Block 2 Review Slides from Thoracic Cavity2-end Flashcards
(112 cards)
1
Q
Inguinal Canal:
Openings:
Deep inguinal ring:
• opening in _________ fascia
• located about __ inch above inguinal ligament, halfway between ASIS and pubic tubercle
• inferior epigastric vessels pass _____ to deep _____ ring
A
- opening in transversalis fascia
- located about 1⁄2 inch above inguinal ligament, halfway between ASIS and pubic tubercle
- inferior epigastric vessels pass medial to deep inguinal ring
2
Q
Jejunum and Ileum
Lymph Drainage:
• The lymph vessels pass through many intermediate ________ nodes and finally reach the
superior _______ nodes, which are situated around the origin of the superior ______ artery.
A
Lymph Drainage:
• The lymph vessels pass through many intermediate mesenteric nodes and finally reach the
superior mesenteric nodes, which are situated around the origin of the superior mesenteric
artery.
3
Q
Arteries of the Anterior Abdominal Wall:
-branches of ____________ artery (terminal branch of internal thoracic artery)
• contribute to supply ______ abdominal wall, just inferior to _____ margin
A
branches of musculophrenic artery (terminal branch of internal thoracic artery)
• contribute to supply anterior abdominal wall, just inferior to costal margin
4
Q
Abdominal cavity structures:
Stomach:
Relations:
Anteriorly:
• \_\_\_\_\_\_ abdominal wall
• left costal margin
• Diaphragm
• _(right/left)_ lobe of liver
Posteriorly (stomach bed): • Diaphragm • Spleen • _(upper/lower)_ part of left kidney • _(left/right)_ suprarenal gland • splenic artery • Pancreas • transverse mesocolon (separated from stomach by lesser sac)
A
Relations: • anteriorly: • anterior abdominal wall • left costal margin • Diaphragm • left lobe of liver
- posteriorly (stomach bed):
- Diaphragm
- Spleen
- upper part of left kidney
- left suprarenal gland
- splenic artery
- Pancreas
- transverse mesocolon (separated from stomach by lesser sac)
5
Q
External Oblique:
Superficial inguinal ring
• opening in _____ oblique aponeurosis located immediately _____ to pubic tubercle
• it is the anterior (superficial) opening of _____ canal
A
- opening in external oblique aponeurosis located immediately superior to pubic tubercle
- it is the anterior (superficial) opening of inguinal canal
6
Q
Celiac Trunk:
branches of splenic artery:
- numerous pancreatic branches (as many as 10):
- supply ____, ____ and ____ of pancreas
Left gastroepiploic (gastroomental) artery: • originates near \_\_\_\_ of spleen • reaches greater curvature of stomach in \_\_\_\_\_\_\_\_\_\_ ligament and runs along greater curvature from _(left/right)_ to _(left/right)_ → anastomoses with right gastroepiploic artery
Short gastric arteries (5 or 6 in number):
• originate ____ to hilum of spleen
• reach stomach in gastrosplenic ligament and supply _____ of stomach
Terminal branches;
• enter spleen through its hilum
A
branches of splenic artery:
• numerous pancreatic branches (as many as 10):
• supply neck, body and tail of pancreas
Left gastroepiploic (gastroomental) artery:
• originates near hilum of spleen
• reaches greater curvature of stomach in gastrosplenic ligament and runs along greater curvature
from left to right → anastomoses with right gastroepiploic artery
Short gastric arteries (5 or 6 in number):
• originate close to hilum of spleen
• reach stomach in gastrosplenic ligament and supply fundus of stomach
Terminal branches;
• enter spleen through its hilum
7
Q
Pancreas
Blood supply
- Lymph Drainage:
• Lymph nodes are situated along the arteries that ____ the gland.
• The efferent vessels ultimately drain into the ____ and superior _____________ lymph nodes.
A
Lymph Drainage:
• Lymph nodes are situated along the arteries that supply the gland.
• The efferent vessels ultimately drain into the celiac and superior mesenteric lymph nodes.
8
Q
Liver:
- right limb of _ (right sagittal fissure) formed:
• anteriorly by _____ for gallbladder
• posteriorly by groove for ___
- left limb of H (left sagittal fissure) formed:
• anteriorly by fissure for _____ ligament of liver (ligamentum teres hepatis)
• posteriorly by fissure for ligamentum venosum
A
- right limb of H (right sagittal fissure) formed:
- anteriorly by fossa for gallbladder
- posteriorly by groove for IVC
- left limb of H (left sagittal fissure) formed:
- anteriorly by fissure for round ligament of liver (ligamentum teres hepatis)
- posteriorly by fissure for ligamentum venosum
9
Q
Celiac Truck
Branches:
Right gastric artery
- usually originates from proper ______ artery
- descends to ____ end of stomach
- runs to the left along _____ curvature of stomach
- anastomoses with _(right/left) gastric artery
A
- usually originates from proper hepatic artery
- descends to pyloric end of stomach
- runs to the left along lesser curvature of stomach
- anastomoses with left gastric artery
10
Q
Anterior Abdominal Wall
Vertical and horizontal planes:
- _______ plane that passes through lower part of body of L_
- located about midway between ____ notch of ____ and pubic symphysis
A
- horizontal plane that passes through lower part of body of L1
- located about midway between jugular notch of sternum and pubic symphysis
11
Q
The jejunal mesentery is attached to the _____ abdominal wall above and to the (right/left) of the aorta,
whereas the ileal mesentery is attached _____ and to the (left/right) of the aorta.
A
The jejunal mesentery is attached to the posterior abdominal wall above and to the left of the aorta,
whereas the ileal mesentery is attached below and to the right of the aorta.
12
Q
The jejunal wall feels thicker because the permanent infoldings of the _____ membrane, the _____
circulares, are larger, more numerous, and _____ set in the jejunum, whereas in the upper part of the ileum
they are smaller and more ____ separated and in the lower part they are absent.
A
The jejunal wall feels thicker because the permanent infoldings of the mucous membrane, the plicae
circulares, are larger, more numerous, and closely set in the jejunum, whereas in the upper part of the ileum
they are smaller and more widely separated and in the lower part they are absent.
13
Q
Abdominal Aorta Branches: - visceral branches: UNPAIRED: • celiac trunk • \_\_\_\_\_\_ mesenteric artery • inferior mesenteric artery PAIRED: • \_\_\_\_ suprarenal arteries • \_\_\_ arteries • gonadal (testicular/ovarian) arteries
A
Branches: • visceral branches: • unpaired: • celiac trunk • superior mesenteric artery • inferior mesenteric artery • paired: • middle suprarenal arteries • renal arteries • gonadal (testicular/ovarian) arteries
14
Q
Lymphatic drainage of thymus?
A
Lymphatic drainage:
- the internal thoracic arteries (parasternal)
- the tracheal bifurcation (tracheobronchial)
- in the root of the neck
15
Q
Phrenic Nerve: - branch of \_\_\_\_\_ \_\_\_\_\_\_ - contains fibers from \_\_\_\_\_ \_\_\_\_ of \_\_, \_\_ and \_\_ spinal nerves
A
branch of CERVICAL PLEXUS
contains fibers from VENTRAL RAMI of C3, C4 and C5 spinal nerves
16
Q
parts of the SVC and where are they located
A
upper part located in:
superior mediastinum
lower part located within:
pericardial sac, in middle mediastinum
17
Q
Duodenum
- Relations of first part:
Anteriorly:
• The quadrate lobe of the ____ and the _______
A
Anteriorly:
• The quadrate lobe of the liver and the gallbladder
18
Q
Arteries of the Anterior Abdominal Wall:
deep circumflex iliac artery
• originates from distal part of external iliac artery (just above inguinal ligament)
• runs superiorly and laterally toward ASIS and continues along iliac crest
• supplies lower lateral part of anterior abdominal wall
A
deep circumflex iliac artery
• originates from distal part of external iliac artery (just above inguinal ligament)
• runs superiorly and laterally toward ASIS and continues along iliac crest
• supplies lower lateral part of anterior abdominal wall
19
Q
Pancreas
Blood Supply
- Veins:
• The corresponding veins drain into the ____ system.
A
Veins:
• The corresponding veins drain into the portal system.
20
Q
Inguinal Canal: Openings: Superficial inguinal ring: • opening in aponeurosis of \_\_\_\_\_\_\_ oblique • located immediately \_\_\_\_\_ to pubic tubercle
A
- opening in aponeurosis of external oblique
* located immediately superior to pubic tubercle
21
Q
Thoracic Duct
- (Largest or smallest) lymphatic channel of the body?
- Where does it begin?
- Where does it pass thru?
-Ascends in _____ mediastinum behind esophagus, with azygos vein to its right and descending thoracic aorta to its left in superior mediastinum ascends along (right/left) border of
esophagus to _____ thoracic aperture
• in root of ___ arches to the left, posterior to __(right/left) common carotid artery and (right/left) internal
jugular vein
• terminates at ___ of (right/left) subclavian and left internal ____ veins
A
Largest lymphatic channel of the body
• begins in upper part of posterior abdominal wall (L2 level)
• sometimes begins as a dilated sac (cisterna chyli), but more often by direct confluence of
right and left lumbar lymph trunks and intestinal lymph trunk, which collect lymph from
lower limbs, pelvis and abdomen
• passes through aortic hiatus of diaphragm
• ascends in posterior mediastinum behind esophagus, with azygos vein to its right and
descending thoracic aorta to its left in superior mediastinum ascends along left border of
esophagus to superior thoracic aperture
• in root of neck arches to the left, posterior to left common carotid artery and left internal
jugular vein
• terminates at union of left subclavian and left internal jugular veins
22
Q
the SVC is formed where? Where does it go and describe the path? Tributary:
• azygos vein joins SVC just before it enters pericardial sac
A
posterior to 1st right costal cartilage, at right border of sternum, by union of right and left
brachiocephalic veins
Descends vertically to terminates in upper part of RA, posterior to 3rd right costal
cartilage
23
Q
Testicular Veins
- form a _____ around testicular artery (pampiniform plexus)
- as it ascends, plexus becomes _____ in size and eventually a ____ testicular vein is formed on each side.
- runs _ on posterior abdominal wall (behind peritoneum)
- right testicular vein drains into ___
- left testicular vein drains into (right/left) renal vein
A
• form a plexus around testicular artery (pampiniform plexus)
• as it ascends, plexus becomes reduced in size and eventually a single
testicular vein is formed on each side.
• runs up on posterior abdominal wall (behind peritoneum)
• right testicular vein drains into IVC
• left testicular vein drains into left renal vein
24
Q
Gallbladder
• ____-shaped sac lying on visceral surface of ____
• stores ____ and concentrates it by absorbing ____
A
- Pear-shaped sac lying on visceral surface of liver
* stores bile and concentrates it by absorbing water
25
Duodenum
• Parts of the Duodenum:
The duodenum is situated in the ______ and _____ regions and, for purposes
of description, is divided into ____ parts:
Duodenum
• Parts of the Duodenum:
• The duodenum is situated in the epigastric and umbilical regions and, for purposes
of description, is divided into four parts:
26
major tributaries to brachiocephalic veins?
from neck:
-vertebral and inferior thyroid veins
from thorax:
-internal thoracic vein
27
Duodenum:
Blood supply
Veinous drainage:
• The superior pancreaticoduodenal vein drains into the ______ vein
• The inferior vein joins the superior _______ vein.
* Veinous drainage:
* The superior pancreaticoduodenal vein drains into the portal vein
* The inferior vein joins the superior mesenteric vein.
28
Pancreas
Blood Supply:
-Arteries:
• The splenic and the superior and inferior pancreaticoduodenal arteries supply the pancreas.
Pancreas
* Blood Supply:
* Arteries:
* The splenic and the superior and inferior pancreaticoduodenal arteries supply the pancreas.
29
External Oblique:
Inguinal ligament:
• ____ border of external oblique aponeurosis that extends from ____ to pubic tubercle
• it is folded _____ on itself forming a _____ structure called inguinal ligament forms boundary
between ____ and thigh
• lower border of external oblique aponeurosis that extends from ASIS to pubic tubercle
• it is folded backward on itself forming a trough structure called inguinal ligament forms boundary
between abdomen and thigh
30
Internal Oblique:
Where is it located?
What is the origin?
Insertion?
-Location:
located immediately deep to external oblique
-Origin: thoracolumbar fascia, iliac crest and lateral 2⁄3 of inguinal ligament
Insertion:
-on an anterior view, upper fibers run superiorly and medially (similar to
internal and innermost intercostals) while lower fibers are more horizontal
31
Thymus relations (anterior and posterior)?
anterior relations:
- sternum and adjacent parts of upper 3 costal cartilages,
- anterior margins of pleural sacs and lungs
posterior relations:
- pericardial sac,
- left brachiocephalic vein,
- aortic arch & its branches, trachea
32
```
External Oblique:
Fascia lata (deep fascia of thigh) attaches ______ to inguinal ligament
```
(deep fascia of thigh) attaches superiorly to inguinal ligament
33
Thymus Appearance?
Thymus
• Appearance
• varies considerably with age
• largest in early part of life (until puberty)
• progressively involutes thereafter, and is largely replaced by fat
34
Left Phrenic Nerve:
- Crosses __(right/left)__ side of ____ arch
-passes ____ to root of __(right/left)__ lung
* Descends between ___ sac and ___ pleura
* reaches diaphragm close to ___ of heart
• terminal branches pierce diaphragm to supply ____ part of _______ covering _____ surface
of diaphragm
- Crosses LEFT side of AORTIC arch
- Passes ANTERIOR to root of LEFT lung
- Descends between PERICARDIAL sac and MEDIASTINAL pleura
- Reaches diaphragm close to APEX of heart
- Terminal branches pass pierce diaphragm to supply CENTRAL part of PERITONEUM covering INFERIOR surface of diaphragm
35
the brachiocephalic veins are formed by union of? where?
subclavian & internal jugular veins at root of neck
(posterior to
sternoclavicular joints)
36
Gallbladder:
Parts:
Fundus
• anterior, _____ end which projects below ____ border of liver
• it is in contact with _____ abdominal wall at level of tip of right _th costal cartilage
Body
• middle part of ____________ (between fundus and neck)
• contacts visceral surface of liver (superiorly) and transverse ____ and duodenum (inferiorly)
Neck
• narrow, tapering end, ____ the fundus and directed toward ____ hepatis
• usually makes an _-shaped bend and becomes continuous with ____ duct
Parts:
Fundus
• anterior, rounded end which projects below inferior border of liver
• it is in contact with anterior abdominal wall at level of tip of right 9th costal cartilage
Body
• middle part of gallbladder (between fundus and neck)
• contacts visceral surface of liver (superiorly) and transverse colon and duodenum (inferiorly)
Neck
• narrow, tapering end, opposite the fundus and directed toward porta hepatis
• usually makes an S-shaped bend and becomes continuous with cystic duct
37
Duodenum
Superiorly:
• The entrance into the lesser sac (the ____ foramen)
Superiorly:
| • The entrance into the lesser sac (the epiploic foramen)
38
Arteries of the Anterior Abdominal Wall:
• superficial epigastric and superficial circumflex _____ arteries (branches of femoral artery)
supply _________ structures of ______ part of anterior abdominal wall
• superficial epigastric and superficial circumflex iliac arteries (branches of femoral
artery)
supply superficial structures of lower part of anterior abdominal wall
39
Rectus Abdominis:
| It is ______ and thicker below, broader and _____ above
It is narrower and thicker below, broader and thinner above
40
At the jejunal end of the mesentery, the ___ is deposited near the root and is scanty near the intestinal wall.
At the ileal end of the mesentery, the ____ is deposited throughout so that it extends from the root to the _____ wall.
At the jejunal end of the mesentery, the fat is deposited near the root and is scanty near the intestinal wall.
At the ileal end of the mesentery, the fat is deposited throughout so that it extends from the root to the
intestinal wall.
41
Jejunum and Ileum
Nerve Supply:
• The nerves are derived from the ________ and ______ (vagus) nerves from the superior _______ plexus.
Nerve Supply:
• The nerves are derived from the sympathetic and parasympathetic (vagus) nerves from the
superior mesenteric plexus.
42
Difference between jejunum & Ileum
The jejunum lies _____ in the upper part of the peritoneal cavity below the _(right/left)_ side of the transverse mesocolon; the ileum is in the lower part of the cavity and in the ____.
The jejunum lies coiled in the upper part of the peritoneal cavity below the left side of the transverse
mesocolon; the ileum is in the lower part of the cavity and in the pelvis.
43
Thoracic Sympathetic Trunk:
3 thoracic splanchnic nerves (greater, lesser and lowest/least):
• originate from _(lower/upper) part of thoracic sympathetic trunk (_th ganglion and below), pierce
diaphragm and terminate in _______ (subdiaphragmatic) ganglia in abdomen
• Contain __________ sympathetic and _____ afferent fibers
• 3 thoracic splanchnic nerves (greater, lesser and lowest/least):
• originate from lower part of thoracic sympathetic trunk (5th ganglion and below), pierce
diaphragm and terminate in prevertebral (subdiaphragmatic) ganglia in abdomen
• Contain preganglionic sympathetic and visceral afferent fibers
44
Duodenum
First Part of the Duodenum:
• The first part of the duodenum begins at the _____ and runs upward and backward on the
______ plane at the level of the _st lumbar vertebra.
First Part of the Duodenum:
• The first part of the duodenum begins at the pylorus and runs upward and backward on the
transpyloric plane at the level of the 1st lumbar vertebra.
45
Duodenum:
Nerve Supply:
• The nerves are derived from sympathetic and ______ (vagus) nerves from the celiac and superior mesenteric plexuses.
Nerve Supply:
• The nerves are derived from sympathetic and parasympathetic (vagus) nerves from the
celiac and superior mesenteric plexuses.
46
Right phrenic nerve:
-descends along __(right/left)__ side of _(right/left)_ _____ vein and _____
- Passes _____ to root of _(right/left)_ lung
- Descends between _____ sac and ______ pleura
- Reaches diaphragm on _(left/right)__side of IVC
- Terminal branches pass through ______ opening of diaphragm to supply _____ part of peritoneum covering _____ surface of diaphragm
* descends along RIGHT side of RIGHT BRACHIOCEPHALIC vein and SVC
* passes ANTERIOR to root of RIGHT lung
* descends between PERICARDIAL sac and MEDIASTINAL pleura
* reaches diaphragm on RIGHT side of IVC
• terminal branches pass through CAVAL opening of diaphragm to supply CENTRAL part of peritoneum
covering INFERIOR surface of diaphragm
47
Rectus Abdominis:
| Insertion: _th, _th and _th costal cartilages and xiphoid process
Insertion: 5th, 6th and 7th costal cartilages and xiphoid process
48
Arteries of the Anterior Abdominal Wall:
__th and __th posterior intercostal arteries, ______ artery and _____ arteries
• supply ____ lateral part of anterior abdominal wall
10th and 11th posterior intercostal arteries, subcostal artery and lumbar arteries
• supply upper lateral part of anterior abdominal wall
49
Left brachiocephalic vein:
is (shorter/longer) than right BCV and (vertical or oblique)
. It runs inferiorly and to the (right/left), posterior to _____ and ______(or its remains), to join the ____
Left brachiocephalic vein:
• is longer and oblique
• runs inferiorly and to the right, posterior to manubrium of sternum and thymus (or its remains), to join the. right brachiocephalic vein
50
Celiac Trunk
Proper hepatic artery:
• ascends between two layers of ________________ ligament toward _____ of liver (porta hepatis)
• divides into right and left branches that enter liver through ____ hepatis
• right branch usually gives off _____ artery (supplies gallbladder)
• within lesser omentum, proper hepatic artery lies _____ to (hepatic) portal vein and to the _(right/left)_
of common bile duct
Proper hepatic artery:
• ascends between two layers of hepatoduodenal ligament toward hilum of liver (porta hepatis)
• divides into right and left branches that enter liver through porta hepatis
• right branch usually gives off cystic artery (supplies gallbladder)
• within lesser omentum, proper hepatic artery lies anterior to (hepatic) portal vein and to the left
of common bile duct
51
the SVC returns to heart venous blood from _____ of body: which includes which structures?
Returns to heart venous blood from upper half of body:
| • head and neck, upper limbs, • thoracic wall and some thoracic organs (esophagus, trachea, bronchi, pericardium)
52
Rectus Abdominis:
Divided into segments by _ transverse fibrous bands (tendinous intersections
or inscriptions)
• superior tendinous intersection is just ______ to xiphoid process
• inferior one is at the level of _____
• _____ one is half-way between the other two
divided into segments by 3 transverse fibrous bands (tendinous intersections
or inscriptions)
• superior tendinous intersection is just inferior to xiphoid process
• inferior one is at the level of umbilicus
• middle one is half-way between the other two
53
Internal Oblique:
| has a _(lower/higher)_ free border that arches over contents of ____ canal
has a lower free border that arches over contents of inguinal canal
54
Tributaries of azygos vein:
• _(right/left)_ posterior intercostal veins (except 1st, which drains into right ________ vein)
• posterior intercostal veins of ___ to __ spaces join to form right superior intercostal
vein, which then drains into ____ vein
• posterior intercostal veins of _th to _th intercostal spaces drain directly into azygos
vein
* hemiazygos and accessory hemiazygos veins:
* _____ tributaries (esophageal, right _______, pericardial, ______ veins)
Tributaries of azygos vein:
• right posterior intercostal veins (except 1st, which drains into right brachiocephalic vein)
• posterior intercostal veins of 2nd to 4th spaces join to form right superior intercostal
vein, which then drains into azygos vein
• posterior intercostal veins of 5th to 11th intercostal spaces drain directly into azygos
vein
• hemiazygos and accessory hemiazygos veins:
• visceral tributaries (esophageal, right bronchial, pericardial, mediastinal veins)
55
Pancreas
Blood supply
- Nerve Supply:
• ________ and parasympathetic (vagal) nerve fibers supply the area.
Nerve Supply:
| • Sympathetic and parasympathetic (vagal) nerve fibers supply the area.
56
Duodenum
Inferiorly:
• The head of the ________
Inferiorly:
| • The head of the pancreas
57
Thoracic Sympathetic Trunk
Branches:
• upper ganglia (usually upper _ or _) give off branches to _____ viscera (heart, aorta,
bronchi, lungs, esophagus) → contain _______ sympathetic and ____ afferent
fibers
Thoracic Sympathetic Trunk
• Branches:
• upper ganglia (usually upper 4 or 5) give off branches to thoracic viscera (heart, aorta,
bronchi, lungs, esophagus) → contain postganglionic sympathetic and visceral afferent
fibers
58
Celiac Trunk:
Splenic artery:
• runs to the _(right/left)_, along superior border of pancreas, _____ to stomach and lesser sac (it follows a wavy course)
• on reaching left kidney, it enters _______ ligament and runs to _____ of spleen
• runs to the left, along superior border of pancreas, posterior to stomach and lesser sac
(it follows a wavy course)
• on reaching left kidney, it enters splenoreal ligament and runs to hilum of spleen
59
Thoracic Sympathetic Trunk:
__(Highest/ Lowest least/greatest)__ splanchnic nerve originates from _th ganglion
Lowest/least splanchnic nerve originates from 12th ganglion
60
Internal Oblique:
remaining fibers become continuous with an aponeurosis which inserts into
____ process, ____ alba and pubic bone
remaining fibers become continuous with an aponeurosis which inserts into
xiphoid process, linea alba and pubic bone
61
Internal Oblique:
its lowest tendinous fibers join (lowest/highest)_ endinous fibers of transversus abdominis to
form conjoint tendon which attaches to ____ crest and ____ line
its lowest tendinous fibers join lowest tendinous fibers of transversus abdominis to
form conjoint tendon which attaches to pubic crest and pectineal line
62
Thoracic Sympathetic Trunk:
• (Greater/Lesser) splanchnic nerve originates from _th and _th or __th and _th ganglia
• Lesser splanchnic nerve originates from 9th and 10th or 10th and 11th ganglia
63
Internal Oblique:
upper fibers insert into inferior border of lower _ or _ ribs and their _____
cartilages
upper fibers insert into inferior border of lower 3 or 4 ribs and their costal
cartilages
64
the right brachiocephalic vein is (short/long) and almost (vertical/oblique) it the joins left brachiocephalic vein posterior to ______, at (right/left) border of sternum to form ______
is short and almost vertical, joins left brachiocephalic vein posterior to 1st right costal cartilage, at right border of sternum,
to form superior vena cava
65
Types of Inguinal Hernia:
Indirect inguinal hernia:
• most common type of inguinal hernia (2⁄3 to 3⁄4 inguinal hernias are indirect)
• hernial sac leaves abdominal cavity lateral to _____ epigastric vessels, through deep inguinal ring
• neck of hernial sac is _____
• results from a persistent ________ vaginalis (outpouching of peritoneum that in the ____ is responsible for formation of inguinal canal)
• considered to be ___________ in origin
• more common in ______ and ____ adults
Indirect inguinal hernia:
• most common type of inguinal hernia (2⁄3 to 3⁄4 inguinal hernias are indirect)
• hernial sac leaves abdominal cavity lateral to inferior epigastric vessels,
through deep inguinal ring
• neck of hernial sac is narrow
• results from a persistent processus vaginalis (outpouching of peritoneum
that in the fetus is responsible for formation of inguinal canal)
• considered to be congenital in origin
• more common in children and young adults
66
Azygos Venous System
Azygos Vein
• Azygos vein ascends in ________ to the level of T_
• It arches forward over root of __(right/left)_ lung
• terminates in ___
* Azygos vein ascends in mediastinum to the level of T4
* It arches forward over root of right lung
* terminates in SVC
67
Celiac Trunk
Branches:
Right gastric artery
• usually originates from proper _____ artery
• descends to _____ end of stomach
• runs to the _(right/left)_ along lesser curvature of stomach
• anastomoses with _(right/left)_ gastric artery
Right gastric artery
• usually originates from proper hepatic artery
• descends to pyloric end of stomach
• runs to the left along lesser curvature of stomach
• anastomoses with left gastric artery
68
What are the (3) parts of the aorta?
- Ascending aorta
- Arch of the aorta
- Descending aorta
69
Inguinal Canal:
Contents:
• males → _____ cord (including genital branch of genitofemoral nerve) and ilioinguinal nerve
• females → ____ ligament of uterus (_____ cord that extends from uterus to ____ majus),
genital branch of genitofemoral nerve and ilioinguinal nerve
• males → spermatic cord (including genital branch of genitofemoral nerve) and ilioinguinal nerve
• females → round ligament of uterus (fibrous cord that extends from uterus to labium majus),
genital branch of genitofemoral nerve and ilioinguinal nerve
70
Anterior Abdominal Wall
Vertical and horizontal planes:
Transpyloric plane:
• crosses costal margin on each side at roughly the _th costal cartilage
• passes through opening of ______ into ______ (pyloric orifice), body of pancreas
and ____ of kidneys
• crosses costal margin on each side at roughly the 9th costal cartilage
• passes through opening of stomach into duodenum (pyloric orifice), body of pancreas
and hila of kidneys
71
Jejunum and Ileum
Blood Supply:
Arteries:
- Superior Mesenteric Artery:
• The arterial supply is from branches of the superior _______ artery.
• The intestinal branches arise from the _(right/left)_ side of the artery and run in the mesentery to reach the gut.
• They _____ with one another to form a series of _____.
Jejunum and Ileum
• Blood Supply:
• Arteries:
• Superior Mesenteric Artery:
• The arterial supply is from branches of the superior mesenteric artery.
• The intestinal branches arise from the left side of the artery and run in the mesentery to reach the gut.
• They anastomose with one another to form a series of arcades.
72
Duodenum
Blood Supply:
Arteries:
• The upper half:
• Is supplied by the ______ pancreaticoduodenal artery, a branch of the ______________ artery.
* The lower half:
* Is supplied by the ______ pancreaticoduodenal artery, a branch of the superior ________ artery.
Duodenum
Blood Supply:
Arteries:
• The upper half:
• Is supplied by the superior pancreaticoduodenal artery, a branch of the gastroduodenal artery.
* The lower half:
* Is supplied by the inferior pancreaticoduodenal artery, a branch of the superior mesenteric artery.
73
Abdominal Aorta:
Parietal branches:
* UNPAIRED : median ____ artery
* PAIRED : _____ phrenic arteries, ____ arteries (4 pairs)
* parietal branches:
* unpaired: median sacral artery
* paired: inferior phrenic arteries, lumbar arteries (4 pairs)
74
Rectus Abdominis:
Semilunar line: ____ skin groove that indicates _____ border of rectus
abdominis muscle
• more prominent in ____, muscular individuals when muscle ______
• extends from tip of 9th costal cartilage to pubic tubercle
semilunar line: hallow skin groove that indicates lateral border of rectus
abdominis muscle
• more prominent in thin, muscular individuals when muscle contracts
• extends from tip of 9th costal cartilage to pubic tubercle
75
Esophagus
• in superior mediastinum it lies _____ to trachea and ____ to vertebral
column
• in posterior mediastinum lies ____ to pericardial sac (separates esophagus from
LA) and ______ to vertebral column
• close to diaphragm, it lies ____ to descending thoracic aorta
• in superior mediastinum it lies posterior to trachea and anterior to vertebral
column
• in posterior mediastinum lies posterior to pericardial sac (separates esophagus from
LA) and anterior to vertebral column
• close to diaphragm, it lies anterior to descending thoracic aorta
76
Rectus Abdominis:
| Origin: ____ symphysis and pubic _____
Origin: pubic symphysis and pubic crest
77
arteries to thymus?
small branches of internal thoracic arteries.
78
Celiac Trunk
Common hepatic artery:
• Proper hepatic artery:
• ascends between two layers of ____________ ligament toward hilum of liver (porta hepatis)
• divides into right and left branches that enter ____ through porta hepatis
• right branch usually gives off ____ artery (supplies gallbladder)
• within lesser _______, proper hepatic artery lies anterior to (hepatic) _____ vein and to the left
of common bile duct
• ascends between two layers of hepatoduodenal ligament toward hilum of liver (porta hepatis)
• divides into right and left branches that enter liver through porta hepatis
• right branch usually gives off cystic artery (supplies gallbladder)
• within lesser omentum, proper hepatic artery lies anterior to (hepatic) portal vein and to the left
of common bile duct
79
Celiac Trunk
Common hepatic artery:
Course:
- runs anteriorly and to the ____ to reach superior aspect of 1st part of duodenum, where it
divides into two branches: ____ hepatic artery & _____________ artery
runs anteriorly and to the right to reach superior aspect of 1st part of duodenum, where it
divides into two branches: proper hepatic artery & gastroduodenal artery
80
Inguinal Canal:
Oblique passage, about _ cm in length, through ____ part of anterior abdominal
wall
Oblique passage, about 4 cm in length, through lower part of anterior abdominal
wall
81
Aggregations of lymphoid tissue (Peyer’s patches) are present in the _____ membrane of the _(upper/lower)_ ileum along the __________ border.
Aggregations of lymphoid tissue (Peyer’s patches) are present in the mucous membrane of the lower ileum
along the antimesenteric border.
82
The jejunal mesenteric vessels form only one or two arcades, with ____ and ______ branches passing to
the intestinal wall. The ileum receives numerous ____ terminal vessels that arise from a series of ____ or
____ or even more arcades.
The jejunal mesenteric vessels form only one or two arcades, with long and infrequent branches passing to
the intestinal wall. The ileum receives numerous short terminal vessels that arise from a series of three or
four or even more arcades.
83
venous drainage of thymus
Venous drainage
• the left brachiocephalic vein
• the internal thoracic veins. •
84
Inferior Vena Cava (IVC) - Course in mediastinum: Long or short course?
Pierces central tendon of diaphragm at the level of ___?
Where does it terminate?
* very short course in middle mediastinum
* pierces central tendon of diaphragm at the level of T8
* terminates in lower part of RA
85
Jejunum and Ileum
Ileocolic Artery:
• The lowest part of the ileum is also supplied by the ileocolic artery.
Ileocolic Artery:
| • The lowest part of the ileum is also supplied by the ileocolic artery.
86
Anterior Abdominal wall
External Oblique:
• Origin: ____ surface of ____ _ ribs
• Insertion: on an
____ view, fibers run inferiorly and _____ (similar to external
• intercostals) → lower fibers insert into ____ crest → remaining fibers become continuous
with an aponeurosis which inserts into _____ process, linea alba and pubic bone
* Origin: outer surface of lower 8 ribs
* Insertion: on an anterior view, fibers run inferiorly and medially (similar to external
• intercostals) → lower fibers insert into iliac crest → remaining fibers become continuous
with an aponeurosis which inserts into xiphoid process, linea alba and pubic bone
87
The inferior vena cava (IVC) returns to heart venous blood from ____________ of body. Which includes what structures?
returns to heart venous blood from: LOWER HALF of body
| abdomen, pelvis and lower limbs
88
Duodenum
Posteriorly:
• The lesser sac (first inch only), the ___________ artery, the bile duct and the portal vein, and
the ______ vena cava.
Posteriorly:
• The lesser sac (first inch only), the gastroduodenal artery, the bile duct and the portal vein, and
the inferior vena cava.
89
The jejunum is ____ bored, _____ walled, and redder than the ileum.
The jejunum is wider bored, thicker walled, and redder than the ileum.
90
Phrenic Nerve
- phrenic nerves are accompanied by _______________ vessels
• innervation: ___ fibers
sensory fibers:
• pericardium (____ and ____ layer of serous)
* mediastinal pleura and _____ part of diaphragmatic pleura
* ____ part of peritoneum covering ____ surface of diaphragm
• pain caused by irritation of structures receiving sensory nerve supply from
____ nerve is referred to shoulder region (C_ to C_ dermatomes)
-phrenic nerves are accompanied by pericardiacophrenic vessels
innervation:
• innervation: MOTOR fibers (diaphragm)
sensory fibers:
• pericardium (fibrous and parietal layer of serous)
* mediastinal pleura and CENTRAL part of diaphragmatic pleura
* CENTRAL part of peritoneum covering INFERIOR surface of diaphragm
• pain caused by irritation of structures receiving sensory nerve supply from
PHRENIC nerve is referred to shoulder region (C3 to C5 dermatomes)
91
Duodenum:
Lymph Drainage:
• The lymph vessels follow the arteries and drain upward via ________ nodes to
the gastroduodenal nodes and then to the _____ nodes and downward via
pancreaticoduodenal nodes to the superior mesenteric nodes around the origin of the
superior ________ artery.
Lymph Drainage:
• The lymph vessels follow the arteries and drain upward via pancreaticoduodenal nodes to
the gastroduodenal nodes and then to the celiac nodes and downward via
pancreaticoduodenal nodes to the superior mesenteric nodes around the origin of the
superior mesenteric artery.
92
Rectus Abdominis:
| it is separated from its fellow by _____ ___
it is separated from its fellow by linea alba
93
Rectus Abdominis:
| long strap ______ that extends along whole length of _____ abdominal wall
long strap muscle that extends along whole length of anterior abdominal wall
94
Inguinal Canal:
| Lies ______ and immediately _____ medial part of inguinal ligament
lies parallel and immediately above medial part of inguinal ligament
95
Gallbladder:
Cystohepatic triangle (of Calot)
• area where ____ artery is found
• limited by cystic duct, common ____ duct and ____ surface of liver
Cystohepatic triangle (of Calot)
• area where cystic artery is found
• limited by cystic duct, common hepatic duct and inferior surface of liver
96
• 3 esophageal constrictions:
* at junction of ____ and esophagus
* where esophagus is crossed by aortic arch and __(right/left?) __ primary bronchus
* where it passes through diaphragm
• These are areas where _____ foreign bodies can lodge or through which it may
be difficult to pass an esophagoscope
• these are also areas where strictures (narrowings) may develop after drinking
______ fluids
• 3 esophageal constrictions:
• at junction of pharynx and esophagus
• where esophagus is crossed by aortic arch and left primary bronchus
• where it passes through diaphragm
• these are areas where swallowed foreign bodies can lodge or through which it may
be difficult to pass an esophagoscope
• these are also areas where strictures (narrowings) may develop after drinking
caustic fluids
97
Thoracic Sympathetic Trunk:
• _Greater/Lesser)_ splanchnic nerve usually originates from _th to _th or _th to __th
ganglia
• Greater splanchnic nerve usually originates from 5th to 9th or 5th to 10th
ganglia
98
Celiac Trunk
Common hepatic artery:
-- Course:
• runs anteriorly and to the _(right/left)_ to reach superior aspect of 1st part of ______ , where it
divides into two branches: proper ____ artery & gastroduodenal artery`
Course:
• runs anteriorly and to the right to reach superior aspect of 1st part of duodenum, where it
divides into two branches: proper hepatic artery & gastroduodenal artery
99
External Oblique:
Lacunar ligament
* _______-shaped expansion at medial end of inguinal ligament
* its fibers pass _______- to attach to pectineal line, on superior ____ of pubis
* crescent-shaped expansion at medial end of inguinal ligament
* its fibers pass posteriorly to attach to pectineal line, on superior ramus of pubis
100
Lymph Vessels
* testicular lymph vessels run with ______ cord to deep _____ ring
* ascend on _____ abdominal wall(behind peritoneum) to reach lumbar (lateral aortic) lymph nodes
* lymph from scrotum drains into ____ inguinal lymph nodes
• testicular lymph vessels run with spermatic cord to deep inguinal ring
• ascend on posterior abdominal wall(behind peritoneum) to reach
lumbar (lateral aortic) lymph nodes
• lymph from scrotum drains into superficial inguinal lymph nodes
101
Jejunum and Ileum
Venous drainage:
• The veins correspond to the branches of the superior mesenteric artery and drain into the superior
mesenteric vein.
Venous drainage:
• The veins correspond to the branches of the superior mesenteric artery and drain into the superior
mesenteric vein.
102
Cecum
Relations:
Anteriorly:
• Coils of ____ intestine, sometimes part of the greater _____.
• The anterior abdominal wall in the _(left/right)_ iliac region.
Anteriorly:
| • Coils of small intestine, sometimes part of the greater omentum.
103
Cecum
Relations:
Posteriorly:
• The psoas and the ____ muscles
• The femoral nerve
• The ____ cutaneous nerve of the _____.
* The appendix.
* Medially:
* The appendix arises from the cecum on its _____ side.
Posteriorly:
• The psoas and the iliacus muscles
• The femoral nerve
• The lateral cutaneous nerve of the thigh.
* The appendix.
* Medially:
* The appendix arises from the cecum on its medial side.
104
Cecum:
Blood Supply:
• Arteries:
• Anterior and posterior _____ arteries form the _____ artery, a branch of the superior mesenteric artery.
Blood Supply:
• Arteries:
• Anterior and posterior cecal arteries form the ileocolic artery, a branch of the superior mesenteric artery.
105
Cecum:
Venous drainage:
• The veins correspond to the ______ and drain into the superior ________ vein.
Venous drainage:
| • The veins correspond to the arteries and drain into the superior mesenteric vein.
106
Cecum:
Lymph Drainage:
• The lymph vessels pass through several _____ nodes and finally reach the superior ______ nodes.
Lymph Drainage:
| • The lymph vessels pass through several mesenteric nodes and finally reach the superior mesenteric nodes.
107
Cecum:
Nerve Supply:
• Branches from the ________ and parasympathetic (vagus) nerves form the ______ mesenteric plexus.
Nerve Supply:
| • Branches from the sympathetic and parasympathetic (vagus) nerves form the superior mesenteric plexus.
108
Appendix
Blood Supply:
• Arteries:
• The appendicular artery a branch of the _____ ___ artery.
* Blood Supply:
* Arteries:
* The appendicular artery a branch of the posterior cecal artery.
109
Appendix:
Venous drainage:
• The appendicular vein drains into the _______ cecal vein.
* Venous drainage:
| * The appendicular vein drains into the posterior cecal vein.
110
Appendix:
Lymph Drainage:
• The lymph vessels drain into one or two nodes lying in the ________ and then eventually into the superior __________ nodes.
Lymph Drainage:
• The lymph vessels drain into one or two nodes lying in the mesoappendix and
then eventually into the superior mesenteric nodes.
111
Appendix:
Nerve Supply:
• The appendix is supplied by the ________ and parasympathetic (vagus) nerves from the superior _______ plexus.
• ______ nerve fibers for visceral pain from the appendix accompany the ______ nerves and enter the spinal cord at the level of the _th thoracic
segment.
Nerve Supply:
• The appendix is supplied by the sympathetic and parasympathetic (vagus)
nerves from the superior mesenteric plexus.
• Afferent nerve fibers for visceral pain from the appendix accompany the
sympathetic nerves and enter the spinal cord at the level of the 10th thoracic
segment.
112
Ascending Colon
• Location and Description:
• The ascending colon is about 5 in. (13 cm) long and lies in the right lower quadrant.
• It extends upward from the cecum to the inferior surface of the right lobe of the liver, where it
turns to the left, forming the right colic flexure, and becomes continuous with the transverse
colon.
• The peritoneum covers the front and the sides of the ascending colon, binding it to the
posterior abdominal wall.
Ascending Colon
• Location and Description:
• The ascending colon is about 5 in. (13 cm) long and lies in the right lower quadrant.
• It extends upward from the cecum to the inferior surface of the right lobe of the liver, where it
turns to the left, forming the right colic flexure, and becomes continuous with the transverse
colon.
• The peritoneum covers the front and the sides of the ascending colon, binding it to the
posterior abdominal wall.
