lateral to the internal iliac
What is the blood supply to the ureter?
Upper = renal artery
Distal = branches of aorta, iliac, gonadal
Where is the SVC in relation to the other vessels?
The SVC is to the right of the aorta
The aorta is in the middle of the SVC and pulmonary trunk
What are the retroperitoneal structures?
Supra renal gland
Aorta and IVC
Duodenum (2nd and 3rd parts)
Esophagus (lower 2/3)
What ligament holds the portal triad?