Exam 2 Flashcards
(226 cards)
1
Q
The endothoracic fascia lines what?
A
*the entire pulmonary cavity
2
Q
What do the external and innermost intercostals do?
A
*elevate the rib
3
Q
What does the internal intercostal do?
A
*depress the rib
4
Q
What kind of space is the intercostal space?
A
*real space
5
Q
What is the floor and roof of the intercostal space?
A
- roof- superficial fascia
* floor-endothoracic fascia
6
Q
Where does the posterior intercostal artery get blood from?
A
*thoracic aorta
7
Q
What does the internal thoracic artery supply blood to?
A
*anterior intercostal artery
8
Q
What does the musculophrenic artery supply blood to?
A
*inferior anterior intercostal artery
9
Q
Where does the subcostal artery get blood from?
A
*thoracic aorta
10
Q
How many veins are on each side?
A
*12 (11 and 1 subcostal)
11
Q
Where do the veins end?
A
*venous system (venous blood to sup Vena Cava)
12
Q
What innervates the intercostal nerves?
A
*anterior rami of T1-T12 spinal nerves
13
Q
What does the posterior ramus supply?
A
*bones, joints, deep back muscles
14
Q
What innervates a dermatome?
A
*cutaneous sensory fibers
15
Q
What innervates myotomes?
A
*motor fibers
16
Q
What is the peritoneal cavity?
A
*potential space that allows the GI track to slip around
17
Q
What is the pleural line of reflection?
A
*where visceral and parietal pleura are continuous
18
Q
What covers the lungs, and adherents it to all its surface?
A
*visceral pleurae
19
Q
What lines the pulmonary cavities?
A
*parietal pleurae
20
Q
What happens are the costodiaphragmatic recess?
A
*parietal pleura in contact with parietal pleura (potential space)
21
Q
What has no pain receptors?
A
*visceral pleura and lung tissue
22
Q
What do the visceral and parietal pleura have?
A
*serous membrane (secretes slippery/ capillary layer fluid to help with movement)
23
Q
What moves posteriorly during expiration?
A
*sternum
24
Q
What happens during passive expiration and what muscles are used?
A
- no muscles used
* pull thorax wall closed, diaph relaxes
25
What is an active process?
*inspiration
26
What muscles are used during inspiration?
*sternocleido mastoid and scalenes
27
What muscles are used for active expiration?
*rectus abdominus, internal and external obliques
28
What innervates the diaphragm?
*right and left phrenic nerves (sensory and motor fibers)
29
What arises from the prechordal mesoderm?
*central tendon of diaphragm
30
Where do all muscles of the diaphragm insert on?
*central tendon of diaphragm
31
What is the central tendon of the diaphragm innervated by?
*phrenic nerve (C3, C4, C5)
32
Where would you feel an infection of the diaphragm?
* referred pain on top of shoulder/side of neck
| * somatic innervation
33
What is the BS to the central tendon of diaphragm?
*left pericardiacophrenic vein and artery
34
What is the BS to the diaphragm?
* right musculophrenic artery and vein
| * inferior phrenic
35
What is a congenital hernia?
* when the esophageal hiatus doesn't close and the GI track develop above diaphragm
* lungs don't develop, because the heart is pushed up and it compressed the lungs
* 50% survive
36
Where do congential hernias usually happen?
*left-postural lateral
37
What is longitudinal folding a result of?
*rapid growth of neural tube
38
What happens during longitudinal folding?
*amniotic folding around embryo (except connecting stalk)
39
What does the connecting stalk become?
*umbilical cord
40
What innervates the septum transversium?
*phrenic nerve
41
What innervates the pleuroperitoneal fold?
* phrenic nerve
| * visceral innervation
42
What does the septum transversum fuse with and form?
*pleuroperitoneal folds (separates thoracic cavity from abdominal wall)
43
What does the septum transversum become?
*CT of liver, central tendon of diaphragm, heart
44
What kind of innervation is the peripheral edge of the diaphragm?
*somatic, all other parts are visceral
45
What does the lateral plate mesoderm split and become?
*body cavity (visceral and parietal layer)
46
Why can the bronchoplumonary segments be removed?
*they have their own air and blood supply
47
How many bronchopulmonary segments are there?
*10-12 per lung
48
What is pleuritis?
*inflammation of the pleurae, loose slipperiness (friction goes away)
49
What do you hear in pleuritis?
*cloth rubbing together (pleural rub)
50
What is the treatment for pleuritis?
*antibiotics
51
What is pleural effusion/ empyema, and what is its diagnosis and treatment?
* fluid in cavity
* lungs compressed (prevent from inflating fully)
* x-ray or percussion (dead sound = fluid)
* drain (thoracentesis)
52
What does the needle pass through in thoracentesis?
* external, internal, innermost intercostal
* costal parietal pleura
* intercostal space (9th and 10th)
53
What is tension pneumothorax?
* struggling to breath and pulling air in, inflate empty space
* diaphragm push down even more, no venous return to heart (squished)
54
What is simple pneumothorax (ataleltasis), how is it treated, and what are the symptoms?
* fail to inflate
* lungs not completely collapsed, small air in cavity
* body takes care of it
* dyspnea (diff breathing)
55
How is chronic pulmonary collapse treated?
* scaring pleura so visceral and parietal won't separate again
* pleurodesis (scape pleura or sprinkle irrating powder)
56
What is pulmonary collapse and what are the symptoms?
* lung won't inflate on its own, shrinks about 1/3 size of cavity
* acute respiratory distress, cyanosis
* becomes a real space
57
Why does pulmonary collapse happen?
* spontaneous (tall, thin people)
| * traumatic (injury to thoracic wall)
58
What is a pulmonary embolism and what is it due to?
* blockage in pulmonary artery
| * due to blood clot, glob of fat, air bubble
59
What can a pulmonary embolism cause?
* mild block goes unnoticed
* large block gives dyspenea (diff breathing), acute respiratory distress, chest pain, coughing, sweating, cyanosis
* can knock out entire lobe of lung
60
What can a lung that has pulmonary embolism do?
*ventilate but not profusing blood
61
What does pulmonary embolism come from and what are the risks factors?
* deep vein thrombosis (thromboembolism)
| * age, varicose veins, immobility, dehydration, recent surgery, poor health (smoking, obesity)
62
What does the anterior abdominal wall do?
* protects abdominal viscera
| * helps in active expiration
63
What are the abdominal quadrants?
* right/left upper quadrant
| * right/left lower quadrant
64
What are the abdominal regions?
*epigastric, umbilical, hypogastric, left/right inguinal, left/right lumbar, left/right hypochondriac
65
What are the muscles of the anterolateral abdominal wall?
* 3 flat: external/internal oblique, transverusus abdominis
| * 2 verticcle: rectus abdominis, pyramidalis
66
What is in the rectus sheath?
*deep fascis of rectus abdominus, apernosis
67
What gives off the anterior intercostal artery?
*musculophrenic artery
68
What delivers blood to abdominal wall?
*musculophrenic artery
69
What does the 10th and 11th posterior intercostal arteries deliver blood to?
*lateral wall
70
What does the inferior epigastric artery deliver blood to?
*post side of rectus abdominus (inferior part)
71
What does the superficial epigastric artery deliver blood to?
*anterolateral wall
72
What does the superior epigastric artery delivery blood to?
*superior rectus abdominus
73
What innervates the thoracoabdominal nerves?
*anterior rami
74
Where are the thoracoabdominal nerves?
*T7-L1
75
What happens in the upper trunk of venous drainage?
*end up in thoracoepigastric vein, into axillary vein
76
What happens in the lower trunk of venous drainage?
*end up in saphenous opening
77
What happens to lymph superior to the transumbilical plane?
*ends in axillary lymph node
78
What happens to lymph inferior to the transumbilical plane?
*flows to superficial inguinal lymph node
79
What is a umbilical fold?
*where peritoneum is draped over something
80
What does the ductus deferens enter through and what is medial to it?
* deep inguinal ring
| * epigastric vessels medial to ring
81
What is fetal circulation and what happens to it?
* umbilical artery under external iliac artery (blood goes sup and end up in inferior Vena Cava)
* get filled and become ligament
82
What did the round ligament of the liver use to contain?
*umbilical vein
83
What does the lateral, medial, and median umbilical fold contain?
* L: inferior epigastric artery and vein
* medial: umbilical artery
* median: reminiscent of development of digestive system (Urachus)
84
What is in the portal triad?
*fresh arterial blood, blood from GI track (branch of hepatic portal vein) and bilium (bile duct)
85
What is attached to the greater/lesser curvature of the stomach?
* greater omentum
| * L: lesser omentum
86
What is in the lesser/ greater omentum?
*L: hepatoduodenal/ hepatogastric ligament
| G: gastrophrenic/ gastrosplenic/ gastrocolic
87
What do the external/ internal oblique and transversus abdominis have?
*own anterior and posterior leaflet of deep fascia
88
What splits the leaflets of the external/ internal oblique and transversus abdominis?
* rectus abdominis
89
What is the GI tract lined with?
*epithelium derived from endoderm
90
What are the 2 layers of smooth muscles in the GI tract?
*inner circular layer, and longitudinal layer (mesoderm derived)
91
What is amylase for?
*break down carbs
92
What is lipase for?
*break down fat
93
What is the purpose of the small intestine?
*absorption of nutrients
94
What is the purpose of the large intestine?
*absorption of water
95
What happens in the anal canal?
*innervation switches from visceral to somatic
96
What does the stomach have?
*3 irregular layers
97
What is the biliary apparatus?
*gallbladder and various tubes leading to duodenum
98
What is the esophagus made of?
*superior 1/3 mostly skeletal muscles, inferior 1/3 mostly smooth
99
What gets added in the duodenum?
*acid chyme (duodenum glands secrete alkaline fluid), pancreatic juice (digestive enzymes), and bile (emulsify fat)
100
Where is bile produced and stored?
* P: liver
| * S: gallbladder
101
What is gastric mucosa?
*lining of stomach, secretes gastric juice (hydrochloric acid)
102
What is acidchyme?
*gastric juice and food
103
What kind of input is the Vagus nerve?
*parasympathetic input
104
What provides sympathetic input to the 2 plexus?
*abdominopelvic splanchnic nerve pathway
105
What are the 2 plexus in the GI tract?
*submucosal and myenteric plexus
106
How can you get esophageal cancer?
*if gastric content bubble up through the diaphragm
107
What is retroperitonum?
*Big portion behind peritoneum
108
What is the BS of the GI tract?
*celiac trunk, superior/ inferior mesenteric artery
109
What is it called if the small intestine hangs from it?
*mesentery
110
What is it called if the large intestine hangs from it?
*transverse mesocolon
111
What supplies the foregut, midgut, and hindgut?
* F: celiac trunk
* M: sup. mesenteric artery
* H: inf mesenteric artery
112
What is the foregut?
*distal esophagus to middle of duodenum
113
What is the midgut?
*distal half of duodenum to splenic flexure (transverse colon- descending colon)
114
What is the hindgut?
*spenic flexure to anal canal
115
WHat are the branches of the celiac trunk?
*comon hepatic, left gastric and splenic
116
What is the BS to the liver and duodenum?
*common hepatic artery
117
What is the BS to the lesser curvature of the stomach?
*left gastric artery
118
What supplies blood to the rectum and sigmoid colon and superior half of the anal canal?
*superior rectal artery
119
Where is there an anastamosis between in the GI tract?
*superior and inferior mesenteric artery
120
What are the 4 main veins of the hepatic portal system?
*hepatic portal, splenic, superior and inferior mesenteric
121
What are the minor veins of the hepatic portal system?
*left gastric veins
122
What is the setup of the hepatic portal system?
*artery, capillary bed in wall of GI, portal veins, capillary bed in liver
123
What kind of blood is in the first and 2nd capillary bed?
* 1: oxygen rich, nutrient poor blood
| * 2: oxygen poor, nutrient rich
124
What collects bile?
*left/right hepatic duct
125
WHat are the contents of the hepatoduodenal ligament (portal triad)?
*bile duct, hepatic artery proper, hepatic portal vein
126
What is serosis of the liver?
* death of hepatocytes and replacement with fat and CT
| * blocks branches of hepatic portal vein (can cause collateral circulation)
127
What is the cause and treatment of serosis of the liver?
* cause: alcoholism
| * treatment: liver transplant, portosystemic shunts
128
What drains the blood to the round ligament of the liver?
*para-umbilical veins
129
What is esophageal varacies and what are the symptoms and treatment?
* varicose veins in esophagus
* black/ tarry stool
* fatal
* cauterize
130
What can varacies in the umbilicus cause and what is it also called?
* blue veins around umbilicus
| * caput medusae
131
What divides the anal canal into the visceral and somatic innervation?
*pectinate line
132
What do varacies in the wall of the rectum or anal canal cause?
*hemorrhoids
133
What is the symptoms superior and inferior to the pectinate line?
* s: right red blood in stool
| * I: hurt/itch
134
What do neural crest cells make?
*PNS and gut tube (make ganglia)
135
What can remain in falciform ligament and lesser omentum?
*ventral mesentery
136
What buds off the foregut?
*trachea, liver, gallbladder, pancreas
137
What does visceral mesoderm become?
*2 layers of smooth muscle (inner circular and longitudinal )
138
What is the yolk sac lined with?
*endoderm
139
What is lateral folding the formation of?
*embryonic body cavity
140
What does the yolk sac become?
*epithelium that lines GI track and things that bud off
141
What happens if the dorsal mesentery remains or disappears?
* R: greater omentum, transverse colon
| * D: GI tract up again wall (called 2nd retroperitoneal)
142
What organs are secondary retroperitneal?
*ascending/descending colon and esophagus
143
What is the vitelline duct incorporated into?
*umbilical cord (proximal part)
144
What does longitudinal folding cause?
*things to move to more definitive position
145
What remains in contact with the yolk sac?
*midgut
146
What is temporary incorporated into the umbilical cord?
*allantois
147
Where does the allantois form?
*apex of bladder
148
What happens when allantois remains and disappears?
* R: Urchus,
| * D:causes median umbilical fold
149
What happens at week 4 of embryo development?
*establishment of gut regions, gut BS, foregut derivatives bud off
150
When the stomach turns 90 degrees the greater/lesser omentum goes which way?
* G: left
| * L: Right
151
Where does most of the rotation happen?
*midgut
152
What is the gut tube suspended by?
*dorsal mesentery
153
What happens at week 5?
*midgut loop
154
Where does the gut rotate around and which way?
*axis of s. mesenteric artery (counterclock wise)
155
What does the cranial loop and caudal loop become?
* cranial: most of small intestine
| * caudal: most of large intestine
156
What happens at week 6?
* physiological herniation (midgut loop herniates through umbilical cord)
* 90 degree counterclockwise rotation around viteline duct
157
What happens at weeks 10-11?
* retraction of physiological herniation
* midgut loop returns to abdominalpelvic cavity (turns another 180 degrees)
* vitelline duct disappears
158
Where is the Vitelline duct attached to?
*proximal to illeocecal junction
159
What is left sided colon and what can it cause?
* final 180 degree turn doesn't happen
| * GI tract more free than should be, parts of GI tract can wrap around itself (can impede peristalsis (Vovulus)
160
What is reversed rotation?
*clockwise rotation
161
What is atresia and stenosis and what is it due to?
* A: part of GI tract doesn't form due to a twist and blood can't get there
* S: narrowing
162
What can stretching of the walls of the GI tract cause?
*visceral pain (very painful)
163
What does Meckel's diverticulum contain?
*gastric mucosa
164
What are some diseases that are caused by failure of closure of the ventral body wall?
* omphalocoele
* gastroschisis
* omphalocoele
165
What is Omphalocoele and what can it cause?
* failure of midgut loop to return
| * high mortality (cause cardiac abnormalities)
166
What is gastroschisis?
* reherniates back out because of weakness around umbilicus
| * high survival rate
167
What is congenital aganglionic megacolon caused by?
* failure of myenteric plexus to form (can't perform peristalsis)
* muscles can breakdown
168
Where does congenital aganglionic megacolon happen at?
*distal GI tract, distal rectum (where plexus didn't form)
169
How do you treat congenital aganglionic megacolon?
*remove part that doesn't work
170
What can happen if the vitelline duct remains?
*form cyst, vitelline fistula or ileal diverticulum (Meckel diverticulum)
171
What is vitelline fistula, signs and treatment?
* opening between GI tract and umbilical
* poop comes out of umbilicus
* just tie it off
172
What is a fistula?
*abnormal connection between organd and outside or organ and organ
173
What is the floor, roof, anterior, posterior, and lateral borders of the mediastum?
* F: diaphragm
* R: superior thoracic aperture
* A: sternum and costal cartilage
* P: mediastinum pleural
174
What is the level of the ascending/descending aorta?
*sternal angle
175
What does the phrenic nerve innervate and what is its position?
* inn area around central tendon of diaphragm
| * stuck to fibrous pericardium, ant. to root of lung, sensory fibers
176
Where does the Vagus nerve fun and what are the inputs?
* runs post to root of lung
| * parasymp. inputs
177
What is fibrous pericardium attached to and surround?
*attach to central tendon of diaphragm and surrounds heart and blend into roots of great vessels
178
Why can you only have a small amount of fluid in peric. cavity before it kills you?
*fibrous per. cannot stretch
179
What is hemopericardium?
* heart cannot fill properly
* take care immed. or die
* can cause cardiac tamponade
180
What is a sign of tension pneumothorax?
*distended jugular veins
181
What causes hemopericardium?
*leak from trauma to chest, damaged heart from myocardio infarction, pluged drainage tube after heart surgery
182
What is cardiac tamponade and what are the signs?
* heart compression
* hypotension, cyanosis, pulseless electrical activity (can't feel pulse), distended jugular veins, rapid weak pulse, diminished heart sounds
183
What is the treatment for hemopericardium?
*pericardiocentesis
184
How is pericardiocentesis done?
* go through bare area of pericardium (5th or 6th space between rib) and get blood/pus out
* parasternal approach
185
What are the 3 circuits of the heart?
* pulmonary (pressure from R side)
* systemic (pressure from L side)
* coronary
186
What are the pericardial sinuses?
* transverse pericardial sinus
| * oblique pericardial sinus
187
Where can you clamp the pulmonary trunk and aorta during surgery to cut off BS?
*transverse pericardial sinus
188
What is a different expectation for coronary circulation?
* Left coronary artery gives rise to the posterior interventricular branch
* LCA dominant
189
What is normal coronary circulation?
*RCA and LCA share equally in BS
190
What is atherosclerosis and what can it result in?
* starts as fatty deposits, plaque forms over
| * myocardial infection
191
Where do most coronary artery occlusions occur and how do you fix it (describe)?
* proximal part of AIV
* coronary arterial bypass (use artery)
* balloon angioplasty (use stent to hold open)
192
WHere does the ligamentum arteriosum run?
*between pulmonary trunk and arch or aorta
193
What is a volvulus?
* twisting of GI tract
* visceral/ dull pain, but intense
* diagnosis with imagining
194
What is esophageal atresia and what is it caused by, signs?
* failure of recanalization (opens up again)
* caused by too much tissue on trachea side and not enough on esophagus side
* baby can't feet, vomit, foaming white stuff in mouth/nose, baby swallow air (distended stomach)
195
How often do esophageal atresia and tracheoesophageal fistula happen?
*1 in 3000 to 1 in 5000 babies
196
How do you treat esophageal atresia?
*resect, long gap atresia repair (pull and esophagus lengthens)
197
What is an ulcer and what are the types and what are they caused by?
* eroding in gastric lining
* caused by helicobacter pylori
* peptic, duodenum, and gastric ulcer
198
What causes ulcers?
*smoking, alcohol, stress
199
What can gastric ulcers put you at risk for and where is the pain?
* around xiphoid
| * hemorrhage
200
How do you diagnosis an ulcer?
*endoscope, x-ray, breath/blood/stool test
201
Where is the pain for duodenum ulcers felt?
*in skin over liver
202
What are the tissues?
* visceral pericardium (epicardium)
* myocardium
* endocardium
203
What is in the visceral pericardium and what is it continuous with?
* serous layer and underlining fat
| * cont. with tunica externa
204
What is in the myocardium and what is it continuous with?
* cardiac myocytes
| * contin with tunica media
205
What has their own intrinsic rhythm?
*cardiac myocytes
206
What is the endocardium continuous with?
*tunica intima
207
What is the Fossa Ovalis?
*remnant of oval foramen (blood from RA to LA, bypass lung)
208
What is the SA node?
* pacemaker
209
What is in the RA?
*column of muscle in wall (pectinate part) and smooth part
210
What does the crista terminalis divide?
*part of smooth muscle and muscles in wall
211
What is the smooth part and other part from?
* S: vessels
| * embryonic heart wall
212
What is the interventricular septum?
*mostly muscle, sup part is CT (membranous portion)
213
What is the membranous portion part of?
*fibrous skeleton
214
What is rheumatic fever?
*strep to heart, can effect valves and heart tissues
215
What is in the atrialventricular septum?
*fibrous skeleton of heart (support valves)
216
What are the functions of the fibrous skeleton of the heart?
* forms membranous interatrial septum
* supports opening of valves
* electrically insulates atria and ventricles
* tunnel for electrical signal to go through
* membranous part of IV septum
217
How are the walls of the heart in diastole, atrial systole, ventricular systole?
* D: relaxed
| * A and V: contraction
218
Where does the conducting system of heart originate and influenced by?
* O: nodes
| * I: autonomic nervous system
219
What is the conducting system of the heart?
*SA node, AV node, AV bundle, R and L bundle branches, purkinje fibers
220
What are 5 adaptations for bypassing fetal lungs, liver?
*Ductus arteriosus, oval foramen and valve, ductus venosus, umbilical vein, umbilical arteries
221
What does the lung have?
*high resistance to blood flow (LA blood pressure is low)
222
What is the former ductus arteriosus?
*ligamentum arteriosum
223
What is the former oval foramen and valve?
*fossa ovalis
224
What is the former ductus venosus?
*ligamentum teres
225
What is the former umbilical vein?
*round ligament of the liver
226
What is the former umbilical arteries?
*medial umbilical ligaments
