Flashcards in Dissector Info Deck (43):
Where is the apex of the heart located?
left 5th intercostal space near the mid-clavicular line
Where is the coronary sulcus located on the heart?
in between the right atrium and ventricle
What does the right coronary artery arise from?
right aortic sinus (which comes from the ascending aorta)
How is the pulmonary artery related to the bronchi in the hilum of the LEFT lung?
it is located superior to the bronchus
How is the pulmonary artery related to the bronchi in the hilum of the RIGHT lung?
it is located ventral to the bronchus
Where does the esophagus cross over the descending aorta anteriorly?
level of the 8th vertebra
Where does the esophagus enter into the diaphragm?
level of the 10th vetrebra
What ribs form the costal margin of the diaphragm?
Where is the transpyloric plane located?
It is said to lie roughly a hand's breadth beneath the xiphoid process of the human sternum.
The plane in most cases cuts through the pylorus of the stomach, the tips of the 9th costal cartilages and at the level of the intervertebral disc between L1 and L2
motor and sensory supply to the abdominal wall is provided by what nerves (4 sets)?
7th-11th intercostal nerves, subcostal nerves, iliohypogastric, and iliolinguinal nerves
Describe the distribution of the superficial nerves in the abdomen wall.
7th intercostal- level of xiphoid process
10th intercostal- level of umbilical
iliolinguinal- exits the superficial ring to enter the scrotum
Do the inferior fibers of the internal oblique abdominis and the transverses abdominis contribute to the rectus sheath?
No. they insert on the pubic crest
Are inguinal hernias more common in males or females? Why?
males, because the canal and the associated structures are larger and weak following descent of the testis
What occupies the inguinal canal in men and women?
men- spermatic cord
women- round ligament
What nerve exits the inguinal canal?
Does the iliolinguinal nerve exit the superficial ring of the inguinal canal in men and women?
Yes. LATERAL to the spermatic cord/round ligament
What does the iliolinguinal nerve continue as in men and women?
men- anterior scrotal
women- labial nerve
What is the spermatic cord covered by as it exits the inguinal canal?
external spermatic fascia derived from the external abdominal oblique
The sides of the superficial ring of the inguinal canal are designated what?
lateral and medial crura
What is the inguinal ligament formed by?
fibers of the external abdominal oblique aponeurosis ONLY.
At the pubic tubercle, what does the inguinal ligament become?
What is the floor of the inguinal canal formed primarily by?
inguinal ligament (with some lacunae ligament)
What is the deep inguinal ring formed by?
reflection of the transversals fascia
What artery and vein would you see just medial to the deep inguinal ring?
inferior epigastric artery and vein
What is the roof of the inguinal canal formed by?
combined arching fibers of the internal abdominal oblique and the transverses abdominis muscles (these insert on the medial aspect of the pubic crest as the FALX INGUINALIS)
What forms the internal spermatic fascia of the spermatic cord
reflection of the transversalis fascia at the deep ring
What are the cremaster muscle and its fascia derived from?
the roof fibers of the internal abdominal oblique in the inguinal canal
NOTE: the cremaster fascia forms the middle fascia of the spermatic cord)
Where does the posterior wall of the inguinal canal extend from?
deep inguinal ring laterally to the falx inguinalis medially (at the medial aspect of the pubic crest)
What supports/strengthens the posterior wall of the inguinal canal?
medially- falx inguinalis (very strong)
laterally- inferior epigastric vessels
Where is the weak area of the posterior wall of the inguinal canal?
between the inferior epigastric vessels (laterally) and the falx inguinalis (medially)-- this is what direct hernias would occur
Do direct hernias occur medial or lateral to the inferior epigastric vessels?
medial (indirect occur lateral)
What is the internal spermatic fascia formed by?
trasversali fascia at deep ring
What is the cremaster muscle and fascia formed by?
internal abdominal oblique aponeurosis in the canal
What is the external spermatic fascia formed by?
external abdominal oblique aponeurosis in the canal
What innervates the cremaster muscle?
Are the phrenic nerves medial or lateral to the vagus nerves?
What rib attaches to the sternal angle?
When inserting a chest tube, intercostal vessels and nerves are avoided by placing the tube immediately:
above the margin of a rib. VAN triad runs directly BELOW each rib
A needle inserted into the 9th intercostal space along the midaxillary line would enter which space?
During a heart transplant procedure, the surgeon inserted his left index finger through the transverse pericardial sinus, and then pulled forward on the two large vessels lying ventral to his finger. Which vessels were these?
The transverse pericardial sinus is an area of the pericardial cavity located behind the aorta and pulmonary trunk and anterior to the superior vena cava. So, the two large vessels lying ventral to his finger are the pulmonary trunk and aorta; the large vessel lying dorsal to his finger is the superior vena cava.
While observing in the OR, you see the resident insert a needle through the body wall just above the ninth rib in the mid-axillary line. She was obviously trying to enter the:
The ductus arteriosus sometimes remains open after birth requiring surgical closure. When placing a clamp on the ductus, care must be taken to avoid injury to what important structure immediately dorsal to it?
left recurrent pharyngeal.
The left recurrent laryngeal nerve is a branch of the vagus that wraps around the aorta, posterior to the ductus arteriosus or ligamentum arteriosum. It then travels superiorly to innervate muscles of the larynx. It's important to protect this nerve during surgery! If the left recurrent laryngeal nerve becomes paralyzed, a patient might experience a hoarse voice or even have difficulty breathing due to a laryngeal spasm